Diet & Med Recommendations

[Natasha]

In March our 4 year old labrador retriever was diagnosed with AIHA – after receiving two blood transfusions her hct went from 9 to 18. She was started on prednisone 50mg. One month recheck showed mild increase to 20 of hct. She was started on mycophenolate & just had a one month recheck, hct is 22. reticulocyte is normal after being very low initially. I’m wondering if this gradual increase in hematocrit is normal? Or if I should push for different medication regime. The meds are definitely hard on her and she’s lost close to 15 pounds & continues to have diarrhea. She seems to have worse GI symptoms with kibble so we’ve eliminated kibble & transitioned to wet food but I’m seeking any insight on good gentle diets. She currently eats a mixture of wet food, egg whites, bone broth & stew meat that is boiled.

This diagnosis took us completely by shock & this forum has really helped me feel not so alone the last two months.

[Patrice]

Hi Natasha,
I’m sorry to read about your Labrador retriever.

You may have received a detailed email from me. As I have mentioned in that email, I feel that the mycophenolate can have some very negative gastrointestinal side effects, far more than another commonly prescribed immunosuppressive drug, cyclosporine.

You say that the reticulocyte count is normal. Do you have the recent CBC and chem screen reports? I would like to look at copies. You can upload them using the Urgent Advice page, see the link in the menu on the upper right of the page.

This increase in hematocrit is not normal but we have seen this many many times with these dogs on this forum. Mycophenolate has become more popular as a treatment in recent years because it is less expensive. But it also have more significant side effects. One of which is suppression of the bone marrow. This can account for a dog remaining in the low 20’s HCT PCV.

I am also not particularly happy that she has become weakened by the gastrointestinal symptoms which are more severe with this drug, sometimes leading to colitis and continued diarrhea. Our philosophy is to try to keep a dog as healthy as possible while treating them. Once they begin to have continued diarrhea, which leads to dehydration and dietary changes, the dog is at a disadvantage.

Please talk with your vet about switching to cyclosporine, after a short drug holiday from the mycophenolate. There are other things we can suggest as well. But right now it is critical to get her body stable again so she can remain strong enough to tolerate the medication treatments.
Do you have more questions?
my best, Patrice

[Vally]

Hi Natasha, just wanted to say hi and happy to help. Patrice has given some good advice. Definitely ask to switch to cyclosporine.

Regards, Vally