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Dr. Taus
Dr. Taus, Veterinarian
Category: Veterinary
Satisfied Customers: 504
Experience:  Veterinarian with experience in equine and small animal medicine.
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Resolved Question:

Diarrhea after being on preds 20mg (macro lone/pred-x)

Meds tried to fix diarrhea so far
Carafate 1hour before food & protein in food
Metrogyl tabs 2 & 2 times per day

Metrogyl as above & scourban 2 x day

Still no good :(
Submitted: 1 year ago.
Category: Veterinary
Expert:  Dr. Taus replied 1 year ago.
Hi there,

I'm sorry to hear that Storm has not been feeling well. It sounds as if you and your vet have been quite thorough in trying to treat her diarrhea.

My first question for you is, why was the pred prescribed initially? Was it for more intestinal problems, or was there another medical condition (skin issues, etc)?

If she's been on meds for diarrhea less than 10-14 days, it's worthwhile to continue and see if you get an improved response with more treatment. However, if the diarrhea is just going on and on, it's time to try something different. Some dogs will see an initial improvement in their diarrhea and never get completely better until they go off meds (the meds keep their GI tracts a little messed up), so discontinuing one or all of your meds (particularly the antibiotics-- metrogyl and scourban) may be helpful. I would involve the vet who prescribed them in this decision, though.

If it hasn't been done already, I'd also recommend sending a sample of the diarrhea to the lab to see what we are dealing with. They can look under the microscope for bacteria that cause diarrhea, and measure cobalamine and folate, vitamins produced in the intestine that can become low in diarrhea and make diarrhea last longer. If they are low, treating with Vitamin B might help.

Finally, if you can't find a cause, an abdominal ultrasound or endoscopy may be useful. I once had a patient with colon cancer who had no signs other than diarrhea we just couldn't get to stop. This is rare, and I hope it's not the case with your dog, but it's something to consider.

I hope this is helpful. If so, please rate me positively, and don't hesitate to let me know how I can help further.
Customer: replied 1 year ago.
Hi thanks for your reply
Storm had to be put on the pred course because from 6 months old she
Had food allergies then unfortunatly I soon worked out we had a whole lot else going on contact allergies & atopic allergies.
The atopic allergies has been the hardest on her & me too see my girl suffer but I refuse too give up!!! It's not her fault we just manage it all the best we can. My vet thinks Atopica is our last resort too keep the hives break out & her at bay but after she has reacted to the pred I'm scared too try but Storm is running out of options he said once you start it you can't stop at least for the first 3 months. Storm is a bullmastiff so it is very expensive Atopica but it's her health Whilst on the meds & the effect on her vitals has me wondering is it the path too take ?
Expert:  Dr. Taus replied 1 year ago.
Atopica has a different mechanism of action than pred, and some dogs that cant tolerate pred do well on it. Unfortunately the expense is quite great (its the main reason many of my clients dont use it). It may be worth a tru to get your poor girl comfortable.

If you havent already, you might consider desensitization. This involves an allergy test and a series of individualized allergy shots to reduce your dogs sensitivity to allergens. Its the same principle used by human allergists, and it is successful in about 85% of patients.

Can you or your vet consult with a veterinary dermatologist? These specialists often have experience formulating combination therapies in difficult cases. Allergies are so frustrating, and treating them often boils down to trying therapies until you find the one that works. New advances like staph phage lysate and combining antihistamines with nerve drugs like gabapentin has had some success. In some cases, atopica is a good way to get the allergies under control, and the dose may eventually be able to be reduced, especially in combination with other drugs. If atopica is not your first choice, I'd recommend looking into desensitization therapy first. I think with a big dog with severe allergies, any route you take will be expensive- once we move past antihistamines and pred, that's very hard to avoid.

It's pretty common to see pred induce ulcers and diarrhea. I would expect the carafate to be the most helpful medication in your arsenal. If nothing is working, including going off meds, another thing to consider is misoprostol, which can counteract some of the effects of steroids.

Dr. Taus, Veterinarian
Category: Veterinary
Satisfied Customers: 504
Experience: Veterinarian with experience in equine and small animal medicine.
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