Life on prednisone

[irotas]

Hi all,

It's been a while since I've posted here - sorry to be away so long!

Unfortunately Manni has had some rough times over the past few months. After (literally) dozens of visits to the vet, tests, treatments, etc, basically what we've got (aside from a huge bill) is a diagnosis of a "pemphigus-like autoimmune disease that's not pemphigus but cannot otherwise be identified".

We've moved forward with a treatment of prednisone to calm down his immune system, which has done a remarkable job so far (which is the first treatment that's had any real positive effect in 3 months).

Of course, now all Manni wants to do is drink water and pee. We've had 2 pee accidents in the past 2 days - and he's a big dog

I asked my vet what we should do to adjust to life on prednisone. He pretty much said "do nothing - it just makes you thirsty, which makes you have to pee". Well, I'm not quite ready to just do nothing - I'd like to get some advice from you folks with real-life experience.

Basically what I was thinking so far is upping his potassium intake (apparently prednisone causes potassium loss) and getting his sodium intake down as low as possible (AAFCO recommends minimum 0.3%). For potassium I was thinking of mixing some cooked lentils into his food - Google says it's high in potassium, low in sodium, and good for dogs in general.

I'm very much open to feedback and thoughts here - my poor dog has suffered enough and I really want to do what's best for him!

 

[JessLough]

Is there anything else, instead of Prednisone that he can be on?? I really do not like the side effects of Prednisone, anyways

 

[Jynx]

I know long term pred can have negative effects( I would insist on cbc/kidney/liver function tests every six months or if you see a problem.

While pred can be a life saver , I also do not like using it long term. Has the vet talked about Atopica? Can be costly, but can also help with immune system probs.

 

[Brattina88]

I would deffinitly be getting a second and/or third opinion, IMHO. What are Manni's symptoms? I'm sorry he has not been feeling well I can understand the feeling - and the back and forth to vets with no "solid" answers. Pemphigus-like...hmmm... does he have blisters and skin issues?? If so, I would strongly recomend going to a canine dermatologist. Seriously. I wish I would've taken Maddie, sooner. I sure would've saved a lot of money... it was actually cheaper than all of these office calls and treatments at the 'regular vet' that weren't really working (or only masking symptoms... like pred can do)
Your vet sounds "old school" with the "do nothing - it just makes you thirsty, which makes you have to pee" IMHO he should be at least a little more concerned about pred long term

Prednisone can be helpful, but it can be really harmful too. There are a lot of side effects, and things you should look out for while they're on pred and IMO its way overused in vet-world . I definitely agree with Jynx, I would insists on regular tests... Pred can cause some serious hormonal and metabolic changes in the body... Cushing's, Diabetes, glaucoma, behavior changes, skin issues, weight gains... all of this come to mind with long-term use of prednizone (sometimes sensitive dogs, short term can cause this, too)

Prednisone Side Effects in Dogs

Anyway, I see that your in Canada -- but I could ask Maddie's dermatologist if she has any vet recomendations in the area... may be a long shot, but hey
Just let me know if you're interested


oh, and {{{{get well soon vibes!}}}}} coming your way!

 

[Barb04]

My vet had me give a milk thistle capsule to help with the liver.

 

[irotas]

Thanks everyone for the responses! Let me try to answer everyone in one go:

1) His symptoms are many, complex, and vary from day to day. The initial symptom (although we didn't think much of it at the time) was a gradual decline in interest in food. It didn't happen all at once, but we noticed it. The first symptom that actually prompted us to go to the vet was that he was licking one of his toes incessantly, so much so that all the fur came out and it was red and swollen. While we were at the vet, a big patch of fur fell out of his back and there was a 2.5cm oval-shaped lesion underneath - all red and crusty and gross (and it's still there, 3 months later). He's also been very lethargic and pretty much lost interest in life. He didn't want to come to the door when I got home, he didn't want to go outside to pee, he didn't want to get up to go to the kitchen and eat, he didn't take his treats even when I put them right in front of his nose, etc. His latest affliction is a mildly injured paw (he slipped in a pile of leaves) that rapidly progressed into a really terrible (I mean, *really* terrible) infection. It look more than a month to get that under control. He has been basically miserable for 3 months. Until this week we have been seriously talking about euthanasia.

2) We've actually seen 3 different vets, one of which is the top veterinary dermatologist in the Toronto area. We've run so many blood tests, cultures, biopsies, x-rays, etc etc that I've lost count. The only thing that has come back definitive is that the bridges between his skin cells are being attacked by his immune system and are rupturing - two separate tests confirmed that. They said it basically behaves like pemphigus under the microscope but isn't pemphigus because it doesn't meet the other diagnostic criteria. After almost $4k of testing and treatments, we basically said "Look, no more tests - just give us what you think is the best treatment given everything we've seen, and if it works, great, if not we're going to have to put him down in a few weeks". That's how we got to prednisone.

