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Great news! I understand fear of removing the prednisone but you wean very very slowly for that reason. He needs to adjust. You will know if it is too much too fast. Just remember that it's a steroid and you don't want him on it long term short of being addisonian ... it isn't a good thing. Great news about the water intake. Keep up the good work. Kim
Mornin' Tina,
Sounds like things are progressing nicely. :) Trink's BMs would improve then start to get bad again, then improve a little more....then one more mess, then it was over. Of course, I kept letting her sleep in the bed with me during most of this while an empty crate sat within sight. :p I finally did put her in the crate for couple of nights when I ran out of clean sheets then lay in bed watching her and crying. :rolleyes: And her appetite wasn't the greatest then either - she was finicky when I first got her but she got really turned off by food during this period. I kept dark Karo syrup close at hand in case of hypoglycemia, which teeny tiny ones are prone to. ;) And then, being my Prima Dona, I had to add a drop of Karo to her food to get her to eat it for a couple of days. :D
I hope Jasper is better and better with each passing hour.
Hugs,
Leslie and the gang
I, too, am so glad to hear that Jasper has been improving! And I'm totally on the same page with you as far as being apprehensive about stopping the prednisone prematurely. If anything, I will say that it seems as though your vet has underestimated Jasper's need for steroid supplementation throughout this entire episode, so I would be very nervous if she were to tell you to just stop the prednisone "cold turkey" at this point. As Kim says, even if Jasper is starting to produce enough cortisol on his own, the prednisone should be tapered over a period of several days rather than suddenly halted. But since Jasper is still having abnormal stools, I'm not sure that it's even time yet to start a taper. I will be very anxious to hear what your vet recommends at the end of the week.
As far as the improvement in Jasper's thirst and urination, that may actually be due to the fact that the prednisone has rescued him from his Addisonian state. As odd as it sounds, excessive thirst/urination can be a symptom of Addison's as well as Cushing's. So perhaps the improvement you are seeing is a result of the normalization of his steroid level.
Marianne
Hey All,
Jasper continues to improve each day. As of his evening meal tonight his food is mixed 50/50 canned prescription food and his regular dry food. I am taking it very slow. So far so good. His stools continue to get better also, they aren't completely normal yet, but getting there. This evening I felt like I was celebrating out in the yard. I told him this was the best one yet and to keep it up. My neighbors probably think I have lost it! :p
His energy is much better also, but not quite back to normal yet. As of today, he has been drinking and urinating a bit more again. I will measure the water that is left in the morning, but I think he has drank about 32 oz so far. Marianne, what you said about his drinking improving because his steroid level may be getting more normal makes sense. I did read that increased drinking and urination can be a sign of Addison's also, so I was wondering about it actually improving some as his cortisol level came up, but didn't know if that was feasible or not.
And I agree with you completely that my vet has underestimated Jasper's need for the supplemental prednisone. I believe it may be because for a long while he wasn't showing any of the critical symptoms of low cortisol. That was puzzling to me also, and still is - I watched him like a hawk. Then when that severe vomiting started and he was hospitalized the first time, although he got the Percorten and a dexamethasone injection while in the hospital, I think the 2.5 mg daily dose of prednisone after he got home was not enough to compensate for how low his cortisol had originally dropped. He seems to have done much better on the 5 mg daily dose, which is what she sent him home on after the 2nd hospital stay. He continues on that dose now.
Back when he was getting the 2.5 mg dose, I asked her if he would need to be tapered down when it came time to take him off it, and she said no, because it was such a low dose. I hope she will view it differently now after all that has happened and he has been on the 5 mg dose since last Friday, and will plan to taper him off when the time comes. If she doesn't recommend that, I will ask about it for sure, I am too scared to have him stop cold turkey. Can anyone tell me what the normal tapering process and time frame should be? Just so I can have an idea of what to ask. She will be calling on Friday for an update and to discuss the next steps.
Thank you all so much for your continued support and prayers.
