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Inflammatory Bowel Disease
Inflammatory bowel disease in Rottweiller
Inflammatory bowel disease in older Lab
Pain and Inflammatory bowel disease in Jack Russell
Inflammatory Bowel Disease
Inflammatory Bowel Diseasealso see Digestive System
also see Diarrhea
also see Medication
Inflammatory bowel disease in Rottweiller
Question: HI DR MIKE I AM A NEW SUBSCRIBER. I HAVE A ROTTWEILLER WHO IS 4,
HE WAS DIAGNOSED W/ IMFLAMMATORY BOWL DISEASE ABOUT 6 MONTHS
AGO. HE HAS BEEN TAKING METRONIDAZOLE , 500 MG WHICH HAS BEEN WORKING FINE.
MY DOG WAS A FEW POUNDS OVER WEIGHT SO THE VET
RECOMMENDED PUTTING HIM ON LOW CALORIE FOOD. HE HAS BEEN ON
PRO PLAN BEEF AND RICE FOR 4 YRS, SO I BOUGHT HIM THE LOW CALORIE
PRO PLAN FOOD. I SLOWLY STARTED MIXING IT INTO HIS FOOD, HE IMMEDIATELY GOT
DIARRHEA-SO I STOPPED THE LOW CALORIE FOOD. HE HAD DIARRHEA FOR 4 WEEKS SO
WE INCREASED HIS METRONIDAZOLE TO 1000 MG. STILL NO CHANGE. THE VET RECOMMENDED SWITCHING HIS FOOD TO ANOTHER BRAND AND PROTEIN. SO I TRIED NUTRE LAMB AND RICE. STILL NO CHANGE. THEN WE TRIED NUTRE CHICKEN AND RICE,
NO CHANGE. AT THIS POINT NOTHING SEEMED TO WORK MY VET WANTED
TO PUT HIM ON CORTIZONE. I WASNT TO HAPPY ABOUT THIS, SO I DECIDED
TO TRY COOKING FOR HIM. I MAKE HIM BOILED CHICKEN AND RICE OR BOILED
CHOPMEAT AND RICE. WELL EVERYTHING CLEARED UP. IN THE PROCESS I HAVE SLOWLY TRYING TO PUT DOG FOOD BACK IN HIS DIET, I HAVE TRIED MANY BRANDS AND AS SOON
AS I GET HIME TO 1/4 OF A CUP THE DIARRHEA RETURNS. I AM AFRAID HE IS NOT GETTING ENOUGH VITAMINS IN PEOPLE FOOD , IS THIS HEALTHY FOR HIM ?. HES 120 LBS AND
HE SEEMED VERY HUNGRY SO I ADDED POTOTOES TO HIS FOOD, THAT SEEMED TO HELP.
IN THE PROCESS HE HAS LOST 4LBS. MY VET HAS NOT RECOMMENDED ANY TYPE OF PRESCRIPTION FOOD FOR HIM. I FEEL IF I COULD CONTROL HIS IBD WITH DIET IT WOULD BE BETTER THAN THE O YOU CORTIZONE, DO YOU AGREE?? WHEN THE VET DID THE ENDOSCOPY & TOOK A BIOPSY OF HIS STOMACH AND INTESTINE, THEY FOUND IBD AND THAT HE ALSO HAS FOOD ALLERGYS. CAN YOU RECOMMEND ANY TYPE OF
FOOD I COULD TRY?? I READ AN ARTICLE THAT SAID COCONUT HAS BEEN KNOWN TO
RELIEVE DIARRHEA IN CROHNS DISEASE-DO YOU RECOMMEND TRYING IT??THANKYOU , DEBBIE
Answer: Debbie-
I strongly agree with your feeling that it is better to control inflammatory bowel disease through
dietary means than with corticosteroids, when it is possible to do that. It is also worth trying therapies
other than corticosteroids prior to settling on them. I do think that there is a time when they are
helpful and when it is necessary to consider their use, but if you can control the diarrhea through
feeding a home-made diet, it is definitely possible to formulate a diet that will meet all of his needs.There are several dietary approaches that work to control different forms of inflammatory bowel
disease. For dogs that are allergic or sensitive to certain food ingredients, all that is necessary is to
avoid the food that causes problems. It can be difficult to identify the offending food, though. Since
you seem to have had success with both chicken and beef in the home-made diet, they are probably
causing problems. This makes a food allergy less likely, but some dogs are allergic to things like
preservatives, dyes, or the plant proteins such as wheat, corn or soybean. There are a couple of new
diets on the market that are composed of hydrolyzed proteins, which produces a protein molecule
that is below the size that causes allergic responses, in theory making these diets ideal for dogs that
have a tendency to react to food. Hills makes z/d (tm) diet and Purina makes HA and LA (tm) diets
in this manner. We have not tried the z/d diet, yet, but we have some trouble getting dogs to accept
HA diet.The other approaches to inflammatory bowel disease are to feed highly digestible diets, such as Hills
i/d (tm) or Purina's OM (tm) diets, to feed low residue diets such as Iams Low Residue (tm) diet and
to feed low fat diets, which is different than low calorie or increased fiber dietary foods. I think that
you may be having success with the home-made diet because it is low fat. If you don't mind making
the diet but would like advice on how to balance it, Dr. Rebecca Remillard has a web site
(www.petdiets.com) on which she offers to formulate diets for individual patients for a fee. She is a
