Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Diet and IMHA

I too am battling IMHA with my dog. He is 3 and diagnosed in May 2008. He's on pred, Imuran, pepcid, clavamox, denosyl and vitamin E. Since diagnosis he has been very lethargic, very little to no ball playing, no running, muscle wasting in back legs, he went from an energy level of 10 to a 1 and has remained there since May 2008. His liver values are higher than they would expect from the meds and after testing they put him on the L/D diet about 2 weeks ago. He's due to get liver values checked again tomorrow. Although he liked the L/D initially he is not crazy about it now. Since he's gained 20 lbs since diagnosis, I know he has some weight to lose so I haven't been too concerned about him eating less as losing a little weight may help him. I have heard that some of you home cook for your dogs. I was going to bring the Dr. Dodds diet with me to the vet tomorrow to ask about it. Have you found that the home cooking has helped? I know every dog is different but geez if he could get a little more energy then he would probably drop the weight no problem. (and I hate making him eat something he hates when he's this sick). I know I am probably grabbing at straws looking for something to give him energy at this point but after 3 1/2 months of treatment and getting up at nights with him I am getting worn out and so is he. His PCV count luckily has remained around 35-38. Any thoughts appreciated. Chris

Chris Pittsburgh

Hi Chris, I think that it's really great that his pcv is remaining in the 35-38 range! That is all we ever expect from Chance now a year later, mostly because his spleen was removed. But 37 is the low end of normal so your dog is in the correct range. If he has been maintaining in this range for a period of time, he has reached what may be his normal level. What dosage of prednisone are you giving him now? That could probably be lowered *carefully* until you are on a minimal dose (say 1-2mg every other day). That will reduce the liver values very quickly and the weight problems will begin to resolve on their own over time too. Prednisone causes a condition called Iatrogenic Cushings Disease. This creates a situation similar to when the bodies own adrenal gland over-produces it's own cortisol. It's called Iatrogenic because it is caused by administering prednisone in high doses. This over supply of cortisol causes all kind of serious side effects, like many that you are mentioning. When the adrenal gland, which normally produces cortisol, senses the flood of cortisol from the daily prednisone it stops producing it's own cortisol. In order to coax it to begin functioning (properly) on it's own, the prednisone dosage must be reduced slowly. Never more than 25-33% at any time and maintain at that new dose for at least 2-3 weeks. When you reach a subclinical dose, or a dose that is very low (perhaps below 2-5mg), you can begin to give it on alternate days. This is the coaxing of the adrenal gland part. Your vet is very familiar with this reduction process and should be helping you to lower the dose. Some dogs can eventually stop the prednisone altogether, others remain on a low maintenance dose. As for diet, I have always fed a home made diet to both my dogs. I use a form that used to be known with the cute acronym BARF, bones and raw food. You won't see that mentioned too much any more, now they simply say "raw." I do credit this diet and the supplements I give to keeping Chance alive and helping him return to good health. You don't have to go to this extreme if you aren't comfortable, there are many versions of home made diets. The important part is to make sure that whatever you do, it remains properly balanced over a period of time. This website has a wealth of information about home made diets, either cooked or raw, and has some sample balanced recipes. http://www.dogaware.com/dogfeeding.html#Balance Dr. Dodds is very proud of her Liver Cleansing Diet, it has shown to be effective for many dogs with severely high liver values. It is pretty stringent and dogs may not like it over a long period of time. My home made diet consists of portions of vegetables like carrots, green beans, spinach and kale (both cooked) food-processed with meats like ground beef, ground turkey, and eggs. I use cooked liver (Cassie hates it raw) and give 1 oz per 10 pounds of dog weight per week (so Chance gets about 12 oz a week). Each dog gets, in addition, raw meaty bones with their meals. The raw meat is chewy and the dogs really work the bones underneath to a fine consistency. The bone provides the essential calcium and other minerals. Those who wish to skip the bones can add ground eggshell to do the same thing. I carefully measure each portion so I know how to control their weight. My 100 lb dog Chance gets about 1 lb of mix per meal with a raw meaty bone that is about 1/3 a pound. He eats two of these meals a day, so about 3 pounds of food a day. I often give sardines or canned salmon as treats. Dogs don't really digest grains well and don't need them. So I don't use anything like rice etc. Some people don't even feed vegetables. If you look at the many people who feed home made diets, you will see thousands of versions! Feeding home made is still a grass roots effort. You won't find many vets who "approve" of it. I attended a full day seminar on dog food this summer held by the vet in charge of the nutritional program at Cornell University. He explained that most vets don't get much training in food and can be influenced by literature from dog food companies. He covered all kinds of food, but did give high marks to home made diets that are well balanced. He gave a special mention the the value of adding small quantities of vegetables. He says the problem is that the research is just not there yet to show this value. Commercial dog food companies will attempt to show that giving a home cooked diet is dangerous. That raw food is loaded with salmonella and other dangerous bacteria. This Cornell vet did research that showed that many processed on the shelf foods also contain salmonella! Healthy dogs have high acid environments in their stomach and can dissolve bone and destroy bacteria quite easily. The question is, do dogs that are ill have the same ability? I wasn't so sure of that with Chance so when he was his sickest, I cooked all his food and did not give him raw bones, but gave egg shells instead. Give this website a browse to see if anything there is what appeals to you. patrice

