Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - A Little Good News

It's been such a sad few weeks, I'd like to share some good news with you guys - There's still hope - Winston's been sick for 7 months - had his 4th transfusion on 12-31. At the suggestion of you folks and Dr Dodd, I requested a complete serum chemistry which hadn't been done in afew months. I was concerned about liver values since Winston's been on the Atopica at such a high does for so long. On 12-31 his PCV was 19. The newest lab work came back at 32. He's highly regenerative however there are still spherocytes (sp?). The liver values are within normal range but his kidney value was up to 57. The doctor thought that might be from the high protein diet I've been feeding Winston - I'm stopping the beef liver treats - and cutting back on all others. I added the milk thistle and am keeping my fingers crossed his bloodwork in 2 wks maintains this level if not goes up alittle. He's slid backward after each time in the past - He needs to get ahead of the disease on his own rather than through the Gamma Globulin infusions and transfusions. He's been feeling pretty good for the last few weeks -has been wagging his tail more and carrying it higher than I've seen in a long time. He even ate a rawhide yesterday. (I know - I know - not good but can I take away everything he loves?) Hasn't yet shown alot of interest in playing with his toys but I'm keeping my fingers crossed. We've not been able to take a walk in a very long time which he dearly loves. Maybe some time soon.... I'm hoping Winston will be a success story - and I'm hoping to hear so many more successes from all of you.

Lisa TX

This is wonderful that Winston is feeling much better. I too am hoping that the results in 2 weeks will be awesome! Good luck...

Mardi Northern Calif

That is very good news indeed! It is amazing how things they did before they got sick we all took for granted and now when they do those same things like chew rawhide,go for a short walk, play with a toy or another dog brings tears of joy to our eyes. Keeping our paws crossed Winston has alot more good news in the very near future:) Cheryl & Ginger

Cheryl & Ginger Pinevile pa

Lisa, We always welcome good news and we are keeping our fingers crossed that Winston's next bloodwork will be great! It is so good to see them a little happy, that is all we ask for. Linda

Linda Sapphire

Lisa -- glad to hear that Winston is doing better and getting stronger. One of the lessons learned here is that it takes time, and it takes a lot of decisions from the vets to find what works right. Please take care and I'll keep you and Winston in my prayers.

Brenda VA

Hi Lisa I will be praying for more good news for Winston - a jump from 19 to 32 is incredible. Lets know how you all go. Silka

Silka Melbourne Australia

Lisa, That is a great PCV! I hope that Winston can hold his own now and continue on the upward trend. He sounds like a little trooper. Please keep us posted on his progress. Good luck! Samantha and Millie.

Samantha Geelong Australia

LISA I AM PRAYING FOR WINSTON. I WAS WONDERING IF YOU WERE DOING HERBS BECAUSE I THINK THAT MIGHT HELP A LOT. GO TO THIS WEB SITE DRHARVEYS.COM AND CALL HIM THERE IS A 1866 # THERE IS NO CHARGE ALL HE WANTS IS HIS BLood OOD WORK. IT WAS TOO LATE FOR ME I LOST MY BUDDY. I WILL BE PRAYING FOR WINSTON

LUCY NY

That's great to hear that Winston is getting better Lisa. The presence of spherocytes would have me greatly concerned. My memory is bad but was Winston diagnosed as idiopathic or was there a known trigger? How are they seeing the spherocytes?...on a smear at the vet or sent away to a specialist. They've got to get this under control or this will cause problems. Did Dr. Dodds recommend anything for this? I hope you get his Kidneys back to working properly. Atopica is known for causing renal failures so it's good you caught it when you did. HUGS and positive vibes coming Winstons way. Johnny & Tessy

