10 YO Anatolian Shepherd - prednisone question

[SuperK]

Hello - I had a very long detailed post typed up but I must not have checked the button and I lost it. Getting rather warm in my office, so will just ask quite simply has anyone just had a dog that was extra- senstive to Prednisone?

My big baby ~160 lbs was put on pred for injury in June (60mg for 4 days, then 40mg for 10 days then 20mg for 10 days). Exhibited instant symptoms of cushing's, but initial vet refused to even THINK that could be due to the prednisone, saying muscle wasting only happens with extended use. He started losing muscle tone noticeably within days of being on it. After several set backs, finally went back to my old vet (after he lost 30 lbs and all the muscle in his poor body - his head was pointy, his temples were visable and his eyes actually rolled back in his head as he chewed) and he was only willing to go as far to say that the prednisone could have caused IF he already had an excess of cortisol (i.e. Cushing's) in his system.

He has been off the pred now for four weeks, and has gotten SO MUCH better. Head is back to normal big size, his fur is soft again and he has butt cheeks! He is still struggling with hind quarter weakness, but I am thinking that will take the longest, since he's pretty lazy. He doesn't understand the purpose of a "walk" unless you go somewhere...and the end of the driveway doesn't constitute a viable destination in his mind.

Anyway - this is a great forum for information and support, glad I happened to find it! Any insight is appreciated...

Stacy & Keskin

PS - I'll post more on symptoms, and history after it cools off in here!

[littleone1]

Corky and I want to welcome you. You have found a wonderful group of very caring, supportive, and knowledgeable people, who have a great deal of experience with cushings.

There is a type of cushings, Iatrogenic cushings, that can be caused by extended use of Prednisone. Once the Prednisone has stopped being given, the cushings symptoms will eventually disappear.

Have there been any tests or ultrasounds done to confirm that it is cushings disease that is not caused by the Prednisone? If there were any tests that were done, it would really help our members give you better feedback if you would tell us about the tests that were done, and if you would post the test results that were not in the reference range, along with the reference range.

We're all here to help you get through this.

Terri

[SuperK]

Thanks for the welcome and the reply!

I am trying to get things sorted out, and the more I read the more I learn... Thank goodness for sites like this and the support I have seen already! Here is the recent history that I supplied when I went back to my original vet:

Two months ago (June 3), I took him to get his nails trimmed. Normal in/out of car until we got home and he refused to come out of the car. I tied him to a long lead and opened both doors. I didn’t see this happen, but he must have “fallen” out of the car back-end first because of the way he had been facing and how the lead was tied. Over the course of the next week, he progressed to being in so much pain that he would just stand and pant for long periods of time, and refusing to go up/down stairs. Food/water intake at that time was normal, except that I found he couldn’t stand long enough to eat, and once I started feeding him while laying down, his intake improved.

