Grey Not Responding To Ibd Treatment

[bboylan]

My six year-old grey has been getting treated for IBD for nearly a month, 20mg of pred twice a day, with tylan powder, eating the Royal Canin hydrolized protein food.

 

A little background info..... Near the beginning of the year, she had very loose stool and after about six weeks we got her straightened out by feeding turkey and rice, Forti Flora probiotics, and then introducing Pure Vita kibble. She did well until early November, when she began having completely liquid stools. We tried turkey and rice with probiotics again and put her on a round of metronidazole. She had no improvement and began the IBD treatment on December 5th.

 

She has responded to the pred, tylan, and HP food with minimal improvement in her stools--it's more like thick cake batter now. What really concerns me is her dramatic weight loss. She's always stayed very lean after being off the track for four years, so she didn't have any fat to lose. She has gone from 58lbs to 45lbs in a month and a half, and she looks very close to emaciated. We had a recheck with the vet office yesterday, and I asked to try budesonide instead of the prednisone. The vet insisted that it would be useless to try a less potent drug at this point and referred me to an internal medicine vet. I would really like to try and manage this with diet and medication changes if possible, instead of making her undergo biopsies. And my feeling is that an internist would simply manage her care through diet trials also (though at a higher price point).

 

Is there anyone out there who has had their hounds on both budesonide and predisone? Which drug did they do better on? And what have been your experiences with an internist? Is it worth the money to go that route, or should I experiment with her diet on my own?

 

Thank you for any input.

 

 

 

[MP_the4pack]

Has she been tested for worms? Sometimes negative stool sample doesn't mean they are worm free.

[Houndtime]

For what it's worth, I have used, very successfully, the veterinarian's potato diet. Also, slippery elm bark made into a warm tea. Oatmeal soothes the stomach and a limited, unique, protein. Some dogs do not do well with turkey. https://holistichealthpetvet.com/nutrition/potato-diet-for-diarrhea/ I refused a stomach scope and biopsy for my dog who had lost 10 lbs. I put him on the potato diet and within 12 hours the diarrhea stopped. Maybe we were just lucky. We had spent over $1200 on tests.

[MaryJane]

Get a consult with Dr. Couto.

 

My dog has IBD and she is treated with diet (fish protein and home-made diet), Vit B12, and probiotics. She is a seizure dog so, we decided that we would not use either pred or bute since she is on so many other meds.

 

Also, you want to check what may have caused it and the likely suspects would be a tick borne disease like Lyme or erlichia or an intestinal parasite like hooks. If yourvet has not already checked - the platelets might also be affected.

 

My Lucy's IBD was caused by one of the medicines for seizures. Right now it is under control just as long as she gets her diet and her monthly B12 shots which I give her. The probiotics are not as necessary now as in the beginning when we first started to treat.

Edited December 30, 2018 by MaryJane

[greysmom]

I have an IBD dog as well. FWIW, she is *extremely* sensitive to chicken - which we discovered through a food trial. She cannot tolerate *any* chicken, including that in hydrolyzed diets, and in the chicken fat tocopherols used as a preservative in treats and foods. So we had to find a food, that she would eat, with neither chicken or chicken fat tocopherols.

 

Once we did that, we embarked on a long course of treatment with acupuncture and Chinese medicine. Acupuncture is actually approved by the FDA for treatment of intestinal issues in people, including for IBD/S. So there is a history of it being effective.

 

Our practitioner is also a licensed veterinarian, so she was able to guide us using traditional medications and then weaning Lilly off them. We never did use steroids for her, but she was on metronidazol, tylan, probiotics, appetite stimulants, vitamin B12, and other treatments prior to beginning this modality.

 

We did this eastern medicine treatment for about a year. She had weekly needle sessions for a month, then every other week, then once a month. Lilly was also on a course of herbal treatments along with the acupuncture. We saw a huge difference within the first month, and Lilly continued to improve until she was no longer taking any rx medications, Chinese herbs, or having needle sessions. She's been treatment free for over two years now.

