Help! Ibd

[tbhounds]

My suggestion is to find a new vet-- an internal medicine Dr or a gastro vet. I'm assuming your vet is starting your hound on chlorambucil (leukeran-- a chemotherapy drug) because he/she feels your hound may have cancer of the GI tract-- ie lymphoma, adenocarcinoma.

I also wonder why he/she would have your hound on a rather high dose of pred WITH Budesonide AND chlorambucil. Maybe, I'm not getting the whole picture.

Did you ever have a biopsy to give you a true diagnosis? If so was it via a scope or a "true cut" (surgery) method?

When my hound was so horribly sick initially with his IBD the specialist we saw (gastro Dr) did not recommend to feed him when he didn't want to eat. He said to let them decide when their tummys are ready for food. Now, that being said I'm sure your not willing to watch your hound go w/o food for days on end. My suggestion to you is keep it simple-eggs, meat baby food (lamb if that's what he wants), oatmeal. If he wants lamb-greyt-- just watch what comes out the other end. IBD is in awful hard disease to get under control but, it takes the right team to do so.

Not dissing your vet because I know I don't have the complete picture here but, IMHO I would seek a second or third opinion before I started the newly recommended protocol.

[greyhead]

My suggestion is to find a new vet-- an internal medicine Dr or a gastro vet. I'm assuming your vet is starting your hound on chlorambucil (leukeran-- a chemotherapy drug) because he/she feels your hound may have cancer of the GI tract-- ie lymphoma, adenocarcinoma.

I also wonder why he/she would have your hound on a rather high dose of pred WITH Budesonide AND chlorambucil. Maybe, I'm not getting the whole picture.

Did you ever have a biopsy to give you a true diagnosis? If so was it via a scope or a "true cut" (surgery) method?

When my hound was so horribly sick initially with his IBD the specialist we saw (gastro Dr) did not recommend to feed him when he didn't want to eat. He said to let them decide when their tummys are ready for food. Now, that being said I'm sure your not willing to watch your hound go w/o food for days on end. My suggestion to you is keep it simple-eggs, meat baby food (lamb if that's what he wants), oatmeal. If he wants lamb-greyt-- just watch what comes out the other end. IBD is in awful hard disease to get under control but, it takes the right team to do so.

Not dissing your vet because I know I don't have the complete picture here but, IMHO I would seek a second or third opinion before I started the newly recommended protocol.

Tracy, the dog was diagnosed with IBD by endoscopy in February. So this has been going on for a while.

 

I've heard that IBD is thought to sometimes morph into cancer. But my sense is that that doesn't happen at all quickly. So if the cancer drug is being proposed with that in mind, without any other proof from testing, I think her vet is just wrong.

 

If it were me, I'd give the budesonide at the soonest opportunity and see an internist afterward. Worked for us. I think there was a plan to see an internist at Angell?

 

But, Tracy, have you any observations about any time off of prednisone before commencing budesonide, or does it not matter? I can't begin to fathom why you'd have them on both at once.

[tbhounds]

To address a few of the above questions-- yes, the IBD can morph to cancer- happened with my boy-adenocarcinoma. He was stable for 3 years- then the vomiting started (he always just had diarrhea in the past). A gastronomy (true cut biopsy) proved my worst fear. He was originally diagnosised via a scope which does not always give you a true diagnosis- many times there are cancer cells lurking deeper with in the lining of the gut. That being said GI lymphoma is rather rare in Ghs so, I believe most clinicians are comfortable with the intial diagnosis of IBD. In my boys case in know it was IBD he was so stable for so long before it morphed-adenocarcinom-a is very aggressive and would have taken him long before it did.

To the best of my memory I think I switched to the Budesonide from the pred without a washout period-- I most definetly did not give both at the same time. We started with he 3mg dose daily and ended up being able to give that dose once every third day. Looking back- I have to wonder if I continued to give the Budesonide with more frequency would that have prevented the inflammation from morphing to cancer?? Guess I'll never know.

I still have a problem with this vet starting this hound on leukeran without clear knowledge that there is cancer lurking. I'm pretty keen on a definitive diagnosis before starting a medical protocol.

