Staffie X Tiger Diagnosed with AIHA

[admin]

Hi Adam

I am sorry to hear about this scare you have had with Tiger’s PCV, although I am very glad it was “just” a scare and not an actual drop. Thankfully your specialist was on the ball and picked this up quickly. I totally agree with Patrice and Sheena though – the vet needs to get this sorted so that it doesn’t happen again, as Tiger’s treatment relies on accurate results.

How is the diarrhoea? From what I remember of my visit to Australia many moons ago, you guys eat pumpkin a lot so hopefully it’s easy to get there (it’s a nightmare to find in the UK). I do hope it’s eased up. I was a bit alarmed by the rapid decrease of medications, although I wonder if he has been on a loading dose as Patrice suggested, and if Patrice and your specialist are happy for you to lower it, then I’d go with that! My personal preference – and I am not a vet – would be to reduce one drug at a time. That way, if Tiger were to suffer a relapse, you would know which drug it was related to.

Re: freezing cyclosporine. If the manufacturer’s instructions say not to, I wouldn’t. It may only say this because it hasn’t been tested after freezing, but some medications are affected by extremes of temperature (e.g. vaccines) and therefore I wouldn’t risk it.

Re: skin lesions. Is the cefalexin helping? I’m not sure if you have it in Australia, but there is a liquid chlorhexidine surgical soap here called Hibiscrub which I have used on my cats. It cost a fortune from the vet, but I was able to buy it for half the price in a pharmacy. Do check it’s safe for dogs, but that might be one to consider. If not, I am sure there will be something similar there.

You are not needy Adam. I am not surprised you are feeling upset. You have had a huge shock and a lot to come to terms with in a short space of time, not to mention this latest blip with the results. I know that Tiger’s PCV is a little lower than it was before, but I think that this is not uncommon with a reduction in medication (others – please correct me if I am wrong!) and that sometimes a drop of a few percent is seen when meds are reduced. As others have said, see how Tiger is in himself. This is such an important indicator of what is going on. Some people use the “capillary refill time” as an indicator – press lightly on the gum with your finger for around 5 seconds and quickly release. It will be white where your finger was. The pink colour should return to that white area within 2 seconds. That’s a good little thing to try if you are feeling nervous.

As has been said, Tiger’s gums will look slightly paler when he has been resting. This is normal and healthy, as long as the colour improves once he starts moving around. I check Mable’s gums (a cat who has not had IMHA) and the same happens with her. She ended up having a PCV which was right at the top end of high. So you see, you are not needy. This disease affects us all and makes us a little paranoid. You are still in the thick of it and I think you are coping remarkably well. Have faith in yourself and please know that you are always welcome to come here and ask questions, or simply let us know you are having a difficult day. I promise we will understand.

Please give that beautiful boy a big cuddle from me. I can see why he is called Tiger! I hope you’ve managed to have a nice Easter and that Tiger is feeling well in himself.

Mary and Mable x

[Adam]

Hi Everyone,

Thanks for all your replies. It really gives me a lot of comfort knowing you are all there to help me with this.

I have some good news. Tigers new PCV reading today (taken at the specialist so we get no errored readings) was 34, 2 points higher. I think this is a good sign, seeing as we are more than 48 hrs into his reduced dosages. Tiger is more active and alert with every passing day. His appetite is good at the moment, eating two solid meals a day with some small picking between. The diarrhea seems to have stopped.

He hasn’t passed a bowel movement for more than 12 hrs now, which is a massive improvement from the multiple diarrhea poos he used to do a day.

He also seems to be drinking less water (he was drinking at least 3 full sized bow, but is still consistently weeing. I am hoping that is a good sign that his body might be reducing his tummy bloat and water weight, as his stomach has been huge for the past week, it seems to be coming down though.

His next test is on Wednesday. But I was wondering, how frequently should we be doing these tests after his next dosage drop?

Also, I noticed that alot of you mentioned that the tests for PCV you are doing are done using lasers? The only test Tiger has had to check PCV has been the spun blood test in the glass tube. These are what he gets every time.

Once again, thanks again to all of you, I really appreciate your comments and emails.

Love Adam and Tiger.

