Prednisone

[Guest Stripeyfan]

I hope it's ok to pester you GT folks with more questions about Kelly. He is currently on 10mg prednisone daily (5mg am and 5mg pm along with 500mg oxytetracycline 3x day) for his chronic diarrhea and malabsorption - cause is still unknown but after he instantly had watery big D after finishing the last course of antibiotics a week ago the vet suspects SIBO might be one of the problems, so he's back on those too. (They haven't done a stool test for the SIBO though.) For now, together, at these doses, they seem to be having a good effect.

 

My first question is if the prednisone dose seems high, medium or low. My second question is about how worried I should be that he is still on 10mg after 3.5 weeks (before that he was on 30mg for 3 days, then 20mg for a week). We tried to step it down to 5mg daily 2 days ago but had to put it back up as he had soft, mucousy stools again within 24 hours. The vet's not too worried about the antibiotic use long term but has said if we can't eventually reduce the pred ( (in 6-8 weeks or so) we may have to have Kelly scoped/biopsied etc, which of course we'll do if we have to, but we're not keen to put him through it as you can imagine!

 

Thanks for letting me hassle again.

 

ETA we are taking a urine sample in on Monday to check nothing nasty's happening to his kidneys. Also edited because I hit post halfway through typing!

Edited April 17, 2010 by Stripeyfan

[RobinM]

For Beau's diagnosed IBD we started him on 40mg of pred. upped it to 50 mg in 3 weeks, plus 50mg of imuran, down to 30 and held there after 1 month- held there for 6 months, then lowered all the way and now on budesonide after 1 year, 1 month on pred and imruan. He is off imuran too.

[Guest mcsheltie]

That is a very low dose of Pred. I start cats on that dose. With GHs I use 20mg 2x daily as a starting dose. So don't worry about that.

 

The amount of time it is taking you to wean off is not unusual. In fact until you get him stabilized (find out the food or SIBO triggers) you will not be able to wean him off the Pred. I have had both cats & dogs on low dose Pred long term (1 yr or more)with no problems. 6-8 weeks is not a problem.

 

Quality of life needs to be considered when making treatment decisions. Not the knee jerk reaction some people have... Pred is bad get them off as fast as you can. Living with IBD, the cramping and other symptoms is not a good life. If they are doing fine on Pred... Good! A lot of vets don't think about Budesonide. But eventually most IBD dogs will end up on it.

 

Long term use of antibiotics with IBD is not uncommon. I know of many cats & dogs that are kept on Metronidazole. I would take a fresh stool sample in on Monday. Try to get one that is as formed as possible. The looser the stool the harder it is to isolate bacteria & critters in it.

[greyhead]

Definite malabsorption and possible SIBO, okay.

 

Is Kelly getting B12 injections for the malabsorption?

 

What did the ultrasound show about the location of Kelly's intestinal difficulty? If it's in the small intestine, which is where most of Spencer's was, a scope can't get there. The only thing that makes sense in that case is the surgical biopsy. I don't know what your thinking is, but our vet said the information that comes from biopsy doesn't have a large effect on the treatment. Yes, if you know exactly which type(s) of inflammatory cell(s) are involved, she said you can sometimes "tweak the treatment nicely." But the basic treatments are about the same, mainly an immunosuppressant (budesonide for us), antibiotic(s) (Flagyl and Tylan), and dietary restriction. Btw, his stools didn't firm up completely until we added the Tylan, which he hadn't seemed to respond to previously (before the SIBO was diagnosed). The other thing we used for firm stools was glutamate, which he doesn't seem to need anymore.

 

But I got off track. Spencer was 8 and had lost 20 lbs. Apart from the anesthesia issue, Robin can tell you that recovery from abdominal surgery for these guys is another huge setback. We had trouble finding an internist to consult with us/our vet because the orthodox version of IBD is that you can't diagnose it unless you can Name That Cell through biopsy. I wasn't interested in putting Spencer through all that and possibly losing him, just to have somebody walk in the room and say, "Sorry we lost your dog, ma'am, but we know exactly which inflammatory cell made him sick!"

 

We did find an internist eventually, an older woman with a GI specialty. We only needed to see her once,last May, and she basically confirmed everything we were doing. We'll see her again on Monday to discuss that Spencer's year on budesonide is up and whether he can now stop it.

