Forum Replies Created
Hi Beth
I developed a habit of keeping my hand on Worzel’s chest all the time, especially in bed, because it was may way of monitoring him! I still do it now, funnily enough. Like all greyhounds, he has a very profound, strong heartbeat, so maybe you won’t be able to do the same with Heathy – I’m not sure. If not, Patrice’s groin pulse method is the easiest way by far.
Phil & I were chatting last night about how bad Worzel was with his rapid reduction – he actually remembers him being far worse than I do, so I hope that reassures you. He remembers us having difficulty rousing him when he had been asleep & him being exceptionally tired & not interested in anything at all. I remember he went off his food somewhat as well, but then he had been eating humungous amounts, so don’t worry if Heathy doesn’t want as much now. We made sure he was comfortable & quiet – he didn’t like too much fuss or cuddles because he was weak, hurting & a bit miserable. I promise this all changed after the initial couple of weeks – he was back to himself in no time. When we stopped the pred completely, I noticed a massive improvement & his muscles gradually came back. For him, his sunken bits behind his eyes were hideous (pred head) & made him look like a skull, bless him. It has all filled out beautifully. I forgot to mention (Phil reminded me) that I panicked at the size of his salivary glands, thinking the worst (cancer) of course, but it was just they looked really big because his jaw muscles & everything else had shrunk so much. He was beginning to struggle chewing anything with those atrophied jaw muscles – that’s how bad he was. But we all have to remember that it was the pred that initially saved their lives & we just get through this withdrawal symptom stage as well as we can.
Dr Dodds is a very friendly, down to earth person & will not mind at all if you contact her & explain what’s happened – everything is flexible according to how Heathy is getting on with the reduction. As Patrice says, she is great with other vets too.
Again, don’t get hung up on the liver enzymes, please. Worzel was on azathioprine at full dose (50mg per day) for a long time & it was the PRED reduction & milk thistle that made the difference. I really do think things will improve with pred reduction. Worzel absolutely STUNK (bad wind & smelly breath) on the pred too – that also got less & less at each reduction. We quite often have a laugh about our stinkers on here – the drugs seem to give them awful smelly wind!
So, keep your chin up & look after that beautiful boy – it will a hard couple of weeks, but you CAN do this, no problem. If you are concerned about anything at all, just ask.
Love & cuddles from us all
Sheena, Worzel & Ollie xxxx
Hi Jen
I feel like I’m always being negative (sorry) – Baytril (enrofloxacin) does have a risk of potential neurological side effects including seizures that you need to look out for – it can cross the blood brain barrier – but the severity of the effects seems to be dose dependent, i.e. higher doses pose higher risk. Has Maggie ever had a seizure at all? If not, hopefully she should be OK on lower doses. Have a look at this, specifically the adverse effects & toxicity:
http://www.merckmanuals.com/vet/pharmacology/antibacterial_agents/quinolones.html
The occurrence of seizures is far lower in dogs than in people -it is dangerous for us humans, so don’t touch it if you can help it. Rubber gloves!!!! There is also mention of hemolytic anemia there, but I’ve had a look elsewhere & the risk of that is small compared to some other antibiotics.
http://www.marvistavet.com/html/body_enrofloxacin.html – sucralfate must be given at least two hours apart from the enrofloxacin, also says enrofloxacin can increase the kidney damaging properties of cyclosporine.
From what I’ve gleaned from looking antibiotics up so far (it is a mammoth job), the groups that pose the biggest risks for IMHA are the cephalosporins (including cephalexin), sulfa drugs including trimethoprim-sulfa (accidentally prescribed for Worzel) & the penicillins including clavamox, amoxicillin, ampicillin.
Personally, I would still discuss doxycycline with your vet as a safer alternative in case Maggie develops any problems, even though it does have GI side effects. Because it it so commonly used, especially for tick borne disease, I feel more confident that it won’t affect Maggie’s anaemia.
http://www.merckmanuals.com/vet/pharmacology/antibacterial_agents/tetracyclines.html
I found this article on ear infections which I thought you might like to read:
http://www.merckmanuals.com/vet/eye_and_ear/otitis_externa/overview_of_otitis_externa.html#v3270483
It looks like topical application is very effective, coupled with antibiotics.
