Skip to content

Opinions on treatment and weaning off too fast

IvansMommy

Guest

My dog, Ivan, is a 15 year old Rat Terrier (20 lbs). Last month he was diagnosed with a small epulis on his lower gumline. He also has a large bladder stone, which has gone asymptomatic after herbal treatment.
On May 27, 2015, we went for a walk. My neighbors had recently used Chemlawn service. About an hour after returning home, I noticed all of Ivan’s gums were bleeding. The epulis was inflamed and bloody. He had petechiae all inside his mouth and beginning on his abdomen. Poop was dark and appeared to have blood.
Vet ran blood tests, tick panel, fecal occult blood, lung xray. Started him on doxycycline.
The next day, his numbers came in very low (platelets 12, lymphocytes low, high urea nitrogen, high Alk phosphatase, high NRBC). He was started on 15 mg prednisone 2x daily and 1/4 tab azathioprine 1x day. He was already on pepcid due to chronic gastritis. Added sweet potato to his homemade diet to protect his stomach.
He had a couple rough days with pale gums, lethargy, decreased appetite. Platelets had dropped to 5. Tick panel all negative, but found a fully engorged nymph deer tick on him. Decided to continue doxycycline at half dose, just in case.
Re-checks every few days after revealed his platelet count going up to 56 (or more like 100 with clumping) , poop normal, petechiae disappearing, gums all good, epulis shrunken to half it’s size and zero redness. RBC, which had been normal initially is now 4.6. Yesterday’s cbc showed platelets at 500 and liver being affected. Vet wants his prednisone dosage dropped from 30mg/day to 5 mg/day. At first she wanted the azathioprine switched to every other day, too, but changed her mind.
I’m concerned that this is too fast. She isn’t weaning him down slowly and everything I’ve read said that can cause relapse or other side effects. That most dogs are on these medications for months and wean off over months as well.
I decided to drop from 15 to 10mg at last dose, then I’ll go to 5mg. I will be starting him on Milk Thistle today to protect his liver.
My vet is busy now, and I’m sure she hates that I keep calling and second guessing her, but this is my baby. I’m not even sure how much experience this vet has with AIHA or the outcomes of her previous patients.
What I need is opinions from parents who’ve dealt with this disease. Doctors don’t know everything. We know our dogs the best. What was your treatment plan, results, weaning schedule? What worked or did not? Anyone else’s dog respond so much, so quickly, to treatment? I’m scared to death of making a mistake and risking his life. Emergency care and transfusions run about $3500-$5000 each here. I have 21 other animals to care for so I can’t afford a ridiculously high bill on top of what’s already been paid. Thank you.


Details

Brigitte

Guest

Hello Ivan’s mommy!
You are totally right, the prednisone dose should not be lowered this quickly. It is generally recommended to not lower it more than 25-33% every 2-3 weeks, preceded by a blood test. You certainly do not want a relapse and a fast tapering of the prednisone could trigger that. It sounds like Ivan is doing good, these little guys are pretty tough! You say that the liver is being affected, you could give him milk thistle (tincture or powder) to help his liver and also Sam-E (Denamarin). You are so right, these dogs need something to protect their stomach. On this forum we usually recommend to give sucralfate. It protects the digestive tract very well and because of that it needs to be given at least 2 hours away from all other medications so it does not interfere with absorption. Talk these suggestions over with your vet.
Best wishes,
Brigitte


Details

IvansMommy

Guest

Thanks. My vet seems to be dismissing me now. She was too busy to call me back and isn’t answering my email about dosages of supplements. I’m going to taper off pred a bit slower than she’d like anyway. Do you know what the dosage and schedule for giving Sam E and Milk Thistle would be? He is 20 lbs.


Details

Brigitte

Guest

It is annoying when you don’t get answers from your vet, but I always give them the benefit of the doubt. Maybe there are emergencies, surgeries or something else she just can’t get away. I can not give you the dosages for those supplements, sorry. maybe someone else will answer. If you really can’t get any answers from your current vet, is there a possibility to find someone else? You really can not do this all without the help of a vet that is experienced with this disease.
Best wishes,
Brigitte


Details

lynn

Guest

Ivan’s mom, Brigitte is right and so are you. I know I faced the very same thing but I am so glad hayleys vet knowing she had to be lowered but still took the chance of lowering very slow . but I too can not give dosage. rat terrier’s are wonderful fur children . I wish you and irvan the very best… and vets sometimes have so many things on their mind from time to time… then bingo next time they are like a different person. I am sorry irvan has had such a bad ordeal… it’s very hard on our sweet babies and so hard on our heart as we love them so. lynn & hayley


Details

Vally

Keymaster

Hi Ivan’s mum, I so agree with the others. That reduction from 30mg a day down to 5mg a day is the largest reduction I’ve ever heard of. Most vets will often say reduce by 50%. Actually that wasn’t a typo was it? 15mg a day maybe?