 

On the other hand, it defies common sense not to do a fecal culture and sensivity to identify the bacterium causing SIBO. It's non-invasive, relatively inexpensive, and may save the dog's life. Relative to your original questions, I understand IBD dogs need to be on immunosuppression for at least a year, and it doesn't sound like Kelly has been. I only worry about Kelly being on prednisone because the bacterial situation or SIBO hasn't been addressed with any precision if at all; suppressing his immune system at all is not going to help that situation.

 

You can never ask too many questions of those GTers who have or have had IBD dogs! And I personally never tire of warning people about the dangers of SIBO, though I do get very tired of vets not doing so! (You can't believe the eye-rolling I endured from the techs when I insisted on not only SIBO testing, but inclusion of C. perfringens! I really had to suck it up to get through that. But after the results came back positive, well, they all became my BFF's!) Anyhow, Robin and I will probably shove each other out of the way for the chance to help you, so ask away!

 

 

[greyhead]

I would take a fresh stool sample in on Monday. Try to get one that is as formed as possible. The looser the stool the harder it is to isolate bacteria & critters in it.

 

I hadn't heard this. If they're going to culture it, why would it need to be more solid? I'm not challenging you, I'm just curious! I'm becoming an H&M geek!

[Guest mcsheltie]

I would take a fresh stool sample in on Monday. Try to get one that is as formed as possible. The looser the stool the harder it is to isolate bacteria & critters in it.

 

I hadn't heard this. If they're going to culture it, why would it need to be more solid? I'm not challenging you, I'm just curious! I'm becoming an H&M geek!

It wouldn't affect a culture or PCR test as much. But the usual diagnostic is looking at a smear or flotation on a slide under a microscope. When the dog is having liquid poop everything runs thru them extremely fast. The amount of microorganisms is less in each subsequent stool. Most of these bacteria are found in normal stool samples. When stress (or whatever) allows them to proliferate is when they cause problems. In completely liquid stool the amount present may look to be normal or nonexistent. Coccidia & Giardia are extremely hard to isolate in completely liquid poo. With Giardia and liquid stool both the antigen test & flotation need to be done to find it.

 

The best stool sample is the first one of the day and get it right to your vet. Since each subsequent one usually becomes looser.

 

Another thought... along with Clostridium, they should also test for Cryptosoridium.

Edited April 17, 2010 by mcsheltie

[Guest Stripeyfan]

Kelly hasn't had an ultrasound yet - it's something I'm going to ask about next vet visit as I would much, much prefer him to have a non-invasive procedure. Greyhead, he isn't having B12 injections but it's also on my to-ask list. And he definitely has damage to his small intestine- which is where the roundworm were (original post here) - and our vet agrees they could be what caused the damage as he had such a massive infestation.

 

However she also thinks he has problems with his large intestine as when he comes off the pred, he immediately has colitis - mucusy D rather than watery - which I understand is caused by large intestine problems (when he comes off the ABs the D is the watery sort). I think this was caused by the prescription diet our old vet put him on as he never had that sort of soft stool before then. We were able to control the D with the bland diet alone up to that point as I think before then he really did just have worm damage. Now, who knows... (sigh).

 

Yes, I'd like to know if he really does have SIBO and if so, what bacteria is causing it. But – and sorry if this is a stupid question!! - if he's on ABs, and they're keeping him firm, does that mean they're controlling the bacteria and therefore would stop them showing up? The other thing is, he's never had any loss of appetite and not really had the foul-smelling 'pudding poo' that I understand is typical of SIBO. He just goes from firm to loose to liquid D. So maybe we are more likely looking at IBD? I am just praying it's nothing even more sinister.

 

Thanks for the replies and letting me ramble on.

[greyhead]

It wouldn't affect a culture or PCR test as much. But the usual diagnostic is looking at a smear or flotation on a slide under a microscope. When the dog is having liquid poop everything runs thru them extremely fast. The amount of microorganisms is less in each subsequent stool. Most of these bacteria are found in normal stool samples. When stress (or whatever) allows them to proliferate is when they cause problems. In completely liquid stool the amount present may look to be normal or nonexistent. Coccidia & Giardia are extremely hard to isolate in completely liquid poo. With Giardia and liquid stool both the antigen test & flotation need to be done to find it.

 

The best stool sample is the first one of the day and get it right to your vet. Since each subsequent one usually becomes looser.

