Page 80 – Second Chance AIHA Dogs

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Keymaster

Hi Mike

Thanks for the info – so far, I can’t see anything untoward with your drug regime, although the atopica should ideally be given on an empty stomach – to get the 2 doses 12 hours apart would be better too – so you could change the morning dose to 10am? Sometimes dogs have tummy upsets with the high starting doses of atopica, but it usually passes when the dose can be reduced. Dr Dodds has a protocol for atopica called pulse dosing – give it at 10 mg/kg for 5 days rest 2 days, then at 5mg/kg for another 5 days. The lower dose is repeated after a 2 day rest on a 5 days on, 2 days off cycle as long as is needed. I don’t know if you have decided to contact her or not, but you could discuss this aspect with your vet. It also says that “atopica induces rapid T-cell suppression within about 48 hours and has been safe, effective, and well-tolerated at these doses”. As I said earlier, I would also urge you to contact Dr Dodds to see if she is happy about so many immuno-suppressants (aza can suppress bone marrow) – our lovely Tamara has had problems with her gorgeous boy Ashki & I hope she is around to tell you about her experiences.

Good that you have famotidine, but I agree with Brigitte – I am also a huge fan of sucralfate – it is wondrous as it coats the GI tract, enabling it to be protected & ulceration will heal nicely using this drug. A “last thing at night” 1 gramme dose (2 hours after the last medications) was the only thing that stopped Worzel’s stomach pain. To me, it is an absolute essential.

If your vets thinks there is a possibility of an infection, I am relieved to see the doxycycline. I presume they are doing tests for infections etc? Worzel was on a high dose for about 5 weeks to make sure it killed off the tick-borne disease he caught. It gave him terrible tummy ache, poor lad. I see you are giving the azathioprine with food – that is good. Has she had any tummy issues at all?

Yes – lack of nutrients & lack of enough thyroid hormone can really hold their recovery back. Many owners find that adding thyroid hormone & giving the supplements really helps to get an improvement.

The PCV going up & down a bit – are they always taking the blood sample from the same place? My specialist insists that we ALWAYS take a sample from the neck, not from the leg. Taking them from different places might give different results. As Vally mentioned, hydration levels make a difference too. And these drugs can make them dehydrated at times – I expect you already know that though!

Sorry to be a bit of a stick-in-the-mud, but I am always dubious about supplements. You mentioned Drs Foster/Smith chews. I’ve never heard of them (probably because I am in Europe) & can’t even get on their website to check it out for you. (Can anyone else check this out for Mike please?) I’m not saying there’s anything bad about it but I prefer it when II can read that supplements have genuine research to back up the statements & can prove they are free of nasty things such as arsenic, heavy metals etc. I would rather you to used PetTinic for now. I would prefer to be cautious & for you to use a well known & trusted brand & your vet is saying Lola needs Vit Bs & iron.

Finally (thank goodness for that you say!) the pred weaning process you followed doesn’t look overly aggressive BUT did you take before & after PCV checks? If there is a glitch during weaning, you have to increase the pred back to the previous dose & wait for things to settle down. I notice you mentioned a few ups & downs – was that during weaning? I am ultra-cautious on dropping the pred – it’s vital to get it exactly right or relapses do happen.

Going to grab some food now – I know you want to add to the information.

Speak soon
Sheena x

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Keymaster

Hi Mike. I am so sorry you are going through this with your precious little gal, Lola. You will find this site to be accurate and knowledgeable. And I know I can say this for all of us – we are glad you found this forum, although sorry for the reason why, of course. Please feel free to ask your questions and post your concerns, no matter how trivial you think they might be – it ALL adds up.

You have already gotten some really great advice and asked some very important questions. It is wonderful that we are world-wide so someone is always checking. Sorry for all the questions, it’s necessary though. I can tell you from experience, I was like a deer in the headlights – had not a clue what was going on when my 35 pound cocker spaniel, Sadie, was diagnosed with AIHA in 2009. This forum, these people, helped save Sadie’s life. I also had a wonderful vet AND Dr. Dodds on Sadie’s side too. Please, as both Sheena and Vally have said, e-mail Dr. Dodds – she always responds. She is our go-to guru – the most knowledgeable and caring vet anywhere. Along with her research and hectic practice, she still continually works with AIHA/IMHA pets and helps save lives. She is also one of the best with working WITH your vet and is most diplomatic. Your vet does sound like he/she is on the right track – that a huge hurdle in caring for this horrible disease.

I see Sheena has already asked about the THREE very important medications/supplements that are absolutely necessary when our pets are on such high doses of immune suppressants. Please be sure Lola is on ALL three of these: liver, tummy and anticlotting and taken at the appropriate times, as Sheena also mentioned.

Another ‘must have’ for Sadie and some of the other pets here, is PetTinic, which is a liquid vitamin-mineral supplement, containing Thiamine, Riboflavin, Niacin, Vitamin B6 and Vitamin B12. But PLEASE CHECK WITH DR. DODDS before adding this. She is actually the one that suggested it for Sadie years ago and Sadie is STILL on it. I only stopped once and with Sadie’s last relapse, her vet asked if I still had her on it. I had not, thinking it was no longer needed – wrong. We started back immediately and will have her on it for good. I typically buy it on-line, can run anywhere from $10.00 to $16.00 for a 4OZ bottle. Good stuff.

