Prescriptions/suggestions

[Colleen]

Hi,
My dog Hunter had a mast cell tumor removed in October 2019 – successful with clear margins. About a month later, we noticed a stumble when he walked and he quickly declined from there. We had a mobile vet come to the house who diagnosed him with Valley Fever and autoimmune disease. He prescribed prednisone, flucanazole and doxycycline. When Hunter was able to walk better, I took him to my regular vet. The blood work showed no more valley fever, but did still show autoimmune disease. More prednisone was prescribed and eventually azathioprine was added in February because his red blood cell count was not where it should be. Hunter began to have bloody stools and so I brought him back to the vet. It was too soon to see if the azathioprine was effective in raising the count but he added famotidine and omeprazole for possible ulcer as a result of the prednisone. On 4/1/2020 we went back for recheck and his count was at 13%. The vet prescribed Mycophenolate Mofetil in addition to everything else. On Easter Sunday hunter took a turn for the worse: diarrhea, lethargy and loss of appetite. I called the vet to ask if they thought the Mycophenolate may be causing side effects and if we could/should discontinue this and replace with cyclosporine (he had mentioned cyclosporine at a previous visit and I’ve since read several success stories with it). His opinion was that it was the disease progressing and to see a specialist or the emergency vet; cyclosporine may not take effect soon enough.
Last night we went to the emergency vet who wanted to keep him overnight and do a blood transfusion and have him see an internist the next day. We declined due to cost, and they suggested discontinuing the azathioprine as this can cause the bone marrow to stop regenerating red blood cells. There was a significant decrease after this was prescribed in February. They also prescribed Clopidogrel for potential blood clots, but I am hesitant due to the melena.

I have not yet talked to my regular vet since the emergency vet, but have seen another cyclosporine success story just today and want to ask again for this, though I know this is my unprofessional opinion.

At this time Hunter is barely eating. Only a bite here or there, but this evening he threw up for the first time and it appears he did not digest anything. I don’t know if the pills I have given him today were absorbed because it seems all he had eaten today came up.

Thank you for any insight you may have.

[Vally]

Hi Colleen and welcome.

I’m so sorry Hunter is so sick right now, but you’ve done every right and reacting so quickly is most likely why he’s still alive right now.

First of all, Mycophenolate Mofetil is really a last resort drug, Cyclosporine is definitely the better way to go. What you’re describing about Hunter’s reaction to the Mycophenolate is not uncommon at all. See here:
https://www.secondchanceaihadogs.com/AIHA_Terms/mycophenolate-mofetil

I believe Cyclosporine is the better drug to go with and whilst with my boy, Bingo, it worked very quickly, it can take time to start working. It’s important if you do use Cyclosporine, there can be some gastro issues to begin with. Ideally it’s given without food and away from other meds, but if gastro issues present, then it’s better to give it with a little food.

Make sure prednisone is always given with food. Omeprazole, ideally 30 minutes before food and famotidine can be given with food.

Clopidogrel is also important as clots are a big problem here. I understand your concern though with the melena. I’m hoping that the famotidine and omeprazole will help with that.

Ideally I think Hunter would be better hospitalised right now, especially if he’s not eating and throwing up, but I understand cost can be a big factor.

Try doing small meals and maybe make a broth (no onions) and syringe that into Hunter (no needle of course).

Speak to your regular vet and ask for the cyclosporine. You could also ask for a prescription and have it filled at a pharmacy. That’s usually a cheaper way to get drugs as vet’s prices are usually much higher.

Please ask anything, happy to help.

Vally