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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Kent, an update and question
| Hi everyone, I havent posted in a while. It seems like Kent and I have had to adjust to a whole different normal than before. We have had his AIHA under control, and he has developed CRF as a result, i think, of his meds, or age. Thats been going okay too until recently. His hematocrit has been jumping around the last month, one day will read 30, then 23, then a week later 29. last week was 29, now, today inhouse at vet was 23. I dont know whether to increase pred or imuran or both or something, vet says leave as is, it may be because of his kidney disease that his kidneys are no longer making the hormone that tells the bone marrow to release new cells. but the imuran does suppress bone marrow too. I'm so confused. (Patrice? Help, please, thank you). Should we then be lowering the imuran? (25mg eod, pred is 10mg eod, levothyroxine 400mg every day/2)ursodial 175mg eod + supplements). Last week he started to have gooey poops again, and i took him off all of his supplements (he takes alot now) to give his body a break. I was planning on slowy adding them back in, but now do not know what to do. His bun is around 60 and his creatinine has gone up to 2.1 from 1.8. High but not dramatically so. his appetite is up and down, and so is his energy and his mood. Last night he was very quiet and today did not want to get out of bed. When he did, he came into the kitchen, and just slid/fell down, and had a petit mal seizure. Our vet believes it could be from anything, and could be a one time thing or a new thing. I took him to the vet, hematocrit is 23, nothing else seems off. If anyone had any ideas of what could be going on please let me know, i hate this horrible disease, and this is so frustrating and i am just so sad - just when i think we've rounded a corner, it seems to be a cliff instead. Please pray with me for a recovery. Christine and Kent |
| Christine Fl |
| Christine, Your vet is correct. This kidney hormone is called erythropoietin or EPO. It is a glycoprotein that acts on the bone marrow to increase the production of red blood cells. Stimuli such as bleeding or other causes of anemia trigger it's release. In the very early days of Chance's non regenerative state, the specialist suggested we attempt giving him shots of this to try to stimulate the bone marrow. My vet has a special relationship with the local prison. If they have medications that have expired, they give them to her for use in dogs. She was able to get me a vial of EPO. I was just about to use it and this was one of the first questions I asked Jean Dodds. She advised me not to use it first, but as a last resort. So we did not use it but started the cyclosporine first. The problem is that the EPO generally available is human EPO. If you administer it there is a chance that the dog will have an autoimmune reaction to the human proteins and then you have two problems, not just one. But, that said, it can work. It is used all the time in humans to assist in anemia. It can be very expensive. Dr. Dodds would call this type of anemia Kent is experiencing "anemia of chronic disease." The numbers are not terribly low, but many dogs can adjust to these lower numbers with small changes in their lifestyle. I don't have much more time today, but I believe there is a recombinant canine epo available. Whether it is on the market or not, I cannot say for sure. If this were me, I might ask the vet about these epo shots and see if they have ever used them. I know my vet does use it because she gets a constant source from the prison. A nice elderly neighbor has these shots on a regular basis for his anemia. I am sorry to hear about the small seizure. He may be just having trouble adjusting to lower blood pressure and is having a syncopy episode, not a seizure. Next time watch him very carefully and write down everything you see afterwards, esp look at the eyes, size of pupil, color of gums, is there tetany in the limbs, take a pulse rate while it is happening. Time it, time how long the pulse rate takes to return to normal etc etc my best patrice |
| Patrice NYS |
| Thank you Patrice. We just had his full blood done about 2.5 weeks ago, and nothing too out of balance except the obvious - rbcs down, he did have reticulytes but not huge amounts. He has not had a seizure or fainted since yesterday morning. i'm staying home today and watching him. The vet wants me to look into finding epo, and i am working on that. Cornell did a study and manufactured, made, tested, i'm not sure, epo for dogs but they never put it on the market, i think for financial reasons. If i recall, the study proved pretty effective, and the dogs could handle it much longer than with the human epo, which they sooner or later reject. The only other thing i can attribute some of this too, are the supplements. I had been giving him coq10 50mg a day, and ran out. while waiting for the new bottle to arrive, he seemed fine. But just got it yesterday, so he went cold turkey without it for about 1 week, and i saw yesterday that you have to be very careful to taper the doses down, and not go cold turkey. I may have caused this by not having the coq10 on hand. I dont know. Otherwise, his liver kidney numbers are about what they have been. I sometimes worry i give him too many supplements - he gets fish oil for omega 3, coq10, sAme, milk thistle, dogzymes, vitamin b (with his subqfluids), calcium, pet tinic, vit e. He also takes aluminum phospate gel powder to bind the phosporus in his foods. I had some donated azodyl, and was giving that to him also, its supposed to bind toxins and bring the bun and creatinine lower. I am considering adding chitosan, i have done research