Might be running out of options for Lucy....
Lucy went in for a dental cleaning on Monday and I got some more bad news for her. Yet another medical complication in her saga. Before I explain that, let me back up a bit and explain how we got here.
Lucy did terrific on my month of travels at the beginning of the summer. Shortly after we moved however, she had an IBD flareup. She started having runny stools and loss of appetite again. So I quickly found a new vet in our new hometown and took her in. After some consultation, we decided to try to increase her cyclosporine dose and attempt to ween her off of prednisone. Her cyclosporine level was at 190. The reference ranges for an anti-inflammatory dose is 300-600 and for an immuno-suppressive dose is 600-1500. After consulting with a pharmacologist at the NCSU vet school, we decided to aim for 600. That meant doubling her dose as often times as the levels increase, the absorption by her body gets better and a doubling of the dose can lead to more than a doubling of the level. We decided to keep her on the prednisone until the cyclosporine level increased sufficiently. We'd recheck in a month.
A month later, her new cyclosporine level came back and it had actually dropped from 190 to 175. So we doubled the dose yet again. This presented some problems for her as she started having some additional stomach upset. So I backed off and slowly increased the dose again. After two weeks, I got her onto the full dose and so we went another month to let her level stabilize. During this time, she continued to have periodically runny stools, but her appetite was reasonably good. Nearing the end of the month, I started to notice that it looked like her incisors were receding into her gums. So when I took her in for another cyclosporine level recheck, I scheduled a dental appointment for her.
The good news is that her cyclosporine level is now 630 which is where we want her. The bad news, she still is having IBD problems. The horrible news is that as a result of the high dose of cyclosporine, she has developed severe gingival hyperplasia. This basically means her gums are severely overgrown, causing her some pain, difficulty chewing (NOT GOOD for a dog with digestive problems), and are potentially a breeding ground for harmful bacteria that her body won't be able to fight due to the immuno-suppressive dosage of cyclosporine.
So now we're stuck between a rock, a hard place, a firing squad, and a speeding train with no apparent exit. :-( To fix the hyperplasia, I can either put her through fairly involved and painful oral surgery to remove overgrown sections of her gums every 12 weeks or so, or I can back off on the cyclosporine which is basically keeping her body from destroying it's own small intestine. All the while she's still stuck on prednisone which is giving her the full body shakes and some SERIOUS food guarding issues, not to mention depression.
I'm writing this post mainly to ask for some suggestions. I need to think outside the box on this. Her new vet is awesome and is making phone calls to experts around the country to get ideas for treatment options. But I figured I'd cast a wide net and see if maybe someone not so intimately involved in her situation might have a good idea for us. Any and all thoughts would be greatly appreciated.
Lucy did terrific on my month of travels at the beginning of the summer. Shortly after we moved however, she had an IBD flareup. She started having runny stools and loss of appetite again. So I quickly found a new vet in our new hometown and took her in. After some consultation, we decided to try to increase her cyclosporine dose and attempt to ween her off of prednisone. Her cyclosporine level was at 190. The reference ranges for an anti-inflammatory dose is 300-600 and for an immuno-suppressive dose is 600-1500. After consulting with a pharmacologist at the NCSU vet school, we decided to aim for 600. That meant doubling her dose as often times as the levels increase, the absorption by her body gets better and a doubling of the dose can lead to more than a doubling of the level. We decided to keep her on the prednisone until the cyclosporine level increased sufficiently. We'd recheck in a month.
A month later, her new cyclosporine level came back and it had actually dropped from 190 to 175. So we doubled the dose yet again. This presented some problems for her as she started having some additional stomach upset. So I backed off and slowly increased the dose again. After two weeks, I got her onto the full dose and so we went another month to let her level stabilize. During this time, she continued to have periodically runny stools, but her appetite was reasonably good. Nearing the end of the month, I started to notice that it looked like her incisors were receding into her gums. So when I took her in for another cyclosporine level recheck, I scheduled a dental appointment for her.
The good news is that her cyclosporine level is now 630 which is where we want her. The bad news, she still is having IBD problems. The horrible news is that as a result of the high dose of cyclosporine, she has developed severe gingival hyperplasia. This basically means her gums are severely overgrown, causing her some pain, difficulty chewing (NOT GOOD for a dog with digestive problems), and are potentially a breeding ground for harmful bacteria that her body won't be able to fight due to the immuno-suppressive dosage of cyclosporine.
So now we're stuck between a rock, a hard place, a firing squad, and a speeding train with no apparent exit. :-( To fix the hyperplasia, I can either put her through fairly involved and painful oral surgery to remove overgrown sections of her gums every 12 weeks or so, or I can back off on the cyclosporine which is basically keeping her body from destroying it's own small intestine. All the while she's still stuck on prednisone which is giving her the full body shakes and some SERIOUS food guarding issues, not to mention depression.
