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Charlie's IMHA

Ramona

Guest

Hi — my hound Charlie was diagnosed with IMHA about 6 weeks ago. He has been on Prednisolone (high doses) and Leflumonide for 6 weeks and really has not responded. Atopica was added a week ago and still no improvement. In fact, he has vomited on two occasions after taking Atopica. I’m pretty much exhausted and wondering if we are doing him more harm than good with all the meds.


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Vally

Keymaster

Hi Ramona, I’m so very sorry to hear about Charlie and I know you’re worried sick.

Atopica is a good drug in that it has fewer side effects than prednisone, but some dogs do have tummy issues with it. How are you dosing it? It should be dosed away from food, but for dogs that can’t seem to tolerate it, you can give it with a little food and see how he goes with it and then try without food. Some dogs just won’t tolerate it without food. I know some people have kept the drug frozen and dosed it that way, although the drug company has not approved it’s use that way.

Is he on stomach protection? Prednisone, in particular, can do some damage. My boy ended up with ulcers until we started using stomach protection from the high dose pred.

I know you are exhausted. This is a truly cruel disease and the early days are the pits. Our dogs look much worse in the early days because of the drugs, but they are life savers.

Also, is Charlie on thyroxine at all? Dr Jean Dodds, who is an expert in immunology recommends thryoxine as part of the treatment for this disease, even if a dog is not hypothyroid. Truly, we’ve seen some dogs turn around when thyroxine has been started. I’m actually sure that’s what started Bingo’s improvement. Even though he was already on it, Patrice, on this site, told me to stop giving it with food, and from that point on, we had improvement in his numbers.

What is Charlie’s bloods like, what was his last PCV?

Ramona, ask anything at all – we’d love to help.

Vally & Bingo (diag Nov 2011, in remission)


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Vally

Keymaster

My again, this is Dr Jean Dodd’s information on the disease and her recommended treatment.

https://www.secondchanceaihadogs.com/hemopetresources/

It’s the third item on the page.

Vally


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Ramona

Guest

Thanks for responding Valley. Per my Vet’s instructions, I have frozen the Atopica. He only had it on an empty stomach for 3 days. On the third day is when he vomited it up 3 hours later along with his dinner, supplements, and other meds that I dosed on the hour. So, then I separated the meds so that he takes half in the morning (Leflumonide and Prednisolone) and the other half in the evening (Atopica, Prednisolone, and Aspirin.) And started giving the Atopica after dinner since we think it was upsetting his stomach.

As for stomach protection from the Prednisolone, I keep reading about that and am worried. When I asked my vet about that and giving him something like Famotidine, she said there was no clinical proof that it helped. Last week I bought some on my own and have been trying to give it to him 15 min before meals. I have read that perhaps 2 hrs ahead of time is better, but I have very limited time before leaving to work.

Your mention of Thyroxine is very interesting. That has not been recommended but I am familiar with it because my other beagle Ramsay takes it for his thyroid issue.

We do blood work weekly. We did it twice this week because there was a short window of improvement. When all thi started, his PVC was initially at the 22 range, then went down as low as 19. When it went back up to 22, the vet said she ideally wanted it higher before backing off the Prednisolone but was going to back off anyway because he had been on high doses for so long. So she slightly lowered dose of Prednisolone for one week, and his PCV went back to 20. Because of that she added the Atopica. Charlie took that for 3 days, and then we went in early for the blood work because I was concerned when he vomited. Then we were surprised to learn it went up to 24. I say surprised because of the vomiting and also because he looked more lethargic, slow, appetite not as good as before. Because PVC went up, vet wanted another check this week because if number up again, she wanted to adjust med dosages. Yesterday is when we did the test again, and PVC back down to 20 and I am seeing more appetite issues, very tired/weak, and the vomiting after dinner.

In addition to all the meds, Charlie takes folate, a probiotic, melatonin, and Vitamin B injections once a week.

Thank you for reading and providing the resource link and the feedback. I am just so disappointed that he’s not responding and facing my worst fear that he may not survive this awful disease.


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Vally

Keymaster

Grrrr, just lost a post. I clicked to check a link about thyroxine, as there is evidence it stimulates red cell production – I’ll find the link for you.

I’m sorry Ramona, I’m very worried that this vet may not have much experience with treating this disease. That’s not unusual and I mean no disrespect at all to your vet. My local vet had no idea what was going on and said I needed to take Bingo to an internal specialist, who had it worked out immediately. Having said that, it still took some time for the meds to do their work and Bingo wasn’t stable until, from memory, 3 months later. That’s when we started reducing prednisone as his red bloods were finally almost in the normal range. We started reducing when he was in the low 30s.

