Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - For Patrice

Thanks, Patrice. I will show the vet specialist the Hemopet website tomorrow. However, she will probably dismiss it as she does everything else, i.e., Dr. Dodds protocol for IMHA; Standard Process blood/bone marrow building supplements, etc. Perhaps our regular vet would be more open to these than the specialist. Darcy, like Chance, was diagnosed with non-regenerative anemia. When she was first diagnosed six weeks ago, her PCV was 20% and stayed there for two weeks, then it was down to 13% a week later when she went to the specialist (we had to wait one week before the specialist could see us). That was when she had a transfusion. After the transfusion, PCV was 36%. One week later it was 19%; eight days after that 15%. She will probably need another transfusion when we go in tomorrow morning. Her gums and inside of ears are pale and lately her eyes have been tearing, which I had attributed to allergies. Now I read that eye discharge is an indicator of folic acid deficiency and that folic acid and/or B12 deficiencies can contribute to anemia. Darcy has been on 30mg. of prednisone for 2-1/2 weeks and on azathioprine for 1-1/2 weeks. Prior to that, the regular vet teated her with Baytril for a UTI and Doxycycline for possible parasite/tick bites. I believe you said in an earlier post that Chance was on cyclosporine. I know yours has been a long process. What meds is Chance on now and how is he doing?

Karen NC

Hi Karen: don't dismiss the specialist too quickly. Was it you who was no thrilled with their vet? I can't remember. What type of specialist is this doctor?

Courtney SLO

Courtney, Yes, I'm the one. She is an internal specialist. I hope she knows what she's doing. She has a bad bedside manner, but maybe that's her way of dealing with very sick animals --- not getting attached or showing any emotion. One of the things I don't like about her is that I have to make her answer my questions. She doesn't explain anything unless I push her to do so. The only thing she has told me about Darcy's condition is that it is non-regenerative anemia and that it is definitely not AIHA. She says that it could be immune system related, but she doesn't know for sure. She is treating it as if it is with prednisone and azapriothine. She told me last week that some people choose to take their pets off the meds to see if their bone marrow will start regenerating on its on. She doesn't offer any advice, just gives me some options and I have to make the decisions on my own as to what is best for my dog. My husband believes that Darcy should be treated with antibiotics. The reason for this is that when her anemic condition started she was immediately put on doxycycline. During the period that she was on the antibiotic, her PCV level remained at 20%. When she was taken off of the antibiotic it plummeted to 13%. Last week I asked the specialist if there could be a correlation between the antibiotic and the stable PCV and she said no. I am doing everything I know to do for Darcy. My work and pretty much all other areas of my life are on hold. I am so frustrated and depressed. But, I have to remind myself that it's not about me --- it's about Darcy and what's best for her.

Karen NC

karen, im not familiar with ur specfic situation but if your vet is 'dismissing' dr. dodds then i think its time for you to find a new specialist wishing darcy well,

josh california

If you can find another specialist, or even a competent generalist vet, do go see them. Trying to deal with these kind of diseases with an uncooperative vet adds stress to you and the dog. After 6 weeks of seeing different vets, including an internal med specialist, we are finally making some progress now that we can take Ethel back to her original specialist from the ER vet. He listens to us and doesn't just dismiss any alternate ideas immediately as the other specialist did. Ethel had been having very goopy eyes. It started two days before her IMHA crisis, and for six weeks after we had been giving her OptImmune (cyclosporine 0.2%) in her eyes twice daily with no results. The second specialist just said to keep doing it the rest of her life and that "it should be working by now", with no other real concern (but she made sure to run another Schirmer test to bill us for). After another week of no results, her original specialist was willing to actually LOOK at her eyes and prescribed a neomycin/polymyxin/dexamethasone eye drop for two weeks that cleared her eyes up the NEXT DAY, and even took a culture. Dismissive vets treat us and our pets as nothing more than a revenue stream -- and we don't have to put up with it! If their bedside manner is at all discomforting to you, your family, or your pet, don't go back there. This specialist refused to give us results other than "she's doing fine", waited until the last minute to fax test results over to the ER vet prior to a three day weekend, mixed up test results we watched her perform (Schirmer), and has made no attempt to follow up after telling us Ethel was so Cushingoid her pred needed to be cut by 50% immediately (oh, wait, not immediately, only after the test results come in, after we questioned the immediacy, then promised results tomorrow, then never called back, etc...) Our ill dogs do not need to subsidize miserable business practices by borderline competent vets practicing little more than witchcraft with 15 year old treatment protocols. The ER vet is half as expensive, hundreds of times more competent, actually calls us back, is willing to listen to our ideas, and most importantly, is actually helping our dog get better instead of nagging us about the next time they can bill us to shoot her up with vaccines.

