CIMDA

Hi
I purchased my little springer holly on 18 th march this year,believing the couple sold her as had adhd child torturing her n holly was only 18 months old n needed a life.
This was not the case,a month later found my lovely girl,my first dog who I absolutely adore had substantial mitrAl valve heart disease n could go into heart failure at Any time.
So I changed her diet homecooked ,vitamins ,amino acids ,fish oils,etc to try n ward off heart failure as long as could as shes a wonderful wonderful girl.
Two months went buy
Holly was in season a month got infection uterus amoxycillin several times
Then false pregnancy
Coughing more antibiotics ,thought it to do with heart
Lungs,seemed afected
She,was slowing down but thought it heart related
Then 3 and a half weeks ago I woke she was slumped down
Holly was always a wee happy bubbly excitable girl
Rushed vet thinking heart failure
Vet said ate something
?
Weekend of hell coughing spasms chest fever lethargy
Back vet Monday
Vet said respiratory tract infection
Possible pyometra as swollen inflamed red sore abdomen
Home bbaytril antibiotics
Another two days slumped fever fell
Rushed in Wednesday
Kept overnight
105 temperature
Liver enzymes up but bloods ok
Said maybe lyme disease or memingitis!!
Started treating for lyme
Released holly on five antibiotic a day
Thurs night she bad spasms pain panting ill
Friday blood in poo
Phone vet said let her heal over weekend?
I said she in pain
Rushed vet satrday said I think shes dying on me
Kept her in nine nights
Stared steroids,meningitis two days didnt help
Then went on flagyl n baytril antibiotics
She very sick started gastro protectants cimetidine sfeedin
By now red blood cells platelets very low n anaemia
They say it touch n go whether she survive
I didnt have money for lots expensive exploratories
So still no further forward whst hapening
Heart just coping n no more
Bad pain abdomen xray ultrasound see nothing in abdomen
Say if has pyometra only mms n be treated with antibiotic
Try doxycycline abx two days
Then high dose steroid ,n baytril n.let home but she brighter but pain stomach n anaemia
So cant let walk long be careful not bang herself
She has survived
Asked put back on doxycycline as well as baytril incase its lyme co infections
As needle biopsy spleen said fungus protozoa
Though flagyl anti protozoan tab no help
I live alone
Dealing with this,myself
Nursed my cat with cancer heart disease 7 months. N she died in December
I cannot believe me n holly going through this
Now vet said it could be immune mediated
Lymph nodes enlarged
Spleen enlarged
But he never ruled out meningitis ur lyme either
Symptoms very similar to.them
Shes,brighter on steroids baytril doxy n gastropeotectant
But she has a fever in the night especialy
And whole abdomen swollen sore
Give oats probiotic prebiotic fish oil yogurt
Mix camomile to relax,n nettle tea for iron in food
Feed chickens turkey steak mince potato peas carott rice chick peas n tahini for iron
Shes enjoying food whereas before steroids too ill
Steroids,will damage heart further
But white cell count has improved
Red cell count n anaemia worse
I feeding more meat for iron
Devestated
She so sore abdomen at night
Damp towel doesnt do much
Thought of rub caster oil on dunno if safe so havent
Anyone experienced dog immune mediated pain abdomen?
What could help?
Vet doesnt know what causing pain!
Could it be the bowels inflamed?
Womb?
Cant get spayed cause heart even if was well enough
She is,so restricted n I cannot stand her having pAin
Shes only 21 months,old n only together short time
But holly is my girl
Love her very dearly
Any help regard helping pain in her abdomen
Or anaemia n red cell count
Would be very apreciated
Does enlarged spleen cause pain?
Anything I can do to help that?
Any alternative health suggestions?
Thank you for listening
I cudnt get a more lovely little dog
Its breaking my heart what shes going through
C n h xx

Oh Christina, I'm so sorry Holly is so unwell.  Has your vet given you a firm diagnosis - has he said she has immune mediated haemolytic anaemia or thrombocytopenia (platelets)? The two condition together is called Evan's syndrome.  I can only deduce that this is what he thinks she has and if she has improved whilst on the steroids then this is probably the correct treatment.  Do you know how much Holly weighs?  The dose for a dog with an immune mediated disease is 1-2mg/kg/12hrs. Do you know the results of the blood tests, eg., how low are her red blood cells and her platelets? Do you have any numbers

Her tummy pain could be pancreatitis.  A dog on steroids should be on a low fat diet to avoid upsetting the pancreas. I'm so please your vet has put her on a gastroprotectant. 

You said she has blood in her stool, has this improved since being on the steroids?  Has her temperature dropped? Does your vet know if the anaemia is regenerative or non regenerative?

To a certain extent, if it is an inflammatory immune mediated disease, such as haemolytic anaemia, meningitis etc.,  the treatment is the same, that is an immunosuppressive dose of steroids.  If you go into the files you will find articles about IM anaemia and thrombocytopenia and also an excellent drug protocol that can be used as a guide. 

Drugs, including flea treatments etc, stress, bacteria, vaccines etc., all have the potential to be a trigger for immune mediated disease but a major trigger factor is hormones, and a season certainly could have started this off.  Unfortunately there is no way of confirming what caused her to have an immune mediated disease but she has had a couple of triggers at least.

I presume you are back at your vets soon.  I do hope things have improved since her last visit.

Jo

It sounds confusing as to what is actually wrong with Holly. Pain in the belly as well as blood in the stool can indicate pancreatitis. Pancreatitis can be caused by steroids. So I wonder if that could be going on? Has your vet tested her for that? If it were pancreatitis it is important to let her GI tract rest, and heal, while keeping her hydrated, usually by IV or injection. Jo or someone will be on soon to help. They have more experience.
Hugs to Holly and You.
gail, and Lola.

Hi Jo and gail
Thank you for your mails
Was at vet yestrday and hollys temperature was good 102 though still inflamed stomach area
But this,time,last week was 105 thouth it does fluctuate
The stomach pain started before she was on steroids from the moment shr collapsed
I still concerned something going on with womb as still false pregnancy but thet cudnt see pyometra n said if mms abxs meds sort it out
Vet hasnt git definitive diagnosis just trial n error with meds as I do not have much financial resources
:-(
Havent given me exact readings of platelets red white counts
Just now,they all.massively dropped from being normal when she first got ill
Hence they said touch n go whether my girl would survive or not
Will look up pancreatitis
Ask vet
Back thurs ask take bloods again see what readings are
Holly 16 kg
They say may drop 37.5 mg steroid once a day to lower dose
Keep on doxycycline as not rule,out lyme co infections
Cover all bases
Didnt rule out meningitis either
But at least shes,eating
A bit brighter in herself thouth this tum pain a real concern
And heart substantially damaged already
Bur shes,a fighter I know,she wants to be here
So we will fight together
I hope her counts are better soon
Its been a horrendous 25 days for both of us
Ten days of that she at vets
Im amazed how stoic dogs can be in the face of pain n illness
I just love her so very much
And she has been playing with her toys,a bit whereas cudnt before
Poor,soul has so many problems to contend with
How these people coyld have sold her on cause ill
It just makes you love them.all the more
X

Hi Christina

There are some positive signs, and that is a good.  I hope by Thursday Holly's blood results will have improved.  If it is meningitis then this dose of steroids is ok, but if Holly's problem is  immune mediated then the dose of steroids shouldn't be lowered for at least 10 days and preferably for 21 days +.

