Prednisone + Apartment = ?????

 Dog walkers? Pee pee pads? Litter boxes? Those grassy pee stations?

Unfortunately, there's not a lot you can do about a dog on Prednisone. She's going to have to pee. I've taken Prednisone, short term, and it's quite unpleasant.  I would confine her in an area with no carpet, in case she misses, but I probably wouldn't put her in a crate. It's not really fair.

This is absolutely the right place for the post --

Prednisone has some severe side effects, and to be honest, even *if* it makes you crazy to a degree you will need to make some serious adjustments to your own schedule (including getting up at night -- you may be sleepless for a while if you want to save her life).  I don't mean that unkindly *at all* -- but these immune-suppression drugs are VERY difficult.

Willow's mom will be along shortly - Willow had thrombocytopenia.

 Crate training has tot ake more than an evening or two.  But that may help -- but you can't have her barking/whining either in an apartment.

My first suggestion would be to get her some "bitches britches" -- the panties they put on female dogs in season.  BUT you will need to get human continence pads for inside of them for them to be absorbent enough to hold that quantity of urine.  I used to use the "xtra-long" ones (the thickest you can buy) and cut them in half.  PUt a piece of nylon first aid tape over the cut end (or all the stuff just falls out).  THEN stick it in the panty. 

In fact, I found it better to fold over the other rounded end about an inch -- and when you stick it to the panty put the folded end up so it almost covers the tail hole (because of where the female urethra is -- it will just leak out of the hole otherwise).  That should keep her while you are at work. 

Even if you have to leave her in a small room -- like a bathroom -- you want to be careful because if anxious a dog can tear up the room. 

It will be MONTHS before you can wean her off the prednisone and get her back to 'normal'.  It takes a long, long time.

The other thing that is really important is to give something to protect the liver and kidneys.  Prednisone can be extremely damaging to the body   You can use milk thistle (easily obtained at any health store) -- give **at least** the adult human dose or exceed that double given twice a day.  This will help protect the liver (and to a lesser degree the kidneys) from the ravaged of the prednisone.

You can also talk to your vet about using the milk thistle or even something like Marin or Denamarin -- those are pricey tho, and I don't know what your budget will handle.

It is critical that this dog get ALL she needs to drink -- that is the body's own way of trying to rinse out the chemical and protect itself.

Also-- be aware.  Prednisone does more than just make them drink -- it can mess with the muscles so that it can make it so a dog that normally has excellent potty training skills can *not* hold their urine normally.  They can go out and TRY to squat and not be able to .. and then a few steps later it may let loose in a rush when they aren't expecting it.  It doesn't happen with all dogs but it DOES with some.

I'd also be very hesitant about the dog being outside *all* the time simply because with any of the cytopenia illnesses, the resultant low platelets can cause the dog to bleed (and bleed to death) over even the slightest bruise or bump.

Don't try to make her go all night long without going out -- not just because it's inconvenient, but you don't want her to *forget* to be housetrained.  Damage control during the day is one thing, but honestly it's going to be difficult for her not to simply decide to release her  urine any time because she does during the day. 

It's difficult but you CAN get thru this.  I would make the suggestion that you try to find either doggie daycare or even a neighbor who may be able to let her out? I know that's not always possible but for a while until you can begin to lower the pred it may help.

Take care and good luck.  There's another thread on here that is 75+ pages long that is about IMHA -- another auto-immune disease where the dogs have to take the huge immune-suppression stuff.  It's difficult -- very, very difficult.  You'll find a lot of folks here who are very supportive.

 My dog was on Prednisone for years.  The large amount you are giving your dog is not going to make it fun for you.  Or her.  My dog would've  done well with "grassy pee stations", if he had been in an apartment.  I had often thought of that.  Luckily I was home most of the time.  If, on occasion my dog didn't make it and I wasn't home, he only wet by the back door.  So, I would've put something right there for him.  You definitely need the milk thistle.  I did not have him on it in the beginning and his liver tests finally came back not too good.  He was put on milk thistle and it immediately corrected the problem.  Good luck to you.  It will start getting better when she gets weaned down to a lower dose.  But it takes a long for you to see the improvement in the peeing department. 

 Ohhh, the mat under the pads is a REALLY good idea!

PhoebeJulie

the lowest the vet had ever seen (7 was the number that he told me, but I do not know what the units are). Subsequently, she is on a mega dose of prednisone to bring her platelet count back up (40mg 2x daily) which it has; after 1 week it was up to 164, which is apparently on the low side of normal. The vet wants to continue the mega dose for two more weeks to bring it back up to mid-range normal and then consider tapering the dosage. She weighs 45-50 lbs (it ranges), and I am slightly concerned with the dosage, but because it is being used as an immune-suppressant, I think that the amount is normal.

Yes, the amount is exactly what Willow was started at and she was about the same weight.  "7" means 7,000 which is, as they said, much too low.  Willow's were 12,000 when she was diagnosed.  Anything, under 40,000 and the dog is at risk for spontaneous internal bleeding or bleeding from any little bump/bruise.  It's a scary thing. 

