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Ashley
I’m not a vet either, but we are telling you from our experience with what has happened with other owners on here AND from wide reading of bona fide vet/uni studies what we think you should do in light of what could happen on the relapse front. I was in the medical profession, but that does not mean I categorically agree with everything they say by any means – sometimes the opposite! Lola is only a little light girl & this really is a big reduction in view of her weight.
I’m sorry – I MUST stick my neck out here – I don’t agree with your vet at all about the adrenal aspect, and I am especially worried about the fact that Lola has relapsed already – this screams CAUTION to me. Brigitte is right – we have seen this too many times (yes we can name names) & we are only concerned about a good outcome for Lola – we are not trying to be negative or anti-vet, just careful. For the sake of a few weeks more on the pred? It’s nothing. She is your dog so you must decide, but I personally would not agree to the regime suggested by your vet in view of the circumstances. I have read many, many studies and this is my opinion – please don’t do this so quickly. We did a terribly fast reduction (25% per WEEK) with my dog Worzel who did not have the “standard form” of AIHA – a completely different form from Lola – no clotting risks, went downhill s-l-o-w-l y, bone marrow problem rather than intravascular, etc, etc. I would never, ever, ever recommend this to anyone who has a dog with the “usual” form of AIHA and neither would my specialist – it could be disastrous. He categorically told me that this would never be done with a patient who had had intravascular haemolysis, or clotting risks. Sadly, Lola IS in the situation of having the more usual form & I must emphasise my opinion of the importance of a slow reduction.
Dr Dodds is without doubt in my mind the best source of experience you can find – you can consult with her on the internet & the link to Hemopet is in the blue bar at the top of this page https://www.secondchanceaihadogs.com/hemopetresources/
If you are in any doubt whatsoever about what to do, please contact her – Lola is the most important thing, after all. If she says the proposed large reduction is OK, that’s all well & good.
Best wishes
Sheena
Hi Ashley
I know this is a dilemma for you and it is very difficult when the vets recommend something and you are unsure. I am inclined to agree with what others have said, in that I would stick to a slow reduction in pred. In addition to the adrenal risk, is the risk of relapse as discussed. I would also suggest you consult with Dr Dodds before you make a decision one way or another, and by all means ask her to consult directly with your vet. Lola is your precious dog and you call the shots.
As Hope pointed out – is Lola on any anti-clotting medication? This is really important. From a personal (and human) point of view, I can recommend Omeprazole. Fabulous stuff!
With very best wishes,
Mary and Mable x
- This reply was modified 12 years, 1 month ago by admin.
Hey there Ashley!
If you are having any hesitation about contacting dr dodds or doing a full consultation I really suggest you email her. I know you are trying to figure out what to do ASAP and she WILL answer general questions. send her an email and give her a brief overview of what’s going on with Lola and she will help as much as she can with the info she has. If you are venturing into the consultation lane she will let you know.
I can add that our specialist wanted to do a fast wean with Steve on the pred bc of side effects, like 40% from 80mg to 50mg. I emailed dr dodds and she said she wouldn’t do that, to at least do 25-30% reductions but just often. She said every 5-7 days until we got to a dosage our vet was happy with. So for Lola you could do 10mg (now) –> 7.5mg for 5-7 days, 5mg for 5-7 days , etc etc. Just a suggestion!
Ashley, yes I agree totally as well. I would do the 7.5 for a few weeks at least, either by cutting up the tablet or by doing 10mg one day and 5mg (half a tablet) the next day. By jumping the gun and going straight to every second day, and a 50% reduction, the risk of a relapse happening again, I think, is just too great.
I was at the 5mg mark and vet said to start skipping a day and problems hit. Even at the 2.5mg mark, tried skipping a day, problems again.
If you do decide to do as your vet has suggested, and skip a 10mg dose every second day, and Lola has problems, then it mean Lola needs to go back up to her 10mg a day AT LEAST. In my case, when Bingo relapsed at 5mg a day, we had to go back up to double dose of 10mg a day and start weaning again.
Risking a relapse or problems with the glands simply means that Lola’s prednisone dose will need to go back up again anyway, hence more side effects until you can try to lower the dose again. Doing it slower, as Sheena said, only slows it down by a few weeks lowering the risk of any problems.
My best,
Vally & Bingo (relapse expert)
Hi Ashley. You poor girl going through all this with Lola. Trust me, I too have been there with Sadie. And agree too – consult with Dr. Dodds – she’s an amazing person.
Okay – here goes,
PREDNISONE (WEANING):
I really hope to listen to what we are all saying (YES, I AGREE WITH ALL – SLOW, SLOW, SLOW reductions).
Sadie would have been over all this long ago had we weaned her slowly. Please read her ‘story’ so you’ll understand where I’m coming from when I say, go SLOW.
