# IBD again



## zuma (Nov 5, 2009)

I'm hoping you guys with experience with IBD kitties can give me some advice. 
Leelu was diagnosed in May and after a round of Metro she seemed back to her usual self. About 2 weeks ago she started having intermittent diarrhea, one time completely normal and the next cow dung style. The vet put her back on the Metro and B12 shots which worked just fine for about 10 days. She had another bout of diarrhea just as I was starting to wean her off. I thought I may finally have identified the can that doesn't agree with her and we kept doing Metro every other day. This morning she woke me up scratching the box and (sorry for the graphic descriptions) there were a couple of fully formed poop roll and a tiny bit if diarrhea, but vomit everywhere. She looked uncomfortable and nauseous. I gave her a quarter of Pepcid this morning and it seems to have helped settle things down, but I'm back to square one. 

TL;DR
It looks like the IBD is flaring up while on metro, what medication would you try? I know they all have side effects and it's a matter of figuring out a combo that works but I'm worried. I know long term cortisone is bad for the heart and kidneys and longterm metro has a host of problems associated with it too and I think doodlebug said in another thread that it may be contributing to have IBD progress to lymphoma. I'm calling the vet in a few hours, but I'd like to be as informed as possible. If anyone has any advice and/or experience, please share. Thank you.


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## doodlebug (May 13, 2006)

What is she eating...specifically...canned, kibble, raw? Brands and flavors? What foods has she done well with, what ones do you think are issues?


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## zuma (Nov 5, 2009)

She's eating all canned now, a mix of Weruva, merrick and wellness core. She did best on raw, but she won't eat it anymore, not home made and not commercial. Not even a lick. 
I don't know if the metro makes her feel odd, but she did the same last time, after about 10 days on metro she gets very picky and while she is hungry and complains for food, every can I open she just turns up her nose. So when she did that I gave her one if the fancy feast cans I keep for emergencies. She licked the plate clean, but had diarrhea a few hours later. So I assume something in that can doesn't agree with her at all.

I try to avoid chicken as much as I can, but she just doesn't eat enough of the other stuff. I have yet to find a can of an other protein source that she actually likes and will eat. It's so frustrating.


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## texasgirl (Feb 27, 2013)

It could be that the particular kind of Merrick and Weruva has higher carbs so I'd look into that.

My brother's cat has IBD and he was going diarrhea for years before we finally got it under control. His kitty, Cody, was on Leukerin for a while ( a cancer drug) and then went on prednisolone afterward. He was still going diarrhea constantly until we looked at what he was eating. We switched to EVO 95%, Nature's Variety Instinct and Merrick (pate only). His poos were better but still very soft so we went on the Instinct organic raw (chicken) It was the raw that cleared it up for him. He doesn't have a problem with chicken.

My brother got lazy a while back and fed Fancy Feast pate food. Immediately afterward Cody would do a nasty, horribly stinky poo, along with a pile of vomit. He's learned to stay away from that food!


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## zuma (Nov 5, 2009)

Thanks texasgirl. I'm not sure whats causing the problem, but is high carb commonly an issue with IBD?
I'd buy anything if it'll help her, but she's such a picky cat. She won't eat nature's variety instinct, or any pate from merrick. The only pate she eats is wellness core (and fancy feast). She likes the Weruva stuff the best, but that's either fish or chicken in gravy, so I don't want to feed it too much. She won't touch raw anymore, but I used to freed her raw chicken and that never caused any problems, so I'd be inclined to think it's other ingredients more than the actual chicken. I just wish I could get her back on raw. I keep trying, but she won't even touch it if it's mixed with her food. 

I left for an hour or so and when I got back she looked better, begged for food. I wanted to wait a bit longer to settle her stomach, so she had water and promptly threw that up as well. Poor thing, I just wish I knew I how to help her.


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## texasgirl (Feb 27, 2013)

High carb food IS an issue with IBD, unfortunately. And that makes me mad, too. These pet food companies will peddle their food as nutritionally balanced but won't put the carb % on their label. And they'll tout their food as hi-protein but most of the protein is from plants and not meat, so the cat is not getting the adequate protein it needs.

Gravy is very high-carb. It's tough that you're in Canada, as I don't know what food brands are available to you. Here's a list I carry around with me that show the amount of carbs in each wet food can.

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdg 

Hope there are some brands of low-carb food on there you can use!


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## texasgirl (Feb 27, 2013)

Oops...

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf


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## texasgirl (Feb 27, 2013)

I think I got your location mixed up with someone else's. Not sure if you're in the USA or not.

