Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Cody spiraling downward

Hi everyone, Cody is caught in the typical "catch-22" with his AIHA.......we're happy his PCV level is up to 40, but the "cure" is gonna kill him....still on the prednisone, and constant antibiotics for the skin infections, and the diabetes which is not getting under control......he's lost 25 lbs. in 6 months.....remember, this poor dog is only 2 YEARS OLD!!!! He has scaling under his coat all down his back, smell coming from his ears and body....it must be yeast from his weakened immune system....so I'm putting him back on a pro-biotic.....does anyone know of a good one for dogs? He's headed in the wrong direction with all these drugs....I want to cut back on the prednisone, but my Vet is afraid to "rock the boat" right now......he's actually seeming worse on the insulin shots.....urine accidents all over.....more drinking and peeing than ever......this is no life for such a wonderful sweet soul.....Thanx for letting me vent, and any in-put....Tammy and Cody

Tammy/Cody N.J.

Tammy, I'm sorry to hear of these setbacks. First, since his PCV is in the correct range is it possible to start reducing the meds? Is the destruction under control? Perhaps you can start to reduce to a maintenace dosage now. As for the skin infections I've been battling the same thing with Tessy for the past 8 months. The best antibiotic for this would probably be cephalexin (keflex). This works wonders for the skin conditions. I also bath Tessy frequently with Panoxyl soap with 5% benzoyl peroxide. This helps. I've also used Selsun Blue (red top) the medicated shampoo. This works really well also. If the ears are smelling it could be a number of things but most likely they will put him on drops for this. Tessy ALSO had to have this done and a few weeks of drops cleared it right up!!! She had yeasty ears. I think your best bet might be to consider reducing the pred...even by a little. Johnny & Tessy

Johnny

Tammy, while I have actually no advice to give for what your Cody is battling I just want you to know that I am thinking and praying for you...Kelly

Kelly Redding

Ginger did not do well on the pred and we had to slowly reduce it and then stop it. What other drugs is Cody on? Ginger's PCV did not drop when we reduced the Pred, she stayed on the Aza and cyclosporine. Maybe you should ask your vet again about reducing the pred, how much is Cody on and how much does he weight and how long has his PCV been in the normal range? Sending our prayers to you and Cody. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Hi Tammy - I'm sorry to read about all you are facing with Cody right now. Not all dogs tolerate all of the IMHA meds well (mine was one of those). If your vet feels Cody needs to be on an immuno-supressant dose right now and, therefore, you can't lower the pred, have they considered alternative meds that Cody may tolerate better? If they aren't willing/able to do that, I might seek a second opinion if you are able b/c there are different options out there and, while pred is generally acknowledged as the cornerstone of IMHA treatment, sometimes it takes a different med or a lower dose of pred in combination with another for a particular dog. Best wishes for you and Cody - you're right - two is awfully young to be fighting so I hope you are able to find a solution that works soon. Take care. Bonnie

Bonnie Chicago

Tammy, I would ask them to consider just aza and cyclosporine. Maybe reduce the pred. From my research, until Cody can get off the pred- there will be side effects. Macy lasted only a month on the drugs but I saw what direction she was headed. Even if she made it, it would not have been a "good" life. It is a catch 22 but lowering the pred gradually would seem to be the best choice at this point. Keep your spirit up.... -Darren

Darren Long Beach

Hey Tammy, Just checking to see how Cody is doing?...Kelly

Kelly Redding

Thanx so much for all in-put and kind words.....Cody is about the same today....the reason my Vet hasn't tried other immunosuppressant drugs is because his PCV responded good to the pred, and she says they all suppress the immune system....that's what they're suppose to do, to help with the destruction of the red blood cells.....but than of course you have a weak immune system......I started him on Forti-Flore Pro-biotic to help build his immune system back up....I'm praying it strengthens him.........my Vet also insists 1 year on pred. shouldn't create ALL these problems...that Cody has a weak constitution in general, and he would have gotten diabetes eventually......It's hard to say....I don't know enough about other cases to make an intelligent assumption on this one.....Tammy

Tammy/Cody N.J.

