posting for a lady in our support group

[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!"

[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  – 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. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

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

[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

[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."

[Jo CIMDA]

I hope it all goes well for Bozo.

Jo