Anyhow, I agree with Brigitte and Lynn. If there’s not a reason why Ivan needs to come down rapidly, stick with 25-33% reductions. I prefer what you’ve done. From 15mg to 10mg a day, and I’d slow it down after that from 10 to 7.5mg. I actually hit a problem when Bingo was at 5mg going when we wen tot 5mg daily to 5mg every second day.

With Denamarin, Ivan being 20lbs, get the 225mg packet and use 1 a day. This should be given on an empty stomach, 1 hour away from food.

For Milk Thistle, Dr Dodds recommends (for a 20 lb dog) 20% of human dose. Milk thistle can be added to food.

I’ve never heard of sweet potato helping the stomach. As Brigitte said, most of us have used sucralfate (I think this is prescription only).

Wow 21 other animals. You’re a champion.

Vally & Bingo (diag Nov 2011, in remission)


Details

admin

Keymaster

Hi Ivan’s Mum!

Lovely that you have joined us – if you have 21 other animals, you must be a real softie – what others do you have? We’d love to hear about them.

I couldn’t agree more with Brigitte, Lynn & Vally – take the reductions slowly & carefully. You can read more about prednisone here:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/
and how to reduce it safely here:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/
I’d just like to emphasise how important taking the dose down slowly is – relapses are no fun & it is much better to do the right thing so Ivan recovers properly. We also normally recommend getting them off the prednisone completely before reducing the other immuno-suppressant drug(s) (in your case, the azathioprine) & to get regular PCV checks – it’s usually much better that way.

Could I also recommend getting Ivan’s amylase levels checked each time too. Azathioprine can cause pancreatitis & a raised amylase level can be a “first” indicator of that. My dog Worzel was on azathioprine (still has one per week) & my specialist said we must do this at every check up to make sure he wasn’t having a problem. I think it’s very important with smaller dogs to do this too.

Again, I agree with the denamarin – it is great for liver protection & provides red cell building blocks. If you are using milk thistle & Sam-E separately, here is a site which you can work out the milk thistle dosage from:
http://www.canine-epilepsy-guardian-angels.com/milk_thistle.htm
It says use 20% of the human dose for a 20lb dog. There are also other recommendations there which are helpful.
Here is the manufacturer’s site for Sam-E complete with dosages:
http://www.nutralifepet.com/sam-e-for-pets

I must also say that having a specialist who has experience of this disease is very important. I was lucky to find someone here in France who trained at Cornell University so his being able to speak English was a big help too! I would recommend you find someone who knows their stuff. If you are unable to do that, we have a link on here to the wonderful Dr Dodds of Hemopet who many of us have consulted. She is wonderful, kind, highly experienced & very qualified. You can find her under our heading Hemopet resources
https://www.secondchanceaihadogs.com/hemopetresources/
and you can do an online consultation with her using the form you can see bottom left. Her fees are very reasonable & you will only pay the $100 consultation fee to start with, then there are usually no further consultation charges. Hemopet is a charity too – that makes it doubly nice to use her as it helps with the greyhound rehoming. If you use her lab, obviously there would be charges for that kind of thing, but most of the tests can be done by your own vet anyway.

Ivan sounds like a real cutie – give him a hug from me. Hope we have helped a little. Ask anything – we are all here to help.

Love Sheena, Worzel (diagnosed Dec 2012, in remission) & his friend Ollie xxxxx


Details

IvansMommy

Guest

Hi again. Thank you all for your input. I was really freaking out about the reduction in meds. Ivan is now down to 5 mg a day prednisone and so far it’s going okay.
He began milk thistle at my vet’s recommendation of 1 capsule a day (1000 mg) and has been experiencing stomach issues (gurgling, vomiting liquid, semi-loose stool) as well as allergy-type symptoms. Based on the dosage for dogs his weight, this is way too much. I’m not sure what my vet is thinking. Anyway, I’ll cut that way back tomorrow. Hoping all goes well until his re-check on Wednesday.
Other pets: Let’s see, I have 4 cats left, 2 rescued deer mice, 1 African clawed frog, 6 raccoons (3 adults, 3 babies), 1 pregnant Virginia opossum, 6 striped skunks, and five days ago I took in a baby Mourning Dove that was found in a friend’s pool filter. I had the routine down until the bird arrived. Her new favorite thing is flinging formula at my bathroom walls. Bonus points if she can hit me in the eye with some. :)
Thank you all again. It has given me a lot of hope to hear that Hayley, Bingo, and Worzel are doing well with their treatment.


