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

Hello everyone, Kahlu had his 2 week checkup and blood draw on Thursday. The vet was pleased with how he looked, more alert and a bit less atrophied, but we are now talking of Cushings. The blood was sent away and the waiting game began. The BC Provincial Agility Championships are held right here on Vancouver Island this weekend. Since competing is out, I offered to drive around the judges. I picked two up Thursday evening and of course the talk went to my dog pretty soon. One judge was so touched, she had tears in her eyes and gave me a hug! I never met the woman before... Friday I am pacing, because the call should come any minute. It came on the way to the airport and the results are good! RBC 5.6 HTC 0.43 thank goodness I had pulled over! His liver enzymes are still very high, they actually all went up a bit again. So I picked up the next judge and again, with these people pretty well all you do is talk about dogs. When I mentioned my sick dog, Arlene just looked at me wide eyed and said: I had a dog that had that. And guess what Patrice, it was a Giant Schnauzer! My next question of course, did he live? She said that this was years ago when they had only prednisone. The dog was 5 when he got it and lived 5 good more years, when he died of non AIHA related causes! Arlene also knows Newman, the Mini Aussi Agility dog in Joanne's Success stories. We are now reducing prednisone from 20 to 15mg. The vet thinks we should now reduce it in 2 week intervals, because it gives him such a hard time. You think she is pushing it? Would it be better to go down to 10 in 3 weeks or 12.5 in 2 weeks? I just might get my vet to contact Dr. Dodds again. Sorry, this was a bit long winded, but I had so many positive things happening the last two days, I had to share. Thinking of you all, best wishes, Brigitte & Kahlu

Brigitte BC

That is great news for Kahlu! What a small world meeting these people. That reduction does sound right and because Kahlu has had such difficulty with pred I would do it, so I would drop Dr Dodds a note to confirm since she has been helping you. Laurie

Laurie CA

I forgot to address Kahlus rising liver enzymes. Wylie is having the same problem. Her ALT had been going down and this week her ALT jumped 200 points in 45 days, so my vet is suspecting 2 things first rule out some sort of infection so she is on doxy now. If the ALT continues to rise he want to look at her gall bladder. SO I would check with your vet about these possibilities Laurie

Laurie CA

Great news Brigitte. You must be doing something right for Kahlu. I'ld assume that since his HCT is leveling off the pred reductions are a good thing. If you are concerned with the next reduction (15-10...only 33% reduciton) then maybe you could drop to 12.5 for a week and then down to 10 the following week instead of 33% drop in two weeks. Either way I don't believe (my opinion) that either option is drastic. I think the lower the pred gets the more cautious one should be. Either way....Dr. Dodds advise will at least calm your nerves and give you reassurance. I'm hoping and praying that with the reductions Kahlu's liver #'s will start to lower. When Tessy had high numbers I switched her to a more bland diet and now her numbers and lower....don't know if that will help you or not due to the drugs. Does he take anything for his liver? Anywho, enjoy the weekend with Kahlu and give him high paws from Tessy. Johnny & Tessy

Johnny

Brigette, That is pretty wild about Arlene! I just checked my subscriber list for GIANT and I don't see her as a member, but that doesn't mean that I haven't talked with her via email at any time! GIANT has members all over the world and thus the connections between Giant Schnauzer owners is quite complex. I actually have a good friend who lives on Vancouver Island that has owned Giants for a long time! Look, any dog being treated with high doses of prednisone WILL develop Iatrogenic Cushing's Disease. To the body, it doesn't matter where the high dose of cortisol is coming from, either disease of the adrenal glands OR artificially from high dose prednisone. The difference between the two is how they are treated. A dog with a disease of the adrenal glands has a tougher time with treatment. A dog that has Iatrogenic Cushing's Disease (or caused by high doses of corticosteroid use) can, in most cases, simply reduce the dose of prednisone slowly and the adrenal glands will respond, releasing their own cortisol, until there is eventually a normal balance achieved. It's very important to understand that the slow reduction of prednisone is for this reason. The adrenal glands "sensed" that there was too much cortisol in the bloodstream and they basically shut down and atrophied. If you suddenly stop administering prednisone, the adrenal glands are not prepared to produce cortisol after having been "asleep" for a long period of time. They will fail to make and circulate the proper amount of cortisol to the body. This can be a deadly situation. There can be a serious "crash" without the right amount of cortisol in the body. This is called an Addison's crisis. Thus, slowly decreasing the prednisone dose gives the adrenal glands time to "wake up" and produce cortisol again. Eventually going to an every other day dosing schedule is a primary way to finally ween the adrenals off of artificial supplementation. Your reductions should be done in this way: >never reduce more than 25-33% at any one time >reduce only one drug at a time. >precede reductions with a blood test. if the dog is stable a PCV may be sufficient. >generally don't reduce more often than every two weeks, again judging by how stable the dog seems. >prednisone at lower doses, considered subclinical, can often move to one dose a day rather than a split dose. If this is done, the morning is the preferable time to dose. (a subclinical dose might be something like 2-5 mg) Once you reach a much lower dose, say 1-2 mg a day, you can begin thinking about an every other day schedule. >But in every case, always do the actual math needed to determine what % you are actually decreasing by. If you switch to a once a day dose or an every other day dose, you might accidentally be doing a 50% reduction! In this case begin looking at the overall weekly dose and work the math to make sure the reduction is more like 25%. >example: dosing is at 2 mg bid (2ce daily) = 4 mg daily. 25% of 4 mg is 1 mg. 4 mg minus 1 mg is 3 mg. So dose would be 1.5 bid. >3 mg x 25% is .75. 3 minus .75 is 2.25. If this were me I would go to 1.25 in the morning and 1 in the evening. >at less than 2 mg daily I would go to dosing once daily in the morning. >at less than 1.5 mg daily I would begin looking at every other day dosing, but work out the weekly dosage so it isn't lower than 25-33%. So the doses may go up a bit every other day rather than staying the same. Is this all as clear as mud? ;-] Laurie, doxy can significantly increase ALT and has done so in nearly every dog treated with this drug for tick diseases. Dr. Dodds is out of the country for a trip and will return in 1-2 weeks. Assistant is holding emails until she returns. my best patrice