What other drugs is this hound on or tried- tylan, metronidazole, azathiprine, B-12 injections-tummy protectants (carafate), anti nausea medssuch as Cerenia and ondansetron.....????

Edited April 1, 2012 by tbhounds

[Guest jurishound]

Sadly, our beautiful Talca was also DX with IBD, which I believe turned into lymphoma. She was managed well for about a year with a venison diet (which is why it isn't a "novel" diet for Harley) and a relatively low dose of pred, until she developed DIC and plummeted. Harley's course has been much different. Strangely, he didn't present with diarrhea - his symptoms began with a cough, from the effusion that developed around his lungs. He was DX by endoscopy.

 

Harley is seeing an internist at Angell. When it became clear that the pred (at 60 mg, then 50 mg) and azathioprine weren't controlling the inflammation, she suggested adding chlorambucil, which apparently treats both alimentary lymphoma and IBD. It scared me because gloves are required to administer it and the side effect profile terrified me, so I held off administering it. He is also on flagyl, mirtazapine, pepcid, sotolol (for a tachycardia he developed), and weekly B-12 injections. A walking pharmacy.

 

The vet called in an RX for "people" budesonide to get us started until the mail order drug arrives, so he can start tomorrow. I asked whether he should be taking the pred at the same time as the budesonide and I believe the theory is to taper off the pred after he starts the budesonide. Does anyone know definitively whether this is a bad idea? He is in pretty bad shape and seems to be getting weaker and thinner He did end up eating a little bit today, so hopefully he can hang in there. The chlorambucil was the vet's first recommendation for an alternative agent, but we will try budesonide instead. He will not be taking all three at once.

[greyhead]

The vet called in an RX for "people" budesonide to get us started until the mail order drug arrives, so he can start tomorrow. I asked whether he should be taking the pred at the same time as the budesonide and I believe the theory is to taper off the pred after he starts the budesonide. Does anyone know definitively whether this is a bad idea? He is in pretty bad shape and seems to be getting weaker and thinner He did end up eating a little bit today, so hopefully he can hang in there. The chlorambucil was the vet's first recommendation for an alternative agent, but we will try budesonide instead. He will not be taking all three at once.

 

I Googled "tapering off predisone for dogs" and got this, among others: tapering pred . It's coming back to me now. Here's the short version. Spencer was only on 20 mg pred for several days. We were told to discontinue gradually, using a half dose for a couple of days and then a quarter dose for a couple of days. Do read the link! You'll need a plan for tapering; the longer Harley has been taking it, the more time you'll have to devote to tapering. (I'm a bit confused about whether your vet or the internist is handling Harley's case now.) I do recall that Spencer's internist thought the 20 mg. the vet had prescribed was really high for a greyhound, especially since we didn't have a diagnosis at that point. (Long story.)

 

I'm also not familiar with the kinds of IBD symptoms Harley has -- coughing, not diarrhea. Spencer's IBD was preceded by SIBO and hookworm. Any idea what precipitated Harley's IBD? I remember, now, when you lost Talca. You're getting more than your share of this problem.

 

Prayers are continuing here at full strength. You have to finesse this change, I think.

[Guest Mom2Shiloh]

I would give Slippery Elm 3 x day --- powder form, mix with warm water into a soft pudding texture and syringe down throat.

coats the gut, calms the gut and will stop diarrhea

 

I was going to say Slippery Elm Bark Powder in all caps-- it is my and my holistic vet's absolute Go To for colitis, IBD -- any gut or stomach issues. I usually just mix it in with the meals though. (When I or a human friend need to take it (it's been a huge help to one of my friends with Krohn's disease) it's easier to fill some capsules to get it down.

 

My vet usually wants a 24 hour fast followed by 4-5 days on the potato diet (will post if anyone is interested)... gradually moving back toward an easy to digest meal with the Slippery Elm added. Potato is way easier to digest than rice or pasta and surprisingly, most dogs like it.

 

In addition to this, I just came across (again) an article in a 2003 issue of CG Magazine that highly recommends L-Glutamine as the very best treatment for colitis.

 

Oh.. I forgot, someone recommended ProZyme? Digestive enzymes are Really good, but Animal Essentials Plant Enzymes and Probiotics is recommended over ProZyme.

