IMPT/Steroids -Weight loss

[Boxacrazy]

We are still doing battle with IMPT.
However I am starting to get worried as Nora is losing weight week on week.
The weeks ago she was 25.55kgs, a week later she dropped to 25.15kgs and now yesterday she weighed in at
24.80kgs.

Nora was put back on antibiotics yesterday.
As it appears she may have a urine infection.
She is having accidents in the home (weeing on the carpet) despite having someone come home every two hours
to make sure she is having toilet breaks. I know that this isn't her fault it's being caused by steroids and her drinking
copious amounts of water.
The trouble I'm having is trying to pump the food in to give her the calories she needs without upsetting her tum
and giving her cowpat outputs.

If anyone has any idea's I'd be really grateful.
She is currently being fed a grain free complete that is high in protein.

Her platelet count last week was 190, week previous 146, week previous 177, week previous 90 something and on diagnosis was 19.
We hopefully get the results of yesterday's blood test either today or tomorrow.
The result will determine if her steroid dosage can drop down from 30mg of preds twice daily.

Kirstine & Nora

[Jo CIMDA]

Hi Kirstine

I can't remember how long Nora has been on the preds.  Can you write her drug protocol so far please?  Usually if they start to lose weight it can mean that the preds are starting to have more effect than you would like and it may be prudent to add another drug (that is assuming she isn't on another immunosuppresssant) and reduce the preds.  Larger dogs do have this problem sometimes.  Also it is not uncommon for a dog to get a urine infection and antibiotics usually sort this out.

Jo

[happydogs]

My lurcher lost a lot of weight on the preds and its only when the dosage was reduced that her weight began to stablise. She is still on extra rations though.  Apparently preds is very hard on sighthounds - possibly due to their lack of body fat?

You have my sympathy re the weeing - Indy went through four or five bowls of water and left huge puddles if we weren't quick enough. Again this improved when her dosage was reduced and now we only need to let her out every four or five hours.

[Boxacrazy]

She has been on steroids now for 5 weeks.
Originally she was on
Omeprazole 1 tablet before meals in the morning.
Prednislone 30mg (6 tablets) am and pm so daily total of 60mg
She was originally on antibiotics for two weeks too clavaseptin 1 1/2tablets am &pm.

Now she is just on Prednislone and on Friday pm she was allowed to drop down to 4 tablets (20mg)
So she is now on 20mg (4 tablets) am and pm so a daily dose of 40mg.
I was told to leave her next blood test to 20th November so that we get more of a better idea as it takes a while
for the steroids to drop and give a true reading? This vet (my normal was on hols or training last week) said her levels were normal and had to push her for the levels and was told oh 155 so normal...but it's still a drop on last weeks. I know levels can
go up and down but wanted to keep track to see how she is doing.

I have got some advice to add some lamb mince to her food and to spread the amount of her daily ration over the day with the mince and hopefully this will also help with her being so hungry. Nora has never been a 'fat' dog but she looks like she has lost a lot of muscle and condition. Which the scales are showing.

Am seriously considering replacing the carpet with lino/vinyl if I can convince the OH that it's a good move.
It will be more practical in the long run.

Thanks again
Kirstine and Nora

[Jo CIMDA]

Hi Kirstine

Five weeks on an immunosuppressive dose of preds, especially for a large dog, is quite a long time and I hope this is the reason her weight and muscle is dropping.  When a dog is on immunosuppressive doses of preds they should be monitored for side effects of the drug/s.  Also her platelet count is within normal limits but if she were mine I would take her for a blood test before the 20th just in case the downward trend is continuing. With IMTP unless the owner sees brusing or bleeding then you will not know if the platelet count is stable or reducing because, generally, the dogs appears well.