A few things really have me worried.

The prednisone can’t be reduced until Charlie is stable. That means he must have a PCV of at least 35. To start lowering at 22 just won’t do anything to help. I’m sorry I also answered last night and it was late (I’m in Australia so most likely my night is your day). I totally missed the Leflunomide. That is very possibly the problem and it may not be the Atopica. To be brutally honest, Leflunomide is not a good drug and it’s side affects are often severe tummy issues. Dr Jean Dodds doesn’t use it in her protocol and, I’ll see if I can find the evidence, but I believe it didn’t do well in clinical trials. The safer drugs to use alongisde of the prednisone are Atopica, azathioprine (for a short term), mycophenolate mofetil.

What are the doses of drugs Charlie is on now? What is his weight and breed?

I would keep on with the Famotidine. Can you stretch it to maybe an hour?

I’m sorry, you may not want to hear what I’m saying. It’s very hard to go against what a vet directs, but I’m very worried that Charlie’s treatment is just not right. With complicated cases, you can refer to Dr Jean Dodds and do an online owner’s consult. She is a lovely lady who is very clever, particularly with this disease. Do you think your vet would consult with her? Do you have a copy of blood tests as if you do the owner consult with her, she’ll check those. She is very thorough and she gets back very quickly. Her protocol of drugs will most likely be what I referred you to though. She has a one-off charge, once the consult fee is paid and she responds, you can simply email her back again and she’ll get back to you, so it’s a very worth while consult fee.

My very best, Vally & Bingo


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Ramona

Guest

Valley–no worries about the timing of your posts. I usually don’t get a moment to sit down till late night/wee hours of morning here in California. You have been very helpful as not many people understand. No one around me has had their pet diagnosed with this disease.

Our vet is an internist/specialist in our area. I’m sure she is not as experienced as Dr. Dodds, but she was at least able to give us a correct diagnosis. Before we saw her, our regular vet was stumped and alarmed with the PVC. She sent us to Vet #2 to do ultrasound and get second op. Vet #2 misdiagnosed Charlie with Rocky Mountain Spotted Fever. So we wasted about 2 weeks treating for that until I went back to my regular vet and said he wasn’t responding. She then sent us to Vet #3, the internist who is currently treating Charlie. I’m open to doing the online consult with Dr. Dodds and I’ll see if our treating vet is open to collaborating as well.

Let’s see if I can remember the med dosages. I believe it’s 20 mg/ml of Prednisolone twice a day, 70 mg of Leflumonide every 24 hrs, 125 mgs Atopica every 24 hrs, and a special formulated aspirin every 24 hrs (we get this from compound pharmacy).

Charlie is a beagle/basset mix. Nine years old. Normal weight is 50+ pounds, but he’s down to 43 pounds now.

His stomach issues got really bad today. I only gave him the Prednisolone after breakfast and then his diarrhea started. As a result we went to the ER (same hospital as treating vet but she doesn’t work the weekends). They checked vitals which were all good and did urinalysis to make sure no urinary tract infection–he was clear. Gave anti-nausea injection and more meds for the nausea and diarrhea. Charlie seemed to respond to that. He ate his dinner without hesitation, it stayed down, along with all the meds, and so far, no diarrhea. Looked more comfortable tonight, no tremors.

We see the internist next Wed. I plan on asking her about the thyroxine and if she is willing to consult with Dr. Dodds.

What are your thoughts about blood transfusions? Our vet advised that it was an option, but said it would not provide sustained results, only a brief period of relief that would just buy time to continue to adjust meds. And it was super expensive, possibly more than we can afford. My husband did some research and said it looked to him that any positive results would only last about 7 days.

Ok, signing off so I can get a little nap before I have to get Charlie out of bed for his bathroom break. Good night.


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Vally

Keymaster

Ramona, I hope by the time you read this, you did get some rest. It’s hard to do worrying about our boys when they’re so sick.

I’m sorry Charlie was feeling so sick today and you had to get him to the ER for help. I’ve no idea how many times I had to do that with Bingo. You’re right, nobody really understands what you’re going through right now, the worries and the stress. That was the main reason this site was set up. We don’t want anybody to go through this alone.

The dosage of the pred and Atopica seem good. The Atopica is probably a bit high, (the dose in the product insert says 100ml for his weight) but it’s usually started at a higher dose and then brought down to the therapeutic dose.

