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Old 01-17-2020, 01:46 AM   #1
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Default Prednisone use and hair loss

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!
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Old 01-17-2020, 09:06 AM   #2
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Callie has Cushings. There is a type of Cushings that is caused by steroids and once the steroids are removed and leave the system then the Cushings goes away if it was caused by the steroid. A Cushings dog should never be on steroids either unless itís a life or death situation. Melatonin is very safe and doesnít effect dogs the same way as humans and doesnít make them sleepy. The melatonin and lignins donít actually treat Cushings they just help the symptoms. The actual medicine for Cushings is like a Chemo drug. Cushings when not caused by steroids is caused by a tumor on either the adrenal gland or the pituitary gland and the medicine attacks the tumor to try and destroy it so itís not producing the hormones but if to much is given it can completely destroy the gland then causing Addisons. Just taking her off the steroid will not cause Addisons. The only symptoms I getting that say Cushings to me is peeing more and wanting to eat more and possibly being lethargic. Is her Alkphosphate liver number up? Thatís generally the first sign of Cushings and then you would move on to the test where they take blood then give a small shot of hormones and retest the blood at certain intervals. Being on steroids long term can do other damage then just Cushings so I would attempt to take her off of it. At almost 13 I have opted not to treat Callies Cushings and just the symptoms.
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Old 01-17-2020, 12:58 PM   #3
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Thank you, Taylor. On the one hand, I would like to take Jenna off prednisone to see if this is the reason behind her current troubles, but am not sure how to properly reduce it if she's taking the lowest allowed dose, and I'm terrified she'd become unable to walk again, or that her eye pressure might shoot up. I'm surprised to hear it won't cause Addisons, that's all you see when you read up about it.


I'm also afraid of causing other disease with the medicine, which I can't deny could be happening now, so we're between a rock and a hard place, but I guess there's not much else we can do. I know steroids usually need tapering, like a one day off, one day on for weeks kind of schedule, and it concerns me that her vet didn't agree. Her vet wanted to switch her back to NSAIDS (metacam) to control what they thought was inflammation of some kind in her central nervous system which was causing the spinning and wobbling and inco-ordination. And yes, we did treat her for inner and middle ear infections although there was no real sign of that. They presumed this was all due to a tumor or cerebellar decay. But metacam never really worked on this issue like prednisone did. Once we started it, she was back to living an almost normal life till I started noticing the advancing fur loss, coupled with the heightened anxiety and house accidents, and now that she's tired all the time. I do realize that might be because she's almost 12 years old and it's a cold winter for us here in the pacific northwest, but it's so hard to see her like this.



She's been on prednisone since last March and they gave me a few weeks to a few months with her at that time. Of course that was a best guess without proper diagnostics. If she had a pituitary tumor could that have been why she had vestibular symptoms and ataxia? And then could that be why she's showing Cushing's like signs now? Or is it more likely all due to the pills? How is the best way to find out without putting her through too much stress? She's terrible with blood draws because she fights like mad and then she's uncomfortable for a long time afterwards because she hurts herself by struggling. She has some degree of arthritis in her lower back and rear legs, perhaps even her forelegs, and this was also a reason to put her on steroid treatment.



I'm uncertain if the Alkphosphate test has been run, I can call and check on that. But I do know her vet recommended for her to just have the LDDS, when I asked about it around a month after her dental, because she doesn't think the ALP is reliable enough. She also wanted to do an abdominal ultrasound which at the time was kind of pricey and I didn't have the funds for but now we're on a payment system so I would like to request that again if it will show whether or not Jenna's adrenal glands are intact. I imagine they'd be a bit hard to see on such a tiny dog but that's the only reason I can think of that her vet would want to do it.


Jenna has been having accidents in the house since we moved from Alaska. I put it down to stress of the move originally but when it kept happening we took her to the vet (a different one from the current vet) and she surprised us with the news that Jenna was going blind. This was based on Jenna's iris atrophy which was something I hadn't noticed previously. So we put her accidents down to her changing vision and the anxiety it ramped up in her. She had no UTI or any other sign of illness at that time...that was almost 4 years ago.
I mention it because her cataracts formed quickly after that and have matured to a point where I believe Jenna only sees a fraction of difference in light changes now, if anything, and so if I'm not taking her out preemptively and she suddenly feels the need, she'll potty on the carpet or linoleum. But she doesn't make too much wee and what I notice most is the frequency of needing to go which has increased in the last few months.

When feeding her, we've changed her from the vegetarian diet she was on since 2013 when she got vasculitis and the vet in Alaska, where we were at the time, said it was due to meat protein. She now eats Purina EN that's a chicken and rice pate. She really likes it and would probably try to eat a whole can if I left it on the floor. At times her lower abdomen begins to look very full and tight and I worry that even the amount I'm feeding, which I'm conservative with, is too much. She does eventually settle after a meal but I see her relax quicker if I put a few kibble on her plate after she has her canned food. That way she gets that "extra treat" she's looking for but I'm not feeding her anything sugary or over the top that could make her bloat up. I might note here again her horrible gas. I don't know exactly what causes that, if it's just how she eats or what she eats.