Hugs,
Tina and Jasper
Hi Tina,
In humans the method is typically to start spacing the doses out over more days. In other words, if one is taking 10mg a day, when the tapering starts, the dosing would go to 10mg every other day for 2-4 days, then 10mg every third day for 2-4 days, and so on until the pred is gone. This is how I am instructed to use it anyway. ;)
Here is some info I found on VetInfo -
http://www.vetinfo.com/how-to-taper-...og-dosage.htmlQuote:
How to Taper Off Prednisone Dosage
When the vet establishes that the dog no longer needs prednisone treatment, the dose cannot be simply discontinued starting from the following day, because the dog can get severely ill. The prednisone should be gradually tapered off. The vet may decide to taper off prednisone by halving the daily dose or administering a normal dose every second day to the dog. After one week, the dog can get less prednisone, or get the initial dose of prednisone once every three days.
After another week, the dog may get a small dose every day or the initial dose once per week. The tapering off of prednisone treatment typically takes between two and five weeks, depending on the initial dose of the drug, the disease the dog is being treated for and the reaction of the dog when the dose is lowered. You should always follow the recommendations of the vet and never forget to administer a dose of prednisone to your pet. You should never administer prednisone to your pet when it is not recommended.
Read more: How to Taper Off Prednisone Dog Dosage - VetInfo
Hope this helps!
Hugs,
Leslie and the gang
Happy weekend Everyone!
Thanks for the information about tapering prednisone Leslie. I did do some further reading also so I would be prepared.
I talked to my vet late yesterday and provided her with a full update on Jasper. He is continuing to hold his own! :D :D Yesterday morning I started mixing his food 1/4 canned prescription food and 3/4 his regular food, and plan to decrease the canned further tomorrow. And today I am transitioning him back to 2 meals a day rather than 3. He has been tolerating the food transition, and his stools have continued to improve, they are almost back to normal now, but not quite. He seems to have a good appetite and has been eating the mixed food just fine, but when I tried to see if he will eat his regular food by itself, he won't. He totally snubs it, turns his head and won't eat a bit. As soon as I mix it with some of the prescription canned diet, he eats it right up. Little stinker!! :rolleyes: So I don't think it is an appetite problem at this point. My vet is aware of this. I am not going to worry about it now, I may need to figure out something different with his food for the long haul.
My vet has directed that we continue with his meds the same for a bit longer. She does not feel that his adrenals would have recovered in this short of a time after his cortisol was so bottomed out, and feels he needs continued supplementation with the prednisone for now. She is continuing the dose at 5 mg daily. She said we absolutely would need to taper him when the time comes (whew, I was worrying about that!). She said the soonest she was looking at repeating the stim test was the week after next, and said that we would taper him down to the lower 2.5 mg daily dose a week before the test and then he would need to be totally off the prednisone for a couple of days before the stim test. I think this sounds reasonable. Hopefully Jasper will be able to tolerate that. He seems comfortable now on the 5 mg dose for the most part, I think.
I have noticed that his water intake and urinating have been steadily increasing again over the past few days. My vet is aware, she does not think it is because his adrenals have recovered and are producing too much cortisol again, but thinks it is probably a side effect of the prednisone. On 9/13 he drank ~ 43 oz, yesterday 9/14 ~ 67 oz. I will be measuring today and tomorrow also. So far no additional accidents in the house, but I let him out twice during the night last night.
She did mention that sometimes it can take months for the adrenals to regrow, and we talked again about how sensitive Jasper has been to the Lysodren. She also briefly mentioned the possibility that he could stay addisonian, I think she just wanted to remind me that it could happen. I imagine we won't know more about that until the next stim test, so I really am going to TRY to not worry about that. :eek::eek:
So that is where we are at. Kim, Marianne and Leslie, I feel like this is all in line with the concerns and suggestions you all mentioned. I am concerned about the increased drinking and urinating, but he is much better overall.
Your thoughts and feedback would be welcomed and appreciated. Thank you all so much.
