Muscle atrophy/Too Skinny?

[Diana & Sharky]

Hi all,

My dog Sharky was diagnosed with IMHA on Nov 12th, a month ago. He’s been on prednisone just as long – his hemocrit levels are making gains, but not enough to taper the dosage of medication. He weighed a healthy 32lbs at the start of this and takes 20mg of pred a day – 10mg in the morning, 10mg in the evening. He’s been on this regimen for 4 weeks.

Beyond the IMHA, now I’m worried about how the prednisone is whittling away at his body. He’s down to the bones right now at 24lbs – he’s lost 8lbs of fat and muscle.

Any advice? :/

[Vally]

Hi Diana, nice to meet you and Sharky. I’m sorry Sharky has been so ill but I’m thrilled to hear his bloods are heading the right way. What were and are his hemocrit levels? He’s actually on a lowish dosage of prednisone, ideally it’s 1mg per pound of weight divided into two doses a day, but if Sharky is responding, that’s great.

Yes, prednisone has shocking side effects and muscle atrophy is one of them. My boy lost 10kg (22 pounds) in about a month and he looked shocking. Just bones and a big belly. Really though, until the prednisone is reduced, the atrophy will not go away. When you can reduce the pred, you’ll see a different fairly quickly too.

Don’t be tempted to give high fat foods, as they could cause pancreatitis. Best is to feed lots of small meals with low fat high protein foods. What are you feeding Sharky (love his name!!!). I was a raw feeder, but Bingo ended up with stomach issues so I was told best to swap to cooked food while on high dose prednisone. Is he on stomach protection? Sucralfate is the drug of choice for that, but must be given away from food and drugs as it prevents absorption.

As we’re all paranoid here, can I ask if Sharky is on aspirin or the like? Especially in the early days, its vitally important to prevent blood clots. Not all dogs need it, but the majority do.

Welcome to the forum and feel free to ask anything. We love to help.

Vally & Bingo (diag Nov 2011, in remission)

[sheena]

Hi there Diana & Sharky

Vally has said it all- we really do want to put your mind at ease. High protein, low fat, more frequent meals.

A big welcome to the worry club! We have all been very concerned about the initial weight loss with the prednisone – it is a catabolic drug at the higher doses needed to combat the disease, which just means the body will absorb or “eat” it’s own muscle. It’s not nice to see them like this – my boy Worzel was emaciated & skeletal – he didn’t have an ounce of fat on him (greyhound), but the muscle soon returned once we lowered the pred dose. You have to be patient, I’m afraid, as the prednisone must be reduced slowly to avoid a relapse- please see our glossary item on prednisone tapering – it is important not to rush this, otherwise you may have to start the treatment over again & none of us want that to happen to our pooches!

Prednisone tapering info:

https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

I am really pleased to hear Sharky’s HCT is improving – the best news! Keep going in the upward HCT direction, Sharky.

Best wishes
Sheena, Worzel (diagnosed December 2012, in remission & no spring chicken ) & his best pal Ollie xxxx

[Diana & Sharky]

Hi Vally!

10kg, HOLY COW! That’s a whole other dog! And Sheena – it almost goes without saying – I can’t imagine a sighthound losing or gaining a pound.

When my dog initially fell ill I just thought we were up against the disease – I never considered what the medications would do to him. It’s been a learning process, to put it lightly.

Right now he’s on daily 20mg of prednisone; 215mg of denamarin; 20mg of famotidine; 25mg of azathioprine; 100mg of doxycycline; and 10ml of aspirin; and a little melatonin to wash it all down. We’re phasing out the aspirin and azathioprine.

[Vally]

Oh I’m an idiot. He lost 1 kg not 10kg (I Googled the pounds as we don’t use them, but also Googled 10kg as well). He started at 8.5 and went to 7.5 very quickly. So sorry about that. Yes, that’s more than a dog :)

Sounds like your vet knows what he’s doing. I’m a little paranoid (have I mentioned that once or twice???), but I’m not sure the aspirin should come down yet. Best way is to have the vet do a blood smear, to see if there are any irregular blood cells. If there are, then the aspirin should stay.

