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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - symptoms after 1st pred reduction
| After being on a whopping dose of 60 mg of pred 2x a day and getting great results, my vet decided to lower Allie's does by half. Now she seem really weak and appears to be panting more. I did read in another post the same symptoms, is this common? Thanks, Kat and Allie |
| Kate Northwest |
| How many days has Allie been on the Prednisone? And how much does she weigh? |
| Otto Brooklyn |
| Allie has been on the pred I guessing since the day she crashed and was in the hospital, almost a month ago. She use to weigh about 62 pounds, but is up to 72 pounds. Her weight gain is partially my fault since there was a period when she was too weak to eat, so I was giving her anything, and now I am trying to cut back, but with multiple pills a day, it is the easiest way to get them down her, with a little treat. I am just so worried all the time about her, I cannot tell if I am over reacting about the panting. I understand that she is struggling right now, and has gone through alot, she just seems so sad and different. Any thoughts? Kat |
| Kate Northwest |
| Kat: My understanding (as a new "AIHA" mom; my dog, Shadow, was diagnosed on October 19) is that 60 mg of pred 2X a day is not an unusual dose for a dog of Allie's size. I think the standard initial dose is 2-3 mg/lb split into two doses. That's what Shadow (who weighs 20 pounds) was on for the first three weeks (20 mg every 12 hours). And, I think the standard protocol is to reduce a dog's dose of prednisone by 1/2 once their PCV stabilizes. But, each dog is different; responds differently to medications; and responds differently to a reduction in their medications. Shadow developed GI bleeding, so we had to cut her pred back sharply and suddenly. BUT, she was also taking Imuran (brand name for azathioprine) and Atopica (brand name for cyclosporine), and had been on both long enough for them to have kicked in. Shadow did experience the same extreme lethargy as Allie, when her dose was reduced (but, Shad's was cut from 40 mg/day to 10 mg/day because of the internal bleeding) so - after confirming that she no longer had blood in her stools - I bumped her reduced dose of prednisone back up to 20 mg/day (10 mg every 12 hours). She recovered from the lethargy three hours later. We're going to keep her on the 10 mg every 12 hours for five days (provided her stools stay clear), then reduce her to 10 mg. I'd encourage you to talk to your vet. You might want to ask him/her if Allie needs to be put on azathioprine and/or cyclosporine or another immunosuppresive - with enough time for one to kick in before her pred is reduced, if she's not already on them. Allie's personality changes are normal. She doesn't feel good, has little oxygen and, therefore, no energy. Shadow (at 10 yrs and 20 lbs) has always been my "circus" dog, jumping over the six-foot fence in one leap (something she did the day before she crashed). She only had one gear, and that was fifth! Suddenly, she's stuck in first and can't even jump onto the bed. Even her voice has changed. My hope is not to keep Shadow alive, if living the rest of her life means staying as she is now. My hope is to help Shadow heal so that she can return to doing the things she loves best - running, jumping and playing. That's everyon on this board's hope: to help restore the quality of life that our dogs' once enjoyed. Don't lose hope; talk to your vet. And, read Meisha's hope and everything else you can about this dreadful disease. Don't be afraid of offending anyone: your job is to be Allie's advocate. Best of luck to you and Allie. Sandy |
| Sandy Utah |
| Kate...for what it's worth...my yellow lab 'Daisy" weighed 80 lbs when diagnosed July 23..She has been taking Cyclosporin, then switched to Immuran along with her Prednisone. Initially she was on 80mg/day split into two doses. She has been tapered to 70, 60, 50 and currently is on 40 mg split into two 20mg doses until we get her blood results done (this Thursday). They don't want to reduce her Prednisone until they see she is headed towards clinical remission. Her treatment is being directed by a group of Internal Medicine/Oncology specialists who seem to have a good grasp of this disease. Good Luck with Allie. |
| Ron B San Mateo |
| Thank you for the comments. Along with the prednisone, she is also on Immuran, carafate, pepcid and antibiotics. Last night I was not sure if I was being parinoid, or if she was crashing. I believe she is a little bit better today, at least she is not panting. Like Shadow, Allie was my goofy dog who always was sneaking into my bedroom to be on the bed, or at my heel looking for another walk. Now while she is struggling to walk, I am also struggling with fear and loss of what we use to have together. My vet has been wonderful and I do feel confident with her choices, I just was not sure over the weekend if we needed to be seen and would I know if there was truly a crisis situation. It is such a crazy, day by day disease. I do appreciate people sharing their experiences, it does help me at least. Kat |
| Kate Northwest |
| I, as well as everyone on this forum, know how hard it is to be patient but know that it is very early into this for your dog. Newman was experiencing the same lethargy and side effects from the meds a year ago when he was diagnosed. He is still on Prednisone and Azathioprine (we hope to get him off meds in the new year) but is doing very well. It was several months before he was back to his old self. We have just returned from Arizona where we competed in agility at the World Cynosport Games. Needless to say he is back to his old and kicking butt even while still on the meds! Please, please don't lose faith. Yes, they seem sad and different but more than being sad, I think they just feel crappy. Give it some time. Dogs have an incredible capacity to fight what ails them. Trust that your dog is doing just that. |
| Louise Toronto |
| I just wanted to make a couple of comments here in regard to the pred dosage and reduction schedule. The least amount of prednsione a dog with AIHA/IMHA should be on at the onset of the disease is 1 mg per pound of the dogs weight per day divided into 2 doses, one dose to be given in the morning and one dose to be given in the evening. In some cases that I have seen vets have given 2- 3 mg per pound per day but that is not the norm with most vets. This large doseage at the onset of the illness is called a loading dose 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: “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 from a source that is a few years old, this is the pred reduction schedule that many of the veterinary teaching hospitals use when dealing with AIHA/IMHA. Exceptions to the above reduction info can perhaps be made when you are using a higher loading dose at the onset of the illness. Another thing to remember is that blood work should be done before each reduction to make sure such a reduction is warranted. I have seen many many cases in which the vet has laid out a pred redution schedule and not done blood work before these reductions. Making pred reductins without first doing blood work to see if such a reduction is warranted can be very harmful for a dog with AIHA/IMHA. Also many vets tend to reduce the pred by too large of a percentage when they do reduce it. This can be very harmful for the dog as well. It is very important to talk over each pred reduction (other meds as well) with your vet before doing them. If you feel he/she is doing the redcution too much/too soon, please tell your vet that and ask him/her to get a few another opinion on this redcuiton from a veterinary internal medicine specialist. |
| Joanne MN |
This thread was discussed between 12/11/2007 and 13/11/2007
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