Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Kahlu AIHA frustration

We have been doing pretty good, more energy, feeling and looking better over all. We have done 2 reductions and are now down to 30 mg per day. Over the Easter weekend Kahlu got more tired, more bloated and sad looking. His eyes started to get guncky and I also suspected an other UT infection. Blood tests on Thursday showed he is holding at 36Htc and 4.4 RBC. I was so hoping with the reduction he would improve. The UT infection was also confirmed and he is back on Antibiotics. Unfortunately we did not see our regular vet and chemistry was not done. On my way out my regular vet just walked in. She always gives me the feeling Kahlu is the only dog she cares for! We talked quickly and she gave me a call later last night. She then did some research and came up with the following: Hi Bridget I did some research tonight. I think we should decrease his iron supplementation - they can get into toxicity problems. I would cut it in half for now. It sounds like the tapering usually takes about 6 months, and it sounds like they usually taper the pred first like we thought, but it depends on which drug is causing the most side effects and concerns. Apparently 1 in 50 dogs can get a hepatotoxicity from the azathioprine. If we reduce the pred again and his liver numbers are still going up I would conclude that it is likely due to the azathioprine, not the pred, and at that point I would recommend starting a very gradual taper of the azathioprine. Perhaps we should be doing blood work every 2 weeks instead of weekly, unless there are some concerns, and I would recommend the full panel with the chemistry monthly. That's all the thoughts I have for now Tutteli She actually sent me an e-mail on her day off! Any thoughts? Brigitte & Kahlu

Brigitte BC Canada

Brigitte...I feel your frustration. The smallest of things can get to me at times. Was Kahlu using more energy over the weekend? Perhaps the body is trying to catch up. I know this is the case with Tessy. Some days she is more active than others. The days after the active days she seems to just want to rest....unless she knows there's food on the way. I can't really suggest anything with regards to the reductions cause Tessy isn't there yet. It does sound like Kahlu has a great doctor who knows what he's doing. As far as the iron supplementation droppage goes...maybe he should have run a chem panel to see Kahlu's levels before deciding to drop the iron any. I can't see how it can harm kahlu by dropping his dose of iron but I'm not a doctor either....so this is only an opinion. Tessy was taking two multi-vitamins a day at first and then after her relapse they said to stop giving them to her. She seems to be doing fine now. It is up to you if you want to switch the testing from weekly to bi-weekly. I still test Tessy every week. It terrifies me that I might miss something important by waiting another week. Maybe when she becomes stable I will consider bi-weekly testing. Whatever the outcome, I hope and pray for the best for you and Kahlu. You're doing a good job so far so keep up the good work and keep us posted. Johnny & Tessy

Johnny

Brigitte, I am really confused is your vet calling azi iron supplementation, its an immunosuppresant??? Or is she talking about an iron supplement you are giving? Can you post Kahlus chem panel? Wylie MCHC was elevated and one of the reason can be too much iron so my vet had me discontinue the pet tinic. Laurie

Laurie CA

Laurie, sorry for confusing you. My vet's suggestion to cut the iron in half (to 100mg) is separate from the reduction of the azathioprine. I have given him 200mg up till now, recommended by Dr. Dodds, together with folic acid and B12. I can not get the pet tinic here in Canada, so I just give the supplements in individual doses. Dr. Dodds gave us the doses that would be in the pet tinic. Last week Kahlu's ALP was 500, ALT 448 and GGT 506. It had gone up from the week before when we reduced the pred from 50 to 40 mg. So we are concerned about his liver enzymes. I just got back from a nice walk and Kahlu was so much better again. I guess the Antibiotics have kicked in. He will be on them for 3 weeks again. I am wondering if he could be on a maintenance dose? So we hang on to the roller coaster.... Brigitte & Kahlu

Brigitte BC Canada

Brigette, I am sorry to hear that Kahlu has another UTI. I suspect that the eye gooping is allergies. I knew that it was spring at least a month ago because Chance's eyes began gooping. I use human eye wash with a cotton pad to clean his eyes and a small bit of a veterinary eye antibiotic with hydrocortisone in it to reduce the swelling and irritation. We always think of "iron poor blood" as being the cause of anemia. That's not necessarily the cause of AIHA. Low iron absorption can contribute to faulty red blood cell manufacture. The main function of iron is to combine with copper and protein to make hemoglobin that is in red blood cells and carries oxygen. Iron also helps certain enzymes in the body. We need iron regularly because red blood cells only live around 120 days, die and need to be replaced. In a dog with AIHA, this may happen at a faster pace. Dosing iron in some ill dogs can be tricky. Iron absorption happens in the small intestine. If there is malabsorption, the iron just won't be utilized. The only way to get it into the system in that case would be administration with a syringe. This, by the way, can be a problem with B12 absorption as well and that vitamin may need to be administered the same way. Dogs should get about 35 mg of iron daily for every pound of food they eat and it shouldn't be iron oxide or carbonate. So let's look at Pet-Tinic. Per teaspoon it has 12.5 mg of iron and this comes from beef liver paste and iron proteinate. The recommended dose is 1/2 teaspoon per 25 lb of body weight twice a day. So for a medium sized dog of about 50 pounds, this would equal 12.5 mg. This would be in addition to any supplements of iron in the dog food. This might be tricky to determine, but you can assume that quality food will try to have the optimum dosage as determined by the recommended cups per dog weight. I would personally not dose iron supplements any more than 60-80 mg a day. Chance gets about 2-3 lbs of food a day. I give him about 1-2 ounces of liver twice a day. That provides a proper quantity of iron. (Liver is dosed at no more than 1 ounce per 10 lbs of dog per week). my best patrice

