Not producing enough red blood cells – Page 4

Keymaster

Terri,
I’ve looked into Cellcept (Mycophenalate) before on behalf of previous owners. The main problem with this drug is that it a human drug being used off label for veterinary treatment. That’s not unusual, many human drugs are used for dogs because there is just not enough money or interest to test many human drugs for use in animals. So some veterinary clinics started using it to see if they could fit it into their clinic protocol. So it has been become more popular. That doesn’t mean that it doesn’t concern me that the side effects are not clear in dogs.

So never-the-less it is used in human medicine, and there are some significant side effects in humans on Mycophenalate, enough that I always mention to concerned owners that they should be aware of them and cautious. Here is a human study that indicates some serious gastrointestinal side effects.

https://www.ncbi.nlm.nih.gov/pubmed/21094821
“Mycophenolate mofetil (MMF) was introduced as a new immune-suppression drug in the mid-1990s. It is widely utilized in solid-organ transplantation immune-suppression regimens. Side effects include gastrointestinal (GI) toxicity in the form of nausea, vomiting, and diarrhea. Physicians tend to reduce the dose of MMF or switch their patients to an enterio-coated formula to overcome the side effects. Because GI side effects are well linked to MMF, colonoscopy is not utilized in most of the cases to investigate the diarrhea. However, Crohn’s disease-like changes in the colon, erosive enterocolitis, and graft versus host disease-like colonic changes associated with the use of MMF have been reported.”

So why does this happen? The short story is the way these drugs work is to cause changes in certain cells to reduce their numbers. Cellcept is attempting to lower the number of a certain type of cell that may be responsible for the autoimmune attack. But the cells of the digestive tract can be similar and they can also be affected.

Prednisone is a commonly used drug to reduce gastrointestinal inflammation and you are already giving that.

Looking up the effectiveness of metrondiazole for dogs with IBD, I find this hopeful information from the 2006 World Conference Update On Inflammatory Bowel Disease.
https://www.ncbi.nlm.nih.gov/pubmed/21094821
“Treatment with antimicrobials can be justified in IBD, in part to treat secondary SIBO, and partly due to the importance of bacterial antigens in IBD pathogenesis. Ciprofloxacin and metronidazole are most commonly used in human IBD, but metronidazole is the preferred drug for small animals. The efficacy of metronidazole may not just be related to its antibacterial activity, since there may be immunomodulatory effects on cell-mediated immunity. Further, other antibacterials such as tylosin may also have immunomodulatory effects, and empirically this drug has proved useful in many cases. In fact, a recent study in a rodent model of intestinal inflammation has shown that both metronidazole and tylosin are effective in decreasing inflammation. Finally, cases of HUC have recently been show to antibacterials such as enrofloxacin, suggesting a possible infectious agent underlies this condition. In fact, a recent study has confirmed the presence of invasive E. coli in HUC lesions.”

So, as I have always believed, metrondiazole is very reliable in veterinary treatment for diarrhea and colitis. I will remind you that high doses over long periods of time can lead to certain side effects. I have also experimented with my vet using the lowest effective dose for longer periods of time which were very effective and tolerated. I think I remember that Chance, at 93lbs, should have been getting something like 1000 or 1200 mg a day, split into 2 doses. We dropped that to 100mg twice a day after a short time and it worked very well.

The next thing to look at is making sure that the diet is non abrasive and does not irritate any further. I’ve returned to Mary Stauss’ site DogAware for more help.
http://dogaware.com/health/digestive.html
“In general, you want to stay away from all grains and other starchy foods that take a long time to digest, such as potatoes and corn, limit the amount of fiber (from vegetables), and avoid dairy, to see if that helps.”

Look at your dog food for this:
“Carrageenan, an ingredient used as a thickening agent in many canned foods, has been associated with intestinal ulceration, inflammatory bowel disease (IBD), and acid reflux. While most studies have been done on carrageenan, it’s possible that other thickening agents, such as carboxymethyl cellulose, polysorbate 60 and 80, guar gum, xanthan gum, and agar agar, may also contribute to digestive problems in sensitive dogs.”

“Many dogs with IBD, chronic pancreatitis, or other gastrointestinal problems have difficulty digesting fat and may need a low-fat diet.”

My usual diet for simple diarrhea is scrambled eggs and deli rotisserie chicken. But with the liver involvement you may want to investigate Dr. Dodds Liver Sparing diet. It the top item on this page.
https://www.secondchanceaihadogs.com/nutrition-resources

Mary lists a number of supplements that she recommends. You might try one of these as well. This one, glutamine, would be something I would try if I was faced with colitis.
https://vcahospitals.com/know-your-pet/glutamine

I am upset by the finding by Dr. Dodds about the extreme hypothyroidism. This is something she pushes to be one of the first diagnostic tests that should be run when a dog develops an autoimmune issue. Many vets don’t bother with the testing or they only test one part of it. Then if they see a very low, but normal level, they accept this as perfectly normal and refuse to treat it. Dogs do far better when they fall in the middle of the range between high and low. My breed, Giant Schnauzer, can be severely impacted by low normal thyroid, suffering behavior changes, epilepsy, and as was the case with Chance, profound bone marrow failure.

So please request this brand of thyroid supplement, Thyro Tabs, I have used this for years to treat my dogs. My vet’s medical technician did extensive research to ensure they were providing the best. You can find the product insert on this page, near the bottom. Click on the picture of the Thyro Tabs pill bottle. Print this page and present it to your vet asking for a prescription. Do not accept any other generic substitute, they are not effective in dogs.
https://www.secondchanceaihadogs.com/medication-resources

The liver “damage” is a normal part of using prednisone. The liver processes this drug and liver cells are damaged, releasing enzymes into the blood. These enzymes can become very high, the liver can be extremely sensitive and enlarged. It can feel very uncomfortable for dogs. The important thing to know is that the liver is regenerative. If there was no organic disease prior to this, then it will heal once the prednisone is decreased. Please do not be alarmed but please do use the supplement Denamarin.

I highly recommend the use of Denamarin, a supplement, when the liver is severely damaged. When Chance was so sick from prednisone after several months, Dr. Dodds asked me to send his values from the chem screen test. His ALKP, which has a high normal value of around 212, was over 8600. I started the Denamarin and within a few weeks his value was down to 318. I really stand by my recommendation to use this. You can find the product insert and brochure for Denamarin on this page:
https://www.secondchanceaihadogs.com/second-chance-resources/supplement-resources

Please send me copies of the CBC and Chemical Screen tests. I would like to stay on top of what is going on, these things should have been addressed much sooner. You can use the Urgent Advice page, look at the top menu, and attach the files to this. They come to my email.

I am out of town for a few days and in a place where sometimes I don’t have cell reception. I will do the best I can to keep up.
My best, patrice

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