Hugs,
Tina and Jasper
Hi Tina,
Good to hear that Jasper is continuing to improve! :)
Your vet seems to be right on the mark with tapering and the testing so I feel you are in pretty good hands there. And the effects of the pred may be correct as well. I have a Boston that has to take pred and she exhibits many cush signs the days she gets her dose - she gets it every other day. She pees and drinks a great deal more on those days...but her appetite is always cushy acting! :D She was put here to EAT...a LOT...and OFTEN! :p She's a small Boston - 13lbs - but if I let her eat like she thinks she should, she'd weigh 50lbs by tomorrow. :rolleyes::D
Just so you know, many feel that Addison's is easier to treat and not as hard on the pup as Cushing's. In fact, in Europe it is fairly common to intentionally cause Addison's as the treatment for Cushing's. ;) So try not to worry overly much about the future possibility. We will always be here for you and with you.
Hugs,
Leslie and the gang
Since prednisone can interfere with stim results, you could ask your vet about giving dexamethasone instead, dexamethasone does not interfere with cortisol measurements.Quote:
Originally Posted by Tina
Thank you for the information about using dexamethasone instead of prednisone, I will have to ask my vet about that when I get a chance.
Jasper has been hanging in there for the most part. Stools have continued to normalize, and he seems to be feeling better over all. Last evening (9/18) he vomited once, and seemed to have a decreased appetite again last evening and this morning. That scared me of course after all he has been through. I have him eating his regular portion of his own food mixed with about 2 tablespoons or so of the canned prescription diet. He still will not eat his regular food without mixing a bit of the canned in.
My vet had initially said to start decreasing the prednisone to half a tablet (2.5 mg) daily to get him tapered down, but since he vomited last night, we are going to wait a bit to start the taper. So far he has not had any more vomiting and he ate fine tonight, and seems to feel better tonight. I am hoping that it was a one time thing and maybe he was just nauseated. His stool has continued to be ok so far, but my vet refilled the metronidazole and had me pick that up after work tonight and told me to start it again if the stools got softer or if he is slow to eat or won't eat. Hopefully the colitis isn't trying to flare up again.
On Monday I started leaving him in the barricaded kitchen while I am at work with a couple of pooch pads and his open crate in there. He is very nervous and doesn't like it, and whines a bit when I put him in there. But I just feel it is the best option to allow him access to plenty of water while I am gone, and also so he can have space to pee since he is drinking so much. I hope he will adjust and learn to use the pooch pads and not try to hold his pee all day.
I will be talking to my vet again on Friday, so we will see what the plan is then. I imagine if he continues to eat and feel ok we will start to taper down the prednisone. I am nervous about that. Thank you all for your continued support.
Hugs,
Tina and Jasper
Thanks for the update. Cheering you on. Kim
Thanks Kim, and thanks so much for telling me about the pooch pads! Yesterday while I was at work he used them for the first time. His aim needs a bit of work, but hopefully that will improve with time! :D Today he didn't use the pooch pads but went on the blanket that I put on the floor for him. No matter, at least he is peeing instead of trying to hold it all day. I really hope that he will just get used that and learn that it is ok to use those pads while I am gone at work. So far so good, 2 days in a row.
Tina and Jasper
Hurray! I learned about them from someone on this forum! That is great news. Poor little guy. Great invention though huh? I had the paper like ones and didn't like using them. These are real convenient.
Yeah, I have some of those disposable ones left from before my puppy Shelby was house trained. I put a couple of those down the first day I tried him in the kitchen. All he did was scratch and scruff them up almost into a ball. They were useless for Shelby also, she would tear them up after just a few minutes and tried to eat them. The pooch pads are much better. I am lucky that Jasper still squats like a girl. Not sure how well anything would work if he lifted his leg like a normal boy, lol. :p. :D
Tina
:D:D:D:D:D Oh the visual. You'd have to tape them to the wall or furniture! :D:D:D:D:D
No doubt. I would have to cover a lot of area!! I have never cared that he never learned to lift his leg, it was always kind of a relief actually. And now I am really thankful! :) :)
I talked to my vet yesterday and gave her a full update on Jasper. He is doing pretty well overall, other than continuing with some hesitation when eating at times. Sometimes he will walk away from the bowl for a second or two but then returns and finishes. I am still mixing about 2 tablespoons or so of the canned prescription diet with his regular portion of food so he will eat. The vet doesn't seem too concerned about this for now.