Details

Viewing 8 posts – 1 through 8 (of 24 total)

Reply To: Opinions on treatment and weaning off too fast
Your information:







IvansMommy
Guest

My dog, Ivan, is a 15 year old Rat Terrier (20 lbs). Last month he was diagnosed with a small epulis on his lower gumline. He also has a large bladder stone, which has gone asymptomatic after herbal treatment.
On May 27, 2015, we went for a walk. My neighbors had recently used Chemlawn service. About an hour after returning home, I noticed all of Ivan’s gums were bleeding. The epulis was inflamed and bloody. He had petechiae all inside his mouth and beginning on his abdomen. Poop was dark and appeared to have blood.
Vet ran blood tests, tick panel, fecal occult blood, lung xray. Started him on doxycycline.
The next day, his numbers came in very low (platelets 12, lymphocytes low, high urea nitrogen, high Alk phosphatase, high NRBC). He was started on 15 mg prednisone 2x daily and 1/4 tab azathioprine 1x day. He was already on pepcid due to chronic gastritis. Added sweet potato to his homemade diet to protect his stomach.
He had a couple rough days with pale gums, lethargy, decreased appetite. Platelets had dropped to 5. Tick panel all negative, but found a fully engorged nymph deer tick on him. Decided to continue doxycycline at half dose, just in case.
Re-checks every few days after revealed his platelet count going up to 56 (or more like 100 with clumping) , poop normal, petechiae disappearing, gums all good, epulis shrunken to half it’s size and zero redness. RBC, which had been normal initially is now 4.6. Yesterday’s cbc showed platelets at 500 and liver being affected. Vet wants his prednisone dosage dropped from 30mg/day to 5 mg/day. At first she wanted the azathioprine switched to every other day, too, but changed her mind.
I’m concerned that this is too fast. She isn’t weaning him down slowly and everything I’ve read said that can cause relapse or other side effects. That most dogs are on these medications for months and wean off over months as well.
I decided to drop from 15 to 10mg at last dose, then I’ll go to 5mg. I will be starting him on Milk Thistle today to protect his liver.
My vet is busy now, and I’m sure she hates that I keep calling and second guessing her, but this is my baby. I’m not even sure how much experience this vet has with AIHA or the outcomes of her previous patients.
What I need is opinions from parents who’ve dealt with this disease. Doctors don’t know everything. We know our dogs the best. What was your treatment plan, results, weaning schedule? What worked or did not? Anyone else’s dog respond so much, so quickly, to treatment? I’m scared to death of making a mistake and risking his life. Emergency care and transfusions run about $3500-$5000 each here. I have 21 other animals to care for so I can’t afford a ridiculously high bill on top of what’s already been paid. Thank you.

Details
Brigitte
Guest

Hello Ivan’s mommy!
You are totally right, the prednisone dose should not be lowered this quickly. It is generally recommended to not lower it more than 25-33% every 2-3 weeks, preceded by a blood test. You certainly do not want a relapse and a fast tapering of the prednisone could trigger that. It sounds like Ivan is doing good, these little guys are pretty tough! You say that the liver is being affected, you could give him milk thistle (tincture or powder) to help his liver and also Sam-E (Denamarin). You are so right, these dogs need something to protect their stomach. On this forum we usually recommend to give sucralfate. It protects the digestive tract very well and because of that it needs to be given at least 2 hours away from all other medications so it does not interfere with absorption. Talk these suggestions over with your vet.
Best wishes,
Brigitte

Details
IvansMommy
Guest

Thanks. My vet seems to be dismissing me now. She was too busy to call me back and isn’t answering my email about dosages of supplements. I’m going to taper off pred a bit slower than she’d like anyway. Do you know what the dosage and schedule for giving Sam E and Milk Thistle would be? He is 20 lbs.

Details
Brigitte
Guest

It is annoying when you don’t get answers from your vet, but I always give them the benefit of the doubt. Maybe there are emergencies, surgeries or something else she just can’t get away. I can not give you the dosages for those supplements, sorry. maybe someone else will answer. If you really can’t get any answers from your current vet, is there a possibility to find someone else? You really can not do this all without the help of a vet that is experienced with this disease.
Best wishes,
Brigitte

Details
lynn
Guest

Ivan’s mom, Brigitte is right and so are you. I know I faced the very same thing but I am so glad hayleys vet knowing she had to be lowered but still took the chance of lowering very slow . but I too can not give dosage. rat terrier’s are wonderful fur children . I wish you and irvan the very best… and vets sometimes have so many things on their mind from time to time… then bingo next time they are like a different person. I am sorry irvan has had such a bad ordeal… it’s very hard on our sweet babies and so hard on our heart as we love them so. lynn & hayley

Details
Vally
Keymaster

Hi Ivan’s mum, I so agree with the others. That reduction from 30mg a day down to 5mg a day is the largest reduction I’ve ever heard of. Most vets will often say reduce by 50%. Actually that wasn’t a typo was it? 15mg a day maybe?

