Hello all,
Sorry to have been absent for so long. I thought I'd update on Jenna for anyone still interested and perhaps glean a little insight from those who have had dogs on long term prednisone therapy or who have/had dogs with Cushing's-like Syndrome.
After almost a year of daily prednisone at the lowest dose (1/4 of a 5 mg tablet, roughly 1.25 mgs) I'm seeing some side effects in Jenna that have me concerned. Up until about September of last year she was doing well with this dose. It was keeping her ataxia and 'old dog vestibular' issues under control and we'd had no further stomach trouble from the added omeprazole/sucralfate combination. She's also continued her two eyedrop regimens: ketorolac and latanaprost but sadly her cataracts are moving now and we have to monitor them very carefully so the lenses don't slip into the anterior chamber of the eyes. Because she has scalloped irises, the latanaprost isn't really helping much on this front. Jenna's vet and I do hope that the predisone is also helping keep her pressures down where the drops might be failing.
After having a much needed dental at the end of September 2019 where she amazingly lost no more teeth
, she began to show signs of something like Cushing's. She's started having accidents in the house again, although she doesn't drink much water at all, she's become increasingly agitated and clingy, even moreso than she's been in the past, and the most noticeable is her fur is falling out.
She currently has a very thin, lightened and sparse coat. We believe she's part Chihuahua, so she doesn't have the Yorkie standard pelt and coat, but what little she has is now so thin she can't bear being out of doors for more than a few minutes for her toilet. This isn't conducive to any kind of exercise. She sleeps pretty much all day unless she's in one of her agitated states. Her vet hasn't run bloods on her since September but those came back okay. Her appetite, when she's not unconscious, is as if she's starving at each mealtime. She scoffs her food and then has lots of gas afterwards, I doubt she chews it much before it goes down. Her stools continue to be somewhat toothpaste like in consistency.
To combat this I've tried to drop her omeprazole, but she would begin scratching the back of her neck, and tongue chewing (although her tongue doesn't always function well anyway due to how many teeth she's lost) and if I put it up to the .2 mls a day she's allowed, to reduce whatever excess CSF she might have, (she's been presumed to have either a cranial tumor or cerebellar deterioration although she's not had an MRI to confirm either because my vet doesn't have one) her bowels become more loose and I have to give her the sucralfate to keep her from proceeding to diarrhea.
I see her slowing down and I'm worried. Am I medicating too much or not enough? She's been recently prescribed 3 mg a day of melatonin to try to help with the anxiety and hair loss, but that seems a bit much for a 5.6 lb Yorkie so I want to start her slowly. And knowing it's liable to make her more sedated, I wonder if all she'll ever do is sleep?
I'd also like to remove the omeprazole/sucralfate because I'm not sure it's helping keep her tummy from being aggravated by the prednisone. It was actually suggested by another YTer who has dealt with dogs who have acquired Chiari syndrome, which a lot of Jenna's original symptoms sounded like. It did seem like it was doing her some good last year, but I'm not sure anymore if it's doing anything other than upsetting her stomach.
On top of all that, what my vet and I are thinking now is: if Jenna has not succumbed to the supposed cerebellar deterioration or possible brain tumor, then is it likely that she has either and perhaps even needs the prednisone any longer? I'd like to slowly wean her off that as well, with my vet's okay, but I've no idea how slowly I should go (my vet seemed to think it could be stopped in a day to two days, but that isn't what I've read) nor how I'd reduce what is already considered the "lowest possible therapeutic dose" of prednisone according to my vet. I agree that slicing the pills into anything smaller than quarters tends to pulverize them and you're lucky to pull an 8th of a tablet out of that. However I can't imagine that smaller dogs than mine need as much a 1.25 mgs a day? Isn't it supposed to be dosed by weight? Shouldn't I have to wean her off these pills so I don't throw her into an Addisonian crisis? Isn't that possible for a dog who's been taking even the smallest dose for 10 months?
So for now we've decided to keep her on the prednisone, but to add the melatonin. Is anyone here familiar with this protocol for reducing side effects like polyuria, anxiety spikes and fur loss in a Yorkie taking prednisone long term for other issues? Melatonin, from what I understand, reduces cortisol...but if prednisone is synthetic cortisol doesn't that defeat the purpose of taking the prednisone in the first place? Will Jenna's original symptoms: lack of coordination, turning in circles and falling, being unable to walk properly, all come back if I use the melatonin? Does melatonin really help with fur loss? Is 3 mg a day for a 5.6 lb dog too much? Should we be looking into lignans, which I've read is another supplement used in conjunction with melatonin for dogs with Cushing's like symptoms? (BTW, she's not been diagnosed with Cushing's but no further tests have been run to confirm or deny she has it and her vet and I are at odds that the prednisone is causing these issues.)
Bravo if you've read this far or even understand what it is I'm trying to say. I'm afraid it is late and I'm absolutely shattered between work and worry over Jenna. Can I just ask for some clarity on the subjects I've stated here? I know there's people here who have dealt with these issues and illnesses and I really need some help trying to figure out what would be best for Jenna and if there's any other questions I should be putting to my vet.
Many thanks in advance!