Hoping that Holly continues to be bright and starts to recover.

Jo

Thanks Jo
Yes its lovely to see improvement as it has only been in the last few days that there been any improvement
Before that nothing worked
By Thursday she been on this dose steroid 8 days before that she,on lesser dose n not coping
I think they concerned re heart disease
But yes,i will be concerned they lower so soon as only just begining be bit brighter n still unwell
Shall see what vet thinks
Thank you for your support!
I think its,just great having a little dog ,they are great ti be around
Though heart braking when unwell
C n h x

Hi Christina

Check out the Michael J Day drug protocol in the files.  It can be used as an excellent guide.

Fingers crossed

Jo

Hi there
Hollys white blood count is normal now on the strong steroid dose ,red blood cell count up a little bit but vet says she needs to stay on the 37.5 mg of steroids till Thursday,that will be 15 days on the strong dose then take bloods again.
The problem is holly is still very sore in the abdomen!:-(
Realy red as shaved and can see,really inflamed and very hot.
She had no abdomen pain before she slumped a month ago .
Though did have uterus infection n false pregnancy
And numerous amtibiotics because of uterus and heart problems
Holly is feeling sick on antepsin steroids doxycycline n baytril
She us sitting just now panting away nose watery just not well
Abdomen hurts n heart speeding
Im so down!:-(
Shes not even two yet
Only together since mid march n to go thru all of this
I hate that she so poorly
Thst steroids make heart worse
N worst of all her abdomen the vet cannot find out what is wrong
I give wet food
But at friends she got a lot o dog biscuits
And popping in tum n pain worse
Could her intestines or bowel be damaged now
Since she had the immune collapse?
I mix oats with every meal,yogurt,probiotic,prebiotic,fish oils,aloe vera
Yet the pain n inflamation lasts!:-(

Holly had a bad night last night
Abdomen on fire
Had ti use frozen pack on it
She feels sick and tongue looks all wrinkly n grey n when give meds shr reluctant to open her mouth n a bit reluctant to eat
Though she has not got sickness n diareah
I feel that there is something going on in her abdomen that xray n ultrasound didnt pick up on
We are in limbo
Her being v unwell
Yet not ill enough to go to heaven but seriously afecting the quality of her life
And yet as I said vet cannot find anything in abdomen
Could it just be her immune system has caused the inflamation
?
Its so hard to see her like this
Though she is still eating
Breathing loud again !:-(
Thanks,for listening x

It sounds like an infection. Being on steroids can cause infection. If it were my dog I would get her to a different hospital to have other people look at her.
gail.

I think that too perhaps you need a 2nd opinion.  She sounds v poorly.

Hi
Thanks for replies
Im afraid I dont have the financial resources to go to another vets.
And thAts why I wasnt able to get conclusive tests done also!:-(
I do my best but financially my hands are tied.
Just day at a time
Was bavk at vet today as she was shaking for hours
Vet said side effect of pred
Take day at a time
N she didnt want to eat then she picked up again
Oh boy its,a emotional rollercoaster n that is,so eurolyme
How do folk cope with thatx

Hi Christina

***I'm sorry to read that Holly is not very well. I wonder if the steroids are a bit high and this is inflaming her liver giving her tummy ache?

Jo

Hi Christina,

As Jo said - Holly only weighs 16kg and she probably only needed 16-20mg of pred twice a day initially, it may well be the pred causing the tummy problems.  Is your vet open to discussion with you about this?

Hugs & I hope Holly is feeling better soon

Hi
Back at vet today
Vet wudnt reduce pred yet because of anaemia n red cell count being gwt
She did five phos n lots of mucus yestrday at once
I have been saying to vet that could she have inflamed bowels?
Now I hope today this taken seriously
Vet said the shaking a soes effect of prednidale
But in the night spasms on her back breathing laboured like when she first ill
Hot
Inflamed abdomen
Vet said since white blood cells improved to normal again with pred n red cells up a bit that he sure it must be immune mediated as she would be dead by now otherwise
But if it is immune mediated could it also mean that whatever caused it is stil lurking making her ill
Could cost thousands to get conclusive tests
Desperately frustrating guessing games instead
Are most dogs with immune mediated disease realy ill for a long time?
I cannot bear holly being so poorly ,shes only 21 month old n only been together mid march
Its awful this
Im struggling as one day to next one moment to next dont know if will lose her soon
And putting her through this confuses me
Sometimes feelit unfair
But theres still life in her yet despite ill
But beginning to wonder if she will ever get past this chronic stage
It hurts so much
As shes my little darling!
Sorry sometimes make mistake predictive text
X

Hi again n thanks for listening
X
Holly gets prednidale once a day imorning
Would it be better spaced out twice a day?
Also is it normal for immine mediated dogs get much iller in nightimr and morning?
She realy is very sick then
And thst hasnt changed
Today 15 th day of strong prednidale 37.5 Mr
And doxycycline
And antepsin n cimetidine
N she lying there abdomen inflamed v hot
Breathe laboured
She will pick up in the day likely but nights n morning a nightmare for her n me
She used to be so happy in the mornings
Now she looks at deaths door
I have been crying
:-(
My poor girl

Hi Christina,

Yes, the pred is normally split into two equal doses initially, morning & evening.
AIHA/IMHA is an autoimmune disease.

Has your vet had much experience with autoimmune diseases?  You need one that does & one that is willing to listen to you

Hugs

Hi Angela

Do you have any blood figures? Can you find out what her last red blood cell reading is either HCT or PCV will be fine?

