Jasper (12 yr old Mini Schnauzer) is now at peace

[frijole]

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

[Squirt's Mom]

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. 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. 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.

I hope Jasper is better and better with each passing hour.
Hugs,
Leslie and the gang

[labblab]

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

[Tina]

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!

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

[Squirt's Mom]

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 -

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

http://www.vetinfo.com/how-to-taper-...og-dosage.html

Hope this helps!
Hugs,
Leslie and the gang

[Tina]

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! 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!! 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.

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

[Squirt's Mom]

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! She was put here to EAT...a LOT...and OFTEN! She's a small Boston - 13lbs - but if I let her eat like she thinks she should, she'd weigh 50lbs by tomorrow.

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

[Harley PoMMom]

Happy weekend Everyone!

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.

Since prednisone can interfere with stim results, you could ask your vet about giving dexamethasone instead, dexamethasone does not interfere with cortisol measurements.

[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

[frijole]

Thanks for the update. Cheering you on. Kim