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 1 
 on: Yesterday at 04:03:13 PM 
Started by annandhenri - Last post by annandhenri
Hi Jo

Thank you for replying.

The sodium and the potassium seem to move down together, which is odd. 
The other odd thing that happens is the urea goes down as the potassium goes up.  Which appears to be the opposite way to how it should move. The potassium also seems to fall down at the end of the cycle before it starts to rise again.

The ratio is quite high as the potassium is on the low side, but so is the sodium and chloride.
He's ok in himself.  He really doesn't like his sodium below 153 and chloride below 113, which they seem to be, but it's taking more docs to move them and keep them stable
yes, he's drinking more, he does if he doesn't get enough docs, or if the potassium goes low
Food is not withheld and he eats regularly throughout the day, do you think this might be playing a part and age?
this has been going on a while, so different batches of docs have been used
The kidneys are good on the blood test and kidney function test.  The endocrinologist ran the electrolytes, the potassium was the same and the sodium slightly lower than at the usual vets
The endocrinologist wonders if it's to do with the distal tubes of the kidneys that exchange the sodium and potassium and age related sluggishness

On a different topic, a few weeks back he had to have his spleen removed and a 2kg mass.  He was almost ready for his docs injection before the surgery, but after the potassium dropped from 3.9 to 2.7, part from the drip during surgery and part from to surgery, so no docs could be given.  The diagnosis is splenic osteosarcoma, which is really rare.  They said the spleen was primary so hopefully, it's gone with the spleen.  Because the potassium dropped low, we've had to give a lower dose of docp these last couple of cycles, which then doesn't seem to keep the sodium and chloride stable, so they are going off before the potassium can rise enough. 

Thank you for the paper.


Ann
x

 2 
 on: Yesterday at 03:48:07 PM 
Started by Hengistbury - Last post by Hengistbury
Thanks for your input, Jo - appreciate it!
Yes, it's been a steep learning curve and, alas, a painful one!!  His 'incidents' are 'owner directed aggression' and I have been badly bitten.  It's like a red mist and he attacks ferociously over an apparently mild provocation (he resents being man-handled after a poorly managed traumatic injury as a 6m old) usually over perceived anticipated pain (very challenging to groom!!?) then it subsides and he is a bit sheepish.  He is muzzle trained ( I believe all dogs should be) but I have had to be careful that the muzzle isn't associated with anticipated perceived pain so try to minimise usage.  We have established a cooperative routine whereby he has a quick nail file (Dremel)and brush before his walk, without needing to resort to the muzzle.  He has learned to pick up his paws to be dried - everything by cooperation rather than force.
This latest incident is the first since his thyroid treatment began (Jan 2020) and that is what has un-nerved me - I thought it was under control.
He has OA in his hips and hock.  Monthly Osteopen injection, Hydrotherapy every 3weeks, Gabapentin and Paracetamol daily (with Codeine added if he needs a bit extra pain relief). And daily Fluoxetine to boost those seratonin levels. As well as daily Yumove 360 and Hills JD diet.  That regime has worked faultlessly for 20 months. 
As I explained, I think we unwittingly created a perfect storm whereby his pain overwhelmed the hormone control medication and so we returned to square one.(?). Or there could be another underlying factor that we have managed to mask for 20 months . . . .
He will celebrate his 12th birthday early October - something I didn't believe possible in January 2020.   I then need to seriously assess the risks to myself ( and potentially to others - though that has never been a concern to date) and his QOL - if there is mis-trust and fear of handling him and perpetual use of a muzzle - given that his pain will only increase with time . . . . . Such a horrible situation, but he is such a happy-go-lucky Beardie chap in most everyday situations - I walk him with confidence, we have house-guests, he loves to greet people and dogs - yet I have the responsibility to keep him safe and I'm not sure I can when I don't have the confidence that his treatment protocol is fail-safe.
Rest assured, my decision will be a considered one, and made with his happiness and comfort paramount. 

 3 
 on: Yesterday at 11:49:58 AM 
Started by Hengistbury - Last post by Jo CIMDA
Hi

Thank you for all the information.  It certainly can be useful to others in a similar situation.

You are very well informed about hypoT and hormone supplementation so I have nothing to add re dosing etc.

You say that he has arthritic pain.  Is this osteoarthritis?  Is he on something like Yumove as well as pain relief?   If no other clinical reason is found then would you consider him wearing a muzzle when he is out for a walk?  It is so difficult to know, when a dog 'bites back', whether it is a temperament problem, fear, an undiagnosed clinical problem or a hormone problem.

I do hope things calm down for you both very soon.

