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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Reduction of prednisone
| Hello everyone, I seem to be full of questions. I think I'm just looking for reassurance. We are dealing with the thrush in Keeli's mouth right now. Will start reducing prednisone this week. We are already off the cyclosporine. Still taking the original dose of azothiaprine. Am really nervous about reducing the prednisone. She weighs 26 pounds now and has been on 10mg 2 x daily of prednisone with pvc staying at 33%. We are reducing to 7.5mg 2 x daily. What should I expect from this reduction. I know it takes a very long time to reduce the prednisone. Just don't want any relapses. It really worries me. Any thoughts anyone? Best Wishes Joann and Keeli |
| Joann Binger Ok |
| I think it depends on the dog. Richard w/ Dylan reduced every week without relapses, and Cookie is being reduced weekly as well without problems (she is down from 40mg a day to 5mg a day). |
| Monet Sammamish |
| Monet I'm sure you're right. I thought would go a little slower than that. Maybe every two to three weeks depending on how she does. We took the cyclosporine from 100mg eod to nothing and it didn't affect her or cause any problems. Joann and Keeli |
| Joann Binger Ok |
| Hi Joann, Sorry for being absent for a bit, just trying to recover and get some work done too. This is an important issue and certainly one I have some strong feelings on. My opinion is that each case is unique and needs to be judged uniquely. Dylan's attack was very acute, her PCV went to 10% in 3 days from her first symptom and prednisone alone stopped it quickly (between 3 and 4 days) and within 2 weeks it was back at 39%. Also, Dylan was clearly very reactive to the drug and was on too high a dose really. Her musclle loss was immediate and within 1 month she could not lift her head, nor her body from muscle loss and paralysis and this is despite a couple of reductions before that. Drug efficacy (effect) always varies uniquely for each individual and everything pointed to excess effect in Dylan. Her aggression was severe, her water intake intense. Her drive for food 10 fold greater, I could see muscle loss in a week of use. All signs prednisone was acting intesely on her. I also am very familiar with prednisone use in human autoimmune diseases, so I treated it like it was going to kill Dylan if I did not reduce it quickly and I am certain it would have if I had not acted to reduce quickly. Prednisone was also suppressing her RBC production and a slow and steady drop in PCV over the 4 weeks that followed the 39% while on pred was caused by prednisone. Once we got it out of her, her PCV rose again to 42%. I have not measured it lately, but Dylan walked a 3 mile walk with me last week (Yeah Dylan :-) My vets were always a little leary about reducing until I talked to them. Thank God for vets who listen. They listened carefuly to my behavioral descriptions and always ended up agreeing and letting me reduce more quickly. Although they did not initially agree that the drop in PCV was from prednisone, as it continued, they did agree. So each case is unique and it really depends on how treatment is going and how the drugs are reacting in YOUR dog. I fear the long term consequences of pred use too, like bone loss, arthritis and broken bones, which can occur wth long term hi dose use. A link provided by Patrice made it pretty clear what was going on in Dylan. she had the symptoms in order starting immediately and progressing daily down the list. http://www.kateconnick.com/library/cushingsdisease.html In our society, we tend to think pills are safe and I am not one of those people. I think everything is toxic. So eliminating toxins to keep the liver healthy and all the other organs and body from being damaged, I reduce chemical stress as fast as I can and I take it very seriously. Dylan was never on Azathiprine nor Cyclosporine too which is a little unique. This is also due to my beliefs (serveral years of research in pharamacology and 20+ years fighting Crohn's disease in my ex-wife). I would have added them if necessary, but not just for the sake of it. The chemical load on the liver is huge. So for many reasons, I considered the drugs equally dangerous and I fought both. Drug ineractions also provide a complex environement to reduce them in and the intent of using multiple drugs is to be able to use less of each of them, which Vets and Doctors just don't get, so they use high doses of them all together. Even to the point where we have seen dogs who could not recover until the doses were lowered. With Dylan I knew every change that followed a reduction was do either to prednisone, or the disease. She gets better, it is not the disease; she gets worse, it is the disease. Nothing to confuse the issue, but again, prednisone does not work alone in all dogs. Other dogs also have much more chronic problems and cannot be compared easily to Dylan's situation. Every dog and every case is unique! I am surprised they reduced and removed Cyclosprine first, but I guess it must not be working, oor they think it is not, as they usually prefer that (I could not afford it and that may be a legitimate reason for dropping it first too). Azathiprine is not preferred over Cylcosporine usually as it has fewer side effects than Azathioprine. The differnence between anemia symptoms and Cushings Doisease were pretty obvious and each time I reduced prednisone I saw positive change clearly indicating anemia was not coming back. This is critical. I did not need to go for a blood test to see anemia and I knew when I reduced prednisone that the effects were positive AND that Dylan stablized after each reduction. I was not guessing, merely observing my dog uniquely for result