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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Question about reducing Atopica
| I am looking for some information about what to expect as we get closer to weaning our GSD mix Sheba, off of her Atopica. Currently she is taking 250 mg (125 mg morning and evening) daily and we are down to 5 mg of pred every other day for the next week. If her PCV is good next Thursday, we will stop the pred and retest in two more weeks. If we are holding steady then, we will reduce her Atopica. When I talked to the staff at ISU’s veterinary teaching hospital (she was diagnosed and treated there in the beginning) they said we would most likely cut her dose of Atopica in half to 125 mg once per day for two weeks… then more blood work, further reductions, etc. Is this normal or should I be talking to them about a slower reduction? When I asked our local vet (wonderful, very knowledgeable guy – saved Sheba’s life by referring us to ISU) he agreed that this sounded appropriate. What should I expect for further reductions? Any insight/help would be most appreciated. Thanks! Rita |
| Rita IA |
| Rita, We reduced according to a schedule that Dr. Dodds sent me specifically for Chance so take what I say with advice. We reduced his Atopica by no more than 25%-33% per reduction and went for approx. 2 weeks with that reduction until the next reduction. I carefully determined what dosage levels I needed to buy in order to accomplish each reduction so that I didn't end up, for instance, with a box of 200mg left over. You will need to do some math. I preceded each reduction with a full CBC and spun PCV to make sure the reductions were appropriate. If I saw something on a CBC I didn't like, I maintained at the current dosage for up to 4 weeks before checking the CBC again. We maintained a small dose of prednisone every other day during this reduction period. This helps the adrenal glands gradually begin to function properly on their own. The every other day dosing is actually the best for this. It would also be important for you to know how long Sheba has been currently at a good pcv. If it has only been a short time, like 4 weeks, I personally would be much more conservative than your vet has mentioned. If you are into something like 6 months with no change in your good PCV, then, maybe yes, the reduction could be done more quickly. I would continue to do frequent CBC checks, about once every 2-3 weeks, until you are done with most of the reductions. Then switch to just a pcv about every 3 weeks to ensure that things are ok. my best patrice |
| Patrice NYS |
| Savannah was diagnosed 2 weeks ago. She is currently on prednisone, cyclosporine and azathioprine. Her appetite is not good and she's very lethargic. Her pcv was 19. How long does it take to see improvement? She has maintained the pcv 19-20 for about one week. She spent 9 days at the vet school and had 4 transfusions |
| savannah florida |
| Rita, You may take what I say with a grain of salt and always remember that your vets are the experts, they have the clinical experience to back up what they say. My personal feeling is that the pcv is not stable yet, certainly not at the ideal 37-45 range, and that significantly reducing any meds at this point would be unwise. Experience on this board has shown that the best outcomes result from careful and gradual reductions in meds over months of time, not weeks. If you feel a little unsure of what is happening you can contact Dr. Jean Dodds at Hemopet.com for med protocol reduction advice. She has 20+ years experience dealing with canine blood diseases and this would be something she could help you with. Often vets are grateful for the long distant help she provides. My vets were very excited to have such a famous person advising long distance and often said, "well, run this by Dr. Dodds first before we decide what to do." my best patrice |
| Patrice NYS |
| Rita: It can takes weeks for some of the meds to kick in. It is not unusual to have transfusions in the meantime. It is not ideal, but you do what you have to. Som eof these IMHA dogs never get back to the "ideal" range in the pcv dept. My Lola was very lethargic at first, but then kicked in. I am curious as to the trasnfusions at 19%. It's not a great number, but it's not terrible either. Are you seeing an internist or other type of specialist? |
| Courtney SLO |
| We are using Fl vet school in Gainesville. After the transfusion the highest pvc was 23. she was checked this morning and is still 19. I think the ave drug has affected the bone marrow from producing red cells and they have reduced that. Her appetite isn't the greatest either, but she's hanging in there. She's only 21 pounds. |
| savannah florida |
| Have they done bone marrow aspirations? Coombs Test, Immune Panel and Babesia? |
| Courtney SLO |
This thread was discussed on 27/08/2008
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