On 6/13/11 he went to the vet because he was in so much pain. Since everything else seemed normal (for him) so only the pain issue was addressed. He was prescribed 60mg Prednisone for 4 days, reducing to 40mg for 10 days and 20mg for 10 days. No blood or urine analysis done at this visit. He was also prescribed Tramadol 150mg 3x daily for pain. (Doc diagnosed a definite neurological issue, possibly spine related). Also his right rear leg was extremely swollen and Doc commented (this came to a “head” about two days later, and an abscess popped and drained. Another one formed on his foot (same leg) about a week after that). After the initial dose of the meds, the pain subsided greatly, and he seemed to improve. I only gave him the Tramadol a couple of times, since it seemed to make him act funny and just knocked him out. His appetite and water intake remained normal to slightly elevated due to the nature of the prednisone. However, in less than week, I noticed he had lost a lot of muscle mass and has continued to lose dramatically, despite eating and exercising as much as he will tolerate. I started him on Fish Oil upon the first reduction of pred to 40mg, and as he continued to lose weight so fast, I started him on raw (chicken) diet in order to help him gain some muscle back. Around this time, I noticed that he was having some issues drinking water, it took him longer and there was slime in the bowl when he was done (rinsing his mouth out, but not getting it to go down). 3 days after the pred was reduced to 20mg, he had a violent episode of diarrhea, and he went a day without food, but resumed raw diet (with addition of canned pumpkin) and everything was ok (poop normal, etc.). On July 7, three days after he was off the prednisone completely, he had another diarrhea episode, and I really thought he was dying. He was very lethargic and wouldn’t get up or even lift his head. . I had a panic moment and started him back on the prednisone, just for the need to do SOMETHING to help. By midnight, he managed to lift himself up enough to drink some water, and by morning he was back to “normal.” At this time, I changed his diet BACK to kibble, and noticed that he was having a hard time eating it, at times almost choking or aspirating the food, so I began to soak it and serve it wet. He was back on the Prednisone 2x day (40mg) for four days and we returned to the vet the following Tuesday when blood/urine samples were taken, and it turned out that he had a urinary tract infection and liver levels were high. He had also lost 20lbs. He was put on Amoxicillan 200mg x3/day and advised to discontinue the prednisone (per 10 day instructions) and return in 2 weeks for another blood/urine work up. I was also advised to dilute his food with rice and or potatoes in order to give the liver a break from proteins, which I have done to some extent. I feed him handfuls of kibble on the floor (he seems to have an issue with his tongue and not being able to pick it out of a dish…) as he will eat, and then his main meal consists of kibble soaked and mixed with oatmeal and yogurt. He won’t tolerate eating very much at a time, and he burps a lot. His appetite and his general attitude and demeanor vary so much from day to day that it’s truly like being on a roller coaster ride. He’ll go from not wanting to move and sleeping most of the day and not wanting to eat to getting up by himself and barking, and letting me know he needs to go outside, is hungry, etc.

Another thing I noticed after the first vet visit, was that he was sneezing up a very green (grass colored) glob of hard mucous from time to time. That was before he started the amoxicillin, and I haven’t noted it since. Also after starting the antibiotic, he finally stopped panting and heavy breathing that had persisted since the initial visit. He has always had problematic ears dirt/infections etc. requiring constant attention/cleaning and that condition completely cleared up within the first week after the initial visit.

Currently, he requires a lot of assistance getting to a standing position, and I’m quite sure it’s painful for him. However, it’s hard to tell if he requires assistance because of the muscle loss and weakness, or if he’s having a hard time due to neurological breakdown. Where he was very strong in the front legs, he’s also weakening there, (just in past two days quite “suddenly”) falling two or three times before getting to a standing position. He also seems to be having trouble completing urination (started last night). I noticed this prior to the diagnosis of the UTI, but it had improved (back to normal) after the first few days on the antibiotic. I think the prednisone was helping him with the pain and perhaps relieving some inflammation related to the neurological issue. However, I think it may have contributed to the muscle wasting and the liver problems. (I just started him on Milk Thistle to support liver function).

I emailed this to their office before we came in so it could be reviewed. When I came in, Dr. had reviewed and was prepared. We spent 3 hours getting x-rays and another urinalysis. No bloodwork was done since he was still on the pred at that time. It turned out that antibiotic wasn't working, so he was put on keflex and urine sample sent out for culture/sensitivity. X-rays revealed extensive arthritis in his spine, the area where his ribs attach is completely fused, with say 1/4" of bone growth. Doc is attributing neurological issues to this, said it's by far the worst case he's ever seen. He also said that the dog had not been on the prednisone long enough to have had that alone be the cause for the extreme muscle wasting, and suggested that he may have had cushing's PRIOR to any of this happening, and he still wants to test for it. Of course all of this has put me into research mode - which led me here. I'm running out of space, so will continue on another post...

[SuperK]

We discontinued the prednisone but this time every other day for two doses instead of just stopping. The urine culture came back and there were two resistant strains, so he was put on another antibiotic called Zeniquin (marboflaxacin). The last dose of pred was given on the same day he started the Zeniquin. At this time, appetite was about zero, and two or three days later the diarrhea started. This time it didn't stop until after the antibiotic stopped, lasting about a week. Poor guy - couldn't get him to eat anything on some days, other times he'd eat chicken or eggs that I cooked for him. However, in SPITE of chronic diarrhea and eating very little, his body began to return to normal. His head lost the pointy/sunken in look and muscle was returning. Also, his coat began to improve, and he had dark flaky looking dandruff for about a week. The hair on his groin started to grow back and his fur is softer to pet. We went back for a follow-up urinalysis four days after antibiotic was done. This was on August 11th and he had gained 8lbs. He still had bacteria in urine, so another 10 days of Zeniquin was ordered. However, this time there has been NO diarrhea. His appetite is finally back to normal, likes his kibble again with regular amounts of water and pee. He was also showing signs of pain, so doc prescribed Previcox, which seems to help. However, he still has problems getting up unassisted, and is ouchy on walks, which he would rather not do at all.

