Probiotics and Immunosupression

[Smachak]

When the immune system is highly suppressed should probiotics be given?  Can the probiotics do more harm than good?

My dog is currently on leflunomide 60mg daily (almost 6 weeks) and has just tapered to 10mg pred per day.  He now has developed diarrhea which I think is from the leflunomide as stool sample was negative.  Vet had me try probiotics first and his diarrhea became much worse.  After two days I quit the probiotics and started on metronidazole low dose (250mg per day) and the diarrhea seemed to improve.  Now 3 days off the metronidazole diarrhea is back.

Don't really want to go back on the metronidazole as his liver enzymes are sky high as it is.

Is it worth a try at probiotics again...or is that too risky with the high immune suppression??

Thanks!

[Jo CIMDA]

Hi and welcome

As one of the major adverse effects of leflunomide is diarrhoea then there is a good chance that your boy's diarrhoea is a result of the medication, especially as the stool sample came back negative. 

Metronidazole is used as an antibiotic but it also slows down the motility of the gut allowing more water to be taken out by the intestines, and this is why it often works very quickly. So even without bad bacteria present,  it can still be used to resolve diarrhoea by returning the natural rhythm to the gut.  It is often used as and when needed, and not like an antibiotic that you have to finish a course of treatment.

Pre and probiotics can balance the gut, so that is a good thing to use, so no need to worry, but there are also other natural things you could try.  See below:

Pectin has the ability to solidify the stools and you can get a product with a combination of both Kaolin, pectin and a prebiotic: 
http://www.pro-kolin.com/  I don't know if they sell this in the US but I'm sure there will be an equivalent product available.

L-glutamine is another remedy that you might try, and also Milk thistle. Both of these are also good for the digestion, and liver inflammation, and lots of owners give Milk thistle to help with the side effects of the drugs.  Take a look at these links:

http://dogcare.dailypuppy.com/lglutamine-dogs-7588.html
http://www.peteducation.com/article.cfm?c=26+1303&aid=1431
http://www.petplace.com/article/drug-library/library/over-the-counter/kaolin-and-pectin-kapectolin-k-p

The following is from the book The Veterinarian's Guide to Natural Healing by Martin Zucker:

Milk thistle: 250- 500mg twice a day for dogs depending on the size and severity of the condition.

Glutamine: 500mg twice a day for all animals

Slippery elm is another natural remedy for diarrhoea and many people with AI dogs find it very useful:
1 teaspoon powder two or three times a day for each 25 pounds bodyweight.  Mix with warm water or chicken broth.  Give at time of feeding.

Bentonite clay: 
Small dogs: Half a teaspoon powder mixed with food. 
Medium dogs: 1 teaspoon;
large dogs 2 teaspoons:
Giant breeds: 1 tablespoon.

Pectin:
Small dogs; 1/8th teaspoon
Medium and large dogs; 1/4 teaspoon
Giant breeds; 1/2 teaspoon.

Do some research and then have a chat with your vet. You might find a combination of products do the trick.

Jo

[Smachak]

Thanks Jo,

I will look at these other options as for some reason the probiotics seemed to make everthing worse.

One of the reasons I ask this is because on the website for Proviable probiotics made by Nutramax, it says do not use with immune suppressed dogs.

And I will discuss with my vet as she is very open to try things other than the meds.

Thank you so much!

[BrookeR]

Hello,
I used protexin probiotic powder with my staffy Pepper from the moment i found out she had impa. She was originally immune suppressed using pred and then we changed to cyclosporine and eventually back to the pred. Throughout the whole time she was immune suppressed she was on the protexin (powder form) probiotics and she never had any problem with them. Pepper also has a very sensitive gut and has had a lot of problems with food allergies and intolerances. She gets loose stools from eating certain foods.

I have never used Proviable probiotics made by Nutramax but I wouldn't have thought that probiotics would cause the problem. Can you contact the manufacturer and ask why they say not to use in immune suppressed dogs and mention the diarrhoea and see what they say?
Or try a different probiotic?

Whenever I would taper/or increase dosages of medication with Pepper, whether it was cyclosporine or pred it would take her a while the adjust maybe 2-3 weeks to the new dose. Sometims she would get sick and be unsettled. Pepper is a very sensitive individual though.
How long has it been since you tapered?

[Smachak]

The first bout with diarrhea he had was July 6th, 8 days after dropping to 15mg pred.  On and off diarrhea for about a week until he took the metronidazole.  He was on that for a week, which cleared the diarrhea and now 3 days later diarrhea is back.  Also dropped pred to 12.5mg per day on July 12th and just dropped to 10mg per day on July 18th.  He is on aggressive pred taper because he has been on higher dose for a year and his body and organs are in bad shape.  He has been on 60mg leflunomide for almost 6 weeks so they are counting on that to keep him from relapsing. So far it has been working.  He has never had diarrhea with pred reduction before, so I am guessing it is the leflunomide. But who knows!

I am in the US so probiotics are different and I can't get most of what you have.  The probiotics here also have many strains of live bacteria...some up to 14.  I think this is too many for my dog.  I am going to try some of Jo's options with milkthistle (even though he is on Denamarin) and also the slippery elm.

Thanks for the help!  I will also look up the probiotic you use and see if it is available here.

Hope Pepper keeps on doing good!

[BrookeR]

My thoughts would be that it's the leflunomide causing it.
I'm in australia, so I'm not sure if protexin would be available for you to get in the US?
I did a lot of reading when pepper got sick, especially into natural remedies. Pepper is allergic to dandelions and I felt milk thistle was too similar too risk trying that with her. But otherwise I would have tried it. I have read a lot of mention of slippery elm and it's benefits. So I would look into trying that if your dog doesn't have any troubles with being to allergic to those sort things.
Good luck!

