Skip to content

New to IMHA, help with diarrhea and vomiting

Shay

Guest

Hello,

Five weeks ago today, Addy, my 11.5yo Australian shepherd/German short-haired pointer/lab mix, was diagnosed with IMHA. It’s been an emotional rollercoaster, but I’m happy (and lucky) to say that she has improved bit by bit each week. I would be happy to go into more detail about her story in a reply to this post but just want to briefly summarize where we are at today and ask for your advice on how I should treat the diarrhea and vomiting she’s been experiencing.

Addy has been seeing an internal medicine specialist since her diagnosis. Her PCV has been stable around 35-36 for the past 3.5 weeks, but unfortunately, according to last week’s blood work, she is still showing signs of hemolysis with spherocytes in her blood. We will check her blood again in about a week and if she still has spherocytes, will probably have to add another immunosuppressant to her regiment.

Her liver enzymes are high (I don’t have the exact numbers right now). She was on denamarin for several months prior to the IMHA diagnosis and has been back on it for the past week. Her bilirubin is also very high and measured 3.7 one week ago (although that is much better than the 33 it was 4 weeks ago when we took her home from the hospital).

Five weeks ago, she was a healthy 50 lb dog. When we took her home from the hospital 4 weeks ago, she was really swollen and weighed 58 lbs. At her last weigh in one week ago, she was 39 lbs. Getting her appetite back has been a struggle, and I have had to syringe feed her until this past week when she started eating better on her own.

She is currently taking 100mg of cyclosporine (stored in the freezer) 2x per day, 30mg of prednisone (20mg in the morning, 10mg at night), 20mg of omeprazole 2x per day, and 34.5mg of clopidogrel at night.

She has done two rounds of metronidazole, the most recent of which finished 3 days ago, for previous bouts of diarrhea. I expressed concern about the potential for interaction between the metronidazole and cyclosporine to her vet, but he assured me that it had been okay in other dogs that he had treated.

Overall, the past week has been positive. Addy had been eating more on her own and was finally exceeding her caloric requirements. Additionally, her bowel movements were formed more often.

However, yesterday morning, a few hours after a small but normal bowel movement, she started having diarrhea again. She has gone about 10x in the past 36 hours and about 1.5 hours ago most recently. For the most part yesterday, I withheld food save some chicken and white rice a few times. This morning, I gave her about 1oz boiled chicken with about 1/4c white rice with her prednisone, and she threw everything up about an hour later.

Aside from the diarrhea, she had been acting normal yesterday with good energy and she was acting hungry all afternoon and evening, begging for food. She was the same this morning, but has been resting this afternoon. She isn’t acting lethargic as she’s still alert and interested in her surroundings, just a little tired.

Any ideas? I don’t think that she has ever had white rice on its own so that could explain the vomiting, but I’m not sure. I hate to withhold food since she has lost so much weight but also don’t want to aggravate her GI tract right now. I called and left a message for her doctor earlier today but have yet to hear back.

Any advice would be greatly appreciated. This whole experience has been such an isolating and difficult ordeal. It’s nice to know that there are people out there who are willing to share their experience and advice.

Thank you!


Details

Vally

Keymaster

Hi Shay and welcome to the site.

I’m glad to hear Addy has improved and fingers crossed, she’ll keep doing that.

I wonder if you would ask your specialist about using sucralfate. This works as a bandage to the stomach and helps to heal and protect it. The omeprazole is more to reduce acid and will help, but the sucralfate is excellent for stomach issues, if that is what’s happening. It must be given away from other drugs though, or it stops their absorption. Ideally last thing at night is good and 2 hours away from food and drugs. It makes it hard to dose, I know.

Use a sushi type rice if you can, it’s more sticky. You can also use plain tinned pumpkin (or steamed pumpkin) – NOT pie pumpkin, as that contains sugar I think.

