New Diagnosis - Please help!

[Shirl D.]

Please take him to the vet right away. The symptoms you are seeing may be metronidazole toxicity. I'm NOT a vet, so please don't think I am diagnosing him in any way, but it can be serious and I want to make sure it's looked at immediately if it's a possibility. Here's a cut and paste with one story about metro toxicity from our website. I thought it usually happens with long term metro, but you never know.

Warning – a personal story with an EPI dog and Metronidazole Toxicity
In some rare cases …. some dogs “may” have an adverse reaction to Metronidazole… especially if used long-term. The treatment is to stop the Metronidazole immediately…. but Valium may also be used as an antidote to Metronidazole poisoning. The following is an actual example of an Metronidazole poisoning with an EPI dog:
Dave & Linda, owners of Sasha
August 2011

Our GSD, Sasha, was taking Metronidazole and was on her third round. I let her outside in the late evening to do her business before bedtime. Walking back to the house, she began to stumble and stagger, barely making it up the back porch steps. The best way to describe her walk was as if she were in a drunken stupor. Then when she came inside, she threw up four times. The fact that she had a hard time standing and walking really scared us, so my husband took her to an emergency vet center since it was already 10 p.m. After racking up a $1258 bill there, we received a call at 8 a.m. (Sasha was left there overnight) the next morning informing us our dog was getting worse, now not being able to stand at all and her eyeballs were rolling around in her head. They suggested we come pick her up and take her to another hospital to see a neurologist. Our poor Sasha had to be rolled out on a gourney and lifted and put in the back seat of our car.
After the 25 mile drive to the other hospital, techs lifted Sash out of our car and carried her in on a stretcher! She laid sideways on a mat on the floor as her eyes continued to roll in her head. It was heartbreaking, and we thought for sure we would lose her. The neurologist suspected Metronidazole toxicity but said he wanted to rule out a brain tumor or spinal infection so told us he wanted to perform an MRI on her head and do a spinal tap. We agreed to this but are always hesitant about anesthesia, especially with a dog in this condition.
This is where we made another costly mistake. In retrospect, looking up the side effects of Metronidazole, a rare side effect is built-up toxicity from it, of which Sasha had the exact symptoms – vomiting, unable to walk or stand, disorientation, the eyes rolling. Time and Valium is the antidote.
The MRI and spinal tap came back normal. so the vet started Sasha on Valium, and within 24 hours she made a remarkable improvement. We picked her up the next day and could not believe that was the same very sick dog we left there, as she waked right up to us with her tail wagging!
This was a $3,900 lesson. My point is if your pet is on Metronidazole and you notice any side effects that affect the central nervous system, Stop the metro immediately. Go to your vet for the Valium. We could have saved a lot of money if we would have gone this route at first. If after a day of the Valium there was no improvement, then the MRI and spinal tap would have been needed.
Hope our story helps someone. These scary and horrible side effects from the Metronidazole are rare, but they do happen, so be mindful of them if you pet is on this medication. I am also happy to add that Sasha doesn’t appear to have any residual effects and was totally back to her normal self within a few days.
Since this story there have been approximately 5 cases of Metro toxicity/poisoning from members on the Epi4Dogs Forum. Although easily reversed, some vets are now opting not to use Metronidazole if there is another option.

[Shirl D.]

I just realized that your post was from last night. Please let me know how he is doing. Call me if you want. 845-399-7539.

[Barb]

Andrea, I was offline yesterday and have just read your thread. I hope you have some answers for Blu ....I am so sorry you are going through all this. It sounds like there was a reaction to the metro, but please let us know when you can if this is the case. We will be looking for an update as soon as you are able.

Thinking of you and Blu.

Barb

[Shirl D.]

Andrea just emailed me copies of bloodwork from the Emergency vet today and from 6/14 when he was there last. I'm uploading them here for reference,

[Shirl D.]

Client.pdf

(667.51 KiB) Downloaded 194 times

Client.pdf

(667.51 KiB) Downloaded 194 times

[Olesia711]

Hi Andrea, this is Olesia, First i hope that Blu is okay, TG you took him in to the emergency vet. His lethargic state could be from the Metronidazole which i would ask the vets to stop immediately and switch to Tylan. Also, with the tick disease, Anaplasmosis, i am not sure when it i was caught but sometimes that can trigger an immune mediated conditions like thrombocytopenia (whcih is VERY similar to IMHA that my dog had) which will display with low hematocrit, (HGT).....but it looks like Blue has had low HGT since last year?? In any case, not only can metro toxicity can trigger lethargy... so can Anaplasmosis.

1. Because i do not know if this tick disease has been taken care of or not, i would continue with the Ciproflaxin..... and especially if this has segued in thrombocytopenia.
2. With the Metro, i would tell (not ask) the vet you want to stop and give Tylan instead.
3. Depending on the possibility of thrombocytopenia, you may have to keep Blu on steroids.
4. The Cobalamin is low/normal.. as an EPI dog he need to be on B12 as part of his regimen. Glad that you ordered the Pet Factor B12.
5. The Folate score of 6.2 indicates that Blu has some sort of food sensitivity (this happens with a lot of EPI dogs) so although you ordered Sport Elite (which i used and loved:)) it may or may not work for Blu. Try it, but if loose stools continues- -long after enzymes and tylan, you might want to look at a prescription hydrolyzed food........
6. The Maropitant is Cerenia.... unless your dog is throwing up, i wouldn't bother using.
7. I'd keep Blu on the Omeprazole... especially if he is have what you think looks/sounds like acid reflux.... once you start the enzymes and he has been on them for a while, if he doesn't show any "acid-reflux" like symptoms, THEN i would stop the OMeprazole on only use if necessary.
8 The Proviable is a good probiotic.... BUT.... i see where yo are giving two... this also could be triggering loose stools.... so this is something i would stop (temporarily) and then start up again with just one Proviable product and start with only half a dose... watch the poos and see if this triggeres loose stools or if it is fine. if fine, then i would increase to full dose after a week or two... but i would NOT give two proviable product... ALSO... give this 2 hours AWAY from any anti and will not kill the bacteria in the Proviable.
9. Diphenoxylate is an opioid for diarrhea.... and this may not be necessary at all once you get Blu on enzymes for EPI diarrhea AND Tylan diarrhea to treat SID......

