AIHA or IMHA

GratefulDawg

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. 

I know the FIRST thing they took Billy off was the sucrylfate beceause somehow they had "studies" that showed it likely was inhibiting the cyclosporine (it apparently does other things - it literally "coats" the stomach apparently) 

Prilosec is pricey -- and they had Billy (29 pounds) on TWO a day (which is twice the adjult human dose) but it worked well.

I can tell you that as soon as I stopped ALL dairy with Billy the body began to absorb the cyclosporine better.  It isn't just when you give the pill -- it's NO dairy at all because the body takes a long time to process the cyclosporine.  It doesn't just suck right in there (whcih is WHY they do two pills a day on a drug that is supposed to be a 24-hour drug.

And the big deal is -- when you're giving these G-NORMOUS doses (and that is a massive dose of cyclosporine)  the body is taking the hit for all the side-effects, but if the body isn't USING it, it seems smart to me to try and make sure that the body **uses** what you're giving!! 

I home cook and giving Billy his pills with dairy was part of his calcium intake - so it wasn't JUST how much he absolutely LOVED it ... I had to re-organize everything to change that, but it was most definitely worth it.  I know they were really careful about it -- evaluating one thing and then another.  They didn't want to remove the sucrylfate because it's WAY cheaper than anything else, but they were positive it was inhibiting the absorption of the cyclo. 

But then we just weren't getting the cyclo to kick in (he was still having to be transfused!!!) and she jumped on the dairy. 

Is Tessy on doxycycline??  That was the other wild card with Billy -- because the doxy kept stimulating the immune system at the same time they were trying to get it to slow down.  But that was the third piece of the puzzle that helped everything work when they took him off the doxy.

 

Thanks Calliecritturs.  You're extremely good at explaining things.  Tessy just had her cyclosporine and thyroid meds.  I hid it in a handfull of chicken and green beans and she gulped it right down.  The bad thing with the cyclosporine is the liquid or gel inside them.  I remember when I used to put it inside chicken for her she bit it and the liquid/gel went everywhere.  Hopefully we don't have this problem anymore.

I wonder how often her cyclosporine levels should be checked.  Since you said it can take weeks for the blood to fully absorb the cyclosporine should I wait at least a few weeks or even bother doing one.  I know Dr. Dodds doesn't think they are necessary but should they be done considering she's on such large doses?

The only meds/drugs Tessy takes is:

1. Cyclosporine  100mg/twice daily 8:00am and 8:00pm
2. Azathioprine  37mg/day 5:00pm
3. Prednisone  50mg/day 5:00pm
4. Aspirin  8mg/day 5:00pm
5. Omeprazole  (unknown at the moment) 5:00pm
6. Eltroxin  25mcg/twice daily 8:00am and 8:00pm
7. Multivitamins  1 1/2 - 2 per day with food ....pending what/when I feed her

I would really like to reduce the cyclosporine really soon.  Dr. Dodds also found this amount to be high.  She recommends no more than 10mg/kg to start.  That would only be 170mg/day for Tessy.  The reason we didn't reduce it was because the trough test came back showing just over 200 for a reading....which I think is onthe low side of the scale is it not?

 

Johnny,

Two things you said about Dr Dodds really hit home.  That she wanted to start reducing the other immunos.. that is what she recommended for me also.  And also that she thought that was a pretty high dose of Cyclo.  

Let me ask you one thing, just to be sure.  Are you giving her Modified Cyclo?  Because both Val and I had unfortunate experiences with getting unmodified Cyclo when we first started.  And that would explain a lot if you had the wrong type of Cyclo.  Of course if you are using the one made for dogs then that wouldn't be a factor.  The unmodified is easy to spot, they come in tiny capsules.  The modified come in big fat gelcaps.

Assuming you are using the correct Cyclo, that is a lot and when we did that to Clops she got a huge skin rash that really scared us.  Went away as soon as we got her lowered to a proper dose.  The reason we overdosed was because we didn't realize we were using the wrong kind then switched in the middle so suddenly she was going from 150 of something that didn't absorb well to 200 of something that did. 