Have you tried a bit of cooked chicken breast on top of the raw to see if she'll eat it? Sometimes that helps. Or freeze-dried chicken mixed in with it? Raw really is the best diet for your baby.


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## texasgirl (Feb 27, 2013)

And if she continues to vomit you should stop the Metrodonizole (I am assuming that is what Metro means?)

Sorry for so many posts!


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## zuma (Nov 5, 2009)

Thanks for your posts. I am in Canada, but the local independent store carries a pretty big variety. Nearly all of which I've tried at some point. Thanks for the list, that's interesting and I'm definitely keeping that. The large majority of foods I feed seen to be below 10, but there's a few that are above. I'll take it with me on the next shopping trip. 

I've tried giving her cooked chicken but she's not a fan of it alone and not when it's mixed with anything. For a while the bonito flakes and fortiflora worked, but not anymore. 

And yes i mean metronidazole. I've been told I shouldn't stop it abruptly. This seems very similar to what we dealt with in May, same miserable look, can't even keep the water down and just seems uncomfortable.


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## texasgirl (Feb 27, 2013)

The ideal amount of carbs for a cat is between 0-5% but NO MORE than 10%. Maybe if you get as low carb as possible it might help her. And just so you know, NV Instinct Dry Chicken (with raw coating) is 13% carbs. It's higher than the 10% but still much lower than most dry food brands out there (Evo is supposedly 8 carbs but tests were done and it was really around 13%. Wellness Core claims theirs is 11%)

I didn't know you can't stop the metro immediately. My brother's kitty was on that once and he was never told that. I do know you can't just stop Prednisolone, though. You have to be weaned off it or it could be fatal.


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## texasgirl (Feb 27, 2013)

Here's a chart for carb % in DRY food: 

Dry Cat Food Nutritional Information 

Notice that Nature's Variety Instinct Raw says 7% but I contacted the company and it's actually 13% for Chicken and 15% for Turkey/Duck.

It's astonishing how many carbs are in most dry food!!


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## zuma (Nov 5, 2009)

Oh ok. I was going by 10% because of what the chart says, basically 10 and below is likely very little carbs. I will pick up a few low carb ones, but I think I tried most before. It's so tough when you know what they should eat and they simply won't touch it. 

I'm not planning on feeding any dry, but thanks anyways. 

From what I've been told, it's not that it would be fatal or anything, but chances for a worse flare up increase if you stop suddenly. But anyways, hopefully the vet will call back soon with a plan. I'm assuming he'll want to put her on prednisolone. I'm not keen, but we have to do something. She almost got her weight back after losing a bunch in May. It's so frustrating and I know i haven't even experienced the worst of this whole IBD thing yet, but I hate it already.


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## Heather72754 (Nov 1, 2013)

Poor Leelu, and poor you - so sorry your girl is going through this. When she vomits, does she frequently vomit near/around the litter box? My cat with IBD used to do this and come to find out it was because it was painful for him to move his bowels and therefore would cause him to be nauseous, poor guy.

He was tried on Atopica, which is an off-label use of an atopic dermatitis drug, but I have to say it didn't help him. We only started it a short time before we lost him, so I don't know if it would have eventually been effective or not. I have read where there are many people who have had good results with it, but you would have to talk to your vet. It's not a really obnoxious med either, so if you're used to dosing Metro you'd have no trouble with this one.


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## doodlebug (May 13, 2006)

Ok...I'm just going to start babbling and hopefully there will be some sense to it...

Food: 

I know you said she went off of raw. Have you tried RadCat or Vital Essentials? These come in tubs rather than little medallions or patties and are pretty juicy. Kobi wasn't into Instinct or Primal Raw, but he loves RadCat and VE. Have you tried freeze dried raw? Holly won't eat regular raw, but loves Stella & Chewy's freeze dried duck duck goose. She loves it dry but won't eat it hydrated. The rep told me to just add the water and float the pellets on it...and she eats it that way and gets in most of the water too. 

Yes, carbs are harder to digest especially since they don't have a large amount of the enzymes needed. But given that you are using good canned foods, you're in the right zone and I wouldn't be overly concerned about it. But I would add a probitoic/digestive enzyme supplement (I like Animal Essentials or Wholistic Pet). This makes it easier for her to digest her food, her gut doesn't have to work as hard. 

I would eliminate carrageenan, although that may be difficult given her pickiness. Weruva Truluxe and Cats in the Kitchen are carrageenan free though. 