I’m sorry to hear Maggie is very wobbly & knocked into your little one – are they both OK? No injuries I hope. That is frightening. Dizziness & loss of balance is really common with ear infections, as it causes vestibular (balance) problems, so Maggie must be feeling horrible. Could you stop her using the stairs without supervision? Easier said than done, I know! The vet could also give you motion sickness pills to help her with the dizziness if it doesn’t settle soon.
How long will the antibiotics take to work? Don’t know on that one. Because ear infections are external to the blood system itself, logically the pills will take longer – do you have a topical application too? That would be quicker from reading the ear infections info in the link above.
Hope this helps – let us know how she’s doing when you have time
Love & cuddles from us all
Sheena, Worzel & Ollie xxxx
Hi Beth
You could try a large bath towel used as a sling – spread as widely as possible underneath his tummy/chest a carry him like a shopping bag, but with two hands. We had to do this for a couple of weeks with one of our dogs when he had a stroke & it works well, but I sympathise – the stairs are hell. Please be careful.
I think I’m the only one who has done a fast pred drop with Worzel – everyone else has been able to do the sensible slow reduction as far as I can remember (anyone else please say????). He was really weak before we lowered the pred & we sometimes had to lift him on & off the bed & settee (spoilt or what?). He was very grumpy & uncomfortable in the first 2 weeks of the drop – the withdrawal symptoms make them feel really BAD. He did not want to do anything at all & just lay there moping & didn’t like being touched – he was sore, I know. It sounds like Heathy is suffering the same symptoms – his poor little atrophied adrenal glands just aren’t working properly yet – they need to wake up & this takes time. I can honestly say I felt like absolute rubbish (I can’t say the word I want to say on here!) myself when I came off a longish course of pred. I had to carry a card round with me for ages, so it’s not any easy journey. Poor Heathy must feel an awful lot worse than I did.
I can only tell you that I religiously checked his gums, pulse rate & regularity, looked at his poo carefully for diarrhea or blood (black, tarry is an indication of blood). As he is usually right next to me, he was easy to keep an eye on. There is a risk of dehydration if they have diarrhea or vomiting at this stage & he would need to see the vet. If you are in any doubt about him losing consciousness or being about to collapse, that is when the vet is needed too. Shaking, shock or trembling are also signs of crisis.
Do you think he has really gone downhill fast? If he is finding it difficult to walk & this has happened quickly, I am just a little concerned – has this happened before? There is a big difference between weakness & collapse of course. Excessive thirst is a warning too. If you are in any doubt at all about the pred drop hurting him badly, my advice would be to contact Dr Dodds & maybe go for a 4 or 5 day reduction, rather than 3 days. As you know, we did 50% per week & that was painful.
I think you might be seeing some jaundice – yellowing of gums, eyes, skin – by now if he has a liver infection. Everything in his tests looks like pred effects & I know Patrice’s Chance’s enzymes were even higher than Heathy’s, so don’t get sidetracked with the liver for now – we’ll worry about that when he’s off the pred – first things first. In my experience with patients with severe liver problems, you usually see some degree of jaundice, nausea, a very bad reaction to any fatty food, diarrhea, abdominal swelling. People feel really puky & unwell.
He WILL get through this – I know you will know if something urgent happens & get him to the vets. It didn’t happen to Worzel, even though he suffered – you just know they are not themselves & it’s not nice to see them like that – but it’s so worth it in the end. Getting the drug out of his system & getting the denamarin into it are number one priorities to get him better. He is absolutely gorgeous by the way, as I knew he would be – I adore Staffies – they are wonderful natured dogs – his photos are in the slideshow on the RHS of the screen now.
Any questions, just ask, anytime
Love Sheena x
Hi Jen
So sorry to hear Maggie has this problem again – you are really going through it – poor girl, she is. At least you are not away from home this time! With the immuno-suppressants, their immune systems aren’t able to cope with infection as well as they normally should.
