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- Overwhelmed and don't know what to expect- just started Prednisone on Charlie
Hi Todd-
I went back to look at what Dr. Dodd recommended on the slippery elm and she mentions also to me to mix with food but to separate from medications by 30 minutes
You are right, I should be giving the Nutrigest twice a day…he started off on Fortiflora per my vet and that was once a day, and when he ran out I ordered the Nutrigest to replace it and didn’t realize that does say to give twice a day. Charlie doesn’t like it much though in his food, so I have to mix it with the slippery elm and give separately. Dr Dodd did indicate that you can add a little honey to it so that makes it tolerable for him.
Thanks for the comparison of prednisone dose for your Colby, I took the dose x 4 to compare to 50 lb Charlie and our dosing schedule taper is about the same. My current 5mg dose daily is about your 1.25mg daily dose. I think I’m already seeing some decreased thirst and appetite with this lower dose.
I finished his metronidazole today so we will see if the diarrhea comes back. My dog also eats rabbit poop and I’m pretty sure this last round of diarrhea started after I caught him chowing down on some fresh dog poop from another dog. I am constantly trying to pick up his poop so he doesn’t eat it. I don’t know why he is doing this, if the prednisone makes him THAT hungry or if he is deficient in something….he NEVER ate poop before.
That is a good suggestion to wrap the pills in turkey-I guess I use to use chicken in the past to give pills, but Dr. Dodd said chicken was a “hot” food, so he doesn’t get chicken for a treat anymore. Because he gets so many pills/day I have been using a pill pocket and shoving all of them in one and the ones I can’t fit in give with a smiggen of peanut butter and it goes right down. When I run out of the pill pockets, I’ll go to turkey.
Thanks for the recipe for the homemade diet. I worry that he won’t get enough protein and nutrients/ fats if I don’t do it right or give him the right quantity or portion of carb/protein…at least with commerical food that is all figured in. I’m going to see how this next week goes and then I think I’ll be cooking this coming weekend.
When you say not to despair, you give me hope. This morning he was so bad he could barely stand or walk…he got all his morning pills (t-relief and DPLA is for his arthritis) and by noon he was alert and walking ok and tonight went for a 20 minute (very slow) walk. So big difference from morning to evening. It is so hard, I’m not looking at giving him years like most of you…I’m looking at months as long as he is not suffering and still has some quality of life. If he can get enough strength in his hind legs to be able to get up to stand without assistance I will consider that a big WIN. Hopefully the prednisone has not set him back so far that he can’t recover.
Deb,
The fact that you got him on a walk is awesome. You want to get him moving but there is a balancing act.
I was always giving Colby boiled chicken and rice when I had to give her bland food with the diarrhea. But on the last go around the gas was so bad from the chicken we were dying. Now I get why chicken was not on the list of foods. Try cooked white fish (cod). use some salt, pepper and a good amount of oregano and some olive oil. Dr. Dodds told me its the spices that really attracts them to the eating and I can vouch for that. You get the good fats from the fish and the olive oil.
When i mix the slippery elm & nutrigest with water and then pour & mix in the food, Colby doesn’t even care or notice it. If my ratio’s are 2oz fish + 3oz veg + 1/2 cup rice for a 12# dog, I don’t know if you are 4 times that amount per meal or probably less due to an older less active dog. I wouldn’t;t worry as much about the nutrients in your kibble vs real food. for one, there will be no comparison of fresh cooked food vs commercial dog food. Second, you are getting vitamins from your other supplements. Third, the priority is getting the bowel issues under control. That takes healing. So the proper diet is key to address that. You can have all the nutrients in the world but if the dog has diarrhea they are just coming right out and nothing is getting absorbed.
Colby would eat deer poop before getting IMHA. She never ate dog poop. Her own throw-up is another story. However, she did start doing things that she never did before she started with the meds. For one, she started chewing on bully sticks. She never chewed on anything. Never a toy and could care less about a bone or bully sticks. She would just burry them in the couch, bed etc. Months after being on the meds she would go to town on a bully stick. In a way this was positive since her dental hygiene was bad (dental disease is a possible trigger of IMHA per Dodds) and I was contemplating getting her cleaning just prior to when the IMHA hit. I did get that done, along with teeth removal, a couple of months ago. Colby did develop pica (eating non nutrient things like toilet paper or paper towels). Now that I have been giving regular food it seems that stopped completely. So, I am thinking maybe this was her hunger level or feeling that she wasn’t getting enough volume when I was giving her dried dog food. The amount was so small (3/4 cup a day split into 2 meals). so she constantly was looking for food even though she didn’t need it. She was fine weight wise. The volume of the fresh food the Veg and rice helps add bulk and she hasn’t felt the need to eat the paper anymore. At least from what I have seen since for the past several weeks.
