Evans Syndrome :(

[Patrice]

Amy,
I’m sorry, I thought you had this. Go to this page:
https://www.secondchanceaihadogs.com/hemopetresources
Click on the second picture on the left side:
Dr Dodds IMHA Disease and Bone Marrow Failure

This will open a pdf of the protocol. You can clip on the arrow on the upper right to open it in a new window where you can print it and save it.

If you would like to receive a consultation from Dr. Dodds, the link to that page is just above this protocol. Click on that to take you to her website where you can request a consultation. Vally has reminded folks to scan their lab work into one file because the upload for the consultation is limited.

Many owners have done this over the years and in many cases it was the key to success. Both Vally and I received consultations from her. Think of this as a second opinion, as you would get if you were very sick. Your vet can chose to collaborate with Dr. Dodds, as many do. My vets were very grateful for this help.

Reducing the prednisone is tricky and I cannot advise you decrease this on your own. Your vet or in collaboration with Dr. Dodds can advise you when and how to reduce the dosage. Without seeing any of your lab work or the vet’s reports I can’t say whether this would be appropriate now or not. In general, however, if a dog is on two or more immunosuppressant drugs, such as cyclo and prednisone, and begins to show some progress, it is appropriate to begin reducing the prednisone slowly.

Here is something you can read about the reduction of prednisone that will help you understand.
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction

On this page are several articles about canine iatrogenic Cushings disease, or Cushings caused by giving high doses of prednisone. This describes the multiple side effects.
https://www.secondchanceaihadogs.com/dermatology-resources

At the top of each page on this website are boxes that contain links to many resources. You can also find theses resources under Second Chance Resources in the menu. Under AIHA Terms you can find many glossary items that help you understand the language the vet uses.

my best, patrice

[AmyE]

Thanks you! Yes I know how the reduction works but since she was on prednisone only last time it was a VERY VERY slow process. I would like to get her off as soon as possible. My Vet reduced her from 30mg to 20mg yesterday because she feels the cyclosporine is really what is working. I will go and read the link you posted.
Thanks again!
Amy

[Patrice]

This is a 33% decrease, the highest we recommend for dogs we have seen on this list. We see when there is a greater decrease, some dogs relapse, and it is harder to come back from that relapse. Expect to wait about 2 or more weeks to do another decrease. I would recommend doing a full CBC complete blood count PRIOR to decreasing again. We want to see these values either remain stable or improve. If the important values begin sliding downwards, you may need to go back to a higher dose again. Dr. Dodds protocol addresses this also.

Coal will feel and also act like he feels worse, this is due to the prednisone reduction. It’s also probably the hardest time for owners, who simply want their dog to feel better and act better. Please be patient during this time. It took me about 7-8 months to reduce Chance’s prednisone and cyclosporine. Medically he was better, but this reduction made him feel awful. I never stopped returning to the vets for CBC’s and PCV’s. I also did chemical screens frequently to ensure his many body systems were improving. Do not stop providing protection such as pepcid and denamarin.
my best
patrice

[Vally]

Amy, the only time I’ve come across really quick reductions is where the prednisone is really doing more damage than good. As Patrice says, please be patient. I know that’s so hard right now, but a quick reduction just makes relapse more of a possibility.

Hang in there.

xxx

[Amanda Goodman-Alvarado]

Hello,
My dog was recently diagnosed with Evans syndrome . He was originally referred by my regular vet to a critical care vet due to enlarged spleen & given prednisone & yunnan baiyao. He did very well on those meds for 3 days but then the critical care vet determined that he had Evans syndrome & changed his meds. They gave him prednisone & mycrophenolate along with antibiotics, antinausea meds & prilosec. After 3 more days on those meds he got much worse & collapsed. They admitted him & did a blood transfusion and removed his spleen. He stayed in hospital 2 days & vet saud clinically he looked great & his HCT was stabilized at 20% so he came home 2 days ago. He was so weak coming home.. He is barely able to get up. Lays with his eyes open breathing rapidly most of the day & only gets up once or twice a day to drink water or pee/poop. His stool is dark tarry & slightly bloody. (Prior to spleenectomy surgery it was normal medium brown). It us a task getting him to eat even with Entise appetite stimulant. I try new things each day & have been able to get him to eat some with certain table foods but nothing else. I am afraid he is dying, he is so weak. Should the prednisone & mycrophenolate have kicked in by now? Is it too late to try something else? Is he misdiagnosed with Evans syndrome? Prior to a month ago he was full of energy and would outrun me any day.

[Amanda Goodman-Alvarado]

Hello,
My dog was recently diagnosed with Evans syndrome . He was originally referred by my regular vet to a critical care vet due to enlarged spleen & given prednisone & yunnan baiyao. He did very well on those meds for 3 days but then the critical care vet determined that he had Evans syndrome & changed his meds. They gave him prednisone & mycrophenolate along with antibiotics, antinausea meds & prilosec. After 3 more days on those meds he got much worse & collapsed. They admitted him & did a blood transfusion and removed his spleen. He stayed in hospital 2 days & vet saud clinically he looked great & his HCT was stabilized at 20% so he came home 2 days ago. He was so weak coming home.. He is barely able to get up. Lays with his eyes open breathing rapidly most of the day & only gets up once or twice a day to drink water or pee/poop. His stool is dark tarry & slightly bloody. (Prior to spleenectomy surgery it was normal medium brown). It is a task getting him to eat even with Entise appetite stimulant. I try new things each day & have been able to get him to eat some with certain table foods but nothing else. I am afraid he is dying, he is so weak. Should the prednisone & mycrophenolate have kicked in by now? Is it too late to try something else? Is he misdiagnosed with Evans syndrome? Prior to a month ago he was full of energy and would outrun me any day.

[Patrice]

Amanda,
I’m sorry to read this.
I’m going to suggest you try to take him to a specialty clinic if you have one nearby, for a second opinion. If you can find a board certified internist immediately it is important to determine if there is either internal bleeding or he has developed hemolytic anemia.

I don’t know every detail at this point but I do want you to get him somewhere safe so they can provide supportive care. At this point he belongs in emergency care, not at home. I am concerned also about inappropriate clotting that could be serious. We can talk more about at home treatment but he needs to be stabilized by a specialist very soon. Try to take a sample of stool and urine if you can collect some. But don’t waste time if thats too hard. I’ll check back in the morning and hopefully Vally will be on soon to check in as well.
My best Patrice

[Vally]

Amanda, I’m so sorry to find you here because I know how worried you are.

I agree with Patrice, I think you need a second opinion quickly. Please do go to an internist for help. Your boy is not stable right now and, yes, I also think he is much to sick to be home.

Mycophenolate can make many dogs feel sick as well. It’s not a favourite of mine for our dogs. If your boy does have AIHA, then cyclosporine is a better second drug to prednisone.

Please let us know how he’s going.

Regards, Vally