[Patrice]

Adam,
That is really super news! 34 is excellent, just a few points away from low normal: 38%. Nothing to worry about here.

Lowering the dose of prednisone has been responsible for reducing many negative side effects. They will still continue to exist until he has completely reduced and stopped the prednisone. He will have fat and fluid redistribution and there will be continued muscle wasting / atrophy. These account for the bloated tummy look and a general de-conditioning.

Lowering the dose of cyclosporine helped reduce the diarrhea. I think you can safely try giving this about 2 hours before a meal on an empty stomach now, which allows for maximum absorption.

Hmm. All clinics should be taking a full CBC complete blood count and chem screen to monitor his condition. This is always the first step in diagnosis. I am surprised they have not done this. It is really very important. Automated analyzers are used widely because they can not only perform the test quickly, they also provide a wide range of diagnostic information that used to be quite labor intensive to obtain.

I can’t image how you could make a mistake with a spun PCV. There is nothing to calibrate. It’s simply a small tube of blood, spun in a centrifuge, and held up against a chart. PCV’s were used, though spun by hand, in WWI during the later 2 years of the war on the battlefield when they began attempting transfusions!

A chemistry panel tests kidney function, liver function, electrolyte levels, glucose levels, pancreatic enzymes, etc. It tells us essentially how healthy he is. This is usually where we see the negative effects of prednisone, liver enzymes can be greatly increased for instance or there can be signs of it bothering the pancreas.

You can view a short introductory video on the CBC here:
https://www.secondchanceaihadogs.com/aiha-video-library/aiha-introductory-videos/

The CBC shows relationships between the variety of cell types in the blood. For instance an important value that is missed when you only monitor the PCV is the platelets. In autoimmune disease, these can also be low. I don’t think that is the case with Tiger but it would have been very important in the first few days to find that out. The CBC also provides values for the white blood cells, for instance looking for infection.

Here are the guidelines for reducing prednisone:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

It is usually wise to reduce only the prednisone for a period of time to begin getting rid of the annoying side effects, which are numerous. Some of these, like muscle wasting, will take months to recover from. But they eventually do go away!

Reducing the cyclosporine can follow once he has reached a clinically good HCT and has remained stable for a period of time. This drug has fewer side effects and these tend to go away very soon after discontinuing it, generally with no lasting effects.

We’ll be here to help you through these steps, don’t worry!

I’m so glad to hear he is more himself this week! Good work Dad!
my best
patrice

[Tamara]

Hi Adam, I am not current on your and Tiger’s story, I’m just dropping in and trying to catch up as I can. I wanted to comment on freezing cyclosporine though. I have been freezing cyclosporine for Ashki’s entire illness, it was recommended to me to reduce GI side effects. We did test cyclosporine levels as Ashki was not responding, and his levels were fine, so it seems that clinicians have discovered this trick of freezing to help with the GI effects and it doesn’t affect efficacy. I have heard from others on another forum who also freeze the cyclo, for what that’s worth. I just store it in the freezer.

Ashki did have an unusual (for dogs) side effect from the cyclo, of proteinuria (protein in the urine) which indicates compromised kidney function. We are hoping it will resolve as we continue to wean. We picked it up when we saw that his serum protein and albumin were dropping over time, and so did a urinalysis and urine protein/creatinine ratio to measure it. I had to change his diet and we added a med.

Best wishes to you and Tiger, I’m so happy to hear he’s at 34!

tamara and ashki

[admin]

Hey Adam!

There you go – Tiger is doing really well & you are already seeing the drug reduction having a great effect on the drinking etc. Such great news.

I always got a full CBC before & after each reduction – there are other cells to monitor & other readings which indicate how well the organs are coping. I couldn’t agree with Patrice more – this needs to be done to make sure everything is going to plan.

I won’t go on too much about the cyclosporine – I have posted a new topic already – but if I were you, I would not freeze it, full stop. It is always good to get input & ideas from other people – please don’t stop airing these things, folks.

Love to you & Tiger – you are doing a wonderful job, Adam.

Sheena, Worzel & Ollie xxxxx

[admin]

Hi Adam

I am so pleased to hear you got good news with Tiger’s results, and that he is feeling better and better in himself! That’s wonderful news and you must be thrilled.