Johnny

There was never a known trigger identified for the onset, however, I believe one of his relapses was a result of his receiving his monthly Sentinal - I cannot believe it never occured to me till I came to this site that, with his condition it would be inadvisable. One would expect the doctor to have said something as well - but.... Winston's most recent bloodwork was sent off vs on-site. Dr Dodd had expressed concern with the high dose of cyclosporine - 25mg 2x/day - Winston currently weighs 7.5lbs. She suggested liver damage needed to be ruled out as a cause for the most recent relapse. Weirdly enough, his liver values were normal. I've not received any other recommendations other than diet change at this point to get the Kidneys issue addressed. If I understand correctly, the spherocytes indicate destruction of the red blood cells is still going on -I just don't know what more could be added to the medication routine he's on to stop the process. I've learned from so many on this site the hazzards of the leflumide .. which Winston's doctor has suggested twice. I've given him Milk Thistle for the liver - Folic acid is suppose to stimulate the blood production - Bioprep - which Dr Dodd did not comment on when she wrote me back - along with the Cyclosporin, Azathiprine and Prednisone. His Azathiprine dose is very minimal - I need to know more about that - Lucy - you mentioned herbals - I'll check the website you referenced. When I go in next, I'm going to get a copy of the most recent bloodwork and forward to Dr Dodds office - see if she will look it over and give me some recommendations. I'll keep you posted. Thanks for all the input.

Lisa TX

Hi Lisa, Have you had any feedback from your vet or Dr Dodds on why Winston is continuing to destroy red blood cells after 7 months? Is it that he keeps relapsing? You mentioned Winston was on very low dosages of Azathioprine - did Dr Dodds mention anything about increasing this dose to try to get the destruction under control? In regards to leflunomide, a lot of people on this site don't like it (namely Patrice and Joanne), there is a thread here where they discuss their concerns. You've probably already had a look at this. I personally don't know much about this drug and it was never suggested to me by our vet to be part of Millie's drug regimen. When I queried Millie's vet on worms / flea treatments, she did not hesitate to recommend 'Advocate' topical flea/worm treatment. I was disappointed she suggested this and told her nicely that I didn't want to put anything into Millie that might over-stimulate her immune system for fear of a relapse. Leonie said there wouldn't be a problem, but I am not prepared to take the risk, even though Millie is in remission. Please keep us posted Lisa, we are hoping for the best for Winston. Samantha & Millie.

Samantha Geelong

Lisa, That is such great news about Winston..I will keep you both in my prayers...Kelly

Kelly Redding

Lisa: I just wanted to mention that Atopica can cause the elevated kidney values (elevated BUN and creatinine) you are seeing. It's a rarer side effect of high doses over a prolonged period of time (affected 2.65% and 7.8% respectively of the dogs in clinical trials). We had this same problem with Sheba and at first we thought it might be related to her age (she was approx. 12 at the time and the vet thought she could be developing kidney issues) and so we switched her diet for a while. Then I found the above information and sure enough - after she was totally weaned from the Atopica her levels dropped to normal or near normal. You might want to check out Atopica's website (http://www.us.atopica.com/product_label/en/index.shtml) and share the information with your vet. Hopefully Winston's values will start to drop as you start to lower his dose of Atopica. Good luck and it's great to hear he's doing well otherwise! Rita, Mike and Sheba

Rita IA

I'll pick up the copy of Winston's bloodwork on Monday - His doctor is about an hour away so she called me with the results earlier so I haven't gotten my hands on the details. Dr. Dodd did not respond specifically to the dose of Azathiepine. She was more concerned with the amount of the Atopica he was receiving. But when I email her again, I'll ask her opinion on what she thinks the best combination would be to stop the destruction. As to the relapses...He's never actually been stable -After each transfusion/gamma globulin infusion he's been up over 30 but slowly dropped. My giving him the Sentinal was after the first transfusion. I think it contributed greatly to his needing another so quickly after the first. As soon as I get the detailed report, I'll make contact with Dr Dodd and let you all know about her suggestions and pass them along. I know several of you have mentioned spheracytes were seen in your bloodwork as well. Thanks for all your insight out there - and the new info to read. I'll be prepared for his next appointment!

Lisa TX

Hi Lisa, Millie stopped having spherocytes in her blood after about 4 weeks or so I think from memory. 7 months is a long time, so I guess the destruction has never been under control if Winston has never been stable. What does Dr Dodds say about Leflunomide? I'm confused here on this drug - do you try it if nothing else is working? Keep us posted, I hope you get some answers soon and stop the destruction, you'd be very keen to get Winston off these high doses of drugs as soon as you can. Samantha & Milie.

