Lola

[Vally]

Sorry Ashley, what is the dosage of the tablet that Lola is taking. They come in all sorts. Yes, I would ask to reduce the daily dosage by no more than 25% especially bearing in mind that Lola has had difficulty in the past going to every second day.

I became totally paranoid because I have never been able to get Bingo onto every second day. A problem every single time. I refused to reduce by more than 25% and I dragged it out to 2 months with each reduction. I went over the top on the length of time :)

Regards, Vally

[admin]

Hi Ashley

I agree with Brigitte & Ashley – take it slowly. I would be inclined to be very cautious in Lola’s circumstances – 25% is enough of a reduction for her as Lola has already relapsed. The total should be divided into 2 doses 12 hours apart. I would personally do these reductions once a month with a relapsed dog too. When you get to a low dose, say 5mg (2.5 mg twice per day) with a smaller dog, then you can go to once a day with say the 3mg or 2.5mg. Some vets do like to go to every other day at LOW doses, and we often chat on here about that being a good thing or not – it is controversial – but we are talking about very low doses here, not sudden big reductions. What is important to know is that her adrenals glands need to be woken up slowly, not with a “bang” of a big reduction. These poor glands cannot spring into action quickly enough & Lola will feel ill because she isn’t able to produce enough of her own cortisol. The other thing to think about is that some dogs will always need a small amount of prednisone (like Vally & Bingo) – this is not a big deal all – a small dose is not going to give them any problems. How much does Lola weigh & what was her previous dose, Ashley?

Don’t worry about Lola’s coat – she will start looking much better when the dose is reduced. Worzel suffered terrible muscle atrophy & looked like a moth-eaten skeleton on the high dose. I was surprised how quickly he started getting back to normal on a lower dose. He really did look 95% back to his old self after we stopped the pred. We are very lucky that Worzel doesn’t need any pred now, but he still has one azathioprine (50mg) per week as my insurance policy against relapses. I am terrified even now that this will happen to him & refuse to stop this one pill! As you know, we are all mad, crazy & paranoid & I admit this disease has made me very cautious.

Hoping this has helped – please be careful. Most vets have never seen this disease before & we all want Lola to get through the reductions without any problems.

Best wishes to you all
Sheena, Worzel & Ollie

[Ashley Younger]

Thanks all for the advice. I have listed Lola’s current medications below:

Denamarin Medium- liver, 1 tab once a day

Famotidine- tummy protector, 1/2 pill twice daily, 20mg

Melatonin- helps absorption of Azathioprine

Prednisone- 1 tab every other day per yesterday’s convo with vet. She’s on 10mg. I did not reduce dosage yet after reading everyone’s comments. I have a call into our vet.

Azathioprine- 25ml, 0.64 ml daily, 25mg

If she’s currently on once a day prednisone at 10mg, what do you all recommend the reduction be? I’m bad at math and terribly overwhelmed. I want to take your suggestions to my vet.

Also, do the rest of her medications seem right? Anything jump out at anyone? Anything missing?

It sounds like everyone recommends Dr. Dodd. Am I correct? My husband wanted to track down a specialist within driving distance, but that will still be quite far. I think it makes more sense to utilize Dr. Dodd’s online services in conjunction with our current vet (who we really like). I think the best option would be for Dr. Dodd to advise my vet and for them to collaborate. Thoughts?

What else am I missing?

[Ashley Younger]

Also, Lola is about 35lbs.

[hope]

Hey Ashley!

I’m not nearly as knowledgeable as everyone on here but i think a 10 –> 7.25mg a day taper would be good. That’s a 27.5% decrease.. you need to be really careful, especially since you know Lola has had trouble with big tapers.

Is she still having trouble with her tummy? Steve was last month and the vet switched him from Famotidine (Pepcid) to Omeprazole (Prilosec).. apparently the latter is a stronger one. I don’t know why they don’t automatically put all of our pups on it since these meds are so hard on them but it’s an option.

What about aspirin or something for clotting? That’s something I really really worry about with Steve so we do 1/8 81mg aspirin BID.

I’ve spoken with Dr. Dodds via email several times since Steve was diagnosed in June. I told her I would pay a consultation fee but she said she was more than willing to answer general questions via email, and she’s super fast generally (within hours). If you want her to consult with your vet, she is super willing but then I think you have to pay the consultation fee. Its only $100 or so and I think sooo worth it. She’s awesome.

