New to AIHA, dog in trouble

[admin]

Hi Rick

What a relief for you to see Brandy feeling better in herself & the less haemolysis news is excellent too. I expect you know the spherocytes are red cells that have been “bitten”, so they lose their bi-concave shape due to the damage to their outer layer. A reduction in the number of these would be a good sign, as well as the ghost cells (red cell membrane that is left complete or intact after haemolysis). These things will gradually diminish with the drug treatment, which looks great to me by the way. I am glad everything else looks normal on the ultrasound too. Did you manage to find out any information on reticulocyte numbers?

When she is home & eating properly again, I would highly recommend adding the supplements & milk thistle that many of the others have suggested after discussing this with your vet. Rest assured they are all recommended by other vets to prevent raised liver enzymes (drug side effects that have to be dealt with) & to provide much needed building blocks for the red cells.

The 4Dx sounds like the Snap test you have over there to test for various tick diseases, so again they are covering all the angles. I wish we had that test here – it would have helped Worzel get a diagnosis much faster. It’s really frustrating when the cause is difficult to find. Sometimes, we never do find out exactly what triggered the AIHA.

Hoping for even more good news on Brandy very soon – maybe you can sleep easier now you know she’s feeling better.
Hugs to Brandy & our best wishes to you
Sheena, Worzel & Ollie xxx

[Rick]

Hi Sheena,
Reticulocyte count 30%
Rick

[admin]

Hi Rick
I like the 30% – regenerative response to anaemia – thanks for letting us know. Hoping Brandy is improving again today
Sheena

[Rick]

Brandy had another good night, and her PCV went up another couple points. They have transitioned her to oral meds in preparation for coming home, hopefully tonight(!!)

I guess we now move to phase 2 – recovery, and I have a bunch of questions. I will ask her doctor most/all of these questions tonight, but would also like the benefit of your experience.

1. What rate should she have CBC tests?
2. Any tips or tricks on how to get her eating pills? She can’t have anything high fat or high protein so Peanut Butter is out, for example.
3. Prednisone or Prednisilone? She was on Prednisone but moved to Prednisilone. I understand that Prednisilone doesn’t need to be processed by the liver ??
4. How often will she have to pee? Do I need to sleep at the back door to let her out every hour, for example?
Has anyone been successful with getting them to use a litter box?
5. Supplements. I noted references to supplements, especially to protect the liver, but was unable to find details. What should she get?
6. What is the indication that she can start reducing Pred, and what rate should it be reduced?
(I’m probably getting ahead of us, but I am concerned about the high dose Pred affecting her Addison’s).

Thanks again,
Rick

[Hope]

Hi there Rick and Brandy!

Excellent news about Brandy’s PCV going up — fingers crossed she can get home tonight. I know both of you will be much happier/more peaceful..and personally I think it’s important for recovery.
I am nowhere near the information and brains that everyone else has but I can help as much as I know with Steve’s experience:
2. She cant have protein at all or just not purine (ie meat) protein? Steve is a dalmatian and is thus prone to urate bladder stones.. He’s actually got 2 now we are trying to keep out the way. Basically any meat protein turns into stones for him.. He has to be on a low purine diet but he can have all the peanut butter he wants bc it’s a low purine protein. He also can’t have pill pockets bc those have yeast and yeast is high purine. I don’t know how picky of an eater brandy is but Steve’s appetite is voracious on the Pred. I usually tuck his pills into a piece of string cheese or a strawberry and he seriously doesn’t even chew. If you come across something else please let me know bc I’m always trying to figure this out myself.
4. When Steve first came home he was on 80mg Pred (40mg BID), and he peed constantly, including in the bed..he’s a terribly spoiled bed sleeper. I had to take him out every 1.5-2 hours to prevent accidents. It’s gotten better since he’s gone down to 15mg BID but I also take him out every 2-3 hours.
With pred reductions, everyone has taught me LOW and SLOW. No more than 25-30% tops at a time and I think they are supposed to be stable on each dose a month before you decrease. Unless the side effects warrant faster reduction.
Hope this helps a little!
Hope

[admin]

