That's great news -- and lovely to see him enjoying a chew. :) I'm glad you were able to correctly identify what was happening and fingers crossed the treatment goes well and he will eventually be off the steroids or on to a very low maintenance dose.
One thought: you might try giving some probiotic yoghurt just before (like, 20-30 minutes) he gets his prednisone (maybe 1-2 tablespoons). Prednisone can cause stomach upset. Many of us who have been on steroids and share info about it have found yoghurt helps. Alternatively, something like omeprazole or cimetidine -- used for stomach upset -- about 20-30 minutes before. These are both used for cavaliers with syringomyelia. Sometimes omeprazole itself causes nausea in some dogs, but that's fairly unusual.
Is the prednisone enteric-coated (eg covered in a coating that prevents it being absorbed immediately in the stomach)? Enteric preds are generally tolerated a lot better and are easier on the stomach. Perhaps they would not dissolve within the right time in a dog's stomach as opposed to a human's, but it is just a thought.
Of course, check with your vet about using any of these things first (expect yoghurt -- unless he isn't allowed to eat dairy). :)
Kate: I would love to offer the picture of Butters and the roses to Cavalier Matters. Let me know how I might go about that :) The only reason I didn't enter it for the calendar was it is in portrait format and not landscape
In terms of an update on Butters, last week was a pretty rough week. After further investigation into the best treatment for Butters' MMM, our vet decided that he should be on 10mg prednisone BID instead of daily in order to get him into the immunosuppressive range of therapy. Last week, Butters became terribly nauseous with the increase in dose. Our vet recommended famotidine and ondansetron as an initial attempt to get the nausea under control. We also tried the yogurt before meals, as Karlin recommended. However, from Mon to Fri, he progressed to dry-heaving with his stomach audibly gurgling continuously throughout the day. He still was holding down all of his meals, but clearly was not at all comfortable. This past Fri night, his symptoms became so terrible that he sat at the edge of the bed all night long, refusing to lie down because he was so nauseous in that position.
We took another trip to the vet on Sat to get this under control. Even though he has not been vomiting, he has lost 2 pounds since his diagnosis (likely from the added muscle wasting from the prednisone). He received an anti-emetic shot while in the office, and was started on a more heavy-duty belly protocol to help mitigate the side effects from the prednisone. We received several additional medications to try to get his nausea and acid reflux under control. Butters is now switched over from famotidine to omeprazole daily for his acid reflux. He is on sucralfate twice a day to coat and protect his stomach. Briefly, he will be on Cerenia daily (no more than 5 days on before he has to go off of it for at least 2 days) for the nausea. He was continued on ondansetron as needed for breakthrough nausea. We have been doing this in addition to his 10mg of prednisone twice daily, and are still giving him the yogurt before his meals.
Since he started this on Sat, he has been doing so much better. He finally was able to sleep after the vet visit, and no longer is having any evidence of nausea. We really have not needed ondansetron at all for breakthrough nausea. He is so much more comfortable. His energy level has increased, and yesterday we found him chewing a bone that he had taken out of his doggie bed.
My vet consulted with a specialist this week, with the recommendation to consider reducing the prednisone and adding on either azathioprine or cyclosporin for immunosuppression if he cannot tolerate the prednisone at its present dose. At this point, he has been doing so well now that we have the nausea under control. We have decided to try to pull him off of the Cerenia in the next couple of days and see how he does on the remaining regimen (the other medications are helpful anyways to protect his tummy from the prednisone). The other immunosuppressive drugs have their own host of side effects as well. Plus, he likely will only have to be on this pred dose another 2-3 weeks, assuming his blood tests at his follow-up visit confirm that the disease has responded to the treatment. We know that he better tolerates the lower dose, so we are reluctant to add on another drug at this point.
It continues to be an up and down battle, but we still are hopeful. His positive response in the chewing department give us hope that the antibodies are being eliminated and he will have a good long-term prognosis. Potentially, he could be off medications completely if we do it right the first time and get him into full remission. We will have to just wait and see.
You must be counting pills and measuring doses in your sleep! You could contact Tania Ledger via the Cavalier Matters website re the picture of Butters and the roses, or email her at firstname.lastname@example.org and attach the picture.
Kate, Oliver and Aled
I want to warn readers that this will be a difficult post to absorb... even writing it through the tears has been a difficult process for myself
I have to say I have been reluctant to post, because I have just been hoping and hoping for something positive to hold onto and report since my last post a month ago. But, I am sitting here 9 months pregnant with my terribly sick guy resting his head on my belly, feeling just awful for all of us. My husband is suffering too with the events for Butters of the last few weeks. I feel I need to write things down instead of continuing to focus on it between just the two of us.