 

Another thought... along with Clostridium, they should also test for Cryptosoridium.

 

Thanks, Julie, I see what you're saying. But I think doing a smear or flotation for SIBO would be hardly worth it. I asked the tech at our vet's to submit the loosest part of Spencer's sample to the lab for his C&S, because I figured it was the sickest.

 

Stripeyfan, because we had such a gawdawful experience, I'd counsel doing a C&S instead of a slide smear or flotation if I suspected SIBO. And if that doesn't settle it, there's the Texas A&M procedure for determining toxin production by the bacteria. But as Julie said, many of these bacteria are normally present. It's the quantity that's key, as you probably know, but I'm saying this for the benefit of those who may be as in the dark as our family was before Spencer's drama.

 

Maybe that's why so many vets ignore poop for anything but parasite detection -- like a smear or Texas A&M are the only choices. If something like Clostridium, for instance, is *seriously* overgrown, it will produce toxins and you don't need TAM to tell you so! But a C&S on the poop at a good local lab will quantify how many bacteria are growing, and they know how many of each kind to expect. So if the number is way beyond what's expected, then you know they're toxic. And the sensitivity part is great for figuring out which a/b's will work; in Spencer's case we needed all three a/b's that were supposed to work! Maybe because he had two different strains of the C. perfringens.

Edited April 18, 2010 by greyhead

[greyhead]

Kelly hasn't had an ultrasound yet - it's something I'm going to ask about next vet visit as I would much, much prefer him to have a non-invasive procedure. Greyhead, he isn't having B12 injections but it's also on my to-ask list. And he definitely has damage to his small intestine- which is where the roundworm were (original post here) - and our vet agrees they could be what caused the damage as he had such a massive infestation.

 

However she also thinks he has problems with his large intestine as when he comes off the pred, he immediately has colitis - mucusy D rather than watery - which I understand is caused by large intestine problems (when he comes off the ABs the D is the watery sort). I think this was caused by the prescription diet our old vet put him on as he never had that sort of soft stool before then. We were able to control the D with the bland diet alone up to that point as I think before then he really did just have worm damage. Now, who knows... (sigh).

 

Yes, I'd like to know if he really does have SIBO and if so, what bacteria is causing it. But – and sorry if this is a stupid question!! - if he's on ABs, and they're keeping him firm, does that mean they're controlling the bacteria and therefore would stop them showing up? The other thing is, he's never had any loss of appetite and not really had the foul-smelling 'pudding poo' that I understand is typical of SIBO. He just goes from firm to loose to liquid D. So maybe we are more likely looking at IBD? I am just praying it's nothing even more sinister.

 

Thanks for the replies and letting me ramble on.

 

Sorry, I think I mixed your dog up with another one when I asked about the ultrasound. The last couple days were really confusing for me. That's my excuse and I'm stickin' to it! It sounds like the AB is controlling but perhaps not eliminating the bacteria. Another AB may need to be added or perhaps substituted. (I just read that a lot of resistance developed to tetracycline, so it's not used as much; don't know if oxytetracycline tends to overcome that resistance or not.) As I mentioned in my post above, it took three AB's to tackle Spencer's SIBO. And the way I would know we weren't done yet was when we'd stop an AB and the poop would get softer and smellier again. Yes, Spencer SIBO involved "foul-smelling pudding poo", so I don't know what it means that you don't have that. But SIBO and IBD are not mutually exclusive; if there is IBD or some other intestinal condition causing diarrhea, well, that would transform what would otherwise be pudding poo into diarrhea.

 

Interesting about the roundworm history. I don't know what kind of damage roundworms do. Spencer had hookworm for a long time before we found it. Hookworms excavate channels in the intestinal wall! I have no doubt that such damage makes the intestines more vulnerable to infection and inflammation!

 

I hope people more knowledgeable than I will jump in and answer some of your questions too. I only know what I know, which is what I learned through Spencer's case. It doesn't apply to everyone and it is limited. So I'll shut up now and let someone else talk!

