Liver Enzymes

[Vally]

Heathy’s happy pill list is:

4am Carafate 1
6am Prednisone 20mg?? – 2 tabs (with food)
6am Aspirin 1/4
7am – Pepcid
9am – denamarin – can this go in here?????
10am – meal
1pm – meal
4pm pepcid 2
5pm Marin 1.5 (with snack) with denamarin??? (if twice a day)
6pm – prednisone 20mg ?? – 2 tabs (with food)
9pm – carafate 1
10pm – snack

Can anyone see any problems with this???

Vally

[Beth]

Hi Vally, thanks for that! I just have a couple of thing…. Fortunately ive been able to take leave over the next week, probably two, as Heathy is in need of continual care, however the Happy Pill schedule probably needs to take into consideration my working hours, for the follow on months… I leave for work at 8, and can be back for 4. The 10pm meal slot is when my dog walker comes in, i can leave food for her to put down, and the 1pm walk/meal slot is when i can visit home to check on him and feed/ walk him. If theres nothing going on in the office after 1pm i can work at home in the afternoons.
So the 9pm denamarin, i can do for the next two weeks but most likely not after that. I do also get up at 2am to let him have a pee, so i can give him something then if that helps. But i was hoping as the pred gets less i wont need to be up every two hours in the night for his pee breaks.
To be honest i will do anything that it takes, as long as i can accommodate work!
The denamarin should be arriving this evening, oddly im quite excited about starting him on it!
Hugs and Paw,
Beth and Heathy

[Beth]

Vally, oh yes the other thing was that the vet suggested stopping the aspirin now, hope thats an ok idea. Also the prednisone tablets are 20mg each, so 4 a day is 80mg (this was what yesterdays schedule looked like) his is now on 1.5 pills twice a day (60mg) and this may go down mid week. I just say this for clarity, i know it doesnt affect the schedule :)

Cheers!
Beth x

[Vally]

Ahhhh, you’re another night worker, and you have a 10pm dog walker – wow.

I’ll just bet your excited about the denamarin. I’m excited too. This truly worked magic for Bingo and lots of others.

The aspirin, I’m not sure about stopping yet. Anyone???

If the bloods are in the normal range, can the aspirin be stopped, or is it better to wait until the pred comes down???

Vally
xxx

[Beth]

Oh whoopsy! Sorry, no they should all be ‘am’, not ‘pm’! I leave work at 8am and return at 4pm and have a 10 am dog walker.

Beth.

[Vally]

Well that makes more sense. Wow I was amazed at your 10pm walker.

So how about if we do the denamarin at 8am? And I actually think it’s given once daily. What are the instructions on that?

Vally
xxx

[admin]

Hi Beth

Vally’s schedule looks good to me – I know you’ve dropped the pred a bit more – good stuff!

Vally mentioned the aspirin – I am also reluctant for you to stop the aspirin without checking with Dr Dodds – you need to ask if your vet has checked for spherocytes & auto-agglutination on a blood smear (you can see these things on a slide) – see the following for more information:

https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/

I saw on the top of one of the tests “hemolysis – no significant interference” so that is good – no problem there. Although his platelets are a little high, they are no where near the danger level of 1,000,000 or over, so no worries on that score either. If Heathy has no (or very few) spherocytes & no agglutination (cells sticking together), that would be great news – BUT (why is there always a but???) as you are doing a fast reduction, these risks could possibly re-emerge – this happened to Linda’s Sadie. I am afraid I am the site nag on clotting as this is by far the biggest risk with IMHA, so I am always very cautious. I would definitely check with Dr Dodds if it were me – just a quick one-liner to ask her by e-mail if you should stop it at this stage or wait until later, when the pred reduction is finished.

It’s great that you will have some time off with Heathy – I’m sure the peeing will reduce in frequency with the lower pred dose. That should mean some much better quality sleep for you – I don’t know how you’ve managed so well with all this to contend with – great job, Beth & Heathy! Try & be patient on the liver enzyme front – the liver is an amazing organ – incredibly regenerative.

Let us know how Heathy is when you can – enjoy your some relaxing YOU time too!

Love & hugs
Sheena & the boys xxxxx

[Beth]

Hi All,

Thanks Vally for the meds chart and Sheena for the aspirin advice. I love the way that each of you are a “site nag” on something! It seems Brigitte is the GI Superwoman, Sheena the Clotting Superwoman and Vally the Meds Interaction Superwoman! Its great for keeping Heathy and i in check.

Heathy is not his best today, i think its the weakest I’ve seen him. I had to carry him down the stairs to the front door to go to the toilet this morning, which isn’t easy as a 73 pound dog. I live in an upstair condo so any tips on getting him about would be appreciated.

Its a scary week for me as we just went down to 60mg yday, and ive been thinking that we will need to go down more, pretty soon so i asked Dr Dodds and she suggested going to 40mg in 3-5 days (3-5 days of being on 60mg). I’m leaning towards taking him down again in 3 days after a pcv has been taking, as he is obv suffering now from something bad (either the condition of his liver or the reduction in pred) His tongue still looks pinky red so im hoping he’s ok on the anemia front at the moment.

What i was wondering, is how quick i will notice a relapse if one occurs on the lower doses? Will it be a 24 hour thing or several days?

My vet is still concerned about a liver infection of some kind, but i am so reluctant to have a biopsy/ aspirate done. She seems to be going on the liver values but as far as i can tell, they will take at least a week to start dropping. I just pray that they havent shot up too much again.

So the plan for now is 60mg until wednesday, pcv check, and then if its still holding, to drop the pred to 40mg wednesday evening and then do a complete cbc/chem on friday/saturday.

When you say that your pups seemed ‘under the weather / off colour’ with a pred drop, what do u mean? How did they appear? Very lethargic? How soon did this pass?

Oooo… Started him on denamarin this morning, yay!

Thanks and love,
Beth and Heathy.
xx