Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Feeling Guilt, need some advice/answers

My 9 yr old cocker/golden ret. Simba was diagnosed with AIHA last Saturday. I had no clue what this disease was when my vet explained his symptoms. Simba's count was 18 at the time of admittance for the usual treatment of steroids/pred etc. this was at 2:00 PM. He also was very jaundice (eyes, lips, gums etc.) By 5:30 pm the vet called to say that his diagnosis was corrected but felt that Simba should respond to the treatment and will keep me posted. The next morning at 10:00 am vet called and told me that Simba's count had dropped to 8 and he was not responsive to voice, not eating, drinking or able to walk. The vet suggested that I come visit with him and that we should decide on what we wanted to do (indicating wether or not to put him asleep) that Simba's prognosis was poor. My family and I go immediately to spend time with him. When we arrived, Simba was just lying on his side, did not respond to my voice, no movement at all except his eyes were open and moving rapidly back and forth. (a symptom the vet said worried him)? After spending about 1.5 hrs of crying, petting and talking to Simba the vet tech kept telling us that he had never seen a drop like his so low before (8) and his eye movements were a concern and that we should consider putting him to sleep. The tech said he thought that Simba would not make it through the night and that no one would be present for him. He continued to say that if it were his dog this is what he would do. This would be our last gift of love to Simba. The tech was just so sure Simba condition was not going to improve. Well we did NOT know anything about this disease and didn't have time to do any research. After 20 or so hours of treatment his count was at 8.9 and he didn't seem to be alert/responsive to anything and I couldn't image my Simba looking so bad we made the decision to have him put asleep. After extreme grieving, I did some research to find out that we could have possibly done a transfusion and that it usually takes 1-3 days before signs of improvement can occur with treatment. I'm devastated that we could have done more, especially when I specifically asked the tech during our visit if there was anything else we could do! I'm so sick with guilt that I was mislead into ending a precious life that maybe I didn't give enough time for the meds to work or given the opportunity to try a transfusion. The vet himself didn't say anything to me about further options. Although he did mention something a transfusion during the initial exam diagnosis. I'm so heart broken and angry, did I do the wrong thing to soon? Cindy

Cindy Shelley USA

Hi Cindy, I am so very sorry to hear about your precious boy Simba. Please accept my deepest condolences for your loss. While I am fortunate to have a surviving IMHA dog, I know exactly what you are going through. This disease probably has a less than 50% survival rate, it's an extremely difficult disease to treat and manage, even if the dog survives the initial crisis. The drugs have extreme side effects on our babies, and it's so hard to go through this with them. The other problem is that it is relatively rare (not that we think so, given how many new cases visit this forum), so a lot of vets do not have experience in treating this. You should not be blaming yourself for what happened to Simba - this disease strikes suddenly and is devastating in it's effects on our dogs. You did the right thing getting Simba to the vet and putting your trust in them. It is true that a blood transfusion should have been performed I cannot lie to you, but obviously your vet did not explore this option.... I am so sorry for this, I can't imagine how it makes you feel, but you CANNOT blame yourself. It can take longer than 1-3 days for the dog to respond to treatment. Prednisone is usually about a week, Dexamethasone given intravenously much quicker. What you did for Simba was out of love and a decision you made with the information you had at the time. It was the ultimate kind decision we have to make for our dogs. You were not to know about the blood transfusion, as you said you simply had no time to research this disease. I think you should talk with your vets, and suggest they educate themselves further on AIHA/IMHA and the treatment options available, and on the appropriate emergency care for a dog in IMHA crisis. This may save the life of another dog who presents with IMHA/AIHA at their clinic. Again, I am so very sorry for your loss, and hope you can let go of the guilt you are feeling as it is not your fault. Our sincere condolences, Sam & Millie.

