Reducing pred in IMHA?

Update:

Yesterday, the specialist told me to cut her Atopica to 35 mg a day instead of 70.  He said that things "couldn't be better" so far as her levels are concerned.  Anybody here want to weigh in on what I should expect from the new dosage reduction?  I have noticed that, as we've reduced the pred, she's not so frantically hungry and thirsty, which is good.  Also, I'm watching for any "paleness" or lethargy--so far, her energy is great!

Thanks again--

That's a big drop (they had me do it far far more slowly than that) -- so you'll see a cessation of whatever side effects that does was causing.  I'm not copping out here -- Billy had a bunch of different side effects that ceased at different levels.  When he was at the high high doses there was a ton of drooling, and the UTIs were absolutely fierce. 
 
Honestly, it's really unusual to see them take the dose down soooooo fast.  It's been over a year getting Billy off the meds and they didn't even let me start reducing the Atopica until he'd been OFF pred like 2 full months and then it's been weaned off at month intervals for each drop.  Like from 75 to 60 to 50 to 35 to 25 to 20 to 10 and now 10 every other day (for another week). 
 
I'm not saying your vet shouldn't ... but I think my vets were concerned about a relapse.  Typically when they relapse (at least from what I've heard) it can be harder, faster and *worse* than the initial problem.  But Emma began to respond very early on and Billy didn't.  I'm not second guessing your vet ... only telling you what I've seen done in others.  Good luck.
 
 

So far, so good--her PCV is holding steady at 51 after a bit more than a week on the new dosage.  She'll have her "real" CBC at the end of the week; I just wanted to see for myself how she was doing.

Good for you -- I'm gonna also say to anyone lurking -- 51 is VERY high for any other breed other than grehound or whippet (like Emma).  36 - 49 is typical

Yep, Ems is actually an Italian greyhound, and I did ask both vets about the fact that it was that high, but we figure that's probably normal for her.

Which makes the drop even scarier.

I have also asked what happens if her PCV drops but stays in the normal range (ex: if it dropped to, say 42 or something).  They said they would test again within a few days to see whether it was continuing to drop.

Knowing what I know now, I would have had them check her PCV when they did her annuals, just to get a sense of what her normal was, so I'd know.  But that's not something you normally even think of, you know?

Thanks for all your continued concern, guys.  And, callie--I just read your post in the other thread and could WEEP for you!  What fabulous news!  (Okay, off to post there, 'cos Billy deserves to be able to read his congratulations posts! XD)

<3

New update--holding steady at 51 after two weeks on the reduced cyclosporine dosage.  She's scheduled for a CBC in two more weeks; at that point, he may drop her dosages again.

She looks GREAT--pink, energetic, bouncy...the joy is definitely back.  She's no longer eating like a pig, though she keeps gaining weight as if she were.  I'll be glad when she's off the pred! :)
 

It's truly not 'weight' -- it's an accumulation of water being stored abnormally by the tissues.  I know it looks like 'fat' and it's truly truly not.  She won't lose it until she's not only off the pred but off the cyclosporine. 

The change in Billy when we got him nearly off the cyclosporine was astounding -- and he continues to 'lose' altho I haven't changed his food at all -- it's simply his body getting rid of the drug. 

If you look at pics of movie stars who have been on steroids (Mickey Rooney comes to mind) you'll see it's a typical result to the steroids in the body to get all puffy and 'fat' looking.  Billy also developed bigger 'deposits' on one side over the other that had us really concerned at one time (particularly over his right hip -- it looks like he had a big 'lump' on his hip and it was JUST from the cyclosporine!!)

It's great that she's holding so well.

Interesting note -- this year the AKC has asked for *and gotten* a special study that's being done on "silimarin" - which is milk thistle and it's role in protecting the body from various drug toxins and particularly it's role in helping the liver and kidneys.

It's interesting that altho I was the one (along with my holistic vet) who initially was pushing the milk thistle -- at this point even the regular vets are right on board with it.  The holistic vet is also telling me NOT to stop it even tho the cyclosporine has stopped simply because the body stores these drugs for SO long and the body needs the help in detoxing itself.