[Jo CIMDA]

Hi Brooke

Good to hear from you, and thank you for your very helpful  postings.

How are things going?

Jo

[BrookeR]

Hi Jo,
Pep had been continuing on at her 5mg once daily pred dose. It's now winter here so I decided it was the best time to try to see if we could get her on a lower dose. So I dropped her back to 5mg every second day. We made it to 3 weeks and then she began to limp and have trouble getting up in her back end. Her spirits dropped and I recognised the familiar pattern and so we quickly went back to every day 5mg dosing.
I really didn't want to have to go back to an even higher dose. She has now been a week back on 5mg per day and is back to normal. So I am accepting now that this is the dose that we are going to have to maintain indefinitely. She turned 10 in June and so I'd prefer her to be as comfortable as she can be for the rest of her life. Which hopefully will still be a long time. I'm hoping to find the fountain of youth for her

[Jo CIMDA]

Hi Brooke

That's great news, and it is often much better to accept that a low, daily dose of pred achieves a good life and homoeostasis.  I am so pleased that you have finally achieved this balance.

Many thanks for the update.

Jo

[Smachak]

Brooke,

The protexin in not available in the US.  But I think you are correct that the diarrhea is from the leflunomide. What is odd to me is that he was on the leflumomide for a month before the diarrhea showed up.  But maybe it took that long to build up in his system.

I am going to order the milkthistle (as he is on Denamarin and has no problems with that) and also try the slippery elm and glutamine.  Not all at once though!

I might have to try the Proviable probiotics again.  I'm a little afraid because of his reaction last time and because their web site says they don't recommend with immune suppression, but it was prescription from my vet....so I guess I should trust her.

Thanks for the help!

Sue

[BrookeR]

Hi jo,
Aside from the recent attempt to taper pepper further (& failing) she is actually doing the best that she has in years. That is in terms of her allergies. She is having no problems with loose stools and only very very rarely gets the slightest bit itchy. I am not having to put all the crazy effort in either to keep her itch free. She is just okay as is. I'm only bathing her every few weeks or so now. She still has all her special diet and supplements but that's it. Her body seems to have finally found its happy place. She is even better now than she was when on the allergy vaccines. She isn't limping at all on this dose. She is 10 now though and my vet has just noticed her knees have just got a bit clicky on examination. But it's to be expected with her breed and age (especially considering what she has been through with the Impa).
I tried so hard to keep her off the pred, but I've accepted now this is how it has to be. So she is happy for the time she has left. We are as low a dose as we can be.

Hi sue,
I don't have any experience with leflunomide, but from what I've read diarrhoea is a side effect.
Perhaps it has taken a while to build up in your dog's system and start being a problem with the diarrhoea ? Nausea is a common side affect of cyclosporine. Pepper took it for some time and was fine and then all of a sudden started to get nauseous. Im not sure why either.
Just make sure you try one thing at a time and try it for a while. Especially with natural remedies they may take a while to build up in the system. So if you only try for a few days and then add something else you won't know for sure what is causing the reaction.

Just wondering if the proviable probiotics may have another ingredient in it (other than the bacterias) that could be causing a problem. It's a long shot, I'd say More likely still the leflunomide, but just a thought. Is it in paste form or powder? I don't know about the product, but sometimes different brands can add different ingredients. I have always had to research everything I give pepper thouroughly. I once tried omega topical oil with her thinking it would just be omega oils and didn't read the fine print. When I put it on her, it smelt strong and I quickly read the ingredients and it had tea tree oil added. Pepper is highly allergic to tea tree oil. The last time she had it on her she puffed up like the Michelin man. Luckily I got it off quickly and she was fine. But I would never have expected tea tree oil to be in omega topical oil .

[Jo CIMDA]

Hi Brooke

Your dedication and hard work finally paid off and this is good news for you and Pepper.  It is a very stressful time when you are trying to do all you can and not achieving the goal, but you and Pepper are a good example to others to keep going. 

It is much more difficult when you have a dog with special dietary requirements.  If a dog can tolerate it, live yogurt can be all that is needed to restore good bacteria to the gut, but again if there are allergy problems this may not be possible.  My vet once told me to get acidophilus from the health food shop and not bother with veterinary products - but there still might be compounds used that can upset a dog with allergies. It is all a bit trial and error, unfortunately.

Good to know that Pepper is doing well.

Jo

[BrookeR]

Thanks Jo. It does feel good that my hard work has paid off. But I would do it all again in a heartbeat for Pepper. She is so special and the greatest reward.
I used to give Pepper human probiotics for a number of years before I began giving her animal probiotics. Until I read information that dog's had some different gut bacteria than humans that wasn't being covered by the human probiotics that I was giving her. So I changed over to one for dogs.
I do however, still give her human sockeye liquid salmon oil. As from what I could find it is better quality and a lot of the canine ones have Rosemary in them. Which can cause seizures in some dog's. I didn't want to tempt fate with that.

One thing I would change if I could, is never putting her on the desensitising allergy vaccines. All our problems began when we stopped them. I now feel they compromised her immune system. But we will never really know.

[Jo CIMDA]

One thing I would change if I could, is never putting her on the desensitising allergy vaccines. All our problems began when we stopped them. I now feel they compromised her immune system. But we will never really know.

That is very interesting and useful to know Brooke.  Thank you for that information.

Jo

[Winstedt-School]

it's good that I came across this forum, I honestly did not know that it was possible to help animals using such things