Several folks have asked lately how Jamie is doing since his diagnosis with Inflammatory Bowel Disease back in January. I'm very happy to say he's GREAT!
Some people have also asked "How did you find out it was IBD?" so I'll review our journey, which began about this time last fall.
IBD is one of those things you never think about until your dog gets it. For me, it was one of those weird, rare diseases that "someone else's dog" got. I knew dogs with IBD and I knew dogs who had died from it, but when Jamie's symptoms began last October and November, it was the furthest thing from my mind.
In fact, I was pretty sure he had stomach cancer. Stomach cancer in Belgian tervuren is nearly epidemic. It presents in tervs at something like 20 percent higher than the normal canine population. It's also high in Belgian sheepdogs (although not as high as tervs) and is practically non-existent in Belgian malinois.
Jamie's symptoms started mildly. He occasionally vomited, occasionally had diarrhea, occasionally wouldn't eat. It wasn't every day, just now and then. A trip to our family vet yielded a possible diagnosis of acid reflux. We went home with meds to treat the symptoms (we'd done no diagnostics yet so at this point, that's all we were doing - treating symptoms).
Initially, this seemed to help. The vomiting and diarrhea episodes were further and further apart and his appetite seemed regular.
Of course, that didn't last.
Before long, he was back to regular vomiting and his appetite was becoming increasingly picky. He got to the point he would take the boiled egg off his breakfast kibble and place it to the side of his bowl. What previously elicited delight and drooling was now relegated to "yuck" status.
A return to the vet yielded blood work that showed nothing out of the norm. A change of meds to address a possible ulcer was the next step.
This helped. Sort of. Kind of. And eventually, not really. Jamie was losing weight. He was mildly lethargic. He ate very little. If he did eat, he vomited. If he didn't vomit, he had diarrhea. Our vet referred us to the emergency clinic in Iowa City. After preliminary diagnostics, the vet there felt it was a bacterial overgrowth in his gut. Jamie spent the night in ICU and came home the next day, re-hydrated thanks to IVs and with a massive dose of antibiotics.
This whole journey was a roller coaster. One day we were up, the next we were down. Just when I thought we needed to go back to the vet to pursue the problem, he acted and ate just fine. Soon as I thought he was fine, he crashed.
Jan. 6, 2011 (one of those dates that you remember just because) Jamie vomited and it was laced with blood. He also began having bloody diarrhea. Off we went to the emergency clinic to start the panel of diagnostics that eventually resulted in the IBD confirmation.
Initially, everything was normal: bloodwork, x-rays, ultrasound. There were no tumors, lumps, growths, foreign bodies or ulcers. He was perfectly normal. Except that he was literally bleeding from both ends, wouldn't eat and was now a walking skeleton. Jamie was spending several nights in the ICU, hooked up to IVs to keep him hydrated and living.
I was seriously starting to wonder if this was going to be the end. You never envision your dog's possible death until it smacks you along side the head that neither he nor you can go on living this way.
The final diagnostic was an endoscopy. This would allow the vet to see the condition of his digestive tract and take biopsies from various spots along the way to be evaluated in a lab at the Iowa State University (go Cyclones!) vet school.
It is my understanding that an endoscopy and the subsequent biopsies are the only way to confirm Inflammatory Bowel Disease. You can study the symptoms and make an educated guess (well, if you're a vet and qualified to do that sort of thing) but IBD symptoms mimic so many other conditions, if you want a definitive answer, the endoscopy is the only way to get it it. In addition to going down his throat to look at his stomach, they also scoped through the rectum to look at the large intestine.
The vet who did Jamie's scopes said his esophagus was the only part of his digestive tract that looked normal. His stomach and intestines looked, in her words, "like raw meat." The entire surface was raw and bloody. The texture was pebbled, like cobblestones.
Poor guy. If he managed to eat food and keep it in his system, he couldn't digest it. He was getting no nutritional value from what little food he managed to eat. Left untreated, this certainly would have killed him.
Treatment was A) prednisone B) restricted diet and C) prednisone. A lot of prednisone.
Due to a clinical mis-labeling, Jamie started at 50 mg of pred twice a day. This seemed like an absolutely ridiculous amount and after counting the available tablets they sent home with me, I called back to the clinic to question the dosage. It was supposed to be 25 mg twice a day.
Thanks to the pred, Jamie ate like the proverbial horse. I think he would have eaten horse if he could have gotten hold of one. His diet was restricted to a single protein source (venison) and a single carb (potato).
Over the next 5 months, I was able to gradually taper down his dosage of pred: 20 mg twice a day, 15 mg twice a day, 10 mg twice a day, etc., until he was taking 2.5 mg every other day. We were now back under the treatment of our family vet and she cautioned that Jamie might take pred for the rest of his life.
By May, he was very stable. He stopped throwing up, his stools were normal, he loved food again and he had regained his Belgian joi de vrie. We stopped the pred completely, with the caveat that if his symptoms flared, he would go back on it.
His diet continues to be restricted but that's not as bad as it sounds. There are a LOT of venison and potato dog treats available on the market, plus Natural Balance makes a canned venison and potato formula that is great for stuffing Kongs. And Jamie is lucky - the Farmer and I both love potatoes so he enjoys "table scraps" of baked, boiled, mashed, fried 'taters.
Almost six months later, life is good. Jamie still has IBD, it's not something that can be cured, only managed. He was diagnosed at a moderate level of the disease, at the midpoint between mild and severe. There's no telling how long it had been chewing away at his gut until the symptoms grew strong enough for me to notice.
I felt horribly guilt - why hadn't I noticed this sooner? Why hadn't I pushed for more diagnostics earlier? Why didn't I just cut to the chase and have them do the endoscopy first thing instead of spending six weeks treating symptoms and running tests that were non-conclusive?
Well, realistically, very few of us are going to run out and do a $1,300 procedure just because our dog throws up. Knowing what I do now, it WOULD have been the right thing to do but how in the world could anyone have known that? Certainly not me or any of the vets that treated Jamie along the way. The route we took was sensible, moving from the least invasive to the "last chance" tests.
I remain in awe of the medical advances now available to our pets. And I can't say enough good things about the vets who treated Jamie. As a whole, I found them more compassionate and genuinely caring than several of the cardiologists and other medical staff I encountered when hospitalized with my irregular heart beat a few years back.
And I am very, very happy Jamie is still with me, spending his twilight years dozing on "his" leather couch, pestering his little brother and giving "butt gooses" as he sees fit.