Could use some good thots...Snickers has IMHA

I am really happy to hear the good news!

Ok... so no cheese? Why? and why did no one tell me this sooner (at the vet)?

Ok, so cyclosporine is on an empty stomach right? Now can pred be on a full or empty stomach?

Feeding is going to become a three hour ritual I think.

Unfortunately I can't have anybuddy in the room when I give meds... they are little hoovers and if snickers drops a pill out of her mouth it'd be gone before I said "drop it" so everyone but snickers goes outside until meds are done... wish I could use the competition but i can't chance her not getting all the pills. 

Cyclo, in particular, is best given on an empty tummy for absorption purposes (you are giving cyclosporine that's formulated for dogs, right?  Atopica was what the doc recommended for Ems, and I ordered it online, usually from Petmeds; there's a 10% off coupon I used every time that helped a wee bit).  I didn't know this until I read it online, and I questioned the e-vet about it (he'd never mentioned it!) and he said that "ideally" this is the case; if it upsets her tummy, though, you may have to give her a bite of something, especially at first.

Ems was initially on the following:

Cyclosporine (Atopica) 35 mg x2 (so, four pills total: 2 25s and 2 10s)
Pepsid 5 mg x2
Denamarin (medium) x1
Doxycycline 50 mg x2
Prednisone 10 mg x2
Clavamox 125 mg x2

She took everything except the Denamarin twice a day.  Six pills at a time proved to be too much for her poor tummy to handle, so I took to giving her the cyclo, denamarin, and pepsid first (both the cyclo and Denamarin need to be on an empty stomach) and then the rest half an hour later, with food.  She stopped throwing up after that.

One thing I learned is that with IMHA, the belly MUST BE KEPT HAPPY.  Callie kept impressing this upon me (usually in all caps! :D), and she was so right!  Early on, when she didn't eat, the vet told me to "prime the pump" with a little Hills Science Diet AD, and that's what I put her pills in, as well.  The vet also prescribed AD for my parents' dog, Tessa, even though she had pancreatitis, so it might still be okay.  You could ask--it's one thing they are typically guaranteed to eat (the vet likened it to filet mignon), and you want her to get the pills down and keep them down.  Eventually, Ems started gaining weight--a LOT of weight--because of the pred.  Once I started Ems on milkthistle instead of Denamarin, I put it in a spoonful of plain yogurt (I started off using full fat for her because she lost so much weight at first, but with Snickers' pancreatitis, you'll want to use lowfat--make sure it's PLAIN and not "LIGHT," which contains artificial sweeteners) at night.  She viewed it as a treat and LOVED it...and it had the added benefit of helping her tummy, as well. :)

A lot of this stuff is going to be trial and error--what Snickers can tolerate and what she can't, how much you can afford (I started Ems on Denamarin because the vet recommended it, since her liver was showing signs of damage, but later switched her to milk thistle, which is more pure and less expensive), etc.  There are people on here who know much more than I do--and of course your vets will be your first line of defense--but I just went through this and, boy, do I know what you're dealing with!

I look at her sometimes, so pink and energetic and--well, truly, "joyful" seems to be the word--and I have a hard time believing it's the same dog!  We're praying that you have the same happy disbelief with Snickers one day soon. :)
 

I don't think it's one of those commonly known things about the dairy and cyclosporine -- Dr. Goldkamp did some extra research and felt it was one of the things preventing Billy's body from absorbing it.

I'd give it ALL after eating.  Even if you have to leave her a bit hungry ... give the meds (so she's eager for whatever you use to give them IN) and then give her a bit more to eat.  Pred needs food ... always.  too hard on the stomach.

 Make SURE you give ... what were they having you give?  Tagament?  Zantac?  whatever -- dogs can take any of them.  I told you Billy took Prilosec -- TWO a day (and it's a once a day pill).  But by golly his tummy hung in there!!

But among the typical 3 (Tagament ... Zantac and ... dang there's a 3rd one I can't remember) ... they each last a different length of time in the body -- Tagament is only a 6 hour drug.  Zantac I *think* is a 12 hour.  The 3rd one, if memory serves, is 8 hours.  So give it often as the directions say (and you'll likely have to split pills -- the vet should be able to give you the dose if you don't have it).

But the Calm Stomach -- you can give that ALSO.  (confirm that with your regular vet) -- truly truly helped Billy a ton.  And again -- you give it right along with everything else.

Now, once you know the pancreas is ok -- you can give braunschwieger -- but for now it might be too fatty with the pancreas all having been riled up.

However -- if you get beef heart -- just lightly saute it.  Refrigerate it -- then I often just slit it and shoved pills inside pieces of heart too.  It's too yummy to chew much -- and it tends to cube up nicely in 3/4" inch cubes (that tends to be how thick they slice it at the markets -- one beef heart is HUGE -- it's about 3-4 or more pounds.  They slice it and sell it in slices.  Shouldn't be too horrible for you to handle (I know you're veg*n) and it's easier to deal with than liver (and better for her).

 I think the third one is Pepsid!

 She's on sucralfate and pepcid for her stomach.

