Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Reducing Prednisone

Hello everyone... I know I mentioned previously being concerned about reducing the Prednisone and Azathioprine, but after today's vet appointment, I'm really feeling nervous. Although Rex's PCV is still in the "normal" range, since reducing the Prednisone a week ago, it dropped from 40 to 38. Is it normal to see a drop after reducing the meds, and should I wait a week before re-checking? At this time, we made no other med changes...continue Prednisone (20 mg- 1 tab twice a day). Rex weighed in at 37lbs. today. Our vet suggested to re-check in a week and if it continues to decrease, will have to increase to our original dose of 60mg/day (divided in two dosages). Just wondering if it's normal to see "drops" when decreasing or eliminating medications?

Kapri Arizona

Dear Kapri, Congrats on Rex stabilising. To reassure you, it is quite normal to get PCV readings that fluctuate by a few points, and does not mean the dog is 'relapsing'. It can depend on how hydrated the dog is, time of day, is the dog stressed, how the blood was handled etc. I don't think you should be alarmed just yet by this drop. Retest in a week, and if the downward trend continues, you will need to take action. A few of us here ask our vets to look at a sample of blood on a slide under a microscope to check for spherocytes. If my vet can't see any, it helps calm any fears I might have about relapse. I have been fighting IMHA for 14 months with Millie. In that time, Millie's PCV readings have fluctuated netween 38 and 47 since achieving remission. Just wait and see how Rex's next PCV is. Be vigilant but try not to worry! Sam and Millie.

Samantha Geelong Australia

Kapri, A drop in hematocrit of 2 is not really a big deal. Since you are continuing with the same doses of Pred and Aza, I think he is doing ok. Small things like hydration, stress, recent food intake or exercise, can influence small fluctuations in the HTC. At 37lbs. 40 mg Pred per day is still a pretty large dose, so try not to worry too much! Best wishes, Brigitte

Brigitte BC Canada

Dear Kapri, I just looked back on your previous post and noticed you have already reduced the Azathioprine by half? What was your vet's reasoning behind that? Aza can take a few weeks to kick in, so I was wondering why it was reduced so quickly? Was Rex suffering from some bad side effects? Sam and Millie.

Samantha Geelong

Hi Kapri, We also just started reducing our dog Codys prednisone 3 weeks ago...he too dropped 2 pts. from 36 to 34 PCV....but as everyone said, that's not a big deal, unless it continues downward too much......it seems with this disease you have to weigh everything out as you go along....in Codys case he developed diabetes, maybe from the prednisone ( he's been on 40 mgs./day.. for 1 year now ) and has to take insulin shots 2xday....our Vet said if we didn't get the diabetes under control, that would kill him before even the AIHA. But we're doing a VERY GRADUAL REDUCTION......1/4 pill less/day to start......even if it takes a year to wean him down....at least eventually, hopefully, some of the pred. side-effects will dissipate,and his system will get strong without the AIHA getting worse again. The drugs can be hard on these poor dogs.....my Vet is concerned about Codys liver from the pred., so we had to make a move....anyway, I hope your reduction for your baby is smoothe, uneventful and successful in the long run!!! Keep us posted....Tammy/Cody

Tammy/Cody N.J.

Thank you for your responses! I do feel a little better and am now anxious to return to the vet to re-check. We have a vet appointment for this Thursday, and I will keep you updated. Sam, you're correct that we did cut the Azathioprine in half already, but I was told that was because Rex was on a really high dose to begin with (25mg 2x/day). It has been recommended to reduce the Aza again to 25mg-every other day, along with reducing the Prednisone. I have my reservations about reducing both medications at the same time. Tammy, I'm sorry to hear that Cody has developed diabetes! I know how difficult and worrisome dealing with IMHA is and am saddened to hear that Cody has developed another health issue. As the weeks go by, I'm learning more and more...and one thing I've realized is that these medications are driving me crazy! If you stay on them too long, it could cause other problems (liver, kidney, and more)...If you wean them off too quickly, a relapse could occur. I'm trying my best to be patient and strong. At times, I feel emotionally drained and mentally tired, but then I think of Rex and how he must feel, physically, emotionally & mentally. He has shown our family that he is a fighter and I have to be one too!

Kapri Arizona

Hi Kapri, Just checking in to see how Rex is doing with his pred. reduction.....Cody is stable with PCV of 35...for him that's a good number, and is consistent with him feeling well w/o signs of AIHA. As mentioned, the key here is GRADUAL. Yes, the diabetes stinks and complicates EVERYTHING, but he's getting another glucose curve done tomorrow, and we'll see how close we are to stabilizing his blood sugar.....give Rex a hug from me and Cody!! Tammy

Tammy/Cody N.J.

Just wanted to post an update on Rex....As it turned out, we had to postpone his vet appt. to this past Monday, 3/29. His PCV went down from 38 to 37 (which he has dropped from 40 to 37 since reducing the Prednisone). No further reductions in Prednisone at this time (20mg- 1 tab 2x/day). Although it wasn't a big drop, I found myself disappointed. For a while, we were seeing his PCV increasing five points at a time, and it was so exciting and encouraging. However, from many of the postings I read, I'm aware that some dogs may never get to the higher range of "normal". For the past three weeks, our vet wanted to reduce the Azathioprine to 25 mg every other day, and Dr. Dodds agreed when he was his PCV was at 40, but I was hesitant to reduce both meds at the same time, as I felt we wouldn't know which reduction caused any change. Now that a couple of weeks have passed since the Pred reduction and he seems to be "somewhat" stable, any thoughts on going along with Azathioprine reduction? Behaviorally, the only concerns I have with Rex is that his legs (maybe muscles) appear weak. He still cannot jump on couch or climb the stairs, and when he moves fast around the house, he appears to lose his footing, as if I just polished the floors. I also noticed a new growth on his lower eye lid...not sure if this has anything to do with sickness or medicine. As always, we thank you for your continued support! Kapri & Rex

Kapri Arizona

Kapri, I remember the reduction dilemma very well. You are correct that the meds should not be reduced at the same time. I always struggled with the Aza reductions, because how do you reduce by 25 or 33%. I can't remember if I actually did this, but how about giving the aza 2 days and then not on the third and so on. I think that would be a safer option. Unless Rex suffers terribly form the side effects (how is his liver?) you could also just wait an other week or two before you reduce. The muscle loss is definitely a result of the high prednisone doses. Be careful, Rex could very easily get hurt now. Don't polish the floors!! :) Check if he has a lot of hair at the bottom of his feet, between his toes and balls. If so, cut it out. It took Kahlu about 6 months to have at least most of his muscle back. But then he went swimming and there was no holding back. I am probably repeating myself here, have Rex's Thyroid levels been checked? Hang in there and be patient. Best wishes, Brigitte

Brigitte BC Canada

Reduce the azathioprine to 25mg from what amount?

Johnny

Thanks Brigitte for your input! (My husband said it's a good excuse for me not to clean the floors. LOL!) We'll be checking his liver and thyroid this week. @ Johnny....Rex has been taking 25mg- once daily, and vet wants to reduce it to 25mg - once every other day, along with reducing the Prednisone from 60mg to 40mg. We reduced the Prednisone a couple of weeks ago, and although his PCV's haven't dropped drastically, it is down to 37 from 40. I've been resistant to reduce the Aza any further at this time. Additionally, just re-did CBC and vet says everything looks good except WBC's are still high. I'll be picking up a copy at next vet appt. on Monday. Any thoughts why WBC's are high and what does this usually mean?

Kapri Arizona

This thread was discussed between 20/03/2010 and 04/04/2010

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