Dosing Question for Prednisone and Azathioprine

[admin]

Hi JLS & Gidget (great name by the way!)

Couldn’t agree more about going more SLOWLY with the pred reduction – Linda has had a very hard time with poor Sadie’s relapse & she is trying to tell everyone so it doesn’t happen to their dog. Linda, Vally & Laurie have given you some fantastic advice.

I am glad they have added the azathioprine in, although the preferred drug is cyclosporine for most vets. Aza takes a week to 10 days to to get the T-lymphocytes (the things that are responsible for destroying the body’s own blood cells in error) under control, so stay as you are for a while until the azathioprine has a chance to work.

I’m really pleased you’ve found us – we can certainly look at the blood tests if you would like to upload them on the urgent advice link. I see our lovely Vally has put all the links on for you.

My dog Worzel responded really well on aza with no side effects – luckily – you need to keep an eye for for pancreatitis symptoms though as some dogs (usually the smaller ones) don’t tolerate it sometimes. The symptoms are extreme tummy ache, vomiting & diarrhoea – in which case stop the aza immediately & go back to the vet. If this happens, it’s no big deal, but it needs to be treated & then you’d just change to cyclosporine instead. You can read about aza here:
https://www.secondchanceaihadogs.com/AIHA_Terms/azathioprine/
and pancreatitis here:
https://www.secondchanceaihadogs.com/AIHA_Terms/pancreatitis/

I’d like to re-iterate about the tummy protection – sucralfate is wonderful – the best in my opinion. Gidget needs this to prevent ulceration – very important. It is also important to check if there is any clotting risk – if they have done a blood smear (I hope they have), I can tell you straight away. I know standard poodles often have low platelet problems with IMHA too – we can look at the blood tests for you with pleasure.

Worzel also became skin & bone, even though we fed him a huge amount of food compared to his usual meals! He could pee for France as well – they are so thirsty with the pred & need to drink loads to stay hydrated. That is just the way it is with this disease & we all have to get through this stage as well as we can – it will pass & Gidget will gradually regain muscle, I promise. I was amazed how quickly Worzel looked more normal when we reduced the pred. But you cannot reduce the pred until they have been stable for a while – too risky. Please trust us on this – the last thing we want is for any of our babies to suffer a relapse as it prolongs the treatment greatly.

Don’t ever feel alone – one of us is usually around as we a world wide. If you are worried about anything or have any questions, don’t hesitate to put a message on here.

I know I have repeated some of the things the others have said – I just wanted to re-iterate how important these things are. There are many ups & downs for all of us with this disease!

All my best wishes & a big hug to you both
Sheena, Worzel (diagnosed Dec 2012, in remission) & his friend Ollie xxxxx

[Brigitte]

Hi JLS,
I finally get to pipe in too. I am so sorry your Standard Poodle has AIHA, but glad you came here for advice. Linda, Vally and Sheena have pretty well covered everything for now and I don’t want to repeat what they are suggesting. It is such a steep learning curve, but over the next few weeks you will understand the disease better and be able to help Gidget better. When we dealt with the disease, I had to change vets because my “old” vet just sent me home with little info, some liver support pills and not much else. My “new” vet was fairly knowledgeable but after a few weeks was thrilled to get some guidance from Dr. Dodds at hemopet in California. It was not feasible for us to travel (5 hours) to a specialist, so the consultation with Dr. Dodds was very valuable. I think it is very important to have a vet on board that understands the disease and has treated it successfully more than once.
I have Standard Poodles! I remember being quite upset to all of a sudden have a Poodle that was shedding. So don’t be alarmed if that happens. My dog’s coat ended up pretty shaggy but a few weeks after beoing able to slowly reduce the prednisone his coat came back as beautiful as before. You say that Gidget is eating lots and I assume you are feeding kibble? I always laughed at people that were cooking for their dog, but guess what?? I used to feed raw when I lived in Europe and was thrilled at the convenience of kibble. However when my dog was ill I felt so bad to put all these medications into him and I wanted to do something good for his body, not just shoving pills into him. On this forum I found the link to Dr. Dodds liver sparing diet and I can highly recommend it!
http://www.canine-epilepsy.com/Liver%20cleansing%20diet.htm
It felt so good to do that and my dog loved it! You can play around with it, use different vegetables (never onion) or proteins like LEAN turkey or chicken. This diet is also good to prevent pancreatitis (as long as you use lean meat) which is a danger with the high doses of prednisone. It has already been mentioned that it is very important to use a stomach protectant (Sucralfate!) in order to avoid ulcers, but because it is so important I mention it again. You want to avoid this painful side effect at all cost!
Best wishes to you and Gidget,
Brigitte

[Patrice]

Audrey

Audrey Before Prednisone

 

Big-eyed Audrey

[JLS]

Cute pup! But those images are very similar to what I’ve seen with my dogs eyes. Mostly I see the whites in the tops of her eyes. Will that go away eventually?

I’m sorry that I haven’t been able to post. I won’t be able to reply to everyones posts though I did read them all a few times now over the past few weeks and really appreciate the information and support. TRUST me if I didn’t follow instructions it’s not intentional. It’s just I’m overwhelmed with things and been doing the best I can here and there.

