Vets, medrone and conflicting advice

[Maddiesmum]

That's good, hope it controls the itching.

[Baggy]

That's good to hear - fingers crossed it will work.

Think we will try to see the original vet when the review is due...even though it's a bit further to travel.

[CurlyCatz]

You may find the tablets every second or so day and reducing the dose right down works very very well, ive known many many animals to be stabalised for similar conditions on this type of regime.

[Baggy]

Spoke to the original vet today - it is the case that Dinah has had a shorter acting injection this time, bet vet said we should not start the tablets for at least two weeks until the injection is starting to wear off, so am very glad I followed it up.

Vet wants us to try the tablets, but advised us to give one tablet every other day and after two weeks cut it down to half a tablet.  If she is still not itching we can reduce the dose further and she feels that a smaller, regular dose will be better than the injections.

She says the injection and tablet steroids work in slightly different ways and that the tablets should allow us to dose her more accurately - basically so she will avoid having flare-ups.  We'll try it, but if it's too stressful or if it doesn't work we'll be straight back on to the jabs.

Deffo agree we wouldn't want to put her through allergy testing at this stage in her life - she has had some inconclusive tests in the past and this allergy is supposed to have been "summer only" but it's affected her for the full year she has been with us.  An elimination diet would be a challenge as she's a very fussy eater, we have an "Aladdin's Cave" of cat food to cater for whatever she fancies at any given hour!

Thanks all for the advice, will let you know how her itches progress...

[CurlyCatz]

Personally if she were mine i'd go down the once every 8 week injection if it sorts her itching out and also means she doesnt have the stress of more daily tablets than necessary.
I do think at her age the quality of life versus length is the key issue and I'd be fairly reluctant to go down the intradermal skin testing and elimination diets etc to try and find out what the allergy(s) are esp when you are already dealing with her crf.

If i remember correctly there are varying types of medrone with 1 type being shorter acting and the medrone V (i think) being a longer acting one so there may be a correct reason for the alternating advice on when to start tablets after the injection is given but its defo something i'd double check.

[Baggy]

She has access to Dinah's records but has she really read them.  Sadly, they often don't so maybe she thinks she is saving you a vet visit.  

We also have no idea what the records say - if she looked at the last record only it will have on record that tablets were prescribed.  I'll call tomorrow a.m. and ask about the jab, for peace of mind.

I know what you mean about thinking of all these questions on the way home.  We've  all done it. 

Try not to worry too much about the steroids.  Unnecessary use is a bad thing but Dinah obviously needs them and is doing fine so far.  While some cats probably do OK with intermittent use clearly Dinah doesn't seem to be one of them

[CarolM (Wendolene)]

....

The short course obviously hasn't worked, but am not certain why the new vet is so keen for us to have the tablets (she has access to Dinah's records so should have been aware the injections work for at least 8 weeks) instead of a jab. 

Also, she has had an injection today too and we've been advised to start the tablets straight away - last time we were told not to try the tablets for at least four weeks.

Why do I always think of these things when I'm half way home instead of at the surgery?! In my defence I did get that "don't ask me any questions, I'm a vet" vibe!

She has access to Dinah's records but has she really read them.  Sadly, they often don't so maybe she thinks she is saving you a vet visit.  Or maybe she always gives tablets and doesn't see why she should change.  It does sound as though Dinah had the short acting jab this time and possibly the long acting one previously.
I know what you mean about thinking of all these questions on the way home.  We've  all done it.  You think of loads of things to ask before you go and then they throw something unexpected at you that you've not had time to think about.

Try not to worry too much about the steroids.  Unnecessary use is a bad thing but Dinah obviously needs them and is doing fine so far.  While some cats probably do OK with intermittent use clearly Dinah doesn't seem to be one of them

[Baggy]

I don't know what it's called but there is also a short acting corticosteroid injection, could Dinah have been given a short acting one?  Do you have the receipt with the itemisation on to see what she was given?

The receipt isn't itemised - typical! That would make sense sense though...

I do feel more heartened about this now in terms of it probably not making any difference to her kidneys whether it's a jablet or a tablet, but am certain Dinah would be much happier with a jab.  She's had her Fortekor every day for 5 months now without any complaint, but after 3 days on the medrone started hiding under the bed at tablet o'clock!

The tablets didn't seem to have much impact on her itching after a 7 day course - but when I asked was told that it was because we had stopped giving them to her (as instructed!).  It seems that one vet thinks we should treat this as and when it flares-up, the other with a view to preventing it full stop.

If only we knew what actually caused it...

[Tiggy's Mum]

Tiggy was on depo medrone injections for over a year, I did ask whether the tablet version would be any better ie a steady dose instead of dipping off towards the end but my vet said there was no real difference and from my point of view one injection was easier then adding anothe tablet to her daily regime! .  As you know she also had CRF (was on Fortekor from day one), every single blood test her kidney results improved, including the entire time she had the corticosteroid (depo medrone) injections.