Yes the drugs (in particular the prednisone) do so much damage, BUT, as I’m sure you’ve also discovered, they’re life savers.

Regards, Vally & 7.5 kg (aka Bingo)

[Sheena]

Hi again Diana & Sharky!

Yes, Vally is spot on – please, please get a blood smear done before stopping the aspirin. Clots are a real killer with this disease. There is a lot of information about abnormal clotting here:

https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/

Can I also advise & urge you very strongly NOT to phase out the azathioprine just yet – please follow the normal protocol for drug reduction which is to wean them off the prednisone FIRST, and only then the second immuno-suppressant (in your case azathioprine). In my opinion, this is vitally important for a better recovery & is backed up by research & followed by renowned specialists in this field. We find through experience that dogs do not relapse so often if you stick to this rule. Basically, the pred is the initial stop-gap life saving, quick acting drug. The azathioprine takes a bit longer to kick in & is the drug that keeps the immune system under control until it has “got over” it’s over-reaction.

We kept Worzel on the azathioprine until he was completely off the prednisone (well actually he had prednisolone which is just a different form of the drug). Both my specialist who trained at Cornell Uni AND our wonderful Dr Dodds wanted me to do this. I know it’s difficult when your vet “disagrees”, but I promise this is the conventional & safe way to treat the disease from research. It makes perfect sense to me to do it this way & we try to persuade everyone to do it this way as it is much less risky. After Worzel was completely stable & free of the pred, we slowly reduced the azathioprine. I hope I’ve explained this OK – if you have any questions or need to take some “proof” that this is a better way, please always ask. I can easily put you onto some veterinary links to use.

Come on Sharky! Keep getting better & better for your Mum.

Sending huge hugs
Sheena, Worzel Ollie
xxxxx

[Diana & Sharky]

Vally, what a sad club we’re all in! I think I had a sympathy heart attack when I saw 10kg but I believed it. (not that 1kg off a 8.5kg dog is any better!) My dog has visible cheekbones right now – and I had no idea dogs even had cheekbones.

Not only that, but I’ve gotten used to how emaciated he looks… I’ve been pouring over this site for the past few weeks but what inspired me to make this topic is that my husband visited his hometown for two weeks. When he returned and saw Sharky he was shocked by his weight loss. I think I spend so much time with Sharky I lose sight of what is “normal” – so while I feel he can survive this skeletal state, I want to keep perspective.

Sheena, THANK YOU! Will not phase out the azathioprine. My vet has dealt with a few cases before but of course, I wonder if she’s read as much as I have :). I’ve been looking at Dr. Dodds work and I’m following her liver cleansing diet – I boil cod for the main protein and let me tell you, the kitchen and fridge smell horrible. Well, I’m willing to do anything that will aid my dog in his fight.

[Vally]

Diana, I suddenly realised Bingo had a skull. Same as your husband, my nephew couldn’t believe how bad Bingo looked at the very beginning. He could hardly walk as he’d lost all the muscle in his back legs. Month later, he told me he really though Bingo had no hope – to be honest I also had little hope. I hadn’t met anyone here at that stage. It was Bingo’s specialist that said to give him a chance. I love this guy!!!

I’ll bet Sharky loves the smell of your stinky kitchen and fridge – yes we put up with a lot.

Don’t forget to take care of yourself too. It is so very draining.

What was Sharky’s last PCV result?

Any serious issues, do a consult with Dr Dodds. She’s an amazing lady. Her fees are very reasonable and once you’ve lodged a consult, she responds very quickly and then if you have any more queries, you just respond her to email. So, basically, it’s a one-off fee for expert advice. She happily consults with other vets too.

Vally & Bingo
xxx