3) So now we're on day 6 of the prednisone. Remarkably, Manni is doing so much better! He's got more bounce to his step, he's eating better (though not perfect, but better), the spot on his back is better, and his foot is almost completely healed. The big downside is that he's thirsty *all* the time and has had 2 pee accidents in the house. We've got a little baby that's learning to crawl so the thought of a dog running around the house peeing everywhere is a bit unnerving. Aside from that I'm also concerned about the long-term side effects of prednisone and how to mitigate them. I'm really not a "do nothing" kind of guy.

4) As for prednisone vs other drugs, this is the first oral immunosuppressant Manni's been on (he's been on a topical immunosuppressant for many weeks - Tacrolimus). I think the vets decision to prescribe that one vs others is probably based on a combination of cost considerations and the fact that we're now treating something that we don't really know what it is, and perhaps prednisone has a broader spectrum of therapeutic uses than other drugs. I'm really not sure - at the time of the prescription, we had just finished talking about euthanasia, so we were willing to give anything a try if he felt it had a reasonable chance of success.

Anyway, it seems like many other people here have experience with prednisone, so keep the advice coming! Manni thanks you! *woof*

 

[irotas]

Has the vet talked about Atopica? Can be costly, but can also help with immune system probs.

I read online that Atopica is even more expensive than Tacrolimus. We've been using Tacrolimus and the expense of that one is absolutely killing me ($160 for a 30 gram tube after taxes). Going for something even more expensive is terrifying. I really love my dog but there is some vague line somewhere of unaffordable medicine, as terrible as that sounds

 

[Brattina88]

Good for you! :hail: You wouldn't believe how many people I've run into who have flat out said they would not take their dog to a derm because it was 'so expensive' and they're "just dogs" Anyway....

Barb, that's very interesting. I hadn't thought of that.

You might also want to consider trying Essiac tea I don't personally have any experience with it, but I've heard a lot of good things about it, for dogs that nothing else has worked in the rescue & everything

Also, I'm trying this with Maddie & her skin issues. In some aspects, she sounds similar to Manni because she had a simple cut and it got infected really fast and really bad. Also, she has a bacterial & yeast infection that spread so fast we've been treating it for about 2mos now (and also diagnosed her with Vitamin A Responsive Dermatosis -- cockers and labs, I tell ya ) Dog Dry Skin - #1 RATED Treatment | Voted Best Remedy for Itchy Dogs Skin

Good Luck to you & Manni!! ((((((((hugs)))))))) & {{{+++Get well soon vibes+++}}}

 

[irotas]

Dog Dry Skin - #1 RATED Treatment | Voted Best Remedy for Itchy Dogs Skin

Thanks for the link. I've actually concocted my own anti-itch+healing formula for Manni. I don't measure everything exactly but this is roughly it:

1) 1-2 cups of warm water
2) A few drops of tea tree oil
3) A few drops of lavender oil
4) A few drops of jojoba oil
5) A few drops of oat extract
6) About 1/8 teaspoon of aloe vera concentrate
7) A small handful of epsom salt

So far I've only used this for his paw but I don't see any reason why I couldn't put it on his back as well. I mentioned this recipe to a couple vets and they didn't have any problem with it - although I didn't get the feeling that they were too keen on such natural homemade remedies.

 

[irotas]

I found a really good article (though full of medical jargon - have a dictionary ready!) on pemphigus and all the possible treatments and considerations:
Canine and feline pemphigus foliaceus: Improving your chances of a successful outcome - Veterinary Medicine

Apparently prednisone is a common first choice for treatment because if it is going to be effective in the long term it will usually show significant clinical improvement after just 10 days or so - the other treatment options take longer to take effect. I read elsewhere that Atopica takes many weeks, which really isn't practical here since we didn't even know what it was that we were treating.

 

[lizzybeth727]

Sounds like you've done a great job throughout the diagnosis and now through the treatment. I agree that pred has a lot of bad side effects, but if your choices are pred or really horrible skin infections, the pred is definately a good choice.

I'm working with a dog right now who has bad allergies, and the scratching causes infections. The itchiness seems to come and go, so we just monitor him closely and when it seems like he's starting to itch too much, we'll give him an incredibly small dose of pred (I think it's 5 mg twice a day) for a few days until his skin clears up again. I know that you usually have to gradually increase and decrease the dosage, but it's not such a big deal when you give such a small amount.... and we're lucky that the small amount actually works.

So I guess what I'm saying is, hopefully when your dog's skin clears up, you can decrease the amount of pred you have to give him, and keep him on a smal dose as a "maintenance" type of treatment.

As for the drinking, maybe you could keep the water bowl picked up, and just offer him water several times a day; at least then you'll have his schedule figured out of when he'll need to pee after drinking, and you'll be able to prevent potty accidents that way.

