Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tessy results Frustrating

Hi everybody. Had Tessy in today to get her Thyroid rechecked and also had a CBC done. The results were not what I had expected to say the least. The good news is that her thyroid levels are good now. I think the doctor said the number was 42...still trying to find the reference ranges for this number and if it would be the same with a sick dog pumped full of drugs. The other good news was that her platelet numbers are finally falling close to normal levels (514!!!). The bad news however is that her HCT dropped from 29.3 to 28.7, RBC dropped from 3.91 to 3.81, and HGB dropped from 10.3 to 9.8. The drop isn't what bothers me....it's the fact that she has levelled off again. A one to two point raise or drop is not enough to say she is improving or not. I said almost a month ago that I thought she was levelling again by the trends in her numbers but we just remained on coarse because of the variences of each test taken. Optimism is slowly turning to frustration. We have yet to reach the 30% mark and she's been in the high 20's now for approx. a month. She was in the high 20's for almost a month before she relapsed last also. I just fear that she will never get over the hump. Since the HCT, RBC, and HGB dropped (only a little) the doctor wants to remain with the same meds and retest in two weeks time. Myself...I would prefer to reduce the azathioprine and then the pred after 2 weeks time. Trends are showing that she is not going to rise too much higher than she already is unless something is done. I'll sleep on it tonight and try to figure out a coarse of action in the morning. I'm just happy that the clinical signs are all good. She's about the same as she was a month ago so I can't complain. I just can't wait for her to get close to 100%. I guess I'll have to pray a little harder. Johnny & Tessy

Johnny

Hi Johnny, Tessy's results don't look too bad, I know it's hard though when the numbers don't climb. Statistically, they really didn't drop too much, since we might see two different results from the same day even, when they are that close. But, one thing, you know Aza is a marrow suppressor, and so is Pred I guess. One thing to keep in mind though, is that you might only want to reduce one med at a time. We started with Pred. We didn't do anything with Aza until Tiggs had been weaned off of Pred. Not saying this is the best or only way, just what we did. But, it seems like most vets like to maybe only tinker with one at a time. Seems like Aza has less short term side effects if she is tolerating it well. Just remember, no more than 25-35% and keep an eye on her. And, your right about her clinical signs. There are a lot of folks whose dogs never make it into the 30's but still have a great quality of life, with great clinical signs. Numbers just plain stink, at least I think! Hang in there :) melissa and tiggs

melissa slc

Johnny, I feel your frustration! Ren's PCV dropped again since last visit. She was at 41.2 and now she is at 36. I can not understand why this happens. The Vet and I had a heart to heart talk today. She said that Ren will always have a "battle" with AIHA. She is just one of those dogs that will not go into full remission. So, we take one day at a time. One thing I have learned on this web site is not to be too consumed by the numbers. I have found that is difficult to do but a necessity to keep my sanity. Also Johnny, do not be too hasty in med reduction. Yes, long term steroid/ immune suppressants have terrible side effect but AIHA relapse is far worse. Sue & Ren

Susie Delaware

Johnny, I really feel for you. I thought so many times, that I just want Kahlu to get up, shake himself and make this horrid disease go away. It all takes way to long and is hard on our dogs and on our bodies and souls. I feel that just this week, it is week 16 after diagnosis, we are back to some sort of a normal life. We have reduced the Aza from 50mg to 25mg after being on it for 12 weeks. By then we had lowered the prednisone to 20mg. Looking back I think it would have been better to lower the prednisone more instead of the Aza. My vet wanted to do it this way, because she thought that maybe the Aza was the medication that elevated Kahlu's liver enzymes. We now know this was not the case. So now we keep the Aza at 25mg and lower the pred. Kahlu was in the low 30ies for a long time before we started to reduce. We all want the best for our dogs and make the right decisions. But it is so hard, because every dog is different and every disease is different. I know you will do a lot of research before you make your decision, so you will make the right one for Tessy! The last 4 weeks when we got good results from the vet, Kahlu seemed even better after those phone calls. I am sure he sensed my relief. So try and stay positive, I am sure Tessy is a pretty sensitive gal. Take care and best wishes, Brigitte & Kahlu

