By Dr. Becker
Mandy is a 12 year-old soft-coated Wheaten terrier. I met her in January 2009. Her owner was trying desperately to stabilize her after a terrible bout of pancreatitis (page 1).
Mandy had a very long history of "sensitive stomach," loose stools and anal gland issues. She also had surgery on both knees early in life to correct torn ACLs, and had painful knee arthritis.
Mandy's Digestive Troubles
Mandy's case is a classic scenario many vets see almost daily: chronic, long-standing GI inflammation that causes symptoms in each area of inflammation. Upper GI inflammation causes vomiting. Inflammation of the small intestine causes gas, bloating and discomfort. Lower GI inflammation causes diarrhea.
Prior to the pancreatitis, Mandy's mom had tried many different diets in an attempt to reduce the vomiting and diarrhea. She showed me labels from all the most recent foods she had tried, including NutroMax Natural, Evanger's, Hill's W/D, Purina EN and Nature's Variety Prairie.
Although poor Mandy had been rotated through many different dog food brands, they all contained chicken and at least one unnecessary, pro-inflammatory carbohydrate.
Diagnosis: Chronic GI Inflammation Caused by Something in the Diet
After examining Mandy and studying her history, I concluded the GI inflammation was the byproduct of either a food allergy or sensitivity to something in her diet.
Inflammation renders the lining of the GI tract unable to absorb nutrients efficiently. Because food is not adequately digested or absorbed, food particles begin to putrefy in the gut, causing:
- A purge response (vomiting)
- Significant gas production from the fermentation of partially digested food in the small intestine
- The body's need to rid itself of the brewing toxic stew by increasing peristalsis (contractions of the large intestine), which causes diarrhea
Opportunistic bacteria thrive in this unhealthy GI environment, causing dysbiosis, an imbalance of the beneficial bacteria needed for efficient digestion and nutrient processing. Dysbiosis will also contribute to chronic soft stools, and soft stools lead to chronic anal gland problems.
Dogs were designed to maintain their glandular systems in working order naturally. However, other organ systems must be working properly as well. Anal gland health and stool health are intimately linked. Firm, well-formed stools naturally express a dog's anal glands with every bowel movement. When stools are chronically soft or liquid, there's not enough pressure to express the glands. They become full, and sometimes impacted.
This is what Mandy was dealing with. I explained to her mom that I wanted to fix the root issue, her gut inflammation, and see if her anal glands would return to normal functioning on their own.
Unhealthy Gut = Unhealthy Dog
The bigger picture with many of my chronic GI patients is the underlying immune system deterioration that occurs, along with the increased risk of acute GI problems, including pancreatitis.
More than 70 percent of an animal's immune system is located in their GI tract, so if the gut isn't healthy, the patient isn't healthy. We call cases like Mandy's "acute on chronic," meaning there was a long-standing, underlying chronic condition that brought on an acute, potentially life threatening episode – in her case, pancreatitis.
Many pet owners think their dog or cat was doing fine until a sudden event changed their quality of life overnight. In many cases, owners have assumed chronic symptoms were "normal" for their pet.
I've had pet owners say, "My dog has never produced a firm stool, that's normal for him." Or, "My cat vomits daily, it's normal for her." Those kinds of comments tell me the owners have accepted symptoms which are designed to show us where the body is having underlying issues, as normal for their pet.
Why have so many people adopted this way of thinking?
Much of the problem, in my view, lies in the reactive veterinary medical system. It convinces pet owners mediocre health is the standard, so having a list of non life-threatening symptoms is acceptable.
Mandy's mom had taken her to the vet countless times, year after year. Each entry in her medical record was the same: patient doesn't feel well, is vomiting and has diarrhea.
And each visit, the treatment was the same: a GI antibiotic and antacids. No discussion of the whys or hows; no viable protocol to reduce future episodes. Fortunately, Mandy's owner got tired of not getting answers, and more importantly, she was tired of seeing her beloved dog feeling lousy much of the time.
Mandy's mom wanted to prevent future bouts of pancreatitis, help heal her long-standing GI issues, and address her arthritis.
We had our work cut out for us.
Mandy's Healing Protocol
I suspected a food allergy was the root of Mandy's GI issues, because most of her life prior to all the new food trials she had consumed dog food containing chicken and rice.
Our first goal was to get Mandy onto a novel, low fat, grain free food to give her GI tract a break from potential food allergens. We decided on a turkey-based commercially available dehydrated raw food and added a quality probiotic, digestive enzyme, and a natural supplement for dysbiosis called Bio-HPF1.
I recommended no further vaccines for Mandy, and also prescribed a daily exercise protocol and chondroprotective agents (CPA's) to help with her arthritic knees. Her mom also began an oral disinfecting protocol for Mandy's significant plaque and tartar buildup.
Mandy's recheck in February 2009 showed her PLI (Pancreatic Lipase Immunoreactivity) at a normal level (page 2). Her pancreatitis had resolved. Her stools were firm and there were no further episodes of vomiting or diarrhea.
Mandy's painful knees continued to be a problem, so we increased the level of CPA's in her diet.
2010 Brings a New Health Challenge for Mandy
In October 2010, a small lump was discovered on Mandy's front left forearm. A fine needle aspirate revealed abnormal cells (page 3), so the lump was excised and sent to a pathologist.
The diagnosis was a neurofibrosarcoma, also called a nerve sheath tumor (page 4). This type of tumor is locally invasive and difficult, if not impossible, to completely remove surgically.
Nerve sheath tumors (NST's) originate in the myelin sheath which surrounds the peripheral nerves. The sheath provides mechanical and physical support, as well as insulation for the nerves that transmit electrical signals.
An NST tends to re-grow where it was removed, which is what happened with Mandy.
I referred her to a soft tissue surgeon who excised the tumor again, this time with bigger margins. Mandy's owner opted for radiation treatments to deal with the underlying tumor cells the surgeon couldn't remove. Mandy finished her 20 radiation treatments in January 2011 (page 5).
Mandy has remained cancer-free since she completed treatment. She has had no further episodes of pancreatitis, anal gland issues or bowel problems.
It is our hope that by fixing Mandy's long-standing GI inflammation, we have improved her overall immune health and vitality, reducing the potential for uncontrolled abnormal cell growth to recur in her body.
Mandy's mom continues to help support her aging musculoskeletal system, and we are now focusing on slowing down age-related changes, including muscle atrophy.
Mandy has overcome her chronic dysbiosis and even cancer. She's a happy senior girl with a good quality of life.
Mandy is a wonderful example of what can happen when a pet owner is committed to finding answers. Her mom's decision to tackle her lifelong GI issues when she was 9 years old takes courage, time, effort, and patience.