Patrice NYS

Thanks for your info - very informative. I will delve into this web site. Looks like lots of good stuff to read there. I have never heard of latrogenic Cushings disease. I've heard of Cushings but didn't know anything about it. He is currently on 20 mg of pred twice a day. My regular vet started to reduce it about a month or so ago but then his pcv started to fall a little and he put him back up at the higher dose. In the meantime, I took him to an Internal Medicine specialist that started the Imuran in hopes that in time we can reduce the pred. She did indicate the Imuran can be harder on the liver though. There is so much to research with this disease. I am trying, as is everyone on this site, to do the best that I can for my him. That's great that your Chance it doing well after a year! I will talk to the vet tomorrow about diet some more. I know I spoke with my original vet a few months back about it and he wasn't real receptive. I am thinking this new Intern Med doc will be more receptive - but we'll see...I just want to make sure what I give him will not do more harm at this point. I feel strongly that the diet plays an important rule though in their health and it does in ours. Really appreciate the info. Chris

Chris Pittsburgh

Hi Chris, Something you said in your original post about your dog made me worry. You said his muscles were wasting in his back legs. This happened to my Sunny also and we lost him. I know that every dog is different, so what I say may not pertain to your dog. However, Sunny's PCV eventually went up to 37 and held in the mid thirties for a couple of weeks. We lowered the pred. After 11 days his PCV went down to 34 and he seemed more lethargic, so under my vet's advice I increased the pred back to the original amount. I now believe that this was a fatal error. I wish that we would have tried leaving the pred dose down longer. Sunny's muscles wasted away very quickly after we increased the dose back up and he eventually could not get up or even hold his head up. Of course I will never know what would have happened if we would have continued the lower dose of pred. Only 18 days after increasing the pred we had to have him put to sleep. The vet cried and apologized that she could not save him. All I am saying is to watch carefully how much muscle wasting is happening, because the results can be devastating. Please remember, I am not an expert. I am just telling you my experience in hopes that it will help you and your dog. Good Luck, Leslie

Leslie Oceanside

Leslie, I appreciate your concern. I'm glad he is going tomorrow as he looks like he feels like crap tonight. His gums are pink though. I remember reading about your Sunny in earlier posts. I'm so sorry you lost him. You did what you could for him. I don't write here often but I read the posts just about every day and I cry every day. I've come to the conclusion that the only people who truly understand are others that have dogs with this disease. It is just so devastating. I've learned alot from others on this site and have found it somewhat comforting to know that Alex and I are not going through this alone. It's just so sad that so many suffer. Chris

