Staying on low dose pred long term?

[Musiaka]

Musiaka has been doing great on pred, he only vomited twice since february and his blood results aren't too bad (a bit hight alt and the vet didn't like his creatinine levels, even though they were within the norm - she said new research shows it might be high). Compared to how he was last year this time of the year it's like day and night. Last year he was shedding and vomiting like crazy, pretty much everyday. His liver enzymes were over the roof and we had to get iv fluids.
This year even his shedding is less severe and he looks like he enjoys life. His eating well, not too much and his fur is of a better quality.

Vet suggested to switch him to chlorambucil, but it is even necessary at this point, if everything is going that well? He's on 1,75 mg pred which, if I'm not wrong, is considered a shadow dose. I might try to get it down to every other day. Can we just go with pred and regular blood checks for the rest of his life and only get him off of it if smth goes wrong?

 

[daftcat75]

Pred is hard on a cat. Every other day dosing would be easier as pred metabolizes slower than 24 hours. Just one of the reasons why pred is hard on a cat. But chlorambucil comes with fewer long-term risks than pred. I know you're nervous about touching the protocol since he's had success with it. But if it were my cat, I would want to transition him off long-term steroids if he seems to be doing as well as you say he is. Has he regained any weight? I would be worried about the muscle wasting that comes with long-term pred use now that more immediate worries have been allayed. Since he did respond to pred before, I'm thinking going back to pred if chlorambucil doesn't do the job is still an option.

 

[PushPurrCatPaws]

Musiaka has been doing great on pred, he only vomited twice since february and his blood results aren't too bad (a bit hight alt and the vet didn't like his creatinine levels, even though they were within the norm - she said new research shows it might be high). Compared to how he was last year this time of the year it's like day and night. Last year he was shedding and vomiting like crazy, pretty much everyday. His liver enzymes were over the roof and we had to get iv fluids.
This year even his shedding is less severe and he looks like he enjoys life. His eating well, not too much and his fur is of a better quality.

Vet suggested to switch him to chlorambucil, but it is even necessary at this point, if everything is going that well? He's on 1,75 mg pred which, if I'm not wrong, is considered a shadow dose. I might try to get it down to every other day. Can we just go with pred and regular blood checks for the rest of his life and only get him off of it if smth goes wrong?

A dose of 1.75 mg prednisolone is not that big of a dose. It's my view that if he's doing quite well on that, and you and your cat's vet have discussed all the potential issues/benefits of being on pred more long-term, you may have found a good remedy for him that lets him enjoy life. How old is he?

I have experience with long-term prednisolone use in my cat, prescribed for her allergic bronchitis (asthma), and she does fairly well with it. It's recommended to get regular blood work and check-ups done, so that you can stay on top of any possible issues -- but, for her, in her case, she does great. It's really helped her asthma. I've tried using the alternate, with AeroKat mask &c., but the oral pred works better for her. She had some issues a few years ago with overgrowth of demodex cati mites (from being immunosuppressed), but this was resolved in working closely with a veterinary dermatologist and we came up with a great solution for my cat's additional issue. I do realize that she could develop other health effects at some point... I guess I just keep her going on as little pred as needed and hope for the best. It's a decision each one of us has to make.

I don't know much about chlorambucil but in reading up on it, and unless your cat actually has very severe diagnosed IBD, or lymphoma/cancer or the like, its possible side effects plus it being a drug for which a human seems to have to wear gloves in order to administer to the cat and to clean said cat's litterbox, that would result in me choosing to go with pred as an anti-inflammatory. Just know that the longer your cat is on prednisolone, the more used to it the cat gets and you really have to be very careful in weaning the cat off of pred, should you ever decide to stop using it. For example, for my cat, I would need to take a very careful 2-4 months at least to responsibly and slowly wean her off of pred, just to make doubly sure she does have any adverse metabolic issues. A cat that is on pred for a shorter time (e.g. less than several years) and/or at the lowest of doses, still needs a weaning period when going off of it but it can be for a much shorter time period.

 

[Meowmee]

Musiaka has been doing great on pred, he only vomited twice since february and his blood results aren't too bad (a bit hight alt and the vet didn't like his creatinine levels, even though they were within the norm - she said new research shows it might be high). Compared to how he was last year this time of the year it's like day and night. Last year he was shedding and vomiting like crazy, pretty much everyday. His liver enzymes were over the roof and we had to get iv fluids.
This year even his shedding is less severe and he looks like he enjoys life. His eating well, not too much and his fur is of a better quality.

