April 28

After two days of having Jack on 5mg of prednisone a day, SA reported some 'trembling' when she and Jack got home from their run.  It was a pretty chilly morning, but it's more likely he needs a little bigger dose.  So for now, we're going to do a 5mg in the AM and a half tablet at 2.5 in the PM.

Had a great phone discussion with DVM Mike Doe, who's been our vet for many years.

He was very encouraged by Jack's last 'lytes.  I mentioned that the Na/K Ratio and Na was above and the K below the midpoints of the range, probably indicating too much DOCP.  He didn't disagree.  He agreed that we can start to fine tune it down, as long as we continue to do both 12 and 24 day testing this month.  He also agreed that I can take over managing dosages and doing the injection at home, once we have him stable.  He does DOCP injection subcutaneously, not IM.

In other news, our other dog, Cleo, who is a 13yr old Grand Dame has started on Cholodin.  It's made a dramatic difference in her attention, alertness, obedience and everything, in under a week.  Amazing Stuff.  It worked almost miraculously on our late Alex, who suffered from CCD (Poodlesheimers).

Cleo:

More agility today, possibly the beach tomorrow!

April 26

Reading about Prednisone.
I find that too much prednisone leads to:
Hyper thirst and hunger,
thinning skin and hair loss
elevated liver enzymes, which can damage the liver.
I got a full slicker brush off Jack when I brushed him, and before AD, I got almost nothing.  It could be because the weather is warming up, but poodles don't shed.
This IS too much prednisone.
I'm starting an experiment, giving him half his dose of Prednisone, or 5mg/ day.  If he gets lethargic or loses appetite, I'll know to go back to the larger dose.

April 25

Jack's electrolytes were again "fine" yesterday, according to the vets, so we went ahead with the same Percortin injection today: 2mls.

Sodium= 149  Ref range= 139-154

Potasium= 4.3 Ref range= 3.6-5.5

Na/K ratio: 35  Ref range= 27-38

Na is above the midpoint of 146.5.  K is below the midpoint of 4.55.  Ratio Na/K is above the midpoint of 32.5.  I'm curious how much they fluctuate before and after the injection.
I've been told that in the early stages, percortin has a cumulative effect, and his next month lytes might show he's getting too much, with the K too high.

Jack is a little frantic in the mornings until he gets his breakfast.  And then, he's hungry and thirsty most of the time.

I'm curious how the prednisone works.  I understand it's a substitute for Cortisol, a glucocortoid that manages how sugar is metabolized.  It has nothing to do (as I understand it...) with the electrolytes which are managed by the DOCP injection.

I'm curious if Prednisone dosing has any relationship to diabetic or hypoglycemic conditions in dogs.  Always more research to do.

April 22

Frustration today, with how the prednisone has changed this dog.  Everything and anything paper has to go in the mouth.  Yesterday, he ate about half our tax forms.  Yup...ate 'em.
Today on our walk every scrap of paper had to elicit a "leave it" or a "drop it".
Jack was never like this before the onset of AD.
Sooner or later, this dog is going to get hold of something that kills him.  Or, I just keep him in his crate or a leash at all times.
I've got to reduce the prednisone after his next Percortin injection.
I suspect the high level of Prednisone is responsible for his inattention at agility today as well.

April 15... Ski Dog!

Jack and I went up to Carson Pass, near Red Lake early this morning with our friends David and his Pomeranian:  Max.  This was his first experience with snow.
It turns out that Red Lake is a free for all for snowmobiles from Nevada now.
So, we made the strategic decision to ski up a watershed away from the road where the nasty machines were roaring around.
It was a pretty good climb, but the day was beautiful and warm, the snow only a day or so old.  Jack was post-holing and galloping around like a floppy Fozie Bear from the muppets.  Once he figured out that if he stayed behind us on our ski tracks, he wouldn't sink in, he did just great.  In fact, he figured out that he wouldn't sink in at all if he stood on the back of my skis!
After we crested the top and started back down, Jack got very tired.  So we took a break, ate a snack and I gave him his second prednisone of the day.  He rebounded completely in about 20 minutes.
We skied back down to the trailhead without any incident, other than my getting my forearms sunburned.  I've been doing this long enough that you'd think I'd have learned....
Anyway, a beautiful day on the snow, and Max and Jack seemed to have a great time.  Jack is a little tired today, but he doesn't seem stiff at all.  His tail is up and he's smiling, so I don't think we overdid it.

April 14, back to Agility

Back on the full 10mg/day of Prednisone, per Vet's orders, Jack had an accident at the back door this morning. I need to teach him to "touch" my hand with his nose to let him out.  Toni's idea, and it's a good one.