Samantha Geelong

Sounds very frustrating for you Lisa. 50mg of cyclo/daily is an awefull lot. Usually the recommended amount is (to start) 10mg/kg/day so for Winston that would be 34mg daily. Now, I've heard in some cases where vets will start slightly higher than this but this is only until there is a response. Tessy was taking 200mg/daily for months when the starting dose should have been 175mg/daily. I could see them starting Winston on 40mg/daily for the first maybe week to a month (or like TEssy "months") but usually this gets tapered back to 5mg/kg after the first week if there's improvement. What are the amounts of the other drugs Winston is taking. Prednisone starts at 2mg/kg....so in Winstons case approx. 7mg (perhaps 10mg would work here)...they usually start at higher levels. Azathioprine starts at 2mg/kg also so the same amounts as the pred. I'm not sure what sizes are available for aza...50's??? Maybe 1/4 tablet to start (12.5mg???). It's a little too high but I don't know if you can get the aza compounded and I also heard it wasn't wise to do. It's also very hard to split a 50mg aza cap more than quarters even with a really good pill cutter. Perhaps you could try danozol. Ask Dr. Dodds about this drug. It works (I think) with the pred to inhibit the binding capabilities of the antibodies that stick to the RBC's. Danazol is very pricey and may be hepatotoxic to the dog so ask with caution. Lisa...have you ever considered contacting a TCVM or an acupuncturist? I've been hearing lots of good things about both with regards to AIHA lately. The fact that Winston is highly regenerating is such a good thing. Just gotta get the destruction under control. I'd higly recommend doing this!!! I'ld drop the bioprep if I were you. I know Dr. Dodds doesn't think it's entirely safe for a dog on immunosuppressing treatment. Add Pet-Tinic to his food daily as a good blood builder. I saw HUGE results for Tessy once htis was added. I'd also assume you had his thyroid checked already. Sometimes low dose thyroxine will help. Ask Dr. Dodds this also. I wouldn't mind hearing a brief history of everything that was tried thus far...if you don't mind. Email it to me if you'd like or just post it here. Sorry to ramble so much. If I can help in any way possible it means so much to me. I know when Tessy first got sick I would have been lost if it weren't for people like Patrice and Joanne. I'll keep Winston in my thoughts and prayers. Hope to hear an update on him soon. Johnny & Tessy

Johnny bluemajestic@hotmail.com

Hi Johnny, In relation to the Azathioprine, we were able to get Imuran in 25mg tablets. I just cut this in half for Millie initially (Millie is petite at about 4.5kg, which must be about 9 pounds or so), so she could get the 12.5mg recommended dose. Samantha.

Samantha Geelong Australia

Hi there Just to add that I know nothing about Danazol, but that was what was suggested as a possibility for Riley, in addition to increasing everything else, but the vet said he could only have it for two weeks as it was extremely toxic to the liver and he already had damage. Riley was also on 50 mg of cyclosporine for the last while, hoping it would stabilise things and then be able to reduce, but unfortunately not so. Good luck Lisa, with Winston, prayers from Downunder for a turnaround for you all. Silka

Silka Melbourne Australia

Samantha, I figured it was available in smaller pills somewhere. I asked the doctor here if I could get it in smaller dosages than the 50mg we were using and they said I couldn't. I'm currently splitting a 50 into quarters for Tessy. They are never the same size! Maybe it's a Canuck thing???

Johnny

Johnny, I just had to 'Google' Canuck, never heard that term before - now I get it! :) Maybe it is a Canuck thing! I HATE cutting the pills too - I have to cut the 25mg into quarters now.... and it is never the same size. I'm often disposing of quarters that I have cut too small (scared of not giving Millie enough!). It would be easier for you if you could get a 25mg and only cut it in half! Never mind.

Samantha Geelong Australia

Lisa, Ruger started the leflunomide a week ago and so far so good. Still disease present but I will keep ou posted. We started him on a low dose so I hope that next week we see improvement. Johnny, Dr. Dodds does not suggest the bioprep. I have Ruger on this and have een wondering about it as my vet is not a fan of it either. What is the reasoning behind this? Seems a lot of web pages suggest it but is this just from the strong advertising? Just wondering.

jaime parker

Jaime, she says that the Bioprep is not entirely safe for a dog on immune suppressing therapy. I'ld recommend switching to pet-tinic if possible.

Johnny

Just checking in on Winston. Any news as of late? Prayers and best wishes for him. Johnny & Tessy

Johnny

This thread was discussed between 17/01/2010 and 26/01/2010

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