Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Epileptic dog with fast onset AHIA

My 4.5 yr old Spinone developed AHIA over the weekend. He has been epileptic since 20 months old but it has been reasonably well controlled with phenobarb and potassium bromide. At one point after one nasty cluster, he was given the loading dose of KBr and he then went on a maintenance dose of that and was seizure free for nearly a year but as the bromide continued to build in his blood, he started showing signs of bromide toxicity so we lowered that drug and had to increase the phenobarb, most recently on the 16th to 150 mg bid. Over the weekend he was listless, had pale gums etc so we took him to the vet first thing yesterday and his hematocrit was 22. Although he ate well last night it fell to 12 even though they put him in pred, imuran, and doxy. ( ticks are already out here and he's had a few). They are transfusing blood into him now. Seems hopeless but I'm willing to see if he will respond to the drugs. He's not producing reticulocytes very well if at all. They were very low. They are also introducing keppra so they can remove the phenobarb in the off chance this is a phenobarb reaction. Despite this dog's epilepsy, he's achieved a Master Hunter, Rally, and some agilit titles as well as Rally obedience. He's also had a host of other issues including pano, prostitis, etc. It just makes me sick that Monk, who is so good natured and such a trooper , has yet another huge health challenge. Any advice would be accepted. Dee

Dee Lancaster PA

Dee, I am sorry to hear about your Spinone. This is not a straightforward situation because it is complicated by the epilepsy. I know for sure that a rarer side effect of phenobarbital is anemia (and liver damage). Was this the cause? That is the question here. Your vets must do some diagnostics to get to the root cause in order to treat it correctly. It would be easy to say that it is the cause, but it isn't necessarily a direct relationship. Are your vets specialists or are they working with specialists? I think that would be very important at this point. An internal medicine specialist will be able to evaluate both of the serious conditions simultaneously and do the proper diagnostics and develop a treatment protocol. Non regeneration is a more serious form of anemia and can be caused by autoimmune damage to elements in a dog's bone marrow. However, it is true that tick disease can be a trigger to this. The meds can cause this kind of failure. And there are other health issues that can also lead to this failure. Suspecting and treating for an autoimmune component seems to be a good treatment right now but they are also probably searching out the root cause. It is a wise choice that they have dropped the phenobarbital for now and replaced it with levetiracetam. See the information below about a study that was done about this drug for dogs. http://www.morrisanimalfoundation.org/blog/category/dog/additional-therapeutic-option.html Additional Therapeutic Option for Controlling Seizures Study Results: "Primary, or idiopathic, epilepsy, a common disorder in dogs, is characterized by recurrent seizures with no known cause. Antiseizure medications are most often used to treat this disease; however, up to 30 percent of dogs are resistant to the medications and less than half of all epileptic dogs remain seizure-free without experiencing drug-related side effects. Scientists at North Carolina State University evaluated and validated a new antiepileptic drug, levetiracetam, as an add-on drug to be used in conjunction with today’s conventional treatment with phenobarbital and potassium bromide. Based on the results of the study, levetiracetam is a safe add-on therapy in epileptic dogs when treatment with phenobarbital and potassium bromide has failed to control seizures." Please let us know some of the results of the diagnostics that they have done so far. my best patrice

Patrice NYS

Dee, I'm sorry you are going through this. This site is a life saver literally ! Patrice is one of the people who have helped me most through my long haul with my dog Gunner. It is a battle everyday. Sometimes we get ahead of the game then have set backs, but I have found more information on here then I have gotten from most professionals. Not that I wouldn't run every single thing by your vet 1st ( thats very important) But people here have been through so much and have so much helpful information for you to present to your own vet. I will keep you and Monk in my prayers, with the right care and treatment from the beginning makes it all a whole lot easier ! Keep us posted and feel free to ask anything ... I sure did and still continue too :) Love , Jacki and Gunner xo

jacki jacki.fusion@yahoo.com

Dee - I was sorry to read about Monk - he has gone through so much for a young dog! And, I can imagine how stressful it is for you to deal with IMHA and epilepsy at the same time. I hope he is more stable today and the transition to Keppra is going well and keeping his seizures at bay. Have your doctors told you yet if they believe the PB triggered the anemia? I am asking b/c my dog has been in remission from IMHA for almost four years and about three months ago began having seizures frequently enough that we had to put him on Keppra. Everything I've read said that Keppra is used as an add-on medication (as the article Patrice posted states) but there appears to be a trend among specialists in Chicago to try Keppra alone in some cases. We don't know the cause of Murray's seizures - they suspect either brain disease or insulinoma. Keppra on its own has not done a good enough job controlling the seizures so they are talking about switching him to PB and, given his IMHA history, it concerned me to see that PB could be an IMHA trigger. Murray is quite a bit older than Monk and definitely could not handle a relapse now. I do hope Monk is getting better - clearly he is a fighter with all he has been through. Please keep us posted on how he is doing. Best Regards, Bonnie

