Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Gill & Phoebe need help

Hi everyone I must apologise most profusely for not posting on the site, I have from time to time been checking in on everyone's progress but due to family commitments have been unable to find the time to write. A quick update on Phoebe. She has been doing great since her last trip to Royal Dick for her blood clot, her PCV at the last count was 45 - my little miracle - and she has been playing with her toys and eating like a horse. Then last weekend I noticed her shaking a lot and her breathing became shallow totally out of the blue - phoned royal dick in edinburgh and they thought another possible blood clot so had to go to emergency vet here. After many tests nothing could be found with her bloods (my vet thought it might be Addison's and increased her prednisolone which I was not very happy about as we were down to three quarters a day). Then on Wednesday Phoebe seemed to deteriorate further so I took her back to see my vet. There was a locum vet who was excellent and said she thought Phoebe might have a bladder stone and arranged a scan the next day. Sure enough stones in her bladder and her uretha were found. My vet arranged for her to go to Royal Dick for specialist treatment due to her AIHA. They were astounded at how well she looked despite the kidney stones and immediately put her onto intraveneous drip and a special diet. they said the would do a further scan today to find out if the fluids and diet had changed anything. Now - the reason I need your expertise/help/advice/anything!!! Just spoke with her vet Alisdair and he has explained that her scan today showed that although the stones have not increased they have not moved. She also has 'lumps' on her adrenal glands and enlarged liver due to preds. Surgery, he has said, is out of the question. The treatment available to her is firstly a medication that has side effects that will raise her blood pressure and cause all sorts of problems due to her adrenal glands and give off hormones which will harm her and this medication has only anecdotal results - no papers have been written on the results, the second course is a medication with fewer side effects but it will lower her blood pressure and cause nausea. He recommends the latter. So you can see we are in between a rock and a hard place. She has really perked up these last few months whilst I have been looking after my Mum following surgery and a real comfort to me. Alisdar is ringing me tomorrow to get my decision (some decision!!!!) as to what course to follow. That is where you my dear friends come in - does anyone have any experience of their beloved friends having kidney stones with AIHA and what treatment was used, and was this treatment successful. I understand in the USA the stones could be lasered, but, according to Alisdair we are about 10 years away from treating our canines with lasers here in the UK. I know that ultimately, with all the other problems that have appeared on the scans that our time with Phoebe is limited, however, I really want to give her the best possible chance to get home and have a few more months with her - god willing. Hope you can help any glimmer will most welcome! Kindest Regards Gill and Phoebe xx

gill morrison uk

Gill, I am so sorry to hear about what has happened to Phoebe. I think I can give you some help so you will understand this better and will be able to make an informed decision. The most important thing you need to know right now is what KIND of stones these are. Since Phoebe is a female I am suspicious that these are Struvite bladder stones. Most cases of stones are this. The other form of canine bladder stones are called Oxalate. It is important for you to read some about this so you know the difference between the two and the kind of (successful) treatments that are recommended, at least in the US. At the risk of getting booted from posting (vetnet does not do well with links to marvistavet). Please read this webpage carefully: http://www.marvistavet.com/html/canine_struvite_bladder_stones.html Within that page is a link to a webpage for Oxalate stones. Read that also with the knowledge that these are rare in female dogs. Here is a link to a drug that I believe that your doctor has discussed with you: http://marvistavet.com/html/body_allopurinol.html I hope this will help you. Once you have read this information, if you have more questions, post here and I will try to help. my best patrice

Patrice NYS

Sorry to hear about Phoebe's newest hurdle Gill. Hopefully you'll figure out the right coarse of action and that the stones are not oxalate. Is she peeing alright? Keeping her on a VERY STRICT diet is important so whichever diet they give her it's important to only feed this. This diet will depend on the type of stone of coarse. I was always under the impresion that it could take up to 1-3 months to dissolve stones....maybe I'm wrong. I find it weird that they'ld up the pred because the "thought" it might be addisons. With her pcv as high as it is I'ld be getting her to a maintenance dose of meds sooner than later. Hope to hear from you soon. Give Phoebe some hugs from Tessy & I. Johnny & Tessy

