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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Maggie update - week 3 of treatment
| Patrice, Cindi, Dylan's dad, et al... Maggie, a 7 year old yellow Lab with bone marrow IMHA is now in week three of her treatment which consists of the following: 80 mg daily prednisone 50 mg every other day of Azathioprine There is some mild improvement and some concerns. Fortunately, my vet is open to treatment modifications to address Maggie's condition. Two days prior to Maggie's diagnosis (around late October), her key numbers were: HCT: 26 Reticulocyte: 1.2% Absolute Reticulocyte: 48. (Moderate improvement in anemia occurs at > 110-150 Her numbers at the two week point of her treatment, last Thursday: HCT: 23 Reticulocyte: 2.9% Absolute Reticulocyte: 85 The past few days, she has been more lethargic and generally less herself. I took her in this morning to get checked out. She did not have a temperature and her gums were pink. I want to note that the other CBC draw times occurred in the late afternoons: HCT: 20 Reticulocyte: 3.4% Absolute Reticulocyte 87 So there is an improvement in her immature RBC production, just not enough to make a difference in Maggie's anemia. My vet and her consult are concerned about how Maggie is feeling so they want a chem panel done on her to eliminate any underlying condition (ie urinary tract infection). She is also concerned about the effects of the Prednisone so she will also probably prescribe Maggie Cyclosporine and if necessary an antibiotic. I am reassured that my vet feels pretty positive about Maggie's prognosis but also notes her condition and the complexity of her illness. She says that everyone in her office is very fond of Maggie and working hard to get her well because she is "a special little dog" (all 87 LBs of her). Otherwise, Maggie has a good appetite and regularly seeks attention. She is really feeling the prednisone and her anemia still hasn't started to turn a corner. I feel we are close, its just hard to see her suffer from these side effects. questions: Is there a difference in HCT according to when its taken? Cyclosporine - the good and bad. Sounds like its really made a positive difference in the condition of many dogs, including Tori and Chance, once added to treatment protocols, but that the side effects can be unpleasant. My vet is working with the internal medicine specialist from Colorado St. U. vet hospital to determine the right brand for Maggie's specific case. You guys are awesome. I have the full CBC results except for today's so if you want any other numbers I can provide them. Thanks, Maggie and Robert |
| RobertN Superior |
| Robert, The side effects of cyclosporine are a great deal less bothersome than those of prednisone. It targets (or inhibits) the T-cells of the immune system, not the whole immune system. Prednisone targets the whole immune system by flooding the body with cortisol. It's like the difference between a wrecking ball and an archaeological pick. I have read the results of the research study for the use of Atopica, as applies to dogs that have atopic allergies. Keep in mind that the dosages for use in non-regenerative anemia are most often the same dosages they prescribe for dogs with allergies. In studies like this they will often dose at 2-3 times the recommended dose to determine what the side effects will be. At extremely high doses they began to see some more serious negative side effects. But at regular doses the most common side effects are gastrointestinal, like diarrhea or vomiting. The most important result from the study, for me, was that when they withdrew the drug, the side effects cleared very quickly. That is not the case with prednisone. Those side effects can take months to clear depending on the dosage and duration of the treatment. My personal experience is that Chance, on his highest dose 220 mg (the same starting dose for Atopica for allergies), he would act a little spaced out for an hour or so after his dose. We weren't at that high dose for very long, Dr. Dodds only stays at this dose for about two weeks. Meanwhile I was beginning the prednisone decrease. This would have been in July-August 2007. Once I got him down to around 180mg he no longer was being bothered by it and by week 4 we were into fabulous regenerative numbers on his tests. I continued to slowly taper this drug and by Christmas we had discontinued it. I know a few dogs on this forum have had more serious gastrointestinal problems. It will be apparent right from the start if this is the case and removing the drug immediately stops this side effect. Some dogs vomit in the beginning and Dr. Dodds has advised the owners to either try giving the doses with food or decreasing the dosage temporarily. Usually this is just enough for the dog to tolerate the drug and then they can return to full dosage. I feel this is a safe drug. It has been tested not