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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tiggs update- low energy
| Well, Tiggs continues to be in 'remission' with a PCV hovering between 39 and 40. We did a CBC this week, and our vet said that his red cell/hematocrit however was a bit low. No reticulocytes, which is apparently good when they are considered to be in remission. My vet consulted with 2 internal med vets who said the low hematocrit was somewhat normal for IMHA, and they gave her the go ahead to cut the Pred by an additional 25%. After discussing this together, we thought maybe we should wait another week to be sure he's still in a good range and not on a downward trend. He currently is on 20mg/day where he'll stay until next week. Also still on daily Azathiaprine 30 mg. I think that this week his energy is really low. He seems depressed to me, and of course I'm really worried. I'm trying not to worry of course, because his PCV is good, but I can sense a subtle shift. Could this be depression, or disease, or what? I've adjusted to the fact that he'll never be the same (ie, lower energy, more mellow, etc) with IMHA, but for some reason, this week he just seems low. |
| melissa slc |
| Trust you gut instinct. I could tell when Drago's blood count fell. Do go to the vet, so what if they think you are nuts or the count really didn't fall. It will give you soom piece of mind. |
| Sue PA |
| I'm praying for you and Tiggs, Melissa. |
| Leslie Oceanside |
| Melissa, I concur with Sue. When you are caring for an IMHA dog for any length of time you become able to pick up on subtle changes more than your vet possibly could only seeing your dog for visits. Perhaps its not even an IMHA issue but something else going on at the same time. And you know what they say about paranoia...which really applies in our situations..."Just because your paranoid doesn't mean that something isn't really out to get you!" IMHA doggie mommies and daddies know best! Sending Tigg and you lots of healing thoughts and support. Cheryl (and always Barkley) |
| Cheryl Medford |
| Well, my worst fears have been confirmed- Tiggs PCV has dropped from 40 to 35 in less than a week. While it's not critical this minute, clearly the downward trend is there, and we are in panic mode. This morning he didn't touch his food, highly unusual given his voracious Pred-driven appetite. My vet has a theory that the Azathiaprine could be causing this- she is treating a Maltese who had a similar slip after months of stability, and it was the Aza. She is running another full CBC as well as a urine. Current med protocol is 20mg Pred/day, 30mg Aza/day, pepcid, 20mg asprin. Tiggs has been doing wonderfully up until now, with a stable PCV of 40 for about the last month or month and a half. She feels that it is a bit unusual that after such stability to see this kind of a slip when we haven't changed a thing. SCARED TO DEATH! melissa and tiggs |
| melissa slc |
| Melissa, Ask your vet if they would kindly humor you and do a hand spun PCV. Sometimes there can be errors in the blood draw (that damage cells) and using automated analyzers that can bring back a small change in the reading that seems alarming. Our vet's automated analyzer always comes back anywhere from 4-6% less than the hand done PCV. Our specialist noted this when he was reviewing their blood work. He did his own blood work by hand and came back saying, "Chance's PCV is just fine, their automated analyzer is a little mis-calibrated. It's not unusual. So don't panic quite yet. This is still a very high PCV, so near the normal 37 as to be really considered ok. Chance never gets much higher than 38% and we are quite satisfied with that. There can be many other reasons why the pcv fluctuates a little that don't necessarily indicate hemolytic destruction. Dr. Dodds would call this "anemia of chronic illness." Something as simple as an infection can do this. But in general, our blood is in a constant state of change as old red blood cells die and new ones are made. If there are small issues with the production of red blood cells, for instance dietary issues, there can be some difference in the cells themselves. The aza can also contribute to rbc production issues. I would, however, want to know what is amiss that affects appetite. The prednisone does make one feel ill, I had to take a high dose once for an allergic reaction and I felt so ill while taking it and then decreasing it, I was totally wasted. my best, patrice |
| Patrice NYS |
| Thanks guys. Patrice, thanks for your words. I normally wouldn't sweat it, but outwardly, the changes are there...the PCV was confirmed with a CBC run in a lab, as well as in house. Also, wbc's were in the normal range, so doesn't look like infection yet...You mentioned the rbc destruction by Aza, this is definitely theory number one at this point. She will hopefully be able to confirm via bloodwork, and in this case, have others dogs been taken off of aza when this occurs? Would they increase the Pred then to compensate? Right now he is on the 20mg/day, and for a 67 lb dog, apprarently this isn't considered a high dose, though the usual side effects are all there. Anyways, thanks all. I'll keep you posted. melissa and tiggs |
| melissa slc |
| Melissa, I'm not sure from your response to Patrice if you did or did not have the PCV spun out seperately ( here I go again Patrice!)at the vet's office. Patrice suggested to me several weeks ago that I have them do that every time Mac went in for blood work, as the PCV is a more accurate method of determining where his blood levels are at. (Patrice explains that much better than I just did--ha!) On Tuesday I brought Mac in for his weekly blood draw and the vet called me several hours later with the news that his HCT dropped from 35 to 26. She was just about in tears and so was I because the week before we had done a Happy Dance together in her office celebrating Mac's good numbers. She called the specialist she's been co-doctoring with and was told to run the PCV seperately, because she was suspicious of such a huge drop with no outward signs of lethargy from Mac. Wouldn't you know it, the PCV came back at 32! She said sometimes there are little clots in the tubes that make it hard for the machines to "read" the true numbers. My vet was short staffed on Tuesday, and somehow this seperate test wasn't performed. My dog is also on Aza and I'm not sure I like it for him. I'll be talking to my vet on Friday about switching to cyclosporine, even though it's more expensive. We need to get him off prednisone and I think that the cyclosporine will help him reach the higher numbers more quickly. Good luck with Tiggs, I'll be crossing my fingers for you. Jane |
| Jane MN |
This thread was discussed between 24/09/2008 and 25/09/2008
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