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Author Topic: stella pred reduction  (Read 58767 times)

Jo CIMDA

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Re: stella pred reduction
« Reply #90 on: August 31, 2012, 08:34:30 AM »

Hi Elisabeth

I'm so sorry you are having to deal with Stella being unwell again.  If you say it is just like the first time then this is probably on the top of your list of differentials and I hope a blood test will confirm this.  I know very little about Babesiosis, I'm sure you and your husband know much more, but I did look up some details in a veterinary book (if it helps) and it states that 'Microscopy and PCR may be better for post-treatment follow-up, as IFA titres may persist for years; Dogs with B. gibsoni remain persistently infected and can act as carrier animals even after treatment; Dogs infected with B. canis may be cured after treatment; co-infection with other vector-transmitted pathogens (eg., Erhlichia, Haemobartonella, Leishmania) should be considered, especially in animals that fail to respond to treatment'.

I dont think it is at all likely that her muscle weakness is due to the preds as she has been on such a low dose for a while now her muscle strength should be good enough not to cause these symptoms.

Addison's is not expected in dogs that have been on long term pred use.  Addison's is an immune destruction of the adrenal glands. The only reason I mentioned it is because it should be considered in any dog who becomes exercise intolerant or who collapses, because it can so easily be overlooked.  Addison's disease occurs in dogs with a genetic predisposition but when a dog has one AI disease there is always a possibility of them getting another - it doesn't always happen but it does sometimes and we have no way of knowing what AI disease/s our dogs are predisposed to.

 In a way Elisabeth if Stella is positive to Babesiosis then you know the course of treatment and it has worked very well before, and also you will be a step ahead of the game this time.

Hurry up with those blood tests!

Thinking of you.

Jo
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shawkyelisabeth

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Re: stella pred reduction
« Reply #91 on: August 31, 2012, 08:25:14 PM »

Blood results will only be out by tomorrow, a first update of our visit to the vet  revealed that stella has hip dysplasia not related to the autoimune condition but definitely genetically inherited and most probably evident quiker than in oher dogs due to her long history of sickness at a young age.her back also shows. Deformity which is uncommon at this young age, her reflexes are compromised, due to a nerve condition. X rays revealed this and i have to accept this as a fact i have to deal and live with. As long as stella can walk acceptably and without pain we can deal with it, when we have to start carrying her around...i dont know how i will manage. I will wait for the blood results tomorrow and take it in little steps from there.....
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Jo CIMDA

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Re: stella pred reduction
« Reply #92 on: September 01, 2012, 08:28:36 AM »

Hi Elisabeth

I'm so sorry you have further problems with Stella.  You must be exhausted.  I hope there is something that can be done to make her more mobile. Are you using a sling to help her at the moment? This might be just an acute stage and even a towel under her middle, so you can assist her along, may be useful and I am hoping that this acute phase might pass.  What about anti inflammatory drugs or pain relief for her hip dysplasia. I wonder if she was in pain when she went through her grumpy phase a couple of months ago.

Take a few deep breaths Elisabeth.

Jo
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shawkyelisabeth

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Re: stella pred reduction
« Reply #93 on: September 01, 2012, 10:39:13 AM »

Really jo i am in tears now reading your post for all your compassion, i dont know what i would do without you and all the other cimda friends...stellas blood results turned out badly...her hematocrit is down to 26.8from 41 last time six weeks ago her haemoglobin is 8.3 from 12.9last time, her rbcs are 4 from 4.95 last time, her wbcs are high at 33.8, she has an infection, but the new vet who was very understanding with her ai history was not able to establish a reason yet. I will still discuss the bloods with him today and see what kind of action concerning the inflammation he suggests. I
I syart to reproach myself that i might have reduced the preds too quickly at the stage of 5mg once daily to eod and maybe should have kept her on the daily 5mg much longer, but i considered three weeks long enaugh with all her clinical signs being really good, now i have to look ahead and think: is this a relapse? If yes, at what dose am i supposed to restart, is it worth it, should i start with the antibiotics treatment first andvsee how it works out, then i am afraid rbcs will be destroyed again and anoher blood transfusion is out of question. And then i have to deal with the diagnosis of hipdysplasia which has definitely no cure for stella. She is well today on her legs but always hesitating to go upstaiirs. She has always been weak in her legs but this extreme weakness turned out all of a sudden.
Addisons was definitely excluded by the vet as well as my husband, but thank you jo for always giving a hint of what could be.
Pls help me with establishing if this is a relapse! Thank you because if it is i have to take actin quickly.
Hugs elisabeth
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shawkyelisabeth

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Re: stella pred reduction
« Reply #94 on: September 01, 2012, 10:55:57 AM »

