Forum Replies Created
Hi Beth
Have you sent the results to Dr Dodds? Stupid question, I expect you have already! The GREAT news is that the anemia is getting much, much better – practically normal, which is good.
Had a quick look through the test results – I was a bit confused about the dates of each test as the sheets came through to me in 4 “bits & pieces” & I couldn’t make out completely what was going on (probably me being a technophobe – sorry – if you have a minute, scan & send them to me & I’ll pass them on), but here are my initial thoughts:
No doubt that Heathy is suffering from Iatrogenic (unintentional) Cushings Disease, i.e. way too much cortisol from the prednisone. Here is our succinct explanation:
https://www.secondchanceaihadogs.com/AIHA_Terms/iatrogenic-cushings-disease/
Raised neutrophils, high platelets & a high white blood cell count are all symptoms of this too. I personally think you will have to be patient for the liver enzymes to come down – it won’t happen overnight & you have not long lowered the dose. Don’t forget he was on a mega-high dose for quite a long time. Their kidneys are also a bit knocked out off kilter with the pred, so the BUN/creatinine ratio should settle too.
Has Heathy had a thyroid function test? Just a thought as hypothyroidism can also cause high neutrophils/high platelets. Maybe it could be worth doing as this also can cause some of the blood anomalies. Again, be guided by Dr Dodds, but my opinion is that this is all pretty much down to the high pred dose. Every high value can easily be caused by high pred doses except the MCV (mean red blood cell volume) which is also normally seen when recovering from AIHA, IMHA, anaemia – nothing to worry about at all.
Vally is absolutely right – the milk thistle in the Denamarin (plus the other goodies in there) is your best friend to help bring these enzymes down, together with Dr Dodds’ wonderful liver cleansing diet. It made a big difference to Worzel within a couple of weeks & others, like Vally’s Bingo, have also suffered the same side effects too. I don’t remember exactly how high Patrice’s dog Chance’s enzymes were, but they were sky high because he’d been on the pred for a long while too. They came down nicely though, so take lots of comfort in that. I know she will be looking at the tests when she has time & may well spot something I haven’t. In the meantime, you’ll have to make do with me!
Beth, please try not to worry too much – I really think this is drug induced, so will settle down in time. Heathy just needs to get this nasty stuff out his system slowly, but surely.
Love & hugs, Sheena & the boys xxxxx
Hi Beth. Hi Heathy (love your shortened version name, very cute). So sorry for the reason you’re here. Sorry too, to have been MIA and not responding timely. But you have the best here and they are on top of this – great advise AND you have communicated with Dr. Dodds – awesome! I love our family here. And please, as all have said – START THE DENAMARIN IMMEDIATELY. And as all have said, the high liver values come with the treatment, as nasty as it is – a necessity. We have all been there (read our stories under Our Stories). And again – you are doing a fantastic job staying on top of everything. Heathy is a very lucky boy!
Sadie’s pic just flew by on the forum site screen – and looking at her pink tongue, I still remember way too well the loneliness of all this and getting her back to that pink tongue and back to health. It’s still a roller coaster – but if you can get them over the infamous “regenerative” hurdle – it’s day to day happiness and you rally and smile with every good/better/great PCV check. This disease CAN be beat!!!
Yes, a pic would be wonderful – when possible. I will be checking on Heathy’s progress – keep up the great work – and get that Denamarin, okay?!
Love and huge, hang-in-there hugs, Linda and Sadie (diagnosed AIHA March 2012)
Hi Mike
Things are looking better – I am really pleased Lola is making progress now. Fantastic news on the reticulocyte front, which is so important.
I totally agree with Vally & Patrice – the muscle atrophy will get better gradually when you lower the pred dose – I don’t think many of us have escaped this with our babies & it is impossible to prevent. Over-exertion is not a good idea until her muscles do come back as they can damage tendons & ligaments. We’ve all suffered adverse comments too – we KNOW our dogs look awful, thank YOU! I promise you Worzel looked like a skeleton at one point & the specialist said he had never seen such a rapid muscle decline in a dog on pred. I was really surprised at how quickly he regained his muscle tone – he still thinks he is a racer & can still run like the wind when he feels like it!