Please give that handsome boy a cuddle from us. He’s doing so well :)

Mary and Mable x

[Adam]

Hi Everyone,

Tiger is doing really well :) he is eating well, active and happy at the moment. I take it as it comes each day with him, but safe to say I am relieved a little bit that we might be on the road to getting better.

His staph cysts have all gone down and healed, but he is currently on 600mg cephalexin 2x a day. I have enough left for 2 more days, should I be asking the vet for more of these?

Seeing as Tigers immunosupressive meds haven’t been tapered again, we will probably see the same infections come back again? I really want to avoid this, as they were definitely causing some discomfort for him.

Adam xx

[admin]

Hi Adam

I do think you are on the road a recovery with Tiger! He has done amazingly well. If the infected areas have completely healed & are no longer red or pink, my personal opinion is that Tiger will be fine after the next 2 days of cephalexin. Because this particular antibiotic is not “ideal” for IMHA dogs, it would probably be better to stop it. However, I think you should discuss this with your vet to be sure as I am only an ex-nurse, not a vet.

It goes without saying that the staph infection could easily come back, so you need to keep a close eye. Unfortunately, staph is a bacteria that is present on skins “naturally” – it’s usually only when the immune system has a problem that it rears it’s ugly head. It is really common to see staph infections with this disease, as you know – so if more pills are needed later on, so be it. Don’t worry if that happens.

I would also thoroughly wash Tiger’s bedding etc at the highest possible temperature – anything he could get it back from really. Bacteria are killed by soap – they go “pop” as it bursts their outer membrane. Satisfying to know you’ve killed the horrible little things! I also use chlorhexadine a lot – any sign of anything on my boys, they get some dabbed on the problem area. It is very cheap here if you buy the concentrate, then make it up yourself, which is easy.

Many dog shampoos are available that contain chlorhexadine – maybe discuss with your vet about giving Tiger a preventative shampooing regularly to stop the staph coming back. When the drugs are eventually reduced, you have less risk, as you quite rightly say.

Hope this helps – great job Adam – Tiger is doing so well, thanks to you.
Love Sheena, Worzel & Ollie xxxx

[admin]

Hi Adam

I am sorry to hear about this scare you have had with Tiger’s PCV, although I am very glad it was “just” a scare and not an actual drop. Thankfully your specialist was on the ball and picked this up quickly. I totally agree with Patrice and Sheena though – the vet needs to get this sorted so that it doesn’t happen again, as Tiger’s treatment relies on accurate results.

How is the diarrhoea? From what I remember of my visit to Australia many moons ago, you guys eat pumpkin a lot so hopefully it’s easy to get there (it’s a nightmare to find in the UK). I do hope it’s eased up. I was a bit alarmed by the rapid decrease of medications, although I wonder if he has been on a loading dose as Patrice suggested, and if Patrice and your specialist are happy for you to lower it, then I’d go with that! My personal preference – and I am not a vet – would be to reduce one drug at a time. That way, if Tiger were to suffer a relapse, you would know which drug it was related to.

Re: freezing cyclosporine. If the manufacturer’s instructions say not to, I wouldn’t. It may only say this because it hasn’t been tested after freezing, but some medications are affected by extremes of temperature (e.g. vaccines) and therefore I wouldn’t risk it.

Re: skin lesions. Is the cefalexin helping? I’m not sure if you have it in Australia, but there is a liquid chlorhexidine surgical soap here called Hibiscrub which I have used on my cats. It cost a fortune from the vet, but I was able to buy it for half the price in a pharmacy. Do check it’s safe for dogs, but that might be one to consider. If not, I am sure there will be something similar there.

You are not needy Adam. I am not surprised you are feeling upset. You have had a huge shock and a lot to come to terms with in a short space of time, not to mention this latest blip with the results. I know that Tiger’s PCV is a little lower than it was before, but I think that this is not uncommon with a reduction in medication (others – please correct me if I am wrong!) and that sometimes a drop of a few percent is seen when meds are reduced. As others have said, see how Tiger is in himself. This is such an important indicator of what is going on. Some people use the “capillary refill time” as an indicator – press lightly on the gum with your finger for around 5 seconds and quickly release. It will be white where your finger was. The pink colour should return to that white area within 2 seconds. That’s a good little thing to try if you are feeling nervous.