PhoebeJulie

Of course, she is drinking TONS of water and panting like crazy (she has long hair that we trim in the summer to keep her cool, and she is due for another trimming this week).

The panting is also a side effect of the Prednisone.  I wasn't sure if you realized. 

PhoebeJulie

This is not a huge issue for the time being, as I am temporarily at my mother's where she can stay outside so she can pee whenever she needs to. 

As Callie mentioned, be very careful because most likely if her platelets fall for some reason, you won't know it.  And, if she's outside any little bump or God forbid another dog gets near her even just to play and rough houses with her.  It could cause bleeding.  Also, same for grooming and doggie daycare.  My vet stronly recommended against being around other dogs if it could be avoided. Not just for the bleeding but also they are likely to pick up any little thing with the immune system suppressed the way it is right now.  Of course, the other dog you have would be the exception, that's unavoidable.  My vet would of had me carrying her into the office if she had been lighter. 

PhoebeJulie

I will be gone for at most 6 hours at a time during the day, so I was planning on crate training them while I am gone. Is 6 hours at a time too long for them to stay in crates?

If she's never been in a crate before, now is not a good time to teach her that.  Stress can cause relapses of this problem and as it is the apartment in itself is going to do that. 

For during the day, if it's not possible that someone dog sit her or at least come over to check on her a couple of times, then all the suggestions you mentioned are great to get her thru.  At night, unfortunately, you are going to need to get up with her.  I slept on the couch the entire 5 months so she could wake me if needed.  And, it was about every 1-2 hours on the doses you are at right now.  I was exhausted.  But, you get thru it. 

Hope this is helpful. 

Thanks for all the feedback! You guys have given me a lot to mull over. Phoebe is doing very well. Pretty much just acting normal aside from the pred side effects.

My biggest concern right now is the panting. I am worried that she is having trouble sleeping because of it, which cannot be good with her trying to get better and everything. Any ideas on how to help mitigate this?

Also, is there any information that I can read about the Milk Thistle you mentioned. I am more-or-less familiar with natural and homeopathic remedies, (my mother had us seeing a homeopathic doctor regularly as children) but I am not well-versed at all in its application to dogs. I have seen milk thistle mentioned many times before in these forums but would like more information on it, and you guys seem to be more experts on this than most vets, having lived with dogs with immune problems and seen first hand what does and does not work. Also, which organs does prednisone affect?

Most of this might be mentioned in the 75 + pg post and I will check it out. Thanks for the advice!

PhoebeJulie

My biggest concern right now is the panting. I am worried that she is having trouble sleeping because of it, which cannot be good with her trying to get better and everything. Any ideas on how to help mitigate this?

Willow was given Tramadol to take as needed for pain, discomfort, etc.  I broke the pills and only gave her 1/2 the prescribed dose just to take the edge off and help her sleep. 

Prednisone effects the liver and kidneys too.  At first I bought just the regular milk thistle capsules at Whole Foods and broke the capsule and added the powder to her food every meal.  I'd say I was giving her 2 capsules with each meal.  I'd double check with Callie but I don't think you can give "too much".  I think as much as they will tolerate is best.  Willow had some gas and upset with it at first but we still kept going with it.  But, she's a sensitive dog to begin with so you cannot go by her reaction. 

Then later we went to Denosyl and Marin.  The vet gave it too us but it's available without prescription too I believe. 

Hope Phoebe is feeling OK today!!

Lori

PhoebeJulie

My biggest concern right now is the panting. I am worried that she is having trouble sleeping because of it, which cannot be good with her trying to get better and everything. Any ideas on how to help mitigate this?

Pred makes them hyper, and ultra thirsty -- and generally uncomfortable.  Give her ALL the water she wants -- and ice can sometimes help a whole lot.  Since you are familiar with homeopathics -- chamomilia would be helpful (like 3-4 pellets, and crush them in a folded piece of paper and pour on her tongue if she won't just chew them up).  If she appears to have trouble sleeping, Hylands Calms Forte would be an excellent choice but one that won't stress the other organs.  If you can find a Whole Foods that carries -Heel products, they have a "Calming" formula that also is really really good and works faster than Calms Forte.

PhoebeJulie

Also, is there any information that I can read about the Milk Thistle you mentioned. I am more-or-less familiar with natural and homeopathic remedies, (my mother had us seeing a homeopathic doctor regularly as children) but I am not well-versed at all in its application to dogs. I have seen milk thistle mentioned many times before in these forums but would like more information on it, and you guys seem to be more experts on this than most vets, having lived with dogs with immune problems and seen first hand what does and does not work. Also, which organs does prednisone affect?

Milk thistle is an herb -- very benign.  It's best use is as a "protectant" -- altho it does also detox the liver somewhat (sam-e is better for that and works really well *with* milk thistle).  I would *start* at the adult human dose of milk thistle.  Most dogs don't object at all to the taste and usually you can just empty the capsules (or get it bulk from somewhere like http://www.leavesandroots.com ). 

