AIHA or IMHA

So do you think that Baytril would be OK in this situation or should I ask for something different?

Johnny&Tessy

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

 

It would definitely be something I would discuss with my vet tomorrow after reading that

Johnny, I'm so glad that Tessy seems to be pretty stable right now. 

I don't have much to offer on the UTI other than Willow had many of them before this illness and it wasn't until they cultured the urine to find out what bacteria it was and they gave her the right antibiotic for that bacteria that she finally was rid of them. 

She'll pull thru the antibiotics too.  Willow has been on more antibiotics than I could list here.  I always tried to give her yogurt to help with restoring the good bacteria but I know with your medications now you cannot give dairy.  Maybe there is a pill form?? 

Either way, the results are pretty postive for her!! 

How's she been acting?

 

calliecritturs

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. 

 

No pseudomonas is not a typical UTI, it would be one that is considered a nosocomial UTI, but it is opportunistic and not that unusally in immunospressed patients...which is what cyclosporin does.

 Also just found this:

. Regarding drug interactions, some pet health products, especially those containing mineral supplements like aluminum, calcium, iron and magnesium can interfere with proper absorption of Baytril. The stomach ulcer drug sucralfate can also interfere with absorption. Baytril can also alter the desired concentration of the drug theophylline when used concurrently with it. In addition, baytril can increase the risk of kidney damage from the immunosuppressive medication cyclosporine when the two are administered together. Once again the above is just a sampling of potential interactions rather than an all inclusive list. As always, it is important to let your veterinarian know about all the health products your pet is taking, prescription and non-prescription, so they can determine proper treatment options and adjust the medication and administration schedule accordingly. It is important to remember that the majority of pet medications available today all have potential side effects and possible drug interaction complications.

calliecritturs

Billy took tons of cranberry and tons of D-Mannose because it helped.

I always read this but I thought cranberry was only good if you needed to acidify the urine??? 

 

I give Tessy probiotics in the form of Forti Flora only when she's on antibiotics.

The whole culturing thing I am considering highly.  I talked to the vet briefly today concerning this and it was decided to wait and see where were at in a week or so.  That's before I came home and read up on Baytril.  I'm also wondering if the interaction with the cyclosporine and enhanced chance of kidney damage is from extended long term use of Baytril with the cyclo OR if it's given at the same time.

I'm going to pick up some baby wipes tomorrow to try on Tessy.  I did cut the hair near there very short when I shaved her.  I've been cleaning her every few days but maybe I'll start cleaning her more frequently. 

Thanks again,

Johnny & Tessy

I use wipes on Willow all the time too.  Also, canned food helps add more water to the diet.  And, of course with all she's got going on it could be anything but Willow's food was creating a high urine Ph.  The other thing I used to do is freeze unsweetened cranberry juice in ice cube trays and give a couple to her as a treat.  I'm not completely sure every UTI should have cranberry though. 

willowchow

calliecritturs

Billy took tons of cranberry and tons of D-Mannose because it helped.

I always read this but I thought cranberry was only good if you needed to acidify the urine??? 

No -- in fact cranberry is very very *very* minorly acidic.  The reason it "helps" ward off urinary tract infections is because it is a form of glucose -- the glucose bonds with the infection cells and keeps them too "slippery" to stick to the urinary tract walls.  D-mannose is just a different form of glucose (magnesium as a 'sugar' -- literally looks/tastes like confectioners sugar) and does the same thing only "more". 

Humans wouldn't take cranberry at all IF acidifying was a problem because human urine is typically too acid for comfort already (whereas most dog urine is more alkaline) -- the aim truly *is* to give the infection cells something to bond with to leave the body. 

You have to be careful b/c Willow runs oxalate crystals which is less typical.  oxalate flourish in more acidic/less alkaline urine which is why you tend to be concerned about that -- but truly cranberry is very very minorly acidic -- so much so that it's pretty much not a concern and the advantages of the "bonding with infection cells" usually outweighs the Ph value.

willowchow

I'm not completely sure every UTI should have cranberry though. 