board certified veterinary nutritionist.From a medication standpoint, if metronidazole works well, we are comfortable using it long term
when it seems necessary but it has been linked to some long term problems, including cancer, so we
usually try sulfasalazine (Azulfidine Rx) and tylosin (Tylan Rx) as alternatives. If they work, we are a
little more comfortable using them long term.If you fnd that you do need to consider the use of corticosteroids at some point in the future, it would
be worth checking into the current recommendations for immunosuppressive medications at that time,
as there is current work on alternative medications, such as cyclosporin (Sandimmune Rx), which
might work out to be a better option, although it is too early to tell right now.I have not seen any information on coconut use in dogs that I can remember but I'll try to remember
to check into this and get back with you if I find anything.Mike Richards, DVM
11/15/2000
Inflammatory bowel disease in older Lab
Question: We have a 10 year old black lab who will be 11 in September.
He has been diagnosed with Inflammatory Bowel Disease in the past and is on
Metronidazole medication every other day indefinitely.Also, do you recommend any other course of treatment
for the Inflammatory Bowel Disease? The medication he
is currently taking seems to be effective, but we want
to make sure that it is not dangerous long-term. We
love him very much and want to make his life more
comfortable and last as long as possible. We are not
concerned with cost; we want to do whatever we can.
lease help!!!!!
Thanks! ShannonAnswer: Shannon
We have used metronidazole long term in several patients. There are no
problems with chronic use of metronidazole reported in the veterinary
literature that I can find. However, there is some evidence that chronic
use of metronidazole in lab animals can cause cancer. This does not mean
that occurs in dogs but it should be factored into the "risk / benefit"
analysis.There are a number of treatments for inflammatory bowel disease. Are you
pretty sure that it is necessary to be using the metronidazole
continuously? The reason I ask is that it surprises me that this
medication would work on an alternate day (every 48hr) schedule. Many
things work that I don't fully understand, so it is possible that an every
other day schedule would work effectively and that your vet knows something
about this that I do not. But if you haven't tried stopping the medication
it would be worth asking your vet if he or she thinks it would appropriate
to give that a try at this time.Inflammatory bowel disease is a pretty non-specific term. It covers several
different diseases and disorders. If you know a more specific diagnosis,
such as lymphocytic-plasmacytic enteritis or eosinophilic colitis, it would
give me a better starting point for letting you know what alternative
treatments are possible.Mike Richards, DVM
7/15/2000
Pain and inflammatory bowel disease in Jack Russell
Question: Dr. Mike, Our little Jack Russell Terrier has quite a lengthy medical story
which is on the attached document. The basic problem is extreme pain that
may be associated with inflammatory bowel disease, based on lab tests done
so far. Treatment has not been very helpful in controlling the pain. Any
help you can give us will be greatly
appreciated. Thank you.
Answer: Judy-
At the present time there seem to be two favored strategies for dealing
with painful inflammatory bowel disease conditions.The first is to use anti-spasmotics such as loperidine (Immodium AD tm),
diphenoxylate (Lomotil tm) and a combination of chlordiazepoxide and
clidinium bromide (Librax Rx). It is probably easiest to start with either
loperidine or diphenoxylate to see if this strategy helps at all and then
to use Librax for longer term use if there seem to be benefits. We
have not seen any really significant side effects associated with
loperidine or diphenoxylate in our practice but there are warnings about
ileus (stopping intestinal action) and pancreatitis in the literature and
it is possible to cause neurologic effects if the dosage used is
sufficient. I can't give you any specific cautions about Librax use in dogs
because I can't find any references to side effects in the literature
available to me. I will continue to try to locate information on this.
