Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Update on Holly 10-2-08

Hi all, Have posted in awhile, just been buried in things. After 18 months of a rollercoaster Holly is holding her own. She is still on meds and we cannot seem to get past the point that we are on with her meds per the vets. We have a new young vet that is working with our vet and he has taken over Holly's case. He seems to be more knowlegable, although does not want to reduce any meds in fact last month he upped them on us again, taking her back to 2mg of prednisone a day (we were down to 1mg a day) and the same dosage on the aziathioprine daily 1/4 tablet. I am getting ready to fax recent blood work out to Dr Dodds to ask her opinion. We did have a complete thyroid test and was sent to Dr Dodds August 31 and all was normal with that which was great to hear. This past Monday's blood work we had a superchem done which we had not had done since Jan. Good news is her Hematocrit continues to rise and is at 53.4. Her WBC is holding in at 4.7, she is always in the low range. Her retic count is down to 1.0, last reading on August 31 was 1.4. Now to the upsetting part to me, even though the vet does not seem upset, her Alkaline Phosphatase reading was 1317 and has never in the 18 months been this high. In Jan it was 255 and in Feb we had started her on new dog food, Natural Balance (fish and sweet potatoe) so she gets no corn, soy, etc or any fillers what so ever. She is also on milk thistle 2 1/2 teaspoons a day. The new vet says it is just because she has been on long term steriods and tells me not to worry and not to change anything in her meds. He had no problem with me faxing blood work to Dr Dodds and said unless she says to lower meds he would not because she is stable. I am so very thankful that she is a survivor, but always in the back of our minds is will our baby ever be med free, I pray and hope that some day she will. So this post was so long. Linda

Linda Sapphire

I'm unclear why you're still on daily meds or what Holly's specific situation is. her PCV sounds fine. Is there a platelet issue? I just want to share my experience. Missy is a 5lb maltese. Missy had been off all meds for 9 months when she relapsed, this was 8/2004. She recovered from the second episode and my vet and I were very reluctant to take her off daily pred. Stabilizing to 2.5 mg/day in Jan of 2006 she had lost most of her coat and was exhibiting cushings symptoms and had low thyroid. Started on thyroid meds and this resolved, chicken to slow down pred so that stayed the same. Last Year 2007 Missy went through two bouts of demodex, 4/07 and then again in 10/07. Demodex is mange that is not contagious and typically to a stressed/low immune system. The second time we went to a dermatology specialist. He said lower the pred. and that usually recurring demodex is a sign of worse problems but we treated it. We're now down to 1.25mg MWF and the demodex is under control but we still get meds for that a couple of times a week. Her thyroid med dose had to be lowered so it was obvious that the pred was supressing this as well. My point is that I know it is scary but long term daily pred can/will cause issues. My vet and I didnt' take the EOD literature to heart because we were scared of a relapse and he was convinced that at such a small does she was eliminating the pred. Her liver values were always fine but she had low white counts at times. Everything you read about pred says to get to EOD at least so that the adrenal glands can recover and also in my case it was obvious that it affected her thyroid as well. Right now we are going through a period of possibly inflammatory airway disease (bronchitis/asthma) and I'm pretty sure all the immune issues/medications can't have helped with that either. So I guess I'm just saying the lease meds possible to remain stable the better you will be in the long run. Good Luck Mary and Missy

Mary Tx

A correction from me sorry, she was 2.5 mg daily of pred prior to the thyroid issue being discovered in Jan 2006 (so 18months of that). We then started thyroid and worked our way down to 1.25mg daily until last fall when the demodex showed it wasn't going away. I see from the archives that holly is a dachsund, probably small like Missy, and that your vet is worried about reticulites. I don't recall examining the retic. that closely honestly except at the start of each episode. Mostly the PCV/platelets which weren't an issue, just low PCV. Anyways good luck and keep my info in mind. I know it is very scary to go down to EOD. But the meds can cause issues long term if you can't get them low enough. Mary

Mary Tx

Hi Mary, Thank you for your advice and suggestions and sharing your experiences with Missy. I know how dangerous this long term effect can have on them, and I expressed my concern yesterday to this new vet letting him know that I really wanted to decrease something, he just kept telling me know. The vet he is working with our other vet was not knowledgable at all about AIHA and so we were constantly consulting with Holly's internist down in Atlanta. So this new vet is young and seems to know a little more about the immune system, but again not sure how much I am trusting him at this point which is why I am going to fax Holly's records to Dr Dodds and ask her opinion. The main thing I am so upset now about is her alkaline phosphatase reading being 1317 when back in Jan it was like 292 and she has been on milk thistle twice a day for a year now. And as far as the retics, Holly's internist in Atlanta has always stressed to me the importance of keeping the retics under 1 and it seems like as soon as we go below 2mg of pred those retics go up. So Dr. Dodds it is and I will post once I hear back from her. Thanks, Linda

