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Beth your email with test results has been received. Patrice and Sheena will help you with those. For the liver enzymes its definately the drugs but in particular that wonder drug prednisone thats doing that. Have you got some Denamarin yet? That works wonders. Started working on Bingo’ s ensymes immediately.
Vally And Bingo
xxx
Hi Beth. Hi Heathy (love your shortened version name, very cute). So sorry for the reason you’re here. Sorry too, to have been MIA and not responding timely. But you have the best here and they are on top of this – great advise AND you have communicated with Dr. Dodds – awesome! I love our family here. And please, as all have said – START THE DENAMARIN IMMEDIATELY. And as all have said, the high liver values come with the treatment, as nasty as it is – a necessity. We have all been there (read our stories under Our Stories). And again – you are doing a fantastic job staying on top of everything. Heathy is a very lucky boy!
Sadie’s pic just flew by on the forum site screen – and looking at her pink tongue, I still remember way too well the loneliness of all this and getting her back to that pink tongue and back to health. It’s still a roller coaster – but if you can get them over the infamous “regenerative” hurdle – it’s day to day happiness and you rally and smile with every good/better/great PCV check. This disease CAN be beat!!!
Yes, a pic would be wonderful – when possible. I will be checking on Heathy’s progress – keep up the great work – and get that Denamarin, okay?!
Love and huge, hang-in-there hugs, Linda and Sadie (diagnosed AIHA March 2012)
Hi Beth
Have you sent the results to Dr Dodds? Stupid question, I expect you have already! The GREAT news is that the anemia is getting much, much better – practically normal, which is good.
Had a quick look through the test results – I was a bit confused about the dates of each test as the sheets came through to me in 4 “bits & pieces” & I couldn’t make out completely what was going on (probably me being a technophobe – sorry – if you have a minute, scan & send them to me & I’ll pass them on), but here are my initial thoughts:
No doubt that Heathy is suffering from Iatrogenic (unintentional) Cushings Disease, i.e. way too much cortisol from the prednisone. Here is our succinct explanation:
https://www.secondchanceaihadogs.com/AIHA_Terms/iatrogenic-cushings-disease/
Raised neutrophils, high platelets & a high white blood cell count are all symptoms of this too. I personally think you will have to be patient for the liver enzymes to come down – it won’t happen overnight & you have not long lowered the dose. Don’t forget he was on a mega-high dose for quite a long time. Their kidneys are also a bit knocked out off kilter with the pred, so the BUN/creatinine ratio should settle too.
Has Heathy had a thyroid function test? Just a thought as hypothyroidism can also cause high neutrophils/high platelets. Maybe it could be worth doing as this also can cause some of the blood anomalies. Again, be guided by Dr Dodds, but my opinion is that this is all pretty much down to the high pred dose. Every high value can easily be caused by high pred doses except the MCV (mean red blood cell volume) which is also normally seen when recovering from AIHA, IMHA, anaemia – nothing to worry about at all.
Vally is absolutely right – the milk thistle in the Denamarin (plus the other goodies in there) is your best friend to help bring these enzymes down, together with Dr Dodds’ wonderful liver cleansing diet. It made a big difference to Worzel within a couple of weeks & others, like Vally’s Bingo, have also suffered the same side effects too. I don’t remember exactly how high Patrice’s dog Chance’s enzymes were, but they were sky high because he’d been on the pred for a long while too. They came down nicely though, so take lots of comfort in that. I know she will be looking at the tests when she has time & may well spot something I haven’t. In the meantime, you’ll have to make do with me!
Beth, please try not to worry too much – I really think this is drug induced, so will settle down in time. Heathy just needs to get this nasty stuff out his system slowly, but surely.
Love & hugs, Sheena & the boys xxxxx
Hi Everyone!
Wow, thank you all for every precious piece of advice!
So since we spoke before i have got him on sucralfate (carafate) and am due to have denamarin delivered today, and hepatosupport vitamins in a couple of days time. The sucralfate is proving tricky, Heathy is happy for me to put a syringe in his mouth when it is covered in cottage cheese, but not when it has meds in… So he is currently taking the carafate tablets on an empty stomach (two hours since food) with a thin coat on fat free creme cheese on. I known this isn’t ideal but i will try again with the syringe this week. His stool is looking heathy-ish at the moment. He was on a probiotic near the start, ‘Proviable’, i will look to starting that again.
