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Cooper again

Started by Shannon, August 30, 2012, 04:23:06 PM

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Shannon

Sorry I am posting so much and being a pain.

He's just done quite an orange poop. Would I be right in assuming this could be gastric ulceration? Other than that, could it be discolouration from the metronidazole? Should I increase his H2 blocker?

Penel CIMDA moderator

You're not being a pain at all, but I don't know the answer to your question.
I'm guessing orange poo means more bile in the system - hopefully Jo will be along soon. x
Penel
(SLE, Surrey - UK)
Forum Owner
CIMDA

Shannon

Thanks Penel,

Maybe I'm just being a worry wart. I know orange poop can be because of haemolysis as well as liver problems etc. The vet gave him some "diarrhoea suspension" on friday and he's been a bit bunged up since then so I also wonder if that may have something to do with it.

I've also been wondering if his lethargy is possibly related to the high dose of pred? He will get up for food and cheer up a bit then but mostly he just has this air of sadness about him...

Penel CIMDA moderator

I think with liver problems poo is generally grey ish or yellow ish, not orangey?

Maybe he just feels a bit off, I'm sure the high doses of pred must make them feel a tad strange.
Penel
(SLE, Surrey - UK)
Forum Owner
CIMDA

gschellinger

I know it's hard to look back and see the incompetence of the vets. I think they do the best they can. But some seem to be clearly more informed than others. Lola is not better. She is worse. Thank you for asking about her.
gail.
gail and Lola (SLE, hereditary cerebellar ataxia, chronic undiagnosed nasal congestion) usa

Shannon

I think I'm going to have to take Coop back to the vet tomorrow. I'm not sure what they can do for him but I just want him checked out properly in case there is something else at play here.  He is terribly depressed and every now and then he seems to be sore when rising again. I'm not sure if this is normal when trying to get a relapse to go back into remission but I am really worried. He is also constipated now and I'd imagine that's not making him feel too good either. I'm so worried he isn't going to come out of this one.

gschellinger

I would be doing the same thing. I hope it isn't anything serious.
Best wishes.
gail.
gail and Lola (SLE, hereditary cerebellar ataxia, chronic undiagnosed nasal congestion) usa

Penel CIMDA moderator

Let us know how you get on.  I think being constipated will make him really uncomfortable too, so hopefully if you can get that sorted out he will feel better.
Penel
(SLE, Surrey - UK)
Forum Owner
CIMDA

Shannon

Just back from the vet. He had an ultrasound and his liver is very enlarged with very well defined portal tracts. They're now going with a liver problem because of the yellow poop, depression and now the hepatomegaly. I asked if the pred couldn't have caused it and he was inclined to think not as he had been on such a low dose and has basically been on the higher dose only for a few days.

He's on new antibiotics and a liver tonic for now and we will get the blood results later this afternoon.

I am so very worried about my boy.

Jo CIMDA

Hi Shannon

What dose of steroids has Cooper been put on?  Is it an immunosuppressive dose of preds?  When a dog relapses there is no option but to increse the steroids to 1mg/kg/12hrs,  anything less and the treatment won't work.  With IMPA the response is usually quick, but of course he may have an infection too.

The liver will be enlarged and this is to be expected, but the liver can take a lot of punishment.  Is Cooper on a good gastroprotectant such as Antepsin or omeprazol and ranitidine?  This is essential.  I'm please to read he is on a liver support. It might be prudent to introduce another drug such as Azathioprine at this stage because this might reduce some of the side effects of the preds and it means you might be able to start weaning down the preds after 10 days and still maintain a good level of immunosuppression.

Good luck

Jo

Shannon

Hi Jo,

He's on 1mg/kg twice daily so at this point that works out at 32 mg odd per day. The problem is that he's lost a kg in the last week since this all started. I will discuss azathioprine with his vet when I speak to him.

Would steroids be the cause of this dramatic hepatic enlargement so soon after the immunosuppressive dose was initiated? He started on Thursday evening?

He is on Ranitidine as a gastroprotectant, do you think thats adequate?

Is the yellow/orange poop normal when the liver is taking a hammering with steroids? Will the hepatomegaly reduce when the steroids reduce? He is still eating very well he is just very depressed and withdrawn.

I'm so sorry for all the questions, I'm just so very concerned about him. Thanks for all your advice it is very much appreciated.


shawkyelisabeth

Shannon, i am probably in the same situation with stella relapsing i am afraid, i hope treatment will be effective, good luck, i know what you are going through and how worried you must be, i think there is nothing we can donbut start all over agai. Thanks god we have the cimda people and especially jo who is always encouraging us not to give up. Elisabeth

Jo CIMDA

Quote from: Shannon on September 03, 2012, 11:34:00 AM
Hi Jo,

He's on 1mg/kg twice daily so at this point that works out at 32 mg odd per day. The problem is that he's lost a kg in the last week since this all started. I will discuss azathioprine with his vet when I speak to him.

Would steroids be the cause of this dramatic hepatic enlargement so soon after the immunosuppressive dose was initiated? He started on Thursday evening?

He is on Ranitidine as a gastroprotectant, do you think thats adequate?

Is the yellow/orange poop normal when the liver is taking a hammering with steroids? Will the hepatomegaly reduce when the steroids reduce? He is still eating very well he is just very depressed and withdrawn.

I'm so sorry for all the questions, I'm just so very concerned about him. Thanks for all your advice it is very much appreciated.

Hi Shannon

Cooper is on the correct dose.  Did he react to the steroids in this way the last time he was on an immunosuppressive dose? 

The liver will enlarge because of the steroids but I wouldn't have thought it would be causing him these problems so soon after starting treatment and his poop wouldn't be orange in colour just because he is on steroids. I wonder if his liver is enlarged because of another reason.  Is his breed prone to liver problems?  Has he had anything recently (other than the preds) that may have caused his liver to react in this way?  Has he had a blood test recently, if so what did it show up and did it show he was anaemic? Very often anaemic dogs will have orange faeces and this can be one of the first signs to look out for.

As the steroids are significantly reduced the hepatomegaly will reduce also.

Ranitidine is adequate but introducing something like Antepsin will line the stomach and give better protection.  Both  ranitidine and Antepsin can be given but Antepsin should not be given within 2 hours of other drugs otherwise it will inhibit their absorption.

Milk thistle is another very good liver support.

I do hope he picks up soon.

Jo

Shannon

Hi Jo

He's a cocker spaniel and I'm not sure of any hepatic diseases they might be prone to.

His last full blood panel was in March and everything was within normal limits then. He had blood drawn today so those results should be back in the late afternoon.

He's had an anal gland issue recently and was put onto metronidazole and synulox, not sure if that could have set something off. The other thing I'm toying with in my mind is toxin exposure - I bought a new bag of his normal dog food 10 days ago and he'd been going to the loo more frequently since then and the poop started changing colour. The vet doesn't think this is a likely option though.

His mucous membrane colour is really good at the moment (although he seemed a little pale on Saturday) so I don't think he's anaemic but I'm sure that won't reflect the early stages of anaemia.

He didn't react like this at all the first time round with the pred, which makes me wonder about something else cooking here. He also seems to have a mild fever that fluctuates and had a neutrophilia on his blood smear this morning. He is now on enrofloxacin to combat any infection as well as the liver tonic.

I will try and get him some milk thistle to help his liver along too.

I really don't know what to think or do at this point to help him. Thank you so much for all your care.

Shannon

Just got his biochem results back and liver and kidneys are okay. I'm so relieved about that. I'm now wondering if I the underlying problem is GIT related, in light of the strange poops he's passing.