New to IMHA, help with diarrhea and vomiting

Shay

Guest

Hello,

Five weeks ago today, Addy, my 11.5yo Australian shepherd/German short-haired pointer/lab mix, was diagnosed with IMHA. It’s been an emotional rollercoaster, but I’m happy (and lucky) to say that she has improved bit by bit each week. I would be happy to go into more detail about her story in a reply to this post but just want to briefly summarize where we are at today and ask for your advice on how I should treat the diarrhea and vomiting she’s been experiencing.

Addy has been seeing an internal medicine specialist since her diagnosis. Her PCV has been stable around 35-36 for the past 3.5 weeks, but unfortunately, according to last week’s blood work, she is still showing signs of hemolysis with spherocytes in her blood. We will check her blood again in about a week and if she still has spherocytes, will probably have to add another immunosuppressant to her regiment.

Her liver enzymes are high (I don’t have the exact numbers right now). She was on denamarin for several months prior to the IMHA diagnosis and has been back on it for the past week. Her bilirubin is also very high and measured 3.7 one week ago (although that is much better than the 33 it was 4 weeks ago when we took her home from the hospital).

Five weeks ago, she was a healthy 50 lb dog. When we took her home from the hospital 4 weeks ago, she was really swollen and weighed 58 lbs. At her last weigh in one week ago, she was 39 lbs. Getting her appetite back has been a struggle, and I have had to syringe feed her until this past week when she started eating better on her own.

She is currently taking 100mg of cyclosporine (stored in the freezer) 2x per day, 30mg of prednisone (20mg in the morning, 10mg at night), 20mg of omeprazole 2x per day, and 34.5mg of clopidogrel at night.

She has done two rounds of metronidazole, the most recent of which finished 3 days ago, for previous bouts of diarrhea. I expressed concern about the potential for interaction between the metronidazole and cyclosporine to her vet, but he assured me that it had been okay in other dogs that he had treated.

Overall, the past week has been positive. Addy had been eating more on her own and was finally exceeding her caloric requirements. Additionally, her bowel movements were formed more often.

However, yesterday morning, a few hours after a small but normal bowel movement, she started having diarrhea again. She has gone about 10x in the past 36 hours and about 1.5 hours ago most recently. For the most part yesterday, I withheld food save some chicken and white rice a few times. This morning, I gave her about 1oz boiled chicken with about 1/4c white rice with her prednisone, and she threw everything up about an hour later.

Aside from the diarrhea, she had been acting normal yesterday with good energy and she was acting hungry all afternoon and evening, begging for food. She was the same this morning, but has been resting this afternoon. She isn’t acting lethargic as she’s still alert and interested in her surroundings, just a little tired.

Any ideas? I don’t think that she has ever had white rice on its own so that could explain the vomiting, but I’m not sure. I hate to withhold food since she has lost so much weight but also don’t want to aggravate her GI tract right now. I called and left a message for her doctor earlier today but have yet to hear back.

Any advice would be greatly appreciated. This whole experience has been such an isolating and difficult ordeal. It’s nice to know that there are people out there who are willing to share their experience and advice.

Thank you!

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