Transfusions are sometimes needed. Your vet is right, they don’t do anything except buy time for the drugs to work. I know they are horrendously expensive. Bingo didn’t need one, so I was very lucky. His lowest PCV was 15% and he was coping at that level. I was totally shocked at the time as I thought he seemed better. Some dogs can have a higher PCV but not be coping.

If needed, make sure that the transfusion is capped at 25%. Any higher and the body doesn’t think it needs to work to make blood, so it gets lazy.

There is a link here from the item in the glossary.
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion/

As to how long a transfusion lasts, there’s no real answer to that. It depends on how much red cell destruction is still going on. Some dogs have only ever needed 1 transfusion, other more.

The drugs really do make them feel very ill. Bear that in mind. The first weeks they really do seem to get worse before they start to improve. You’re going through the worst of it now.

Please don’t let the vet reduce the prednisone yet. It’s much too soon. Charlie needs to be stable with a normal PCV for a few weeks before his meds can start to be reduced.

Please also bear in mind that it could be the leflunomide that could be causing stomach problems. “The most common side effects associated with leflunomide, based on limited veterinary studies, include GI signs (inappetence, vomiting, diarrhea) and lethargy. In dogs, bone marrow suppression (leukopenia and thrombocytopenia) has been reported.” I’m quoting this from Today’s Veterinary Practice March/April 2014 edition. So not only can it cause stomach issues, it can also suppress the bone marrow, which is trying to make red blood cells.

My very best, Vally & Bingo


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Ramona

Guest

Hi Valley– yes I got a little rest, thank you. Now with the nausea meds, Charlie seems a little more comfortable. He is excited about food again but that presents yet another problem. He wants to run to his dish but is so weak he has fallen a couple of times. I will probably start putting him on a leash and escorting him to his dish.

Thanks for info on transfusion. It’s so expensive, if Charlie gets worse, I don’t think I will be able to go that route.

In the meantime, I filled out the online consult for Dr. Dodds last night. Attaching the records was a little tricky. I’m not so tech savvy. Hope it went through. So now I anxiously await her response.

Thanks again for all your feedback. Hope you and Bingo are enjoying life. By the way, is Bingo in complete recovery? Does he have to take any medications to remain stable?


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Reply To: Charlie's IMHA
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Ramona
Guest

Hi — my hound Charlie was diagnosed with IMHA about 6 weeks ago. He has been on Prednisolone (high doses) and Leflumonide for 6 weeks and really has not responded. Atopica was added a week ago and still no improvement. In fact, he has vomited on two occasions after taking Atopica. I’m pretty much exhausted and wondering if we are doing him more harm than good with all the meds.

Details
Vally
Keymaster

Hi Ramona, I’m so very sorry to hear about Charlie and I know you’re worried sick.

Atopica is a good drug in that it has fewer side effects than prednisone, but some dogs do have tummy issues with it. How are you dosing it? It should be dosed away from food, but for dogs that can’t seem to tolerate it, you can give it with a little food and see how he goes with it and then try without food. Some dogs just won’t tolerate it without food. I know some people have kept the drug frozen and dosed it that way, although the drug company has not approved it’s use that way.

Is he on stomach protection? Prednisone, in particular, can do some damage. My boy ended up with ulcers until we started using stomach protection from the high dose pred.

I know you are exhausted. This is a truly cruel disease and the early days are the pits. Our dogs look much worse in the early days because of the drugs, but they are life savers.

Also, is Charlie on thyroxine at all? Dr Jean Dodds, who is an expert in immunology recommends thryoxine as part of the treatment for this disease, even if a dog is not hypothyroid. Truly, we’ve seen some dogs turn around when thyroxine has been started. I’m actually sure that’s what started Bingo’s improvement. Even though he was already on it, Patrice, on this site, told me to stop giving it with food, and from that point on, we had improvement in his numbers.

What is Charlie’s bloods like, what was his last PCV?

Ramona, ask anything at all – we’d love to help.

Vally & Bingo (diag Nov 2011, in remission)

Details
Vally
Keymaster

My again, this is Dr Jean Dodd’s information on the disease and her recommended treatment.

https://www.secondchanceaihadogs.com/hemopetresources/

It’s the third item on the page.

Vally

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Ramona
Guest

Thanks for responding Valley. Per my Vet’s instructions, I have frozen the Atopica. He only had it on an empty stomach for 3 days. On the third day is when he vomited it up 3 hours later along with his dinner, supplements, and other meds that I dosed on the hour. So, then I separated the meds so that he takes half in the morning (Leflumonide and Prednisolone) and the other half in the evening (Atopica, Prednisolone, and Aspirin.) And started giving the Atopica after dinner since we think it was upsetting his stomach.

