Overwhelmed and don't know what to expect- just started Prednisone on Charlie – Page 3

Keymaster

Hi Deb and Todd,
I was out of town last week so I have missed a lot of your discussion.

First, Dr. Dodds Liver Cleansing Diet is right on our website. Go to this page and click on her picture with Cleansing Diet. This will open a document in a small window, if you click the expansion arrow you will get the full pdf document. You can print and save this from here. It is described in detail.

https://www.secondchanceaihadogs.com/nutrition-resources

The concept behind this diet, especially for dogs that have AIHA and IMHA, but really for all dogs that are quite ill, is that foods that contain red blood cells, when digested, release the contents of red blood cells into the digestive tract. The elements of red blood cells then have to be processed by the liver and also the kidneys. Livers under stress due to prednisone or other medications will be further stressed trying to process this material. Removing meats that contain red blood cells from the diet simplifies the work of the liver.

The liver is highly regenerative and with some help can recover fine as the drugs are removed, provided there was no organic disease prior to this. Alkaline phosphatase and alanine aminotransferase are enzymes released usually by the liver when it is under stress and there is cellular death of the liver. This is not always the case but usually with prednisone this is the cause. I have seen extremely high values of these two enzymes in dogs on prednisone. Chance’s were sky high, frightening even Dr. Dodds. After all the things he went through, in the end his values returned to near normal.

I know this is extremely difficult, how far do you take the treatments? My goal has always been to encourage owners to become immediately proactive in contacting Dr. Dodds and getting on the correct protocols ASAP. The longer a dog must endure with treatments that are not effective, the sicker they become. So moving quickly maintains their general overall health so they can muster the strength to recover. Trying to pull a highly deconditioned dog out of these conditions is really tough.

We were at that point with Chance in the late spring of 2007. He was hardly able to walk, potty and he was a shell of his original brassy Giant Schnauzer behavior. One night I came home from work around midnight and I took him out to pee, just across the street to the fire hydrant. He laid down in the street and would not get up. I was hysterical, trying to roll him onto a blanket and pull him back up the driveway. Finally I woke Mark up and he came out and carried him in.

The next day I called my pet sitter, who is a vet tech, to come over and help me make a decision. We sat on the deck in fine weather talking. Chance was laying there quietly. Suddenly a rogue squirrel showed up at the feeder. He got up, scurried down the steps and made a good effort at trotting over to the feeder to chase the squirrel, giving a good woof.

Sue turned to me and said, “Patrice I see sick dogs all day long. Chance is nowhere as sick as any of these dogs. Don’t give up yet, he’s not that sick.” So a friend had recommended Dr. Dodds to me. It was 2007 and I had never heard of her. I thought how could a vet all the way across the country be interested in helping me with Chance? Well I screwed up my courage and called her. As I was leaving a message, she picked up the phone breathlessly and started asking me questions, rapid fire.

Within a week he was on her protocol. Withing 4 weeks he had turned the corner. My vet wholeheartedly agreed with Dr. Dodds protocol and was a significant help in monitoring him and administering tests and other care. It took many months for him to recover. It was nearly a year before he looked really healthy. But inside he was getting better.

Remember that the drugs are harsh, they cause all kinds of awful side effects that can seem worse than the problem you are treating. Don’t confuse those side effects with not getting better inside. The rear leg weakness is extremely common and it does go away, almost, but not quite. Chance was weak in the rear end and so were many other dogs that were treated. But that did not stop him. Rear end limbs tend to supply a kind of rudder for balance but not contribute so much to the power of the walk. Thus you see dogs moving fine with one rear leg.

Mixing slippery elm into food is not a good thing to do. By it’s very nature SE seals to the gastrointestinal wall creating a barrier to absorption of all food, vitamins and medications. By giving it this way it has been decreasing nutrition and the medication significantly. It should be given away from all food and medication at least with 2 hours or more on either side. I gave Denamarin on an overnight fast to ensure a long time in contact with any potential ulcers and no risk of malabsorption of food, vitamins and meds. This supplement decreased his liver enzymes incredibly fast. I highly recommend it. Slipper elm is fine for dogs not quite so sick, but when it comes to a dog that is critically ill it is very important to decrease those enzymes quickly.

