Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tiggs Update 5/9/09- Advice Needed

Hi everyone, We found some gunky stuff on Tigg's back yesterday that worried me, thinking it might be a return of his Staph infection. Alas, it has turned out to be allergic dermatitis that is slightly infected, but not too much of a cause for concern. Tiggs' will do a two week course of Cephalexin antibiotics to clear it up. My vet did a PCV, and I'm still in shock, because it's his highest yet- 50! This is actually slightly higher than his pre- IMHA baseline HCT of 48. Now she wants Tiggs off of meds. We are only remaining on 15 mg of Azathioprine every other day. So, she said to stop immediately, give one dose Tues, then another dose next Sat, and repeat for two weeks, then STOP. I'm so nervous. So many people seem to experience relapse nearly one year later, and I have expressed concern about stopping the meds. We have however, done every reduction very conservatively, and it's taken us over 10 months to get here. So, I guess this is the next logical step. But, it scares me to death. I guess I'd love the opinion of some of the 'long termers' out there who have IMHA survivors and who are off of meds. What are our odds of relapse, vs. the risks/bennies of staying on low doses of Pred. At least now I know about this sh*tty disease, and will be better armed to see it coming if it does rear it's ugly head in the future. I just feel like whether Tiggs' is on meds or not, life will never be the same, I can never relax again knowing what might lurk in his body. I am so proud of my boy, he is amazing, so good natured. It just can get overwhelming to make good decisions for them, and weigh everything out. Thank you all so much for listening and for sharing any thoughts, support, experiences, and ideas you might have. melissa and tiggs

melissa slc

Correction: I meant to say "What are our odds of relapse, vs. the risks/bennies of staying on low doses of AZATHIOPRINE." We are no longer on Pred.

melissa slc

And, the last thing I'll add, since we all like pics: http://www.flickr.com/photos/dzinelvrslc/sets/72157617497766390/

melissa slc

What a beautiful set of pictures! I can see the Love you both have for each other.I also see how happy you both are. You have beat this thing! You are such an inspiration to us. Of course I can not advise you, since we are not nearly at the point of that decision. I am sure lots of people will tell you their stories and then you will make the right decision. Best wishes to you and Tiggs from, Brigitte & Kahlu

Brigitte BC Canada

Melissa, I can't say anything about making a decision about going off the meds because we never got that chance. I do understand about how you feel about never being able to be carefree with Tiggs as I feel that way about all 4 of my dogs that are healthy. This disease robs you of all innocence and will probably always leave a little seed of fear behind. Try to look forward instead of back and think how wonderful it would be if Tiggs was finally drug free. You have all fought a tough battle and come out on the other side. Good luck now and in the future. Penny

Penny Lytle Creek Calif

Hi Melissa I'm the same as Penny, we never got the chance to be off meds, but I know how I felt when we started reducing Billy's pred - petrified! When I lost Lily (Billy's half-sister) back in 2006, I didn't know anything about this disease, but as I learned more I became more paranoid - my family used to howl laughing at me checking poo/wee and gums, even the vet was sick of me. Try to put it to the back your mind, it'll always be there niggling away but you still have Tiggs at the end of a hard battle and that is all that matters really. Good luck. Steph

Steph Gloucestershire UK

Melissa, I don't know how long you have been reducing the azathioprine but the Veterinary Drug Handbook says in regard to Azathioprine and IMHA, and I quote: "In recovering dogs with immune-mediated hemolytic anemia, taper the withdrawl of the drug slowly over several months and monitor for early signs of relapse. Rapid withdrawl can lead to a rebound hyperimmune response." End of quote. Since it appears Tiggs is not having any adverse side effects from this drug it may be very wise to visit with your vet and tell him/her you are very uncomfortable with this plan and ask for a longer withdrawl period. You might then decide to lower the dosage a bit more or increase the days between dosages before totally stopping. You might also want to ask your vet why the huge hurry to get off this drug.

