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- Eddy P. – AIHA
Hello,
My dog Eddy was diagnosed with AIHA/IMHA on September 30, 2015. Eddy is 10 ½ years old and weighed 44.53 lbs. He had collapsed at home on the September 29th and my daughter rushed him to our local animal emergency. (Of course we were on the other side of the country when this happened.) After a blood panel was completed the doctor suspected AIHA (or IMHA, depending on the doctor,) and he was kept overnight. The following morning when my daughter went to check on Eddy, he collapsed again and it was recommended he be transported to a critical care hospital for animals that was a couple of hours away. He was taken there by my daughter and son and when they arrived, Eddy collapsed again. He was admitted immediately and his PCV was 18%, (October 1st.) He had a transfusion of PRBC and his PCV went up to 26% but by the following morning it dropped to 20%, (October 2nd.) He had another PRBC transfusion and his PCV went up to 28% and then dropped to 25%, (October 3rd.) We cancelled the remainder of our trip and flew home to be with Eddy. He was released from the hospital on October 3rd and we all drove the 2 hours back home. His medications at the time of his release were:
Prednisone 20mg 2x a day
Cyclosporine 100mg 1x a day
Mirtazapine 15mg 1x a day for appetite/anti-depressant as needed
Famotidine (Pepcid) 10mg 2x a day
Omeprazole (Prilosec) 20mg 1x a day
On Sunday evening I noticed Eddy wasn’t doing as well as he had been earlier in the day and we took him back to the local animal emergency, he was given a check-up, his PCV was 23%, and sent home. The following day, Monday, October 5th Eddy had a check-up with his veterinarian and he recommended we talk to his other doctor about adding Mycophenolate. As luck would have it, Eddy ended up back at the animal emergency that night, October 5th. His PCV was 20%. He stayed the night and his doctor from the critical care hospital came up to the animal emergency to treat him. Eddy was given a double unit blood transfusion and two Human Intravenous Immunoglobins and stayed another night in the hospital. On Wednesday, October 7th he was released and his PCV was 28%. His medications at the time of this release were the same as above with the addition of Mycophenolate 125mg 2x a day and Metronidazole 1x a day.
Eddy continued to improve and on October 13th, his local veterinarian reduced his Prednisone from 20mg 2x a day to 20mg in the morning and 10mg in the evening. Around October 29th, Eddy developed severe diarrhea and colitis and was prescribed one medication that didn’t help and then was given Lomotil 2.5mg 2x a day and it helped. At his check-up on November 8th, Eddy’s PCV was 32% and his veterinarian then changed his dosage of Prednisone to 10mg in the morning and 10mg in the evening. No other changes in medication. On November 10, his PCV was 35%, November 18, PCV was 37% and on December 1, PCV was 40% and he weighed 39lbs! We were so happy, cautiously happy but happy! We changed the Mirtazapine to 7.5mg 1x a day and the Lomotil to 2.5mg every other day. On December 15th his PCV dropped to 38%. I naturally was very concerned but our veterinarian said this could be normal because the disease can cause the PCV to fluctuate a little. Before the counts came back we had discussed making changes in Eddy’s meds. After the count, it was decided to leave the meds at the same dosages. On December 31st, his PCV dropped again to 36% and his weight is 37lbs. His local veterinarian recommended that Eddy go back for a visit with his other doctor that treated him and gave him the transfusions. Eddy has an appointment with him on Tuesday, January 5th. I am so worried and upset! I am wondering if there are any questions that I should ask his doctor on Tuesday? One questions that I do have is how do I know if he is in remission? (I’m thinking positive!!) And is this recent drop an indication that he is relapsing? I should add that we have been giving Eddy F3 Micro Algae since the beginning, because we thought it might help with red blood cell production. It hasn’t seemed to hurt!
I’m sorry this is so long but I wanted to make sure you had as much information as possible. Thank you so much for this forum and for any support, help and advice you can give!
