Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Cooper's Update

A week ago we increased Cooper's AZT to 50mg once a day from 25mg, and stayed the same at 30 mg once a day with Prednizone. We are very happy with the results so far increasing our PCV from 33.5 to 36.5 Hopefully we can keep climbing. We also administered a tick test and found it to be negative as as many here suggested. The concern that I have at the moment is the infection that he has in his front paw has been difficult to heal. Four weeks ago I noticed a blister like soft swelling between his toes on his front paw. The vet said it was not a cyst and indicated that he would rather not asperate it because of possible IMHA ramifications. He also found a small puncture wound on the bottom of his paw that seemed to the problem. A slide indicated a slight staph infection. Clindamycin(75mgx2)for three weeks did not help. He punched the blister and found primarily air and a little fluids. Bayril(68mgx2)for 10 days has done very little. We have tried to keep it as clean as possible washing twice daily with bacterial soap and also soaking the paw in Epson salt solution twice daily. Today the vet prescribed Ciprofloxacin(375mgx2). We have taken CBC and Super Chem tests every 10 days with results being in line with his IMHA progress. Temp. has stayed normal. I am very concerned that this infection could work it't way into the bone and become very serious as well as endanger our progress with the IMHA. Any and all feedback from this board would be greatly appreciated.

Ron Lakeland

Ron, Great news on the rising PCV! I know some people have had cultures done on infections (Usually for UTI) and had their Vet dose for the particular strain of infection. I don't know if that would be true for Cooper's infection. That is one of the worst things about this fight you are walking such a tightrope trying to keep a balance with the immune system. My thoughts and prayers are with you, Penny

Penny Lytle Creek Calif

Ron, I am very glad to hear that the tick tests were negative. 36.5 is a great pcv and Cooper should be acting as though he feels much better! I can understand your concern about the paw. Our Cassie got a huge thorn into her pad once. The vet said that it would be worse to try to remove it because she would have to actually cut the pad open. She said we should give her antibiotics and it would work its way out. I was skeptical, but it actually did work! It probably took about 1-2 weeks. Patrice This website had an enormous amount of information about paws and claw diseases and injuries. Read here to see if you can find something that sounds similar to what you are experiencing. http://www.lowchensaustralia.com/grooming/intercysts.htm http://www.lowchensaustralia.com/grooming/nailconditions.htm http://www.lowchensaustralia.com/grooming/nailconditions2.htm http://www.lowchensaustralia.com/grooming/nailconditions2.htm#links

Patrice NYS

Hi Ron, I'm happy to hear that Cooper is progressing so nicely, I understand your concern about the paw. It's so scary the side complications that our dogs can develop. I don't really have any advice, but I am hoping for the best and that Cooper starts responding to the antibiotic. Do you have him on any supplemental immune boosters? I know alot of people here supplement with holistic meds that support healthy immune function. Hopefully someone can elaborate. Also, I know there are a few antibiotics that can be given through shots and IV's- perhaps they are stronger or more effective if Cooper is somehow resistant to the to the others he has tried. Good luck, please keep us posted. melissa and tiggs

melissa slc

Hey Ron, great to hear Cooper is progressing positively. The tick test coming back negative is also a good thing. I know how hard it can be to keep an infection at bay. It can also be tough keeping a sore spot clean. Have you tried putting something over his paw to keep it clean while he's up and around or outdoors? Putting a wrap or sock over the paw (after applying an antibiotic cream) might help to keep the dirt and infection at bay. You could also try to keep him away from areas where infections linger...ie..around garbage bins etc. It's really important to keep it clean if at all possible. I know how tough that'll be given it's on a paw. Hopeully you will both get over this obstacle. How's Cooper doing today? He must be acting and feeling better due to the recent increases in his blood. Keep up the good work and don't let a little setback get in the way of your success. Give him hugs from Tessy & I. Johnny & Tessy

Johnny

Thanks to all for the great comments. Yesterday I finally convinced the vet to take a culture on the infection in Coop's paw. I connected with DR. Dodds and she was adamont about getting the results of both an anaerobic and airobic culture. She also thought that there would be a high probability that it would come back as Clostridium and should be treated with an injection of Penicilin. In the mentime we are still on antibiotics until the culture come back.