Hope Lola and you are having a good day!
Hope and STeve

[hope]

O_o! If you do a 7.25mg Pred, you would have to cut a 10mg pill into halves and then some also into 1/4s. And you would give 1/2 a pill + 1/4 a pill for the 7.25mg.

[Ashley Younger]

Here’s the latest:

I talked to our vet, and she feels that Lola has been on prednisone long enough that she is not at adrenal risk from the proposed reduction. (Lola was diagnosed in January or February of this year and has been on prednisone since then.)

Additionally, Lola has done well on this reduction before and only relapsed after reducing to every other other day.

Our vet said even more gradual reductions are often implanted when dogs have been on prednisone less time than Lola has and when they are having more severe autoimmune issues than Lola appears to be having.

Our vets biggest motivation to drop to every other day, rather than a reduced daily dosage, is to mitigate the prednisone side effects and to give her system a break every other day.

So, that’s where we are. I welcome your thoughts as we’re trying to decide the best course.

[admin]

Ashley,
how often did you do the reductions? I would suggest to reduce to 7.5mg every day. I am pretty sure there are 5mg tablets so that would be 1 1/2 tablet. if you have a pill cutter that is no problem. This would be a 25% reduction. Then if Lola is doing fine with that you could go to 5mg every day or 7.5 one day 5 the next. You could do the reductions sooner, lets say every 2 weeks instead of 3 or 4. You could also leave the 10mg one day and go to 5mg the next. This again would be (in my little head:)) a 25% reduction. I think I would rather do the reductions sooner than reduce the amount by 50%. I respectfully disagree with your vet on doing a 50% reduction, especially since Lola had a relapse already. Keep in mind though, I am NOT a vet, not even a scientist, I just have read a lot about the disease and seen many cases.
Our vet did work together with Dr. Dodds and it was the best scenario I could wish for. On top of my dog getting input from the best of the best, our vet learned lots about the disease. Since we live fairly remote, this was less stressful for my dog, cheaper for me and I would do it this way again. I would be very interested what Dr. Dodds suggestion would be!
Best wishes,
Brigitte

[Vally]

Sorry Ashley, what is the dosage of the tablet that Lola is taking. They come in all sorts. Yes, I would ask to reduce the daily dosage by no more than 25% especially bearing in mind that Lola has had difficulty in the past going to every second day.

I became totally paranoid because I have never been able to get Bingo onto every second day. A problem every single time. I refused to reduce by more than 25% and I dragged it out to 2 months with each reduction. I went over the top on the length of time :)

Regards, Vally

[admin]

Hi Ashley

I agree with Brigitte & Ashley – take it slowly. I would be inclined to be very cautious in Lola’s circumstances – 25% is enough of a reduction for her as Lola has already relapsed. The total should be divided into 2 doses 12 hours apart. I would personally do these reductions once a month with a relapsed dog too. When you get to a low dose, say 5mg (2.5 mg twice per day) with a smaller dog, then you can go to once a day with say the 3mg or 2.5mg. Some vets do like to go to every other day at LOW doses, and we often chat on here about that being a good thing or not – it is controversial – but we are talking about very low doses here, not sudden big reductions. What is important to know is that her adrenals glands need to be woken up slowly, not with a “bang” of a big reduction. These poor glands cannot spring into action quickly enough & Lola will feel ill because she isn’t able to produce enough of her own cortisol. The other thing to think about is that some dogs will always need a small amount of prednisone (like Vally & Bingo) – this is not a big deal all – a small dose is not going to give them any problems. How much does Lola weigh & what was her previous dose, Ashley?

Don’t worry about Lola’s coat – she will start looking much better when the dose is reduced. Worzel suffered terrible muscle atrophy & looked like a moth-eaten skeleton on the high dose. I was surprised how quickly he started getting back to normal on a lower dose. He really did look 95% back to his old self after we stopped the pred. We are very lucky that Worzel doesn’t need any pred now, but he still has one azathioprine (50mg) per week as my insurance policy against relapses. I am terrified even now that this will happen to him & refuse to stop this one pill! As you know, we are all mad, crazy & paranoid & I admit this disease has made me very cautious.

Hoping this has helped – please be careful. Most vets have never seen this disease before & we all want Lola to get through the reductions without any problems.

