Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Update on Summer

Hello Everyone, We just got back from the vet,and Summer's HCT is up to 27!! She dropped a bit last week to 18, after a high the week before of 22 after her blood transfusion. I was praying that she would still be at 18, and it just would not be any lower, and we are up. The Doc is decreasing her pred from 50mg 2x a day to 50 once a day (remember Summer is only 40lbs and her dose was so high because her HCT was 6). She will be taking her Azathioprine, every other day. I could not be happier! She has last a couple of lbs since this started, so the doc recommends I feed her a bit more, which is GREAT as she is so hungry! Carrie and Summer

Carrie DFW

That's awesome to hear Carrie!!! I'd be a bit concerned with the large reduction in meds though! The general rule of thumb is to never drop by more than 35%! If I were you I'd ask to go to 50 in the am and 25 inthe evening for a week and then recheck. THEN go down again! Keep a good eye on her if you do go ahead with this reduction. Did you reduce the azathioprine also? Johnny & Tessy

Johnny

Carrie, I am so happy Summer is keeping up the fight and doing good! I am assuming that the 50% reduction in prednisone is done because she is on this very high dose. It will probably be ok, but just to be on the safe side I would go with Johnny's recommendation. give the vet a call and see what he thinks. The adrenal glands have to woken up VERY slowly. I think with this high dose they are still suppressed too much to even start rubbing their eyes. But really, you can't loose by keeping Summer on 25mg (I guess you could even go 20mg) at night for a week. I know you want her off these nasty drugs asap, but it pays off to be patient! Best wishes Brigitte & the poodle boys

Brigitte BC Canada

Thank you, I will still give her her regular dose tonight, I will talk to him tomorrow. She will stay on the Azathioprine, but we are going down to every other day. I have been on pred myself,and always weened really slowly. When asked him, when we were there, he said it was because it is such a large dose and she is so small. I have plenty, so I think I might just give her 25mg (1/2 tab) in the evenings and 50mg in the morning for three days, then go to 1/4 at night/3 days, then 50mg in the mornings I know that is how I weened off. Again, I will call him in the am. They are treating 3 other dogs with IMHA right now at this practice and all are doing well. Carrie and Summer

Carrie DFW

Carrie, The rule is to only go down with one drug at a time. I can not remember how long Summer has been on the Azathioprene, but I know it takes a while to take effect. I know Summer is on a way higher dose of pred than she maybe should have been and that is why the vet reduces her at this pace. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Carrie -- so glad to hear that Summer is responding to treatment. All my best to you and your special, brave girl. Please take care and please keep us posted.

Brenda VA

Hello, just to clarify, The first vet I took her to did nothing, just suggested I go to a specialist, he did not even tell me what was wrong and acted like it was no big deal. I got the blood tests from him and read them myself. That was on 20 December. When I got to this vet on December 23, he knew Summer was quite ill. Summer had a HCT of 12, and even with 100mg/day pred went down went to 6 in just 6 days days, so he gave her a transfusion on 29 December,and then increased her pred for two days to 150/mg and added the Azathioprine then we weaned her back down to 100/mg pred. Both drugs have remained consistent for two weeks. He is not weaning her off of either drug, just lowing the doses,since they are so high and she is only 40 lbs.She now takes 50mg Azthioprine/day, he just wants to decrease it to every other day. He gave me a copy the protocol he is using for treatment, it is from Veterinary Information Network, Inc. The only concern I have right now, as far as treatment is decreasing the pred this rapidly. I will call him in the morning. How often is normal on pred to urinate during the night? Summer has been waking us to go about every 90 min. With the decrease will she go less? Thank you, I really appreciate all the advice. You all are veterans of this,I am not. Like I said I will call him in the AM and update again after that.

Carrie DFW

Carrie, I think it is great that your vet is getting information from VIN. Obviously he is willing to learn more. Why don't you suggest he consult with Dr. Dodds at hemopet. She would be more than willing to help you, her cost is very reasonable and she is THE expert. The subject of drug reduction comes up a lot. Just so you see that I did not make this stuff up, here is a copy from an older of Joanne Dickson's posts on the subject of drug reduction: 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: “The level of medication should be kept constant until the PCV is normal for at least three to four weeks. If the dog is having severe side effects from the prednisone (e.g. polyuria or polydipsia, panting, exercise intolerance) the dose can be lowered slightly after two weeks or another medication such as Azathioprine can be added to the treatment regimen. Remember this medication needs to be given two to three weeks to take effect before the dose of prednisone can be decreased.” “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 a from a source that is several years old, this is the prednisone reduction schedule that many of the veterinary teaching hospitals follow in regard to AIHA/IMHA End of quote of the quote:) I remember the subject of drug reduction being challenging and confusing at times. I think if you could get Dr. Dodds involved you would have the best information available. It is quite possible that she agrees with your vet, but at least then you don't need to second guess your decision. Best wishes and make sure to keep us posted! Brigitte & the poodle boys

