Split: Split: For Hope and Steve

[hope]

Hiya Brigitte!

I had actually never seen that before so thank you for bringing it to my attention! My bookmark bar is getting to be super packed these days lol! I read what she wrote on heartworm preventative — and I learned something! I thought it was okay for us to give meds only during the summer months and discontinue in the winter. But apparently my state, LA, is one of the “special” (har har) ones where it should be given year around.
I had actually contacted Dr. Dodds today by email and she recommended Heartgard or Trifexis. I am a little confused because I keep reading that Trifexis is awful. She also said that Sentinel is good for non-liver-stressed dogs; if Steve wasn’t on IMHA drugs, she would have recommended that one as well. I’m going to keep reading and see what I can find; we’re paying the regular vet a visit on thursday to get the meds and I want to walk in there knowing what I would and would not take.

Hugs to all!!
xoxo Hope and the stinkers

[hope]

Hey all!
Question about meds — Steve is down to 10mg Pred once a day. Would it be unusual to see muscle atrophy at this point? I know any amount of Pred for any length of time isn’t good and it takes time for muscles to atrophy. But I’ve noticed in the last week, he has this kind of indentation in his back hip area (bilateral) that I read could be a sign of muscle atrophy, he seems a little uncoordinated and he even used Jeffrey’s stairs tonight to get on the bed, which he has NEVER done. I’m taking him by our regular vet tomorrow to talk about heartworm preventative but I was going to show her the “dents” (for lack of a better word) also.

Thanks!
xoxo hope and steve

[Vally]

Hope, Bingo certainly never got all his muscle tone back and the worse is his hips and back legs, so I think yes it’s very likely. I think when Steve’s pred goes down even lower, there’s a good chance Steve will improve though. Bingo, since he became sick, was never able to jump up on the couch or bed again.

Just today I bought a bundle of PVC pipes and have been scrounging through the local recycle bins :O for empty soft drink cans. I’ve set up a pole walk exercise thing with the poles resting on the slightly indented cans, set out about 12 inches apart. He’s only a shortie. He has to walk over them to get a treat. I also make him do 3 legged standing by holding up one leg at a time to make him balance on the other 3 to strengthen core and legs. Walking backwards is also good work on the back leg muscles. Bingo’s not too good at that one though – he usually cheats and turns sideways.

Vally & shortie.

[hope]

Evening all!!

So I took Steve in today to see his general vet.. Steve hasn’t seen her since moving to the specialist’s clinic. I thought he would love to see her but he flipped out actually and hid behind me lol — I think he’s repressing the memories ( I certainly am too) of the time he was in there when first diagnosed.

We wanted to start him on heartworm prevention but I said we needed a blood test to make sure since I had lapsed for a bit in giving it. While they were there they did a PCV… 45%!!!! Yay Steve!!! I think she was getting ready to pull a combo medication out — that’s her go to — but I told her no and insisted on Heartgard, which was recommended by Dr. Dodds.

So the atrophy and weird “lumps” that I mentioned by Steve’s hips… are you ready for it… FAT!! lol i was mortified… super duper relieved though so i really dont’ feel that bad but embarrassed just a little! He’s gained 12lbs since the last time they saw him in early early June and they said it was too much, that we need to put him back on a diet. I kind of felt bad because they were telling me 12lbs is a huge amount of weight, imagine if a person gained that much. I don’t know what to do though because he’s always so hungry. i feel awful refusing him food.
One more thing… he’s got little bumps/pimples/flaky skin patches on his back. It looks EXACTLY like the folliculitis he used to get as a puppy, which we treated with medicated shampoo. She said she wanted to treat it like staph and put him on Cephalexin. But isn’t that a KNOWN cause of IMHA? i thought so and found this…

http://vetspecialistsofrochester.com/pdf/Internal-Medicine/Immune-mediated%20anemia.pdf

What do yall think?

Vally – that’s so neat that you do strength training/trick things with Mr. Shortie. I’d love to try stuff like that with Steve (especially since he’s a chunker right now)!!

hugs to all!
xoxo hope and the chunky twins

[admin]

Hi Hope

I agree with you – you must be very careful about which antibiotics you choose for Mr Steve. Penicillin based antibiotics are not recommended either. Sorry to be rude, but I think your vet needs to do some homework & it’s a good job YOU are thinking so carefully, clever girl. Possible AIHA/IMHA drug triggers include antibiotics (such as sulfonamides, cephalosporins, penicillins), vaccines and procainamide and the site you found says so too.
Here is a human site which says the same:
http://www.nlm.nih.gov/medlineplus/ency/article/000578.htm
If in doubt, ask Dr Dodds what she would recommend.

Worzel was a bit of a “fat little piggy” too – kind of barrel shaped with stick legs and some weight gain! It’s the pred – he was Mr Ravenous – he started to whinge & moan for food all the time. We tried to stick to a good quality high protein diet & keep the fat to a reasonable level – they need some fat in their diet, obviously, but it’s best to stick to the lower fat content things like chicken, lean mince etc if you can. He resumed normal shape & his muscles came back pretty much as they were before after we stopped the pred, but it takes time. Too thin – we have been through that & it’s far more worrying, believe me. He also has a few fatty lumps, small cysts & had calcinosis cutis (calcium lumps under the skin) which have mostly gone. If the price we have to pay for these drugs that saved their lives is a few small lumpy bits, well it’s nothing to be too concerned about! That is exactly what my vets say too. PCV 45!!!! I am so happy for you, Hope. That’s great. Don’t overdo the exercise for Mr Steve until he recovers his musculature – they can damage themselves at this stage as their muscles are unable to support the joints, ligaments & tendons properly. Of course dear Jeffrey is free to do whatever he can, though.

