Not producing enough red blood cells

[Terri]

Patrice, thank you for your quick response. The blood is red. I just called the emergency vet and am waiting for them to call me back. I am going to ask for the metronidazole. Is that different from the omeprazole she is taking? We are also going to try the yogurt, egg and pumpkin mix. Thank you.

[Patrice]

Terri,
Metronidazole is an antibiotic that is commonly used to treat dogs digestive issues like colitis.

I have 2 big dogs and my vet will prescribe it for me with not even a visit. It works quickly. I do keep a bottle on hand.

There can be some negative side effects used at high doses for long periods of time. You don’t need to worry about that. Often, a dog will respond to chronic issues with much lower maintenance doses.

The omeprazole is a Proton-pump inhibitor that helps prevent ulcers in the stomach. Prednisone is a caustic medication and combined with strong stomach acid can definitely lead to ulcers. So this drug reduces the acid. Still continue this until you stop the prednisone.
My best Patrice

[Terri]

Patrice, Ginger’s regular vet prescribed one dose of Diagel on Friday for the diarrhea, and I have an extra dose. He said he wanted to try that first before starting her on more pills. Ginger’s diarrhea got better over the weekend but is now back with a little bit of blood. Should I give her the second Diagel? She has an appointment Wednesday to get her PCV, and I can talk to him about the Metronidazole. I am frustrated that she wasn’t put on it first because I did not think that the one dose of Diagel was going to heal the colitis, especially with ongoing medication. Also, she does not like the pumpkin or yogurt. I am feeding her boiled chicken, a little cooked rice, Science Diet duck for sensitive stomachs, and scrambled eggs. Please advise. Thank you, Terri

[Patrice]

So, my concern is that the vet didn’t decide to do a stool sample to see if this is bacterial. So we don’t know exactly what’s the issue. But regardless, dogs are so prone to digestive upset that most vets do just treat immediately, which can be diagnostic, if metronidazole works, then we know it’s inflammation and bacterial.

So diet wise, chicken and eggs are fine. Rice is actually an irritant to the colon. However if you boil sushi rice in a lot of water until it is mush, that is equivalent to it being already digested into sugars. That would provide calories and the rice congee would be gel like. I’m not so sure about the dog food. Most of those special foods rely on ingredients that aren’t necessarily “food.” An alternative to pumpkin is yams cooked until they are mushy. Sweeter tasting.

So, need to identify why there is blood in diarrhea, or treat as if bacterial or inflammatory colitis. Provide easy to digest food, low roughage but soft bulk. Diarrhea alone weakens a dog and we certainly don’t want her becoming dehydrated. That will quickly make her less stable. Lots of fresh clean water.

I wouldn’t let this more than a day or two more without attention.
Patrice

[Terri]

Thank you. She is eating well and drinking plenty of water. I gave her the other dose of Diagel because I didn’t want this to continue . If she is not better tomorrow, I will take her in. Otherwise I will have them take a sample Wednesday morning. Is colitis common for dogs on prednisone and mycophenalate? Can the medicine cause inflammation? Can it be treated if they continue to take this medication? As I have read other messages on your blog, I am seeing that others are having a similar problem that our vets, although professional and nice, do not treat these dogs as separate cases. I am having to push for additional tests. I have told them that I want her to receive any treatment that she needs.Thanks, Terri

[Patrice]

Terri,
Dogs with these conditions sure do develop other disease conditions due to medication side effects. The biggest problems are due to the very high prednisone doses. Things like ulcers, pancreatitis, drug induced Cushing’s Disease, skin conditions like staph infections, hair loss, heavy panting, frequent peeing, muscle loss and fat redistribution, inflamed liver, UTI, severe dehydration etc are all attributable to prednisone.

Digestive problems are also a problem especially if the dog is getting antibiotics.

Other drugs like cyclosporine can cause digestive problems.

Some other immuno-suppressant used behave like chemo drugs and can lead to bone marrow suppression which makes the anemia even worse.

We are here to notice those things and help you understand which things are to be expected and those that need quick attention.

I have a link on our site to Dogaware.com. Mary Strauss has been collecting and cataloging canine nutrition and disease information for years. We have a collaborative relationship, she is my go to for diet and disease information.

This page discusses digestive problems, starting with mild and occasional diarrhea. Further down she discusses more serious conditions, like colitis.
http://www.dogaware.com/health/digestive.html

I trust everything she has written, read the information about colitis and other conditions that could have blood in stools. She lists many home treatments, I’ve already mentioned the rice congee. It’s usually a good idea to try one supplement at a time so you can figure out what is helping.

Ah, you’ve picked up on our greatest difficulty in helping owners, the difference between vets treatments. It can be a struggle. We don’t like to make judgments about vets, after all owners need to trust their vets. But sometimes we do try to suggest either playing a stronger role in decisions and care or getting a second opinion.

Occasionally there have been sad stories with vets not having an appropriate emergency treatment protocol. My heart sinks when a vet is only prescribing prednisone with no stomach protection for instance.

I do promise to always politely note when I think the vet should be providing certain treatments or should be more proactive with testing. I am not always satisfied with their response.

You are Gingers best advocate. No one knows her like you do and you spend most of the day with her. Your vet may spend a half hour with her. You drive the bus. They must include you as part of the team that cares for her, not stuck out in the waiting room. Be polite and thank them for their expertise but be firm about your desire to be included in everything and have the ability to make important decisions. If it feels somehow wrong, speak up.

Ask me if you need any help understanding Mary’s information.

Want to know how she is tomorrow.
My best Patrice

[Terri]

Patrice, I took Ginger to the vet Tuesday because of the bloody diarrhea. They finally put her on metronidazole, but she is still having bloody diarrhea once or twice a day. She has now had 4 doses of the medication. I called the vet again today to see if she should be on something else. He wants to try to give it a chance to work for a couple more days. If it doesn’t, he wants to take her off the mycophenalate for a few days to let her colitis heal. They took her PCV on Tuesday instead of waiting for her appointment on Wednesday. She had not fasted, and she has also lost blood because of the colitis. Her count was still 29.5. I got the report back from Dr. Dodds. Ginger has severe hyperthyroidism and some liver damage, probably from the IMHA and meds. She is now on medication for both. I feel that she should have been on the metronidazole sooner. I want to help her with this diarrhea. She is still eating well and drinking plenty of fresh water. Please advise. Thanks so much, Terri

[Vally]

Terri, Mycophenalate is known to cause stomach problems in some dogs, so perhaps that’s the problem, although I would not expect to see red blood for stomach issues. Stomach blood is much darker. Red blood usually indicates a colon problem.

Her blood count is still at a safe level, even though not normal. I suspect when the diarrhear is stopped, her count will be good.

I’m so glad she’s on thyroid and liver medication. I’m sure you’ll see a different.

My best, Vally