Pred/Atopica not working anymore

[admin]

Hi Mike

Things are looking better – I am really pleased Lola is making progress now. Fantastic news on the reticulocyte front, which is so important.

I totally agree with Vally & Patrice – the muscle atrophy will get better gradually when you lower the pred dose – I don’t think many of us have escaped this with our babies & it is impossible to prevent. Over-exertion is not a good idea until her muscles do come back as they can damage tendons & ligaments. We’ve all suffered adverse comments too – we KNOW our dogs look awful, thank YOU! I promise you Worzel looked like a skeleton at one point & the specialist said he had never seen such a rapid muscle decline in a dog on pred. I was really surprised at how quickly he regained his muscle tone – he still thinks he is a racer & can still run like the wind when he feels like it!

Oh, yes, the eyes say it all – their eyes do become bright again when they are getting better. Never thought about that until Patrice mentioned it, but it is true.

Keep up the great work Lola!

Sheena, Worzel & Ollie xxx

[admin]

Hi Mike. So great to read the great news about your precious Lola! I am sorry to have been away – family health problems (dad and sister-in-law) and was dealing with tapeworms with my poor little gal, Sadie. The family “stuff” continues, but Sadie is doing well NOW (darn fleas!!!!).

Oh goodness – some people just should not talk. Sadie gained about 8 pounds (ravenous dog!) with the high doses of immune suppressants and people always commented on how fat she was. They did not mean to be mean, but it was all I could do to not say, ” goodness – she’s alive folks – would you please just NOT comment on her belly and comment about her being alive!!!” As soon as the meds were lowered, she lost weight, her coat became shiny black again AND her muscles came back. And she relapsed twice, so it’s been a bit rough for her. But she still, managed to rebound quite quickly.

Just to show you how they can hold on – even with the flea infestation and tapeworms – she went down (her normal PCV had been 46 prior to AIHA, last CBC 6 months prior) to 34% about 10 days ago (yes, I panicked!!!) AND after realizing she had tapeworms (yuck!!!) and treatment, Friday – her PCV was 50%. Poor baby had been struggling for goodness knows how long. But what I’m saying is – they fight – they hang in there. They let us know (yes, the eyes…..) and Lola is a great example of this too. So, way to go Lola – you keep on fighting!!!

Mike – you are doing such an awesome job! Lola is responding to your wonderful care. Keep us the great work and please, keep us posted.

Love and huge way-to-go hugs to you and Lola, Linda and now better, Sadie

[Mike Chen]

Another update. Since the PCV and bone marrow started trending upward last time, the vet took her out of acute (checking 2-3 times a week) care and at a more normal rate. We did PCV today and it went up to 27 despite taking her pred from 40 mg to 30 mg. Lola’s energy is much better too. I can just tell from her demeanor that she’s much more alert.

So our doc says things are moving along as expected. Her current pred dosage is 30 mg (20 in AM, 10 in PM). We’re going to do a CBC in 2 weeks and then assess where we go from there. We’ve talked about potential long-term low doses of pred or atopica. She didn’t respond to the atopica, but that may have simply been the bone marrow exhaustion that the Pet-Tinic seems to have corrected.

In any case, she’s back to being her lazy goofy self, which is a huge relief. She still hates exercise but she loves begging for food so we are using that to motivate her to follow us around the us and do sit/stand.

[Vally]

Well who’s a star!!! That is just the best news Mike.

Long term pred is not the end of the world as I’ve discovered. I really truly wanted him off it totally, but he’s one of the one’s that will stay on it. Bingo says long term pred is the best!!! He actually has some arthritis issues, so it helps to keep all of that in check and also keep him pain free. Bingo’s specialist says “a little pred keeps an old boy happy”. I agree.

Shhhhh, Bingo doesn’t realise the sit/stand is an exercise. He is so focused on the treats, he can’t sit fast enough now.