It does sound as if the preds are causing Holly to be so unwell and in my experience it does get worse at night especially if the weather is warm.  Perhaps a damp cloth placed over her would cool her off a bit and make her feel more comfortable.  Are you giving the Antepsin with the preds?  Antepsin should be given two hours after or before medication because it lines the stomach and it will inhibit the absorption of the drugs. Also I do wonder if Holly is a bit dehydrated.  Is she eating well?  She should be wanting to eat and drink a lot, if she is not then it is likely that the preds are beginning to be a problem and the only option is to reduce the dose and perhaps introduce another immunosuppressive drug.  If her HCT/PCV is in the upper 20% then a reduction in preds could prove to be the best action.
Good luck today.
Jo

Thanks Angela and Jo for your replies
Holly at vet Thursday
Blood test revealed white cells normal
But red blood cells still low,still anaemic
Sorry I never got exact figures as vet was adament holly had be on prednidale 37.5mg once a day
As red cells still havent responded with one,week 25 mg
And 15 days 37.5 mg prednidale
Is prednidale same as the other prenisodole?
I asked if I could split the dose 12 hr apart
Vet said ..no
I was concerned asholly  so bad in the night wondered split dose helo
As pred in mornings
Vet said no
Also holly having shaking fits when pred is due amd for several hours,at a time
Seems like back spasms heart bidders it horrible
Shes also changed body shape
Bigger abdomen,smaller lower half torsu like shrunk in
Vet said steroid chAnge shape
And I have been saying for weeks maybe inflamatory bowel
Well wed morn she v ill
Thurs mien very very ill
Many poos ,blood mucus in poo
Vet checked bowel
Yes blood n mucus
I said she in terrible pain with it
Vet say holly not sore when they palpitAte abdomen
,ii said
Shes,in agony in the night
At 4 pm she stil hadnt eaten not even fresh salmon n rice!!!
Unheard of for holly
Vet try give pro kolin
I said doesnt help she need colitis meds
She
Said we cant as they interact with what she on
Cimetidine
I asked take of cimetidine n give flagyl as she needs help
Vet wanted to stop lyme med doxycycline as been two weeks
I said not happy with thEt as if holly got immune mediTed disease because of lyme
Doxy needs taken at least four weeks
Usualy eight though four at least
So holly
On antepsin twice a day
Doxy. N flagyl
Prednidale
Antepsin makes feel sick
So cut to twice a day
Misses cimetidine but vet keeping of even when stop flagyl
She has crawly noise throar at times
Gags feels sick
But has done

Hi Christina

Are you in the UK?

Pednisolone and prednidale is the same - the generic name of the drug is prednisolone.  The whole reason for splitting the dose is to limit the gastric effect and this is usual practice.  The dog still gets the same amount in a 24hr period.  It is said that prednisolone given early in the morning maximises the effect because that is when the body's own cortisone levels are at the highest but that is no good if it causes stomach ulcers that may bleed and cause iron deficiency anaemia (not AIHA).  I have known many dogs to have bleeding stomach ulcers because of taking preds and have become anaemic as a result.

Holly may have a bacteria in her gut such as campylorbacter.  This can often be the case when the immune system is compromised due to steroids.  Perhaps a stool sample should be sent to the lab.

Did they not send off a blood sample to confirm she had Lyme disease? 

It does sounds as if the preds are causing Holly discomfort in her abdomen. 
Cimetidine can be changed to Ranitidine and this can be bought cheaply from a supermarket and also it is much kinder to the liver than Cimetidine. Ranitidine is used far more than Cimetidine these days.

Did your vet tell you the HCT or PCV figures?  Before I comment more I would like to know what the figures are. Aslo can your vet identify immune cells on the blood smear?

The anaemia, stomach problems, steroids dose etc., it doesn't 'fit'  and more information is needed.

Jo

Thanks Jo
I adked vet if there was amother ant acid that didnt interact like cimetidine does with flagyl
But vet just said give antepsin
We are unfortunately working without a lot of test results apart from the blood tests n.scans abdomen n heart
Because I do not have the money for all the expensive tests
So vet had said if give lyme meds will know if helping etc
So it a guessing game as costs astronomical for sending things private testing outwith the practice
She has had stomach pain since she colapsed before the meds
I think possibly immune mediated colitis
Next blood test I will write down.her red blood levels
I wonder if I should split the pred dose even thouth vet say no
Will ask again vet
If ranitidine could be used instead of antepsin
Dont like antepsin not good for holly make feel sick
Shr still blood poo
And do use wet towel at night but temp always goes up
N.ill unable eat n move around in mornings
Its so hard
Im concerned we not geting to root of problem
And have heart problem.also
Incredibly stresful
My hope is that she can get healed from this
But its not lookin very good
Yet I guess white cells normal good
How long does it usualy take to get red blood cells up with pred?
Thank you for listening n.helping
X

Hi Jo
In what way does the steroid dose not fit?
Holly has had inflamation n.fever ever since she collapsed
Pain in abdomen before steroid use
But never before the day she got ill
She had two xrays n.one ultrasound on abdomen
But vet cudnt see what causing the pain
Though spleen enlarged
Lymph nodes enlarged
Vet did needle biopsy on spleen
Lab said could be fungal protozoa infection
But not conclusive
Flagyl helps,with protozoa eg giardia
But she hasnt received any anti fungals as not conclusive
Thanks,again
Realy apreciate this website very much x

Oh yes,and meant to ask
How do I check out the Michael j drug files thanks x

Christina, is this what you mean? It is under "Topic: Auto Immune Haemolytic Anemia (AIHA) - start here." on the site. I have copied a bit for you:


Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h                         10-28 days
0.25mg/kg/q24h                         10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

Have copied it all to save you looking - it may help:



(AIHA) Non-regenerative Autoimmune Haemolytic Anaemia 

A dog can be anaemic from either blood loss (internal bleeding), or destruction of the red blood cells, or a decrease in their production in the bone marrow. 

There are many reasons why anaemia might develop, eg. autoimmune (or immune mediated) destruction of the red blood cells occurring in the circulation of the blood (regenerative AIHA) or within the bone marrow (non-regenerative AIHA), tick borne diseases such as Lyme disease, cancers, parasites, poisoning (zinc, onions etc), a reaction to drug administration, hyperthermia, systemic disease. However, in the absence of an identified, underlying cause, the most common form of haemolytic anaemia is primary non-regenerative AIHA.

The life of a red blood cell is approximately 110-120 days. After this time the old red blood cells naturally leave the body and are replaced by young red blood cells, (reticulocytes).  Reticulocytes are formed in the bone marrow, and when they are ready they migrate to the circulation where they mature and then exit the body when their life span is complete.  It's a circle of life – as the old red blood cells die off new ones replace them.  This is a normal daily occurrence.

If this normal process is prevented from happening, as in the case of a dog with non-regenerative AIHA, where the dog's own immune system is producing antibodies which are destroying these young red cells in the bone marrow, eventually the dog will become anaemic.  This is a chronic form of AHIA.

The destruction of the red cells in the bone marrow starts some weeks before clinical signs appear and initially, the dog will cope quite well, as their body adjusts to the gradual effects of this form of anaemia.  However, eventually there will come a time when the lack of red blood cells in the circulation shows in various, external clinical signs.

