ElisHope
Mike do you know if Cyclosporine takes as long to work as Azathioprine?
I keep seeing 2 weeks for Azathiprine to work but my vet made it sound like the Cyclosporine would start to work much sooner.
I'm going to jump in and say it's very individual. SOMEHOW this is at least somewhat breed-related. They warned *me* when Billy was first up at the University of FL Vet School that cockers don't respond well to IMHA *period*. And there's something about him being a buffycoat that further makes that a problem.
That being said -- it was almost SIX WEEKS before Billy was really responsive to cyclosporine and his body didn't get a clue at all for at least 3-4 weeks. (hence all the transfusions)
Ok -- not trying to scare you to death -- just trying to make a point that it is VERY individual.
Why? If you look on Dr. Dodds' website http://www.hemopet.com she makes quite a point that coat color is a big deal **for some unknown reason** regarding auto-immune/immune-mediated stuff anyway.
Sooooo studying this stuff becomes overly-complex just because the variables are so vast (unless they want to induce IMHA into 40 unlucky dogs of one breed/color JUST to prove the point and no one wants to do that because it's likely not going to prove anything anyway).
HOWEVER Cyclosporine has to reach a "level" in the body -- meaning that altho they try hard to keep the amount going in the body to be stable (which is why, altho it's a 24 hour drug, they often give it TWICE a day simply to avoid any "hill/valley" peaks and lows in how the body reacts to it). but literally it has to build to a certain level in the body before it really begins to act like the super immune-suppressor rather than just an anti-inflammatory.
That comes down to one word -- **absorption**. Knowing you've read this whole 64 page encyclopedia of posts on IMHA, you've read the discussions on dairy and the possibility that dairy may inhibit absorption of the cyclosporine.
Meaning -- for about the first 2 1/2 weeks Billy was on cyclo, he was getting all his meds with dairy (yogurt or ricotta cheese). They were testing his blood every few days to see what his "cyclosporine level" was to monitor how well he was "absorbing" -- and that was the first concern. He wasn't absorbing as much as he was taking. SOOOOO the hunt began for what was preventing it from being absorbed?
Was it a breed thing?
Was it some other medicine they were giving? (The first thing they did was take him off the sucrylfate and substitute Pepcid and later Prilosec b/c of the potential sucrylfate has for "coating the stomach" to the exclusion of meds being absorbed *sometimes*).
I've always homecooked for my dogs and they made me go on a vet approved diet (Hills 
) simply to rule out any "human error" and keep everything consistent. That's one of the things I meant above when I said it's really interesting how they "diagnose" things and rule out this or that in trial and error to find out what is and isn't working.
NEXT they made me stop the dairy. That was the one that seemed to turn the trick and the absorption began to go up FAR faster. that was at about 3 1/2 weeks. So I began to use liverwurst -- not a wonderfully high quality thing to use BUT it was easy to transport to the University and it was easy to handle.
My point is -- SOME Of it **is** specifically individual. SOME Of it is breed-related. SOME of it is related to other drugs/chemicals they're taking.
It seems to be far more cut and dried that they'll say azathiaprene takes a couple of weeks. However -- cyclosporine is definitely the drug of choice but it seems like it is faster in some than others.
My other thought would be -- whether there would be a difference between the generic cyclosporine and the Atopica (which is MADE **FOR** dogs I think specifically, altho I know they give it to cats -- but MADE to dissolve/absorb in the animal stomach).
It seems like Eli's was at least somewhat responsive to the prednisone -- that's a big huge deal. That and the fact that you caught it earlier than Mike and I did (well, I caught it at 20 and it went up to 29 on pred, but because they put him on the doxy thinking it was tick disease, that made him crash further and in 36 hours he was down to TEN).
Judah -- if you find anything germaine that tells a comparison between cyclosporine/azathiaprene and response time, post it would you pretty please???
ElisHope
There are two medical students who are working with Eli. He is being watched 24/7 by someone at all times. That makes it easier to leave him there and not feel bad that he is lonely.
When you're talking about LEAVING a **very sick dog** at a vet school where they know no one -- keeping them emotionally comfortable is a bug huge mega deal.
You're right -- he's not lonely. And you are more "right" to be concerned about that than most folks would understand.
One of the things we haven't even discussed on here is how the dog feels. We know that when the PCV or Hematacrit drop below about 25 they get queasy and the lower it goes the more sick to their stomach they feel. But they also feel weak, and often dizzy.
The drugs also can make them feel cruddy. Many of them are hard on the stomach -- and prednisone actually has all sorts of emotional side effects (it makes them hungry, makes them drink like fiends so they gotta pee ALL the time but it can make them frustrated, grumpy, jumpy, nervous, etc.)
So encouraging them -- like a student getting to know them and being there to pet them, reassure them, and generally make them feel "more normal" really helps. And silly stuff like phone calls, faxes, etc. helps!
Your concern is a valid one, Judah -- it's not just we emotional owners missing our dogs -- it truly helps the DOG to have that kind of close supervision.