So frustrated about prednisone

[Shetlander]

Right now I'm at my wit's end with Quinn's new vet who refuses to tell me how to safely titrate Quinn off pred and doesn't even have the decency to call me himself. Instead he makes the poor tech to deliver the news that I can't do what I feel is best for my own damn dog.

 

Quinn's been on pred for a month with no improvement in his IBD symptoms. The vet's big concession to my request to take him off pred was to cut the dose from 20 mg once a day to 10 mg (Quinn's 37 -38 lbs). But how would reducing the dose help if it isn't working at its current level? Meanwhile I'm paying a fortune to have someone come let him out twice a day and getting up at least once a night to take him out or he pees my bed. I'd be ok with both those things if Quinn was better but he isn't. I'm ready to scream.

 

At least I do have an appointment with another vet for the 20th at least but I don't want to wait until then to titrate him off.

[Tiga's_mom]

Tiga has been on and off it for a couple of years now. He's mostly on it because of his allergies. I take the dose up or down depending on how he's doing. He needs less in the winter. You can't just stop giving it, it can be very shocking to their system. If you want to ween him off it, this is what we do. Our vet says that it's better for the animal to have it every other day as opposed to every day because that gives their immune system a chance to work on its own. If you're giving 20mg every day, then personally, I would take that down to 10mg every day for about a week. Then go down to 10mg/day every other day for about a week, maybe a little more. Then go down to 10mg every 3rd day for about a week or a bit more. After that, you should be good to take him off it all together. Keep in mind, that if you stop it and need to start again, they usually have a higher doseage to start with so that it can work. If Tiga goes off it completely and then has a flair up, we have to give him double or more of his usual doseage for a few days. That makes him drink a lot of water and pee a whole lot.

 

I am not a vet or anything, this is just how our vet has advised us with this medication. I hope it all works out for you. I'm also very frustrated about prednisone. I don't want Tiga on it, but it's the only thing that gives him relief from his allergies and we've spent a lot of money trying other things.

[Guest SweetJordan]

Right now I'm at my wit's end with Quinn's new vet who refuses to tell me how to safely titrate Quinn off pred and doesn't even have the decency to call me himself. Instead he makes the poor tech to deliver the news that I can't do what I feel is best for my own damn dog.

 

Quinn's been on pred for a month with no improvement in his IBD symptoms. The vet's big concession to my request to take him off pred was to cut the dose from 20 mg once a day to 10 mg (Quinn's 37 -38 lbs). But how would reducing the dose help if it isn't working at its current level? Meanwhile I'm paying a fortune to have someone come let him out twice a day and getting up at least once a night to take him out or he pees my bed. I'd be ok with both those things if Quinn was better but he isn't. I'm ready to scream.

 

At least I do have an appointment with another vet for the 20th at least but I don't want to wait until then to titrate him off.

That's a little strange, because if it was going to help it would have by now. IBD doesn't always respond to prednisone as you already figured out. They actually use a different medicine in human medicine that works like prednisone w/o the side effects. It can only be used for IBD though because of the way it works. Don't know if anyone has ever used it in animal medicine. Do they have vet GI?

[Shetlander]

Thanks for the schedule, Tammy. I'll follow that schedule while I'm waiting for his appointment with the consulting vet on Nov. 20th. He started 10 mg on Wednesday so at least it is down from 20. I'm not worried about furture need for it since it hasn't been helpful with the IBD. I've seen it work in some of my other dogs for various sitautions such as your dog's allergies. But it isn't working on Quinn so I really want him off as quickly as can be safely done.

 

They actually use a different medicine in human medicine that works like prednisone w/o the side effects. It can only be used for IBD though because of the way it works. Don't know if anyone has ever used it in animal medicine.

 

Are you talking about budesonide/Entocort? That was my first choice over pred but the cheapest I could find it was about $150 for 30 off the Internet and it was in capsules which would have made dosing very challenging. So I reluctantly agreed to pred.

 

Do they have vet GI?

 

I had him at MSU a few months back and the vet there said that almost all IBD dogs need pred. That was before the diagnosis was confirmed. So I don't think that route is going to offer me much in the way of alternatives.

[Bill Fosher]

You must taper the dog off prednisone very gradually, even if it appears be be having no clinical effect on the main complaint. Steroids are complicated drugs, and you really need to take your vet's advice on this one -- even if it is delivered via the tech. Poor manners on the part of your vet not to explain better what's going on, but the advice is sound in my experience.

 

As well-meaning as Tammy is (and her vet's advice and mine are nearly identical) I would not try to mess around with his prednisone dosage without your own vet's advice. Every dog and every set of conditions are different.

 

Do this wrong and you may end up looking back on the multiple pees in the night and the dog-walking expenses as the days of wine and roses.

