| | Q: Dear Dr. Mike,
My 2 1/2 year old German Shepherd, Simba, has had diarrhea for the last five weeks. He has lost twenty-two pounds (from ninety pounds). Initially, I didn't notice that he was eating outdated dog food from a pet store. It was manufactured in September 1995. In the last two weeks he has been eating new food, but the diarrhea has persisted. I took him to the vet, he tested his stool sample for parasites and pancreatitis. The vet said that pancreatitis was a possibility, but there were no parasites. I've done some research and don't believe that it is pancreatitis because his lower abdomen is not painful to palpations, has not had a loss of appetite and does not vomit. He was neutered and vaccinated just prior to the diarrhea. Could this have affected the situation being that his system was malnourished from the old dog food and then had to combat the antibodies from the vaccines? He also spent four days in a kennel a few days after the vaccinations at this point is when I noticed the diarrhea. Is it possible that there could be parasites that were not detected and can pancreatitis be determined by just taking a stool sample? These are the things that I have tried: fasting him, giving pepto-bismol and white rice. There was a slight improvement after the rice, but after eating regular food again, he resumed the diarrhea. Right now, I have fasted him and gave him charcoal tablets. I broke the fast slowly with vegetable broth, then cooked vegetables and now rice and oats. I don't have any more ideas, so any input would be greatly appreciated on my Simba's behalf. Thank-you in advance, Judy
A: In any German shepherd with chronic diarrhea my first instinct is to look for pancreatic insufficiency. In this case, insufficient digestive enzymes are being produced to allow proper digestion. This leads to persistent diarrhea. Pancreatic insufficiency is reasonably common in shepherds. There are pretty accurate tests for this condition now. Blood tests for trypsin like immunoreactivity (TLI) and serum folate levels are an improvement over older tests utilizing digestion of X-ray film. It is important not to overlook other possible causes, though. These tests are simple enough to include in the initial workup of a case, along with the more obvious things you mention, such as ruling out intestinal parasites, a general blood panel to make sure that there is not an obvious organ system problem (liver, kidney) and an attempt to make sure bacterial enteritis is not a problem.
Pancreatic insufficiency is NOT pancreatitis. It is an entirely different problem. Your vet may have been referring to this but phrased the concern badly or may be thinking that pancreatitis is possible. I would tend to agree that it isn't too likely as a continuing cause of diarrhea, though.
If no problem can be found with the labwork above, then the possibility of malabsorption disorders like lymphangectasia becomes more likely. Diagnosis of these conditions is best done by biopsy, usually utilizing an endoscope. We refer patients to an internal medicine specialist for this procedure.
The food can't be ruled out as a source of the initial problems but something else is probably keeping the problem going. Lots of times stressful situations bring on the clinical signs of problems such as pancreatic insufficiency and lymphangectasia or plasmacytic/lymphocytic enteritis -- and then these problems just keep on going.
Mike Richards, DVM