 

Your vet did a disservice to you in refusing to try budesonide. It is an older and slightly less powerful drug, but it tends to be more effective in greyhounds than prednisone for IBS due to their unique physiology. There are several vets I know (on this forum and through social media) who use it on their own dogs.

 

But you need to find something to feed her. To do an effective food trial you would stop the rx diet and fast her for at least 24 hours, or until she stops having diarrhea. She's not gaining any nutrients from her food at this point, so fasting will not make her lose and more weight. Make sure she continues to drink water, vegetable broth, or Pedialyte for babies to keep her hydrated.

 

Then start feeding her small amounts (a 1/4 cup to a 1/2 cup) of a bland diet. A bland diet consists of equal parts of a carb source and a protein source. I recommend staying away from rice as a carb. Unless it is very overcooked dogs don't really digest it, and that's not what you need right now. Use overcooked pasta, peeled white potatoes boiled and mashed, boiled and mashed sweet potatoes, and even certain beans (chickpeas, adzuki beans) mashed up can be used.

 

For a protein source, choose something unique that you have good access to like tilapia or other white fish, venison, bison, or beef cooked to render the most fat out of it or rinsed after cooking.

 

You can add in vegetables if your dog likes them and put everything in a crock pot to make larger batches.

 

Feed one protein for 7-10 days to see if she can tolerate it. With at least a day of fasting in between. Once you find one, you can either search for a commercial diet, or stick with home cooking. A dog can be on a plain diet for a couple months without having additives for vitamins and minerals to maintain proper nutrition.

 

Our Lilly is on a commercial diet of Turkey protein with sweet potatoes. She only eats canned food, no kibble. She also gets a 5 oz can of tuna every day. There's no law that says a dog *has* to eat kibble - it's just cheaper for the humans! I have found a few treats that are ok under her restrictions as well.

 

It's going to be hard until you can finally put the pieces together, but once you do you will all be much happier!

 

Good luck!

[cleptogrey]

i presume she had a cbc and all of her basic functions were accessed. my late female had chronic colitis, she was on flagyl long term. we finally weaned her off after 6 months. she had lost 12 lbs in a little more than a month. not saying that your dog does not have ibd. have you tried a straight over cooked rice diet(japanese short grain rice is not only the tastiest but the most glutenous and fattening) and then added one ingredient in at a time? i always add extra water to rice, when it cools it's more of a solid, no grains are left.you can also cook the source of protein in the rice. i do that for my kidney/pancreas challenged old dog. he loves it, won't eat rice otherwise. it does sound like a consult w/ dr. couto is in order. best of luck.

Edited December 30, 2018 by cleptogrey

[3greytjoys]

General fecal test for worms; and now important to also have a comprehensive fecal diarrhea panel.

(The comprehensive diarrhea panel can reveal more serious underlying conditions, but doesn't include worm testing; therefore, both fecal tests would be needed.)

If the comprehensive fecal is positive for dangerous bacteria, get a separate susceptibility test (sensitivity test) to determine the most effective antibiotic against that bacterial strain.

(There are many more drug resistant bacteria strains these days.)

 

Many Greyhounds don't do well on prednisone and may have difficulty recovering from prednisone's harsh effects on the body, including weight loss, suppression of immune system, and suppression of adrenal glands (potentially permanent), but it cannot be stopped abruptly. Prednisone dosage must be tapered down slowly before stopping.

 

Internal medicine specialists are most valuable because their expertise is much more in depth than a general vet.

Tests provide necessary information. If cheaper, a general vet can order tests, then share results with a specialist.

 

Greyhounds can decline very quickly with incorrect treatments. (Sadly, IBD was an original incorrect guess for our hound's diagnosis.)

 

 

 

 

[bboylan]

Wow, thank you, everyone, for the responses!

 

I'll give the vet's diet with elm bark a shot.... I know she'll love that and at least it'll make her happy until we are able to get more answers. I'm also totally game to start diet trials, either home cooked or with different dog foods.

 

She is also on B12 shots (forgot to share), and she started on Pepcid today. She has had blood panels, though I don't think they are CBCs. Her proteins are low and liver enzymes high. I'll definitely ask about the CBC and the fecal diarrhea panel.

