Immune mediated arthritis- is this amount of lethargy normal on preds?

[8141lindsay]

Hiya iv posted on the site for newbies already regarding missys recent diagnosis of immune med arthritis,only diagnosed on monday and started immune supressing pred that evening. Shes sleeping an awful lot,only rises if she hears her lead being lifted! But shes not pestering me for a walk nor is she that bothered about eating or drinking. She does do both but its like she needs to be reminded too.i lifted her lip to check her gums and it was near stuck to them it was so dry,but when i scooted a bit round her mouth she got up and drank away. gum refill s good and scruff of neck can be lifted and goes down quick enough but not as fast as it would normally. Before diagnosis she was quite needy but now doesnt want to be bothered. I know shes going through alot but shes had acute pancretitis few years ago and since that episode vet has suspected she has chronic pancreatitis.I have an electrolyte sachet from the vet in the house for emergencys is it safe to use on her on steroids? Also should i get her seen by vet in morning or is this lethargy/sleepiness to be expected? Thanks x

[Jo CIMDA]

Hi

Yes take Missy to your vet this morning.  If her gums are dry she is most definitely dehydrating and this can be dangerous.  Also when a dog is on high doses of preds she should want to eat and drink to excess.  Missy is not doing this and she is also lethargic.  I suspect the adverse effects of the very high doses of steroids she is on is causing her problems.  Also, she may have an infection, and need antibiotics, because her immune system is suppressed.

When a dog is on high doses of steroids, and Missy is on higher than the initial suggested dose, and they are displaying symptoms like Missy is then it has to be dealt with straight away.  Ask your vet to check her red blood cells and platelet number because when a dog is responding in this way this can increase and become a serious problem.

Good luck

Jo

[8141lindsay]

Straight after I posted last night she did have a drink and she got up and cleared her dry food which I had poured water over too! She was spritely this morning cos she was getting out to my mums to be minded while im working ,and she ate and drank then too,but she just sleeps all day there and its only at night she gets dry an dopey basically just after her 2nd dose steroids right through to the next morning and she's bright again. I will take your advice and get her to vets this afternoon  x

[polly]

Make sure that there is a bowl of water very close to where she is resting. When my dog was first diagnosed with IMHA and on huge doses of medication I left several bowls of water for him in various places because his illness /medication effects made him reluctant to move.

[Catherine]

What a good idea! 

[8141lindsay]

Missy thankfully has been bright as a button all day,eating drinking barking! Rang vet and they didn't think there was a need to see her in a rush...said to see how she is tonight and bring her in tomorrow if I'm still worried. But they did say same as polly, lots of water close by! But now this whole scenario starting again;dry gums and flat out and she wouldn't eat very much after her steroids tonight only ate a mouth full. She'll be going first thing in morning,though I dread it as vet wasn't nice to me at all last time,I honestly think she's out of her depth with all thats going on with missy. Don't really have any confidence in her any more x

[Jo CIMDA]

Hi

If you really feel your vet is out of her depth then please find another vet or ask Missy to be referred to a specialist. 

Her behaviour isn't normal for a dog on immunosuppressive doses of steroids and the symptoms she is displaying possibly indicates too much steroid.  If she were my dog I would want her steroid reduced to 1mg/kg/12hrs.  If the generally accepted, starting dose is sufficient, and the top Vets consider it is, then why should a dog be on more when you have a greater risk of side effects.  The principle behind steroid use is to give the least amount that will do the job, and no more.   If the starting dose proves not to be enough then it can always be raised. 

Please look again at the posting about what to expect after treatment has started.  Spontaneous dehydration is not good because it causes an imbalance in electrolytes and other biochemistry values, and it can also concentrate the red blood cells and if you add the fact that high doses of steroids can cause a rise in platelets then it isn't something that you want for Missy.

I hope your vet responds to your concerns and your meeting is pleasant, because battling with a vet just makes your anxieties worse and is very stressful. You need support.  It is essential that you and your vet work together for Missy and if she can't do that then there is always another vet who will.

Good luck today.

Jo

[8141lindsay]

Thanks so much jo! Saw vet today and felt a bit more confident in what to say,don't know if she appreciated my new found knowledge tho! So far so good tho,she did bloods and was very thorough with her,she couldn't find any obvious cause for concern iv to go back on Monday morning. She didn't cut back on steroids but said possibly from Monday. Also got more electrolyte sachets to give her til then. A lot happier and missy a lot brighter this evening thank god! I'm seeing a different vet in same practice on Monday,she's the one who actually diagnosed missy so I'll be happier to see her take on everything too x so glad found this website because I'd have really struggled otherwise!

[Jo CIMDA]

Hi

That is really good news.  I hope you have a good weekend with Missy and the vet reduces the steroids to 1mg/kg/12hrs on Monday. Stick with the vet you feel you can have a better working relationship with and who is open to discussion.

Fingers crossed.

Jo

[8141lindsay]

Hiya need some info please! Missys dose was reduced to 7.5mg in morning and 5mg in evening a week ago.had hoped we'd have a bit more life about her,but she's still awful sleepy and no interest in playing but happy to walk,although she's only getting 2 short walks a day while her immunity low. Vet says that's standard on prednisolone and she's eating and drinking plenty.that's the only improvement in her to be honest! But today she's limping again!not badly bit she's holding it up occasionally and doesn't want to be bothered. If I ring vet she will be upped on the steroids again and I think she's too high already! Any suggestions?x

[Jo CIMDA]

Hi

It is quite normal to assume a relapse if a dog with IMPA limps during treatment, but a relapse on this dose is very unlikely and the occasional limp is not uncommon.

As long as she is eating and drinking loads then she is probably coping with this dose of steroids, so try resting her for a while to give her body a chance to replace the synovial fluid in the joints, and see in a couple of days if she is still limping.  Steroids put strain on ligaments and cartilage and also make muscles weak so this could be another reason for her limping.  A true relapse of  IMPA will present with a high temperature but it is unlikely when she is on a very high dose of prednisolone.

Hopefully in a few days you will see an improvement. She may not return to playing etc., until the steroids are reduced further.

Jo

[8141lindsay]

Thanks jo! Sorry i know theres alot more serious cases on here,and i really feel for everyone. Feel useless just when i see how helpless missy is and im so scared to do anything wrong by her! Appreciate your advice Xx

[Jo CIMDA]

Hi

I really understand.  It is so hard to deal with in the early days, and you are no different to anyone else here.   You just have to believe that she will not be on this dose for much longer and things do get better.  Having said that, you must always check that the drugs are not overwhelming her and that is not easy when you, and possibly your vet, doesn't have the necessary experience.  Trust your instinct. 

It is important to keep a dog on the correct dose for the correct duration of time, but know when to reduce the tablets. Too much isn't necessarily a good thing. Check out the Michael J Day protocol and 'What to expect when Treatment has Started' and use as a guide.

Jo