Common, initial 'telltale' signs of chronic anaemia:
Your dog may have a craving to eat the earth or compost, or chew on concrete or bricks.  Another indicator could be bright orange coloured faeces and dark coloured urine (this is the blood pigment leaving the body). Your dog may become weak or lethargic, or even collapse for a few minutes through lack of oxygen to the brain, especially when excited. Take a look into your dog's mouth and see if the gums appear pale. If the red blood cell count is extremely low, the tongue and whites of the eyes may have a blue tint to them. Occasionally the dog's gums, skin and possibly whites of the eyes, will look yellow with jaundice. Other signs to consider include loss of appetite, high temperature, inexplicable limping and depression.  Consideration must be given to recent potential trigger factors such as hormone imbalance (recent season/whelping), vaccination, drugs, pesticides, flea treatments etc., also predisposing factors such as breed and age.

The family history of your dog is very relevant to any investigation, and can contribute towards achieving a diagnosis of an autoimmune disease. Dogs with a primary autoimmune disease have a genetic predisposition to one or several autoimmune diseases. Autoimmune disease runs in families so it is possible if one dog in a litter, or a relative, develops autoimmune disease the others may follow. 

Non-regenerative haemolytic anaemia is the most common form of primary AIHA but your vet should not assume this diagnosis. As stated previously, a dog can become anaemic for a variety of reasons and these will need to be investigated.  However, it appears some vets don't consider that AIHA can be a primary disease occurring in the bone marrow and very often a grim, incorrect diagnosis of leukaemia is given.  Blood testing and examination of a blood smear is vitally important to a diagnosis of AIHA. A bone marrow biopsy, though very intrusive, may give a firm diagnosis but sometimes a diagnosis of non-regenerative AIHA is achieved by elimination of other primary or secondary causes of anaemia.

Autoimmune disease is often a 'fight against time'.  If the red blood cells are below 12%, a blood transfusion is likely to be necessary to 'buy time' for the treatment to work.  The dog needs to be sustained through this early period of the disease. It is not necessary to have 'typed' donor blood for the first transfusion but subsequent transfusions need to be compatible therefore the recipients blood should be taken and sent away for blood typing before the first transfusion is given so that the type can be determined should another transfusion be necessary. Obviously, blood transfusions carry risks but they can also save lives. Early diagnosis and treatment may avoid this procedure. 

Once treatment has started, an increase in red blood cells will hopefully be seen in approximately 5 days (the time it takes for the reticulocytes to develop and migrate to the circulation). The level of reticulocytes seen in a normal blood smear is very low. When a dog is recovering from AIHA the levels should be very high and this reflects the level of anaemia.  Correct dosage and duration of treatment is absolutely crucial to a favourable outcome.

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h                         10-28 days
0.25mg/kg/q24h                         10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!


WHAT TO EXPECT ONCE TREATMENT HAS STARTED

If a dog has a serious autoimmune disease, then the sooner treatment commences the better chance the dog has of survival.  The main delay to starting treatment is obtaining a diagnosis or at least your vet being sure that he hasn't missed anything that could be made worse by giving high doses of steroids.  Achieving a diagnosis can be a fight against time. 

If your vet has decided that in all probabilities your dog has an autoimmune disease, then to a certain extent, which autoimmune disease your dog has, as far as treatment is concerned, is irrelevant because with the exception of a few diseases, they are all treated the same, that is, with immunosuppressive drugs.  The main objective is to 'knock out' the immune system and virtually stop it from working (or near enough) so the destruction will cease and give the body a chance to recover.  As previously stated, this treatment regime works in most cases, that is, if it has been given early enough and the dosage is correct.  All dogs are different and some can tolerate the drugs better than others. In proportion to their size, small dogs seem more able to tolerate higher doses of steroids than large ones. Some diseases are more serious than others and carry a poorer prognosis. So the initial crisis is a crucial time, however anecdotal evidence shows that many more dogs survive than die if correct treatment is administered in good time.

It is hoped that a positive response can be seen within 4-6 hours of starting treatment (depending on the disease), but in a serious, life threatening situation, the first 2-7-14 days can be a very worrying time.  Assuming the dog has stabilised he will quickly feel much better, and if he is in hospital may be allowed home within a week.

When he comes home he will probably have a 'goody bag' full of drugs.  He will be on a high dose of steroid, usually prednisolone, and he may also be on another immunosuppressive drug, such as Azathioprine.  Your dog will be weaned off in a controlled manner according to his wellness and clinical observations. 

Note: High doses of steroids must not be stopped abruptly.  Your dog could go into an adrenal crisis if the medication is withdrawn too quickly. 

In addition to immunosuppressive drugs he should have something to protect his stomach from excess acid.  The last thing your dog needs when he is feeling poorly is a bleeding stomach ulcer caused by the drugs.  Sometimes, Antepsin is given to coat and protect the stomach (but this must not be given within two hours of other medication otherwise it will stop the drugs from being absorbed).  Zantac (Ranitidine) may also be prescribed to take away the excess acid. Zantac does not inhibit the absorption of the drugs. Another gastroprotectant used is omeprazol. To minimise irritation to the stomach it is usual for the daily dose of steroid to be split into two doses and given with food, one dose in the morning with breakfast and the other dose with his evening meal. I have known several dogs, who did not receive a gastroprotectant as a part of their treatment regime, who went on to develop anaemia. This is not autoimmune haemolytic anaemia but iron deficiency anaemia caused by bleeding stomach ulcers. Using a gastroprotectant is a good preventative measure. When the steroids have been significantly reduced to a low dose, a gastroprotectant may not be necessary.

Excess acid produced because of the drugs may make a dog prone to developing pancreatitis. A dog with pancreatitis will appear in pain and his back may be arched as if he can't straighten up.  He may be lethargic, seem bloated and have a tender abdomen. Dogs usually go off food and water, may vomit and look depressed.  If you suspect that your dog has pancreatitis, don't try to feed him because it will make the condition worse. Take him to the vet as soon as possible as he may require treatment or need to go on an intravenous drip to stop him dehydrating.  Again, the risk of pancreatitis should be minimal once the dog is on a lower dose of steroids.   A low fat diet is best when your dog is on high dose steroids or prone to pancreatitis. 

As your dog's immune system is being significantly suppressed, he will be more likely to pick up infections, and will not have the ability to fight against them.  As a precaution a broad spectrum antibiotic is often prescribed. Also it is sensible not to exercise him in areas where he is more likely to encounter infections, for example, a park or a popular dog walking area. 

Whilst your dog is on high dose steroids he will want to eat and drink excessively. However, this also means that he will want to urinate more and this can sometimes cause temporary incontinence.  You may have to get up to let him out during the night and if you leave the garden door open during the day, it may save some mopping up!  He cannot help it and won't like it either, so don't be too hard on him, it's only temporary. You will notice as he is weaned off the drugs the unwanted side effects will subside and he should return to normal habits and behaviour.  Urinary tract infections and/or bacterial skin pustules are not uncommon when a dog's immune system is suppressed, and this is often the reason for a dog to be off colour during this time.  Note: Always consider a urine infection if your dog seems under par.  A course of antibiotics will usually sort this out quickly.

