Help and advice – Experience with Acute Respiratory Syndrom in AIHA dog

[Anne]

I forgot to mention that the last change that happened was a Prednisone reduction (from 25 to 20) and taking his Immuran every two days rather than everyday. Here’s his full meds right now (I do not include the new meds for his skin, as I’m at the office and don’t have them with me):

Prednisone: 5mg pills/ 2 in the morning and 2 in the evening for a total of 20 mg
Immuran: 25 mg/every two days
Cyclosporin: 75 mg, morning and evening
Aspirin: 8mg/in the morning

[admin]

Dear Anne-Marie,
I am so sorry that today’s results were not what you were hoping for. I am in a rush (going to donate blood today, for people:)) but my first thought was that maybe this was too big of a reduction because you reduced 2 medications at the same time? I think that before you add an other medication I would try and just go back to the dose you were at before? I think I remember that Bilbo did ok with that. Where was he at for his last check? how big of a decline is it? There are always ups and downs, there are so many variables depending on how hydrated, stressed your dog is, time of day, full or empty stomach, who took the sample and how was it handled.
This is just a small bump in the road, keep stiff upper lip, you and Bilbo will beat this! I am interested what everyone else thinks.
Best wishes,
Brigitte

[admin]

Hi Anne-Marie

WE understand you completely, absolutely. What rotten luck for you & sweet Bilbo. I am so sorry your other half is away – isn’t it always the same when things like this happen? But you always have us to talk to.

Forgive me being blunt here – you need to contact Dr Dodds immediately. Bilbo WAS regenerative, which we were all so happy about – something has happened to either stop this or caused a re-chute of the haemolysis (maybe both), i.e. that trigger has re-emerged – is Bilbo on antibiotics still, or have you stopped them completely now? I am presuming they are finished now. If so, there may be an infection responsible – I can only guess. I agree with Brigitte – it could easily be too many reductions of too may things done all at the same time – this gives you absolutely no clue as to what has worked for him & what has not. Personally, with a relapse like this, I think you might have to at least put the doses back up to where they were when he was doing OK, or even to what he was on at the start of treatment – Dr Dodds can help you here. I appreciate the skin problem is difficult, but this is “minor” compared to the anaemia side of things. Also, the addition of other immuno-suppressants needs to be discussed with Dr Dodds – I would not be happy to do this either if I were you, especuially as he was improving wonderfully.

Linda & Sadie, Vally & Bingo & others have been through this relapse scenario, so you are no way alone in what has happened. Relapses are a real pain, but are certainly not uncommon & can be overcome. Usually, they happen because of poor drug weaning protocols or the fact that original trigger has not been eliminated. Have you any blood tests or other tests results available to send? We can have a look for you gladly.

In the meantime, please do not get disheartened – I truly believe that because Bilbo was regenerative, this can be beaten once more. Consider it a “glitch” – as with Linda & Sadie – it’s just a matter of getting your treatment right once more, like you did at the beginning.

Give your lovely tummied boy a cuddle from me, contact Dr Dodds – and please keep positive. I promise I would do anything to help my dogs too, but I would never cause them suffering. Who cares what others may think about how much we love them? Not me.

Love & bisous, Sheena & the boys xxxx

[Hope]

Hey there Anne Marie!

I’m so sorry to hear about Bilbos setback — that’s terribly disheartening and it’s even worse because your husband is away. I don’t know how to read labs, etc but what sheena said above makes A LOT of sense to me. Maybe reducing both the Pred and the other immunosuppressant at one time was too much. And you really can’t know which (or both) is the problem because they were dropped together. I think you truly have every reason to be hopeful and positive –he was doing super well and he’s just having a setback hopefully.
We all love our babies as much as you so you don’t need to explain yourself here — it became a rule VERY quickly when Steve got sick that no one was to comment unless it was super positive and helpful. I don’t need to explain to someone why I would do anything for my fur baby just as my brother would do for his kids. You are so not alone, not at all!
Again I don’t know as much as most on here but I don’t understand why your vet would be hinting about letting go. Is this a specialist? If not, maybe you may consider switching to an internist or vet school.. They are more equipped and experienced with dealing with IMHA. I found that it seems many general vets are just out of their leagues with this disease.
And I totally second contacting Dr. Dodds — she is amazing and very easy to talk to and get in touch with. And she’s the best so it’s just a win all around!

Super hugs to you and bilbo!
Xoxo hope and Steve

[Linda]

Oh Ann-Marie – you are really being tested. I am sorry. But PKEADE don’t give up. Sheena is so right – many of us have been right where you are now. ONE drug at a time with weaning. I agree with Sheena and I think someone else said too – go back to where Bilbo was doing well. Keep him there – stabilize him.

I am so thinking of you and will write again later.

Much love, Linda

[Anne]

Hello everyone,

Just got back home from work. Thanks for all your good wishes. Bilbo was in a good mood, and it certainly made me happy.

The vet emailed me to say that unfortunately, she had not received the results, but she should have them tomorrow morning. She always sends very detailed reports (as some of yuo already know, because I shared some of them), so hopefully I’ll be able to email the report to Dr. Dodds and all of you right away. I wish I could have gotten it tonight.

