Opinions on treatment and weaning off too fast

IvansMommy

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My dog, Ivan, is a 15 year old Rat Terrier (20 lbs). Last month he was diagnosed with a small epulis on his lower gumline. He also has a large bladder stone, which has gone asymptomatic after herbal treatment.
On May 27, 2015, we went for a walk. My neighbors had recently used Chemlawn service. About an hour after returning home, I noticed all of Ivan’s gums were bleeding. The epulis was inflamed and bloody. He had petechiae all inside his mouth and beginning on his abdomen. Poop was dark and appeared to have blood.
Vet ran blood tests, tick panel, fecal occult blood, lung xray. Started him on doxycycline.
The next day, his numbers came in very low (platelets 12, lymphocytes low, high urea nitrogen, high Alk phosphatase, high NRBC). He was started on 15 mg prednisone 2x daily and 1/4 tab azathioprine 1x day. He was already on pepcid due to chronic gastritis. Added sweet potato to his homemade diet to protect his stomach.
He had a couple rough days with pale gums, lethargy, decreased appetite. Platelets had dropped to 5. Tick panel all negative, but found a fully engorged nymph deer tick on him. Decided to continue doxycycline at half dose, just in case.
Re-checks every few days after revealed his platelet count going up to 56 (or more like 100 with clumping) , poop normal, petechiae disappearing, gums all good, epulis shrunken to half it’s size and zero redness. RBC, which had been normal initially is now 4.6. Yesterday’s cbc showed platelets at 500 and liver being affected. Vet wants his prednisone dosage dropped from 30mg/day to 5 mg/day. At first she wanted the azathioprine switched to every other day, too, but changed her mind.
I’m concerned that this is too fast. She isn’t weaning him down slowly and everything I’ve read said that can cause relapse or other side effects. That most dogs are on these medications for months and wean off over months as well.
I decided to drop from 15 to 10mg at last dose, then I’ll go to 5mg. I will be starting him on Milk Thistle today to protect his liver.
My vet is busy now, and I’m sure she hates that I keep calling and second guessing her, but this is my baby. I’m not even sure how much experience this vet has with AIHA or the outcomes of her previous patients.
What I need is opinions from parents who’ve dealt with this disease. Doctors don’t know everything. We know our dogs the best. What was your treatment plan, results, weaning schedule? What worked or did not? Anyone else’s dog respond so much, so quickly, to treatment? I’m scared to death of making a mistake and risking his life. Emergency care and transfusions run about $3500-$5000 each here. I have 21 other animals to care for so I can’t afford a ridiculously high bill on top of what’s already been paid. Thank you.

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Keymaster

Hi Ivan’s Mum!

Lovely that you have joined us – if you have 21 other animals, you must be a real softie – what others do you have? We’d love to hear about them.

I couldn’t agree more with Brigitte, Lynn & Vally – take the reductions slowly & carefully. You can read more about prednisone here:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/
and how to reduce it safely here:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/
I’d just like to emphasise how important taking the dose down slowly is – relapses are no fun & it is much better to do the right thing so Ivan recovers properly. We also normally recommend getting them off the prednisone completely before reducing the other immuno-suppressant drug(s) (in your case, the azathioprine) & to get regular PCV checks – it’s usually much better that way.

Could I also recommend getting Ivan’s amylase levels checked each time too. Azathioprine can cause pancreatitis & a raised amylase level can be a “first” indicator of that. My dog Worzel was on azathioprine (still has one per week) & my specialist said we must do this at every check up to make sure he wasn’t having a problem. I think it’s very important with smaller dogs to do this too.

Again, I agree with the denamarin – it is great for liver protection & provides red cell building blocks. If you are using milk thistle & Sam-E separately, here is a site which you can work out the milk thistle dosage from:
http://www.canine-epilepsy-guardian-angels.com/milk_thistle.htm
It says use 20% of the human dose for a 20lb dog. There are also other recommendations there which are helpful.
Here is the manufacturer’s site for Sam-E complete with dosages:
http://www.nutralifepet.com/sam-e-for-pets

I must also say that having a specialist who has experience of this disease is very important. I was lucky to find someone here in France who trained at Cornell University so his being able to speak English was a big help too! I would recommend you find someone who knows their stuff. If you are unable to do that, we have a link on here to the wonderful Dr Dodds of Hemopet who many of us have consulted. She is wonderful, kind, highly experienced & very qualified. You can find her under our heading Hemopet resources
https://www.secondchanceaihadogs.com/hemopetresources/
and you can do an online consultation with her using the form you can see bottom left. Her fees are very reasonable & you will only pay the $100 consultation fee to start with, then there are usually no further consultation charges. Hemopet is a charity too – that makes it doubly nice to use her as it helps with the greyhound rehoming. If you use her lab, obviously there would be charges for that kind of thing, but most of the tests can be done by your own vet anyway.

Ivan sounds like a real cutie – give him a hug from me. Hope we have helped a little. Ask anything – we are all here to help.

Love Sheena, Worzel (diagnosed Dec 2012, in remission) & his friend Ollie xxxxx

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