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Discussion on Long term dextamethazone use | |
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Posted on Thursday, Apr 5, 2001 - 12:30 am: Dr. O,Our horse with the auto-immune disease(probably pemphigus) has been on steroids for 5 months now. We tried to keep lowering the dose, from 90 to 45 to 24 mg every other day. After three months, as I discussed in the hoof care forum, his sheath and stomach started to swell and we took him off the dext. for a week. For a few days he seemed better, then his back legs and sheath really blew up. Our vet gave him a big shot of dext. and said to give him 40mg every day. I did as he said. His legs aren't swollen, but if we don't ride him, his sheath is hugely swollen, and his stomach is always swollen, too.(We have ruled out the shavings allery idea) Now, after a month on every day steroids, he is losing muscling along his topline and looks about 30 years old. It really breaks my heart. I started him on Trental in addition to dext. for about 10 days and the loss of topline seemed more dramatic, so I stopped. My vet did not think it was the Trental, but the dext. causing this. I think he believes we are reaching the end of the line. Do you think the dext. could possibly be contributing to the swelling? I know it's causing the muscle loss.My vet calls it dependent edema, part of his systemic problem.( He also has big swellings over his eyes and they run constantly.) Do you think going to a larger dose and giving him a few days off might stop the muscle loss? Are you familiar with Trental and do you think I should throw more drugs at him right now? He is so weak now. My daughter had a lesson on him and I thought he was going to fall over, he tripped so much, and didn't want to move at the end, he was so exhausted. I feel like I 'm killing him with this medication. But maybe he'd be worse without it, I don't know. Any thoughts you have would be deeply appreciated. |
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Posted on Thursday, Apr 5, 2001 - 1:39 am: I just went back over your whole story. You said you bought the horse with the condition and that he was quite sound. Can you get any information from the previous owners as to how long they feel this condition may have existed? When you began treating him, was it because of any abrupt worsening of the condition? Or did you just begin to treat it and when you got no response, the treatment kept escalating?If his condition is as bad as you describe, maybe you could try weaning him off the steroids. Before you began treating him, he seemed in perfectly acceptable condition except for some hypertrophied tissue at the coronary bands. Then he got hit with antibiotics which sometimes can be a bit of an upset to the system. Then came the heavy - duty steroids that, as Dr.O said, could possibly hamper the ability of the immune system, to fight an existing ongoing condition that it may have been handling ok. What I'm trying to say is, if his only problem was thickened coronary bands, and all the other dismaying symptoms developed after the onset of treatment, perhaps it is time to withdraw treatment for a while. Of course, you would have to withdraw medication as per your vet's instructions ( when dealing with steroids ). It probably would be wise to do a fairly comprehensive blood test at some point soon. If he's in the condition you describe, I wouldn't ride him. Instead, I'd walk him on a lead just to keep him somewhat exercised. Any swollen areas, you could gently massage or, if its warm enough, a gentle water massage with the hose. Any temperature? Any soreness? Any lessening of appetite? Excessive drinking? Lays down more? Manure change? Run it by your vet. Perhaps he need a rest from medications. |
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Posted on Thursday, Apr 5, 2001 - 9:34 am: The steroids did help pretty dramatically. the swelling came down completely on the coronary bands, though they still crust over with a white material. The big difference was his way of moving. Before the steroids, he took short, quick strides, and wrung his tail at the canter. After starting steroids, he began to overstride and was able to do collected canter in very short order. He looked like a different horse. Before, his mucus membranes were inflamed, and there were a few sores in his mouth. His mouth seems okay now, although when we cleaned his sheath when it swelled, we found a small sore on his penis. The steroids did not help his eyes, though, which were always a little weepy, but now are quite bad. my vet did comprehensive bloodwook when he had the "crisis" a month ago, and did not come up with anything conclusive. At this point, I think his attitude is to try just about anything that might help. I did take him off the steroid very abruptly for a week and he swelled like a balloon and it scared me. Perhaps doing a dose twice a week would give his system a chance to "rest"I read on a dog vet site that dextamethazone lasts at least 48 hours in the system. If that is true, the every other day therapy would seem to be ineffective for adrenal relief. Perhaps that is why the steroids are having such side effects, now.(although it is in the last month, with every day dose, that he has gone downhill fast) (I just read this, and I know Dr. O suggests the pred. every other day, which is shorter acting, but my vet felt it wasn't strong enough) I don't know if the extra swelling would resolve itself in time, or if it is his disease progressing, in spite of the steroids. That is my dilema. |
