Rocky — IMHA, day 16 – Page 2 – Second Chance AIHA Dogs

Keymaster

Lauren,
I am so sorry to read about Rocky. I am glad you have found a good vet and that the treatment protocol is perfect! You can help a lot at home by making sure the medications and supplements are given properly and that the food he gets is easy to digest.

I do recommend the use of Denamarin and used it with Chance. It is a pharmaceutical grade veterinary supplement made by Nutrimax. There are two ingredients. The first is Sam-e, a natural substance that helps the liver cells recover from the damage caused by processing prednisone. The other is silybin which is the active part of an extract from milk thistle, known as silymarin. This helps reduce oxidative stress in the liver. At one point Chance’s liver enzymes were close to 10x the normal values. His liver was very unhappy and it made him very uncomfortable. Denamarin quickly brought those numbers down to very near normal. You will see this on the chemical screen tests as alanine transaminase (ALT) and Alkaline phosphatase (ALP, ALKP.)

Use caution when giving any of these supplements so that they don’t conflict with the medications you are giving.

Pepcid and other acid protection should be given about an hour before a meal. Prednisone should always be given with the meal, not on an empty stomach. That alone helps protect the stomach.

Sucralfate is literally a bandage that coats, so it can block absorption of nutrients and medications. I found the best time to give it was on an overnight fast. But put at least one hour before meals/meds and two or three hour after dosing meds and food.

Atopica (cyclosporine) needs to be given on an empty stomach for best absorption. It can have a side effect of nausea and diarrhea in the first week. You could try giving it with food during this time until Rocky adjusts to it, that usually helps significantly. Then once he is adjusted switch to giving on an empty stomach.

Denamarin, because it contains Sam-e, should be given on an empty stomach, at least one hour before feeding, because food decreases the absorption.

Trying to juggle all these meds is tricky. Mark works days and I work nights so we were able to dose Chance with all his meds around the clock very easily. If you both work the same schedule it becomes tougher. Asking a family member or good neighbor to help can make things run smoothly. We made up a chart so we could check off when a med was given.

Keep a notebook in the kitchen and jot everything down each day, all the meds, dosages and times and details like how much food he ate, how did he feel, did he take a walk, do his business. My little book was invaluable and I still have it where I can look at it now and then, 7 years later, just to remind me how hard this was but how successful we were treating him. Chance’s progress is carefully marked in detail. On one page I write that Chance actually walked all the way across the school field to the playground that night! It was the first time he had been able to do that in months. I noticed as he got much better we got sloppy and didn’t always enter on a daily basis. A sign that he had improved so much we no longer worried about him recovering.

What you will be doing at home is good nursing care, making sure he gets his medications and nutritious easy to digest food. Lots of fresh water. A quiet environment and plenty of rest. Prednisone will make him feel very hot so put up some small fans on the floor with a folded blanket so he can cool off. When his liver begins to become enlarged from the prednisone he may not want to be on soft surfaces like the couch or bed and will seek out these cooler hard surfaces. But the folded blanket will protect his elbows. Chance’s elbows became raw from the prednisone.

He is going to be peeing all the time. We got to the point that we would sleep on the couch so we could get him out around the clock. I would get home at 1am and relieve Mark on the couch. If your dog is house trained, he will feel awful if he can’t help himself and pees in the house, make a special effort to get him out often.

He may not want to take a walk, but be sure to spend the same amount of time with him each day that you normally would spend on the walk. I would go through the routine of putting on his collar, getting the leash and then Chance and I would make it to the end of the driveway and then sit there watching the world go by. I tried in every way to make sure he thought that life was perfectly normal. There were times when he justed wanted to be left alone and I honored that. This disease and the drugs can make a dog feel uncomfortable.

With good care, he recovered. I have seen this happen many hundreds of times with other owners and their dogs since Chance was ill . The nursing care is what makes the difference. I see the same thing happening for Rocky, you are good owners and you have done all the right things.
my best
patrice

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