The current issue I am having is what appears to be some incontinence. when lying down on her belly with her legs sprawled out (frog legs) and when she gets up there would be a large wet spot. Maybe overfilled bladder, since it doesn’t happen all the time. But, something new. Have to get back over to the vet.
This is our routine:
My wife gives morning meds when she wakes up.
1hr later I mix up slippery elm, rx nutrigest and water (watery) into her food. I split it and give half w/ pet-tinic.
45min – 1hr later I give the balance.
At night I do the same thing. Whoever gets home from work 1st gives the meds.
Todd, a big thank you for your help here.
Deb, Bingo relapsed twice, both times when we were decreasing his prednisone. We were doing a 50% drop the first time when we went from 10mg to 5mg that he relapsed. It happened again later when we were reducing his pred. In the end, we just started doing super slow reductions over a long period and he ended up remaining on a small dose of pred.
I’ve check Bingo’s old records. They were always funny about testing his thyroid because they said the prednisone would affect the test. I can only see that the T4 was checked, not the TSH.
Another idea about the diarrhoea, has Tylan powder even been mentioned? You could ask Dr Dodds what she thinks about it rather than the Metronidazole. Tylan is an antibiotic used for colitis and chronic diarrhoea. I needed a script to get it here, but I think there you can get it from Amazon, but please check with Dr Dodds first. She was the one that first suggested it to someone here, but I’m not certain whether the dog was at that point suffering colitis, so may be different from what Colby is going through now.
Sweet potatoes (the orange ones – we call the kumaras here) are yum!!! We usually eat them instead of pumpkin. They are very good for you. I peel them, although you don’t have to. The skin is a bit tough though. I then steam them, or you can boil them. Exactly like potatoes or pumpkin.
I feed Saba raw (I did Bingo too, but not while he was sick), but I now buy raw frozen patties, but then I usually cook up some sweet potato and add it to the raw.
Vally & Saba
Vally & Deb,
Dr Dodds had mentioned Tylan (tylocin powder ) to me in out last email exchanges. Said to start that “after” the Metronidazole dosing is done. Need the Metronidazole to get it under control and cleared ups and then the Tylan is given after for maintenance. Assuming of course the diarrhea is gone and bowl movements back to normal. I forgot about this so will look into getting some. Pretty sure I need a script for this as well.
Deb, I didn’t look up all the meds/supplements listed but one thing that could maybe help is prilosec (Omeprazole), which is an antacid and was given from the start to Colby for the Pred. given in AM with meds. The other thing Dr. Dodds mentioned was a small amount of unsweetened apple sauce before bed to help with stomach acid build up overnight until next dose of prilosec . For colby it was a 1/2 – 3/4 teaspoon of unsweetened applesauce.
Vally, when you said Bingo relapsed, you didn’t tell me how you knew…was it the labs or symptoms? If symptoms what were they? We just went from the 10mg to 5mg too…so need to know what to watch for.
I am finding that Charlie is doing a little better with the lower dose of prednisone at 5mg daily now- not so much drinking, peeing, panting or restlessness…..HOWEVER, I’m also seeing that he is not as hungry and not really eating as much. Before on the higher pred dosing he couldn’t eat enough, now he is more or less back to eating a small amount for breakfast, a little at lunch, main amount at supper.
Before all this happened, Charlie would self feed. I would leave food in his dish all the time. He never was overweight, although maybe carried a few extra pounds. He would like to eat and walk around and would eat throughout the day small amounts, and would mostly eat the main amount right before bed. I never had problems with him getting me up to go out at night and he would sleep in as long as I wanted to sleep without disturbing me.
Now I have to get up with him twice a night, about 1am and 5:30am- the 5:30am is usually his pooping time, so don’t know if when the stools become a little firmer if he can wait until 7, or if I need to move his feeding time in evening to later. I would love to get a full nights sleep if I can get this figured out.
