Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - How much medicine is too much?

Alex has been battling this for 4 months. He has been consistantly on prednisone, started taking Aziothioprine and feeling better however liver values increased and was switched to Atopica. Since starting on Atopica 9 days ago his condition has declined. He is approximately 70 lbs and on 200mg in morning and 100 mg in evening. His pred was reduced from 30 mg a day to 20 mg a day starting yesterday(Sunday morning). After going for a recheck today due to jaundice noted the want to reduced pred to 10 mg a day. I am very concerned about this significant decrease in the short period of time but his liver is failing. Since starting the Atopica his bilirubin levels have significantly increased to 8.7 today. The additional meds he has been on are Denosyl for the past 8 weeks or so, Ursodiol for bile for approximately 3 weeks, Liquid vitamin E tsp a day, Clavamox 500 mg twice a day for the past 4-5 weeks. In addition to the above meds she wants us to start Baytril(2 1/2 Tabs daily) and Reglan to nausea. He vomited once last monday night a week ago and last thursday. He goes back on friday for a recheck of liver values. I am seriously thinking of cutting some of these meds out as I feel like I am killing him. Doesn't the liver have to filter out chemicals? Wouldn't it make sense to decrease the amount of chemicals you put in your body to help the liver recover a little bit? I started him on Dr. Dodds liver cleansing diet a few weeks ago however he now does not like it. The vet had him on LD which Alex hated but now says its too high in fat. She said to give him rice and chicken until he gets a recheck on friday. I have learned alot from what people on this site write. While I know none of you can give us "medical" advise, your input is appreciated. He is going to an Internal Medicine Specialist and every time I walk out of there it is with more pills. If the pills were helping him then I would gladly give them however as I said before I feel like I am kiling him. Anyone been through this?

Chris Pgh PA

Chris, If you click on the link at the top of the page titled AIHA treatment it will take you to the section of Joanne's page that gives info on the different drugs. Atopica is cyclosporine. It is a terrible place to be when you can't decide what might harm your dog more the disease or the treatment. There are no answers but the ones that come from your heart. Thinking of you and Alex Penny

Penny Lytle Creek Calif

Chris- when my dog was on the edge of death we cut her meds about 70% on a whole... and she physically started to rebound each day. the high doses of meds in some scenarios work this disease out and the dog recovers... in other cases (mine included) they seemed to suck the life right out of the animal. my 42 pound pit bull lost over 20 pounds at her worst, over a period of about 3 months. she also lost the majority of her muscle mass and was reduced to skin and bones. not only that, but she couldnt even lift herself up off the floor or even attempt to walk for about 2 weeks. this all got that bad because she was on high doses of meds for months and months, and instead of helping her it not only hindered her but almost killed her. i also want to mention that my dog is on a weekly anabolic steroid injection that has played a major role in stabalizing her falling blood count. i really hope alex gets better

josh california

Chris We were giving Maggie the following dosages each morning with her food.:- Cyclosporine 5 x 100mg = 500mg, Azathioprine 2 x 50mg = 100mg, Famotidine 1 x 20mg, Prednisone 4 x 20mg = 80mg. Due to a infection we gave her 500mg of Clavamox which is a antibiotic 2 hours later. At 5:30PM we give her with her food Famotidine 1 x 20mg, Denamarin 2 x 425mg =850mg (for her liver), 500mg of Clavamox 2 hours later. We did start here on a Thyroide medication, but it was too late. Maggie was 88lbs. Hope this helps Karon

Karon SC

Thanks for your input. I'm not sure what to do. There is no easy answer. It seems his liver is damaged from the drugs. I feel like I have alot of "what ifs" at this point but I guess you don't get a second chance at this. I tried to find good doctors and rely on their expertise. It seemed the drugs he was on were pretty much consistant with what others were on. The complications just seem to be increasing for him. He has no quality of life at this point and I think he has had very little quality of life now for months. I just kept hoping it would get better. Instead the drugs that were supposed to be helping are making him worse. He's just such a sweetheart and only 3 yrs old. We have an appointment at the vet again friday but I think I'll call today to see if I can reduce any of the meds. Thanks for your thoughts.

Chris PA

Chris, I can honestly say that I know what you are going through and it is heartbreaking. After two months on all the meds, my Sunny got to the point where the drugs were doing too much harm and his quality of life diminished. I truly believe that the drugs killed him, although I'm sure that the drugs gave me more time with him. He was only five years old. Sometimes no matter how hard you try and how much money you spend, things are out of your control. Keep loving your dog. He will feel it and it will comfort him. You are in my thoughts and prayers today. I hope that reducing the meds will help your dog. Leslie ps - Try not to dwell on the "what ifs". You have done the best you could with the knowledge available.