I’m not sure if I explained in a prior post but the true shocker of this story is that her brother (our other dog) was diagnosed with osteosarcoma on his leg two or so weeks prior and had his leg amputated maybe a week prior. We did not do chemo for him due to expense and it just didn’t feel right. So we opted for cancer diet home cooking, a million natural pills, IV vitamin c, and on/off doxy. All hoping to extend his life past that 4 month mark given by attempting to keep mets out of his lungs. So it required an insane amount of my time, money, and research along with having the unfortunate luck of his sister surprising us with this. And believe it or not, even with the leg amputation he hasn’t suffered at all (Aside from the first couple days). She is the poor one suffering :(

Anyways, her dr got back and has been super awesome. I never did put her on that other pill so just the prednisone. He felt that since she was improving so well weekly it might be best not to introduce other side effects or cause any changes. Instead just to reduce. He is for getting her off it asap because of several good reasons he pointed out. At the same time he agreed with trying to keep it under a 25% reduction every 2-3 weeks. So she went from 40 to 30. Now she is at 25 for a week because 22.5 was pretty hard and 20 was over 25%. I’d like to get her off a tiny bit more faster though so I was thinking about putting it at 20% next week which he thought would be fine.

He put her on Pepcid and was putting her on liver protection but the bottle was $80 and he said he didn’t know of Sams or Costco having that one. So instead of that he said I could do Sam-E and Milk thistle. He said 400mg of Sam-E should be fine but I only gave her 300.

The milk thistle is my trouble. I bought Oregon Wild Harvest but it says 3 caps is the serving size. It says Organic Milk Thistle Seed 1260mg combined with Milk Thistle Seed powdered extract at 240mg. It’s an odd dose compared to what he gave me (don’t have it on me right now). Do you know if this is ok to give her? How much for a 50lb dog is safe?

Sorry, I’ve got to run out the door. But she has been doing a lot better as we reduce. She’s in the 40’s now count wise. Her liver test wasn’t great last so this milk thistle is important.

She’s not starving as much or acting as crazy now. She’s not lost anymore weight since I last reported and actually gained about 1 lb I’d say. She’s got her strength etc back. So really doing great here. Just praying it’s not an underlying cause still like cancer but we’ll see once she’s totally off the pred how she holds up.

Thanks and I’ll keep an eye out tonight. Really hoping for help with this Milk Thistle and wouldn’t mind opinions on the Sam-e.

[admin]

Hi JLS

No wonder you’ve not had time to keep to post – don’t worry about that. I’m sorry to hear about your other dog – osteosarcoma is an evil disease too – it is amazing how well they can cope with 3 legs (I have a couple of friends with 3 legged dogs) & I hope he will continue to be happy & get good quality of life for as long as possible.

Here is the guide for milk thistle from Dr Jean Hofve & Dr Jean Dodds – see dosage & administration.
http://www.canine-epilepsy-guardian-angels.com/milk_thistle.htm
It says you can safely use 200mg per 10 pounds, so maximum 1000mg for a 50lb dog. Have a read about the doses they suggest. I would go for a much smaller amount first, then increase it gradually as it can cause diarrhoea, so introduce it gently. Are her enzymes very high?

& for Sam-e
http://www.nutralifepet.com/sam-e-for-pets – it says ” 10mg of SAMe for every pound of body weight” therefore 50lbs = 500mg.

Hope this helps!

Love Sheena xxxxx

[Vally]

Hey, JLS,

Dogs are amazing aren’t they. They’re not phased by suddenly having 3 legs. They just get on with it.

Yes, it gets harder for them when the dosage comes down a bit, that’s because the flood of cortisone is suddenly being turned off, and they need to start making their own again. I found it necessary to slow down the pred reduction as the dose came lower, so just keep doing it slow.

The better drug to reduce those liver enzymes is Denamarin. That’s because it’s dose is precise for dogs. But it’s not cheap at all, although if you get it on line or through other stores, it’s much cheaper than what vets charge for it.

Sheena has given you the dosages for Gidget to use.

You can also use Dr Dodd’s liver cleansing diet. A lot of us have done.
http://www.nutriscan.org/knowledge-center/cleansing-diets.html?utm_source=tumblr&utm_medium=blog%20post&utm_campaign=liver2014Q2

Regards, Vally & Bingo

[Bellabear]

Just a note to say : 4 years ago we went through this with Bella. They insisted on Lifetime Prednisone Therapy with Azathioprine. Bella’s eyes were bulging within a week, she refused to walk. Maybe because she couldn’t see or she was sore, we don’t know. She began to exhibit bizarre behavior, from manic , to depressed….. Repeated sitting to laying down, like an automaton. This was the last straw. She had been on prednisone 2 wks. They said it doesn’t upset stomach, it doesn’t hurt, it doesn’t make eyes bulge. Do NOT DISCONTINUE. I weaned her over a few days, as she had only been on it 2 wks. They insisted weaning would take Months. I started with Vitamin K,………..it’s been 4 years, she has not been back to the hospital. Fast forward 2016, she jumped on couch & tore ligaments……Next day went to get x-ray,. Results $5000+ to do surgery. Gave her Quellin, alias Carprofen, Discontinued for human use….. That evening Bella deathly ill, from 1 dose. Vomiting……….Called vet, let him know, there are NO warnings as per law, of any kind….Wrapped her leg with ace bandage,. Gave her & still do 1/2 tsp per day organic turmeric. In 2 wks walking better, in 1 month Running at the park, in 2 mths trying to jump off bed, & has….Trust your vet. Quellin,. & $5000 surgery,. Prednisone & Illness, vs vit K. She thrives today. Prednisone & Azathioprine, Quellin & Surgery would benefit them, but surely would have killed Bellathebear by now. They will never profit again, at her expense………….

[Bellabear]

P.s. Her initial bleeding, was shortly after her unnecessary Vaccination……..Get a tithers tes. There’s a vet that hadn’t vaccinated in over 10 years multiple dogs…….He claims as MANY others, the canines were still immune, 10 years on,. After they themselves vaccinated only once. The science is clear, the proof is there, but most vets continue to profit, at the expense of Your loved ones.