One other thing...she used to have beautiful pink insides to her ears before beginning the prednisone...now the skin looks darker, almost a dark grey or light black...is this the skin change that they call nigricans? Could it indicate that she's developing diabetes and wouldn't that show on a CBC? She's a very skinny dog in my opinion, but not all diabetics are obese. And the skin color change happened within a month or so of starting the prednisone. Is it possible that there's already other damage to her system from taking it this long? What tests should be performed to determine that?


Taylor, do you see the melatonin and lignans helping with Callie's symptoms? Does she have fur loss also? The vet practice owner didn't seem to think it would do all that much, but he's not the vet treating her. I think he finds 'alternate cures' to be hokum. But I would really like to find the best of both worlds in Jenna's treatment. I almost dread giving her anything else to have to take at the moment, but I'm very conflicted as to how to approach this the best way. And...well...quite frankly I feel we're running out of time. Some days she just looks so spent and weak, but I'm in my 50's and there isn't a day that goes by that I don't feel every one of those 5 decades. But Jenna is quite probably going to be my last baby and she and I simply can't enjoy life without one another. She's gotten me through so very much...how can I not go to great lengths to make her golden years the very best they can be?


Sorry to wax so maudlin. I'm desperate and at the end of my rope these days. Thank you so much for all your advice, it helps to have someone else to speak to about these things who understands.
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Old 01-18-2020, 02:15 PM   #4
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Remember Prednisone in its self can cause them to be more hungry and to drink and pee more. You have to trust your vet so if your not trusting them then I would try to find one you do trust. If he says just stopping the prednisone is fine then you need to trust him. If you stop it and her issues start happening again then you can go back on it. One thing you need to look at with age and everything is if coming off the prednisone starts the issues again do you want to just keep her comfortable for the time you have left or do you want to try to put her through more testing? With Callie I want to have more quality days with her then quantity which is why when they tried to pull her off pain medicine I refused and put her back on it it. I know that stuff is extremely hard to think about but sadly when they are sick and getting old we have to think about it. Many people in my Cushings group who had dogs showing the signs of steroid induced Cushings pulled their dogs off of it right away and the dogs started to get better as the steroid cleared out of their system. Me personally before putting her through any more testing I would try getting off the prednisone and see what happens. I had more luck with CBD oil helping Callie's hair then the melitonin but when he liver became compromised I pulled her off of it because CBD oil can raise liver enzymes.
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Old 01-21-2020, 01:29 PM   #5
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Of course I want her comfortable. I would love more time with her too though. It's a thin line to walk, isn't it?
Her vet was on vacation this last few weeks, so I haven't had any time with her to run ideas past her. Naturally if it comes to a choice of having Jenna being able to walk properly or having her struggle with her remaining time, I'm going to choose walking. But I do think that even 1.25 mg a day of pred is too much for her. She may be able to still be comfortable with less. The question is, how to reduce it just enough that the side effects are better controlled and yet the desired results achieved?


I wish this stuff came in liquid form so it would be easier to administer a smaller amount to the smaller dogs. Seems like this dose can be given to dogs who range in size from 5 to 20 lbs. i.e. 2.5 mg per 10 lbs of body weight...but would that mean that a 20 lb dog could take just the 1.25? Ergo the 5 lb dog should be able to manage on half that dose? (I'm probably just confusing you.)


https://www.medi-vet.com/Prednisone-...et-p/10683.htm


That's an awfully wide margin for error, imo.


Also, there's this:
https://dogtime.com/dog-health/53163...e-side-effects


It does say that depending on the condition the dog is being treated for, increases or decreases in dosage are sometimes considered. I'm wondering if Jenna could do just as well on a smaller amount of prednisone and she might be happier for it. I'd love to see her a bit more active, not to mention, furrier. The rest we can deal with.



But would that mean a smaller pill or perhaps a day apart between doses? My vet has said that we could try giving her a day away from it, and then reversed and said it has to be every day,... or to take her off it and begin metacam within a 24 to 48 hour period to see if her symptoms are managed with a different drug.



So maybe you can see why I'm confused. It can't be that she could skip and day or not. And one to two days seems awfully quick to switch between steroids and NSAIDS. If you're trying to keep the animal from suffering stomach issues, like bleeds, you can't administer them too close together. That much I know.



So even with iatrogenic Cushing's symptoms, the melatonin should help with Jenna's fur, right? If I opt to keep her on prednisone, is there anything else I should watch out for that might signal a need to reassess her treatment?



How is Callie doing now, btw? How long has she had Cushings?
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