of the reduction. When I was certain (usually within 5-6 days), I considered another reduction. This is what is critical. Each dog is different and you can never know before hand if it is too much pred, the disease if gone, whatever. You can only make your best hypothesis, make a decision, try it, determine the result and continue, or back off depending on the result. If Dylan does relapse, I will start with half the prednisone dose and if her PCV rises quickly again, will reduce prednisone even faster. Due to her reactivity, I cannot leave her on it. I hope to prevent the severe muscle loss next time if there is a next time. I also don't believe that once you get down to low doses, and alternating days, that a low dose provides any protection against the disease at all, so I am not going to leave her on a dangerous drug out of fear the disease might come back. I believe it will come back either way and that I need to be prepared with a plan if it does. I cannot act out of fear, I just know that fear always takes you in the wrong direction. I have seen people who have relapsed and because of it stay on a low dose, but low doses do not provide immune suppression, just anti-inflammatory properties. My plan includes getting Dylan strong again, rebuilding all her muscle and getting her liver and organs healthy as quickly as possible, adding fat to her normally lean body and feeding her the best natural diet, so she is well prepared for the next fight if it does occur. That is all I can do. Depending on your dog, I suspect the 2 X 7.5 mg, about .5mg per pound per day will still be suppressing the immune system (remember this is only a guess, as I don't know your dog's case that well). You also do not need to worry about adrenal gland function yet, as they will not be kicking in with cortisol yet. As you get to lower doses, you have to make sure the adrenal glands start up and produce cortisol to replace the loss of prednisone. This is when more care is required, but there are different symptoms to watch for (achy, uncomfortable, lethargic, etc). The longer they are on prednisone the harder it will be generally for the adrenal glands to kick back in, so more care is required after longer term use. With Dylan I reduced 10 mg per day each week until we got to lower doses and then we started dropping doses rather than reducing, bt pretty much made a change each and every week except the last 2 I waited 2 weeks because prednisone was at such a low dose and she was recovering, but quite frankly, I doulce have done the last 2 in 1 week intervals as well. But this was Dog Dylan and her case. I really hope this long winded description helps. Try not to let fear decide things for you. We are all guessing and hter eis no simple solution. You can only do your best, watch for the result of change and take the necessary steps after. Fear will not help you. I really hope you see nothing but benefit as your reduce and are able to have a happy dog free of the disease and thr drugs. Richard and Dog Dylan (Diagnosed March 19, free from prednsione since July 6, getting stronger every day) |
| Richard Burnaby |
| Hi again, Having read your other post, I now see why Cyclosprine was removed first. And I do stand by my comments that there is as much to be concerned about from the drugs. Immunosuppressants can be very toxic and have more problems when combined. Some dogs don't react at all with them and other cases they work great in. Prednisone at low doses is safe in the short term for most dogs, although there have even been allergic reactions to it in people at least. But at 2 mg/pound and 1 mg/pound per day, that is very high and even dangerous levels for many dogs. You are still over .5 mg/day and that is still considered a high dose, not a low dose. You may even be experiencing the 33% pcv level because of the prednsione. So again, you make reductions when you can and if it goes up, or stays the same, GREAT. If it goes down, then you go back and maintain for longer. I suspect reducing pred will help the PCV come up, but I again I don't really know the entire timeline. It would be easier for me if I did, but stable, or improving PCV is all you an hope for and is a GREAT thing. Remember, one step at a time, this disease is very complicated and is unique in each and every dog. We are always guessing to some degree, vets, me, you, everyone. We just do our best and hope for the best and determine what to do after a change based on what happens. It is a very stressful disease, so try not to second guess your decisions, or be afraid, just try to observe accurately and make the best decisions you can with what you know. We will be here to help if we can. Best of luck, hopes and prayers for you and Keeli. Richard and Dog Dylan - 10 year old puppy again :+)~ |
| Richard Burnaby |
| Richard Thank you for putting it that way. I too am concerned about how the pred is affecting Keeli. She has tremors and is not as strong in her hind quarters as she usually is. It really worries me. Am keeping a close eye on things as I reduce. She will have been on 7.5mg for a week this Friday and am going for lab work that evening. Her gums seem more red than they have been and she is more active. Hoping the pvc is up. I'm glad you took the time to let me know how you feel about the meds. It is a real concern when Keeli has never taken anything but her vaccinations (which I blame on this disease). Now she has been on so many things her poor body is wondering what happened. Thanks for standing by for further questions. I'm sure I will have some as I try to get her off all of this. Patrice has been most helpful also. Joann and Keeli |
| Joann Binger Ok |
This thread was discussed between 17/09/2011 and 18/09/2011
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