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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - How long is too long to be on Prednisone?
| We're really starting to see the negative side effects of the Prednisone on Reggie. He was diagnosed June 9th and has been on 100mg/day ever since. He's also on 50mg of Azathioprine every other day and 250mg of Cyclosporine every day. He's 50 lbs. Reggie is starting to have a terrible time standing and walking and we can see his leg muscles wasting away. My question is how long is too long to be on a higher dose of the Prednisone? I know it's a necessary evil, but when are we doing more harm than good? I'm hoping someone can give me their experience with the drug - I don't know what I'll do if he becomes unable to walk. |
| Amy Wisconsin |
| I'm thinking you should talk to the vet about getting the pred dosage down to 50mg daily. I'd drop back to 75mg for 5 days then to 50mg. Given the dosage of cyclosporine as well as azathioprine this would be safe and a very good idea. Do you have copies of the recent CBC's? It would be nice to know some of the numbers! Johnny & Tessy |
| Johnny |
| See, the problem is that his red blood cell numbers have not started coming back up yet. But 100mg/day seems really, really high. He was at 26% when he came home (after a 6 day stay) and at 21% two days later. |
| Amy Wisconsin |
| Hi Amy, Glad to hear Reggie is doing better. It is amazing what a commmunity can do when they pull together. We had several donations to assist us with Henri's medical expenses....it allowed us to continue the journey with him. We were so blessed. High doses of Prednisone are a necessary evil until the other meds kick in. Prednisone is a quick acting immunosuppressant at high doses. At lower doses, it is an anti-inflammatory. Since Reggie is not stable with his IMHA, the vets will likely not want to change his medication regimen yet. When he is stable, they will likely begin by lowering the prednisone dosing in an incremental fashion. Henri (who was only a 5-lb puppy) was on 50mg/day prednisone for at least the first month. We tapered down very slowly to 25mg/day, 12.5mg/day, 5mg/day, 2.5mg/day, and then 2.5mg/EOD. Each new dose was held for 2 weeks to monitor for relapse. The side-effects of high doses of pred are difficult. We had just finished potty training Henri when the IMHA hit and the pred has him wetting his bed all the time. Healing Wishes, Ella and Henri |
| Ella Seattle |
| But what happens if the dog loses use of their legs? There's no way I could carry Reggie outside to go potty. I just don't think he's anywhere near stabilizing - his gums are SO white still :-( |
| Amy Wisconsin |
| Hi Amy, The good news is that whatthey lose from the predniosone, they can gain back. In 3 weeks Dylan lost her ability to get up and walk on her own. At her worst, she could barely hold her head up. I had a harness I put on her and then a towel I used as a sling under her belly. I would tighten the towel (roll it up on top), then stuff some part under/in the harness to hold them together with one hadn (she lost so much weight that was easy to do). Then I helped her up with one hand on the harness/towel and the other holding her back end with the other edge of the towel, so I could hold her horizontal and even tilt her back for a poop, I helped her walk when she could, carried her to pee. Pooping became the hardest task as she could not get back into position very easily, but we managed. The harness made it possible to tilt her back without losing a grip on her body. I dragged her kennel out back and let her hang out im my yard with me and the other dogs. I used a 2 wheel dolly to transport he to the car, to the vet and to a Regional Dog Agility Championship and all over the venue. She was gettign better at that time and really enjoyed her trip. Now that the prednisone is lower, she has regained her ability to sit up, walk, get up on my couch and even has a skip to her step. I have created a photo journal, including photos from before and then starting from about 1 month, when she could not walk. I was too busy beforethat to take pictures, just trying to figure out how I was going to handle her situation, like you now. http://www.facebook.com/media/set/?set=a.177206759001413.58939.100001362714581&l=9a192fafa5 My "Furarri" http://www.facebook.com/photo.php?fbid=168409893214433&set=a.108157862572970.20068.100001362714581&type=1&l=0baa58d32d&theater The album is not over, but the photos are showing she is looking better now, walking and her muscle is returning and she is gaining strenth, can do everything she needs to on her own now. Richard and Dylan |
| Richard Burnaby |
| Wow - you can really see Dylan's weight loss in some of those photos! Reggie is still eating (chicken or beef with rice and any table scraps he can get his mouth on) but has actually gained weight from all the fluid build-up in his chest/gut. We went to church last night and he decided he wanted to come with us - he managed to jump/pull himself up into the van and I couldn't get him out! He's definitely become more clingy now that he's not feeling well - and I don't blame him one bit. I actually kind of like that he's now sleeping next to my bed on a rug - keeps him close so I know when he has to go potty or is breathing heavier. Reggie has been on some dosage of Prednisone since June 3rd, and we're definitely seeing the nasty side-effects. The poor guy can barely get up off the floor and walks to slowly and painfully. I just pray the AIHA gets under control before the meds kill him :-( |
