Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - amy the battle begins

Our beautiful crossbreed bitch Amy was always full of life, she's just short of her 7th birthday.A couple of months ago we noticed a small lump on her jaw. The vet thought it was an infected salivary gland and after many weeks of antibiotics he decided to operate as the lump was still present. Her surgery was booked for the 8th March. Two days before her surgery we noticed that she was a little out of sorts - not as keen to eat her food (prior to this she had not missed a meal in her entire life!) and just not quite the happy little girl she has always been. During the night before surgery she had diarrhea which was very yellow in colour. We put all these symptoms down to the infection and the vet was happy to go ahead with surgery. That evening when we picked her up she was looking very sad and not at all well but we were told this was normal and just due to the anasthetic. That evening she refused to eat anything apart from some scrambled egg hovever she quickly vomited this back up. The next morning she was worse and unable to keep even water down. We also noticed to our horror that she was jaundiced ( eyes, mouth, tongue, skin and inside her ears) We rushed her straight to the vets where they tested her blood and found out her PCV (packed cell volume) had dropped to 12. The vet suspected AIHA and we rushed another blood sample to the labs 50 miles away for a Coombs test. We took her home while we waited for the results. She quickly went down hill and her vomiting and jaundice became more severe. During that day we read everything we could find online about Auto Immune Haemolytic Anaemia and were terrified by what we found out. At 6pm that night (9th March) the results came back positive. To us this was the worst news in the world- Amy's body had turned on its self and she was destroying her own red blood cells. From what we had read we knew our beloved little girl was probably going to die. She was started immediately on a high dose of Prednisalone to try and stop the destruction of red blood cells but as she was still vomiting we were given Cerenia tablets (an anti emetic) plus an antibiotic (as the treatment would kill her immume system) and finally an antacid to reduce the damage the steroid would have on her stomach. We knew that the most important factor in the treatment been successful was the speed at which we could start her on the prednisalone so when later on that night she hadn't even managed to keep the anti-emetic down never mind the steroid we decided to take her to the emergency out of hours vet. There she was given an injectable anti-emetic plus an IV shot of dexamethesone steroid to get her started ( not as effective as prednisalone but better than nothing!) The next day (10th march) she was worse still and her PCV had hit 10. The vet said there was little more he could do and if she was still the same the next day then decisions would need to be made. We knew exactly what that meant. We took our little girl home and prayed. We couldn't believe this was the same Amy who was so fit, healthy and happy just days before and I think we all kept hoping we would just wake up from this nightmare. That day we watched as our darling started to fade away. By that evening she was barely conscious but still hanging on. We knew she was dying but if she wasn't giving in, how could we? We read that sometimes a blood transfusion could keep them alive just long enough to give to drugs time to work. What did we have to loose? After several phone calls to various vets we convinced them to give her a chance. That evening she was hospitalised at given blood throughout the night. Her potassium levels were also found to be dangerously low and they treated her for that at the same time. We called every 2 hours during the night to see how she was doing and every time we called she was a little better and a little stronger. To our huge releif she had not only made it through the night, her PCV had risen to 20. The big test would be if sshe managed to hold this level during the next day. Waiting for the results that next evening (11th march) was nerve wracking. Could we dare to hope she had managed to hold....but she did! We took her home and carried on with the drugs. That evening her jaundice started to subside and we started to breath a litle easier. The next morning (12th march) to our disappointment the jaundice was as bad as ever. We took her to the vets expecting the worst but with great relief we found that her PCV had risen to 24! The next day it was almost 25! We know it is going to be a slow process and a relapse could occur at any time but at least she is heading in the right direction. We are still having a struggle to get her to eat anything though. After the first week she still wouldnt eat anything and we had to start to syringe feed her - a process which she comes to hate more each time we have to put her through it. We are now ten days on and she had begun eating a few mouthfuls of food such as stew, beef and sweet biscuits but we still have to supplement this with syringe feeding her and would be grateful for any advice from people who have come out of the other end of this struggle with food. Now, it is still very early days and we are still holding our breath but she is still with us and slowly making progress. With AIHA i think thats all we can ask for...

john collett teesside england

I am so sorry to read that Amy has IMHA. You have come to a great board with a lot of information. You will also find a lot of great supportive people who have all had to deal with this disease. You will also find a wealth of information at this website http://www.cloudnet.com/~jdickson/ This really is a one day at a time disease. With Keiko (mini dachshund) who was diagnosed in June 2007 it was one day at a time, one week at at time and one vet visit at a time, BUT so worth it! We have been lucky and Keiko is still with us today. She is an almost 3 year survivor!! So above all, try not to give up hope. I am sure many others will come on and give you better guidance than I can, just wanted to wish you and Amy the best. ((hugs)) Jess, Keiko and Hushi

Jess BC

Here's sending Amy strength and loads of hugs to get her through, I have just lost my little girl Holly, may you as her family also find the strength to get her through this difficult time. Sending you loads of love and support.

