Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Macy doing ok

Hi all....I hope that Kelly, Briggite, and Silka are holding up as well as all others who have lost their beloved companions. It was such a sad time last week that I felt hopeless but lately there has been some good news. I have read many posts lately on the pro's and con's of different drugs. I just wanted to let you know what has been working for Macy....when we first started out our great vet Dr. Page recommended we use all the drugs at our disposal in case one or more did not work. Macy has been on pred, cyclosporine, aza, and leflunomide. I questioned the leflunomide but my vet assured me that this was being used at universities with many positive results and virtually no side effects. Obviously, we do not want to continue on all these drugs long term but so far, so good as far as her bloodwork is concerned. She has been holding steady with a PCV of 39 and the spherocytes that were present before are no longer there. I pray that this continues.... My question at this point is what should I expect? Macy is certainly not the same dog. She cannot jump on the bed, she labors to get around, and her appetite comes and goes. I have read about other dogs on the board where their pups have eaten like crazy. Macy will eat a few items by hand and not much at one time. Is this normal? Is the Leflunomide killing her appetite? Will she have to be taken off the drugs before I see any resemblance of her old self or is this her new life? It has been two weeks tomorrow since she returned from the hospital and I am so grateful to be in the position we are in. What should I expect going forward? How long will this take? I know each case is different and there are certainly no guarantees but I am just trying to get an idea of what the process is from here.....Thank you...

Darren Long Beach

Hi Darren I am so pleased to read about Macy doing ok, thus far. I think you will get different stories as to what to expect. Riley was on all those drugs except leflunomide, and neither was we very food driven before he became ill, but after, and I believe it is the cortisone, made him want to eat everything in sight - which certainly helped with giving him the drugs. As you know, we had a hard time reaching stabilisation, and the specialist vet I saw, wanted Riey to reach reference range before reducing, and as I see it, Macy is in that range. I understand from others, that symptoms reverse as the reductions take place, but how long it takes I dont know. In Riley's case, he had adapted to his health restrictions, knew his back legs didnt work, and that he couldnt jump etc, but just occasionally, when things were better, you would see a glimple of the "old" Riley, and it would be exciting. I had all the same questions you do, but it sounds like Macy is on the right road, I guess now its all about reductions and your vet will no doubt guide you on this road, and I understand it has to be done slowly. It is hard to watch this happening - thank you for the concern about us - I miss Riley heaps and occasionally it just overtakes me in the middle of doing something else, and I have Bonnie and we go for lots of walks - she is currently sprawled on the couch watching "Judge Judy". :) Im sure all the other experienced ones will soon come in with their stories. Good luck Darren, I look forward to the next stages of Macy's improvement. Dont lose heart - last week was tough on all of us. Silka

Silka Melbourne Australia

Darren, Sounds like Macy is improving really well.. My Madison was diagnosed 16/1/09 so just over a year ago now... She has been drug free since Sept and back to her normal self again.. The drugs do change the way they are until most have been reduced or stopped. Madison had 2 transfusions within the first week and was on all the medication except leflunomide.. She was never a big eater and when she first became ill we had to hand feed her for about 3 weeks and really force her to eat. After about 3/4 weeks on the medication she would eat anything and just stayed in the kitchen until something fell on the floor she could eat. All her leg muscles deteriated and she found it hard to jump up at all, she also put on a lot of weight... After about 2 months of slow constant improvement we slowly started reducing the medication. Then in Sept she was drug free. Her muscles came back, she lost the excess weight, she went back to her normal eating pattern and once again became a bossy little Diva.. :) It all takes time and a lot of patients, the drugs do effect them but then again do help save them.. Samantha & Madison

Samantha Perht

Darren, sounds like things are looking up for you and Macy! 39 is a great PCV to have. Do you have any idea what her hemoglobin count is? She'll start to come around with time. The drugs are most likely causeing the side effects you are seeing. HOWEVER...please do not rush to get her off drugs at this point. Try to hold steady for another little while and have a recheck for spherocytes. That's a super huge deal to see none of these present. Usually one has to wait untill there are a couple weeks of stabilization until the meds can be adjusted. Did you get a chem profile done? I'ld get this to check on all the values from the drugs. Act accordingly. Best wishes, Johnny & Tessy