He is however the weakest I’ve seen him since the anemia was bad and he had the blood transfusions. He was on 80mg prednisone up until yesterday when the liver enzyme results came out much worse than last week (ALT 1736, ALP 5462, AST 260). The figures are very scary. So my vet has suggested that we bring the prednisone down to 60mg immediately, and she is consulting with an internist that she has contacted occasionally about Heathy, on Monday. I sent the results to Dr Dodds and she said “they need to reduce the prednisone dose more quickly as these liver enzyme levels are high enough to be dangerous. His PCV is now in very good shape.” So my gut instinct is to get an in-house pcv done on wednesday and if its holding then to reduce it to 40mg (so that would have been a 50% reduction in 4 days) Thoughts? Ive also asked Dr Dodds what reduction/rate she recommends. His PCV is 39%, so I’m VERY happy about that but he is currently paying a high cost it seems for the meds that saved him. He is currently on no other immunosup. I was wondering if things work out ok with the prednisone reduction/liver enzymes that he should go back on azathioprine?
The vet also recommended stopping the aspirin at this point.
Fortunately he has always been regenerative, apparently at one point his bone marrow was kicking out high levels of immature red blood cells. His anemia is still a mystery to me. I have my suspicions that he ingested something that set it off. In the previous 30 days of him being diagnosed, he had stayed at my dogs sitters house and we had stayed at my (now ex-) boyfriends house over xmas, where there is a multitude of DIY chemicals, garden treatment etc. they are two places i will not take him again.
Since the crazy liver value results on saturday, the vet also talked about maybe he has developed a liver infection and spoke of doing a liver biopsy. Unless you all think this is a real possibility i am not entertaining that idea right now. From the start i have been doubtful of the need for the high level of prednisone, and I’m determined not to be side tracked into thinking it could be something else other than the fact that he is suffering from the drug toxicity. He has classic Cushing disease symptoms in abundance, like you say Sheena, even the neutrophils elevation ties in with that.
I have been consulting with Dr Dodds, we spoke about the possibility of hypothyroidism. I asked my vet again about this but she thinks that the steroids will mask/bias the test results. Have any of you experience of thyroid problems in your dogs? Dr Dodds suggested that it was protocol to put dogs in this situation on thyroid drugs regardless of test results as a support for blood regeneration, but my vet seems to think that procedure, and Dr Dodds suggestion of anabolic steroids, are out of date protocol. I’m a little confused, obviously my vet is a little out of her depth with all this but she does refer to the literature and other vets.
Heathy has had shifting lameness for about a year and half now, which I’m convinced is something to do with all this. However he proved negative for tick borne diseases.
Like i said, today he is pretty weak, he is still eating, peeing and pooping fine and not being sick, so i am hoping that his liver hasn’t started to fail. I think he must feel pretty rough though, especially according to what you have said about the side effects of coming off prednisone. He seems worst than before. Im hoping he will pick up.
Im hoping a lot at the moment. Hope is the antidote to fear.
Vally, can i send u his drug schedule over email to look at? I saw your email address on Patrice’s email.
Also, i have uploaded a couple of photos of my lad on the website, they are of him before all this started, as a younger lad, before he developed his distinguished grey beard :)
He is loving his belly stroked even more now, he always was big into belly tickles! I think a gentle stroke is soothing on his poor aching body. He also still manages to enjoy a little game of ball inside the house. ‘Which hand is the mini-ball in’ is his favourite and he gets to stay lying down for that.
You are all so brilliant.
Love Beth and Heathy xx
Ps. Have many of you ever found out what caused the AIHA? Im desperate to know in Heathys case, so i can protect him from it in the future, but i suspect i will never know.
Hi Beth
Please trust Dr Dodds implicitly. This wonderful lady has more experience & qualifications (human AND veterinary) than you can imagine. She is also has many research papers – please do follow her advice. The thyroxine protocol recommendation she gives is for a very good reason – it promotes blood cell production & most dogs on here have been on saloxine (thyroxine) at some stage – some still are. Prednisone can actually suppress the thyroid gland, thereby slowing blood cell production -see this research paper which states that glucocorticoids alter TSH (thyroid stimulating hormone) levels:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784889/
– a good reason to put Heathy on it. Her anabolic steroid protocol is also very useful – my specialist said we would definitely consider doing that if Worzel continued to emaciate at such a rate – thankfully we didn’t need to. We have known dogs be on that protocol too.
