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Author Topic: Henri  (Read 990 times)

annandhenri

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Henri
« on: September 05, 2018, 05:02:43 PM »

Hi,

I was a member of the group when you were on yahoo.  Henri, my frenchie, is 11 now and has had addisons for 9 years.  It took a while to get the optimal dose but he's been stable for years now.  Just this last week he's gone off his food, which isn't like him.  The vet gave omeprazole which didn't help.  She's now added antepsin and upped the dose.  We also did a full blood panel, which is should very mild increase in lipase and liver bile enzymes.  We go tomorrow for more tests for both and a chest xray and ultrasound.  The vet said once we rule all that out we can assume he has some ulcers.  I'm so worried about him. Has anyone had this in a dog with addisons?  He's always had a teeny tiny dose of pred and percorten.

Thank you so much

ann and Henri   
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Jo CIMDA

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Re: Henri
« Reply #1 on: September 06, 2018, 09:54:24 AM »

Hi Ann

Welcome back!

You have done so well with Henri. 

I presume the full biochemical blood test showed that Henri's Addison's was being well controlled, however,  I wonder if the teeny, tiny small daily replacement dose of prednisolone might not be enough and this is why Henri has gone off his food.  Sometimes as a dog ages the dose has to be adjusted and increased.   Is he showing other signs of being deficient in cortisol, eg., lethargy?    If there are gastric problems, I have read that this can inhibit the absorption of prednisolone, so perhaps you can check this out. 

Conversely, prednisolone can raise the levels of  lipase and liver bile acids, but usually the increase has to be moderately high before it is significant. 

Chronic use of prednisolone can cause gastric ulcers.  I would have hoped that the omeprazole would have had some good effect as it is the most commonly used drug to heal gastric ulcers. 

 I haven't known a small replacement dose of pred to have this reaction in the  numerous Addisonian dogs that I have had contact with.

 I would check that Henri's Addison's  is being well controlled.  I do hope you are further enlightened after the tests today.

All the best

Jo


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annandhenri

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Re: Henri
« Reply #2 on: September 24, 2018, 04:39:27 AM »

Hi Jo

All the blood tests were good and the liver is fine. Henri has been diagnosed with a hiatus hernia. He is on the omeprazole and antepsin. The vet thinks we can manage it with drugs. He's been very picky with his food especially in the morning. I know he's playing me a bit too as he knows I won't leave him without food and he'll get the chicken or venison.  His addisons has remained stable with this and I've kept his pred the same.  He's never been a very pred dependent dog. Its more challenging though as he doesn't always want to eat in the morning. I'm worried to as we only have enough percorten to the end of the year and the last thing I want is to have to switch to zycortal. He's such a reactive and sensitive dog

Ann and Henri
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Jo CIMDA

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Re: Henri
« Reply #3 on: September 24, 2018, 06:36:00 PM »

Hi Ann

This is good news for Henri. 

Don't worry about switching from Percorten to Zycortal because they are both the same generic injectable suspension -
Desoxycorticosterone Pivalate  (DOCP). 

What time of day do you give the pred?  If you don't give it in the early morning then this might be why Henri doesn't want to eat breakfast.  Alternatively, you could try giving it last thing at night so his cortisol level is good enough to stimulate his morning appetite. 

Jo


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annandhenri

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Re: Henri
« Reply #4 on: September 24, 2018, 11:24:59 PM »

Hi Jo,

I am worried about the zycortal. The active ingredient is the same, but the emulsifier and the preservative aren't. The action must be south different with a different emulsifier. It's also given sub-q and )end I had his percorten IM.

I have always given him the pred about half an hour after his breakfast. Now I. Trying to coax a few bites down in the morning and then giving the pred. I did wonder about upping the pred to stimulate appetite but he's eating ok later and he does well with this amount of pred he has.  The vet has upped his omeprazole so maybe that will help.
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Jo CIMDA

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Re: Henri
« Reply #5 on: September 25, 2018, 10:51:56 AM »

Hi Ann

I didn't know the emulsifier is different, so thank you for that information.

Go by your gut instinct with Henri.  You have dealt with him well so far and you know him the best.

I hope things improve.
Jo
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annandhenri

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Re: Henri
« Reply #6 on: September 26, 2018, 10:33:37 AM »

Thanks Jo. The main challenge is getting him to eat in the mornings at the moment and to sleep through the night without the acid building up. We've just tweaked his medicine so hopefully it will help.

Because otherwise he's so well and the addisons has been so well under control for years and he's so lively and full of it, it's hard to remember that he's an 11.5 year old French bulldog.

The addisons has remained really stable throughout the hiatus hernia causing the ulcers and problems which I'm thankful for. He's never been very pred dependent which must help.

Yes, the emulsifier is different that's why it can't be given IM like percorten that can be administered both ways. I'm over the moon that percorten is back in production. I have enough for about 3 more months so I hope it lasts until we get some.