As has been said, Tiger’s gums will look slightly paler when he has been resting. This is normal and healthy, as long as the colour improves once he starts moving around. I check Mable’s gums (a cat who has not had IMHA) and the same happens with her. She ended up having a PCV which was right at the top end of high. So you see, you are not needy. This disease affects us all and makes us a little paranoid. You are still in the thick of it and I think you are coping remarkably well. Have faith in yourself and please know that you are always welcome to come here and ask questions, or simply let us know you are having a difficult day. I promise we will understand.

Please give that beautiful boy a big cuddle from me. I can see why he is called Tiger! I hope you’ve managed to have a nice Easter and that Tiger is feeling well in himself.

Mary and Mable x

[Adam]

Hi Everyone,

Thanks for all your replies. It really gives me a lot of comfort knowing you are all there to help me with this.

I have some good news. Tigers new PCV reading today (taken at the specialist so we get no errored readings) was 34, 2 points higher. I think this is a good sign, seeing as we are more than 48 hrs into his reduced dosages. Tiger is more active and alert with every passing day. His appetite is good at the moment, eating two solid meals a day with some small picking between. The diarrhea seems to have stopped.

He hasn’t passed a bowel movement for more than 12 hrs now, which is a massive improvement from the multiple diarrhea poos he used to do a day.

He also seems to be drinking less water (he was drinking at least 3 full sized bow, but is still consistently weeing. I am hoping that is a good sign that his body might be reducing his tummy bloat and water weight, as his stomach has been huge for the past week, it seems to be coming down though.

His next test is on Wednesday. But I was wondering, how frequently should we be doing these tests after his next dosage drop?

Also, I noticed that alot of you mentioned that the tests for PCV you are doing are done using lasers? The only test Tiger has had to check PCV has been the spun blood test in the glass tube. These are what he gets every time.

Once again, thanks again to all of you, I really appreciate your comments and emails.

Love Adam and Tiger.

[Patrice]

Adam,
That is really super news! 34 is excellent, just a few points away from low normal: 38%. Nothing to worry about here.

Lowering the dose of prednisone has been responsible for reducing many negative side effects. They will still continue to exist until he has completely reduced and stopped the prednisone. He will have fat and fluid redistribution and there will be continued muscle wasting / atrophy. These account for the bloated tummy look and a general de-conditioning.

Lowering the dose of cyclosporine helped reduce the diarrhea. I think you can safely try giving this about 2 hours before a meal on an empty stomach now, which allows for maximum absorption.

Hmm. All clinics should be taking a full CBC complete blood count and chem screen to monitor his condition. This is always the first step in diagnosis. I am surprised they have not done this. It is really very important. Automated analyzers are used widely because they can not only perform the test quickly, they also provide a wide range of diagnostic information that used to be quite labor intensive to obtain.

I can’t image how you could make a mistake with a spun PCV. There is nothing to calibrate. It’s simply a small tube of blood, spun in a centrifuge, and held up against a chart. PCV’s were used, though spun by hand, in WWI during the later 2 years of the war on the battlefield when they began attempting transfusions!

A chemistry panel tests kidney function, liver function, electrolyte levels, glucose levels, pancreatic enzymes, etc. It tells us essentially how healthy he is. This is usually where we see the negative effects of prednisone, liver enzymes can be greatly increased for instance or there can be signs of it bothering the pancreas.

You can view a short introductory video on the CBC here:
https://www.secondchanceaihadogs.com/aiha-video-library/aiha-introductory-videos/

The CBC shows relationships between the variety of cell types in the blood. For instance an important value that is missed when you only monitor the PCV is the platelets. In autoimmune disease, these can also be low. I don’t think that is the case with Tiger but it would have been very important in the first few days to find that out. The CBC also provides values for the white blood cells, for instance looking for infection.

Here are the guidelines for reducing prednisone:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

It is usually wise to reduce only the prednisone for a period of time to begin getting rid of the annoying side effects, which are numerous. Some of these, like muscle wasting, will take months to recover from. But they eventually do go away!

