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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - sophie's journey back to health
| Today is a big step for Sophie her bld work is remaining stable so the vet says we can now go to once a day prednisone. We are very nervous about this because last time that is when she had a relapse. She is to be on 2 mg of prednisone once a day from 2 mg twice a day so I'm thinking I will give her 1 mg tonight and then 2 mg in the morning and then .5 tom. night and then 2 mg daily after that so its not so sudden for her. The vet tells me not to worry about it but I am. She is so heavy now from 24 lbs to 31 lbs in 3 mths is shocking. She litterly wobbles when she walks now. I'm sure she has developed cushing syndrome from the pred. she has all the symptome the pot belly ,swag in her back, thinning hair and so forth but hopefully this will all resolve when she is completely off the pred. so I am very excited to get down to once a day. The vet says the plan is by xmas she should be off of her meds. I have introduced milk thistle to her now 200mg daily split twice a day to help her liver and kidneys 'she is still spilling large amounts of protein in her urine. Nights are her worst for being so very hungry and she is only allowed 1 cup of K/D food daily now so Im hoping with no pred. in the evenings it wont be so bad for her. She is starting to show a little playfulness now bringing her toys to you and catching the ball for maybe 3 throws before it tires her out. I have found a way to finally save a huge amount of money weekly. I asked today if they could spin her blood instead of a complete CBC and they agreed so from $80. weekly for blood work it now will be $17.00 how crazy is that! They never mentioned this but i read somewhere that they can spin it so I asked. This is going to be a huge savings for us so if you are going through the same as me ask for that instead. The meds. alone are a lot of money. |
| debbie N.B. Canada |
| Debbie, I am sorry, I was away from the forum for a few weeks, so I don't know Sophie's story. A drop from 4mg to 2 mg a day is a 50% reduction and seems too much to me. On the other hand at these low doses i am puzzled Sophie still has these side effects. Either way I think I would go with 1 mg morning 2 mg evening for two weeks. Then do a PCV and then reduce to 2 mg once a day. This way you would be in the recommended 1/3 reduction. Better safe than sorry? Especially if she already had a relapse. Do you recall at what dose that was? If it were my dog, depending on her age I would even consider to leave her on a small dose for the rest of her life. This is what Dr. Dodds (the expert in these matters) recommended to us after Kahlu relapsed. Is Sophie on any other medications like Azathioprene or cyclosporin besides the prednisone? If that is the case it is a whole different story all together. To do a PCV at the vet is a good and cost effective method to find out where the PCV numbers stand. However it does not give you a complete picture. I would still do a complete CBC every once in a while. Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| Hi Brigitte, Thank you for your comments Sophie's story is about 5 down on this site. She is an American Cocker 7 yrs old and developed Evans Syndrome after receiving her Parvio vaccine and having her teeth cleaned. Its been a terrible battle for her and we have taken her to P.E.I. for a second opinion because our own Vet wasn't sure about certain things and made too many mistakes with her care. The specialist there said that all of these symptoms that Sophie has now will go away once she is off the pred. completely. She is one of the few dogs that has such a hard time on pred. She is spilling huge amounts of protein in her urine still. Her symptoms of cushings isn't new she has had this for quite a while. We have been seeing a new vet here since June who is a internal specialist and her reduction has been 20% weekly eg. from 3mg.twice a day for one week to 2.5 mg twice a day and so forth with a complete CBC each week. Sophie has cont to increase in weight each week. And you are so right about it being odd that at such a low dose that she would still be having all these effects. This vet said the exact same things that the dosage that she is on is so low it would be the same amount as she would be producing herself and she is wondering if she had cushing pre all of this. Dear Lord I hope not. The vet is very worried about her weight gain. The good news is she didn't gain any this last week! I agree a CBC is the best but we are now strapped for funding we are now borrowing money for her health it has taken all our savings to save her so far so a spin every week is good for now to give us a little relief to catch up on our bills. Im not sure why she has advised a 50% drop in her pred though . that does worry me and ty for you support in that I'm starting to doubt myself .Yesterday I gave her 2mg of pred, 600mg omega 3, 2.5mg Benazepril ,100mg milk thistle, in the morning and at supper time I gave her 100mg of milk thistle , 600 mg of omega3, 2.5 Benazepril, 4mg of aspirin, and I gave her 1mg of the pred. even though my vet said not to give her any. I'm just too scared to go down 50%. I do know that any drop we make the following 2 days Sophie is quieter and her nose becomes dry and warm. It could be the stress of going to the vets and having them poke her for blood. So Im not sure what to do for tonight should I give her no pred like the vet said or give her 1mg or .5mg. Any advise from the board I would be grateful. My prayers and support for all you and your wonderful dogs who are going through this too. The hope that I have received from all of you have been wonderful. Thank you so much. |
