Chronic vomiting

[GinnyWhippet]

Hi all - I am looking for help for my 11 month old whippet. She was diagnosed with SRMA 3 moths ago. She was on the road to recovery with prednisolone. She relapsed, the pred was increased and she developed stomach ulcers. A week in hospital and discharged with Atopica, pred. And Cerenia and omeprazole. She would not tolerate Atopica and struggled with Omeprazole.

She is currently taking, pred 5mg (vet says CRP is very good less than 10) and Famotidine. She did have a feeding tube which has been remove as she is eating well. The problem that we have is that she cannot keep any food down. She vomits approx 1-2 hours after each meal regardless of what she eats - we have tried everything.

We are no out of ideas and out of money - maxed out the insurance plus another 6k !

Her current presentation is normal - energetic, Interested and friendly - eating and drinking well (probably due to pred) but she just wont keep ant food down. We have also tried several probiotics. Cerenia also works sometimes but it feels like we are just masking the problem. She also has intermittent diarrhoea.

Booked into the vets today - any ideas what I should be asking for? Or what might help?? Many thanks in advance.

Alastair

[Catherine]

Regarding the Omeprazole, that did not agree with my dog so I changed to Zitac and she was able to keep her food down. Is she definitely vomiting or could it be regurgitating? I found feeding my dog with her bowl raised stopped the regurgitating. Also you could try feeding her smaller meals several times during the day although obviously away from any medication that must not be given around feeding times.

Hopefully Jo will be along soon to advise about the SRMA.

[Jo CIMDA]

Hi Alistair

Your poor girl has been through a lot.  The good news is the SRMA seems to be in remission, and in herself she is very well and happy. 

Years ago it was usual to prescribe Omeprazole or other gastroprotectants when on high doses of prednisolone because of the potential issues that you have described.  In recent years, giving a gastroprotectant when on high doses of preds, is no longer practiced and therefore gastric ulcers are not uncommon.  Omeprazole is given to heal the ulcers.

I am sure you have tried everything, so please forgive me if you have considered the following.

Give smaller meals and more often.
Do you know if the gastric ulcers are healed and no longer present?   
Is the vomiting that she is producing digested or undigested food?  Is it bile?
Have you recently changed her food?
Is she fed raw, wet or dried food?
Is she drinking enough, or could she be dehydrated?
Does she still need Omeprazole, or another proton pump inhibitor, to allow the ulcer to heal fully?
Does the diarrhoea indicate that there may be a bacteria present that needs an antibiotic such a metronidazole?  Metronidazole also has the ability to slow down the gut and allow more time for the water to be removed, thereby producing firmer stools.

My feeling is that her stomach, and probably her whole digestive system, has to be given more time to return to normal. It has been through a rough time.
 
When she is off preds, then perhaps a probiotic can be given, but this is not advised while there is some level of immunosuppression, although 5mg a day is not a high dose. Acidophilus is a very good gut bacteria. 

Is the vet intending to reduce the preds further?  If so then perhaps you could give 2.5mg a day (see the Prof. MJ Day Protocol) and then reduce to 2.5mg every other day and then leave it off altogether.  This will have a good effect on her stomach, but only if your vet is happy that she is in remission. It is always a balance between resolution of the disease, and the side effects of the drugs. Sometimes a different immunosuppressive drug has to be given to lessen the side effects of the steroids, and your vet did this with Atopica.  It is not a very well tolerated drug, so I am not surprised, but there are many other immunosuppressive drugs that are available now, should the need arise, but she now seems in a good place, so fingers crossed! .

Relapses are not uncommon, but it is hoped with SRMA that long term remission can be achieved, and there is no longer the need for steroids.  Anecdotally, SRMA is something that often occurs in a young dog and although in the first year or so relapses can occur, long term remission is expected to follow. A good immunosuppressive drug protocol is essential. 

Trigger factors are key to maintaining remission, and although it is impossible to protect from all potential triggers such as hormones and stress,  any potential known triggers should be avoided, these include regular spot on treatments, worming and vaccinations etc.  If a dog has worms or fleas then treatment has to be given, but only if necessary. I asked the head of the RVC, if a dog has an AI disease should they be vaccinated again, and he said NO! He said that the benefits and risks have to be considered, and in a dog with a genetic predisposition to AI disease the risks are too high.   So be mindful of these potential triggers.

I hope you had a positive experience at the vets today.

Best wishes
Jo