 

I have scheduled an appointment with another vet at the practice for a second opinion, and also with the internist we were referred to.

 

I googled Dr. Couto... It seems like the Greyhound Health Initiative is what I'm looking for? I've never heard of it. Thank you for that suggestion!

 

 

 

 

 

[3greytjoys]

Per MaryJane's mention of Dr. Couto; here is his link: http://www.coutovetconsultants.com/

Dr. Couto is highly experienced in Greyhound medicine. Recently retired from Ohio State; and still offers e-consultations. If you're planning to obtain more tests, he will need all current e-records and test results.

 

Glad you're moving forward with your local vet and internal medicine specialist. Having been through two similar situations with two different dogs, addressing a hound's condition in a timely manner is extremely important. Due to early misdiagnosis, unhelpful medications, etc., one of our hounds dropped to 50% body weight (skin and bones!) and was not able to recover. The other dog was diagnosed at age two. After nearly losing her, she eventually recovered and lived 12 more years on a novelty single protein kibble. She could not tolerate any other foods or treats.

 

Here is a fecal chart that may be helpful when communicating updates with your vets:

https://www.proplanveterinarydiets.ca/wp-content/uploads/2016/04/PPPVD-Fecal-Scoring-Chart-EN-FINAL.pdf

 

 

 

 

 

[tbhounds]

How was the ibd diagnosed?

[Mimismom]

The definitive diagnostic test for IBD is intestinal biopsy. It sounds like that wasn't performed. Since that is invasive and requires general anesthesia, often veterinarians will try a medication and food trial to produce the desired results (normal stools and no vomiting). Please make sure that your dog has been dewormed often (strongid) and is taking a monthly heartworm prevention like Interceptor, Sentinel, or Trifexis - which all do an excellent job of deworming against roundworms, hookworms and whipworms.

My grey Mimi's stools improved 100% with a Royal Canin diet called GI fiber response, after trying Hill's ID, metronidazole, fortiflora, etc...

She is not diagnosed with IBD, but more so with a fiber responsive food sensitivity.

Best of luck!

[NeylasMom]

I'm wondering how your vet arrived at the IBD dx. Especially with blood work abnormalities. Seems to me there could be multiple things going on. Given the drastic weight loss, I would focus your money and energy with the internal medicine specialist. IMO specialists are worth their weight in gold, both for their much deeper knowledge and their ability to give a thorough differential diagnosis. Don't be afraid to ask a lot of questions, including in the case of more expensive or stressful testing, if the result were positive how would that change our treatment plan or what would our options be.

 

I have no idea, but wondering if an abdominal ultrasound could be useful. Those can be done without anesthesia. Given the elevated liver values I would want a look at the internal organs.

[bboylan]

Well we saw the internist on Saturday and she's doing the fecal panel, a test for histoplasmia, and she did a new ultrasound. The ultrasound showed more fluid (though still a small amount), no thickened intestinal walls, and normal sized lymphs. Now she is on baytril and lasix.

 

We are still waiting for the results of the fecal and the fungal test. If those tests don't show anything, we've been quoted on an endoscopy and the vet would like to have that done by the end of the week.

[Bizeebee]

On 1/7/2019 at 9:25 PM, bboylan said:

Well we saw the internist on Saturday and she's doing the fecal panel, a test for histoplasmia, and she did a new ultrasound. The ultrasound showed more fluid (though still a small amount), no thickened intestinal walls, and normal sized lymphs. Now she is on baytril and lasix.

 

We are still waiting for the results of the fecal and the fungal test. If those tests don't show anything, we've been quoted on an endoscopy and the vet would like to have that done by the end of the week.

I see you haven't posted a follow up, but we're sort of in the midst of this same process (not quite to the steroid stage yet), and I'd like to know what those tests showed and how your pup is doing?

[Shannon]

Hi Bizzibee-

What’s going on with your dog?  

Edit: sorry, I just saw in another thread that your dog had no “GI symptoms” but had weight loss, low folate, and low cobalamin, and that you had started a hydrolyzed diet last month, which caused worsening of stool.    

Have you done any further testing or have you tried anything else? 

 

Edited June 25, 2019 by Shannon
Typo and Read an older post and saw some information I didn’t recall.