Johnny

Darren, It is good to hear that Macy is improving. My poodle, Tootsie, started to improve very slowly as her drugs were taken away. It is 8 months since she was diagnosed and she is still taking 5 mg of prednisone every other day and 3/4 of a 50 mg of aza every other day. Tootsie was back to her pre-illness self after 4 1/2 months. I would have been very discouraged were it not for the Meisha's web site and this forum. My vet was encouraging also as he has successfully treated AIHA in the past. Tootsie had a blood test today and we will find out Monday if we can reduce her meds further. You and Macy will be in our prayers. Barb & Tootsie

Barb Ohio

Its the drugs that are causing her not to eat and be listless, probably the cyclo and azi. 39 is a fantastic number so quick. Is Macy on any anti-nausa meds? I think she should be because of everything she is taking. YOu don't say what level her pred is at. Can you post her cbc numbers her weight and dosage of meds? From a lot of what I read here, the pred has the worse side effects and is the one to start tapering first. If Macy is on a really high dose of pred you may ask about reducing it a little bit since her PCV is high. I have protocal that says number holds at 2 weeks, then reduce pred, again if number is holding to reduce pred, (this is only if her platelets numbers look good. And dogs may need to be on a low dose of pred for a year or more. Then the azi is reduced next. Laurie

Laurie CA

Hi there Darren (and Macy)! 39% is a fabulous number! My AIHA boy went to the Bridge two years ago ( a six yr survivor and was still in complete remission when he passed)but wanted to let you know I can relate to each and every one of your concerns. As many know, with this disease, sometimes its two steps forward,two steps back, one step forward,....and so on. Prednisone alone will make them have a serious appetite. I lost many sandwiches in the beginning when my Jacob was on high doses of pred. I believe that the combo of meds is what might be causing Macy's appetite suppression. Jacob was a very muscular labby/pitt mix so it was very hard witnessing him not being able to jump on the bed, couch, etc. Rest assured....that is temporary. Once you are able to reduce the meds ,I promise you, one day out of the blue, Macy will do something that she hasnt done in a while and it will probably bring you to tears. It may be just doing something silly like the "goofy dance" (thats what I called it when Jacob would lay on his back and go crazy squirming across the carpet as if he had an itch.) I remember the first day Jacob jumped on the couch. That was the turning point for us and it was all uphill from there. He regained every bit of his muscle back. His face had gotten almost skeleton-like. Trust me, things are moving along for Macy much faster than they did for my Jacob. It took months for us to get a pcv in the 30's. Take a deep breathe and try to relax (easier said than done I know). Macy seems to be making remarkable progress and you WILL have your "old" Macy back. Best wishes! Hugs to you for being an awesome daddy and hugs to Macy for being one tough pup! Teresa

Teresa va

Thank you all so much for your kind words of encouragement and your knowledge. None of us asked to be in this situation and I honestly don't know what I would have done without this forum. I went from complete panic thinking I was going to lose her to just praying to god she would come home. Now that she is home, I am just trying to adjust again and realize this is a long term marathon fight. Macy and I are ready though. Reality sets in quick that this is a long term, life changing unfortunate situation. I wouldn't change it for a bit though and I feel, once again, so fortunate. The hard part is when friends or family members ask if she is "all better" now. It is such a hard disease to explain. I just tell them that she is improving but has a long way to go and leave it at that. As for the numbers....Macy weighed 55 pds before this disease started. She is a shepard/husky mix and was probably 5 pds overweight which ultimately may have been a good thing because she is down to 45 pds. She is getting a full CBC every week and has one scheduled on Monday. She is on 50mg of pred a day (1 pill of 25 mg's- 12 hours apart), 50 mg of Aza every other day, 240 mg's of cyclo (1 pill of 120mg every 12 hrs), and 95 mg's of Luflonomide per day. In addition, she is on aspirin, heparin (3 injections a day to prevent blood clotting), milk thisle, melatonin, and pepcid. I have metaclopromide for nausea but the vet only wants me to give it to her if she is drooling, won't eat anything, or vomiting. I also have mirtazapine to stimulate the appetite but I don't give that to her either as long as she is eating a decent amount. The less drugs the better. The hard part is finding healthy foods she will eat consistently. She will eat treats all day which she wouldn't do when she was first sick. Also, any recommendations for the pills? She will only eat by hand usually and is on to my tricks of pill pockets, putting it in sandwich meat, etc. so now I have to manually force them down her throat which is no fun for any of us...please advise if anything worked for you. Her last CBC read good numbers for her pancreas, a little elevated for her liver due to the drugs, a PCV 0f 39, and no sphercytes present. Is there something else I should be asking about? Some specific numbers? Please let me know what it is I should be asking for...Thank you again.

