Pln/ibd/ple/vasculitis - Metamucil Thread Updates

[Guest Fasave]

This is a continuation of the metamucil thread. Because it is really not just about fiber, I thought I would start it under a new header.

 

Today I visited both the IM doc and a holistic vet. At the IM vet Safari weighed 77 pounds, up 7 pounds from when all this started two weeks ago even though he is not eating well. This means he has an incredible amount of fluid in his abdomen right now. They tested the stool sample for bacteria and it came back negative. They are still doing further parasite tests. The bad news is that his blood work continues to worsen. He is albumin is up to 2.6 which "could" mean this is not due to the IBD at all but likely kidney failure. His creatinine was up to 4.2 from 3.9 four days ago and his BUN is at 66. Both of these results could also be because of dehydration. He could have vasculitis of the kidneys or something else that would require a biopsy that I'm not sure is a good decision right now. She want's me to start imurane tonight. This vet is not optimistic that I will be able to bring Safari back to normal life.

 

At the holistic vet, she treated him with sub-q ozone therapy. She also did aquapuncture. Yes, aquapuncture with is acupuncture using b12 injections. She sent me home with a slew of homeopathic treatments to start administering. She also told me to stop the flagyl being that it does not appear to be working. I didn't get the sense that she thought Safari as sick as the other vet.

 

I didn't tell either vet I had been to the other as I really wanted to see what the approach would be. I did share blood work and medication with the holistic vet. Now I have to make some decisions.

 

1. What to feed him. Continue to try to get him to eat with regular home cooked meals or try a prescription diet (Royal Canine limited ingredients).

 

2. What meds/supplements to give him. Continue the flagyl, start the imurane, start the homeopathic treatments?

 

Has anyone walked this path before? While I wanted to explore other options, I feel like I may have overwhelmed myself with possibilities. Any insights would be greatly appreciated. Thanks!

[Guest Fasave]

Latest update is that the IM doc would like to admit him to the hospital tonight to administer a drug that will increase the flow of red blood cells and allow the imuran to work more quickly. They were vague as to what the end result would really be so I've decided against this treatment. I've contact the holistic vet and she's going to meet me at her clinic in the am to try another ozone therapy treatment and she will send me home with some sub q fluids. It's amazing how quickly things can turn for these guys. While I've known he's been sick for a while, I'm still in shock over the gravity of the situation. Here's hoping for a good night and little more quality time for the two of us.

[RobinM]

Depending on the actual diagnosis.

 

The imuran and pred together saved Beaus life along with a presecription diet of HP/ZD OR HA. YOU can mix z/d wet with the HP or the HA. but nothing else. NODDA. No other treats than the prescription.

 

He was started at 50mg of imuran and 50 mg of pred in late Jan. We are down to 5mg of pred and 12.5 mg of imuran. In the right direction.

[Guest Fasave]

Thanks for the info Robin but it really looks like they are leaning more towards kidney failure than IBD at this point. If the kidneys weren't involved I might be more receptive to the idea. They still don't know what is causing all of this so that also makes it difficult to treat because without being able to treat the cause, they can only treat the symptoms. It could also be vasculitis of the kidneys. If this is the case, these drugs are hard on the kidneys. This has been the struggle since the start in that not only is he restricted on the foods he can eat but they also have to be low protein.

[Batmom]

In the context of your dog's illness and the method of administration, "ozone therapy" is quackery plain and simple.

 

Please let your dog have qualified medical care.

 

Sending prayers.

Edited September 27, 2009 by Batmom

[sweetdogs]

I hope the fluids help Safari feel better & give you some more time to figure this out.

Have you consulted with OSU?

[tbhounds]

I think right now I would be worried about the fluid in his abdomen. Most often they get abdominal ascites because their blood proteins are too low (albumin) is too low (2.6 isn't that bad). You can lose the albumin either through your GI tract (PLE) or through your kidneys (PLN)--sounds like your boy is doing both. Have they run a U/A recently to see what the protein level is in his urine?? What was his last UPC ratio? It's tough because most often they want to start the IBD dogs on Pred which will be really hard on his kidneys. There is another drug--Budesonide that worked really great on my IBD/PLE boy--ask your vet to see if that's an option at this point.

Which medications do they have him on for his kidneys--anything besides the home-cooked diet??