Anyway, I hope that if you get any answers about Cyclo in the blood (trough test) you can kind of post the info here.  In case anyone comes along in the future who does it.  My doctor at OSU said she just uses the CBC to see where the Hematocrit is and then adjusts the dose based on that.  In my case even had she done a trough test it would have showed low then high.  

 

 

Cyclops Monthly CBC Report.

Hematocrit Range (36-60) Last month 42.7  This month 47.0  

Platelet Count Range (170-400) Last month 458 This month 420

Serum Iron Range (98-220) Last month 65 This month 85

All of the above are heading in the right directions.  Will be lowering her Cyclo to 100mg 2x/day.  Will continue her on 20mg Aspirin and 1 Iron Pill per day.

------------------------------------------------------------------------------------------------------------------

 I noticed a couple of things that are starting to head in the wrong direction.  They are still within the normal range but I am going to ask OSU what they think.

 

MCH Range (19-28) Last month 21.3 This month 19.8 (just 0.8 within normal)

MCHC Range (30-38) Last month 31.6 This month 30.4 (just 0.4 within normal)

Red blood cell indices. There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). They are measured by a machine and their values come from other measurements in a CBC. The MCV shows the size of the red blood cells. The MCH value is the amount of hemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average red blood cell. These numbers help in the diagnosis of different types of anemia.

Johnny&Tessy

I remember when I used to put it inside chicken for her she bit it and the liquid/gel went everywhere.  Hopefully we don't have this problem anymore.

During the IMHA treatment I taught Billy two commands that have been invaluable.  You will think I'm crazy but I'm NOT. 

"Chew GOOD" and
"Just swallow!"

yeah, for real.

It's like teaching a dog to "speak" in order to teach him NOT to bark.

Teaching them to chew is easy.  Take strips of meat -- something a bit tough like steak or something you can hold in your hand.   As the dog bites/chews at it you say "GOOD ... chew  chew chew GOOD!!!"

sort of hang onto that piece of meat to encourage the dog to use their teeth but verbally praise as they use their teeth to nibble and then continue to chew it once it's in their mouth.

Ok -- next -- take something slippery like liverwurst, braunschweiger, OR all meat babyfood.  Either cut it into small bites or take a blob of the baby food on a spoon.

Let the dog take JUST the bit of slippery food (hold it up above the nose so the throat stays straight) -- hold your other hand under the jaw so once they lick it off you encourage them to "Just swallow".

Next SHOW the dog the pill ... and show them while you bury it in another blob of the slippery food, **and have one more blob of plain food ready to go FAST**.

Hold that blob with the pill high above the nose and have the other blob ready to go.  Say 'Just swallow' as you hold it above the nose and let them take it OFFER THE OTHER BLOB IMMEDIATELY.  They have to "just swallow" the first one to gulp the second.  Praise again "GOOD JOB -- that was just swallow!!"

A few times you will need to "contrast" these two commands one after the other.  Alternatively you are praising for them hanging onto the food encouraging them to "chew GOOD" and then conversely you SHOW them you've put something in the next blob of food and you want them to "Just swallow".

VERY SOON they get it.  If it's yummy she'll TELL me so I can have fun with it.  the other is yummy as long as I just swallow it but there's something INSIDE that isn't yummy!!

Yes, honestly they learn -- it promotes trust -- you're making sure the dog knows when something may be vile (or not to be broken like the cyclo) so they can avoid something unpleasant -- but hey, you're ALSO helping them to enjoy something pretty yummy if they chew it.

 SO -- mine then truly enjoy stuff like watermelon, cantalope, apples, etc. -- because they've learned to CHEW them (so they get the goodness out of them AND it digests better). 

**DON'T** use meat to put the cyclosporine in -- it makes them WANT to use their teeth  **and** it's not slippery.  You will find the liverwurst (sometimes it's called "braunschweiger", sometimes "liver sausage", sometimes "liverwurst" but there are many well-known brands of it.  I can promise you the dog will LOVE it. 

