Dylan, the Mini Schnauzer‏

[Vally]

From Kathleen:

Mini Schnauzer rescued last year. He’s ten, had bladder surgery and then did not recover well Collapsed a month ago and was diagnosed with IMHA (or cancer that triggered the IMHA). Pred 10 mg (1.5 2 daily) raised his hemocrit to 28-29 percent, then a few days ago it was back under 20. Vet added Leflunomide 20 mg (1.5 in am). He’s also on Pepcid 10 mg at breakfast and dinner, Tylan powder (same), Benebac (same), Omega 3 (same), Chinese herbs yuan paioyao once a day for five days (just started), then off five days.

 

[Vally]

Official welcome from me to you and your handsome boy.

What does Dylan weigh? I’m a bit worried that prednisone dose may be too low a dose. It should be 1 mg per pound per day, divided into two doses. That would mean Dylan should be weighing in at 10 pounds? I’m sure he weighs more.

Send copy of your last blood test results through on the Urgent Advice and someone will come back to you about that.

I’m also a bit worried there’s no mention of aspirin or a blood thinner. A blood smear would show if that was needed – it isn’t always needed but in most cases, yes to prevent blood clots.

Vally & Bingo (diagnosed Nov 2011, in remission)

[Kathleen O’Donnell]

Hi, Vally.
He is big for a Mini, he weighs 27 (was 29 before his bladder stone surgery).

Something else to add: he was on metacam briefly after the surgery, I know that’s on the list of possible trigger drugs. No vax before the surgery. The collapse happened about ten days after.

His pred dose is 10mg 1.5 pills twice a day, so that adds up to 30mg. Let me know if that’s ok.

I will send the most recent blood test though they just did one Tuesday and the vet said he sees evidence of red blood cell production.

I love this board and am so glad I found it.
Kathleen and Dylan

I have asked the vet about blood thinner. He said “In this case we would not use, because he is on steroids, and using both together, may cause him to bleed internally. So we want to avoid that combination whenever possible.”

[Sheena]

Hello to you both, Kathleen & the very handsome Dylan. A huge welcome & apologies for not replying sooner. As always it’s rotten that you have had to come looking for help – we all did – and hope you’ll get the feeling that we’ve all been through this awful disease so understand thw worry & angst that goes with it!

Hoping to see blood results including a smear hopefully – we can see a bit more about what’s going on. I am assuming there could be a bleeding/platelet issue as the chinese herb you mention (also known as “I’m yunity “) is being used? Or is it for suspected cancer you mentioned? Or something else?

Here is some info on one use – very interesting indeed:
https://www.secondchanceaihadogs.com/chinese-medicine-study-splenic-hemangiosarcoma/

As Vally says, the pred dose should be 1mg per pound or 2 mg per kilo. The second (added) immunosuppresant is generally cyclosporine these days as it has the least side effects & is usually well tolerated. Azathioprine is some vet’s choice ( my dog Worzel was on that, but I would have changed to cyclosporine if he had not responded) or mycophenolate mofetil, but we don’t get many dogs on here on leflunomide generally.

Please know we are all here to help – no-one wants to go through this alone.

Sheena, Worzel & Ollie xxxxx

[Sheena]

Sorry – forgot to say Vally is spot on as ever – clotting poses a big risk for the majority of our dogs, so we always want to be 100% sure they are not at risk from abnormal clotting (sometimes called hypercoagulable state). The blood smear & possibly the blood test results will reveal this.

Here is some info on that: (sorry – bet you are inundated with things to read now! )
https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/

[Kathleen O’Donnell]

Hello to all! This is so hard, I’m feeling overwhelmed with all the things I have to read and decide.

The herb was recommended by my regular vet and a homeopathic vet. We don’t know if it’s cancer; they suspect not, but said this was good to use in his case. Should I not?

He is also on Ferrum Phos 6x for the anemia, and Phos LM 1, for stress and for calming.

