Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Reducing meds - nervous

Hi! I need some suggestions.... I really want my Mia off her meds as soon as possible, but my vet has reduced her Prednisone from 50 a day to 25. And totally took her off Doxycycline. Azathioprine will stay the same at 25 a day. She's a 3 1/2 year old American Eskimo weighing around 26 pounds and was diagnosed with IMHA on 9-22-08. Her lowest PCV was 3 that first week. Now it's up to 27. I want to do the best thing for her, but I am very nervous and my husband DOES not want the prednisone reduced that much so suddenly. Thanks, Liz and Mia

Liz Nashville

My vet would not reduce my Sofie's pred until her PCV stayed at 40-45% for two weeks, only then did we start dropping the Pred, at 25% each week as long as her PCV stayed up. She was on Doxycillian for 1 month, then stopped that. It took almost 3 months before she was totally weaned off the Pred slowly, but has never had a setback since day one.

Joanne Wyoming

Thank you Joanne! She has had 37.5 of Pred today. We might keep her here and see how she does. The good thing about this is that I take her to the vet everyday while we are at work, so she will be watched all day. She pees all the time and didn't know what else to do. Our vet has been really nice! I am so happy your Sofie has not had a another round of this. That is wonderful! I am also giving Mia 1 Pet-Tab Plus a day and she also loves cottage cheese and yogurt! She eats better than myself!!!

Liz Nashville

Listen to what your vet says. Reducing the amount of meds too quickly can bring on a relapse. Our Peke, Bella, was diagnosed on 9-28-07, over a YEAR ago and just yesterday came off all meds. She was on 1/4 or 10gm Pred 2x weekly for the last two months. She's bneen of aziothiaprine for several months now and also off Doxycycline for at least 6 months or so. It's a long ride.. be prepared, both physically, financially, and most importantly, emotionally. Bella's PCV fluxuated from 20-27% for 3-4 months, then showed slow signs of getting into the 30's.. and now has been at 40% the last two visits. She gets her blood checked 1x month now... and is being watched VERY closely now that she is off Pred totally. We can only hope & pray that there is no relapse..

Jason Myrtle Beach

I don't think that a PCV of 27 is even into the normal range quite yet. It's a fantastic improvement from 3, but I wouldn't even consider dropping any meds yet. We didn't begin decreasing until Slinky had 2 readings in the normal range (37-55). We also never decreased more than 25% of her dose (until the end-you have to at some point to stop :) ) and only one med at a time. I think this very slow wean really worked well for her. Just for comparison, her diagnosis was 6/26/07, we began weaning from meds on 7/23/07 and didn't finish weaning until April of 2008! Slinky is a 13 lb. dachshund for comparison, so we were really down to tiny doses at the end. Slinky is doing great and just keeps delivering great PCVs. I couldn't be more grateful.

Stephanie Chicago

Liz, Why did your vet lower the Prednisone? Our vet lowered Darcy's Pred level drastically -- from 30 mg. to 5 mg., but it was because she developed pancreatitis. She also took her off the Azathioprine because of the same thing, but doubled up on her dose of Cyclosporine. Her PCV was 26.5% last week and we're going today for a recheck. I was really nervous about the big drop in Prednisone. By comparison, Mia's drop was a lot smaller. Karen

Karen NC

Hi Karen! BTW, my husband and I have been praying for Darcy. Please let us know how her check up goes. I have no idea why he lowered it. I told them this morning when I dropped her off that we weren't going to reduce it until her PCV holds in the mid 30's. She gets her PCV checked every Thursday. I can't wait to see what it is. Thanks, Liz and Mia

Liz Nashville

When I pick Mia up in the afternoons, I usually don't see the vet. I will ask to see him today and we'll talk about all of this. Does anyone know exactly what Doxycycline is used for? Does if have anything to do with ticks?