Johnny

Dear Patrice and Johnny Thank you so much for your prompt response. Patrice As usual a font of all knowledge. I have read the information and followed all the links to marvistavet and have printed off the information so I can discuss which stone type Phoebe has. As she has not had any symptoms other than shaking last weekend (no sign of any urine infections at all) I am at a loss as to which type this is struvite or oxalalate. If the only way to tell is a stone sample then I feel all is lost as Alisdair has said the surgeons at Royal Dick do not want to operate on Phoebe with all the complications she has. I read about Allopurinol and it said this reacts with Cyclophosphamide. Is this in anyway connected to cyclosporine (atopica)? Phoebe is taking 50mg of atopica per day. I am at my wits end that she will not return from Edinburgh and will spend another sleepless night surfing the www to find any information I can. Does anyone know of any animal who has taken Allopurinol for kidney stones and what the results were? Johnny I think due to the breathing and shaking my vet assumed addisons and recommendation is to increase the preds (but all the time I felt this was against my better judgement - just a gut reaction) and it turns out I was right. Alisdair has reduced Phoebe's preds since she returned to Royal Dick. I have to inform him tomorrow as to what course of action to take but, in all honesty, I really do not know what to say - I do not know what type of stone she has and therefore do not know what to do!!! Thank you for your kind words and Patrice for your (yet again) invaluable advice and assistance. I will pass all this information on to Alisdair tomorrow. Many many thanks and kindest regards Gill and Phoebe xx

gill uk

Wouldn't an urinalysis help to tell what kind of stones she'ld have? Johnny & Tessy

Johnny

Hi Johnny & Tessy that is exactly what I am going to ask Alisdair tomorrow - I would have thought that they are quite thorough in their investigations but I am sure he told me on the phone tonight that they could not be 100% sure of the type of stone (at that point I did not have Patrice's information re: type of stone) Phoebe has so I guess I shall just have to bite the bullet and let her go on the medication, but I really do not want her to suffer after she has been doing so well. Also, like you Johnny I thought it would take some time for the stones to dissolve, I guess as they do not know what type they are they do not know for certain whether they will dissolve with diet/flushing or not!! Nothing is ever straight forward!! Kind regards Gill & Phoebe

gill uk

prayers and thoughts for you and Phoebe, I know you will get to the bottom of it and that Phoebe will get through this bump. melissa and tiggs

melissa slc

Hi Gill, I am sorry to hear Phoebe has kidney stones. Did they give her anything for pain? I bet that is what is causing her breathing and shaking issues. Kidney stones are extremely painful. Does she seem to be hunching her back? Not sure what they could do for your girl but my father is into his 5 month of passing stones. He still has over 100 in his one kidney. They are treating him with shock wave lithotripsy. Just recently they inserted a stent to help him pass the larger stones more easily. Is that a possible option for our canines? That I am not sure about. Some stones do pass on their own but if they are too large and get stuck in the ureter, that can cause kidney failure if something isnt done to pass the stones. My dad's stones are calcium oxalate stones. They determined his type by having him "catch" them in a strainer-like thing. I'm sorry as I am sure this wasnt much help but I can tell you that they are extremely painful and the first thing they should do is put Phoebe on a heavy duty painkiller. I hope you can get some answers as to what can be done for your girl. Teresa

Teresa va

Gill - I haven't had to deal with kidney stones but I do know a bit of what you are going through - caring for a parent while taking care of Phoebe at the same time and having to take multiple things into account as you decide what is best for her - a history of AIHA just makes other conditions more complicated. I know how difficult that can be when you are trying to figure out what to do. So, if you are spending your night searching the web, know that you have friends on the other side of the pond who are thinking of you and Phoebe and hoping for a good outcome. I've been part of this forum for over two years and it has struck me that no two cases of AIHA are the same but one thing we have in common is a deep love for our dogs and a deep commitment to do what's best for them. So, please know that many of us are here with you tonight. Bonnie

Bonnie Chicago

Gill -- so sorry to hear that Phoebe is having some additional challenges with these stones. It sounds as if Patrice and Johnny have given some help, and now you have to talk to Alisdar tomorrow. I can't really help much other than to send best wishes to you and Phoebe and to keep you in my prayers. I am hoping that you and Alisdar can decide on a treatment that will work for her. I do agree with the posting that part of her symptoms might just be expressions of the pain she's experiencing. Our sweet dogs are so limited in what they can tell us about their medical issues! Please take care and know we're all pulling for you!

Brenda VA

Gill, I am so sorry to hear of Phoebe's new problems. It just doesn't seem fair to add on anything new. Phoebe has seen tougher challenges and met them with your help so hopefully she can get through this and back on the road to recovery. Keeping you both in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Hi everyone Just a quick update on Phoebe - they have put her on medication called Prazosin which will hopefully open up her uretha and perhaps help her to pass the stone, but the meds have quite a few side effects so here's hoping she's ok. Thank you so much for all your kind thoughts and words. Kind regards Gill & Phoebe xx

gill uk

Gill, you're doing a great job with Phoebe. By the sounds of htings she's in very good hands. Keep a good eye on her and give her some hugs for me. Prayers and positive vibes for Phoebe from Johnny & Tessy

Johnny

I don't have anything I can offer other than send some good vibes yours and phoebes way. One thing I have found is the resilience of our pups is beyond belief and I hope she fights her way through this as they seem to be able to do time and time again. Kath

Kath scotland

This thread was discussed between 23/11/2009 and 26/11/2009

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