I am not sure what more I can help you with at this point, direct me as to where you want to go with this.
my best, patrice

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Todd

Guest

Hi Patrice ,

I too can attest to the affects of the medication and the long term affects of the back legs. Colby is a small dog 12lbs (half Schnauzer) so with smaller body not sure if that aids in quicker leg recovery. The steroids also zap the energy level as well. I remember her perking up and barking when seeing other dogs she knew, seeing deep or squirrel’s. Then came short walks and the last was her ability to jump. The jumping on the couch and out bed, which is really high, took about 7 months.

As far as the slippery elm and food, I would inquire with Dr. Dodds. The instructions to me were to specifically add to her food twice a day , when having bowel issues. That was also confirmed again more recently when I started using it again mixed in with the diet. Not sure if it depends on species, age, etc so best to confer with Dr. Dodds. In general, slippery elm may affect the absorption of some pharmaceuticals or nutrients. This is why in my case Dr. Dodds said to give the medications, especially throxine 30min prior to taking slippery elm. I do my meds a min of 1hr before giving the food mixed with slippery elm. Slippery elm on its own contains some nutrients which is why it doesn’t affect the absorption of all nutrients but may affect some as well as pharmaceuticals.

As far as taking slippery elm on its own, I was never able to get Colby to just eat it on its own. Not sure if your dog liked it as is or you mixed something into it.

Of course another aspect to consider is time. In our case, we are both working parents. There are only so many hours in the day to do the “ideal” timing.

In our case we also gave Denamarin in the AM when Colby woke up. Originally, we gave it alone 30min before anything else. But, have to give with a little cream cheese on it to get her to eat it, She will eat every other pill out of my hand except that one.

Now I give all morning meds together (Denamain, Thyro-tabs, Prilosec, and the every other day dose of prednisone) since I need to give meds 1hr before food/slippery elm. I then need to split up her food, since she will throw-up (homemade food diet) if she attempts to eat it all at once or too close together. So, that adds another hour. That is already a 2+hr process, plus the walk time necessary, since she now typically needs to go right after eating. I am already at 8:30-9:30 before I get out the door, starting at 6-6:30am.
If I now had to slot slippery elm in with 2hrs before giving food, it would be like 10:30am+ before I got out the door or would have to wake up around 4am to start giving meds to get out at 8:30-9. Then same issue on the night end when we get home from work to the time she would eventually eat.

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Deb

Guest

Todd, Patrice and Vally, Thanks for the support and encouragement. To be truthful, I am just worn out trying to take care of Charlie by myself and work full time. Dr. Dodd told me this last week not to give up, and I’m not ready yet, but it is so hard to know at his age if he can turn the corner- if this is due to the prednisone or old age or both.

My biggest issue is his hind end weakness. I can’t see this getting better as he has NO muscle mass left and is all bones in his hind end. He had some difficulty getting up before starting the prednisone and now if he can get up once in a week by himself without help it is a surprise. He has to wait for me until I get home, can’t get up to get water, is sore laying in one spot, and has had some fecal incontinence when he does struggle to try to get up. He is also so unstable that he has trouble with defecating. Tonight I let him outside and he was out for a while so I went to check ont him and he had lost his balance in the snow and was sitting in his pile of poop. If I don’t watch him, like last night, he ate his poop and then I started with diarrhea again during the night. He had just finished up 10 days of metronidazole and now we are back to the loose stools, so restarted the metronidazole again this morning.

