Best Hypoallergenic Diet for AIHA

[Drew]

Dear Patrice and Vally,

I have some updates on Sophie, and would value your thoughts again. I have uploaded the cbc and pcv values from a vet visit on May 13 and May 27, with a message on the urgent advice part of the website.

To complicate the matter, during the past two weeks, she had pink urine again so her urinalysis and x ray have also been submitted.

Here is a summary of where we have been with Sophie. The last three entrees are the new results since my last post.

March 23: RBC 3.19, HCT 19.1, Diagnosed with AIHA and began 10 mg of prednisone

March 25: RBC 2.41, HCT 16.6

March 30: RBC 2.51, HCT 18.2, PCV 25

April 15: RBC 5.26, HCT 41.5, PCV 40

May 13: RBC 5.39, HCT 39.9, PCV 39, reduced prednisone by ½ (5 mg once a day) on doctor’s order

May 14: treated for pink urine with antiobiotic. Urinalysis showed no bacterial growth, detected some rbc.

May 27: RBC 5.01, HCT 36.3, PCV 38

The doctor today said that due to her 3 point drop in HCT, she should go back up to 10 mg of prednisone. She wants to do another cbc in 2 weeks and if stable continue at the 10 mg prednisone for at least 6 weeks before considering tapering.

As you can imagine, this was not news we were hoping for.

As I mentioned in my last post, at our May 13 visit, I proposed a 25% reduction and expressed my concerns about the vet’s 50% reduction, but our vet would not agree to it. She wanted to follow what she described was the accepted protocol. So, during the last 2 weeks, when she was on the lower dosage, we watched Sophie very closely for symptoms you noted in your prior message to us.

The positive was that during this time, she was even perkier, had more energy (going on longer walks), reduced shaking in her legs, and her diet was returning to normal. On the 10 mg of prednisone, her appetite was increased and more varied. During the two weeks she was on 5 mg of prednisone, her portion size decreased back to normal, and she became more discriminating in what she would eat (as she has always been).

Also, Sophie gets extremely stressed when we feed her the sufralfate through the syringe, and having one feeding of that, instead of two, seemed like a positive change for her. By appearances to be tolerating the ½ reduction well and improving in her energy level and behavior.

But, we are now concerned about her 3 point HCT drop. I would value your thoughts on the plan moving forward. Do you think the drop in the HCT is of concern and does it warrant going back on the full dose of prednisone, as the vet has recommended? (Her pcv was a 1 point drop to 38).

And if we maintain her on the full dose for another 6 weeks as the vet recommends, she will have been on 10 mg of prednisone (her weight has fluctuated between 12-13 pounds) for a little over 3 months (minus the 2 weeks she was at 1/2 dose of 5 mg). I am concerned about the long term health implications of being on full dose for that long, but I we have to tolerate that if the other option is risk significant drop in pcv.

Finally I am trying to understand what the drop in the HCT levels means and how it may relate to the prednisone reduction schedule. The drop after the prednisone reduction seems to suggest that her body is continuing to destroy her red blood cells and it was only the higher dosage of the prednisone that was stopping it, which suggests an underlying cause that is continuing to trigger this response. Her reticulocyte number went from 70.6 on May 13 (pre reduction) to 255 on May 27 (2 weeks post reduction), which suggests that she is producing more red blood cells to compensate.

If the underlying cause is still present, and assuming she is able to maintain her pcv levels due to the prednisone, would a more gradual reduction help?

The news today was discouraging, but we are still maintaining hope and trying to do our best for Sophie. We would value your continued advice.

Thank you so much.

Drew

P.S. On the pink urine, after 2 urinalysis and being on 2 different antibiotics for close to 4 weeks, the doctor thinks that this is due to feeding her beets. The doctor found some red blood cells in her urine but not enough to color it pink, which it was when we took her in. The x ray of the abdomen showed no stones. I asked whether the urinalysis showed any evidence of kidney or liver disease, which we are concerned about with the predisone, but the vet said there was no evidence of damage to either.