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Dr. Joey
Dr. Joey, Board Certified
Category: Dog Veterinary
Satisfied Customers: 4688
Experience:  15 yrs in practice, specialist canine/feline medicine
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Has severe ibd, diarrhea, lost weight, not eating well, on

Customer Question

Has severe ibd, diarrhea, lost weight, not eating well, on many meds
JA: I'm sorry to hear that. What sort of animal are we talking about?
Customer: French bull dog nine years old
JA: OK. What is the bull's name?
Customer: T-bone
JA: Is there anything else the Veterinarian should be aware of about T-bone?
Customer: Was seen at vet for urine retention, they are focusing on ibd, and no answers about why urine retention except possibly neurological
JA: Strange behavior is often perplexing. I'm sure the Veterinarian can help you. OK. Got it. I'm sending you to a secure page on JustAnswer so you can place the $5 fully-refundable deposit now. While you're filling out that form, I'll tell the Veterinarian about your situation and then connect you two.
Submitted: 3 months ago.
Category: Dog Veterinary
Expert:  Dr. Joey replied 3 months ago.

Hello I am Dr. Joey. Thanks for trusting me to help you and your pet today. I am a licensed veterinarian with over 16 years of experience. I look forward to working with you.

Oh, this poor guy. I do need to clarify what exact your question is about. Are you more worried about the IBD which does not sound entirely controlled (if so, then I need to know what medications/foods,etc you are current using to treat this). Or, are you most concerned about the urine retention (and I can give you some ideas for causes and best next step to determine what is going on; can you please let me know what testing has already been done)?

Thanks for clarifying.

Customer: replied 3 months ago.
He is currently taking prednisone 20 MG bid, tylan once daily, bethanechol 5 MG tid, cyclosporine 50 MG bid, lope raiders 2 MG once daily, famotidine bid, and team adolescent 50 MG for pain. His rear end is red and sore so we keep him clean and put aquaphor ointment on it after every loose bowel movement. He needs help urinating by placing a paper towel near his rectum. Not sure if he needs pressure to urinate or if he needs to stop focusing on having a bowel movement. When resting he will leak both urine and feces. We have tried the hill's zd dry and wet, he only eats a few pieces of the kibble. He was eating boiled chicken and rice, but we were told to try ground bison and gluten free pasta, ate once and now won't. We have tried duck which he ate twice and now not interested. We offered white fish and won't touch it. He used to weigh 29 lbs and now weighs 20 lbs. He was at two er hospitals and has had blood work, urinalysis, multiple ultrasounds, gi work up with biopsies, his protein levels are low, he is getting b-12 injections at home weekly, urinalysis showed crystals but no bacteria. He also took sulfasalidize 250 MG tid for ten days. The last hospital also did a fecal transplant. We can not even determine what is causing the urine retention since the ibd is so out of control. Right now we are worried about him continuing to lose weight and no positive progress. Please help.
Customer: replied 3 months ago.
Sorry not lope raiders the med is loperamide
Customer: replied 3 months ago.
Sorry it is tramadol for pain
Customer: replied 3 months ago.
The hospital also did a CT scan
Expert:  Dr. Joey replied 3 months ago.

This guy has become quite complicated for you.

With regard to urine retention, this can certainly and most commonly be caused by a spinal lesion but it might take advanced imaging with a neurologist (MRI or CT scan) to evaluate for this.

I also want to make a comment about bethanechol. If you feel it is helping and there was no worsening of the IBD when this was added in then you should probably continue, but one of the contraindications to use of this drug is any time there is an inflammatory gastrointestinal lesion which is by definition "inflammatory bowel disease."There may be intestinal stimulation that will aggravate the potential for diarrhea with use of this drug. I tried to do some research to see if anyone else has had issues using this in IBD patients and there were multiple reports. So, I cannot recommend use of this drug IF there has been any worsening of the IBD since starting. Was an ultrasound done of the bladder? An alternative medication is to try a urethral relaxant like phenoxybenzamine in addition to frequent expressions. But I have to say inability to urinate due to bladder atony or detrusor issues is complicated; sometimes consultation with a specialist is very important to determine the best medications and treatment.

He also needs to be monitored closely for development of urinary track infections.

For the IBD, I am most worried about this not eating. I assume he was diagnosed based on biopsies so we can rule out cancer in the digestive tract as the cause. Any time we have protein loss then this becomes a more serious problem. The diet that traditionally works best for this is a low protein bland diet (e.g., Hills i/d low fat or Royal Canin Low Fat) which are usually reasonably popular diets. I am not terribly worried about a hypoallergenic diet as it is not extremely common to have a food allergy lead to this much difficulty treating IBD. The bot***** *****ne with food, though is that we need him eating.

