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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - For Johnny or Patrice
| Richard Ford told me to get in touch with you about my 7 year old rescued dalmatian who has IMHA. I have tried to post once but Richard said that it might not come up because of the drug names. I have taken them all out now. This is Lucy's case... We are a very active couple we compete in Rally and Obedience and she goes everywhere with me. She is my only child. Tuesday July 19th I knew something was wrong she didn't eat her breakfast and didn't want any treats. When I got home from work she did not come to greet me so I took her to my local vet. They started her right away on Pred and Doxy and something for her stomach. Took her home that night and back to vet the next morning where they deciced to do her first blood transfusion. She was sent home on fluids and meds that night but I knew her breating wasn't right so I took her to our emergency vet where she spent the night. Thursday morning I picked her up from ECvets and carried her to my vet where they wanted to do another transfusion. I told them I wanted to take her to the NC state vet school where I know they can do so much more. At vet school she couldn't hardly walk in. She had blood in her urine her PCV was 11%. They took her right back and stared matching her for a transfusion. Every transfusion brought her count up but went right back down. She had transfusions on July 20th, 21, 22, 24, 27. She developed blood clots in her lungs on the 25th and was moved to the oxygen cage. She stayed there for 3 days but then got a blood clot in her neck where they had the IV. She developed lots of Edema in her face and front right leg. They moved it to her right back leg and the same thing happened. They had her on Heparin so they added 1/4 of an Aspirin with Plav. The edema caused so much pain she was put on pain meds. The edema did go down but she still has some in her back and front right legs now. Lucy came home on Aug. 1st and I had such a rough night. Just so worred about her. My brother-in-law was here for a couple of days and he's a vet so he helped me get throught the first few nights. By Wed. Aug. 3rd she was bleed very large clots from her rectum. The dr from the vet school took her off the plav and said this could happen until it got out of her system. I was in a panic and carred her to the ECvets again. Where that vet told me the same thing. Her last blood test was on the 9th with my local vet. Her PCV was at 27.8% which is the highest she's been but my vet is really worried about her liver count which is high. I think in the 600. The dr at vet school gets all results and is not to worried about her liver. She said with these cases she doesnt worry until it get in the thousands. Lucy is currently on 7 meds. I watch everything she does Her poops, pees, water she drinks, amd when she just moves from room to room. I check her gums about 4-5 times a day. I get her up and walking just a little just down the street and around our yard. I've made her meals into 4 small meals with 2 veggie snacks (greenbeans or carrots) between. We go back on the 22 for more blood work. Thanks for the support and reading my long story. I just want to make sure I'm doing thing right. If you have any suggestions I am open to them. Thank You Dana and Lucy |
| Dana NC |
| Dana, I am sorry to hear about the very complicated problems you have had getting treatment for Lucy. It sounds like she is more stable now at 27% PCV. This edema was probably a result of too many transfusions done very close together. That is a lot of fluid to add to the body in such a short time. The body has a hard time processing it all into the proper places in such a hurry so it ends up going into interstitial tissues. Usually the most common place is the abdomen. But limbs are another location where fluids will accumulate. Movement (using large muscles) is one way that we encourage fluids to move back into the venous system and return to the heart. Then they can be processed by the kidneys for removal. Being sick means that Lucy is not moving around a lot. But these little walks will help immensely as long as they are approved by the vet. I see that she was prescribed Doxycycline. This is usually done in cases where there is a suspected tick disease. If they have not done testing for tick diseases and have been continuing the doxy with no apparent benefits then it is time to either test fully for tick disease or revisit whether this drug should be continued. It is very hard on a dog's system and can cause inappetance. I assume she is still on prednisone? High doses (which are necessary right now) will cause a variety of side effects that can seem worse than the disease itself. This is called Iatrogenic Cushings Disease or a condition caused by the medication. One side effect is that the liver, while processing the prednisone, will spill enzymes into the blood. These liver enzyme levels can become very very high. Your one vet is correct, they can rise into the thousands. My dog had one value, ALK PHOS, that was over 8600. Yes, you don't necessarily need to worry about them this high because they will drop when you eventually withdraw the prednisone, if there was no prior liver disease. However, the liver can become inflamed during this time and make Lucy very uncomfortable. Keep small fans blowing around the house and put down soft blankets in front of them. She will not want to lie on soft places like couches etc. Using a special liver sparing diet is very beneficial to allow the liver to rest as much as possible during this time. It consists mostly of using some type of cooked white fish, some cooked vegetables like green beans, squash etc and some type of cooked starch like potatoes. Mush them all up well. It is not a nutritionally complete diet, but short term it will be fine. Supplement with something similar to Pet Tinic for necessary vitamins and minerals. If this were me I would continue to stay in contact with the specialist at the veterinary college. Your local vet may have not treated such a severe case of AIHA in a long time and may not be familiar with the most recent clinical treatment protocols that the specialist uses. You can certainly continue to see your regular vet for routine things like blood tests and physical exams as long as the specialist is getting this information. I will reinforce that you need to be continuing to use some form of stomach protection like pepcid to reduce the risk of prednisone causing stomach ulcers. In addition, I would advise using sulcrafate to heal any possible ulcers that may have formed. It is a paste-like substance that coats the mucosa of the gastrointestinal tract. This should not be given within two hours on either side of foods and medicine as it will inhibit absorption. Giving it during an overnight fast is best. If there is very little continued upward movement on the PCV after several weeks I would ask the specialist about adding another immunosuppressant drug in addition to the prednisone. This would be done so that the dosage of prednisone can be lowered slowly. This will reduce those awful side effects. One drug that I used and is quite successful is cyclosporine. Please do not adjust the prednisone dosage without the knowledge or help of the specialist. This is very important. Right now, she seems stable. Take a deep breath and relax. Take another deep breath. You are doing fine. Try to stay on a routine with Lucy and not let her see you get upset, she will see this and be stressed out more. my best patrice |
| Patrice NYS |
This thread was discussed on 15/08/2011
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