Jump to content

Severe IBD - steroid, chlorambucil


Recommended Posts

One of our greyhounds, Finn (8 years old), has been struggling with continuous diarrhea for years - since late 2015 (of course, numerous fecal testing, tick testings, and any other possibilities as much as we could think of, we were told, whatever takes - we have done.  Went grey-savvy vets),  lost more than 10lbs. finally, we have decided to get consultation with Dr. Couto about his situation (March) and we decided to do endoscopy (colonoscopy)  - it was done late April this year. Biopsy came back as "Moderate to severe lymphoplasmacytic entierritis (duodenum, ileum, stomach) with mild secondary lymphangiectasia."

We immediately started with steroid - first we tried Pred and it didn't work Finn well so we switched Budesonide. And we switched hydrolyzed prescription kibbles - no more meat proteins taken. Beside then, he started taking weekly vitamin B12 injection (GI panel revealed his B12 level was extremely low) and tylosin powder with opmeprazole (for ulcer we found through endoscopy). However, we couldn't get the result what we wanted so vet finally prescribed us chlorambucil... started taking it every other day for few weeks; however, again, Finn hasn't respond what we wanted to him so increased dose it to taking every day.  It's bee about a week; however, he still hasn't shown improvement.

We are so hopeless right now.  We were told if nothing these drugs wouldn't work, that would be the end of option in terms of taking prescription drugs.  Regarding hydrolyzed prescription food - we have been trying Purina HA but after trying this for about 4 months, we wonder if that food would not be the best match.  We now ordered both Blue Buffalo HA & Royal Canin's HA as we want to try both to see how Finn would respond.

What I'd like to ask you here - if you have any experiences with your greys with IBD; especially, for those who took similar journey as we are taking right now.  I am not sure how many people actually deal with steroid + chlorambucil.... Finn started having diarrhea episodes back in October 2015.  It has been so long - again we tried as much as we could time to time, back then things we tried were what we believed the best for him but eventually everything was failing.  Then we finally decided endoscopy but still we can't figure out why Finn cannot recover despite of all of medications. 

 

Link to comment
Share on other sites

First, just wanted to say I'm sorry you're dealing with all of this. We're dealing with this currently as well, though we aren't as far down the path. We're operating under the assumption that our dog has some kind of IBD but have not yet done a scope/biopsy. Fortunately, our hound (Bismarck) seems to be slowly improving and was never quite as bad to begin with. So, I don't have any nice and neat answers, but hopefully can at least share some of what we've found to help.

Firstly, as far as the hydrolyzed protein - we've had our guy on Purina HA since March/April and I do think we hit a plateau of how much stool quality improvement we were going to see on that food. I personally think that the same way these hounds just inexplicably do better on certain foods also applies to these hydrolyzed foods. Hopefully one of the other options will work for your guy. Though, FWIW I'd read up a bit on DCM before I went with Blue Buffalo, although I can definitely appreciate that this gut problem & solutions has to take precedence over something that is only a potential problem.

We've found that fiber content is really important for our guy, but that psyllium powder just made his poop weird, not better. Bismarck needs vegetables and/or Olewo carrots to get his stool looking better and we can hopefully eventually transition to a regular kibble that just has more fiber built in. The HA definitely does not have enough fiber for him. I would recommend using Olewo carrots if you haven't already, they really help our guy a lot.

We also did not have any luck with Tylosin, but Metronidazole (at max dosage) does seem to help a lot. I have no idea if that's indicated with what you know your dog has, but might not hurt to ask if your vet had already recommended tylosin.

Disclaimer here, we have not tried this, but we decided that we would investigate more 'holistic' methods before we went down the road of putting Biz under and doing a biopsy/steroids (mostly because his outward health is much better than test results show). The first thing we will try next, if our current path doesn't pan out, is acupuncture. I've read enough to be comfortable trying that for IBD in dogs, and if your dog will tolerate it, it may be good to check into. Our vet has also mentioned that some supplements she would recommend (but has not yet) before we went down the biopsy road. If your vet(s) aren't as well versed with some of the alternative stuff it might be good to check around for one that might be.