[greyhead]

Budesonide is working very well for Spencer too, but he also takes Flagyl and Tylan. And he doesn't have PLE or PLN. But budesonide is supposed to have far less obnoxious side effects than either pred or imuran.

 

I'm puzzled that your vet could have examined a poop sample today and declared that there's no bacterial overgrowth. Spencer's sample was sent out to a lab, who watched for a week to see what it grew, and we didn't get results until then. Which is not to say I think that's Safari's problem, just that it doesn't sound like a valid test procedure. (I'm hoping ahicks51 will chime in here with an opinion.)

 

Can you tell us what potions the holistic vet gave you? I would hope they aren't limited to homeopathic remedies but also include some herbs, only because I have more experience with and faith in herbs and I know them to have much power to address problems with internal organs. I'd hope she'd give you something containing rehmannia for his kidneys.

 

I've never heard of ozone therapy either, but I don't know everything! Sub-q fluids help a lot with dehydration related to kidney malfunction. (I've had two cats with kidney failure.) But one wants to be sure not to add to the ascites, so I wonder how that's being addressed. (B12 is always good to get with sub-q's because it's water-soluble and he'll tend to lose B12 more quickly with sub-q's.)

 

Hang in there. You may be, understandably, overwhelmed by choices but you're not alone.

 

 

[greyhndz]

Melissa, how are his liver function tests?

 

66/4.2 could certainly be attributable to volume depletion. It can be deceptive because the ascites appears to be a fluid overload, but actually it's just a shifting of fluid from the intravascular space to the abdomen, and can leave the dog (or human) very dehydrated, especially when they use diuretics to decrease the ascites. Sometimes it comes down to the "chicken or the egg" theory - is his renal disease due to volume depletion or is it actually one of the causes because, when he spills protein in the urine, it then causes fluid shifts from the vessels to the peritoneum --> ascites.

 

You may well see improvement in BUN/creatine with IV or subcut. fluid replenishment. I hope they also cultured his urine to be sure he isn't infected, as that can hike his renal values as well. Has he been given either HetaStarch or another volume expander? These will pull fluids back into the vessels and slow down leakage into the peritoneum.

 

I think the most important consideration (IMHO) is: how is Safari dealing with all this? Are the visits to Angell and the holistic vet stressful for him? Is he tolerating being confined for IV therapy? Is he eating or showing an interest in things he usually gets excited about? What do his eyes tell you?

 

I know the team at Angell is excellent, and it's easy to get caught up in their agressive treatment plan. And you, being the great mom that you are, want to do everything and anything to bring Safari back to a point where he enjoys his life. But it sounds as if you're at the same fork in the road that I reached with Lexi, where you have to make the decision about continuing to aggressively treat him or keep him home and make his time with you as happy as possible. I let Lexi make the decision for me, and only you know Safari well enough to know what he would want.

 

Lots of healing vibes and hugs to your beautiful boy

Jordan

[greyhndz]

I'm puzzled that your vet could have examined a poop sample today and declared that there's no bacterial overgrowth. Spencer's sample was sent out to a lab, who watched for a week to see what it grew, and we didn't get results until then. Which is not to say I think that's Safari's problem, just that it doesn't sound like a valid test procedure. (I'm hoping ahicks51 will chime in here with an opinion.)

 

Actually, assuming they were testing for c. difficile, it's a very simple and quick antigen test (and/or c. diff. toxin A/B) that doesn't involve a culture (which would take a minimum for 48 hrs for a final result. I can get results within a couple of hours, or less, from when the stool sample gets to the lab.

 

From the CDC site, if it doesn't put you to sleep:

 

Which laboratory tests are commonly used to diagnose C. difficile-associated disease?

• Stool culture for C. difficile: This is the most sensitive test available, but the one most often associated with false-positive results due to presence of non-toxigenic strains. Stool cultures for C. difficile also are labor intensive and require the appropriate culture environment to grow anaerobic microorganisms. Results are available within 48-96 hours of the test.
• Antigen detection for C. difficile: These are rapid tests (<1 hr) that detect the presence of C. difficile antigen by latex agglutination or immunochromatographicassays. They must be combined with toxin testing to verify diagnosis.
• Toxin testing for C. difficile*:
  • Enzyme immunoassay detects toxin A, toxin B, or both A and B. It is a same-day assay but less sensitive than the tissue culture cytotoxicity assay.
  • Tissue culture cytotoxicity assay detects toxin B only. This assay requires technical expertise to perform, is costly, and requires 24-48 hr for a final result. It does provide specific and sensitive results for C. difficile-associated disease.

