Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - newly diagnosed young Rott

My Rott girl, 2 1/2 years old was diagnosed with sudden onset AIHA on Fri. She was only sick 1 week while waiting for a diagnosis. She dropped 14lbs She was hospitalized Fri 7/16 afternoon and was there til Tue the 20th. Her HCT went from 28.9% Tues the 13th to 15% Sun the 18th, She was on IV medications Bonnie is now home. At the hospital her HCT on Tues was up to 17% and she came home. Her gums/tongue are still pale and she still pants, but she is active and playful once again Having a hard time with food right now- all she wants is cooked pork and cooked liver but hey it is food (I can occasionally get in a few bites of yogurt or chicken) She is eating 4 meals a day and occasionally vomits some of a meal She is getting in total for the day 600 mg Doxy (split up between the 4 meals) 40 mg Pred (split in two doses) 5ML Pet-tinic once a day plus 1 Chlor-oxygen 2 times a day 1000 mg Vit C once a day 1 milk thistle twice a day 1 B complex 50 once a day 1 slippery elm twice a day her re check appt is Wed the 28th

rottlady NH

I am so sorry to read about Bonnie's sudden illness. She is a very young dog for this to happen. It sounds from your report that she received excellent care in the clinic. We all hope that this treatment will be successful for her! Reading over your medication and supplement list it appears that your vet has some knowledge of what combinations to use in treatment. Let's look at some of these things to figure out what they do. The most important drug on this list, if this is a diagnosed case of IMHA (immune mediated hemolytic anemia) or AIHA (autoimmune hemolytic anemia), is prednisone. This is a corticosteroid that provides immunosuppression. Fancy words. Blah. This is really the same sort of thing that the body (in the adrenal glands) produces all the time, every day, to help the body adjust to stress. We call this cortisol when the body makes it and prednisone or prednisolone when we buy it from the vet. Our body carefully regulates cortisol because it is a very potent steroid or glucocorticoid and too much or too little can have negative effects on many body systems. So when you dose a dog with a suspected autoimmune disease you are giving it *too much* cortisol in hopes of suppressing the immune system which is engaged in a battle against its own body. There are many elements to the immune system and they regulate many things like destruction of bacteria or viruses that don't belong in the body. Unfortunately, the immune system can also destroy red blood cells when it senses something wrong with them that it can't identify as "self." So Bonnie is on a moderate dose of prednisone. I would guess being a Rottie, that she is somewhere around 80-100 lbs? So 40mg a day is a low-mid range dose for a dog her weight. As example, my dog, at 98lbs., was on 80mg a day. This drug does and will cause many negative side effects. This is termed Iatrogenic Cushing's Disease. This simply means that there is too much cortisol in the body and it is caused by artificially administering it via prednisone. Once the drug is removed, the condition resolves. That is not the case in dogs that have true Cushing's Disease. The other important drug on your list is doxycycline. This is an antibiotic that is commonly used to treat tick diseases, not only in dogs but in humans as well. What does this have to do with anemia? One of the many dangers of tick disease is that it can insert itself into the red blood cells in order to reproduce. The immune system senses something foreign about the RBC and begins destroying them to get at the tick disease. This can also be called an autoimmune attack but in this case the attack is directly focused on the tick disease, and indirectly at the red blood cells. So very often a vet will refer to this as IMHA or the immune system is fighting a battle and the red blood cells get in the way. Your vet may suspect or already have tested for a tick disease. If that is the case, treating with doxy will bring very quick results. Prednisone makes a dog very hungry and thirsty. Then they need to pee all the time. The body systems that control stress get out of whack and the dog can pant a lot, lose muscle tissue, fat redistributes to different spots on the body and in general they feel pretty uncomfortable. Both doxy and prednisone can be very hard on the stomach. The pred can lead to ulcers and in some cases so will the doxy. The pred makes the dog very hungry but the doxy can make a dog feel so ill they don't want to eat. So stomach protection is very important. Using some form of pepcid about 1 hour before meals is proper and helps reduce the chances of an ulcer forming. I suspect that Bonnie is vomiting because of the doxy. You can help her by making sure that she gets food when you give this med and by giving it during the meal so there is some food already in her when it goes down. Many folks make a little "sandwich" of bread with some **really good food** and carefully drop the doxy inside of it. Offer this in the middle of the meal. Slippery elm is a natural way to coat the esophagus and stomach in an attempt to heal any ulcers that may be forming. Sucralfate is the veterinary medication that provides a similar but stronger effect. It is appropriate to dose either of these well away from any medication administration or food ingestion as they can interfere with absorption. An overnight fast is ideal. Milk thistle is the milder form of the essence (silymarin or silybin), which assists the liver while it is processing high doses of prednisone. If you must keep Bonnie on prolonged treatment with prednisone (more than 3 weeks or so), then it might be wise to step up to a veterinary version called Marin or even Denamarin. Pet-Tinic is an iron/B vitamin supplement that is ideal for pets that need support while they are ill and not eating well. However, it is important to understand that giving a *lot* of iron is not necessarily the best way to "fight" the anemia. Iron poor anemia is a very different form and does not exhibit this kind of sudden onset. So prescribed doses of Pet-Tinic and about 1 ounce of liver per every 10 pounds of dog weight, per week, is appropriate. So for a 100 lb dog that works out to about 10-12 ounces a week of liver. The liver must work very hard during this illness, not only processing the prednisone, but also processing waste products that result from the destruction of the red blood cells. It can become overwhelmed. Feeding red blood cells in red meat can intensify the amount of waste the liver must process. So sometimes during this condition, it is best to feed meats that are easier on the dog's liver such as white meats or fish. Red meat, including liver, are best given in small quantities. Many folks here have used some form of Dr. Dodds' liver sparing fish diet. The 28th is quite a bit of time from now. Watch her carefully and don't hesitate to take her back sooner if you feel something doesn't seem right. This condition can have plenty of quick ups and downs in the first few weeks. I am hoping that there is just smooth sailing from here on in. You will find plenty of support here so please stop by often for updates! my best patrice

Patrice NYS

I am sorry to hear of Bonnie's diagnosis. Have you found your way to Joanne's site yet? http://www.cloudnet.com/~jdickson/ You have come to a very special board where you will find great people who understand exactly how you feel. Everyone is willing to share what has worked for them or offer ideas for your girl. Keeping you both in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Thanks Bonnie WAS 79 lbs on June 30 when she was well. She had dropped to 70 lbs when I took her to the vet the 13th because she had mucous stool, a low grade temp, was panting alot, had pale gums and had quit eating. (her first sign she was not perfect was the 8th when she got 50/50 solid/sloppy stool) I had a vet appt the 13th, 15th and 16th On the 13th her HCT was 29% On the 15th it had dropped to 25% on the 16th she had dropped to 69lbs and her HCT was 16%, she was diagnosed with AIHA and she was hospitalized where it dropped to a low of 15% She was diagnosed additionally over the weekend with Haemobartonella canis (AKA mycoplasma hemocanis) which is a tick disease By Tues the 20th her HCT had risen to 17% and she came home where getting her to eat has been a huge challenge.She initailly dropped a few more lbs down to 65 but has since gone back up to 68 We DO eventually over the coarse of a day get a decent amount of food into her (our target goal is 3-4 cups total for the day)but each of her 4 meals is a 30-45 min heartache for me as I try and fail many times in finding something she will eat. She is VERY hungry and rushes the food but if it is not what her stomach wants she backs away and lays down like it is toxic Up until now she has always been a great eater and has always eaten whatever I hand her and eats meals in less than 5 min so this is especially frustrating The scientific papers are very discouraging My vet is 1 hour away and i have both financial and transportation issues so unless she crashes or seems poor we will have to go back just once a week Bonnie is very playful and has good spirits but her gums and tongue are scary pale. The icterus in her eyes is almost totally gone and her urine is normal color instead of peach tea

rottlady NH

I can highly suggest then that you join a email forum called Tick-L. It has several experts that frequent the list, including a vet, and very knowledgeable members. They can help you will all the details regarding testing, treatment and outcome. I have been on this list for nearly 4 years now and I say that you can trust Bonnie's life in their hands. Please don't hesitate to join. Go to this page: http://saluqi.home.netcom.com/ticklinks.htm and select: Managing your TICK-L subscription options, etc. Subscribe, sign off, change options, or search the list archives from the TICK-L home page This will take you to a page where you can subscribe. You can set your account to a daily digest or get individual posts. You can also read and post at this site if you wish. It is a private list and requires subscription. If you want a head start, this website: http://sites.google.com/site/blackgsd/ is my favorite. Gil is a consummate researcher and collects all the information about ticks she can find. She never gives up. Once you read her story you will know why she dedicates herself to helping other owners whose dogs have tick diseases. I understand your financial situation. I don't necessarily think this will be that expensive, but you will find out more when you post to Tick-L. She is reacting to the doxy and that is why she will not eat. Follow my instructions on how to best dose this. Do not stop giving it to her no matter how much she refuses it. my best patrice

Patrice NYS

I forgot to mention no vomiting yesterday (23) or today (24) at all. I had called the vet Thurs (22) and they told me to split the doxy up between all 4 meals instead of dosing it just twice a day and the vomiting stopped right away I gave her a Pepcid almost 1 hour ago and will be feeding/giving Doxy for the last time of the day in a minute

rottlady NH

oh many papers mention using low dose aspirin for dogs that have agglutination. Bonnie had/has that However, I have always been taught to NOT give aspirin to a dog taking Pred thoughts?

rottlady NH USA

Hi, I am so sorry to hear about Bonnie's illness. At least you know the cause - tick disease. Many dogs with IMHA can never have the cause of their illness diagnosed. I am glad that Bonnie has stopped vomiting, I certainly know how Doxy can make you feel, having recently been on it myself as malaria prevention for a trip to Africa. My dog Millie was treated with low dose asprin during her initial IMHA crisis. Blood clots are a common cause of death in dogs with IMHA, so we do use asprin to help prevent this. I am sure Millie had a minor stroke during her crisis, and I immediately questioned my vet after several people on this forum encouraged me to discuss using asprin with our vet. Try to keep Bonnie rested, and I hope the 28th brings good news and a rise in PCV. Keep us posted on her progress. Sam & Millie.

Samantha Geelong Australia

This is a tough question. I don't know all the clinical evaluations that have been done up to this point. The point of the aspirin is to prevent inappropriate clotting which can be very harmful. I suspect that while Bonnie was in the hospital they were concerned about that and probably gave her something similar. If the vet did not mention aspirin in the discharge papers then it would be wise to call them first before giving her anything they have not recommended. If this was a true case of autoimmune hemolytic anemia they would indeed give low dose aspirin therapy simultaneously with prednisone in the early stages. This has been shown by Cornell University to prevent this type of inappropriate clotting. But again, please don't do anything your vet has not directly advised you to do. If you are indeed faced with Mycoplasma haemocanis, then this is a unique situation. From what I am reading, it can be a co-infection with other tick diseases. I find it extremely bizarre that you are in New Hampshire experiencing this. Have you traveled anywhere recently? Can you tell me if Bonnie ever had a surgery to remove her spleen? This would be the way this disease could take hold so easily. Or has she been ill prior to this time? I have taken the liberty of searching the archives of Tick-L to find you some information written by one of the experts on this list. This is the dosage recommended for treatment of Mycoplasma haemocanis: "doxycycline, 5 mg/kg, PO, q12h, for 3 weeks." So Bonnie at 68 pounds is equal to about 31 kilograms. So 31kg X 5mg = 155mg doxycycline, PO (by mouth) q12 (every 12 hours), for 3 weeks. This is equal to 310mg per day. You are currently using 600mg per day, qid (divided into 4 doses, given four times a day). This is a big difference. I imagine this would make just about any dog or human sick to their stomach. Below is the information that I obtained from archives and is courtesy of one of the experts on Tick-L: "A few years back new information from analysis of its DNA showed that the organism previously classified as Haemobartonella canis is in fact a Mycoplasma, so the organism was reclassified/renamed Mycoplasma haemocanis. This organism and related Mycoplasma species that parasitize red blood cells are called hemotropic mycoplasma to distinguish them from several other Mycoplasma species that parasitize/colonize other canine tissues. The related disease formerly known as *haemobartonellosis* is now more correctly denominated "canine hemotropic mycoplasmosis," but a great many still refer to it by the older name. Information--online and elsewhere--about the condition may be under any of these various names. In dogs a Mycoplasma haemocanis infection *generally* does not produce apparent disease if the dog has an intact healthy spleen and a robust non-compromised immune system. Splenic pathology, splenectomy, immunosuppressive drugs, immunocompromise from concurrent disease or other severe stresses are events that can permit a "silent" M. haemocanis infection to erupt into overt disease. Treatment of dogs sick with clinical hemotropic mycoplasmosis involves tetracycline antibiotics (e.g., doxycycline, 5 mg/kg, PO, q12h, for 3 weeks), sometimes with transient addition of corticosteroids to quickly stop immune-mediated destruction of RBCs, plus whatever supportive measures are indicated. There is some debate about how to handle healthy "carrier" dogs with "silent" M. haemocanis infections that are discovered in the course of blood-donor screening and the like. It might seem logical to treat these dogs since eliminating the infection could cut the risk of serious disease developing at some future date; the hitch is that antibiotic treatment does not appear to be all that effective at eliminating carrier-state infections. IMO the attending DVM should make an individualized assessment of the dog, its environment, risk factors, etc., and decide on a case-by-case basis whether to treat. A couple online resources: http://www.peteducation.com/article.cfm?cls=2&cat=1556&articleid=293 http://www.zoologix.com/dogcat/Datasheets/MycoplasmaHaemocanis.htm "

Patrice NYS

I found a good article that again indicates that this is usually only found in dogs that have had their spleen removed.: http://www.langfordvets.co.uk/lab_pcr_canine_haemo.htm "The bacterium formerly referred to as Haemobartonella canis has recently been renamed as Mycoplasma haemocanis. M. haemocanis usually only induces haemolytic anaemia in splenectomised or immunocompromised dogs (e.g. those on chemotherapy or immunosuppressive corticosteroid treatment)." To see a few images of microscopic slides of red blood cells that have this bacterium inside them go to http://www.google.com/imghp and put this into the search field: Mycoplasma haemocanis It seems that it is relatively easy to see these inside the RBC under a microscope.

Patrice NYS

In regard to the question of low dose aspirin, way back when, in the early 1990's when my Meisha was diganosed with AIHA, aspirin was not recommended for dogs on steriods like prednisone. Now it has become a very accepted practice. You can learn more at this URL: http://www.ncbi.nlm.nih.gov/pubmed/15934255?dopt=Abstract But as Patrice has mentioned to you do NOT start giving aspirin, or any thing else without orders from your vet to do so.

Joanne MN

Not to worry, I am not giving aspirin on my own. But will ask the vet when I see them Wed She is positively dianosed with the Haemobartenalla canis/mycomplasma hemocanis. They tell me she is negative for all other tick illnesses they tested for. I am asking Wed what they tested for beyond what I already know (they did the 4DX twice during our visits before hospitalization but that only tests for Lyme, E.canis and anaplasma) Her spleen is intact and is in very good condition- well it was til now We feed a very high end diet, I do not use any chemicals on the dogs or in the house other than Interceptor HW pills and even those I generally rotate between using full dose and Safeheart dose We have not traveled outside of the VT, NH area They told me this HC/MH is VERY rare in this part of the country BUT it is passed not just by ticks but also fleas. We did pick up fleas twice at training class (got rid of them promptly each tiem ie within a couple days!) and some of the dogs that come to the center for classes and agility trials are from outside the area or are Southern rescues The reason they have classified her AIHA as primary/idiopathic is because the HC/MH does not cause illness except very rarely or in otherwise compromised dogs Bonnie did get stung by a hornet less then a week before her illness (she caught it in her mouth ) and was heat stressed due to our heat wave we were having but the vets think there must be some other unknown trigger that we may never discover We do manage to get our target amount of food in by the end of the day but it is a huge production finding what she will eat at that moment. She is not historically a picky dog. All my dogs eat whatever I put in front of them (fruit to nuts, veggies to meat) and eat without any hesitation so this pickiness is a hugely stressful and exasperating thing.

rottlady NH USA

No doubt the mycoplasmosis coupled with the sting and interceptor was probably enough to push her over the edge! Interceptor alone can trigger this disease and weaken the immune system enough for the tick disease to blow up and outta control. Did you use interceptor within the last month or two before the illness?

Johnny

She has gotten Interceptor (either full strength or the Safe Heart dose) May 1 - Nov 1 since she was a pup, so yes she had gotten a does of Interceptor May 1, June 1, July 1 But she was not even off let alone ill til May 8 She has also been stung in previous years

rottlady NH USA

I don't know if I quite understand what you are saying....did she get diagnosed with the Mycoplasma hemocanis on 8th of May? And then she got two dosages of interceptor AFTER initial diagnosis of MH? I'm a fan of interceptor myself....I believe there are FAR less problems with this treatment.

Johnny

I did prior research for another member here a while back that indicated that bee stings can and do set off intense immune system responses that can include developing AIHA. Having a prior history of bee stings "set-up" the immune system ahead of time and this last sting most likely triggered the intense response. Thus, your vet's consideration that this is a primary/idiopathic case of AIHA. The mycomplasma hemocanis may have been present already, but not expressed. The immune system had been performing its job admirably in fighting it (via some actions by the spleen) and Bonnie may have been considered a "healthy carrier," as the expert on the tick list has found. It most likely was the severe challenge to the immune system that triggered the mycomplasma hemocanis to be expressed. There are several of us on this forum who have or had dogs that had their spleen removed. This singular incidence defines the major risk of a dog or human having a splenectomy, the lack of protection against a mycomplasma. This was a perfect storm and nothing you did specifically contributed to this. You have taken superb care of Bonnie and it is your diligence in finding the answer that has saved her life. my best patrice

Patrice NYS

NO She gets ONE Interceptor dose on the 1st of each month (May-Nov only) She got her most recent dose (and it was the low safeheart dose) on July 1 On May 8 she had 50/50 sloppy/solid stool and that continued til Sun am the 11th. At which point she had solid stool til pm on Mon the 12th at which point she had mucous stool and did not want to eat well her first vet appt was the 13th when her HCT was 28.9% but they first thought she just had heat stress colitis (due to the extreme heat (for us) Bonnie was diagnosed with Mycoplasma hemocanis on the 16th when we hospitalized her with an HCT of 16%

rottlady NH USA

Thank you to Patrice and everyone else for being a polite and helpful sounding board You are being very nice and helpful :)

rottlady NH USA

You're Welcome

Johnny

I realized that above I said she had sloppy stool MAY 8. That is a typo and should be July 8

Rottlady NH USA

How's Bonnie doing today? Hoping all is well. My thoughts and prayers are with her. Johnny & Tessy

Johnny

yesterday was rough as after her first 2 meals she was not keen on eating but by 1AM we had met our minimum daily intake goal- it was a rough day for that though Today breakfast and lunch meals went well Tomorrow is her recheck and bloodwork. I am very very afraid it will show no improvement. I am terrified that I will end up having to put her down because it is financially the best option (I have been unemployed 2 years and have made a payment schedule with the vets but there is a limit to even that) Diane and Bonnie

Rottlady NH USA

Diane, Your two best weapons right now are doxycycline and prednisone. Both are relatively inexpensive. You can do several things on "the cheap" to reduce your costs. A number of folks here have gone to places like Walgreens or Walmart to get their doggie medicine cheaper. I hope someone will pipe up here and detail this out for me a little? Pet-Tinic is great and finish up what you have, but you can give the same essential vitamins by getting them at the drugstore BOGOF. You need a good B-50 and about 10-12 ounces of liver a week to substitute for this. The rest of it is some sugar and water. The ingredients in Pet-Tinic are: Corn Syrup, Water, Sucrose, Glycerin, Beef Liver Paste, Iron Proteinate, Sodium Citrate, Caramel Color, Citric Acid, Niacinamide, Potassium Sorbate, Cyanocobalamin, Thiamine Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Cupric Sulfate, Natural Anise Flavor, Sodium Hydroxide. (Sugar, water, liver, some B vitamins, a bit of copper and a little flavoring and preservative) You can substitute well cooked rice and honey for the sugar calories. When Chance was very ill I blended honey, egg, cooked rice and a bit of yogurt well. I added some warm water and I slowly syringed it into his cheek so he would drink it. It provides some easy to digest calories and a bit of fat and protein. I did this about 4-5 times a day. Your vet will most likely give you a very large syringe for free if you ask for it. (Remove the needle!) Spray the inside of the syringe with a little canola oil to keep it slippery. Sulcrafate would be great, but you can still get by with a paste of slippery elm made with warm/hot water. Be vigilant in administering this. I think I bought a bag of this at the health food store for about .50. The milk thistle can also be bought at the health food store for very little and will be fresher and more potent. Just talk to the health consultant and ask them to help you. When you go to the vet ask for just a "spun PCV," not a full CBC. This a simple visual measurement of the amount of red stuff vs the white stuff in the blood. It is extremely accurate and should be very inexpensive. If they charge you more than $8-9. for that I would be surprised. You may have to pay a tech service charge to draw the blood, I usually pay about $10 for that. You have done a full CBC probably several times, you don't necessarily need to do this every week or every other week unless there is a crisis. You simply want to see if the PCV is going up slowly but surely. The organism you are fighting is actually very visible under a microscope. It shows up as a dark line inside the red blood cells. Your vet can take a small bit of this blood that was drawn and examine it to see if the organism may still be showing up. So you would have to pay an office visit fee for the vet for a recheck. Most of what you need to do now is home nursing care. If Bonnie is stable, then you can treat her at home. That is what I did with Chance for the most part, besides the regular bi or tri weekly vet visits. The most important thing that they will provide for you is the evaluation about when to begin decreasing the prednisone dosage. Bonnie is not eating and feels sick mostly because of the doxycycline. I remember going through that with Chance. Any owner with a dog that has a tick disease goes through the same thing. It is very difficult. Dogs can't be reasoned with. However, you are the adult and you know what is best. Be pleasant with her, but get the job done. She doesn't feel well right now and I *really do understand* how disheartening this is to you. None of us know what will happen at the other end of treatment. But most folks that come here, stay here, and they stick with doing the hard work. I am ALWAYS amazed to see dogs survive successfully that I had my doubts about privately. It was accomplished with simple good home nursing care and attention to detail. Please give that a go for right now and try to relax some. If you do your best then whatever happens will be under your control. If you are successful then you will know you did the right thing. If you are not successful, you will know you did the best you could. In either case what is important to Bonnie is that she is at home with her family around her. Be cheerful with her so she knows she is loved. my best patrice