Oh, yes, the eyes say it all – their eyes do become bright again when they are getting better. Never thought about that until Patrice mentioned it, but it is true.
Keep up the great work Lola!
Sheena, Worzel & Ollie xxx
Hi Beth & Heathy!
I absolutely LOVE Staffies/cross staffies – they have the nicest, sweetest nature – I bet he’s a handsome, affectionate chap.
Great to hear Dr Dodds is already helping. I see you’ve had wonderful advice from Vally, Brigitte & Tamara regarding diet etc. & I can’t think of anything to say that they haven’t already mentioned. It certainly looks like he’s not digesting / absorbing his food too well.
I mentioned that Worzel underwent a very scary 50% per WEEK pred reduction because he was wasting away so quickly – he looked like a bag of bones with a sore on his leg that wouldn’t heal up. This is NOT the recommended reduction protocol at all, but sometimes a faster reduction is needed for clinical reasons & I think the muscular dogs suffer more from the pred, although other builds of dog often tolerate it a little better. With Heathy’s liver enzyme levels, you have a very good reason to reduce. I made sure I knew what to look for in the way of problems (see Addisonian Crisis) – heavy panting, very slow pulse, cardiac arrythmia (irregular heartbeat), fainting, drinking loads of water etc so that I could take him to the vet if necessary. I also did a PCV/HCT blood test the day before & 4 days after each reduction to make sure the anaemia was still under control. I would advise you to do this too (local vets can do this, no problem) so that you can put your mind at rest & to spot any potential problems quickly. Small changes in PCV are not important, say a difference up to 5-6, but anything over that might need a temporary medication increase.
In the end, we were lucky – Worzel had none of these problems – I hope Heathy will be the same. He was really off-colour & a bit miserable the first 2 weeks of the drop though. I have had the misfortune to take pred for over a month & the reduction process is no fun – the withdrawal symptoms are really horrible – I felt like I had been punched all over & was sore to the touch, also incredibly tired. I think Worzel felt the same. But we got through it in the end – I admit I watched him like a hawk – none of us can help worrying, you know. Heathy’s adrenal glands will slowly wake up, start to work properly again & he will soon feel much better.
Anyway, I’ve wittered on enough – please, please keep sending long messages – we love to hear how things are going & to help with anything you are concerned about. When you have time, it would be great to hear Heathcliff’s story from the beginning. We would really love to see a photo of Heathy too!
Sending love & hugs to you both
Sheena, Worzie & Ollie xxxxx
Hi Jen & Maggie
Glad you had a good trip & Maggie’s rapid eye movements are back to normal now. It’s always horrible if something happens when you are away from home & your usual vets, plus young children – wow, you’ve done a great job. It must have been the ear infection as the antibiotics have worked nicely. Poor girlie – it takes a while for their balance to get completely back to normal, but it sounds like she’s really improving day by day. Let us know how you’re getting on when you get time – when is Maggie’s next PCV/CBC?
Sending love & hugs,
Sheena, Worzel & Ollie xxxxx
Hi Elizabeth
I’m sorry to hear about all your troubles no wonder you are worried. Tamara & Brigitte are right – the pred dose is way too high – don’t worry about what’s happened – it’s happened – it’s in the past & we will do our best to get Heathcliff sorted out. The azathioprine is also hard on the liver, but do I feel the prednisone is the culprit at such a high dose.
You need urgent help from a good vet – I would urge you to contact Dr Jean Dodds at Hemopet
https://labordatenbank.com/cake/hemopet/onlineorders/hemopet_add
Please do it today – she is normally very quick at getting back to you & works on a Sunday, but not a Saturday. If you have a blood test, you can scan & attach it to the consultation for her to look at. Tell her exactly what happened with Heathcliff & exactly what drugs/doses he is on. She will get back to you & ask for more information.
The ideal pred dose for Heathcliff at 1mg per pound i.e. 75mg or even 70mg per day divided into 2 doses 12 hours apart. My instinct tells me you will have to reduce it to that level, but I am reluctant to tell you to drop it so quickly in case it makes him ill – these drugs must be dropped slowly in normal circumstances – so Dr Dodds is the best person to advise you on this. Because the dose of pred is so high, Heathcliff’s adrenal glands will be completely suppressed (atrophied) & won’t be producing any cortisol – they need to wake up slowly – they can’t just spring into action. See
https://www.secondchanceaihadogs.com/AIHA_Terms/adrenal-glands/ when you get time.
