New to AIHA, dog in trouble

[admin]

Hi Rick. I am SO glad to read the news of Brandy’s PCV OF 30!!! Way to go!!! I am in England and have little to no internet, but wanted to mention supplements for:

LIVER: Sheena and Hope are right: Denamarin. I had my girl, Sadie, on that for a good while. BUT, I later opted for the less ‘processed’ combination of (brand that I use) HerbPharm Liquid Milk Thistle (Amazon or direct from HerbPharm AND in health food stores) AND (brand that I use) Lumina CellFood SAM-e. Both milk thistle and SAM-e are the MAIN components in Denamarin, but these are ‘pure’ forms. I give it to Sadie in her food, 20 drops milk thistle and 12 drops SAM-e. Sadie weighs 39 pounds.

IRON Supplement: (brand) PetTinic. Sadie has been on this from day one of diagnosis and continues to thus day. Directions and dosage are on bottle (liquid). It is NOT a pure supplement AND has sugar, BUT it is an incredible iron supplement (promoted by Dr.Dodds too). I swear by this supplement. This also goes in Sadie’s food. (So it’s the three supplements, milk thistle, CellFood SAM-e and PetTinic).

TUMMY: I would recommend Sucralfate now. It’s an incredible drug and safe. Later I stopped it with Sadie and used 1/2 tab of 10mg Prpcid daily, but I also added the slippery elm cocktail (I’ll send, if you want it) and to this day, will give her a bit of slippery elm powder (open capsule, and add a bit to plain Greek yogurt). It soothes the tummy.

For administering pills, I break a small piece of the Duck and Pea Pill Pockets (Greenies). These are the hypo-allergenic. Not a whole one, just enough to cover the pill. They really stink, but after a year and a half, I’m over the smell and Sadie gobbles them down. I know you are watching the protein intake, so maybe a small amount or a small amount of cottage cheese? Or a andante carrot piece (push into small piece), green bean? I have done all these, but for Sadie, the pill pocket (one capsule size covers 4-5 pills) worked best.

Vally’s pill schedule was a huge help. Please have her send it. You’ll be amazed how it alleviates the did I or did I not? Thanks dear friend (Vally)!

Sleeping downstairs with Brandy would be a good idea. She’ll get better with time. I know it’s all mind boggling right now. Sadie would cone to me to go outside, but I just take her too. She did have her accidents, which she never did prior to AIHA, meds, constant consumption of H2O.p, but we both got it with time. Yes, as Sheena said (to me too!!) – lots of cool, fresh water always. Just remember, what goes in, must come out. ;)

Hang in there. You’re doing the most awesome job!!!

Love and hugs, Linda and Sadie

[Vally]

Hi Rick, I can’t wait to hear that Brandy is home. Whilst it’s scary when they get home, I think it’s so much better for them and us. You’ve got a lot to read and take in above, so I won’t add anything.

If you don’t have a pill chart, please let me know and I’d love to make one up for you.

Actually Sheena you mentioned a CBC every 3 days. We used to do a PCV every 3 days, not complete blood works. Were you doing complete?

Love Vally & Bingo

[Rick]

She’s home!
As expected she is quite tired but is alert and happy to be home.
She slept 5 hours straight and only got up because I wanted to see her move to make sure she was okay.
She really wanted to go for a walk this morning with her brother but I limited her to a short 5 minute loop.
Stool looks good but I haven’t yet caught urine to check color.
She is hungry every 20 minutes but still picky about what she eats (which happens when she is not feeling well). Her “job” is to clean up her brother’s food dish and she happily did that today. She didn’t do that last time she was home. No problem getting pills in her.

Meds:
Prednisolone 15mg twice per day
Cyclosporine 50mg twice per day
Metoclorapramide 5mg every 8 hours for 10 days.
Omeprazole 10mg once per day
Plavix 75mg (1/4 pill) once per day

The hospital discontinued Sulcrate because she was eating okay but I would like to restart it. Historically she has a very sensitive stomach.

Can I give Cyclosporine and Prednisone at the same time or should I skew them? I want to give all pills with some food so I would split her meals if they need to be skewed.

Vally, I would certainly appreciate a copy of your pill chart – there is a lot to keep track of.

Her Hematocrit from the external lab was up to 25% yesterday – up 3 points from the day before. The external lab has been lower than PCV from the local clinic.

Next PCV will be Thursday morning. Her gums are still paler than normal but the same as yesterday.

Okay, breathe now…

[admin]

Rick,

Great to hear Brandy is home & her PCV is up too – good luck with the next one, of course – ever upwards, hopefully. Lab results do vary a small amount – we used a human lab as well as the vets and they were often a few points different.

Just a quick note on the metoclopramide – this drug speeds up the emptying of the stomach, so it can decrease or increase the absorption and the effects of other drugs that are absorbed in the GI tract, particularly the small intestine (small bowel). The effects of cyclosporine can be accelerated when used together with metoclopramide. I expect you vet has told you about this, but I wanted to mention it. It may be significant when you stop the metoclopramide.

