AIHA or IMHA

• 09-09-2009 11:05 PM

  In reply to FrisbyPI

  Al's Mom Joined on 08-26-2009 Posts 33 Points 25

  Re: AIHA or IMHA Reply Contact Thank you for the information on vet schools.  I think that I will contact them.  If I do decide, however, to take Al to one of these schools that is somewhat far away, am I ultimately going there for a second opinion?  What should I say when I call them?  So, Al did get a transfusion today with 1 unit of matched pRBC's.  When I went to the vet on Saturday, his PCV was 23 but his blood was also sent in for the crit and I found out yesterday that it was only 19 as of Saturday. (is it normal for a PCV to be 4 off from the crit?  This seems like a lot - isn't the crit the same only more accurate as it's done by machine?)  Yesterday, his PCV registered 18 and his breathing was very labored.  They told me he would need a transfusion in the next few days.  This morning, he was pretty lethargic.  I called the specialists today and they conferred with my vet and I took him up there and his PCV had dropped further so they transfused.  I definitely understand what you're both saying about not doing the transfusion until necessary.  I certainly agree and feel very vulnerable being pretty new to all of this and not always knowing the right questions to ask.  I think that their thinking is that it's taking Al a while to respond to the medication.  His PCV was at 10 when he entered the hospital almost 3 weeks ago and he was non-responsive to the drugs.  He was transfused twice in the hospital.  I believe that they initially thought due to his non-responsiveness that he would need a transfusion by last Thursday or Friday, but his PCV was sliding slowly, although it was continually sliding.  His proteins were low, so now I have to administer carafate every 8 hours as they think the pred might be messing with his stomach lining.  They told me not to give him any other medication within one hour before or until two hours after the carafate, but they didn't say anything about food.  I think that this goes to one of Callie's earlier assertions that certain things can inhibit the absorption of the medication.   Has anyone else's dog taken this and, if so, with or without food? As always, I appreciate your insights - thank you. Meredith

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• 09-09-2009 11:34 PM

  In reply to Al's Mom

  calliecritturs Joined on 09-10-2007 Central Florida Posts 10,861 Points 3,330

  Re: AIHA or IMHA Reply Contact Al's Mom: I think that I will contact them.  If I do decide, however, to take Al to one of these schools that is somewhat far away, am I ultimately going there for a second opinion?  What should I say when I call them?  Don't even worry about that -- IF you feel comfortable with it your vet can refer you to any vet school -- but at the same time, if you really aren't quiet happy with how your vet is handling it, then just call them and tell them that.  Be honest 'I don't know whether this is a 'second opinion' or if I just need to switch, but I know we need help".  That's honestly good enough.  You may not be able to make that decision until later. Al's Mom: When I went to the vet on Saturday, his PCV was 23 but his blood was also sent in for the crit and I found out yesterday that it was only 19 as of Saturday. (is it normal for a PCV to be 4 off from the crit?   It's not at all unheard of -- a "hematacrit" is literally a machine -read value.  The blood is completely processed by machine, including the blood value is "read" by machine. A packed cell value or PCV is done totally by human hands -- a tiny tube is filled with blood and packing is put in either end -- that is then spun on a centrigufe to "separate" the blood and they then hold that tiny tube up to a paper scale to 'read' it. So essentially if part of a dro of blood "more" is in that tube, or part of a drop of blood "less" is in there -- just that tiny variation can actuaally make the readings widely different.  However -- even with a hematacrit -- two different machines sitting side by side can be minorly calibrated differently.  So "sampling error" can occur. Al's Mom: His proteins were low, so now I have to administer carafate every 8 hours as they think the pred might be messing with his stomach lining.  They told me not to give him any other medication within one hour before or until two hours after the carafate, but they didn't say anything about food.  I think that this goes to one of Callie's earlier assertions that certain things can inhibit the absorption of the medication.   Has anyone else's dog taken this and, if so, with or without food? Cyclosporine absorption– general discussion re: dairy inhibition of  absorption Page 39/Last half of page Page 45/Post 12, Page 68/Post 3, Page 72/Post 3  – Slippery elm cocktail (suspected ulcer/stomach help) Page 92/Post 13 – various things that can inhibit cyclosporine absorption Carafate was one of the drugs they took Billy off FAST because it inhibited the absorption of the cyclosporine.  Billy wound up on Prilosec.  Pepcid is also used.  Billy did NOT respond to the cyclosporine well at all at first -- it took him almost six weeks before he leveled out.  He had to take his cyclosporine WITH food.  You can get really locked up in do's and don'ts -- but it has to be what works with THIS dog, so don't let him go if he starts being iffy about food -- you gotta keep him eating.  it is crucial. Let me know if I can be of any help at all -- Dr. Dodds has been amazing to help several folks decide which vet school to use.  You can email her straight thru Hemopet.org. Good luck.