Depending on what autoimmune disease your dog has, he will probably need to have regular blood tests.  Biochemical blood tests will also keep an eye on other body functions, such as those of the liver and kidneys, which is important at this stage.

Assuming good progress is being made, the clinical signs of his illness are diminishing and positive signs of improvement are apparent, your vet will want to start weaning him down from the high doses of steroid.  This process can take 3-6 months or more, and usually begins anytime after 10 - 28 days from the start of treatment, depending on the results of his blood tests and his clinical signs.
Relapses are not uncommon, especially in diseases that are difficult to control, for example SLE.  A relapse may mean that initially, your dog needed to be on a higher dose of immunosuppressive drugs for a longer period of time, or your dog may have been weaned off a little too quickly and then the dose withdrawn too soon.

If a relapse occurs he will probably show similar clinical signs to his initial crisis.  He will have to go back on an immunosuppressive dose of prednisolone, but it may not have to be quite as high as before. A combination drug may need to be added at this stage. The weaning process will then have to start all over again. Returning to an immunosuppressive dose will mean that he has to go back on a gastroprotectant.

Thank youbonniemist
Very helpful!:-)x

Hi everybody
Holly has got a bit brighter in herself since I changed pred to two doses a day
Vet didnt agree with this
But I listened,to folk on here and it does,help x
As well as the flagyl helping her intestinal pain
Still sore n fragile but brighter
Apart from got a scratch from a cat yestrday n it quite a big wound
Top layer skin away
Round circle n wound underneath
Keeping eye on it
Its deep
Gave baytril antibiotic as well as her flagyl n doxycycline n pred
Concerned it dangerous,as immune system low with pred
So keep eye on
If not feel much beter tmoro will have take vet
Must be cat claw got her
Any recommendation help heal wounds?
Thanks
Apart from that good that her energy up!:-)x

Hi Christina,
I don't post very much but have been reading your posts about your Holly. If you can get Manuka honey to put on the wound it may take care of any infection. It is a great product, good for so many things.

Best wishes for Holly and you. I'm glad you listened to Jo and Penel and split her dose of pred.
gail

Hi Christina

Wound healing is difficult when a dog is on immunosuppressive doses of steroids but you are giving antibiotics, and as Gail says you could try Manuka honey.  Glad she is a little brighter.

jo

Thank you gail and Jo x
Yes im realy glad Jo and penel told me about splitting pred
As I say my vet said ...no
But I went ahead n she hasnt been shaking for hours since I did that
Thank you for this website and all the work that is put in to help little dogs like holly
You know I love her so very dearly!!!
Will get some manuka honey gail
She had it before internaly to help heart
But going vet today because we havr ben through so much that I dont want her to get infected
Vet didnt take bloods
Just leaving on 37.5 my pred a day
For amother while
But I give homeopathy to try offset side effects
Oh tis never ending being Florence woofingale for all us caring for our sick dogs!x

Hi
Went to vet n she cleaned the wound out n gave me...
Manuka honey gel to speed healing!:-)X

 :) excellent!!!

Hi
Wel im very happy to say to everyone that holly is doing well!;-)
Shes not 100% but is brighter n enjoying herself more!
Im very delighted to still have her in my life as shes just such a wonderful girl!:-)
The flagyl has been.helping the colitis thouth I am.concerned the vet is stopping it soon after three weeks
concerned as she still has mucus in her poo
And worried re it deteriating again,but on a diet for sensitive tum,n probiotic so will see how she goes
Holly still on doxycycline antibiotic incase it was lyme disease
On antepsin anti sickness med twice a day
And unfortunately still on high dose pred 37.5 mg split into two doses twice a day
We were hoping ro reduce pred n I see that should realy be on high for 28 days max
She was on 30 mg for ten days
And has been on 37.5mg since the 19 th July
Vet said cannot reduce pred yet as red blood cells 5.2
They should be 5.5
But have gone up from 4.3 so improving
So I have keep on high dose another two weeks n then get tested
Bit concerned with her being on steroids so high so long!
What does everyone think?
Platelets normal
White blood cells normal
Moving right direction but just want do right thing for my girl!
Thanks for listening
C n h x

So good to hear that Holly is improving. I wish I had the answer about the high dose of pred. Jo or Penel will let you know on that. I would be concerned about the length of time she has been on it too.  Have you tried slippery elm for her GI tract troubles? It is very good for firming up poop and ridding it of mucus. Of course you would want to check with your vet on that I suppose, and start slowly. But I have not had trouble using it for my dog at all. She also has a very sensitive GI.

Thanks gail for being pleased to here about my girl
Iasked vet about slippery elm and physillium husk shed never heard of any of them!!
She told me not to give holly anything else as could interfere with absorbtion of meds
I read internet that this could happen so im wary of doing so
But I also believe she could have immine mediated inflamatory bowel as she in pain the moment she collapsed so concerned stoping meds as she was in bad pain until she went on them
And I find that intolerable
Do use probiotic
Organic yogurt
Mix camomile tea and oatbran in her dinner couple times a day to ease digestion,relax her,cleanse liver as on steroid n antibiotic
Thanks ,glad s elm helps your dog x

It's hard to make changes when you have a dog getting well, who was at deaths door before. Your Holly sounds so much better. That is what is important. I hope the trend continues for her and she can be a happy healthy dog. You are doing so well taking care of her. I know what it is like to be so connected to a sick dog. Every little improvement is so important! It's almost like it is you, yourself getting better  :) At least that is how I feel, when Lola feels better for a while.

Best wishes for continued improvement for Holly!

gail.

Thanks gail
Yes I couldnot be happy at all if she isnt
Love so v much
Lola nice name,how is she doing?
Best wishes
C n h x

Hi Christina,
Can you get the last red blood count results from your vet; it will be listed as hct - haematocrit or pcv - packed cell volumn.  If Holly has been on pred since the beginning of July she really needs a reduction & it is not always necessary for a dog to be completely within range before reducing the meds; just on the way.

Hugs

Thanks Angela
Vet said red blood cells should be 5.5
But are 5.2
But cant reduce till 5.5
Does this mean anything?
Up from 4.3
Which is good
But vet wont reduce until 5.5
Platelets ,white blood cells normal
X

Hi Christina,

The normal ranges for RBC (red blood cell count) are 5.5 - 8.5 here & most likely where you are based on your vets comment.  As she is just under the normal range you may find that reducing the pred may actually help Holly & her results; she has been on a high dose for to long I feel.