[Guest Stripeyfan]

No worries Greyhead, I have lots of days like that (esp at the moment!). Kelly did have a complete stool test done when they found he had worms, but there were no bacteria present then... however I'm not sure if they tested for everything – probably not, seeing as how useless they were with everything else – and I'd imagine because they caused him to have so many flare-ups by insisting his problem was diet-related when what he really needed was to remain on the bland diet for a good while to let his gut heal, it's become a problem since, along with the IBD-like symptoms. So I'll definitely have a word with the new vet about it, especially if the D returns after his next course of ABs ends (which is just after his next follow-up). Would it be ok to PM you at some point if I need to know anything else about the SIBO/IBD stuff?

 

As for the worm damage, I sometimes wonder if he also had hooks and/or whips that just happened not to show up when the test was done. He hadn't been wormed for soooo long and I'm guessing if his trainer neglected to do that for him, he won't have been too great with his other dogs either, so doG knows what they could have all had. And even if it was just the rounds, there were so many of them that I'm sure they won't have done him any good at-all. Poor boy!

 

Thankyou for all the answers so far, as usual you guys have given me some greyt information! And please can I sneak in a request for some good thoughts that the urine test we're taking in tomorrow will come back clear?

 

Thanks

[greyhead]

You can PM or email me anytime. Hope you and Kelly have a productive visit at the vet. Just be sure you don't discuss doing a "fecal" test, because that only tests for worms. You have to ask for a culture-and-sensitivity test for bacteria, and you may need to choose which bacteria you want them to culture for. Our lab tests for 3 or 4 (E. coli, Salmonella, not sure what else). I just told them to make sure one of the tests was for Clostridium; I'd read an article by a vet about it, and I just knew from the description that that might well be the culprit. (I'm intuitive sometimes. Can't explain it. I've just learned how to recognize it and trust it when it happens.)

 

Hugs to you and scritches to Kelly!

[Guest lsanta]

Hi, everybody. I'm new. My 11-month old boy, Manolo, has been diagnosed with SIBO. I need some opinions. What causes SIBO? The vet began with Flagyl, but it didn't help him. Now he's on Tetracycline and Ketoconazole?. How long should I wait to see results, if any? I'm really desperate and hate to see him poop so badly! Please help me. Thank you.

[Houndtime]

We went through this last year with Fuzzy. We spent $1300 on tests and meds in about 12 days. Next was a stomach scope and biopsy and I just took a breath and said hold it.

 

He did terrible on prednisone. We had him on it for three days and it took 10 days to get him off. I did the veterinarian's potato diet and then put him on a single protein diet. I chose Dick Van Patten's Duck and Potato and kept him on it for about a month. I bought kibble, canned and treats all the same.

 

Look up the potato diet and give it a shot. Fuzzy was better in about 12 hours. He had lost 11 lbs. Also, make a slurry with slippery elm bark (health food store), pumpkin, probiotics, oatmeal, and yogurt can help too. Just, not all at once. Good luck with your pup.

Edited November 24, 2014 by Houndtime

[cello]

Our 10 year old girl Lady has been on Prednisone for 19 months now, and is doing great. She has been diagnosed with Protein Losing Enteropathy, and lymphangiectasia through ultrasound and an endoscopy scope. She started on 20mg of pred twice a day. We eventually got her down to 10mg twice a week, but that was not quite enough, so now she is on 10 mg of pred three times a week. She has to eat an ultra low fat diet consisting of prescription kibble, pasta and boiled chicken. She has regained the substantial amount of weight she lost, and rebuilt her muscle mass. We found out that Lady was so ill through routine pre-surgery blood work. Her protein levels were so low, our vet said that she likely would have bled out after the extraction he was planning on doing. Protein levels are now back in the normal range and we are thrilled that our special girl has made it to her 10th birthday! Things looked pretty bleak 19 months ago, but fingers crossed, she is doing great. We are super thankful for the wonderful Internal Medicine Specialist vet that has handled her care for the past year and a half. I won't kid you though, this has been hugely expensive to deal with. Enormous vet bills, and a very expensive feeding regime. In all likelihood, Lady will remain on Prednisone for the rest of her life. I did ask her IM vet about the Budesonide. Her opinion was that she wanted to start her on pred first and see how that went. At this point Lady does not seem to suffer any side effects on this low dose, and quite frankly, pred is a very cheap drug compared to Budesonide. Good luck!

[Burpdog]

Are you sure your 11 mo old boy doesn't have either hook or whipworms? To be absolutely sure you need to take a sample every day for 3 days in a row. I would treat for worms at that age. Many greyhounds do not do well for bowel issues when put on pred