Diane Luton.England

John, I'm sorry to hear Amy has this terrible disease. Like the others have said it's a roller coaster ride for sure! Taking it one day at a time is really the best course of action. A rise in PCV is awesome to hear! This is what we want. Are you still having problems with her eating? This is one of the most common problems in the onset of this disease. Not only is this a problem but it's one that really hits US as owners because it can be really scary to deal with. The fact that she is eating *some* food is excellent! You are doing absolutely the right thing in syringe feeding her also. It's important to get the nutrients in to help the body heal and also build new blood. Time to get creative....scrambled eggs, boiled liver (very small amounts), lean roast beef, chicken/turkey boiled, sweet potatoes, white fish, etc. For now you should focus on getting her to eat. I'd recommend you get a FULL blood panel done to check the liver, kidney, & pancreatic numbers. There are so many different reasons that a dog won't eat and these can help determine if it's related to either of these. Are you having problems giving the meds? It's SUPER important not to miss a dose (especially the pred or any other immunosuppresants). If you can you should give these with food...a good handfull or two if you can. This'll make it easier on the stomach. Have you noticed anything being wrong in the pee/poop department? Discoloration, pain/straining? Any types of pain or even vomiting? We really have to be carefull for problems like ulcers. You could use a stomach protectant like sucralfate if this is suspected but you should be carefull when you give it with regards to meds. Sometimes it can affect the absorption of the meds....especially cyclosporine. Another option would be the slippery elm cocktail. I wouldn't be adding these unless it was really suspected to be ulcers though. Pepcid before eating might also help some to calm the stomach. If she continues to have problems not wanting to eat you could ask the vet to put her on Mirtazopine....an antidepressant used as an appetite stimulant. I hear this works great. Is she drinking alright now? Once you get her eating you could add milk thistle to the food for her to help protect the stomach. Lots of us here also use a product called pet-tinic - a blood builder supplement. Good luck and keep us posted. My thoughts and prayers are with AMy. Johnny & Tessy

Johnny

A big thank you to all who have replied to our thread regarding our dog Amy. Your time and words are very much appreciated.

Joanne Teesside

John and Family Please know that I am keeping your girl Amy in my thoughts and prayers. Please keep us updated on how she is doing. Cheryl & Ginger

Cheryl & Ginger Pineville pa

John, My Brinnie was diagnosed with this just last week so I am fresh in this thing like your family. I got baby food, salmon, chicken, beef, rice, eggs, cheese, etc. She, like Amy, would take maybe 2 bites at a time and then once the prednisone got in her system which was yesterday, she started to eat more. Not like she used to, but so much better than she had in 5 1/2 days so keep at it! Brinnie is still at 19 PCV so I would imagine that Amy with blood tranfusion and the PCV so much higher than it was, that she will start eating soon. Just keep trying anything! I got back tomorrow to check her levels and pray they are higher based on how she's acting. Is Amy still lethargic or is not eating the only thing that isn't changing? I'm here for you. I pray we all get through this on the positive side! Hang in there! We're all hear for you! Christina

Christina Nashville

John and Joanne, I am keeping you and Amy in my prayers and thoughts it sounds like she is a fighter. It is so important to have a Vet who is well versed in treating this. I am stunned that they would send her home with such a low PCV initially.

Penny Lytle Creek Calif

Dear John and Family, I'm sorry to hear about Amy and the stress that you've been going through over the past week and a half. Like you and many others, I'm way too familiar with what you've been feeling. (My Rex was diagnosed a month ago) The first week or two is the worst because of all the confusion and emotions. On the other hand, I'm very excited to hear about Amy's progress and will continue to pray and hope that she continues to get better each day! Hopefully, Amy's appetite will return soon. Rex didn't eat for almost two and a half weeks before I took him in to the vet. After Rex was diagnosed with IMHA, I started cooking food for him vs. "Kibbles n Bits" and he started to eat again. In addition to being better for him, it was something different. Not to mention, I felt good because I wasn't just feeding him "pills." Once the prednisone kicked in, his appetite went into high-gear and at times, he actually drives me crazy begging to eat all the time. He now eats three smaller meals (breakfast, lunch & dinner) vs. one large dinner. Hang in there and know that you are not alone in this battle! Take care, Kapri & Rex

Kapri Arizona

Dear John and Joanne, I am so sorry to hear about this scary diagnosis for Amy. You have come to the right place for advice and support. How is Amy doing today? Sam and Millie.

