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 1 
 on: Yesterday at 09:12:32 AM 
Started by Bbell - Last post by Bbell
Hi Jo,

thank you for your reply. Its such a long story I didn't know where to start!

She was diagnosed with IMHA in 2016, and that was a battle in itself but after a year or so her red cells were behaving, then a relapse in 2017 but this time it was IMT and has been since. It is currently only the platelets that are an issue.

She is a 6yr old Lurcher, currently 22 / 23kg and our latest protocol (since December) from the RVC in Hatfield was 40mg Pred, 40mg Leflunomide and 1 tablet of Denamarin. and after bloods to check every 2 weeks, we have been reducing , we got down to 20mg per day, bloods were checked, then the next part of the protocol was and currently is 30mg every other day. So it was an increase but not every day as before. I was uneasy from all the information I have read but we have previously tried weanings and failed so I thought maybe this would work, and i wasn't making it up, it was the RVC's protocol.

Can you put them on 3 immunosupressives? and does that mean you can lower the dose of each to balance it?

She has had Vincristine before, I believe you cant have it more than once? she also had the IVIG once or twice before. (that may be the other way round! it will be correct in my notes)

They did initially look into a cause but came back idiopathc.

 ---I apologise if I'm rambling with no order ---

She had been on Cyclosporin since the beginning of even the IMHA, but the new vet we saw at the RVC at Xmas swapped this out for the leflunomide. This is where her platelets went from 21 to 354 !! I thought that was amazing / hard to actually believe, but since then its gone down ... 139, 112, and last friday 80.

One of my local vet seems to always choose the 'increase pred and wait two weeks' option but that doesnt solve anything - I am due to see my vet again this morning as she has been vomitting since the change in protocol, I am preparing to be quite brutal in terms of her long term prognosis because this is no fun for her.

I dont believe we can carry on yoyo-ing, increasing the pred as soon as we dont like the numbers. she is clearly a refractory case and Spleenectomy has been mentioned but not seriously concidered by the vet or specialist so far.

I have noticed that it has been every february that she has a downturn - hardly a medical conclusion though! 

I really appreciate your taking the time to reply x


 2 
 on: February 18, 2018, 04:58:35 PM 
Started by Bbell - Last post by Jo CIMDA
Hi and welcome

I am sorry Bluebell is having this problem.  Is it only the platelets that are low or does she have IHMA as well? 

I don't know what dose of prednisolone she is on or how much she weigh etc.,  and the drug regimen she has been on so it is difficult to comment.  If the leflunomide isn't working then the vet could introduce azathioprine or mycophenolate to give more immunosuppression.

If her platelets get very low again they may consider using a drug called Vincristine to boost platelet production or a transfusion of human IVIG. 

http://www.cliniciansbrief.com/sites/default/files/attachments/CoC_Canine%20Primary%20%28Idiopathic%29%20Immune-Mediate%20Thrombocytopenia.pdf

 The bottom line is they have to find out the cause of the IMTP.  It is primary or secondary to other disease.

http://veterinarymedicine.dvm360.com/overcoming-diagnostic-and-therapeutic-challenges-canine-immune-mediated-thrombocytopenia

Perhaps you can cast your mind back to the circumstances that caused a huge rise in platelets (changing drug) and why they then started to fall.

Jo



 3 
 on: February 18, 2018, 04:43:15 PM 
Started by kaitythorpe - Last post by Jo CIMDA
I hope it all goes well for Bozo.

Jo

 4 
 on: February 18, 2018, 03:31:01 PM 
Started by kaitythorpe - Last post by kaitythorpe
Thankyou for the replies, I forwarded them onto Fiona and she has provided this response.

"Thank you so much, he was on 40mg (20mg tablets) twice aday at first then decreased two weeks after to 1 and a half 20mg tablets twice a day for three weeks, now down to one 20mg tablet twice a day, he has spoken with a specialist a couple of times and said what he is on now is gold star treatment, I guess I'm in two minds about it all,his results were doing so well then the decrease in Pred he seems to be going downhill by his numbers, but to me and anyone who knows him has seen such a change (for the better) in him every week, his more brighter everyday, eating so well, his only concern for me is his gum colour isn't as pink,its pale."