Leslie Oceanside

Chris, I know what you're going through. It's hard to know what is the best thing to do concerning the meds. I look back and think that I should have started Darcy on the Cyclosporine instead of opting for the Azathioprine, but the specialist didn't make it clear to me about which would be best and I decided to try the less expensive med first. Then the Prednisone and Azathioprine brought on her pancreatitis. Now I read that Azathioprine causes bone marrow destruction and Darcy's bone marrow wasn't producing RBCs to begin with. She'd been on Cyclosporine for three weeks when the pancreatitis developed, so just last night we doubled her dose. Now I'm wondering if this is the right thing to do. Her gums are pale, but she seems to have energy. We go for a blood test tomorrow. Didn't mean to burden you with my problems, just wanted to let you know that I understand and can sympathize with you. I will pray for you and Alex, that you will make the right decisions for him. Tell your specialist about your concerns and make him/her listen. Also, you can email Dr. Dodds and ask her advice about the meds. She always responds quickly. Keep us posted. Karen

Karen NC

I typed a comment before and hit submit however it didn't show up so if it appears twice - my apologies. We had an ultrasound done today and it doesn't look good. Alex has a lot of liver damage due to the meds. He's always been sensitive to the meds and my regular vet says prognosis doesn't look good. He said although he is not in "pain" that he is suffering. He is going to consult with the specialist tomorrow before we make the decision to put him down. Of course now that I brought him home he eats, he chews his rawhide, and although he looks awful, he seems spunkier. It'so hard to know what to do. Guess we'll take it one day at a time. Karen,I know what you mean about the Azathioprine. If I had things to do again I may do them a little differently and hope for a better outcome. There are alot of dogs that are on it and they appear to do well though. It's good that Darcy has energy as Alex never really came back from getting sick. How did Darcy's blood test go today? My thanks to all of you for your suggestions and kind words. Chris

Chris PA

Chris, It's a good sign that Alex seems spunkier, is eating and enjoying his rawhide. You are in a better position than the vet to guage Alex's pain tolerance level. How can he be suffering if he's not in pain? How does the vet know that he's suffering? I know you mentioned the liver cleanse diet and that Alex didn't like it, but have you tried milk thistle or something else the health food store might recommend for dogs with liver damage? Standard Products has excellent supplements for dogs and they probably have one that is geared specificially to the liver. I know that some people on this forum give their dogs ground up milk thistle. Darcy's PCV was down three points today --- 23%. I am disheartened about this. The specialist had told me last week that the blood test of her Cyclosporine level had been low, so we started a double dose of it Monday evening. Today the specialist said that the Cyclosporine didn't register AT ALL in her system and that we may have to change to the name brand drug. This, after I went out to Costco and bought a month's supply of Cyclosporine. If there's a chance that she won't absorb it, I'd just as soon go ahead with the brand name before her PCV level drops more. It is very frustrating, especially when the information is dispensed in bits and pieces. I'm calling Costco to find out more about the name brand and see if I can returned the unopened boxes. We should receive the thyroid panel tomorrow, so I'll be discussing the possibility of changing to the store brand at that time. Hang in there with Alex. I know you'll make the right decision about what's best for him. You can read him better than anyone else. Karen

Karen NC

Thinking of you and Alex and hoping for the best.

Courtney SLO

Chris, I am praying for you and your Alex today. I know what you are going through and my heart hurts for you. Leslie

Leslie Oceanside

Thanks we appreciate the prayers. We also keep all of you in ours. We are taking it day by day. He definitely seems to feel sick every time I give him the Atopica. Tomorrow we talk to the Internal Medicine doc to get her thoughts on things and see what she thinks his prognosis is based on the most recent test. I will mention the milk thistle to her. I took him off all meds except the immune suppressant drugs. I'll keep you posted. Right now he is eating roast beef with potatoes - hey I'm just glad he's eating (probably not the best for his liver though). We wish the best for all of you. Chris

Chris PA

Chris, saying prayers for good news for you and Alex tomorrow. I think he deserves the roast beef. :) sharon

Sharon CT

chris- having liver and kidney abnormalities while on such high doses of meds is pretty normal in some cases... one vet told me that my dogs kidneys would fail within 6 weeks and then a month after she told me that (after strongly reducing meds), her kidney levels were fine and its been over a year with no issues i hope alex gets better

josh california

I have a 2 year old West Highland White and we've been battling for 5 months. Initially she responded well to pred 20mg a day but then was dropped to 10mg. She then crashed and its been awful ever since. Blood transfusion this week, the az (which I was never sure about) drug which has now caused liver problems. She's had diruetics for fluid retention this week, tablets for her stomach too. Today she is having a scan on liver and heart. The vet wants to try cyclosporin. I feel terrible but don't think we can go on like this much longer. Things seem to be getting worse and worse. I was told she had pure red blood cell aplasia to begin with but now they don't see sure - they think it might be IMHA too. She'd had bone marrow biopsies at the beginning and numerous blood tests and scans. We have insurance up to a limit but I'm starting to wonder if its fair - where this is all going and with the ever increasing bills whether we can go on funding it all. Clare

Clare Fox United Kingdom

This thread was discussed between 13/10/2008 and 24/10/2008

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