Nora still needs some sort of gastroprotectant because she is still on a significant dose of steroids, and the best one for you to get is Ranitidine.  Supermarkets sell it in 75mg tablets (cost £1 - £1.60 for 12 tablets)  and the dose is 2mg/kg/three times a day (Plumb's Veterinary Drug Handbook) .  High doses of steroids cause excess stomach acid and this is why your vet put Nora on omeprazole (I don't know why the vet doesn't think she needs a gastroprotectant on the current dose) but this also means that Nora should be on a low fat diet so as not to over-tax the pancreas.  Personally I wouldn't give lamb, as it is a fatty meat,  but try her on chicken or fish, whether it be a home or branded diet.  Spread her food over several meals during the day.  If she is really hungry then give her some more food.  It must be horrible being very hungry all the time and the extra may build up her muscles and put the weight back on.

Drinking, weeing and eating a lot is a good sign.  It means the drugs are having the right effect.  As the steroids are reduced all these symptoms, and the loss of muscle, will improve.

Jo

[Boxacrazy]

Hi Jo,

Thanks so much for taking the time to respond.
She has been losing weight for the last three weeks, every time I have taken her in for a blood test I have weighed her
more for my own reference, they didn't seem to be worried if I weighed her or not.
However it has proven useful to show that she has dropped weight etc.

The vets seemed to think as she wasn't being sick etc she was fine and didn't need a gastro protectant after the initial course of gastro protectant. Should I again push that she should be on a gastro protectant as the younger vet (newly qualified) does seem open to listen to me and work as a team so to speak to help Nora.

They also have not advised re diet either (although guess vet's don't specialise in nutrition), as other wise I would have adjusted her diet accordingly.
She is currently on a meat (lamb, duck & rabbit) grain free diet which is high in protein (31%) and oils and fats are 16%.
I have found another grain free (different brand lamb only) which is lower in protein and fats being 21% protein and 10.5% fat. They also have a white fish grain free variant I could try.
We used to feed 2 meals a day am & pm, but am able to feed her 4-6 times a day if needed if that's what it takes to be better for her.  Currently I haven't been able to up her food levels without making her out put like cow pats which again can't be good for Nora. As she can't be able to process and utilise what is going in.

Thanks again for all your help/idea's it's been really helpful.

Kindest Regards
Kirstine and Nora

[Jo CIMDA]

Hi Kirstine

Nora should still be on a gastroprotectant, even if it is not omeprazole.  I have known many dogs who have not been on a gastroprotectant and have developed iron deficiency anaemia because they have developed stomach ulcers that have bled, so it is a good precaution to keep a dog on some sort of gastroprotectant.  Nora is still on a reasonable high dose of pred and will be for some time.   

Personally I would feed Nora at least three times a day because smaller portions are much easier for the pancreas to process and if she is losing weight then I would increase her food over a 24 hour period. Little and often may help her digest it better.  Dogs on preds want to eat a lot.  Let her get over this disease, and if she is a bit over weight when she is in remission then you can reduce her food.   I'm not suggesting that you over feed her but do give her at least an amount that will enable her to keep the muscle and weight she has, if not put a little of what she has lost back.  Steroids will temporarily reduce the muscle mass anyway.

Jo

[Boxacrazy]

Thanks so much Jo,
It makes complete sense.

I don't like the weight loss she has, guess it's hard as when you show you always keep them a bit leaner
or slim compared to what I call a 'pet' weight but by no means 'obese' as it's not good for joints.
Nor so lean that you see the pin bones etc. As any weight loss shows so quickly but she was in good condition
and actually slightly heavier than her normal maintenance weight.
She's used to getting her daily ration of food allowance in two meals plus the Kong's in the morning when she
was left and in the afternoon after my lunchtime home visit. (This would be normal work day routine)

At the moment she gets two daily 'big' meals and 4 Kong's full of food (due to having visits every 2 hours)...but I can easily do three meals plus the 4 Kong's.
I don't mind if she's a bit plumper than she'd normally be I'd far rather her be a bit heavier weight wise and be well in herself than have a leaner and unhappy Nora.

She's already improved and hasn't had any accidents in the house since the preds dose was decreased to the 4 tablets twice daily. Her appetite for food and water hasn't decreased yet.
But still would like to put lino down as think it would be more practical in the long run.
But as long as it keeps going in the right direction I don't mind as long as Nora is ok..

Will definitely ask the vet if she can go back on the gastro protectant. Don't want to make it worse for Nora.

Thanks again Jo

Kirstine & Nora