6 months old standard poodle

[CristinaLelia]

Thank you! 🌹

[Catherine]

Results can vary from lab to lab, machine to machine, that is why it is best to keep to the same one if possible. Just another of those worrying things at a stressful time. Hopefully Tucker's results will be good on Monday to help you feel a bit less stressed.

[CristinaLelia]

Tucker Update:
PCV up to 35% and the specialist said she want to start weaning from 30 mg to 20 mg starting today. No more doxycycline either and back in 2 weeks.Thoughts please?

[Catherine]

That is good news, but.....if he is coping well on the Preds. I would have wanted to keep him on that dose for longer. Or if reducing, to reduce to 25mg first. I certainly would not leave the next blood test until two weeks' time. I think it is best to keep an eye on things to make sure the HCT/PCV continues to rise and keeps stable.

[Jo CIMDA]

Hi

Although the protocol below recommends reducing the dose between 10-28 days, as long as the dog is tolerating any side effects anecdotal and clinical evidence has shown if each dose can remain 21 days, then remission is more likely to be achieved.  The protocol has to be tailored to the individual, and the dose and duration is decided on the resolution of the disease and the side effects of the drugs.  Just because there is a remarkable increase in the PCV doesn't mean that the immune system is stable yet and has returned to normal function.  Clearly the drugs are working and Tucker's body is responding, which is brilliant news, but if the dose or duration is reduced too soon then a relapse may occur and then you have to start from the beginning again and this means longer period of being on high doses of prednsiolone.   Anecdotally, the best way to decide when to lower the dose, and  the duration, is to get to 10 days and then monitor each day and if at for example, 14 days all is still ok, then extend this period to 16 - 18 - 21 days etc., watching all the time for unwanted side effects.   Usually, after 21 days the dose can be lowered but not by too much.  The protocol below is an excellent guide and it can be tailored to the individual.

35% is still just under the normal reference range and as long as Tucker is tolerating the drugs it might be prudent to keep him on this initial dose for at least until his PCV is within normal range.  To repeat, just because the PCV is increasing doesn't mean that the immune system has returned to normal function.   The only thing now that is keeping the immune system under control is the preds, and that is why a longer duration gives the steroids a better chance of achieving long term remission.

Jo



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 based 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


Don't forget the gastroprotectant!

[CristinaLelia]

I sent an email to the IM dr and I told her I am not comfortable at all about weaning already. The answer is typical: arrogant and nothing changed. I am confused, scared and I have no clue what to do. I still didn't wean it yet.


"I spoke with Dr. H regarding  your email. Her medication tapering strategy is very similar to what your friend reported but she takes each patient's unique situation into account when making decisions on treatment.

Since Tucker is still very young, he is a more unique case of IMHA so his plan is being tailored to him specifically.

How is he feeling today?

Please let me know if you have any more questions or concerns!
Shannon, CVT
Internal Medicine

[Catherine]

I so sympathize with you! I and many owners have had to struggle with vets etc. who, in a lot of cases, have not had much experience of certain autoimmune diseases, but who insist that their way is correct. Even nowadays, and despite Jo Tucker and her CIMDA campaigning to get autoimmune in dogs more known about, some vets still have no idea how to do things. Especially with regard to the medication.

If I had listened to my vet, some years ago, my dog with Autoimmune Haemolytic Anaemia would have died. Instead I listened to the advice of Jo and others, went by my own gut feeling and how my dog was and how the blood test results were. I then had to make myself very unpopular with various vets! I would never have dreamed of going against my vet but when her HCT kept dropping I knew I had to do something.

What worries me is that your vet is saying his case is unique, so does that mean they have not had many cases like him?

How is Tucker – does he seem to be coping well on the medication? As I said before I would be wanting to have blood tests more often for him.

I and other members on this Forum can only advise and say about our own experiences. We can not tell you what to do at the end of the day. That has to be your decision and I know it is not easy, believe me. I am lucky that, nowadays I have a vet that will listen to me and we sort out any of my dogs' problems together. Sometimes we disagree on treatment and we will go with his ideas and sometimes he will go with mine.

I wonder if your vet could come to a compromise. Perhaps you should ask if there is any reason for reducing that quickly and also by that amount. If Tucker is coping well then perhaps he could stay on the 30mg a day,  a week longer. Then perhaps he could, all being well reduce to 25mg. If your vet is tailoring the medication to Tucker then why not err on the side of caution?

So...perhaps approach your vet again with your concerns and some ideas and ask if there is a good reason for reducing so quickly. Obviously, you have to be diplomatic (although firm).

[Jo CIMDA]

Hi

You do need a vet who will work with you.  Catherine has said it all, and I can't add any more, only to say  that you either go with your vet and follow her instructions or find another vet.  Your vet's protocol may work, but there is no way of knowing until you try.  We can only advise you of our experiences but ultimately it is the responsibility of your vet. I would ask her the reasons for reducing the preds before the PCV is within normal range, and ask her what the likelihood is of a relapse. 

Jo

[CristinaLelia]

Thank you so much Catherine and Jo for your help!

I just read that  giving prednisone to a puppy who's younger than 6 months old can have terrible consequences. Tucker was 5 months and 3 weeks old when they start it , and I think this is the reason the Internal Medicine Specialist didn't respected the protocol and give him a slight lower dose.  On the phone, she told me she want him out quick because he is too young to have the immune system suppressed so long.
Anyway, I didn't weaned yet. I am scared, confused and I don't know what to do 😢

[Jo CIMDA]

Hi

Prednisolone can affect the absorption of calcium in a growing pup and this maybe why your vet is being cautious, and I understand that,  however, if a dog has a life threatening autoimmune disease then the risks and benefits have to be considered and the best treatment, dosages and duration has to be decided on. 

Lets hope that the current protocol that Tucker is on will do the trick.

Jo

[CristinaLelia]

Thank you so much for your support. Today we had a blood test and my puppy PCV is up to 44%. 🙏🙏🙏🙏

[Jo CIMDA]

That is fantastic news!!!!

Thank you for the update.

Jo