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Author Topic: Saying Hello  (Read 129 times)

Brunos mammy

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Saying Hello
« on: October 11, 2017, 09:47:44 AM »

Hi my name is Amanda and we have been fighting IMHA for 18 days my boy Bruno was doing pretty well and the last pcv was only 16.7 we got up to 26
He is now panting a lot and his behaviour is changing
So nerves now and sat looking in to space this morning in the garden we off for bloods later today
Praying for higher numbers
We had never heard of this bloody awful diseases xxx 19 days ago and now it's taken over our life's
Bruno is on prednisone omerperzole and Sucralfate with a high protein diet and loads of love and cuddles
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Jo CIMDA

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Re: Saying Hello
« Reply #1 on: October 11, 2017, 10:13:01 AM »

Hi Amanda and welcome

I am sorry that your Bruno has IMHA.  I really know what you are going through and it is a dreadful shock to the system.

Can you tell me how much Bruno weighs and what dose of prednisolone is he on?

Prednisolone is the first line drug of choice for IMHA but the dose has to be correct.  Take a look at Michael J Day's immunosuppressive drug protocol in the files.  It is the best I have come across and it can be confidently used as a guide. 

The signs and symptoms you are seeing are a result of the prednisolone.  Is Bruno on more than 1mg/kg/12hours prednisolone?  If he is then this likely to be the reason for the symptoms you are seeing.  Side effects of preds are bound to show but there is a level at which the side effects become intolerable and if the dose is higher than I have mentioned above then it would be wise for your vet to reduce it to 1mg/kg/12hrs.

Also Bruno might be a dog who doesn't tolerate preds that well (if he is a large dog then it is more likely) so perhaps introducing another drug such as Azathioprine at this stage might be prudent.  It takes about 6 weeks for Aza and most other immunosuppressive drugs to kick in, so to introduce another drug now means that in a few weeks time you can lower the preds and still maintain a good level of immunosuppression.

It is good he is on a gastroprotectant but I don't know why he is on  two, usually omeprazole is enough to protect the stomach.   I don't know why he is on a high protein diet but I would be careful that the  fat content is not too high.  A low fat diet should be given if a dog is on high doses of prednisolone  to avoid pancreatitis.

I hope Bruno's PVC is increasing now.

Jo


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Brunos mammy

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Re: Saying Hello
« Reply #2 on: October 11, 2017, 11:20:26 AM »

He is on 1.5mg twice a day of predinose he weighs 25.63 lbs they said high protein diet to help with red blood cells regeneration they added omerperzole too his meds as they thought he might have an ulcer
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Catherine

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Re: Saying Hello
« Reply #3 on: October 11, 2017, 11:56:21 AM »

He needs to be on about 12mg of Prednisolone TWICE a day, a total of 24mg a day.
1.5mg twice a day is only 3mg and way too low.
I hope his PCV is okay today but I am guessing that if he has been on such a low dose of Preds. the panting is due to a drop in PCV. I hope I am wrong but I would take him straight to the vets or at least phone them and discuss increasing the Preds. to an immunosuppresive  dose immediately.

Here is the medication protocol:  (You might also want to read this: http://cimda.co.uk/smf/index.php/topic,11.0.html  )

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!
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Jo CIMDA

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Re: Saying Hello
« Reply #4 on: October 11, 2017, 06:26:13 PM »

Hi Amanda

I was totally wrong when I presumed the symptoms you are seeing is a result of the prednisolone.  Catherine is absolutely correct.  Bruno is not on nearly enough prednisolone and if he continues on such a low dose this will never resolve and he will get a lot worse, and the situation will become dangerous.

Bruno weighs just under 12kg so as Catherine says he should be on 12mg/kg twice a day. Have a word with your vet as soon as possible and if your vet won't treat Bruno as the protocol below then find another vet.   The immune system has to be suppressed for the destruction of the red cells to cease and 1mg/kg/12hrs is the lowest immunosuppressive dose a dog should receive for IMHA.  This is the reason why his PCV hasn't risen.

Good luck with your vet.

Jo
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