Also, she has had an injection today too and we've been advised to start the tablets straight away - last time we were told not to try the tablets for at least four weeks.

I don't know what it's called but there is also a short acting corticosteroid injection, could Dinah have been given a short acting one?  Do you have the receipt with the itemisation on to see what she was given?  My vet tried Tiggy on an anabolic steroid (which did nothing) and then an injectable short acting corticosteroid with a view to putting her on the long acting one (depo medrone) if she improved, which she did.

[Baggy]

Carol, I'm certain the jabs are also Medrone, and the vets have always advised that they would like to give her as few jabs as possible - so thinking about it, it does mean her kidneys have been improving even though she's been on the medrone so I'm a bit less worried.

...but what has confused me is that we were advised to try the tablets on a really short course and then to stop giving them as soon as we possibly could - which makes them sound as if they are worse for her than the injections.  The vet gave us the tablets last time to try and see if they worked, which would save Dinah a trip to the vets for a jab.

The short course obviously hasn't worked, but am not certain why the new vet is so keen for us to have the tablets (she has access to Dinah's records so should have been aware the injections work for at least 8 weeks) instead of a jab. 

Also, she has had an injection today too and we've been advised to start the tablets straight away - last time we were told not to try the tablets for at least four weeks.

Why do I always think of these things when I'm half way home instead of at the surgery?! In my defence I did get that "don't ask me any questions, I'm a vet" vibe!

[CarolM (Wendolene)]

I don't want to confuse the issue for you but I'm probably going to.  The jabs that Dinah is having are probably Depot Medrone which is a long acting injection that releases the steroid slowly over a period of time.  The amount of steroid she is getting from the jab could well be similar to taking tablets every day.  However, if this is less stressful for her than taking tablets then stick with it.  What is most important is her quality of life and she seems to be doing very well on them.

[smudgepickles]

Out best freinds are not disposable objects and should not be treated as such by any vet.

well said by a true caring miowmy 

your welcome baggy 

xx

[Baggy]

Thanks both, I feel a bit better now!

19 with CRF isnt old my Bella is 26 on 18th Jan and last year they told me it was going to be before xmas she would have to be pts, she is happily playing with a catnip mouse as I type 

26, wow! Dinah also loves her catnip mose  Sometimes I think vets say pessimistic things as they don't want to give us false hope - but sometimes I wish they would just say nothing at all!

I'm going to telephone the original vet on Monday and ask her opinion.  They are both from the same practice but diiferent branches - we've only swapped because we moved house. 

As well as not stressing Dinah by having to give her the steroid tablets (she is fine with the Fortekor as they are a bit tasty!), I feel we can monitor her CRF better if she's just on the Fortekor and having jabs.  If we give her the medrone tabs and her kidneys get worse we won't know if it's the medrone causing it or it's because the Fortekor is just less effective.

I do completely understand and agree that it's better for her to have quality of life over quantity, if the other vet agrees tablets are better for her than the injections I will completely accept that, but really hate the "well, she's old so we may as well treat it like this" attitude. 

[Gill (sneakiefeline)]

I would definately go back to the original vets cos if she is Ok with injections and having to force tablets into her will just cause stress and that will be very bad for her.

Its always best to avoid long term steroid use but sometimes its going to give a cat the best quality of life irrespective of the side effect but vets should consider their human patients feelings as well as the health of the cat.

Out best freinds are not disposable objects and should not be treated as such by any vet.

[smudgepickles]

god dont they infuriate you...........I sometimes wonder if 2 vets read the same text books. 19 with CRF isnt old my Bella is 26 on 18th Jan and last year they told me it was going to be before xmas she would have to be pts, she is happily playing with a catnip mouse as I type 

I think maybe go back to the original vet ans ask their opinion

Good luck Baggy with Dinah 

xx

[Baggy]

Dinah has an allegy, we don't know what causes it, but every 8 weeks or so she has had a steroid injection which sorts it out.  Last time the vet said to try some medrone tablets, but to to take her off them as soon as the itching stopped as it's best to have the smallest dose of steroids possible because she has CRF (although her kidney levels are nearly normal now).  We did this, and she started itching again as soon as we stopped.

Took her back today, saw a different vet who advised keeping her on a dose of medrone every other day indefinitely.  I said the other vet had recommended stopping ASAP because of her kidneys and she said "yeah, but she's near the end of her life so she may as well have the steroid".  What a great bedside manner.  I know she's nearly 19 and it's better for her to be less itchy and perhaps live for a shorter time, but thanks a lot .

I'm now worried we're not doing the best thing for her by giving her the medrone tablets, and I'd rather take her in for an injection every 8 weeks (she hates these tablets and already has to have a Fortekor once a day too).

It drives me mad when one vet says almost the exact opposite of another  I know the solution is to stick with one vet, but when you've got a madly itchy pet and there's one appointment left it doesn't seem fair to hold out over the weekend.  I feel really frustrated!