Advice

[dom]

Piper is a 10/11 year old cocker spaniel who was diagnosed with IBD last year and IMPA a few months ago. She doesn't have any typical IBD symptoms, instead her abdomen bloats and hardens, stomach distends and she has episodes of gagging and retching. She was referred to Willows and was diagnosed with the IBD (severe in the stomach and moderate in the small intestine). This has been controlled with food and zantac (liquid 3 times a day) and no meds until the beginning of the year when Metronidazole was introduced.

A few months ago she became lame on 3 legs over night and had joint taps 2 days later which confirmed the IMPA. She was put on a low dose of pred to try and keep her water intake low (when she drinks water, this affects her IBD as it hits the stomach and starts the gagging). After an initial improvement, she went back down hill and the dose of the pred was increased. This lead to her bowels stopping completely, the start of heart failure and liquid on her lungs and around the heart. After scans and tests at the specialists again, they believe that the preds have had an adverse affect on her body and IBD. She was put on a quick reducing dose of the preds to get down to a low as dose as possible.

Medication wise, she is now on a reducing dose of Aza (was on 3/4 of a tab daily, now on 3/4 of a tab every other day) a four day pred dose cycle (5mg, 0mg, 2.5mg, 0mg and so on), cytotec, folate acid, Metronidazole and zantac. Pain relief, she can only tolerate paracetamol twice a day.

So to my question! She is only able to eat 1 spoonful of food five times a day to avoid flaring up her IBD, and she is dropping weight. Before being diagnosed she was 10.2kg and she is now 7.4kg. She was sick on Sunday and since then she has been gagging, drinking a lot and smacking her lips constantly. She has been sick again today but it was just water that she brought up. She was at the vets yesterday to check her folate levels (results back tomorrow) and he also ran a general blood level check due to her sickness. But he said that the zantac and cytotec should be stopping any nausea. Does anyone have any thoughts on it? I have left a message with the specialists for a call back but on our last visit they said that we have no further treatment options for Piper so there isn't much point going back!

[Penel CIMDA moderator]

Hi Dom,
I'll see if Jo is around to pop in and advise you.  Piper is such a very complicated girl.

[Catherine]

Could the Cytotec and/or Metronidazole now be causing the sickness etc.?

[Jo CIMDA]

Hi Dom

The big problem when a dog has several problems is knowing what is exactly causing the sickness and other clinical signs.  One automatically assumes that it is one of the conditions she is having medication for,  or in fact the medication itself, but with a dog like Piper she may have pancreatitis or  even kidney issues secondary to her known problems  that may be causing sickness.  One has to look at a broader picture sometimes.  The blood results may show something that your vet can treat.

Zantac and Cytotec are gastroprotectants and I don't think they necessarily stop vomiting they just heal the effects of an ulcer.  I wonder if omeprazole could be used in stead of cytotex as it is really the best gastroprotectant and is used to actually heal ulcers.  Perhaps your vet could give anti-sickness tables such as Cerenia or even metoclopramide but this has to be a veterinary decision based on her current blood results.  Has your vet suggested a specific prepared diet that is perhaps concentrated or even predigested?

It is a very difficult situation.  I can't remember if she has seen a gastroenterologist. If she hasn't, is there any chance of getting a referral?

Jo

[dom]

Thanks Penel 

Catherine - my local vet did query as to whether the cytotec might be doing more bad than good about 2 weeks ago when Piper suddenly bloated again and was rushed in. But we made the decision to lower her steroid dose again and my specialist prefers to only make one change at a time so the cytotec remained and Piper improved with the steroid reduction. It seems to be a bit of a balancing act with medication 

Thanks Jo  my local vet has rung today and Pipers blood is looking good. Her folate levels are back up so she can stop those from tomorrow. He has suggested a third gastroprotectant (I can't remember the name but I am collecting them tomorrow so will confirm) but also to consider starting her on dulcolax as her bowels are barely functioning so maybe what food she is having, is staying in her bowels for too long and making her feel sick (clutching straws here!) 

Piper is under a specialist (Jane Eastwood at Willows who is the head of internal medicine, she seems to know what she is talking about but has said that they haven't seen a dog react to steroids as badly as Piper before). She is on a homecooked food as directed by Willows (white fish, rice and sweet potato) and has been since Feb this year (she tried a few of the special tinned foods but none of them agreed with her). When Piper was last at Willows (a month or so ago) her pancreatic levels were higher than last year (she was tested for pancreatitis last year before the diagnosis of IBD was confirmed) but the levels weren't worrisome.

She is walking slightly oddly for the last two days but no sign of being lame so it might just be tiredness as she isn't sleeping at night very well. She is regurgitating food today and drinking a lot and doesn't seem as settled as she was yesterday. 

[Jo CIMDA]

That all seems very positive Dom.  Good luck with the new meds.

jo

[Clover]

Just a long shot here, but did they rule out megaesophagus?

[dom]

Just a long shot here, but did they rule out megaesophagus?

Its never been mentioned but she wasn't doing the gagging/choking/etc until about 12 months before the IBD diagnosis 

[dom]

Piper started on Famotidine on Friday and I thought by Sunday that there was a slight improvement but this evening she is back to regurgitating and smacking her lips. She seems absolutely fine in herself and her usual IBD symptoms aren't there, so maybe I should just keep an eye on it and stay hopeful that its just an oddment for the moment 

[Penel CIMDA moderator]

I do think sometimes it can take a few days to get used to a new medicine.  Poor Piper she has been poorly for such a long time now. 

[dom]

I do think sometimes it can take a few days to get used to a new medicine.  Poor Piper she has been poorly for such a long time now. 

She was sick in the night and slept in until 6am (unheard of since she has been ill!) but seems to be okay again today. Hopefully I will see a difference in a few days.

It has been a long time  and I think that if everything was as bad I wouldn't continue but to compare photos from 2 months ago on the way to the vets again when she had lost the ability to weight bare her head but was unable to lay down due to the pain in her elbows 



to today's naughty post dinner face 

[gsdsian]

Poor Piper.  But what a difference in those photos.

We had a vet from Portugal seeing practice with Lowri a few weeks ago and she suggested Cerenia in combination with Famotidine if Mabon's nausea became unmanageable again.  She said that they are using the 2 meds together a lot with better results than either using them on their own and better using them than Metaclopromide.

Fingers crossed the Famotidine sorts things out for her.

[Penel CIMDA moderator]

That's good to know Sian thanks for sharing.
Dom you're right, Piper is looking loads better now you compare those two pics.  She's certainly not one to give up is she.

[dom]

Piper is lame on her front left leg and is unable to weight bear on her back left leg. Her front wrists look swollen. I am just waiting for a call back from her specialist, I am hoping that we can increase the dose of aza back up and it works straight away

[dom]

Bit of an update. The specialist asked me to take Piper to my local vets today for a general check up. This morning she was lame on the front left and stiff on the back left (so switched from last night). No temperature and heart/lungs sound fine. Her whole left side, from front leg, neck, along the spine and down the back leg seems to be weak but there is no swelling or pain. On examination her front right elbow was very painful and she has been unable to weight bear on it since this morning, but the vet does feel that she has an underlying issue in that leg. She was completely flat on getting home but has managed a 2.5 leg bounce around when wanting food! She has also lost weight, she was 7.45kg last week and is 7.3kg this week.

The vet isn't entirely sure that it is a IMPA flare up but has agreed that her aza can go back up to the top dose for her weight. I am not sure to be honest. She doesn't seem to be in pain (apart from the right leg now) but can barely walk