I agree with everyone here about the reduction being WAY too aggressive. What do these vets that wean aggressively NOT get about this?!!!!! It’s just AIHA 101 logic – SLOW REDUCTIONS and over a period of at least a few weeks between each reduction. After Sadie’s relapse because of an aggressive reduction, I did one month between each reduction. I do realize that’s really slow, but I was not taking any chances for another relapse. It has taken an incredible amount of time, but we are finally down to 3.5MG of prednisone daily (she’s off Cyclosporine completely).
By the way, I get Sadie’s prednisone from Costco (great price and they discount it for uninsured dogs/cats/pets and people too!). Prednisone comes in 20mg, 10mg, 5mg, 2.5mg and 1mg. So, now with Sadie on 3.5mg daily, I give Sadie a 2.5mg and a 1mg (together with the tiniest amount of pill (duck) pocket around both pills) = 3.5mg (daily, once a day, now being so low). So, if you are now giving Lola 7.5mg, you could give her 5mg in the AM and 2.5mg in the PM. Does that sound right everyone? AND agreed with everyone here – DO NOT do every other day. Not yet. As everyone said, the prednisone and Azathioprine have suppressed the adrenal glands – they need to wake SLOWLY.
AZATHIOPRINE:
I am assuming that Lola is still full course on the Azathioprine? I used Cyclosporine (Atopica) with Sadie. At the end, she had some really bad side effects from it. I had to wean both the Prednisone and Cyclosporine intermittently. She is now totally off the Cyclosporine, which is not the way most have done here, but it worked for Sadie (so far). Sadie’s PCV is now higher than her pre-AIHA PCV, this morning testing at 48.1%. Yeah Sadie!!!
PROBIOTIC SUPPLEMENT:
Just be careful with this. It can have an adverse reaction and cause diarrhea. It did with Sadie – whom ALWAYS has poop issues. I can not even do pumpkin (pure) with her. However, like Vally with Bingo, I have on occasion given her plain slippery elm. I love that Vally cooks it to a roar!! Although, I just put a VERY, VERY SMALL PINCH right in Sadie’s food. But I like her idea much more and it’s most likely much more beneficial and tolerable. Although, Sadie never had problems with it being put in her food.
The other thing that has helped Sadie’s poops, is a product called Perfect Form by Honest Kitchen: http://www.thehonestkitchen.com/perfect-form
I don’t give as much as they say, because again, it has an adverse reaction with Sadie, so I do the same as with the slipper elm, a VERY, VERY SMALL PINCH. Her am and pm food has one squirt of PetTinic and a VERY, VERY SMALL PINCH of Perfect Form in it, every day. She was having some problems (test poop, fine) a few weeks ago, not now. It works great – pick-up-able. Amazing how our dog’s poop makes us smile!
DENAMARIN (LIVER PROTECTION):
Didn’t you mention that Lola is on Denamarin. Great drug. Great. But I later opted for a more natural approach and began to use Milk Thistle and SAM-e. I use HerbPharm liquid Milk Thistle and CellFood SAM-e, both are brand names. I get them both from Amazon.
I tried to do the math and figured that to equate to the Denamarin dosage Sadie was on (she weighed, at onset of AIHA, 35lbs), I would use 20 drops of HerbPharm liquid Milk Thistle and 12 drops of the CellFood liquid SAM-e. She has had NO liver problems, test results all good, thank goodness.
BACTERIAL INFECTION:
You mentioned Lola’s vet thinks she has a bacterial infection right? And I think several have asked, what is she on for this?
FUR LOSS / LUSTER LOSS:
Pre-AIHA, Sadie had an incredible soft, dark black coat. People complimented her all the time. With the Prednisone, she not only lost much of her luster, she also started to prematurely turn grey. I also found 20X the amount of fur balls around the house, so she was shedding. But then when I started to wean her off the medications, the shedding actually got worse for a few months. Now, it’s growing back in and she’s getting that luster back. She is still grey in those same spots, but she looks incredibly better.
Sadie also became ravenous and gained weight with all the medications – seven pounds!!! Her pre-AIHA weight was 35, and she went up to 42 at one point right before we started weaning her! She was a tubby!! Today she weighed 37.5, so thankfully, she’s loosing. She’s also not quite so ravenous.
The second time around, after relapse due to too aggressive weaning, the reductions were VERY SLOW. I weaned about 20% each reduction, at 30 day intervals, keeping the every day regiment. Depending on what the reduced dose was, I gave the higher (mg) in the AM and the lower(mg) in the PM. All this – because my dear friends here walked me through it. Without them, I am quite sure, Sadie would not be here today.
NEVER THE SAME:
You are right – this horrible disease changes them. They are never the same. But if indeed they do make it, we are the lucky ones. So, although not the same, they are with us and usually they come back almost to where they were. Lola will come back. It will take some time. It has been almost two years now with Sadie and she is just now wanting to play, wanting to run (she stopped that completely for almost a year!) and not so anxious as she was on the nasty, but necessary, drugs.
Hang in there with Lola. You are doing an incredible job with her and she is doing well because of you.
MUCH LOVE AND HUGE HUGS:
Linda and Sadie
Will post more later but did contact Dr. Dodds. Waiting on her full report. Have not lowered the prednisone.
![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\\"")