Vet suggested to switch him to chlorambucil, but it is even necessary at this point, if everything is going that well? He's on 1,75 mg pred which, if I'm not wrong, is considered a shadow dose. I might try to get it down to every other day. Can we just go with pred and regular blood checks for the rest of his life and only get him off of it if smth goes wrong?

I don’t know the full history or why he was on it? Does he have IBD or another condition? I briefly read part of your post that said he needed gall gallbladder surgery maybe. Chlorambucil is usually used for cats with suspected or confirmed intestinal lymphoma. How old he is would be a concern too. Most dvm won’t keep a young cat on steroids for long due to possible damage unless there is no other choice.

Over time they can cause kidney and other damage. It’s great the steroid helped his vomiting. My Merlin was on steroids for a few weeks for suspected IBD and c diff. Eventually I weaned him off them and put him on a home cooked diet and he is pretty much cured now. His main symptom was runs/ mooshy stool.

 

[Musiaka]

Pred is hard on a cat. Every other day dosing would be easier as pred metabolizes slower than 24 hours. Just one of the reasons why pred is hard on a cat. But chlorambucil comes with fewer long-term risks than pred. I know you're nervous about touching the protocol since he's had success with it. But if it were my cat, I would want to transition him off long-term steroids if he seems to be doing as well as you say he is. Has he regained any weight? I would be worried about the muscle wasting that comes with long-term pred use now that more immediate worries have been allayed. Since he did respond to pred before, I'm thinking going back to pred if chlorambucil doesn't do the job is still an option.

I will definitely lower to 1,75 mg every second day, just trying to wait it out until he makes 4 full weeks without vomiting. A slightest deviation from his current routine sets him off. The last two times he vomited was after eating a bit of boiled pork and after me accidentally giving him too much s.boulardii. I need to be strict with giving him the same food everyday without any treats and to avoid empty stomach at all costs.

We never really had issues with Musiaka's weigh. His weight has been consistent all these 6 years I've had him. Right now he's a bit above the ideal weight, but probably looks the best he ever did, a large strong cat. His fur has never been this good, but it's probably the vitamine paste, since this brand is even used for show cats as it makes the fur amazing.

Is chlorambucil really milder than pred? It scares me to read that it's a chemotherapy drug and that I will have to avoid his saliva on my skin. He rubs on things and chews random stuff, like my phone. Is there no other drug as an alternative to pred if we're getting off?

 

[dustydiamond1]

Gypsy is still getting one half of a .05 dose every other day and doing fine on it however Jcatbird worries about it and I promised to talk to our vet about alternatives. She mentioned a possible substitute but I don't recall what it is at this moment and she has her hands full with her ill kitty Banjo right now.

 

[Musiaka]

A dose of 1.75 mg prednisolone is not that big of a dose. It's my view that if he's doing quite well on that, and you and your cat's vet have discussed all the potential issues/benefits of being on pred more long-term, you may have found a good remedy for him that lets him enjoy life. How old is he?

I have experience with long-term prednisolone use in my cat, prescribed for her allergic bronchitis (asthma), and she does fairly well with it. It's recommended to get regular blood work and check-ups done, so that you can stay on top of any possible issues -- but, for her, in her case, she does great. It's really helped her asthma. I've tried using the alternate, with AeroKat mask &c., but the oral pred works better for her. She had some issues a few years ago with overgrowth of demodex cati mites (from being immunosuppressed), but this was resolved in working closely with a veterinary dermatologist and we came up with a great solution for my cat's additional issue. I do realize that she could develop other health effects at some point... I guess I just keep her going on as little pred as needed and hope for the best. It's a decision each one of us has to make.

I don't know much about chlorambucil but in reading up on it, and unless your cat actually has very severe diagnosed IBD, or lymphoma/cancer or the like, its possible side effects plus it being a drug for which a human seems to have to wear gloves in order to administer to the cat and to clean said cat's litterbox, that would result in me choosing to go with pred as an anti-inflammatory. Just know that the longer your cat is on prednisolone, the more used to it the cat gets and you really have to be very careful in weaning the cat off of pred, should you ever decide to stop using it. For example, for my cat, I would need to take a very careful 2-4 months at least to responsibly and slowly wean her off of pred, just to make doubly sure she does have any adverse metabolic issues. A cat that is on pred for a shorter time (e.g. less than several years) and/or at the lowest of doses, still needs a weaning period when going off of it but it can be for a much shorter time period.