Couple of other side notes: He developed a nasty pressure sore on his hip - probably because I let him lay on that tile floor the day I thought he was dying without repositioning. It is healing well, from half dollar size to size of a quarter now. As a result, I have been having him lay mainly on his other side and I just noticed a couple of bald patches. One on his hind end, which is consistent with where liquid from his diarrhea got under the fur and I couldn't get clean enough and the other on his body side, no itching or other issues, just hair fell out. Also, same leg same side, further down around his knee and his hock it is scabby and appears somewhat itchy but hair is still there.

Ears are back to the usual state, easier to clean now that I don't have to chase him around to do it. He has some level of ataxia, which at first I was attributing to the weakened hind end, but now I'm not so sure. I noticed the side of his face that he predominately rests on was droopy and his eye looked funny...then when he laid on the other side, that side cleared up and the other side was droopy. So, maybe something vestibular going on, but not sure what ???

I don't know what to think, other than in all of my research, he did not show any signs of Cushing's prior to being put on the prednisone. He's always been a big drinker and big pee-er, he's a big dog. Doc attributed diarrhea episodes to feeding raw chicken, but after reading up on cortisol "withdrawal" I have finally quit beating myself up for feeding him the wrong thing and starting him back on the prednisone the day I thought he was dying. I think he WAS dying, and instinctively I did the right thing. Had I been with the vet I'm with now, I would have called, but I was never told what to look for, or that he could have such a problem since he was "tapered" off of it.

I need a break from sick dog...he's improving, but I know vet will want to do more tests. I think it's just going to have to wait awhile, the time and money (and worry!) I've been through has ruined this summer... Thanks for reading my book of an entry, all thoughts/comments are appreciated!

Stacy & Keskin

Oh - he's currently on Fish Oil, Milk Thistle, Glucosamine/Chondroitin/MSM supplements, and gets a tablespoon of apple cider vinegar mixed with probiotic yogurt morning and eve. I will start him on SAMe probably this coming week, per vet's recommendation.

[SuperK]

BTW - here is a list of the tests that the vet recommended:

ACTH Response - Stim test
ACTH Endogenous - not sure what this one is?
and a very expensive ultrasound with vet from MSU (luckily we are close to MSU, so MSU vet comes to us)

[addy]

Hi and Welcome,

Cushings is a hard disease to diagnose because no one test is perfect and other illnesses can give you false positives and negatives.
I am hoping others will come along and give you feedback. It is quite possible that the Prednisone caused Iatrogenic cushings and once the drug is withdrawn, as Terri mentioned, Cushings goes away. I would not want to rush in to tests until you were certain the correct period of time has elapsed since stopping the prednisone.

Currently, exactly which symptoms seem to concern you the most?

When my pup was first diagnosed, her colitis was more of a concern to me than her Cushing symptoms which at the time were mostly hair/coat.

It sounds like you have been through a lot and maybe you need a break from "sick puppy" for a bit to regroup. I could totally relate to that, was in that place myself last winter:) It seems the consensus is that Cushings is usually slowly progressive and some of the experts will go on to say "seldom an emergency" so you have time.

Hugs,
Addy

[Harley PoMMom]

ACTH Endogenous - not sure what this one is?
This test measures the ACTH (adrenocorticotropic hormone) in the dog. ACTH regulates the production of cortisol by the adrenal glands and its concentration can be measured in the blood. If a dog has PDH the amount measured will be elevated, in a dog that has ADH the ACTH measured is low.

I was wondering if thyroid problems have been ruled out because recurring ear infections are one of the symptoms of Hypothyroidism.

Love and hugs,
Lori

[Squirt's Mom]

Hi Stacy,

You have given a great account of Keskin's recent history. Thanks!