Liz Nashville TN

Liz, Doxycycline is used to fight tick-borne diseases. Most vets will prescribe this medication at the onset of AIHA in case it's cause is tick related. My Tipsi was on 10mg of Doxycycline twice a day for two weeks at the beginning of her battle with AIHA. Once tick diseases were ruled out as a cause of her anemia, the medication was stopped. I wish you and Mia luck in your fight against this disease. Layla & Tipsi

Layla Brantley Raleigh

Liz, I can understand your uncertainty and alarm. It's hard when you don't know exactly what the vet has in mind when they suggest a change like this. Can you tell us how much experience this vet you are working with has with treating AIHA? There is no one standard treatment for this condition yet. It can be caused by many things and is expressed differently in many different dogs. Sometimes certain breeds are more susceptible than others as well. The most important factor in treatment is having a vet who has significant clinical experience under his/her belt. If you had a family member who had a very serious form of cancer, you might start with your family doctor, but they would quickly send you to see a specialist oncologist. This is very similar because the symptoms are so serious and life threatening. And as in cancer, though this is *not cancer*, treatment of AIHA includes a cocktail of drugs. Some work better than others and there are specific side effects for each drug. Then there are drugs that are given to help reduce the side effects of the treatment drugs! Prednisone is the workhorse drug of not only vets but human doctors as well. It has a known effective history for many conditions and the side effects are well known. Those side effects can be very very hard on the body. It's important to start immediately with prednisone because it is so fast acting. But it's also important to reduce prednisone when it is possible and begin using another effective drug that has less side effects but takes longer to become effective. Thus you will see folks here on this board mentioning several other drugs like cyclosporine or azathaprine. The reason for reducing the prednisone slowly has a lot to do with the adrenal glands. They help us deal with stress to the body by helping our heart rate, keeping our electrolytes at the proper levels, monitoring the amount of blood in our arteries and several other functions. They do this by releasing cortisol. Unfortunately, the body sees prednisone as the same thing as cortisol. When it senses that there is too much in the body, the adrenal glands stop making their own cortisol. If this goes on for a long enough period of time, the adrenal glands begin to atrophy and it becomes harder to get them to work on their own again. Suddenly removing or quickly lowering the dose of prednisone can be somewhat dangerous because of this. The body has a hard time reacting to stress of *any kind*. That is one reason why you see many people here on this list very carefully lowering the dosage of prednisone by no more than 25-33% at a time and preceding that with a blood test to make sure it is ok to do that. It's often a good idea to hold at that dose for a few weeks to allow the adrenal glands to adjust. Every vet and doctor knows how to do this reduction process. If the prednisone is also still providing a significant contribution to suppressing the immune system, it is also necessary not to remove it too soon. This would be considered a immunosuppressive dosage (like 40 mg a day depending on weight). A reduction dose (after a period of time of larger reductions) to jump start the adrenal glands would be down in the range of maybe 5 mg a day, then 3 mg a day then maybe 2 mg. Then switching to 2 mg every other day etc. This is a subclinical dose. All this said, if you are working with a specialist who has significant clinical experience and they have treated hundreds of dogs, then their knowledge of what to do may be very appropriate. Most of these folks have learned how to treat this disease *on the job*. It is very much an art form. My local vets were up to the challenge of treating my dog, but they always said to me, "Run this dosage change by Dr. Dodds before we do anything." I had complete confidence in them, but they were willing to learn from her about this. It's so important to be confident in your vet, if you aren't then you live on the knife edge. It sounds like you like your vet very much too. Another factor may be the fact that you have had Mia on doxycycline. This drug, as mentioned already, is used to treat tick diseases. Some tick diseases will cause a form of anemia and even severe platelet destruction. If there is a known exposure to a tick disease and tests bear out the diagnosis of this, treating with high doses of doxycycline for at least 6-8 weeks is very important. In this case treating with prednisone would be contraindicated because it would suppress the immune system at a time when the immune system needs to be on the alert and fighting this tick disease. Whatever the case is, it's always good to try to talk with your vet and express your concerns. Not all owners want to talk about these kind of details so vets may skip over this part thinking the owners aren't interested. If you are proactive, you will learn a lot from your vet. Try to approach them with appreciation for all they are doing to help you. That will reassure them you are not being critical of them. Tell them you are on a support group for owners like yourself and you hear conflicting information. If you can find information on the internet that is scholarly, copy that and bring it with you to show what you are learning. I have found every vet I did this with to be very interested in what I was reading and willing to talk about it. Last year my vet and I learned how to take a blood pressure on Chance with my gear from home and information I found on the internet about dog's pressure readings! Believe it or not, most local vets don't take blood pressures. You will only see that in fancy clinics! It will become more common in the near future as there is a new piece of equipment that is on the market to do this. Good luck, Patrice