Hi Rick
Wonderful news that Brandy is getting better – I bet you can’t wait to get her home & her brother will be ecstatic to see her too!
1. “What rate should she have CBC tests?” – Every 3 or 4 days until the PCV is within normal limits. Then once per week. Any less than this, you will find yourself worried sick over the slightest thing! If you think her gums look paler or are worried in any way, get an immediate check to put your mind at rest. Gum checks should be done when dogs are active, not when they’ve just woken up as their spleen acts like a storage bag for blood when they are resting. The spleen will expel blood when activity is taking place and gums will be more pink.
2. “Any tips or tricks on how to get her eating pills? She can’t have anything high fat or high protein so Peanut Butter is out, for example.”- I’m afraid I popped them down Worzel’s throat by hand because then I knew then that he had taken them properly, but he is the easiest dog in the world to give pills to. Other people have used “pill pockets” but they may not be suitable for Brandy’s diet. Hope someone else can suggest other ideas. There are some drugs that must be given without food, some with food & some not within 1 or 2 hours of other medications. Looking at the current meds:
Prednisone/prednisilone can be given with food
Cyclosporine must EITHER always be given with food (many people find it doesn’t upset their tummy so much that way) OR NEVER given with food. Whichever method you choose, you must stick with that to maintain the same amount of the drug in the bloodstream.
Pantaprazole is a tummy protector (PPI) & must be given at least one hour, preferably two hours away from any other drug & food
Sulcralfate – tummy protector – very important to give 2 hours away from anu other drug &/or food
Ondansetron prevents nausea & vomiting – I would imagine this will be stopped before she comes home, but if not, please ask the vet about dosing.
Metoclopromide – another anti-nausea drug – vet will advise you when to give it, but usually given half an hour before food to prevent vomiting & nausea.
Plavix – as advised by your vet.
Vally has a pill chart you can use – I know she would be delighted to send you a copy if you would like one.
3. Prednisone or Prednisilone? She was on Prednisone but moved to Prednisilone. I understand that Prednisilone doesn’t need to be processed by the liver ?? You are spot on – prednisone is converted by the liver into prednisolone.
4. How often will she have to pee? Do I need to sleep at the back door to let her out every hour, for example?- We all have to put up with more frequent toilet visits. Some dogs cope better than others, but it really shouldn’t be that often. I reckon Worzel went out 2 times extra during the night, maybe every 3 or 4 hours to start with. Please make sure that Brandy has plenty of drinking water available – dehydration is a risk & would make her more ill, so you need to encourage her to drink plenty.
“Has anyone been successful with getting them to use a litter box?” – Can’t answer that as I didn’t try it!
5. “Supplements. I noted references to supplements, especially to protect the liver, but was unable to find details. What should she get?” – Others are more familiar with what is available in the US than I am. Milk thistle is vital for liver protection as it prevents liver enzymes from increasing, which is a common side effects of the pred. Iron supplements are also recommended to help to provide the building blocks for red cells. Please take advice from others on which products are best in the US – I have seen Denmarin, PetTinic, SamE & slippery elm mentioned. Good quality products is always the key to avoiding contaminants such as heavy metals.
6. “What is the indication that she can start reducing Pred, and what rate should it be reduced?” – I would personally never advise a reduction in pred before 3 or 4 weeks of having a stable PCV in the normal range when haemolysis has occured, and then only a 20%-25% reduction per month UNLESS there is a clinical reason for a faster or slower reduction. In light of Brandy’s adrenal gland history, this really needs to be discussed thoroughly with your vet. You may have to go against convention here because of the Addisons – I am not a vet & would rather your vet advised you. My gut instinct tells me more slowly than the “norm” though because of her history. Please also read our glossary item on prednisone which explains exactly why this has to be done so carefully. You will see that not all dogs can come off the pred completely – this is no big deal – some will always need a small maintenance dose & they do just fine.
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/

Other information is available in our glossary terms that you will find useful including:
https://www.secondchanceaihadogs.com/AIHA_Terms/cyclosporine/

Hoping this answers some of your questions. Looking forward to hearing that Brandy is able to come home – sending you all our very best wishes,

Sheena, Worzel & Ollie

[admin]

Rick – it looks like Denmarin is the best choice from reading Hope’s question on supplements just now – I would always go with Patrice’s suggestions as she has great knowledge.
Sheena

[Patrice]

Nutrimax had a really good explanation about Denamarin and there are some good videos on the side about how the liver works.

http://www.nutramaxlabs.com/dog/dog-liver-health/denamarin-for-dogs