Patrice - 54. page

[Patrice]

Hope,
Brigitte’s idea is super!

I make all my dog food at home. Willie gets a raw diet, but Cassie needs less fat in her diet so I precook her ground meats that I use in water to get the fat out. I drain the ground beef and turkey and reserve the broth. I put it in a fat separator and pour off the broth for them in their bowls. You can imagine how intent they are on this event, hovering around the kitchen until the broth is cool enough. You would only need a bit of meat to flavor the broth.
my best, patrice

[Patrice]

Vally,
I think it would be safe to set aside cautions that apply to giving meds to humans, canines are different enough. This schedule looks pretty good to me.

Using some of these drugs together is a pretty standard protocol at most veterinary clinics. Dr. Dodds’ literature notes successfully utilizing both prednisone and cyclosporine in a dog during the same treatment period. And because of how they need to be taken, one with food, the other without, pretty much excludes them being in the stomach at the same time.

The most important consideration is making sure that prednisone is given with food to try to avoid ulcers. And second would be to attempt to protect the stomach at all times in case it does happen. I used an acid preventer 1 hour before meals in addition to the sucralfate on the overnight fast. This was critical because I was trying to prevent other secondary illnesses that would have reduced Chance’s ability to survive. I remind myself sometimes about the little dog on vetnet whose stomach hurt so bad from ulcers that she ate a whole bunch of socks. She lost her life in surgery when the vet was trying to remove those socks. That really hit me hard and I will not forget that.

Cyclosporine, a fungus, really needs a special environment to be absorbed properly and that is an empty stomach.

Sucralfate is really just a mucous goop that by its very nature coats the mucosa of the stomach as a protective barrier. It’s OTC cousin slippery elm behaves exactly the same way. Nothing is going to get past it!

I had a rough time with Chance’s med schedule. In addition to not making any red blood cells he was also not making white blood cells either (Expect he was making those evil T-cell lymphocytes.)

Because he was at great risk of opportunistic infections all the time he had to be on antibiotics constantly. So I had to try to fit those into his schedule as well. And then there was the Soloxine, can only be given without food.

Mark works days and I work nights. If it weren’t for him putting in his 100% effort and helping dose Chance, this would not have worked. Even then, I had to give up a ton of sleep to make sure he got his meds at the right time and to make sure he got out to pee all the time. I often leave Mark’s contribution out but I can tell you, despite the fact he didn’t understand much of what I was doing, he never once questioned me and stayed with the plan. Chance survived because he worked so hard. When I would get home at 1am, Mark was always asleep on the couch next to Chance.

I too slept for months on the couch and would wake up three times during my “night” to give him meds. I gave them “breakfast” at 12 noon so, from when Mark left at 7am until 12am, there were 5 hours to dose meds. Mark started with the Soloxine at around 5-6 am. I would get up three times between 7 and 12 to give him his Atopica, antibiotic and later his pepcid. Before I left for work he would get supplements and then Mark started giving more meds the second he walked in the door at 6pm. We kept a meds chart in the kitchen, it was the only way to stay sane.

It’s a very hard job. Owners provide the most important part, the nursing care.
my best
patrice

[Patrice]

Rick,
I am really happy to hear that she is eating, feeling better and delighted to see you. Good signs all the way around!

Many dogs are prescribed prednisone and cyclosporine (Atopica) at the same time. They perform the same function, immunosuppression of the immune system.

The difference is that prednisone is like a wrecking ball, suppressing the immune system completely whereas Atopica (cyclosporine) is more like a small ballpein hammer. It only targets and suppresses the T-lymphocytes, those cells of the immune system responsible for the autoimmune attack on the red blood cells.

The reason to use cyclosporine in addition to prednisone is twofold. First is to allow us to decrease the prednisone dose to reduce the side effects and second to really target just what we need to target. In addition cyclosporine’s side effects are minimal (mostly temporary stomach upset) and once you remove the drug they are gone.

I am not sure why your vet told you to give the cyclosporine with food. This in direct opposition to the manufacturer’s instructions. I know Dr. Dodds made it clear to me that I had to give it on an empty stomach for proper absorption.

Here are the dosing instructions from the Atopica patient insert:
“The initial daily dose of ATOPICA is 5 mg/kg/day (3.3-6.7 mg/kg/day) as a single daily dose for 30 days. SNIP>
*ATOPICA should be given at least one hour before or two hours after a meal.* ”

Please draw your vet’s attention to this and ask them if they still want you to dose it with food. It’s likely giving it with food will decrease its effectiveness.
http://www.us.atopica.com/just-For-Vets/how-To-Administer.htm
my best,
Patrice

[Patrice]

Nutrimax had a really good explanation about Denamarin and there are some good videos on the side about how the liver works.

http://www.nutramaxlabs.com/dog/dog-liver-health/denamarin-for-dogs

[Patrice]

Hope,
Each clinic and vet develop their own protocols that can vary depending on their clinical experiences. Your vet has had success with this once a day dosing and wants you to do it that way. Prednisone is widely used for many conditions and vets are very experienced with decreasing it carefully.

It’s not necessarily how I would do this but that said nothing is written in stone. Each dog is different and responds differently when the prednisone is decreased. I have just learned to be more cautious over time. That’s not a recommendation, just my careful nature.

I am sure that if you have difficulty with this dosing your vet will respond to your concerns and make alterations.
my best
patrice

[Patrice]

Hope,
Denamarin was the most important supplement I gave to Chance. His liver enzymes were over 10x normal. By the time we neared the end of his prednisone dosing (which extended from April to Jan the following year) his liver enzymes were nearly normal and remained so the rest of his life.
my best
patrice

[Patrice]

The difference is in dosing is according to the risks of thrombosis. Lapsing in a critical care patient might prove dangerous. Erring on the side of caution in an ambulatory patient at home is probably less critical.

As I said, I don’t think at this point it is probably necessary, but again I haven’t see the latest blood tests so I have no idea what his status is at this point.

If they are thinking of discontinuing it then they also think it isn’t necessary. So in that case, a few hours on either side won’t make a big difference. But I would shift the other end a few hours and then shimmy back and forth with the times to get it back to normal over a few days. If you can understand what I am saying?
my best
patrice

[Patrice]

Hope,
I am assuming this is being dosed for a non-acute risk of deep vein thrombosis. If it was acute, you would have him in hospital.

The critical element seems to be how often they prescribed the dose. If is it non acute, it appears that dosing once a day is appropriate, acute seems to be every 6-12 hours. I would consider this drug to not necessarily be critical with Steve right now, he has been stable for at least a week, correct?

In general it appears that timing is critical in maintaining a protection against thrombosis.

“Low molecular weight heparins have a more predictable bioavailability, allowing standardized dosing without individual patient monitoring.”
“Enoxaparin at 0.8 mg/kg SC q 6 hours consistently maintained target levels of anti-Xa activity in normal dogs without evidence of hemorrhagic complications.”

This is a tricky thing to advise. If this were me, and only me, I would give up dinner. I gave up many things when Chance was ill, including sleeping on a bed…. That is not necessarily what you need to do! Can you call the vet to find out what kind of wiggle room you have?
my best
patrice