AIHA or IMHA

 The key, as Gratefuldawg clarified, is that they are at HER pace.  This isn't a trot - the heart isn't having to push blood thru 'fast' (which is the big deal with cyclosporine - you have to keep the blood calm).  But the vets are also nagging him to keep her fit and not let her weight balloon -- so that's probably a good compromise. 

Bottom line folks, you're hearing it ... two folks both still "dealing" with their dogs in auto-immune disease, both trying very carefully to do it 'right' and both needing to do things a little different.

Honestly?  I think Lori's probably right for Willow and Gratefuldawg is probably right for Cloppy.  

Their MENTAL health plays a huge part in this -- I know with Billy silly things like getting his 'email' and 'faxes' when he was up at Gainesville PROBABLY saved his life.  Willow's got some issues being 'out' and just being "out" would be it's own form of stress for her.  

On the other paw, Cloppy is more outdoorsy normally -- so missing such stuff probably would not be healthy for her *mentally* and the dogs really have to WANT to get better because they have to withstand a lot of crap during the treatment for auto-immune diseases.  

This sort of discussion is SOOOOOOO valuable for the owner who has a dog in crisis -- because just evaluating what *Your* dog needs is a big huge frigging deal to be honest and it is SOOOOOO frustrating to try and rightly determine what *your* dog really needs to survive and be happy.  

We just wanted to update a milestone---Willow walked the 1.2 mile trail that we used to do daily for the first time in 7 months!!  :)

willowchow

We just wanted to update a milestone---Willow walked the 1.2 mile trail that we used to do daily for the first time in 7 months!!  :)

WILLOW!!!  Way to go! 

 That's great Lori; I'm really happy for her (and you).

willowchow

We just wanted to update a milestone---Willow walked the 1.2 mile trail that we used to do daily for the first time in 7 months!!  :)

You know, I bet it feels every bit as great to Willow as it does to you, Lori!!  That is an awesome milestone!!

 Thats so awesome!  Go Willow Go!  

 Callie,

Did you say Billy had skin problems on Cyclosporine?  While brushing Clops yesterday I could feel with my fingers bumps all over her skin.  I don't know if she has an infection of the skin and needs antibiotics or if this is a side effect of the Cyclosporine.  

What antibiotics are not good to take with Cyclosporine?  In case the vet decides to giver her some.. I think you mentioned Doxycycline before.. 

She does not seem to be bothered by the bumps.  She is not scratching or itching.  I don't see any flakes and her fur seems to be healthy.  Just that her skin is very bumpy.  

I need to take her in for a blood draw anyway.  

His skin was horrible -- Billy's always had allergies and his skin was THE WORST on cyclosporine. 

Before you try antibiotics, see if Dr. B will give you herbs instead (there are Chinese herbs like Coptis that may help rather than having to go straight for antibiotics).

Look at her skin to know if it's papules (bumps that are just hard bumps without pus in them) or pustules (bumps that head up and have junk in them) and specifically WHERE they are on the body (that's a big deal in Chinese medicine - are they on the under part of her body where it is more damp - under in creases,etc. OR on the top of the back or outside of the body?

Typically you start with the *least* antibiotic possible -- usually something like cephalexyn for skin (not one of the heavier, newer drugs). 

The problem with the steroids is that all the toxins they leave in the body eventually begin to come to the surface -- hence the breakouts.  It's the body's way of trying to get rid of them.  You may need to bathe her a bit more frequently -- Selsun Blue can be really helpful to contro staph (don't leave it on a long time and rinse copiously) and then use a light tea tree oil and water rinse to discourage staph.  But be sure to get her dry-- you don't want dampness to cause more problems.

   I'm sorry to hear about the bumps and hope it's nothing serious, but you definitely need to have them looked at. Jessie used to be a mega allergy dog before starting immunotherapy, and Cephalexin (sp?) was prescribed for her skin infections; Simplecef was also used. I've never heard of Doxy being used for the skin, but I could be wrong. Give Cloppy some lovin' for me.