I have a refill of the metronidazole on hand in case the colitis flares up, but have not needed to restart it this point. Yay!! She said we will keep things the same for the weekend and she will check in with me on Monday. If he continues to do well, the plan is to start to taper down the prednisone. She said she did not want to do that on the weekend. I told her I was nervous about that, actually I am quite scared. She reassured that we would do it slowly and said that the dose he is getting now (5mg once a day) is higher than the dose he would need if he had addisons. So I guess that is somewhat reassuring as far as trying to decrease the dose. I am still scared though because he seems to be feeling pretty good now. I think I am just gun-shy because he was so incredibly sick a couple weeks ago.
Jasper has had a pretty good day today, and I am so grateful. I would say it is the first really good day he has had since he was so sick. Hopefully we have turned the corner now!
I will update again after I find out what the plan is on Monday. I hope everyone and their pups are having a good weekend!
Hugs,
Tina and Jasper
Great update. Keep up the good work and know we are all behind you guys! Kim
TIna, I am so happy to read Jasper is improving. I understand your nervousness about changing a med when you see improvement. Each time I had to finally discontinue an eye drop, I would worry so much.
Go slow and remember to breathe. If Jasper seems off at all , just call your vet and come here. :):):):)
I hope the colitis stays at bay!!!
You are doing a wonderful job. Jasper is very lucky to have you.
Yay, good news for Jasper. I'm glad he is doing better. That was so scary what he went through before. Tapering off the prednisone at a steady schedule should be okay. You are looking for him to not need it any more over all. So if he can remain in good health, without the pred that would be an optimal result. You'll be taking it really slow with the weaning and this will give his body time to adapt to not needing it and take over doing everything itself.
Hang in there.
hugs,
Sharlene
Hi Tina,
Good to hear that Jasper continues to improve! :) Keep up the good work and let us know how the vet visit goes.
Hugs,
Leslie and the gang
Hi Everyone,
Thanks so much for the kind words. Jasper had a pretty good weekend overall. I gave my vet an update tonight, and the plan is to start tapering the prednisone on Wed 9/26 to half a tablet daily, which will be 2.5 mg daily. She said we will keep him on that dose for several days before taking him off it for a couple days to get another ACTH stim test. She will call next Monday to see how he is doing. She wanted to start the taper on Wed so that if there were any problems we would know before the weekend. She feels he will do fine on the lower dose, but I am scared of course.
My fear of course is that he is not producing any or very little cortisol on his own, and that we will get into trouble when the dose is decreased. I forgot to ask her, but if he started not feeling good on the lower dose, can I just give him another 1/2 tablet to make up the difference? And will that prevent the severe symptoms that he had before? She said that 5 mg is a high dose for him and we need to taper it down.
So that's the plan currently. I am just reluctant to do any changes because he seems to be feeling so much better now. :rolleyes:
Hugs to all,
Tina and Jasper
Today is day 4 on the reduced prednisone dose, Jasper has been getting 2.5 mg daily since 9/26 when we started the taper. So far so good, he seems to be feeling ok. He has been eating and hasn't had any of the scary signs of low cortisol. I am so relieved that he is tolerating the decreased dose, but I am still scared about stopping it for 48 hrs in order to do the next stim test. I am guessing my vet will be looking at that for some time next week. I will be checking in with her on Monday.
He is continuing to recover from the addisonian crisis, I have learned that this takes a while. It has been almost a month! He continues to drink and pee excessively, but other than that, seems to be getting back to his old self. I am so thankful. He has come a long way. :)
I hope you and your pups are all having a great weekend.
Hugs,
Tina and Jasper
I am so glad Tina. It is wonderful to hear Jasper is on the mend.
I am so glad that Jasper is getting better. It does seem to take a while to recover from these addisonian crisis incidents. So no hurry in that regard.
I know you are happy to see him doing so much better.
hugs,
Sharlene
Hi Everyone,
I talked to my vet a few hours ago and gave her an update on Jasper. We went over everything, and she is concerned that the Percorten injection that Jasper was given when he was in his crisis is coming due in the next day or two if he is still low and needs it. Apparently it is given every 26 days, and he had it on 9/6.
