Toxic reaction to medication - MDR1?

[Rebecca bratter]

I"m reaching out for some advice and input here as our baby girl Madiba is in bad shape.  She is a 2 year old aussiedoodle, I think shes F2B, or the product of 2 aussiedoodles, I can say that her personality is for the most part, all Aussie, she is a seriously smart, playful, intuitive, somewhat human like dog with a strong herding instinct.

We had to hospitalize her last Wednesday as she came down with what is generally referred to as HGE, a catch all I guess for bloody, watery diarrhea coupled with abdominal pain.  We took her to her vet and she was given meds and a subcutaneous injection for dehydration.  She came home and by evening she was getting worse, in a lot of pain and breathing heavy, couldn't walk easily.  Early on thursday we took her to the 24 hour animal hospital, we have never been here before and it was not necessarily our choice, but it was an emergency . We visited her that evening after a full day of IV fluids and she was much much improved, looking great, usual happy self, we brought her bland chicken and rice and we limited it to a small serving and she gobbled it up.  Next day the doc called and said she was alert and looking good and could go home but he would ideally like to keep her another day to keep hydrating her.  No way we wanted to leave her there if we had a choice.  When we picked her up, I can only describe her state as looking as if she was heavily sedated combined with a light stroke.  She couldn't keep her eyes open and she couldn't stay on her feet, her back legs seemed weak and if she stayed upright for a few moments she couldn't keep her eyes open and she would fall asleep on her feet and fall over.  I can't tell you how alarmed and sad I felt to see this.  We have no experience with this situation so my husband and i mistakenly thought she was exhausted from her experience.  She's never spent a night away from both of us before.  But by evening, she was looking really bad.  She was not functional and just slept both on her feet and laying down and she couldn't seem to put her tongue back in her mouth.  We took her back to the hospital at 2am and talked to the vet about what could be causing this secondary reaction and then I started researching and googling like crazy.  So we know that many herding dogs carry the MDR 1 gene mutation and one of the medications they cannot tolerate is imodium.  Madiba was fine until they gave her imodium.  We thought it was the metronidazole so we pulled her off of that and I asked them to pull the imodium, but they didn't.  We had her detoxed and she was given activated charcoal and once that happened she did perk up a bit.  But her body temperature keeps dropping and her heart rate is slow.  We saw her yesterday and she was in bad shape again and I found out they have continued to give her imodium, i flipped.  Now they have pulled the imodium and are changing all of her meds.  She is completely out of her stupor and is alert, her diarrhea is subsiding but her vitals are not bouncing back and the docs can't seem to keep her temperature up, she is with a heat lamp and hot water packs.    Now about 24 hours have passed since her last imodium dose but honestly, I am just going on a theory here about MDR 1 and a toxic reaction to imodium.  I have spoke with poison control and asked if they could give her naxologene, which is supposed to be an anti dote, but they don't have it.

I am scared to death that I'm going to lose my precious baby if her vitals don't stabilize.  She is on constant fluids but she won't eat.  Is it possible that this substance takes a while to clear the body and she will bounce back once it does?  I know it affects the blood/brain barrier and it's not just in the bloodstream.  I have no experience  with this but seeing her complete change in mental state and alertness once off the imodium and her lapse into a sedated stupor when they give her this med, I am thinking she carries the MDR 1 gene and is reacting.  

Any thoughts or ideas from anyone who might have some experience with this would be greatly appreciated.  She's been in the hospital almost 4 days now.  I want her home desperately. We tested her for Addisons and she is negative and we had a sonogram and they saw nothing unusual.  Thanks.

[Shari Becker]

Rebecca, I am so sorry for your pup's health struggles. It sounds so scary. I personally would do everything in your power to get a second opinion or a second expert to weigh in. Possibly see if your regular vet has weekend call hours. I might look for a holistic vet in the area and try to reach them, too. Not so much to take over care (because it sounds like your puppy is quite ill) but to add an alternative POV on things you might want to do or try... I think if you have asked them to stop giving her any medication and they continue to do so that you could pretty much threaten to sue them. (Not sure it is legal for them to medicate her without your permission. THere are other tactics to deal with stomach ailments....

[Karen, Jasper and Jackdoodle]

Rebecca, I'm so sorry to hear this. 

I hope she turns a corner soon and starts to improve. 

[Lori, Winnie, Bob and Indie]

I have absolutely no ideas, but I just wanted to show my support for you and Madiba. Sending you a virtual hug and saying a prayer...

[charlotte bednarsh]

Rebecca, I'm not certain where you live, but I would definitely explore if there is a vet school near you; teaching hospitals generally has an good understanding of complex situations and certainly would have been aware of the issue with the immodium.  I would definitely get a second opinion as to what course of action is best.  Please keep us posted and we are all thinking of you.