I don't really know his age, I wish I would. I've had him for 6 years and he was fully adult when I adopted him. His teeth are worn out and some are missing so I'm guessing he's not young. But his character is not of an elderly cat. I'm guessing around 10 years old.

Yes, seems like there is no easy decisions with cats like ours, who can't just live their life without any medical intervention. How much pred does your cat receive? For how long? Sorry to hear about her asthma!

I'm just thinking... how much worse can a small dose of pred be than regular vomiting? The flareups affect his liver, the acid is damaging his esphagus and that's probably what destroyed his teeth. Not to talk about constant malabsorbtion... Chlorambucil sounds scary. But I will talk to the vet and seriously consider if it's better for Musiaka than pred.

 

[Musiaka]

I don’t know the full history or why he was on it? Does he have IBD or another condition? I briefly read part of your post that said he needed gall gallbladder surgery maybe. Chlorambucil is usually used for cats with suspected or confirmed intestinal lymphoma. How old he is would be a concern too. Most dvm won’t keep a young cat on steroids for long due to possible damage unless there is no other choice.

Over time they can cause kidney and other damage. It’s great the steroid helped his vomiting. My Merlin was on steroids for a few weeks for suspected IBD and c diff. Eventually I weaned him off them and put him on a home cooked diet and he is pretty much cured now. His main symptom was runs/ mooshy stool.

Yes, an "unofficial" ibd. Steroids is pretty much the only thing that helps him. His vomiting is pretty severe otherwise, during shedding season it can be daily. In April last year he vomited so much that his ALT went up to 1000 and he had to get iv drops.
Is Chlorambucil only used in cats with lymphoma? Not as an IBD symptom prevention?

 

[Musiaka]

Gypsy is still getting one half of a .05 dose every other day and doing fine on it however Jcatbird worries about it and I promised to talk to our vet about alternatives. She mentioned a possible substitute but I don't recall what it is at this moment and she has her hands full with her ill kitty Banjo right now.

I see, let me know when you find out what the suggested alternative was

 

[Musiaka]

What about metrinidazole? Is that maybe milder than pred and not as inconvenient as chlor?

 

[daftcat75]

Metronidazole is an antibiotic. It does seem to be the preferred drug for gut bugs. But it's not going to help with IBD. Not like pred. I would discuss your concerns with pred vs chlorambucil with the vet or a specialist. Better that you are onboard with your team than to go it alone--even with the support here. At the end of the day, none of us are vets.

Re: chlorambucil. Not that scary. You'll want to get it compounded into a form that he will take himself so you don't have to touch it yourself. For Krista, that was a highly concentrated anchovy flavored oil. Instead of having to pill her or squirt a whole 1 cc of liquid into her, I got it 10x concentrated so only 0.1 cc was needed. I put this tiny dot of oil on a plate and added an equally tiny dot of salmon oil. Krista licked up this small oil slick (no bigger than a penny) and then she was free to eat her food unadulterated. I did have to wear gloves to draw the oil and put it on the plate. But other than that, it is a tiny dose of medicine that will be diluted by the volume of your big strong cat. You won't have to worry about him licking you or handling his waste. If you yourself are immuno-compromised, you may want to take the extra precautions. There are a couple of dosing protocols. One is every three days (or twice a week since every third day keeps moving the dosing days in the week.) Another protocol is a larger dose every two weeks. They have both proven to be effective. As for side effects, I only ever saw Krista sleep a little more on dosing days. Other than that, I didn't see her lethargic or nauseated like you might expect from a human taking chemo.

 

[dustydiamond1]

When I find out about alternatives I'll definitely let you know. Her low dose of pred maintains Gypsys quality of life. Without it she had gotten nerve zings that cause her to lick dig at her feet til they were red, swollen and sore.