Patrice NYS

Patrice has given some excellent advise, on cost cutting I 2nd the suggestion of not getting yoru druges at the vet and use Costco if you have one. Wlagreens is extremely expensive. My Jake recently started blood pressure meds and Walgreens wanted $85.00. It is only $7 at Costco. I thought Wal-mart would be cheap too, and recently check for a prescription for myself. IT was $65 at Wal-mart and $35.00 at Costco. Take care and hope you get a better reading today. Laurie

Laurie CA

So we are back from the vet. After being hospitalized from 7/16-20 she was 69.5lbs (down from her norm of 79) 7/20-22 we were having trouble getting her to eat anything or drink much and she was vomiting. The vet had us split the doxy up throughout her 4 meals and no vomiting since the 22nd 7/23-27 while tough to find WHAT she is willing to eat we were getting the target of 3-4+ cups of food in her each day (her norm is 2 1/2 cups a day) 7/28 back to the vet and she is 62 lbs!!!!!!!!!!!!!!!! OMG That is a loss of 6.5lbs since she came home and a grand total loss of 17lbs since she started this illness!!!!!!!!! The GOOD news is that her spleen is LESS enlarged, her eye whites are clearer, her urine is clearer(and all the extra unwanted stuff in her urine is gone or nearly so) her attitude is good AND her HCT/PCV is up to 22% (it was 17% on the 20th when she came home) Oh and also there is almost no agglutination AND lots and lots of neucleated RBC (That's the brand new baby ones right?) So keeping on with what we are doing Praying she GAINS some weight and............... we need to spay her once she is stable but before her next heat cycle (Oct) or we run the risk of starting all over again if the cycle starts/hormone changes occur etc......... So, overall, Yes there is good news but also bad and complicated news too We go back next week to recheck the blood and she mentioned at that point maybe a CBC/chem profile but we won't need another of those if all is well and we will just be doing PCV/HCTs instead P All we did today for bloods was a PVC/total protein ($28 + the office call since she was examined too) and redid the urinalysis. I have some friends with extra but still good pred and Doxy IF I need it (one dog recently died @14 and the other is all well and weaned off pred)

Rottlady NH USA

Hi Everyone Re: the cost of drugs. I get almost all of Mercedes ("human")drugs at "Walmart". (In Canada, at least, they do not carry "canine drugs"---i.e. Denamarin, I find they are way cheaper than anywhere else, and far less expensive than purchasing drugs from my vet. Also, the "more" you can get your vet to prescribe at one time the better---i.e. Two months of pred, as opposed to "one" month--- as you pay a " dispensing fee" every time the pharmacist has to refill your prescription. Walmart can also do "compounding" and it is often way cheaper to get a "compounded drug" than to pay for the "name brand". I.E.--I have a standard poodle with Addisons Disease. She is a on a med. called "florinef". My pharmicist can compound this drug for me for "one half" the cost of the name brand. Don't know that would apply to any of the drugs your dog is currently on, but may be worth asking about! Hope that helps. Maureen and Mercedes

Maureen BC Canada

This thread was discussed between 23/07/2010 and 29/07/2010

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