Meds:

If she responded to the Flagyl and then started having issues when the course was finished, maybe she needs to be on it long term. As we know, it has it's risks when used that way...but chronic vomiting and diarrhea surely will cause more issues. Definitely do a probiotic if using this...since it's an antibiotic it's not only killing off the bad bacteria in the gut, but the good as well. 

Tylosin is another antibiotic that has been used successfully for IBD, although I'm not sure about the side effects. Something for you to research.

I would look into Budesonide before using Pred. Still a steroid, but with lower side effects. 

Atopica (cyclosporine) was mentioned. It didn't do anything for Kobi, he got significantly worse while on it. 

There's also the Leukeran (chlorambucil) that Kobi is on. Wicked expensive in the US, but since you're in Canada it's affordable (about $40 a month if taken every 3 days). Kobi has tolerated it well except for 2 things...it lowers his immune system so his herpes flares up. He's on 1000mg a day of l-lysine. He still has one eye that's a bit watery, but no big deal. His blood tests have shown a low white count twice now, the second time bounced right back up. He has a vet appt on Thurs to see if it recovered this time. 

Other Supplements:

B12 shots twice a week at a dose of .5ml. Even if her blood test doesn't indicate that she needs it. For some reason it helps the IBD kitties.

Salmon oil is an anti-inflammatory has has been found to be helpful.

Slippery Elm is wonderful stuff. It can be made into a syrup (recipe on littlebigcat.com) and given about 1/2 hour before a meal to help sooth the digestive tract. It also has a lot of fiber, so it helps keep the poop formed but soft. If she's vomiting near the litter box it's usually associated with straining to poop...that can occur with constipation or with diarrhea. SE would be beneficial for either situation. 

Another med for vomiting is Reglan, but honestly the SE worked better for Callie than Reglan or Ondesteron (brand name Zofran). 

Lots of small meals are easier for them to deal with than 2 a day. Callie was up to 6 when I finally lost her.

Hopefully there's something in all of this that will strike a chord with you...let me know if you have any questions.


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## zuma (Nov 5, 2009)

Thank you so much doodlebug! I'm going to print this and refer back tomorrow for the vet consult and the shopping trip following. 

I have tried RadCat, but couldn't find Vital Essence. She had maybe one lick of the entire tub of RadCat. I've also tried freeze dried, no luck, rehydrated or just as is. She actually looks at me as if I'm nuts. I've also bought some nuggets, I don't remember the name now, but she also made it clear that this is not food to her. I don't know what turned her off of it completely, but ever since she first got sick in May, raw has been out 100%. I want to keep trying, I know she did best on it, but maybe if she feels kinda yucky, she doesn't want it. I'm actually considering putting her back on the elimination diet of a local company she was on several years when the allergies first flared up. I've asked them to send me a nutritional analysis first though. I know a lot more about nutrition than I did then. 

Again, thank you so much, I'm going to pick up some supplements and I'll have a chat with the vet tomorrow to see what we can do for her. I hope she can keep down some of her dinner, but she's finally asleep now. I may have more questions tomorrow. thanks!


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## kwarendorf (Oct 12, 2009)

Franklin has IBD, diagnosed via biopsy. The only thing that keeps his IBD under control is prednisolone. He has been on a maintenance dose (5mg every other day) for over 4 years, and will likely be on it for life. I move a couple of years ago and the new vet, a recent grad, tried to wean him. It didn't work. when the does got down to 2.5mg every other day the runs and vomiting returned. I went back to my old vet and his view is that the risks associated with pred use are far less than the risks associated with active IBD.

Kyle


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## zuma (Nov 5, 2009)

Thanks for sharing your experience. I've kinda come to the same conclusion. I still don't really want her on meds longterm, but it's not about what I want. I'd rather she have a happy, pain free life that may or may be not be a bit shorter, than a long, miserable one without any drugs. I think I'd make the same choice for myself. Though I may need you all to remind me of this some day. 
The vet suggested to try the high dose of metro again for a week, and if there is no improvement or getting worse we'll add the steroids. Initially she perked right up, but I can tell it's not doing enough and it kills her appetite. So I'm calling with an update tomorrow and we'll likely start the steroids and hopefully that will settle things down for her. Poor girl. And I've got a whole slew of supplements, none of which she is taking now, but I'm hoping the steroids will make her hungry again.


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## zuma (Nov 5, 2009)

*Metronidazole side effects*

Has anyone dealt with side effects from metro? Leelu has just been off while on it and I'm just waiting for a call back from the vet or I'll zip off to the e-vet. 
I've googled the side effects and they seem to match somewhat. I'm even more suspicious because she's been similar on the last round of metro, but less pronounced. I'll trust an actual vet or people with real experience over Dr. Google though. 

