AIHA or IMHA

Just popping in to say I'm glad to see that Coop's numbers are improving.  Mike, hoping for continued good tests for Cyclops!  Please give them both some nice belly rubs from me. :)

Coopbay

Today is the second morning I've given Cooper the reduced amount of Pred. I don't know if its in my head or not, but Cooper is acting much different. He has a little more energy and seems happy

Pred, MUCH more so than the other immune-suppressors, is *very* fast for you to see a change in them.  We haven't said much -- and probably not ear enough, that PRED has a **huge** impact on the emotions and temperament (for humans, too!) -- and it completely depeends on the individual -- it can make them sad, or it can make them zoomy.  It can, in a BIG way in some dogs (and humans) make them GRUMPY.    (my Dad had to be on pred for a year and a half and my Mother was convinced she'd never live long enough for Dad to be off it!!  They fought more in that year than ever -- which if you knew MY folks you'd know was adding to an already stellar record).

When you go to wean-off of ALL the drugs you'll know that at some levels you won't notice a difference -- with others WOW.

I've mentioned earlier -- Once they started reducing the cyclosporine on Billy he had one threshold that was tough to get over.  When we first started to reduce it he bobbled and we had to go back up.  BUT the second time ... phew, getting below that 110 mg. level was such a HUGE deal.  He had been MISERABLE at 110 and his skin was worse than ... oh man it was indescribably bad.  And at 100 -- wow -- suddenly it was WAY better.

They probably will *not* reduce the cyclosporine at all on Coop until they get him completely OFF the pred.  And my &guess* is that the next one to go will be the azathiaprene unless you convince them differently -- simply because the cyclosporine lasts in the body better. 

 I'm glad that Coop is doing so well and hope he keeps improving.

GratefulDawg

If the PCV is the same or better than last month then we're going to reduce the Cyclo from 125 2x/day to 100.

  Good luck Mike; I hope Clop's results are good enough to reduce the Cyclo.

calliecritturs

Pred, MUCH more so than the other immune-suppressors, is *very* fast for you to see a change in them. 

Yes, I saw the dog I knew coming back to me with each reduction. 

Hey everyone.  Hope everyone and their furkids are doing great today.

I had Tessy in for her Thyroid tests as well as a CBC today and the results were mixed between good news and bad news.  The good news is that her Thyroid numbers came back as 42.6 (T4).  Doctor said to remain with the same thyroid meds till next check.  Tessy's platelets also showed improvement.  They dropped from 723 to 514!  Getting better!

Bad news is that her Hct dropped from 29.3 to 28.7, her RBC dropped from 3.92 to 3.81, and her HGB dropped from 10.3 to 9.8.  I know that this is not a big drop at all and to be honest I do not even really consider this a drop.  I DO however consider these new numbers a frustrating disappointment.  Her HCT has been in the high 20's for over a month now with no large improvement.  We have yet to break the 30% mark.

I had her doctor do a smear today because she missed sending the blood out to the pathologist.  I just don't want to take her back in to draw more blood tomorrow so I was stuck with a smear.  The doctor said that the smear showed signs of regeneration and there were very few spherocytes showing.  She said in order to get a really accurate report the blood would have to be sent out. 

Now I just don't know what to do.  I feel we should reduce some of her meds but then there's the whole spherocyte thing got me worried.  Anybody out there got any advise or opinions they'ld be beyond appreciated.

Johnny & Tessy

 Johnny,

I forgot.. are you on all 3 immunosupressants?  (Pred, Cyclo and Aza) ?

I don't know how you can reduce anything until her HCT goes higher.  I don't know, each dog is different.  My dog's HCT skyrocketed once she was on Cyclo with no other drugs.  

I'm waiting on my dog's CBC results right now and I'm *still* nervous.  I mean I think the HCT will be the same or higher but  I still get paranoid.

But you are right, that much of a "drop" is really no drop.  Until we got Clops meds straight she was fluxuating between 23.something and 25. something for weeks.  Always going up or down 1 point.  At that point I was just thankful she was holding steady.  

Maybe Callie will see this and get your current meds and ask some of her experts.  I know whenever I spoke by email to Dr. Dodds her answer was always "cyclosporine" and even when I was scared and didn't have much faith I just kept listening to her and thngs worked out.

Nice to hear from you Johnny.  Give lots of love to Tessy.

Mike

Watch her like a hawk -- given that all 3 values dropped it is likely a true "drop" not just a normal fluctuation, but all sorts of stuff can impact it like how much the dog had to drink that day (because it's all # of cells per volume so if there is more liquid in the blood it spreads the cells out).

 Given that the crit isn't going up, I'd look at WHY the body isn't responding better.

 Are you giving ANY dairy?  that can inhibit the absorption of cyclosporine.

Are you using sucrylfate to protect the stomach instead of Zantac or one of those?  Sucrylfate can inhibit the absorption of the cyclo too.

 Have they tested to see where the levels of the cyclo is in the blood??  That might be a good thing to do.