Joanne MN

Thank you all for your responses and support. Joanne, thanks for that info. To answer the question about how long we've been tapering, I would say we have very slowly been tapering Aza. He used to be on 30 mg/day, then a few months ago, we went to 15 mg per day (this is actually a very low dose for his weight which is now 66 lbs down from 78 when his hypothyroid was dx). After a couple months on that, we went to every other day on AZA at 15 mg. And he's been on that dose now for probably 2 months. So, in all reality, it has been a slow reduction. So now for the next two weeks, we go to twice a week. If the PCV looks good, then we stop altogether. What's interesting is that each time we have tapered AZA, the PCV has increased- I guess I would attribute this to the fact that AZA is a marrow suppressor (?). We will absolutely monitor. I've already warned my vet that we will be in there probably once every week to two weeks once meds cease to be sure we aren't slipping. So far, with regards to meds reductions, my vet has erred on the conservative side, which of course has been fine with me- I think slow and steady is the best course. I guess I wouldn't say that she's in a huge hurry at all to get him off, she's been steering this reduction slowly with the goal to have him off for the last several months. Thank you all again for your support and thoughts. It means a lot. I appreciate you all, and as always, thinking of you and your dogs. melissa and tiggs

melissa slc

Hi Melissa & Tiggs We can't give you any advice on being off med's, cause Ginger is not off them and probably never will be and it will two years since she was initially diagnosis this Sept and has been almost one year since her relapse. She is still on 50 mg of Aza eod and 25 mg of cyclosporine eod and is she is doing just fine. However she has a chronic case of AIHA and will never be med free. I think if you check the success stories they will be a few dogs that have been just fine and have been med free for years. Pictures are great and Tiggs looks like such a love muffin!! Cheryl & Ginger

Cheryl & Ginger Pineville PA

I agree Melissa, this is so scary. Is the only way to find out that an AIHA is chronic, when they have a relapse? I just got a call from a Lady who's dog got diagnosed at the same clinic as Kahlu, 2 months ago. His HTC was in the single digits, Nicki is now up into the mid 30ies!! Best wishes to everybody, Brigitte& Kahlu

Brigitte BC Canada

Hi Melissa and Tiggs, YIPPEE! Happy dance for you both! Kent was off meds at one time because of a severe bout of pancreatitis. Once he recovered, we kept him off meds, and he relapsed several months (4) later. After being applied with frontline - in retrospect, a bad move. He had only been on pred, and had NOT been as tapered down as recommended because of the hospitalization with Pancreatitis and our normal vet was out of town. I hope you can get off the meds, just watch closely for signs of relapse, you know what they are now. You will NEVER be free from looking for these anyway, but i found once i accepted that, i got a little less paranoid. I would hold off on any vaccinations, flea products, etc. and make sure to just monitor monitor monitor. Best, Christine and Kent

Christine FL

I did email Dr. Dodds this morning, and she responded right away! She agrees with my vet, so that is what we'll try. It's nice to have her agree, I feel a little better. I will just be watching him even MORE like a hawk. Thanks so much to you all. melissa and tiggs

melissa slc

Melissa, Those are great photos! It brought tears to my eyes as I can see the love in your eyes for Tiggs. I feel the same way about my Alex. Happy Mothers Day! Chris & Alex

Chris Pa

Dr. Dodds is an Angel! Her agreeing with your vet should put you at ease (a little bit?) I know I will consult with her when the time comes for us to make that decision. Congratulations and best wishes to you and Tiggs, Brigitte & Kahlu

Brigitte BC Canada

Melissa, Congrats on all fronts !!! Photos are fantastic thanks for sharing. All of us hope to get to the place that you are at with Tiggs and wish you the very best as you continue to move forward. Side Note: Brigitte, From your postings with Kahlu I believe that we are about the same place in our quest to beat this nasty stuff. Hopefully we can compare notes with each other. Ron & Cooper

Ron Lakleland

Dear Melissa & Tiggs, 1st, thanks 4 the re; (Layla Aza. Reduction) I think going fr. every other day to 1 X a week is too drastic, should have been 1 step in-between. Will call vet. (Should have questioned it before!) 2nd, Congrats on weaning off meds! My heart went out as I read your thread, as I couldn’t have put it any better. I wish for the days when Layla was lithe & shiny and LOVED to cruise at 20 mph behind the car for 3 miles without breaking into a pant! I pray we can someday get close to that scenario again. Your pics are adorable, what a lovie Tiggs is! Yes this disease sucks!!!!! And people have no clue of what we are going through. Now I have an idea of what cancer survivors must endure, with the constant dread of re-occurrence. Our happy, innocent, loving fur balls are stripped of their right to a regular, unencumbered, simple life of a Dog. Anyway, love & prayers sent your way & as “Red Green” says; “We’re all in this together”. (Unfortunately). T & Layla

T. Rose & Layla Erie

This thread was discussed between 10/05/2009 and 13/05/2009

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