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Judy and Cookie dog picture

If Love Alone Could Heal 

by Judy Parisi, Editor-in-Chief   

I told my dog Cookie (my copilot, my best friend, my loyal companion) that if love alone could heal her, she’d be running in the park, jumping hoops in agility, and just simply feeling great. But unfortunately love alone will not heal her or bring her back to the robust and healthy dog she once was. In October 2008, Cookie was diagnosed with Inflammatory Bowel Disease (IBD), Exocrine Pancreatic Insufficiency (EPI), and liver problems. Regardless of how this happened (origins unknown), we must now rely on expert veterinary care to make her better. Of course, with a lot of love thrown in.

Cookie’s health problems began in March 2008. Her stomach started making loud gurgling sounds so loud it would wake me in the middle of the night. She also started having intermittent diarrhea. I took her to the vet. They did a blood test and tested her stool sample only to find that everything looked normal. Thinking it was a food allergy, her holistic vet recommended trying different protein sources that were novel to her (such as whitefish and duck). She also prescribed herbal remedies, such as Slippery Elm and Ginger.

But through the months that followed, Cookie's diarrhea continued on and off as well as the stomach noises and then gas. This was a dog who never had gas (believe it or not). And most troubling, she was losing weight. Finally, when her symptoms became more regular and her weight loss continued no matter how much she ate, I took her to an internist for an ultrasound and x-rays. Both showed no abnormalities. The internist prescribed Metronidazole (Flagyl, an antibiotic) and Prilosec.

Over the next month, Cookie seemed to get better. Her diarrhea subsided and it seemed like her troubles were behind us. But, then the symptoms reappeared. The internist recommended an endoscopy to check her stomach and intestines. I admit I cringed at the thought. This meant she had to go under anesthesia and undergo yet another test at the vet – an occasion that had become all too frequent and depressing. Finally I took her to another internist. It wasn’t that I didn’t trust the first one, but I wanted another opinion and Cookie's health seemed to be deteriorating at a quicker pace.

The day I brought her to the new vet I was prepared emotionally for the endoscopy – and prepared Cookie by fasting her from midnight. Fortunately, a good friend came along for moral support. The vet actually thought we should skip the scope that day and pursue one more test to eliminate a possible other cause for her condition. You see this whole process was about eliminating other causes. I insisted on the scope – both Cookie and I were ready that day and I couldn’t bear waiting even another day to see if she did, in fact, have IBD (at this point a fairly good guess) or even worse, cancer.

The endoscopy confirmed the IBD and not cancer. My friends and I all breathed a collective sigh of relief. But the worse part wasn’t over. Over the next few weeks, Cookie continued to lose weight in spite of the drugs and food change (now she was on a limited venison diet). And then the discovery that her health was further compromised and complicated by the fact she also has EPI (Exocrine Pancreatic Insufficiency) and elevated bile acids in her liver. The EPI could have been with her for awhile, but just three weeks earlier when she had the endoscopy, a blood test indicated her liver was fine. Thus, this could've been caused from one of the drugs she was being given for the IBD -- namely, Azathioprine.

It’s been a rocky road with medicine trials, but we’re hoping to stabilize her so at least she stops losing weight and actually starts gaining it again. Right now Cookie's on Prednisone and Cyclosporine (replacing Azathioprine) for the IBD, Denamarin (for her liver), Reglan (for GI motility and to control nausea), and is getting Pancrezyme in her food to replace her pancreatic enzymes needed to help digestion and absorption.

Cookie always appeared to be a stocky dog. Even though most of it was due to her thick coat, she had a rugged looking frame. Many people said she looked like a bear. But that’s changed. While Cookie’s one-time normal weight was 63 pounds, this week she weighed 42.6 pounds at the vet, down three more pounds from the week before. All in all, she’s lost over 20 pounds, much of it muscle. And as a result of the medications, she has lost much of her thick, gorgeous fur.

As I mentioned, the origins of IBD and EPI are not known. But there seems to be a genetic link between the two illnesses and German Shepherds. And as Cookie is part Shepherd, that is a possibility. The most important thing now is focusing on getting her better, regardless of how it started though that would be helpful to know for others.

It just so happens that while I was writing this letter today, the guy who services my water filter system called to schedule the annual service visit. Since he’s been to my house before, he knows I have animals, and asked how they were. I said the cats were okay but Cookie wasn’t doing so well. He said “Well, sometimes all you have to do is give them a pat on the head and a hug.” I wish that were the case, but as soon as I hung up with him I gave Cookie a big bear hug and lots of love. I know somehow it really does help.

More to come on Cookie’s condition, as well as more information on canine Inflammatory Bowel Disease and Exocrine Pancreatic Insufficiency.

UPDATE 12.11.08:  Cookie gained five pounds!  This was fantastic news from the vet this week since it is the first time in months that Cookie has gained weight instead of losing it!  The week prior at the vet was the first time she didn't lose weight but was stable from the week before.  She now weighs 45.4 pounds, still a bit away from her normal weight of 63 pounds, but still this is progress.  Also, Cookie's liver values on her recent blood test showed improvement (albeit not tremendous) but still improvement.  Most recently her AST was 78 vs. 101 the week prior.  Normal range: 15-66.  Her ALT was 619 vs. 801 the week prior. Normal range: 12-118.  Her GGT was 71 vs. 87 the week prior.  Normal range: 1-12. 

For the first time since her treatment began in late October with the new internists, Cookie's vets and I are optimistic that the medications and food change are helping.  Currently, Cookie is getting Cyclosporine twice a day, Clavamox twice at day, Denamarin once a day, Reglan twice a day, a shot of Dexamethasone once a day (temporarily replacing the Prednisone), and a pancreatic enzyme replacement in her food.  I believe the Dexamethasone has been a tremendous help in her weight gain.  Of course, I need to watch her closely as this is a powerful drug that can cause negative side effects (namely, stomach ulcers).

Cookie currently eats four to five times a day.  Each meal consists of a can of dog food along with a cup of dry (both Royal Canin Special Veterinary Diet).  Again, we are dealing with several conditions: canine Inflammatory Bowel Disease (IBD), Exocrine Pancreatic Insufficiency (EPI), and a damaged liver.  We still do not know the cause of, or relationship between, these conditions.  I am hopeful Cookie will continue to improve, and that by detailing her illness and the treatment methods, I may help others in similar situations. 

Cookie is scheduled to have a bile acid test (her second) this weekend which will further determine the health of her liver.  Wish us luck!  And thanks to everyone who has sent us emails of support and good wishes.

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