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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Heart disease and IMHA
| My dog has both IMHA and heart disease (mitral valve insufficiency). She was hit with IMHA on January 9th and had a blood transfusion - she had both low platelets and low rbc's. She started to fill up with fluid repeatedly and eventually was diagnosed with heart disease which was made worse by the IMHA and the pred. It has been two months and her heart disease is worsening to the point where I am afraid it will kill her before the IMHA does. Her PCV has held steady at 32 but she continues to fill up with fluid and has to be drained on a weekly basis as there is over a liter of fluid in her belly each time. She is on 3 times a day furosemide, and enalapril once a day. she gets pred 20 mg a day and azithioprine 50mg once a day. The vet told me last week she has pulmonary hypertension and her left sided heart disease is causing right sided failure? Not sure what that means. The bottom line is that he started her on vetmedin last wednesday and so far it is not helping. it may even be making her nauseous. is anyone else's dog on vetmedin and do you know how long it takes to work? Her appetite has slowly decreased to the point that now it is a struggle to get her to eat anything at all. I am at my wit's end, desperate to get pills in her. I am wondering if there is any hope at this point to turn her around and get her heart disease under control. The vet thinks lowering the pred is key. Sorry for the longish post but wanted to fully explain the situation. |
| Cheryl New York |
| Cheryl, I am so sorry to hear about your girl. This is doubly difficult for you right now to treat. My dog Chance had autoimmune non-regenerative anemia in 2007 but recovered very well from that. It wasn't until spring of 2009 that he was diagnosed with a minor mitral valve insufficiency. My vet specialist immediately put him on low dose therapy which included: vetmedin, lasix (furosemide) and benazapril. Later in the year they prescribed digoxin for an arrhythmia. The meds, at low doses, were sufficient to keep him relatively active. Late last year, he began to have more trouble and by the end of the year was losing his appetite and he lost some weight. A revisit with the specialist early in this year showed that he was experiencing a lower heart output level. The specialist said that the doses of his meds were fine for a year ago, but now were too low. Some minor adjustments of those and the addition of spironolactone have improved him considerably. Vetmedin is a new class of veterinary heart medication. In fact it is revolutionary. Dogs taking this drug will have their lives extended significantly. It should be the *first drug* to be prescribed when a dog is diagnosed with a heart condition. I am sorry that this did not happen in your case. The other drugs, lasix and spironolactone, are diuretics that help the body eliminate excess fluid, most esp around the heart and from the lung. As the heart fails to do its job well, fluid "seeps" out of the vessels around these areas. There isn't enough "push" to get all the blood out to the body, so some pools in that area. Benazapril and enalapril are ACE inhibitors that help relax blood vessels and in general help the heart work more efficiently by removing some of the resistance from these vessels. Digoxin is a special class of drug that comes from the plant foxglove. Its job is to steady the heart rate, keep it more even, and slow it down a bit. This drug is particularly tricky to dose and for that reason many vets are reluctant to prescribe it. Just a little too much in a dose has the potential to make someone very sick. Most of these drugs come from human medicine and are prescribed "off label" for veterinary medicine. The only drug that is specifically for canines is Vetmedin. The simple explanation for what is happening to your girl is that her heart is trying to work harder to do its job and that causes it to change structure and shape. The walls of the heart pump begin to stretch out too much. These leads the heart to fail. The pressure around the heart from excess fluid makes it harder to pump. Everything in the body is waiting for this blood to arrive so organs etc begin to notice the lower blood flow and complain. In addition, the lowered blood output of the heart leads to less blood flow to the kidneys. The kidneys are not able to function as well and this can lead to nitrogenous wastes "leaking" back into the blood stream. These wastes are not good for the body. In small amounts they can make a dog lose appetite and feel nauseous. In larger amounts they can actually go into the brain and cause neurological symptoms such as circling, head pressing, staggering, agitation and some others. In dogs with kidney disease, owners can use special diets and other treatments to help eliminate these wastes from the system. Many dogs with kidney disease go on to live a long life with this assistance. There is a wonderful yahoo group called k9kidneys that has been in existence for over 10 years and has nearly 4,000 members. In dog with heart disease that is causing problems to the kidney, it is called pre-renal azotemia. This simply means that the buildup of nitrogenous wastes in the blood stream (azotemia) is due to a problem BEFORE the kidneys. The kidneys themselves are fine. The two results on a chem screen test that show this are called BUN, blood urine nitrogen and creatinine. A