Samantha Geelong

Dear Cindy, I am so unhappy to read your post. What an awful time you and your family have had. I know that everyone here is giving you a big hug right now. It is likely that your vet doesn't see this condition very often and might not have the kind of clinical experience to fully understand the treatments that are required in this severe of a case of AIHA. He may have known a good deal about what was happening, but lacked the knowledge to implement full emergency treatments. It is hard to guess what did happen. The situation was, though, very serious and Simba was doing very poorly. If you had tried to possibly move him to a specialty clinic, he might have passed in the car on the way. You were all there with him to help him across and I am sure that this was very important to him. We accept this serious responsibility as humans because we love our dogs so much. I think it is human nature to always look back and think that if only I did something a bit different, well things would have been better. I had a rocky time in my early adult years, coming from a home with alcoholism. When I finally broke free of that hold on my life, after much hard work, I decided I would never look back again and second guess myself. I promised I would make the best decision I could at the time with the information I had at hand. And then I would live with it. It has been very freeing to know that I can accept things without worry. There is so much to learn about this disease that after 3 years I am still studying something new nearly everyday. It would be impossible for you to fully understand what you needed to know in order to decide what action to take in just a few hours. In Simba's memory you can move forward, after your grieving, by promising to do something to help other owners whose dogs suddenly have this crisis. It can be as simple as coming to this forum and posting a kind note to an owner once a week. You can become more active and donate to Meisha's Hope for Joanne: http://www.cloudnet.com/~jdickson/bandanna.htm Take the time in the future to go back and talk with your vet privately. Attempt to heal the anger that you will have about this by expressing that to him and asking him for his help in understanding this. You may be surprised that he probably grieved that night also. I am sure that vets around the world decided to become a vet because they love animals and care deeply about helping them. Please accept my sincere condolences for your great loss patrice

Patrice NYS

Dear Cindy, I am so sorry to hear about Simba. IMHA is a difficult disease and, as Sam said, some vets do not have a lot of experience treating it. You made the best decision that you could with the information that you had at the time. You loved Simba very much and you did not let him suffer when you were told that he was not going to improve. This is the best that anyone can do for her dog. I hope that you will be able to let go of the guilt. Simba was aware of your love and good care - please remember it too. Take care of yourself, Aden

Aden Jerusalem

Cindy, Please accept my deepest sympathies on the loss of your most beloved Simba. Know that you did all you could at the time with the knowledge you had at that time. That is all any of us can ever do. Also know that Simba loved you so much he would not want you to be consumed with guilt and grief. When you feel up to it, I urge you to read the Loss & Grief page at the Meisha's Hope AIHA/IMHA Web site: http://www.cloudnet.com/~jdickson/loss.htm This page was written with input from those who have lost their dogs to AIHA/IMHA and contains many resources that will be very helpful you during these most very diffcult days. Know that you are in my thoughts and prayers.

Joanne MN

Dear Cindy Please accept my heartfelt condolences in the loss of your beloved Simba. Simba would not want you to second guess yourself in regards to his treatment as you did the very best you could for him during a difficult and confusing time, you also acted on the advice of a professional. I know that guilt is a natural part of grieving and in time you will realized that you made the best decision possible. I have walked in your shoes before in regards to having to say good-bye to my dogs way before we were ready to let them go and so have others on this forum and we know exactly how you feel, so know that you are not alone. Believe me over time this pain will lesson and your tears will be replaced by fond memories that you have of Simba and remember he will be with you always now as he is a part of your heart. I will be praying for strength for you and your family during this difficult time. Cheryl & Ginger

Cheryl & Ginger Pinevile Pa

Dear Sam & Millie, Patrice, Aden, Joanne, Cheryl & Ginger, Thank you all so much for your kind words of encouragement, prayers, and advice. You have enlightened my heavy heart today. This has been the hardest week for me and my family and after days of no sleep or eating myself, I now have some comfort in knowing I have hope to eventually get through my guilt and pain. I have decided to take your advice and meet with the vet and talk about my feelings of how this situation was handled, the lack of options I could have possibly taken, and express how they could handle the poor pet/family that is faced with this decision. I know this is going to take me some time to get through this grieving because everytime I come home and Simba is not there greeting me with his wagging tail, loving eyes and happy to see me excitement dance. Coming home everyday I am reminded of how much I love and miss him! I know I will be here on this site daily for support from all of you and to give my support to others as well. I will update everyone with the results of my conversation with the vet. You all are wonderful people, thank you so much. Cindy