Chris Pittsburgh

Chris, Here is a website that about Cushings that I really like, there is an entry for Iatrogenic Cushings too. http://www.kateconnick.com/library/cushingsdisease.html Check out the first three photos of Chance in this album. You will see what the side effects of prednisone look like and how improved he looks now after a year. http://www.flickr.com/photos/patricel/2857651904/in/set-72157602714279765/ 40 mg of prednisone is a very high dose. Dr. Dodds advised us to get the dose down slowly and switch to another immunosuppressive drug, in our case cyclosporine, so as to reduce these undesirable side effects. Imuran is another immunosuppressive drug. Your internist may also decide to begin decreasing the pred dosage. 3.5 months is really a very long time to be on this high of a dose. my best Patrice

Patrice NYS

Hi Chris 3 months of being on a high dose of Predisone seems like a long time to me, especially since his numbers have been good. Has your vet suggest Cyclosporine and perhaps reducing the Predisone? Predisone had some really bad side effects on my dog Ginger and she was put on the Cyclosporine and the predisone is being gradually reduced and she is doing much better and has had no side effects from the Cyclosporine and that is now slowly being reduced. Keep in mind that not all dogs react the same to the medicines and something may work for one and not the other. We hope your dog is feeling better soon. Cheryl & Ginger

Cheryl & Ginger Pineville PA

I know I agree that it seems like a long time. I wonder if my original vet had started something like Imuran back in June if he would be reduced by now. He's been on the Imuran in addition to pred for 2 weeks now. The internist said we could try Imuran or the cyclosporine. She said the cyclosporine would be an additional $400 -$450 per month. Unfortunately, with two kids in college, I can't afford the additional $400+ per month in addition to the other meds. This past month alone with liver and blood tests, meds,and prescription food I have spent almost $1,000. I thought I read a post over the past couple weeks where someone said they got cyclosporine at Cosco for like $50? I have to check on that. He had a CBC/Chem today and a reticulocyte count (whatever that is). We get results tomorrow and I am hoping we can start reducing the pred. In the meantime I think I will call Cosco to check things out. I am curious how long were your dogs on Cyclosporine before they were able to start reducing the pred amount? Chris

Chris Pittsburgh

We began reducing the pred. very gradually even before she began using the cyclosporine due to the side effects. After about 2 months on the cyclosporine and good pcv readings during that time we are now very gradually reducing that too. She has been on the Imruan since the beginning and is still on that and probably will always be on a maintenance dose. By the way what is your dogs name? Cheryl & Ginger

Cheryl & Ginger Pineville PA

Cheryl, My dogs name is Alex - he's a standard poodle. The vet is beginning to reduce the pred to 20 mg in a.m.and 10 mg in the p.m. Also the Imuran to every other day now. His bilirubins and ALP is increased so she is adding Ursodiul, a bile thinner. He is now on Denosyl for liver, Clavamox, Vitamin E, Pepcid, Prednisone, Imuran, and Ursodiul. I am looking at this thinking how could anyone feel good, dog or human, with taking all of these medicines. I just don't know what the right thing to do is anymore. I have been treating him since end of May and he is no better, but no worse - he's just in limbo. We go back the end of next week for more bloodwork. I changed from my regular vet back in August since he didn't appear to be improving and at that time he was only on pepcid and prednisone. Since he's at the Internal medicine doc he has all these additional meds and he still is the same. It's sad as he was so active before. He would love to run, put his head down like a horse and take off. As a matter of fact he was so so active that I even thought of getting another dog just to tire him out a little. With both kids off to college we got him as our "empty nest" puppy. My husband and I both really enjoyed him. Alex and I did everything together, obedience classes, therapy work, he was my exercise partner (I gained 10 lbs over the summer as I stopped walking since he couldn't) he even worked with me most days. It's crazy this disease. Chris

Chris Pittsbugh

This thread was discussed between 22/09/2008 and 24/09/2008

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