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• 09-10-2009 8:47 AM

  In reply to Al's Mom

  cerberusdog Joined on 07-13-2009 Posts 79 Points 0

  Re: AIHA or IMHA Reply Contact Al's Mom: So, Al did get a transfusion today with 1 unit of matched pRBC's.  When I went to the vet on Saturday, his PCV was 23 but his blood was also sent in for the crit and I found out yesterday that it was only 19 as of Saturday. (is it normal for a PCV to be 4 off from the crit?  This seems like a lot - isn't the crit the same only more accurate as it's done by machine?)  Yesterday, his PCV registered 18 and his breathing was very labored.  They told me he would need a transfusion in the next few days.  This morning, he was pretty lethargic.  I called the specialists today and they conferred with my vet and I took him up there and his PCV had dropped further so they transfused.  I definitely understand what you're both saying about not doing the transfusion until necessary.  I certainly agree and feel very vulnerable being pretty new to all of this and not always knowing the right questions to ask.  I think that their thinking is that it's taking Al a while to respond to the medication.  His PCV was at 10 when he entered the hospital almost 3 weeks ago and he was non-responsive to the drugs.  He was transfused twice in the hospital.  I believe that they initially thought due to his non-responsiveness that he would need a transfusion by last Thursday or Friday, but his PCV was sliding slowly, although it was continually sliding.  For Calypso, we chose to do blood transfusions only when she showed clinical signs of being in distress...which your dog seemed to be showing signs of.  The blood work for a HCT and PCV are often run on 2 different machines, so you will see variations. At my emergency clinic they just used the PCV to show them trends.   Al's Mom: Thank you for the information on vet schools.  I think that I will contact them.  If I do decide, however, to take Al to one of these schools that is somewhat far away, am I ultimately going there for a second opinion?  What should I say when I call them?  I would just tell them that you are wanted a 2nd vet to look at your dog and would like to make an appointment Al's Mom: His proteins were low, so now I have to administer carafate every 8 hours as they think the pred might be messing with his stomach lining.  They told me not to give him any other medication within one hour before or until two hours after the carafate, but they didn't say anything about food.  I think that this goes to one of Callie's earlier assertions that certain things can inhibit the absorption of the medication.   Has anyone else's dog taken this and, if so, with or without food?.  Carafate should be given on an empty stomach, no food no meds. It will inhibit the absorption of medications. Carafate coats the stomach so well, that it is hard for anything else to absorbed.

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• 09-10-2009 8:49 AM

  In reply to calliecritturs

  Johnny&Tessy Joined on 04-18-2009 Nova Scotia Posts 148 Points 55

  Re: AIHA or IMHA Reply Contact Al's Mom....Exactly what Dr. Callie said!  Tessy's PCV is always a few points higher than her hematocrit.  I usually always get the CBC with the HCT so that I can look at all the other readings.  Once in a while I get a PCV just to check to make sure the difference is still there. I also second the carafate (sucralfate Tessy was on).   When Tessy was put on this she started to crash.  Her crit dropped from 29 (start of sucralfate) to 20 (end of sucralfate/carafate) in only a matter of a week.  We switched her to omeprazole and she's been doing much better. Tessy also responded to the cyclosporine the same way Billy did.  The first week was awefull trying to get her to take it without puking.  Eventually her body got used to it and now she doesn't puke at all anymore.  Like Callie...I ALWAYS give the cyclosporine with food...as well as all her other meds. Has there been any news on the post transfusion results yet?  Will be praying and sending positive vibes Al's way.  Johnny & Tessy

