The Onset of AIHA
Sadie is a beautiful, almost five year old, jet-black, female Cocker Spaniel, born June 14, 2009, living in Tampa, FL. On Friday, March 29, 2013, Sadie collapsed. We immediately went to the vet, where they did a full panel CBC and an in-house PCV. Her PCV was 21. Her gums were almost white and her tongue was ash colored. My mind was spinning with questions and my heart was crushed.
Thankfully, Sadie’s vet was familiar with her symptoms and after an extensive exam, she was diagnosed with AIHA. He immediately gave her a shot of prednisone and started her on a regiment of 40mg prednisone, Doxycycline, PetTinic and Pepcid (for her tummy), daily. Ten days later, we changed from Doxycycline to Baytril and added 50mg Atopica (cyclosporine) daily. Shortly after, we later added Plavix to protect against inappropriate clotting.
Three weeks after her collapse and diagnosis, her PCV was 32 and it was determined that we should start weaning her off the Prednisone, as she beginning to show some bad side effects; heart murmur, muscle atrophy. It was an aggressive decrease, – 50% -, from 40mg to 20mg daily. We did the 50% for one month and then we went to an even more aggressive weaning of the prednisone: one 20mg prednisone every other day for five days, then 20mg every third day for five days, then 20mg prednisone every five days for five days.
Sadie’s PCV started to drop and on the last five day dose regiment, she RELAPSED and collapsed again. Her PCV was 24 and we were back at square one – 40mg of prednisone and 50mg of Atopica. Her palsy had also moved from her right side to her left side.
When Sadie’s PCV rose to 44, we again began wean the Prednisone. BUT this time – VERY, VERY SLOW. The reductions on the Prednisone were in increments of 25% per month. We did weekly PCV’s and monthly CBC’s to check blood levels and constantly checked her mouth for pink tongue and gums!
We decided to stop the prednisone weaning and begin the Atopica weaning. Sadie was now on 15mg of prednisone, but still on the 50mg Atopica. Mid October, after a VERY, VERY SLOW Prednisone weaning, we started the Atopica weaning.
Atopica (Cyclosporine) dosing is different; the lowest dose is 10mg. Sadie’s first reduction would be lowered to 35mg daily (25mg AM and 10mg PM). Throughout the Atopica weaning, the prednisone was kept at 15mg daily (10mg in the AM and 5mg in PM).
From the onset of Sadie’s diagnosis of AIHA in March 2013, Dr. Reyes has been awesome. Most often, she had answers, and when she didn’t, she sought out answers. She continues to be knowledgeable, supportive and willing to listen as Sadie hopefully moves toward remission.
Today, Sadie seems to be in remission. Her Prednisone and Atopica weaning continues, slowly. We wean one drug at a time and over a period of a month, with continued weekly PCV’s and monthly CBC’s.
Sadie responded immediately to the medications and we had a vet that had knowledge of AIHA. Sadie’s vet’s quick determination and appropriate medical treatment was the initial “save” for sure. But remember – WEAN SLOWLY.
Sadie’s prognosis looks good. We take it day by day and check her gums constantly. She is slowly getting back to pre-AIHA self. Her palsy remains on the left side of her face, but seems to be getting better with the Prednisone/Atopica reduction. She will most likely be on a low maintenance dose of Prednisone for her life. We can live with that!
Much love, Linda and Sadie