 5 
 on: February 18, 2018, 01:33:26 PM 
Started by Bbell - Last post by Bbell
Hi Everyone,

My girl Bluebell was diagnosed late 2015 \ 2016 with IMHA, after a battle we got that under control. Approximately a year later we had weaned off all meds, but this only lasted 1 week. Early 2017 she relapsed / developed IMT. This is where we have been since. Yoyo-ing numbers and no successful weaning protocol. Last wobble was at Xmas, a change in cocktail of drugs (swapped out Atopica for Leflunomide) saw a huge rise in platelet numbers but since then a constant gradual decrease. We are currently at 80.

She isn't crashing (partly because the vet and I are catching any anomalies in behaviour / readings early) but isnt getting better either. They seem reluctant to take her spleen out but I wonder if this might have to be our next step?

She is definately not adhering to normal protocol and so 2 years on we're still on Prednisone, with all its horrid side effects.

Any advice or thoughts greatfully recieved xx



 6 
 on: February 17, 2018, 11:12:12 PM 
Started by kaitythorpe - Last post by Jo CIMDA
Hi

 I am very sorry if this lady has emailed me and not got a reply.  I can only assume I haven't received it.

 Catherine has given some good information about the drug regimen, and she is right when she says that the dose of preds wasn't high enough, and it is still not an immunosuppressive dose if Bozo weighs 24kg. 

Imuran (azathioprine) is a very good 'combination' drug but it takes at least 10 days before it starts to take effect and it doesn't reach it's full potential for at least 6 weeks, so this cannot be relied on, at this time, to give any added immunosuppression.  As Bozo is doing well in himself and is therefore coping well with the preds, I feel Fiona should talk to her vet about increasing the preds to 50mg a day (dose split into two 25mg doses).  The dose and duration of drugs is vitally important  if the disease is to be controlled.   Alternatively, get a referral to a vet college or a specialist referral centre, or if the vet is not confident about the dose of medication then ask if he or she will telephone a vet college for further advice. 

Jo

 7 
 on: February 17, 2018, 11:00:18 PM 
Started by MonasWeim - Last post by Jo CIMDA
Hello Simona - and Riley!

It is lovely to hear from you and to know that Riley is now 10 years old! 

I can't answer your question about using colostrum as a health aid in a dog that has autoimmune problems but I have emailed my friend who is a vet and I hope she will come back to me soon with some useful information.  Her dog is due to whelp a litter so there might be a delay in her replying.  I have always considered it unwise to boost immunity if the dog has a predisposition to AI disease, but wait and see what my friend says. 

This makes interesting reading from a human website:

http://www.pemphigus.org/handling-prednisones-side-effects-naturally-2/

Leaky gut is linked to AI disease in humans and you may want to do some research in this area.  I do think the right diet can make a difference but it has to be tailored to the individual.  BrookeR has kindly made some good suggestions about probiotics etc.

I sincerely hope that Riley doesn't have aspergillosis.  There are other causes of rhinitis.  One of my girls had erythema multiforme and this was accompanied with a thick nasal discharge.  This was treated with essential fatty acids and after a few months of treatment it cleared up.

Recently a member of CIMDA posted this information.

"For information I bought a machine called saline plus to help with  her rhinitis. She has been using it four months now and the results are really good. She has far fewer reverse sneezing episodes and less mucous discharge. Touch wood she has also been infection free. I would certainly recommend it to any owners whose dogs may have respiratory problems." https://www.salinplus.com/


I have just got a reply from my vet friend:

Colostrum will balance the immune system and is perfectly safe for dogs
with autoimmune disease.  I started taking it daily myself a few years ago,
and since then I have not only never had the flu, I've really never had a
cold.  I get mine from New Zealand because all the cows are grass fed and
not on antibiotics and growth hormone.


She goes on to say:

This is a good article on aspergillosis. http://
veterinarymedicine.dvm360.com/when-consider-aspergillosis-dogs   

Rhinoscopy and cranial X-rays are advisable if cancer is suspected.  If he
wants a supplement for nasal carcinoma turmeric would be a good choice.
Treatment is radiation, I've worked with two cases in Beardies recently one
has done really well with intensity modulated radiation therapy,

http://www.vetcancergroup.com/services/radiation-therapy/intensity-modulated-radiation-therapy--imrt-.html



 I do hope the outcome is good for Riley. He is a tough cookie.   Please let us know how things go.