 

[daftcat75]

My Betty has been suffering through a weekly cycle that looks like hairballs without the hairballs. She eats well for a few days. Then her eating slows way down. And it culminates in some kind of ejection that puts her off food for the rest of the day. It hasn't been hair itself in a few weeks. It's not always food. Sometimes it is stomach acid. Sometimes it's a vomit, and sometimes it's a regurgitation. It really doesn't clearly point to one problem or another yet. I'm still waiting for insurance to settle our first claims and decide her pre-existings (there should be none!) before I run her through the gauntlet of vet tests. In the meantime, I started her on a soil-based probiotic that really seems to be making a difference. I know it's been far too short to say it's a cure. But she seems to be eating more readily and larger portions like her gut is not bothering her as much as before. My nibbler is turning into a gobbler! She also doesn't seem gassy anymore. She was never a room clearer. But occasionally if I sat with her, she would have gurgles and a mild aroma of gastric distress.

This is the stuff. Right now, I'm adding half a capsule into her food, twice a day.
Pet Flora | Cat Probiotics - Vitality Science

You can get it cheaper with the Finicky Cat Trial Pack. If you write their customer service, they can help you pick the other samples.
Finicky Cat Trial Pack - Vitality Science

 

[PushPurrCatPaws]

I don't really know his age, I wish I would. I've had him for 6 years and he was fully adult when I adopted him. His teeth are worn out and some are missing so I'm guessing he's not young. But his character is not of an elderly cat. I'm guessing around 10 years old.

Yes, seems like there is no easy decisions with cats like ours, who can't just live their life without any medical intervention. How much pred does your cat receive? For how long? Sorry to hear about her asthma!

I'm just thinking... how much worse can a small dose of pred be than regular vomiting? The flareups affect his liver, the acid is damaging his esphagus and that's probably what destroyed his teeth. Not to talk about constant malabsorbtion... Chlorambucil sounds scary. But I will talk to the vet and seriously consider if it's better for Musiaka than pred.

Milly gets 1.25-2.5 mg daily. Usually if or when I've tried weaning her off (or even going every other day) for more than 2-3 weeks, she begins having too many cough attacks again. She's more prone to coughing when the Spring allergens arrive (*now*), and also when the leaves fall in the autumn (lots of birch pollen right outside our windows). I use an IQAir air filtering system, which helps a ton, and I do all the other things needed for an "asthma cat", but her asthma is definitely progressive. I know her symptoms really well, though, and honestly, the dosing of her pred is an ebb-and-flow exercise, a by-now well-oiled judgment call on my part... sometimes I give the tiniest of doses, sometimes I give more. This has been thoroughly discussed with her vet, who knows the pros and cons of Milly's case. Use of the AeroKat w/ Flovent just didn't do the trick for her (and we tried that for nearly 2 years). I agree with you that, when considering any med, you have to decide which is worse for the cat, the issue itself (like vomiting, or severe coughing, both of which are very hard on the system and a cat can actually work up a body memory of that "behavior", often causing even more coughing or vomiting) -- or every other day of a small dose of a steroid, whether short- or longer-term.

 

[dustydiamond1]

My Betty has been suffering through a weekly cycle that looks like hairballs without the hairballs. She eats well for a few days. Then her eating slows way down. And it culminates in some kind of ejection that puts her off food for the rest of the day. It hasn't been hair itself in a few weeks. It's not always food. Sometimes it is stomach acid. Sometimes it's a vomit, and sometimes it's a regurgitation. It really doesn't clearly point to one problem or another yet. I'm still waiting for insurance to settle our first claims and decide her pre-existings (there should be none!) before I run her through the gauntlet of vet tests. In the meantime, I started her on a soil-based probiotic that really seems to be making a difference. I know it's been far too short to say it's a cure. But she seems to be eating more readily and larger portions like her gut is not bothering her as much as before. My nibbler is turning into a gobbler! She also doesn't seem gassy anymore. She was never a room clearer. But occasionally if I sat with her, she would have gurgles and a mild aroma of gastric distress.

This is the stuff. Right now, I'm adding half a capsule into her food, twice a day.
Pet Flora | Cat Probiotics - Vitality Science

You can get it cheaper with the Finicky Cat Trial Pack. If you write their customer service, they can help you pick the other samples.
Finicky Cat Trial Pack - Vitality Science

It looks looks like great stuff!
I've been a firm believer in probiotics for a couple of years now, ever since our vet reccomended them for an bit of blood on the end of her poop and anus. This is what we use, it works great for us.
If I ever need to switch for any reason I'll try your stuff. So happy sweet Betty is improving she keeps doing so

 

[Meowmee]

Metronidazole is an antibiotic. It does seem to be the preferred drug for gut bugs. But it's not going to help with IBD. Not like pred. I would discuss your concerns with pred vs chlorambucil with the vet or a specialist. Better that you are onboard with your team than to go it alone--even with the support here. At the end of the day, none of us are vets.