 

[Baxter'smybaby]

I don't have any advice--just want to say I hope Manni feels better for the long term--it's tough when you are dealing with unknowns, and expenses just keep piling up!

 

[JennSLK]

Emma was on Pred untill she died. Not much you can do about the thirst. Its a side affect. Dont withold watter. Not to mention wieght gain.

 

[Bigpoodleperson]

My dog is on prednisone, will be on it for life, and would die without it. I love pred. I respect pred. I know what pred can do (good and bad). Working at a vets I see it be a maricle drug all the time. I know everyone thinks its overused in the world. It is very hard though when cost is a factor, and the owners just want the itching to go away.

I would say the top side effects are increased thirst, increased urination, and increased appitite. The appitite was the biggest thing for my dog. He eventually adjusted to it, and has been doing very well. Since your dog is on im assuming a high dose, and is not even a week into it yet, then i would too say to just give it time. He will adjust, and the dose Will be lowered (you cant keep a dog too high for too long).

Are the accidents in the same spot each time? Can you lay a bunch of towels down by the door incase he has an accident then he will hopefully go on the towels?
I dont know if i would mess with his potassium/sodium. I honestly dont know if being on pred. you could throw him into an addisons problem by doing that (frequently in addisons you have high potassium/low sodium which is what you are trying to do with the diet).

For now I would just let him have whatever water he wants. Get him outside as often as possible. Feed him smaller meals more frequently, and see how he does. Im glad they found something that works with him! FYI, atopica is Extremely expensive, and takes awhile to take effect (and effect varies with each dog).

 

[LittleBigDog]

It sounds like one of the authors of this book has had some possible benefit with diet therapy - Small animal dermatology
By George H. Muller, Danny W. Scott, Robert Warren Kirk, Craig E. Griffin

But if there were any solid protocol, I suppose your dermatologist would know. Good luck - autoimmune conditions are so challenging!

 

[Renee750il]

BigPoodle, I have had dogs develop tumors from the use of prednisone. Even my vet -- and he uses it -- will admit it's something to watch for. Not all dogs have that reaction, but it doesn't seem to be a rarity either. Best to be informed and make an informed choice and then be extremely watchful. I know for me, prednisone is a medication of last resort. Steroids, as a group, should NEVER be used indiscriminately or as a "magic pill."

 

[irotas]

So here's the latest update - the vet has diagnosed pemphigus, saying that pemphigus is not really one disease but a class of related diseases, and in Manni's case he has a very non-classical presentation. He also thinks Manni may have Cushings disease based on some clinical signs and indicators.

Unfortunately Manni vomited quite a bit of blood about a week after we started him on prednisone, so we're now transitioning him off that and onto azathioprine.

Also, Manni has developed a relatively large purpose "bruise" on his abdomen with no apparent external trauma (he's never out of our sight anymore). We took him to the vet who did a complete blood count, which didn't really show much of anything. We did a liver test which shows his liver enzymes to be *really* high. They don't know if this is a result of the prednisone or if he's got some undiagnosed liver disease. Sigh ...

So yeah, Manni needs some good thoughts if you've got some to spare. They are recommending ultrasounds and tests for Cushings which would run us almost $800. I don't think we can go any more into debt with this than we already have so at the moment we're just crossing our fingers and hoping for a miracle. :dunno:

 

[dachshunds4me]

I didn't read all the posts but you need to get him OFF the pred. and onto a more modern immune system suppressant.
There's the newer drug approved for allergies, my vet mentioned a few different ones, and he doesn't have to be on pred to help heal.
If your vet isn't aware of newer treatments, ask, or switch vets.

 

[irotas]

I guess I owe it to everyone that responded to this thread to announce that quite tragically we had to put Manni down. While he was responding quite well to the predinsone (aside from the drinking/urination), within a week he developed a gastic ulcer and was vomiting blood. We transitioned him to azathioprine, which wasn't working as well (he started licking his paw again, and was getting worse) and after a few days he had a quite sudden and intense onset of vertigo.

Watching my dog fall again and again was heartbreaking. After 5 months of treating his symptoms without a clear understanding of what exactly was afflicting him, we were exhausted financially and emotionally. He barely ate anything in his last few days, and what he did eat he vomited up. I can't imagine why a dog, a Lab especially, would refuse to eat unless they felt like absolute crap.

So, with a heavy heart and lots of tears, my wife and I took Manni to the vet and were with him in his final hour. He went quite peacefully and knew to the end that he was loved and cherished.

I want to thank everyone here for all the advice over the years with Manni. He was our first dog and such a learning experience. We will get another dog eventually but for the time being we just need to recover from this experience first.

-Adam

 

[Renee750il]

I am so sorry, Adam. You did right by Manni -- after living a full life of love and loyalty with him. He will send you someone to help heal the raw emptiness, be sure of it.