Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Juliet's AIHA

I am so glad to have found this site. Our boxer/lab/pit mix Juliet was diagnosed after a variety of tests to rule out other causes and began prednisone treatment about 1 week ago. I earlier posted a thread on Prednisone Reaction, but after some research believe that our Juliet's incontinence last night may be a UTI as a result of the immune suppression. I am beside myself with worry and concerned because her diagnosis came as a result of our Vet spotting her pale gums at her annual check up on 11/24. She had no symptoms at all! Now on the Prednisone she is lethargic and based on what I have read, she probably has a UTI as a result of that. Of course, as these things do, it is all happening on the holiday. There is an emergency vet but that is 40 miles away. Love to hear from anyone who has had this experience and has advice in general including diet changes or other things we can do to help her. (I have already placed an order for Tintic and that is on its way).

Pat Vermont USA

Pat, I responded to your first post, but let me say that if you do not agree with the first diagnoisis, then do check out a second opinion! Praying others here will respond quickly, who have dealt more with the health issues of their pets. Their advise to me has always been, don't wait if you see a change in behavior or condition or if you do not feel comfortable with the treatment. But stay calm, as your pet can and may pick up on your stress. (Sometimes easier said than done!) Ask the vet as many questions, especially now that you are trying to research the condition your dog may have. Blessings, Cindi & Tori

Cindi PCB

Pat, first of all....take a deep breath! You are on a long and rocky road, a roller coaster. You will need a lot of strength. Juliet needs you to be her rock. If you are freaking out, Juliet will pick up on it and that is not good for her. Try and stay calm. Believe me, I know this is hard. The side effects of the prednisone are very normal. It is awful what they do, but remember, they save Juliet's life. As you mentioned it is quite possible that Juliet has a UTI. Luckily they are fairly easily treated with antibiotics. It would however be good if the urine be sent to a lab and the right antibiotic given. Since Christmas is literally at the doorstep, I think I would take Juliet in today and have them check her urine at the vet clinic and give her an antibiotic anyway if the test comes back positive. I would have them take blood and do a simple PCV right there, just for peace of mind and so you know where you are at with the RBC. This should be quick and fairly inexpensive. I would also discuss with the vet if you could add a second immune suppressing drug, (azathioprene or cyclosporine) as you have probably read in the Meisha's Hope success stories, these medications can help tremendously. How old is Juliet and what dosage of prednisone and other drugs is she given? With the prednisone it is very important that she is also on a stomach protectant. Try and have a daily planner on hand and write everything down time and dosages. I was so frazzled and sleep deprived in those first few weeks, my brain turned to mush. I had pill containers that I filled every night and then I still wrote everything down precisely to make sure everything was given at the right time. It sure is a juggling act and all consumeing. I hope Juliet feels better soon and you can enjoy the holidays. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Thanks Brigette. Juliet 7.5 years old Her Prednisone dosage is 40mg twice a day. She is also on Chewable Gastri Soothe also given twice a day. I think our Vet (trained in Canada) is doing a good job. Juliet was in for a route check and she picked up on the pale gums right away and did the pack cell test in the office. When she saw it was 20, she sent a sample for the more extensive test. She put her on an anti-biotic right way in case it was a baterial infection, then scheduled her for a liver and spleen ultrasound. That came up negative. Next, we did a marrow test. Following that she put her on an anti-biotic to project against bone infection. She has been on the Prednisone and antiacid med since December 10. We had her back to the vet this past Tuesday to get her checked for temperature because she seemed lethargic. She had no temp. Our vet called on Thursday night just to see how she was doing and she seemed fine...then this happened last evening. So, I am washing all the bedding. Left a message for our vet...at the office and may call her at home...which she told us to do if we have a problem. So that's the story up to the minute. Juliet is out on a walk with her Dad right now. It is cold but sunny and she has her coat on!

