Reducing pred in IMHA?

BTW -- order more than one bottle - at four droppersful a day he was going thru two and a half bottles a week.  I only order once a month so I have been ordering a dozen bottles at a time.  *rolling eyes*.  I've panicked a couple of times when the order ran late *grin*.  Usually you get it in under a week just UPS or USPS. (I'm in FL and he's in CA)

 Okay, her internist has dropped Emmy's pred to 2.5 mg once a day (she's been at the 5 mg dosage for six weeks, with the cyclosporine at 35 mg for four weeks).  He said there's really no "right" way to reduce the two meds, and that reducing the Atopica would be good because it's more expensive, but that given her liver values, he thought the pred was the way to go.  We'll re-test in two weeks and then see about the Atopica.

Re: the milk thistle--he agreed that all of that is benign, and the only concern with adding anything new is that, since it's apparently chemicals that messed her up originally, there's a risk with anything new...but that stuff like this is very unlikely to cause problems.  He actually recommended starting with Vitamin E (400 IUs every other day)--don't know whether that's because she's already getting milk thistle in the Denamarin or what.  I  started the Vitamin E yesterday and will order the milk thistle tincture, and add that after she's done the E for a bit.

I'm much more careful with Emmy's meds than with my own; when I've been sick and on antibiotics, etc., I've occasionally missed a dose or been late--but with her I set my alarm!  When she was so sick, I was literally dosing her at exactly 6 AM and 6 PM.  The things we do for our babies.... :)

I noticed this morning that Her Pinkness is getting her waistline back.  It's not really a concern for me (especially after what you explained about the pred and fluids), it's just nice to see her looking more like she did before she got sick. <3 <3 <3
 

I think you'll find it will continue to go up -- this  was a HUGE HUGE worry to me.  Billy's went up to 56 at one time just before I got to take the cyclosporine down -- his blood was literally stringy almost instantly after being drawn - it scared the bejeebers out of me.

That has reduced now that he's off the cyclosporine.  This is another reason I'd tell you to push HARD on the milk thistle.  There's so little we can do to protect them from these drugs.

At this point I would think the vet will want to wean off maybe a little faster.  I know at the end of billy's treatment I couldn't WAIT for im to be off it -- I was scared to death those last couple of months because his blood was SO thick.  It seems to be a cyclosporine thing but that's just MY assumption.

Well, she had another CBC and chem on Thursday, with the results coming back Friday.  Her PCV is still 53.3.  They gave me the total blood count but I don't remember it...and her liver levels are back in normal (one is in the higher normal range, about 110, I think, and I believe the other is in the fifties).  

They faxed the results to FVS, and I called and left a message asking the doc to call me and let me know how to adjust her meds (which he said he was going to do if her results were still good).  Didn't hear back, so I called again shortly before closing, because he'll be out of the office until Tuesday, and by then it will have been nearly a week since her blood test (this was always frustrating when she was having weekly tests, because I felt like he was making decisions based on results that were going to be replaced, sometimes the very next day).

 I know he's busy, and that they were apparently REALLY busy yesterday, but I also did ask him a month ago if he'd like her local vet to take over, and he said no.  Am I being unreasonable to hope he'd call me back when he knows he'll be out of the office for three days, and let me know whether I can cut back on the really expensive meds that I sometimes have to reorder in the interim (not to mention what the high doses can do to her liver)?  I feel like a complainer, but I get really frustrated by this.

 So, and maybe it was wrong to do this, today I just gave her the 25 mg Cyclosporine instead of both the 25 and the 10.  He was talking about cutting her back to 10 a day last time we spoke, anyway (he opted to cut the pred again instead), so I figure this will be kind of an interim reduction that may (I hope) ease her down from 35 to 10, plus I will be able to use some of the brand new box of 25s that I just opened yesterday morning.

 Any thoughts?  Man, I feel like a whiner posting this here....

 She looks great, though!


 

There were times when I simply reduced it by my own logic -- and frankly, in MY opinion going from 35 to 10 is sheer lunacy.  I'd go to 25 -- for not less than a week and if it were me I'd use the package and then reduce to 10 -- that's STILL a heck of a drop. 

Even when we began to 'hurry' getting Billy off at the very end I did it in small increments.  Simply because you don't want the body to have to deal with a sudden drop.  Remember, the body doesn't respond to this like it does pred -- the body is responding to "levels" of cyclosporine in the blood and when you drop that huge 35 to 10 drop the body will have to deal with a very obvious DROP in the amount in the body. 

 Just my opinion.  And I'd probably be sucking my own vet in ANYWAY.  You're not getting consistent response out of the speciality vet and SOMEBUDDY has got to care!!!

PS -- I'm not getting email notifications any more on the board -- so you might want to email me.  I **almost** missed this!