| debie N.B. Canada |
| Debbie, I personally would not have too many problems just doing a spin some of the time and doing a full CBC every month or 6 weeks. We did that with my Meisha from time to time. If Sophie were my dog I would be concerned about the 50% drop in pred. I do have some information that might be helpful to you in regard to the prednisone reduction. This information is from a Magazine called “Veterinary Medicine” subtitled clinical solutions for practicing veterinarians. This is the June 1999 issue. In the article called “Managing immune-mediated hemolytic anemia in dogs” by Stephanie J, Lifton, DVM, Dipl. ACVIM which was peer reviewed before publication we find the following information and I am quoting here: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased.” “Once the disease is in remission, the dose of prednisone can be lowered by 25% to 35% every three to four weeks until the lowest dose that keeps the disease under control is reached. This can be accomplished by either decreasing the dose or the frequency of administration (e.g. twice a day to once a day then every other day then every three days and so on.) If the dog is receiving more then one immunosuppressive drug, change the dosage or frequency of only one drug at a time.” End of quote. Even though this is a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA It is not wise to go against the instuctions of a vet so if you are very uncomfortable about the 50% decrease it would be wise to call the vet and talk to him and ask why the 50% decrease. Pred indeed has many side effects but reducing it too much too quickly can lead to relapses and damage to the adreanal gland. Far too many vets reduce the pred for AIHA/IMHA dogs too quickly and many times the dog will suffer as a result of this too fast reduction. Please try and contact your vet and express to him your great concern about this large of reduction. You and your dear Sophie are in my thoughts and prayers. |
| Joanne MN |
| Debbie, I so feel for you, how confusing. If Sophie would be my dog, I would contact Dr. Dodds. You can e-mail her at hemopet @ hotmail.com (remove spaces) If you do it, make sure to be short and clear. Give her all the numbers from Sophie's latest few CBC's and the medications she is on. Describe her clinical signs, age breed and weight. Dr. Dodds will get back to you as soon as she can. She is a VERY busy lady, but I know she will help when ever she can. Tell your vet that you are contacting her. Any reasonable up to date vet knows of her. Some think she is phenomenal, some think she is a quack. ( I think she has bruised some vets pride?) Are you still working together with the vet college on PEI? Many people on this forum have only high praises for Dr. Dodds I really think she could help Sophie. I asked my vet to consult with Dr. Dodds, which she gladly did. She found that she learned so much from her. Best wishes, Brigitte & the poodle boys PS: Greet NB for me, I have been there many times, my sister lives in Fredericton |
| Brigitte BC Canada |
| You are so sweet thank you for your quick responses as of yet i have only decreased her 1mg at supper time . I think I will stick with this for this week and see what her blood work shows on Monday. I did mention my concerns with my vet but she seemed to think Sophie is ready for this. I don't mind going against her wishes in this if its in the best interest of my little dog she has suffered so very much since May. I'm just surprised that she wants to go down 50% now when all along she was an advocate of a 20% reduction. I'm wondering if its because the dose is so small now. I'm sure Dr Dodds would know. Is there a fee for his opinion? |
| DEBBIE N.B. Canada |
| Hey Debbie, sorry you have to go through all this confusion with med reductions but those here who have had a dog relapse due to reducing meds too quick will always recommend slower more gradual reductions. The trick is to SLOWLY wake up or turn on the adrenal glands. When the dogs are on such high doses of steroids the adrenal glands "go to sleep" so to speak. High or excessive doses of cortisole (pred) causes these symptoms you are seeing with Sophie (hyperadrenocorticism/iatrogenic cushings). The most important time to take med reductions slowly is at this stage where you are at with Sophie. Don't worry about weight gain if it's only a little and don't worry about the cushings symptoms. They'll subside with time. Better to deal with this than a relapse. Look up iatrogenic cushings. This should answer a lot of your questions with regards to the symptoms you are seeing. If I were you I'd also send off for a FULL thyroid panel. Dr. Dodds (female) or Michigan State University are the BEST places to do these tests BUT if I were you I would take the Dr. Dodds route as then you can get the full deal package for under $300 bucks...but if money is an issue then you gotta do what you can. Hypothyroidism can aslo show some of the symptoms you are describing. Very worthwhile to have checked BEFORE removing all meds. If you are not comfortable with doing a 50% reduction (and if it were me there'd be NO WAY i'd ever consider this large a reduction) then by all means don't. Keep it slow and steady! Eventually you'll want to go to an every other day schedule and then every third day, etc. Keep us posted on how she's doing. (I have 8 cockers...one a survivor of this disease and another battling it as we speak). Lots of positive vibes for Sophie, Johnny Tessy & Sadie |
| Johnny |
This thread was discussed between 09/08/2010 and 11/08/2010
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