Sincerely, Carol
Hello Carol,
I am so sorry your Eddy is so sick. but you sure came to the right place, there are many people here that went through the same or at least a similar ordeal as you are going through with your boy. I am not an expert, but I will just tell you what sticks out for me. First of all, don’t continue with the Micro Algae! It is a waste of money. I know it sounds phenomenal, but so far it is all anecdotal and we try to discourage it.
Your vet is right, the PCV fluctuates. I am pretty sure the drop you describe is not a relapse. The PCV can fluctuate depending on how hydrated Eddy is. Was the check at the same time of day? Full or empty stomach? It all plays into it.
I would highly recommend to put Eddy on a couple of supplements and meds. One that is very important to protect his stomach and intestines from the harsh medications is Sucralfate. Eddy has the famoditine but the sucralfate literally coats his tummy and protects it. This however means that you have to give it away from all food and other medications. This can be a bit of a juggling act but it is well worth it. All the medications really give Eddy’s liver a lot of work. You should give him Sam-E and Milkthistle to help the liver heal. If he does not yet have high liver values, I can almost guarantee that will happen. So if you can support that with these supplements that would be great. One thing we have found here is that many dogs benefit from adding thyroxine to the mix. Some vets add it without even checking the thyroid levels because they know they will be low. They might be affected by the prednisone but they are still low. For some dogs being low thyroid (hypothyroid) is even the reason they cam down with this disease. This is certainly a subject I would bring up on Tuesday.
Your vet should be able to tell from the blood if ther is still destruction going on. If there is not I would say Eddy is in remission. Of course there is always the danger of a relapse, this is why it is important not to reduce the prednisone too quick. 25-33% every 2-3 weeks after a blood check that is stable would be safe.
Thank you for taking the time and write so detailed about Eddy. This will help others to give you more information.
Best wishes,
Brigitte
Hi Carol, and welcome. I’m glad you’ve found us.
First of all Eddy sounds like a champion and he certainly went to extremes to get you home.
I agree absolutely with what Brigitte has said. Firstly, the Algae has not be proved to work anywhere. The only statistics offered on this working is by the Company itself. There have not been any outside trials done.
Thyroid medication is recommended in all cases, as it helps the marrow produce red blood cells.
The PCV will go up and down, yes, depending on how hydrated they are, more hydrated, a lower PCV, more dehydrated, a higher PCV.
Keep an eye on Eddy’s gum colours, that’s always a pretty good indication of how they’re doing. Most of us are all very paranoid and find the minute our dog is acting a bit funny, they get their lips pulled down to check their gums. I remember one lady, Lynn, saying her dog was so used to this that she used to smile automatically.
Just remember though that if Eddy is lying around, his gum colours WILL naturally be paler and when he’s more active, they should be redder. So don’t check when Eddy is just lying there. It’s all to do with the spleen. A dog’s spleen will react to what’s happening and release blood as and when needed. Very clever.
And yes, the liver, if not already suffering, will suffer from the drugs it’s processing. The best product around to help the liver copy is Denamarin (in Australia, we use Denosyl).
If you have a copy of blood results, send them through on the Urgent Advice and someone will have a look at it for you and explain what’s happening. https://www.secondchanceaihadogs.com/urgent-advice/
If you need a chart for Eddy’s medications, I’d be happy to do that for you. Just list the time and the drugs and I’ll get it to you.
Also, if you’d like to post a photo of Eddy, please do. We’d love to see him. Do that by using the Upload your photo, on the right. It will take a day before it shows up as it needs to be approved (to protect the site).
My very best and VERY GOOD LUCK on Tuesday.
Vally & Bingo (diagnosed Nov 2011, in remission).
Hi Carol & Eddy
So pleased you’ve found us & I’m very happy to read about Eddy getting much better – he really is a super-hero. I’d love to see him – Photos please! The more info we have, the better – thank you for all the details.
I couldn’t agree with Brigitte & Vally more on everything. Stop the money wasting algae – it is unproven & I promise we have researched this before for people – there is no proof it helps at all & I personally think it’s a money spinner for the company.