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• 09-10-2009 8:52 AM

  In reply to calliecritturs

  cerberusdog Joined on 07-13-2009 Posts 79 Points 0

  Re: AIHA or IMHA Reply Contact calliecritturs: [Cyclosporine absorption– general discussion re: dairy inhibition of  absorption Page 39/Last half of page   Dairy inhibiting the absorption of cyclosporin is unproven. There is no literature to support it, I checked both human and canine literature. We give dairy to children on cyclospoin all the time. Trust me if there was any thought that dairy reduces the effect of cyclosporin we would restrict dairy in that child population that takes cyclosporin. Plus my dog Calypso reguarly took her pills with cheese and has gotten better.   I too like Callie and Johnny give Cyclosporin WITH food, Calypso also responded by puking all the time if I gave it on an empty stomach. After talking with the vet, she told me that they see that frequently and wanted me to give it with food. She said that sometimes when it is given with food they might increase the dose depending on how the dog is doing.

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• 09-10-2009 8:55 AM

  In reply to cerberusdog

  cerberusdog Joined on 07-13-2009 Posts 79 Points 0	Re: AIHA or IMHA Reply Contact On a side note, Calypso is doing great. We just got her labs back! Her liver values are again normal, so Denamarin did a GREAT job! There is no sign of infection this time, so they think we caught it early and wiped it out. Her HCT is 42, so we are continuing with her medication wean.
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• 09-10-2009 10:25 AM

  In reply to cerberusdog

  Al's Mom Joined on 08-26-2009 Posts 33 Points 25

  Re: AIHA or IMHA Reply Contact Thanks, everyone.  That's wonderful news about Calypso! I just got off the phone with the dr. and although Al seems to be doing well after the transfusion, I am a bit distressed.  It has been a little less than three weeks and the dr. is not sure if Al will respond to the drugs or not.  He said to give him 4 to 6 weeks because it can take dogs this long who have bone marrow mediated destruction, as Al does.  When I asked him if there were any alternatives if he doesn't respond to the meds, his basic answer seemed "no." I know that I shouldn't go there yet and that I should still have hope, but this wasn't quite what I wanted to hear.  I hate this disease.

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• 09-10-2009 10:57 AM

  In reply to cerberusdog

  calliecritturs Joined on 09-10-2007 Central Florida Posts 10,861 Points 3,330	Re: AIHA or IMHA Reply Contact
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• 09-10-2009 11:06 AM

  In reply to Al's Mom

  calliecritturs Joined on 09-10-2007 Central Florida Posts 10,861 Points 3,330

  Re: AIHA or IMHA Reply Contact Al's Mom: I just got off the phone with the dr. and although Al seems to be doing well after the transfusion, I am a bit distressed.  It has been a little less than three weeks and the dr. is not sure if Al will respond to the drugs or not.  He said to give him 4 to 6 weeks because it can take dogs this long who have bone marrow mediated destruction, as Al does.  It was six weeks after Billy got on cyclosporine before he really BEGAN to respond to the cyclosporine.  Cyclosporine has to reach a "level" in the body to be hugely effective. Destruction in the bone marrow makes it harder (Billy's was that way too).  Keep the faith -- don't let yourself get discouraged.  It's a VERY individual thing.    Don't let someone else's situation make you feel desperate.  Breed, constitution, other drugs, situation -- it is all very very unique.  The fact that he's doing well after the transfusion is a good thing!!

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• 09-10-2009 11:15 AM

  In reply to Al's Mom

  FrisbyPI Joined on 07-17-2009 Rhode Island Posts 118 Points 0

  Re: AIHA or IMHA Reply Contact Al's Mom, How old is Al? Age was a huge consideration in making treatment decisions for Frisby. She is "very old" for an IMHA dog--and we had to pay attention to that, along with the disease. Frisby did slide a couple times and then very slowly started to improve. (I began to think 19 was a good number for awhile!) It's never a bad idea to get a second opinion. I had a vet ready at Tufts in case we needed to go there. I was also very concerned about the stress of travel--the many trips to the hospital caused a lot of stress for Frisby (again, age probably played a factor) and she was always in worse shape when we arrived. That said, I would not hesitate to take her to Tufts (or the hospital) if I felt it were needed. I would try to make sure I had someone with me. It does sound like the transfusion was needed because of the decline. Because this illness can more so quickly, what might make sense one day is thrown out the window the next. Frisby and I send our love and prayers. Kate Kate and Frisby