[MaggieDog]

No suggestions on weaning the dose down, but I feel for Quinn - I was on pred briefly myself a while ago and it threw me for a loop. Perhaps a holistic vet might be a good next step?

[TotallyTerry]

Excuse my ignorance but I have no idea what IBD is.

 

I do know a lot about prednisone and I have to agree with Bill 100%. Any animal or human has to be weaned off gradually.

 

You may not like the vet, but I would listen to him until you find another. He was complying with your request to take the dog off prednisone but doing it gradually as it needs to be done.

[Shetlander]

You must taper the dog off prednisone very gradually, even if it appears be be having no clinical effect on the main complaint. Steroids are complicated drugs, and you really need to take your vet's advice on this one -- even if it is delivered via the tech.

 

I'm very aware of how important it is to titrate carefully with pred. That's why I'm so frustrated. I told the vet several times during the appointment that I wanted to take Quinn off the pred. His compromise was to go down to 10 mg and then insinuate that Quinn would likely need to be on steroids (or a drug where they need to test to make sure the dog's bone marrow isn't being destroyed) for life. Quinn is two. I never should have left the exam room without a schedule on how to titrate off. Instead, I was weak enough to let the vet pressure me into a slightly modified continue as is -- lower dose of pred and a different prescription diet. But after leaving, I called twice requesting a schedule to titrate off safely. The first time, I got no response. Today, I was told the vet wanted Quinn to continue the 10 mg pred for two weeks, then they would run a blood test which wasn't identified or it's purpose explained by the poor tech.

 

Poor manners on the part of your vet not to explain better what's going on, but the advice is sound in my experience.

 

Well, yes, if by sound you mean continue the dog on a medication I've repeatedly said I want discontinued instead of telling me how to safely titrate off.

 

Do this wrong and you may end up looking back on the multiple pees in the night and the dog-walking expenses as the days of wine and roses.

 

I understand that. Really, I do.

 

Again, if Quinn was doing any better, I wouldn't care about expenses and inconvenience. But in addition to pred not helping him and my petty concerns about money and sleep, I also don't like Quinn on an immunosuppressant. His system is screwed up enough already. I wanted my dog off pred --safely-- sooner rather than later. The vet appears to be refusing to help me achieve that goal.

 

I do appreciate your concern for Quinn's health and safety. As an aside, the vet never once mentioned the dangers of stopping pred suddenly. Though maybe he just figured I knew at least that much.

[Shetlander]

Perhaps a holistic vet might be a good next step?

 

That's who we're going to see on the 20th

[Shetlander]

You may not like the vet, but I would listen to him until you find another. He was complying with your request to take the dog off prednisone but doing it gradually as it needs to be done.

 

Ok, obviously I must have been ranting in my first post. Sorry. It's been a rough week in a number of ways. My vet isn't complying with my request. He has only reduced the dose. He has not told me how to wean the dog off gradually.

 

IBD is Inflammatory Bowel Disease.

[MaggieDog]

Perhaps a call to the vet you'll see on the 20th is in order? they may not want to supercede another vet, but it's worth a try and since they are holistically minded they may be more understanding of your insistance to get Quinn off the pred (or even want him off pred by the appointment anyway).

[Shetlander]

Perhaps a call to the vet you'll see on the 20th is in order? they may not want to supercede another vet, but it's worth a try and since they are holistically minded they may be more understanding of your insistance to get Quinn off the pred (or even want him off pred by the appointment anyway).

 

The person who did the phone intake knows he's on pred, as well as the other meds. Since this vet has never laid eyes on Quinn, she may want to wait until the first very comprehensive visit. I wish I could get him in sooner but it's 90 miles away and there are imporant trainings going on at work next week so I can't just take off most of a day. Drat.

 

I guess in the grand scheme of things, waiting an extra week and a half to start titrating isn't going to kill us.

 

Thanks for your understanding. Apparently, you speak from experience about the medication. I know it can be a miracle drug but it carries a price tag.

[Guest SweetJordan]

Thanks for the schedule, Tammy. I'll follow that schedule while I'm waiting for his appointment with the consulting vet on Nov. 20th. He started 10 mg on Wednesday so at least it is down from 20. I'm not worried about furture need for it since it hasn't been helpful with the IBD. I've seen it work in some of my other dogs for various sitautions such as your dog's allergies. But it isn't working on Quinn so I really want him off as quickly as can be safely done.

Are you talking about budesonide/Entocort? That was my first choice over pred but the cheapest I could find it was about $150 for 30 off the Internet and it was in capsules which would have made dosing very challenging. So I reluctantly agreed to pred.

I had him at MSU a few months back and the vet there said that almost all IBD dogs need pred. That was before the diagnosis was confirmed. So I don't think that route is going to offer me much in the way of alternatives.

