Pred/Atopica not working anymore

Keymaster

Hi Mike,

I’m sorry you’re here looking for answers because I know you’ll be very worried about Lola. There are some wonderful people here so I hope you’ll feel very welcome. We all want to do whatever we can to help you and Lola.

Some of the clever ones will be on soon I’m sure. Can you just go over again what is Lola taking now. I understand Lola is still taking pred 40mg (is that 20mg twice a day?), 100mg atopica (once a day?). What about the aza Is she still taking that?

Also does she take anything else? What about thyroxine? Sometimes, adding in some thyroxine helps to get the marrow producing again. Has her thyroid been tested?

I’m sorry there’ll probably be a lot of questions.

If you have a copy of the blood tests, you can use the Urgent Advice at the top to attach them and they’ll be emailed to the administrators. Patrice, Sheena and Mary are all very clever at understanding them and will be able to help you to understand what is happening. You can also just type them into a note here if you like.

I would also recommend you run all this past Dr Jean Dodds. She’s a wonderful lady who is an expert in thyroid and the immune system. She has helped many of us here and can really help when there’s a problem. You can do an online consultation and attach blood tests (it only seems to accept a 1 page attachment, so I scanned my tests together before attaching it to the consult request) (there is a $100 fee for a consult, but it is merely a donation to help with her work). If you’re vet is open to contacting her that would be marvelous. I’ve posted the link if you’d like to go that way:
https://labordatenbank.com/cake/hemopet/onlineorders/hemopet_add

As to the atopica being the problem, it’s always possible. Whilst there is a protocol for the treatment, each dog really reacts differently. I know some dogs do have tummy problems when they take it. Are you still giving it at the moment? It is supposed to be given away from food. At least 2 hours after food or 1 hour before food, however some dogs can’t tolerate it and it is given with a little food. How were you dosing Lola with it?

When will she be tested again? Actually with the +/-, I thought the allowable difference was more like 6 rather than 2. It can vary depending on how hydrated they are. The more hydrated they are the lower the PCV will be. The more dehydrated they are the higher the PCV.

It’s possible that once Lola is stable again, she may need to stay on prednisone. Some dogs can’t come off it totally. My Bingo is one of them. He still takes 1.25mg daily and he’s most like going to stay there.

My very best,
Vally & Bingo (diag Nov 2011 – in remission).

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Keymaster

Hi Mike

I’m glad you’ve found us – this is really worrying for you, I know. Lola is definitely a case for Dr Dodds. I completely agree with Vally – this is your number one priority – she has tremendous insight into this disease & is always delighted to work alongside your existing vet, using the internet for consultations. It’s a real shame that things were progressing so well, but she has started to fall again – I’m so sorry – it’s rotten for poor Lola.

I have a couple of ideas. Has Lola been tested for Vitamin B12 or folate? There is a possibility that she doesn’t have enough “building blocks” available for making new red cells. This is not uncommon, so don’t worry. I agree with Vally about the thyroxine (saloxine for dogs) – it makes a lot of difference to many dogs because it encourages red cell production & is part of Dr Dodds treatment protocol. She may also need to be on a low dose of pred forever – again, nothing to worry – we have many people on here in the same position.

Do you know what caused the initial IMHA attack? I know that it’s not always possible to find the trigger, but is it possible something has happened again? I presume she doesn’t get vaccinated – vaccines can trigger IMHA. Is there any way she could have had a tick bite? Again, tick diseases are a common trigger. Did she have any pre-existing health problems?

Do you know if a blood smear has been done? If you have any tests results at all, please feel free to send them via the urgent advice link: https://www.secondchanceaihadogs.com/urgent-advice/
It might give us some idea of what has happened along the way. Also a full list of medications & another other information you can think of that may possibly be relevant.

I personally found that my dog Worzel’s PCV started to rise even more after when we slowly (over 12 months) reduced the azathioprine. It can act as a bone marrow suppressant in the long term, even though it was a wonder drug for Worzel, getting him regenerative in about 2 weeks. I am presuming Lola is still on the azathioprine? I am not saying you should stop it by any means, but I would discuss this possible side effect with your vet & Dr Dodds to see what they think. The atopica might take a bit longer to kick in. I have no personal experience with this, but I know others have had to be patient. In the meantime, the pred should be starting to keep her stable.

Dr Dodds would say that around the PCV/HCT mark of 15 is the limit for transfusions, but it depends on how ill the dog is, of course. Small transfusion that don’t take Lola over the PCV of 25 mark are advised. Hemopet provides every kind of blood product, by the way, so your get can source it there of Lola needs it. Splenectomy is a very last resort option & I would never consider it myself unless the spleen is actually diseased. Is her spleen enlarged at all? The spleen’s job is to deal with any abnormal red cells (and various other things). Have they done any ultrasounds at all? Sorry to ask so many questions!!!

