Need help and advice. At a loss for my poor dog luna

[Ashley1106]

Yea

is she still on both drugs ?

J

[Ashley1106]

Imha was detected probably about a month ago I brought her in Bc she was panting and always seemed like she was out of breath I thought it was just her b12 being low but they told me that her levels were like 8 and 26 I think it was her hemoglobin and hematocrit levels and they put her on prednisone 20mg twice a day for about a week and her levels stayed the same so then they added imuran and we retested 10 days later and her levels went up to 11 and like 35 I’m not sure if those were exact numbers. So then they decreased her prednisone to 10 mg twice a day. And all while this is happening her epi is out of control with cow pie stools and weight loss. I wasn’t sure if it was prednisone causing it or what so we figured we’d see if while decreasing the prednisone of the stools would get better but nope. Idk what to do we did two diff meds the metronidazole and pro—pectin and nothings helping. What did you do!!????

Hi,

I am so so SO sorry to hear about Luna.

My Izzy, diagnosed at 1+1/2 yr with EPI, was also diagnosed with IMHA (Immune mediated hemolytic anemia) at age 7.
She is now 13+12 and doing well.

I will gladly help you, but i need more information.

First....how long ago was the IMHA detected and exactly what was the treatment..... what is still being done for Luna regarding the IMHA if anything.
Also... how low did her hematocrit go? What is the level now... or when they said she was stable?

Next... the weight loss..... and the fact that she can't handle the food that she used to be able to.. my gal also lost a ton of weight after the IMHA......

Has your vet tested for :
1. Diabetes
2. Low Thyroid

Looking forward to hearing from you.... i'd like to get a more detailed picture of what is going on. so that hopefully, as a parent of and EPI + IMHA survivor, i might be able to help....

[Ashley1106]

Also did u find out if your dog had primary or secondary hemolytic anemia.

Imha was detected probably about a month ago I brought her in Bc she was panting and always seemed like she was out of breath I thought it was just her b12 being low but they told me that her levels were like 8 and 26 I think it was her hemoglobin and hematocrit levels and they put her on prednisone 20mg twice a day for about a week and her levels stayed the same so then they added imuran and we retested 10 days later and her levels went up to 11 and like 35 I’m not sure if those were exact numbers. So then they decreased her prednisone to 10 mg twice a day. And all while this is happening her epi is out of control with cow pie stools and weight loss. I wasn’t sure if it was prednisone causing it or what so we figured we’d see if while decreasing the prednisone of the stools would get better but nope. Idk what to do we did two diff meds the metronidazole and pro—pectin and nothings helping. What did you do!!????

Hi,

I am so so SO sorry to hear about Luna.

My Izzy, diagnosed at 1+1/2 yr with EPI, was also diagnosed with IMHA (Immune mediated hemolytic anemia) at age 7.
She is now 13+12 and doing well.

I will gladly help you, but i need more information.

First....how long ago was the IMHA detected and exactly what was the treatment..... what is still being done for Luna regarding the IMHA if anything.
Also... how low did her hematocrit go? What is the level now... or when they said she was stable?

Next... the weight loss..... and the fact that she can't handle the food that she used to be able to.. my gal also lost a ton of weight after the IMHA......

Has your vet tested for :
1. Diabetes
2. Low Thyroid

Looking forward to hearing from you.... i'd like to get a more detailed picture of what is going on. so that hopefully, as a parent of and EPI + IMHA survivor, i might be able to help....

[Olesia711]

yea, prednisone alone usually does not work..... they put my gal on super high dose prednisone + cyclosporine... but the fact that they put Luna on Imuran (which is Azathioprine) is another drug in place of cyclosporine.

My Izzy's IMHA was so bad that even pred+cyclosporine was not bringing up the hematocrit (the red blood cells were still breaking apart too soon) so my vet contacted a vet school and they said to try Leflonumide (another immune suppressant drug given for Rhematoid Arthritis.... this helped but then we went from regenerative to non-regenerative in the bone marrow and had to stop the Leflonumide.

Ask your vet for Tylan instead of Metronidazole... it will NOT interfere with Imuran (Azathioprine).

