IMHA Med side effects

[Anna]

My almost 5 year old Standard Poodle Jackie was diagnosed with IMHA 6 weeks ago on Nov 24th. Her PCV was at 23 and she had 2 blood transfusions that eventually got her up to as high as 38. She has been on high doses of prednisone and cyclosporine along with omeprazole, probiotic, recently sucralfate, and an antibiotic. We just started Azathioprine so that we can take her off of cyclosporine as the vet seems to think it isn’t working. She almost immediately started losing weight within the first 2 weeks of being diagnosed and has had horrible diarrhea since the beginning. We reduced the prednisone thinking that the side effects were because of that and her PCV dropped to 32 where it has held for the last two weeks. Two weeks ago she started having blood in her stool and it has gotten worse and worse. She is now skin and bones but still eating pretty good and drinking a lot due to prednisone. The vet is saying that she has never seen a dog on prednisone lose weight even though it can cause muscle wasting. She thinks that with that and the blood in her stool, she has cancer. They didn’t initially do cancer screenings because she is so young and poodles are predisposed to this disease. I have read a lot about how prednisone is a horrible drug and can cause severe side effects so I don’t know if I should spend the several hundred more dollars to do the cancer screening or if these are common side effects. I wanted to wait see if the sucralfate helps with the bloody stool as that should coat an ulcer if she has one in her intestines. Has anyone seen similar side effects to these meds? Thank you in advance for any support. This is a horrible disease and I have pretty much been a mess for the last 6 weeks.

[Tamara]

Hi Anna, I’m so so sorry that Jackie has been diagnosed with this horrible disease and that you and she are going through an especially horrible time. These meds are really hard on the dogs, and more so on some dogs than others. I’m so glad you’ve started her on sucralfate — we always recommend that dogs be on it immediately because of the GI side effects of these drugs. Definitely prednisone, but also cyclosporine, can be very hard on the GI tract. It’s scary that the blood in her stool has gotten worse.

Many dogs lose weight on these drugs — my Ashki was at one point 15% underweight, and he did not have blood in his stool, so with the blood loss I think it makes sense that she has lost a lot of weight. It is very good that she is eating well and drinking. How is she acting and feeling otherwise?

When did you start the sucralfate? Has an ultrasound been done? How is her chemistry? Are there other indicators that are leading your vet to believe that cancer is a possibility such as a very high white blood cell count? Sorry for all the questions — we just want as much information as we can get so we can understand what is happening and support you in making the best decision possible for Jackie.

This disease is so scary, we were all a mess and there are times I still am as Ashki and I are still fighting this disease. T his forum is wonderful, there are very knowledgeable people here who will help you, I am fairly new to the disease, my Ashki was diagnosed last April, so while I have learned a lot I am also still learning.

Another question that I always ask — does your vet have a lot of experience with IMHA, is she a specialist? This is very important. Even specialists struggle with this disease, I had to change specialists because the first one we saw had very limited experience and was not open to my input and questions. He did do a very good job of protecting Ashki with prophylactic drugs for GI and organ function, but in other ways there were problems. Ashki has been doing much better since we switched, although I wish I had been more assertive about some things, even with the new vet.

Remember, you know Jackie better than anyone, and that knowledge is incredibly valuable and important. That knowledge, combined with education about this disease will make you an informed and educated partner in her treatment and care and you will be able to make the best decisions about her care.

Sending you big hugs —
tamara and ashki

[Colleen]

Hi Anna,
My Boxer, Romeo, has lost weight as well and I think it’s mostly due to muscle wasting. He also has had diarrhea since the beginning so I suppose he doesn’t absorb as much nutrients, etc. and the diarrhea may cause weight loss also. He was diagnosed on Nov 7 and has been on Myco and now Aza and neither seem to be working for him yet :( Our vet is also talking about cancer because Boxers are prone to cancers and also because he isn’t getting better and we don’t know the cause of his IMHA. I’m sorry I don’t have much helpful information for you, but I wanted to know I’m going through some of the same things as you :( Hang in there – thinking of you!

Colleen

[Anna]

She just started sucralfate two days ago but I have no idea how long it takes to work. She just had an accident this morning all over my living room and it was horribly bloody. I don’t know what other factors there are that makes my vet think she has cancer. I haven’t heard anything about white blood count or about any other numbers besides total protein which is at 6 and her PCV at 33 on Tuesday. She has good and bad days. Last week I thought she was doing really good and her energy seemed good so I thought for sure her PCV was going to be in the high 30’s again and was really disappointed when it only went up to 33 from 32. The vet said that the bloody stool could have had an effect on it not increasing. I feel like if we don’t get this GI issue resolved we are never going to get her PCV up.

They have not done an ultrasound or xrays. I guess they have another specialist come and do those every Monday so I am trying to decide if I should have that done this Monday. I am leaning towards doing those diagnostics especially since it seems to be getting worse. I was avoiding it because I have already spent so much money. This vet hospital is large with probably about 10 vets. They assigned me to the vet the works the chronic cases and she says that she has experience with this disease but I am not sure how much. I know she has been in the business for a long time so I can imagine she runs into these cases a lot working at a 24 hour emergency hospital. Thanks for your support!!

[Tamara]

How often is she getting the sucralfate? Is it being given 2 hours apart from all meals and meds? It is a very good sign that she can maintain a PCV of low 30s with bloody diarrhea — that will definitely keep the PCV from going higher. This is kind of simplistic and I’m sure you’ve done this, but just thought I would ask, have parasites been ruled out like giardia, etc? Just trying to think of everything I can. I know other more knowledgeable members will jump on soon.