Re: chlorambucil. Not that scary. You'll want to get it compounded into a form that he will take himself so you don't have to touch it yourself. For Krista, that was a highly concentrated anchovy flavored oil. Instead of having to pill her or squirt a whole 1 cc of liquid into her, I got it 10x concentrated so only 0.1 cc was needed. I put this tiny dot of oil on a plate and added an equally tiny dot of salmon oil. Krista licked up this small oil slick (no bigger than a penny) and then she was free to eat her food unadulterated. I did have to wear gloves to draw the oil and put it on the plate. But other than that, it is a tiny dose of medicine that will be diluted by the volume of your big strong cat. You won't have to worry about him licking you or handling his waste. If you yourself are immuno-compromised, you may want to take the extra precautions. There are a couple of dosing protocols. One is every three days (or twice a week since every third day keeps moving the dosing days in the week.) Another protocol is a larger dose every two weeks. They have both proven to be effective. As for side effects, I only ever saw Krista sleep a little more on dosing days. Other than that, I didn't see her lethargic or nauseated like you might expect from a human taking chemo.

Wizard did very well on chlorambucil. I pilled him and just wore gloves and washed my hands after. I was a bit nervous about it at first but it was not a big deal. We never got to the point of compounding, dvm never mentioned that as a possibility.

 

[daftcat75]

Wizard did very well on chlorambucil. I pilled him and just wire gloves and washed my hands after. I was a bit nervous about it at first but it was not a big deal. We never got to the point of compounding, dvm never mentioned that as a possibility.

Krista was a nightmare for pilling. I hate pilling because I can't seem to do it as easily as all the demo videos. It turns into a nasty wrestling match and picking up a spit out pill to try again and again. This is why compounding seemed like a good idea with a medicine I was supposed to limit my contact with.

 

[Meowmee]

Yes, an "unofficial" ibd. Steroids is pretty much the only thing that helps him. His vomiting is pretty severe otherwise, during shedding season it can be daily. In April last year he vomited so much that his ALT went up to 1000 and he had to get iv drops.
Is Chlorambucil only used in cats with lymphoma? Not as an IBD symptom prevention?

I am not sure if it is used in ibd cats. My Wiazrd was on it for suspected lymphoma as well as prednisilone, he was on only pred at first. He already had kidney disease and anemia first so we had to be careful about the pred.

* update: this wedgewood link says it can be used in cats for ibd as well. It does have side effects as well I imagine for longterm use.

Chlorambucil for Veterinary Use

 

[Meowmee]

Krista was a nightmare for pilling. I hate pilling because I can't seem to do it as easily as all the demo videos. It turns into a nasty wrestling match and picking up a spit out pill to try again and again. This is why compounding seemed like a good idea with a medicine I was supposed to limit my contact with.

That is great it is available that way too. Wizard was pretty ok with pilling compared to my others. I had used gel capsules for pills for along time for all my kitties for meds and put some oil on the capsule to help. I had a lot of Sybil’s meds compounded but she would not eat them in food. . Angie was notorious for pretending to swallow pills and I would find them later spit out, lol.
Quinn is pretty difficult with pills but I can squirt a liquid, when he was a kitten I could pill him. Merlin I can do liquids, I can’t remember now if I tried to pill him oddly.

Zena is a good boy and either eats meds in foods or sometimes the pill pocket, metro was the hardest. But he would switch back and forth, was a fusspot and it was hard at times, for Merlin too. I had to give him an appetite stim to make him hungry enough to eat the meds in food. I haven’t tried pilling him yet because he was not touchable when I first brought him inside.

Either way it can be an ordeal with a liquid in syringe too because poor Syb would drool etc. with the bitter ones, and pills were getting too hard for her. Byron was great with pills and so was Tess. Not that it was ever super easy though but not so stressful that we had to try alternatives.

 

[Musiaka]

Krista was a nightmare for pilling. I hate pilling because I can't seem to do it as easily as all the demo videos. It turns into a nasty wrestling match and picking up a spit out pill to try again and again. This is why compounding seemed like a good idea with a medicine I was supposed to limit my contact with.

Sorry to hear about the pilling struggles you faced with Krista! Musiaka is the complete opposite, the perfect cat for pilling. I always follow with a lickable treat though.