[Bizeebee]

31 minutes ago, Shannon said:

Hi Bizzibee-

What’s going on with your dog?  

Edit: sorry, I just saw in another thread that your dog had no “GI symptoms” but had weight loss, low folate, and low cobalamin, and that you had started a hydrolyzed diet last month, which caused worsening of stool.    

Have you done any further testing or have you tried anything else? 

 

Well, at the time of that post the internist thought the malabsorption issue was a protein sensitivity, so we went on the hydrolyzed food and folate/cobalamin supplement, did that for 3 months and then took him off the supplement and tested again. He failed the challenge (his folate and cobalamin levels were still low), and his stool had gotten worse as the three months went on. With that we've sort of ruled out this being a food sensitivity, at least to any animal protein.

About a month ago (same time as the folate/cobalamin challenge), we did another abdominal ultrasound and it showed the expected inflammation in the small intestine. This was not as visible the first time (March) so clearly it's getting worse, not better.

The suspicion now is that he has a bacterial overgrowth causing the ibs/ibd type symptoms, so now he's been on Tylan powder, the folate/cobalamin supplement and the hydrolyzed food (plus twice daily gabapentin) for almost a month. 

We're pretty frustrated that we aren't seeing any changes/improvements in his stool or constant hunger (especially while on this special/expensive/annoyingly low-calorie food) So, I've just been trying to dive into the forum here to look for IBS/IBD stuff, but there's a lot. Our vet has mentioned a scope and biopsy, but I'm honestly not thrilled at that prospect if there's other tests that could be done before something where we have to put him under and stab him  

[tbhounds]

3 hours ago, Bizeebee said:

Well, at the time of that post the internist thought the malabsorption issue was a protein sensitivity, so we went on the hydrolyzed food and folate/cobalamin supplement, did that for 3 months and then took him off the supplement and tested again. He failed the challenge (his folate and cobalamin levels were still low), and his stool had gotten worse as the three months went on. With that we've sort of ruled out this being a food sensitivity, at least to any animal protein.

About a month ago (same time as the folate/cobalamin challenge), we did another abdominal ultrasound and it showed the expected inflammation in the small intestine. This was not as visible the first time (March) so clearly it's getting worse, not better.

The suspicion now is that he has a bacterial overgrowth causing the ibs/ibd type symptoms, so now he's been on Tylan powder, the folate/cobalamin supplement and the hydrolyzed food (plus twice daily gabapentin) for almost a month. 

We're pretty frustrated that we aren't seeing any changes/improvements in his stool or constant hunger (especially while on this special/expensive/annoyingly low-calorie food) So, I've just been trying to dive into the forum here to look for IBS/IBD stuff, but there's a lot. Our vet has mentioned a scope and biopsy, but I'm honestly not thrilled at that prospect if there's other tests that could be done before something where we have to put him under and stab him  

Have you tried budesonide?

[Blaidd49]

Did your vet suggest Baytril and amoxicillin. It took 10 days of Baytril along with about 6 weeks of amoxicillin and Tylan to get my old girl's bacterial overgrowth under control.  We also used RxClay to help with the loose stool sand  malabsorption

[Bizeebee]

12 hours ago, tbhounds said:

Have you tried budesonide?

Not yet, I'm guessing that steroids will be next, but I'm hesitant to start them if we are dealing with a bacterial overgrowth.

 

12 hours ago, Blaidd49 said:

Did your vet suggest Baytril and amoxicillin. It took 10 days of Baytril along with about 6 weeks of amoxicillin and Tylan to get my old girl's bacterial overgrowth under control.  We also used RxClay to help with the loose stool sand  malabsorption

No, we've done a few short courses of metronidazole in the past, but for the time being we're just on the Tylan. We haven't really discussed doing a stool culture yet, that seems like the logical step to definitively diagnose a bacterial overgrowth and determine the best way to treat.

[Blaidd49]

On 6/26/2019 at 9:29 AM, Bizeebee said:

Not yet, I'm guessing that steroids will be next, but I'm hesitant to start them if we are dealing with a bacterial overgrowth.