I know, this disease is SO expensive. Any test that they want to do, I always ask what are the possible outcomes, and with each of the outcomes, how would it change the treatment plan? Which outcome is most likely, other than IMHA? Can we do a trial of changing treatment and see if there is a response, would that be safe? Is there any other way to test that is less expensive?

[Anna]

She is getting sucralfate every eight hours and it said it needs to be 1 hour apart from the other meds so that is what I have been doing. They haven’t checked for parasites, but that is pretty unlikely since we live in an apartment and she really wouldn’t have had access to anything with parasites. The antiboitic she is on is metronidazole which should take care of any parasite or cdiff.

[admin]

Hi Anna

I’m very glad you found us. This is really awful for you – I’m so sorry to hear Jackie is having such a rotten time. It costs a lot of money to get this disease under control sometimes & I sympathise, Anna.

Tamara has given you the most wonderful advice, especially that you need an internist that has really good experience with this disease (it’s incredibly rare) & you are right in thinking this bloody diarrhea needs to be investigated & got under control as soon as possible. Losing more blood will not help & she’s only a young girl. If you are in any doubt at all about finding local expert help, you can contact Dr Dodds via our Hemopet link. She is incredibly knowledgeable & a really nice, compassionate person with masses of experience. Many of us have consulted with her & that is why I cannot speak more highly of her:
https://www.secondchanceaihadogs.com/hemopetresources/
Her fees are very reasonable & she will not let you down.

I also think an urgent ultrasound would be the best way forward – maybe Jackie has a bleeding ulcer somewhere. You would not believe the ravaging effects these drugs have on the the gastro-intestinal tract. Sucralfate is wonderful stuff, acting like a bandage & producing a protective mucous which allows ulceration to heal. Although this can’t happen overnight, it’s the best treatment you can give in my opinion. But it has been going on for too long now.

I can assure you that my Worzel (a greyhound) was the same with the prednisone & my specialist was very concerned that he was almost “eaten” alive – he rapidly & unbelievably became skeletal, but he is now pretty much the same as before the diagnosis. I imagine that poodles are a very similar shape – lots of muscle & not much fat. So, we need to get this sorted as soon as possible – I wish there was an alternative to prednisone, but there isn’t – it’s a renowned muscle “eater”. I imagine Jackie’s appetite is not great at times either. Worzel refused to eat – he got thinner & thinner. It was the worst of times for us, but we got him better eventually, slowly.

I am a little suspicious about the metranidazole – how long has she been taking it? It can have interactions with the IMHA meds, but sometimes we don’t have a choice but to give it in life-saving situations.What does your vet think the infection was/is?

I am also concerned about the azathioprine, even though it works well for many dogs – it can cause pancreatitis. My dog tolerated it well & made a good recovery, but some dogs just have a bad reaction to it & this normally happens in the first few days of treatment. Do you think Jackie is in pain at all? That would manifest itself in arching of the back, lying stretched out with front & rear feet as far from each other as possible, accompanied by diarrhea &/or vomiting. Pancreatitis is serious, but treatable but it needs attention from a vet straight away. High amylase would show up in the blood test, then further tests should be done to investigate.

Has Jackie been vaccinated recently? Or given heartworm treatment?

Do you have any blood tests you could send us? And every other possible test? Please use the urgent advice link
https://www.secondchanceaihadogs.com/urgent-advice/

I know you think it is unlikely that Jackie has picked up an infection, but it is possible. My dog was regularly & vigilantly protected from fleas & ticks, but he still contracted a nasty disease called ehrlichiosis. Anything is possible & there are loads of nasty bugs that can cause IMHA.

Please could you tell us if Jackie has had any previous health problems at all – it is imperative to find the cause of the IMHA wherever possible. Sometimes, we never know, but it is always best to eliminate everything we can. Has Jackie experienced tummy problems in the past? This is important as they need to be able to absorb the right nutrients to have the building block for making red blood cells. Lack of iron, vitamin B12 can cause big problems.

I’m so sorry to ask loads of questions – we would like to help as much as possible. Jackie is not in any danger at her current PCV level, but the blood loss needs to be investigated otherwise you won’t see much of a rise in PCV.

Anna, I know you are very concerned – I’m glad you’ve come here for help & we will all try our utmost to support you. Everyone here has experienced the horrendous early stages of this disease, so we know how you feel – and they are such a lovely bunch of people who care deeply about each other & their pets. These people were a huge help to me when Worzel was ill & I had never heard of IMHA – we are all beside you & we can fight this together.

Best wishes to you & Jackie
Sheena, Worzel & Ollie xxxxx

[Anna]

I don’t have any of her records. Jackie was vaccinated in June of last year and never had heartworm meds. She has been on metronidazole for I think 10 days but they gave me more to give her. I actually felt like the diarrhea got worse from that but I don’t know. A couple of weeks ago she ate the electrode pads off of our muscle stimulator and I didn’t even know that she had done it until she threw it all up. She didn’t get any of the wires, just the sticky pads and it looked like she had eliminated all of it. After that she started bleeding so they gave her antibiotics and probiotics for what they thought was colitis. It actually got better after that but now for about a week it has just gotten so much worse. I don’t think she is in any kind of pain. She has had tummy problems before, she will randomly vomit but not very often, usually if she ate a chunk of a rawhide bone, which she doesn’t get anymore. She had a bladder stone removed in 2013 but hasn’t had issues since.

I decided that I do need to see an internal medicine specialist so I have called my vet and she has referred me to somewhere else. I just left them a message to schedule an appointment so hopefully we can get in soon. Thank you so much for your advice. I have been feeling so alone through this since no one knows what I am talking about. I am beyond thankful to have found this group to see what others have gone through.