Pred/Atopica not working anymore

[admin]

Hi Mike. So dog-gone thrilled that Lola is doing better and better!!! Awesome news to read!! Sadie will definitely be on a low dose of immune suppressant too. As she had a bit of a rough time with the Atopica (cyclosporine), she will most likely be on a low dose of prednisone. We’ll see.

I wanted to add to you too, as I did earlier to another post today, that I use Nutrimax’s Crananidin for dogs, which is a cranberry supplement. After checking her urine and being sure it was not an infection, and if I caught the tall-tale sign of being a bit off (dark color, thicker, her cleaning herself a lot – she never licks, unless this is happening), I would start the Crananidin, 1 tablet a day for about 10 days and then maintenance for another few weeks. Some people use it daily. And Sadie thinks it’s candy! Loves the taste. But ask your vet and/or Dr. Dodds.

Sadie too, as many others here, had her share of “accidents” when on the high doses of immune suppressants (50mg Atopica, 40mg prednisone). It was so sad. She too, never had accidents pre-AIHA. Her accidents were always by the front door, as if she was trying to be there as soon as the door would open, but just didn’t happen in time. I could not leave her for more than a few hours. Pre-AIHA, she was used to going 6-8 hours, although I didn’t ever do that, but she could, if necessary. When she started to have the accident, she would be so embarrassed and tuck her little head in shame. I never got mad. She would sit by me so sweet while I mopped it up and disinfected the floor. I didn’t want to stress her out – poor little gal. I’m sure you’re the same with Lola. As much as I love wood floors – thank goodness for tile!

So glad you’re using the Pet Tinic!! I am such a huge advocate for it too. Another maintenance for Sadie forever!!!

Our love and hugs to you and Lola. Keep up the fantastic job!!! xoxoxo Linda and Sadie

[Mike Chen]

Hi folks,

It’s been almost three weeks since I’ve updated. They’ve been a quiet three weeks, which is good news (and work has been super busy)!

Last Tuesday, she went in for another PCV check. That was the one month mark for her 30mg pred dosage w/ Pet Tinic and 12.5mg aza EOD. It was at 32, so basically going up at the exact pace as the first two weeks at 30mg.

A recap of her meds/PCV:

Starting point: PCV held steady at two weeks at the 15-17 range at 40mg pred, tapered off atopica completely and tapered down aza (in case they were suppressing bone marrow).

Week 1 – Added Pet Tinic: PCV went up to 21 (+4).
Week 2 & 3 – Lowered pred to 30mg: PCV went up to 27 (+6)
Week 4 & 5 – Held steady: PCV went up to 32 (+5)

Lola is down to 20mg pred and due for a PCV check tomorrow. Our doc said she’s inclined to keep her on this for possibly a month before even thinking of starting the taper and looking at other meds.

We did a CBC before adding the Pet Tinic and after; one week after, her bone marrow regeneration went from none to active and she started responding to the pred again. I don’t know how this will go long term again but it does seem like the Pet Tinic provided her bone marrow with the support it needed to get going.

I’ll post tomorrow after a new PCV check. Fingers crossed.

One question — I know the vet said that PCV checks typically have a tolerance of +/- 2. Given that, it seems like her PCV is moving up at a steady slope. Does PCV increase typically directly correlate to the amount of pred given? Or is it just that the pred is an on/off switch and the PCV does its own thing once the immune system is on the “off” position?

Thanks again for your support!

[admin]

Looking REALLY good Mike – I bet you are thrilled at Lola’s improvement. I hope she is feeling much better & getting back to her usual self.