Reference range from: http://www.bichonfriseusa.com/caninebloodwork.htm
There should be a group file with explanations somewhere to

Hugs from Oz

Thanks angela!:-)
Yes I agree however I do not know how much to reduce it by!
And will be doing it and not letting vet know if vet doesnt reduce soon but by how much I wonder what is a safe reduction.
Shes been high 37.5 mg since 19 th July
Shes 16 kg
X

I already had to reduce to two doses a day without vet consent as vet didnt agree two doses
My lord if id left her with one dose shed stil be shaking for hours every day!!!
Vet good in other ways but maybe not much experiences im this,dont know x

Hi there.
Have just reduced hollys dose a tiny bit from 37.5 mg to 33.5 mg
Was thinking 4 mg and leave it a week blood test next Thursday see what vet thinks then.
Fingers crossed her anaemia at 5.2 is up to 5.5 and vet will work with me to reduce pred.
As not happy her being high so long.
Hardly reduced as erring on side of caution but its a start in right direction.x

Hi there again
Looking at mj protocal and think 4 mg not enough to reduce
Also as Jo n penel said before unsure why holly at 16 kg on 37.5 mg a day
When.mj protocal say 32mg
So thinking of reducing to 31mg starting tmoro
Reductions of 6.5 mg and see how her bloods are on 6 days time
Because yes the vet would continue keep high cos anaemia but at what cost?
Does this sound like a reasonable plan?
She does seem.very sleepy today
How do they react when meds reduced?
Another problem.im a bit concerned with is,that I was planning on taking her off flagyl bowel meds tmoro and wonder if to much alongside cutting pred
Vet wanted to cut bowel med a week ago but I feel she needs it
So stopping it6 days before go back vet to see how she goes
Maybe I should only cut pred by 4 my after all when takin of bowel meds,this week
Unsure x

Hi christine

The steroids would normally be reduced at a minimum rate of 25% and each reduction 10-21 days apart.  Holly has been on a high dose for long enough and the M. J Day protocol is an excellent guide. Reducing the dose at the right time is a very important aspect of successful immunosuppressive treatment.

It is so difficult for the owner when the vet won't lower the drug at the right time.  It is very common though.

Jo

Thanks Jo
Yes im starting to lower it now and will continue re mj protocal
I probably should have started it after 28 days but vets insistance put me off im afraid
But now I realise enough is enough
Slowly gently and surely holly has to be weaned to lower doses even.if still anaemic
That was whst comcerned me the anaemia
But hope it continue to improve
I think I will reduce to 31.5 mg
Today
From 37.5mg
And she gets taken of flagyl bowel meds too
See how she manages
It is a worry as shes,fragile
Fingers crossed
Holly n Christina
X

Hi there
How do folk cope with having different opinion to vet?
Im not sure how to deal with it
Regards giving holly 2 doses a day vet doesnt need to know
But im a bit stuck on whether to tell vet I reduced dose against their wishes
I was wondering if should wait to after blood test results on Thursday
What if red blood cell count goes all of a sudden down?
Because I dropped the dose?
As she is,still anaemic
Id have to tell vet then what im doing
But not sure if want to aproach the subject before I know result blood test
I feel the vet be so annoyed at me going against wishes
And need to have a good rappore
Its a dificult one
X

Christina, what was Holly's HCT (PCV) last time?

Can you not bring the next blood test forward - say this coming Monday and hold off reducing until you get the results then? Then if you think the medication should be reduced (sorry Christina I can not remember all Holly's details), and the vet does not want to reduce, then say you really feel the meds. need to be reduced. Say you feel it will help and do it BUT then have another blood test 4 days later say just to make sure it has not been detrimental.

It is best to get on with your vet or to find one that will listen to you. If your vet disagrees with you then ask them why they are suggesting this or that. It might make sense or it may be that they are just going by the textbook (which is not necessarily always right!). BUT if you really feel Holly is deteriorating at any time because of the medication (or illness) then do not worry about upsetting your vet(!), it is Holly's life that counts not what the vet thinks of you. It is very difficult to explain in an e-mail, Christina. I do not want it to sound as though we should all ignore our vets, but, as, unfortunately has been shown with other dogs, vets do not always know best......... :o(

Hi bonniemist
Yes you are right the right thing for holly is always what is foremost,even if it annoys the vet!!
Welk holly on high dose steroid since 10th July!
Vet no reduce as she still anaemic red blood cell count 5.2 instead of 5.5
I decided to.keep going reduced it from 37.5 to 31.5 yestrday
And will see with blood test thurs how she is
Because I reduce yestrday I decided just to keep it there
I agree maybe shud of waited to see next test results but its been to long her tummy expanded n thin lower half ,nose watery ,breath heavy at times panting side effects steroid
I know if I have to tell vet I did it they be pissed of at me
I do like them n trust them
And want to stay with this vet
Just not sure they got much experiences in this
Already cimda helped holly a lot by splitting dose in two
So I. Trusting of what Jo n penel n everyone else here says ,based on sound experiences
So I take day at time see how holly coped
U know shes such a lovely natured girl
Shes not even 2 yet but has gone thru so much!
She has matured so quickly n seems to have developed such a depth of character beyond her years
Weve only been together since march
Feel very close
Just the two of us
I would be pretty lost without her u know
Shes my girl!:-)
And shes a fighter! X

Oh christina

It is very difficult when you have a vet who is not treating your dog correctly but from what I have read your vet is yet another one who doesn't have a clue!  Can't you go to another vet in the practice?  It is not right for Holly to be on this high dose since 10th July.  Her symptoms are predictible and I suspect that her red cells won't increase whilst she hs still on this high dose.

It is terrible that owners have to be put in this situation but sadly it is not uncommon.

Jo

Thanks Jo
I am.going to see another vet in this practice thurs as mine on holiday
Always good get another opinion
But im.going to follow mj protocal if hollys system coped
Take it every 28 days a reduction as dont want to rush it but I will reduce it
!x

Hi Christina

Sometimes seeing a different vet is the best thing that can happen.

Good luck

jo

Thanks Jo!x
Bit stunned!!
This vet didnt want a blood test didnt take a blood test n.just said we would normaly reduce steroid by a half!!!!!
What?
But instead of droping it from one n a half tablets he drop it to one tablet a day
Said leave for month
Then blood test!!
Well my god to go from no drop to a third of a drop just like that?
So I droped it from satrday to one n a quarter
She woll stay on that two weeks
Then drop to one for two n a half weeks
Then if she coping hed drop to half a tablet
Well based on mj protocal that isnt hapening
I will drop to 3/4 tab two weeks
Then half a tablet
If they suggest half then nothing
Then I will ask to lower slower re mj protocal
Anyway he wanted to stop gastropeotectant!!!?
I said no
As long as she on steroid I want her on gastroprotectant!!!
He stoped her antibiotic today and thAts enough to see how she coped
To stop amtibiotic gastroprotectant nreduce by a third wud have been.too much I think for her fragile system!!
And then if she got realy ill how wud we know what she needed!
Hmm!
Do vets n.doctors not realise how sensitive our systems are?
I get so surprised
Thank you x
If this site wasnt here I wudnt have known any different
Fingers crossed my wee girl copes with the changes!!
Trying to make it as subtle as possible
Weird vet does,nothing re change then want to change everything!!
He said she shud be fine on no gastroprotectant on lesser steroid dose
But still on high dose!
Hmmm :-(
X
Thank god I have 14 extra tablets to tide me over

I am stunned too in that the vet did not blood test Holly and suggested waiting a month!