Ron Lakeland

Hi Ron, My dog Benson developed abscesses when he was on high doses of the IMHA meds. The abscesses were treated surgically but afterwards the abscess wounds would not heal while he was on prednisone. Two wounds were on his hind paws which were especially open to dirt and infection when we walked. I cleaned his wounds at least twice a day with saline and covered him with boots when we walked. With all the blood tests, we were able to track if he needed antibiotics. He needed them several times during the months he was on pred and imuran. The wounds finally closed after he went off the pred. Good luck with the culture and I hope that it yields answers. And tell Cooper to keep up the good work with the rising PCV. Take care, Aden

Aden Jerusalem

Hi Aden, Thanks for posting and telling us about your experiences with Benson and I will pass along this information to our vets. Just this morning the vet opened this up for drainage, and now the extra task of keeping it clean. We will be back in Monday for further observation with his paw as well as culture results. Ron&Cooper

Ron Lakeland

Hi Ron When Billy was alive we had a huge problem with infection and abcesses. We had two months where his feet pads got infected and burst and over Xmas his anal glands abcessed and burst leaving a huge deep wound on his butt cheek, he also had abcesses on his elbows which burst. They were all treated with AB's and washing regularly with antibacterial wash. He wore baby's slipper socks in the house and when he went to the vets he wore boots. He had been on a large pred dosage for a long time and once the pred was reduced, his wounds did start to heal but it was a very slow process, some still hadn't healed when he went to the Bridge. From my experience, try to keep them clean but don't get them too wet if that makes sense! as I found that he lost more skin/flesh if it got too soft. We unfortuately had the extra problem of calcium deposits all over his body so if he had a wound the whole lot lifted off making it worse than it was. Steph

Steph Gloucestershire UK

Hi Ron, My Kent also developed a blister between his toes on his front paw while on meds. I was given a bottle of blue solution from the vet that i put 1 tablespoon in warm water and stood his paw in it for 15 minutes (not easy with a schnauzer!) twice a day and also an antibiotic creme. After a few days of cream, and socks (even outside - i didnt have boots for him)(yes, i changed the socks when done with the walk :)) , it got better, and he never had to take oral abx for it, and it never came back. It seems on pred etc that they are more open to infections than before. I hope Cooper is feeling better soon, Christine

Christine FL

Two weeks of increased Aza to 50mg and our PCV went from 33.5 to 36.5 the first week then 38 the second week. Then last Monday we came back down to 25mg Aza and todays PCV was 36. Pred. has been held at 30mg during this same period. My vets intent is to stay this course for two more weeks. If we continue to go back down to the 33 range he wants to add Cyclosporine to the mix. We have all said that the numbers game don't always tell the whole story. Cooper is showing improved energy and a little playful at times. Though not dynamic incouraging just the same. The culture we ran for Cooper's paw infection turned out to be negative, both as anarobic and aerobic, and the infection is improving with the continuing help of Ciprofloxacin. His Superchem panel shows: From 5/7/09 test ALT 149 down from 215 on 4/30/09 ALP 411 down from 658 " GGP 60 down from 79 " HCT 34.2 up from 33.4 " WBC 26 up from 25 " RBC 4.15 down from 4.38 " Reti 4.00% and 166,000 count Neutrophils 23000 T4 0.04 Another panel was taken today with results available next monday. many others have been in this same situation of holding the PCV at or above normal. I'm aware that it could take weeks or even months to each this level, However I am very concerned that we are taking the right path to get there. Dr. Dodds has indicated that her approach at this point would be to drop Pred to 20mg , keep Aza at 25mg and force his system to stop being lazy and regenerate on its own. knowing full well that it could take several weeks with his system lingering in the low 30's before we get posive results. On the other hand my vet wishes, as I have stated earlier, would like to add Cyclosporine to the mix of Pred. and Aza to get positive results. In each case PCV's and complete panels will continue be taken. This has been a bit "longwinded' but I am very concerned about which course of action we should be taking. Any and all feedback would be greatly appreciated. Ron&Cooper

Ron Lakeland

Ron, I am perplexed as to why your vet wants to add cyclo at this point since cooper is just under the borderline. Sounds like your vet is doing the blood test version and his PCV is probably a lot higher than that if your vet is using "I am sorry I can never remember the terminology" the blood test vs the spin test, the spin test is most accurate of the two and results will usually be 5-8 points higher. And its cheap about $15 and you get your answer while you wait, it only takes about 10 minutes. I would have this done anyway to get a get baseline on Coopers level. If you have read posts on testing many dogs who have the blood version done are all over the map if they did not get a good draw, are dehydrated, etc. Patrice speaks of this I think in Rens post from this week. Laurie