As for stomach protection from the Prednisolone, I keep reading about that and am worried. When I asked my vet about that and giving him something like Famotidine, she said there was no clinical proof that it helped. Last week I bought some on my own and have been trying to give it to him 15 min before meals. I have read that perhaps 2 hrs ahead of time is better, but I have very limited time before leaving to work.

Your mention of Thyroxine is very interesting. That has not been recommended but I am familiar with it because my other beagle Ramsay takes it for his thyroid issue.

We do blood work weekly. We did it twice this week because there was a short window of improvement. When all thi started, his PVC was initially at the 22 range, then went down as low as 19. When it went back up to 22, the vet said she ideally wanted it higher before backing off the Prednisolone but was going to back off anyway because he had been on high doses for so long. So she slightly lowered dose of Prednisolone for one week, and his PCV went back to 20. Because of that she added the Atopica. Charlie took that for 3 days, and then we went in early for the blood work because I was concerned when he vomited. Then we were surprised to learn it went up to 24. I say surprised because of the vomiting and also because he looked more lethargic, slow, appetite not as good as before. Because PVC went up, vet wanted another check this week because if number up again, she wanted to adjust med dosages. Yesterday is when we did the test again, and PVC back down to 20 and I am seeing more appetite issues, very tired/weak, and the vomiting after dinner.

In addition to all the meds, Charlie takes folate, a probiotic, melatonin, and Vitamin B injections once a week.

Thank you for reading and providing the resource link and the feedback. I am just so disappointed that he’s not responding and facing my worst fear that he may not survive this awful disease.

Details
Vally
Keymaster

Grrrr, just lost a post. I clicked to check a link about thyroxine, as there is evidence it stimulates red cell production – I’ll find the link for you.

I’m sorry Ramona, I’m very worried that this vet may not have much experience with treating this disease. That’s not unusual and I mean no disrespect at all to your vet. My local vet had no idea what was going on and said I needed to take Bingo to an internal specialist, who had it worked out immediately. Having said that, it still took some time for the meds to do their work and Bingo wasn’t stable until, from memory, 3 months later. That’s when we started reducing prednisone as his red bloods were finally almost in the normal range. We started reducing when he was in the low 30s.

A few things really have me worried.

The prednisone can’t be reduced until Charlie is stable. That means he must have a PCV of at least 35. To start lowering at 22 just won’t do anything to help. I’m sorry I also answered last night and it was late (I’m in Australia so most likely my night is your day). I totally missed the Leflunomide. That is very possibly the problem and it may not be the Atopica. To be brutally honest, Leflunomide is not a good drug and it’s side affects are often severe tummy issues. Dr Jean Dodds doesn’t use it in her protocol and, I’ll see if I can find the evidence, but I believe it didn’t do well in clinical trials. The safer drugs to use alongisde of the prednisone are Atopica, azathioprine (for a short term), mycophenolate mofetil.

What are the doses of drugs Charlie is on now? What is his weight and breed?

I would keep on with the Famotidine. Can you stretch it to maybe an hour?

I’m sorry, you may not want to hear what I’m saying. It’s very hard to go against what a vet directs, but I’m very worried that Charlie’s treatment is just not right. With complicated cases, you can refer to Dr Jean Dodds and do an online owner’s consult. She is a lovely lady who is very clever, particularly with this disease. Do you think your vet would consult with her? Do you have a copy of blood tests as if you do the owner consult with her, she’ll check those. She is very thorough and she gets back very quickly. Her protocol of drugs will most likely be what I referred you to though. She has a one-off charge, once the consult fee is paid and she responds, you can simply email her back again and she’ll get back to you, so it’s a very worth while consult fee.

My very best, Vally & Bingo

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Ramona
Guest

Valley–no worries about the timing of your posts. I usually don’t get a moment to sit down till late night/wee hours of morning here in California. You have been very helpful as not many people understand. No one around me has had their pet diagnosed with this disease.

Our vet is an internist/specialist in our area. I’m sure she is not as experienced as Dr. Dodds, but she was at least able to give us a correct diagnosis. Before we saw her, our regular vet was stumped and alarmed with the PVC. She sent us to Vet #2 to do ultrasound and get second op. Vet #2 misdiagnosed Charlie with Rocky Mountain Spotted Fever. So we wasted about 2 weeks treating for that until I went back to my regular vet and said he wasn’t responding. She then sent us to Vet #3, the internist who is currently treating Charlie. I’m open to doing the online consult with Dr. Dodds and I’ll see if our treating vet is open to collaborating as well.