Patrice NYS

Patrice, Thank you so much! This was really what I was looking for for a while. I never thought of looking at the pred over the whole week. I kept thinking, how do I go eod and not go down 50%. Like I said before, I am a Kindergarten teacher, math....not so much. But I think I can handle it from here. I also somehow forgot about the step of dosing once a day. So far my vet has reduced on the conservative side and I am sure that has helped in the long run to keep Kahlu stable. Thanks again for spending the time to explain! Laurie, Kahlu also has a UT infection. This has been going on for over 6 weeks now. We did a culture and that turned up e-coli. So he is again on Antibiotics (Clavulin) I never thought that could have an effect on his liver too. Thanks for bringing it up. Johnny, Kahlu has been taking lots of Milk thistle in capsule form up to now. This week the vet gave me a high quality liquid tincture. ($40 for a 100 ml bottle it better be high quality, but it should last about 3 weeks) he is also taking Zentonil, an other liver support (and also very expensive. I think this is what our US friends refer to as Sam-E) I feed him no grain, high protein and low fat kibbles with lots of home cooked fish, chicken and veggies. We do what we can, right? Thanks so much to everybody, best wishes, Brigitte & Kahlu

Brigitte BC Canada

Patrice, I took Arlene to the airport last night. She is not on the Giant list and did not know you. Where on Vancouver Island is your friend? We are in Campbell River on the east coast. If you ever come here please let me know! I want to take you out for dinner, have a barbecue or some other type of celebration! I hope you, Chance and your whole family is doing well. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

I will have to ask Heidi where she lives. I know she must use the ferry to get to the mainland for some veterinary care. I would love to visit Heidi some day. I can't imagine that I will do it very soon though. Maybe when I retire! We have had a very tough time with Chance. He was seen by his specialist about 1.5 months ago and we put him on some good medications. He was doing fine on them and feeling very good. I got a panicky call from the vet's office two weeks ago that one medication was being recalled because the manufacturer of this generic said that some pills could contain more or less of the medication. This particular medication has a very narrow range between a therapeutic dose and a toxic dose. They ordered another bottle of this medication. Within 2 days of starting this new bottle, he began having seizures. It didn't take me long to figure out that it was probably this new bottle of meds (from a different manufacturer) that was causing this. I rushed him to the vets and later Mark drove him to the specialist in Buffalo. We had a blood level taken to check for this med and I finally got the results back showing a too high amount at 12 hours. He was getting a toxic dose of medication. He's fine now, it took a couple of days for him to settle out from this. No harm done. But I can assure you I will not be getting any generic medications for him ever again. I am pretty shook up though. my best patrice

Patrice NYS

Ahhh, Patrice, how awful. I am so glad Chance is fine now. How scary. There was a post a little while ago, where you sounded rushed and I was wondering what was wrong. This really makes me think, Kahlu's drugs are mainly generic. But since he has had no reaction I guess he should be ok. I guess we never stop worrying... There is no other way to get on or off Vancouver island with out an at least 1 1/2 hour beautiful ferry ride. It would be great to see you here one day. Best wishes to you, Chance and your family, Brigitte & Kahlu

Brigitte BC Canada

This thread was discussed between 16/05/2009 and 20/05/2009

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