AIHA or IMHA

Great 'crit!!  And carafate may be a good choice now that the drugs have kicked in (Billy had it at the beginning but it was another *sigh* of the things they took him off because they feared it was blocking absorption of the danged cyclosporine).  But man, I can remember how huge we celebrated when Billy's 'crit rocked over into the mid 30's == I can actually remember David and I doing a HUGE 'whooooooooo hooooooooooo' at the vet's office that night.

And the sam-e and milk thistle don't work immediately -- but even if they are preventing elevation it's a big deal.  Good good results -- shows your hard work.  Have a party!! And give her scritches from Aunt Callie too pretty please?

 We are pretty darn happy! Just got back from taking Calypso on her morning jog.

We decreased to the Pred from 15 mg twice a day to 15mg in the morning and 10mg in the evening.

My specialist is out of town at a funeral so when we talked to the Intern she wanted to cut the Pred in half and wait 30 days before decreasing any more.....which I have read studies of other vets doing that and it might be okay since Calypso has only been on it since 6/12. But being a long term steroid user myself I was uncomfortable with that and so was my vet. So we decided on a slower wean that will still get us to 15mg per day in 30 days (if her blood work cooperates). My vet plans on talking with Dr H on Monday about why the quick drop.

cerberusdog

My vet plans on talking with Dr H on Monday about why the quick drop.

Yes, let us know *but* I can promise you it will likely come down to "medical opinion" -- given that I'm older than dirt *grin* I have seen vets (and doctors for humans, too) have as many scheduled for prednisone wean-off as ... well as many as the number of vets/doctors I've spoken to.  I point blank asked my OWN doctor once why it varies so much and he grinned and said "because each of us has our own unique experiences of what worked well, and what we WISHED we'd done either to save a patient or save a patient's side effects.  But generally it comes down to whatever your *professor* in vet school was comfortable with -- they all seem to be different for the above-mentioned reasons.  But most doctors are simply going to give you the phrase 'medical opinion', but you're right -- it can  vary ALL OVER the place, and often it will vary with the doctor depending on the particular disease and patient."

It was a long answer (and I actually made notes on it) but I tend to think it's an honest/accurate one.  I know when they dropped Billy's pred I was terrified -- I *hate* prednisone (I actually can't take it at all any more because I have such heinous reactions to it), but Billy didn't resond for SO long that I was terrified ... period.  To quick and I was afraid he'd relapse, too slow and I was afraid we'd kill his kidneys.  It was the university who dropped Billy's *fast* but her contention was that the cyclo HAD kicked in and it would bear the brunt of immune-suppression.

It's all scarey stuff but I'm glad you and your vet are totally on the same page.  That's a good feeling.

FWIW, Willow was weaned off it in 5mg intervals too.  They checked her blood every 2 weeks and if all was well they decreased by 5mg. 

willowchow

FWIW, Willow was weaned off it in 5mg intervals too.  They checked her blood every 2 weeks and if all was well they decreased by 5mg. 

Pi went off my 2.5 mg intervals, but he's smaller than a bunch of the dogs currently so that makes sense :)

Have we heard from Cooper's mom??

Tessy has been weaning her pred every week so far.  The reductions were as follows...50mg - 40mg - 30mg - 25mg - 20mg - 15mg - 12.5mg - 10mg (she's on now) - 7.5mg starting tomorrow.  This schedule was set up by Dr. Dodds with just a little tweak by myself.  Dr. Dodds wanted to go every 5 days but we discussed it and made it every 7 days.  Reason being is so that I can be home towatch her for the first couple days after a reduction.  She's only had two CBC's since reducing and that was once she was on 40mg (no increase in crit) and again at 20mg (increase of 5 points in her crit).  I'm not sure if we'll remain on the 7.5mg of pred and start to wean the azathioprine or continue with the pred reductions.  I'm pretty sure the cyclo will be the last to go.  That's what Dr. Dodds would like to see so I'm going by what she wants. 

Tessy has an appointment tomorrow afternoon for a full CBC and chem profile so we'll discuss future reductions then.  I'll keep you posted.

