IMT

[Jaialai]

Hello members I've lost a dog to IMHA Oct . 1 I was  and still am devastated . I spent  almost  $5000. trying to save him. He was a six-year-old male Shih Tzu.Just yesterday I brought his mother in to the vet  And she has been diagnosed with IMT. Someone recommended me to join this group so I can try to find some kind of answers as of this morning she was eating. She's not taking any food for me right now. They did some kind of chemo IV to try to stimulate her body to make platelets . She's also taking prednisone and doxycycline . I had some kind of hope when she was eating now I feel like I'm going down the same path that I had with her son. I don't know if I should spend thousands of dollars again only to lose another one. This is so devastating I can't believe that I've had one dog after the other come down with these autoimmune diseases. I was hoping the prednisone would stimulate her appetite, But that doesn't seem to be happening at the moment. Any advice would be appreciated. I feel  from what  I've been reading that these dogs need to be hospitalized until their body  Begins to function on its own. I was so hoping that maybe this could turn around, without having to spend again thousands of dollars again only to lose another . I'd like to  hear experiences Of what I can or should do. Please Help!

[Jo CIMDA]

Hi and welcome

I am so sorry you have had both of your Shih Tzu's with IMTP.  It is certainly a wicked blow, but it can happen because the bottom line with autoimmune disease is  the dog has a genetic predisposition, that has to be triggered by something to activate an autoimmune response. Many of the 'triggers' can be limited but the genetic predisposition never changes, and because there are no DNA tests for autoimmunity one never knows if a dog has a genetic predisposition until an AI disease develops.

A dog that has an AI disease tells quite a lot about its relatives. Both parents are at least 'carriers' but they may prove to be 'affecteds'  at a later date (as his mum has).  'Affecteds' pass on a greater number of deleterious genes to their offspring than 'carriers'.  It is so unfortunate for you to be going through this twice, and believe me I know how devastated you feel because the same happened to a litter I bred - when the pups were 4 years old they started to develop AI disease and a couple of years later mum got AIHA. So I truly sympathise with you.  I had no idea I had bred a litter from a dog that was an 'affected' or even  a 'carrier' for AI disease.

It may be that the other pups in the litter could develop an AI disease, so limit the triggers such as vaccines, preventative wormer and flea treatments and other drugs and chemicals as much as possible.

However, the present situation does not have to be as bad as you fear because with the correct treatment, and immunosuppressive drug regimen,  many dogs with IMTP can survive and some only get it once in their lives, although a relapse is always possible.

I wonder if the IV drug was vincristine?  Vincristine has the ability to provoke the body into producing a large amount of platelets within a short period of time.  This usually buys time for the drugs to work and stop the destruction of the platelets.   The dogs should be hospitalised until the platelets are high enough to prevent a spontaneous bleed and that is over 50 but it is likely the vet will wait until the platelets are over 100 before sending the patient home.   After the use of Vincristine the next thing you have to be sure of is the correct drug regimen.  If the dose of prednisolone is too high then you may have serious adverse effects that can be life threatening.  If the dose is too low then it will not be sufficient to suppress the immune system in order to stop the destruction and start the road to remission.   The following is the best immunosuppressive drug regimen I have come across and it can be confidently used as a guide.  Prof Day is among the top veterinary immunologists in the world.

Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

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/q 12hrs (q = every)

Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days
Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.

"Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.


Prednisolone should increase the appetite but often if the dose is too high then it can affect the dog's appetite and so many other body systems.  It will make the dog feel lethargic and unwell.  Also, a dog should be on a gastroprotectant such as Omeprazole or Ranitidine to protect the stomach from the excess acid that the steroid produce, so if she isn't on anything to protect her stomach then you should ask your vet if you can have something.  Doxycycline can also make a dog feel nauseous, so this might be contributing to the way she feels.

The important thing now is to make sure her platelets are increasing and also that she isn't anaemic - and to check on how much prednisolone she is having.  She is a little dog, and smaller dogs cope much better with high does of prednisolone than larger ones, so this good news,  but the dose has to be tailored to the individual, taking into consideration if the disease process has been halted and any adverse effects of the drugs.

I hope you will see more positive signs very soon, and this will be worth all the worry and dollars spent.

Jo