[Nancy, Ned, Clancy, and Charlie]

I don't have any experiences or knowledge to help you, but want you to know that I care and am pulling for Madiba to begin improving and healing soon.

[Karen, Jasper and Jackdoodle]

Rebecca, how is Madiba doing? 

[Rebecca bratter]

 I am happy to report that Madiba is doing much better .  She;s been hospitalized for 5 days now!  Today her hypothermia is subsiding and her body temps and heart rate seem normal, I'm just praying that she's stabilized because I can't have her there another day . She is anxious and depressed to come home.  She's still not herself, but she seems to be out of the danger zone and I couldn't be more thankful.  boy is she a mess.  She has shaved patches on 3 legs as they had trouble finding a vein for the IV and she's had activated charcoal which has coated her mouth and butt.  I can't wait to give her a makeover.  I have some serious issues to deal with now - getting her formally tested for MDR 1 which I'm doing.  As soon as we pulled her off of the Imodium, she came around.  Finding a new flea, parasite, heartworm medecine for her as I am pulling her off of Trifexis, she's been off of it for a month but only because I forgot to give it to her.  Any suggestion as to safe alternatives would be very appreciated.  She was on advantix and sentinel when we lived in DC but that didn't hold up in Miami but we may have to go back to it.  And I need to see a specialist because she may have IBD/IBS.  She's had diarrhea on and off for a few day bouts every other month.  Once the diarrhea subsides she is constipated for a day or two and then all normal again. Karen, I know your Jackdoodle has this so any hints on signs and what to look for would be helpful.  Lastly, I need to change up her diet and probably get that wellness bland formula. Lots to do but boy will I do anything for this little girl, I just need her to recover.  Thanks Karen and everyone for your thoughts.  

[Karen, Jasper and Jackdoodle]

I'm glad she's doing better!

IBD and IBS are two very different things. IBD is Inflammatory Bowel Disease, which is an immune-mediated, incurable disease of the lining of the GI tract, similar to Crohn's disease in people. IBS is Irritable Bowel Syndrome and it's basically a nervous stomach. IBS is managed with diet alone; there are no diagnostic tests for it, and dogs don;t die from it. IBD can only be definitively diagnosed with an endoscopy/colonoscopy under anesthetic or exploratory surgery, and prior to that there are all kinds of less invasive tests that are done, including ultrasound, barium Xrays, and a GI blood panel. 20% of all dogs reliably diagnosed with IBD cannot be managed no matter what you do; 20% can be managed with diet alone, and the remaining 60% require a combination of drugs and special diet for life. It's not something I would wish on anyone, but JD was diagnosed in December 2011 and knock on wood, he's doing okay. You absolutely must have an internal medicine specialist for any dog suspected of having IBD. It's a very difficult and frustrating disease to treat, as it takes some experimentation to get the meds and diet right. I hope Madiba doesn;t have it. 

[Linda, Charlie Brown and Beau]

Just saw your post Rebecca.  So glad she is improving.  Just wanted you to know you we are thinking of you and praying her to be able to go home with you soon.  Keep us posted.

[Nancy, Ned, Clancy, and Charlie]

So glad that Madiba is improving.

[Kathy Brady]

Rebecca,

Having just gone through a crisis with Tully, my heart and thoughts are with you. I hope Madiba will be her crazy Doodle self very soon.

[Rebecca bratter]

Kathy:

I read your posting and have been thinking about you and Tully all day and have been meaning to tell you I know exactly how you feel and what you went through.  Our experience with Madiba was so similar and she was tested for pancreatitis because she had a lot of the symptoms but it came up negative.  Still not sure what exactly her GI issue is but we now know that she is MDR1 positive and her decline was due to her reaction to imodium.  Please everyone if you have and aussidoodle on this doodle page, get your baby tested!  We almost lost her and I went through what you went through.  I didn't sleep, I went on this website, I researched everything I could, I reached out to everybody who is in one of my doodle groups on facebook, I even called the aspca poison hotline.  That's how I came to suspect the toxicity, from being able to connect to so many resources.  I cried my eyes out for 2 days thinking about my poor baby suffering.  in the end, she was in the hospital for 5 days which should've been 1 if she'd never had imodium.  I'm happy to say she's back to her nutty doodleness and cuter than ever.  Her energy level is not quite what it was before but I also think that too much activity in the heat really stresses her out even though she acts like she never wants to relax.  It's possible that this stress caused her HGE/GI flare up in the first place so I am keeping a journal and noting when her stool changes to see if it's tied to stress or maybe over activity.  So far, nothing notable but I'm giving her a lot more down time and quiet time.  

I'm so relieved Tully is on the mend and i love this website too and am thankful for those that know so much for sharing it with us so we can give our doodles the best possible life!