Brigitte & Vally have already given the best possible advice – just to back up what they have said I’m adding my advice too – thyroxine is a vital part of treatment for dogs with this disease, even if they are not hypothyroid, and has often made a HUGE difference to dogs struggling to maintain a good PCV during treatment. The recommended dose (as per Dr Dodds of Hemopet) for dogs with this disease is 0.1 mg per 12-15 lbs. of optimum weight twice daily, to stimulate hematopoiesis. It is worth getting a thyroid function test (full panel) done in case Eddy is hypothyroid, in which case he may need a higher dose.
Sucralfate – also very important & the best tummy protector you can use. Denamarin – livers really get a hard time wih these drugs, so essential to add it in to lower those enzymes & protect it from damage.
Predisone/prednisolone must be withdrawn very slowly & carefully to avoid problems – as Brigitte & Vally have said. Here is our guide to safe reduction:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/
Can I just clarify something please? Is Eddy still on Mycofenolate? Drugs such as azathioprine & mycophenolate mofetil can evetually act as bone marrow suppressants during the longer term. My dog Worzel was on azathioprine – it saved his life for sure – but his PCV was stilted (in low normal) somewhat until we lowered the azathioprine which was reduced AFTER completely reducing the prednisolone to none at all. I am not saying that is what is holding Eddy back, but it’s worth bearing in mind for chatting about with your vet. Obviously, you cannot stop this drug – it must be withdrawn slowly – plus it may well have made him turn the corner in the early days of treatment. We haven’t had very many dogs on that particular drug & research on dogs is a bit sparse, but here is some info for you:
https://www.secondchanceaihadogs.com/AIHA_Terms/mycophenolate-mofetil/
Wishing you all the good luck in the world on Tuesday – if you need any other information or veterinary resources to take with you, feel free to ask. We have lots of information & some links in our AIHA terms
https://www.secondchanceaihadogs.com/aiha_terms/
Please let us know how you get on – give Eddy a big cuddle from me & tell him he’s a very clever boy!
Sheena, Worzel (diagnosed Dec 2012, in remission) & Ollie xxx
Hello,
Thank you so much for all the suggestions and information. I uploaded a picture of my sweet Eddy today! Eddy’s appointment yesterday didn’t go as well as I had hoped. His PCV has dropped again and is now at 34%. The veterinarian at the critical care hospital did not rule out that Eddy may be relapsing. He was reluctant to add Thyroxine because he said that Prednisone skews the blood test results on the thyroid function. To get a true result of thyroid function he said we would have to wean Eddy off of the Prednisone to do the test and he felt that wasn’t an option. He also said that increasing the Prednisone wasn’t a good idea right now because of the muscle wasting that Eddy has experienced as a result of the Prednisone. He said another option was to run a blood test to see what Eddy’s levels of sporine were and depending on those levels, we could increase the cyclosporine or we could just increase the cyclosporine now. I opted to do both! Increase the cyclosporine now and do the blood test as well, because he said the results could take a few days and I just don’t want to risk waiting a few days.
Sheena, Eddy is still taking the mycophenolate and I discussed that with the doctor yesterday. He recommended that Eddy keep taking it mainly because he says he isn’t comfortable increasing the Prednisone.
We also discussed the Milkthistle, Sam-E and Denamarin and he agreed that would be beneficial for Eddy. I decided to have Eddy take the Denamarin mainly because it was the easiest option right now. We also discussed sucralfate and because Eddy is doing so well with the Pepcid and Prilosec at the moment, he recommended we keep Eddy on those and if there is any change in how he tolerates his meds, we can add the sucralfate then.
The last blood panel Eddy had was at the beginning of November. I think I will ask for another one when he sees his local vet next week and I will send the results. Or should I have one run sooner? Here is a list of Eddy’s meds as of today:
Prednisone 10mg 2x a day
Mycophenolate 125mg 2x a day
Atopica (Cyclosporine) 100mg 2x a day
Denamarin 425mg 1x a day
Mirtazapine 7.5mg every other day
Lomotil 2.5mg every other day
Omeprazole (Prilosec) 20.6mg 1x a day
Famotidine (Pepcid) 10mg 2x a day
I didn’t get much sleep last night because I was thinking about my sweet boy all night. I’m just not sure what to do next?