Dear Tammy, Can you please post some more info about Cody's history? What Pred dosages is he currently on? Has he had IMHA for 6 months? When did his PCV reach the normal range? His PCV is in the normal range at 40 - that's certainly good news. Have you reduced the Pred over the time Cody has had IMHA? How long has it been since his PCV has been stable? As you start to reduce the meds, the problems Cody is having will reduce. It may be good to consider Azathioprine or Cyclosporine as a second drug. They do all suppress the immune system, but work in different ways and have some different side effects to each other. Some dogs tolerate some meds better than others. It is not ideal to leave dogs on high doses of immune supressants for prolonged periods of time if they don't have to be. I don't feel your vet would necessarily be 'rocking the boat' by reducing the Pred if all Cody's results are good - no spherocytes present, normal PCV etc. Reductions should be done at between 25-33% of dosage at a time. This is the schedule I followed with my dog Millie who has been fighting this disease for just over a year. She is no longer on Pred (reduced and discontinued over 9 months), and is on a maintenance dose of Azathioprine, which she will probably be on for the rest of her life. We started reducing the Pred from 10mg a day, to 7.5mg day, to 5mg day etc etc.... Keep us posted on Cody's progress. We all know what you are going through! All the very best to you and Cody, Samantha & Millie.

Samantha Geelong Australia

Hi Tammy, I would also like to know what dose he's on, and how long he's been on it, and if it's been reduced at all. A year on a high dose of Pred would be very difficult for any dog to handle. When tiggs was first diagnosed, he was on 120 mg/day, and I thought the meds alone would kill him. When he began to stablize, we followed the protocol that Colorado State and Dr. Dodds prescribe: that is, when the PCV is in remission range, and there is no further destruction, you can start reducing the meds by 25-30% every 2-3 weeks of stable disease. Once we began that reduction schedule, the effects subsided. Tiggs also developed hypothyroid, which is very common in IMHA dogs on Pred...so you could have this tested, which might explain his skin scaling, smelling, etc. Just some thoughts. I hope this helps and you get on a good medication track. melissa and tiggs

melissa slc

Tammy, is he still on the 40mg/day of pred for a 60 pound dog? You said before that everytime you reduce the pred he crashes really fast and becomes sick. How exactly did you go about reducing each time and how low did the pred dose get before he started crashing? Perhaps you are handling the reductions wrong? As far as the diabetes goes....yeah long term pred is known to cause this and likely isn't helping it any. Did you get the MRSA taken care of yet? If you can you should find out Cody's Retic counts and his most recent morphology. The later will tell us what the RBC's are looking like....spherocytes, polychromasia, etc, etc. Very important numbers to follow...especially in Cody's case where you aren't sure what's going on. Is it possible he isn't getting all the nutrients required to make and build blood? I don't know what else to say. I'd strongly recommend you contact Dr. Dodds and have a sample of blood sent to her for analysis. This was one of the best things I could have done for my Tessy. Dr. Dodds will notice things some vets won't. There's a test she can do that will check her thyroid (breed specific!!!), CBC, and Chem profile all together. She will write her own analysis down for you which is great. To me...I don't quite understand the reasoning of your vet and his knowledge/experience in dealing with this disease. That's why I'd send the blood to Hemopet. Plus they look at the blood and do hand counts which is the most accurate way to analyze blood. If you are interested just let us know and we'll add the site for you. Give Cody some BIG Canadian Hugs for me. Johnny & Tessy

Johnny

Tammy - Your vet is right in that other meds will supress the immune system BUT those other meds may be tolerated better than pred by some dogs, i.e., not have the side effects. As you know, no med is without side effects, it's just a matter of finding which one works better for Cody. As others have said, I really think it is worth looking into given the concern you've expressed for Cody. If your vet isn't open to the idea, I would talk to another if you are able - many of us have had to seek a second opinion in the midst of treating IMHA. Dr. Dodds is also a good resource - she is in the EU until Feb. 4th but she's been corresponding with me via email so I'm sure she would get in touch with you as soon as she could. Take care - Bonnie

Bonnie Chicago

Is there anyway possible you could get a second opinion, maybe a phone consult with Dr Dodds or a vet who has experience in treating AIHA in your area. I think the phone consult with Dr Dodds is about $30.00 Sending our prayers for Cody Cheryl & Ginger