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• 09-10-2009 11:34 AM

  In reply to FrisbyPI

  calliecritturs Joined on 09-10-2007 Central Florida Posts 10,861 Points 3,330	Re: AIHA or IMHA Reply Contact FrisbyPI: It does sound like the transfusion was needed because of the decline. Because this illness can more so quickly, what might make sense one day is thrown out the window the next. Oh yeah -- WHAT KATE SAID!!!
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• 09-10-2009 11:42 AM

  In reply to calliecritturs

  Al's Mom Joined on 08-26-2009 Posts 33 Points 25	Re: AIHA or IMHA Reply Contact Thank you all - you make me hopeful, which is what we need right now. Kate - Al is only 6, so he's pretty young.  I am going to call these vet schools to see if they have any ideas. Callie- I'm going to call you tonight, so when a "646" or "212" number crops up, you'll know it's mine. Meredith
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• 09-10-2009 11:49 AM

  In reply to Al's Mom

  calliecritturs Joined on 09-10-2007 Central Florida Posts 10,861 Points 3,330	Re: AIHA or IMHA Reply Contact Grooooo-veeeeyyy!!  I gotta stop on my way home and get my adjustment which is why I won't be there til 6.  I think Billy can almost TELL when it's a "IMHA dog ring" -- he goes all a wriggle and never leaves my side whilst I'm on the phone!! LOL
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• 09-10-2009 11:53 AM

  In reply to calliecritturs

  cerberusdog Joined on 07-13-2009 Posts 79 Points 0	Re: AIHA or IMHA Reply Contact
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• 09-10-2009 12:44 PM

  In reply to rwbeagles

  GratefulDawg Joined on 12-24-2008 Posts 270 Points 40

  Re: AIHA or IMHA Reply Contact  Wow I don't even feel like I know anyone here anymore.   Things are going so fast I can't really keep up.  Should anyone want a one-on-one dialogue with me via e-mail, I am more than willing to spend time with anyone who wants my opinions on things.  I did this with Judah and his dog Eli and they both seem to be doing well.  Callie, I see you started an index or something.  Good deal.  Months and months of struggle with Cyclops shouldn't go to waste.    9 months and Cyclops is doing well.   About the only new thing is that in discussing what our next step is with Cyclops we are talking about when and if to get her off the Aspirin.  So far no sign that her platelets are going to cooperate.  But they may once we make our final reduction.  I say final because my vet thinks that Cyclops should remain on 25mg Cyclosporine every 12 hours for the remainder of her life.  Right now we are at 50mg every 12.  Will see in a few weeks if the HCT is still holding at 47 which I have no reason to believe that it won't be.. and then we'll make our final reduction.  The only other thing will be to check every once in a while to see if we can stop the Aspirin.   Every dog is different.  Cyclops always takes her Cyclosporine 2 hours after eating with only enough food to get it down.  Never had a stomach problem.  Both Dr Dodds and my vet at OSU want her to be off the Pepcid AC as soon as we stop the Aspirin.  They both are of the opinion that there is no problem with taking Cyclo without taking Pepcid.. that the Pepcid is mainly for the Pred and the Aspirin.   Of course Cyclops' stomach has always been like a cast iron ketttle so your milage may vary.  My intent is to have her off of every med except the 25mg Cyclo ASAP.  But I won't quit the Aspirin until her platelets are in the normal range for several months. I wish I had the ability to keep up each day with everything.. I am thankful that Callie is here for everyone.  If anyone ever wants my opinion on anything please don't hesitate to contact me.  I feel like I can do more good on an individual basis than I can throwing my opinion out there each day.  If you need a second opinion I'd be happy to share what I know with anyone.   What I've learned with both Cyclops and now Eli.. #1 Vet School, Vet School, Vet School #2 Get off the Pred as soon as the dog is stable.. which for me was 1 month.  For Eli it was about 10 days and he was off. #3 Cyclosporine is a miracle drug #4 Ultra Low Dose Aspirin as long as needed, when needed. Aspirin shouldn't be started until or unless the HCT climbs out of the danger zone, don't start it right away and don't do anything without checking with your VET SCHOOL. #5 Pepcid AC is the stomach protectant of choice (when used with Cyclosporine) that is being recommended by 2 different Vet Schools. #6 Each dog is different so my list may not apply to you.  Its what I would do if I was going through this all over again. Best wishes to you all! Mike

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