With our AIHA Bearded Collie we NEVER reduced her medication until after getting her blood test results. One can not judge what is happening with a dog's blood cells, etc. just by looking at it, blood tests are needed as well especially when anaemia is involved because it is better to treat it sooner rather than later if the values start to drop again. Of course if the dog is having serious problems because of the high dosage then obviously reducing before a blood test is acceptable but then a blood test should be done as soon as possible afterwards.

When was she last blood tested and what was her HCT (PCV) then?

Holly still needs to have a gastroprotectant whilst on a high dose of steroids - you certainly do not want to risk her getting more problems without one.

I know how difficult it is to go against what a vet suggests but I really feel you need to find another vet OR stay with this one but say you want regular blood tests whilst the medication is being reduced. I personally can not see why a vet would refuse to do a blood test and I feel to wait a month until a blood test, in these circumstances, could be detrimental for Holly.

Hi Christina

I agree with Bonniemist.  The M J Day drug protocol is the one that I feel works the best out of all of them, and is a good guide but the dose and duration must be tailored to the individual and this means there is always room to be flexible within a protocol.  There are protocols that reduce by 50% so your vet is not wrong but anecdotal evidence shows a slower reduction leads to a better outcome but if a dog is suffering, and is in a life threatening situation, as a result of prolonged high doses of preds then the reduction might have to be 50% or more as in a case I know where a dog had AIHA but she also had a concurrent pyometra (a life threatening infection of the uterus) the infection had to take priority and the steroids were reduced from 50mg a day to 10mg and had the specialist not have reduced so dractically then the infection would have killed her. As long as the reduced dose is not less than 0.2mg/kg/24hrs adrenal function will be supported. This is not a normal case but it goes to show how the treatment has to fit the dog and the disease/s present.

When treating a 'classic' case of AI disease, when a dog is being weaned down the reduction should be steady to avoid a relapse of the disease and the whole situation must be asessed at every stage and that includes any side effects of the steroids.

Good luck

Jo

Thanks bonniemist n Jo,
At moment holly seems to be coping with the small reduction ,i will take it day at time,following m j. Protocal while I have extra tablets to do so
When.tabs run out will have speak vet about how I feel the protocal the way I want to go
Day at a time
Fingers crossed she copes!
If I see any change back to vet ,blood test,assess what is going on.
X

Hi Christina

Don't let the tablets run out as you must continue to give some steroid as I explained previously.
Glad she is coping ok.

Jo

Hi Jo
I meant when the extra tablets I have saved up run out
I will then have to explain to vet how im dozing holly
Until then I have some extra on top of what vet prescribes so can slowly reduce in line wi protocal
Early days as just reduced for a week now
I will do everything in my power to keep holly well
She realy is a great girl n not even 2 yet
She learnt to swim this week in the sea
It made me happy to see her enjoy herself
Espec after the hell shes been through
Fingers crossed
X

Hi everybody
Thanks for all your support!xx
So glad to say that holly doing well
And have managed to reduce pred from 37.5 mg
To 18 mg.
Slowly in line with mj day protocal
Spoke to vet re protocal today
And she happy to reduce every 2 weeks just now see how holly copes.
She does get a bit shaky and wet nosed at first then it passes
I said im not happy stoping antepsin anti sickness medicine whilst she on steroids
But vet said she will give now but when dose lowered she wont give me anti sickness medicine
But I do not want holly on steroids without anti sickness medicines
If vet stops antepsin
Can I give her zantac?
Alongside steroid?
How much for a 15 and a half kg dog?
Would that be ok as I dont need prescription for it
She has ulcerative colitis already
And semsitive stomach
So have be gentle re tum
Vet wasnt going to take blood test
But I said we dont know if shes still anaemic id realy like to know
So we got blood test
One other thing her paws very very sensitive crack n get cut. Between pads
Well holly licks them and she needed antibiotics couple of weeks ago because they sore
Vet said vaseline good
Any other suggestions to help would be great!
So happy to have my girl
Together 6 months,now ,at one point didnt think id have her at all
So full of personality
She,squeaks and talks a lot very expressive,
Got her a donkey toy and four plastic balls yestrday
The excitement was high running from room to room interchanging toys
Two balls in mouth
Or one donkey whilst flicking ball about tail wagging away
Or sitting chewing ball squeaking contentedly
What a lassie!!
Lovely to watch when she like that
Brings a huge smile to my face!
C hh x woof

Nice to read your good news Christina. Holly does sound so much more stable than in the past. I gave Lola Pepcid with her steroids, to help reduce the stomach acid. I think Zantac may be a similar product. Not sure. You could ask a pharmacist.

Not sure about the cracking of the paws. Vaseline maybe could help but does she lick it off. Hard place to moisturize since they do lick so much. Maybe more fish oil in the diet would help. You could try virgin coconut oil and rub it in good, but my guess is she would then want to lick her paws even more which might work against healing.

I loved hearing about Holly and her new toys. She sounds good!
gail

She sounds so cute.  I have two cockers so I know just what they are like!
Zantac is ok with steroids - I'd give it half an hour before the pills.  Half a Zantac 75 twice a day would be ok I think  - will get Jo to check on this too?
Zantac is different to Antepsin in that it just reduces the acid, whereas Antepsin also lines the stomach.  I don't understand why your vet won't give you more Antepsin.
At least you are ok following the MJD protocol now though which is great.
Have you tried giving Slippery Elm powder, that is really good for sensitive tummies, my Lola has it every day and has done for years.  I get the one from Dorwest Herbs it's called Tree Barks powder, are you  in the UK?

Hi Christina

That is a very encouraging post.  I'm so pleased  Holly is happier now and well done for getting her steroids reduced.  Zantac is a trade name for Ranitidine.  Ranitidine can be bought much cheaper than Zantac from you local supermarked.  It is usually described as indigestion tablets.  If you read the back of the box it will say Ranitidine 75mg.  The dose for Ranitidine (or Zantac) is  2mg/kg/three times a day (Canine Medicine and Therapeutics by Neil Gorman).  It has a very wide safety margin and as Penel suggested one half of a tablet twice a day would be fine for a cocker.

The only think that worries me about putting vaseline on her paws is the dirt sticks to it and it may cause secondary infection.  How about using aloe vera gel?