I have no personal experience with cyclosporine and I know you have read the glossary item about it, but I have seen others give it at the same time as the pred – Vally, Linda & Patrice will help you more than I can on this one. Whatever you decide to do on the cyclo front, it is important to always do the same & also give the same size meal with it each time. It’s a nightmare! The tummy meds (omeprazole & sucralfate) as you know must be given completely separately, otherwise they will prevent absorption & that is not a good thing.

Glad to hear Brandy is a good girl with her pills – that makes life a lot easier. If you are worried about anything at all, please ask – we all know how worrying it is, especially when they first come home. I honestly worried about every daft little thing imaginable & I think you’ll find everyone on here was the same (still are!). We have a little “joke” on here about how this disease has affected us all – this is the crazy, paranoid, roller coaster world of AIHA.

Best wishes & a big hug for Brandy from me
Sheena, Worzel & Ollie

[Tamara]

Hi Rick, so happy to hear that Brandy is home and doing well! I was told that I can give pred with cyclo so that is how I gave it until I was giving several at one time and just wanted to break up the meds a little.

We have the same experience you do, Ashki’s HCT is typically a point or two lower than the PCV.

Until recently (the last two weeks) I was taking Ashki in at least 3 times a week to check PCV and there were a couple weeks when I started freaking out because his gums looked paler or he was less energetic than usual and so we went 4. Sheena is so right, we are all so paranoid about every little thing and it is wonderful to be able to post here about all our worries and here from everyone who has gone through this before, as well as those of us who are in the fight right now.

Sending you and Brandy much love and many hugs and all the best wishes —

tamara and ashki xoxoxo

[Vally]

Yay she’s home.

As you’ve done, keep exercise to an absolute minimum for now. She won’t have much energy. It’s great she wants to go for a walk though. I also found the pred itself used to knock Bingo out a lot. As he moved to lower doses, there was a very visible difference.

I’ve always given prednisolone with food and Cyclosporine away from food. I was told to give cyclo at least an hour away from food. Some dog’s don’t tolerate it without food though. What has the vet suggested? As Sheena said, if you’re giving with food, stick to giving it with food, if without, stick to without.

I like the idea of continuing the sulcrate. It also helps to protect the stomach. Really important to keep this away from all meds though, as it stops the absorption of them. Bingo ended up with ulcers from the pred. He was then put on sucralfate (which I think is the same) and it worked brilliantly. We only stopped using it when he got down to much smaller doses of pred.

It’s probably a good idea to post the times of the dosing of the drugs here. That way if anyone spots a problem, they can let you know.

Send me an email and I’ll get a chart back to you. Let me know when you send an email and I’ll take my email off from this note.

Love Vally & Bingo

• This reply was modified 10 years, 4 months ago by Vally.

[Rick]

Thanks everyone for the well wishes.

The vet wasn’t concerned about giving Pred and Cyclo together so I will do that. I want those doses with food and as far away from the stomach protectors as possible.

We had a great day today. She ate plenty, took all her pills and got plenty of sleep. She is much more focussed and alert than even this morning. Her tail is up and wagging a lot :)
She is sleeping now but her energy is really good, even if you don’t consider her terrible state last Friday.

Her gums are still paler than I’d like to see so I’ll keep watching those.

Vally, email sent re: meds schedule.

Regards,
Rick

[Patrice]

Rick,
I am really happy to hear that she is eating, feeling better and delighted to see you. Good signs all the way around!

Many dogs are prescribed prednisone and cyclosporine (Atopica) at the same time. They perform the same function, immunosuppression of the immune system.

The difference is that prednisone is like a wrecking ball, suppressing the immune system completely whereas Atopica (cyclosporine) is more like a small ballpein hammer. It only targets and suppresses the T-lymphocytes, those cells of the immune system responsible for the autoimmune attack on the red blood cells.

The reason to use cyclosporine in addition to prednisone is twofold. First is to allow us to decrease the prednisone dose to reduce the side effects and second to really target just what we need to target. In addition cyclosporine’s side effects are minimal (mostly temporary stomach upset) and once you remove the drug they are gone.

I am not sure why your vet told you to give the cyclosporine with food. This in direct opposition to the manufacturer’s instructions. I know Dr. Dodds made it clear to me that I had to give it on an empty stomach for proper absorption.

Here are the dosing instructions from the Atopica patient insert:
“The initial daily dose of ATOPICA is 5 mg/kg/day (3.3-6.7 mg/kg/day) as a single daily dose for 30 days. SNIP>
*ATOPICA should be given at least one hour before or two hours after a meal.* ”

Please draw your vet’s attention to this and ask them if they still want you to dose it with food. It’s likely giving it with food will decrease its effectiveness.
http://www.us.atopica.com/just-For-Vets/how-To-Administer.htm
my best,
Patrice