These medications are presently considered to be the best choices with
anti-cholinergics considered to be more likely to cause problems and less
effective.The second approach that seems to be recommended fairly frequently now is
to try the truly novel protein diets, such as HA formula from Purina. This
diet is made from hydrolyzed protein to ensure that the diet is unlikely to
incite an allergic response. It may not be significantly better than the
very novel proteins you have already tried.There has been some experimentation with a medication, budesonide, which is
a form of cortisone that has been used in humans for inflammatory bowel
disease conditions, as well. It is reported to work better than prednisone
for some patients according to Alan Stewart and Joel Bolineck from Special
Veterinary Services in Berkeley, CA. (presented at the ACVIM meeting 1997,
reference located on the Veterinary Information Network).Simethicone (not sure of spelling on this one) might work better to relieve
gas pressure than Curtail since I think it has more of a direct effect on
gas that is present.There is some chance that if the pain is associated with pyloric stenosis
or gastroesophageal reflux, which I think is why metoclopramide (Reglan Rx)
is sometimes used. An alternative to this is cisapride (Propulsid Rx) which
might also be an alternative to consider.The testing that has been done and the treatments attempted are all
recommended for the types of problems that you are seeing with
your Jack Russell. There are times when it is necessary to go through an
extraordinarily frustrating diagnostic process before a solution to a
problem can be found. I hope you are nearing the end of this search.Mike Richards, DVM
1/5/2000
Q: I am fostering a rescue GSD that my vet is pretty sure has inflammatory
bowel disease. He has had cow pie stools for 3-4 months now and vomiting or
at least retching like he needs to vomit almost nightly. Did a blood work up
and fecal sample. Blood work was pretty normal he said except for a slightly
elevated white count which he said is normal in cases of IBD. I've tried 4
kinds of food including Proplan chicken and rice, Avoderm, Breeders choice
lamb and rice, Eukanuba low residue, Pinnacle, and now something that is
lamb and barley. I've also cooked potato and turkey for him and he does
somewhat better on that but nothing stops the plops and retching. He always
sounds burpy and gurgly. My vet had me give him cimetidine 3x's a day. Is
there a danger in using that long term? We finally started him on pred and
even that hasn't made a difference. He was on a high dose at first and now
is down to 1 20mg every other day. Shouldn't there be some improvement by
week 3? I also pop some Tums in his food when he eats . I try to feed him 3
meals a day if I'm home..2 if I'm not. He seems to vomit when his stomach is
empty and has lots of mucous in the vomit. I had a call into my vet but
haven't heard from him yet. Because he is a rescue dog, funds for tests are
limited but I'm getting frustrated and desperate. He eats voraciously but is
very thin. I also put Prozyme on his food. Any suggestions? He did have a
slight giardia count but we treated him with metranidazole so that is not a
problem now. My vet said that should have helped with the IBD too so we
continued it for 4 weeks but no change. One thing I might mention is that
when I pick up his stools, I have to hose the yard because they are so soft.
The water froths almost like the stools are soapy. I also talked to the
small animal clinic at UC Davis and they suggested peppermint in his food
for the nausea.
Barb
A: Barb-
In the blood work, was there a test for trypsin-like immunoreactivity in the
serum (TLI test?) or a test for folate levels? These tests help to rule out
pancreatic enzyme deficiency as a cause for long term diarrhea. If this test
has been run and enzyme deficiency has been ruled out it may be difficult to
help much with this problem without advising spending a lot of money on
further testing, such as intestinal biopsies. Prozyme does not seem to be
adequate as an enzyme replacement for many dogs with pancreatic
insufficiency, although it does seem to help some of them.When using dietary manipulation to try to help with IBD it is best to use a
single antigen diet. To the best of my knowledge, it is necessary to make
such a diet at home or to purchase one of the specialized diets from
companies like Innovative Diets or Purina's and Hill's prescription diet
lines. The diet should have one protein source and that should be a protein
type that the dog has not eaten previously. This may be why the
potato/turkey diet seems to help while the others don't. Most commercial
foods have mixed protein sources, despite what the labels say.It is usually safe to use cimetidine long-term.
