Those of you who have read my posts know how we struggle with Snowie's itchy skin. We have tried almost everything -- you name it, we've tried it. But still, he has itchy spells. We thought with the cold weather that he'd be less itchy. But then he started moulting (getting ready for his winter coat no doubt) and the scratching, licking, and chewing built up to such a fury that no-one was sleeping in our house -- he did not stop scratching, all night, all day, exhausting! On Sunday night I was chatting to my brother's father-in-law who is a vet. He lives out of town, so when he visits I always make sure I get a chance to chat to him (poor man!). This time I was interested in how cortisone affects cortisol production, and what the risks of stopping cortisone are. We got onto Snowie's itchy skin and he convinced me to put Snowie onto a course of prednisone to get the itching under control. He said that excessive scratching in itself can lead to problems such as skin thickening and cancer from damaging the skin cells so much (really?). He also said that Snowie needs to sleep, and if he's up all night scratching and licking, that can't be good. He said to be careful with stopping the cortisone, however, that it MUST be done gradually so that the body's natural cortisol production does not go into shock. Unfortunately I don't remember exactly what he said about cortisol production shock, because I do know that giving cortisone makes the body stop producing it's own, So does sudden withdrawal cause shock where no cortisol is being produced at all, or that in that time for the body to start production, the lack of natural cortisol in the in-between period can cause shock? Perhaps someone in the know can comment on this (and I will ask him next time I see him!). He mentioned fatty deposits and liver problems, but was that when using or suddenly withdrawing cortisone? Nevertheless, he encouraged us to start immediately as follows: - 2 tablets in the morning, 2 at night, continue until all itching has stopped - Reduce dose to 1 tablet morning, 1 at night, unless itching starts again, then up the dose. - If itching stops, reduce dose to 1 tablet in the morning - If itching stops on the 1-tablet dose, reduce to 1/2 a tablet each morning, then 1/2 every other morning. If itching starts again, up the dose until itching stops, reduce again, and so on until hopefully no more cortisone tablets. He said it would be bad to give 20 mg (4 tablets) per day for 6 months. But for a few weeks according to the schedule above should be fine. Well, I've been against cortisone for a long time and especially since the emergency vet, who pumped Snowie full of cortisone after he transformed into a Charpei from an apparent insect/spider bite, said that cortisone is bad news and should not be given unless absolutely necessary, that once you start, you mess with the natural cortisol production and then it becomes very difficult to manage. But we were so sleep-deprived from Snowie's scratching all night and keeping us awake that I was prepared to try the cortisone. So the next morning we gave Snowie one prednisone tablet at breakfast. I decided to be cautious and start with a low dose rather than 2 in the morning, 2 at night. That night we all slept like a dream! And this is how it has been all week. He got one tablet every morning for three days, and today, the fourth day, he got a half a tablet because the itching has stopped so dramatically. Even better than no itchiness is that he so much more playful and energetic. I guess cos he is also sleeping all night. He is more awake during the day though -- it is interesting, not so much sleeping -- and now, instead of chewing his paws all day, he's been chewing his old hooves, which he had long given up chewing. I suppose he needs to chew feet -- thankfully not his own! Hopefully we will be able to wean him off the cortisone fairly soon if it keeps going as well as it has been going now. Hopefully his skin has mended enough that it will remain itch-free for a long time. And hopefully we have not messed too much with his natural cortisol production.
I hope that works for you. Oban had to be on Prednisone all summer, his itchy season. The next summer we went to Atopica, a lesser evil than the Pred. Both target symptoms, not cause. The first summer Reactine, an OTC antihistamine helped him but as is typical his itchies just got worse and lasted longer.
We used pred with my old yellow lab Lundy who had terrible allergies/itches all his life. It really helped so much. We used it on and off but we're always careful to wean off slowly each time and only used when he got really bad. He was so happy when the itching stop. It is such a hard thing to manage but the pred really helps when nothing else does. Sam and Mole
I only have a vague memory from when I worked for the vet and my understanding is that it is essential that prednisone is gradually stopped, the immune system is 'squashed' by the tablets, so gradual withdrawing of the medication allows it to resume.
It's great that the prednisone has worked - your poor boy must feel better. My last Lab (chocolate boy) had skin problems and every so often needed a course of Prednisone. We found a very low dose for a week (gradually tapering off as you've said) worked wonders and he'd then be fine for 2 or 3 months. My boy lived to 14 1/2 years so the meds needn't cause problems. Hope Snowie continues to be itch-free.
@MF I can answer some of your questions from the human perspective which might help. I guess it would be broadly similar in animals. The worry with steroids is indeed long term causes cause suppression of the bodies own natural steroids which are required for all body functions. In humans a course of a moderate dose for 2 weeks is fine without tailing it off. For example, 40mg (8 tablets) for 2 weeks to treat an asthma episode. If it is longer than 2 weeks then reducing to a stop as you advice above is the normal procedure. In the longer term, steroids can cause weight gain, sugar problems (by which I mean diabetes) and thinning of the bones (osteoporosis) as well as possibly irritation to the lining of the stomach (ulcers). By stopping it without weaning down for longer causes it can cause fatigue, muscle weakness, dizziness, excessive thirst, fluid retention, and behaviour problems - and could in fact have fatal consequences. Steroids can be really helpful, and can be life saving. But they are not without their risks. I don't know if this helps at all, and you must get veterinary advice for the use in dogs, particularly with the doses, but the generally principals I am sure are the same in dogs as they are in humans. jac
Steroids can be a miracle drug but as drjs@5 says they need to be taken with care. I spent 3 yrs on steroids, the first year damping down my over active immune system and the next two weaning off them, with a few hic-ups along the way. I must have suffered nearly every side effect going but I have them to thank for saving my sight. Lucan was originally on steroid tablets before changing to an inhaler, he doesn't do well on them, even a small 5mg a day dose causes him to lose weight and condition, but this is fairly unusual.
