Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - nervous about charlie's prednisone reduction

Charlie my 1 year old labradoodle was diagnosed 1 month ago. He has made significant improvments over the past month. He had his PCV checked today and he is maintaining at 37. The vet said that a normal range would be between 35 and 55. He is on 40mg pred. 50mg azathiaprine 20mg aspirin and 10mg Pepcid. The Vet wants me to reduce his prednisone to 20mg and discontinue the aspirin. I absolutely questioned the vet whether this was too much of a reduction and if we should take it slower. He thought that we should start with this and see were he is in 2 weeks. Since he responded so well over the last month. If he goes down then we would re-evaluate at that time. I'm very nervous but will start this reductions today. I know that the pred is rough on their systems and need to trust the vet. Does anyone have any advise or any early signs i should be looking for if he doesnt respond well, since he is already extremely tired from the pred. Thank you, and I keep all of you and your doggies in my prayes.

Carol Vancouver

Carol A normal PCV in a dog is in a range from 37 to 55. I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased. “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA By the way if you have not read my Web site on AIHA/IMHA as yet you might want to do so. The URL is http://www.cloudnet.com/~jdickson/ Be sure to follow all the links on the first page to many other sites on AIHA/IMHA that will be very helpful to you and do read the Success Stories pages. They will show you what has worked for other dogs in terms of treatment options and give you alot of HOPE.

Joanne MN

HI Carol, Joanne has already provided you with some very good info. The only thing I will add is that we have been following the protocol of 25% reduction every 2-3 weeks of stable disease- per Colorado State University protocol.. It sounds as though this reduction your vet is proposing is more like 50%, you might want to do a smaller reduction and see how it goes in another 2-3 weeks. When we began some of our early reductions, it was common that Tiggs' PCV was fluctuating by about 3 points. Just keep an eye on it, and don't be afraid to go in for a PCV check if you have any concerns. Glad that Charlie has been doing well, melissa and tiggs

melissa slc

Joanne, I just wanted to let you know that your website is one of the first sites I found the night charlie was diagnosed. Plus, it was one of the only sites that offered HOPE, that dogs can get through this. Thank you so much for that. Before I found this forum, I read many depressing stories of loss, so I googled canine anemia sucess and this forun came up. Thank God it did, it has helped so much. Melissa, thank you for reponding, I am watching charlie like a hawk. I followed the vets instructions and so far so good, charlie slept so well last night, he even snored like he used to. We went for a walk today and he seems to be doing fine. I am making sure to keep my eye on his gums and it is absolutely nerve wracking worrying about him, as I'm sure you understand. I will definately take him in for a check if anything changes. Thank you again, take care carol

Carol Vanc

Carol, I think if you are going to go along with your Vet with the larger cut in the meds I would test again at 1 week just to be sure. It seems to be a lot harder after a relapse if you can imagine anything worse than the first time. I am not trying to second guess your Vet but we have all had to dig our heels in sometimes with our own Vets. Go back and read through some of the success stories at Joanne's site and compare the reductions. I am glad that Charlie has responded so well and hope he continues as well. Penny

Penny Lytle Creek Calif

Penny, I think that is a really good idea and I will probably do that. I cannot imagine going through this again.

carol Vanc wa

After reading about the gradual Pred. reduction, I’m wondering if my vet is doing it too drastically. We went from 20 mg. 2 times a day to ½ that, then to ½ that, in a time span of a month. Layla seems so lethargic, like when she was on a high dose. Any thoughts on this? Thanks, Terese

T.Rose Erie

I would not cut 50% if she is not having pred complications, if she is not having from what I understand the main reason for not dropping the the dose rapidly is do you something bad to the adrenal glands and the dog or even person for that manner can get very sick. hopefully someone else can explain it better Laurie

Laurie CA

T Rose, I was going to post the following post yesterday after you mentioned Layla's good PCV. But decided not to, yet I kept it in my "word file" so I am posting it now T, While I am thrilled to hear that your dear Layla is doing so well if she were my dog I would be a bit concerned about the possibilty of the prednisone being discontiuned after only about 2 1/2 months. I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased.” “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA Discontining the pred too quickly can lead to an adreanal gland crisis and/or relapses. Please don't think I am trying to "rain on your joy" because I am not. I just have seen too many cases of AIHA/IMHA relapses and/or adreanal gland crisis when the pred has been disconinued too quickly and that is a mistake far, far too many vets make when dealing with AIHA/IMHA. This site http://www.marvistavet.com/html/prednisone.html says and I quote "Prednisone/prednisolone are commonly used for several weeks or even months at a time to get a chronic process under control. It is important that the dose be tapered to an every other day schedule once the condition is controlled. The reason for this is that body will perceive these hormones and not produce any of its own. In time, the adrenal glands will atrophy so that when the medication is discontinued, the patient will be unable to respond to any stressful situation. An actual circulatory crisis can result. By using the medication every other day, this allows the body's own adrenal glands to remain active." Notice it says "Prednisone/prednisolone are commonly used for several weeks or even months at a time to get a chronic process under control. And this site http://www.peteducation.com/article.cfm?c=26+1461&aid=1422 says and I quote "Additionally, the dosage for steroids usually changes with each animal over time. The animal is usually started at a high or 'loading' dose for a few days, and is then dropped to a long term maintenance level. Finally, a reduced dosage is utilized that slowly weans the animal's body off the medication. During the maintenance stage, it is preferred to use oral medications and give them only every other day in the morning. This also reduces the chance of suppressing the hypophyseal/pituitary gland feedback system on the adrenal glands. By gradually decreasing the level of steroids at the end of the treatment, veterinarians greatly reduce or eliminate potential problems with the adrenal glands being unable to function normally as described above." End of quote As you can see this site also mentions a slow weaning process. Just a few thoughts for whatever they are worth

Joanne MN

Carol, I like the others would also be very concerned to reduce the meds that much this soon. We just stopped Aziathioprine for Holly and I asked Dr Dodds about lowering down the prednisone from 2mg to just a tad lower and she said no, have to wait for 2 months to see how she does on the elimination of the aziathioprine. Even then she said she suspects Holly might have to remain on low dosage of the prednisone otherwise she is more prone to relapse. Since we are at it for 2 years I am following her instructions. Linda

Linda Sapphire

Thank you for all the info. Charlie is also acting very tired he isn't as thirsty but still wants to eat. i am feeding him normal no extra anymore. I have decided to call the vet to let them know I am not comfortable With the amount of pred reduction and want to give 30mg instead of 20mg. Thank you again for all the support

carol vanc wa

This thread was discussed between 27/02/2009 and 28/02/2009

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