advice on meds please, new to this!

[jessjazz90]

Hi folks, not sure if I have posted this on the right place? We have had a really bad week and a half. Our Jessica (English cocker) went for a routine check with the vet nurse following some surgery having her teeth cleaned. She had been pretty quiet and low in herself that day so I voiced my concerns to the vet nurse. She called the vet in who examined her and we both noticed that Jess was moaning a little when the vet touched her tum. The vet recommended obs for a couple of hours, blood tests and a scan of her belly. I took a call about an hour later to say that it was bad news and that my darling Jessica has AIHA and pancreatitis. I knew of both ilnesses and knew that it was really, really bad news. The vet put her on a drip and steroids (preds) along with antibiotics for the pancreatitis. Her PCV count early on was 18. Over the next couple of days her PCV count dropped to 14 and stabalised at that. On the first sunday she threw a tantrum and ripped her drip out. The vet didn't replace it as she was eating and drinking and keeping food down (although not great quantities). The vet kept uping the dose of the preds and on Thurs, as her levels hadn't gone up she asked for my permission to put her on Atopica at £85 a week. I said that was fine as we just wanted Jess to be okay. Kate, the vet decided that, as she wasn't on a drip any  longer that she would allow her home that day. We have had a really bumpy ride over the weekend. Jess is keen to eat but can't stomach large amounts and brings the food, plus her tabs back. We even had to ask the vet for permission to redose her on Sat night as all of her food and meds came back. We managed to get through the weekend and had an appt with Kate yesterday for checkup and pcv test. Her levels have stayed the same same (we were very deflated) but Kate said that the pancreatitis is well under control and she is certainly producing more and more red cells and there seemed to be less of the "bad cells" on the slide that she did. So, she is now on Atepsin and Zantac to help put a lining on her stomach, predisilone steroids twice a day, atopica twice a day, imuran once a day and a low dose of asprin to stop a her getting blood clots. Has anyone got any experience of this and these drugs? Just been for her blood test and her levels have gone down slightly to 13, gutted. Kate's going to keeo her on all of the drugs and retest on Monday. We are at our wits end so any advice would be very, very much apreciated. thank you 

[Jo CIMDA]

Hi Jessjazz

Welcome.  I'm so sorry you are having these problems.  It is a tricky situation when a dog has pancreatitis and has to be on high doses of steroids.  Is Jessica insured, because if she is it would be best to take her to a specialist asap., and they can monitor both diseases?

If her red blood cell count is 13% then you really need to go again and check her blood tomorrow - or better still get a referral to a specialist.  You can't, and don't have the time, to wait until Monday.  Very often a blood transfusion is needed when the PVC  gets to 12%, and she may need a transfusion tomorrow if her PCV has fallen.

It will take approximately 5 days (once the immune system is significantly suppressed and the bone marrow starts to produce new red blood cells) for the reticulocytes (immature red blood cells) to filter through to the circulation of the blood and this is why if the PCV goes below 12% a transfusion is often needed to 'buy time' for the steroids to work.

It is probably the Atopica that is causing the sickness, but to be honest all the drugs can cause a pancreatic dog to be sick. It is usual for either azathioprine or atopica to be used in combination with prednisolone and although I have heard of all three being used at the same time it is very rare.  Atopica and Azathioprine take 10 days at least to kick in and Azathioprine doesn't reach its full potential for one month, so at the moment neither of these drugs will be having much effect on the current situation.  These drugs are good when the steroids start to be reduced as they still maintain a good level of immunopsuppression.  What dose of steroids is Jessica on?  Please check out the Michael J Day drug protocol in the files.  It is an excellent guide.

Are you giving Antepsin with the other meds or has your vet told you to give it a couple of hours either side of the meds? Antepsin shouldn't be given with other medication as it can inhibit the absorption of the drugs.

There are articles in the files that you might find useful.

Good luck

Jo

[jessjazz90]

Hi jo, so glad you have replied, i have heard so much about u from carole who u helped with her american cocker, stryder. Jessica isn't insured and we havr already paid out aroun 1000 but jess is 2orth it. The vet has said that a blood transfusion is pointless until her pcv count starts to go up. She is on 1.3mls zantac, 3 times a day, 2.5 mls atepsin 3 times a day but vet told us to finish what we have as she seems ok with the pancreatitis now, she is also on 50mg atopica, twice a day, one 25mg imuran once a day, 4x5mg preds twice a day, also a low dose of asprin for blood clots. We worship the ground she walks on so any advice would be great, jenny & jessica

[Jo CIMDA]

Hi jo, so glad you have replied, i have heard so much about u from carole who u helped with her american cocker, stryder. Jessica isn't insured and we havr already paid out aroun 1000 but jess is 2orth it. The vet has said that a blood transfusion is pointless until her pcv count starts to go up. She is on 1.3mls zantac, 3 times a day, 2.5 mls atepsin 3 times a day but vet told us to finish what we have as she seems ok with the pancreatitis now, she is also on 50mg atopica, twice a day, one 25mg imuran once a day, 4x5mg preds twice a day, also a low dose of asprin for blood clots. We worship the ground she walks on so any advice would be great, jenny & jessica

Hi Jenny & Jessica

Oh yes, I remember Stryder!

I really don't understand your vet saying that "a transfusion is pointless until her PCV count starts to go up".  The whole point of a blood transfusion is to support the dog whilst the PCV is low and 'buy time' for the drugs to work. Does your vet have any experience in treating AIHA?  Can you go to another vet, perhaps in the same practice? sometimes getting someone else to look at a case is the best thing.

Jess is on an awful lot of drugs.  I don't know how much Jess weighs but, personally if she were mine, I wouldn't want her on any more than 1mg/kg/12 hrs of prednisolone.  I know you are giving Asprin to avoid blood clots but given that she is prone to pancreatitis the drugs should be kept to a mimimum and all the different drugs she is having is not helping her pancreas to remain stable.  Does she really need to be on Atopica and Azathioprine?   This is the opposite of another cocker who has just got over pancreatitis and has IMPA.  The specialist has reduced his prednisolone early and this is probably because they are concerned about the preds causing another bout of pancreatitis.

A dog on high doses of prednisolone etc., who doesn't have a genetic predisposition to pancreatitis would be at risk of getting pancreatitis on all these drugs,  so a dog who has just got over it, should be given even greater consideration as to how much steroid  and other drugs they have,  and they should also be kept on all the gastroprotectants. It is a tricky situation but a balance has to be achieved, although it is not easy to pitch.

Another blood test to check her PCV will either show that it is reducing, and therefore she probably needs a transfusion, or it will have increased in which case it will give you peace of mind over the weekend.  A dog with AIHA can lose 4% of red blood cells a day.

Think about having her checked again.

Jo