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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