Charlie has lost about 14 pounds over the last year, down to 50-52 pounds, probably due to the cancer and just not as interested in eating, but lately since the prednisone, I’m really alarmed-The top of his head is a boney ridge when you pet him, you can feel his spine and no muscle mass at all in his hind quarters. The fact that he can’t get up when I’m not home means he can’t self feed even if he wanted to. Do I need to give him more calories in the form of protein or fat?
Can’t feed Charlie raw as he has no spleen- can you microwave the sweet potatoes or are they better steamed? I know that pumpkin is also on the list, can you used canned? (not the pie mix I’m sure)- pumpkin is very seasonal here but if the canned can be used, I could try that, I know that is suppose to be good for diarrhea/loose stools
Todd- is Pet-tinic what Dr. Dodds recommended for multiple vitamin? When I asked her about a recommendation for one, she said not to worry about and just give the Nutrigest. I went ahead and ordered a chewable Pet-Tab Plus. I find that he eats chewable pills like treats but when I try powder (ie the Nutrigest) to mix in his food he doesn’t like it at all and turns his nose up at the food so I might have to switch to the tablets.
My goal is to try to simplify only essential meds/supplements as this is getting way too complicated…not a fan of chronic antibiotics. I’m thinking once his pred is low his liver function tests will be ok and he won’t need the Denamarin..is this what you have found?
Appreciate all the ongoing advice, especially regarding diet as that is what I’m struggling with now.
Vally & Deb,
Vally, I am als curious at to deb’s question on how you knew about relapse.
Deb, How often do you go for blood tests for PCV? When I changed meds I was very apprehensive at these times and typically went back for blood work a max of a week, maybe even 3 days later at times, which was a point of anxiousness.
As far as the sweet potato, I would think Microwaving should be fine. Can even bake them in the oven for an hr plus to get them nice and soft. If I remember unsweetened pumpkin in the can is what I used or tried at some point in the beginning. Colby would not eat the pumpkin but loved the sweet potato. Can also get baby food jars of sweet potato. I did that in the beginning.
Colby also used to self feed. I used to just fill the bowl up in the AM and she would typically eat once a day around the time we had dinner. After the IMHA and meds that is not longer possible. She probably would eat till she threw up. The reduction in drinking is what I noticed in colby. The hunger for food never really went away and any times if she hears something that can be interpreted as food coming she goes nuts with her tongue.
There were times that Colby didn’t want to eat or stopped eating but many of those coincided with bowel issues. You may not be done yet with that process. Could be Charlie wants something different. I had many times that things Colby loved she stopped eating and then ate things she didn’t like before. My thought was she was associating the bad feelings from the meds with what she was consuming. So maybe changing the food type might help. I still can’t say enough about the food/diet Dr. Dodds suggested to me. Colby can’t get enough. I had the same issues with the nuttiest. I used to give Colby a Kids unflavored probiotic periodically and would pour the powder on a slice of deli turkey. I tried the same with the Rx Nutrigest and Colby wouldn’t eat it. I tried sprinkling it on her dried food at the time and no go. At the time I was mixing the slippery elm w/ water and would pour it on her dried food and she would eat that without issue. But once I added the Nutrigest she didn’t want it at first but then guess she was hungry and figured out she had no choice. However, once I went to the real food (Cod/veg & rice) and then mixed in the slippery elm and nutrigest she didn’t taste it at all. its taste is probably overpowered by the regular food and smell/taste of oregano.
Pet-tinic was told to me by Dr. Dodds. I think primarily due to the iron content, which would aid in red blood cell production. This was from the info Dr. Dodds sent me initially: “To help stimulate the bone marrow
we use a hematinic like Pet-Tinic (Zoetis/Pfizer), Lixitinic, or Hi-Vite”. You can email her and ask about it. There are other vitamins in it as well.
My dog was never tested for Thyroid so no idea what the process involves. Based on my dog’s breed, which is one of the 50 predisposed breeds susceptible to thyroid disease, which could lead to IMHA, are put on thyroid supplementation regardless (.1mg/10 lb) with Thyro-tabs (brand name for Throxine that Dr. dodds prefers to use). The Dr. is the hospital that treated Colby initially never heard about using Throxine. Per Dodds, it’s given regardless since Throxine, at this level, helps to stimulate the bone marrow and enhance platelet production, regardless of whether tests indicate hypothyroidism or not. So, I guess I didn’t need to get tested or maybe since things were progressing then no thyroid testing was needed.