Yes, I was talking about entocort. I didn't know if they used that in animal medicine or not. That sounds strange that they would want the dog to take pred. for life esp. at such a young age. In human medicine they would never put an IBD patient on pred. for life, and as I mentioned entocort is typically used instead(and only short term).Neither are used as maintance drugs. Has the vet tried other meds? I think that pred. can be okay short term, but it seems like many vets feel that the answer to everything is with pred/corticosteroids.

I think that trying a holistic vet is smart and something I would do myself.

A lot of people w/ IBD turn to alternative med. due to ineffective responses from conventional med. and undesirable side effects. The problem is that because they don't know what causes it it's difficult to treat. And simply treating symptoms doesn't fix the problem.

[Laurae]

Liz, I sympathize with the feeling of being frustrated that your vet is clearly not listening to you or taking your concerns seriously. I have had vets in the past who did the same--one actually rolled his eyes at me when I asked him about something I'd been researching on the Internet. I think maybe some vets must not get a lot of informed clients and so they tend to make decisions without feeling like they need to take the input of the owner into account. Fortunately, there are plenty of fantastic, knowledgeable, caring vets out there, so I'm so glad to hear you're switching.

 

That said, even if the new vet agrees that Quinn should come off the prednisone, you already understand that you need to taper down. It's likely he or she will want you to taper down in a similar manner to what you're actually already doing (and that Tammy outlined)--that is, to go down to 10 mg every day, before switching to 10 mg every other day and so on. Thus, it's entirely possible that even while following the advice of your current vet, you're already beginning a titrating protocol that you can continue with the new vet.

 

Besides working out how to get Quinn off the pred, I hope your new vet find a way to give your poor pup some relief from the IBD symptoms. IBD is no fun, and the sooner you find something that works, the better.

[Shetlander]

That sounds strange that they would want the dog to take pred. for life esp. at such a young age.

 

I thought so too, though he was speaking vaguely at the time and it was as we were moving towards our respective doors, so I didn't get clarification the way I should have. It was just an all around poor interaction between us.

 

Quinn is also on Metronidazole and Sulfalazine.

 

I have had vets in the past who did the same--one actually rolled his eyes at me when I asked him about something I'd been researching on the Internet.

 

A vet at MSU rolled her eyes at the intern when I objected to exploratory surgery. Speaking as an eye-roller myself, the time not to do it is in front of a concerned client even if you do think she's an idiot.

 

I think maybe some vets must not get a lot of informed clients and so they tend to make decisions without feeling like they need to take the input of the owner into account. Fortunately, there are plenty of fantastic, knowledgeable, caring vets out there, so I'm so glad to hear you're switching.

 

I wonder if they don't sometimes get tired of clients coming in with information from the Internet, friends and reading. I always try very hard to communicate that I see the vet as the expert when I bring up questions, conerns or alternative ideas. Still, as the dog's owner I'm a partner in his care. Getting me on board would seem to increase the chances of success for the proposed treatment.

 

I know the right vet is out there but my experience has been that when the dog has an especially challenging condition, it can be difficult to find him or her. Probably the same thing happens with rare or difficult medical problems in people and I've been fortunate enough not to run into that. I'm keeping my fingers crossed that this vet will a new approach that will work better for Quinn.

[Laurae]

Here's my story:

For several months, my Sophie had terrible bouts of diarrhea, vomiting, lethargy, and not eating. The bouts would occur once every six weeks or so and last a few days each time. I knew something was wrong with her, but I had a hard time convincing my (all-natural, holistic, expensive, blah blah) vet. He kept telling me that she was just being a dog, probably just eating rodents during our hikes and that didn't agree with her. We even had to go to the emergency vet at 11 pm one night because we suspected a blockage. I am no vet, but I know my dog (and even if I didn't, it was happening far too often), so I knew something was wrong. She'd wake me up three times in the night to strain with diarrhea. And I'd still wake up to a mess on the carpet. Finally, after doing some research on the Internet, I read that an uncommon symptom of hypothyroidism is GI upset. I asked the vet to do a full-panel thyroid test and send the blood to Dr. Dodds' lab.

 

Well, the test results came back with Dr. Dodds' interpretation. One of her thyroid levels was very low. A simple Soloxine dose twice a day has completely eliminated her problems. Completely. She is asymptomatic now. We have a different vet now.

 

Get informed, trust your gut, and stand your ground.

[Guest SweetJordan]

Well I think it says more when a client has done some research on their own. It use to be that whatever a doctor said had to be the law, but now things are changing and I think for the better. I think it can be difficult to say to a doctor that you don't agree w/ him or her when they are the ones who have the medical degree. But the truth is that you know yourself, child, animals etc. better than anyone. So you know if something is off and if something seems to be working or not.