Good luck sorting your vet out
Love & cuddles, Sheena, Lumpy Worzel & Ollie

[hope]

Hey Sheena!

I must say I agree — I’m bothered to say the least that she would have prescribed that. This is kind of additive to her not catching the anemia the day before he crashed when I brought him in … PCV was 35% and she was like ‘oo that’s normal, no worries.” And she didn’t want to put him on aspirin or anti-clottig meds either.. everything changed for the better when he moved to the specialist. She certainly doesn’t know IMHA, and she needs to if she’s going to keep seeing Steve.

Thank you very much for that link — from the NIH! Wonderful! i’m going to bring that with me when I see the specialist on Monday, though I’m more confident he knows this already.

I would much rather have a chubby Steve than an underweight Steve lol..I was just embarrassed bc I was like ‘omg is it a lump? what is it?’ and without touching, she was like ‘that’s a fat roll.” lol! They want him to start losing weight but like Lumpy Worzel and all the other Pred babies, he’s always hungry. And I feel awful withholding food too… he literally jumped on the counter at the vet’s office bc he saw her jar of cookies on the shelf. They said he needs to get back to 50lbs. Ive started taking him for SHORT walks 3x a day..I’m not exactly an exerciser myself lol so we couldn’t do much more (anymore) than that. He definitely tires himself out if he overdoes it so I’m still trying to keep him relatively calm. As for stinker, hubs and I have said a few times that we honestly wouldn’t know if something was wrong with Jeffrey or notice lethargy bc he sleeps CONSTANTLY. he sleeps –> gets up to potty –> takes up a sip of water –> back to bed –> repeat cycle. lol!

hugs to you and your gorgeous boys!
xoxox hope and the lumpy stinkers

[Hope]

Hey all!
So I took Steve in to the specialist today.. They did a chemistry, CBC, thyroid recheck, PCV – 44%! But also we showed them Steve’s back and the internist said she thought it was pyoderma. We told her that our regular vet had prescribed Cephalexin but that we never gave it because of the associated risks as a cause of IMHA. She agreed she wouldn’t have given it and prescribed Clindomyacin. Does anyone have any experience with an IMHA pup on that antibiotic?
Thanks!
Xoxo hope and the stinkers

[Patrice]

Hope,
Good to hear that you have a normal PCV! Excellent.

See if you can get me a nice tight shot of some of these things on his back.

Chance had some things on his skin the whole time we were treating him, some were large and did not look good.

He had not only stopped making red blood cells, but he was also not making white blood cells. This left him open to all kinds of infection. So he was constantly on antibiotics of one kind or another until the Atopica began to work and he could fight infections again. At one point he got a staph infection and I used Cephalexin (Keflex) which is especially good at clearing staph and other skin infections. Once that cleared we moved to a different antibiotic. We used different antibiotics at different times for different things, but the reality was that if we didn’t, he could have died from opportunistic infections similar to what AIDS patients get.

Some skin infections in an AIHA dog on prednisone can be quite serious, for example staph can develop into MRSA, a more dangerous staph variant. But for the most part, dogs that get skin problems during treatment will recover their coat and skin condition over time once the drugs are removed. Ask your vet if they think it is safe to use fish oil capsules now, that will help the coat significantly.

Here is a list of all antibiotics that are available to the vets for treatment. You can read the benefits of each one and why they are prescribed.
http://www.veterinarypartner.com/Content.plx?C=187&S=1
In general, it is always best to use the most targeted antibiotic you can that is specific to the particular thing you are fighting. Constantly using broad spectrum antibiotics is not appropriate unless it is an emergency. That may mean a skin scraping to pinpoint what you are fighting.

I think what you are seeing is one of several skin conditions related to Atopica. Chance had either benign histiocytomas or granulomas, and other things like staph or crusty dermatitis. Some of these will respond to topical treatments with medicated shampoos, your vet could prescribe something for that.

I think the important thing to know is that most of these are benign conditions and they are directly related to the immunosuppression activity of Atopica or prednisone. When we reduced his meds down to nothing his skin improved significantly. However, a few of those red raised cysts remained. They were not dangerous, just unsightly. When he had his knee operated on in the future, I asked the surgeon to remove the two worst ones on his back hip.

I know these things are so hard to look at. People may look at your dog and think, “why are they not caring for their dog properly? Chance looked like a dead rat, his coat was horrible, he was potty. I would take him for walks when he felt better and I would be so proud that he could be walking again, but I felt compelled to explain to people that he is getting better after being sick for a long time. I am sure they didn’t believe me.

Look at the first three photos of Chance on this page. You can see what he looked like after being treated for 6 months, then a few months after he got better and finally a year after he recovered. I am positive you will see the difference in his body and his coat.
https://www.flickr.com/photos/patricel/sets/72157602714279765/

I hope these pictures wil encourage you to believe that Steve will look better!
my best
patrice