Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Ruger PCV Drop/Ulcer Questions

Ruger's check up today revealed a PCV drop to 25 and bad bleeding ulcers in his stomach. His dr. thinks the pcv drop is from the ulcers and not the disease however the disease is still active so she is hesitant to drop the prednisone too much. She started him on sucralate, prilosec and is decreaasing the prednisone from 40 mg to 30 mg I am hoping and praying the decrease does not make his PCV drop any lower. Anybody have any suggestions on how to treat the ulcers and get his PCV back up while we wait for the cyclosporine to kick in....He is tough but any suggestions are much appreciated.

Jaime Parker

Jaime, This also happened to Coco. The vet recomended Purina EN canned food as is very easily digestible and it seemed to help. Coco was on sucrafate is that the same as sucralate? and do you need her sucrafate? Cocos vet also prescibed ranitidine which is an antacid. I have that also if your vet decides to add that. Cocos vet also thought the ulcers where adding to her pcv drops. Take care and I'll keep you both in my prayers....Kelly

Kelly Redding

Hi Jamie I am sorry to hear that Ruger's PCV went down to 25, was this a big drop or just a small one? Ginger's vet had her take Carafate to help with the ulcers. How is Rugers acting is he eating okay? We continue to keep Ruger's in our thoughts and prayers and hope he feels better soon. Cheryl & Ginger

Cheryl & Ginger Pinevile pa

Jaime, the sulcralfate will help this greatly. It is one of the better stomach coaters to give. Give him the pepcid with this and it would probably help some also if you want...but ask the doctor first. Also, you should be giving the meds with food. This'll help prevent the meds from irritating the stomach any further/less. Hasn't Ruger been on anything like pepcid or sulcralfate fromthe beginning? Has he vomited any? NSAIDS can worsen this...is Ruger taking low dose aspirin? If they persist then you might have to have xrays or ultrasounds done to look for foreign bodies. Try to feed him a bland easy digestable diet (liver cleanser diet?) until this clears up. Keep an eye on his stools. This can help tell the severity of these ulcers.If you notice lots of blood in the stool (black & tarry looking) then either call the vet ASAP or get to the vets ASAP. This would most likely require a stay. Oh...and this would most likely be one of the causes for a drop in PCV. Did they see spherocytes? Let us know how he's doing. Prayers and best wishes for your boy. ~~~~HUGS~~~~ Johnny & Tessy

Johnny

Hi Jaime, Sorry to hear Ruger has ulcers. Millie had them too, carafate (which I think is the sulcralfate) helped a lot with that, but just remember to give it at least an hour before meds to ensure it doesn't interfere with med absorption. Fingers crossed Ruger gets results from adding the cyclosporine. All the very best, keep us posted. Samantha.

Samantha Geelong Australia

Jaime, Johnny is right about giving the meds with food. Some of the meds like the prednisone for sure. If I remember correctly, Cyclosporin should be given without food. Sucralfate (Carafate) should also be given without food or any other medication. It is good to give that one over night. Oh the juggling of the meds... Best wishes, Brigitte

Brigitte BC Canada

Thnaks all.. he dropped from 32 to 25 o that seems big to me. He has been at 30-32 since he got out of the hospital in December so this is upsetting. He has been taking pepcid twice a day with the prednisone but apparantly that was not strong enough. He has had a few black stools but mostly reddish/brown. She thinks the reddish part is coming form the blood that is traveling quickly through his system. I have been giving all his meds except the cyclosporine with food. He is not interested in his dog food at all. If I add somehting to flavor it then he will eat a bit. This also is discouraging as he was eating so well before. We are starting the sucralate and the prilosec tongiht so hopefully this all helps. They did see spherocytes and agglutination. Mild but still present. How long soes it usually take to get the disease gone? We are going on 2 months already and I fear Ruger is getting tired of fighting, especially with this added trouble of the ulcers. We are also taking him off the aspirin which makes me nervous with the agglutination. He is tough and he is a fighter so the disease will stop soon, then we can wean the pred and the ulcers will go away too. Bridgette, you are so right...juggling of the meds on this roller coaster ride....no fun!