Cindy USA

Cindy, I am very sorry for your loss. I understand your grief and frustration because I lost my girl to this awful disease too. It is very unfortunate that there are still a lot of Vets that consider this a rare and fatal disease. Yes, the odds are not always in our favor but a lot of dogs do make it. We tried everything to save our dog but we were not able to so. Even if you had the knowledge that you have since learned it does not mean that the outcome would have been different so please don't beat yourself up. The important thing is you were there for Simba and loved him enough to let him go even though it would break your heart to do so. I agree the coming home always seems to be the worst, but it does get easier and I hope the memories of all the great times with Simba will help lessen the pain you have now. I am glad you have decided to stay on the board I think it helped me a lot to heal. Take care Penny

Penny Lytle Creek Calif

Cindy I just would like to add that maybe the vet saw something that was not mentioned to you. You stated Simba was unresponsive and had rapid eye movement perhaps your vet thought that Simba might have had a very severe stroke and that is why additional treatment was not recommended, you may find out more details when you go back to talk to the vet when you are feeling better. Simba will be greeted by some terrific dogs at the rainbow bridge and they will be happy to show him the way and where the never ending supply of dog treats are kept. Again I am so sorry for your loss, and please remember to take care of yourself too. Cheryl & Ginger

Cheryl & Ginger Pineville Pa

I am so sorry to hear of your loss. Please know that even with the very best of care, and with less severe anemia, dogs die from IMHA. You can not predict what the future would have been even if you had known about treatment. Like all of us, you did the best you could at the time with the knowledge that you had. It's so hard, but he loved you and he knew you loved him. Ronda

Ronda Illinois

Cindy, I am so sorry to read your story. I am sorry for the loss of your beloved Simba. I feel your frustration and I understand your guilt completely. I had to make the devastating decision to put my 10 y/o border collie down 2.5 weeks ago. She had cancer. It was clear that she was slipping away and would not recover it was the only decision to make. I struggled with the guilt of having to make that decision. For the first couple of days it consumed me. Please know that you made the best choice you could have with the information you had at the time. You were all there with Simba. He knew you loved him. And I think that is all we can ask for when faced with these seriously ill dogs - that we are there with them when it happens. I know how much worse I would be feeling if Toqua had passed while I was not home. Alone. I hope that you and your family can find peace with all of this. The tears will soon be replaced with smiles and laughter when thinking of Simba. He was met by so many special angels. He is healthy and strong now. Mt deepest condolences to you and your family. Jessi

Jessi BC

Cindy, I am so sorry for your loss... I have lost two dogs to this nasty disease, both were older. Wolfie was a 15 1/2 old siberian husky mix...hers was brought on by an infection. She bravely battled for a month, but I had to make the decision to let her go, quality of life just wasn't there anymore. Aiyana was my 12 1/2 year old Golden, hers was vaccine induced and came on just 20 months after losing Wolfie. She also bravely battled for 2 months, and let me know it was time to let her go. I really think that as devastating as this disease is, it is much harder on the older dogs. Their chance of survival is even less than that of a younger dog...it's just too much for their senior bodies to handle. You did everything you did, out of love, and that can never be wrong. blessings, Julie

Julie IL

Cindy, I am so sorry for your loss. I lost my girl Macy in January of this year after a brave and brutal one month fight that included 3 transfusions. Yes, transfusions can often buy some time but they are just temporary fixes. I just don't want you to think that you missed the "cure" or anything like that for Simba. We even spent a thousand dollars on humangammaglobulin that was used in one of the transfusions. I have been where you are at as well with sadness and guilt. Please don't feel guilty or second guess yourself. This may sound corny or cheesy but I honestly feel that our dogs let us know when it is time and Simba let you know. On Macy's last day she had the same fluttering of the eyes that you describe. She had absesses all over her body and the vet said this is what was likely causing the fluttering. I've also read (I honestly don't remember where but I thought it was kind of true and comforting) that a dogs soul/spirit leaves the body 24 hours before "death". I don't know.....I am just really sorry for you and hope you do not put guilt on top of sadness, as hard as that may be. It is not fair to you Cindy. My heartfelt regards, Darren