Speakin' of Toni, she took a little video of us running a very simple agility course today.  Jack was really brilliant on the course, with a lot of energy, and a laser focus.  In fact, better than he's ever been.
I've been cautioned about his activity/ stress level so soon after the Addisons crash, but he seemed fine.  I watched him like a hawk, and he was just great.  We quit a little early as he clearly needed to pee.  But it was a big celebration when we got home.
Jack's Agility Run

April 13... First Electrolytes

Jack had his first electrolyte panel yesterday, and it came back dead on normal:
Na 149
K 4.3
Ratio: 35
Chlorides 113
Bicarbonate 20.
The vet made a point of telling me to keep him on the "same dose of prednisone", which he'd set at 10mg/day.
Which I think is too much.

Jack is returning to his former happy, yet still skittish self.  His strength is improving, as he did a couple of perfect "dances" (on his hind legs) in the vet's lobby to the delight of the staff yesterday.  He's starting to pull out ahead of me on walks again (which I do discourage, but it's heartening).
I'm thinking of taking him up to Carson Pass this Sunday for his introduction to snow with David and Max, if the weather looks good.
I'm trying to keep him entertained during the work day with a kong full of cookies.  So far, so good, he hasn't eaten anything wierd.. that.. I ...know..of....
Shoot.  Just as I was typing that, he chewed up a pack of post-it notes.  Aarrrrr.....

April 11...new normal?

As of this writing Apr. 11, he's had no prednisone for 24 hours, and is a very happy guy.  I even got him playing with a rag/squeaky toy last night!  He's never played with toys before.  He got all goofy, it was delightful.
I'm giving him a half a tablet of prednisone this morning with his breakfast.
He's been on brown rice and chicken 'soup', with a little yogurt on the side.  I think giving him small meals and occasional treats throughout the day might help in dealing with the Hungry Coyote pred syndrome.
He will work for a long time to free a cookie wedged into a kong.  Need more toys like this to keep him busy and focused.

April 9... Hunger!

After a few days of giving Jack Prednisone (5mg, 2x day), Jack is constantly hungry.
He picks up bits of paper and chews, sometimes swallowing if we don't tell him to "Leave it".
Occasionally, he brings pieces of paper into the living room, and just drops them there.  We're thinking it's a new game.  Poodles are always coming up with new games, so we laugh along with him.
Easter morning we left both he and Cleo in the back yard to go to church.  Jack has been drinking a lot of water, and his throughput is amazing.  He's had some accidents when he can't get outside fast enough.
When we returned from church, Jack had devoured about half of a paper bag containing wood chips.
Monday, April 9.  Sue Ann left for work, and not 10 minutes later I hear a "crack" sound.  Jack is in the living room, a broken prednisone bottle is on the floor, along with about 5 doses of pred.  Oh..no.
Rushed him to the vet, as he's probably eaten 20-25 doses.  They induce vomiting.
We now realize we need to change all the rules around here about dog access.

Reaction Mar 31 2012

Jack started eating again the next morning, a combination of reluctant and desperately hungry, if that makes any sense.  I could only get him to eat a liver treat or two at first. That evening, Mar 31, he ate a full meal again, and was smiling and wagging for the first time in a week.
I'd been reading everything I could find about AD, trying to understand the relationship between hormones and electrolytes that seem to be the key to the goal of returning Jack to some semblance of his former happy (if slightly nutty) athletic self.

Diagnosis, March 2012

March 25, 2012: Jack and I went up to one of our favorite hikes, near Skyline and Joaqin Miller roads in the Oakland hills.  Jack was very low key, and hadn't finished  his breakfast, which was rare for him.
All through the hike, his energy was low, and he stayed right behind my knee, instead of running up ahead and waiting for me..."are you coming?".  He didn't want to interact with other dogs or humans on the trail, also uncommon for him.
He didn't touch his supper.  We knew there was something wrong at that point.
He wouldn't eat anything else again until Tuesday morning Mar 27.  He ate part of his breakfast, so we thought whatever had been wrong might be turning around.
However we noticed an odd quivering when he was laying on the couch with us.  Like a little shiver occasionally.
Over the next couple of days, this got worse and he'd just spend the whole day in his crate.
We got him into the vet Mar 29.  They examined blood, stool and urine.  When the test results came back, the electrolytes were off enough to reinforce our fears: Addison's Disease.
As he was continuing to decline the vet, Dr. Michael Doe, suggested we start a course of treatment including a Percortin-V (DOCP) injection of 2ml/50mg (based upon the recommended dosage of 10mg/lb) and 5mg of Prednisone.  They also administered the ACTH test, and sent the sample off to the lab.
The next day March 30, the ACTH results indicated no adrenal stimulation at all, confirming the Addison's diagnosis.