Also.....the 35 value... that is the Hematocrit.... Luna is in much better territory, but this is still not good enough. She still needs to be monitored. You will want to see the hematocrit at the very least in the high 30's but you can breathe a sigh of relief when her hematocrit is anywhere in the 40's.

My Izzy's Hematocrit got stuck in the low 30's ..... nothing worked and she wasn't out of the woods.... i asked the vet to test her thyroid. He looked at me like i had 3 heads. I insisted, he reluctantly tested. And then he apologized. Sure enough she had low thyroid.... as soon as they determined the right dose of levothyroxine / solaxine..... her hematocrit start moving upwards

THyroid can get out of whack when there is an immune situation going on so if this is happening to Luna too..you kind of have to fix the whole dog, just not one part, in order for her to fully recover.

And don't think jsut because Luna is losing weight that Low thyroid "might" not be involved.
Also.... have your vet check for diabetes.... just in case.

1. To deal with the loose stools.... my suggestion is talk to the vet and insist on swapping out the Metronidazole for Tylan.

2. Also... i know this is counter-intuitive to everything we tell you with an EPI dog..... but for now, greatly reduce the fat content of the food you are feeding her for now. Get something low in fat, low in fiber.... BUT give a tblsp of sweet potato or pumpkin or something for the right type and right amount of fiber.

3. And/or give a little slippery elm


This is a 2018 update on IMHA... but in short.... the key take-aways are:

IMHA is a complex soup of many different presentations,” he said. “Some versions destroy red blood cells by popping them and others eat the red blood cells; some dogs have the disease affecting their platelets and others don’t. You can’t expect one cookie cutter treatment to work.

The foundation of treatment is steroids often combined with one or more immunosuppressant drugs such as cyclosporine, azathioprine, or mycophenolate

Because blood clots frequently are a complication of IMHA and thrombosis is associated with higher mortality, aspirin, heparin, or clopidogrel also are often used to reduce the risk of blood clots, said Mackin.

However, there’s little evidence on which drug or combination of drugs is most effective, said Richter.

The upcoming consensus statement will provide recommendations for using immunosuppressants, said Mackin, adding that tailoring treatment to individual dogs is crucial and that more therapeutic drug monitoring tools are needed.

“Dogs have narrow therapeutic windows,” he said. “
The gaps between effective, ineffective, and dangerous drug doses are really narrow.”

One such tool is an assay that was developed at the Pharmacodynamic Laboratory at Mississippi State University College of Veterinary Medicine.... that can help gauge the immunosuppression activity of cyclosporine and provide dosage guidance to veterinarians who submit blood samples of dogs they are treating. Similar assays likely will be available soon for other drugs, said Mackin

Our hypothesis is based on our opinion that there already are effective immunosuppressive drugs available, but that treatment should be individualized for each dog to control the disease while minimizing side effects

https://www.veterinarypracticenews.com/ ... imha-near/

Hope this helps a little... talk to your vet. he is working with the right class of drugs, the problem is each dog is different..... BUT i hope some of the suggestions i have made will help.

Just a FYI.... it took us 5 months before my Izzy was truly stable. And it has been 6 yrs since, and we have not (thankfully) had a relapse!

Please keep us posted!

[Ashley1106]

Yes we did blood work I’m going to ask if the thyroid panel was included in the blood work as it was 300$ for just the bloodwork. I am going out to buy her a diff kind of food now. My question is should I go grain free? I’m already giving her food that is low in fiber and fat and not too expensive so I’m thinking of switching to grain free. Not sure which food to get.

yea, prednisone alone usually does not work..... they put my gal on super high dose prednisone + cyclosporine... but the fact that they put Luna on Imuran (which is Azathioprine) is another drug in place of cyclosporine.

My Izzy's IMHA was so bad that even pred+cyclosporine was not bringing up the hematocrit (the red blood cells were still breaking apart too soon) so my vet contacted a vet school and they said to try Leflonumide (another immune suppressant drug given for Rhematoid Arthritis.... this helped but then we went from regenerative to non-regenerative in the bone marrow and had to stop the Leflonumide.

Ask your vet for Tylan instead of Metronidazole... it will NOT interfere with Imuran (Azathioprine).