Johnny & Tessy

Johnny&Tessy

This schedule was set up by Dr. Dodds with just a little tweak by myself.  Dr. Dodds wanted to go every 5 days but we discussed it and made it every 7 days.  Reason being is so that I can be home towatch her for the first couple days after a reduction. 

And see - that's another excellent reason to vary the schedule -- the body will react to pred far far faster than it does to cyclosporine (which achieves a "level" in the body via absorption and stays there -- pred lingers but the levels fluctuate FAR faster.

 Thanks everyone for sharing your Prednisone wean stories!

It does makes me feel more comfortable with the decision we made for Calypso. I tried to think in terms of what my GI doctor would do with my prednisone and he would freak out if I cut my pred in half. When I was on 100mg of Prednisone he did allow me to reduce by 20mg until I got down top 60mg, but after that I have to go in shorter doses. If Dr H still wants to cut in half on Monday, I am sure he has a good reason and really I would just like to know it....is it because of research, side effects, or just what has worked for him.  I am pretty unconcerned with a 20% reduction so I do not think that he will understand why we did what we did.

Johnny, thanks for sharing Dr Dodd's prednisone wean, it gives me a reference point for what percentage of prednisone Dr Dodd weans every 5-7 days. As of right now we have agreed to a 5mg decrease every 10 days. But what you said makes me wonder if my vet has been in touch with Dr Dodd, because she mentioned waiting 5 days then dropping it another 2.5mg for 5 days.

I am not overly concerned with a slow Prednisone wean because Calypso has only been on Prednisone for 45 days. Plus we are Cyclosporin. I would rather go slow and be able to see that her body is ready to come off then have to go back on the high dose if she has an issue with a 50% reduction. Thankfully the advantage I have is Calyypso's age....as long as her organs were healthy going into this which we have no reason to believe otherwise.

Johnny&Tessy

Tessy has an appointment tomorrow afternoon for a full CBC and chem profile so we'll discuss future reductions then.  I'll keep you poste

Good luck Tessy!

Woof, woof...keeping you in our thoughts today Tessy!!

Calypso

Johnny&Tessy

Tessy has an appointment tomorrow afternoon for a full CBC and chem profile so we'll discuss future reductions then.  I'll keep you posted

We're sending positive thoughts your way!

Tessy was in to see the doctor today and have some blood sucked.  I will not be able to get the chem results until tomorrow but I got the urinalysis and cbc results.

CBC results were the same as the last visit for the most part.  HCT 34.4, RBC 4.58, WBC 13.3, HGB 11.5, & platelets up to 586 from 461.  I must have spoken to soon without knocking on wood the other day when I said Tessy's platelets were falling to normal limits cause now they went up again.  They aren't high but still went up.  I'm not concerned for now unless they continue to go up.  They've been fluctuating like this for months now.

On to her urinalysis.  I'm not sure what to think about this.  I only had a stick done today to save on money.  There was a small trace of blood found so the infection wasn't totally cleared up yet.  Time to go another two weeks of antibiotics for her again.  Does this sound normal or should I have them draw the blood straight from the bladder and culture it?  I'm also wondering an awfull lot as of late about bladder/kidney stones.  The reason being because her previous micro came back showing negative on the WBC and RBC.  We'ld have to do an xray to see this and to be honest the money just isn't there.....unless it was absolutely needed.  If anybody has any advise it would be great.

Another concern is the continuous use of antibiotics.  Is this alright to do?  She was on BioClav to start for two weeks followed by cephalexin for 3 weeks and now we are going to try Baytril for 2 weeks.  Apparently Baytril is a more potent antibiotic and I only have to give it to her once a day.  She starts this new antibiotic tomorrow with her dinner so if anybody knows anything about this one please do tell.

I'll update this tomorrow when I get the results back from her chem panel.

Hope all is well in doggie world today.

Hugs to all from Johnny & Tessy

We have used Baytril alot with my cat that had kidney issues and my dog that cureently has lots of UTIs. It is used to treat broad spectrum bacterial infections. I remember that there are some meds that you can not mix it with...like maybe stomach meds...I will need to google and check that out.  It is pretty hard on the stomach, it causes my Skylla to have runny stool so watch for that (it is a side effect).