Laurie CA

Ron, The reticulocyte numbers say it all. At a HCT of 34.2, a 4% retic and 166,00 is moderately high regeneration. There is always a ratio when there is anemia (and that's generally considered a HCT below 38-37%) between the number of reticulocytes and the hematocrit. The lower the hematocrit, the higher the percentage and absolute number of reticulocytes there should be in order to be considered highly regenerative. So if the HCT was only around 8 and the retic percentage was 4% and the absolute was 166,000, using a math formula would show this really isn't as regenerative as you would wish. You would want to look for much higher values, perhaps over 500,000! Increase the HCT and the actual % and absolute # can be lower to be considered highly regnerative. So thus, at a HCT of 34, 4% is moderately high. When you reach a level that is not considered anemia, then it should level out at around 1% and 60,000 and this would be considered normal. Some dogs will level out at the low end, like Chance does, around 37-38. But you can tell they are stable because their retic count sits around 1 - 1.5 % all the time. The body is quite satisfied with that number. And in addition, there should be clinical signs of recovery! At 34%, it's not dangerous, and in fact Cooper should be feeling and acting much better. The downside of continuing prednisone treatment is that there continue to be negative side effects that make him feel yukky. And it can negatively impact liver health etc. Cyclosporine is used as Atopica commonly now for treatment of atopic dermatitis or allergies caused by inhaled substances. It is quite safe, if very expensive and would be, at higher doses, an effective immunosuppressive. You start at a higher loading dose and then reduce that until you have a positive response. A few dogs have side effects, but most don't. Our goal with Chance was to get the prednisone down slowly asap and thus we started at a high dose of cyclosporine and maintained that for quite a while, while dropping the pred. His health condition required that the pred be eliminated. my best patrice

Patrice NYS

Hi Ron, I am happy your beautiful boy Cooper is doing pretty good and glad Patrice could explain it all in such an educated and understandable way. I have no experience with Cyclosporin, but like Laurie I was wondering why the vet wants to add an other drug, since he is doing ok and the side effects are tolerable. There are so many things to consider, it is confusing. One thing I was wondering is the T4 result of 0.04. On my scale (normal 12.0 -51.0) this is extremely low. I am assuming we work with different scales? Best wishes, Brigitte & kahlu

Brigitte BC Canada

Laurie, Thanks for your questions and input. We have been taking PCV spin tests twice a week every week since this all started almost 3 months ago, and we take a complete panel including a CBC Hematocrit test every 7-10 days.The PCV is the most accurate, as you have alluded to, and has been in our case about 3-4 points higher each time. Cooper has not been able to hold the numbers at the low end of normal with 30mg Pred. and 25mg Aza and cintinuing with higher doses of either or both of these two drugs yet again seem unacceptable because of the hidious side effects. So our vet believes it might be in our best interests to introduce Cyclosporine into the mix if this downward trend continues over the next couple of weeks. And yes Brigitte, there are so many things to consider and awefully confusing as well. We are all very lucky to have each other to bounce things off of. Also Brigitte, our T4 Reference Range is 1.0-4.0 and Cooper is at 0.4 registering (LOW) on this scale.

Ron Lakeland

Ron, I was reading your other post, I think it was your first that you mentioned Cooper at one point was up to 39 and your vet immediately started reducing ther pred? Just curious. Did you mentione this to Dr Dodds? Laurie

Laurie CA

Laurie, Thanks for your followup. I'm not certain if I covered all the bases when I talked with Dr. Dodds however she asked a lot of questions and I tried to give her a much info as I could. You make mention of our first post of April 28 (Cooper's Challenge with IMHA). Hindsight we came down to fast. Ron

Ron Fl.

Ron, thats the one, the reason I ask and I think its very important, if you dont remember telling Dr Dodds, to still do it, thats an important #. is from that post its sounds like they reduced the pred too fast. There is a good reference somewhere on this board in archive about getting stabalized like wait a minimum of 4 weeks, if the # stays the same the reduce, etc, etc. And the reason for reducing pred up front is if the dog is having serious side effects from the pred. I know how our minds get in a blur and mixed up trying to remember everything, I started writing down all of my thoughts and questions and then faxing them to my Dr, so he would have a chance to review and then respond. Laurie

Laurie CA

Ron, I forgot to add at the onset of the disease, to keep the # level over a period of time, sounds like Cooper went PCV went up fast and then when they reduce the pred it dropped Laurie

Laurie CA

This thread was discussed between 05/05/2009 and 16/05/2009

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