My girl, Sadie, has been through several relapses. The first time Sadie relapsed, as Sheena notes, was because she was weaned too fast. Sadie, as Lola, never really dipped to a horrible PCV at onset (21), but still collapsed in front of me and was so very scared, as I’m sure your Lola and you were too.

Our pups are about the same weight, I just wanted to mention that Sadie, at onset, was put on 40MG prednisone daily (20MG in AM, 20MG in PM), as Lola, and Atopica (cyclosporine) was added too, but only 50MG of Atopica. She rebounded quite fast and then the weaning was too quick and we were back to square one. She recently relapsed again October 2014, but we only put her on 20MG of prednisone and she, thank goodness, rebounds once more. Sadie has not ever been on Azathioprine.

I know the PCV up/down percentage is very scary. Sadie’s PCV bounces up and down. Not by a harrowing amount, but at times (especially recently) it will run between 2-8 points higher/lower. It did freak me out, due to her relapses, but I continue to test her PCV every 10 days. With that, as Vally said, some dogs will be on a ‘maintenance dose’ for their life, as her Bingo. Sadie will be one of those dogs too.

As Lola, Sadie’s PCV bounces up and down too. Not by a harrowing amount, but at times (especially recently) it will run between 2-8 points higher/lower. It did freak me out, due to her relapses, but I continue to test her PCV every 10 days. With that, as Vally said, some dogs will be on a ‘maintenance dose’ for their life, as her Bingo. Sadie will be one of those dogs too. Sorry, but it’s a wait and see.

You are here for the right reason, to help Lola. Please stay with us and let’s get Lola healthy again.

Love and hugs, Linda and Sadie

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Keymaster

Hi Mike

I’m glad you’ve found us – this is really worrying for you, I know. Lola is definitely a case for Dr Dodds. I completely agree with Vally – this is your number one priority – she has tremendous insight into this disease & is always delighted to work alongside your existing vet, using the internet for consultations. It’s a real shame that things were progressing so well, but she has started to fall again – I’m so sorry – it’s rotten for poor Lola.

I have a couple of ideas. Has Lola been tested for Vitamin B12 or folate? There is a possibility that she doesn’t have enough “building blocks” available for making new red cells. This is not uncommon, so don’t worry. I agree with Vally about the thyroxine (saloxine for dogs) – it makes a lot of difference to many dogs because it encourages red cell production & is part of Dr Dodds treatment protocol. She may also need to be on a low dose of pred forever – again, nothing to worry – we have many people on here in the same position.

Do you know what caused the initial IMHA attack? I know that it’s not always possible to find the trigger, but is it possible something has happened again? I presume she doesn’t get vaccinated – vaccines can trigger IMHA. Is there any way she could have had a tick bite? Again, tick diseases are a common trigger. Did she have any pre-existing health problems?

Do you know if a blood smear has been done? If you have any tests results at all, please feel free to send them via the urgent advice link: https://www.secondchanceaihadogs.com/urgent-advice/
It might give us some idea of what has happened along the way. Also a full list of medications & another other information you can think of that may possibly be relevant.

I personally found that my dog Worzel’s PCV started to rise even more after when we slowly (over 12 months) reduced the azathioprine. It can act as a bone marrow suppressant in the long term, even though it was a wonder drug for Worzel, getting him regenerative in about 2 weeks. I am presuming Lola is still on the azathioprine? I am not saying you should stop it by any means, but I would discuss this possible side effect with your vet & Dr Dodds to see what they think. The atopica might take a bit longer to kick in. I have no personal experience with this, but I know others have had to be patient. In the meantime, the pred should be starting to keep her stable.

Dr Dodds would say that around the PCV/HCT mark of 15 is the limit for transfusions, but it depends on how ill the dog is, of course. Small transfusion that don’t take Lola over the PCV of 25 mark are advised. Hemopet provides every kind of blood product, by the way, so your get can source it there of Lola needs it. Splenectomy is a very last resort option & I would never consider it myself unless the spleen is actually diseased. Is her spleen enlarged at all? The spleen’s job is to deal with any abnormal red cells (and various other things). Have they done any ultrasounds at all? Sorry to ask so many questions!!!

Has Lola been tested for abnormal clotting at all? This is very important as she may need anti-clotting medication – please see
https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/

There is a wonderful product called Denamarin which we all use or have used to protect our dogs from the effects of the drugs, especially the liver, as these drugs raise liver enzymes. I would definitely recommend you add some to Lola’s medicines. Also, is she on any tummy protectant? These drugs are very harsh on the stomach & intestines, can cause ulceration & add to the problems. The usual (preferred) drugs used are famotidine & sucralfate. They must be given 2 hours apart from any other medications otherwise they can prevent absorption. I mentioned B12 & folate earlier because some dogs get bad tummies & are unable to absorb enough of these things, so may need help with supplements. These supplements should only be given under veterinary advice as they can actually cause more harm than good if they are not needed.

One last thing – kidneys – does Lola have any problems at all? Kidneys monitor oxygenation in the blood & produce something called hematopoeitin (also called hemopoeitin) which stimulates red blood cell production. If the kidneys are compromised, they may not produce enough of this hormone.

Now I have questioned you into the ground, I will leave you in peace! I hope we have helped & can continue to help. You best port of call is Dr Dodds, I promise. She is incredible & a very lovely person too.

Best wishes
Sheena, Worzel & Ollie x

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