Well, remember that the first time he reduced the Atopica, he dropped it from 70 to 35!  That drop made me more nervous even than the pred drop (that was 20 to 10 to 5 to 2.5 daily).

I think I'll keep her on 25, and call him at the end of the week if he still hasn't called me.  The reasoning he gave for wanting the next drop to be to 10 was that 35 to 25 "wasn't much of a drop."  I'm thinking, "isn't that the point?"  XD

I'd feel more comfortable keeping her at 25 for the remainder of the box (13 more days), then dropping to 10, unless the next drop needs to be the pred again.  But you kept Billy on pred longer than cyclosporine, right?

Anyway, thanks again. <3

 

No -- he was on both at first, and they weaned him off the pred 1st (while on the cyclosporine) and then after about a good big month on cyclosporine alone THEN they started to wean him down from the cyclosporine. He was on both 6/06 - 11/06 (wean off of pred took from August to November) then in December we started the wean off of cyclosporine and that took til first Saturday in Septemer, 2007.

I agree with what you said about the 25 mg box--if I don't hear from him (which I might or might not), I'll just continue her on the 25 and let her regular vet know, and see what she says about going to 25, then 10 (or if she'd rather alternate reducing the two meds as we've been doing).  I might even just wait and see if he calls.  It's frustrating; I know she's not a critical case and that he's busy, but he could even just have someone call each time and leave me a message, I'd think. *sigh*

I also don't want him to rush the reduction because he thinks he's making me happy.  I just want updates!  I think I've shown that I will go to the wall for my girl...just call the play, coach, and gimme the ball! ;-)

(Thanks again, Callie.)

 

Yeah -- vets that *listen* are a prize commodity.

New bloodwork:

 PCV: 53%

ALP: 134

ALT: 74 

She's been on 2.5 mg of pred for a month (down from 5) and we dropped the cyclosporine from 35 to 25 two weeks ago (the E-vet had wanted to drop to 10, but when I never heard back from him I consulted with her regular vet and we agreed that 25 was much better).  I'd hoped they'd go to 10 of the cyclo, because I'm about to use my last dose of the 25 mg pills tomorrow morning, but they want to drop the pred again, to 2.5 mg every other day, and keep her on 25 mg of cyclo.

Anyway, the really great news is that she's PINK and really energetic. :)  I have her on a vitamin E every other day and two droppersful of milk thistle every evening (she LOVES it on plain yogurt--seriously, I don't even have to mix it in and she goes nuts), and that seems to be helping her liver.  Thanks, Callie, and everyone! <3

 

Good job -- I'm glad to hear it's still doing good!!! 

Today's PCV was 55%!  I joked with them that they might need to start considering using Ems as a blood donor.  I did wonder if that might be too high, but her doc thinks hers is just normally high (I'm going to ask them to go back to May, when I had a complete "wellness" physical done, with blood chems, etc, to see whether they have that info; it might give us a sense of what normal is for her.  Can't believe none of us thought of this before). 

Her vet is going to consult with the e-vet tomorrow but thinks they may just phase out the pred entirely (she's on 2.5 mg every other day right now).  Then they'll start working on decreasing the cyclosporine. :)

The sty that she had a month ago came back, though, and the vet said there was a little discharge from it, so she's put Emma on Simplicef, 50 mg a day for two weeks.  When it showed up before, she thought that the pred Ems was taking would knock it out, but it apparently hasn't--or it did, but the thing came back; not sure (could this be a side effect of her depressed immune system?).

Anyway, just an update!  I brought her home "to stay" four months ago tomorrow, I think it was.  In some ways, it feels like it's been years; in others it seems like almost yesterday....

I'm hoping she may be drug-free by Christmas.


 

Mmmmkay, this time she got a different e-vet with a different take on things.  He said to cut the cyclosporine by going to the 25 mg every other day for a month, and then we might drop it altogether (25 mg is apparently the effective dose and the suggestion is that if you drop below that, the body doesn't register it, anyway).  Then they'll deal with the pred--I don't know whether they'll have her stay on the pred alone for a bit and then phase that out, or what.  STILL might be able to stop in time for Christmas (I hope). :)

The high PCV is a side effect of the pred -- it literally makes the blood thick.  Just before Billy finally got off of it, they took blood from him and literally in seconds it had coagulated into a stringy mess IN the syringe!! 

I have heard NO vet say the body doesn't register below 25 mg of cyclosporine.  C'mon that doesn't even make sense - why do they MAKE 10 mg caps and Em isn't a big dog at all. 

There's a point where most of these vets think "Oh this dog's gonna be ok and I've got rushes here" and they just dis you. 

You gotta get off the pred before you can get off the cylcosporine -- it's a dicey difference when they're still using one drug to back up the other. 

 Yell til you get heard if you have to!