Samantha Geelong Australia

Thank you to Jess, Diane, Johnny, Christina, Cheryl and Ginger, Penny, Kapri and Rex- your thoughts and prayers have been a great comfort to us. I am pleased to report that Amy's PCV was 26 yesterday and as long as she doesn't get any worse she doesn't need to see the vet again till Monday!! Fingers crossed... At the moment she has her good days and bad days or to be more accurate her good hours and her bad hours. Has anyone else noticed that a couple of hours after the prednisalone is given their dog becomes unsettled and uneasy? Amy seems to go off for up to 6 hours before she starts to pick up again. Her breathing becomes shallower and faster although this seems to be more marked through the night. Just as she seems to be getting the Pred out of her system it is time for another dose! We just have to keep telling ourselves that the drug is saving her life not poisoning her! Amy is still quite reluctant to eat although she did eat some of her dog biscuits for the first time since she became ill this morning but soon vomited them back up. Since then she has eaten small amounts of raw mince, cooked mince and gravy and mashed potato. It certainly is a challenge to find food she will even look at! She is still very lethargic although it was only a week ago that she was so close to death I guess she is doing pretty well! It is heartbreaking seeing her looking at her ball and not having the strength to pick it up though. Has anyone been told to give their dog vitamin B1 (thiamin) supplements? Our vet recommended 50mg twice daily which seems very high? I will let you all know how Amy is tomorrow. Thanks again for all your support, my thoughts are with Brinnie and Rex and the people who love them. p.s. If anyone is reading this because their dog has just been diagnosed with AIHA I urge you to read as much about the condition as you can and don't be afraid to push your vet to give your dog the treatment it needs. If we hadn't insisted on a blood transfusion to buy Amy some more time, we wouldn't have our little girl now...

Joanne Teesside

I also wondered if everyone else has been prescribed antibiotics along with the Prednisalone? We were initially given Noroclav but another vet said not to give this as it has actually been linked to triggering AIHA. At the moment Amy is not on any antibiotics but as soon as she tarts to go for walks again she will have to go on one type or another due to her low immune system with the steroids.

Joanne Teesside

Norclav is a version of Ammoxicilan (sp?), which is a Penicillin. I haven't heard much on people using this antibiotic while their dog is anemic but I also haven't heard of it being a trigger. Perhaps someone else here knows more on this. There are HOWEVER several antibiotics that are known to induce immune hemolytic anemia and these are...sulfaTri drugs, cephalosporines such as cefotetan and ceftriaxone (two biggies of the cephalosporines)...but I've used cephalexin in the past and many others here have also with no effects, B-lactamase inhibitors, piperacillin, and doxycycline in a select few. Doxycyline is used very often by vets in the onset of this disease just in case it might be tick related. I don't know how much of a fan I am of this due to the fact that it can ramp the immune system up which isn't what we want. If people are CERTAIN it isn't tick related then they should avoid this in the beginning! Many of us here...like I was saying... use cephalexin (keflex) with good results. Perhaps you can ask to use this one. ANYWHO, a climb in PCV to 26%!!! YIPPIE! The side effects from the pred you are describing is normal. I think most of us have been through the same thing! Tell us the drugs Amy is taking and the doses and times of day. Can't really offer much advise without knowing these stats. If I were you I'd ask to switch from vitamin B1 (thiamin) to a more suitable Bcomplex vitamin with iron and folic acid in it. Many of us here use a product calle Pet-Tinic which you can order online but it may take some time to reach England unless you can find it there somewhere. Hopefully some of the others can chime in on the proper doses to supplement each individually cause I really don't know the amounts...but others here have done that. Oh...and use milk thistle. It's a herb that helps protect the liver. Keep us posted. I'll keep Amy in my thoughts and Prayers. Johnny & Tessy

Johnny

This thread was discussed between 17/03/2010 and 19/03/2010

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