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Author Topic: Bobbi  (Read 151 times)

claricechin

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Bobbi
« on: March 20, 2018, 10:43:36 PM »

Bobbi was diagnosed with IMHA on 31 January and after taking several weeks of medicines her PCV has bounced back to 38 this week.

Medicine she’s previously on:
Prednicare 5mg/tablet 1.5tablet twice a day
Famotidine 5mg twice a day
Clopidogrel 75mg 1/4 tablet per day
Aspen-imuran 25mg 1/2 tablet per day

The vet has decided to pause Bobbi’s daily intake of famotidine for a week to avoid her stomach gets used to it.
But I’m a bit worried if it’ll do any harm to her without the stomach protectant?
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Jo CIMDA

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Re: Bobbi
« Reply #1 on: March 21, 2018, 10:23:57 AM »

Hi and welcome

I am sorry Bobbi has IMHA.  Looking at the dose of prednisolone,  I presume Bobbi is a small girl - how much does she weigh?  Has she been on the same dose of prednisolone since the beginning of treatment?

If Bobbi has been taking Famotidine since the beginning of treatment I wonder why your vet thinks it is upsetting her stomach?  If you are concerned then why not ask your vet to change to another gastroprotectant such as ranitidine?  One week without a gastroprotectant might not affect her, but who knows?

Imuran (azathioprine) tablets should not be divided, so I would also ask your vet about the safety of giving Bobbi a split tablet and ask if you should give a whole tablet every other day as opposed to splitting a tablet and giving a daily dose.

 https://www.medicines.org.uk/emc/medicine/2882

6.6 Special precautions for disposal and other handling


Health professionals who handle Imuran Injection should follow guidelines for the handling of cytotoxic drugs (for example, the Royal Pharmaceutical Society of Great Britain Working Party Report on the Handling of Cytotoxic Drugs, 1983).

'Provided that the film-coating is intact, there is no risk in handling film-coated Imuran Tablets. Imuran Tablets should not be divided and, provided the coating is intact, no additional precautions are required when handling them'.
 

Jo
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claricechin

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Re: Bobbi
« Reply #2 on: March 21, 2018, 04:46:00 PM »

Thanks Jo.

Sorry I should have given more details about Bobbi - she is a Shihchonpoo (Shih-poo x Bichon Frise) and will turn 1 year old next month.  She is gaining weight since two weeks ago and now she's 7.01kg. 

We are trying to control her diet but due to the side effect of steroid, she keeps asking for food the whole day (used to wake us up at 4am because she is too hungry  ::) ) and now aside from her two main meals, we will fit in some snack time with some vegetables and little bit of meat. 

She has increased from 10mg to 15mg on her prednicare within the first few days when her PCV dropped from 23 to 18 and has been on the same dose since then until this week, it's reduced to 12.mg daily.

For Famotidine, the vet suggesting to give a one week break is that he worries the medicine will block/ stop the glands from releasing acid after prolonged intake of the medicine.  I wonder if giving Bobbi some natural herbs (e.g. slippery elm bark) would help easing her stomach or protecting her stomach?

It's interesting to learn about Imuran, I'll bring it up to the vet next time.  Meanwhile, there's a warning on the label that it needs to be handled with gloves.
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Jo CIMDA

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Re: Bobbi
« Reply #3 on: March 22, 2018, 08:47:27 AM »


Hi

Bobbi is a little girl and smaller dogs cope much better with immunosuppressive doses of prednisolone, so that is good news.  Your vet is starting to reduce the dose now, which is necessary. Her appetite should reduce as the steroids are lowered but it is a common side effect.   For your information, below is the best reducing protocol for prednisolone that I have come across and it can be confidently used as a guide.  Prof Day is one of the world's leading veterinary Immunologists.

Slippery elm is a good herb that can heal the calm the digestive tract, but I have not heard of it being used as an alternative to a gastroprotectant during immunosuppressive therapy. As your vet is only withdrawing the famotidine for one week it may not have any lasting effect.  If Bobbi starts to show signs of upset tummy or bringing up bile then ask your vet to reconsider and either put her back on famotidine or put her on a different gastroprotectant.  Omeprazole is the most common gastroprotectant used with immunosuppressive therapy.

Jo


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.

The dose of azathioprine 2mg/kg/24 or 48 hrs, can be reduced initially by giving a lower dose tablet per day, or gradually reducing from daily dosing to every 2nd day, every 3rd day, every 4th day etc..... Remember, azathioprine tablets should not be broken or handled without gloves.

“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.

 

 
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claricechin

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Re: Bobbi
« Reply #4 on: April 12, 2018, 06:42:50 PM »

Update on Bobbi
Her latest blood test result:
PCV 43.2
New red blood cell count 25

While we will restart reducing her Pred dosage (from 15mg to 12.5mg per day), I wonder if there’s any concern on her new red blood cell count as it’s sognificantly dropped from 120 last week?

Is it because the PCV is considerably high that would slow down the production of new red blood cells?
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Jo CIMDA

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Re: Bobbi
« Reply #5 on: April 12, 2018, 09:22:00 PM »

Hi

  Fantastic!  A PVC of 43.2 -  that is within normal limits.

By the 'new red blood cell count'  I presume you mean the reticulocytes.  Yes, you are right.  As the red blood cell count within the circulation of the blood rises to within normal limits, production of reticulocytes will self regulate, and the numbers will continue to reduce until they are back to normal production eg., only producing enough reticulocytes to maintain normal PCV levels.  It is a circle - as the old red blood cells leave the body (usually around 100 days) new, immature red blood cells migrate from the bone marrow to the circulation of the blood, maintaining a constant level of red blood cells.

 This is great news.  Many thanks of the update.

Jo

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