Cranberry is more helpful to *prevent* uti rather than treating them -- there are certain types of  bacteria that bond more willingly with the glucose but both cranberry *and* d-mannose are primarily to ward off a UTI rather than to treat it.  Once you've *got* an infection typically you need antibiotics to get rid of it.   The cranberry and d-mannose may *help* a bit to send the bacteria on its way, but their major help is to prevent more bacteria from sticking to the urinary tract walls. (which in an immune suppressed dog can help even while you're treating for one)

willowchow

 The other thing I used to do is freeze unsweetened cranberry juice in ice cube trays and give a couple to her as a treat.  I'm not completely sure every UTI should have cranberry though. 

I love the idea freezing the cranberry juice, thanks for the idea. I use frozen yogurt, but never thought of the juice :)

Johnny&Tessy

I give Tessy probiotics in the form of Forti Flora only when she's on antibiotics.

For a Purina product Forti Flora is a danged good probiotic.  Yogurt is one form of a probiotic but Willow's right -- probably not a good  time to give dairy. 

You can get probiotics at any human health store -- and typically a child's probiotic is enough.

However, one I *really* like is Now Brands' "GR-8-Dolpholus" -- you don't have to refrigerate it - which is a big plus for me and it's just plain a darned good probiotic.  The big deal with a probiotic is to give it at odd times -- NOT with the antibiotic.  That's always my problem with Forti-floria because it's made to go in their food and I typically give antibiotics AT mealtime -- so I like a prpbiotic I can give later on in the evening. 

Now to give my input about the Baytril --

Johnny&Tessy

The whole culturing thing I am considering highly.  I talked to the vet briefly today concerning this and it was decided to wait and see where were at in a week or so.  That's before I came home and read up on Baytril.  I'm also wondering if the interaction with the cyclosporine and enhanced chance of kidney damage is from extended long term use of Baytril with the cyclo OR if it's given at the same time.

I think your question is a good one -- I never thought very much about the lack of use of Baytril when Billy was sick -- but I have to wonder if they weren't simply being cautious because there may have been suspicion Baytril was hard on the kidneys when paired with cyclosporine (dunno how new that data is) -- I *thought* they were just holding it back in case they needed a stronger one -- but I remember being astonished when Billy had the pseudomonas that they didn't use Baytril then but skipped right to the bigger drug, but I suspect they may simply have been avoiding Baytril all together.

In honesty, this whole IMHA deal is SOOOOO new, and it's taking a lot of dogs having a LOT of problems for them to come to any real conclusions -- I mean, no one wants to volunteer to have their dog take a drug suspected of CAUSING a further problem so I'm sure most of their conclusions are coming from case studies. 

Baytril, for years now, has been THE drug of choice so often because it's easy to give and it's generally well tolerated stomach-wise so I'm sure it was one of the first drugs vets would reach for in treating these dogs so immune-suppressed.  SO I'm sure somewhere it has become a big deal that vets began to notice "oh boy -- another dog I treated for IMHA and had to use a lot of Baytril with is NOW in renal failure".

Honestly?  I'd probably ask the vet to change.  I'd ask them to do the culture and sensitivity FIRST tho and find out what the heck kind of bacteria you're talking about and what WILL kill it.  You don't want to switch drugs 100 times.

Now -- for the "lighter moment" -- Billy actually learned AS A COMMAND "Nope you gotta WAIT ... don't pee! you gotta DONATE for Dr. B!!"

 He actually got really good at "going on command" (you get about so many hours waiting in vet's offices and up at Gainesville where you get your "shot" when a student comes by to walk you -- you'd better PEE FAST) *grin* and then, eventually at NOT going so they could gather a caught sample vs. having to have a cathether on those occasions when a caught sample would do.  (A plain urinalysis doesn't need a 'sterile draw' -- and a caught sample is fine -- but when you do the culture & sensitivity they have to have a sterile draw either done by aspirate directly from the kidney by needle or via a cathether.)

Good luck -- man, Billy DEFINITELY understands this one!!

calliecritturs

Willow runs oxalate crystals

She's only had struvite but I see what you are saying. 

