My American Bulldog's chronic diarrhea: B12 not helping, what's next?

Thank you for submitting your question regarding Remi. In the bloodwork that was run, did it include GI specific testing such as cobalamin, folate, PLI and TLI levels. These are values that will give information such as the location of GI disease (small intestine vs pancreas) and treatment options. I typically do this planel in conjunction with an abdominal ultrasound. This information with the ultrasound can give insight into conditions such as inflammatory bowel disease, pancreatitis, exocrine pancreatic insufficiency, food sensitivities or as you mentioned cancer. The anti-inflammatory properties of the antibiotic she was on could help even with a tumor in GI tract, but there are so many other causes of diarrhea that would respond as well. I think it is worth pursuing further bloodwork and the ultrasound. If you can get a diagnosis, then a treatment plan can be developed. I hope this information helps!

With a normal stool sample and blood panel, the next steps are experimenting with diet - specifically a hypoallergenic prescription diet (such as Royal Canin Ultamino, which is definitely the most expensive option, but also the one that seems to work best in diagnosing food allergies. It takes eating ONLY the prescription food for about a month to see if it helps, and then if it does help you can certainly experiment with less expensive foods. If you she would having signs of food allergy you'd need to do a full 3 months, but for intestinal issues, you should see a response in just a couple weeks) OR a high fiber/easily digestible diet (such as Hills Fiber Response EN). Some dogs need continual probiotics to keep normal stool. Treating any underlying anxiety (if present) can also help. Finally, a gut biopsy, which is much more invasive and costly can be done. Since she isn't yet spayed, I would consider doing a gut biopsy when/if she is spayed because that would be minimal additional expense or trauma for her while she's already have an abdominal surgery. I hope that helps! Wishing you the best with this difficult issue - It can take a long long time to get to the bottom of things

It can be IBD among other things, the next step would be a specialist ultrasound, if no definitive diagnosis is obtained after the ultrasound the last resort step is surgery to take samples from the intestines for histological analysis.

I suggest you put Gus on a probiotic for a month to see if it helps. I strongly recommend you use Fortiflora (no human probiotics). Fortiflora comes as a box of 30 packets - one packet on food daily so this will give you one month to see if it helps. If it does, great, you can keep him on it indefinitely. If it doesn't help then you need to go to more testing like for inflammatory bowel disease or food allergies. ( https://www.allivet.com/p-1130-purina-pro-plan-veterinary-diets-fortiflora-dog-supplement-box-of-30.aspx?SearchTerm=fortiflo+Auto )

There are several things I try for diarrhea that is not responding to typical treatments - sometimes I give the medications for a longer duration, sometimes I'll try a different antibiotic, and sometimes I'll try a different diet (which it sounds like your vet is attempting with the EN). Your vet might also want to retest a stool sample - sometimes with diarrhea there just isn't enough actual feces to get a positive results. Chronic diarrhea can also be caused by inflammatory bowel disease which is a more severe form of IBS and ultrasound and special blood testing can help diagnose this. Corticosteroid medications and B12 injections are often the recommended treatments for IBD.

Thank you for submitting your question regarding Bellamie. If the pain medications are not helping her situation, then I worry about a primary gastrointestinal tract disease. I recommend a full blood panel. Values such as cholesterol and albumin can be affected by chronic gastrointestinal disease. I would also do a GI specific blood panel that measures cobalamin, folate, TLI and PLI levels. These are vitamins involved in digestion and pancreatic values. From there, an abdominal ultrasound by a veterinary radiologist may be needed. A prescription diet trial could be beneficial as well. I hope this information helps!

That sounds like a very difficult situation. If the steroids are not helping Abby within about 72 hours, I would call your veterinarian to let me know, so they can decide what to do next based on the results they have so far. It sounds like your next option would be to do intestinal biopsies to try to figure out exactly what is going on in Abby's gut. Other options would be a consultation with a veterinary internal medicine specialist if one is available in your area.