Edited September 27, 2009 by houndznigz

[Guest Fasave]

Thanks everyone. Safari has been at Angell five times in the last two weeks. Yes, we've done x-rays (chest for heart failure & abdomen, ultrasound pulling fluid to analyze, urine analysis (no UTI), and countless other tests. The impression I received from them this afternoon was that they are at loss as to the cause. They were offering me final options but the prognosis is "grave" and they are not optimistic that he will get back to the same quality of life he had prior to start of this downward trend. Angell's ICU is loud, bright and not restful. I'm not sure in his current condition he could even survive the stress.

 

I understand the ozone therapy sounds "wacky". But honestly, at times like these, those comments don't help. I've been trying for two weeks to make this dog better the conventional way. A lot of medical treatments we receive today seemed wacky at one point in time. Ozone therapy is a really just a way of getting extra oxygen to the organs to help them heal. Pretty simple as a concept. Kind of falls in the category of might not help but couldn't hurt at this point. Also, the holistic doc is board certified, on the board of directors of the AHVMA, is a former professor at Tufts Veterinary College and Harvard and actually had my nutrionalist at Angell as a student. I am certainly not familiar or comfortable with a holistic approach but sometimes you need to try new things.

 

As Jordan knows, this is not a new problem. Safari spent three nights in ICU at Angell in January after six months of undiagnosed problems. I've worked with this team over the year and we gave him an incredible nine months since this time. As Jordan pointed out, at some point you need to figure out if it's time to move on.

 

Overall, Safari is in pretty good spirits. He only wants to eat what he's not allowed to eat because of his IBD issues. This further leads to complications in recovery. You feed what he wants, he gets sick, he dies. You feed him what he can eat, he won't eat, he starves and he dies. You just have to keep working to find a place somewhere in between and we found it for a while.

[Guest TeddysMom]

I don't have any advise, just wanted you to know that I sending good thoughts and prayers your way. I hope Safari recovers and has some more time with you.

[Batmom]

Ozone therapy is a really just a way of getting extra oxygen to the organs to help them heal. Pretty simple as a concept.

 

I'm sorry, but the body does not work that way.

 

Best wishes to your pup.

[Guest VanillaBean]

I hope whatever you try, it works!

[Guest eaglflyt]

If your dog has an autoimmune disorder, prednisone and Imuran may be very beneficial. I, personally, have an autoimmune disease and these drugs (and others) have pulled my feet out of the fire many times. Yes, there can be side effects, but none were as bad as the disease manifestations. My kidneys normalized with the use of these drugs, as well as other systemic issues (vasculitis, pericarditis, etc.). If my dog were in need of this treatment, I would not hesitate.

 

I tried the holistic route, and got increasingly sick and it was very expensive with no benefit.

 

The methods backed by scientific, peer reviewed studies were what made a difference in my condition.

 

Good luck. I know the decisions are difficult. Also, you might consider a different critical care center if the one you have experience with is not what you would choose. I'll keep your dog in my prayers ... and you, too.

[Guest longdoglady]

 

No advice just feeling your pain. You are doing all you can for Safari and he knows that.

[Guest HersheysMom]

Thanks for the info Robin but it really looks like they are leaning more towards kidney failure than IBD at this point. If the kidneys weren't involved I might be more receptive to the idea. They still don't know what is causing all of this so that also makes it difficult to treat because without being able to treat the cause, they can only treat the symptoms. It could also be vasculitis of the kidneys. If this is the case, these drugs are hard on the kidneys. This has been the struggle since the start in that not only is he restricted on the foods he can eat but they also have to be low protein.

 

Melissa, how's he doing today? Have you thought of a duck and potato diet - Royal Canin Innovative Veterinary Diets or Natural Balance duck & potato. With Star's IBD she still had bloody stools on Hills i/d, but she could do the duck & potato. It's also low-ish protein in case it is a kidney issue.

 

Also, what about Tylan powder - that works a lot of times when Flagyl doesn't.

 

I know you are frustrated - it's hard to just be putting a band-aid over the symptoms and still have no idea on the cause - and you've been trying so hard!