| Amy Wisconsin |
| Hi Amy, I really understand your pain watching the prednisone taking them away, but it is a delicate balance. The AIHA needs to be stopped. The fact that prednisone scares you is a good thing in my opinion, though. It IS a necessary evil, but Reggie is in that intermediate state where AIHA is likely the main cause of his low PCV still. Doing what you can to provide building blocks of RBC's (Pet Tinic) is important now. Dylan has been eating like a horse every day. That was one of the things I struggled with, was how much to feed her. I was and am still feeding her close to double what I did before she got sick. She is on a raw diet and is a voracious eater and always has been. This was my first clue that somtheing was really wrong. She hesitated to eat. The alarm bells went off and that was a good thing for her. All through this disease she has eaten voraciously, except one day when she was so anemic she could not sit up, or lift her head. I would add that prednisone stimulates metabolic activity and "burns" up the body. It causes resources from all over to be consumed and at the really high doses there is no way for them to take in enough food. Over feeding also over works the liver (more frequent smaller meals is bettter than less frequent big meals), dilemmas every which way you turn. Prednisone causes a form of Cushing's disease. This is a good view of the symptoms that was provided by Patrice in an earlier thread. http://www.kateconnick.com/library/cushingsdisease.html Dylan had about 15 symptoms on this list after 4 weeks. Long term use can lead to bone loss and other problems as a result too, but worry about that after AIHA is under control. Dylan's case was very acute, unlike many hear which seem very drawn out. If I had not got prednisone in her within 24 hours of her first symptom (PCV 21 24 hours after hesitating to eat), she was certainly dead (PCV 10-12? 3 days later, slight brain damage due to anemia). Cyclosporine, Azathiaprine, which take longer to act, would never have had a chance. Her recovery (PCV) was remarkably fast as well (2 weeks PCV = 39). It almost seems like whatever triggered it was also gone quickly, unlike what I see here in only 3 months on this list. Either way, I was 100% sure the prednisone had the AIHA under control, before I reduced her prednisone, 2 weeks at 2mg/lb/day. Most often this is also done longer, 3 weeks and possibly more (my vets words). I was always sure, her weakness at 4 weeks was not anemia and was a result of prednisone and the muscle loss and hind end paralysis it caused. Behaviorally this was pretty obvious. She also had the bloodwork to support it. I did buck the trend and reduced prednsoisone as fast as my vet would let me. In 3 months on this list, there are 3 main groups of problems I ahve observed: AIHA and slow recovery, or some recovery and then slipping AND; Prednisone and it's side effects, long term complications that often end in other injuries and/or euthanasia AND; other diseases and complications that accompany AIHA dogs. Everyone here expressed a great deal of concern and fear that AIHA would return if I reduced pred too quickly (a valid concern for sure), or she would experience issues with fast prednisone withdrawl. This is due to needing the adrenal glands to kick in, which is important for sure, but does not apply until you get down lower in dosing; 2 mg/lb, 1 mg/lb, even half that, there is no adrenal gland function to kick in yet, pred is too high. But I was careful to watch closesly for anemia and AIHA and along with her good PCV was a good reticulocyte cound (immature red blood cells) and no spherocytes in her blood, which are a physical sign of AIHA. All of the staff at Dylan's Veterinary office call her the "miracle dog" for how fast her blood recovered and now how fast her body is recovering (they were also concerned at how fast she lost her muscle). In some ways I feel fortunate. Her prednisone level though will soon not be protecting her at all (if I Continue reducing it) and that is a scary thought. Will AIHA return? Will it be fast and deadly? Do I have the enrgy to do what we did again? Don't know! I certainly hope, "none of the above" is the answer! I have kept Dylan on her raw diet that she was on before and I do believe her state of health before and after AIHA also contributed to her speedy recovery. How much we will never know, but she is still on her raw diet, only pepcid AC and pred (10 mg split) every second day. She still eats like she is going after her prey and now I actually see and feel muscle in places it had been lost from. "Dylan has muscles in her ass" :-D It was a lot of hard work, but a good vet, a lot of persistence and patience, good support and lots of information and knowledge all helped. Richard and Dylan (I also have video I need to put together that shows her progression and it shows my taking her out in her harness and sling when she was at her worst) |
| Richard Burnaby |
This thread was discussed on 21/06/2011
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