stella pred reduction

[Shannon]

Hi Elisabeth,

Again I'm no expert but if it is the ALP that is worrying you a lot, that liver enzyme can be directly related to the pred. ALP is an enzyme that has different forms called isoenzymes. It can come from bone, liver, muscle and a few other organs, but most importantly it can also be caused by high levels of endogenous or exogenous cortisol. As the pred dosage tapers the ALP should drop with it. GGT is an enzyme associated with the bile ducts of the liver so that, like your vet says, can indicate a cholangitis. I'm glad she's on liver supporting meds, they can only help her. Stella will fight her way through this and get well again. Hugs to you both.

[Penel CIMDA moderator]

Jo is doing her best to get back online, and said to tell you reducing the pred may well help.

[shawkyelisabeth]

Pls look at my post on JOs COMPUTER IS OUT OF WORK.. I have to add the stella is also on antibiotics for another week , three kinds og food supplements to support her liver, glucosamine for her joint problems, another drug for her liver plus regular vitamin d injections.. Plus aza plus preds...its a handful of tablets..sometimes i think she is just getting too much of it and i better throw away everything and let her heal all by herself, but this is wishful thinking of course..and i try to be patient and give her all the time it takes, i hope i am doing the right thing..

[Penel CIMDA moderator]

Have copied and pasted your post Elisabeth.  I will phone Jo today and read it to her.

h, thats why no answer from jo to my posts...i started to become desperate..i needed some reassurance from her about the aza..how long shall we give it to stella  until we can start to reduce the preds. I did it on my own today reducing the preds to 12.5 mg twice daily after  14 days at a dose of 18.75 mg 2 x daily and 11 days of aza at a dose of 50mg once daily.. My vet is very understanding but he is inexperienced with the combination treatment aza/preds and wanted to stay on the 18.75 mg dose for anoth week , but stella is very week due to her liver problems, she has difficulty walking and has ulcers on her inner gums that increase in size..so being sure that this all is pred related i take the risk and reduce the preds, with her hematocrit around 30 i think that is not a completely wrong decision and now i keep all fingers crossed that her anemia doesnt get worse again. I am away for a few days to europe leaving her in the good care of my mother, i hope she will not miss me too much and get depressed.. Do you think that we can reduce the preds again after a fortnight or so and hen stay on a lower dose for a longer period?

[shawkyelisabeth]

Thank you penel!

[Jo CIMDA]

Have copied and pasted your post Elisabeth.  I will phone Jo today and read it to her.

h, thats why no answer from jo to my posts...i started to become desperate..i needed some reassurance from her about the aza..how long shall we give it to stella  until we can start to reduce the preds. I did it on my own today reducing the preds to 12.5 mg twice daily after  14 days at a dose of 18.75 mg 2 x daily and 11 days of aza at a dose of 50mg once daily.. My vet is very understanding but he is inexperienced with the combination treatment aza/preds and wanted to stay on the 18.75 mg dose for anoth week , but stella is very week due to her liver problems, she has difficulty walking and has ulcers on her inner gums that increase in size..so being sure that this all is pred related i take the risk and reduce the preds, with her hematocrit around 30 i think that is not a completely wrong decision and now i keep all fingers crossed that her anemia doesnt get worse again. I am away for a few days to europe leaving her in the good care of my mother, i hope she will not miss me too much and get depressed.. Do you think that we can reduce the preds again after a fortnight or so and hen stay on a lower dose for a longer period?

First of all I must apologise for not being online.  As Penel kindly posted, my computer was not working but we have managed to link it up to another monitor so for now I am back on the forum. Thank you to all those who keeps this forum going - I'm not sure I'm needed here anyway, as the advice from members has been so good.

Hi Elisabeth

I'm sorry you have been worried and unfortunately I've not been here for you, but to be honest what you have done is exactly how I would have managed the situation.  It does sound like Stella's main problem is the side affect of the preds and now she has been on Aza for 9 days you can reduce the preds and 12.5mg twice a day seems just about right.  I hope now that the preds are reduced her PCV will increase and you should see a gradual drop in her liver enzymes.  I would plan to reduce the preds again in two weeks.  If the side affects do not improve but her PCV is stable you could reduce again after 10 days, but the situation has to be assessed at that time. Certainly if her reticulocytes are high then her bone marrow is working well so I am hoping that you will soon see an improvement in her anaemia.