Let’s see if I can remember the med dosages. I believe it’s 20 mg/ml of Prednisolone twice a day, 70 mg of Leflumonide every 24 hrs, 125 mgs Atopica every 24 hrs, and a special formulated aspirin every 24 hrs (we get this from compound pharmacy).

Charlie is a beagle/basset mix. Nine years old. Normal weight is 50+ pounds, but he’s down to 43 pounds now.

His stomach issues got really bad today. I only gave him the Prednisolone after breakfast and then his diarrhea started. As a result we went to the ER (same hospital as treating vet but she doesn’t work the weekends). They checked vitals which were all good and did urinalysis to make sure no urinary tract infection–he was clear. Gave anti-nausea injection and more meds for the nausea and diarrhea. Charlie seemed to respond to that. He ate his dinner without hesitation, it stayed down, along with all the meds, and so far, no diarrhea. Looked more comfortable tonight, no tremors.

We see the internist next Wed. I plan on asking her about the thyroxine and if she is willing to consult with Dr. Dodds.

What are your thoughts about blood transfusions? Our vet advised that it was an option, but said it would not provide sustained results, only a brief period of relief that would just buy time to continue to adjust meds. And it was super expensive, possibly more than we can afford. My husband did some research and said it looked to him that any positive results would only last about 7 days.

Ok, signing off so I can get a little nap before I have to get Charlie out of bed for his bathroom break. Good night.

Details
Vally
Keymaster

Ramona, I hope by the time you read this, you did get some rest. It’s hard to do worrying about our boys when they’re so sick.

I’m sorry Charlie was feeling so sick today and you had to get him to the ER for help. I’ve no idea how many times I had to do that with Bingo. You’re right, nobody really understands what you’re going through right now, the worries and the stress. That was the main reason this site was set up. We don’t want anybody to go through this alone.

The dosage of the pred and Atopica seem good. The Atopica is probably a bit high, (the dose in the product insert says 100ml for his weight) but it’s usually started at a higher dose and then brought down to the therapeutic dose.

Transfusions are sometimes needed. Your vet is right, they don’t do anything except buy time for the drugs to work. I know they are horrendously expensive. Bingo didn’t need one, so I was very lucky. His lowest PCV was 15% and he was coping at that level. I was totally shocked at the time as I thought he seemed better. Some dogs can have a higher PCV but not be coping.

If needed, make sure that the transfusion is capped at 25%. Any higher and the body doesn’t think it needs to work to make blood, so it gets lazy.

There is a link here from the item in the glossary.
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion/

As to how long a transfusion lasts, there’s no real answer to that. It depends on how much red cell destruction is still going on. Some dogs have only ever needed 1 transfusion, other more.

The drugs really do make them feel very ill. Bear that in mind. The first weeks they really do seem to get worse before they start to improve. You’re going through the worst of it now.

Please don’t let the vet reduce the prednisone yet. It’s much too soon. Charlie needs to be stable with a normal PCV for a few weeks before his meds can start to be reduced.

Please also bear in mind that it could be the leflunomide that could be causing stomach problems. “The most common side effects associated with leflunomide, based on limited veterinary studies, include GI signs (inappetence, vomiting, diarrhea) and lethargy. In dogs, bone marrow suppression (leukopenia and thrombocytopenia) has been reported.” I’m quoting this from Today’s Veterinary Practice March/April 2014 edition. So not only can it cause stomach issues, it can also suppress the bone marrow, which is trying to make red blood cells.

My very best, Vally & Bingo

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Ramona
Guest

Hi Valley– yes I got a little rest, thank you. Now with the nausea meds, Charlie seems a little more comfortable. He is excited about food again but that presents yet another problem. He wants to run to his dish but is so weak he has fallen a couple of times. I will probably start putting him on a leash and escorting him to his dish.

Thanks for info on transfusion. It’s so expensive, if Charlie gets worse, I don’t think I will be able to go that route.

In the meantime, I filled out the online consult for Dr. Dodds last night. Attaching the records was a little tricky. I’m not so tech savvy. Hope it went through. So now I anxiously await her response.

Thanks again for all your feedback. Hope you and Bingo are enjoying life. By the way, is Bingo in complete recovery? Does he have to take any medications to remain stable?

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