Advice required for Jessie Whippet

[mickwhippet]

Hi,
my whippet Jessie has just been diagnosed with AIHA. She's 3 years old.
She had a bone marrow biopsy yesterday on which we are awaiting the results – will be a week or so due to Christmas –
just to check whether if there is evidence of cancer.
She hasn't responded to the steroids very well after 3 weeks and her levels are still around the 20 mark.
She is now on Imuran too.
She is approx 10kg – she has 25mg of Imuran, 40mg of prednoldale and also antexin and zantak for her stomach.
What I need help with is her diet – we have three other whippets and they all have raw food – mainly raw meaty bones – chicken, beef, lamb, fish etc.
We supplement this with eggs, carrots, chopped veg etc and occasional leftovers.
Is this a good diet for her – she's really greedy but she looks very wasted – whippets can't lose too much weight without looking really frail.
SHould we go back to kibble and tinned food or is there anything specific we can give her?
We are in the UK.
thanks in advance
Mick and Liz and Jessie, Bob, Ted and Jasper whippets

[Catherine]

The  Imuran will take a while to work. 40mg seems a big amount of Preds. for Jessie. Here is the protocol here:
http://cimda.co.uk/smf/index.php/topic,11.0.html
What HCT/PCV level did she get down to?
How long was she on the raw diet before she became ill? If she has been on it for some time it probably will not be a good idea to start changing the diet whilst she is trying to get better because it may make her worse, and you will not know whether it is the illness, medication or change of diet causing any problems. If on the other hand she has only been on a raw diet for a few months then gradually changing to a kibble etc. diet may be best. You can always go back to raw then, when she has recovered.

[mickwhippet]

Hi,
Thanks for the response.
She has been on the raw diet for approximately 10 months.
We noticed she was slowing down and a bit stiff around 2 months ago but nothing too drastic.
Then I noticed her gums were pale around the middle of November and we got her checked out.
The vet has just called with her results (unexpectedly early) and her bone marrow is normal and appears to be full of red blood cells . So that must be good news. Sorry I don't know the technical jargon.
We were told the HCT/PCV levels but it was all a bit of a blur – I remember 23 at one point.
Just checked the preds and it's 4 5mg tablets twice a day, is this/could this be a problem? She's had 4 blood tests and it hasn't risen yet, the first blood test showed abnormal shaped red blood cells.
To say she had an anaesthetic yesterday, she's quite perky today, nothing like she was/should be, but hopefully the latest update is good news.
Thanks again

[Catherine]

It does sound like good news. I am just wondering why her HCT has not risen more in 3 weeks if it has stayed around the 20s. Hopefully Jo or other members can advise you as I have to sign off in a moment and I can not think of advice at the moment. I do know other medication can be considered. There is always a possibility it can be something other than AIHA though.

Did you look at the link I gave you? If Jessie is having a total of 40mg Preds. a day then that is double what the protocol says and could start causing her problems and the extra dosage is probably not any extra benefit to her.

Did she have her last blood test yesterday? Can you get her tested again on Monday to see how things are and also (if the vet has not already done this) can you have a full biochemistry (general health profile) blood test as well as the haematology to check out her kidneys, liver etc. ?

[mickwhippet]

Kidneys are fine, they were checked yesterday morning  – 
She's had an xray – everything looked fine, been treated for lungworm etc
the link took me back to the home page?
The vet is phoning us on boxing day so i'll ask about the pred dosage.
The vets have admitted that she is a bit of a conundrum but have been brilliant so far.
Thanks

[mickwhippet]

link working now – i'm not sure if I should reduce the amount or wait until I speak to the vet.
Is it the same steroid – just a trade name difference?

[Penel CIMDA moderator]

For smaller dogs 4mg per kg is quite acceptable for the first couple of weeks, or until the Imuran has started to work. How long has she been on Imuran?

My cocker was 12kgs and was on 50mg several times for a few weeks at a time.  She was also on 25mg Imuran once a day.  It's usually 2 - 4 wks before the Imuran starts to work.

The general protocol that we've always followed is 2 - 4 mg per kg prednisolone split into two doses over 24 hrs.  Smaller dogs can take the bigger doses, bigger dogs cannot.

Prednidale is same thing - prednisolone.

V good that there are new red blood cells forming, is that what they meant?

I'd keep her on a raw diet but I might drop the bones and keep feeding raw mince with bone content rather than raw meaty bones for now.

I'm sure Jo will be along soon but I really hope that your whippet starts to improve v soon.  It's all v stressful having poorly woofers.

[mickwhippet]

Hi
Thanks for your response. That puts my mind at rest.
She's been on Imuran for about 10 days.
Bone marrow biopsy results showed normal amount of red blood cells.
I'll keep her off the bones – we got some green tripe mixed with fish today – nice;–(
she mainly has chicken backs and turkey necks.
she has 4 tablets of 5mg prednidale twice a day at the moment – so it tally's with what you say.
Really appreciate your help – we've never had anything like this to deal with before, it's been incredibly stressful.

[Penel CIMDA moderator]

Aww she's gorgeous.  It's awful when they are so ill isn't it.  Makes you feel so helpless.
I think that everything you're doing is the right thing though.
Obviously don't let her do any exercise - no running for her for a while I'm afraid.  Just gentle little tiny walks.

[Jo CIMDA]

I'm sure Jo will be along soon but I really hope that your whippet starts to improve v soon.  It's all v stressful having poorly woofers.

Hi Mick, liz and Jessie.

I did reply at leangth very soon after you posted but unfortunately it seems to have gone missing.  Basically I said the same as Bonniemist and Penel.  Jessie's pred dose is high (but within the range) and this can sometimes prevent the red blood cells from increasing within the circulation of the blood.  It is more significant in larger dogs as Penel said but still if her bone marrow is regenerating then it could possibly be reduced and it could even be more beneficial in a lower (but still immunosuppressive) dose.  I did hope Penel would help with the raw feeding - where did this posting go?

Fingers crossed she will start to pick up very soon.  She is a lovely looking girl.

It is very stressful, but that will become less as you get used to the treatment and when her red blood cells really start to increase and you see good results.

Jo

[mickwhippet]

Hi,
a quick update.
Jessie is now on 30mg of Preds per day.
Her bone marrow and blood smears both show as regenerative but her red cell count is still around 23 and has remained stable at that throughout.
Vet and pathologists still haven't found out why her blood count isn't rising and not much general improvement – although Jessie seems a little brighter. Her gums are still pale.
Her hind leg muscles have all but withered away but she still wants to go for walks, she doesn't chase about much though.
She's also been treated for a possible blood parasite. Possibility of a CT scan to check for tumours in her spleen or a splendectomy – which apparently used
to be common practice but not so anymore – vet loathe to put her through an operation whilst she is so anaemic.
She is still on her raw diet but has pilchards, chopped veg, a bit of James Wellbeloved kibble and the vet has given her 2 shots of vitamin B.
She has perky days and not so perky days is this normal? We think she is going the right way and then she dips again.

[Penel CIMDA moderator]

Is Jessie still on Imuran as well?

[mickwhippet]

yes, still on Imuran and all the antacid stomach protectors (zantac etc

[Jo CIMDA]

Hi,
a quick update.
Jessie is now on 30mg of Preds per day.
Her bone marrow and blood smears both show as regenerative but her red cell count is still around 23 and has remained stable at that throughout.
Vet and pathologists still haven't found out why her blood count isn't rising and not much general improvement – although Jessie seems a little brighter. Her gums are still pale.
Her hind leg muscles have all but withered away but she still wants to go for walks, she doesn't chase about much though.
She's also been treated for a possible blood parasite. Possibility of a CT scan to check for tumours in her spleen or a splendectomy – which apparently used
to be common practice but not so anymore – vet loathe to put her through an operation whilst she is so anaemic.
She is still on her raw diet but has pilchards, chopped veg, a bit of James Wellbeloved kibble and the vet has given her 2 shots of vitamin B.
She has perky days and not so perky days is this normal? We think she is going the right way and then she dips again.

Hi

I think the dose of steroids is still too high and this is probably the reason why her red blood cell count isn't rising.  She is only weighs 10kg and if she had been on 40mg for three weeks, and then 30mg, she is still on more than the lowest immunosuppressive dose of preds and this far into the disease it is hoped she would be on much less.  It is known that when a dog is having very high doses of steroids for long periods  the red cells plateau around the mid to late 20%.  It is only when the steroids are reduced that the red cell count start to rise again.

Check out the Michael J Day immunosuppressive drug protocol in the files. It is an excellent guide to an immunosuppressive treatment regime.  You will see the recommended starting dose is 1mg/kg/12hrs and it is reduced from there.  It is rarely necessary to use the highest immunosuppressive dose of 2mg/kg/12hrs.

I hope she improves soon.

Jo

[mickwhippet]

Hi, another update.
Jessie has now been referred to Liverpool Small Animals Teaching Hospital. Her bloods went up to 29 last week, but down again to 26 this week. She is a bag of bones, her thigh muscles have completely disappeared. She still wants to go out so we carry her on the uphill bits and she eats like a pig but the new specialist vet says she doesn't look like she should do on steroids – she would expect a much more bloated dog.
She spent an hour with her today, going through her history etc and basically said that she's had enough time to respond to the treatment so it's probably something else and not AIHA after all.
She asked if i've heard of Addison's disease – which I have (from off here) so she'll be having tests for that even though the steroids might mask the results somewhat, plus further ultrasounds and X–Rays etc and they are looking at her joints as one of the first symptoms I remember was her looking quite stiff . She did say that cancer is a possibility but she would be unlucky due to her age and she said that Jessie looks a very sick dog. Hoping we get to the underlying cause in the next few days so we can move forward.
Thanks for all your help so far.