Customer: replied 3 months ago.
We did have a neurologist consultantion and he recommended an MRI unfortunately we could not afford GI work up and MRI we had a team evaluate what was the priority so they agreed the IBD was the primary focus for now. That is why they started the bethanechol. I can not give info on if his IBD changed on this med since it was started in the hospital. Currently he is having watery stool sometimes and dark brown tar like stool.
Customer: replied 3 months ago.
the ultrasounds were done on his bladder and no stones or masses, or thickening.
Customer: replied 3 months ago.
He has had GI issues since 2014, ultra sound was completed and we used prednisone, tylan powder, flagyl and Purina probiotics. He ate chicken and rice, then was in a high protein dry dog food. The IBD cleared up after three weeks and he was fine for two years.
Customer: replied 3 months ago.
Any time he got food that was not his diet he would have a flare up but two days in low dose prednisone would clear it up.
Customer: replied 3 months ago.
Last flare up end of may beginning of June, stool was returning to normal, then we noticed he wasn't urinating. Went to vet, had x-ray which showed overly large bladder, which was drained by catheter and sample sent for urinalysis. Catheter went in fine so the vet did not feel there was an obstruction. The next day he still was not urinating so we went to the er hospital. The diarrhea didn't start until he ate the food at the hospital even though I brought his food and told them to only fed his specific diet. This hospital also told us that they saw a lesion near his ureter, that was also felt rectally, but when CT done no lesion found and the vet said that maybe what she was feeling rectally was the bulbis from the urinary catheter. I transferred him to Angell animal hospital in boston, ma due to these concerns.
Expert:  Dr. Joey replied 3 months ago.

That is a wonderful vet hospital in Boston.

I really wish I had a new miracle for the IBD but it is a matter or adjusting medications and food and trying to come to that perfect equilibrium. He is on an excellent combination of drugs. Things can certainly be tweaked but I am not sure that we are going to find that one drug that will make all the difference. I agree the major issue is the IBD, primarily because of the discomfort with the loose stool and the now slowly lowering protein levels. My top worry with him doing great for years and suddenly not is if something changed in the GI tract (in some situations IBD can be a precursor to cancer). Some specialists believe if we are certain of our original diagnosis that the immunosuppressive drugs are not always a good thing; so perhaps playing with this and focusing on small intestinal bacterial overgrowth.

Some subtle IBD treatment changes you can always discuss with your veterinarian:

1)A lower fat diet, which seems to help reduce the protein losing problem a bit. Ask if they think the bethanechol could be worsening the IBD since it sounds awfully suspicious it might be and then perhaps trying an alternative.

2) Adding back in metronidazole or another drug for anti diarrhea and anti-inflammatory like sulfasalazine for a bit might be a good trial.

3) Prebiotics to support normal intestinal bacterial (these are different than probiotics)

4) Herbal therapies which primarily prove consistently helpful in small intestinal bacterial overgrowth:

Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Natural Path Herb Company; Boost the Qi, Kan Herb)

Huo Xiang Zheng Qi San (Agastache Combination, Natural Path Herb Company; Protect the Middle, Kan Herb)

I hope that the information I provided has been helpful. Please let me know if for any reason you need further clarification, have more questions, or were expecting a different type of answer.

If you received all the information you needed, then kindly submit a rating.

Customer: replied 3 months ago.
I was wondering how much longer do we continue to treat him if he is still losing weight. I do not want him to suffer and I can not get any answers on how long before we should see improvement from the cyclosporine? If I order the prebiotics will he survive by the time I get them and start treating him with them? Will his body start to shut down and then it will not matter if we continue treatment?
Expert:  Dr. Joey replied 3 months ago.

The how long you continue primarily depends on how he is doing; how is his quality of life. If he is otherwise thriving, happy and social then we are good. It sounds like this is not the case in that he is not eating well, at least. So, you are at a point there is no wrong time to make this decision. It is a very personal one that you must make with the family and taking into strong consideration how he is doing.

I do not have much faith in cyclosporine helping the digestive tract (personally I have better luck with azathioprine) but if you are to try this drug it might take 4-5 weeks before we can even rely on its effect. The reason I personally feel it is problematic is that it relies on the digestive tract for absorption, and even in a do with a normal digestive tract we have huge issues with variable absorption. So, there is a huge chance in a dog whose GI tract is not right that this drug is not even going to get absorbed. If there are questions about absorption at the 4-5 week time point then a cyclosporine blood level can be performed to see if it actually getting absorbed (but this is an expensive test). However, there is a newer study that shows in some cases of IBD refractory to steroids that cyclosporine might work.

Tough call on ordering prebiotics. I don't know. It sounds like we are not seeing much improvement. You could give yourself a time frame such as the next week and there is some conservative improvement then go for prebiotics.

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