Darren Long Beach

Cindy, I'm sorry to hear of your loss of precious Simba, you and your family are in my thoughts and prayers, I lost my precious Katie JoJo to this disease on July 24, 2009, she was diagnosed on July 20, 2009 and lost her battle on July 24, 2009. I felt guilty believing I could have done more for her but the night of the 24th I wrote down these words and they have helped alot..If you want put Simba's name... Again I'm so sorry for your loss Dear Mommie, I know how much you love & miss me. I love & miss you too, but God said it was time for me to be with my big sister Sassy, Uncle Cesear and him. He also said that you have a lot of love to give and I’m so happy Unkie Roy & Auntie Debbie brought my baby brother into your life. He’s a handsome little guy and I know he’s helping you heal from my sudden departure. Don’t worry Mommie I’m doing great, running and playing with everyone here at the bridge and I’m no longer in pain. Uncle Cesear & Sassy told me something and I believe them. They said that you will never stop loving and missing me and that you will tell and show Harley about his big sister Katie JoJo. Mommie I will always be with you and will always love & miss you, I’ll be here watching over you & Harley. Well mommie I have to go it’s snack time and we are having one of my favorite snacks FROSTY PAWS.. Oh and mommie please stop blaming yourself for letting me eat all the onions I wanted. It’s not your fault…God wanted me home with him. I love & miss you and Harley. Tell my baby brother that he looks great in my red harness… Love Always Your Precious Baby Girl Katie JoJo

Maria Lafayette

Dear Cindy -- Your letter was heartbreaking. First that you lost your dear Simba to this horrible disease, and then that you were torn up with guilt because you didn't get the information from the vet that you needed, so you could understand what Simba's treatment options were. I second what everyone here has said. Most of us who lost our dog to this disease -- including me -- never heard of it until it heartlessly struck our beloved dogs, and the IMHA moved so quickly that we never really had the time to comprehend all that we needed to know to help us to decide what to do. The grief, regardless of the specific circumstances, is intense and painful. But you did the best you could with the information you had available to you. And you made your decision based on the most important piece of information you had -- that Simba was deteriorating and the future was uncertain. You loved your boy so much that you were willing to let him go -- you would suffer so that he wouldn't suffer. I am glad that you were there with him, so that he shared his last moments on earth with you, and he passed enveloped in your love and care. Those last moments of love will provide you much comfort in the days, months, years ahead -- it has been that way for me and for others. Please stay with us on the forum. People here will understand your grief, and that understanding will also be a comfort. Please take care of yourself; please release yourself from guilt that is unnecessary. As someone already said, if Simba could speak to you, he would tell you he loved you and thank you for loving him so much to let him go.

Brenda VA

Please don't beat yourself up. I lost my puppy AT 9 MONTHS also making that heartbreaking decision to listen and take the vet's advice to put him to sleep. His PCV was also 8, I did previously give him a blood transfusion when his PCV was 8. It lasted about 5 weeks and he gradually dropped back to 8 again. No meds worked. Nothing helped. Sometimes no matter what you try nothing works. If I had given him a second blood transfusion at great cost I was told he still could die and his PCV would again drop. He was a verysick puppy making less thabn 0.1 new red blood cells. I too thought I should not have listened to the vet but now on reflection two years later I know I could never have saved him no matter what. It is so hard at the time they look ok but you know they aren't. My puppy had liver damage due to such low red cells affecting all his body. Sometimes the kindest thing you can do is to say goodbye knowing that they do not suffer anymore. kind regards. Julie (Australia)

julie australia

Cindy...I am so sorry to hear of you loss. Please don't beat yourself up as you my baby boy Killian's condition was extremely rapid just as with your baby Simba. Your description of Simba's condition is identical to how Killian was when we took him. We did the transfusion and everything else that the vet suggested. We too were faced with the decision to put our beloved pet to sleep. It was one of the most difficult decisions we have ever made. We still wonder if we would have kept going it the outcome would have been different. We are the ones that still feel the pain. My boy has been gone 2 1/2 months and I still don't go through a day without missing him. But in my heart I know your Simba, Killian and all the others taken by this terrible decease are running free. Please find comfort in this forum...as it helped me tremendously. God bless.

Maryann MI*

This thread was discussed between 09/07/2010 and 15/07/2010

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