 

No, we've done a few short courses of metronidazole in the past, but for the time being we're just on the Tylan. We haven't really discussed doing a stool culture yet, that seems like the logical step to definitively diagnose a bacterial overgrowth and determine the best way to treat.

The original vet I saw felt a culture or antibiotics were not required and just had her on metronidazole, once my vet came back he did a culture and started her on amoxicillin pending results and then added in Baytril once he had the results

[Bizeebee]

13 hours ago, Blaidd49 said:

The original vet I saw felt a culture or antibiotics were not required and just had her on metronidazole, once my vet came back he did a culture and started her on amoxicillin pending results and then added in Baytril once he had the results

We've just started a longer course of met, so we'll see how that goes.

Do you remember whether your vet sent the culture out, or did it in house? If it went outside, do you know where they sent it?

When we brought up the culture to our internist he was interested in the idea (because he'd never had one done before) but skeptical it would actually help us - which is why he hadn't pushed for it all along. His perspective is that there are too many bugs and we don't know enough about them for the culture to help target treatment. Which makes sense on it's own, but is not at all in line with what it seems like a lot of people here on GT have experienced.

I just wonder, because this dog has not been on any ABs (other than the met and one course of cefpodoxime for a sheath infection) the whole time we've had him (almost a year). I'm definitely in favor of any medical professional who doesn't just throw a bunch of antibiotics at every problem - our regular vet and this internist are both hesitant to use them without solid proof - but I just wonder if we need to at this point, just to see if it would do anything.

[greysmom]

Re: steroids

Most vets will just use Prednisone because it's the standard, but there is evidence to suggest that budesonide is better for intestinal issues because it concentrates mainly in the intestinal tract and not in other areas of the body.  It also means side effects are a little less.

But budesonide is an "old" drug and not much used anymore except for horses, so you need to push a bit to use it.  I think I have a link somewhere on my laptop I'll try and find for you.

I've never heard of a vet not wanting to investigate a bacterial overgrowth!   IMO, it doesnt matter if it's a good bug or a bad bug, too many of any bug is not a good scenario.  The culture would be to figure out which AB would work for the particular bug that's overgrown. 

And I'll just mention again, that without an actual food trial you can't really say if your dog has an allergy/intolerance or not.   My IBS/intolerant dog can't eat any hydrolyzed, prescription food  made with chicken (or the one made out of chicken feathers) without having a violent bad reaction.  She picked up part of a pill pocket I dropped on the floor a while ago - literally as small as a pea - and was sick for two weeks.  And you have to really scrutinize everything that they eat, including treats and chews, because they may have the allergen disguised as "natural" flavoring or "mixed sources."

[Bizeebee]

On 6/28/2019 at 7:09 PM, greysmom said:

But budesonide is an "old" drug and not much used anymore except for horses, so you need to push a bit to use it.  I think I have a link somewhere on my laptop I'll try and find for you.

If you have the link or remember where it might have been published, let me know, I'll definitely have to look into it. I'm guessing this will be part of our journey soon...

On 6/28/2019 at 7:09 PM, greysmom said:

I've never heard of a vet not wanting to investigate a bacterial overgrowth!   IMO, it doesnt matter if it's a good bug or a bad bug, too many of any bug is not a good scenario.  The culture would be to figure out which AB would work for the particular bug that's overgrown.

His reaction to me asking really threw me for a loop too, but maybe I used the wrong name/words when asking and he misunderstood? Do you know if it's something the average vet does in their in-house lab? Or is it sent out to a particular place, like Texas AM? OR maybe the fact that the malabsorption/inflammation doesn't seem to be responding to tylan or met is a sign that it isn't bacterial overgrowth after all... I'm just wondering if we need to insist that we blast him with some strong ABs before we move onto a biopsy or steroids.

On 6/28/2019 at 7:09 PM, greysmom said:

And I'll just mention again, that without an actual food trial you can't really say if your dog has an allergy/intolerance or not.   My IBS/intolerant dog can't eat any hydrolyzed, prescription food  made with chicken (or the one made out of chicken feathers) without having a violent bad reaction. 