I do find the same problem trying to time all the meds so they work. I generally try to give the slippery elm at least an 1 hr after he eats and most of his meds before he eats. His current meds are:

T-Relief Xtra Strength- red 1 tab BID
T-Relief- green 2 tab BID
Metronidazole 375mg TID x 10days- restarting again
Clopidogrel 3/4 of 75mg daily
Nutrigest 1 1/2 scoop/day
Slippery Elm 2 1/2 tsp BID
DLPA 500mg 2 capsules daily
Prednisone 10mg daily
GlycoFlex Classic 600mg 2 tab daily
Pet-Tabs Plus 1 chew daily
Thyroxine 0.3mg BID
Denamarin once a day

Just started the thyroxine and denamarin within the last 10 days per Dr. Dodd- all of this is a lot to keep track of.

It does help to hear about other experiences and recovery to give myself something to look forward to. I would love to just get him off the prednisone totally and a lot of the issues would resolve. I think treating the disease is worse than the disease. Dr. Dodd said that he does have anemia of chronic disease and if we can keep his HCT in the low to mid 20’s that is fine for a 15 year old dog. That was what he was before treatment, so I’m kicking myself that I even started treating. The highest we got him to was 33% and right now it’s 27%, but I don’t know at this point if we will be able to get him totally off. (He was started on 20mg twice a day- now down to 10mg daily). Will most of the side effects ( hind end weakness, increased ALT,AST, diarrhea) go away if he gets down to a low dose every other day…or does he need to go off totally to resolve?

Thanks for the help

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Deb

Guest

Thanks Vally, Todd and Patrice for all your support and responses.

Vally the following are his dosing times:

I give the following meds right before his food- in a pill treat (chicken flavored) at about 7am and 5:30pm – his main meals (he eats a little raw carrot and small amount of regular kibble at noon, and a little kibble at bedtime):
T-Relief Xtra Strength- red 1 tab BID
T-Relief- green 2 tab BID
Metronidazole 375mg TID x 10days- restarting again (done with this now- but when I give it needs to be with food)
Clopidogrel 3/4 of 75mg daily-supper
Nutrigest 1 1/2 scoop/day-1 hr after supper
Slippery Elm 2 1/2 tsp BID- noon and 1 hr after supper
DLPA 500mg 2 capsules daily-am
Prednisone 10mg daily-am- just reduced to 5mg daily
GlycoFlex Classic 600mg 2 tab daily- bedtime
Pet-Tabs Plus 1 chew daily-bedtime
Thyroxine 0.3mg BID- 7am with other meds- but if not working wait 2 hrs after eating, 2nd dose I time about 12 hrs later andabout 2 hrs after meals
Denamarin once a day- 1 hr before eating supper

The slippery elm he doesn’t like much, I used to mix a little peanut butter in and he would eat it, but I got a different brand of slippery elm and it is really slimy and the peanut butter doesn’t mix in, so I’ve been using a little honey and he will “consider” eating that.

I’m trying to time this all right but there just aren’t enough hours in the day like Todd mentioned. The thyroxine I know should be on empty stomach before anything else, but my son also indicated that if you are consistent when you give it the dose can be adjusted when labs are checked to determine the dose.

Speaking of labs, do you know if the T4 is the only lab that is checked in 4-6 weeks of starting or is also the TSH?

At what dose of prednisone do you think will be low enough to resolve some of the side effects like the hind end weakness and liver toxicity (and loose stools)? Charlie is 50 lbs and we now have him down to 5mg daily. I’m hoping in another 10 days to go to every other day dosing. Dr. Dodd doesn’t think that he will be able to ever go off of, which saddens me as I think this is the root of all his problems.

Vally, you mentioned your Bingo relapsed- was that on lower doses of prednisone or did you go off totally? What symptoms do you see with the relapse, or was it just the HCT dropping too low?

Dietwise I am still struggling- Todd I see you are using white rice, which I feel is a lot easier than potatoes for a starch/carb= for those of you that do use white or sweet potatoes how do you cook them?- peel on or peel off? cut in cubes, mashed? (I have NEVER cooked a sweet potato in my lifetime).

Also another link on this site talks about increased protein to help with muscle atrophy. Which proteins would you feel would be best for this with gi sensitivity?. I think Dr. Dodd is recommending 2/3 carbs with 1/3 protein, but should it be more like 50-50 to build him up?