Meat babyfood also works well but it's a tad spendy.  But it's pretty easy to give meds with.  I also will take meat baby food and mix it with baby veggies (all this is real human baby food) -- they're silky and the pill will slip right down - you just have to teach the dog to lick it off a spoon.  Once you get good at it typically they will take several pills at once that way.

Gratefuldawg is likely right -- find out SPECIFICALLY if you are using the human formulated version of cyclosporine and then find out if it is modified or unmodified.  THAT could be a huge reason why the body isn't responding to it.

 

You guys are so helpful. Even though I'm not exactly going through what Johnny is, I am still learning. It has been a crazy week with school. Updates on Cooper. He's digging little holes throughout the backyard. NO reason I can see. He's not eating the dirt. His gums look nice and pink. He's been acting pretty well besides the accidents in the house each day while we're at work. Same spot and on the towels. At night, he has been having accidents too. Callie, I got your message last night but my phone wasn't getting great service while I was out. Cooper has plenty of milk thistle still. I haven't ordered the tincture yet. I'm trying to figure out how many bottles I should order. Once that website can get that Chinese herb you mentioned, I will be ordering that for sure. What was it called? If it doesn't need to be prescribed, I can search the internet and see if I can purchase it somewhere. Since school is winding down, 10 and a half more days, I will be running around like crazy to get everything done. Then I can relax all summer at home with Cooper and Bailey. I am taking Cooper in today for his PCV. Last week he was up to 35. Hopefully, he will have gone up a little again. Mike, sounds like Cyclops is doing well. I am not sure what all those numbers mean, but I did know a few of them. :) Wishing all the puppies and parents on here a great day! Val

The herb is Ba Zheng and it's superb for urinary tract infections.  Be sure to order from a reputable place -- it's NOT common at all. 

I think in my last email about the tincture I told you about how long a bottle would last.  I always got a month's worth plus a bottle or two simply because it usually takes almost a week to get the box and sometimes they may not have it in stock (it's pretty darned popular -- HerbPharm is a great brand).  I tend to order $75 worth of stuff at a time to get free shipping -- if it's stuff I *Know* I will use it makes sense.

my week is turning out nuts as well -- appointments every single day after work *phew* wrecks havoc with the schedule.

So far so good with giving Tessy her meds without the icecream.  I've been hiding it in her food and there's been no problems yet.

Hope everybody and their furkids are doing good today.

 

Johnny & Tessy

 Glad its working out Johnny.  When I said that I put my Cyclo in shaved turkey I forgot how big Clops is compared to Billy and Tessy.  She takes the whole thing in one gulp while I hold another piece of turkey to where she is too busy thinking about her next piece to worry about chewing the piece she already has. 

Now according to the manufacturer Cyclosporine absorbtion is not affected by dairy.  At least for humans.  In fact they recommend mixing liquid cyclosporine in chocolate milk for human consumption.  But that doesn't mean things work differently in dogs.  In fact it probably hasn't been studied.  Thats why at this point there is nothing to lose by not giving dairy.  Lucky for us we probably don't give our dogs grapefruit, pineapple or papaya juice! 

For Humans:

How to Take

Liquid cyclosporine can be diluted in milk, chocolate milk, or orange juice. Do not dilute in grapefruit, pineapple, or papaya juice. Use a glass container, not a Styrofoam cup. Stir the mixture well and have your child drink it immediately. After emptying the glass, add more juice or milk and have your child drink that as well, to ensure that he or she is getting the full dose. Do not rinse the measuring syringe in water.

Capsules should be swallowed whole; they can be taken with or without food. Avoid taking this medication with grapefruit, pineapple, or papaya juice.

 

Johnny, did you ever check your pills to be sure they say "modified" on the box?

 

The cyclosporine Tessy takes is the Modified version Atopica.  I researched this before we put her on it just to make sure.