I’m so happy for you Mike. It’s wonderful to see their personalities start to come back and she’ll just get better and better.

Don’t rush the lowering of the pred dosage. You vet sounds as though he knows what he’s doing though. Keep it nice and slow, much less chance of any problems.

My very best
Vally & Bingo

[Mike Chen]

One quick question for you guys — how common is UTI with such a high pred dosage? Before all those, Lola had a bladder of steel. She could sleep for 12 hours without peeing.

About 3 weeks ago, she had her first accident on the high pred dosage. We used amoxycillan for 2 weeks and everything cleared up. One week off of it and she had another accident tonight. Since the pred is suppressing the immune system, this isn’t unusual, correct?

I was thinking of asking my vet to just stay on the amoxycillan for the next 2-3 weeks until we decide what we’re doing with the high pred dosage. Does that seem reasonable?

[Vally]

Mike it is always possible because, as you said the immune system is suppressed, however it is most likely the results of the high dose pred. It makes them incredibly thirsty and so they must drink more water and therefore they need to pee more often. Accidents are more likely to happen because of this. It’s very important though that you don’t hold back the water. It does get better and the accidents will stop, again, when the pred is lowered.

Anyway, a simple way to check is to collect a sample and have the vets check it for anything nasty.

Vally & Bingo
xxx

[Mike Chen]

Also, any recommendations for food/diet brands for long-term support? It’s a bit expensive to just try out. We are using Holistic Select right now and Prescription Diet T/D as a snack.

[admin]

Hi Mike

Great news on Lola – I’m so happy to hear she’s doing well. Oh, yes, waking up for pee pees was the story of our lives for quite a long time because of the prednisone. As Vally says, the less pred, the less pee pees! And it is really important that they drinks lots to keep them hydrated properly & to keep their kidneys healthy. They are at risk for infections because of the immune system being suppressed & urinary tract infections are really common.

I’m sorry to have to worry you – I have to tell you about the amoxycillin. I recently needed an antibiotic for Worzel & the vet (not his fault) gave me something IMHA dogs shouldn’t have. Dr Dodds told me not to give it, thank goodness. So I have been looking into this in more detail & the following antibiotics should not be given to dogs with blood problems such as AIHA/IMHA because they are known triggers of the initial onset of the disease:

1. Penicillin based drugs (sorry – this group includes amoxicillin) – these are the least dangerous of the 3.

2. Cephalosporins (responsible for 50% of reported cases in humans)

3. Sulfa drugs – Dr Dodds told me NEVER use these drugs for dogs, especially IMHA dogs.

2 & 3 are the worst culprits.

Here is just one an example of a vet site that states this:
http://vetspecialistsofrochester.com/pdf/Internal-Medicine/Immune-mediated%20anemia.pdf
There are many sites that say this, so please could you discuss this with your vet to change Lola to something else. I do remember my French specialist telling me to avoid penicillin drugs too.

Now the boring bit – these types of drugs attach a “marker” to blood cells which targets them for destruction by antibodies & we certainly don’t want to encourage more blood cell destruction in our dogs.

As Vally says, the best thing is to do a urine culture & find out exactly what the bug is – you can then specifically pick the right antibiotic to kill it. I hope your vet is open-minded & will understand why I am concerned. If you or your vet need further information on this, please let me know.

People who take pred long term are told to stick to a high protein, low fat diet. When Worzel was ill, we gave him lots of home-cooked organic food such as green beans & carrots (steamed), lowish fat mince, say 15%, chicken, turkey & lamb. He also ate a lot, lot more than usual, which is normal on the pred! Recently he has had very loose stools, so I have added cooked sweet potato & pumpkin, which have really helped. Some dogs don’t do well with chicken, so turkey is a good alternative. If you are working, it is not always easy to do all this.

Please let me know how things are going – please contact your vet as soon as you can about assessing the amoxicillin risks.

Best wishes as always
Sheena, Worzel & Ollie xxxx