Thanks again for all the ongoing responses. I’m very much sleep deprived so hopefully I am making sense with my questions

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Todd

Guest

Deb,

Don’t despair. its a struggle but in the end its worth it and it works out. Yes Charlie will never get off the Pred. Like Valley said you will get down to a maintenance dose. It may be every day or every other day. My dog Colby is on 1.25mg every other day. She is only 12# though. You just recently made a decent drop from 10mg to 5mg. Will take time for the body to adjust to the change and some of the side affects “might” start reducing. Colby started at 10mg and then dropped as follows:
5mg in AM and 2.5mg PM
2.5mg 2x day
1.25mg 2x day
1.25mg 1x day
1.25mg every other day

Colby is on Pred + Mycophenalate so 2ea immuniosuppressants. The Mycophenalate was given by the hospital and has been this dose since inception and Dr. dodds had me continue and pretty sure she won’t come off of this one either.

The Denamarin you should move to 1st thing in the AM when you wake up. I would try and give that on its own at least 30min prior to any other food. I used a very little bit of cream cheese always to get my dog to eat it, For the meds I used Applegate Turkey breast and just used as small of a piece as I could with the meds. However, month later I found my dog would eat pretty much all the pills out of my hand with nothing on them, except the Denamirin. She hates that ones. She always ate the Thyro-tabs (Thyroxine by lloyd) on its own.

I never realized the Metronidozole should be given with food. I always gave with the other meds on their own or rolled in the plain Applegate farms turkey breast. From my email conversation the other week with Dr. Dodds. The 10 day dose is close to the “min” length recommended dose. On the last go around my vet then increased it to 14 days. I would ask Dr. Dodds.

I am not familiar with all of the meds listed but many listed look like supplements.

I have had issues with the diarrhea typically in 2-3 month intervals when it would happen. The last was last month and was pretty much battling it for the month. When she was on he Metronidazole she would get better. Then it would come back and rinse and repeat. However, I would start with bland diet and then once I transitioned back to her kibble it would come back. I know she ate deer poop once or twice and that also could have set it off. Dr. Dodds then gave me a diet for her.

Whitefish – I use cod (cooked in a little olive oil w/ salt, pepper & oregano).
Veg – carrots, chickpeas, spinach & zucchini (steamed and I add salt pepper and oregano
White rice.

In my case (12# dog). 2oz fish, 3oz veg, approx 1/2 cup white rice per meal. I have backed off of this a little. I can’t feed it all at once cause Colby seems to through it up. So I give half and half 1hr apart.

She has had no issues since I started this diet. After about 10 days I asked Dr. Dodds when I could transition back to her regular dried dog food. She told me never. So… Now I spend hrs on the weekend making meals for 10-14 days at a time. Cook better for my Colby then my family :).

I was also told I could do turkey or lamb (Grass fed only – New Zealand) so made a turkey breast last week. Colby loves it and now the issue is she won’t eat the meds out of my hand. As I stated earlier, I mix the slippery elm in with the food. I take the nutrigest and slippery elm and mix with water in a cup and use a fork to blend it. I then mix that in with her food. As I stated earlier. Dr. Dodds told me to mix it in her food originally and I have confirmed this numerous times. Maybe in your case she may say different so I always would confer what you want to do. The slippery elm makes what I call a a gravy of sorts for the food.

I see you give the RX Nutrigest 1x a day. That dose on the container says 1-2 times a day. I give 1 scoop 2x a day, so with each feeding.

At the start Colby wouldn’t walk around much. But not so bad that she couldn’t walk at all. We would try and get her to play with a toy and she would get excited for a second and then lay down and pant due to meds. As the dose went down she did walk more and tried jumping on couch and couldn’t do it. She stopped trying for a while out of fear. After about 6-7 months she was back to jumping the heights she always could before. Couch, bed & window seat. I can’t for the life of me remember at which point the excessive drinking stopped either. Wonder if that was a sign as to big improvement in motor function etc due to reduced meds.

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