All the best

Jo
 

 8 
 on: February 17, 2018, 11:51:53 AM 
Started by kaitythorpe - Last post by Catherine
Do you know if Bozo has been on 20mg twice daily from the beginning? If he weighed 30kg originally the dose should have been 30mg twice daily. Here is a good reduction protocol:

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  Ė 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(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. (Plumbís Veterinary Drug Handbook)

Don't forget the gastroprotectant!

Also some information here: http://cimda.co.uk/smf/index.php/topic,11.0.html

 9 
 on: February 16, 2018, 11:37:05 PM 
Started by kaitythorpe - Last post by kaitythorpe
Hi all, I am posting this for a lady who couldn't get to grips with the forum and sent an email to Jo, unfortunately I think the email must have got lost somewhere along the way and I asked if she would like me to post here for her. Her name is Fiona and below is what I have copied and pasted exactly in her words. Thank you xx

"Hi all, don't know why I'm posting, maybe for support, someone who can relate to my situation, or advice, I'm not to sure,my head is a muddled mess at the moment, so please excuse me if I make no sense at all!

My beautifully, lovely,sweet,apple of my eye Bozo was diagnosed with imha last December 28/12/2017, he went from a 30kg dog down to 19kg in days! ( his now 24.8kg)

He was so ill, he had a transfusion, stayed a few days in the vet, pcv was raising well the whole time until three weeks ago, it went from 29 to 23! I was freaking out, vet rung a specialist, he advised to re test his blood and it came back into the 30s! phew! Fast forward to the next week, again got 23% reading vet added 25mg of imuran once a day to his 20mg of pred 2x a day, this weeks result's came back as 19%,20%,21% ( they testes three times) also added antibiotics 2x a day for 10 days, he says its not looking good, apparently to them his flat at home he is a nightmare to keep still, he is so active, his better then ever, eating like a horse ( literally eats more then the kids minis lol)

What would you guys suggesting adding, doing or anything? Iv emailed Jo Tucker last week, waiting a reply, his on 6 cups of hills active dry kibble I'd love to change him to a grain free option (ivory coat or black hawk?) He dose get some cooked beef heart,liver,kidney,honey,veg as well

I'm a complete wreck with his results, hearing the pts option getting brought up so often haunt's me at night, I know I need to be realistic and face in reality I could very well lose my best mate sooner rather then later, I'd love to do anything I can to help him!
 Thank you for taking the time and reading my novel!"

 10 
 on: February 16, 2018, 09:02:51 PM 
Started by MonasWeim - Last post by BrookeR
Sorry to hear you that and Riley have been having a hard time. It is an emotional roller coaster having a dog with an immune disorder. I have had so many ups and downs with my girl but will keep fighting for her to be as healthy and comfortable as she can be. As you would be the same, thatís why this forum is so great. Everybody understands the feeling and wants to help eachother.

I looked into using colostrum some time back for my staffy Pepper. But in the end we decided we werenít comfortable and felt the immune stimulating aspect of it was too big of a risk.
Pepper is extremely sensitive and allergic to many things, so that was another factor to worry about.

I found jean Dodds book canine nutrigenomics a good read if you havenít already read it. Pepper is on Protexin probiotics but I have been trying to find a higher quality one but thatís all that seems to be available here in australia. Jean talks about higher quality probiotics available in the states.

I have just had a phone consult with a holistic vet specialist in Sydney. They also specialise in Chinese medicine amongst other things. I discussed with them natural remedies and supplements, probiotics, digestive enzymes etc that we may be able to use going forward to try and get pepper in optimum health. Also to try help prevent cancer and some drug free options to help her joints. I am waiting for them to send me through the notes and their suggestions. Pepper will be 11 this year, so like you I am trying to get her in the best shape I can via use of supplements etc.
When I mentioned finding a better quality probiotic the specialist suggested giving pepper things to help her body better absorb and make optimum use of the probiotic. Rather than change probiotics. She suggested slippery elm and was going to come back to me with digestive enzymes and some other options.
I will let you know if they come back with anything else that may also be useful for you and Riley.
Best of luck

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