Today she is feeling slightly worse... less active, no snow rolling, and not wanting to eat. With a great deal of coaxing I got a little boiled chicken down her and a few kibbles. Last night she ate a great meal. Today she definately looks peaked/nauseaus. This is so darn stressful... I'm going to need to start taking pepcid lol. 

I'll be asking my vet today about starting the herbals... I'm shoving so many pills down her already though I haven't started yet, she won't take pills in baby food I have to shove them down her throat. 

I'm going to see if she wants to walk slowly around the block, i'm thinking the sun and sniffing things might stimulate her stomach. 

 She's really not doing well today, we're going in early to get the red blood count and a physical exam to check heart rate/breathing etc and so my vet can consult with the specialists while they are still open. I talked to one of the specialists, they want to know if her decline today is due to nausea or lower red blood cell count... she should be showing some improvement by now. It may be that she is not responding to the meds. I told her rehospitalization is not an option... (for me it is, but DH won't let me). So, she said that if that is the case I might want a bone marrow test to see if she producing red blood cells at all. If not I'll have to have her euthanized. If she is than  another transfusion is an option to buy some more time.

Someone please shoot me. 

I will hold your hands, encourage you and commiserate with you while you puke and cry, but no ... I won't shoot you.  Because I've been there.  I will also cry with you (and I am ... we just got off the phone and I got back to the office to post to ask for Good thots and prayers for you two and you'd posted before you left). 

It just happens THIS fast with this heinous disease.  And there's no telling ... there's no 'calling' it ... ever.  So many times we thot we'd have to put Billy down ... and I have told you (and said this many times on here) ... it's never "over" -- he could relapse.  I STILL check his mouth every single day.  I STILL watch to see if the tail's wagging and if not why not.

It makes you cherish the good times.  But you've got two others who need you ... and Snickers needs you in a different way right now.

I'll call you again later ... and you'll be on my heart all afternoon.  Take it a step at a time -- and whatever you have to do, do it without fear and without remorse because it's as it "is" with this disease.  Snickers KNOWS you were glad to see her, she KNOWS you had her in the hospital trying to get better ... she KNOWS you love her "best". 

She also will tell you what you need to know.  Be honest and straight with her ... and she'll tell you.  Then love her with no looking back ... it won't be easy.  It never ever is (it frankly shouldn't be 'easy' -- they are WORTH our love and our aguish to be honest -- if it was 'easy' there'd be something wrong with you!!).  But ... it will be the 'right' thing no matter what you do.  Today ... or another day.  Don't  hate yourself. 

And remind her -- there's a little Mostlie Sheltie up there who will look for her (and want to know all about OLIVER) ... and Hunter and tons of dogs up there who have been there done it too ... so if she has to go, she'll have TONS of company.  But if she can hang tough and get blood and do it again ... SO BE IT.

*hugs* 

I know it's hard, but whatever the outcome, you *will* make it through this.  We're all here to support you and Snickers.  I'm praying for both you and Snickers. 

C'mon, Snickers--pump out those baby red blood cells!

It's so hard--I know it is--and there's just no way to predict who will respond and who won't.  I was blessed with Ems (though I really thought I wouldn't be).  I'm praying it will be so with you and Snickers.  And, yes, we're all behind you, no matter what. <3

Just got back from the vet, by the time I left my house she wouldn't lift her head to put her collar on. She is really nauseaus, likely from high liver values but we did not test that today to try and save the cost since we'd be making the same decision with or without those particular results. Her red bood cell counts, all of them were improved which is awesome. Her WHITE blood cells now are dropping way too low which is likely why i'm seeing what i'm seeing today (no appetite, lethargic, etc). This is prolly due to the azathioprine. Doing nothing will cause her to go septic and die in short order. The specialist and my vet made the decision to take her off it completely cold turkey today. It's side effects can cause (in some unlucky dogs) elevated liver values and suppressed white cells so we are taking the chance and getting her off it. It's such a tight rope because if this is the drug helping her it will send her into a relapse and she'll die. But, they say it is likely not the one helping her, she is on two others, atopica and pred, apparently the azathioprine takes quite a while to take effect so there is a good chance it's not the one creating this good effect. Do nothing though and she will die due to the suppressed white cells, gosh this stinks.
Please everyone... fingers and toes crossed for her.
We've decided against the bone marrow test due to cost and pain, and the fact that she is creating new red cells at a solid rate so that is not the problem.
I am TRYING to go day by day... I just had to force some Hill's ID hoping it doesn't cause a rebound in the pancreatitis, but needing it to spur her appetite. She is so weak and is down to 40 pounds (from 48 two weeks ago) I went in today prepared to put her down because she looked so crappy compared to yesterday. I can't even look ahead anymore because it is dizzying... I'm just going to try and make it to tomorrow's blood test at 10:40 and hope her white cells have improved and she hasn't gotten an infection. I have to take her temp two times a day now.

She's lost all muscle mass, she is skin and bones with saggy flesh and protruding eyes. There is hope i these white cells rebound off the azathiprine and if it doesn't send her into a relapse.
 

~~**~~**WHITE BLOOD CELLS!!~~**~~**

Oh, God, come on Snickers!!  It must be so devastating to see your dog in the condition you described.  We are hoping and praying for all of you. 

Just saying I am still pulling for Snickers.  Prayers and thoughts for all of you.  Sending puppy hugs.