Bonnie Chicago

Hi all, I had directed Dee to this forum the night before last, I know her from an Epileptic group. Sadly the group got this email early this morning...I am not sure if she will be back so I am going to post, I hope she doesn't mind. Julie Monk's PCV dropped to 19, and at around 10, to 17. Monk was destroying the donated blood cells and not regenerating any of his own. He didn't think he would survive the night and that a second transfusion given the same day would have only delayed the inevitable. So Monk, the brave, beautiful boy with such a kind and full heart, is out hunting with his buds forever seizure free... Sadly, he was only 4.5 yrs old. through my tears, D

Julie IL

Julie, please pass on our sincere condolences to Dee. Sometimes, no matter what we do it is just not meant to be.... Monk is running free, healthy and happy. May the good memories comfort Dee and her family, Brigitte

Brigitte BC Canada

Julie - Please pass my sympathies to Dee as well. Monk had so much to deal with at such a young age and I really feel for her and her family having to deal with IMHA on top of epilepsy (as either is so difficult on its own). Thank you for letting us know - Bonnie

Bonnie Chicago

Julie, I am so sorry to hear about this. It is very sad to hear about a young dog passing. Monk had some significant hurdles to overcome. Dee had done so much already to help him, but this must have been overwhelming for her. Please remind her that she did all she could, in fact even more, to ensure that Monk could survive. Sometimes we just cannot control all of it. Please extend my sympathy to her. Patrice

Patrice NYS

Thank you for your support and kind words. I guess it was a shock that Monk couldn't recover from this. About a year and a half ago, he was diagnosed with Anaplasmosis with associated pancytopenia but his PCV didn't get any lower than about 28 and he responded immediately to the treatment with no need for a transfusion. But his red cells really weren't affected all that much then. However, I suspect that he had some vaccine damage and perhaps bone marrow damage from the Anaplasmosis. Anyway, in a way, I suppose we are lucky that this wasn't a long, drawn out thing if he wasn't going to recover. I had hopes after the transfusion, but our vet said that a second one in 24 hours is rarely successful in the end. I was concerned too that his heart rate was through the roof when we went to say our last goodbyes. I'm glad he wasn't alone. Thanks again. Dee

Deirdre Lehman Lancaster PA

Dear Dee -- I am so sorry to read this thread and hear you lost your dear Monk to IMHA. As I was reading through, I was thinking that there is a Success Story about a dog with epilepsy who overcame IHMA on Joanne's Meisha's Hope website, but then I saw you had to make the decision to let Monk go. I feel for you -- at losing him to IMHA and at trying to fight this horrible disease when Monk already had epilepsy. We lost our beloved beagle, Wiley, to IMHA in May 2005, and she, too, had epilepsy. She also had hypothyroidism and Addison's Disease, and she had handled these so well, that, like you, I felt that it just couldn't be that she had to deal with another life-threatening illness. We tried to fight IMHA for a week, but we also decided to let her go. I see that you are in Lancaster. Our Wiley regarded Lancaster as her favorite place, after our neighborhood, because my in-laws live up there and she could roam off leash in their yard and sniff for bunnies in the woods. I'm sure that Monk had a wonderful life living with you and your family in Lancaster, and your memories of your wonderful life together will be a comfort to you. Please take care and let us know how you're doing.

Brenda Virginia

Dee, my heart breaks for you for your loss! Please accept my sincere condolences and sympathies for your loss. HUGS Johnny & Tessy

Johnny

Dee and Family Please accept my heartfelt condolences in the loss of your beloved Monk. Remember that that you and Monk will never be far apart and every time you think of Monk he is right there in your heart. May your fond memories of Monk help get you through these difficult times. RIP sweet Monk Cheryl & Ginger

Cheryl & Ginger Pinevile PA

This thread was discussed between 29/03/2011 and 03/04/2011

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