She completely lost her appetite and seemed nauseous when on twice a day 75mg metro. I've also noticed her miss a step, but didn't really think much of it. Now that we started the pred, the appetite is back, but she's still lethargic and I noticed her face twitch a couple of times. I also saw her breathing really fast for a few minutes and then back to normal. I'm just worried these are neurological side effects I read about. Does anyone have any experience? Is it possible or is something else going on?


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## RockyandLily (Aug 2, 2012)

Lily had what I believe, was a seizure while on it. We immediately stopped it, and the vet just said to stop it and keep an eye on her. I remember reading that neuro side effects were rare, but maybe they are under reported.I think that metro crosses the blood brain barrier.


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## zuma (Nov 5, 2009)

*Metronidazole side effects*

I just talked to the vet and he said the same thing. They're rare and more common with higher doses than she gets. Said it might be the pred because we just started that, but I really think it's the metro. These side effects have been around before we started the prednisolone and google doesn't say anything about such side effects from the steroids. Though I suppose they could make her feel a bit odd.
He said to reduce the pred tonight and if it's not better by tomorrow, we'll take her off the metro. I'm not sure I want to give her more metro, but I'm not a vet.


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## zuma (Nov 5, 2009)

Rockyandlily, did Lily have any other side effects? How long did it take for the side effects to go away?


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## RockyandLily (Aug 2, 2012)

I don't think she had any other side effects, but the problem happened after her dose was increased, she was a kitten at that point. We stopped giving them to her, and. She has never had another problem like that *knocks on wood* I will never give it to another cat.


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## zuma (Nov 5, 2009)

Thanks. I've pretty much decided to not give her the metro tonight and see. I don't want to take a chance. She's just not herself since we started it and it's getting worse.


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## texasgirl (Feb 27, 2013)

Well, I am a pet sitter and I had to care for a German Shepard while my clients were out of the country and they had just recently put her on Prednisolone. (Like, the day before)

She started vomiting and going diarrhea, then panting really hard. It scared me so I called their vet and asked if I could cut the dosage in half because it was too high for her. So, instead of 2 pills twice a day, we went down to 1 pill twice a day. The tricky part is you can't just stop the drug because it can be fatal so you have to wean the animals off it. The half dosage worked much better.

I imagine kitties can have the same symptoms. Maybe cut the dosage in half (but consult with your vet first!)

I hate to say it but I don't like Prednisolone. That drug makes me very nervous. So, it could actually be the Prednisolone. I wouldn't discount it.


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## laurief (Jun 22, 2008)

This is directly from the current edition of the primary veterinary drug reference, _Plumb's Veterinary Drug Handbook 7th Edition_:

Under Metronidazole, Adverse Effects: "In cats, vomiting, inappetence, hepatotoxicity and rarely, central nervous toxicity can occur with metronidazole therapy ... Genotoxicity was detected in peripheral blood mononuclear cells collected from cats after 7 days of oral metronidazole, but resolved within 6 days of discontinuing the drug. Clinical significance, particularly with chronic therapy, is yet to be determined."

and under Overdosage/Acute Toxicity: "Signs of intoxication associated with metronidazole in dogs and cats, include anorexia and/or vomiting, depression, mydriasis, nystagmus, ataxia, head-tilt, deficits of proprioception, joint knuckling, disorientation, tremors, seizures, bradycardia, rigidity and stiffness. These effects may be seen with acute overdoses, ... or in some animals on chronic therapy when using "recommended" doses ... "

Laurie


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## zuma (Nov 5, 2009)

Thank you Laurie. Would you be so kind to check the prednisolone side effects? Google didn't list any symptoms like those, but I guess every animal can react unpredictably. 

She definitely checks a few of those. She seems more herself this morning, but maybe that's a bit of wishful thinking.


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## texasgirl (Feb 27, 2013)

zuma said:


> Thank you Laurie. Would you be so kind to check the prednisolone side effects? Google didn't list any symptoms like those, but I guess every animal can react unpredictably.
> 
> She definitely checks a few of those. She seems more herself this morning, but maybe that's a bit of wishful thinking.


 
The side effects can include increased thirst and appetite, vomiting, diarrhea and others. ( I will look that up.) It's not really supposed to be given to young cats. How old is your kitty?


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## zuma (Nov 5, 2009)

She's 10. Increased appetite for sure, which I thought was a good thing because she hardly ate just on the metro. But nothing else out of those.