Good news

Jo

Hi gail,penel and Jo,
Thank you very much for your swift replies!:-)
Yes,not sure why vet wont keep on antepsin for whole time on steroids but she said they often stop it when dose reduced,will try persuade to keep on as long as possible!
At least now I know I can put her on zantac or ranitidine,thanks!:-)
Holly is a English springer spaniel,very similar to cockers,mad as a brush!!
Very amusing and demanding and the cheeky facial expressions!!!
Penel,my dear departed cat was on tree barks powder for years,i take slippery elm too,good stuff.
Was concerned it would stop steroid being absorbed,is it ok alongside steroid?
Gail,she gets fish twice a week and I have ordered supplement with fish oil and evening primrose,for heart,skin,hormones.
Im concerned as she due to be in season soon
I cant spay her because of substantial mitral valve heart disease
Read that evening primrose helps doggie hormones
And that homeopathic sepia and pulsatila help too
So she is going to have them all,as her last season uterine infection,false pregnancy,then 2 months later immune mediated illness
Read classical music calms them in heat
So ,no rock music for me during hollys season
Try keep her as relaxed as I can
!!
Oh I think coconut oil be too yummy gail,but maybe unscented!
Aloe vera another good option Jo
Her energy isvery good!
Breathing still very loud when resting,not sure if heart or steroids
And she does gulp a lot at times as if her throat bothering her a bit
Anyone else experience that with their dog?
But she is enjoying life
:-)
X

Hi christina

Holly's season will be delayed because of the steroids, and you won't know when it will arrive.  Usually the steroids have to be at least reduced to a low every other day dose before a season shows.  So don't worry about that at the moment.  She does sound so much better, and there is better to come too!

Jo

Thanks Jo
Yes I thought the steroids may afect the season.
One day there was blood in her urine,i thought it was the start of season,but shes not bled since,it was just a little so not sure what it was.but she was fine the next day.
Holly still on 12.5 mg reduced into two doses.
Seeing vet this week,will ask to reduce 6mg once a day for a month.
See if she tolerates that.
Then it would be 6 mg every other day for a month
Then 6mg every third day for a month
But first is first shall see how she manages
We had blood and mucus on poo a little this week
And tum hot rumbling
She gets probiotic,yogurt,oatbran mixed food to help digestion
Homeopathy for gastritis
Wondered if hormones making it worse,but they shouldnt be too bad,if steroid delays season
Or less steroid afecting gut
And the gulping of the throat feeling sick at times
Penel would slippery elm be ok alongside steroid?
I emailed dorwest herbs ,got no reply

So glad it getting colder then she wont be at risk of fleas!!
Always a concern as cant flea treatment
Cant use wormer either!
Im so happy to have her,
She looks after me too
I fell asleep sofa lastnight and she brushed past me until I woke to go to bed
Shes a,good wee girl!:-)
And still sooo excitable:-)
X

Oh she still on antepsin gastroprotectant too
But think vet may take her off it
If she does,will put on the zantac
X

Hi christina

I was wondering how Holly was doing.  I'm glad she is doing well. When you go to the vet perhaps you could have a urine sample checked because she may have a urine infection.  This is common when a dog is on steroids. I'm glad you are thinking of lowering the preds again.

Good luck with the vet.

Jo

Thanks,Jo
She needed her anal glands emptied
Vet thought that why blood in urine
Bit upset today as her red blood cells have dropped from 5.4
To 5.2
Her platelets and white blood cells are normal thank god
But vet didnt expect the red blood cells to drop
She is on 6 mg of pred a day
And her gums,looked very pale
So vet said we cant lower the pred anymore at the moment
And to keep her on 6 mg which was a great improvement from the 37.5 mg we started with
And vet want see her in 10 days
If red blood cells lower again will have to up steroids
But I will be very upset as she has serious heart disease
And pred wont help
And now,her skin is,thinning on long time steroids so she getting cuts at the drop of a hat
And her hair not growing back where she shaved in summer when ill
Fingers,crossed wont have to up steroids:-(
Thanks for listening
Has anyone else experienced their dogs red cells going down with reduction steroids?
C n h x
Woof
Supposed to keep her calm but shes 2 and a springer spaniel!!

Ps,already got holly on fish oil,evening primrose,vit e for her heart ,hormones and this should help her thinning skin also
Love her so much dont want her to get ill again:-(

Hi Christine

Do you know Holly's HCT or PCV?  How long has she been on 6mg pred a day?

Jo

Hi Jo up till now had been reducing pred every two weeks
She has been on pred 6 mg three weeks now by next week be a month
And vet said if red blood cell count lower than 5.2 need go back high dose pred
Very concerned
Her white cells are normal range and have went up,dont have figures
Platelets went up to 8.5
Its just red cells that went down from 5.4 to 5.,2
They never did that before on.pred
Were always generaly increasing as when she was very ill red blood cells were 3.9
I have worked hard to look after holly and reduce meds as her heart disease substantial
Her gums very pale :-(
Shes still hyper but does tire also
Very wary of going up again to highest dose if it continues reducing
Christina n holly x

Hi all
Hollys gums very pale and then this evening and during tonight,its 3 am justnow poor holly having bad diareah ,mucus lot of it and some blood poo
Colitis realy bad
Upseting me a lot as she was like this when she got ill at first
She gulping throat a bit too
Oh god,hope shes gonna be ok
Giving probiotics and homeopathy for gastritis and diareah
We keep having to go outside for her poo
Shes very vocal so lets me know
Things,like..a,few days ago my neighbours bird feeder burst and we share a back court and holly ate some of the peanuts
I wonder if allergic reaction to that
But I just dont know
Its stressful:-(
Chtistina n holly x
Thanks for listening I apreciAte it espec as I look after holly myself can feel alone in it

Hi Christina,
how is Holly today, last night sounds like it was pretty bad?

Hi penel
Thanks,
Holly has had a sore abdomen since Saturday and it seems a bit sore taking her tablets and sometimes clicking noise throat like its uncomfortable.
Though vet put her on flagyl yesterday for colitis and I think its helping her stomach pain!!
And shes managing to relax a bit more
Its a worry
Back next week for blood tests see how red blood cells doing
Oh the weekend was horrible
But at least the flagyl helps the discomfort:-)
Christina n holly x

Hi Christina
I do hope Holly is feeling much better today.  Please take  her back to the vet if you suspect that her red blood cells are dropping and don't wait until next week.

Fingers crossed.

Jo

Hi Jo
Thanks,yes shes been back had a blood test twice since then
Red blood cells down to 5.1
Hpt levels lower side of normal
So vet said keep her on 7.5 mg pred a day
Up from 6 mg
And antepsin
Though want take off antepsin in new year:-(
Dont realy want that,but vet wants
Test bloods again in Jan
And see how she is
Shes better than was after flagyl
I dont think it was just colitis
I think it.pArt of her immune dysfunction
Sad cant reduce steroid but glad not having to put it up to immuno-supressant dosage
Hope she stabilizes!
Thanks x

I hope she stabilises too Christina.  Fingers crossed.  I'm glad you are taking her for regular tests.

Best wishes

jo

Is there anyway i can talk to you jo or penel on the phone?x

Hi Christina

Can you please email me at:

cimda@aslog.co.uk

Jo