Camilla, AIHA-dog from Italy

[Sheena]

Good luck with the next test – I remembered you were going back about now. How is Camilla? How are you?

Love Sheena x

[eleonora]

hi girls! hi Sheena, you remembered well, we had the control yesterday! With azathioprine camilla has improved again. after 12 days of azathioprine she has gone from 4.8 to 5.1 …. I was hoping better but that’s okay, the important is that the red blood cells increase. reticulocytes increased slightly, they are still in the normal range. the hematologist told us to drop the prednisone and the azathioprine (both from half a tablet to a quarter of a tablet a day). next control between 10-15 days. but the most important thing is that Camilla begins to be visibly better.she still does not run and does not jump into the car but she’s able to stand up longer than before and when we go out for a walk she doesn’t walk, she trots !!!! if we go to the laundry room where the lady of the shop always gives her something to eat she pulls as a sled dog !!!! she is slowly returning to the camilla once. dropping the prednisone she is recovering a little bit of muscle mass even if the head is still very visible bones. I asked to hematologist if it was a good idea to take her to swim and he said yes but only after removing the prednisone because as long as she will be under prednisone she will not recover all the muscle mass. I found a swimming pool for dogs about 40 km from our city, when she no longer takes medication , we go there …. i know that it will do very well also to her spirit because she has always loved to swim. see that she is better makes me more confident, although I have a little afraid of what will happen when she will remove all the medicine. however, at the time I enjoy her progress :))
thank you for remembered!

[Sheena]

Lovely to hear from you Eleonora & lovely to hear the good news about Camilla! You are superstars. I think your story shows that our dogs don’t usually recover properly without that second longer acting immunosuppressant, such as azathioprine or cyclosporine – pred on it’s own isn’t enough. She is now in normal RBC levels which is great news. I will be nagging anyone else to add such a drug – and mention you two!

Camilla will get her muscles back – I agree with your vet completely – when she is off the pred – in the meantime, nothing too strenuous because they can damage ligaments/tendons because the muscle mass around then just isn’t there to support them properly. I am sure that swimming would be a great idea when you have weaned her off the pred.

Personally, I would leave the azathioprine dose as it is for now. I think this is very important & would urge you strongly to do that. Always reduce the pred first, until she is off it completely, please. It is safer to only reduce one thing at a time, then if something goes wrong, you know what it is. Could I ask you to trust me on this as other people have had problems not doing it “conventionally” & I don’t want anything to go wrong. After that, you can reduce the azathioprine for sure. Be careful handling that azathioprine – it is not good to touch it, as you know.

Some ideas for you: My specialist’s way of reducing azathioprine was to drop (not give) one 50mg tablet one day per week, then drop 2 days per week & so on until he only has one, one day a week – it worked for us (hope that makes sense). BUT Worzel was initially a very serious case of bone marrow failure, so we were very, very cautious. Worzel is also quite an old boy & he might not get through another bout of this horrible disease, so caution was important. I am sure there are other ways of reducing & I am just giving you another idea on reduction to discuss as a possibility. I can also see that half a pill per day would be an option, but take it slowly after that, maybe half a pill every other day (I think you probably say, like the French, all the two days), then half every three days …. and so on! See what everyone else says too as these things need discussing.

It is wonderful to hear Camilla has more energy & is feeling much better.

Love Sheena, Worzel (still on 1 x50mg aza per week for MY piece of mind really) & Ollie xxxxx

[Linda]

Hi Elenora. I am so glad Cammila is doing well. Huge grin :).

But, please take your time reducing. And only one immune surpressant reduction at a time. I agree totally with Sheena, PREDNISONE first. Trust me, I did the other. Sadie has relapsed THREE times. With this last relapse (she was bad too, two transfusions, PCV of 11), Today Sadie’s PCV was 48%. This time I reduced the prednisone first (Sadie will be on a maintenance, so she is at probably her lowest dose, 5mg daily). Once down to lowest prednisone (Camilla may not need a maintinence, so it could be – zero), THEN and only THEN, start reducing the aza. All this should be slow and the way Sheena describes is perfection.

Camilla is absolutely precious. Those dark eyes against that pure white fur – georgeous. I know this has been devastating for you and your precious girl. And you have been the most diligent fur mom. Sadie and I are sending huge hugs and much love. Please keep us posted.

[Vally]

Camilla, it’s wonderful to see the improvement. Small steps are giant steps in this business

I totally agree about only one reduction at at time. My specialist also recommended doing it that way. The prednisone is usually the first to be lowered following by the second, in this case the Azathioprine.

Truly, slowing the reduction just makes things safer and less chance of a relapse. As Linda said, reducing too fast can bring on a relapse of the disease. It happened twice with Bingo too, and we’ve seen it happen over and over again.

Love Vally & Bingo

[eleonora]

thanks for your advices girls!!!!

[eleonora]

hi girls! yesterday we went to the control. camilla’s RBC are 5.3!!!! they are slightly increased again, and the great news is that the functionality of her liver is almost back to normal, so in about one week we will leave all the meds she took for liver. we’ll also leave the prednisone (in the last 7 days she took 1/4 tablet every other day) and we will decrease the azathioprine from 1/4 tablet every day to 1/4 tablet one day yes, one day no, one day yes etc.. she will take the azathioprine in this dosage for 1 months and then we will go to control again. Her urinalysis are good (last month she had protein in the urine) so we can also remove the ace-inhibitor (benazepril hydrochloride). She is almost returned to her normal weight (34 kg…. yesterday she was 33,9). she is visibly better. i hope so much that she doesn.’t relapse……..i’m terrified :( but as we say in italy: ” è inutile fasciarsi la testa prima di essersela rotta” that in english i think it sounds like this: “it’s useless to wrap the head before it is broken”. finger cross for us! i’ll let you know how it goes…..

[Sheena]

Hello lovely Camilla, Hello lovely Eleonora!

I am absolutely thrilled to hear the great news! Well done, both of you. The trick to not relapsing is to reduce the medications nice & slowly – there is never any guarantee, but we do find that those who have followed the slowly rule do not relapse nearly as often – rarely in fact. I’m so glad your vet added the second immuno-suppressant – it has really made a huge difference to Camilla’s recovery, Thank you for listening to us,

I love the wrap the head saying – we do have some strange sayings, don’t we?

Camilla cannot have any vaccinations from now on – the risk is too great. That could cause a relapse. Also, any infection should be treated without delay with the correct antibiotic. Three groups to avoid are penicillins, cephalosporins & sulfa antibiotics. These can cause a relapse too. We all hope Camilla will be back to normal really soon & can also be drug-free. Just make sure you get a PCV/ red cell test after maybe a week of reducing any of the drugs until she is off them altogether. I get Worzel tested – a full blood count – every 3 months now. I will do that for the rest of his life. If he is not his usual self, I still worry. If in doubt, I get a blood test done to put my mind at rest!

Please let us know how Camilla gets on with the reductions (which look sensible to me).

Love, hugs & congratulations

Sheena, Worzel & Ollie xxxxx