Prednisone will often help with inflammatory bowel disease so it is
worrisome that it is not helping, if that is the problem.Sometimes bacterial overgrowth problems complicate the treatment of
underlying bowel disorders and the addition of antibiotics that favor the
natural bacterial flora can be helpful, such as tylosin (Tylan Rx) and
sulfasalazine (Azulfidine Rx). You might want to ask your vet whether or not
he or she thinks that treatment with these antibiotics might be beneficial,
as well.Good luck with this.
Mike Richards, DVM
Q: Dear Dr. Mike, First of all, thank you for your wonderful service! Secondly, I have some questions about
Duncan, a 70 lb 3 yr old Bassett Hound (my little buddy) who has been diagnosed with Infammatory Bowel Disease.
I have read through your archives and have seen some info on it, but I have a few questions. Duncan had a history of throwing up, repeated swallowing, finecky eating, etc. After several trips to the vet, we decided to have an endoscopy.
The vet that this affirmed the diagnoses of IBD. He said that there were small raised lesions in his intestine. They were not cancerous. After prescribing Canine ID food for Duncan (Is this a high fiber food as you suggest for IBD?) , without much luck, we are now giving Duncan a 5mg dose of Prednisone every other day. (which is better according to your other articles). He has responded quite well, his appetite has returned, he has all but totally stopped the vomiting , etc.My question: Is 5mg (70 lb dog) every other day a lot? You mentioned Cushing's disease, are there any early warning symptoms? I believe 3 yrs old is young for this kind of thing, will he develop cataracts or other complications from longterm use? Will he ever be cured with the prednisone? Do you have any suggested readings for IBD, or any info on the other two drugs you mention in conjunction with treating IBD,metronidazole and azulfidine? I wish there was something else I could do for him, I would hate to see him develop a problem from the use of Prednisone. He has already gained about 7-8 lbs, and frequently urinates on the days he takes the prednisone. Thank You, D.
A: Five milligrams of prednisone every other day is actually a pretty low dose for a seventy pound dog. It is not
very likely that you would run into significant side effects using this dosage but with long term use it would still
be possible.The helpfulness of increasing fiber in inflammatory bowel conditions is still being debated. There have been reports
suggesting it is helpful and reports suggesting that it isn't. Low fiber diets (i/d is a low fiber diet) have been advocated as well. I think the best approach is to try either one and switch if there is no benefit. Dietary control alone rarely works but it can be helpful. In some dogs hypoallergenic diets help, too.There are a lot of specific causes of the general symptom "inflammatory bowel disease" in dogs. If the exact cause
can be identified it is easier to decide on the treatment. Specific causes of small intestinal inflammation include eosinophilic enteritis, lymphocytic-plasmacytic enteritis, parasite infestation and food allergies or hypersensitivities. There are also a lot of conditions that can be confused with inflammatory bowel disorders of the small intestine, like maldigestion syndromes, malabsorption syndromes, cancer, and large intestinal disorders. Specific causes of colon (large intestine) inflammation include eosinophilic colitis, histiocytic ulcerative colitis, parasitism, cecal inversion, cancer and infectious
diseases.In addition, there is a specific form of large intestinal diarrhea known as irritable bowel syndrome which is different
than the inflammatory bowel syndrome. This is usually diagnosed by ruling out everything else possible. Irritable bowel syndrome often appears to be very painful for the dog and this is an important sign if it is present. This disorder responds to an entirely different treatment routine.It seems likely that your vet has a specific problem in mind and the treatment sounds successful. You might want to
ask your vet about discontinuing the prednisone and get instructions on how to taper off the dose if your vet thinks it is advisable. It is possible to do this successfully after good control the inflammation is achieved, in some dogs.I am not aware of one specific reference that covers these disorders well. There is a lot of partial information in
many veterinary texts and reading several is usually necessary to get an idea of what is going on.To sum up a long note: 1) prednisone at this dosage should be reasonably safe but it is still better to discontinue it if
possible.
2) I wouldn't worry about dietary changes since the current treatment is working anyway.
3) metronidazole and sulfasalazine (Azulfidine Rx) are options for treatment but it seems like you have already found a good treatment and it may be possible to discontinue the prednisone and not have to use any treatment if your vet thinks that is advisable.Mike Richards, DVM
Last edited 08/30/02
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