I'm writing this post mainly to ask for some suggestions. I need to think outside the box on this. Her new vet is awesome and is making phone calls to experts around the country to get ideas for treatment options. But I figured I'd cast a wide net and see if maybe someone not so intimately involved in her situation might have a good idea for us. Any and all thoughts would be greatly appreciated.
Comments
We also have experienced the dental issue with our Shiba but probably not in the same degree. In April we took her in for dental and she came out of it pretty well after having a few teeth pulled and the gums cleaned up. However, we do still get bleeding of the gums and so we are being more diligent about brushing and rinsing.
There is oral rinse (cholrhexidine oral rinse) that can be of help to flush the mouth. I would ask about that to see if it will help in your case if properly diluted. Another thing is supplementing with is Coq10 60 mg. Thus far these things have helped some overall.
You are in a tough place at this point though given the cross complications. Did the vet have a rough idea how quickly the gums would overgrow again after the dental?
In our case our decision for using the drugs was based on making our dog as comfortable as possible even if it meant a shorter life and missing teeth in the end. Right now our Shiba is on some mushier food and this has helped with the eating, but again we are not dealing with aggressive IBD. So far so good she has just hit the 9 yr mark and we are still trucking. I would not give up just yet.
I know what I state does not offer much, but here's hoping for the best and there maybe some other suggestions the vet can offer.
Snf
I wish I could offer some helpful advice, but I know nothing of IBD or the side effects of the cyclosporine.
But I will offer you my sympathies and thoughts. I know the dealing with this is not easy. But I know how much you love Lucy and how much you have done for her. So I hope that between everyone here and your vet, you will find a solution that will be both beneficial and easy on Lucy.
So I'll just send good thoughts to you both, and hope that someone comes up with something that can help her.
*hugs to you both*
I did speak to her vet today, and we have a plan, but it's not really a solution. We're going to stop the prednisone and cyclosporine and put her on budesonide and azathioprine. Budesonide is a steroid like prednisone and azathioprine is an immuno-suppressive like cyclosporine. The side-effects of these drugs are equally bad, but are very different than what she is currently on. The hope is that we can keep her stable on these for 3-4 months to let her body recover from the effects of what she's been on, and then switch her back for 3-4 months, then switch again. etc. The hope with this plan is that by switching, her body won't succumb to the side effects as seriously and that her immunity to their positive effects will grow more slowly.
This plan is clearly delaying the inevitable. But, if it keeps her happy for another year or two, I'll gladly do it. If she's not happy, then I'll have a really tough decision to make. For now, I'm optimistic that I can make her comfortable for the foreseeable future though.
Thanks again for the support!
I hope that it helps her and makes her a little more comfortable than she is now. Keep us updated on how this goes.
All the best with this "solution", I hope it is a success and that she will be happy.
Will be keeping Miss Lucy in my thoughts.
I give my dogs (Akita and Chinook) a plant based probiotic power 1/4 tsp in their meals morn and night.
This is a more frequent problem in lost of dogs these days.
You might want to join the K9kitchen list @yahoogroups.com). It's moderated by Monica Segal and other nutrition people and there are other peoples with dogs with Lucy's problem,
or you might get a consultation about the diet you are feeding little girl.
(www.monicasegal.com)
She also has some brochures on IBD, I believe.
I'm sorry Dave,
Britain
Yes, she's got a long-winded scientific name for her diagnosis, but I've long since forgotten it. We did have a nutritional consult with the nutrition group at NCSU. I had all three of the vets completely stumped. So much so, they haven't charged me for the visit and I still haven't gotten a recommendation from them. Lucy is just that complicated a case. Luckily she's hanging in there right now.
Thanks for the suggestions though!
Thanks for asking!
If you can find the long winded disease name I'll try to find what I can about research altho I'm sure your vet knows this.
As for other questions, is your vet a subscriber to VIN?
Have you gotten a 2nd opinion?
To follow up, Lucy tested positive for three of the four varieties of IBD in dogs: Lymphocytic-plasmacytic IBD, Eosinophilic IBD, and Regional Granulomatous. L-P IBD is the "garden variety" IBD that is most common. Eosinophilic IBD, as I understand it, is commonly developed after a prolonged parasitic infection (Lucy had giardia and hookworm for months leading up to and shortly after I got her). I don't recall the description of Regional Granulomatous, but I think it has something to do with fibrous tissue in the intestine.
As for 2nd opinions, yes. In fact we're on our fifth or sixth opinion right now. :-/ One of the specialists that has contributed to her care is at NC State's veterinary teaching hospital. They helped track down a cryptosporidium diagnosis that had eluded our regular vet, but that's about all they've contributed. The nutritional specialist at the NCSU VTH was completely dumbfounded by Lucy's case and ultimately didn't suggest changing anything about her diet.
You have done everything, now I see, and thank you for taking the time to explain. She's obviously in the right home. I can imagine that it has been so frustrating and so sad for you.
I have the names of the diseases and I think I will become more familiar with what Lucy is going through.
Thank you very much and give Lucy a little hug.
I am so sorry.