Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Med Reduction Question

I was just wondering if anybody here has followed Dr. Dodds' reduction protocol. I ask this because Tessy's doctor was talking to Dr. Dodds and she recommended for us to start reducing Tessy's meds....which I'm totally fine with. The problem I have is with the time span between reductions. Currently Tessy takes 37mg azath/day, 50mg pred/day, & 200mg Cyclo/day. The reduction plan goes like this...Reduce the prednisone from 50mg to 40mg for 5 days, then to 35 for another 5 days, then 30mg, etc. etc. etc. Has anybody gone this route? I know the general rule of thumb is to drop no more than 25%-35% every 3-4 weeks but since this came from Dr. Dodds it makes me wonder. I trust what she says because of her status in this field. I'm just lost as to what to do now since this recommendation came from Dr. Dodds. If this has worked for anybody else then it would make me feel a whole lot better. Thanks, Johnny & Tessy

Johnny

Johnny, I did follow her plans for Chance to the letter. Each dog really needs a special approach. We did do some pretty fast reduction of prednisone, but he had finally responded to the cyclosporine, was making blood for the first time in months and was showing severe side effects from months of high doses of prednisone. His alk phos was over 8600! While we did this reduction, we maintained the cyclo. I would never advise anyone to make medication decisions on their own without first running it by your own vet or Dr. Dodds. This is when your vets clinical experience comes into play. They can monitor a dog's condition carefully to determine if there are any adverse effects from the drug protocol. my best patrice

Patrice NYS

We'll be maintaining the azath and cyclo also. Another thing I was wondering about was if it is alright to give 8 5mg pred pills all at once to make up the 40mg. Her doctor gave us a container of 5mg pills. These won't cause a problem I wonder? I'm not worried about getting them into her but just wondering if they would dissolve too fast and cause problems. Volume wise they take up more space so????? Just a quick correction....she'll be reducing from 50-40-30-20etc instead of 50-40-35-30-25etc. Johnny & Tessy

Johnny

Johnny, The risk of decreasing prednisone too quickly has to do with the challenge to the adrenal glands that it poses. The adrenal glands will "go to sleep" when exposed to high doses of cortisol (prednisone) because it feels that its job producing cortisol is not needed. Dose reduction of prednisone is done gradually so that they can wake up appropriately. If it is done too quickly for them to respond appropriately, and there is too little cortisol in the body, there can be something called an Addison's Crisis. While this is not the same as Addison's disease, the body effects can be nearly the same. So reducing prednisone too quickly DOES NOT CAUSE ADDISON'S DISEASE, but can possibly bring about a similar crisis. You can read here about Addison's Disease and note that there is a mention of atypical Addison's near the bottom. High dose prednisone use is not mentioned in this article so don't be confused. http://www.marvistavet.com/html/addison_s_disease.html my best patrice

Patrice NYS

Hi Johnny, As Patrice comments, its individual for each dog. I can only share my experience. Kent was on high pred, which was lowered over a period of 3 months, down to 5 or less mg a day, then taken off because he developed pancreatitis. His pred was not resumed, and he had not taken any other drugs at this first aiha round. Then, he felt great, it was great, til i noticed red spots on his tongue and tummy almost two months later. Diagnosis: IMT. Not good. So, my feeling is, better safe than sorry when reducing pred. The slower the better. I would ask your vet, and also check the online merck manual. I would simply really proceed with extreme caution, given the risk of relapse if too quick. Thats my opinion, but please consult your vet and find out all the options and opt for the safest route. Good luck, Christine

Christine FL

Johnny, we reduced from 40-30 after 10 days and then to 20 after one week. Kahlu was then on 20 for over 5 weeks. Dr. Dodds thought that Kahlu needed to come down like that, because we probably had him on the very high doses too long. After that we never decreased sooner than after 2 weeks. After almost 5 months we are still on 10mg down from 75mg at diagnosis. It seems to me that Tessy is still on a very high dose of pred for her size. It is so confusing, I wish there would be a protocol written in stone. But like Patrice said it is different for every dog. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Hi Johnny, The reduction of prednisone sounds very fast to me. I liked the approach we took of getting blood levels, tapering the pred starting the NEXT week and then the next week getting blood level again. That made a lot of sense to me because that way, you can see how the dog does at each reduction. It seems to me that the way you're describing would make you wonder whether it was the 50 to the 40, or the 40 to the 35, etc. that led to the dog having problems, if any problems occurred (hopefully this won't happen!). But congrats on Tessy doing well enough to start to reduce. That's wonderful! Leslie

Leslie

Johnny and Tessy, I am going to write what we did with Henri because so far (knock on wood), we have had no complications. Henri's medication weaning process has gone without hitch. So here it goes...2 weeks after every drug reduction, Henri goes in for blood work. The medication reductions have occured every 3 weeks (1 week after each blood check). Henri's hematocrit has been stable ranging from 40-43% at each check. 1st Reduction: 10mg/day Prednisone to 7.5mg/day 2nd Reduction: 50mg/day Cyclosporine to 25mg/day 3rd Reduction: Stop Cyclosporine 4th Reduction: 7.5mg/day Prednisone to 5mg/day 5th Reduction: 5mg/day Prednisone to 2.5mg/day Henri's current medication regimen is: 2.5mg/day prednisone and 12.25mg/every other day AZT. Henri goes in for blood work next week--that would be 2 weeks after the last Prednisone reduction. FYI Henri weights almost 15-lbs. I hope this is helpful in some way. Good luck--we send healing wishes every day. Furhugs, Ella, Bella, and Mr Henri