 

I am not wedded to holistic-only treatments, but I do think when you keep adding things and end up with that many medicines-- the medicines alone are a bit much for most dog's systems... one reason I have both straight allopathic and holistic vets.

Edited April 2, 2012 by Mom2Shiloh

[greyhead]

Just sending prayers, and hugs, and hopes that Harley has felt like eating a little something.

[Guest jurishound]

Thank you for your replies - it helps so much just to know I am not alone with this. Harley started the budesonide today. He ate some bison and sweet potato that I cooked, but now his tummy is quite gurgly. His has also developed abdominal ascites over the past few days, which I am a bit worried about. He did want to go for his walk this morning and for a ride in the car this afternoon. I worry so much about him while I am at work.

[tbhounds]

Ack-- what is his albumin value??

[Guest jurishound]

Ack-- what is his albumin value??

Not sure - but I suspect it has dropped. He did see the vet/internist on Saturday, and she saw what he looked like. She didn't do a blood panel because she thought he had been poked and prodded enough. He doesn't seem distressed at all and is breathing fine - should I be very concerned about this?

Edited April 2, 2012 by jurishound

[greyhead]

It can be due to a lot of things and is expectable, to an extent, with IBD and lymphangiectasia. I'm not sure at what point you should become alarmed. But Spencer had this too for a long time, sometimes moreso, sometimes less. He never lost his desire to go on walks either or had any trouble breathing. So I hope Harley's okay with this for now, but I don't know for sure. Any chance you can take a day or two to stay home with him? It might make you feel better and him too. Any plan yet for tapering off the pred? Your vet/internist ought to discuss with you how that is going to get done. A big part of the point, in my mind, for getting on budesonide is the ability to get off the pred and lose pred's side effects.

 

If the gurgling is from gas, you can give Gas-X and quite a lot of it, actually. We used to give four or five of them sometimes. We didn't mind the smell so much as gas can be painful.

 

 

[tbhounds]

A very low albumin could potentially be very ugly. My boys was so low at one point he needed to be hospitalized to receive hetastarch. To compound things Ghs blood protein normally run on the lower side.

If your vet just saw him perhaps she/he is ok with his clinical symptoms and still wants to continue the prescribed protocol.

I feel for you- IBD is a really tough disease to manage intially- hopefully, you'll strike the right combo of meds soon.

[greyhndz]

Hi Joslin

 

Just PM'd you but thought I'd share... Also forgot to mention that Dandi is also on daily probiotic in addition to pepcid. His cyanocobalamin (B-12) was low, so he received weekly injections x 5 weeks. His folic acid was normal. I personally didn't see any improvement with slippery elm, but if you'd like to try it I have a big bottle of powder and I'm happy to send down some for you to try. He's on Tylan 1/8 tsp/meal. Think about trying the NCU nutrition service for a customized diet. They also have supplements to go along with home-cooked food to complete a balanced diet. And if you'd like to try exotic meats for novel protein, I'll pick up some 'roo for yoo.

 

If Harley has ascites, his albumin is likely critically low. An albumin <2 is considered severely low. IV Hetastarch can increase the albumin, and also increase the amount of fluid circulating in the blood vessels (as opposed to protein leaking through the bowel).But this is a short-term fix for critically-ill dogs, usually a bridge to tide them over until anti-inflammatories or immunomodulators kick in -- as soon as Hetastarch IV infusion ends, the serum albumin will again decline because it will continue to leak through the gut, but if his albumin is low enough to result in ascites or edema, he may need Hetastarch infusions right now to stabilize him. (Dandi's initial albumin was 1.5, and he was in hospital on Hetastarch for 3 days while starting pred and metronidazole.)

 

This is totally my own observation and has nothing to do with medical fact, but Dandi's response to prednisone was not only horrible (within 1 week he already had muscle wasting) but there was no improvement in either his diarrhea or albumin. He looked sunken and emaciated (though he'd only lost 6 lbs). My vet and I agreed that we would gradually taper off pred over the next couple of weeks and had no problems doing so.

 

This is an excellent article about IBD and treatment options.