Re-reading this, I would like to say most steroids for asthma are around 5-7 days, but 14 days is more likely for some COPD patients (just in case anyone comes along and thinks I am talking rubbish - I kind ow was!) And it popped into my head about steroids causing cataracts as well.
How long was Oban on prednisone, when you say "all summer"? Was that a tablet every day for a few months? Re antihistamine, unfortunately it is contraindicated for epilepsy, and some years ago when we gave Snowie a couple of antihistamines, he had a seizure the next day (we didn't know about the contraindication then, vet had prescribed them), so I really don't want to take chances again.
Do you remember the dose and how long you gave it to him? Snowie was doing so well with 5mg/day (1 tablet = 5mg) so that on the fourth day (Thursday) we halved the tablet, but he was up scratching a bit that night. So Friday we gave him a whole tablet, fine that night, so Sat we gave him half, back to itching and also chewing his feet, so this morning back to a whole tablet. I will see how it goes Mon, Tues, and if no improvement on a half tablet, then will go to the vet cos I'm not comfortable deciding the doses alone. Although not sure if the extra itchiness (feet chewing) happened cos he found a big bag of food (discarded) on the beach, not sure what was inside but pretty sure it was bread, maybe bread rolls, maybe chicken breasts, pretty sure lots of chicken bones -- I was up high looking down and couldn't get to him to stop him. When I finally got down, it was polished off! This morning he pooed out a plastic bag! On Fri night I was so worried, he looked like a pregnant cow! But showed no signs of discomfort (bloat). And I'm pretty sure whatever it was -- but pretty sure there was bread -- made his eyes gooey and possibly worsened the itching.
What dose were you using and what was your boy's weight? Did you taper off in that week, or over some time after the week was up? And did you taper off once the itching was over or did you taper off regardless whether the itching had stopped or not?
Thank you so much -- this is really useful! Do you know if there is something that can stimulate the body's own natural production of cortisol? Do you know if a dog like Snowie, who appears to suffer allergy-induced itching, is not producing enough cortisol? Or do all dogs (and humans) produce the same amount of cortisol and that other factors are causing the allergic reactions?
I would reckon it is some other factor involved in the allergies @MF Unexplained low cortisol in humans is sometimes called adrenal fatigue The only way I know they treat it is with oral doses of steroids to replace the missing body steroids - in much the same was as hypothyroidism is treated by giving oral thyroxine (although nowadays I should call it levothyroxine). For the allergies there is normally a driver for it (dog hair or saliva , pollens, fungal spores for instance) - although some people are more prone to allergic responses than others - those people who are atopic have a higher incidence of asthma, hayfever, eczema, nasal polyps and it tends to run in the family. Not really sure if there is an equivalent in animals/dogs - maybe one of our veterinary members might see this and chip in.
Having to think hard to remember about doses as Rolo died in 2012. Initially, on first vet visit for skin problems ( whichy only started w hen he was about 2 1/2 years old) we were given quite a high dosage, I think it was 7mg tabs x2 twice a day. They had an immediate effect and when we needed them again I asked if we could try a lower dose. Can't remember how long it took but eventually I was giving him 4mg, one tablet twice a day for just a couple of days and then immediately cutting down, because they acted like magic on the itching. A couple of times I didn't get him on the meds quickly enough a nd then he needed antibiotics and a longer course, but over the years I became quick to spot the signs. I know steroids can cause problems, but in Rolo' s case they had no apparent side effects and he lived to a ripe old age. He was a big boy, about 38kg.
But what factor?! Then we could treat the specific thing. Unfortunately not one vet knows the answer -- the usual answer I get is: allergies are so difficult to treat. One vet suggested the very expensive allergy test, but even then, she said, the results often aren't conclusive and sometimes impossible to act on, like an allergy to grass. Thank you for the other interesting info about treating humans with low cortisol.
What were the antibiotics for? Did he scratch so much to get infected? Thankfully Snowie's scratching has not broken skin (it did when he was a puppy with very sharp nails) and ironically people always comment what a great coat he has (must be the salmon oil capsules!). But if he lies on his back then you see the mottled skin on his stomach from all the licking and the fur has turned pink, and he has chewed away at his feet. He weighs about 34kg, about average compared to the Labs I see.
For my humans I usually say to get rid of anything in the house that has a scent or fragrance. If you can smell it it can land on your skin and potentially cause allergies. I know this isn't really much help for dogs, but worth looking at your house only to exclude them - particularly floor cleaners, washing powders, air fresheners ("Plug-ins" are the work of the devil LOL)- but there is a limit to what you can do outside. Best defence for the outside is to shower down in fresh water after being out Wish I could help more
After our walks Snowie always has a dip in our pool. Two months ago we stopped using chlorine and put in a plant island -- converted it to a freshwater pond. But still itching... We notice that he seems to scratch more when we all go upstairs to bed. Our bedroom is carpeted in a pure wool carpet. A few weeks ago I hired a carpet cleaner and washed and cleaned it thoroughly... and that night Snowie scratched just as much! I did say to my husband that perhaps we should rip up the carpets, there are floorboards underneath, but then we will be dealing with a less than cosy bedroom! But it might well have to be done! You have been a great help, thank you -- really appreciate your expert opinion.
When he needed antibiotics the vet said the skin was infected - it wasn't broken but red and sore looking. I imagine you've been down the food-change route already? After a few years I started Rolo on tinned tuna and brown rice and that seemed to help. In very old age he refused to eat it so for the last year he was on Symply brand of kibble (salmon and potato).