Linda Sapphire

have you tried the SAMe (human product but there is a vet one too) as well. Missy's levels never went that high but I went ahead and put her on Milk thistle and the SAMe as preventative. I give half a human pill once/day at opposite times from the pred. I think I read about it on the list here which is how I started that. Make sure to get a good brand for SAMe, not all are the same. I get the brand naturemade which is good and shop the sales on the store so it isn't too bad for a small dog.... Good Luck Mary and Missy

Mary Tx

Hi Linda, I'm glad to see that Holly's PCV is still great! I understand your frustration on the med front though. I wonder 2 things, what is Holly's absolute retic count, not her index? While I think the logic in continuing to watch the retics seems sound, I also wonder if this is a case of too much information. If you watch the retic count closely is the variation your seeing something that would be seen in a healthy dog, or a dog in successful remission? We haven't checked Slinky's in a long time because her PCV has been steady at 52-54. I wonder if we'd see some of the same fluctuations in her. I guess I'm wondering how sure it is that the changes in retic count are clinically significant. I'm not saying it isn't, because I don't really know, just wondering out loud. At any rate, I'm glad the PCV is high, because that is still good news, whatever else may be going on, she's keeping her red count high and that's a good thing :)

Stephanie Chicago

Hi Stephanie, Well I have finished updating my spreadsheet and have just been so swamped this past week that I did not get a chance to put everything in the mail to Dr Dodds, but I am planning on doing it at least by Monday. Her last good readings all the way around were in March of 2008, where he PCV was 46.5, absolute retic 32150 and corrected retic was 0.5, at that time she was on 5mg pred because back in Jan she had a bout of vomiting and not sure what happened but her numbers went off the charts, retic was 5.6. Once we resolved this matter then we began lowering the pred dosage only by 1mg a month and it seemed to be working good, but by the time we got down to 2mg pred then the retic count jumps back up to 1.7, 1.4. And actually looking back we were actually down to 1mg daily of the pred when these retic numbers increased, but her PCV continued to grow stronger. So her absolute retic count is always up and down. Since May when it was 78100, June 61200, July 71300, August 119200, Sept 92400 and now this last one 67410, but again we are now up at 2 mg pred daily. Since May, actually since January her PCV has continued to rise, Jan her PCV was 36.4 and now at 53.4. So that is why I want Dr Dodds to expert advice of what she thinks would be good. Even this new vet said lets not worry about the retic count now, but then turns around and says no do not reduce any drugs? So that is why I am so very confused. So this was so long, Linda

Linda Sapphire

Hmmm. I forget the cut-off for absolute retic count, is it 60k or 100k? I guess that's a good sign for Slinky, that I've forgotten. I can't get to my binder easily right now as we moved 2 weeks ago and that box isn't unpacked yet. If it's 60, then all of her values have been high, if the cutoff is 100 then I would wonder if things aren't as bad as they seem. Ah. Just checked the archives. Idexx is 100000, Antech is 60000. So, Holly's values are still high as I think you use Antech right? We used Idexx so those numbers sound low to me. Well, so much for that theory, at least strictly speaking. I do still wonder what fluctuations you would see in retic count in a normal or in remission dog though. Presumably you would at least see some normal values though and Holly does seem to run high. Makes me want to request a full CBC at Slinky's next test (in a month, we have stepped up the monitoring due to the move and beginning chiropractic treatments).

Stephanie Chicago

It is really strange how the labs vary so much.Yes we do use Antech. Hopefully Dr Dodds will recommend something in lowering dosages and see what happens?? I really don't know at this point. Everyone keeps telling me Holly might be one of these puppy dogs that has to remain on drugs for a long time. I sure hope this is not the case. Linda

Linda Sapphire

Do keep us posted on what Dr. Dodds has to say. I hope she can shed some light on things and help you find a way to get Holly off the meds. I would also hope she doesn't have to stay on. Just to find the silver lining here again though-her PCV looks great :)

Stephanie Chicago

This thread was discussed between 03/10/2008 and 11/10/2008

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