I don’t want to panic you but I’m concerned about more cephalexin if it is oral & think you should stop it immediately – I think doxycycline is a safer option instead. I will explain why. I recently almost made a big mistake with Worzel – vet gave us an antibiotic he can’t have, even though the poor guy looked everything up in his drug book – I saw him do it & took his word, but thankfully I did check with Dr Dodds – she told me NOT to give it as it is very risky, and shouldn’t even be given to dogs that don’t have IMHA. Very poor of me not to have done my homework properly for Worzel. Cephalexin also carries some (not all) of the same risks as the drug I was given – so that is why I’m not happy for Maggie to take it – it can actually cause anemia – please don’t panic as it’s only been a couple of days – just discuss this with your vet as soon as possible & say you understand doxycycline would be safer this time because of the IMHA. If you would like me to send them the relevant information on cephalosporins, I would be more than happy to help.
Since this scary event for me & Worzel, I have been adding more information into our glossary:
https://www.secondchanceaihadogs.com/AIHA_Terms/drugsantibiotics-can-trigger-aiha/
so we can all look these drugs up on this site. I doubt if it will ever be complete & will take a long time – also some drugs only carry a very low risk. I didn’t do MY homework properly for Worzel & I apologise to you that I did not investigate the side effects of the cephalexin properly when Maggie was first given it – I only checked for interactions – I’m sorry that I let you down on that.
Have you consulted with Dr Dodds previously? Sorry, I can’t remember. If so, could you ask her what she would recommend for Maggie’s ear problem. It is virtually impossible to find an antibiotic that is 100% safe for IMHA dogs (or for anyone!!!), but doxycycline looks like the safest option to me & is used regularly for many types of infection in IMHA dogs – Worzel was on it for 5 weeks, but he did have tummy ache, I’m afraid. Maggie needs to have something – you have no choice – and she can’t have penicillin based drugs either – nightmare! Let’s hope this is only the ear infection causing the palsy type symptoms on the other side, rather than Horner’s Syndrome.
Sending you & Maggie love, profound apologies & big hugs
Sheena, Worzel & Ollie xxxxx
Hi Beth
Vally’s schedule looks good to me – I know you’ve dropped the pred a bit more – good stuff!
Vally mentioned the aspirin – I am also reluctant for you to stop the aspirin without checking with Dr Dodds – you need to ask if your vet has checked for spherocytes & auto-agglutination on a blood smear (you can see these things on a slide) – see the following for more information:
https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/
I saw on the top of one of the tests “hemolysis – no significant interference” so that is good – no problem there. Although his platelets are a little high, they are no where near the danger level of 1,000,000 or over, so no worries on that score either. If Heathy has no (or very few) spherocytes & no agglutination (cells sticking together), that would be great news – BUT (why is there always a but???) as you are doing a fast reduction, these risks could possibly re-emerge – this happened to Linda’s Sadie. I am afraid I am the site nag on clotting as this is by far the biggest risk with IMHA, so I am always very cautious. I would definitely check with Dr Dodds if it were me – just a quick one-liner to ask her by e-mail if you should stop it at this stage or wait until later, when the pred reduction is finished.
It’s great that you will have some time off with Heathy – I’m sure the peeing will reduce in frequency with the lower pred dose. That should mean some much better quality sleep for you – I don’t know how you’ve managed so well with all this to contend with – great job, Beth & Heathy! Try & be patient on the liver enzyme front – the liver is an amazing organ – incredibly regenerative.
Let us know how Heathy is when you can – enjoy your some relaxing YOU time too!
Love & hugs
Sheena & the boys xxxxx
Hi Beth
Please trust Dr Dodds implicitly. This wonderful lady has more experience & qualifications (human AND veterinary) than you can imagine. She is also has many research papers – please do follow her advice. The thyroxine protocol recommendation she gives is for a very good reason – it promotes blood cell production & most dogs on here have been on saloxine (thyroxine) at some stage – some still are. Prednisone can actually suppress the thyroid gland, thereby slowing blood cell production -see this research paper which states that glucocorticoids alter TSH (thyroid stimulating hormone) levels:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784889/
– a good reason to put Heathy on it. Her anabolic steroid protocol is also very useful – my specialist said we would definitely consider doing that if Worzel continued to emaciate at such a rate – thankfully we didn’t need to. We have known dogs be on that protocol too.
