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Ashki – new thread

Vally

Keymaster

Tamara, you mention “we reduced the pred to 20mg BID” – what was it originally and when was it dropped to 20mg.  I’ve been through the thread but I can’t see it.

Normally wouldn’t start reducing the pred until they’ve been stable for a bit unless there is a specific reason.

Love Vally & Bingo.


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Tamara

Guest

Hi Vally and Brigitte, thank you so much.  I’ve contacted Dr. Dodds again and am waiting to hear from her.

Ashki was on 40 mg pred BID for a week, then reduc ed to 30 mg BID until today, when the internist said to reduce it. When I asked him if we should given that Ashki is not responding, he said that the other drugs (cyclosporine 100mg BID and mycophenolate 250mg BID) are now working completely and we can reduce the pred slowly.  Ash has been on cyclo since 5/1 and myco since 5/15.

I’m looking forward to hearing Dr. Dodds’ input, and will increase the pred if she suggests that.

I’m hanging in there, though I think I’m getting an eye infection :(

Ash is quite tired today, though seems to be in good spirits.  He still rolled in the dirt in the backyard  today :)

with love and gratitude,

Tamara and Ashki


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Vally

Keymaster

Tamara, let us know what Dr Dodds says.

You are NOT to get an eye infection.

Love Vally & Bingo.


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admin

Keymaster

Hi Tamara

I’m sorry I haven’t been around much for a few days. I know how disappointed you must be about the drop, but please don’t get disheartened, Tamara. I think you must go with Dr Dodds implicitly from now on &  I am also not happy about the pred reduction. As Vally so rightly says, the pred should not be reduced until Ashki has been stabilised. The high pred dose (called the cornerstone of treatment) is vital to stop the red cell destruction until the other drugs start working, which they clearly haven’t as yet, as Ashki’s PCV is still dropping slightly, not going up. Some dogs can NEVER stop the prednisolone – that’s not a problem, but it is the case for a few dogs. Please, please do not get too stressed over this (says she who stresses about everything with Worzel even now!) – transfusions are there to keep Ashki going nicely until the treatment starts to work & this does not always happen quickly. Dr Dodds Hemopet provides a full transfusion service as you probably know. I was watching British TV not long ago & a standard poodle had to have over 10 transfusions before he started on the road to recovery! Lets hope Ashki doesn’t have to have that many.

I am also thinking about possible drug interactions here, or the possibility that the trigger of onset has not been found & treated, maybe a long-term health issue, also the hypothyroidism had been around for ages (takes a while to get better from that). I urge you to discuss this with Dr Dodds. The reason I mention the cause is the high neutrophil count on some of the blood tests which generally means infection, but not always (big sigh – this is a complicated disease). Would it be worth asking Dr Dodds about trying doxycyline instead of the flagyl (metronidazol can interact with the other drugs Ashki is on) The only problem with doxy is it does give them bad tummy ache. I think Mary mentioned that people have to stay sitting up for some time after taking their dose because it can irritate the oesophagus. Worzel had to take doxy for 7 weeks & he was really uncomfortable until his sucralfate dose, but it had to be done!

So really all I can say is go with Dr Dodds advice. There are other drugs to try, e.g. azathioprine, and they can be combined, of course – it’s just a matter of finding what works for Ashki. You are such a wonderful Mum & I am sorry Ashki’s PCV hasn’t improved yet. Those baby red cells are there, but they are not getting a chance to replenish the stock. Regenerative is GOOD. Please know I’m thinking of you – I know Patrice has been helping (she is amazing) on the blood results front & the high iron level. We are all behind you 100%.

As Vally says, you are not allowed to get an eye infection! And to cheer you up, please remember Vally’s Bingo took a while to respond (and many others too), so you are not alone.

Anyway sending you loads of love & hoping for a higher PCV really soon – keep us in touch with how things are going. Look after YOURSELF too!

Sheena, Worzel & Ollie xxxx


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Tamara

Guest

Thank you so much.  Dr. Dodds  approved of the meds, and she was encouraged by the uptick in retics.  I got a brief message from the internist this morning that his retics are up again a little!  So cautious optimism is in order.

She said we could try anabolic steroids to continue to stimulate the bone marrow OR IV HIgG.  We’re getting pricing on IV HIgG, but apparently it is very expensive and I am encouraged by this increase in reticulocytes so will probably wait on that.

Unfortunately my eye is not clearing up so I’m running to the doctor this afternoon for drops.

Ashki is resting a lot but is also in good spirits and eating well.

I am so thankful for you all.

Love and hugs —

Tamara and Ashki


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admin

Keymaster

Hi Tamara

Great news about today’s increased retics! I think cautious optimism is appropriate, and it’s brilliant to hear that Dr Dodds is encouraged too.