 

 Just my opinion and I know it doesn't mean much but if it were me I'd have Tessy back on Aspirin.  My vet from OSU told me that it was a good idea to have her on Aspirin whenever her platelets are high, which is why Cyclops has never been off Aspirin yet.  I was thinking of taking her off of it if she had 2 CBC's in a row with low platelets but I'm thinking of waiting for 3 CBC's (3 months) of good results before I remove her from Aspirin. 

 This is just one of those times where I have to do what makes me feel better rather than do what the vet wants.  

 About Baytril, I used it with Takona my rescue dog to get rid of an ear infection.  I did something that no one had done before, I crumbled the Baytril into a powder and mixed it with ear cleaning solution and put it directly into her ear.  This was after giving her Baytril orally didn't work.  It worked so well for me that my vet started doing it with other stubborn infections where it was deep in the ear. 

 After seeing your post about Cyclosporine and Baytril, I'd not use it.   Another instance of you having to over ride your vet.  You are your dog's best advocate.  Not your vet.  Its your dog and no vet can take the time you can in researching these things.  Yeah, there are times especially in emergencies where you have to hold your breath and go on faith that the vet is doing the right thing.  But this isn't one of those times. 

Since Callie had success with Cipro, I'd consider asking the vet about that.  If Cipro can't get rid of an infection then nothing can.  Cipro is the "big guns".  Not that Baytril is any slouch either. 

 I also liked Callies suggestion of making sure her hair is shaved down there and keeping it clean.  Disinfecting wipes or bring her in the shower once a day and just shampoo and rinse her in that area.  

 Just thought I'd offer my thoughts.  I admit I'm pretty anti-establishment.  I am the one saying I am breaking my state's laws with impunity by not getting Rabbies boosters.  I don't care.  No one loves my dog the way I do, so these vets and the state can go to hell if they don't like what I do. 

But I figure you can listen to my wild ideas as well as the establishment and decide whats best for you.

 Best wishes for Tessy.

GratefulDawg

 Just my opinion and I know it doesn't mean much but if it were me I'd have Tessy back on Aspirin.  My vet from OSU told me that it was a good idea to have her on Aspirin whenever her platelets are high, which is why Cyclops has never been off Aspirin yet.  I was thinking of taking her off of it if she had 2 CBC's in a row with low platelets but I'm thinking of waiting for 3 CBC's (3 months) of good results before I remove her from Aspirin. 

Well I appreciate your opinion and think everyone is entitled to one  I agree about the aspirin. The chance of thrombus or embolism is significantly decreased after a month (I think that is what I read)....but that is in cases where the CBC blood work in near normal. In our case Calypso has never had out of normal platelet levels and now her labs show no signs of spherocytes, autoagglutination / clumping...but if that was not the case I would still continue the aspirin therapy. I still have not made the decision to stop Calypso's asprin since the studies I have read have since thromboembolism has been seen in so many dogs that have died. 

 

Alright....so I've decided to go ahead and use the Baytril.  I've read and researched all I could on it and also talked with Dr. Dodds on the matter and she has used it lots of times on immune suppressed dogs who were also on cyclosporine.  I'm only going to give it to her for two weeks.  If it isn't cleared up after that I'll discontinue the usage.

Gratefuldawg, it was only AFTER I took Tessy off the aspirin that the platelets fell to normal levels.  From what I've gathered it can do more harm than good if used long term.  Most specialists will only use it in the beginning stages of AIHA when the dog is in crisis and then most STILL do not want anything to do with them.  Most doctors and specialists will say that the use of NSAID's with corticosteroid drugs is not recommended.  At least that's what I've been told by most.  It was Dr. Dodds that recommended we take Tessy off the aspirin and I was weary at first but now looking back I'm glad I did.  Again every dog is different.  What are cyclop's platelet numbers now?  Some teaching hospitals have very large reference ranges (some even up to 900). 

Anyhow, I just missed a call from the vet so I'm off now to call them back.  The chem results must be in.

Johnny & Tessy