I'd also gotten decent advice here, that we have not yet had to take, about doing a true food trial. You've been dealing with this a long time, so maybe you've already been through it, but to really figure out if there is a food trigger you have to take them down to 1 protein and 1 carb (both homemade) and observe. Then change up one or the other, observe. Repeat until you find something that works and record everything that doesn't. And maybe with the diagnosis you have, food really isn't part of it, but if your vet has you on HA it sounds like they suspect there could be some food involvement.

I'm not a vet, but just in reading this, I wonder why they'd have you try chlorambucil but not azatheoprine?

Good luck with all of this, and hugs for your hounds :)

Link to comment
Share on other sites

Dear Bizeebee, thank you so much for your advice.  Metronidazole is useless for Finn's case, unfortunately.  We just contacted the vet specialist whom Dr. Couto personally knew (and endoscopy was done by him) again... to see what kind of option we might have in terms of prescribed medication.  Let me say this - In fact I haven't been really comfortable adding up more and more of chemicals on Finn.  I think about holistic, but the course would be totally different so I am honestly afraid of the whole change if I really could follow the steps.  Olewo carrots - I once thought if we wanted to use and eventually never opened the bag.  I guess I should try it...  

Regarding chlorambucil - until you told me about another drug might be available rather than chlorambucil.  I will ask this to the vet specialist... we anyway want to meet him again to discuss potential further option(s).

Also, acupuncture - I think that might be what I want to try.  Just so painful to see our sweet boy is losing his weight; especially, by knowing how healthy he was before this whole thing happened.

Link to comment
Share on other sites

1 hour ago, 3AmazingGreys said:

Dear Bizeebee, thank you so much for your advice.  Metronidazole is useless for Finn's case, unfortunately.  We just contacted the vet specialist whom Dr. Couto personally knew (and endoscopy was done by him) again... to see what kind of option we might have in terms of prescribed medication.  Let me say this - In fact I haven't been really comfortable adding up more and more of chemicals on Finn.  I think about holistic, but the course would be totally different so I am honestly afraid of the whole change if I really could follow the steps.  Olewo carrots - I once thought if we wanted to use and eventually never opened the bag.  I guess I should try it...  

Regarding chlorambucil - until you told me about another drug might be available rather than chlorambucil.  I will ask this to the vet specialist... we anyway want to meet him again to discuss potential further option(s).

Also, acupuncture - I think that might be what I want to try.  Just so painful to see our sweet boy is losing his weight; especially, by knowing how healthy he was before this whole thing happened.

Ya, we're not at the point you are as far as medications, but even now I'm just counting the days until we can start to taper things down - forgetting that we may not ever be able to. But if you can find things that work and really improve quality of life then it'll probably be easier to stomach giving him that many meds.

My thought is that even if you do take some more holistic routes, supplements or acupuncture, etc, you don't have to stop the regular meds in order to do that. Just because a holistic vet believes it should be all or nothing doesn't mean that's what is right or what will work. For us, at least, it feels like a little bit of this and that is what is helping, I just wish there were less this-es and thats.

I would definitely try to find out what other meds might work, in lieu of the chlorambucil. Again, I'm not a vet, but it looks like that's a chemo drug and there is definitely more than one chemo drug on the market. We've definitely found that the first dose our vet thinks will work isnt' always enough and sometimes stuff just did't work at all, so there's soooo much trial and error with this process, ugh, it's exhausting. But it's also good that there are so many choices, because it means there's still something that might work :)

Link to comment
Share on other sites

My Lucy has IBD that was caused by her seizure meds (Kbr) and has had this for a few years.  Because of all the meds she takes for seizures, the internist and I agreed to try to manage this without additional meds.  So far, we have been doing OK.  She started with weekly B12 shots and this has since gone to monthly. She is on a probiotic (link follows) daily. Lastly, she is on a home-made diet of white fish, white rice, and veggies. In the morning, she gets white fish and oatmeal. The oatmeal provides fiber.