I’m a little confused as to whether the vet thinks Ashki is responding to his current meds or not? I know that yesterday you said he didn’t think so, but then today he says to reduce the pred as the others are now effective? What did Dr Dodds make of the pred reduction? My feeling is the same as Sheena and Vally’s – that it is too early to start reducing. However, if Dr Dodds is happy with it then I’d go with her advice. I have also heard that immunoglobulin is very expensive, so I hope you don’t have to go down that route. It’s always good to hear that he is ok in himself. He’s bound to be tired from the low PCV and medications, but good spirits is good!

I’m sorry to hear about your eye. Everything always happens at once doesn’t it? I hope they are able to sort that out quickly for you. As Sheena says – look after yourself too, ok?

Give Ashki a big cuddle from me. We are still keeping our fingers and paws crossed over here for more good news :)

Love, Mary & Mable x


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Tamara

Guest

Hi Mary, as I understand it, the pred is given at a high dose initially to immediately suppress the immune system until the other immunosuppressants take effect.  The protocol that Dr. Dodds sent me (I can send it to you all if you’d like :) ) has a very  high initial dose of 2-3 mg/lb/day reduced by 50% weekly, but the animal must remain on pred at least 6 weeks, and the animal needs to be on a small aount of pred for the cyclo to work well (I don’t know about myco).  She said cyclo suppresses the immune system in about 48 hours, and I’ve read that myco is about the same time frame.  However, I think it often takes much longer than that for that suppression to have an effect on the disease.

I’ve read that these newer immunosuppressants were developed specifically so that pred could be used less/at lower doses, because of its devastating effects.  Ashki has definitely been showing iatrogenic Cushing’s – his muscle tone has changed dramatically (which I worry about for his hip dysplasia), skull-like appearance of the head, I found a small lump under the skin, and of course the drinking, eating, and peeing.  Coat changes as well.  So I’m actually relieved that we’re reducing the pred given all that and that Dr. Dodds recommends reducing it faster.  I do want to reduce it very slowly (and at much smaller increments of 50%) because Ash has been on 30mg BID for over 6 weeks.

I honestly think that the reason Ash is responding now is that the thyroid therapy is kicking in, and I’m hoping we will see more of a response as the B12 kicks in too; I think the hypothyroidism and digestive problems were both contributing factors.  Right now we’re just kind of working around the digestive problems by injecting B12, though I did collect Ashki’s saliva and send Dr. Dodds’ nutriscan kit back to her lab so we can identify any food sensitivities.

The internist is working very hard to control costs for me, including reducing the cost of the IVHIgG if we need it. And his nurse is wonderful and pretty much in love with Ashki (as is the rest of the hospital to be honest – how can they not be with that fabulous smile of his ? :) ).

I feel like I spend all my time cooking potatoes and chicken and fish for his liver cleansing diet and of course giving him his meds and going to doctor appointments.  Today he went to have acupuncture and he was so happy to be there and see the vet and the vet techs.  He’s just wonderful.

Thank you all so much for your help and support.  I know I’ve said it before but I’ll say it again, it’s so helpful to have you all to “talk” with about this and have you *really* understand.

With love and gratitude, and many hugs —

Tamara and Ashki


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admin

Keymaster

Hi Tamara

Thank you for explaining that to me as I hadn’t heard it before. Certainly I’d go with Dr Dodds’ advice. What weight is Ashki at the moment? I do remember now you saying to Hope that he was on a very high dose so I’m wondering if they are lowering to the “standard” 1mg/lb dose. I also did not know that the pred helps the cyclosporine to work, as well as the 48 hour time frame (though you are right that it often takes much longer for a clinical response to be seen). Thank you for this information. That’s one of the great things about this forum – we all learn from each other and everyone’s experience is so valuable.

I agree with your plan to reduce the pred slowly, giving the body a chance to gradually adjust. Pred does do horrible things to them, and I know Sheena’s Worzel had some “undesirable” effects from it, which I’m sure she will tell you about. Still, it is a life saver in so many cases.

I hope that with all your cooking, Ashki is eating well? I totally understand your feelings about various appointments etc. It is totally all encompassing at this point, and the amount of nursing care required can’t be underestimated.

Brilliant to hear that the vet is trying to keep costs down. That’s always a sign of a vet who is in it for the right reasons to my mind, as well as the obvious practical implications for treatment. It breaks my heart that people have to (understandably) consider money in these situations.

I’m so pleased that you are feeling a bit more positive about things and that Ashki enjoyed his acupuncture. That’s one of the great advantages dogs have over cats. Cats, generally, just hate being taken anywhere!

When’s the next PCV? We are rooting for good results!

Mary & Mable x

  • This reply was modified 12 years, 4 months ago by admin.