Since my last post, Butters has had just a terrible time with the prednisone. Even with the medication combinations for his tummy (to include Cerenia, Pepsid, Omeprazole, Zofran, Sucralfate) and trying him on a variety of bland diets (we have tried many variations of recommend chemotherapy diets with combinations of chicken, rice, mixed veggies, etc), he has continued to be just terribly sick. There are nights, especially for the 2 nights a week he is off his Cerenia to keep him from becoming immune to its effects, that he is literally up all night gagging with nausea and spitting up. There are many nights that I stay up all night, just trying to hold and comfort him, because he is shaking so badly with his symptoms from the tummy discomfort.
Two weeks ago, we made the transition to cyclosporine to try and more quickly taper the prednisone, on recommendation from the specialist. This allowed us last week to go from giving him 20mg of prednisone a day to 15. However, with the cyclosporine, he now has had on and off severe diarrhea in addition to the continued nausea and tummy upset. We already have had one emergency vet visit, after he started to have blood in the stool. His labwork looked ok, and he did a bit better for a while with an improvement to just soft stools. But, today the diarrhea came back full force. I had left him in his ex-pen to run to the store for some groceries, and came back with him just covered in it. The nausea has also seemed to be worse, not better. Now, even the relief from the Cerenia seems to be waning. The days on the medicine are looking more like the terrible days off... pretty much continuous salivation, nausea, and tummy gurgling.
The hardest part has been seeing how he has been changing with the terrible side effects of this regimen. My husband and I cry together because it feels like we are slowly watching him die. He no longer can jump up on the couch or bed (even has trouble with the little stairs we got for him) because he has lost so much muscle. Food, something that he used to enjoy so much, now is starting to not interest him at all, as there are more and more foods that come off the list of his interests (today, his all-time favorite - peanut butter - was crossed off the list too). He has no interest in playing or toys. The crate, which used to be his safe place, is turning into a place he dreads. All of the special moments that we have shared with him seem to slowly be slipping away, as the things he used to enjoy no longer give him satisfaction. Even cuddling, his all-time favorite activity, seems to be becoming difficult. The little spot he used to snuggle between my husband and I now is too hard for him to get into, as it makes it hard for him to quickly get up when he has a bout of nausea come on. He still wants to be close to us, but he finds it is easier for him to go to the end of the couch where he can quickly get up than snuggle up too closely. Our friends have been amazing at helping us with Butters, continuing to help us watch him during the day during this difficult time. But we are starting to question if it is fair for him. That little spark in his eyes is starting to fade. How much longer can he and we live like this? Will it ever get better?
The only thing that has kept us going these last few weeks were the positive test results, with the positive response from his jaw, that he received last visit. He had regained 50-75% of jaw function, with his CK now down to 400 instead of 16,000 and his antibodies 1/100 (borderline positive for the disease) down from the highest reading >1/1000.
The hardest part about this experience is the dilemma we are in at this moment. If we stop treatment, he will most certainly relapse (he is not yet in remission) and will be guaranteed death at his young age of a year and a half, as his jaws will rapidly begin to no longer function. If we continue treatment, it is quite possible that we will slowly watch him die, bit by bit, in front of our eyes... painfully seeing all the things we have grown to love about this amazing little dog continue to torturously slip away. I just want more than anything our son to grow up with special little dog... to know and love him the way that we do.
My husband and I are both physicians, so we are used to dealing with difficult life and death issues. We are used to helping families make hard decisions, and being faced with terrible dilemmas. We have stood with families as they fight terrible illnesses, and sat with others as they decide the time is to rest and no longer battle. We haven't yet been able to find the right answer for our Butters
Oh my................I don't even have words to tell you how sorry I am to read this update. I have no advice no opinion about what I would do if I was in your shoes. You and your husband are Butters' parents and I trust you can and will do what is right for you and him. He's very lucky to have such good parents who are working as hard as possible to care for him, just think of other dogs going untreated or unloved in his condition.
Please keep us posted......Poor Butters, I hope his beautiful little body can rally and he starts feeling better soon.
I am so very sorry for what you are having to go through. I will keep all of you in my thoughts and hope for the best for Butters. After reading his good test results, is it possible that his symptoms get worse before they miraculously get better. I know when my husband was undergoing radiation for throat cancer, they took him to the brink of death, that was 13 years ago...just a thought.
Please keep us posted.
I am just gutted and tearful on reading all this about poor young Butters. Life can be so awful sometimes, but how I admire you for the loving and devoted care that you are lavishing on your sweet young boy. I can only watch and feel your pain with you. You are, as before, in my thoughts and prayers.
I am so sorry you are having to deal with this. I can only say that I hope and pray that Butters will show an improvement. You and your husband are doing an amazing job taking care of him and he is so lucky to have you both.
Thinking of you all :hug:
Kate Oliver and Aled