She doesn't feel that he has been on the lower dose of prednisone long enough to allow his adrenals to no longer be artificially suppressed from taking the higher pred dose, so doesn't think we can do the stim test this soon. (Not to mention if they haven't regrown from being over suppressed from the lysodren). She wants to recheck his baseline cortisol to get an idea of whether he is still real low or not. This way if he is still low, she will give the Percorten, and if not, I think she said we would look at when we should do another stim test. I will hold the prednisone tomorrow morning, and drop him off for the test on Wed morning 10/3.
The results of the baseline cortisol test are sent to a lab in town, so we should get the results late the same day. Plus it is much less expensive. ;)
After talking to my vet, this seems to make sense at the present time. I know she is concerned about the timing of the Percorten, if it turns out that it is needed. He was so incredibly sick, I am sure she doesn't want to take any chances.
So this is our plan for now. I know it probably is not usual, but nothing about Jasper's response to treatment so far has been usual. He definitely has not read the textbook, and has not been following the rules at all. I have had several talks with him about this, so I am hoping he has been listening. :rolleyes:
I am nervous about him being without ANY prednisone tomorrow. I was scared to decrease the dose, and he has tolerated that so far. If he is going to get sick from holding the prednisone, how quickly would that happen? The vet said that they would give him a dose at the hospital after the baseline cortisol is drawn, so he will be without it about 48 hrs, but really just missing one dose.
Any feedback would be appreciated!
Hugs,
Tina and Jasper
Hi Tina: If he has been doing ok as you wean him I bet he will be ok with none. We weaned my Jenny (also overdosed with Lysodren) very slowly off the prednisone and she kept her appetite and her fiestiness.
Her cortisol is very slowly coming back. I think her baseline was something like .8 up from .4 in April and she is doing ok with nothing for the last 6 weeks or so.
No lysodren, no prednisone. She got picky so I started putting some stinky food in with her normal food and she is eating it all (knock wood)
good luck with the test! I hope Jasper is starting to produce some cortisol also. Judi
Hi Judi,
Thanks for letting me know about Jenny. I have been following your thread but hadn't been able to read it all from the beginning, but I had gathered that Jenny had been over suppressed from Lysodren also. Right about the time I was getting ready to ask you about it, Jasper ended up in the hospital, and it has been pretty tough since. I feel like we have finally turned the corner, and I am hoping it continues!
I am glad to see that Jenny has been doing well and that her appetite has been good for the most part. So if her cortisol is slowly coming back, does your vet think that she won't stay addisonian?
Thanks again for posting.
Tina
Hi. Yes, the vet thinks eventually she may need medication again but the specialist we saw in April told me not to even consider it until she is over 2 for both the pre and the post test in the ACTH
My specialist recommended doing exactly what you are doing tomorrow. He said if the baseline is super low, no need to waste time or money doing the second half of the ACTH.
The specialist also told me that if Jenny were brand new to him, he'd go with Trilostane but since we know Lysodren definitely works on her, if we get to that point again, he'd use lysodren on her at a much reduced dose. But he did tell me I could switch if I want.
It has been a nice mental health break only giving her insulin these days.
Fingers crossed for you & Jasper! Judi
Thanks Judi! That is good to know about Jenny and that your specialists recommendations match what we are doing. It made a lot of sense after my vet and I discussed everything.
It has been a while since she has mentioned anything about how we would handle restarting the Lysodren, but I do remember she said it would need to be at a very reduced dose, if we got back to that point. She has concluded that Jasper is highly sensitive to it. I literally watched him like a hawk while he was taking it, and he still got into a crisis. She has not mentioned switching to Trilostane at this point.
I love your avatar pic, Jenny is so cute! I wish I had a better pic of Jasper, the one I have is kind of dark. He has become afraid of the sound that my camera and phone make when taking a picture, so that is the best one I could find that would fit.
Thanks for all the feedback Judi, I appreciate it.
Tina
Hi TIna,
I hope Jasper does just fine without the pred today and he can start weaning off. Some pups are just super sensitive to these meds but it sounds like your vet is handling this just right - taking her time to let Jasper's adrenal recover and aiding him meantime.