Also my regular vet consulted with someone at Cornell who reco’d the leflunomide as having the least amount of side effects for the other issues Dylan has (IBD, sensitive stomach).

Should I insist on the cyclosporine? I did ask about aspirin. Am I playing with fire?

His gums were a little pinker today and he trotted when walking. A good day like that is all I can ask for at the moment.

His latest hemacrit was 19. My vet said today there are glimmers of RBC production.

Please let me know if I should get him off the leflunomide and thanks. My vet has treated many cases of this and I trust him, but I’m very scared as you can tell.

[Vally]

Of course you’re scared Kathleen. We’ve all been there.

When you get the blood test results through, hopefully it will show that a smear has been done and it will show whether the blood is clotting normally or not. If it shows it is clotting, then you definitely need to point that out and ask for something to prevent it. In some cases, as in Bingo’s, it wasn’t needed as the red cell destruction was happening in the marrow.

The dosage of prednisone is correct. I misread and thought you were giving 10 mg daily, so that’s correct. Sorry if I worried you.

As to the leflunomide, it is another immuno-suppresent. It’s not one that any of us have used personally. Someone may have more information on that. The other drugs are always there as a possibility, so if Dylan starts to go backwards, it can always be changed to another.

If his gums are a little pinker, that’s a great sign and if he has a bit of a trot to his walk, even better. They leave the worrying to us, they just act as they feel.

If your vet has said there are glimmers of RBC production, that sounds as though Dylan is regenerative – that’s the best news you can get.

Please send through that blood test though.

Vally & Bingo

[Vally]

Hi Kathleen

I did reply earlier, but it’s disappeared off the face of the earth! Probably operator error (me).
Trying to write again as much as I recall:

Stop worrying, please. You have said your vet has experience with many cases of this disease, which is wonderful to hear. You also said they consulted with someone at Cornell Uni, who are magnificent in their knowledge of this disease. My specialist here in France did his Internship there & he really knows his stuff.

Pred dose is pretty much a standard thing, but the choice od second immuno-suppressant varies according to vet & to what exactly is the matter with your dog. For example, if a dog has something called Evans Syndrome where the white blood cells are affected as well as red cells, they may chose Vincristine. So your vet has decided on leflunomide for reasons we don’t know. We are not vets, but try hard to give you all the information about current treatments/best practice etc.

Not all dogs need anti-clotting medications, but the majority do – my dog Worzel didn’t & I could not understand for the life of me why he didn’t until the specialist explained it properly – are you sure, I kept saying until it was explained fully. There is an awful lot to understand as it is a complex disease, with varying forms & I have a medical background – it was very hard for me at the beginning, I promise. My dog had bone marrow failure, NOT intravascular haemolysis, so he did not need aspirin or other similar drug. I asked loads & loads of questions of my specialist as I wanted to understand completely what was happening to my dog, in order to get him the best treatment possible. Some of my questions were in hindsight pretty stupid, but I asked them all the same.

All I can say is that we are here to empower you with the questions to get Dylan the best possible help. But further than that to support you with love & hugs – you know that everyone on here has been through the same worry, angst, doubt, “am I doing the right thing” etc.

There are many drugs for this disease, which is great. One of them will work, or if not a cocktail. There is no set in stone treatment & whatever makes your dog respond is good. This does not happen overnight – it can take weeks to work & we have to be patient sometimes. If it doesn’t work, change drug, simple. My vet chose azathioprine – it worked after a couple of weeks. If it hadn’t we would have tried cyclosporine, anything else at all to save my precious boy.

We would love to see the tests – it would help us to explain to you what is happening with your handsome Dylan. Worrying has become part of all of our lives with this disease. This is a great place to share those worries – Vally often says welcome to the crazy, paranoid world of IMHA. Amy says it’s like floating down the steroid river, with rapids & calms. I now say drugs are weapons of IMHA destruction (that’s a new one actually) or a scary rollercoaster ride.

Love, hugs & massive moral support
Sheena, Worzel & Ollie xxxxx