And I should make sure we are checking the reticulocytes as well as PCV? How often should we be doing this? They are having me bring her back in two weeks which will be the 22nd. I feel that is a long time to go. Thoughts?
It's probably not a bad idea to do them pretty frequently early on--since the reticulocytes appear to be what her immune system is targeting, it can help you stay on top of the destruction, and if you catch the corrected reticulocyte count starting to drop, it gives you a little jump on helping her if she's heading for a crash. The RBC indices can also give you an idea of her regeneration--immature red blood cells are larger, so a high value for mean corpuscular volume (MCV) is a pretty good sign that she's making new cells--but the reticulocyte count is a lot more illustrative of what's being produced. Jasper took a while to start regenerating, so we held off until she started to stabilize; we did them weekly for a month or so, and only stopped after her PCV had been definitively rising for a couple weeks. We checked her PCV twice a week as well--sometimes three times a week if she seemed clinically off, and even waiting a day or two was nerve-wracking so two weeks would probably kill me! It's typically a really inexpensive tests, and takes about ten minutes to run, and can save some drama in the long run, so I would recommend doing them pretty frequently to start off.
What kinds of issues did you have with the immunosuppression?
We got really lucky, and didn't have to deal with anything other than a nasty abscess on her elbow. Try to keep her skin as moisturized as possible (vitamin e oil is awesome), and if you see any skin that looks irritated, especially around her joints, it's probably going to crack and be open to infiltration--whenever Jasper had anything like that, I put triple antibiotic ointment on it to keep it moist, and then left it covered for a day or so--I have no idea if that's medically sound, but it seems to have worked pretty well haha. She also gets omega 3s and vitamin e capsules and that's kept her skin in pretty good shape as well. Be REALLY gentle when you brush her teeth, and try not to abrade her gums and leave them open to gross mouth bacteria. It's safest to turn her into a total recluse--no walks, no grooming, and if there have been any nasty cases at the vet when you take her, sweet-talk them into looking at her in the car : ) If you have people over, be totally neurotic about handwashing and taking shoes off. I'm sure Callie's given you a ton of info on supplements and stuff, but d-mannose was a miracle for her bladder, and I still can't believe she hasn't had an infection. The dipsticks we use test "Glucose, Bilirubin, Ketone, Specific Gravity, Blood, pH, Protein, Urobilinogen, Nitrite and Leukocytes," and you can buy them online and probably from your vet too. They definitely don't replace a legitimate UA, but can help catch problems early.
My other concern is that Josey likes to eat her poop.
ughh, Jasper eats out of the litter box, and it got so much worse once the pred-hunger kicked in. It never seemed to cause any issues, but it freaks me out to no end, and she's pretty persistent in terms of what she'll do to get to it. There's something called For-Bid--it's a powder that you sprinkle on her food for three or four days in a row, and it's supposed to make the stool really bitter and turn them off from eating it. I think it's pretty effective, but definitely check with someone who knows their stuff and make sure it's ok to use with IMHA.
How often was Jasper transfused?
She had a whole blood transfusion the night she crashed, and then an additional plasma transfusion the next day because she had some bleeding around her liver (she has von Willebrand disease, so they were trying to pump up her clotting factors and help her reabsorb the fluids). She had her second whole blood transfusion a little over a month later, and her third was a week and a day after that. Her cutoff seemed to be 14--whenever she dipped below 14 it was pretty clinically obvious, so whenever she started inching to 16 or so we got ready to transfuse. A pretty common cutoff seems to be 12, and most importantly, you know Josey, so if she doesn't seem ok below 16 or so, don't feel weird about questioning why they'd let her get so low. Transfusions are pretty last resort, so the mindset of routine transfusions (just to help her along until she can start making blood herself) is sometimes kind of weird to consider. There are definitely legitimate reasons for being wary of multiple transfusions, but transfusing a dog who has been typed and cross-matched, who is in relatively stable condition otherwise, and is on a hefty dose of steroids (reducing the risk of an inflammatory, if not hemolytic, reaction) is a completely different situation from transfusing a critical dog that's been hit by a car, or a dog with hemangiosarcoma.
She is not eating the best, she is still very active, and drinking, peeing, and pooping okay so far. She has vomitted twice, once after starting the prednisone and cyclosporine.
That sounds really good! I don't know what to do in terms of enticing her to eat, but if she's vomiting, try offering her small meals throughout the day? The cyclosporine can definitely take getting used to, and even Jasper's typically iron stomach couldn't handle it initially, but she did adjust. If she seems to be getting dehydrated, unflavored pedia-lite works really well--just make sure it doesn't have any artificial sweeteners (I don't know why it would, but...). You can also mix it with wet food and warm it up a little bit to make it smellier and more appealing if she just doesn't seem hungry (if she's nauseous though, that's probably not a good idea).
I have been trying to figure out what is the best time to be giving everything and I am feeling EXTREMELY overwhelmed with this aspect of things.
Definitely post it! Ours was so ridiculous, and we went through about 9 different schedules before things calmed down a little bit. It gets totally mindboggling,, and every drug seems to have its own specific requirements, but the most important thing is that she's getting them, so don't drive yourself crazy if it's impossible.
Finallyyyy, Denamarin is made by Nutramax, and if your vet doesn't sell it you can definitely get it online!