You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply.
Steve, I'm sorry to hear of this with Sooty. It's easy to be overwhelmed by such a chronic problem unresponsive to therapy but a methodical approach to these dogs should clarify the underlying disorder and narrow down how to approach it. The following is a synopsis of how I would approach Sooty. The order in which I've listed the various diagnostics isn't written in stone and can be varied predicated upon Sooty's vet and your preferences.
1) Presumptively treat for gastrointestinal parasites with 7 consecutive days of fenbendazole. Fenbendazole is effective against all of the common nematodes (roundworms, hookworms, whipworms) as well as the protozoan Giardia. It's available over the counter in pet/feed stores as well as at Sooty's vets hospital. Routine fecal ova and parasite exams are too often falsely negative; hence, the need for presumptive treatment. If a positive change isn't seen...
2) Have a diagnostic panel of blood/urine tests performed. The panel should contain a specCPL blood test which is the most specific of the blood tests for identifying the presence of pancreatitis. It should also contain a TLI blood test which is the gold standard for detecting exocrine pancreatic insufficiency - a failure of the pancreas to produce enough digestive enzymes (maldigestion). To be very complete, serum vitamin B12 and folate levels should be performed as well. Malabsorption disorders (digested food isn't being absorbed properly) are suggested by lower than normal serum levels of these micronutrients. If nothing untoward is found...
3) Consider a food intolerance. Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Sooty's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from his vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (my preference because it avoids the possibility of his being intolerant to even a novel protein). A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time. If such a dietary trial isn't helpful...
4) Abdominal ultrasound (which is particularly sensitive in evaluating the gastrointestinal tract itself) and/or scoping and biopsy of her gastrointestinal tract is indicated. We don’t perform scoping and biopsy soon enough in too many of these patients. We're mainly looking for inflammatory bowel disease (IBD) or lymphangectasia - a protein-losing enteropathy (intestinal disorder) but also need to be concerned with infiltrative malignancy such as lymphoma and solid tumors such as gastrointestinal adenocarcinoma.
Please respond with further questions or concerns if you wish.
As disgusting as that behavior is, it's not likely the cause of his chronic gastrointestinal distress. His flatulence is another symptom of that distress but doesn't clarify the etiology of it. The risk factors for flatulence to arise are diets high in nonabsorbable oligosaccharides, carbohydrates, fiber, or poorly digestible protein; gastrointestinal disease; and low activity or exercise level. Flatulence is controlled using long-term management stategies affecting diet, feeding habits, and exercise. The underlying GI tract disease needs to be corrected.
Please continue our conversation if you wish.
Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.