Patrice NYS

When I look back at Maggie’s journey through this disease, I remember that it all started when a lymph node in her neck enlarged in April. Mid May, we took her to the vets at that time her platelets were showing zero, and the vet thought that there was something wrong with her equipment. She was put on a course of prednisone and the lump went down. It was within a few weeks after finishing her course of Prednisone, it came back up. I’m thinking now, that this was the start of AIHA. We decided to have the lymph node removed, that was June 27th we were thrilled when it came back benign. It was about 6 weeks later that she started to get very lethargic. Her HCT had dropped to 11 August 8th. Our regular vet put her back on prednisone, Doxycycline, and Azathioprine, the full tick panel was done and it came back negative so the Doxycycline was stopped. That next week she had 2 blood transfusions. The Coombs test came back positive for AIHA. We had a Ultrasound, everything that we could. She was on large doses of Cyclosporine, we were giving Maggie the following dosages each morning with her food.:- Cyclosporine 5 x 100mg = 500mg, Azathioprine 2 x 50mg = 100mg, Famotidine 1 x 20mg, Prednisone 4 x 20mg = 80mg. Due to a infection she got in her foot and elbow, we gave her 500mg of Clavamox which is a antibiotic 2 hours later. At 5:30PM we give her with her food Famotidine 1 x 20mg, Denamarin 2 x 425mg =850mg (for her liver), 500mg of Clavamox 2 hours later. We did start here on a Thyroide medication, but it was too late. Maggie went from 106lbs to 88lbs. Our Vet had worked with other patients with AIHA and was consulting with a specialist, She was very open to idea’s and new that I was on a AIHA support site. We had her on the Liver Cleansing Diet to help with all the steroids as her liver was enlarged. September 19th her HCT was up to 32.87. That was the highest it got. Over the next 2 weeks, it dropped to 16. With all the medications, it became just too much for her liver to handle. We said our goodbyes October 4th.

Karon SC

Hi! Mia's PCV level was checked yesterday and it's at 34, up from 27 last Thursday!!! I'm so happy. She is now at 37.5 MG of Prednisone. Since she goes to the vet everyday she caught kennel cough so is now back on Doxycycline. Hopefully in a couple-few weeks her Prednisone will be low enough that she won't have to pee all the time and can stay home during the day. Our vet seems to have had a lot of experience with IMHA. He currently has Mia and 2 other dogs that he's treating. I found out yesterday that one of the other vets in his office is the one that wanted to lower the Prednisone. We will see how she does over the weekend going from 50 mg down to 37.5 mg. So far, she looks good. The vet runs a CBC on her every other Thursday and she'll get that next Thursday, so we will be able to check out all other levels. This week I have noticed that when she eats, she seems as though either her teeth and sore or there is something stuck in one of her teeth or gums. My husband runs his fingers in her mouth every morning and finds nothing.... so when I dropped her off this morning, I asked the nurses to have the vet check that out. She eats slow and has to chew a lot. Her food is small and she should not have to chew and chew. I am also feeding her yogurt, cottage cheese and bananas. She has no problem eating those!! I can't say enough to those that have lost their babies how sorry and heart broken I am for you. There may be a day that Mia can't handle this anymore and I just cannot imagine losing her. She is my everything. She has helped me through so much. My husband and I separated the first of the year and through those weeks, she never left my side. She knew something wasn't right. She tried and succeeded in making me feel better. I just pray so hard that there we be a CURE of this disease soon. Thank you all for your support and comments. I don't know what I would do without ya'll either!!! Hugs, Liz and Mia

Liz Nashville TN

This thread was discussed between 15/10/2008 and 17/10/2008

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