Reducing the cyclosporine can follow once he has reached a clinically good HCT and has remained stable for a period of time. This drug has fewer side effects and these tend to go away very soon after discontinuing it, generally with no lasting effects.

We’ll be here to help you through these steps, don’t worry!

I’m so glad to hear he is more himself this week! Good work Dad!
my best
patrice

[Tamara]

Hi Adam, I am not current on your and Tiger’s story, I’m just dropping in and trying to catch up as I can. I wanted to comment on freezing cyclosporine though. I have been freezing cyclosporine for Ashki’s entire illness, it was recommended to me to reduce GI side effects. We did test cyclosporine levels as Ashki was not responding, and his levels were fine, so it seems that clinicians have discovered this trick of freezing to help with the GI effects and it doesn’t affect efficacy. I have heard from others on another forum who also freeze the cyclo, for what that’s worth. I just store it in the freezer.

Ashki did have an unusual (for dogs) side effect from the cyclo, of proteinuria (protein in the urine) which indicates compromised kidney function. We are hoping it will resolve as we continue to wean. We picked it up when we saw that his serum protein and albumin were dropping over time, and so did a urinalysis and urine protein/creatinine ratio to measure it. I had to change his diet and we added a med.

Best wishes to you and Tiger, I’m so happy to hear he’s at 34!

tamara and ashki

[admin]

Hey Adam!

There you go – Tiger is doing really well & you are already seeing the drug reduction having a great effect on the drinking etc. Such great news.

I always got a full CBC before & after each reduction – there are other cells to monitor & other readings which indicate how well the organs are coping. I couldn’t agree with Patrice more – this needs to be done to make sure everything is going to plan.

I won’t go on too much about the cyclosporine – I have posted a new topic already – but if I were you, I would not freeze it, full stop. It is always good to get input & ideas from other people – please don’t stop airing these things, folks.

Love to you & Tiger – you are doing a wonderful job, Adam.

Sheena, Worzel & Ollie xxxxx

[admin]

Hi Adam

I am so pleased to hear you got good news with Tiger’s results, and that he is feeling better and better in himself! That’s wonderful news and you must be thrilled.

Please give that handsome boy a cuddle from us. He’s doing so well :)

Mary and Mable x

[Adam]

Hi Everyone,

Tiger is doing really well :) he is eating well, active and happy at the moment. I take it as it comes each day with him, but safe to say I am relieved a little bit that we might be on the road to getting better.

His staph cysts have all gone down and healed, but he is currently on 600mg cephalexin 2x a day. I have enough left for 2 more days, should I be asking the vet for more of these?

Seeing as Tigers immunosupressive meds haven’t been tapered again, we will probably see the same infections come back again? I really want to avoid this, as they were definitely causing some discomfort for him.

Adam xx

[admin]

Hi Adam

I do think you are on the road a recovery with Tiger! He has done amazingly well. If the infected areas have completely healed & are no longer red or pink, my personal opinion is that Tiger will be fine after the next 2 days of cephalexin. Because this particular antibiotic is not “ideal” for IMHA dogs, it would probably be better to stop it. However, I think you should discuss this with your vet to be sure as I am only an ex-nurse, not a vet.

It goes without saying that the staph infection could easily come back, so you need to keep a close eye. Unfortunately, staph is a bacteria that is present on skins “naturally” – it’s usually only when the immune system has a problem that it rears it’s ugly head. It is really common to see staph infections with this disease, as you know – so if more pills are needed later on, so be it. Don’t worry if that happens.

I would also thoroughly wash Tiger’s bedding etc at the highest possible temperature – anything he could get it back from really. Bacteria are killed by soap – they go “pop” as it bursts their outer membrane. Satisfying to know you’ve killed the horrible little things! I also use chlorhexadine a lot – any sign of anything on my boys, they get some dabbed on the problem area. It is very cheap here if you buy the concentrate, then make it up yourself, which is easy.

Many dog shampoos are available that contain chlorhexadine – maybe discuss with your vet about giving Tiger a preventative shampooing regularly to stop the staph coming back. When the drugs are eventually reduced, you have less risk, as you quite rightly say.

Hope this helps – great job Adam – Tiger is doing so well, thanks to you.
Love Sheena, Worzel & Ollie xxxx