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- Not producing enough red blood cells
Terri,
I’ve looked into Cellcept (Mycophenalate) before on behalf of previous owners. The main problem with this drug is that it a human drug being used off label for veterinary treatment. That’s not unusual, many human drugs are used for dogs because there is just not enough money or interest to test many human drugs for use in animals. So some veterinary clinics started using it to see if they could fit it into their clinic protocol. So it has been become more popular. That doesn’t mean that it doesn’t concern me that the side effects are not clear in dogs.
So never-the-less it is used in human medicine, and there are some significant side effects in humans on Mycophenalate, enough that I always mention to concerned owners that they should be aware of them and cautious. Here is a human study that indicates some serious gastrointestinal side effects.
https://www.ncbi.nlm.nih.gov/pubmed/21094821
“Mycophenolate mofetil (MMF) was introduced as a new immune-suppression drug in the mid-1990s. It is widely utilized in solid-organ transplantation immune-suppression regimens. Side effects include gastrointestinal (GI) toxicity in the form of nausea, vomiting, and diarrhea. Physicians tend to reduce the dose of MMF or switch their patients to an enterio-coated formula to overcome the side effects. Because GI side effects are well linked to MMF, colonoscopy is not utilized in most of the cases to investigate the diarrhea. However, Crohn’s disease-like changes in the colon, erosive enterocolitis, and graft versus host disease-like colonic changes associated with the use of MMF have been reported.”
So why does this happen? The short story is the way these drugs work is to cause changes in certain cells to reduce their numbers. Cellcept is attempting to lower the number of a certain type of cell that may be responsible for the autoimmune attack. But the cells of the digestive tract can be similar and they can also be affected.
Prednisone is a commonly used drug to reduce gastrointestinal inflammation and you are already giving that.
Looking up the effectiveness of metrondiazole for dogs with IBD, I find this hopeful information from the 2006 World Conference Update On Inflammatory Bowel Disease.
https://www.ncbi.nlm.nih.gov/pubmed/21094821
“Treatment with antimicrobials can be justified in IBD, in part to treat secondary SIBO, and partly due to the importance of bacterial antigens in IBD pathogenesis. Ciprofloxacin and metronidazole are most commonly used in human IBD, but metronidazole is the preferred drug for small animals. The efficacy of metronidazole may not just be related to its antibacterial activity, since there may be immunomodulatory effects on cell-mediated immunity. Further, other antibacterials such as tylosin may also have immunomodulatory effects, and empirically this drug has proved useful in many cases. In fact, a recent study in a rodent model of intestinal inflammation has shown that both metronidazole and tylosin are effective in decreasing inflammation. Finally, cases of HUC have recently been show to antibacterials such as enrofloxacin, suggesting a possible infectious agent underlies this condition. In fact, a recent study has confirmed the presence of invasive E. coli in HUC lesions.”
So, as I have always believed, metrondiazole is very reliable in veterinary treatment for diarrhea and colitis. I will remind you that high doses over long periods of time can lead to certain side effects. I have also experimented with my vet using the lowest effective dose for longer periods of time which were very effective and tolerated. I think I remember that Chance, at 93lbs, should have been getting something like 1000 or 1200 mg a day, split into 2 doses. We dropped that to 100mg twice a day after a short time and it worked very well.
The next thing to look at is making sure that the diet is non abrasive and does not irritate any further. I’ve returned to Mary Stauss’ site DogAware for more help.
http://dogaware.com/health/digestive.html
“In general, you want to stay away from all grains and other starchy foods that take a long time to digest, such as potatoes and corn, limit the amount of fiber (from vegetables), and avoid dairy, to see if that helps.”
Look at your dog food for this:
“Carrageenan, an ingredient used as a thickening agent in many canned foods, has been associated with intestinal ulceration, inflammatory bowel disease (IBD), and acid reflux. While most studies have been done on carrageenan, it’s possible that other thickening agents, such as carboxymethyl cellulose, polysorbate 60 and 80, guar gum, xanthan gum, and agar agar, may also contribute to digestive problems in sensitive dogs.”
“Many dogs with IBD, chronic pancreatitis, or other gastrointestinal problems have difficulty digesting fat and may need a low-fat diet.”
My usual diet for simple diarrhea is scrambled eggs and deli rotisserie chicken. But with the liver involvement you may want to investigate Dr. Dodds Liver Sparing diet. It the top item on this page.
https://www.secondchanceaihadogs.com/nutrition-resources
Mary lists a number of supplements that she recommends. You might try one of these as well. This one, glutamine, would be something I would try if I was faced with colitis.
https://vcahospitals.com/know-your-pet/glutamine
I am upset by the finding by Dr. Dodds about the extreme hypothyroidism. This is something she pushes to be one of the first diagnostic tests that should be run when a dog develops an autoimmune issue. Many vets don’t bother with the testing or they only test one part of it. Then if they see a very low, but normal level, they accept this as perfectly normal and refuse to treat it. Dogs do far better when they fall in the middle of the range between high and low. My breed, Giant Schnauzer, can be severely impacted by low normal thyroid, suffering behavior changes, epilepsy, and as was the case with Chance, profound bone marrow failure.