Jo


 4 
 on: September 22, 2021, 03:56:43 PM 
Started by Hengistbury - Last post by Hengistbury
Thanks, Catherine.
Yes, given on an empty tum, 1 hour before feeding.
Yes, I take your point about over-dose being expelled quickly.  So , therefore, a reduced oral dose would result in an even lower circulating dose . . . but for how long?  Dose was reduced on 7th Sept.  'Incident' occurred 21st.  I have returned to the higher 400mcg dose.
Sadly, if I can not be sure he is receiving therapeutic levels to suppress the aggression then I can not keep him safe.
I am very troubled by this and fear my options are sadly limited . . . . .

 5 
 on: September 21, 2021, 08:43:35 PM 
Started by Hengistbury - Last post by Catherine
Are you giving him his Thyforon on an empty stomach - either 1 hour before or 3 hours after feeding as advised?

Also there is the possibility that if a dog is having too much thyroid medication its body will try to eliminate the medication as quickly as possible and in theory ends up on a lower dose!

 6 
 on: September 21, 2021, 04:04:04 PM 
Started by Hengistbury - Last post by Hengistbury
OK, now in a position to give an update -
    Aug 2021 results.         30.5.             21.2.        0.03
however the blood was collected at 7 hrs post-pill so direct comparisons are difficult.

I contacted the Thyforon manufacturer, Dechra, to ask their opinion on the observed symptoms.  They were very helpful and provided the following insight - Dechra recommend sampling at 3hrs post-pill for the peak T4 levels (not the 4-6 advised by IDEXX) and they have a 'Conversion Calculator' to estimate the 3hr reading from later-taken bloods.
This gives a 3hr value for T4 as :-
   June 2020       44.5
    Oct. 2020.       57.0
    Aug 2021.        40-48.               Dechra give the target range as 30 - 47 at 3hrs post-pill.   They logged my observations as an 'adverse reaction'.

Correct dosage, it appears, is more an art-form than an empirical formula, and each dog will have a personal response.
Armed with this data, dosage was reduced to 350mcg Thyforon, twice daily at 6am and 6pm.  The night-time restlessness has abated (but the night temperatures have coincidentally reduced with the season) and I was confident all was well.

However, unwittingly, we encountered a 'perfect storm'.
       Hydrotherapy had to be cancelled (we go every 3 weeks) so no feel-good endorphine rush
       A family trip to the New Forest resulted in over-doing the play, resulting in painful joints for the next couple of days (pain-relief increased accordingly)
       In addition to the reduced Thyforon . . . .
and we had 'an incident' - a serious red-mist outburst over a bramble caught in his fur.  (!).  So very sad after 20 months incident-free.
It has made me realise that he is 'not cured' but we are merely 'managing' this disorder and the balance is very fragile and sensitive. 
I suspect an increase in pain was enough to sway the serotonin balance  . . . .
I shall return to 400mcg Thyforon to endeavour to re-gain our balanced state but, in the future, be very mindful of deviating from The Plan - we're are obviously on a knife-edge and his arthritic pain will increase with age and, alas, will not be tolerated with stoicism.

I hope these details will help guide others who find themselves on this journey - I shall always treasure those 20 months and that special bond we shared - ' borrowed time' that could have been denied us.



 7 
 on: September 19, 2021, 12:29:20 PM 
Started by annandhenri - Last post by Jo CIMDA
Hi Ann

That is an odd scenario. 

What is the Na:K ratio?
How is Henri in himself?
Does he have any digestive problems? 
Does he have the blood tests taken after meals or is food withheld?  A dog who hasn't eaten for some hours will likely have low potassium.
Is he wanting to eat or drink more? 
You say that is kidney values are good, so are the lab results, especially for potassium reliable?

I wonder if Henri's whole case needs to be considered again from blood results to clinical signs etc.
Is his age is having something to do with it - perhaps his metabolism is slower????

Is the batch of DOCP good?

So many questions!  Being on DOCP for 12 years is incredible.

Below is an excellent paper that you might like to forward to your vet.   

https://www.magonlinelibrary.com/doi/full/10.12968/coan.2018.23.2.82

I hope you can fathom this out very soon.  Please let us know how things go.

Jo



 8 
 on: September 17, 2021, 03:18:32 PM 
Started by annandhenri - Last post by annandhenri
Hello
I wonder if anyone can help shed any light on why
Henri’s potassium is falling low at the end of the cycle
so then we are having to give him a spike drip.
We then have to give a lower than ideal docp dose and it appears the lower the docp dose the lower the
potassium seems to go. It’s like we get a dip in the potassium at the
end of the cycle. He’s been on docp for 12 years now and is a 14
year old French bulldog. His kidney are testing good.

Many thanks
Ann and Henri

 9 
 on: August 30, 2021, 10:24:34 PM 
Started by Helen Cooper - Last post by Jo CIMDA
Hi Helen

The food that Psalm is on sounds very good. It is usual for a dog on steroids to put on weight, but she will lose this when she no longer needs to have steroids. It must be horrible to want to eat all the time, but she can't help it.

