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IMHA Side effects of treatment drugs

Posted : 10/29/2009 11:40:40 PM

Hi to all and thanks for responses to my earlier posts. "Killer" has now survived IMHA and diabetes for 3 months. She was originally placed on 25 mg of prednisone every 12 hours and later began a regimen of azathioprine. Because of the prednisone, she also takes 26 units of insulin every 12 hours for her diabetes. She has been improving in many ways--pcv is now 36, up one from last week, and blood glucose level is still improving. My question for the forum is concerning the side effects of the drugs being administered. We have treated with antibiotics twice for infection--that seems to be part of a normal routine here, and I haven't noticed any of the worst sounding side effects of azathioprine. Killer is developing the "prednisone tummy" as my vet calls it. I am concerned about how this weight gain will affect the rest of her health. My vet was thinking that once her pcv got up to 40, we could think about tapering off on the prednisone. Killer has also started having some dripping nose bleeds. These seem to happen when she eats and drinks. I am thinking this is because at these times her head is below her heart. I can place her food up a little higher, but am wondering if others have experienced these symptoms along with the disease or its treatment. I do realize that all membranes are thinner now and bleeding can occur more easily, but other than that I don't know what could be causing this. Any help on this one? Thanks, ***

willowchow

Posted : 10/30/2009 12:10:02 AM

Hi Killer's mom! I will try to answer some of this as best I can for you.

Willow had a similar disease called IMT. And, it's treated pretty much the same way as IMHA. I can tell you that the tummy will go away as the prednisone is tapered off. It will take some time, but it will happen. The other symptoms will diminish too like the panting, excessive drinking and eating.

If your vet isn't already doing it you should be checking her liver and kidney function. These drugs can really elevate their liver values and mess up the kidneys. If you aren't already using milk thistle and SamE you might want to ask your vet about that as well. And, also she should be getting a Pepsid daily to protect the stomach.

I've heard of the bleeding from the nose before. It could be from just chaffing due to the excessive drinking. Willow had extremely chapped lips and was bleeding due to all the drinking she was doing. We treated it with a Vitamin E stick. So, depending on if your dog is a messy drinker it could be that. It could be low platelets. Have they told you if her platelets were OK. Bleeding from the nose is definately a possible symptom. And, IMHA can easily turn into IMT (low platelets). Or, they can have them both at once (Evan's syndrome). So, I would definately just for peace of mind bring this to the vets attention ASAP. Hopefully, some of the other IMHA survivors will see this and add to this because there could be other causes that I'm not aware of.

Hope Killer continues to fight the good fight. These dogs and what they tolerate have earned my respect.

Lori

calliecritturs

Posted : 10/30/2009 7:46:39 AM

One of the huge risks in this (and similar) diseases is that it can so quickly morph into another auto-immune disease. ONE of those is various versions of "cytopenia" (pancytopenia, thrombocytopenia, etc.) where the platelets are attacked rather than the red blood cells.

THAT risk is pretty huge. That means they bleed far far more easily than before -- and literally can bleed internally just from the effort of walking across the floor.

For that one reason, please call the vet *today*. They will need to check the platelet level just to be sure somethng new "auto-immune" hasn't begun.

Beyond that pred has all sorts of side effects -- and thin membranes and skin can be one. This is just one of those things that you tend to have to jump when *anything* at all unusual happens. Even if a side effect may be "explained" by the drug -- you can't assume that safely. Does that make sense?

Sam3

Posted : 12/24/2009 8:58:38 PM

Hello, my 3 year old Samoyed has UDS (an immune mediated disease where her immune system attacks her pigment cells), and also IMHA. She was diagnosed with the UDS a little over a year ago, and the IMHA about 6 months ago. A recent cbc showed she is now diabetic as well, glucose was 600, so she's getting insulin shots now too. During the past 6 months her platelet count has been as low as 18 and pcv as low as 16. Current platelet count is normal, pcv 35. She's currently down to 25mg of Azathiaprine & 5mg of Prednisone per day. She's been on antibiotics 5-6 times for various infections, fairly common while on these immune suppressing meds. She also has had periodic nose bleeds, though none for about 2 months. A few times I found blood in her water bowl, and she would also sneeze up blood on occasion. Her vet doesn't know what causes the nosebleeds, each time it's happened her platelet count has been normal and low platelet count could cause it. I guess I wouldn't worry too much about the nosebleeds unless your dog is losing large amounts of blood. Apparently it's just one of the side effects of this disease that only affects certain dogs. Also, it appears my dogs diabetes is auto immune related as her glucose level has gone up as the Pred dose has gone down. Anyway, I hope this info helps someone. This certainly isn't what I had in mind when I got my dog just over 3 years ago, but we'll make the best of it.

calliecritturs

Posted : 12/25/2009 2:25:30 AM

Hi -- there's actually a HUGE thread for IMHA on here that has been a tremendous help and support to a lot of folks -- please feel free to check it out!!

Here's a link to the LAST page:

http://community.dog.com/forums/t/90432.aspx?PageIndex=112

I actually have indexed all 112 pages of it for the pertinent ideas if you're looking for something specific.