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Thread: Internal bleeding from prednisone

  1. #11
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    I'm actually starting to rethink his vets altogether. I was promised that they would contact Dr. Kortz and Dr. Rusbridge and neither has happened. Jack has an apt. Jan. 2 with Dr. Kortz because I can't wait any longer for the 2nd opinion on the surgery.

    They do think Jack is seriously affected, before he started taking his Predisone and Gabapentin he was only walking with one leg in the air and screaming. His MIR also showed his brain to be very far back. Now he is close to normal.

    Do you think I should try giving him his Gabapentine 3 times a day and ween him off the pred now? Or, does he need somethign in addition to the Gabapentine? He is not even 11 lbs yet and 8 months (a side effect I think from the pred), so 75 mg may be becuase of his weight? I'm sure his reg, vet woudl give me a prescription until I see Dr. Kortz.

    Thanks!
    Mary Ann (Jack Sprat's mom)

  2. #12
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    I don't like the side effect profile of prednisone in humans much, either. I've seen too many GI bleeds on it, and over the long term, bad Cushinoid symptoms...

    Immediately post-op Bianca was on Gabapentin tid 100 mg. She was NEVER on prednisone before or after surgery. For awhile, she scratched a bit at her sutures, so we put her in a cone. No prednisone, though. Now she is 4 weeks post-op, and off all meds including gabapentin (fingers crossed!). I don't think of prednisone as a long-term solution for anything. It basically suppresses your immune system, which will give you bigger problems in the long run. I'd up the Gabapentin frequency to tid as Karlin said --again, you may want to consult another neurologist here as I'm no expert!
    Barkleigh Bianca’s mom and dad

  3. #13
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    You really need a neurologist's advice on this as these are serious medications. I'd contact Kendall for a vet that is familiar with SM as I know you have been in touch before, who might be able to change his meds. I'm afraid I don't know any vets in your region who know about SM though. I don't want to give advice on self-medicating for something this important -- I am really giving suggestions on what the usual approach would be by many neurologists and am suggesting finding someone (or sit down with your vets) who would go through Clare's document.

    The symptoms you describe, if due to CM or SM, would be considered serious, I'm afraid. Different neurologists will see different things in an MRI -- I'd only want it read by someone very familiar with SM in the breed.

    Kendall would be a very good source of advice.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

  4. #14
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    Kendel is a good call, I'll email her tonight. Is Clare's document on the cavalierhealth.org? I've saw a list of meidcations on there to be used.

    That is great news on Bianca!!!! How long was the recovery? Is she showing less symptoms post surgery?
    Mary Ann (Jack Sprat's mom)

  5. #15
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    Clare's documents are on this site:
    http://sm.cavaliertalk.com/
    I'll be thinking of you and Jack
    Cathy Moon
    India(tri-F) Geordie(blen-M)Chocolate(b&t-F)Charlie(at the bridge)

  6. #16
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    Thanks for asking...but I don't want to hijack your thread! (Bianca is now 4 weeks post op and seriously she is doing so well I 'm kind of holding my breath if that makes any sense...she isn't doing ANY bunny hopping or phantom scratching like she did before surgery, but I have read that it takes up to 3 months for the healing process, and then when the scar tissue forms you may see a return of symptoms so I can't be too premature here). But she is back up to nearly normal activity (no strenuous runs yet) and to look at her, you'd never know she had surgery. Granted, her symptoms were not as severe as many with SM who opt for surgery, as for example, Charlie.

    Anyway, back to the thread at hand--I'm keeping my fingers crossed for you and Jack , so let us know what Kendall/another neuro says.
    Barkleigh Bianca’s mom and dad

  7. #17
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    Thanks Cathy-- I'll take the medication diagram in on my next visit and report back!!! I just hate him being on predinsone.

    Such great news on Bianca! That gives me hope for Jack Sprat.
    Mary Ann (Jack Sprat's mom)

  8. #18
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    Default Jack Sprat Update

    We saw Dr. Kortz in Roseville, CA last week and really liked him. In part because he is very optimistic, but also because he is the first neurologist we have come across that treats multiple Cavaliers with SM and has preformed the decompression surgery several times. Dr. Kortz used to fall into the decompression surgery camp, but now feels that the techniques that exist today will only relieve symptoms for a period of time (6-12 months). Although, he did agree that if we were to do the surgery, that the sooner the better. In his experience, dogs that are medically managed do as well as the dogs that get surgery in the long run. Since this is technically Jack Sprat’s fourth opinion (one was an informal opinion over the phone with a neurologist in OR), we are going to continue on this path. Particularly since Jack is doing so well presently.

    He also suggested that acupuncture remain part of Jack’s treatment as it helps to manage pain. Best of all, Dr. Kortz feels that we can wean Jack off prednisone and instead Jack will take omeprazole in conjunction with his gabapentin! That makes me extremely happy due to the internal GI bleeding, although I guess this medication carries the long term risk of stomach cancer. He did indicate that Jack would likely get worse at times and then need to go back on the predisone. And then when the symptoms subsided, we could take him off again. It reminded me of the progression of multiple scoliosis. I have a good friend and a aunt that have MS and the symptoms flare up and then go away, although with every flare up something remains… a left foot that drags just bit, slurred words, etc. and in this way the disease progresses.
    Mary Ann (Jack Sprat's mom)

  9. #19
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    This is a highly personal decision. The only comment I'd make is that his opinion would differ from many and probably most other neurologists that have done many surgeries in this area. With a young dog with very apparent symptoms personally I'd be thinking of surgery as one of the only options for medium to long term lifespan (and I have a moderately affected dog where I am not considering surgery, weighing up the available options). I know of surgery dogs still doing well with no medications 6 years after surgery. Few dogs post surgery decline enough that they need to be euthenised. Clare Rusbridge has actually tracked the surgery vs non-surgery dogs and there's a higher rate of euthenising with non-surgery dogs. Having spoken directly with her on this issue, she feels that IF a dog has mild to moderate symptoms, medications are a viable option to consider for longer term treatment but she would feel symptomatic young dogs probably have very few options excepts surgery for anything more than a short term prognosis and short term palliative care.

    This is a very personal choice but just be aware that his view would not be a common one. Kendall I know would be more than willing to discuss this further as she also met with Dr Kortz in the process of making a decision. I would recommend getting a bit more context before accepting this viewpoint. Also keep in mind that various surgeons do this surgery in different ways and may all get different results with their approach. I've certainly never heard of *most* dogs declining after only 6-12 months and know of many who are several years beyond surgery and leading normal lives, albeit often continuing on gabapentin for scratching.

    Paper 9 here might be of interest: http://sm.cavaliertalk.com/research/.../london06.html
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

  10. #20
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    Trust me, we did not reach this decision lightly and we continue to question it everyday. But, we have talked to 4 neurologists, and 2 of those doctors are very familiar with SM. One of them was also Rory’s (Kendall’s dog) neurologist, Dr. Harrington. His advice was to wait until Jack was a year and he is becoming more in favor of acupuncture as a means of treatment instead of surgery. There is a lot of concern that in such a young dog his bones are not fully formed and scar tissue or regrowth of the skull would be much more likely. The study (#9) also suggests that the average relief is .2 to 2 years and then there is decline again. Dr. Kortz feels that the dogs that show relief for longer periods are dogs with less severe symptoms to begin with and poor Jack was having very apparent symptoms at 5 months.
    Mary Ann (Jack Sprat's mom)

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