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Reply To: Ashki – new thread
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Vally
Keymaster

Tamara, you mention “we reduced the pred to 20mg BID” – what was it originally and when was it dropped to 20mg.  I’ve been through the thread but I can’t see it.

Normally wouldn’t start reducing the pred until they’ve been stable for a bit unless there is a specific reason.

Love Vally & Bingo.

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Tamara
Guest

Hi Vally and Brigitte, thank you so much.  I’ve contacted Dr. Dodds again and am waiting to hear from her.

Ashki was on 40 mg pred BID for a week, then reduc ed to 30 mg BID until today, when the internist said to reduce it. When I asked him if we should given that Ashki is not responding, he said that the other drugs (cyclosporine 100mg BID and mycophenolate 250mg BID) are now working completely and we can reduce the pred slowly.  Ash has been on cyclo since 5/1 and myco since 5/15.

I’m looking forward to hearing Dr. Dodds’ input, and will increase the pred if she suggests that.

I’m hanging in there, though I think I’m getting an eye infection :(

Ash is quite tired today, though seems to be in good spirits.  He still rolled in the dirt in the backyard  today :)

with love and gratitude,

Tamara and Ashki

Details
Vally
Keymaster

Tamara, let us know what Dr Dodds says.

You are NOT to get an eye infection.

Love Vally & Bingo.

Details
admin
Keymaster

Hi Tamara

I’m sorry I haven’t been around much for a few days. I know how disappointed you must be about the drop, but please don’t get disheartened, Tamara. I think you must go with Dr Dodds implicitly from now on &  I am also not happy about the pred reduction. As Vally so rightly says, the pred should not be reduced until Ashki has been stabilised. The high pred dose (called the cornerstone of treatment) is vital to stop the red cell destruction until the other drugs start working, which they clearly haven’t as yet, as Ashki’s PCV is still dropping slightly, not going up. Some dogs can NEVER stop the prednisolone – that’s not a problem, but it is the case for a few dogs. Please, please do not get too stressed over this (says she who stresses about everything with Worzel even now!) – transfusions are there to keep Ashki going nicely until the treatment starts to work & this does not always happen quickly. Dr Dodds Hemopet provides a full transfusion service as you probably know. I was watching British TV not long ago & a standard poodle had to have over 10 transfusions before he started on the road to recovery! Lets hope Ashki doesn’t have to have that many.

I am also thinking about possible drug interactions here, or the possibility that the trigger of onset has not been found & treated, maybe a long-term health issue, also the hypothyroidism had been around for ages (takes a while to get better from that). I urge you to discuss this with Dr Dodds. The reason I mention the cause is the high neutrophil count on some of the blood tests which generally means infection, but not always (big sigh – this is a complicated disease). Would it be worth asking Dr Dodds about trying doxycyline instead of the flagyl (metronidazol can interact with the other drugs Ashki is on) The only problem with doxy is it does give them bad tummy ache. I think Mary mentioned that people have to stay sitting up for some time after taking their dose because it can irritate the oesophagus. Worzel had to take doxy for 7 weeks & he was really uncomfortable until his sucralfate dose, but it had to be done!

So really all I can say is go with Dr Dodds advice. There are other drugs to try, e.g. azathioprine, and they can be combined, of course – it’s just a matter of finding what works for Ashki. You are such a wonderful Mum & I am sorry Ashki’s PCV hasn’t improved yet. Those baby red cells are there, but they are not getting a chance to replenish the stock. Regenerative is GOOD. Please know I’m thinking of you – I know Patrice has been helping (she is amazing) on the blood results front & the high iron level. We are all behind you 100%.

As Vally says, you are not allowed to get an eye infection! And to cheer you up, please remember Vally’s Bingo took a while to respond (and many others too), so you are not alone.

Anyway sending you loads of love & hoping for a higher PCV really soon – keep us in touch with how things are going. Look after YOURSELF too!

Sheena, Worzel & Ollie xxxx

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Tamara
Guest

Thank you so much.  Dr. Dodds  approved of the meds, and she was encouraged by the uptick in retics.  I got a brief message from the internist this morning that his retics are up again a little!  So cautious optimism is in order.

She said we could try anabolic steroids to continue to stimulate the bone marrow OR IV HIgG.  We’re getting pricing on IV HIgG, but apparently it is very expensive and I am encouraged by this increase in reticulocytes so will probably wait on that.

Unfortunately my eye is not clearing up so I’m running to the doctor this afternoon for drops.

Ashki is resting a lot but is also in good spirits and eating well.

I am so thankful for you all.

Love and hugs —

Tamara and Ashki

Details
admin
Keymaster

Hi Tamara

Great news about today’s increased retics! I think cautious optimism is appropriate, and it’s brilliant to hear that Dr Dodds is encouraged too.

