Steroid help please

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Mollycat
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Steroid help please

Post by Mollycat » Wed Jul 03, 2019 10:21 am

The ongoing saga of Bobby -

Quick background recap, 15 year old male, mild CKD, always had a delicate tummy which recently took a more serious turn resulting in stopping Hills k/d first wet then dry. Attacs of The Dire Rear used to be kept in check with vitamin B injections now not responding to those any more. Also has had runny eyes and nose, sneezing and coughing for over 6 years ever since neutering and retiring to indoor home.

In May he had such a bad time he lost 10% of his body weight in 8 days and nothing seemed to be working. 3 weeks ago we gave him one last chance and he had a 2-week long acting antibiotic shot, a steroid shot, an appetite stimulant and steroid tablets. Next day he was no better but the day after he perked up, started eating and got his new lease of life. We know the steroids are just symptom management and the plan was to reduce gradually to the minimum effective dose. We kept him on the 1 a day for 2 weeks because I was still finding loose stools in the tray, then last week we cut him down to half a tablet. This was harder to give him so we switched to a whole tablet every other day.

Problem is I'm finding loose stools again and still can't be sure from which cat. Molly is a much tougher hardy little moggy who rarely gets issues and shows no other symptoms. She had radioiodine treatment in March and since last November when she was diagnosed hyperthyroid she has not produced a fully formed furball, which is strange for her, so something is amiss in her digestion. The solid stools are thick so I assume these are Bobby's as he does produce thicker ones, but the solid beginning to the loose ones is also thick, so everything in the tray looks like his and nothing looks like hers!!

As for Bobby, in the last few days his appetite has dropped again and his hip bones are sticking out more again. We are upping his steroids back to a whole tablet daily though I'm wondering if this is down to the antibiotic having now worn off, as it coincided with the end of that as well as cutting down the steroid dosage.

Any thoughts from anyone welcome, I don't really even know what I'm asking here as I need to identify whose poo is runny and give it time for the re-increased dosage of steroid to take effect, but I think I just need some fresh thoughts and sympathy! Because when the steroids stop working we're basically looking at time to say goodbye.

Yes we could have further invasive tests and treatments possibly but he is 15 and I don't feel he should be put through all that, and as the vet says whether it's IBD or bowel cancer the steroids are the treatment, and unless we're prepared to put him through cancer treatment, which we're not at his age and health level, there is little point in knowing which it is. He is a very finicky eater and already has Hills i/d to support his digestion. The vet also suspects hyperthyroidism as he has enlarged glands, too many different issues with contrindicated treatments.

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Re: Steroid help please

Post by booktigger » Wed Jul 03, 2019 11:59 am

That is a tricky one if you aren't 100% sure which cat, although the likelihood is him. It could be that going from every day to every other day is too much of a shock to his system, you do have to reduce steroids gradually, although I know from experience half tablets are a lot more bitter to take!

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Re: Steroid help please

Post by Mollycat » Wed Jul 03, 2019 12:16 pm

booktigger wrote:
Wed Jul 03, 2019 11:59 am
That is a tricky one if you aren't 100% sure which cat, although the likelihood is him. It could be that going from every day to every other day is too much of a shock to his system, you do have to reduce steroids gradually, although I know from experience half tablets are a lot more bitter to take!
Reducing was as per vet's advice, I did think it might be a bit sudden. Maybe start missing one day in 4, then 1 in 3, and so on?

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Re: Steroid help please

Post by booktigger » Wed Jul 03, 2019 12:20 pm

Yes, you need to reduce, but you would normally reduce by half a day, then every other day, then every second day etc. Going from 1 every day to 1 every other might be too sudden, as steroids hinder your own system, so it needs a gentle reintroduction so you don't get a rebound effect. Maybe invest in gel caps or the putty stuff to mask the bitterness caused by halving them? It could also be that because his symptoms are quite severe, it's too early to reduce at all, but the only way to know that is to try unfortunately.

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Re: Steroid help please

Post by Mollycat » Wed Jul 03, 2019 1:21 pm

Thanks Booktigger I think his insides are pretty messed up to be honest, if we get him stabilised again we could try missing one a week then two a week and so on. I don't think it's the bitterness, it feels like it's because it's smaller and a different shape that he can hold and spit it out, because they are compressed powder with no coating, so he would still get the taste when it's whole if that makes sense. But maybe the antibiotic in his system is what was really working more than the steroids, I don't know.

It sounds like I'm writing him off but I don't know if we will be able to reduce much if at all, despite the miraculous recovery. He was literally 24 hours from being put to sleep as nothing was working and he had just about given up. It seems a very precarious hold on life with no real cause, it doesn't make much sense to me. I mean, whoever heard of dying of bowel inflammation? And yet that is what he was doing, and these tablets are all that's stopping him. I don't know, if we kept him on the high dose, if he would have long enough left for side effects to start causing issues. And I am scared to reduce too much because it takes so much to bring him back once he does start going downhill. And I wonder how much I can and should put him through. It's awful figuring out the best way isn't it.

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Re: Steroid help please

Post by booktigger » Wed Jul 03, 2019 6:53 pm

Sadly, it is a tricky one. My first cat with intestinal lymphoma I was forced by the vet to make that decision as after 2 weeks of 2 tablets a day, she wasn't improving and the vet said that she would end up starving to death as she wasn't absorbing enough nutrients. As you aren't sure which helped, I'd do a week of a full tablet a day, if little improvement you'll know it is the abs. After that, it depends how happy he is being pilled daily

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