 Have they tested the iron levels?  The body may be regenerating but may not be iron rich enough.  Some of us have had to actually supplement iron.  I shoved iron down Billy's throat constantly -- beef heart, beef liver, prunes, figs, dates, hummos (chick peas are high in iron) and TONS and TONS of leafy greens (romaine, kale, turnip greens -- just not the high in oxalic acid ones like spinach because he had arthritis).

This might not work the same but when Willow had a drop, we held the meds where they were and rechecked again in a few days.  Then if she was still dropping the meds would be increased slightly again or if it was the same she'd keep everything the same and recheck in a week.  All the while, watching the dog very closely. 

It's helpful to know what her normal was before she got sick too.  Do you have any old blood tests?  Willow's platelets were just barely adequate for some time before they dropped to the levels that started the treatment. 

willowchow

It's helpful to know what her normal was before she got sick too

I just had this conversation with a vet that I don't normally see yesterday.  For me it was in regard to the Serum Iron Levels.  He said that there is no way of knowing what normal was for her before this happened.  Getting a CBC w/Chemistry and other tests on a dog once at 1-2 years of age to establish a baseline might not be a bad idea. 

This vet was saying that I'm chasing this serum iron level and that maybe her number was never in the normal range even before she got sick.  Then he said that iron doesn't absorb well and that most likely the pills I am giving her are just going straight through her.

He just thoght I am going a little overboard on all the bloodwork.  I thought to myself that if he thought I was bad he hadn't ever met Callie! 

Hey everyone....let's see if I can answer some of your questions......

Gratefuldawg...as far as waiting for Tessy's HCT to climb before reducing her meds....I've been waiting for 3 months now...kinda.  Here's the deal, When Tessy was diagnosed she was put on Prednisone (50mg) and Azathioprine (25mg).  That's it...no stomach protectants or aspirin or anything of the sort.  At first her HCT would climb more quickly, a few points a week.  Then a point a week and then it levelled out at 28/29 after about a few weeks in.  She remained at this level for a good few weeks with no real gain or drop.  After reading and studying this disease and after carefull deliberation, Aspirin and sulcralfate was added to her med cycle.  Four days later she went for blood work and her HCT had dropped to 21.  I do not know if she was already dropping or if it was due to adding the aspirin and sucralfate.  She was taken to an Veterinary university where she had to stay for a couple of days.  No transfusion was needed and her HCT only dropped to 18/19.  They took her off the sucralfate and switched it to Omeprazole.  Her azathiprine was increased to 37mg, prednisone remained the same at 50mg, aspirin remained at 8mg, and Cyclosporine was added to the mix at 200mg/day (100 in the morning and 100 in the evening).  Again, her HCT started to climb really fast.  By the time she left in a few days her HCT was 24.5.  A week later it went up to 27+ and then a week later up to 28+.  Her hospital stay was April 1-3...in case you want a timeline.  Anyhow....again she improved quite well until she gets to the high twenties where she seems to level off. 

So, Gratefuldawg....like you Tessy's numbers are fluctuating between 27 & 29 (around) instead of 23-25 like Clops was.  This is why I think it may be the meds.  Perhaps she is overmedicated? 

Yes, her cyclosporine levels were checked and I think the number was over 200 ... I can't remember the exact number but I think it might have been 230+/-.

Willowchow......Unfortunately I do not know what her levels were before she got sick.  "Willow's platelets were just barely adequate for some time before they dropped to the levels that started the treatment."  I don't really understand what you mean here.  Do you mean that Willows platelets hindered her progress until they dropped to normal levels?

Calliecritturs....Tessy gets a teaspoon of low fat yogurt icecream with her meds so that she will take them.  You had mentioned this before and I was going to switch it but haven't gotten around to it yet.  She was getting the cyclosporine in the icecream even when we had a trough test done and the number still turned out OK.  I think though that now I will just stick it in the food she gets.  I know that the cyclosporine is supposed to be given without food but the doctors at the university said that it would be OK to feed her with it.  Maybe I can cut down the food she gets with it (only a handfull of chicken, green beans, & scrambled eggs mixed).

She has never had her iron levels checked.  I asked her doctor about it and she said it wasn't necesarry....can't remember why but there was a reason.  Maybe next time I will insist her levels be checked.  Are there any numbers between the CBC and chem panels that might give a glimpse as to what her iron levels might be?  Tessy gets liver, beef heart, spinach, green beans, fish, potatoes, eggs, chicken/turkey, pumpkin and multivitamins on a daily basis.  I would think that between these foods she should be getting enough iron.  What do you think?  I'll still have it checked though.

Anyhow, I know I'm probably forgetting something here.  Clinically she seems to be doing good.  Not like she was before she was sick but good.  I'm just scared to death she's going to relapse again like last time.  It gets to the point that I'm always checking her gums....which I think are sometimes pale and then other times pink.  Of coarse the times they are paler then I get worried.  She has a swollen lymph node near her neck.  The doctor said it was nothing to worry about.  It's actually smaller now than it was before.  Don't know if this means anything or not.