When one of my dogs became ill I knew right away. I knew before she stopped exercising or even showed signs of being ill to an outsider. She became progressively worse when more than one doctor told me that it was her anal sacs and I should have them removed. Without writing a book or explaining why, I knew that was not correct. I didn't know right away, but certain things changed that and made me seriously question it within a few days. I even had one vet tell me that he thought she might have colitis(chronic form) I really didn't want to tell him that he was wrong, but I did anyway. She didn't have the symptoms and I explained to him why that couldn't be right. Then he said, "well you're right she really doesn't have the symptoms." He went back and fourth with things and I even made a list of her symptoms. She saw that vet more than once(as he was at the time my regular vet), but also at least one other vet in the same practice. These vets were known as having a good reputation in the community. Anyway, I kept saying what about her lymph nodes, they are swollen? I didn't get a good response. About a week later my heart sank as I put together that she probably had lymphoma. The vet told me that she was healthy and sent me home. That weekend she wouldn't move from under the dining room table except to eat and this was a dog who was always on the move w/ endless energy. I took her to another clinic after the weekend was over and the vet knew right away that she did indeed have lymphoma, but did a biopsy to confirm it. Getting the diagnosis went on for some two months, w/ people telling me that the clinic I was taking her too should be able to figure it out. I should have listened to my instincts and intuition, and taken her elsewhere sooner. When her oncologist asked me about it she almost fell off her stool and responded by saying, "do you know how big her lymph nodes where when you brought her in.?

The point of my story is that you have to be comfortable w/ the vet that you are using, and if not not go somewhere else. If one isn't helping find one that will. Just as w/ any other profession there are some really great vets and some really bad ones. Though my experience was different I can understand your frustration. Hopefully this next vet will be someone who you can work with and who will be willing to work with you. And even more important hopefully they will be able to help Quinn feel like himself again.

I know sulfalazine is a drug that can be used for long term maintance and control of IBD. Though there is a herb that in studies has been shown to be just as effective as the sulfa drug. I was just curious if he had been given something else or not. I hope everything works out for you and Quinn.

[Shetlander]

Thanks for sharing your stories, Laura and SweetJordan. They illustrate what I've also found. You really need to be the partner in your dog's vet care as well as a strong advocate, especially if anything out of the ordinary pops up.

 

I'll keep looking for the right solution for Quinn. This morning Quinn woke me up to go out (using his favorite method of staring intently into my face from 3 inches away ). I was so tired and didn't drink enough liquids yesterday to wake up after 3 or 4 hours. So it had been 5 1/2 hours since we went to bed. But not only did Quinn hold it that long, he got up to ask to go out instead of the leaking as he sleeps that he's been doing. I felt terrible for sleeping so long but was very excited that he was able to respond so normally to needing to urinate.

 

Just imagine how over the moon I'll be when we can get his poop to be normal.

[Shetlander]

Update:

 

Warning -- immature.

 

I took Quinn to his chiropractor today who kindly gave me a titration schedule for the Prednisone. HA! I keep saying that. HA! He also said Quinn's shoulder was still out and did a new procedure he learned at a conference last week that he feels was helpful for Quinn today. AND he said that Quinn recent lack of exercise tolerance could be due in part to going on the Pred and not just the hard fall he took at his sheep lesson. The two happened at close to the same time.

 

Of course, there is still Quinn's IBD to sort out but I'll take my "ha's" where I can get them.

 

HA!

[Tiga's_mom]

I'll add one for you. HA! lol.

 

I'm just reading all the updates now. No problem at all for the schedule. I have used it quite a bit. I don't even really talk to the vet about his doseage anymore. She tells me that we know him best and she knows that we are aware of how to control it for him. If he has a bad flare up then I call. I really don't like prednisone, but my options are limited. I'm glad that you're getting to the bottom of things with Quinn. I know that on the days that Tiga takes his pill, he is less inclined to want to exercise, but he will, he's pretty used to the pills by now. I hope you can get Quinn off them and get him all fixed up. Keep us updated.

[Shetlander]

I'll add one for you. HA! lol.

 

Thanks!

I'm just reading all the updates now. No problem at all for the schedule. I have used it quite a bit. I don't even really talk to the vet about his doseage anymore. She tells me that we know him best and she knows that we are aware of how to control it for him.

 

I meant to say, but got carried away in my HA's, that the schedule the vet gave me is exactly the one you did.

 

 

I really don't like prednisone, but my options are limited. I'm glad that you're getting to the bottom of things with Quinn. I know that on the days that Tiga takes his pill, he is less inclined to want to exercise, but he will, he's pretty used to the pills by now.

 

I've used pred before with other animals and know it can be a very helpful medication. I wasn't aware it could make the animal less energetic. My other dogs always seemed zippier on it. For whatever reason, pred isn't helping Quinn and may be making him feel worse. Of course, he really did a number on his back and shoulder when he took that tumble so it's hard to say what all is involved in his lower tolerance for exercise.

 

Thanks, again for your help and support.