Usually you work the preds and Aza alongside each other.  The object is to lower the preds and keep the Aza dose the same until you get the preds down to a low dose eg., 5-10mg a day or even wait until the pred dose is EOD.  Then you can start to lower the Aza, and the most logical option is to reduce the Aza to 25mg a day (it comes in 25 & 50mg tablets and they should not be broken).  If you only have 50mg tablets then you start the reduction by giving 50mg Aza EOD and at the next reduction, every third day etc.....

That's probably enough info' for now.  I'm sorry I've not been able to help but thanks again to all those who have given support and advice.

Jo

[shawkyelisabeth]

Thank you jo, thats exactly the reassurance i waited for, it is when to start reducing the aza..so i have something to get to my vet with and he will accept this . Penel, Shannon, Angela have all given good advice and i knew i had to reduce but did not know how to handle the aza and Everyone said...we hope jo will be around soon ! So you are needed along with everyone! Welcome back! Sorry for one more question: do you give aza and preds together or should you leave an interval between them and when you come to eod 5 mg preds do you then continue with the low maintenance dose of preds and stop the aza altogether?
So that was actually two questions!! Hugs Elisabeth

[Jo CIMDA]

Thank you Elisabeth. Yes you can give both tablets together.  You do know not to handle the Aza, don't you?  you can tip it into food or use gloves when handling it.

The answer to your second question is not necessarily. And nearer the time we can discuss how to reduce the two drugs.

Have a good time in Europe.

Thanks for the hugs.

Jo

[shawkyelisabeth]

So good to have you back again, Jo!

[shawkyelisabeth]

I am in prague and i have bad news from home: stella is very weak and apathic, lethargic, refuses to eat and take her medication, she drinks a little, but does not eat at all. She slept in the gaden at night refusing to get into the house most probably because she felt too weak to move. Het hind legs collapse constantly, she did her toilet inside the house today after she was carried inside. Since she did not take her medication the vet told us to give her dexa injection, the long acting cortison that lasts for a few days since she does not take her preds. Neither my husband nor my mother wereable to get her to take her meds...her stools are very dark. They will try to get her to the vet today...i think i dont need advice any more but only only your good thoughts,,...i have done everything i possibly could..my mother told me on the phone it looksbad..and i cannot be back home before wednesday...if it has to be...maybe then it isbetter for her,,she willbeatpeace..she has gone through too much in her short life..it just hurts that i cannot be with her right now but maybe this had to be..i hope she still fights until i get back home...

[shawkyelisabeth]

Stella is gone.......
I ve just got the news....
I thank you all my friends for helping me with her..you ve taught me so much ...she was the best dog i ve ever had..although she was given to me only for a short time....
Oi am Grateful for the good and bad times we had togeth...

I dont want to ask myself whether it was wrong to have gizven h the aza..she started to collapse exactly ten days after the beginning of the treatment, but if i had not given it to her then i might have regretted as well..so,...i need some time to recover and ...life goes on...THank you and god bless you.. Without stella i would not have known you..wonderful compassionate peope...thank you....

[Shannon]

Oh Elisabeth,

I am so very sorry to hear of Stella's passing,my heart breaks for you. She could not have had a more loving mum and no one could have cared for her better or done more for her, she was as blessed to have been your dog as you were to have her in your life. I'm sure your heart is broken but she will be with you always. Big hugs winging their way to you from Coop and I.

[Penel CIMDA moderator]

Oh Elisabeth, I'm so so sorry to read this, Stella was part of the CIMDA family and we will miss her so much     I am so sorry for you being away from her when she passed away.
You have been a fabulous Mum to Stella and have devoted yourself to her care, you couldn't have done more for her.
Sending you all our love and thinking of you at this sad time.

[Jo CIMDA]

Oh Elisabeth, I too am so upset to here this very sad news.  Stella touched all of us and she will be remembered with such affection. I felt I knew her personally.  You are right to be grateful for the short time you had with her but I know the pain is deep and it will take a while to heal before you can smile again.  Stella was such a lucky girl to have you.  She could have had no one better.

Please know Elisabeth that you are in our thoughts. 
Sending you love.

Jo
x

[Walcop]

Hi Elizabeth,

Just read of your sad loss. I can only imagine how you must feel, but from reading above I know you truly cared for Stella.

Take care

Steve