Her poops are OK and she does well as long as I do not "fool around" with her diet.  She get NO commercial dog food at all - even her treats are made by me. She gets two snacks a day - one is yogurt w/applesauce and a pumpkin cake that I make for the dogs and in the morning, whole wheat toast and peanut butter.

 

https://smile.amazon.com/gp/product/B001O3UE9E/ref=ppx_yo_dt_b_asin_title_o08_s01?ie=UTF8&psc=1

Link to comment
Share on other sites

As stated above, one of the very first things that should have been tried was a medically supervised food trial, as a lot of IBD in dogs is the result of an allergy or intolerance to a particular ingredient.  If you speak with the specialist again this should be your first question.  This is how we discovered our dog had a severe chicken intolerance at the root of all her symptoms, exacerbated by a bad infestation of hookworm as a puppy that devastated her intestinal tract. 

Our diet-related ibd dog can not have *any* chicken, at all.  Not even hydrolyzed chicken protein.  Not even that one food made from feathers.  Absolutely none.  Which is extremely difficult to find in a commercial food, especially kibble.  It becomes even more complicated if you add in the restrictions from the on-going diet related DCM issues, as most limited ingredient foods substitute legumes and sweet potatoes,  which are the main culprits in this diagnosis, to date anyway.  But since we eliminated it from her diet completely her symptoms gradually improved.  Gradually as in a couple years, not months or weeks or days.  It's a very long haul.

During that time we did do acupuncture and holistic Chinese medicine with her.  We had a practitioner who was licensed as both a regular veterinarian and an acupuncture provider.  IBD and intestinal issues is one of the only diagnosis that the FDA says acupuncture is approved for treatment.  We tried it on the off chance it would help - I was skeptical! - before going down the steroid route.

Within three weeks of beginning her needle treatments, her vomiting and nausea went away, along with her car sickness.  We did 6 weeks of weekly needle sessions, then another 3 months (I think) of every other week sessions, and tapered down from there over the rest if the first year.  After those first four months she was dramatically better and continued to improve.  At 4-5 months into treatment, our practitioner added in holistic Chinese herbal medicine to help calm her gut and ease her anxiety.  These continued for another 6-8 months and then we began to taper those too.

I did a home cooked diet during the first 6 months of treatment consisting of Turkey, whole oatmeal for carbs and fiber, various veggies and greens, and adzuki beans.  I just popped everything in the crock pot and made a weeks worth of food every Sunday.  After six months I had found several commercial LIDs (limited ingredient diets), and finally found one she liked well enough.  I've had to switch her a couple times due to manufacturing changes, but I can tell right away if there's an issue from the quality of her stool.

It's not normal poop, by any means - funny color, weird consistency - but it's normal for her!  And it's not diarrhea!  It's formed and pick-up-able.  As long as I dont mess with anything in her diet and keep her on a strict eating schedule.

My husband also has IBD, so we are pretty used to dealing with it in our house.  I too am wondering about the chlorambucil, as there are simpler (and probably cheaper) options out there.  Azathioprine and sulfasalazine are immunosuppressants that are usually tried first.  It's  important to remember that IBD, even if it's diet related, is an immune system disease that can be extremely difficult to find answers for, and each individual is going to react to treatment as their bodies dictate.

Sorry this is so long!  Good luck!

Chris - Mom to: Lilly, Felicity (DeLand), and Andi (Braska Pandora)

35764734494_93de5b5963_b.jpg

Angels: Libby (Everlast), Dorie (Dog Gone Holly), Dude (TNJ VooDoo), Copper (Kid's Copper), Cash (GSI Payncash), Toni (LPH Cry Baby), Whiskey (KT's Phys Ed), Atom

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...