IMHA berner with uti

Keymaster

Hi Amy,
I’m sorry you have had so much difficulty, especially with travel and the up and downs with the treatment. Is your boy a Bernese Mountain Dog?

My first comment is that you should be very cautious about decreasing either the cyclosporine or the prednisone this much with only a PCV HCT of 30%. That’s still right on the edge of high range moderate anemia range. While the prednisone has very severe side effects, the side effects of cyclosporine are minimal, usually gastrointestinal.

Perhaps you could describe to me in more detail what all your medications are, how they have been dosed up to now, when you give them and your boy’s weight. The cyclosporine is very helpful in taking on a role in the immunosuppression of the immune system but it’s only been, my count, only a month since you started treatment, it needs a bit longer to really work properly.

The main reason we suggest owners allow their vets to decrease prednisone rapidly is if there is a health condition that is urgent and directly due to the prednisone. Very few dogs develop iatrogenic (caused by the meds) diabetes but those that do need a more rapid reduction of prednisone.

We have seen a number of dogs relapse when the prednisone is decreased too much, too soon before the dog has reached about 36% HCT PCV. This is the lowest normal value for a dog.

The antibiotics are very tricky, if he has a specific infection that they have identified, e. coli, they can often treat more effectively if they use a targeted antibiotic rather than a broad range antibiotic.

The drug you mentioned to treat for a possible tick disease is doxycycline. It can be a very harsh drug to the stomach along with the prednisone. The two of these drugs together can lead to stomach ulcers if the vet didn’t prescribe an antacid. Dogs have very acidic stomach acid and can develop ulcers very quickly. We recommend even something basic like generic pepcid, given 30 min before a meal. Large dogs like yours might benefit from a second dose for their second meal of the day.

Once a stomach ulcer(s) develops it can be very painful and in some cases that are serious it can lead to internal bleeding. I am guessing that the discomfort he is having is because of an ulcer(s). This is one thing we can’t test for very easily. It would be very invasive and difficult for your dog to be tested so we just assume that he probably needs to be protected from ulcers and to treat any possible ulcer that may develop. I have a vivid memory of a dog I helped the owner with many years ago. This lovely little dog was in so much pain from ulcers that it ate a number of socks to stop the pain. This little thing did not survive after they tried to remove them surgically. I tell this because I didn’t know at the time about ulcers like this and it was an important lesson to me to remind everyone after that.

For every dog we see here that is being treated for IMHA (with prednisone), we recommend the use of an “internal band-aid” called Sucralfate. It creates a thick mucous around any possible ulcers and allows them to heal. I recommend it be given on an overnight fast so it has a long time to work. It does interfere with the absorption of nutrition and medications so best to keep it away during those times. While it isn’t a drug, you do need to get it from your vet. It is quite safe and effective.

I am also guessing that he may also have developed pancreatitis, an inflammation of the pancreas which is very painful and can lead to similar symptoms you are describing. The use of prednisone is considered to be one reason this happens in dogs. Your vet can run a specific test for this very easily to determine if this is the case. It is called SNAP cPL Test for Specific Canine Pancreatic Lipase. It is very precise and you will know immediately if this is why he is so uncomfortable.

If the test is positive then you need to fast your dog for a period of time (plenty of water though) when the symptoms seem very bad and then reintroduce him to a very easily digestible diet that has very little fat in it. Fat causes the pancreas to become very active in order to digest it. So the meals should be extremely low fat and with just enough calories to get to the next meal, so preferably small, more frequent meals.

You can also ask for a pack of Carafate to help with nausea and stomach upset so he will feel more like eating. They can also give a shot if necessary.

I would like to see the last two CBC’s and Chemical Screens. I can explain the things on there so you can understand it more. You can use the Urgent Advice page (see it up in the menu items on the right side?) to upload your files to me.

I’m guessing Vally would like to help you with a medication chart so you can get these meds all sorted out according to your schedule.

What questions do you have for me?
My best Patrice

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