Just on a side note, Cyclosporine, according to the manufacturer’s information sheet, does not suggest freezing. I do know that many people do do it that way as it seems to help with gastric problems, so I’ve never done it.

The denamarin will help with the liver issues too.

Let us know what the specialist says.

Regards and best wishes
Vally (angel Bingo) and Saba


Details

Shay

Guest

Hi Vally,

Thank you so much for your quick response! Addy was actually on sucralfate for 10 days a few weeks ago. A couple of days after we took her home from the hospital, she started producing melena, and we suspected she had developed an ulcer. The sucralfate helped almost immediately! I will talk to her vet about putting her back on it. Thank you for the suggestion! It will be tricky to time the dosing especially since she is on both denamarin and cyclosporine, but I’ll figure it out.

I will pick up a sushi type rice tomorrow. I gave her jasmine rice and it was sticky (probably from being undercooked), but another type is worth a shot. I offered her canned pumpkin this morning, but she turned her nose up to it. She has always been a picky eater. I thought about syringe feeding her some but decided against it. I’ll offer it again tomorrow.

Her vet suggested freezing the cyclosporine. He said that although there is no scientific evidence that says it helps with gastric issues, several of his patients swear by it. I’ve read some people say freezing it takes away the odor, but I still smell it after opening it. Have you heard or read anything about whether freezing it can reduce its effectiveness?

Thank you again for your kind words and suggestions. I will report back after speaking with her doctor about the sucralfate.

Best,
Shay and Addy


Details

Vally

Keymaster

Shay, if you want a hand in sorting out dosing times, I’d be happy to help. I love making people get up at 4 am to start the dosing, and then keep you awake until midnight. Seriously, I’d be happy to make up a chart for you. If you would like one, please let me know what times and doses you are doing.

With the rice, it’s better to actually overcook it in extra water until the rice is very soft. You can give some of the rice water too.

Vally & Saba


Details

Viewing 4 posts – 1 through 4 (of 4 total)

Reply To: New to IMHA, help with diarrhea and vomiting
Your information:







Shay
Guest

Hello,

Five weeks ago today, Addy, my 11.5yo Australian shepherd/German short-haired pointer/lab mix, was diagnosed with IMHA. It’s been an emotional rollercoaster, but I’m happy (and lucky) to say that she has improved bit by bit each week. I would be happy to go into more detail about her story in a reply to this post but just want to briefly summarize where we are at today and ask for your advice on how I should treat the diarrhea and vomiting she’s been experiencing.

Addy has been seeing an internal medicine specialist since her diagnosis. Her PCV has been stable around 35-36 for the past 3.5 weeks, but unfortunately, according to last week’s blood work, she is still showing signs of hemolysis with spherocytes in her blood. We will check her blood again in about a week and if she still has spherocytes, will probably have to add another immunosuppressant to her regiment.

Her liver enzymes are high (I don’t have the exact numbers right now). She was on denamarin for several months prior to the IMHA diagnosis and has been back on it for the past week. Her bilirubin is also very high and measured 3.7 one week ago (although that is much better than the 33 it was 4 weeks ago when we took her home from the hospital).

Five weeks ago, she was a healthy 50 lb dog. When we took her home from the hospital 4 weeks ago, she was really swollen and weighed 58 lbs. At her last weigh in one week ago, she was 39 lbs. Getting her appetite back has been a struggle, and I have had to syringe feed her until this past week when she started eating better on her own.

She is currently taking 100mg of cyclosporine (stored in the freezer) 2x per day, 30mg of prednisone (20mg in the morning, 10mg at night), 20mg of omeprazole 2x per day, and 34.5mg of clopidogrel at night.

She has done two rounds of metronidazole, the most recent of which finished 3 days ago, for previous bouts of diarrhea. I expressed concern about the potential for interaction between the metronidazole and cyclosporine to her vet, but he assured me that it had been okay in other dogs that he had treated.