Jaime Parker

I give Tessy's cyclo with food but you want ot be carefull and watch the lymph #'s when doing so or get trough tests every so often. I'd go even longer than an hour before meds with the sucralfate. MYSELF, I used to give it AFTER the meds when Tessy was getting this med. I'd strongly recommend switching from sucralfate to something different like prilocek afterwards due to absorption issues with cyclo and sucralfate. OR at least give the cyclo two hours BEFORE giving the sucralfate. OH...disregard my suggestion of using pepcid with the sucralfate as mentioned above. I misread your first notes and didn't realize you said you were using prilocek with it. Prilocek is better to use than the pepcid (IMO). Good Luck. Johnny & Tessy

Johnny

Juggling the drugs is getting difficult...this is my current schedule. If anyone has any better ideas let me know. I am slo trying to feed him small meals throughout the day to help with the liver and ulcers so that makes it even harder to manage. 7 am sucralfate 8 am breakfast, pred, anitibiotic, leflunomide, milk thistle 1030am cyclosporine 1230 pm sucralfate 130 pm lunch and antibiotic 530pm sucralfate 630pm dinner pred, anitibiotic leflunomide prilosec 10pm cylosporine SHould I switch it around somehow so the sucrafalate is at bed time? What are your med regimens like?

Jaime Parker

I used to dose the carafate at midday and before bed. I did not want to take any chances that it would interfere with the other drugs. It was quite a schedule but it does become routine after awhile. When we began to stop some of the drugs, I found myself a bit lost and having to write down new times and doses for the remaining drugs! Good luck. Always hoping for the best with Ruger. Sam and Millie

Samantha Geelong Australia

Jaime, My vet actually had Coco taking the Sucrafate every 8 hours and her ranitidine (acid reducer) every 8 hours as well. This really seemed to help with her ulcers and before she passed her stool actually started looking fairly normal. Between that and the other drugs it does become quite a circus. We gave her first meds at 6 am and since two were every 8 hrs we were up till 11am. We were told also to give her sucrafate 1 hr before the other meds. I am sending Mr Ruger lots of doggy love from Max and Tito so tell him to get well soon...Kelly, Max and Tito

Kelly Redding

I'm thinking you should be keeping everything on a more strict schedule. Pred every 12 hours, sucralfate every 8hrs, cyclo every 12hrs, antibiotics every 12hrs, etc. I remember with Tessy's schedule it got pretty hecktic at times! I had ot set the alarm clock to get up and give her meds just to stick with the proper schedule. I used to do this religiously so that it was done proper. I also think the sucralfate should be given ONLY for the ulcers and once the ulcers are under control maybe stick with just the prilocek. Would you be willing to get up earlier or stay up later?

Johnny

Yes, I stay up later anyways because he usually has to go out at 12 am and then I take him back out between 6/7 depending on when my kiddos get me up. I was just doing the other meds with breakfast and dinner when we eat because that is when he begs for food. Please set me up on a better schedule, I am willing to do anything. His dr. had said to take the cyclopsorine 2 hours before the other stuff but I haven't figured out a way to do this with the sucraflate, especially when it is supposed to be given 1 hr before the pred??? Kelly I like the idea of every 8 hours on the sucraflate...that makes sense, keep the tummy protected round the clock.

Jaime Parker

Jaime, what kind of antibiotics is Ruger on?

Johnny

Here's an option you could use.... 7am-sucralfate 8am-breakfast, pred, anitibiotic, leflunomide, milk thistle 11am-cyclo 1pm lunch and antibiotic 3pm-sucralfate 8pm-dinner, pred, anitibiotic, leflunomide, prilosec, milk thistle 11pm-cyclo 12pm-sucralfate You could go numerous ways with this...whatever suits your daily needs really but the cyclo, pred, leflu, and antibiotics should be spaced accordingly. Now, due to all the meds Ruger is on the spacing of the stomach protectants is important. Ideally the sucralfate should be given at least one hour before feeding or two hours after. Some say that sucralfate should be given 4 times daily but at least every eight hours should be sufficient. I'm also not a big fan of giving the antibiotics with the other drugs...that's why I was asking what kind you are giving him. Maybe you could schedule separate also???? Hopefully the others here will critique this some as I'm sorta in a rush and input would be great. Let me know what you think Jaime. Johnny & Tessy

Johnny

Thanks Johnny, He is on keflex for his leg infection and trisol(sp?) 3 times a day to help with the diarrhea. His Dr only presribed the sucraflate 2 times a day but 4 times would make the schedule easier. I will ask her if I can give it 4 times.

Jaime Parker

This thread was discussed between 04/02/2010 and 05/02/2010

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