Holly recently diagnosed with Addison's

[Jo CIMDA]

3rd

The excess daily pred won't be helping her chest infection or pancreatitis either.  It is natural to keep upping the dose  but sometimes it muddies the water and you don't know whether the problems are due to the drugs or the disease or something unrelated.

Jo

[HollyPolly]

Thank you Jo for your reply.

I have made another appointment for Holly tomorrow because now that she is off antibiotics we are seeing a return to her previous problems of loose stools and I feel that she has an infection on the bridge of her nose.

I am concerned about her weight, she is 14kg, but with the muscle wastage it looks less. She was 15.5-16kg before her initial crisis when she lost a good kg because she was so ill. She gained a little after crisis but then got Pancreatitis and lost more, since then it has been one thing after another, she only just maintains the 14kg and I suppose all the meds don't help either. Vet's don't seem to be that concerned, but I am!

Holly has had numerous procedures and scans, full blood work, urinalysis, Thyroid, nothing else seems to be obvious, other than raised liver values and raised white cell count, but given the infections and drug regime this could account for that.It is so deeply frustrating for us and Holly.

We cannot go down the route of an Endocrinologist as there is so little money left in her insurance. We used up all of lasts years plus our own money and have now nearly used up this years and we still have 4 months left to go! We are both retired and have caring responsibilities for our son also.

I will mention Mike Herrtage, but, to be honest, one of the vet's we see has already spoken to another vet he sees at a referral practice and he still feels that it is the Addison's which is the problem

We will see what tomorrow's appointment brings, I just hope her electrolyte's are still ok.

[Jo CIMDA]

Hi Maggie

Holly is on so much Florinef, and has had so much done, I am not surprised she is nearing the limit of her insurance.  It is cheaper to pay for a prescription from your vet for the Florinef and then go to a pharmacy to buy the drug.  If you don't do this already it might save some money doing it this way.  It just doesn't feel right that she is on so many drugs and her electrolytes are good and yet the vet thinks it is still her Addison's.  She is not 'Addisonian' and I wonder if it the problem is the result of too much Florinef and Pred.

  The pred might be causing excess acid and this could be why she wants to eat grass.  I wonder if your vet will give her a gastroprotectant? 

Good luck tomorrow.

Jo

[HollyPolly]

Hi Jo,

Fortunately we do now get her Florinef on prescription and she is on an antacid which I buy as it is just so much cheaper than getting from the vet. I still get pred from the vet though as these are not so expensive.

When we go tonight I am going to ask for the pred to be reduced down by another 5mg, she would then be on 5mg a day, which she has been on since diagnosis. She was on 10mg but I asked for it to be reduced before all of these problems started and that is where it stayed until earlier this year when she became so unbalanced, partly, I feel, because she has had so many ups and downs that the vet wanted to minimise stress. When she was first diagnosed we were told that it would be tapered off and only be used in times of stress, but as I say she has had so many problems that it had stayed at 5mg until this year. I think there will be resistance because she has inflammation in her nose and the pred does calm it down. As for the florinef I am not sure what they will suggest. The reason that it has been increased is because she gets dehydrated, she never stays balanced for long. She stabilizes for a while, gets dehydrated, goes on a drip then up with the florinef. Vicious circle I know.

One of the vets we see has treated other dogs with Addisons and fully expected her to stabilise. He did say that some dogs don't do well on Florinef. Where he used to practice they also had Percorten, but we do not have that option here, except in special circumstances. Also, he mentioned that perhaps pred does not suit her and we could try changing to a different steroid.

Today in the short term I want her electrolytes done and pred reduced down to 5mg once a day, slowly. The vet we normally see is away on holiday and he is the one with more experience of Addison's. We have an appointment with him on the 1st to discuss options.



I am going to speak with my husband again about the possibility of seeing an endocrinologist, but to be honest I don't think we will be able to manage it. If we were able to consider this Jo, who could we see. We live in Surrey.

[Jo CIMDA]

 Hi Maggie

Dogs who do not do well on pred are often changed to hydrocortisone.  It is identical to the natural hormone cortisol. I feel as she is on so much Florinef she should be receiving enough glucocorticoid for her daily needs without having additional daily preds, but who knows perhaps she doesn't absorb it as she should.

As you live in Surrey, I think I would be inclined to go to see David Church.  He is based at the RVC North Mimms (J23, M25). He is some info about him.