 

Scroll down to Therapeutic Options for IBD - this also mentions various immunosuppressants and immunomodulators (cyclosporine, etc.) and indications for each.

 

My IM vet (and recent veterinary studies) suggests cyclosporine as the first choice immunomodulator, with/without prednisone or budesonide. I have not found a definitive recommendation for transitioning off systemic pred ---> budesonide, but hopefully your vet will have that information.

 

I don't know what's worse for IBD dogs: the treatment or the disease. I hope this week brings better news about Harley, and food that will spark his appetite. Skritches for your beautiful boy.

 

Jordan

[Guest jurishound]

Wow, Jordan - have you done much research on this? Thanks so much. We have added 1/4 of a baby aspirin to his pharma cocktail, thanks to your work. And his vet/internist reminded me that we are on the second tier of RX, since he didn't respond very well to the first tier. Unfortunately, he won't touch any of the RX diets, so I am sticking by bison and sweet potato in frequent, small amounts.

 

I wish I could take more time off to be with him, but am surprised that I haven't been fired already! He is only alone for 2 - 3 hours in the morning, and 2 - 3 hours in the afternoon. XDH or I go home at lunch time to check on him, give him his med(s), and feed him. Then I hang out with him all night!

 

My fear is that he isn't responding well because (1) we haven't found the right diet/drug therapy; (2) the combination of meds he is on are causing his poor condition, or (3) he actually has lymphoma, in which case the chlorambucil would have been a good idea. Not having answers for this is so difficult.

 

Thankfully, he is still interested in eating some bison and potato, and going out for his walk. These are good signs that I hang onto.

 

Thank you all for your support through this.

[NeylasMom]

I really don't have anything to contribute, except to say that I am following the thread and hoping for the best. This is a really horrible disease to have to deal with and I do not envy you for one second. I hope that you find the right combination of food and meds that work for him ASAP.

[greyhead]

Jordan rocks, doesn't she?

 

You're doing great, Joslin, honestly. You're with him a lot, and I'm sure he's just sleeping when you're not. It's great that XDH is helping too.

 

We didn't even try to feed Spencer the RX diets, and no vet ever suggested otherwise, because he already had a history of doing poorly on white rice and on corn before this ever came up, plus we knew we'd exhausted chicken as a protein, and the RX diets feature most of those things prominently. So maybe Harley knows what he's doing on that score. One thing I realized through our ordeal was that Spencer had no motive for being merely "picky" about food, prima-dona fashion, so I should pay attention to what he tells me.

 

Eating and walking are worthy things to hang your hopes on, and I'm sure there are lots of people lurking and hoping along with you.

Edited April 4, 2012 by greyhead

[sweetdogs]

Eating and walking are worthy things to hang your hopes on, and I'm sure there are lots of people lurking and hoping along with you.

 

There are, so keep us posted.

[Guest jurishound]

Thank you for thinking of us! Here he is on the couch, watching me head to work this morning. This was taken from outside, which is why you can see my image in the window!

 

 

He didn't want to go on his walk this morning - turned right around and headed home. My heart sank. But it was because he was HUNGRY! So, after a snork of bison/sweet potato, off he went. And . . . his poop has improved from liquid to "soft serve" !!!!

 

Keeping fingers crossed.

 

Thanks for rooting for my boy.

[4My2Greys]

:goodluck

[sweetdogs]

He didn't want to go on his walk this morning - turned right around and headed home. My heart sank. But it was because he was HUNGRY! So, after a snork of bison/sweet potato, off he went. And . . . his poop has improved from liquid to "soft serve" !!!!

 

OMG!

[tbhounds]

That a boy! Did you start the Budesonide??

[Guest jurishound]

We started (enteric capsule) budesonide on Monday. The compounded form should be arriving today. He is still on pred, however. XDH reports that he woofed his lunch.

[Guest Fasave]

Jordan rocks, doesn't she?

 

 

 

 

Yes, Jordan Rocks! She was a great resource when my Safari had similar issues. Happy to hear the update on Harley. Continuing to send good thoughts your way!

[NeylasMom]

This is great news! I hope the trend continues.

[Guest sirsmom]

A food to try might be Natural Balance with the lowest fat % you can find. They have quite a few limited ingredients bags to try.