So please request this brand of thyroid supplement, Thyro Tabs, I have used this for years to treat my dogs. My vet’s medical technician did extensive research to ensure they were providing the best. You can find the product insert on this page, near the bottom. Click on the picture of the Thyro Tabs pill bottle. Print this page and present it to your vet asking for a prescription. Do not accept any other generic substitute, they are not effective in dogs.
https://www.secondchanceaihadogs.com/medication-resources
The liver “damage” is a normal part of using prednisone. The liver processes this drug and liver cells are damaged, releasing enzymes into the blood. These enzymes can become very high, the liver can be extremely sensitive and enlarged. It can feel very uncomfortable for dogs. The important thing to know is that the liver is regenerative. If there was no organic disease prior to this, then it will heal once the prednisone is decreased. Please do not be alarmed but please do use the supplement Denamarin.
I highly recommend the use of Denamarin, a supplement, when the liver is severely damaged. When Chance was so sick from prednisone after several months, Dr. Dodds asked me to send his values from the chem screen test. His ALKP, which has a high normal value of around 212, was over 8600. I started the Denamarin and within a few weeks his value was down to 318. I really stand by my recommendation to use this. You can find the product insert and brochure for Denamarin on this page:
https://www.secondchanceaihadogs.com/second-chance-resources/supplement-resources
Please send me copies of the CBC and Chemical Screen tests. I would like to stay on top of what is going on, these things should have been addressed much sooner. You can use the Urgent Advice page, look at the top menu, and attach the files to this. They come to my email.
I am out of town for a few days and in a place where sometimes I don’t have cell reception. I will do the best I can to keep up.
My best, patrice
Patrice. I can’t tell you enough how much I appreciate the time you spend helping others and the research that you do. I don’t know what I would do without this information. I just checked, and the bottle from the vet for the thyroid medication is the vet’s bottle, but it says ThyroTab. The liver medication is Denamarin. I am also putting Synacore probiotics in her food. Dr. Dobbs did send me the diet for the liver, but I am not fully adapting it until we can get the diarrhea under control. Chicken is not on the liver diet, but it is one of the things Ginger will eat right now. She also really likes the Science Diet duck, but I just looked, and it has cellulose and potato starch. For now I will keep her mostly on boiled chicken and scrambled eggs.
Thank you for the offer to look at her CBC. I will send that as soon as possible. I will also be reviewing the links you sent me.
My vet told me today that we can give her the thyroid medication, but in his opinion the thyroid did not cause this disease and has nothing to do with it. I explained that I realize it did not cause it, but when treated for thyroid she may begin to produce more red blood cells. He said he agreed. I will continue to push them to get her everything she needs.
Talk soon. Thank you,
Terri
Patrice, I am sorry it took so long, but I just sent you Ginger’s reports in the Urgent Advice. The second report was an earlier report from the vet, and she had not been on the medication very long. She also had not started the thyroid and liver medication at all. Most immediately we need advice about her colitis. Although the metronidazole and probiotic has helped her diarrhea, she still has some diarrhea and a little blood. She has two days of metronidazole left. The vet wants to take her off the mycophenalate for a few days to try to stop the colitis. I don’t want her PCV level to drop. Is there anything else she can take for the diarrhea? Other than the diarrhea, she has made improvements. Please advise. Thanks, Terri
Patrice and Vally, we made a very difficult decision today and Ginger is now at peace. The bleeding would not stop, and she stopped eating and drinking., She was so very weak. She did not sleep at all last night. I stayed up with her. We were willing to do anything to extend her life, but we knew it was best for her. I am heart broken, but I know it was best. I can’t say enough how much I appreciate having all of the information and friendship you gave me. Thank you so much for doing what you do. Love to you both, Terri
Terri, I’m so so sorry. This is a miserable disease and sometimes no much how much we fight, it just won’t be beaten.
Give yourself time to grieve. We live in a world where we’re expected to just get over it, but I know how impossible that is.
When you feel ready, visit the Bridge page. It was written by one of our ladies and it’s lovely and I know it will help you.
https://www.secondchanceaihadogs.com/the-bridge
My deepest condolences.
Vally
xxx
Dear Terri,
I am sad to read this. I had hoped for a better outcome. But I know that sometimes it doesn’t happen the way we want it to be.
You are an amazing Mom, doing all the right things and asking good questions. Everything you did was done with love and great care. I know that Ginger was so happy that you were with her and that is all she wanted. She trusted you to do this and you honored her by taking care of her so carefully.
It is normal to feel grief and also to feel guilt. We have all gone through that “I should’ve, I could’ve, I didn’t, why didn’t I?” But guilt interferes with the loving memories that we have. I know that she would not want you to feel guilty or sad. She would want you to run around really fast, roll around in the grass, get a cold drink and then take a nap under a tree. She forgives you and wants you to not feel sad.
In time the sharp edges will smooth out and only the good things will remain in your thoughts. I promise it does get better.
It also helps to find a way to honor her memory with something special. I honor Chance with this website to help others, never wanting them to go through this alone. Some owners have mentioned that now that they know about this disease they will make sure others know about it too. Doing something special in her memory will remind you of her in a good way.
We are always here if you want to talk. You can come back two years from now if you want or be here everyday.
Love, Patrice