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Jennifer Van Noy
Jennifer Van Noy,
Category: Dog Veterinary
Satisfied Customers: 84
Experience:  Veterinarian at Riverside Animal Hospital
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I am looking from a vet with experience in treating IBD and

Customer Question

I am looking for advice from a vet with experience in treating IBD and oesophagitis. My dog has been diagnosed w idopathic IBD. She has post anaesthetic oesophagitis. While she drinks water she will not eat even though she seems hungry. It appears as though it is the pain of swallowing which prevents her from eating. We have been trying to force feed her but it has become impossible to continue. We have tried syringe feeding but she spits the food out. She has been on prednisone and azothiaprine for 8 days. Is there anything we can give her to assist her to swallow or is it kinder to let her go.
Submitted: 5 months ago.
Category: Dog Veterinary
Expert:  Jennifer Van Noy replied 5 months ago.


I’m Dr. Jenn and I’m a licensed veterinarian with 18 years of experience. I’m here to help with your question about Song.

I’m so sorry you’re having this problem, but glad you’re looking for the information you need. You may join the conversation at any time by typing in what you want to say then clicking REPLY or SEND. Then we can chat back and forth until you’re satisfied with the information I’ve provided. I’ll do my best to ear your good rating, because that’s the only way I receive any compensation for helping you.

In order to help me help you better, I’ll need a little more information. To start with, please tell me:

  • Which Gastrointestinal signs of IBD did Song initially have? i.e. did she have vomiting and diarrhea, weight loss? Just trying to get a better picture of her history.
  • Is she still on Omeprazole?
  • I see Carafate typed out, is she still on that?
  • Is she on anything for pain control? Esophagitis is very painful.
  • How much does Song weigh and what doses of drugs is she on?

I’ll be standing by and awaiting your reply. Thank you for using our website.

Customer: replied 5 months ago.
Hi Jenn sorry for the delay in responding. Initially Song started vomiting we thought she had eaten something that didn't agree w her. Then it seemed to resolve. She stopped eating raw chicken drumsticks her usual meal and started eating mince instead. She has had no diarrhoea but she has dropped from 15 to 12.5 kilos. She is on 10mg of omeprazole once a day. She takes carafate twice a day. I asked about pain control and I was offered tramadol however it doesn't seem to help it just seems to sedate her. She is on azathioprine 25mg a day which she has taken for 7 days. She will now alternate that dose every second day. Prednisone is 10 mg a day. I recently read a study on VSL#3 probiotic in dogs and I am giving her 3 mg (100 billion bacteria per Gm) per day. I tried her on ondanestron however it does not appear to effect her appetite at all.
Customer: replied 5 months ago.
I should mention that prior to her IBD diagnosis she had surgery for a low grad soft tolissue spindle cell on her shoulder. She did not recover and stopped eating all together after the surgery. I raised my concerns re post anaesthetic oesophagitis and the same clinic did a barium study and told me she didn't have oesophagitis. I took her to another vet and asked him to treat her empirically for oesophagitis w prednisone and there was an immediate positive response she began self eating. After a week I thought there was something more going on and agreed to an endoscopy. This found severe oesophagitis particularly the upper oesophageal sphincter, ulcer and thickened stomach lining which resulted in the diagnosis of IBD. Greater difficulty w regards ***** ***** and a general decline in her overall well being seemed to coincide w administration of the azathioprine. She had one night a few days ago when she developed what looked like polydipsia and polyuria, she was restless and anxious. I stopped the prednisone for 36 hours and the polydyp/polyuria is still present she is not overtly anxious but seems lethargic and a little depressed.
Customer: replied 5 months ago.
In addition to clarify Song started vomiting constantly following the surgery.
Expert:  Jennifer Van Noy replied 5 months ago.

I'll try to get this to flow together, but lots of info to give back and forth.

I like the idea of the probiotic. That won't hurt, may help.

When the biopsy came back as IBD, was she started on both the Prednisone and Azathioprine at the same time? Or was the Pred started, then azathioprine added on? Was she ever on Metronidazole (antibiotic)? If yes, what dose and length of administration? How about a novel protein source?

The surgery for the spindle cell tumor- how long ago was that? Did she recover fully from that or is that how the vomiting got started? I'm not sure of timeline.

Is she doing any vomiting now?

Do you have the actual histopathology report that you could share? Or tell me how severe and what type of IBD she has?

I used to use a fair bit of Tramadol, but further recent absorption studies show dogs barely absorb the drug and it's about useless. Most of the esophagitis (I'm in the US, so no "o" for me) I've treated has needed IV Fluids and IV pain control initially since it is so painful- for me most often a combination of an opioid ( morphine or hydromorphone), ketamine, and lidocaine (MLK or HLK Constant rate infusion) to get them over the hump of being so painful.

Have you used Metoclopramide? Or Cisapride (harder to get now at least in US, but could still get it compounded as of last year)

I like she's on omeprazole and carafate. Is the carfate 1 gm? There is likely room to go up in dosing frequency. This may be helpful.

What are you a currently trying to feeding?

Sorry for all of the questions, this is going to take some time to sort through and come up with a good plan.

Expert:  Jennifer Van Noy replied 5 months ago.

One further question- For the spindle cell tumor. Were they able to get clean margins? What grade was it? Where her chest x-rays clear at that time? How long ago was that?

