AIHA-Just Diagnosed

[Wendy Gonzalez]

Frank was removed from sucralfate and after todays visit she wants to do the following (and she is waiting to hear back from Davis and Dodds):

– Pred 1 full tablet in the morning
-Pred 1/2 at night
-Atopica- 100mg 1 at night
-Famotidine 1 1/2 in the morning
-Cephalexin (750mg )- once in the morning and once at night.
-Thyroxine currently one a day and we will full blood work up on September 2

I have obvious concerns about dropping the prednisone so drastically. I expressed my concerns. He is remaining at 33% and has been in the low 30s for a while now. I told her that this isn’t a race to the top and each case is different.

Frank’s mom

[Vally]

Oh Wendy, I don’t think he should come off the sucralfate while he’s on a lot of prednisone.

The reduction in prednisone isn’t bad, but it’s too early. If I’ve got it right, Frank is taking 20mg morning and night right now and the plan is to drop it to 20mg morning and 10mg at night. Unless he’s having serious side effects, then, he should stay there a bit longer to see if we can get him into the normal range.

How long has he been on the thyroxine? Give that time to work. Also Thyroxine should generally be given twice a day not once a day. What dosage is he on?

You are exactly right, this is NOT a race, and if the reductions are done too early and he relapses, then it just means the prednisone goes back up again to full dose. Been there and it’s very disheartening to have to go backwards.

My best, Vally & Bingo

[Brigitte]

Hi Wendy,
what was the reason to take Frank off the sucralfate? If it is given properly, away from all other medications and food, it will not interfere with absorption of them.

Best wishes,
Brigitte

[admin]

Hi Wendy

Vally & Brigitte are right. Frank needs sucralfate – 2 hours after medications will not stop their absorption. The thyroxine should be twice a day. You are doing a good job getting your point across about being patient. This is a marathon, not a sprint. Taking things slowly is much safer. You stick to your plan & don’t let them change things so drastically as Frank is not even in normal PCV level yet.

How is Frank now? Is the infection clearing up nicely? The antibiotics are the right ones for this, so he’ll soon be on the mend. No more bleeding I hope either.

Love Sheena x

[Wendy Gonzalez]

Hello Ladies,

Sorry I have not been able to get back to you. I just got promoted to another position at my job.

Frank is doing well with his infection. I can see that he healing. The warts on his mouth,well one of them has a hole on the top part. I have been giving some yogurt, but mostly ice chips made out of chamomile tea.

I will request that he gets back on sucralfate next Tuesday. I was not given a reason for the removal of the sucralfate. She just didnt want to get him that prescription. I do remember and just read in my notes that she stated that she believed famotidine would be enough for him. But, I was doing my own research on dogs who are both on pred and atopica and research showed that since atopica is an immunosuppressant that is typical used as a cancer medication that dogs need that extra protectant. Especially since the atopica is absorbed through the liver. Research also showed that dogs that are on both medications would have higher liver counts.

I have been going back and forth on why he needs to be decreased from his pred. From what she told me to, via our phone conversation yesterday, that she wanted to decrease it because it should still be stable with the 100mg Atopica. On top of that, she said something about wanting the antibiotics to work and be effective. I am torn on this.

As for the thyroxine, should it be one in the day and one at night and how far in between (how many hours in between each one)? I want to make a new schedule today for his medications. I have been going off the original one sent to me awhile back and just building on that. :)

Also, could someone let me know what a normal PCV level for a dog should be. I have gotten mixed information on this. Some say 40s, some say 50s. And is it normal for a dog to linger in the 30s for a month? I know this is case by case, but I was curious.

With much furry love,

Wendy and Frank

[admin]

Hi Wendy

I do completely understand what your vet is saying about the antibiotics – pred does make them prone to infection for sure & in theory the cyclo should be doing it’s job. I am reluctant to say reduce more quickly than usual because his PCV hasn’t come up yet, plus you cannot withdraw pred too quickly as the adrenal glands become suppressed & need time to wake up. BUT there are sometimes good clinical reasons for reducing quicker & it may be that you will have to do this. I would ask Dr Dodds if it were me – trust her judgement, Wendy.

A normal PCV is approximately between 37 & 55 (it can be higher in some sight hound breeds like greyhounds) but the “normal” figures vary very slightly from lab to lab. I know it’s frustrating for you because he’s not coming up very quickly, but remember this infection will hold back his recovery. His body is fighting a bug as well as trying to make new blood cells – that’s a lot of work. We also know that cephalosporin may hold them back – that won’t help either.

The thyroxine daily dose should be split into 2 equal quantities, 12 hours apart. How long has he been on it now?

I really think you should ask Dr Dodds for advice on this.

Love & hugs right back to you
Sheena & the boys xxxxx

[Vally]

Wendy, I’d be happy to do the medicine chart for you again. List the meds Frank is on now with the rough times you do them and the dosages.

Thyroxine should be given, as Sheena said twice a day, about 12 hours apart, but also must not be given near food. Give the Thyroxine 1 hour before food or 3 hours after, for it to work properly. In particular, you need to keep it away from anything containing soy products and calcium in that time frame.

Vally & Bingo
xxx