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## texasgirl (Feb 27, 2013)

Didn't you say there was a brief period of fast breathing? Could that be in line with the panting side effect listed?


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## texasgirl (Feb 27, 2013)

And restlessness is another side effect. I wonder if there's an interaction with both drugs being used at same time? She's on metrodonizole too. Did your vet say anything about this?


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## laurief (Jun 22, 2008)

From Plumb's ...

Prednisone/Prednisolone Contraindications/Precautions/Warnings: " ... particularly cats, at risk for diabetes mellitus or with concurrent cardiovascular disease should receive glucocorticoids with caution due to these agents' potent hyperglycemic effect."

Adverse Effects: "Adverse effects are generally associated with long-term administration of these drugs, especially if given at high dosages or not on an alternate day regimen. Effects generally are manifested as clinical signs of hyperadrenocorticism. ... Cats generally require higher dosages than dogs for clinical effect, but tend to develop fewer adverse effects. Glucocorticoids appear to have a greater hyperglycemic effect in cats than other species. Occasionally, polydipsia, polyuria, polyphagia with weight gain, diarrhea, or depression can be seen. Long-term, high dose therapy can lead to "Cushingoid" effects, however."

Overdosage/Acute Toxicity: "Overdoses of glucocorticoids used alone are unlikely to cause harmful effects ... Chronic usage of glucocorticoids can lead to serious adverse effects. Refer to Adverse Effects above for more information."


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## zuma (Nov 5, 2009)

She isn't restless, but yes some periods of rapid breathing. It was strange though, because she was quietly lying on her tree and it just came on and went away and didn't really seem to phase her. The second time it was right after eating, but again, didn't really seem to bother her. It lasted a few minutes and it sure freaked me out. 

I think I'll be looking for a new vet again. He just said that it's a very common drug combination for IBD with small chances for immediate side effects. Longterm is another story on the pred I do know that. But he thought it was very unlikely to be the metro. To me, losing her appetite and being uninterested to play or explore while on the metro alone is enough proof that she does have a reaction to it. What I don't know, if it's a combination or just a matter of being too long on the metro. He did say to reduce the pred and that we'd have to stop the metro if she's not better today. But I've made the decision last night to stop the metro.


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## zuma (Nov 5, 2009)

Thanks Laurie. Definitely seems to me that the metro would be the culprit. Although I suppose combinations can cause weird effects. Hopefully she'll be back to normal soon.


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## laurief (Jun 22, 2008)

There's another section in Plumb's that discusses glucocorticoids in general that contains a LOT of other potential side effects and adverse effects, but those are related to that class of drugs in general, not to prednisolone exclusively or specifically.

I don't know if you've discovered or explored the following feline IBD information website, but if not, you definitely should:

Welcome to IBD Kitties - Introduction


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## zuma (Nov 5, 2009)

Thanks for the link Laurie, I'll read through it. 

I was very reluctant to put her on steroids, but she was so miserable I had to do something. I'm hopeful we can maintain her on a low dose. It sounds like that can cut the chances of long term side effects by quite a bit. I've thought about it long and hard, but I think i'd make the same choice for myself. Life quality of quantity. Although I know, I'll feel guilty. But I'm going to call a few vets around here and see if I can find someone with lots of experience with IBD. I liked my vet, but I didn't care for being brushed off with what I think are valid concerns.


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## laurief (Jun 22, 2008)

If you read through that link, it will provide you with other treatment options to discuss with your vet. You may still decide on prednisolone, but you should do so as well informed about other potential options as possible. I've put cats on pred in the past, as well, for various medical reasons, but it's always a seriously considered option and not one that is easily or comfortably reached. Sometimes, however, it does seem to be the best choice under the circumstances.

In case you miss it on the IBD Kitties website, there is also a link to the IBD Kitties Facebook group where group members discuss and offer support and guidance to each other. You should join that FB group, as well. Here's the link: 

https://www.facebook.com/groups/527768930622787/


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## Mandy and Ellie (Oct 22, 2013)

My dog was on Prednisone before he passed away from cancer and had the SAME side effects. We had to take him off of it because he was just not himself and seemed like it made him feel weird.


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## zuma (Nov 5, 2009)

Thanks, I've been avoiding Facebook, but I might just join for my little furball. 
I'm so relieved, she's much more herself again. Interested and more active and doesn't have that 'out of it' look about her. Not quite normal but much more so than yesterday. The vet also called me back to see how she is and to tell me to take her off the metro. Maybe he read up on it! 
Hopefully the symptoms stay under control.


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