 I knowj I sound like a broken record, but trust me -- after knowing the effects on the kidneys (renal failure and diabetes/blindness/etc.) I'm SO glad I've pushed it as hard as I have all the way thru.  If I had it to do over again, I wouldn't have done a thing different except maybe to have used both tincture AND the dry herb earlier even (I only added the dry herb to the tincture I was giving in the last couple of months.)

Thanks so much for your reply!  The odd thing is that she doesn't even really LOOK puffy; she did for a while, but that seems to have gone down, though she weighs more.

 I'm continuing the Denamarin; thanks for the heads up on persisting with that even after she's off the meds.  I like that there's something I can do to help her get rid of all this STUFF we've had to put into her little system.  And congrats that Billy's doing so well!  We're a couple of proud moms! <3 :)
 

We are, aren't we!!!! RAH!

Well, Ems had her CBC with a blood chem yesterday.  Her PCV is still up--at 53.3, so, hurrah!  But her liver values are also back up a bit (ALT is at 257 and ALP is at 438), after having dropped into the normal range last time. 

She's been on the 5 mg dose of pred for 6 weeks now, and 35 of cyclosporine for 4 weeks...I'm hoping he can and will safely reduce this again so that her liver values go back down.  I still have her on Denamarin and am wondering about increasing that at this point.

Denmaryn is a pharmaceutical.  In total honesty, I would simply ADD milk thistle (and if you can do the tincture it is supposed to be the best absorbed by the body).  I wouldn't do more *chemcial* -- I would add the natural. 

I kept Billy on HUGE doses all year -- and he's STILL on a huge dose.  Towards the end when we knew his body was really showing side effects I UPPED the already huge dose to 'enormous'.  I've got ti back down to 'huge'.  But at this point I'm giving a bit less of the tincture and I've added the capsules of milk thistle just so his body is dealing with it a bit differently to switch it off a bit.

You've got a LONG way to go on wean off ... I can't stress enough all *I* have heard in the past year about using milk thistle, and frankly I'm positive the fact that Billy's still doing well is testament to that. 

Given that you're having liver reactions, I'd sure bump it up -- because you are SEEING response in the blood -- which is the next stage after it really is begining to happen.  If you are *seeing* high liver values it's already causing damage -- does that make sense?? 

I truly wouldn't be afraid of the milk thistle. 

I'm not afraid of it; the one doc had just requested I not add anything while they were weaning her down.  I'm just frustrated, because her levels were back to normal a month ago! 

Where can I get my hands on some ASAP?  I know there's a website you use, but I can't remember where it is.... :( 

If you have a Whole Foods or Wild Oats near you they'll carry HerbPharm tincture. 

Even if you just get a bottle of caps and ORDER the tincture it's fine.  But there comes a point in this disease where we start to get REALLY Protective because we can SEE them suffer side effects, and I know there was a point where I got brave and started doing things to protect him.

http://www.morningstarthealth.com is where I get Billys -- make sure you look for milk thistle TINCTURE.  (he carries some oils too) but he's got a good search feature on there.

but you can give the capsules until you can get the tincture -- I get this mental picture in my head of holding a shield over him when I give milk thistle.  *sigh*

 Okay, I'm thinking it's this: http://www.morningstarhealth.com/store/Herb-Pharm-Milk-Thistle.html

How do I know how much to give?  I don't know where there's a Whole Foods or whatever near me; may just have to put a rush on this....
 

Yep that's it.  I gave Billy (34 pounds) 4 -- I'd give her two if you can get her to take it.  I stirred it in his food.  Start with half a dropper and just increase it every meal and see how she deals with it.

If she balks at 2 give her one. But then give her one capsule twice a day in addition to the one dropperful. 

Remember, Billy's been getting FOUR droppers full twice daily for a year.  That's twice the human adult dose -- it's benign - it literally just helps rinse the yuck out of the liver.