Since I am new to IMHA I am not sure about the UTI hanging around, but what I can tell you this is NORMAL in patient's with IMHA or immunosuppression. It is harder to treat the infections and it takes much longer. 

Okay found this:

Several things kinda got me worried ....

http://www.marvistavet.com/html/enrofloxacin.html

"The use of enrofloxacin (Baytril) can produce crystals in urine. These crystals may show up on a laboratory test thus it is important to be aware of this side effect. Enrofloxacin crystals should not be confused with more clinically relevant struvite, oxalate, or urate crystals."

and also....

"If enrofloxacin is used with oral cyclosporine (an immunosuppressive medication used for inflammatory bowel disease), the kidney damaging properties of cyclosporine may become worse."

 and ...

"Not only is it possible for enrofloxacin to form crystals; entire bladder stones have been formed out of enrofloxacin, rare as this might be. Granted, a urinary stone composed of enrofloxacin is very unusual but it is important to realize that enrofloxacin crystals might be found in a urine sample of a patient on enrofloxacin and that these crystals should be recognized as such."

I'm just not sure if this is worse case scenario if I should scrap the Baytril idea alltogether and go with something else.  I'll sleep on it tonight and decide tomorrow once I get her Chem results back.

 Johnny & Tessy

cerberusdog

Since I am new to IMHA I am not sure about the UTI hanging around, but what I can tell you this is NORMAL in patient's with IMHA or immunosuppression. It is harder to treat the infections and it takes much longer. 

The urinary tract infections ARE a side effect of cyclosporine.  Add to that the immune *suppression* and you've got a dog majorly set up for UTIs who has a tough time kicking them and who will get another one in a heartbeat. (none of that is rocket science but it IS true)

The problem is -- if the dog goes off the meds for several days but the infection is STILL *there* you run the risk of the dog becoming resistant to THAT drug and that can spell disaster for these dogs.  There's another thread where Sunshine girl talks bout Layla having a UTI and there's a discussion on cephalexyn being used.  That is NOT a typical UTI drug -- BUT in these dogs where antibiotics can be such a *trigger* for IMHA and you are so limited on what antibiotics *can* be used it's a big deal to have a "lesser" drug that you can use.  I've had it take WEEKS to kick a UTI in Billy.

I've also seen where a uti will gather speed by ADDING a bacteria that hadn't been visible before hand.  We got to the point where we didn't do the strip test but literally would go straight for a culture and sensitivity (which can be done by a cathether OR an aspirate -- not fun but often necessary) simply because we had to know exactly what we were treating.

At one point we'd been treating a typical UTI that was staph and proteus (I think I spelled that right) and it just didn't "leave" so we cultured it again and dang -- IT WAS PSEUDOMONAS!!!! *yipe*

Pseudomonas is not a typical uti -- but yep -- there it was.  It took us all the way to Cipro to treat that one. 

Now -- as an alternative -- we did TCVM with Billy all the way thru and there are Chinese herbs that can help treat a UTI.  That was always our first recourse and often it would work --

But now you are getting a better idea of *why* I always emphasize the milk thistle so much and why I'm always saying it's not just milk thistle for the liver, but in **high doses** it helps protect the kidneys.

We KNEW that Billy's kidneys were at risk all the way thru because he had microalbuminaria ALL the time.  he still does (you just aren't supposed to have albumin in the urine -- that's supposed to stay IN the blood)

So yes - it can be typical of a dog taking cyclosporine.  Billy took tons of cranberry and tons of D-Mannose because it helped.  It didn't totally prevent, but it HELPED.  His urine was typically very alkaline -- so he got tomato in his food and all sorts of stuff.to "help".  He got sweet potato because it's kidney friendly.  I fixed asparagus for him (and I HATE asparagus) because ... *sigh* it's kidney friendly.

In short I did everything I possibly could and then some to help discourage UTIs.  Since Tessy is a girl -- does she squat REAL low when she goes?  You might honestly try using baby wipes on her when she comes in just to discourage any bacteria growth and you may want to be sure that her skirt is cut VERY close there so bacteria can't crawl into the urethra that way.

(note:  cerberusdog's note says "magnesium" in DAIRY.  d-mannose IS magnesium but it's magnesium in the form of sugar.  Different.)