My opinion is that the aza reduction & Pet Tinic have helped. Without the “building blocks” for making blood cells such as folate & Vit B12, you will get little or no improvement. It is extremely rare for pred to suppress bone marrow in humans except in the elderly – I can’t find anything to say it’s any different in dogs. Aza is far more well known as a bone marrow suppressant. A simplified view – prednisone stops red cell destruction (haemolysis) and destruction of other cells too by suppressing the action of T-lymphocytes which have “accidentally” targeted the body’s own cells. Azathioprine does this too – it takes longer to do this & can definitely suppress the bone marrow. Bone marrow failure can also occur as an immune-mediated response (as in Worzel’s case) & the pred & aza can actually help stop this happening. Does this help at all?

Atopica does not normally suppress the bone marrow; that is why it is used in preference to aza by many vets these days. However, it did work well for Worzel. His improvement in PCV was directly correlated to the aza dose being lowered. Every month we lowered it & his PCV went up. I offered to send you a spread sheet which shows that. You can also see a huge improvement in his haemoglobin level with the folate supplement – haemoglobin level is also very important. We reduced the pred to zero before starting the aza reduction & I saw very little difference in PCV with the pred reduction, so you are right to take it slowly. I appreciate Lola’s scenario is different from Worzel, but the trends seem to have been the same for many of us on here.

We all need to be very aware that dogs that are unable to absorb the essential nutrients from their food because of any kind of malabsorption problems are in the same position – poor PCV/haemoglobin, so will always need extra help from supplements like Denamarin & even B12 injections & antibiotics, pre/probiotics to get the gut bacteria back to normal.

PCV can even vary up to a difference of 4 or 5 with changes in pred – that is not uncommon. It also depends on their level of hydration/dehydration. So a small difference is nothing to worry about – a recheck in a few days is the easiest way to put our minds at rest! In my nursing (& personal) experience, pred always has some effect, even at low doses. That is why some dogs need to take a low dose forever. No big deal if that happens as long as their are well & happy.

Fingers crossed for a good result tomorrow!

Sheena

[Claudia]

Hello everyone, I am a very sad mom of a 12.7 yo male Schnauzer. Back in August 2018 he was diagnosed with mild anemia, blood level at 36 and then I started cooking liver thinking it would help him.
In December 5, I went for a checkup, his level was at 30… started Atopica 100 mg x 2 per day and prednisone at 20 mg per day—he weights 16.5 kg.
Bone marrow aspiration came inconclusive…first doctor talked about leukemia, then myelofibrosis, bone marrow necropsis…and AIHA non regenerative, still quoting macrocytes…
On Dec. 13, blood level went to 24, we started treatment on that day, next check up it jumped to 30, following was at 24, then 22, 21, 18..
We started treatment on Dec. 13 and it was yesterday at 18…retyculites were up always on range between 1.3 to 1.7…only once at 1…seems that bone marrow is not responding.
Yesterday after we were told that his level was at 18, we were given the option of transfusion…this time the ER doctor was very clear and stated that his disease has no cure and is non-regenerative anemia. After she also informed us that blood level could go up between 3-4 points and having a history of dropping levels around that level, she foresaw us returning after a week—for a second transfusion which is more dangerous than the first.
We opted out if the transfusion and brought him home. Still, after reading your posts, I wonder if there is anything that was missing…maybe Atopica suppressed his bone marrow too much? Although they did a test for cyclospirone level and was correct level.
I am injecting him B12… feed him organic dry food no grains…
what am I missing? I am running against time now and I need help… if anyone could help me out, will be extremely grateful.
Thanks,
Claudia

[Vally]

Claudia, I’m so sorry to read this. What drugs are you using right now?

Is he on any thyroxine? I would ask to introduce that into the regime. It needs to be given at least 1 hour before meals or 2 hours after. Thyroxine can help the marrow to produce red blood cells, even if he is not hypothyroid aren’t low. It has helped a lot of our dogs and it’s in Jean Dodd’s protocol to treat AIHA. That’s the first thing I thought of.

Also timing of drug dosing is important. Prednisone always with food, Atopica without food.

The automatic emails when someone responds isn’t working just now which alerts us to posts on the site, so I’ll keep popping in to check.

Vally