Brian Vermont

Yea, you should probably move on. It's one thing for them to not tell you what you want to hear, it;s another not to listen. The antibiotics truly probably have nothing to do with it. But, the doxy should have been given for 3 weeks minimum, I don't recall if it was or not. You and I have been treating this for about the same amount of time. I completely understand as I know everyone here does. I had to stop much of my regular routie so that the dogs can be with me all of the time now. Not that I would change that at all, Lola is truly the closest thing to a child I will ever have, but it is easy to get disillusioned and depressed. I am lucky to live where I do and work where I do becasue it gives me access to vets I wouldn't normally have. Even with all of that, I find myself drifting off into uncontrollable states of sadness. Feel free to email me privately if you ever want to chat or even correspond regularly for support of each other.

Courtney SLO

Karen, I am sorry your specialist is making this difficult for you. I can assure you that Dr. Dodds is considered an expert in this field by many of her peers. However, as I have said here before, she has had a difficult battle over the years with the established veterinarian field. There will always be veterinarians and others in the field that will consider her at some level a "quack." This happens in human medicine as well. While I was at that seminar with her I asked her how this has affected her ability to bring about change. She is very quick to point out that she is fully aware that these attitudes still linger but that it has never stopped her from doing what she wanted to do. She approaches her work with scientific discipline and cites references to back up what she talks about. She has had a dream for a long time to provide safe, readily available blood all over the world. She is about to move into a new $3.5m facility, which she and her husband put up their house for (hemopet is a not for profit organization), that will help her begin to realize this. Soon she hopes to have satellites all over the world for blood banks. In the future look for all testing results to be available on line to vets and *the owners.* She talked at length about the Rabies Challenge. The time being put into this challenge is mostly volunteer. They are performing the study with strict scientific guidelines so there will be no question about the results. Medical (and veterinary) universities teach in a very disciplined way. But I believe that they expect students not to challenge the textbooks or the professors. When someone steps outside of the box and begins to think on their own, there will be a lot of criticism. Your job, as consumers of veterinary medicine, is to be as knowledgeable of the services that your vets are providing to you. I know it is easy to want to criticize your vets for being stubborn or stand offish. Their jobs are becoming more difficult. It's not that the medicine hasn't kept up, it has, but there are still pet owners that blanch when a vet suggests an expensive series of tests or proposes an expensive surgery. I think they get tired of hearing "we don't want to spend that much money, is there something else you can do?" Last spring, after a particularly disturbing night with Chance not being able to get up off the ground and walk inside, I emailed my good friend Joan. She has owned many more Giant Schnauzers than I will ever have and is a real expert. She told me to call Dr. Dodds. I did not know what to expect. To be honest, I thought she wouldn't have the time of day for me. Instead she picked up the phone from the answering machine and began asking me all kinds of questions about the lab results, the treatments we were on etc. She fired off a bunch of instructions for me of tests to have done, medicines to use and asked me to fax her all my test results. She continued to stay with me through the whole summer and into the fall via email. She did indeed save Chance's life. And when she was here 2 weeks ago, she was gracious enough to let us bring Chance to her so she could lay her hands on him and we could get a picture of them together. Dr. Dodds talked about the flood of emails she gets. I can assure you she reads all of them and is motivated to help all of these desperate owners. What I would ask all of you is to be mindful of how long these emails are. She admitted she gets frustrated when she sees long run-on paragraphs that she must wade through. She knows that owners are upset, but wishes they would try to be more concise (my words here) when writing her. She needs to know the facts, things like test results, med protocols etc. Chance is doing great. He's an old dog for a Giant Schnauzer and has been through a great deal in the last year and a half. He still has some weakness in his back legs, but manages to get around quite well. When he's feeling good, he can manage a 2-3 hour walk if