Yes, I just imagine you need a break from all you have been dealing with...as does Keskin. ;) Much of what you have described could be laid at the feet of the Pred, but not all. You want to allow plenty of time for the pred to get out of his system and his body recover before you start any Cushing's testing. These tests measure the amount of cortisol in the pups body in a variety of ways. The problem is cortisol is the body's normal, natural response to stress either external or internal. With all that Keskin has been through, I would expect his cortisol to be abnormally elevated - but that does NOT necessarily mean he has Cushing's. At this point in time, the result would be highly questionable IMHO.

So, take that break, enjoy his company, continue to care for him as you are, and know that you now have a family who is standing beside you, who will walk every step of this journey with ya'll.

Hugs,
Leslie and the gang

[SuperK]

Thank you so much for your replies!

I guess I don't really have any specific questions, just had to get my story out there, hoping for someone to say 'oh yes, that happened to my dog too, you have nothing to worry about' but... he is continuing to make remarkable progress. He's been getting up on his own from a padded surface (of course I have all hardwood/tile in my house!), and doing better on walks outside. He fatigues easily, but we can't be outside long anyway, due to the mosquitoes. I'm in SE Michigan, and they are everywhere at all times of the day. I cover up with a hoodie, long pants sock/shoes and bug spray and they STILL bite me. Poor dog's face is puffy, and I know that's what it's from (benedryl helps!). He's much steadier on his feet, and his back end is gaining strength as well. He's off the antibiotic (praying that the UTI is gone for good this time) since Sat. and so far peeing normally. Has a good appetite still and no more quest for water than he ever had, if anything less.

I am inclined to think that he may have a thyroid issue, if any (due to the ear infections and the fatigue) but want to have him off meds and as much time to recuperate before testing for anything. He is still scabbing and losing hair in places, not sure if this is allergy to bugs or something else (thyroid), but I just can't keep worrying about it. I read someone's response about coat/losing hair after starting Cushing's treatments, so perhaps this is a natural occurrence for him, now that he's healing. I'll worry if it gets worse, or doesn't seem to be running it's course. Happening on different parts of his body, at different times, inconsistent with anything I can find online.

Thanks again for the kind thoughts and words... Hopefully he will continue to improve. Wishing all of you the best for you and your pups, just glad to connect with people that are as passionate about doggie health as I am.

hugs from Stacy and Keskin aka Super K

[Sophie]

Here is my experience with prednisone. I HATE it because of the side-effects but sometimes it's a necessary evil.

My Husky Mix Louie has horrible seasonal allergies. He will literally chew his feet off and scratch himself bloody if not for this drug. Antihistamines have NO effect on him and Atopica & allergy shots are too expensive. So starting in August he goes on Temaril P which is an antihistamine+2mgs of prednisolone. He needs 4 pills to keep his symptoms at bay. That's 8mgs of prednisolone a day. He usually has to stay on that dosage Aug-Sept-Oct. I usually try to taper him down to 2 pills a day in Oct. Then wean him off in Nov or whenever the frost kills off all the stuff that is making him itchy.

He has only been on it 4 days and he already is drinking tons of water and eating like a piggy. Normally he is a finicky eater. On the plus side, he's not gnawing his paws off. I have never noticed any muscle weakness in him. He is very athletic dog and the prednisone doesn't slow him down one bit. He did get a weird bacterial infection one year while on it. Most likely due to his immune system being depressed.

Dangerous drug to be used with caution at the lowest dose possible for the shortest amount of time. If there are other options choose them first. I did have some success with Yucca which is an anti-inflammatory, but last week it had no effect so I had to go to the Temaril P.

Sophie

[Harley PoMMom]

When you are ready to have Keskin's thyroid checked I highly recommend having the thyroid profile done by Dr. Dodds. Here is an excerpt from her webpage:
The main reason for sending Dr. Jean Dodds / HEMOPET the serum samples instead of having the testing done locally, is that HEMOPET is the only group routinely offering expert clinical interpretive diagnostic comments that take into account the age, sex, and breed type of the animal. This often means an expected normal reference range for an individual pet that differs from the test lab's generic broad reference range. Practitioners usually are unaware of these differences, which have been established by published research and Dr. Dodds' many years (46 years this year- 2010) of clinical and research experience. http://www.itsfortheanimals.com/HEMOPET.HTM

Please keep us posted! ;):)

Love and hugs,
Lori