 Anyways....If I can think of anything else I'll add it soon.

Thank you so much for your concern.  It is greatly appreciated.  It's soooooo good to have people to go to and ask questions.

Hope everyone is doing good today and give hugs to your furkids from Tessy & I.

Johnny & Tessy

Johnny&Tessy

I do not know if she was already dropping or if it was due to adding the aspirin and sucralfate.

Adding the Aspirin and Sucralfate wouldn't hurt anything.  But glad you switched to Prilosec  (Omeprazole) - as its suppose to be better, I use PepcidAC which works the same way as Prilosec. 

Johnny&Tessy

Her azathiprine was increased to 37mg, prednisone remained the same at 50mg, aspirin remained at 8mg, and Cyclosporine was added to the mix at 200mg/day (100 in the morning and 100 in the evening).

 wow.. that is a LOT of Cyclo for such a small dog.  I don't know how much more you can safely increase without getting some of the side effects I had with Clop.  I mean Clop is 65 pounds (29kg) and her initial dose was 300mg/day.

Johnny, I already know what Callie is going to say, that is - stop giving any dairy whatsoever.  I know it sucks because its so easy to give pills with dairy.  I started using shaved turkey breast.  I haven't seen any official studies about dairy obstructing the absorbtion of the Cyclo but if there is even a chance that its interfering with the meds then try eliminating it and see if it makes a difference.  Can't hurt.  

Johnny, this is just my opinion, I wouldn't worry about the Iron levels right now.  You are feeding plenty of Iron and you're doing a great job.  Most of my doctors think I'm nuts running the Iron level anyway.  Its been interesting but I'd say that right now your main goal is getting the PCV up.  Besides it would be expected right now that the iron levels are low because its being used to create new red blood cells.

Don't get sidetracked by the small things right now, the main things you want to be asking the vets is the HCT not increasing?  The only reason I can think of is that her body is still killing cells faster than its creating them, in other words her immune system is still in overdrive attacking her own cells.  That is hard to believe with all the Pred, Aza and Cyclo you are on right now.  Her immune system should be knocked out you'd think.  But maybe they have to increase the drugs more.  Thats what I'd be asking the vet.  I'd love to know what Dr Dodd's opinion would be as far as whether to switch to Cyclo only right now.  I bet most vets at this point would be scared to drop anything.  

You seem to have her on all the right things now and the right diet.  I am sure you are frustrated by this.  I know I'm puzzled and confused.  

Please keep us updated on what the vet says.  

Hey Gratefuldawg.....Tessy just had her pred, azath, aspirin, and omeprozole and hour ago and I opted to put it in her food instead of icecream this time.  I'll do the same with her cyclosporine and thyroid meds in a couple hours.  We'll see how it goes in a couple of days I guess.  I know that a few weeks ago Dr. Dodds suggested reducing her Azath. if her HCT remained stable at or above 25%.  At that time Tessy's HCT was 27+ I believe.  Dr. Dodds is in Italy at the moment but when she gets back I will ask her about this.  I'll be sending the blood to hemopet next time so she can look at it personally.

Callie.....is the dairy thing just for when they take the cyclosporine or is it for all meds.  Can she have any dairy at all I wonder?

Oh yeah...Tessy weighs 35.5 pounds.   Remains the same...she doesn't usually gain weight or lose weight.....even given the large amount of food I've been giving her lately. 

Johnny & Tessy

Johnny&Tessy

Callie.....is the dairy thing just for when they take the cyclosporine or is it for all meds.  Can she have any dairy at all I wonder?

Apparently dairy of ANY kind seriously impairs the body's ability to absorb cyclosporine.  It's not a problem with ALL things but it can interfere wtih various drugs.

 HOWEVER, **right now** she can't have dairy at all because cyclosporine takes a while to absorb into the body.  it's not like most drugs where it goes into the mouth and is absorbed immediately and acts immediately.  This is why they have to test the levels of it periodically -- I've seen the time where we were REDUCING cyclo and had levels go UP.  It can take a long time to fully absorb and be processed all the way into the blood -- not hours, not days -- WEEKS.

So don't give any dairy **at all** until she's off the cyclosporine.  Trust me -- Billy LOVES dairy and was bereft that I had to take it away.  But you'll find other things that can be awesome to give meds with  -- and honestly PLEASE try liverwurst/liver sausage/craunschweiger or whatever your stores call it up there.  It is slippery, but it's also high in iron so it truly is a win/win for giving meds.  Once you get into how to cut it up easily I used to slice it up in advance so it was easier to grab. 

Don't worry about weight anyway to be honest -- I've seen vets hassle people about "don't let them gain weight" but shoot -- with THIS disease you GOTTA keep them eating and happy with what they are eating, so you can always diet them later once they survive the illness.  But keeping that tummy happy is a big deal and sometimes that takes FOOD.