Has Lola been tested for abnormal clotting at all? This is very important as she may need anti-clotting medication – please see
https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/

There is a wonderful product called Denamarin which we all use or have used to protect our dogs from the effects of the drugs, especially the liver, as these drugs raise liver enzymes. I would definitely recommend you add some to Lola’s medicines. Also, is she on any tummy protectant? These drugs are very harsh on the stomach & intestines, can cause ulceration & add to the problems. The usual (preferred) drugs used are famotidine & sucralfate. They must be given 2 hours apart from any other medications otherwise they can prevent absorption. I mentioned B12 & folate earlier because some dogs get bad tummies & are unable to absorb enough of these things, so may need help with supplements. These supplements should only be given under veterinary advice as they can actually cause more harm than good if they are not needed.

One last thing – kidneys – does Lola have any problems at all? Kidneys monitor oxygenation in the blood & produce something called hematopoeitin (also called hemopoeitin) which stimulates red blood cell production. If the kidneys are compromised, they may not produce enough of this hormone.

Now I have questioned you into the ground, I will leave you in peace! I hope we have helped & can continue to help. You best port of call is Dr Dodds, I promise. She is incredible & a very lovely person too.

Best wishes
Sheena, Worzel & Ollie x

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Keymaster

Hi Mike. I am so sorry you are going through this with your precious little gal, Lola. You will find this site to be accurate and knowledgeable. And I know I can say this for all of us – we are glad you found this forum, although sorry for the reason why, of course. Please feel free to ask your questions and post your concerns, no matter how trivial you think they might be – it ALL adds up.

You have already gotten some really great advice and asked some very important questions. It is wonderful that we are world-wide so someone is always checking. Sorry for all the questions, it’s necessary though. I can tell you from experience, I was like a deer in the headlights – had not a clue what was going on when my 35 pound cocker spaniel, Sadie, was diagnosed with AIHA in 2009. This forum, these people, helped save Sadie’s life. I also had a wonderful vet AND Dr. Dodds on Sadie’s side too. Please, as both Sheena and Vally have said, e-mail Dr. Dodds – she always responds. She is our go-to guru – the most knowledgeable and caring vet anywhere. Along with her research and hectic practice, she still continually works with AIHA/IMHA pets and helps save lives. She is also one of the best with working WITH your vet and is most diplomatic. Your vet does sound like he/she is on the right track – that a huge hurdle in caring for this horrible disease.

I see Sheena has already asked about the THREE very important medications/supplements that are absolutely necessary when our pets are on such high doses of immune suppressants. Please be sure Lola is on ALL three of these: liver, tummy and anticlotting and taken at the appropriate times, as Sheena also mentioned.

Another ‘must have’ for Sadie and some of the other pets here, is PetTinic, which is a liquid vitamin-mineral supplement, containing Thiamine, Riboflavin, Niacin, Vitamin B6 and Vitamin B12. But PLEASE CHECK WITH DR. DODDS before adding this. She is actually the one that suggested it for Sadie years ago and Sadie is STILL on it. I only stopped once and with Sadie’s last relapse, her vet asked if I still had her on it. I had not, thinking it was no longer needed – wrong. We started back immediately and will have her on it for good. I typically buy it on-line, can run anywhere from $10.00 to $16.00 for a 4OZ bottle. Good stuff.

My girl, Sadie, has been through several relapses. The first time Sadie relapsed, as Sheena notes, was because she was weaned too fast. Sadie, as Lola, never really dipped to a horrible PCV at onset (21), but still collapsed in front of me and was so very scared, as I’m sure your Lola and you were too.

Our pups are about the same weight, I just wanted to mention that Sadie, at onset, was put on 40MG prednisone daily (20MG in AM, 20MG in PM), as Lola, and Atopica (cyclosporine) was added too, but only 50MG of Atopica. She rebounded quite fast and then the weaning was too quick and we were back to square one. She recently relapsed again October 2014, but we only put her on 20MG of prednisone and she, thank goodness, rebounds once more. Sadie has not ever been on Azathioprine.

I know the PCV up/down percentage is very scary. Sadie’s PCV bounces up and down. Not by a harrowing amount, but at times (especially recently) it will run between 2-8 points higher/lower. It did freak me out, due to her relapses, but I continue to test her PCV every 10 days. With that, as Vally said, some dogs will be on a ‘maintenance dose’ for their life, as her Bingo. Sadie will be one of those dogs too.

As Lola, Sadie’s PCV bounces up and down too. Not by a harrowing amount, but at times (especially recently) it will run between 2-8 points higher/lower. It did freak me out, due to her relapses, but I continue to test her PCV every 10 days. With that, as Vally said, some dogs will be on a ‘maintenance dose’ for their life, as her Bingo. Sadie will be one of those dogs too. Sorry, but it’s a wait and see.

You are here for the right reason, to help Lola. Please stay with us and let’s get Lola healthy again.

Love and hugs, Linda and Sadie

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