I have to add that stella is walking fine in the evening but has problems getting up in the morning, her walking condition is on and off, better and worse, maybe the last days was an acute phase, i will still have to look for something to relieve her if she really gets into pain, most probably will have to join a forum for gsd congenital hip dysplasia victims!
And i have to add the new vet doubts very much that it could be a relapse of babesia , i hope he is right.
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shawkyelisabeth

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Re: stella pred reduction
« Reply #95 on: September 01, 2012, 12:06:26 PM »

I have just been on the phone with stellas new vet: he suspects a relapse, not a real infection that couls be related to anything physical but kind of the immune system thinking it has to fight something that is why her liver enzymes are high and wbcs are high. Sorry i cannot explain it better scientifically, but it sounded logic to me. He wants to give her a medecation called depometrol ampula 80mg per week to be given subcutaneously that is slowly released as a supportive treatment for the infection, the liver and the anaemia, then levanox and liver albumin and cephalaxine antibiotics. Pls comment, he seems reluctant to go back to the very high doses of preds but i have not yet discussed it with him, i think he wants to try out this supportivetreatment for one week and see how she responds.
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Angela

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Re: stella pred reduction
« Reply #96 on: September 01, 2012, 12:53:52 PM »

Prayers & fingers crossed here for you Stella

Hugs from Oz
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Angela (AIHA & Addison's)
NSW Australia

Jo CIMDA

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Re: stella pred reduction
« Reply #97 on: September 03, 2012, 10:45:25 AM »

I have just been on the phone with stellas new vet: he suspects a relapse, not a real infection that couls be related to anything physical but kind of the immune system thinking it has to fight something that is why her liver enzymes are high and wbcs are high. Sorry i cannot explain it better scientifically, but it sounded logic to me. He wants to give her a medecation called depometrol ampula 80mg per week to be given subcutaneously that is slowly released as a supportive treatment for the infection, the liver and the anaemia, then levanox and liver albumin and cephalaxine antibiotics. Pls comment, he seems reluctant to go back to the very high doses of preds but i have not yet discussed it with him, i think he wants to try out this supportivetreatment for one week and see how she responds.

Hi Elisabeth

Firstly you didn't do anything wrong in lowering the preds.  Stella was in remission otherwise she wouldn't have had an HCT of 41%.  Her weakness certainly could be due to 26% HCT and the high white cell count of course can be due to an infection but I feel it is likely due to a relapse of AIHA. Does your vet know if the anaemia is regenerative or non regenerative?  For a dog to relapse a trigger has to occur and this can be any stressful situation whether it be the body trying to cope with drugs or any emotional/hormonal situation. 

Depometrol ampula, I presume is methylprednisolone?  If it is, then the drug more potent than prednisolone.  It is an immunosuppressant and therefore I can only think your vet is giving  it to Stella for the AI disease and not for an infection, but perhaps I haven't understood your message properly. I cannot comment on the dose as your vet is giving as it is in a form that I am not familiar with. Perhaps you can check with the vet (or your husband) if this is an immunosuppressive dose, which is essential.  If it is then it will hopefully stop the immune destruction of the red blood cells but you will have to continue with oral steroids and wean down as usual.  There is no other way when a relapse happens. 

Personally, I think  a week is too long to go between blood tests because if her anaemia is non-regenerative and the supportive treatment Stella is having does not work then she could be losing red blood cells at a rate of 4% a day and if it is regenerative then it can happen a lot quicker.  You need to avoid her going so low that she may need a transfusion again. 

Just because this has happened now doesn't mean to say that you can't reach long term remission in the future and Stella will be OK again. Don't even think about her hips at the moment because when she is back to normal again her hips may not be a problem to her. Everything might settle down. This whole episode might be caused by the immune problem she is having at the moment.  You know Stella responds to the steroids and this is a good sign because she can do it again.

Your new vet sounds a good guy with a better understanding of AI disease than your previous one.  I know you don't want to go down this route again but when she is in remission you will be glad you did!

Thinking of you

Jo
 
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shawkyelisabeth

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Re: stella pred reduction
« Reply #98 on: September 03, 2012, 12:41:44 PM »

Yes jo it is methylprednisolone acetate , given intramascular 80mg , once a week meant as a supportive treatment. I will try to get him on the phone to make sure he is aware stella might need an immunosuppressive dose again. In the meanwhile iwill continue with preds every third day as i did. She is doing better today more lively but i am aware that this might be due to the extra shot of cortison and i am not sure if this wil stop her decrease in rbcs. Okay back to the vet. I am glad anyway that he uis understanding. Hugs
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shawkyelisabeth

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Re: stella pred reduction
« Reply #99 on: September 03, 2012, 01:21:59 PM »

