Long term Prednisone

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Jason_C

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My 12 year old Katy had a stroke on June 19, followed by a grand mal seizure about 12 hours later. While at the emergency vet she had another seizure, but I didn't see it so I don't know if it was a grand mal.

They prescribed Keppra to prevent seizures, and then on June 21 her regular vet did full blood work and found no problems. An MRI really isn't an option, so we're at a point where it's a toss-up on whether the stroke could have been caused by a brain tumor.

The vet suggested a round of Prednisone to help remove any potential swelling and/or inflammation. He said that it might be a good idea to keep her on a low dose of Prednisone for the rest of her life in an attempt to prevent future strokes.

It's now 2 weeks after the stroke, and she has recovered almost entirely! I don't see any symptoms of the stroke now, other than that she gets tired faster than usual; but that could still be a side effect of Keppra. She's at the part of the Prednisone where she's taking 5mg every other day until it's gone.

What are your thoughts on keeping her on a low daily dose of Prednisone for the rest of her life?
 
I guess you have to outweigh the risks vs the benefits and her age and length of time she may be on it. I’m wondering (and perhaps someone with more knowledge could speak to it) how does prednisone prevent a stroke and is there another medication that would reduce inflammation that doesn’t have the same long term risks.
My last dog was a Cocker Spaniel and she had major allergies. At around 13 we put her on a low dose of prednisone to prevent any further ear infections (she was totally deaf at this point from them). After roughly 8 months she started to get UTI’s. She’d literally finish the antibiotics and BAM another UTI! One after another….they did an ultrasound of her bladder to see if she had a pocket that wasn’t draining (there wasn’t) and ultimately started using a stronger antibiotic for longer but she still got them. I felt that the prednisone was suppressing her immune system increasing her risk of UTI’s but they said oh no…that’s not why this is happening. I ultimately weaned her off of them and she didn’t get another UTI.
Just my tale of one of the risks of low dose prednisone but again it’s up to you to weigh the risks…just because this happened to us doesn’t necessarily mean it would happen to Katy.
It’s wonderful to hear that 2 weeks later she’s almost back to normal!
 
About 3 years ago, I left Katy (and Bane) with a pet sitter that we'd used several times in the past. But when I picked them up, I saw her paw was bleeding and looked terrible! I was livid, they didn't even notice??

I took her straight to the vet, and she had an interdigital cyst that had burst. He put her on antibiotics and gave me a shampoo to use, and all was well. But after that, the cyst kept coming up about every 4 months! And all the vet could do was give her antibiotics.

After the third time I started to worry about her becoming resistant, so I stopped with the antibiotics and just kept it clean.

Then she had the abscessed tooth in May, and again: antibiotics before removing the tooth. Then shortly after, she had yet another flare up of the interdigital cyst.

Like you, I'm half convinced that her stroke came from bacteria that had become resistant to the antibiotics.

But anyway, the logic behind the Prednisone was that, if she had a brain tumor, it might reduce the swelling around it and give her a better quality of life. And I've noticed that the cyst has more or less gone away in the last two weeks, so I guess it would be a preventative for that, too.

I've read about nattokinase as a preventative for strokes, but it's mainly a blood thinner so I don't know if it does quite the same thing as Prednisone. That's why I'm posting, though; I'm concerned about kidney problems, etc, and if there's a less aggressive option then I'd love to consider it first!
 
Jason_C said:
About 3 years ago, I left Katy (and Bane) with a pet sitter that we'd used several times in the past. But when I picked them up, I saw her paw was bleeding and looked terrible! I was livid, they didn't even notice??

I took her straight to the vet, and she had an interdigital cyst that had burst. He put her on antibiotics and gave me a shampoo to use, and all was well. But after that, the cyst kept coming up about every 4 months! And all the vet could do was give her antibiotics.

After the third time I started to worry about her becoming resistant, so I stopped with the antibiotics and just kept it clean.