We did a 50% per week reduction with Worzel for similar reasons – the pred was doing him real harm & he was wasting away before my very eyes, like a dog being starved to death even though he was eating loads of food. As I said before, I would never recommend this reduction in normal circumstances to anyone without sound veterinary advice. You have the best advice possible from Dr Dodds. Worzel was stable on the anemia front, but had been non-regenerative, so it was more scary than you can believe. I don’t know anyone else who did this drastic reduction, but I am here to hold your hand if you need me. You must do regular CBC/PCVs to make sure all is going to plan. Remember pred was the necessary evil – it has saved his life, but now it’s time to reduce it for sure.
It is probably very unlikely that you will find out what caused the original crisis now – maybe if you have all the old original tests/blood smears etc – that may give us a clue, but it is not always clear. There are so many possible triggers. It doesn’t matter what happened in some ways because he is getting better – glad he was negative for tick diseases. If he wasn’t improving, I can assure you we would all be asking you to get even more tests done to find & treat the cause!
Patrice is right about the automatic blood cell counter anomalies – we have seen this quite often with other people’s dogs too. Sometimes when dogs become regenerative, the various types of blood cells are produced at a far quicker rate than usual, being pumped out at a “rate of knots”, so they are not always the correct size & can be immature versions of the adult cell – a machine is unable to distinguish between these cells as it doesn’t have “eyes” hence without a manual count on a smear test, you can’t be exactly sure of the values. I agree that this could be part of the reason for the out of range values. Hold fire on the liver biopsy unless Dr Dodds specifically asks you to get this done – it will cost lots of money no doubt and may be pointless & stress poor Heathy out even more. I would avoid (if possible) anaesthesia for now as the liver has to rid the body of that too. I know we are asking you to be patient & trusting – you have to be. I am sure the pred reduction will turn things around – it did for us. Just be aware of any problems that I mentioned about Addisonian Crisis, but this (I repeat) is worst case scenario & is treatable.
Hope this puts your mind at rest a bit!
Sending love & hugs
Sheena, Worzel & Ollie xxxxx
Hi Mike. So great to read the great news about your precious Lola! I am sorry to have been away – family health problems (dad and sister-in-law) and was dealing with tapeworms with my poor little gal, Sadie. The family “stuff” continues, but Sadie is doing well NOW (darn fleas!!!!).
Oh goodness – some people just should not talk. Sadie gained about 8 pounds (ravenous dog!) with the high doses of immune suppressants and people always commented on how fat she was. They did not mean to be mean, but it was all I could do to not say, ” goodness – she’s alive folks – would you please just NOT comment on her belly and comment about her being alive!!!” As soon as the meds were lowered, she lost weight, her coat became shiny black again AND her muscles came back. And she relapsed twice, so it’s been a bit rough for her. But she still, managed to rebound quite quickly.
Just to show you how they can hold on – even with the flea infestation and tapeworms – she went down (her normal PCV had been 46 prior to AIHA, last CBC 6 months prior) to 34% about 10 days ago (yes, I panicked!!!) AND after realizing she had tapeworms (yuck!!!) and treatment, Friday – her PCV was 50%. Poor baby had been struggling for goodness knows how long. But what I’m saying is – they fight – they hang in there. They let us know (yes, the eyes…..) and Lola is a great example of this too. So, way to go Lola – you keep on fighting!!!
Mike – you are doing such an awesome job! Lola is responding to your wonderful care. Keep us the great work and please, keep us posted.
Love and huge way-to-go hugs to you and Lola, Linda and now better, Sadie
![bingo-14-5_1200x775](https://www.secondchanceaihadogs.com/wp-content/gallery/aiha-dogs_2/bingo-14-5_1200x775.jpg "Vally\'s Bingo \\"Smile\\"")
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