  Edited to add; looks like Callie and I posted at the same time.

In the realm of IMHA and immune-mediated stuff, they wll sometimes use ODD antibiotics simply to use the *least* drug possible.  Doxy is typically used for stuff like Lyme disease and *sometimes* it is actually used TO punch-up the immune system.  I always mention it because Billy was taking it when the IMHA started and ultimately we figure it was what 'triggered' his disease to start hard.

They almost never use cephalexyn for things like urinary tract infections but it IS used sometimes when a dog has something immune-mediated like IMHA.  Simplicef is another cephalosporin (a cousin of cephalexin) that they often prescribe now -- particularly if they suspect an immunity to cephalexyn. 

But with IMHA they don't "start' with drugs even like Baytril because the stronger a drug is the more apt it is to cause an immune-mediated reaction.  And because some of the immune-mediated infections can get SO bad they have to leave a higher drug as somewhere to 'go' if you can't get the infection killed sooner.  IN other words it's a big balance to not tick off the immune system and get it riled up, but to keep the dog as inflammation free as possible.

So yes, you DO have to treat things like that skin inflammation and get right on it-- but you have to treat it as gently as possible -- did that make sense?

And fwiw -- to the normal person, you would *NOT* hear of drugs "causing" a bad reaction simply because the whole world of immune-mediated diseases changes so fast and it such a difficult treadmill to BE on

There are certain drugs -- like sulpha is a BIGGIE -- that they rarely even prescribe in dogs any more simply because they have been so closely tied with immune-mediated triggers.  Sulpha can be a really good drug, but a lot of vets are getting really leary of it (human doctors too).

They might just leave it alone and have you bathe her more if it's not infected.  Willow had horrible skin that they just watched. And, I bathed her twice a week with Selsun Blue or a prescription shampoo.

I just got back from the Vet.  They think Cyclops may have cancer.  I asked about if its an infection due to the Cyclosporine.  I asked if it was too much Cyclosporine in her blood and maybe bubbling up out of her skin.  I asked about food allergy.  They were going to give me antibiotics and see what happened but I asked them to do a biopsy on the spot.  It will take 5 days to get any results.  

They let me stay for the proceedure and Cyclops was a very good patient.  Did a local and they punctured a hole and took an entire cross section of skin.  I also had them run a fecal and did a CBC + Chem + Iron.  Will get results of the CBC tomorrow.

They pretty much think her lowered immune system probably made way for some type of sarcoma.  If that is the case, I'll probably throw in the towel.  I am not going to put her through Chemo.

 I still have hopes that maybe its some sort of reaction to the Cyclosporine and I have the feeling she is taking too much.  I already know that 150mg x2 held her PCV at 25 with no variance.  If her PCV comes back high like in the 40's or 50's I plan on calling OSU and getting them to let me put her back on that dose as it should hold the level.  I think 200mg x2 is just too much.  

5 days is a long time to wait - its going to be a long 5 days. 

Appetite is very good.  Energy level is very good.  Color is very good.  Skin and fur are aweful.  

I took her off kibble and have her on Chicken and Brown Rice - trying to firm up her stool.  Her fecal test showed everything normal.

Anyway.. I'm going to search around for pictures of sarcomas and see if they look like what she has.  very solid firm bumps flaking off crusty skin on top but when that is scraped away they are red underneath.  Also it is on her back only.. along her spine and a little bit each way off her spine but not on her sides, tummy, chest or legs.  

You know what.. if anyone can beat this Cyclops can.  She has a real will to live.  And I'll do what I can as long as she isn't miserable.  

I'm going to call OSU tomorrow and ask them what happens to the skin of the blood concentration of cyclosporine is too high.. maybe get some answers in the meantime while I'm waiting for the biopsy results.

What a day.  

We are hoping it's not cancer and just some sort of reaction to the medication.  Willow had the most bizarre skin erruptions when she was on Prednisone.