and it seems this can dramatically lower the creatinine. Its the key ingredient in epakitin (very expensive). I also have a homeopathy bottle of drops called renalix that is supposed to be great for kidneys, but everytime i give this to him he throws up. we are going to try switching his subq fluids to the other type (we use lrs now) to try to balance his electrolytes better and keep his potassium levels down. I sent another blood sample to dr. dodds and hope to have results soon to share with you. He seems okay today, just shivering a bit, no appetite yet (normal for him in the mornings). Unfortunately, the kidney disease can only be managed, and it is eventually terminal. I just wonder if it would help to lower the imuran dose, even at the expense of increasing the pred, in case the imuran is suppressing the bone marrow. ?? Thank you so much for your response, and i really appreciate everyone's kind thoughts. Christine and Kent |
| Christine Fl |
| Christine, Follow through with looking for sources of EPO that have expired. Hospitals may have tough regulations, but prisons seem to be less restrictive. Or perhaps skilled nursing facilities might be a source? I agree that the canine compound that Cornell produced would be safer, but getting it may be problematic. If your vet has used EPO before safely, then it would be her/his call about the safety with Kent. If I had reached a dead end with the cyclosporine that is the next step I was going to take. It's not so much that the bone marrow is being suppressed as it is the hormone that is supposed to wake it up is missing in enough quantity (or is intermittent in quantity) to make it an efficient system. Thus the fluctuating numbers you are seeing. My elderly neighbor and I talk about how his HCT fluctuates but never gets very high. Then he knows it is time for another EPO shot. Diarrhea: This must be brought under control in order for all the supplements to be absorbed. B12 is the important vitamin that aids in blood cell manufacture. The only way that this can be assimilated is via a mechanism in the small intestine wall. If that is failing because of malabsorption no amount of oral B12 will be absorbed. Chance has had problems with this absorption so I continue to give him B12 shots on a regular basis. They are cheap and safe. There is a test to determine the levels of b12 (cobalamine) and folic acid in the blood. It is part of the pancreatic panel. This can be a very diagnostic test in cases like this. Ask for them to break out just the b12 and foline test if possible to reduce your cost. You may remember I attended a day long seminar on canine nutrition with the vet in charge of nutrition at Cornell this summer. Here is some of the information about Coenzyme Q10. "Intricate part of the energy production in cells. 1000x more abundant than vit E in membranes. Under oxidative stress will help in vit E regeneration. May actually be an ergogenic (any external influences that can positively affect physical or mental performance) aid in elderly populations. In elderly pop. found to be decreased in many tissues esp. heart and skeletal muscle. Increases respiratory chain activity. Suggested dose in human literature is 100 mg a day. Dogs have 3x number of mitochondria in cells than humans so dosage should be at 100 mg a day for elderly dogs. So don't stop giving the CoQ10! Omega 3's: Provide a proper balance of Omega 6 to 3. I don't have the ratio written down here for some reason, but just keep in mind: THERE SHOULD BE MORE OMEGA 3 IN EVERYONE'S DIET THAN OMEGA 6. Dogs have an even tougher time converting omega 6 properly so are at a greater disadvantage. Omega 6 will increase inflammatory conditions in dogs so really try to cut back on this fatty acid in the diet. Consider any oil of vegetable origin to be tougher for them to assimilate and use because of this. Fish body oil is easy to obtain and is a great source of Omega 3's for dogs. Many people like to give their dog salmon oil. It's pricey. The K9nutrition list owner gives her rotties 3-6 fish oil caps a day. Always add vit E 400 mg to that dosage. I have also added choline and insitol to Chance's supplements as recommended by the Cornell vet. Under phosphorus control: "phosphorus restriction is essential. ensure appropriate caloric intake. phosphate binders: aluminum hydroxide 30-90 mg/kg best at reducing phos. Calcium hydroside 6-7 mg/kg adequate to maintain for long term." Vit D and renal failure: "Cannot use oral D3 - ergocalciferaol cholecalciferol. IV calcitrol is controversial: may help to decrease PTH secretion, make sure calcium and phosphorus are normalized. " Under protein: Nitrogen balance control." Want to supply bodies need for protein: too little leads to proteolysis of lean mass, too much leads to uremia. Early renal failure with protein loss need more protein. As tubules fail and azotemia presents itself protein restriction is needed. Protein source important: Egg, Casein, Soy. Less lysine and arginitine-less nitrogen. " Under fiber and renal failure: "Nitrogen trapping effect: lactulose, psyllium husk powder 1-2 grams per meal" Sorry this is so long but thought you might want to read some of this information. In fact, this seminar was supposed to be just the one day and the second half of the day was supposed to be "Feeding/Supplementing for Diseases" and I have the handout, but there were so many questions about dog food diets in general that that topic took the whole day. I just received a notice that this vet will be presenting this second half of the presentation in a month or so. So then I will know more about the renal failure information. my best patrice |
| Patrice NYS |
This thread was discussed between 22/10/2008 and 23/10/2008
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