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- Maci –almost 3 months post nightmare
Hi everyone,
It’s been almost 3 months since Maci (2 .5 year old shih-tzu) went through this nightmare of IMHA. I have posted before in regards to aftercare suggestions. Yesterday, she went to her biweekly PCV check and she has managed to stay at a solid 48-49% the last 2 months. She has been doing so well. She started off on 10mg of pres and is tapered down to 2.5 mgs.
My vet suggests we keep her on the cyclosporine (she is also taking this daily) for, possibly, the remainder of her life. He says this is to avoid relapse and cyclosporine has minimal side effects, unlike pres.
What do you think? I really don’t ever want to go through that heartbreak again, but I also want her to live a life where she is med free. I want the best for my baby and will do what it takes! Any suggestions, do’s and don’t’s let me know :)
Thank you so much :)
Hi Nicole,
Well done Maci on those beautiful numbers.
I’m more familiar with a dog remaining on low dose prednisone than cyclosporine, but that could possibly be a cost factor, but I’ve emailed Patrice about this and asked her to comment.
Vally
Patrice has responded by email, so I’ll copy that here:
“Cyclosporine, or Atopica, is used often to treat canine allergies at a maintenance dose. That’s lower than Dr. Dodds loading dose and can be lower than the dose used to treat IMHA. It’s obviously different from dog to dog as to how much they need to stay relatively allergy free.
So yes, it can be used as a maintenance dose in any dog that is or was being treated for IMHA. At lower doses side effects are negligible. The ideal is to monitor the lymphocytes values, which Dr. Dodds mentions in her protocol, so they are kept lower than a certain value. Since they are usually responsible for autoimmune conditions, keeping them under control not only reduces allergies but also reduces the reactivity of the immune system to IMHA triggers.
I absolutely recommend to reduce the prednisone first to reasonable levels, say 5-10 mg a day, then reduce high cyclosporine doses to a dose more in line with the maintenance dose recommended for canine allergies. Eventually the prednisone can be removed in some dogs. Chance was done this way. Removing the prednisone was absolutely the best thing for his recovery. The vet and I discussed keeping him on Atopica for his allergies but we didn’t and for some reason his allergies never bothered him after all his sickness. Within a year of diagnosis his body had recovered and I never worried about relapse.”
Her next appointment is September 4th, maybe I can ask them to check those as well as her PCV. Thank you! I am so thankful I found this forum, It has given me so much hope to see so many doggies recover. The internet does not. I will keep you updated :)
Nicole,
If you look under the Second Chance Resources menu you will see a variety of pages of resources. Click on Hemopet Resources. On this page you will see “IMMUNE-MEDIATED HEMATOLOGIC DISEASE AND BONE MARROW FAILURE
W. Jean Dodds,” Click on this picture and it will open her article containing her protocol. You can click on the upper right hand arrow to get to a full page you can read, copy, save and print.
On this page she mentions this about cyclosporine’s role in controlling autoimmune disease:
“The goal of this immunosuppressive therapy is to stabilize the ongoing immune destructive process. The dosage guideline we use is adjusted to maintain the absolute lymphocyte count as about 1/3 of the normal range (750-1500/ul).”
These lymphocytes are a value on your CBC complete blood count. Every time you have been getting blood work done, these are on that test. If you look back at your previous CBC’s you can monitor the exact levels of absolute lymphocytes. Your vet can decide where he wants these levels to be for future protection against relapse.
Also go to this page:
https://www.secondchanceaihadogs.com/medication-resources
Click on the Atopica Product insert picture to open that document. Under Dosage and Administration they explain how to dose a dog with allergies in the beginning and how to taper the dose for maintenance. You want to be discussing this tapering with your vet as an appropriate dose, that will probably not be daily, but on certain days of the week. Print the sheet out so you can discuss this with your vet, paper in hand.
I know Maci doesn’t have allergies but the use of cyclosporine for treating IMHA is an accepted “off label” medical use. It is commonly used now in most clinics for this. The reason I want you to look at dosing for maintenance for allergies is to help your vet tweak the doses according to an acceptable dose in general for dogs.
Absolutely. Dogs do survive this. I base this on years of talking with owners on this list and my own careful research into the details of how treatments have become more sophisticated in recent years. Vets pay far more attention to the emergency acute care stage of the condition and that is very valuable. If there is one thing I can advise all owners, get to the vet fast and don’t worry that you don’t understand all that is happening. Most vets do understand these treatments better and keeping a dog alive past the first 48 hours is very critical to having success.
When Chance was diagnosed with bone marrow failure in 2007 there was little to no information to be found. It was dreadful trying to find ANYTHING at all. Now the internet if full of valid research and descriptions of the condition he was suffering. Of course back then, Dr. Dodds knew what this condition was and she had all the information I needed to save his life.
So things have changed significantly and older textbooks and older studies really are outdated and that information should be taken with caution.
Your vet is one of the more forward looking vets who understands the role of lymphocytes (called T-Cell lymphocytes or commonly called Killer T-Cells) in autoimmune conditions.
These particular immune cells are made in the bone marrow, along with all other blood cellular elements. But then they go to the thymus gland to get their instructions about what they are supposed to be destroying (such as cancer cells.) These cells can become “rogue” and misunderstand their instructions, instead attacking and destroying the body’s cells such as red blood cells. This is the most likely cause of most AIHA and IMHA. Only the triggers can be different from one dog to the next.
Of course without T-Cells we can also become very sick because they do perform a very critical job in our body. So we want to maintain enough of them to protect ourselves. When the immune system has trouble figuring out how to protect us, we get into trouble. So if you are following my chain of thought, for the future we don’t want to completely disable Maci’s immune functions, we want to make it a bit less reactive to triggers.
That means for the rest of her life you must be more cautious about what she interacts with, removing most of the stress from her life. By that I mean all kinds of stressors. Visitors in your home, other pets from outside your home, interactions with wild animals, pests like ticks, fleas, mosquito, foods that are novel or contain “non-food-like” ingredients, avoid vaccine boosters (except for legally require rabies), certain medications like antibiotics or flea and tick preparations that are ingested and become systemic. The list is very long and I can’t cover them all here.
Just remember that she has survived but that she is a slightly different dog than the one you went into this disease with. She is more fragile and needs a gentler life. Humans are very good at being compassionate and care for their pets so this is an easy task. If this were me I would never travel anywhere with her and I would never leave her at home for my own trips. I already make all my dog’s food at home so I can control what goes into their bodies. I see my vet regularly for checkups to ensure I am catching anything amiss.
You are doing a great job in learning all you can about this. You are a Great Mom!
What else can I help you with?
my best, patrice