Hi Carol
Can’t wait to see Eddy! You know, a PCV of 34 is not bad at all, certainly nothing to worry about just now, but it would be GREAT to get him higher. We will try our best to help.
I apologise if I did not make this completely clear – I am sorry if I didn’t push this as much as I should have – thyroxine should be given REGARDLESS – every AIHA dog should be on it. It doesn’t matter about test results (you do not even need to do a test, but it is better to do one in case they are hypo) it is an essential addition to any dog’s medication protocol with this disease. Pred dose is irrelevant – even though it is true that pred dampens thyroxine & dogs & humans who are hypo must up their dose sometimes. The fact that thyroxine encourages the bone marrow to produce MORE red blood cells is the important thing to know. I can forward other research to prove this, but could you please point NOTE 5 out to you vet? Please trust us on this – it could make a BIG difference:
http://drjeandoddspethealthresource.tumblr.com/tagged/thyroid#.Vo2QiChwa2d
I completely understand your vet not wanting to increase the pred – my boy suffered horrendous side effects & was skeletal – BUT please, please do NOT do any risky reductions – stick to our guidelines to prevent a really serious relapse. Continuing the mycophenolate is understandable, but I wanted you to be aware of the possible long term problems. The article above also gives details of cyclo dosing, plus other drugs, so worth looking at that too!
Please remember we only want to help by giving you every bit of information & experience we have. Some vets are open minded, some are not, but it is up to us to do our best for our pups – I did not always agree with our vets & I found it very hard to “be firm” & insist they listen, but I had to do my best for Worzel – learn as much as you can, so you can be Eddy’s supermum. He’s doing OK, so his treatment just needs tweaking to get him fully recovered & in remission.
Love & hugs
Sheena, Worzel & Ollie xxxx
Thank you Sheena for the link. I printed it, read it and will be taking it to Eddy’s local vet tomorrow. ( He needs some refills.) I will ask for the thyroxine to be added to Eddy’s meds.
One of my concerns all along has been the reduction of the prednisone. I was worried that he wanted to reduce it too soon and pushed back on that. He was agreeable and it has been a slow reduction but it still worried me the two times it was reduced.
Eddy has an appointment with his local doctor this coming Wednesday but I may call and have Eddy seen sooner. He just isn’t acting the same. Very tired, moving slower and doesn’t want me out of his sight. I have been checking his gums and they definitely are not as pink as they should be.
Thank you again for the information! I appreciate it so much and so does Eddy!
Sincerely, Carol
Hi Carol & Eddy
It’s a pleasure to help, always. The best “thank you” we can ever get on here is an improvement & then remission – life is good for everyone with that scenario!
I hope your vet will take on board the thyroid info – I have more vet research papers to prove it if you do need it. But be insistent that you want this of course.
I’m sorry you are worried that Eddy is not himself – Mums know best, so you are right to get another test done – always trust your instincts. The only thing I would say is that gums are not pink when they aren’t active. Sometimes, when you get them moving around, the gums look much better & more pink. This is because dogs store a lot of blood in their spleen – it holds such a lot that they can be fast asleep, then instantly be alert & in chase mode! An instant transfusion. But if you are worried, the only way to put your mind at rest is a PCV/blood test. I have always done that with Worzel because the worry of his PCV dropping never leaves me. I promise I am still completely paranoid even now! Don’t reduce the drugs again until you are completely happy with the blood results. And please tell us how you get on – we worry too because we are all in the same rocking boat. Worzel has been the most clingy dog ever since he was very ill – all of us find they are a bit more dependant on us, I think. Maybe it’s my fault too because I still watch him closely for any signs of illness, funny behaviour, pale gums or lethargy. Welcome to our crazy paranoid AIHA world!
Fingers crossed for the next test, Carol. Do it tomorrow for your peace of mind.
Love & hugs
Sheena, Worzel & Ollie xxxx
![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\\"")