Darren Long Beach

Try icecream for the meds if everything else fails. There's been talk however of dairy inhibiting the absorption of cyclo so this could be something to consider. Use just super small amounts...just enough to cover the pills. It'll slide right down! Give him a little at first "WITHOUT" meds in it and try to really make him think htat it's a BIG TIME treat. Once he thinks this you'll be home free.

Johnny

We have to coat Ginger's pills in peanut butter. Have you tried a food from the Honest Kitchen http://www.thehonestkitchen.com/products/ It is a very good food and I did use it for awhile and Ginger loved it, just to expensive for 3 Goldens. Maybe just buy the smallest amount to make sure Macy likes it at first. It is sold in some of the better pet food stores, so you maybe able to buy it in your area instead of online. Cheryl & Ginger

Cheryl & Ginger Pinevile pa

Darren: We had to give Sheba (GSD/Cocker Spaniel mix) her large pills in spoonfuls of soft dog food. (It usually worked although occasionally she'd eat around the pill!) Eating was not a problem for her as she is definitely a food motivated dog. Many people have had success with baby food (just be sure to check the label for things like onion), peanut butter, ice cream, and cheese. Good luck! Rita, Mike and Sheba

Rita IA

Darren, many numbers play a huge role in this and you should be monitoring them in a spread sheet, the platelets, rbc, etc and then when you see them fluctuate you can talk to your vet. If you email me your address I can sedn you the one I did cheflaurie40@sbcglobal.net Even though you are very pleased with your vet, I am still huge proponent of you getting a 2nd opinion Like I mentioned before from Dr Dodds in an email consult. again fantastic numbers for Macy Laurie

Laurie CA

Darren, What a great number! I agree with what everyone else has posted. You might try some Pill pockets, I think all the pet food stores carry them. I get mine at Petsmart. You might give your other dog a treat when your giving Macy her meds. Competition for goodies usually make my dogs gulp down whatever they are tossed in anticpation of scoring the other dogs goodies.

Penny Lytle Creek Calif

Hi Darren, That really is great news about Macy and her PCV holding at 39! What a great number. No spherocytes is great - the destruction has hopefully stopped. You would want to stay stable for a couple more weeks I think, and then thinking about reducing the meds. Perhaps the Pred would be the first one to reduce, especially if Macy has elevated liver values? However, given that she is on Leflunomide, I don't know much about this drug, so the vet should guide you on when you can start reducing this drug - it might be the first one to go down? As for the lack of appetite, I recall that one of the side effects of Leflunomide mentioned by Patrice was loss of appetite. You are probably right that this drug is causing Macy not to want to eat so much. I know the Pred made Millie an eating machine, she became a scavenger and a pest as she was always hanging around the kitchen and trying to steal the other dogs and our cat's food. All the other side effects you mention are normal - Millie could not jump up on the bed or sit next to me on the couch as the Pred had wasted her muscles. As we reduced this drug, slowly we noticed things starting to improve. She's now Pred free - and she's back to her old self. I used to take her for 5 minute walks around our house, and sit outside with her on my lap so she could smell the 'outside smells'. She loved that. As for pills, I would hide Millie's in free-range sliced ham. We have to give Millie 'Vetmedin' capsules (pretty big pills for a little dog like Millie) for her heart, and we cannot give these in food. At first it was quite traumatic for her, as my husband would have to force them down her throat. A year later, and she's sees my husband coming with the pill, and she rolls on her back with her mouth open.... I guess they get used to it, as much as we hate doing it, it's for the best. Maybe you can post Macy's CBC results, and there will be some people here who can make some comments on the numbers to help you know what to ask the vet. Keep us posted on Macy's progress, Samantha & Millie.

Samantha Geelong

Good job Darren and Macy. Keep up the good work.

Mardi Northern Calif

This thread was discussed between 22/01/2010 and 25/01/2010

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