Brigitte BC Canada

Thank you again Bridgette. Do you have the contact information on Dodds? I will get that to him. When you say "reasonable", I hate to ask, but can you define that a bit? Sorry, I just need to be prepared. I just think he is concerned with the really high dose she is on. I have taken various steroids over the years including pred, I have a cluster of autoimmune disorders, so, I am not unfamiliar with the lowering the dosage aspect of it. I can tell you, have have had a few doctors that were too quick to take me off. The outcome was not good. Okay, going to bed, I hope a get a few hours tonight! Thank you again!!! Carrie and Summer

Carrie DFW

Carrie, I think Dr. Jean Dodds does consultations for about $45. If you have blood sent to her it is in the neighborhood of $200 and you can always consult with her. She is extremely busy, but seems to always make time for desperate cases. I had my vet call her and talk to her. I trusted my vet and figured she would now better what to ask and explain the case. Why don't you check out Dr. Dodds (hemopet.org) webpage, I am pretty sure all the prices are on there. I think to get her input would be money well spent. I understand that you are concerned about the high dose of pred Juliet is on. I am sure Dr. Dodds could give you a good and safe protocol to get her of it. I remember she got my dog of the pred faster than the protocol I copied earlier. But then she had the CBC and info on all the drugs that were given to him. Every case is different but she can see so much in a CBC. I hope this helps and that you get some rest tonight. Best wishes, Brigitte

Brigitte BC Canada

Carrie, Go to Dr. Dodds home page: http://www.hemopet.org/ On this page you will see a green rectangular box that says "Sending Lab Samples." Click on this. It will take you to a page where you will see "Sending Laboratory Samples." Click on "Test Request Submission Form and Instructions for Tests." It will open a pdf from. On that form, near the bottom you will see "Consultation Request" $ 45.00. Attach any blood work and lab results that are pertinent. Make a short note as to why you are sending her this request. The consultation will be with the attending vet so be sure to include that information at the top. But if you include your email address Jean will email you also. my best patrice

Patrice NYS

Talked to our Vet,and afte reading TONS, including Dr. Dodds protocol, it seems what he is doing is right. From Dr Dodds Protocol: 1. Prednisone 2mg/kg PO divided BID for at least two weeks, taper very slowly every 10-14 days for another month until platelet count is above 100,000 or PCV is above 21 and stable. Then decrease dose, whenever the blood tests remain stable for two weeks. Eventually the steroids should be given every other day for maintenance. 2. Dogs usually require low dose prednisone every other day for a year or more. 3. Azathioprine 2mg/kg PO SID if needed, then reduce to 1 mg/kg SID, then to 1mg/kg every other day or three times per week. What he said was the dose she is on is very hard on her liver, it is higher than a normal dose, only did that because she was so low 6%. He said since she is on AZA as well, cutting her to a normal dose of 50mg of pred, is safe. She has been right around 20 since Dec 29 whrn she had her transfusion. Now she is over 21 (27) and it is her own blood. Her platelets are 300,000 down from a high of 589,000. He will not decrease again until she is up again and stable for at least two weeks. If she remains where she is he is going to wait another couple of weeks. Ideally he wants to see it go up again before any further reduction in meds. As far as the AZA a normal dose is every other day. He is willing to consult with Dodds if we do not see any improvement, or run into trouble. Carrie and Summer

Carrie DFW

Carrie, I am so glad your vet is doing a lot of studying on Summer's behalf! If you are worried about her liver (and I guess with this high doses we have to be) you should give her lots of Milk thistle. I got a tincture through the vet but you can also give human grade milk thistle. Sam-E would also be very beneficial to heal the liver, it is expensive, but can make a huge difference. More pills and more expenses I know..... Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Brigitte, Thanks to you guys I have her on 1000mg milk thistle/day I also give her Chlorophyll in her water. Everything she gets is pretty much human grade :-) I have pet insurance, so this has not been to financially painful. Carrie and Summer

Carrie DFW

Just a quick update. Seems Summer is feeling better on the 50mg of pred, than she was on the 100mg. She is drinking and urinating less. Good for me, because I had become a zombie. I have been too tired to cook for her, since I have not had any sleep for several nights straight. So, we got her a bag of EVO fish and bag of EVO red meat. Her stools gave been quite loose. I am guessing because of the change in diet. Summer has been on raw up until the DX. Some good news is she has been playing with her toys again, even wants to tug! I took her for a 10 min walkies, and she seemed to fare pretty well. Summer is used to walking at least an hour 4-6 days a week. It is one of her favorite things. Anyway, she also able to jump upon the sofa again. Okay, I am going to go back to sleep for a bit. I am going to go to the grocery later today to buy some chicken livers and hearts. She loves them! I am going to boil some pumpkin too and start mixing that in with her food. CBC tomorrow morning, please pray that it is up, I will post the results. Carrie & Summer

Carrie DFW

I will be praying for Summer! Pray for everthing gose well! Meg & Milo

Meg

This thread was discussed between 10/01/2011 and 18/01/2011

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