If you notice today that he is slipping without the pred on board, call her asap and make sure she knows how he is acting. He may tell you himself whether he can do without it right now or not - and don't take a chance if he needs it. ;)
I am so glad he is better than he was, tho, and continues to show signs of improving. You're a great mom, Tina!
Hugs,
Leslie and the gang
Thanks Leslie! I am hoping that my work load today will allow me to be able to come home at lunch to check on him. That is my plan. Unfortunately I have a meeting at 1, so that makes it a little difficult, but I am going to try, just so I can eyeball him during the day. I hope he does ok, as I really want to get the level checked to see where we are at. I am suspecting it will still be quite low, but that is just a hunch. Thank you for the ongoing support.
Hugs to you and your gang,
Tina and Jasper
So far so good, Jasper seems to be doing ok with the prednisone on hold. It has been about 48 hrs since his last dose and he seems to be tolerating it at this point. We are heading in to the vet shortly, I will drop him off for the baseline cortisol test and any other labs that she feels are necessary. Hopefully we will have the results later today.
Hugs,
Tina and Jasper
HI Tina! Great news. Fingers crossed. Let us know what you find out. KIm
My fingers crossed too Tina
Great news! So glad he seems to be holding steady without the pred! :) That's a good sign to me. ;) Let us know what you learn today.
Hugs,
Leslie and the gang
that is great news! now fingers crossed for today's results
Great that Jasper is doing okay without the pred. How did today go?
hugs,
Sharlene (sorry I've been missing in action for a few days) but reading, just no time to get online and respond to anything *sigh*
Thanks Everyone! No results yet, I imagine my vet will call with them some time today. She went ahead and gave him his prednisone dose yesterday, 2.5 mg, and I have given it this morning also. We will decide how to proceed with the taper after we see what the baseline cortisol level is. I will check in once I have the results.
Hugs to you and your pups,
Tina and Jasper
My vet called this morning with Jasper's baseline cortisol result, it hasn't budged, it is < 0.4 ug/dl (ref range 2-6). :eek: :( She called the lab first thing and had them run electrolytes from the blood that was drawn yesterday when she saw that the level was still so low. She called with those results this afternoon. The sodium was in the normal range and the potassium was at the highest end of normal. She said the potassium was creeping up, which was a concern, and confirmed that he needed another injection of the Percorten. She felt it would be best if I could bring him in tonight, so I did. I ran him in after work and he got the injection. He will also continue on the prednisone 2.5 mg daily for now.
She said she feels it is likely that he is going to stay permanently addisonian since his cortisol hasn't recovered at all in the 4 weeks since it was last checked. We will continue to monitor, apparently if it doesn't show some recovery within 4 months, then he will be considered to have Addisons disease. She was reassuring and said this would not be a horrible thing and that it is treatable. We talked about that a bit and went over what needs to be done in the next few weeks as far as labwork.
I have spent the last couple of hours bawling. I know I did everything exactly as I was supposed to with the Lysodren, and I couldn't have monitored him more closely for the warning signs. He didn't show any during the loading phase when he bottomed out the first time, or during the maintenance dosing. This is apparently when he got toxic and the damage was done. I just don't understand how this could have happened when I was so incredibly careful. I feel like I poisoned him. I am trying to not be so upset because I am so thankful that he is feeling better now, and he looks so much better. But I keep going back to the feeling that I did this to him and that it could be irreversible.
I am sure that part of the reason that I am not handling this well is because I am so tired. I realized that I haven't had a full night of uninterrupted sleep since some time in May when this all started. I am up 2-3 times a night to let him out, which I absolutely don't mind, but it is taking a toll. I am hoping that the drinking and urinating will somehow normalize somewhat, but I am not sure I understand why it is still so excessive since his cortisol is almost at 0. I will do anything to keep him comfortable, so I need to figure out a way to adjust to this.
Thanks so much for listening, I know you all understand.
Tina
((hugs))
There are a couple of people with Addisonian dogs on the K9 diabetes forum and they swear it is easier to regulate an Addison dog than a Cushing dog.
You need some rest. Jasper can certainly take some prednisone for a few more months and just be a dog!
hang in there, this is not the end of the world. Judi