Do you mean a food trial with hydrolyzed protein that just isn't chicken? Or something homemade?

He's been on a hydrolyzed food that's mostly soy, but does have some hydrolyzed chicken (for flavor) and only eating treats without any meat proteins. But, honestly, the only reason we found out about any of this GI stuff was a blood test for malabsorption; he didn't have horrible stools (or even gas) while on regular old chicken/turkey food and his stool was not the reason for any of the testing we did at the start. I highly doubt this is a food sensitivity, especially with how closely I've been reading ingredients and charting his progress as this has gone on.

At this point, I believe that at least a part of the problem is that we have to feed him 6 cups a day in order for him to get enough calories (I hate how low calorie this vet food is) to gain and keep on the weight that he'd lost (that was the concerning symptom that started all this). I've read over and over that too much food will cause soft stool, and while at this moment we're definitely beyond "soft" I do think we're bound to hit a wall in how good it's going to get while we're still on this food. But, the vet is hesitant to have us take him off this food until the inflammation settles down, which it doesn't seem to do no matter what we try. [We don't buy this food from the vet, so I don't suspect it's a profit thing]

My instincts are saying that we are dealing with way too many variables and that we should just cut out all medications, go back on normal food, and just start again. 

 

[greysmom]

A bacterial overgrowth can be seen on a slide done in the office - at least that's how I've always had it diagnosed.   Then you have to send the fecal sample to a lab so they can culture and determine what it is and what AB will work best on it.

A true food trial will involve no commercial food at all.  Under the advice of our vet (food trials can also be done by an allergy specialist or internal medicine specialist), we fasted our girl for about 36 hours, until all stool production had stopped.  Then we chose a carb source and a protein source and home cooked everything for every meal (no treats except for small bits of the protein we were feeding), for two weeks.  Then we moved on to a different combination, changing only the carb or protein (not both at the same time). That way we discovered she was NOT allergic/intolerant of any carb source - corn, wheat, oats, rice and various carby vegetables like sweet potatoes and regular potatoes were the ones we tried - and only intolerant of chicken.

We determined this by the severity and increase or decrease in her symptoms - tummy squeaks, nausea, vomiting, diarrhea, cramping and pain.  It was very obvious when something wasn't working well for her.  Within a meal or two of switching to chicken she was vomiting after every meal, and the gas and diarrhea were very bad.

We actually never did a biopsy of our girl's intestine.  The thickening of the intestinal wall was *very* clear under ultrasound and our vet didn't see the need to biopsy when she was so depleted physically.   So, I guess, we don't really know for sure she had IBS/IBD.  It could be just an allergy/intolerance.

She wasn't on any meds at the time of the trial so we could see how she reacted.  At the same time, she was doing a course of acupuncture to help reduce her inflammation and nausea. 

It only took about two months to get her back in shape once we figured out what she could eat, but by that time she had pretty much developed PTSD about food.  She stopped eating kibble at all, and now only eats canned food with added oat bran for fiber and nutrients. I have to spoon feed her all her meals as she won't eat on her own.  She's the only dog I know who will spit out food already in her mouth.

But as long as we keep her on a strict meal schedule of her approved food, and keep her treats entirely chicken free (not that easy!), she does really well - no tummy squeaks, no diarrhea or gas,  no vomiting or nausea, and she holds her weight easily.  We recheck her ultrasound every year and her intestinal wall, while still thicker than normal, is more normal than when she was really ill.

Boy, this is long.  I haven't written it out in a while.  But it does sound like you may need to have a second opinion and maybe start from scratch.  A lot of internists will do a "records review" and give you that opinion without an exam.  If you haven't yet, I would see about an ultrasound and any other imaging tests that you haven't had done in a while.  We were looking for anything specific when we did our girl's first US, just seeing if there was anything major that was easily seen.  The thickening of the intestinal wall was not something we were expecting, but it did point us in a direction to investigate. 

[greysmom]

Randomized, Controlled Trial of Budesonide and Prednisone for the Treatment of Idiopathic Inflammatory Bowel Disease in Dogs

 

Here's the original study, though I think I might have remembered the results incorrectly.  I haven't had time this am to read it properly.