I’m a little confused as to whether the vet thinks Ashki is responding to his current meds or not? I know that yesterday you said he didn’t think so, but then today he says to reduce the pred as the others are now effective? What did Dr Dodds make of the pred reduction? My feeling is the same as Sheena and Vally’s – that it is too early to start reducing. However, if Dr Dodds is happy with it then I’d go with her advice. I have also heard that immunoglobulin is very expensive, so I hope you don’t have to go down that route. It’s always good to hear that he is ok in himself. He’s bound to be tired from the low PCV and medications, but good spirits is good!

I’m sorry to hear about your eye. Everything always happens at once doesn’t it? I hope they are able to sort that out quickly for you. As Sheena says – look after yourself too, ok?

Give Ashki a big cuddle from me. We are still keeping our fingers and paws crossed over here for more good news :)

Love, Mary & Mable x

Details
Tamara
Guest

Hi Mary, as I understand it, the pred is given at a high dose initially to immediately suppress the immune system until the other immunosuppressants take effect.  The protocol that Dr. Dodds sent me (I can send it to you all if you’d like :) ) has a very  high initial dose of 2-3 mg/lb/day reduced by 50% weekly, but the animal must remain on pred at least 6 weeks, and the animal needs to be on a small aount of pred for the cyclo to work well (I don’t know about myco).  She said cyclo suppresses the immune system in about 48 hours, and I’ve read that myco is about the same time frame.  However, I think it often takes much longer than that for that suppression to have an effect on the disease.

I’ve read that these newer immunosuppressants were developed specifically so that pred could be used less/at lower doses, because of its devastating effects.  Ashki has definitely been showing iatrogenic Cushing’s – his muscle tone has changed dramatically (which I worry about for his hip dysplasia), skull-like appearance of the head, I found a small lump under the skin, and of course the drinking, eating, and peeing.  Coat changes as well.  So I’m actually relieved that we’re reducing the pred given all that and that Dr. Dodds recommends reducing it faster.  I do want to reduce it very slowly (and at much smaller increments of 50%) because Ash has been on 30mg BID for over 6 weeks.

I honestly think that the reason Ash is responding now is that the thyroid therapy is kicking in, and I’m hoping we will see more of a response as the B12 kicks in too; I think the hypothyroidism and digestive problems were both contributing factors.  Right now we’re just kind of working around the digestive problems by injecting B12, though I did collect Ashki’s saliva and send Dr. Dodds’ nutriscan kit back to her lab so we can identify any food sensitivities.

The internist is working very hard to control costs for me, including reducing the cost of the IVHIgG if we need it. And his nurse is wonderful and pretty much in love with Ashki (as is the rest of the hospital to be honest – how can they not be with that fabulous smile of his ? :) ).

I feel like I spend all my time cooking potatoes and chicken and fish for his liver cleansing diet and of course giving him his meds and going to doctor appointments.  Today he went to have acupuncture and he was so happy to be there and see the vet and the vet techs.  He’s just wonderful.

Thank you all so much for your help and support.  I know I’ve said it before but I’ll say it again, it’s so helpful to have you all to “talk” with about this and have you *really* understand.

With love and gratitude, and many hugs —

Tamara and Ashki

Details
admin
Keymaster

Hi Tamara

Thank you for explaining that to me as I hadn’t heard it before. Certainly I’d go with Dr Dodds’ advice. What weight is Ashki at the moment? I do remember now you saying to Hope that he was on a very high dose so I’m wondering if they are lowering to the “standard” 1mg/lb dose. I also did not know that the pred helps the cyclosporine to work, as well as the 48 hour time frame (though you are right that it often takes much longer for a clinical response to be seen). Thank you for this information. That’s one of the great things about this forum – we all learn from each other and everyone’s experience is so valuable.

I agree with your plan to reduce the pred slowly, giving the body a chance to gradually adjust. Pred does do horrible things to them, and I know Sheena’s Worzel had some “undesirable” effects from it, which I’m sure she will tell you about. Still, it is a life saver in so many cases.

I hope that with all your cooking, Ashki is eating well? I totally understand your feelings about various appointments etc. It is totally all encompassing at this point, and the amount of nursing care required can’t be underestimated.

Brilliant to hear that the vet is trying to keep costs down. That’s always a sign of a vet who is in it for the right reasons to my mind, as well as the obvious practical implications for treatment. It breaks my heart that people have to (understandably) consider money in these situations.

I’m so pleased that you are feeling a bit more positive about things and that Ashki enjoyed his acupuncture. That’s one of the great advantages dogs have over cats. Cats, generally, just hate being taken anywhere!

When’s the next PCV? We are rooting for good results!

Mary & Mable x

  • This reply was modified 12 years, 4 months ago by admin.
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