My husband who had been on the phone with the vet on saturday tells me it is an immunosuppressive dose that is given intramuscular and is slowly released and does not need weaning or tapering. I personally am not sure how this goes with e,g. Michael j days protocol how it fits in , but i am waiting for the vets answer to this question. The vet told my husband to stop the oral preds . Stellas 5 mg  every third day are due this evening so i still have time to get a definitive answer from my vet concerning the immunosuppressive dose.keep fingers crossed this crisis will pass! I just need to get myself on the way again with the treatment for stella and be sure that i do the right thing. Would the normal thing be to go back to 20 mg twice daily?
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Jo CIMDA

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Re: stella pred reduction
« Reply #100 on: September 03, 2012, 02:12:49 PM »

My husband who had been on the phone with the vet on saturday tells me it is an immunosuppressive dose that is given intramuscular and is slowly released and does not need weaning or tapering. I personally am not sure how this goes with e,g. Michael j days protocol how it fits in , but i am waiting for the vets answer to this question. The vet told my husband to stop the oral preds . Stellas 5 mg  every third day are due this evening so i still have time to get a definitive answer from my vet concerning the immunosuppressive dose.keep fingers crossed this crisis will pass! I just need to get myself on the way again with the treatment for stella and be sure that i do the right thing. Would the normal thing be to go back to 20 mg twice daily?

Hi Elisabeth

The only long acting steroid I am familiar with is dexamethasone but the duration is only 72 hrs and it does have a half serum life so oral immunosuppressive treatment is needed after 48 hrs, so I can't comment on Stella's currrent treatment. 5mg of pred every third day will not have any effect so there is no point in giving it at the moment.

If a dog relapses then the treatment regime has to start again and that is with 1mg/kg/12 hrs.  I would expect Stella (being a GSD) to be heavier than 20kg and if this is so then she will need a higher starting dose then 20mg/12hrs.

You will get yourself back on the road again and although it is a disappointment you at least know what to do and what to expect.

Fingers crossed

Jo
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Shannon

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Re: stella pred reduction
« Reply #101 on: September 03, 2012, 02:31:12 PM »

Hi Elisabeth,

I think we are definitely in the same boat at the moment and you are right, all we can do is start again and pray that the treatment is successful and both our precious babies get back to normal soon. It is such a scary place to be and one feels so powerless! I think we are probably just as afraid as each other at this point in time. The support and advice that Jo,Penel as well as all the other CIMDA people so freely give makes such an immense difference and I'm so grateful for it. Good luck with Stella, she and Coop just have to get through this because we love them so much. They will be the two African success stories!
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shawkyelisabeth

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Re: stella pred reduction
« Reply #102 on: September 03, 2012, 05:42:45 PM »

Hi, shannon and jo, yes we are in this together, i have been through this all alone against ther will of the first vet and now am not going to wait and take any more risks we have had too many hard times before, i hope i am not too late, this relapse came totally unexpected, stella was so well and showed only minor signs of blibses and i had no possibility of doing bloods more often , that i reproach to myself now, but anyway i look ahead of the road, deep breath, still i try to get on the phone tonight with my new vet who seems to understand ai diseases but reluctant to put her back on high doses quickly enough.
Shannon were are you from? I hope we can make it for our fur kids, i get attached to stella more and more and she is grateful for every moment that she feels better and it breaks my heart to see her coming to me with her cloth ball in her mouth waning me to throw it to her which i do and then she cannot run after it because she is too weak.
I should have started to worry when she showed an orange coloured poo about two weeks ago that was when she started slowly to be poorly .
Big hug to you jo and head up high shannon maybe we can make it!
Elisabeth
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shawkyelisabeth

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Re: stella pred reduction
« Reply #103 on: September 03, 2012, 06:04:03 PM »

Have just been on the phone with my new vet, he is well aware of the dngers of a relapse and assures me that the 80 mg  depo medrol intramuscular are immunosuppressive with A half life of at least one week to three weeks, he told me not to worry and that he preferred this to giving her oral preds. He will,see stella and do new bloods on thursday that means only three more days and he is sure that there will be no xdeterioration on her hematocrit until then. So i should have confidence, shouldn t i and i cannot now on my own increase her oral dose of preds because that would definitely mean an overdose for the time being. Stella is better and lets hope for the best, itis a rollercoaster! Elisabeth
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Catherine

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Re: stella pred reduction
« Reply #104 on: September 03, 2012, 06:33:40 PM »

Elisabeth is there a particular reason you can not get Stella to the vet sooner for blood tests? (Sorry if you have mentioned it before, I am still finding my way around the new site). Having seen that her PCV had gone down quite a bit, I am afraid I would be having her tested every three or four days just to make sure it was not sinking even lower.

Has Stella had a full biochemistry blood test done recently to check her liver, kidneys etc.?

Sorry I can not be more positive, but I am a great believer in regular blood tests to keep an eye on things and especially when things are not going so well. I did this with my AIHA Beardie and we also reduced the medication gradually - it took a year!
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