We did a 50% per week reduction with Worzel for similar reasons – the pred was doing him real harm & he was wasting away before my very eyes, like a dog being starved to death even though he was eating loads of food. As I said before, I would never recommend this reduction in normal circumstances to anyone without sound veterinary advice. You have the best advice possible from Dr Dodds. Worzel was stable on the anemia front, but had been non-regenerative, so it was more scary than you can believe. I don’t know anyone else who did this drastic reduction, but I am here to hold your hand if you need me. You must do regular CBC/PCVs to make sure all is going to plan. Remember pred was the necessary evil – it has saved his life, but now it’s time to reduce it for sure.
It is probably very unlikely that you will find out what caused the original crisis now – maybe if you have all the old original tests/blood smears etc – that may give us a clue, but it is not always clear. There are so many possible triggers. It doesn’t matter what happened in some ways because he is getting better – glad he was negative for tick diseases. If he wasn’t improving, I can assure you we would all be asking you to get even more tests done to find & treat the cause!
Patrice is right about the automatic blood cell counter anomalies – we have seen this quite often with other people’s dogs too. Sometimes when dogs become regenerative, the various types of blood cells are produced at a far quicker rate than usual, being pumped out at a “rate of knots”, so they are not always the correct size & can be immature versions of the adult cell – a machine is unable to distinguish between these cells as it doesn’t have “eyes” hence without a manual count on a smear test, you can’t be exactly sure of the values. I agree that this could be part of the reason for the out of range values. Hold fire on the liver biopsy unless Dr Dodds specifically asks you to get this done – it will cost lots of money no doubt and may be pointless & stress poor Heathy out even more. I would avoid (if possible) anaesthesia for now as the liver has to rid the body of that too. I know we are asking you to be patient & trusting – you have to be. I am sure the pred reduction will turn things around – it did for us. Just be aware of any problems that I mentioned about Addisonian Crisis, but this (I repeat) is worst case scenario & is treatable.
Hope this puts your mind at rest a bit!
Sending love & hugs
Sheena, Worzel & Ollie xxxxx
Beth I would absolutely go with Dr Dodds recommendations and I think it’s very wise of you to run that past her. I think when in the higher doses of prednisone, a 50% reduction isn’t as risky as in the lower doses somehow. Also if the prednisone is a major problem with the liver, then the 50% reduction may be the way to go. With Bingo we did 50% reductions until we got to about 5mg. After that reducing 50% caused problems and we had to keep going back up in doses and slow it down again.
If the prednisone reduction causes problems, you could possibly try using cyclosporine rather than azathioprine, but Heathy currently has a good PCV so fingers crossed there won’t be any need for either.
I’d also go with Dr Dodds recommendation for the thyroxine. Perhaps you can have the bloods tested with Hemopet. It’s true that prednisone can affect results, but I think her testing is just that much more accurate and takes that into account. I know my vet also said the same thing that the pred muddies the waters when testing for thyroid, but Bingo was also taking thyroxine at the time and they were basing his dose on his body and skin condition. When we got to the lower pred results he was tested again and levels are good. Bingo will stay on thyroxine.
As to what caused Bingo’s AIHA, no real idea, however, when I first noticed he wasn’t well, his thyroid was tested and he was found to be hypothyroid, so my guess is that that could have been the trigger.
Just wait until you see what the denamarin can do. Magic stuff :)
PS I’m going to list your med schedule here in another post just so others can run they eye over it to make sure there are no problems.
Regards
Vally & Bingo
![bingo-14-5_1200x775](https://www.secondchanceaihadogs.com/wp-content/gallery/aiha-dogs_2/bingo-14-5_1200x775.jpg "Vally\'s Bingo \\"Smile\\"")
![Brigitte_Cleo_Ripley_Enzo_4](https://www.secondchanceaihadogs.com/wp-content/gallery/aiha-dogs_2/Brigitte_Cleo_Ripley_Enzo_4.jpg "Brigitte\'s Cleo, Ripley, Enzo and Guest \\"Rockin\\"")