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Posted on Thursday, Apr 5, 2001 - 9:43 pm: Usually, steroids are never stopped abruptly. You want to always administer and withdraw according to your vet's direction.The main thing I was wondering was, was the horse's condition becoming worse when you began treating it....or was it a chronic, constant thing that didn't get any better or worse? It sounds as though you feel he was sore ( way of moving )until he started the steroids. Was he? You said his eyes were always weepy...have you ever had his tear ducts flushed? Is he stalled or turned out? |
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Posted on Thursday, Apr 5, 2001 - 10:11 pm: My vet didn't seem too heads up about the withdrawal of steroids. He said, stop them and see what happens.About the condition. Yes, it was cronic and constant. At first we just thought he had a really short, choppy stride. He would run into the canter, wringing his tail. We had him for 3 months before we started the steroids. So we really started to feel that he was uncomfortable. And, as I said, it was like he was a different horse, his way of moving changed so dramatically. He continues even now to take big, big strides, so i'm pretty sure his feet feel much better. And, yes we flushed his eyes and put medicine in them. It didn't seem to help too much. The vet is due next week and I think I'll try flushing again, and more ointment. (The pockets of fluid above his eyes are so strange, like someone stuck a golf ball under his skin.) He does drink more, but his temp is normal and his appetite is ravenous. I have increased his feed as he has been losing muscle,and now he gets 25 or 30% more feed overall. I have not given him steroids since Tues. and his condition seems about the same. I will probably give him a dose tomorrow, Friday. |
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Posted on Thursday, Apr 5, 2001 - 10:19 pm: I forgot to answer your question: he is turned out right now, for the past three days, as the snow is finally melting. He was in at night previously. I want him to be able to move around as much as possible. |
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Posted on Friday, Apr 6, 2001 - 7:41 am: Hello Ruth,I apologize for the delay, I wanted to review the whole post and did not have time yesterday. You ask me to make judgements that I really cannot make without having examined the horse. I can only comment in generalities. We have had a recent discussion about the Trental so you know what I know about this. Yes I think the muscle atrophy could very well be the dex. Though edema and water retention are side effects of corticosteroid use I am uncertain that this is the dex, if other likely possiblities are ruled out (see Diseases: Skin: Swellings) and this was not a symptom prior to institution of the dex, it puts it high on the list. Has anyone run a complete blood panel on your horse in the last month and what were the results ( I would like normals and abnormals please)? The half life of Dex does not give the system the rest prednisolone (not prednisone) would with ADT. The strength of the Pred is dependent on the dose, and in the face of a good response initially to the dex then complications that could be secondary to steroid us I am unsure why your veterinarian is unwilling to try an in between posture. It is wrong to just stop the steroids after prolonged daily, or in the case of dex even every other day, administration, animals need to be weaned off them over a 6 week period. Something else to consider, the more this goes on the more it also resembles some types of toxicity: is it possible your horse is being exposed to ionophores (cattle feed growth promoters like lasalocid or monensin), excessive or deficient selenium in the feed, vitamin deficiencies, or heavy metal poisoning? DrO |
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Posted on Friday, Apr 6, 2001 - 11:03 am: Dr OWe are going to gradually wean him off the dext. My vet suggested putting him on a 2 week course of anti-biotics, just in case it is an infection causing the swelling. He admits to grasping at straws. It is his position that the pred's are interchangable and not detectable in the blood. (?)If I insisted, he would let me try it I'm sure. As to the toxicity- He is on the same feed as our Quarter horse, who is fat as a pig. Our place is small,never had cattle on it, and, the swelling occurred both here and at the indoor he was at for 2 months. I give him good quality feed plus anti-oxidants and oil. He has a mineral salt block that he goes for alot. I asked about the blood tests he did last month- Everything in normal ranges, with a few "insignificant" abnormals. I don't have a copy of the tests. I'll let you know how we make out. Thanks for your input. |
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Posted on Saturday, Apr 7, 2001 - 8:17 am: His position on prednisone and prednisolone being the same are incorrect. He needs to read:Why is Oral Prednisone Ineffective for Treatment of Heaves? by N. Edward Robinson, B.Vet.Med, PhD, MRCVS; presented to the 2000 convention of the AAEP. In experiments where blood measurements following oral administration are done he concludes: "Oral administration of prednisolone (but not prednisone) is likely to be beneficial because it is rapidly absorbed and achieves serum levels close to those that result from intravenous administration." DrO |
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