he gets plenty of rest during it. Certainly not with the gung ho level of energy that he used to be able to manage. Some days when it is hot, we can barely make it around the block. We were faced with two dilemmas earlier this year. The first was that Chance can never have his allergy shots again. So what to do about his allergies? And the second was that he was due for his mandatory rabies vaccination in May. I had lengthy conversations with the specialist and my 3 local vets. I discussed it with Dr. Dodds. I had his titer done for rabies. I went on line and did a lot of research about the legal issues for not getting a rabies vaccination (in NYS this is very serious, esp since we live in an active rabies area). I asked some experts on one of the dog lists I am on. I spent over a month weighing everything before deciding what to do. My vet had said she would be more comfortable giving the shot if Chance was on some kind of immunosuppressive medication. I researched that too. While there isn't much information about this directly, there is mention in the Atopica literature that advises not to give vaccinations when you are using this drug. So why is that? Well, the plain simple truth is that when you are suppressing the t-lymphocytes, they have less ability to mount a reaction to the vaccine! So, thus immunity isn't activated very well. I also found this information when looking at human medicine dealing with folks who have had organ transplantation and are taking cyclosporine. They advise not to vaccinate these folks while they are on this drug. So we toyed with the idea of putting Chance back on Atopica for his allergies and then giving him the rabies vac. Then I remembered that when he was little and we were working with the vet dermatologist, she prescribed a drug called Temaril-P for his allergies. We needed to treat him for a period of time while we were waiting for the allergy shots to start working. This drug was very effective in reducing his allergic symptoms significantly. The down side at that time was that this drug contains a small dose of prednisolone as one ingredient. But now I saw that as a benefit. We could treat his allergies effectively and also suppress the immune system enough to safely give him the rabies vac. So that is what we did. Chance now gets 1 Temaril-P tab eod and .5 tab on the alternating days. One tab contains 2mg of prednisolone (along with trimeprazine). That's all he gets, with the exception of his twice daily thyroid meds: soloxine. He had his rabies vaccination in May with no problems at all (and is now legal to "be at large in the community"). His allergies have been under control all season. When we talked with Dr. Dodds two weeks ago, she reminded us that dogs like Chance, who had such a severe case of non regenerative anemia, should always be on some dose of prednisone the rest of their life. That is where we are now. What will the future bring? Well, I just hold my breath and hope that all goes well. This disease is insidious and can reoccur abruptly with no warning. I just take one day at a time. my best, patrice

Patrice NYS

I heartily second (third & fourth) Patrice's description of Dr. Dodds. I have also met her in a couple of seminars and have emailed and had appts with her if I have a stubborn or complex problem with my AIHA/ITP girl, Sierra. She is beyond gracious with her knowledge. She has always responded to emails. Not just on AIHA/IMHA, but also cancer and was instrumental in helping my friend's husky, Jack, while he battled anal gland carcinoma and worked closely with Dr. Goldstein on Jack's treatment. He lived very well, and exceeded traditional vets expectation by 2 years and up till the very end, was happy and living very well and actively - thanks to Dr's Goldstein & Dodds. Secondly, Dr. Dodds does not charge anything for her email responses and I don't know of any vet or human doctor that does that for people who are not their patients/clients. If I email her, I try to send in a donation also, even at times when it was small donation. Did your vet (specialist or general) run standard tick panels? Pre-emptive treatment with doxycycline (treatment for erlichia) seems to be fairly standard here when when there is a suspicion of IMHA/AIHA. The tick panels help to rule in or out tick borne disease (erlichia, babesia). BTW, there are tests that can be run for b-12 and folic acid deficiency. If you really suspect that, ask for the tests. It's any easy thing to assume, but if Darcy has been eating a decent kibble or canned diet or homemade/raw diet, it would be a pretty unusual occurence unless there is an absorption problem (malabsorption, SIBO, ...). Patrice, I'm glad that you found a way to work with the rabies vax for Chance and that he had no problems. I decided long ago, no matter what, Sierra would not get any more vax, and she hasn't. Of course, this is a highly personal decision each of us has to make.