Brigitte BC Canada

Johnny, I have never paid that much attention to all the numbers, i'm not a vet and i refuse to drive myself crazy with all that stuff i am paying the vet to do. I do however, look at how charlie is feeling and acting. His energy is great, he's starving and now we need to lose weight!! He's juat a little over a year old so i dont know if he is just filling out or eating too much LOL ! I would just relax and hug that doggie of yours and dont let her feel your stress! You are in my thoughts and prayers! Carol

Carol Vanc Wa

I haven't really been paying that much attention to the numbers but it's hard to ignor them all the time. I used to do lots of statistical reports when I was in College and I guess it's hard to get anything "numbers" out of my head. It's just always stuck in the back of my head. I haven't been able to get out to releive the stress as of late. My friend has been after me to go skydiving with him again this year but the funds aren't there for it. If you're ever looking for a way to get all the stress out then I'ld highly (literally) recommend this to anybody. For the time being I'm just going to enjoy each day I have with Tessy. Hope everybody and their furkids are doing great tonight. Hugs and prayers go out ot everyone. Johnny & Tessy

Johnny

Johnny, It's interesting how regenerative Tessy was on that last test but the end result was not even at least a slight increase in the number of red blood cells. Normalizing the thyroid levels might help this. Did Dr. Dodds do the testing? Ask your vet for a copy of the results. It usually explains the test results and shows a range. Dr. Dodds references her history of the particular breed being tested to see if there are "low normals" or dogs that have a low normal result but still are showing signs of the need for supplementation. The important part of the test is insuring that it be done a certain number of hours after the last dose was given and that be marked on the blood test form. Have you revisited starting the cyclosporine with your vet? You might ask Dr. Dodds if she thinks testing the cobalamin (B12), folate and iron blood levels might be advisable. These dietary items need special digestion in the small intestine. If there is a low level of these, it can impair red blood cell maturation. The cobalamin and folate are a part of a larger pancreatic panel. But, for cost, you should be able to break them out to just the two. If they end up on the low side, esp the B12, they can be administered with an easy sub-q shot once a week, which you can do at home. my best patrice

Patrice NYS

Thanks Patrice. I was actually planning on sending Tessy's blood down to Hemopet to have a Profile 7200 (I think it was called) done. I wonder if these tests can also be requested to be done. I'll have to e-mail them and find out. Tessy is already on Cyclosporine since her relapse in the beginning of April. She takes a LARGE amount....200mg total/day. I know this sounds like alot but her trough test showed that the levels were acceptable (230+/-). I thought maybe we should reduce to at least 170mg (cause Tessy only weighs 36 pounds) but her doctor didn't think it was necesary. How's Chance? Is your shoulder getting better? Johnny & Tessy

Johnny

Johnny, If you are using cyclo plus pred plus aza, if this were me I would decrease the aza a bit, then dec the pred a bit. (So about a month of decreases in these) but maintain the level of cyclo. If you see some positive results, then begin decreasing the cyclo. The aza may be acting as too much of a suppressant. Pred is bad in long term use. Chance was at 225mg Atopica for quite a while (at 96 lbs). This drug has been tested at extremely high doses (4-6x this dose) and there weren't serious side effects that didn't resolve once the drug was removed. This drug, as Atopica, is used (esp this time of the year) for dogs that have atopic allergies (inhaled allergies) so they can start out this high (lower for a 36 lb dog: 125? check novartis web site for dosages http://www.atopica.com/product_label/en/index.shtml) and then taper as the symptoms resolve until they reach a maintenance dose. It is targeting a very specific white blood cell, the killer t-cell, that is causing the most problems in AIHA (but also in allergies!) The pred and the aza are wider ranging suppressants and target more of the immune system. Do contact Hemopet about the thyroid results you already have. Dr. Dodds will do a consultation on those results for $30. Which is very inexpensive. If she determines she needs another panel, then follow her instructions. Just returned from the PT's. Good news, the shoulder will be better in a year,one way or the other. The bad news is that we still don't know if there is damage causing my limitations or if it is just a high level of inflammation. In any case, doing anything with my arm above my waist is painful. If there is a SLAP tear in the labrum, they will have to do exploratory surgery and possibly repair the labrum. This is the nice cartilage cushion that sits on top of the cup that is your shoulder socket. This can be torn, making movement painful, and it's very hard to detect this tear. If it is torn, it requires surgery and then about 6 months of therapy. my best patrice

Patrice NYS

This thread was discussed between 19/05/2009 and 21/05/2009

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