Patrice NYS

Thanks Patrice, I just trusted Dr. Dodds dosage for the iron. I might give feeding a bit of liver a try and just leave the iron supplements for a week or two and see where that takes us. As for Kahlu's eyes, they have cleared up with the antibiotics. I guess that was some sort of infection as well. Things are looking up for now! Brigitte & Kahlu

Brigitte BC Canada

Patrice...you amaze me once again. Can Tessy and I come live with you? It would be like having my own specialist! If it weren't for you I'ld have tonnes of unanswered questions. On a side note....Tessy's doctor told me to feed her liver so that she could get the iron naturally. I'm not sure how many ounces it is she gets but were at about half a cup per day.....and she loves it like a treat which is also special since she's been cut back on all her other treats. I just give her a little peice here and there throughout the day. I'll keep you all in my thoughts and prayers....hope everyone is doing good today. Johnny & Tessy

Johnny

Sorry Johnny, I have first dibs! I already invited Patrice to come to Vancouver Island, telling her property is cheap here, but she does not seem to want to move :). Best wishes to everybody, Brigitte and Kahlu

Brigitte BC Canada

Can't we share here....you have her some of the year....I'll have her the rest.

Johnny Nova Scotia

Sounds like a plan! Maybe we can lure her with our universal health plan? No wait, Obama is going to get that for her.... maybe we just lie and tell her we have a universal health plan for animals. I think that could work. Enough of that...but honestly Patrice, we really appreciate your help. Your knowledge has been incredibly valuable! Brigitte & Kahlu

Brigitte BC Canada

Okay, you canucks are tooooo funny! Made me laugh, thank you! If you are ever down in tropical south florida, let me know! Okay, down to business, Brigitte and Kahlu; and all the other dogs out there with liver values going sky high. My Kent had extremely elevated liver values and his liver was actually enlarged to three times its normal size, due to pred and maybe imuran (not sure about this, and brigitte, would like to know more about this re what your vet said). Anyway, it was elevated and his medicine couldnt be stopped. Patrice and others recommended Denamarin, which i got, and which i then substituted with milk thistle and SaMe. And, the results were extraordinary, and our vet couldnt believe it, the numbers or the normal sized liver. Along with the liver normalizing while on the meds, Kent had more energy, and an extra bit of sparkle and joy, than when liver numbers skyhigh. And, i did cook for kent, most all of his meals - dog food was just left in his bowl in case he was really hungry and his shortorder cook was out or sleeping ) There are some great recipes out there, and once you start cooking and get the hang of it along with what does what, it can be fun, truly (most of the time). Dr. Dodds has a great 'good for the liver' recipe posted somewhere. My vet had actually called a holistic nutrionist vet when Kent first got sick and recommended the milk thistle and to start it with pulse dosing. You could jsut try with teh denamarin first, its a combo of the two. Best, Christine and Kent

Christine FL

Hi Christine, I figured a bit of humour would do everybody good.:) Kahlu is already on Milk thistle and we have added SaMe a while ago too. I tried the liver cleansing diet for a few days, but Kahlu got so incredibly hungry, that I added some kibbles to it. I will mention the Denamarin to the vet at our next visit in 10 days. Thanks for your suggestions. Hopefully dropping the iron will have an effect too. It seames my vets comments were a bit confusing to everybody. Not to me, because I just talked to her and knew what she was referring to. (sorry) There were (are) two things concerning me. First the high liver enzymes and then the tapering of prednisone and azathioprene. Of course it is all connected. I was reading one thing then the other, about tapering and then Dr. Dodds recommended yet an other thing. So I was frustrated. Now I try not to think to far ahead and just take one day at a time. Kahlu seems pretty stable at 20mg pred (2x10) and 50mg aza per day. If his liver enzymes have gone up again next week despite the pred reduction, my vet wants to start tapering the aza or do it every other day. I guess it is time to do that anyway? He has been on it for 8 weeks now. I wish it would be all just straight forward, the same for everybody and Christal clear. I am trying not to worry until we have new results again. Brigitte & Kahlu

Brigitte BC Canada

This thread was discussed between 17/04/2009 and 21/04/2009

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