I would ask the vet if Blu now test negative for Anaplasmosis, which i am assuming that they treated with Doxycycline.... Sometimes dogs have to have multiple treatments to get tick disease fully treated.

I agree with Shirl, hold off on the SLippery Elm. When my dog had IMHA, i had to take her off Cerenia (it jacked up her Diabetes blood sugar ) and used Slippery Elm powder instad and she did MUCH better on SLippery Elm.... BUT.... for now, Blue has multiple things going on and taking multiple meds... so hold off for now, but you may need to add later.

The lethargy Blu is experiencing could be from the low HGT value. IMHO This needs to be closely watched...... when my gal had IMHA, she went down to 16, and we were on the hairy edge of her needing a blood transfusion, luckily her HGT started coming up.. but between HGT 16 and HGT in the 20's we were testing her blood bi weekly and then weekly.... cause it can be touch and go.

I hope Blu is okay.
Not sure if i answered all your questions, but hope i helped out a little bit. SOoooooo glad Shirl was online to help you out!.

[Rapids77]

Just wanted to give a quick update on Blu boy.

Last night was scary but I was able to bring him home for the ER vet at about 3:30is this am. The vet didn't really have any answers but go some fluids on board and ran the blood work that was posted earlier. After reading the concerning info about Metro Toxicity, we have discontinued the use of that drug. And....drum roll, he seems MUCH better today. Now, we're changing lots of things all at once so I can't say for certain that the Metro was the culprit, but I'm thrilled that drunk stumbling dog is back to sober, slightly smiling serious boy.

The vet did say he thought Blu might have other issues like IBS as dogs "don't just lose 20+ pounds in a month" and recommended we go to an internalist/specialist for a colonoscopy and other tests. I'm not sure I agree after reading all the stories here and elsewhere but I think I'm going to give it a little time here to see if we can turn Blu around before pursuing that route.

We've also received our new food (Dog Sport Elite) and the Wonderland b12 supplements. Additionally, my original vet had to call and order Tylosin but it should be here early next week and we will start on that as soon as it arrives. Overall today has been a good day. He had 2 to3 loose poops this morning (I'd say around a 2 on the scale, maybe 1.5) I'm learning I must take him out myself if I want legit answers on his poop, the kids are just far too enamored with the poop scale to know if the poop they're arguing over is even brand new. Sidebar there: I was having a REALLY rough time picking up his poop as, you know, that free flow model doesn't scoop well. But I found this awesome set on Amazon and it comes with a rake and the rake = an absolute miracle. I can now get it all cleaned up right away so he doesn't decide to circle around and have it for dessert. https://www.amazon.com/gp/product/B07ZP ... UTF8&psc=1

Blu is still concerned that I'm trying to poison him with his food as he eyes it suspiciously with the new smells from the enzymes. He ate both feedings today though and I used minimal toppers. Definitely planning to get some green tripe and also some raw pancreas to mix in / have just in case all else starts to fail.

I think that's it for now. Another huge shout out to both Shirl - I'm pretty sure I'd still be ugly crying in a corner somewhere if it wasn't for your compassion and guidance!

[Rapids77]

Hello Olesia! I just saw and skimmed through your message - thanks so much for all the great information. I am going to carefully read through it all tonight and make sure I grasp / understand everything you've said. I cannot tell you how thankful I am for your site, forum and the incredible people here. You guys are truly sanity (and life) savers. I'll inevitably be back later tonight with questions on your message. Thanks!

[Barb]

I'm so glad Blu is improving. And so glad you stopped the metro. It sounds like he came through the crisis. You are in good hands with Olesia and Shirl. Please keep us updated when you can. I love that you have kept your sense of humor through all of this!

Barb

[Olesia711]

Hi Andrea,

Thanks for the update and glad to hear that Blu appears to be feeling better.... if this improvement continues (not lethargic) then it is fairly reasonable to suspect that the culprit was the Metro.

SO glad you got the enzymes and B12... and that your vet ordered the Tylan. please keep notes on EVERYTHING you are giving blue (amount, brand name, time given and how you gave) as keeping notes will help you see if each change you make is helping or hindering Blu.....
If you want, go to this page and download (or upload) an EPI log template
https://epi4dogs.com/epi-log/ .... this will help you keep track of Blu's progress... and it will also help you vet figure out what is going on.

Regarding the scope... the vet is correct in that a scope is the ONLY proper way to determine if IBD is going on.... BUT.... quite honestly.... you can pretty much tell via process of elimination or trying hydrolyzed foods.... so we always push the less invasive way first . If you do eventually need to put Blu on a hydrolysed diet for suspected IBD, the hydrolyzed food that we recommend for EPI + IBD dogs is Royal Canine "Ultamino" food.... so far this particular food seems to work the best on a larger percentage of these dogs. Not all, but most of them do best on Ultamino if they are also dealing with IBD.

If Blu is doing #1+ or #2 poos (according to the poo grading chart here on the website) then that is darn good.
Please give us an update daily so that we can help you better help Blu get feeling better.

And YES!!!! Isn't Shirl WONDERFUL??!!! We think she rocks! She gave you great advice and i am glad things are looking up now!