Side effects of large doses of Florinef

[Penel CIMDA moderator]

Well done Pat, for pushing and getting to see Rob Foale - he sounds great.
Keeping our fingers crossed for Willow.

[Jo CIMDA]

Yes, well done Pat.  Oh how we have to strengthen our character for the sake of our dogs.  So many of us have had to do this Pat so you are not alone.

Now Rob has Willow under his wing, I'm sure he will be thorough.

Jo
 

[patp]

Thank you both

The pancreatitis test has come back negative. Although you can sometimes get false negatives he is comfortable, in view of Willow not vomiting or pooping, to rule it out for now.

He is now working on her Addisons and plans to introduce some hydrocortisone alongside the Florinef. He thinks 3 tablets twice a day is too high a dose and the plan is to bring it down to 2 or 2.5 twice daily.
For now, she is on a drip but not eating. Before he lets her home he is going to give her an appetite stimulant alongside Cerenia, an anti emetic. Just in case there are some bacteria hanging around she is going to have some Metronidazol too.

Feeling much better...

Pat
The thyroid anti body test is due back later today too.

[Jo CIMDA]

At least someone with appropriate knowledge is taking control and you do seem so much more confident Pat.  I'm so happy for you, and I like his plan. 

I  hope she can go back home very soon.

Thanks for the update.

Jo

[patp]

Thank you

[Penel CIMDA moderator]

I agree - sounds like a good plan, he's covering all the possibilities.

[patp]

Willow ate a little yesterday but also had diarrhoea with some blood in it.

The Autoimmune Thyroiditis test came back negative. The vet is now concentrating on it being poorly controlled Addisons. He is giving her Metronidazole for the diarrhoea and an appetite stimulant - an SSRI which, it has been discovered, also increases appetite.

Willow's sodium was 136 (139-144) Up from 128. Alongside the drip he has introduced the hydrocortisone.
The potassium was bang on normal at 4.4. 

He is a little concerned about her nervousness and its effect on her Addisons. I told him that she was not nervous (or sensitive as I like to describe it!) until she got Addisons Disease. Now here is a question for this forum - has anyone noticed a change in their dog's character following the diagnosis of Addisons Disease?

[Penel CIMDA moderator]

Which SSRI is it Pat, just out of interest?

[Jo CIMDA]

He is a little concerned about her nervousness and its effect on her Addisons. I told him that she was not nervous (or sensitive as I like to describe it!) until she got Addisons Disease. Now here is a question for this forum - has anyone noticed a change in their dog's character following the diagnosis of Addisons Disease?

Hi Pat

Nervousness comes hand in glove with Addisonian dogs but when the disease is stable and the dog is on the correct dose of Florinef, generally the dog is ok until a stressful situation occurs and this is when the owner needs to give replacement doses of prednisolone because the dog has lost this 'fight flight' hormone response.   

Hydrocortisone is doing the same job as prednisolone by  providing this fight flight hormone.  Hydrocortisone is supposed to be almost, if not the same, as the body's own cortisone and this is why it suits some dogs better than prednisolone.

Willow's persistent nervousness, to me, indicates that she does need more cortisol.  Perhaps she will be a dog who is on an 'average' amount of Florinef for her weight, but has to be daily supplemented with hydrocortisone to control her nervousness. Hormones are very much tailored to the individual as one dog can be 'average' text book and another can need 'off the scale' doses to become stable.  However when stability is difficult to achieve the vet has to think outside the box and test for perhaps an underlying disease and Rob seems to be considering other things. I presume he has considered  other endocrine diseases and not just thyroid disease. Exocrine pancreatic insufficiency (EPI) may be one to consider. The problem with hormones is when one is out of balance it can unbalance many other hormones. 

I hope the metronidazole sorts out her diarrhoea.  It is a very good drug for regulating the gut.

Jo

[patp]

The SSRI is, I believe, Mirtazapine http://en.wikipedia.org/wiki/Mirtazapine. Rob's colleague, Simon, has written papers on its use and he is using it, initially, to increase her appetite but also to lift her spirits.

I am quite concerned about the nervousness issues. We have plans, long held, to sell up and go travelling. We particularly chose a Whippet because we thought she would fit into that plan more easily than a larger breed.
When we spent a night in a hotel, recently, Willow did not cope well at all. She copes better in our Motorhome as that is more familiar. Our plan is to buy a fifth wheeler and tour with it all over Europe. What are people's thoughts on the viability of those plans? Has anyone done anything similar with their Addisonian dog?

Pat

[Jo CIMDA]

Hi PAt

When Willow is stable I can't see any reason why she won't be a normal dog again. It is about getting the meds right and establishing a familiar routine.

Jo

[patp]

Thanks folks I feel better now 

[patp]

Just heard that Willow has pooped normal poop and that her Sodium levels have, at last, lifted into the normal range. She is being discharged tomorrow!

Pat x

[helshaw]

Really pleased Willow is doing well, they are such a worry. I can really empathise with you about feeling neurotic with the vets when you know you are not. Before Buster got admitted to Cambridge a couple of weeks ago I had been to my vets 4 days running and then phoned them twice. When I rang i got the feeling they thought I was neurotic but we know our own dogs inside out and I was proved right even though I wished I hadn't been. Buster has his first check up at my vets this week since leaving Cambridge so fingers crossed. Good luck with Willow and I will look forward to an update.

[Jo CIMDA]

Just heard that Willow has pooped normal poop and that her Sodium levels have, at last, lifted into the normal range. She is being discharged tomorrow!

Pat x

Brilliant news Pat!!!!

Jo