Well, I thought I was in the clear with giving Tessy her meds hid in food but now she just caught on to me....the little bugger!  I did finally get her to take it but it took 3 good handfulls of food to get her to take it.  I'll try again tomorrow to see what happens.  If she keeps it up I might have no choice but to switch back or buy the liver stuff Callie was saying.

 

Trust me - there is NO downside to liverwurst -- it is SO easy.  What is it that makes you so reluctant?

 The liverwurst will work, I used it myself for a while.  I prefered using Hummus, and until I got Clops off the Prednisone she was hungry enough to take it.  In fact she loved the Hummus.  But for some reason once she got off the Pred she started getting more finicky about her food and I had to switch. 

Johnny&Tessy

The cyclosporine Tessy takes is the Modified version Atopica.

 

You can't go wrong with Atopica.  I can't afford Atipica, the prices for it here in the US are unreal.  Thankfully for me, the human version of the Cyclo works just fine with Clops.  So I can get my Cyclo for 175 for 200mg/day instead of 600-800 dollars for Atopica.  

Its funny about price though.. I have to laugh when I see some sites talking about how expensive Atopica is when they are using it for its original purpose such as alergic reactions to the skin.  I mean they are giving 10 mg - 25mg once a day and they think its expensive.  Everything is relative I guess.

I'm not reluctant to get or try the liverwurst.  I just have yet to find it in the stores.  I kinda live in the sticks....all we have is a couple small grocery stores that barely carry anything.  I'm just waiting to get to town to look in some of the bigger stores.  I'm sure they'll probably have it.

Gratefuldawg I had to laugh -- I just saw your post above with the "instructions" -- and MY dogs **DO** get both pineapple and papaya!! *chuckle* altho probably not grapefruit.  My guess is it's the acid content.  Papaya and Pineapple are both helpful additons when you have a dog (*sigh* like Tink) who is so into coprophagia (poop-eating).

At this point I put most of their meds in their food -- but I don't have a med like cyclosporine that requires such specific handling.  The critical thing with the Atopica pill (particularly that, cos I've never handled the human cyclo meds) is they warn you strongly not to allow a stricture to occur -- meaning you have to be sure & certain that pill GOES ***DOWN*** and doesn't get stuck in the throat.  So they encourage you not to just "pill them" (shove the capsule down the throat) but to give them something after to swallow.

 I've used tons of things -- ricotta cheese & dairy things were my favorite, simply because they're a good calcium source when the dog tolerates it well.  But for the Atopica the non-dairy thing was something the University had done their own study on to follow-up another study.  Now I doubt it was a formally published study, but so much of the survival rate DEPENDS on how fast the body will metabolize and store the cyclosporine that they were trying to figure out how to make sure it was absorbed as fast as possible.

I do liverwurst on and off depending on need.  After Billy had problems with pancreatitis I had to err on the side of caution and go to something lower fat, so I use baby food meat and further lower the fat by mixing it with babyfood veggies.  I mix up a jar of "Stage 2" babyfood meat and a container or two of "Stage 2" babyfood veggies (Stage 1 is baby cereal.  Stage 2 is pureed with "no bumps" -- to correspond with the stages of food they put babies thru).  Then I dump the pill(s) in the mixture and use a plastic spoon to scoop it out and hold the spoon above the nose (the same way I offer a pill) and let them lick it off. 

It has the added benefit that it's a good quality food and there is nothing detrimental -- no sulfites or mega preservatives like in deli meat, no salt to speak of.  But it's quite pricey.  But worth it when I need to make sure a med is taken that needs special handling. 

I wouldn't put Atopica in food -- it's too risky.  There IS the potential that the dog may bite into it which would SO not be good.  Those capsules are made to be digested in the stomach and I was told to make sure the dog did NOT break a capsulle because it would burn the mouth and throat.  I don't know what the difference is when it's prepared as a liquid but I'm sure the formulation would be different.

Liverwurst is just so darned much fun for them, and like hummus, is high in iron which is such a biggie for a dog with IMHA.  Hummus is not universally liked -- my dogs are ok with it but even *they* aren't fond enough of it for it to be a treat.  LOL