The azathioprine dosage is right for his weight, so please leave it as it is for now – don’t stop it just yet otherwise he has no secondary long-acting immuno-suppressant. It starts to work after about 10 days or so, so Heathcliff should be suppressed by now. Azathioprine must ALWAYS be given with food to minimise the side effects – that’s very important. Again, carry on with the azathioprine dose until you can contact Dr Jean Dodds. She may want you to change to maybe cyclosporine (atopica) in the circumstances anyway.
See our information on prednisone https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/
“Prednisone dosage for AIHA/IMHA is normally 1mg per pound (2mg per kilo) per day & should be divided into in 2 equal doses, given 12 hours apart. ”
I know his enzymes look high at the moment & he must have been really uncomfortable, bless him, with the ascites. I promise the Denamarin (containing Milk Thistle) will bring it down, but it will take a bit of time for that to happen. We have seen a few dogs with very high levels, so you’re not alone, and they come down nicely – milk thistle is a wonder supplement for the liver.
My dog Worzel was also on azathioprine & prednisolone & he lost loads of muscle mass too. He looked absolutely terrible, Elizabeth, just skin & bone & it happened very quickly for us as well. Even his head lost muscle (this is called pred head) & his eyes looked sunken & awful. We were very worried about him too, When we started to lower the prednisolone, he started to regain weight, so it will come back, I promise. No wonder you can’t get enough food inside him – prednisone is is catabolic – it eats up muscle mass. For now, try & feed him good quality protein & low fat – as Tamara says, fat can aggravate the pancreas/liver. I’m sure Dr Dodds will send you her liver cleansing diet & will have some dietary ideas to get that weight back on him. Worzel also had high liver enzymes (not as high as Heathcliff) but after only 2 weeks on the milk thistle, they were down into the normal levels.
The sucralfate is also very important as Brigitte said. 1mg tablets are available here in France – I don’t know if you can get them over there though – it normally comes as a liquid, which is a real pain. I sneaked a syringe (minus the needle of course!) between Worzel’s teeth & very slowly squeezed the plunger. He didn’t like it much, be he swallowed it! Thankfully, the pharmacist ordered some tablets for me. That was much easier. Ideally, Heathcliff should have 2 separate 1mg doses a day. Sucralfate must be given well apart from the others medications (see
https://www.secondchanceaihadogs.com/AIHA_Terms/sucralfate/) – 2 hours before/2 hours after. I always found the last thing at night dose eased Worzel’s tummy.
It is really hard juggling all the drugs around – some with food – some without etc etc. If you need help making up a drug chart, our lovely Vally is an expert at doing that for everyone.
So, the most important thing is to contact Dr Dodds immediately. She has helped many of us on here – you will be in the best possible hands. You can manage fine with internet consultations, but I would also have a look around your area for a specialist in internal medicine if you feel the vet your using is not going to be open to expert advice. To put it politely, if in doubt, find another vet. This makes a huge difference to the outcome of this disease – lots of folk on here have had to change vets for various reasons are are very glad they did. I hope Tamara won’t mind me saying she is one of those.
Right – stop worrying too much – it only makes you ill & Heathcliff needs you to be on top form! Dr Dodds will get Heathcliff back on track. I trust her implicitly – you can too. We are all here to support you & do hand holding – that’s very important to all of us when our dogs are so sick. Any questions you think of, just ask.
Hugs from us all
Sheena, Worzel & Ollie xxxxx
![bingo-14-5_1200x775](https://www.secondchanceaihadogs.com/wp-content/gallery/aiha-dogs_2/bingo-14-5_1200x775.jpg "Vally\'s Bingo \\"Smile\\"")
![Brigitte_Cleo_Ripley_Enzo_4](https://www.secondchanceaihadogs.com/wp-content/gallery/aiha-dogs_2/Brigitte_Cleo_Ripley_Enzo_4.jpg "Brigitte\'s Cleo, Ripley, Enzo and Guest \\"Rockin\\"")