Best wishes to you all
Sheena, Worzel & Ollie

[Ashley Younger]

Thanks all for the advice. I have listed Lola’s current medications below:

Denamarin Medium- liver, 1 tab once a day

Famotidine- tummy protector, 1/2 pill twice daily, 20mg

Melatonin- helps absorption of Azathioprine

Prednisone- 1 tab every other day per yesterday’s convo with vet. She’s on 10mg. I did not reduce dosage yet after reading everyone’s comments. I have a call into our vet.

Azathioprine- 25ml, 0.64 ml daily, 25mg

If she’s currently on once a day prednisone at 10mg, what do you all recommend the reduction be? I’m bad at math and terribly overwhelmed. I want to take your suggestions to my vet.

Also, do the rest of her medications seem right? Anything jump out at anyone? Anything missing?

It sounds like everyone recommends Dr. Dodd. Am I correct? My husband wanted to track down a specialist within driving distance, but that will still be quite far. I think it makes more sense to utilize Dr. Dodd’s online services in conjunction with our current vet (who we really like). I think the best option would be for Dr. Dodd to advise my vet and for them to collaborate. Thoughts?

What else am I missing?

[Ashley Younger]

Also, Lola is about 35lbs.

[hope]

Hey Ashley!

I’m not nearly as knowledgeable as everyone on here but i think a 10 –> 7.25mg a day taper would be good. That’s a 27.5% decrease.. you need to be really careful, especially since you know Lola has had trouble with big tapers.

Is she still having trouble with her tummy? Steve was last month and the vet switched him from Famotidine (Pepcid) to Omeprazole (Prilosec).. apparently the latter is a stronger one. I don’t know why they don’t automatically put all of our pups on it since these meds are so hard on them but it’s an option.

What about aspirin or something for clotting? That’s something I really really worry about with Steve so we do 1/8 81mg aspirin BID.

I’ve spoken with Dr. Dodds via email several times since Steve was diagnosed in June. I told her I would pay a consultation fee but she said she was more than willing to answer general questions via email, and she’s super fast generally (within hours). If you want her to consult with your vet, she is super willing but then I think you have to pay the consultation fee. Its only $100 or so and I think sooo worth it. She’s awesome.

Hope Lola and you are having a good day!
Hope and STeve

[hope]

O_o! If you do a 7.25mg Pred, you would have to cut a 10mg pill into halves and then some also into 1/4s. And you would give 1/2 a pill + 1/4 a pill for the 7.25mg.

[Ashley Younger]

Here’s the latest:

I talked to our vet, and she feels that Lola has been on prednisone long enough that she is not at adrenal risk from the proposed reduction. (Lola was diagnosed in January or February of this year and has been on prednisone since then.)

Additionally, Lola has done well on this reduction before and only relapsed after reducing to every other other day.

Our vet said even more gradual reductions are often implanted when dogs have been on prednisone less time than Lola has and when they are having more severe autoimmune issues than Lola appears to be having.

Our vets biggest motivation to drop to every other day, rather than a reduced daily dosage, is to mitigate the prednisone side effects and to give her system a break every other day.

So, that’s where we are. I welcome your thoughts as we’re trying to decide the best course.

[admin]

Ashley,
how often did you do the reductions? I would suggest to reduce to 7.5mg every day. I am pretty sure there are 5mg tablets so that would be 1 1/2 tablet. if you have a pill cutter that is no problem. This would be a 25% reduction. Then if Lola is doing fine with that you could go to 5mg every day or 7.5 one day 5 the next. You could do the reductions sooner, lets say every 2 weeks instead of 3 or 4. You could also leave the 10mg one day and go to 5mg the next. This again would be (in my little head:)) a 25% reduction. I think I would rather do the reductions sooner than reduce the amount by 50%. I respectfully disagree with your vet on doing a 50% reduction, especially since Lola had a relapse already. Keep in mind though, I am NOT a vet, not even a scientist, I just have read a lot about the disease and seen many cases.
Our vet did work together with Dr. Dodds and it was the best scenario I could wish for. On top of my dog getting input from the best of the best, our vet learned lots about the disease. Since we live fairly remote, this was less stressful for my dog, cheaper for me and I would do it this way again. I would be very interested what Dr. Dodds suggestion would be!
Best wishes,
Brigitte