Typically it's though of as protecting the liver, first and foremost. But in *high* doses it also protects the kidneys to a pretty decent degree (better  than anything else I'm aware of, at least).  When Billy was taking pred and cyclosporine for IMHA (high doses of both and he was on them months and months -- it's another auto-immune disease that is often fatal) I started at the adult human dose of milk thistle tincture (which is generally regarded as stronger than the powdered ground herb).  And frankly, I went UP from there.  He was on those drugs like 18 months and I was terrified the drugs would damage his body beyond repair.  He was on pred almost 6 months and the cyclosporine 18 months.  Cyclo is even harder on the kidneys than pred.  By the end I had him on five times the adult human dose of milk thistle tincture AND powdered herb milk thistle in addition to that.  But he's ok now -- and altho we know we do have some kidney damage, he functions very well, and the liver -- which took a BIG hit -- is doing very well. 

But you can tell just by the way the body attempts to "rinse itself out" with the pred and the water consumption, how hard it is on the kidneys.

Marin is a pharmaceutical version of milk thistle (it is literally distilled/refined into a pharmaceutical) and denosyl is the counterpart that is like sam-e except distilled, again, into a pharmaceutical.  They actually have marketed it together as "denamarin".  Really good quality -- I have some problems with the company, myself -- but it is VERY good quality if you want to go the pharmaceutical route.  Pricey, but I prefer the natural safety you get with the powdered herb.  You can *not* use the high doses of the Marin like you can the milk thistle herb to protect the kidneys.

Since you are well acquainted with homeopathy -- you CAN treat cytopenia with homopathics but it is *not* for the casual user.  In fact, to be honest, I wouldn't treat it with classical homeopathy either (and I use homeopathics extensively).  Now homotoxicology?  That would be a super choice if that is familiar to you (or email me if you want to know more).  I'm going to link in the Alt Vet website where you can find an alternative vet if you want.

http://www.holisticvetlist.com/

Diseases like cytopenia (and there are many forms of that) and IMHA are  some of those auto-immune/immune-mediated diseases that are so quickly fatal it's scarey.  I used alternative medicine a great deal with Billy -- TCVM (traditional Chinese veterinary medicine) WITH regular veterinary medicine all during his IMHA treatment, and then homotoxicology (a very specialized form of homeopathy) after he was off the drugs to help restore his health.  But I'm honestly not sure ... in fact I highly doubt he would have survived if I'd tried even something as cutting edge/aggressive as homotoxicology alone with the IMHA.

SIDE NOTE:

If you try to use wee pads -- I'm going to go further than just using a desk chair mat under a wee pad.  The quantity of urine we're talking about in a dog drinking non-stop who is on pred?  nope -- it will just roll off onto the carpet.  First I'd use a washable flannel-backed vinyl tablecloth on the bottom.  THEN a folded sheet on top of that (making sure the edges of the folds are inside of the flannel-backed tablecloth -- or you could use a heavy gauge paint dropcloth that is plastic).  THEN on top of that folded sheet you can put wee pads -- but it will take more than one.  A dog on pred is sucking up a ton of water and what goes in comes out.  so give yourself some layers of washable fabric UNDER the wee pads PLUS plastic under that.  And honestly?  Even for a small dog, I'm talking about an absorbent area that is maybe 36" X 54" (half a twin sheet).  Because they will tend to kick up something that is wet and if he has to wet AGAIN you're in trubble!!

Another thot for you -- I used to train my apartment dog to do this.  I used to put her wee pads in the bathtub.   She was small (pom/peke mix) and if she had to go she'd jump in the tub, go and jump out again.  It was EZ to clean (a bit of chlorox down the drain and it was spotless).  No absorption of odor (you will get odor in even linoleum that you won't be able to get rid of) and it was a breeze to clean.  IF she left solid waste ever, I picked it up and flushed it.  But it was SO easy to do for her and for me and we were both happy with it.

The big deal is at least something absorbent under the wee pad (which has a urine scent that does attract them) that is either plastic backed or plastic-backed *and* disposable (pricey but disposable -- I usually have old white sheets I can wash but that might not be do-able late at night in an apartment either). 

When I was in an apartment with Pris I couldn't do laundry at midnight (not and feel even somewhat safe) -- which is actually how I arrived at the bathtub thing.  Pris had been paper-trained as a pup and she would target ANYTHING small, squarish and absorbent (from today's news to a throw rug).  Her *favorite* was the little rug in front of the toilet (she was discerning that way *grin*).  One night I came in *very* late and discovered she'd wet on that little bathroom rug and I knew I couldn't do laundry at midnight, so I spot cleaned & folded it up and tossed it in the bathtub (too big for the hamper). 

I literally forgot it in the morning, but she didn't.  And again that night I was uber late, I came home and she took me directly to the tub -- ever so proud of herself!!  Yep -- she'd wee'd in the tub on that rug.  Thereafter, I just left paper in there and she used it if she needed and I decided it was the easiest and CLEANEST ever.  No danger of the linoleum absorbing odor and I could scrub the heck out of the tub!

How is Pheobe today??  Willow is thinking about her.