CIMDA

Do you mean the total was only 20mg a day? If he weighs about 18kg he should have been started on an immunosuppressive dose of 36mg total a day and then reduced gradually. Here is a good medication protocol:

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 based on a dog receiving an induction dose of 1.0mg/kg/q12hrs (every 12 hours).

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!

I so sympathize with you! I and many owners have had to struggle with vets etc. who, in a lot of cases, have not had much experience of certain autoimmune diseases, but who insist that their way is correct. Even nowadays, and despite Jo Tucker and her CIMDA campaigning to get autoimmune in dogs more known about, some vets still have no idea how to do things. Especially with regard to the medication.

If I had listened to my vet, some years ago, my dog with Autoimmune Haemolytic Anaemia would have died. Instead I listened to the advice of Jo and others, went by my own gut feeling and how my dog was and how the blood test results were. I then had to make myself very unpopular with various vets! I would never have dreamed of going against my vet but when her HCT kept dropping I knew I had to do something.

What worries me is that your vet is saying his case is unique, so does that mean they have not had many cases like him?

How is Tucker – does he seem to be coping well on the medication? As I said before I would be wanting to have blood tests more often for him.

I and other members on this Forum can only advise and say about our own experiences. We can not tell you what to do at the end of the day. That has to be your decision and I know it is not easy, believe me. I am lucky that, nowadays I have a vet that will listen to me and we sort out any of my dogs’ problems together. Sometimes we disagree on treatment and we will go with his ideas and sometimes he will go with mine.

I wonder if your vet could come to a compromise. Perhaps you should ask if there is any reason for reducing that quickly and also by that amount. If Tucker is coping well then perhaps he could stay on the 30mg a day,  a week longer. Then perhaps he could, all being well reduce to 25mg. If your vet is tailoring the medication to Tucker then why not err on the side of caution?

So…perhaps approach your vet again with your concerns and some ideas and ask if there is a good reason for reducing so quickly. Obviously, you have to be diplomatic (although firm).

Results can vary from lab to lab, machine to machine, that is why it is best to keep to the same one if possible. Just another of those worrying things at a stressful time. Hopefully Tucker's results will be good on Monday to help you feel a bit less stressed.

I am a bit confused as the blood test result printout shows HCT as 21.8 but you mentioned 26 for the last result. Or are these with two different vets? Would it be possible for Tucker to have another blood test sooner - tomorrow or Saturday perhaps? It seems a long time until Monday and it may help to ease your mind if you know his HCT is still rising.

So about 17kg. Which would be 34mg of Prednisolone DAILY. I am not sure whether the 30mg could be too low. Perhaps you can have a word with your vet. If you look at those links I gave you there is a medication protocol but I have copied it below:

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 based on a dog receiving an induction dose of 1.0mg/kg/q12hrs (every 12 hours)

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!

I can not help, Karen. Try the search facility on the Forum, I am sure there were a few posts about it some time ago. I am sure Jo will be along later and she will be able to advise you.

Are they sure it is Aspergillosis? I think there are other things (some severe, some minor) that can cause the same symptoms although I suppose they have a test for it?

Did the vets rule out a pyometra? Has she been tested for parasites, Campylobacter? Could it be severe IBS?

Has Pippa been sneezing? If not may a sneeze help to clear her nostril, or would it make it worse? I would keep her out of the long grass at the moment.