David Church BVSc PhD MACVSc MRCVS

Vice-Principal (Learning and Student Experience)

David is part of the Internal Medicine Service and is particularly interested in both disorders of the endocrine system and thoracic medicine. He has had a long standing passion for improving our understanding and management of diabetes mellitus in both dogs and cats. He is also recognised internationally as a pioneer and expert in the management of canine adrenal disorders.


http://www.rvc.ac.uk/small-animal-referrals/about-us/senior-clinicians/david-church

I found this advertisement on the internet for a CPD course for veterinary surgeons  and the speaker is Prof Church.

Common Endocrine Problems encountered in companion animal practice
Diabetes Mellitus - an update on where we are in 2015 Diabetes Mellitus part 2 - what do I do when the insulin doesn't seem to be working. Hypercalcaemia - a logical approach to its investigation and management. Hyperadrenocorticism - still a diagnostic and therapeutic challenge. Hypoadrenocorticism - less common then we might think but a joy to manage. Speaker: Professor David Church BVSc PhD MACVScMRVCS

Jo

[HollyPolly]

Hi Jo,

Thank you so much for the information.

Holly was fine at the vet's, she had even managed to put on a little weight. I had convinced myself that she had lost some more. She has not gained a great amount, but better than losing a bit. Her pred is being reduced by another 5mg from tomorrow, which still leaves her on 5mg once a day. Holly's electrolyte's will be done on the 1st as by then she will have been on a lower dose of pred for a couple of weeks. The vet said we should see a difference in her liver values now that we have started to reduce them further. I also give her Milk Thistle too.

The vet was happy with Holly today and completely took on board what I had been concerned about. He mentioned that perhaps pred does not suit her and that we could try another steroid, but that will be for discussion at our appointment on the 1st along with her florinef dose and reducing the last 5mg of pred. Her nose is quite sore and a bit swollen, she has been given antibiotics for this.

For the time being I am happy with getting another pred dose reduced and for stating my reasons why. Hopefully soon, I can look forward to a time when she is not on them, reviewing florinef and hoping she stays balanced.

Holly's tummy is still playing up a bit and again hopefully the pred reduction will help with this. He was in full agreement about giving the Yumpro, I have also been giving slippery elm on occasions and this helps too.

Thank you Jo

[Jo CIMDA]

Hi Maggie

You seem a lot happier now.  Having a plan is a good feeling.  Hope the reduction of pred works well for Holly.

Jo

[Lovemedogs]

Hi Maggie,
I am sorry you have been having such problems with your girl. It is a bit odd for a dog to be on such a high dose of florinef and to still become dehydrated. Have you had the BUN / Urea checked recently ? My vet checks this routinely every six months of so with his Addison's dogs. Also, checking other kidney values will help to make sure there isn't an issue there, rather than with the Addison's.

Each tablet of 0.1 mg florinef is said to have approximately 0.25 mg equivalent of glucocorticoid within it, so a dog on 1 mg florinef is getting the equivalent to 2.5 mg pred already which is more than most Addisonians need. Very few need pred in addition to florinef

You can get percorten in the UK. I know of quote a few people now that have done this. Some have had to state that the florinef is no longer working effectively as is the case with your dog and others have not even had to make a case. If you used the latest low dose protocol, your girl would start off on a dose of 0.63 ml and you would get almost 7 doses from a vial and after time, maybe even more, so it would likely work out cheaper than florinef.

[HollyPolly]

Hi, thank you for the reply.

Holly is due at the vet's again on the 1st, but her tummy is upset again now that her antibiotics are finished. Foul wind, getting up in the night to go to the toilet, all the usual, so we may have to go sooner.

I will mention the BUN and urea, but she did have urinalysis in Feb this year, so would this not have been done routinely? She is not able to tolerate too much protein, but she does not get that anyway as she is on a very low fat diet, which in itself is low protein.

When she is on antibiotics she is fine, firm stools, very little wind and does not get up in the night, but she cannot keep having them. I now think she has another problem, which is related to the skin on her nose. I have researched(as I do) and it looks very much like DLE. We are keeping her out of sunlight and we do have a topical steroid gel which has helped, but I am not a vet so I really don't know.

She was fine yesterday when the dog sitter came for another visit, but today very restless( has been on and off all week).

If she still has these symptoms on Tuesday we will have to take her earlier.

I really don't think I can cope with any more illnesses to be honest. We have very little left in the insurance kitty!

I do question whether Holly has a reasonable quality of life, as she never seems up for very long. She is definitely not our old Holly, but then again she has had so many problems I can understand why she my not be jumping for joy!

[Jo CIMDA]

Hi Maggie

For some reason the forum isn't letting me post my reply.  If you want to email me at

cimda@aslog.co.uk 

I will be able to forward the posting to you.  Sorry.

Jo