Also.....the 35 value... that is the Hematocrit.... Luna is in much better territory, but this is still not good enough. She still needs to be monitored. You will want to see the hematocrit at the very least in the high 30's but you can breathe a sigh of relief when her hematocrit is anywhere in the 40's.

My Izzy's Hematocrit got stuck in the low 30's ..... nothing worked and she wasn't out of the woods.... i asked the vet to test her thyroid. He looked at me like i had 3 heads. I insisted, he reluctantly tested. And then he apologized. Sure enough she had low thyroid.... as soon as they determined the right dose of levothyroxine / solaxine..... her hematocrit start moving upwards

THyroid can get out of whack when there is an immune situation going on so if this is happening to Luna too..you kind of have to fix the whole dog, just not one part, in order for her to fully recover.

And don't think jsut because Luna is losing weight that Low thyroid "might" not be involved.
Also.... have your vet check for diabetes.... just in case.

1. To deal with the loose stools.... my suggestion is talk to the vet and insist on swapping out the Metronidazole for Tylan.

2. Also... i know this is counter-intuitive to everything we tell you with an EPI dog..... but for now, greatly reduce the fat content of the food you are feeding her for now. Get something low in fat, low in fiber.... BUT give a tblsp of sweet potato or pumpkin or something for the right type and right amount of fiber.

3. And/or give a little slippery elm


This is a 2018 update on IMHA... but in short.... the key take-aways are:

IMHA is a complex soup of many different presentations,” he said. “Some versions destroy red blood cells by popping them and others eat the red blood cells; some dogs have the disease affecting their platelets and others don’t. You can’t expect one cookie cutter treatment to work.

The foundation of treatment is steroids often combined with one or more immunosuppressant drugs such as cyclosporine, azathioprine, or mycophenolate

Because blood clots frequently are a complication of IMHA and thrombosis is associated with higher mortality, aspirin, heparin, or clopidogrel also are often used to reduce the risk of blood clots, said Mackin.

However, there’s little evidence on which drug or combination of drugs is most effective, said Richter.

The upcoming consensus statement will provide recommendations for using immunosuppressants, said Mackin, adding that tailoring treatment to individual dogs is crucial and that more therapeutic drug monitoring tools are needed.

“Dogs have narrow therapeutic windows,” he said. “
The gaps between effective, ineffective, and dangerous drug doses are really narrow.”

One such tool is an assay that was developed at the Pharmacodynamic Laboratory at Mississippi State University College of Veterinary Medicine.... that can help gauge the immunosuppression activity of cyclosporine and provide dosage guidance to veterinarians who submit blood samples of dogs they are treating. Similar assays likely will be available soon for other drugs, said Mackin

Our hypothesis is based on our opinion that there already are effective immunosuppressive drugs available, but that treatment should be individualized for each dog to control the disease while minimizing side effects

https://www.veterinarypracticenews.com/ ... imha-near/

Hope this helps a little... talk to your vet. he is working with the right class of drugs, the problem is each dog is different..... BUT i hope some of the suggestions i have made will help.

Just a FYI.... it took us 5 months before my Izzy was truly stable. And it has been 6 yrs since, and we have not (thankfully) had a relapse!

Please keep us posted!

[Olesia711]

Can you tell me what the name of the food is: the exact name.

[Ashley1106]

I was giving Purina pro plan focus all stages in the picture i attacthed and was going to switch to the pacific in the picture attacthed

Can you tell me what the name of the food is: the exact name.

[jilbert57]

I see it has been a few days. Did you order the Taste of the Wild? A lot of folks use the brand. Let us know how your pup does.

[Ashley1106]

Thank you for checking up on us! I ordered it and have been slowly mixing it in with her old food. I wasn’t sure with epi dogs if you can just switch or have to do it by slowly mixing so I decided to just slowly do it since I was unsure. Her poops still aren’t good and I added slippery elm in starting Sunday night twice a day with meals. I am taking her to a new vet tomorrow to see if they can help us!

I see it has been a few days. Did you order the Taste of the Wild? A lot of folks use the brand. Let us know how your pup does.

[Jean]

slowly at first and keep a record

jx