Anyhow, I agree with Brigitte and Lynn. If there’s not a reason why Ivan needs to come down rapidly, stick with 25-33% reductions. I prefer what you’ve done. From 15mg to 10mg a day, and I’d slow it down after that from 10 to 7.5mg. I actually hit a problem when Bingo was at 5mg going when we wen tot 5mg daily to 5mg every second day.

With Denamarin, Ivan being 20lbs, get the 225mg packet and use 1 a day. This should be given on an empty stomach, 1 hour away from food.

For Milk Thistle, Dr Dodds recommends (for a 20 lb dog) 20% of human dose. Milk thistle can be added to food.

I’ve never heard of sweet potato helping the stomach. As Brigitte said, most of us have used sucralfate (I think this is prescription only).

Wow 21 other animals. You’re a champion.

Vally & Bingo (diag Nov 2011, in remission)

Details
admin
Keymaster

Hi Ivan’s Mum!

Lovely that you have joined us – if you have 21 other animals, you must be a real softie – what others do you have? We’d love to hear about them.

I couldn’t agree more with Brigitte, Lynn & Vally – take the reductions slowly & carefully. You can read more about prednisone here:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/
and how to reduce it safely here:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/
I’d just like to emphasise how important taking the dose down slowly is – relapses are no fun & it is much better to do the right thing so Ivan recovers properly. We also normally recommend getting them off the prednisone completely before reducing the other immuno-suppressant drug(s) (in your case, the azathioprine) & to get regular PCV checks – it’s usually much better that way.

Could I also recommend getting Ivan’s amylase levels checked each time too. Azathioprine can cause pancreatitis & a raised amylase level can be a “first” indicator of that. My dog Worzel was on azathioprine (still has one per week) & my specialist said we must do this at every check up to make sure he wasn’t having a problem. I think it’s very important with smaller dogs to do this too.

Again, I agree with the denamarin – it is great for liver protection & provides red cell building blocks. If you are using milk thistle & Sam-E separately, here is a site which you can work out the milk thistle dosage from:
http://www.canine-epilepsy-guardian-angels.com/milk_thistle.htm
It says use 20% of the human dose for a 20lb dog. There are also other recommendations there which are helpful.
Here is the manufacturer’s site for Sam-E complete with dosages:
http://www.nutralifepet.com/sam-e-for-pets

I must also say that having a specialist who has experience of this disease is very important. I was lucky to find someone here in France who trained at Cornell University so his being able to speak English was a big help too! I would recommend you find someone who knows their stuff. If you are unable to do that, we have a link on here to the wonderful Dr Dodds of Hemopet who many of us have consulted. She is wonderful, kind, highly experienced & very qualified. You can find her under our heading Hemopet resources
https://www.secondchanceaihadogs.com/hemopetresources/
and you can do an online consultation with her using the form you can see bottom left. Her fees are very reasonable & you will only pay the $100 consultation fee to start with, then there are usually no further consultation charges. Hemopet is a charity too – that makes it doubly nice to use her as it helps with the greyhound rehoming. If you use her lab, obviously there would be charges for that kind of thing, but most of the tests can be done by your own vet anyway.

Ivan sounds like a real cutie – give him a hug from me. Hope we have helped a little. Ask anything – we are all here to help.

Love Sheena, Worzel (diagnosed Dec 2012, in remission) & his friend Ollie xxxxx

Details
IvansMommy
Guest

Hi again. Thank you all for your input. I was really freaking out about the reduction in meds. Ivan is now down to 5 mg a day prednisone and so far it’s going okay.
He began milk thistle at my vet’s recommendation of 1 capsule a day (1000 mg) and has been experiencing stomach issues (gurgling, vomiting liquid, semi-loose stool) as well as allergy-type symptoms. Based on the dosage for dogs his weight, this is way too much. I’m not sure what my vet is thinking. Anyway, I’ll cut that way back tomorrow. Hoping all goes well until his re-check on Wednesday.
Other pets: Let’s see, I have 4 cats left, 2 rescued deer mice, 1 African clawed frog, 6 raccoons (3 adults, 3 babies), 1 pregnant Virginia opossum, 6 striped skunks, and five days ago I took in a baby Mourning Dove that was found in a friend’s pool filter. I had the routine down until the bird arrived. Her new favorite thing is flinging formula at my bathroom walls. Bonus points if she can hit me in the eye with some. :)
Thank you all again. It has given me a lot of hope to hear that Hayley, Bingo, and Worzel are doing well with their treatment.

Details
Viewing 8 posts - 1 through 8 (of 24 total)
Reply To: Opinions on treatment and weaning off too fast
Your information: