Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - IMHA/ weaning off drugs

My cocker spaniel, Buster, was diagnosed with IMHA on April 13 of this year. He was rushed to U of Illinois where his red cell was 13. He had a transfusion and was put on 60 mg prednisone and 300 mg cyclosporine, along with aspirin therapy and drugs for his stomach. He did not improve so 20 mg azothiaprine was also added every day. He has since been reduced to 40 mg prednisone, 200 mg cyclosporine every day and 20 mg azothiaprine every other day. My local vet and the vets at U of I do not seem to communicate well, with me or each other. I worry about giving Buster all of these drugs long term. I realize he will be slowly weaned off of most of them, but would like to have some sort of timetable. I am so happy that my dog is doing well, but am worried that he is gaining so much weight, and is so tired all of the time. His blood count is over 40 now, so he is really doing great. While I am extremely happy just to have him alive, I still miss my happy, playful little buddy. Any ideas about a timetable?

Ronda P central Illinois

Hello Ronda, Things are clearly looking up for Buster! A PCV of 40 after not even 2 months is great! I don't know if you have gone on Joanne Dicksons Meisha's Hope site already, you find a lot of information there: http://www.cloudnet.com/~jdickson/index.html The success stories will give you an idea how the reductions can go. They are different for every dog. It is very important though to take it slow! The immune suppressant drugs shut Busters adrenal glands down. This is a good thing, because this stopped the destruction of the red blood cells. The adrenal glands have now to be SLOWLY awakened again. If the drugs are stopped or decreased to fast, you could trigger a relapse. Usually the reductions are not more that every 3-3 weeks, one drug at a time and no more that 25-30%. I have heard of bigger reductions and shorter intervals In the very high doses, but it cant' hurt to be cautious. So you have to be VERY patient. It could take a year to get Buster completely off all drugs. There is also the possibility that he will have to stay on a small maintenance dose for one of the drugs. The weight gain and muscle loss are inevitable with all the drugs. I know it is so hard to watch. Try and put Buster on a very healthy, no fat, no grain diet. Petinic, Omega3, Cranberry and especially a high quality milkthistle would be great supplements. Check out Dr. Dodds liver cleansing diet: http://www.canine-epilepsy.com/Liver%20cleansing%20diet.htm This would protect and help heal Buster's liver from all the drugs. It seems your vet team knows what they are doing, to bad they are not communicators. I think you should be more persistent with them. Ask LOTS of questions. I am sure you pay lots of money for their services, so they should help you understand what is happening with Buster. How old is Buster? It looks like he is on the right path and I know you will slowly get your old buddy back. I am sure more people will chime in with tips, suggestions and stuff I forgot. Please keep the questions coming, there are lots of people here that went through the same ordeal. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Ronda - It's great Buster's PCV is responding but I can empathize with your concerns about the doctors' communication and the meds he is on ... With respect to the meds, one thing you want to look at is Buster's white blood cell count - a low count suggests his body is not able to fight opportunistic infections. My dog was on pred, then Aza was added, then cyclosporin was added when his red count did not respond. At that point, his white count dropped well below norms but the internist did not cut back on the doses of any of the meds and he soon became septic, which was a life-threatening condition. At that point, we had to stop all IMHA meds in order to save him but we likely could have avoided that emergency if the internist had addressed the situation sooner. I'm in the Chicago area and have had to deal with U of I before - their resources are great but I know the communication can be difficult - I wish you and Buster the best. Bonnie

Bonnie Chicago

Thanks for answering. Buster is only 3 years old. I have been feeding him science diet, about 2 cups a day. He weighs about 45 lbs. I have to give him his meds in soft cat food to get them down, about 1 small can a day. He is a huge beggar, but we no longer allow people food. His stomach is rounded now, almost bloated looking. The last time his blood work was done, my vet said his white count was up. He was concerned so called U of I over it and told me that they seemed very happy with Busters numbers. I never did hear exactly what his number were, just that his PCV was over 40. I guess I just love him and can see the changes and wonder if he will get better. He seems so tired all the time. Since this happened, I have become afraid to wake up in the morning, afraid of what will be going on with him. Please tell me this is all normal.

Ronda C. Illinois

I am glad to read that Buster's PCV is at 40 that, is a very good number. I believe Dr Dodds has a protocol for reducing the med's here is her email address if you would to contact her hemopet@hotmail.com. How long has his PCV been in the normal range? This is just my opinion regarding his food intake, I think you could cut down a bit since he is not very active and not burning off a lot of the calories. All my Golden's gets 3/4 of a cup 2x a day as they are not to active and they all weigh around 75 lbs, and are on Evo . I think a dog being overweight is not good for their health in the long run, maybe you can discuss this with your regular vet. I think he will feel better once the pred is reduced and hopefully that will be the first one you can being reducing. You also might want to call Buster's vets and tell them your concerns regarding his reduction of med's, but as others have stated it must be done very slowly. How long has he been on the 40mg of pred? Don't be afraid to speak up as you are Buster's voice. Wishing Buster continued good health and hope he is feeling better soon. Cheryl & Ginger

Cheryl & Ginger caf0208@aol.com

Ronda, I agree with Cheryl, i would try and change Busters food intake. I think you could do better than the science diet. I always laughed at people cooking for their dogs.....but guess what? It felt good to put something healthy into my very sick standard poodle Kahlu. Something really good, not just the drugs. So i started with variations on Dr. Dodds liver cleansing diet. According to her it is very important NOT to feed any grains at the best of times and certainly not to a dog with IMHA. Steamed lean Chicken, turkey and white fish, squash, potatoes, kale, parcley, carrots, potatoes yellow and sweet, would all be very good. I think even a better quality kibble food with no grains would be better. Ask your vets for petinic, a supplement of B12, folic acid and iron. As far as I know, cat food is Buster being tired is totally normal. His body has a lot of healing to do. Also the medications probably make him tired too. I am sure you will see a slow increase in his energy over the next few weeks as his PCV is rising. For now it is good for him to rest a lot. When you go for your next vet visit, you should politely ask for printouts of ALL lab results! You payed for them and they are yours. It would be easier to understand what the vet and some people here are talking about when you see them. I was totally frazzled when I saw the first results, did not mean a thing.... but believe me you will learn fast and start to see trends. It is also good to post the numbers here for people to help you understand and maybe have some tips. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Ronda - The meds can make them feel bad - the distended stomach you are seeing is a common side effect of prednisone. I would make sure he's on a stomach protectant like Pepcid and some liver support like Milk Thistle and/or SamE. His counts are good, sounds like his appetite is good (you are smart to avoid fatty foods given the risk of pancreatitis) so I think what you are seeing MAY BE the side effect of the meds - powerful drugs are need to fight IMHA. Buster may very well be able to get through this - read the Success Stories - it's amazing what can happen. But, if atany time you are concerned, I would get him to a vet for a check. Take care - keep posting - there are so many smart, caring people who have been where you are. Take care- Bonnie

Bonnie Chicago

Ronda, you've got excellent advise above! I just wanna echo the need to get copies of ALL testing. With regards to the WBC....you want the lymphoid response to be at least a third the norm. The crit is very good right now and the fact it remains stable is excellent. I'd be moving towards reducing EITHER of the three drugs but do so slowly. If I had to pick one to lower first it would be the pred. Get this to a maintenance dose. Again, your choice but we can help you along the way. Don't worry too much about the weight gain. You can worry about this afterwards. If you have any questions or concerns feel free to ask. My thoughts and prayers are with Buster. Johnny & Tessy

Johnny

It can be along process reducing meds. We will be going on a year in August this year. Slowly weaning off this drug and that. then we you think they will be off, they say take it every other day :) Its worth it to take it slow.

Pam Il

This thread was discussed between 02/06/2010 and 04/06/2010

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