Foster Hospital’s Nutrition Service Key to Saving French Bulldog with Rare Disease

Multi-department collaboration puts Loki on the road to recovery
A group of smiling individuals holding a French Bulldog in an exam room.
Dr. Deb Linder, V09, GBS16, with colleagues in other specialty services collaborated to find the best treatment for Loki. Photo: Jeff Poole, Cummings School of Veterinary Medicine

A "skeleton dog" is how Lisa Rosum describes her cream French Bulldog Loki after he dropped from 22 to 14 pounds over several weeks. Unable to pinpoint the cause, Loki's veterinarian advised Rosum to take him to Henry and Lois Foster Hospital for Small Animals (FHSA) at Cummings School of Veterinary Medicine at Tufts University. Loki arrived at the ER last spring and began a long, tenuous path to recovery with the help of many doctors across services at FHSA.

In a collaboration between the Emergency Medicine and Critical Care (ECC), Internal Medicine, Radiology, Surgery, Anesthesia, and Nutrition Teams at FHSA, Loki was diagnosed and successfully treated for a severe inflammatory bowel disease called lipogranulomatous lymphangitis, a condition so rare, there are only a few published case reports in dogs. Loki would go days without eating, and when he did, he suffered from vomiting and diarrhea. The Radiology Team detected a mass in Loki's abdomen on ultrasound.

"We see this disease only sporadically, but Frenchies are predisposed to it," says Dr. Alexander Snow, V22 resident in small animal medicine in the Department of Clinical Sciences at Cummings School, who oversaw Loki's long-term care. "There's not a defined treatment. Most cases go to surgery, and most look like cancer. When the biopsy shows it's not cancer, it's lipo granulomatous lymphangitis."

The Surgery Team removed the mass, and Loki remained at FHSA for a few days in the Intensive Care Unit (ICU) on supportive care medications. He began eating again and initially felt better. He returned home but quickly took a turn for the worse.

French Bulldogs are prone to regurgitation, and Loki was not only regurgitating his food but also lethargic. Rosum brought him back to FHSA just one day after coming home. The surgery site was leaking and showed signs of bacterial infection, so a second surgery was scheduled. The Surgery Team found an abscess at the surgical site and removed a large portion of Loki's gastrointestinal (GI) tract on either side to prevent another rupture. Loki remained in the ICU for the next two weeks under the care of Drs. Shaylan Meyer and Ansley Sackett, ECC residents at FHSA.

The FHSA Nutrition Team joined the case, working closely with the ECC, Internal Medicine, Surgery, and Radiology Teams to find the best treatment for Loki. FHSA is the only 24/7 veterinary hospital in New England with nutritional services. Dr. Deborah Linder, V09, GBS16, associate clinical professor in the Department of Clinical Sciences at Cummings School, is one of only approximately 100 board-certified veterinary nutritionists throughout the United States.

"Loki's case was a unique nutritional challenge because we had to completely rethink how to get him the nutrients he needed," says Linder. "It wasn't just about what nutrients, but how to deliver them in a way his body could actually use and absorb them. It was almost more of a delivery problem than anything else."

When the doctors attempted liquid feedings through a nasal gastric tube, Loki's GI tract rejected it. He continued to regurgitate food, so they switched to parenteral nutrition (PN), feeding Loki intravenously to allow his GI tract time to recover. Linder explains that administering nutrition through an IV helped stabilize his weight and put nutrients directly into his bloodstream. They continued to increase his food intake, eventually getting him to eat by mouth again.

According to Meyer, "In working with Dr. Linder, we were able to develop a plan for intravenous nutrition, which was an amazing learning experience for me, my resident mates, and our amazing nursing staff who took phenomenal care of Loki. His case emphasized to everyone just how important nutrition is to a critical care patient." 

 

I always love when we get to collaborate with all the special expertise we have at Cummings School to help animals with unique needs like Loki. We are the only veterinary center in New England that has a team of board-certified specialists in critical care, internal medicine, surgery, anesthesia, and nutrition—all of which Loki needed—that can work together on special cases like this. I'm so glad to have the opportunity to be a part of such an incredible team of experts.

Dr. Deborah Linder

 

Linder experimented with different diets to see what Loki would tolerate. The Bulldog initially did best on a specially formulated highly digestible diet, but after some creative calculations to make sure it was safe, the feline version of the diet was used to provide higher protein.

"It was kind of like building with individual Lego pieces instead of trying to force-fit a pre-built structure," says Linder. "We had to go back to the basics, to the smallest components, to give his body the best chance to rebuild and gain muscle. It was the only way to make sure he got all the essential nutrients he needed."

Rosum recalls the feeding trials, "We had to feed him pretty much upright in a chair so that the food would go down in an upright position for five minutes after he ate. It was a long road. At times, I wondered if we were doing the right thing. Dr. Meyer told me, 'If at any time I think there isn't any hope, I will let you know.' She helped me stay the course and had hoped that these treatments would help him, which of course they did."

"One of the most important factors in Loki's care was, and still is, the dedication of his family," says Meyer. "They visited with him for a few hours every day while he was in the ICU, and no matter how worried we were for him, we never once gave up on him."

When he seemed well enough, the doctors sent Loki home with steroids to treat his lipo granulomatous lymphangitis and supportive and nutritional medications, but he was back at FHSA the following week. He continued to have little interest in eating and regurgitated what he did eat, with bouts of diarrhea. The doctors readmitted Loki and put him back on IV nutrition. Over a week, he showed some improvement and went home with a peripherally inserted central catheter (PICC) line in his neck. Rosum was trained to administer his medications several times a day.

"It was a last-ditch effort," says Snow. "Around this time, Loki turned the corner in a good way."

Two days later Loki was doing well, so Linder tried another diet for his GI tract to better absorb nutrients. She was able to obtain samples of a new elemental type of dog food just about to hit the market. The diet was specially formulated to aid in digestion and reduce the work of the GI to absorb nutrients—and that did the trick.

"It helped with Loki's inflammation, it's very digestible, and he's been on it ever since," says Snow. "Dr. Linder has been integral to this case. At Tufts, we have open communication between the teams. I could go to Dr. Linder with any questions. She not only gave me the answer but why the answer was what it was. It was not only collaborative but a learning experience for me."

Loki's PICC line was removed within a few days, and over the next several months, he gradually weaned off most medications.

"Now he's a pudge ball, and things are looking up for him," Snow says. "We found the diet, and it gave him enough time for the bowel to adjust, and luckily, he has very dedicated owners."

Loki returns to FHSA periodically for weight checks, ultrasounds, and bloodwork to track his recovery.

"I credit the doctors at Foster Hospital for taking great care of him. When we go for check-ups, Dr. Snow brings Loki around to show everyone how well he's doing. Loki's himself again. He's made a big turnaround," says Rosum.

"I always love when we get to collaborate with all the special expertise we have at Cummings School to help animals with unique needs like Loki," says Linder. "We are the only veterinary center in New England that has a team of board-certified specialists in critical care, internal medicine, surgery, anesthesia, and nutrition—all of which Loki needed—that can work together on special cases like this. I'm so glad to have the opportunity to be a part of such an incredible team of experts. And we're so happy to see Loki thriving now!"