Thanks so much
Ann and Henri
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annandhenri

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Re: Henri
« Reply #7 on: January 15, 2019, 06:43:37 PM »

Hi everyone

I'm just wondering if anyone has experience with a hiatus hernia, or acid reflux?  My dogs on medication for this and seems to be going a bit hyper at times and then a bit out of it. I'm not sure if it's a reaction to one of the medications, or a bit old age too. He's on pred for the addisons, omeprazole, antepsin and metroclopremide for the hernia. Thanks so much, Ann and Henri
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Jo CIMDA

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Re: Henri
« Reply #8 on: January 15, 2019, 07:09:03 PM »

Hi Ann

I looked up the side effects of metoclopramide in Plumb's Veterinary Drug Handbook, 8th Edition, and  it states that in dogs it can cause 'changes in mentation and behaviour', so I wonder if this is the problem with Henri.  See this link: 

https://canna-pet.com/side-effects-metoclopramide-dogs/

Perhaps your vet can find an alternative drug.

I hope you can sort it out soon.

Jo


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annandhenri

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Re: Henri
« Reply #9 on: January 19, 2019, 07:09:18 PM »

Hi Jo

I'm wondering the same. I've stopped it two days ago and the behaviour is less. He's wanting to eat but I'm unsure if it's the extra pred or from stopping the medication. The downside so far is he was sick bile in the night last night and had more acid in the night. The vet is looking into cispride, which is supposed to be much more effective so he may only need a teeny bit. He's always been sensitive to medications and inky needs a tiny bit for his addisons. It's hard too to know how much of it is old man syndrome too
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Jo CIMDA

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Re: Henri
« Reply #10 on: January 20, 2019, 10:52:23 AM »

Hi Ann

There are not many drugs that cause adverse effects and the symptoms do not reduce once the drug dose is lowered or the drug is withdrawn altogether. So it is very likely that the improvement you have seen is as a result of stopping the metoclopramide.  See this link:

https://www.wedgewoodpetrx.com/learning-center/professional-monographs/cisapride-for-veterinary-use.html

If there is no real necessity to give Cisapride then perhaps you shouldn't because it just might add to the confusion,eg., what is causing these clinical signs.

The Omeprazole should sort out the gastric reflux.

Jo
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annandhenri

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Re: Henri
« Reply #11 on: March 03, 2019, 11:52:11 AM »

Hi Jo

A lot of the side effects went away with the metroclopremide. Just in case anyone else uses it, it crosses blood brain barrier and can cause some strange behaviours. The omeprazole hasn't done much, but we've changed it to pantoprazole which seems to be better. He's still getting flare up, which are somehow related to where he is in the docp cycle, especially around the peak in the middle. He's on 1mg pred, but still has some symptoms from too much pred. He seems to need the 1mg for other things now though. It's definitely trying to balance
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Jo CIMDA

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Re: Henri
« Reply #12 on: March 04, 2019, 05:54:30 PM »

Hi Ann

Many thanks for the  update on Henri.

It seems things are improving slowly and unfortunately,  it is often a case of try 'this or that' until things improve.  What suits one individual won't necessarily suit another.

Img of pred a day  is negligible, so if you think he is better on it then that is fine.

This is good news.

Jo
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annandhenri

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Re: Henri
« Reply #13 on: March 06, 2019, 06:58:37 PM »

Hi Jo and everyone

I've had to put Henri up to 1.25mg of pred again. It seems to help with the inflammation even though it causes some excess drinking. It's hard to know what's the pred and what's the acid.

Does anyone have any experience with a drug called cisapride?  I think I spoke too soon, we've just had a few days of a flare it with his hiatus hernia. It then seems to affect his breathing.  The vet wants to try cisapride.  He sometimes has metrobactin for diarrhoea but tIt's contraindicated with cisapride. There's just not a lot of studies or info out there on cisapride
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Jo CIMDA

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Re: Henri
« Reply #14 on: March 07, 2019, 08:57:56 AM »

Hi Ann

I am sure the small increase in pred will not do any harm to Henri and it may just make his Addison's induced stress more stable.  Have you tried Ranitidine instead of Omeprazole?

I haven't known a dog to be on Cisapride, and according to Plumb's Veterinary Drug Handbook,  Eighth edition, it is no longer commercially available and has to be obtained by a compounding pharmacy. See this link for more information about the drug:

https://www.wedgewoodpetrx.com/learning-center/professional-monographs/cisapride-for-veterinary-use.html

This article, and  recommended treatments, might be of use:

http://veterinarycalendar.dvm360.com/disorders-esophagus-proceedings?id=&sk=&date=&pageID=6

Cimetidine (2.5 to 5 mg/lb orally every 6 to 8 hours), ranitidine (1 mg/lb [dog], 1.5 mg/lb [cat] orally every 12 hours), or famotidine (Pepcid, 0.25 to 0.5 mg/lb orally every 24 hours, or every 12 hours if there is severe esophagitis) is generally used for 2 to 3 weeks in dogs and cats with acute reflux esophagitis. Since 1987 I have preferred to use famotidine (Pepcid) because of its long dosage interval and the fact that it is associated with fewer side effects. Another H2-receptor antagonist that can be tried is nizatidine (Axid). The dosage is 1.25 to 2.5 mg/lb orally every 24 hours. Ranitidine and nizatidine also have a gastric prokinetic effect. Long-term therapy should be used in hiatal hernia patients with chronic reflux esophagitis if corrective surgery either is not performed or is unsuccessful.

There are probably other drug options you can try.

Jo
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