Ronda So Cal

I had to take Darcy in at 5:00 this morning for a transfusion. She had a scheduled 10:45 appointment, but I got scared when her breathing became labored, so opted to go in for emergency. Her PCV had come down in five days from 15% to 8%. After the transfusion she is at 38%. She's very worn out from the experience, drinking lots of water, but not eating. Hopefully she'll be feeling much better tomorrow. I emailed Dr. Dodds today with Darcy's history and received a quick response. She said that AIHA cannot be ruled out, but she thinks it could be a thyroid related problem because autoimmune thyroiditis is prevalent in beagles. She also said that in the early stages of the destructive process classical signs of hypothyroidism will not be seen. These are the signs the internists looked for and didn't see, so she dismissed a thyroid problem. Dr. Dodd suggested getting my regular vet to send her a sample of separated serum for a thyroid antibody profile and/or just starting her on thyroxine arbitrarily to stimulate her bone marrow to make new RBCs (this alone with the meds she is currently taking and a gastrointestinal sedative and PetTinic). She gave the exact dosage as well as some helpful email attachments. I have passed along this info to my vet, who has heard of Dr. Dodds. I feel the internist would dismiss it. My vet believes we should go ahead with the bone marrow test since it might show something like cancer. I guess if that's the case, then we'll have to take a whole new approach to treatment. A bone marrow test means another trip to the dreaded specialist. Any thoughts from anyone on this? If we do it, it will have to be done when her PCV is up. Thanks to all who recommended Dr. Dodds. I feel more hopeful than I did yesterday. Karen

Karen NC

Karen, I don't know if this helps or not, but my dog Mac was diagnosed with non-regen IMHA in late May, and only recently--last week---did his retic counts suggest that he was starting to regenerate. He has been on 50mg of pred since June, and in mid August azathioprine was started. I would say it took a full month for us to see results from that last drug. But holy cow--is his body responding now! He's running around here with a PCV of 35 and a retic count of 4.1 really strutting his stuff. I'm finally feeling hopeful. Maybe Darcy just needs a little more time? Patrice sent me a link to Dr. Dodd's IMHA protocol for treatment of this awful disease, and my vet sat down and went over it with me. She was doing everything that Dr Dodds suggested except for the thyroid panel, which we then ordered. I'll get results today or tomorrow and I will post them. I know your frustration and despair---I would be lost without this forum! Jane

Jane MN

Karen -- Dealing with IMHA is demoralizing enough; having to deal simultaneously with a pessimistic or cold vet is nearly impossible. If this vet isn't acting in Darcy's best interests and makes you uncomfortable, then you should find another vet. Everyone on this forum will advise that a key element of success against IMHA is strong partnership between the patient's family and the vets. We went to a specialty vet practice in Springfield, VA for our Wiley -- at her regular vet's recommendation -- and the vet who was on duty at the time of admission was terrible. She didn't give us much hope, and the next day, she called to advise that we should come down and say goodbye. We went immediately, and things weren't so bad. After crying my eyes out, I called Wiley's regular vet, and she was a consultant the rest of the time, trying to deal with this vet. Fortunately, after three days, she cycled out and another cycled in who was wonderful. He was a runner up for the Meisha's Hope Award the first year. Good luck to you and to Darcy.

Brenda VA

This thread was discussed between 08/09/2008 and 12/09/2008

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