Customer: replied 5 months ago.
Thks Jenn Prednisone was started before the biopsy then azathioprine later. No metronidazole. Started feeding kangaroo 2 days ago but can't manage to force feed her safely after tonight she just doesn't seem to swallow.Surgery was 8-9 weeks ago following surgery she was vomiting frequently and wouldn't eat except occasional liver treat then increasingly less then nothing at all. Oesophagitis came on after the surgery. I have the histology report form tumour margins were clear.I asked about cisapride and it was prescribed however after the endoscopy it was recommended to stop giving it to her as it would increase ulcer pain.Carafate is 1 Gm tablet. Thks for the info re pain management for the oesophagitis. I think it has been very poorly managed she has been in a lot of pain. Would morphine subcutaneously have the same effect or is Iv necessary to maintain constant dose?I have been feeding pork and veal mince w duck fat to help emulsify when she swallows. We switched to kangaroo but she just won't swallow at all now. How long does omeprazole take to resolve the oesophagitis and an ulcer? I am not sure way to do next w feeding for her now that she is not cooperating at all. I am concerned about the risk of aspirational pneumonia ....
Expert:  Jennifer Van Noy replied 5 months ago.

Was the azathioprine started because she was still vomiting? Or why was it started?

Discounting the esophagitis for the moment- when I have an IBD case, typically I'll start them on novel protein source diet, Metronidazole, Pred, and Colbalamin if needed. Were her Cobalamin levels tested?

She has both ulcers in stomach and esophagus?

Metoclopromide only works on esophageal sphincter, so that may be the better choice.

Morphine SQ works okay, but not as well as IV. Fentanyl patch may be worth looking at. Honestly, it sounds like hospitalization for at least a little bit is likely indicated, then back to home care once she's doing a bit better.

I'm going to be away from my computer for a bit. Let me know these answers and we'll go from there.

Expert:  Jennifer Van Noy replied 5 months ago.

I just want to make sure I get the timeline correct, as it does matter to what my response will be.

My current understanding:

Initial surgery to remove spindle cell tumor on shoulder 8-9 weeks ago.

After that started vomiting, likely esophagitis.

Pred started

Endoscopy of esophagus and stomach. Where there biopsies taken of this or was it a presumptive diagnosis of IBD? If histopathology available- what type of IBD? How severe?

Does she have ulcers in esophagus and stomach?

Azathioprine started 1 week post Pred. Why? Still vomiting?

All the other meds added on too.

Trying to understand if Pred and Azathioprine added on because histopath came back as IBD or exactly why and when.


Customer: replied 5 months ago.
Hi Jen sorry to be away for so long I hope you get this msg. Endoscopy revealed thickened stomach lining and an ulcer in the stomach only. They found no oesoniphils but lymphocytes were found and other immune cells I believe. I was told they treat all IBD as severe although I am unaware of the different grades. She is not losing protein, elevated alkaline phosphotase, one of her liver enzymes slightly elevated ( probably the prednisone?) the azothiaprine started on advice from a specialist ie to treat as severe from the beginning. Yes she has been vomiting less - once a day now. So azathioprine added to pred following endoscopy because of IBD diagnosis. This was approx 14 days ago now. To me she seemed worse on the azathioprine w re to the vomiting. She has low sodium and potassium from the chronic vomiting. Yesterday she had a fecal microbial transplant administered orally and rectally. It's experimental so I don't know wat to expect with that. Would maropitant help her w vomiting and inflammation? Might that be an alternative to the prefer and azathioprine as they don't seem to be doing much to help her...
Expert:  Dr Chris replied 5 months ago.

Sorry, it's a little hard to orientate myself with the photo being so close-up. Can I firstly clarify the orientation? The tail is towards the bottom left of the image, the anus is in the middle, and the lump is middle left? So the lump is above and to her right of the anus. Is this correct?

Expert:  Dr Chris replied 5 months ago.

Oops. Sorry about this interruption. I don't know how I accidentally entered this conversation. I'll be gone...!

Expert:  Jennifer Van Noy replied 5 months ago.

Hi, I got email notification of the message. I'm glad you wrote me back with the additional info, because I didn't want to say anything potentially "negative" without understanding the full story! What I don't understand is why Song is on a steroid if she has a stomach ulcer. Yes, often w/ IBD we do use Prednisone to treat, but we don't put dogs with stomach ulcers on steroids, because it makes the ulcer worse - which causes continued pain, anorexia, vomiting, etc, etc, etc. Both steroids and NSAIDs are contraindicated in cases of stomach ulceration. Now once the ulcer is healed, if she still had clinical signs consistent w/ IBD, and wasn't responding to Metronidazole and novel protein source,then I'd add back in Pred and maybe Azathioprine (or more likely cyclosporine). I do think this needs to be nicely discussed with your vet- that's why I wanted to verify with you that Song does have an actual stomach ulcer.

I wonder how much of the vomiting at this point is due to the Azathioprine + the stomach ulcer + the Pred.

It's good she's not losing protein! Not a surprise her Na and K+ were low.

Maropitant may be useful. How much is she still currently vomiting? Also, considering Metoclopramide too.

If she were my patient -- a dog w/ stomach ulcer and esophagitis with IBD, I would initially be treating with opioid pain meds, Carafate/Sucralfate, Omeprazole, Metronidazole, and likely Maropitant, possibly Metocloparmide too. I'd do as much initially as an injectable as possible, obviously Carafate works as a coating, but want as little in the stomach as possible. I would be pretty aggressive with my treatment as esophagitis and stomach ulcers are very painful and hard to get under control.

From what you've told me, it seems like the initial esophagitis and ulcer was secondary to her lumpectomy surgery/anesthetic event. That's when all the vomiting, etc started. She wasn't having GI issues prior to that. My personal opinion, is the ulcer and esophagitis has to be healed first.

I'm more than happy to continue to communicate with you. I want to hear she's feeling better!!!

I hope this information was helpful to you.

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