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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Medication Advice
| Our specialist called today with the news that Darcy's cyclosporine absorption level is 343.36. The normal range is 600-1200. The specialist suggested two different things, but can't give me any encouragement that they would make a difference. The first thing she suggested is adding an anti-fungual human medication called Ketotonazole that would affect the liver enzymes, which could cause Darcy to absorb more of the cyclosporine. The side effect is liver toxicity, which could happened immediately. The next thing would be to change from Neoral/Atopica to the human med Mycophenolate OR Leflunomide. Both of these are immune suppressant drugs. I emailed Dr. Dodds and am waiting for her reply. I also plan on contacting an holistic vet in my area who makes house calls. Yesterday I contacted another vet in NY who I believe treats this disease with supplements, but I have not had a response from him. His name is Dr. Martin Goldstein. Anyone heard of him? I am at a loss as to what to do for my poor baby. Her clinical signs are still good, but she rests and sleeps a lot. I want to do what is best for her and I do not want her treated like some kind of experimentation. I won't keep pumping drugs into her that have the potential of hurting her even more. I'm considering taking her off all meds and going with an holistic approach. Any advice is appreciated. Please pray for Darcy and please pray that I will make the right decision. Karen |
| Karen NC |
| Karen, I am so sorry to hear about your dilemma. I know Dr. Dodds will get back to you with an answer. The Ketoconazole used in this way is a pharmaceutical "trick," I have seen it mentioned at some veterinary web sites as a possibility. What Dr. Dodds told me about testing the blood levels was not to bother. I didn't do it and Chance responded quite well to the Atopica. His clinical response and his blood tests indicated that. So there was no need for us to check. I would be very cautious about removing her current treatment without working through this with your vet. Or perhaps you can make an appointment to consult with another vet in your area? Are there any other specialists either at another clinic or at your clinic? I worked with three different vets at my clinic and each one has their own personality and approach. Depending on who I was seeing, Chance might not be doing as well as he should or he was doing just fine! Keeping her stable is very important and removing all her drugs may cause great instability at this point. The first thing I would do if this were me is to wonder why the number seems so low? Dosing at the right time of the day, on an empty stomach and using very little food to do so is very important. Will Dr. Dodds say dose once a day or twice a day? These are very important considerations. Let us know what she says, my best patrice |
| Patrice n |
| Karen, I'm sorry to hear about Darcy. I don't believe that Alex has ever had his cyclosporine level checked. I wondered about that. Although he is feeling much better we are still going through one battle after another. It's so disheartening I know. Keep fighting and know that we are all behind you. You will make the right decision for your baby. You and Darcy are in our prayers. |
| Chris PA |
| Thanks Patrice and Chris. Dr. Dodds did answer promptly. She's the greatest. She said definitely not to go with the Ketotonazole or change to the Mycophenolate or Eflunomide as "our experience with those that have given it has not been good." About the cyclosporine level test, Dr. Dodds said that they've never found that measuring those levels has made much difference. And to think I've had Darcy's level tested three times and it was very costly. Dr. Dodds said that the critical thing in determining if immune system is adequately suppressed or not is the absolute lymphocyte count. On 10/30 Darcy's was 2684 and the reference range was given as 690-4500. Dr. Dodds said the immune system should be suppressed to 500-100/cu mL. She suggested starting on Thyroxine asap if I hadn't done so already. The thing is we did that early on, sending the blood work to Dr. Dodds. Even though Darcy's test wasn't that low, my local vet agreed to put her on Soloxine and she was on it for six weeks. I still have 32 tablets left over. The specialist never wanted her on it and took her off when we changed to the brand name of cyclosporine. Dr. Dodds has also recommended anabolic steroid nandrolone decanoate (Durabolin) which is compounded from Franck's Compounding Lab. That would mean one injection a week for six weeks in addition to the Neoral, Prednisone, and Throxine. She said that the anabolic steroid has saved 2 recent cases that are still doing well. The thing that scares me about the steroid is that Darcy developed pancreatitist while she was on Azathioprine and 30 mg. of Prednisone. I need to know more about that. Until I can figure out this thing, I'll keep giving her the Neoral and 5 mg. of Prednisone, along with the PetTinic. It's so tough to know what to do. I do know one thing. Taking her to the specialist every week to have blood drawn is getting us nowhere, is upsetting to her and to me, and is expensive to boot. Darcy is acting great right now. Karen |
| Karen NC |
| Patrice, One more thing. I give Darcy her Neoral at least two hours after a meal, wrapped in a small amount of wet food. The pill is huge! In the evening, I give her the 5mg. of prednisone one hour after her last dose of Neoral. Karen |
| Karen NC |
| Karen, I consider the Soloxine I give Chance twice a day one of the most important medications that he gets. I was able to attend Dr. Dodds' workshop in this area in late summer this year. I was further convinced listening to her talk about how important thyroid function is with this disease and how very serious a disease autoimmune thyroiditis is. Thyroid function is important to many body functions and critical to blood making. Since you have stopped giving the thyroid med this would be a good time to have the test panel done for thyroid to see where you stand with that. This test is at http://www.hemopet.org/services.html under Test Request Submission Forms. Josh uses Durabolin for Sway and it has worked very well. Patrice |
| Patrice NYS |
| Wow, Karen, I'm so frustrated for you! It's so hard when things aren't 'cut and dry.' From what I can tell, you are still exploring every possibility, and you are Darcy's hero, and our inspiration for that. Whatever you decide, have faith that you are an incredible champion for Darcy. We are thinking of you girls, and praying hard to the universe that things will turn around! hugs, melissa and tiggs |
| melissa slc |
| Karen -- Interested to read the latest on Darcy. It's good to know her signs are okay, although sleeping a good bit. You and she are tough, but I am amazed at all of the decisions you have to make and how much you have to study and learn to know what to do. I am glad that Dr. Dodds is there to help you -- how I wish I had known of her when Wiley was fighting. Please take care and know that so many of us are here to offer our support. Some of our members are so knowledgeable. I'm not in that category, so I'll just offer some moral support. I'll keep you and Darcy in my prayers. You'll know how to handle this latest development -- you always work to find a way. |
| Brenda VA |
This thread was discussed between 09/12/2008 and 10/12/2008
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