Overall, the past week has been positive. Addy had been eating more on her own and was finally exceeding her caloric requirements. Additionally, her bowel movements were formed more often.

However, yesterday morning, a few hours after a small but normal bowel movement, she started having diarrhea again. She has gone about 10x in the past 36 hours and about 1.5 hours ago most recently. For the most part yesterday, I withheld food save some chicken and white rice a few times. This morning, I gave her about 1oz boiled chicken with about 1/4c white rice with her prednisone, and she threw everything up about an hour later.

Aside from the diarrhea, she had been acting normal yesterday with good energy and she was acting hungry all afternoon and evening, begging for food. She was the same this morning, but has been resting this afternoon. She isn’t acting lethargic as she’s still alert and interested in her surroundings, just a little tired.

Any ideas? I don’t think that she has ever had white rice on its own so that could explain the vomiting, but I’m not sure. I hate to withhold food since she has lost so much weight but also don’t want to aggravate her GI tract right now. I called and left a message for her doctor earlier today but have yet to hear back.

Any advice would be greatly appreciated. This whole experience has been such an isolating and difficult ordeal. It’s nice to know that there are people out there who are willing to share their experience and advice.

Thank you!

Details
Vally
Keymaster

Hi Shay and welcome to the site.

I’m glad to hear Addy has improved and fingers crossed, she’ll keep doing that.

I wonder if you would ask your specialist about using sucralfate. This works as a bandage to the stomach and helps to heal and protect it. The omeprazole is more to reduce acid and will help, but the sucralfate is excellent for stomach issues, if that is what’s happening. It must be given away from other drugs though, or it stops their absorption. Ideally last thing at night is good and 2 hours away from food and drugs. It makes it hard to dose, I know.

Use a sushi type rice if you can, it’s more sticky. You can also use plain tinned pumpkin (or steamed pumpkin) – NOT pie pumpkin, as that contains sugar I think.

Just on a side note, Cyclosporine, according to the manufacturer’s information sheet, does not suggest freezing. I do know that many people do do it that way as it seems to help with gastric problems, so I’ve never done it.

The denamarin will help with the liver issues too.

Let us know what the specialist says.

Regards and best wishes
Vally (angel Bingo) and Saba

Details
Shay
Guest

Hi Vally,

Thank you so much for your quick response! Addy was actually on sucralfate for 10 days a few weeks ago. A couple of days after we took her home from the hospital, she started producing melena, and we suspected she had developed an ulcer. The sucralfate helped almost immediately! I will talk to her vet about putting her back on it. Thank you for the suggestion! It will be tricky to time the dosing especially since she is on both denamarin and cyclosporine, but I’ll figure it out.

I will pick up a sushi type rice tomorrow. I gave her jasmine rice and it was sticky (probably from being undercooked), but another type is worth a shot. I offered her canned pumpkin this morning, but she turned her nose up to it. She has always been a picky eater. I thought about syringe feeding her some but decided against it. I’ll offer it again tomorrow.

Her vet suggested freezing the cyclosporine. He said that although there is no scientific evidence that says it helps with gastric issues, several of his patients swear by it. I’ve read some people say freezing it takes away the odor, but I still smell it after opening it. Have you heard or read anything about whether freezing it can reduce its effectiveness?

Thank you again for your kind words and suggestions. I will report back after speaking with her doctor about the sucralfate.

Best,
Shay and Addy

Details
Vally
Keymaster

Shay, if you want a hand in sorting out dosing times, I’d be happy to help. I love making people get up at 4 am to start the dosing, and then keep you awake until midnight. Seriously, I’d be happy to make up a chart for you. If you would like one, please let me know what times and doses you are doing.

With the rice, it’s better to actually overcook it in extra water until the rice is very soft. You can give some of the rice water too.

Vally & Saba

Details
Viewing 4 posts - 1 through 4 (of 4 total)
Reply To: New to IMHA, help with diarrhea and vomiting
Your information: