Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Pred. Reduction

Posted 28 February 2009 at 07:25:30 UK time T.Rose, Erie, PA, jnthammer@msn.com 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

Terese Erie

Hi terese. It has taken 2.5 years for my boy to be weaned down to a very low-dose pred every 5th day, so I am not sure what protocol your vet subscribes to. Is there a specialist you can get consult with? I know Philly is a far ride for you but if you want the name of a vet at VHUP I will be glad to provide. I live in Philly. Jan

Jan pA.

Hi Jan, Could I get the name of the vet you use at VHUP if he/she specializes in AIHA? My dog is going to a local vet in Philly. She consults with the resident who treated him when he was hospitalized at VHUP. Things are going well so far, but I would love to take him to a permanent vet at VHUP who specializes in autoimmune disorders just for some consultation. Thanks, Leslie

Leslie

Leslie, Sounds as if my situation is similar to yours. The vet at VHUP I was mentioning to Terese was Choe's primary clinician, also a resident, while he was hospitalized. She consulted with various hematology specialists within the hospital during Choe's long recooperation. Now we stay in touch via e-mail consult (as he goes to a local vet for pcv checks). She actually will be leaving the hospital this summer. So, I'm not sure she will be taking new patients now. My suggestion to Terese was she get a consult asap. Teaching hospitals are usually the best place for such emergencies. The resident you currently are in touch with should be able to give you a referral at VHUP to a hemtologist experienced with AIHA patients. Best, Jan

jan PA

OK, thanks Jan, I will do some asking around at VHUP. It is very reassuring to live in a city with such a good veterinary hospital. They saved Kola from what I'm sure was very imminent death a few months ago, so I want to stay connected there. I wish Choe the best of health!

Leslie

I would have hour vet do a consult with the teaching hospital. Even though I am fairly confident in mine I made him contact ours here in Calif UC Davis as they will will do phone consults with vets. I would be worried she crashed since pred can have serious side effects that can happen of dosing down too fast. How long has she been on the meds and what has her hct been? Laurie

Laurie CA

Thought I'd add a follow up to this thread, because I'm feeling a bit frustrated. Knowing that IMHA is chronic with high potential for relapse, and that the resident who saved our dog in the E.R. will eventually be leaving, I asked for the name of a specialist in autoimmune d/o at VHUP and scheduled an appt a month out for follow up. The appt desk called to tell us our appt was rescheduled to a later time with the original E.R. resident, saying the specialist questioned why our dog was put on her schedule and saying she wouldn't be recommending anything different. I believe immediate treatment at a teaching hospital, and the appropriate care our dog received for AIHA saved his life and is a major factor in his good recovery so far. I would have liked to have in place good care/consultation for prevention into the future, but I guess its a lot like healthcare for humans (i.e. necessary/helpful in the crisis but not prevention oriented).

Leslie

That sounds like a drastic reduction in the meds to me. You are right to hit the alarm button and it would be wise to consult a specialist. A good example of a med reduction would be 20-15-12.5-10 mg twice daily in 3-5 day increments. Then to 5 mg twice daily, 5 mg once daily , then 5 mg every other day for maintenance. This is a very good example from a very well educated woman (Dr. Dodds). Of coarse all dogs are different but the body does need a very gradual decline in the meds so that the body can start to get used to making its own cortisone again. There is always the possibilty that too large of a reduction could trigger a relapse. If you do go ahead with the 50% reduction...you should keep a good eye on Layla and if you have any concerns be sure to call the doc. I hope and pray for the best for Layla. Please keep us posted. She'll be in our thoughts and Tessy sends wags her way. Best wishes, Johnny & Tessy

Jonathan

Leslie, It almost sounds like an ego thing going on ie: If she can't rescue your dog she doesn't want to maintain Kola. It sounds like you may have to look elsewhere for a Vet that actually cares about the animal and not about padding their own personal record. Penny

Penny Lytle Creek Calif

Leslie, my dog Charlie was reduced from 40mg to 20mg but he is also on 50mg azathioprine. I was very worried about the reduction and my vet is an internal specialist.he told me that the aza was a great backup and he was reducing to find where Charlie needed to be. Charlies pcv went up 6% from 37 to 43. He has responded very well. You have to be comfortable with your vet! Every dog is different. If you do reduce watch him closely. I am happy I followed the vet advice but I trust him and i know that god is in control not me! Carol

carol vancouver wa

One more thing. Charlie is staying on his first reduced level of 20mg for 4 weeks then we are reevaluating. Then he will reduce again.... I hope!!!

carol vanc wa

Thanks for the input, Carol. I fear I hijacked Terese's thread, and so our situations may have gotten confused. I apologize, Terese, and I hope Layla is doing well! My dog Kola has been doing really well so far 4 mos out from diagnosis - he has made steady progress and is up to a 42 PCV. His pred has been tapered to 5 mg/day and he is on 50 mg of Azathioprine every other day. I'm more thinking about the future, and all the choices that must be made to try to keep his immune system stable. I really like both our primary vet and the resident at the teaching hospital who is consulting with her. Everything they have been doing so far seems to be contributing to very good progress. But I know that neither are experts in AIHA, and I would feel so much better to have a specialist on board who has seen a lot of dogs with AIHA going in to the future (for the maintenance stage as Penny says). Our primary vet is part of a busy city practice, but the head of the practice told me they only see 2-3 cases of AIHA a year. That seems like such a small number of cases, for a vet to be able to get a good sense of the disease.

Leslie

As addendum, the specialist responded promptly to my contact with her and encouraged us to continue with the resident since things are going well. I was glad she got back to me so quickly, and that the resident can consult if needed. I'm really glad this group exists too for help in future decisions around trying to prevent relapse. Thanks everyone!

Leslie

This thread was discussed between 28/02/2009 and 29/03/2009

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