dog with heart disease will often show a mildly elevated BUN and maybe even a normal, but high, creatinine. These higher levels is often enough to cause poor appetite and nausea. The solution is to increase blood flow to the kidneys. This is done by increasing the dosages of diuretics and increasing the doses of meds that help improve the efficiency of the heart. This is not nearly as easy as it sounds. They all interact in ways that can make the treatment more complex. Treating canine heart disease is a veterinary specialty and I have learned that it is a true art form. My specialist is amazing. He makes no guarantees but helps me adjust the dosages for maximum benefit. If this were me, I would be quite satisfied with a PCV of 32 and yes, I would lower the doses of immunosuppressive drugs. That is MY take on this. NOT necessarily yours or your vets. The second thing I would do if this were me is to see a true veterinary cardiologist. There are three tests that they can perform to get an idea of where the heart is at. 1. A simple x-ray shows the heart shape and the fluid around it. This is extremely diagnostic. 2. ECG shows the heart rhythm and pattern. 3. Doppler ultrasound shows a real time video of the heart and from that they can determine the size of the walls of the heart and the degree of the regurgitation of blood at the mitral valve. These three diagnostic tests will tell you exactly what the degree of the heart trouble is. Costs? Well probably somewhere around $400 or so. A lot, but not too much. If you have a relationship with a specialist already, I would go that route rather than see someone new. Right now you need assistance in determining the dosages of these drugs that will be the most efficient in getting this fluid moving out of the body. Meanwhile, try joining the k9kidneys group at yahoo and read some about how to lower the nitrogenous wastes in the blood. There are a number of dietary changes you can may right now. Ask your vet for a small prescription of mirtazapine, a antidepressant that has a known side effect of increasing appetite. Use a smaller dose than is recommended. The smallest pill size is 7.5. Depending on weight, start with a half a tab and work up to a larger dose if necessary. my best patrice |
| Patrice NYS |
| Cheryl: Good luck with your dog's recovery. I experienced this terrible disease with my dog, but unfortunately lost him. Your are in my thoughts and prayers. I believe there is hope. I have read and heard a lot of dogs recovering from this terrible disease. I have a friend who's dog is doing fine now. Just listen to your vet's advice. Have a wonderful day. Kathy S. |
| Kathy S Pittsburgh |
| Dear Cheryl, Firstly, I am so sorry you are going through this - I certainly know how you feel. Patrice has said it all. I love reading her explanations - makes everything so much clearer and easy to understand! My girl Millie is 12 years old, and was diagnosed with IMHA last January. She was also diagnosed with Congestive Heart Disease at the time. She was immediately put on Vetmedin, and while we had trouble with fluid retention initially, this resolved as the Vetmedin took effect and her anemia began to resolve. Maybe give it a little more time for the Vetmedin to do it's work. We are seeing a vet heart specialist for the first time at the end of this month to check Millie's heart and her progress since her initial diagnosis last year. I should have done this a lot sooner. I also recommend the use of mirtazapine. I have just returned from a 9 day trip and had to leave Millie. We too have had difficulty with her appetite. The mirtazapine did the trick - she has been eating well while on this, and I didn't have the stress of worrying about her eating habits while I was away. Good luck, and please keep us posted on how everything goes. Sam and Millie. |
| Samantha Geelong Australia |
| Thanks for your support. Sunny is eating again - better appetite so that is a big plus these days. However, her PCV seems to be slowly slipping by a point or two a week despite a rise in retics. Her retics are at 70,000 now whereas in the early days they were less than 20,000, but she still has a ways to go. I am not sure why her PCV continues to slip, except that we have had to lower the pred because of her heart disease although she still is on 50 mg a day of azithioprine. her pred is now at 20mg a day (she is a 46 pound dog) and it seemed to be helping to reduce the fluid accumulating in her abdomen but when the vet allowed me to reduce her furosemide diuretic to two times a day from three times a day, she immediately got bloated again. So i upped it back up immediately to three times a day. I am worried I may have to bring her back in to have the fluid removed. This would be the 4th time. I have had her on vetmedin now for about 2 weeks and I honestly don't see much of a change. She still breathes kind of loudly and fast and she is still easily fluid overloaded. I don't dare lower the pred because she is only at 27 in her PCV. The vet calls her in partial remission whatever that means. I think it means he is not sure if there is still destruction going on or not - she hasn't had spherocytes in a while but if there is destruction going on in the marrow would we even see spheroctyes? It continues to be a struggle as we are now in week 10 of this nightmare. It feels like a year! |
| Cheryl New York |
This thread was discussed between 07/03/2010 and 15/03/2010
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