I went back through my original diary and my long email thread with Dr. Dodds to pull out when we dropped her Pred. I give this for an illustration of what my personal journey had been with the prednisone. If you consulted with Dr. Dodds you should ask her how much to drop, when your next drop should be, as well as any factors that would affect performing the drop. Plus, should you do a blood test and when. I personally take Dr. Dodds advice over those of my Vet. She is more experienced so I always run it by her and go with her suggestions. The other thing I learned on this site back around the start of my journey is DO NOT change multiple meds (Immunosuppressants) at the same time. Make single changes once if you change too many variables you won’t know what drug had the negative affect. I also made sure I kept things consistent as well like medicine times, feeding schedule and at the time food.
Pred Schedule:
3/28 – Hospitalized IMHA.
4/4 – Discharged. Pred was 10mg . (5mg – 2x a day.) Along with other immunosuppressants.
4/8 I had increased mycophenalate (2x a day) due to drop in PCV (20 from 29) after I left hospital.
4/17 – I stopped Atopica, since hospital thought that might be source of diarrhea Colby was having. That is what my Vet told me. They also said to drop the Pred to 5mg and 2.5mg. I was not making a change to two immunosuppressants at the same time. So left the Pred dose the same 5mg & 5mg. Note: once I later got copies of the hospital notes, for Dr. Dodds, it seems that was supposed to be done was a temp stop of the Atopica. I had stopped it permanently,
4/21 – Cut Pred to 5mg in AM and 2.5mg in PM
5/5 – Got initial consultation report from Dr Dodds. Her schedule to me was to cut Pred approx every 7-10 days.
5/8 – Pred now 2.5mg – 2x a day
5/19 – Pred 1.25mg – 2x a day
6/5 – PCV numbers dropped a little. Vet wanted to put her back on 2.5mg – 2x a day. Conferred with Dodds. She assured me that as long as Colby’s PCV was 25+ no worries. So, dropped Pred to 1.25mg once a day in AM.
10/17 – Dropped Pred to 1.25mg, every other day. Been here since along with dose of Mycophenalate (immunosuppressant).
Todd, are you in New Zealand – you mention NZ lamb?
Both times Bingo relapsed, he had sudden difficulty walking, not weakness, more a pain issue. When first diagnosed, he was diagnosed with rheumatoid arthritis – that was probably the beginning of his AIHA, immune system attacking his joints. He was off his food. He was never off his food so I checked his temperature and both times he was running a fever so we went back to Emergency. In fact, because I had issues with my vet at the time (I could never see the same vet twice), and I loved my specialist because he put up with my continued visits for check ups, despite the fact that politically, as he was no longer in danger, he should have been transferred back to my local vet’s care, and blood tests showed his PCV had dropped down again.
Deb, the reduction in pred is a bit steep for my liking, 50%, however if that is Dr Dodd’s suggestion, do it. There are times when a dog has been on the prednisone too long and it starts to slow their recovery so they need to do a quicker reduction. We would generally recommend a 25% to 30% reduction over a period of no more than 2-3 weeks. But do as Dr Dodds says.
Also when reducing the prednisone, Charlie will be feeling very uncomfortable right now. His whole system is suddenly trying to replace the cortisol that the prednisone was flooding him with. So I always found Bingo did seem to suffer with each drop for a few days. We also checked his PCV a week after reductions, when it usually did drop by a little, just to terrify me and keep me on my toes, but if there weren’t any steep drops, we would do another test a month later and it had usually gone up.
The loss of weight could also be the loss of muscle mass, yes I remember Bingo’s body head and spine. I would always use more protein than fat. Protein builds muscle.
With the Denamarin, when Bingo didn’t need it for his liver, the specialist actually recommended he stay on it as it’s good for senior dog’s brain health, so we did.
I usually just steamed the sweet potato because it as quicker than baking. Baking would have much better flavour though, and when we eat it at home, it’s usually baked. For Saba I usually steam it. With Bingo, I was also steaming with carrots, beans and peas and a little spinach at the end and feeding with turkey I had poached.
If you use baby food, or anything tinned, check no onion, and with pumpkin, make sure it’s just pumpkin and not pie pumpkin, I think, not the one with sugar. We don’t have tinned pumpkin here, but we have pumpkin and sweet potato all year round.
Todd, I’m certain you’re right, they learn to hate certain foods that are given with meds. I didn’t really notice it with Bingo, but it’s been mentioned before here a lot.
I’m with Todd too, I always double checked anything advised by my specialist, even though I loved this guy, with Dr Dodds.
Big hugs Deb, Vally
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