To get good effect from essential fatty acids the dosage has to be relatively high.  Effectiveness, and to achieve the 'steroid sparing effect'   is said to be dose dependent although the ratio omega 6:3 has not been established.   I would suggest adding evening primrose oil and fish oil to her diet.   Anecdotal:  I knew a beardie once who had PF and the specialist prescribed 3,000 mg a day evening primrose oil and 1,000 mg day fish oil.  If you do increase Psalm's EFA's then I would start at 1000mg EPO and 500mg fish oil and then increase the dose over a few weeks because giving her a higher dose of oil all at once may cause her to have loose stools.

 The dosage of Natural Vitamin E has been established and that is 400iu twice a day (Clinical Immunology of the Dog and Cat by Michael J Day) 

I have copied below some info regarding EFA's taken from my SLO seminar notes.

Jo



  •   Essential Fatty Acids (EFA’s) are given in therapeutic doses, regardless of which primary treatment regime is used.  High doses of EFA’s play an `active’ role in the treatment of skin diseases and should be included in the treatment regimen and in low maintenance doses after remission.  EFA’s are known to be `steroid sparing’ in high doses. This means that they have anti-inflammatory properties which may ultimately, lead to a lower dose of steroids being used and this is especially useful in dogs that remain dependant on steroids. However it is not easy to find a specified dose that is consistently used.  Examples below:

EFA Ratio/Supplements
The ‘therapeutic’ dose of recommended supplements, in the treatment of autoimmune skin disease, often varies from one clinician to another.  Below are some examples with their references.
Quote: “Research is being performed to determine the optimal ratio of omega-6 to omega-3 fatty acids that should be consumed. Previously, it was thought that the ratio should be approximately 15:1. Current recommendations are for ratios of 10:1 to 5:1.” (Omega fatty Acids: sources, Effects, and Therapeutic uses in Dogs, Veterinary Services Department, Drs Foster & Smith, Inc.  Holly Nash, DVM, MS)

Example Therapeutic Dose: Essential Fatty Acids
Quote: “Effect appears to be dose related and optimum doses and the most effective combinations of these oils have not yet been determined. Daily doses of Evening Primrose oil 172mg/kg/day, and Fish oil @ 44mg/kg/day, have been used in dogs over a one year period without ill effects”. (Ref: The Veterinary Formulary by Yolande M Bishop)

•   EFA dose should start at a high level until a response is seen.  This can take up to 12 weeks. EFA’s can cause loose stools. If this occurs, start on a lower dose and build up to the highest dose over a couple of weeks. Avoid using Evening Primrose Oil in dogs with epilepsy.  Always follow manufacturer’s dosing recommendations.

Manual of Skin Diseases of the Dog and Cat by Sue Paterson – Drug therapies for onychodystrophy

Essential Fatty Acid    Dosage differs with individuals   
EPA 400mg/10kg
GLA 100mg/10kg

•   Natural Vitamin E (400-800iu/12hrs) encourages new cell growth.  (Ref: Clinical Immunology of the Dog and Cat by Michael J Day). 

 10 
 on: August 29, 2021, 11:12:49 AM 
Started by Helen Cooper - Last post by Helen Cooper
Hi Jo,
My vet hasn't specified what type of Pemphigus she has but on reading about it I think it's Pemphigus Foliaceous. She started with crusty scabs along her lips upper and lower also on her nose, since being on steroids her lips have cleared but she still has small scabs on her nose plus the pigment on her nose is not smooth. The vet prescribed 6 steroids a day for a month then dropped it down to 4 a day plus antibiotics as the scabs were going inside her nostrils, she now just has small scabs on her nose so has improved and has been on 4 a day for 2 weeks.

The diet she's on is Eden holistic 80/20 with Protein 33%, Crude oils and fats 20%, Omega 6 3.3%, Omega 3 0.3% Vitamin E ( as alpha tocopherol ) 95 mg/kg, I have added this information as you said she needs essential fatty acids and vitamin E, is she getting enough in her diet or should she need supplementing further? also she did suffer with UTI's always on antibiotics until I started giving her organic ACV she hasn't had any since, is it OK to carry on with this.

Psalm has gained weight ( 3-4 kgs ) since being on steroids  and although I knew she would, I am hoping she won't keep gaining weight as she isn't as lively as she was ..... I have reduced her intake of food by 10% and giving her lots of fresh vegetables to fill her up but she's hungry all the time, prior to medication she would occasionally miss meals. Eden is high protein/fats should she be on a high protein diet as I have read conflicting articles on this.?
If she does need extra supplements could you please advise me as to which to get?

Jo I'm sorry for the lengthy reply I just wanted to make sure I've covered everything and thank you so much for your help, it's really appreciated.

   Helen,


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