Case 6

At her next visit in one month Roxy is doing great, and her weight is up to 5 kg. Her owners report that the water intake and urination have improved on the once-daily prednisone. Since her lab results continue to look stable, you decrease her azathioprine to every other day and maintain the daily dose of prednisone. You recommend rechecking her again in one month to make sure Roxy remains stable with this new treatment plan. At this point, if she continues to do well clinically, you can decrease the frequency of her follow-up visits, perhaps seeing her again in two months if nothing changes in the interim. If Roxy continues to do well, you may decrease her prednisone further with the goal of a 0.5 mg/kg dose every other day while maintaining the azathioprine every other day. The low-fat diet and monthly cobalamine will also be lifelong changes for her.

Her follow-up visits at that time will depend on how she is responding. It is not unusual for these patients to have disease relapse once their medications are decreased, so a definitive protocol for follow-up doesn't exist. As a rule, a recheck visit within two to four weeks of a medication change is a good idea. At home, the owners will continue to watch for diarrhea, vomiting, lethargy, difficulty breathing, or abdominal distention. Any of these problems should prompt a visit to you right away so you can recheck lab data and determine whether medication adjustments are necessary.

Given Roxy's positive response so far, she appears to have a good prognosis. Good job!

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