I might have beeen confusing in my last email: the vey said this morning that the blood work showed that Bilbo was still regenerative (we’ll take any good news) BUT that clearly something’s goin on, as his RBC was now down to 21: either a relapse OR he’s losing blood elsewhere as a side effect of Prednisone (stomach ulcers, etc.) So I now have to give him clindamycine for his skin condition, omeprazole in case there are some ulcers or internal bleeding, and sucrafalte to help protect his mucosal tissues.

So what you’re telling me is that most of you hadve experienced a relapse? What happens, usually: you increase the Immuran or any other meds? It is not necessarily a death sentence? Could simply going back to the initial dosing stop the dropping in his RBC? He was doing so well, I’m just… Discouraged. I cried all day, in between meetings and conferences.

Environment might be a factor here, as we don’t know indeed what triggered everything in the first place, but I have three furbabies, and the two others are doing really fine. Wouldn’t it afefct them as well? Some of you mentioned pesticed on grass, in another thread, if i’m correct? Could that be it?

Bilbo’s RBC was at a staggering high of 36 before his meds got lowered.

Skin condition is definitively secondary to the anemia. I think the concern was that it might be a serious side effect of Prednisone, which could be a problem if even a small reduction leads to this? I don’t know.

Thanks to all your kind words and nice wishes. I don’t want to lose my dog, I just want to do my best to help him recover. It really helps talking to you all.

[admin]

Hi Anne-Marie

I am really sorry to hear that you’ve had this blow to deal with. It must have been a shock and I can quite understand why you’ve been so upset.

I’m not an expert at relapses but I know Linda’s Sadie and Vally’s Bingo have had them and are both doing really well, so please don’t feel that all hope is lost. I do wonder if lowering both the immunosuppressants together was a bit too much for Bilbo? I’m really pleased to hear that you are going to contact Dr Dodds, and I am certain she will have useful advice for you about what to do next.

It is good news to hear that Bilbo is still regenerative, although the drop in PCV would make me suspicious of blood loss or ongoing haemolysis. Environmental factors are also important, although it can be difficult to narrow it down as there are just so many factors. Has Bilbo had any recent vaccinations, flea/tick treatment etc?

You mentioned Bilbo’s liver tests – is he on anything to protect his liver? Some of these medications do alter the liver enzymes somewhat. I totally understand what you said about medicating him, but many of these drugs are lifesavers and the others help to prevent side effects, so please don’t feel guilty.

You never need to worry about justifying how much you love your dogs here! We all totally understand :)

Hang in there Anne. I keeping everything crossed that this will just turn out to be a bump in the road and Bilbo will soon be feeling better again. Do keep us posted.

Love, Mary and Mable x

• This reply was modified 10 years, 2 months ago by admin.

[Vally]

Hi Anne-Marie,

I’ve cried in the office many times. It’s only a small office, so whenever I got upset they’d all hug me and I’d start bawling again. At the worst of times, I had to take Bingo’s photos off my computer and phone, because I’d see then and start all over again. So you’re in good company. I’m a cryer.

I agree with the others, I don’t understand the reasoning why 2 of the drugs were lowered at once. My vet said we’d alternate drug reductions, but basically mainly stuck with pred reductions as that has the biggest side effects.

Bingo relapsed twice. When that happened, pred was actually doubled up again. So we tried to lower from 5mg daily to 5mg every second day ( 50% is too much of a reduction, no doubt why he relapsed), instead of going back to 5mg daily, he went back up to 10mg daily for a while. Same thing at 2.5mg daily, hit some problems, back to 5mg daily for a while.

Was Bilgo on stomach protection? Forgive me I can’t remember. If not, that’s super important too. Yes Bingo also ended up with black poos, which vet decided he most likely had stomach ulcers due to the prednisone, and was put on sucralfate. Brilliant stuff in that it worked pretty instantly.

Liver protection too. Bingo is still on SAMe. At first the vet said there was no need for liver protection as yes the prednisone is going to affect the liver no doubt and Bingo’s liver was swelling up. I could feel it :( However the liver is a marvelous organ in that when the pred is lowered, it just sets about making itself all better. However, having said that one of Bingo’s blood tests showed his liver enzymes were starting to get too high, so he was put on SAMe and his liver enzymes started to reduce down immediately. His next test showed improvement. So don’t worry about the liver.

The skin issues aren’t a big issue either. There should be improvement there too as the drugs can be lowered.

Make sure the sucralfate is given away from all meds, as it stops absorption. How often are you to give this? I’m not sure about how omeprazole is dosed.

Another thing, I never trust super high results. That’s the paranoid half glass empty me. Bingo did the same thing to me. One result went from a PCV of 31 to 47 in 1 week. Of course we lowered his pred on that occasion and went in to be checked the next week. His PCV was back down to 32 and his pred put back up again in case this was a true drop and not just a wrong reading. So whenever his PCV suddenly jumps up, I think sure, pull the other one.

So Bingo commiserates with Bilgo and says he hopes he’s feeling a lot better real soon. Vally commiserates with Ann-Marie and sends big big hugs.

Love Vally & Bingo