Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Prednisone or AZT for Maintenance

Hi Everyone, Henri continues to do well. His hematocrit has been stable at 43%, every time it has been checked. Henri was originally on a cocktail of 50mg/day cyclosporine, 10mg/day prednisone, and 12.25mg/every other day AZT. We have successfully weaned him to 2.5mg/day prednisone and 12.25mg/every other day AZT. Our internist would like to continue to wean the prednisone and leave the AZT as is for the first year. Another internist has recommended weaning the AZT and leaving him on a small dose of prednisone. What would be the advantages or disadvantages of either way? Does it matter which we do? Any thoughts would be appreciated. Additionally, since we went below 5mg/day prednisone, Henri has become a picky eater. He will often turn up his nose at meals. Have others had this experience? Do we need to be concerned? Thank you, Ella and Henri Henri, West Highland White Terrier, 9-months old, diagnosed 02/28/09 with vaccine-induced IMHA.

Ella Seattle

Ella, interesting you brought this up, I just discussed the same thing with our vet this week. We don't know yet which route we will take. I said to the vet that it is confusing, because everybody seems to do something different. Her answer: That just means that there are different possibilities to achieve the same goal. It is so hard, because we all want the best for our pups. Kahlu also has had days that he was not too interested in his food. A couple of times it happened, when he came down with an other UT infection. So keep an eye on that. I am so happy to hear Henry is doing well. What an ordeal for such a young puppy. Kahlu is wagging his shaggy rat tail at him! Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Hi Ella, I am sorry, I don't have a lot of answers for you. I am happy for you that Henri is doing so well:) I am just answering to let you know that Keiko has been off prednisone since Mar 08 and remains on a low maintenance dose of AZA. She will remain on AZA for the rest of her life. Jess and Keiko

Jess BC

Hi Ella, Its great Henri is doing so well.. Madison has just come off prednisone but is still on Imuran (same as AZA) every 3rd day. The vet said that Pred has a lot more long term health risks than Imuran so therefore that is why we have gone that way. Samantha & Madison

Samantha Perth Australia

Hi Ella, My IMHA dog Benson was weaned first from prednisone and then from imuran. He had a difficult time with pred and his liver values were very high on it. He managed AZA much better. Benson did not need to be on a maintenance drug; we completely weaned him off all meds. If he needed a longterm maintenance drug, I would have investigated the viability of AZA as the drug, instead of pred. Benson was a canine vacuum cleaner before IMHA. While he was on pred, he definitely ate with derangement. After he was weaned off, he ate intermittently well. He ate less in the summer heat and more in the winter. However, with IMHA, there is no one-size-fits-all way to manage the dogs. You might want to ask these internists what they have in mind for the longterm for Henri. Good luck, Aden

Aden Jerusalem

Hi Ella, Glad to hear Henri has done so well. We slowly weaned Pred first, then went to Aza every other day for about a month, then every 3 days for another 3 or 4 weeks, then stopped all together. Tiggs has been med free since May 16. I check his gums every day, and he's had a PCV every 2-3 weeks and had a full CBC about a week and a half ago. Everything looks good. I hope you can get Henri med free as well! It's scary, but to see how good Tiggs' is looking and feeling, I'm happy with the decision. I hope and pray every day that he continues to have good health, as I do for all the pups here. Good luck, melissa and tiggs

melissa slc

Hi Ella, Sounds like so many of us, including you, are in the same boat with questions about which medicine to wean off first. My dog is on 2.5 mg pred/day, and 50 mg AZA every 3rd day at this point and has been doing well. The original plan was to wean him completely off pred, and then completely off AZA. However, when we stopped his pred from 2.5 mg to nothing, his PCV suddenly dropped and coincided with appetite problems and a bout of diarrhea. We thought it was a relapse at the time, so we put him back on the pred. He's doing fine now. I'm still not sure if the PCV test was wrong however, and whether he lost his appetite because of dropping the pred (though it was so low anyway). For now, I'm just continuing him on what he is on, and will have to think about what medicine to stop first when we get there. Best wishes whatever you decide! -Leslie

Leslie

Hi Folks, Thanks to everyone for your thoughts and responses. We scheduled a meeting with Henri's internist to review the remaining medication weaning plan. Her original plan was to wean Henri entirely off prednisone and leave him on AZT for the first year. The second opinion, we got from another internist, recommended the opposite. She recommended weaning the AZT and maintaining him on a low dose of prednisone for several more months. We sent her recommendations to our current internist and hope we can all come to an agreement on the best plan. I know, the puppy factor makes Henri a little unique. Having IMHA at 5-months of age is very unusual. We will let you know how things unfold. Warmly, Ella and Henri

Ella Seattle

Charlies internist weaned him off aza first, we are hoping to start to reduce the prednisone next week. Charlies was having some diarrhea problems due to the azathiprine, so im glad that he weaned him off that first. We are battling weight gain with the pred though. Glad Henri is doing well doodle hugs carol

Carol

Ella and Family, Congrats to Henri! That has to be mind numbing to get totally opposite opinions from the internists. That is one of the crazy things about this disease while the symptoms are the same the treatment and reactions can be polar opposites. My best to you all. Penny

Penny Lytle Creek Calif

This thread was discussed between 26/06/2009 and 28/06/2009

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