Update on Alice

I just got off the phone with Phil and we have good news to report on Alice. She is ready to come home after spending almost four days in the veterinary hospital. According to Phil she is holding down semi solid food and has not had a vomiting incident since she recovered from surgery.

According to the hospital staff she is alert, really hungry and ready to go home. She has not had a bowel movement yet but that's not uncommon in a hospitalized dog that has not had much in her GI tract for over a week.

They are waiting for the biopsy results but her veterinarian is thinking that she has lymphocytic, plasmacytic enteritis which can be synonymous with inflammatory bowel disease involving the stomach and upper small intestine. Inflammatory bowel disease (IBD) is one of those very confusing diagnoses with multiple conditions that give very similar clinical signs. 

First of all IBD has to be diagnosed by biopsy of the lining of the affected part of the GI tract. There are certain cell types that infiltrate the lining of the GI tract indicative of an inflammatory process. As the name implies, lymphocytes, plasmacytes and eosinphils are the main types of cells that you are looking for on the biopsy.

It gets even more complicated to confirm an IBD diagnosis. Technically you should biopsy eight different locations in the small intestine to be sure. One normal or negative biopsy does not rule out IBD as it can be found just around the bend in another part of the intestine. The biopsies have to be deep enough and include enough tissue to be diagnostic and you have to be very careful not to crush the tissue when you are taking the biopsy. 

The bottom line is that a diagnosis of IBD is tough to make definitively and consequently it probably gets mis-diagnosed fairly often.

To make things even more complicated there are a number of conditions that cause inflammatory cells to infiltrate the GI tract and give a very similar histological picture of the GI tract lining.

For instance, dietary hypersensitivity or food allergy is one such problem. And as we've mentioned before, food gets blamed for more than it's fair share of allergies.

To definitively diagnose food allergy you have to conduct an eight week elimination trial. You have to be prepared to make a home made recipe or feed a veterinary hypoallergenic diet for two months. You can't feed anything else, not treats, no chewable Heartworm medication, just the diet and water. That can be hard on a dog owner and it can get expensive too. Consequently, food hypersensitivity is commonly mis-diagnosed or, maybe more accurately, over diagnosed. 

OK, so it's a weird world of confusion in the chronic vomiting, chronic weight loss arena. But there is good news as far as Alice is concerned. Her veterinarian is doing all the right things to manage her case. She's on antibiotics for a potential bacterial enteritis that could be at the root of the whole problem and she's on corticosteroids which have already decreased the intestinal inflammation to the point that she can handle food without vomiting. 

That's the most important step in the right direction. We also know that there is no foreign body or cancer involved. We can hope that the antibiotics and corticosteroids will do the trick and allow the GI tract to heal. Even if it does end up being a real case of IBD, we can continue to manage that medically for a long time. 

We'll continue to follow this most interesting case on the blog. We should have the all important biopsy results later this week. 

One last thought. Today is election day. Go out and vote if you have not already voted. Participation is the key word in participatory democracy.