only for humans, but also for dogs. The capsule form Atopcia, is dosed for canine use by weight and is easy to administer. It is expensive, but the dosage doesn't need to stay high for a long period of time. The manufacturer often gives rebates. HCT. Yes and no, the time of day, whether the dog was properly fasted or not, was the dog dehydrated, the level of stress and noise in the clinic, your nervousness, the skill level of the vet tech, the length of time the blood sits before the test is done, the calibration of the automated analyzer can all make a huge difference in the accuracy of the CBC (and thus the HCT.) The difference in HCT vs PCV can be significant in our very sick dogs. In general, my vet found, and I have seen MANY times here, the HCT will be 3-6 percent points lower than the PCV. The hematocrit is a percentage of all other blood elements and this can give a lower overall number. Both are measuring the same thing, but the PVC is a good working number for determining medication dosage adjustments rather than the HCT. The Packed Cell Volume test is done visually, a small tube is filled with blood and spun. They hold it up to a chart and get the reading from that. It shouldn't cost more than $15 and is highly accurate. I recommend you ask for this each time you do a CBC in the early days and do this as a singular test once you are beyond crisis and want to take a quick look. I feel better that you will be adding this to your treatment protocol. This saved Chance's life and I am hopeful this will be the same thing for Maggie. my best patrice |
| Patrice NYS |
| Thanks as always Patrice. I was the one to bring up Cyclosporine, and my vet spoke fluently of it, but wanted to consult with the internal medicine specialist at CSU as well as wait for the full CBC results to come back from the lab. Interestingly enough, my vet said some brands work better than others, depending on the situation, and that Atopica would not be the brand she recommend for Maggie's case. She did advise against the generic and is working to find the right brand. I am also pleased that after three weeks, she is willing to modify Maggie's treatment. Maggie has shown some increase in reticulocyte generation, but just not enough. As Maggie is really feeling the affects of Prednisone, her vet is not hesitating at all to add Cyclosporine to the treatment protocol. I will ask my vet about the PCV vs. the HCT. I gave Maggie a marrow bone this evening, and she enthusiastically tore into it, breathing heavily at the same time. Now her poor tummy is extremely bloated. She already had her Pepcid dose about 30 minutes prior to her dinner. I am hoping that much of it is air from breathing so much through her mouth while working on the bone. Is Cyclosporine dosage determined from the weight of the dog? Maggie's last weight was 86 LBs. |
| RobertN Superior |
| Robert, Here is an article of interest from a veterinary clinic website. http://www.marvistavet.com/html/body_cyclosporine.html "When cyclosporine is used orally, two different formulations are available: emulsion and microemulsion. It is probably best not to use formulations other than the microemulsion as they provide the best absorption from the GI tract. Absorption from the GI tract is an issue with cyclosporine and even microemulsification provides only 23-45% bioavailability, better absorption occurring on an empty stomach. Because bioavailability is not optimal in the best of circumstances, it is probably best to avoid generic cyclosporines as their bioavailability has not been tested in dogs or cats." Your vet is referring to cyclosporine that is formulated as microemulsion vs the emulsion formulation. From the Atopica product insert: "ATOPICA (cyclosporine capsules, USP)MODIFIED is an oral form of cyclosporine that immediately forms a microemulsion in an aqueous environment." You can see the full product insert here: www.us.atopica.com/pdf/product-insert.pdf Thus, I am confident that Atopica is a microemulsion. It is dosed by weight specifically for dogs. If you chose to get a generic to save money, you must adhere to this information and specifically ask for the correct formulation. my best patrice |
| Patrice NYS |
| My dog's health, and perhaps her life, is at stake. If I need to spend more money to make Maggie well, I am quite willing to do so. Further, my vet also recommends not using a generic. To paraphrase her, they are less likely to be effective than a brand name. The emulsion vs. the microemulsion is interesting and provides a good talking point for me with my vet. She has been impressed with how engaged and informed I've become throughout this whole process. |
| RobertN Superior |
| Robert, Maggie is in Good Hands. You are doing all you can and It shows. Thoughts as well as Prayers will continue for you both. |
| Kathy Calif. |
This thread was discussed on 11/11/2011
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