Second Opinion for poor Inka

alyssa

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Everyone — I suggested Alina post here after she posted in the AIHA Facebook group I’m in. I’m going to include what I noticed/posted then, and also find and post some of her FB post. Alina I hope you don’t mind but we are going to need a lot more info to help

Hi Alina, someone else should be along shortly but I can tell you we are going to need more info from you! Thanks for posting here. I’m going to copy / paste what I said on Facebook

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THIS is one of Alina’s post from Facebook:
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Her meds are:
• Prednisolone 30mg / day
• Azathioprine 10mg / day
• Cyclosporin 50mg / day
• Amoxyclav 400mg/ day
At the moment she is not moving. Is falling over every time she gets up. Her hair is falling out and her skin is flaking off. She won’t keep any food or water down – waits til we leave the room then vomits and hides. She’s having a lot of difficulty passing stool. She’s asleep all day, only opens her eyes or goes for very small shakey walks. When I try to move her or reposition her she’ll start to wimper.

Vet told us that she has quite severe muscle wastage, and has lost quite a bit of weight (face is looking gaunt).

The vet told me that another transfusion in her condition was quite dangerous and would probably kill her. They can’t increase any of her meds – she’s only 10kg – probably less now with the weight loss.

When I got home from work yesterday she was lying in a pile of her own vomit and seemed so out of it.

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This I believe is her original post with I think some important info:

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Thanks for letting my join the group! So grateful to hear about all your experiences so I don’t feel like the only one going this so much anymore.

This is Inka – 9 yo female Pugalier. We are from Australia, and she was diagnosed with IMHA in mid – November. After initial hospitalisation, medication and a transfusion, her PCV went from 17 to 28. After being discharged on 20mg of Prednisolone, 10mg Azathioprine and 10mg Losec, she got better in leaps and bounds!

On the 23rd of Jan this year, her PCV was so good at 42 that the vets decided it was time to wean her off her Prednisolone. Unfortunately, five days later we were back in at the emergency vet with a dreaded relapse. On the 27th her PCV was 30, dropping to 24.5 two days later and to 18 yesterday.

The poor little girl is now on 30mg of Pred, 50mg of Cyclosporin, 10mg Azathioprine, broad spectrum antibiotic, anti – nausea meds and had a B12 injection.

I hope so much that she makes it through this, but the poor little girl just keeps getting sicker. Her beautiful Maltese-Shih Tzu sister, Sookie, won’t leave her side and keeps her warm under her blanket. I feel so much for the gorgeous dogs I see on here and I want you all to know that I keep them all in my thoughts as I wish them all the good health possible!!

Sorry for the long post! ☺

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Below are my thoughts from FB

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I would be so hesitant if HCT was holding, that is such a big part of the fight… what are her counts exactly, do you know?

How long has it been? I don’t see a stomach protectant in your med list which your vet definitely should of given you with these meds!! So very important! Could be a HUGE part of the problem! I just see a lot of drugs REALLY HARSH on the stomach but nothing to help it. You need to get pepcid / famoditine or sucralfate in this case may be warranted. all must be given 2 hours away from meds & food. Please start one right away! sucralfate is very strong & will heal present ulcers but can also really block med absorption more than the others.

Platelets can be 1 million before they are a problem. Sassy relapsed with Evans, which means her red cells and platelets were attacked, and it took a lot to stabilize her – after which her platelets (previously ZERO) shot up to around 700 and was freaking us out but they settled around 2 weeks later in the 3-400 range. I have a question – did you use IVIg treatment? This can cause platelets to go up before they settle.

It was suggested to me NOT to use penicillin based antibiotics with AIHA, which it seems amoxiclav is? We used Doxycycline with Sassy her first episode of AIHA, & we also used Zeniquin when she had a hugely resistant UTI. I was prescribed Amoxicillian recently but quickly realized it was penicillin and switched her to doxy again. I think Doxy is a little debated here, but it might be needed, discuss with your vet.

She should be on an ultra low dose of baby aspirin to prevent clotting during this time. My 75lb dog only takes 20mg, so it will be even less than that for a 20ish lb dog. It might be difficult to find that low of a dose unless you specifically ask for a specially compounded kind from a pharmacy.

Have you checked for tick illness?

The symptoms you are listing sound very bad BUT also normal. I do wonder if it’s party hunger & too sick to eat because she is getting such powerful drugs on an empty stomach. These drugs really, really need to be given with food. Is she vomiting her meds up as well? I would ask for a course of cerenia for the severe nausea.

If she is barely eating there won’t be much stool to pass. Sleep is VERY NORMAL. Muscle wasting is VERY NORMAL. Weight loss before the prednisone hunger kicks in is VERY NORMAL. Cyclosporine is also very well known for causing severe nausea. I did not use cyclo myself but came very close to.

As suggested more harm may be being done by having her on Aza AND cyclo – is there a reason for this? Did she not respond to treatment until you added both or were both started from the start? You can suppressed bone marrow function and invite horrible infections using both at once.

If not keeping down water you may need to go in for fluids or subcutaneous fluids – this goes under the skin and releases over time & you can also do it yourself at home. She needs hydration, especially on prednisone.

Have you ran a full chemistry panel and looked at her kidneys and liver function? This also test her glucose – these meds can cause diabetes.

If her HCT is stable that is very good. You aren’t in transfusion range yet. How long have she been stable there?

DONT be hesitant to get a second opinion!! I & many others have switched vets. Sometimes you just have to. I would call around and specially ASK the drs at clinics if they have treated this illness before. Then bring EVERYTHING you have and consult.

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Alina, I just read back some of your other post and I have to say I would be looking for another vet. If I understand correctly Inka was diagnosed in November and by Jan they were already weaning drugs – was the reduction at this time larger than 25%? If they thought because she was so good at 42% that is was safe to follow standard reductions, which is 50% at once, that is how this disease can trick your vet if they aren’t knowledage enough about it. NEVER let them reduce more than once drug at a time and never more than 25% every 2-3 weeks UNLESS there are *serious* side effects happening.

I see your vet said Cyclo would be immediate – this is false. It can take WEEKS.

These two things just really alarmed me.

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