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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Good news on Brinnie!
| Great news! Just got back from the vet and Brinnie's PCV went from 18 to 26! WOO HOO! She's been doing great the past 2 days with eating and she even went on a walk this morning with me and our other dog Trixie. I hope this keeps up! Question for those of you who have been through this, my vet suggested that I cut the prednisone in half starting Monday. Does that sound right? I've read that it's supposed to be gradual and half seems quicker than gradual to me. Christina |
| Christina Nashville |
| Good news about the rise in Brinnie's PCV. I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased. Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA Having said all the above I checked back on some of your other posts and saw that Brinnie weighs 70 pounds and is on 120 mg of prednisone per day. This is nearly double the usual rate of 1 mg per pound of the dogs weight per day. So a reduction certianly may be in order but I think cutting it in half may a little too much since that would put you at 60mg per day which is less then the l mg per pound per day. Why not call your vet and ask about dropping it to 80 mg per day, that is 40 mg in the morning and 40 mg in the evening. You will notice that this info says: “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks" at a PCV of 26 you are still quite aways away from the normal PCV (37-55). It certainly may be very wise to call your vet and tell him/her you are not feeling comfortable about such a huge drop. Also when will you be doing blood work again. It is really important to do blood work real often at this point, since the PCV can drop very quickly if the pred is lowered too much too quickly. I have seen that happen more times then I would even like to think about. Another option may be to do blood work again on Monday, the day your vet suggested you make the cut and if the PCV is closer to the normal range then do the 50% drop. Keep up the good work, both of you!! |
| Joanne MN |
| Dear Christina, Great news for Brinnie! Well done to you both. I am glad you are cautious on reductions, I second Joanne's advice above. The very first reduction my vet suggested for my Millie was 50%. I told her I was more comfortable with 25%, and that is how we have proceeded with all reductions since. Millie is still here with me, 14 months later, and I believe the careful reductions played a big part in that. Don't be scared to tell your vet what you feel comfortable with. As many people say, "IMHA is a marathon, not a sprint". Is Brinnie on Cyclosporine or Azathioprine also? Seeing as Brinnie is on extra-high Pred doses, it might be good to reduce slightly, but I personally wouldn't go 50%. Keep us posted on Brinnie's progress, you guys are doing great! Sam. |
| Samantha Geelong Australia |
| Cutting the Pred down already doen not sound like a good idea!!!!! It seems way too soon and way too big a drop! Its great to hear Brinnies PCV is up to 26 but i think it needs to be at least 33 to be at the lowest end of normal. From what I have read and heard a dog is usually on a high dose of Pred for a good couple of months before very gradually weaning them off whilst regularly checking the PCV to make sure it doesn't start to drop. I would definitely talk to your vet about your concerns. Remember you always have the right to ask for a second opinion. I hope brinnie continues to do so well. I am so pleased for you! |
| Joanne Teesside |
| If I were you I'd try to ain to get the pred down to at least 50mg....slowly. 50mg would be a sufficient immune suppressing dose for a dog of that size but like Joanne mentioned above you should never go more that 25-35% at a time when reducing. Her advise of dropping down to 80mg is exactly what I'd do in your shoes. Give at least a week before another reduction...then you could go from 80mg to 55 or 60mg. I'd recommend though that if you do drop down to 80mg you should test BEFORE dropping again to 55 or 60. Myself, I wouldn't even wait to get another test...I'd do a reduction to 80mg as soon as possible. 120mg is quite a large dose and it's obviously done it's job of suppressing the immune system quickly. Of course though the choice is yours to make. If you are worried then maybe another test would be good to have to make you feel more comfortable with the reduction. I would however recommend you get Brinnie on milk thistle soon. Often times owners will put this off until it's too late and the liver is already damaged. Once the liver starts to get damaged this leads to toxicity adn when this happens it send chemicals to the brain which makes hte body feel nauseated...this can lead to a loss in appetite and an array of other secondary problems that can be avoided fairly easily. Large doses of these drugs wreak havoc on the liver! The pet-tinic you hear us talk about all the time is another great supplement. If you can't get this perhaps you should at least get some sort of vitamin supplement to use. One more thing for you to consider. Be VERY carefull taking Brinnie walking. Don't overdo it with the exercise while the crit is so slow. the body is already working hard to pump the low oxygenated blood around the body and exercise could make matters worse. Small walks would be OK i'd guess....just use your own judgement when you think he's starting to get winded. ALSO, when you take him out walking you have to remember that the immune system is suppressed so it's VERY VERY easy for them to pick up any kind of sickness. I used to keep Tessy's activity limited to our own yard until her immune system got a little stronger. She's still on drugs and I'm still nervous about taking her out in public where she can catch something. Good luck and keep us posted. Johnny & Tessy |
| Johnny |
| So glad to read that Brinnie is doing better:) Cheryl & Ginger |
| Cheryl & Ginger Pinevile Pa |
This thread was discussed between 18/03/2010 and 19/03/2010
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