Cookie – IMHA Puggle

[Jeremy Arian]

Hello my name is Jeremy, and this is my first time posting in this forum. I have a nine year old puggle (Pug/Beagle) named Cookie, and she was diagnosed with IMHA on 3/23/17. We took her into the vet due to lack of appetite and her being lethargic which happened after we put her on Cephalexin to treat an ear infection. Little did I know she would have to stay there for the next three days. Although the vet says it is very rare and hard to diagnose Cephalexin as the trigger, I am almost certain this is what triggered her IMHA.

When we brought her in her RBC was at 20%. She received a PRBC transfusion and began a regimen of prednisone and atopica. After the transfusion her RBC was 36%, a day later 34%, and has been steady at 31% since we took her home on Friday.
She seems to be very tired lately as she has been through a lot. But she is eating again and her gums seem relatively pink.
Sunday she developed an stomach ulcer and is currently being treated with Barium.

I am optimistic she will make a full recovery, but I know this disease can be full of ups and downs.

I am reaching out to all of you here for any tips and insights you may have to living with and caring for a dog with IMHA. I would also appreciate it if someone can tell me the cheapest place to purchase atopica. The vet says she will be on it for 6 months, and this is not a cheap medicine. Her current medication regimen is as follows:

8am:
– 10mg Prednisone
– .15 mg Levothyroxine*
– 10mg Aspirin
– 10mg Famotidine

8pm
– 10mg Prednisone
– .15mg Levothyroxine*
– 100mg Atopica
– 50mg Atopica
– 10mg Famotidine
-10mg Aspirin

*She was hypothyroidic before the IMHA diagnosis.

She also gets 4ml of Barium 3x per day for the stomach ulcer. After 1 day we already saw an improvement in the color of her stool.

Any help and comments would be greatly appreciated!

[Vally]

Hi Jeremy and welcome. I’m so sorry to hear about Cookie.

What does Cookie weigh?

There are a number of drugs unfortunately which can be a trigger, and yes, Cephalexin is one of them. There’s a list of them here:
https://www.secondchanceaihadogs.com/AIHA_Terms/drugsantibiotics-can-trigger-aiha/

I know it’s huge, but most important our dogs should never receive cephalosporins, sulfa drugs & penicillins – I used to carry a list with me because I wouldn’t trust the vet to remember what my boy could not have. Sometimes you have no choice, as the drug may be the only drug sensitive to a particular infection.

I’m glad she is stable. When they transfuse, it’s not a good idea to transfuse over the 25% mark, the reason being that the body thinks it has enough red blood cells and the signal is sent that no more is needed, so it can actually slow recovery. It’s also quite normal after a transfusion for bloods to drop. The transfusion is only there to buy time for the drugs to work. It’s the drugs that are fighting the disease.
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion/

She will be feeling very tired and best that you keep her as calm and quiet as possible. I’m glad she’s eating again, that’s always such a worry. The prednisone usually turns them into food monsters.

Pink is good. It’s our favourite colour on the site – boys and girls. Keep an eye on her gums and eye sockets. If you notice they have gone pale, I wouldn’t wait, go and have her PCV checked again. We all become very paranoid about this and our poor dogs put up with us constantly checking. I remember one of the ladies on the forum, Lyn, her dog learned to smile whenever she came near her because she knew she was having her gums checked.

Atopica is very expensive – it’s probably the best drug though. If you ask your vet for a prescription, you can have it filled at a pharmacy, or Costco. You’ll find it much cheaper there. I felt very weird the first time I went to a chemist and put in the prescription. They called out Bingo at the counter when the drug was ready. The cost was about 1/3 of what the vets charge.

The timing of the drugs I think should be changed a bit. This can always be hard when you’re working and have limited hours.

Prednisone and aspirin should always be given with food. Levothyroxine should ALWAYS be given AWAY from food. AT least 1 hour before meals or 2 hours after. Atopica also, should be given away from food. Famotidine can block other drugs absorption. What time are you giving the Barium?

Regards, Vally

[Jeremy Arian]

Hi Vally,

Thank you so much for your response and advice. The vet wants to charge me 90$ for 100mg Atopica and $55 for the 50mg Atopica. I will check my local pharmacy and hopefully they will have it for less!
-Cookie weighs about 30-31lbs.

Thank you for the advice about the medication! The vet hasn’t mentioned this but I will definitely let him know that I would like to change the medication timing on our next check up this Friday. I am giving the Barium at 10am, 3pm, and 10pm. He did mention that the Barium can affect drug absorption. However, she should only be on barium for about a week.

What schedule would you recommend? Does the following look okay? (Ignoring the Barium as she should be off it soon)
8AM- Food, Prednisone, Aspirin
10AM – Levotyroxine, Famotidine
2PM – Food
6PM – Levothyroxine Atopica, Famotidine
8PM – Food, Aspirin, Prednisone
If not what schedule would you recommend?

Are there any other questions or concerns I may need to run past my vet on Friday?

Thank you again for all your help!

Sincerely,
Jeremy Arian

[Vally]

Hi Jeremy, what do you think about this schedule. Let me know if it’s impossible and I’ll try and fiddle it a bit more:

7am Levothyroxine
8.00am Food, Prednisone, Asprin
10.00am Famotidine
12.00 noon food
2.00pm Atopica
4pm Famotidine
6pm Levothyroxine
7pm food Prednisone, Aspirin

Atopica, ideally on it’s own. Famotidine ideally away from all drugs.

If this suits you, I can do a chart for you. Let me know if you’d like it and I’ll email it to you. I can access your email from the back of the site. It’s not visible anywhere to the public anywhere. Patrice is very keen on people’s security.

Regards, Vally

[Vally]

Oh and if you find that giving the cyclosporine away from food causes stomach upsets, you can try and give it with just a little food. It often settles down.

Vally

[Jeremy Arian]

Good morning Vally, and thank you for your advice. No need for you to send me schedule as cookie has a white board that we use for her schedule and is easily changed. Although the schedule you prepared looks great, it will be a bit difficult for my family and I to implement. I know food may interfere with Levothyroxine absorption, but this is how she has taken it before her diagnosis and her levels were what we wanted them to be at. Do you think the following revised schedule is okay? If not, what were you thinking?

8.00am Food, Prednisone, Asprin, Levothyroxine
10.00am Famotidine
12.00 noon food
2.00pm Atopica
6pm Famotidine
8pm food Prednisone, Aspirin, Levothyroxine

Ideally I would like to include the Famotidine into her 8am and 8pm slot. From what I have read it doesn’t seem to have any major interaction with the Pred., Levo., or Aspirin. If this is not possible, is there another antacid that CAN be given with the aforementioned drugs?

Thank you again,
Jeremy Arian

[Vally]

Jeremy, I would really love to see the thyroxine done separately. I understand what you’re saying that it’s always been done that way, and obviously worked, but it’s meant to be given without food.

I would still try and organise things so it can be given separately

I know, I’m the spare time killer !!!

Vally