Then she had the abscessed tooth in May, and again: antibiotics before removing the tooth. Then shortly after, she had yet another flare up of the interdigital cyst.

Like you, I'm half convinced that her stroke came from bacteria that had become resistant to the antibiotics.

But anyway, the logic behind the Prednisone was that, if she had a brain tumor, it might reduce the swelling around it and give her a better quality of life. And I've noticed that the cyst has more or less gone away in the last two weeks, so I guess it would be a preventative for that, too.

I've read about nattokinase as a preventative for strokes, but it's mainly a blood thinner so I don't know if it does quite the same thing as Prednisone. That's why I'm posting, though; I'm concerned about kidney problems, etc, and if there's a less aggressive option then I'd love to consider it first!
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I would suggest you look into CBD oil as an anti inflammatory. I know there hasn’t been a lot of testing done and your vet probably wouldn’t give you any information on it but I firmly believe it helped Blueberry when she had her twitches as a pup and ultimately stopped them. No reason why it couldn’t be used long term.
 
Sorry, how old is Katy?

Tully has been on Pred since she was 11 years old - she's now 16yrs old. She's been on high doses and maintenance doses, once we tried to swap her for another steroid (budesonide) but it caused liver issues. She's basically been maintained at .5mg/kg every day. My 10 year old (who is MDR1 +/+) is also now on Pred for the same condition - IBD (the auto-immune disease) - but is on a lower dose at .5/kg every second day. The only thing I would suggest if you go onto Pred is to add in some marine grade collagen to support the joints and keep her moving to keep her bones healthy.

The side effects that occur at the start of treatment - hunger, increased drinking, urination, hunger, coat loss, dander, hunger - all disappears after they have been on it for a while.

If you are uncertain about maintaining on Pred I'd suggest seeing a specialist for a second opinion. My girls are under the care of a medicine specialist and I find it's so much better for us.
 
Thanks for the input, @Caro ! Katy is 12.

I lay in bed thinking about it all night, and I keep coming back to the same conclusion: if a stroke can be caused by a build-up of bacteria that causes a clot, then it would be a huge coincidence that in the last 2 years she's had several other bacteria-related issues (a cyst on her back, a recurring interdigital cyst on her paw, then an abscessed tooth that caused her face to swell overnight). And that train of thought keeps leading me back to antibiotic-resistant bacteria.

If that's the case, I'm reading that Prednisone often removes the symptoms of an infection, but in fact prevents your body from fighting the infection:
https://www.ucsfhealth.org/education/faq-prednisone

That would be a significant problem if she does, indeed, have antibiotic-resistant bacteria in her blood!

What kind of specialist should I be looking for?
 
I would think that if Katy had an antibiotic resistant infection then it should’ve showed up while she was off the prednisone, not just showing up once the prednisone was stopped.
With my last dog Daisy she’d still get the UTI while on the prednisone but I wouldn’t notice it (her urine smelled to high heaven and she’d pee in the house) until it was really bad. Of course it does lower their immunity so that could explain why Katy would develop an infection shortly after coming off of it.
 
Jason_C said:
What kind of specialist should I be looking for?
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I suggest going to an Internal Medicine Specialist. Pred won't mask bacteria if they test, but it may reduce the inflammatory markers. I am kind of surprised that the vet could not do a specific test if the bacteria load was so high as to cause a stroke, and why not put her on Tylan long term. Anyway, these are things an IMS can work out, even the best general vet needs to be across so much that they can miss the specialist stuff. The IMS has kept Tully alive all these years, I feel that I wasted so much money and time with tests at the general vet with nothing being picked up and yet the IMS managed to diagnose Tully when I was seeing him about another dog - didn't even need to examine her. I will say, my general vets are all now very well versed in IBD (LE-enteritis) because of the reports they get back from Tully's (and now Della's) IMS. You usually need a referral from your general vet and the IMS will report back to them for ongoing management.
 
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