Cheryl & Ginger Pineville PA

Hi everyone, It's Friday 10:00 a.m. in N.J. and I just read all the wonderful comments/info. from everybody.......WOW...you all sure know what you're talking about from your experiences.This is Cody's AIHA history......when I rescued him at 2 months old he seemed healthy/fine....but 5 days later he "crashed"....shallow breathing, listless, etc...Rushed him to the hospital where they never really could figure it out....but he came out of that and got better ( I later found out he had a low PCV than which was NEVER EVEN MENTIONED!!!) After he was neutered at 6 months ( required by rescue I got him from ) he was lethargic, not the same, frightened, didn't breathe right under stress....my point is, I think he's always had AIHA. Than last Feb. he had his booster shot and bloodwork,( which he didn't feel well from ) and my Vet called and said she saw the AIHA in his bloodwork ( PCV 18 ) and rush him to the hospital cause he could die from this. He was put on just 20 mgs. of pred. 2xday cause he weighed 40 lbs. They put him on docycycline in case he'd been bitten by a tick. His PCV went from 18 to 25 right away and cont'd. to linger at 25-34...so in May we cut pred. to 30 mgs./day instead of 40...but within 5 days he crashed with PCV of 20. So back on 40 mgs. pred./day and he climbed back up to PCV 30-34, and now up to 40. But he's had the MRSA leg infection since May being treated with 100 mgs. Zeniquin 1xday, and now Clindamycin 150mgs. 2xday. His insulin shots are 17 units 2xday for his diabetes...which I'm told is really hard to regulate. sorry 'bout the long e-mail, but everyone wanted more info. Thanx for CARING!!! So that's where we're at right now...he eats, plays alittle, isn't in pain...but my Vet said the diabetes is his biggest problem right now because it can destoy very quickly if not gotten under control. But you have to gradually increase the insulin, after doing the glucose-curve every 2 weeks.....hope this gave some insight....Sincerely, Tammy and Cody P.S. Cody has 2 brothers and a new puppy-sister, so things are pretty crazy here......

Tammy/Cody N.J.

I've got a feeling your vet isn't fully qualified to treat or deal with this disease. This is a VERY REAL and often occurance, which is one of the main reasons we always insist on contacting a specialist...Dr. Dodds being the most knowledgable. If this were me I'ld be wanting to get the destruction under control at all costs. Did you and the doctor look at the protocol? Sound like to me the drugs are not doing the job correctly. Talk with the doctor about adding cyclosporine (Atopica) to the mix. You really have to get this under control. Atopica is slowly becoming the drug of choice for treating this disease. Sounds like you are at a standstill with what to do next. You can continue to do as you are doing and the likelyhood of this disease being beat are going to be slimmer (my opinion only). Sorry....I know that sounds blunt but this in my opinion is truthfull. You really need some expert specialist advise on this matter. Don't worry about saying too much in a response .... the more the better!!! Even the smallest of things can help with treating this disease. Feel free to talk (or vent) about whatever you want. Johnny & Tessy

Johnny

Hi Johnny, I'm confused.....what is a real occurrence with AIHA? The diabetes? Or the complications? To me it seems we've got the AIHA under control with his PCV being 40, but the immunosuppression necessary to do that is what's hurting him...so I too am leary to switch to another immunosuppressive when other peoples dogs have passed taking the other drugs....see at this point, he's not suffering any of the symptoms from AIHA ( no energy, shallow breathing, loss of appetite, pale gums, listlessness, etc... )Right now it's the diabetes........I think we're going to start to cut back on the pred.......though it's not an especially high dose, he may not need that dose anymore....Have you heard of alot of other cases of the diabetes with this, from the pred? Thanx Tammy and Cody

Tammy/Cody N.J.

Tammy, at our vet clinic there is a dog with AIHA and diabetes. I can not tell you what or what not they are doing. The only conversation I had with my vets is, that it complicates things immensely. (Interaction of drugs?) I think it comes down to trust into your vet. You can just out right ask, how much experience they have with this situation. You really can't loose by contacting Dr. Dodds. I think we were really lucky as our vets were very happy to work with her and learn. Best wishes, Brigitte

Brigitte BC Canada

I haven't heard of a whole lot of cases of diabetes from pred but I do know that long term pred use can cause diabetes in a dog. I'd imagine Joanne has probably heard of quite a few cases though. I consult with a VERY SMART lady who's dog had diabetes along with AIHA and pancreatitis all at the same time. I'll ask her to see what her knowledge is on this matter. Just because a dog has a PCV of 40 doesn't automatically mean the destruction is under control. It could mean that the body is producing more than it is destroying. More reticulocytes than spherocytes? One more thing you could consider....TCVM (traditional Chinese VEterinary Medicine). This has helped quite a few IMHA dogs who are struggling with traditional treatments not working. You could even go as far as to try acupuncture if you wanted. These two alone would be worth the money to try.

Johnny

Thanx Brigitte.....I will tell my Vet about Dr.Dodds and ask her point blank how much experience she has with AIHA.....my Vet has actually been working with the 2nd opinion I had gotten at a larger Vet Hospital.....both of the Vets have been working on Codys case from the start. I've been with my Vet for 14 years ( 7 dogs ) and we had alot of health issues with them....she had great in-sights and always seems to be right on target....but maybe not with AIHA....I'll find out..Thanx again, Tammy and Cody

Tammy N.J.

Thank you Johnny........any information you have is much appreciated....Tammy

Tammy N.J.

This thread was discussed between 27/01/2010 and 29/01/2010

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