Ella Seattle

Johnny, Nothing to add really, just a huge paws up and support for being ready to reduce again. Tessy rocks! melissa and tiggs

melissa slc

It's been almost 3 years since Choe was diagnosed and I am JUST this week stopping the very last dosage of .05 mg of pred. (1/2 of 1 mg) that I have been giving him once a week. We S L O W L Y weaned down. It has been an up and down roller coaster with his number readings and so it has taken this long to (hopefully) get him stabilized so that he will finally be med free. I guess my experience tells me to inform folks that are questioning....it doesnt have to be in one month or 6 months or even one year to wean your pet of pred. You may need to have him/her on a regimin low dose for several years. Best to all and keep your fingers crossed for my boy. Jan

Jan Phila.

Jan, What GREAT news about Choe. I am so happy for you both. And you are so right,the weaning process does not have to be in 6 months or even a year. The dogs that I have seen do the best long term are those whose medications (especially pred) has been weaned down very, very slowly. Hugs to Choe from me and my little canine red-headed gal, Maddie.

Joanne MN

Brigitte, I think that we are on the same reduction schedule that you and Kahlu are on. I'm going to follow Dr. Dodds' recommendations as I trust what she says. Tessy is still on high doses of cyclo and azath so once we get all 3 down to lower levels then the weaning process will become more gradual (I'm hoping). This will be Tessy's first reduction so I guess you all know where I'm at right now. Just a little nervous and cautious one could say. Dr. Dodds also thought that Tessy was on too high a dose for too long and that the long term effects of these doses would probably do more harm than good. She also wants me to discontinue the aspirin but leave the omeprazole. Even a small thing like this gets me worried! All I can do is keep my eye on her and watch for any negative signs. Hope everyone is doing good today. Johnny & Tessy

Johnny

Johnny, When I was freaking out about those first reductions, my vet told me, that slow reductions are very important but that she trusted Dr.Dodds with those unusually fast ones at that point. Tutteli (my vet) used pretty well the same words as Patrice to explain the awakening of the adrenal glands to me. But she said at these high doses, that would not quite happen yet. Since Kahlu has been down from the very high doses, we have never reduced faster than every 2 weeks and usually 20-25%. If it would come from just any vet I might have had doubts, but coming from Dr. Dodds I was confident it was the right thing. Since you had blood sent to her, you can be even more relaxed I think. She knows what is going on with Tessy from seeing these numbers. I am sure you will see Tessy improve over the next few weeks. Give her a big poodle hug from Kahlu! Best wishes Brigitte & Kahlu PS: Could you send me the approximate cost for sending the blood to Dr. Dodds from Canada? We want to do that in a few weeks, so I can start saving :) b.pletscher@telus.net Thanks!

Brigitte BC Canada

Charlies first prednisone reduction watch nerve racking! He went from 40 to 20 but was also on 50 azathiaprine. We are hoping to start the next pred reduction soon now that we are off azathiaprine now almost 2 weeks. Hang in there and keep a close eye on tessy I'm sure she will do great! Doodle hugs from us!

carol

Brigitte, Go to this webpage: http://www.itsfortheanimals.com/HEMOPET.HTM Read everything on the page and also look for the following words on the page to get the forms for sending blood FROM OUTSIDE THE US: "For those who are outside the USA -- 3 forms to download & print-out:" The cost should be quotable to you by one of these companies: "Ship the samples using FEDEX courier, Priority Airmail, or other Postal Airmail." Be sure you follow all the instructions about EVERYTHING exactly the way they request or your sample will not be allowed to cross the border or it could be damaged in travel. my best patrice

Patrice NYS

Thanks Patrice! I contemplated going to a vet in the States when we go traveling in 3 weeks, but I don't think it is worth the hassle. I will just do it from here. My vet gives me a 50% discount on all blood collections and tests so it will even out in the end. She has done it before with dogs that have thyroid problems, so I am sure they know what to do. I will look up hemopet's website anyway, so I can watch their fingers, just in case! Thanks again, Brigitte

Brigitte BC Canada

I wish out vet would give discounts! I was complaining to them the other day because I get charged $10 everytime they have to simply write out a prescription. They said all vets do this? You'ld think that all the money I've spent there they'ld give a break. Johnny & Tessy

Johnny

Johnny, You can tell them that NOT all vets charge for prescriptions! They are part of the "package" at my clinic. I am convinced, that my vet did not make any money on us the first 2 months, considering all the time she put in. She never charged me for the time she spent talking to an internal specialist and also not for consulting with Dr. Dodds. She has spent hours on the phone talking to me and also looking things up in textbooks. I still come equipped with a long list of questions every 2 weeks and she never minds taking time to answer them. She also did an x-ray once and did not charge me! So I really don't mind spending $40 on that little bottle of milk thistle. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

My vet calls my scripts to target so I can get generic prednisone for 4 bucks. They have never charged to write or call. He is an internal specialist and will also chat on the phone and answer any questions at any time!

carol

This thread was discussed between 10/06/2009 and 13/06/2009

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