Pat & Juliet Vermont

Hi Pat & Juliet. Is it possible to get copies of the testing done to date? Do you know if she is regenerating new blood now? Current PCV/HCT? Reticulocyte count?Weight? ....the more you give us the better. I've never heard of Gastri Soothe before! Anyone else? I looked it up and it seems appropriate. When do you give it to her? Bed wetting? Yeah, a UTI is quite possible but it could also be a reaction tothe pred. Pred does strange things to the muscles and could very easily cause something like this. Get a clean sample to take to the vet for a check. Get them to do a FULL urinalysis and it's best if you can get the sample first thing in the morning! The antibiotics she is on would likely help & prevent a urinary infection depending on what antibiotics you are using. If they are targetting the marrow then it's likely a broad spectrum antibiotic. You really should five her a good probiotic daily while she's on antibiotics. Gotta keep the *good* bacteria going! Give her the pro-biotic approx 2-3 hrs AFTER the antibiotic. If not they'll sorta cancell each other out! What does the diet consist of? If you've been reading the other posts then you know by now that milk thistle and pet tinic are good additions. Talk to the vet about low dose aspirin therapy also. I'd keep walks to a minimum for now if I were you. It's important to keep them well rested and stress free if at all possible. Exercise isn't exactly good at this point due to the low oxygen levels in the body. Very small walks might be OK but if you notice labored breathing or struggle at all then discontinue. Remember also that dogs can be extremely stoic and you may not even notice! Keep us posted. My thoughts and prayers are with you all. Johnny & Tessy

Johnny

Hi All, Today Juliet was started on azathioprine 75 mg per day. The prednisone had no effect and her red blood count had declined a bit after the ten days on the prednisone alone. Juliet is pretty tired, but still very interested in food and has a burst of energy to greet me when I come home from work in the evening. (She is with my husband all day and not alone.)She needs to go out for business about every 3 hours or so and have had no accidents since that first about a week ago. We are feeding her home cooked meals, low fat chicken breast/thighs and ground beef with chopped spinach, green beans or carrots and some pumpkin and basamati rice. Still offering a little kibble, but she is less interested in it. She is still very interested in food, however, as well as the occasional milk bone. I hope that is a good sign? I will talk to vet about low aspirin dose tomorrow morning. It sounds like the does is .5 mg per kg of dog. She is 75 pounds so about 34 kg. I calculate 17 mg of aspirin. Do you get that low dose using liquid baby aspirin? I only have seen tabs at 81 mg for low dose. I have also ordered on line for the Pet Tinic, and it should arrive soon. We are praying this routine works? Will keep you posted. Thanks so much for all advice to date. Pat

Pat Vermont

Pat, good to hear that Juliet is still fighting hard! The addition of azathioprine will help but it takes quite awhile for it to kick in! My drug preference is cyclosporine but it's pricey...but it works much much quicker than the others!! Keep the spinach on the low side as it's high in oxalic acid (can aid in the creation of crystals) but don't worry too much...Tessy gets it also in lolw quantities...it's rich in iron and b vitamins!!! You could add sweet potatoes and white fish also if you'd like. Other options...scrambled eggs, boiled liver or beef heart, lean roast beef, brocolli, zuccinni, etc. Remember to keep with the stomach protectants also. The pred should make them want to eat ALL THE TIME so if she's drawing away from food then it *might* be cause for concern...could be ulcers among other things! Low dose aspirin....I had to get Tessy's compounded by the drugstore!!! Call and ask them and they can likely do it for you...they can get it in within a couple/few days for you and then you know you're getting the right amount each time! Good call on the Pet Tinic! Have you added milk thistle also? When was the last time you did a chemistry panel? Thyroid checked? Keep us posted, Prayers and healing vibes for Juliet, Johnny & Tessy

Johnny

Hi Johnny & Tessy, I have not gotten hold of Milk Thistle yet, but will look into that. You are right about the cyclosporine, it is $100 dollars a week ($89 in Canada but still high) for the dose she needs. Out of reach on our budget, so we have had to go with the next best option. I have been trying to add new things slowly so that I can see if there is a reaction. Her last CBC did show low-thyroid, but vet said it was still in the normal range. From what I have read here and elsewhere, our Vet is doing all the right things. You are right, she wants to eat all the time. Hearing me preparing food in the kitchen and the need to go out are the things that will get her on her feet. She is laying pretty low the rest of the time. I have been going easy on the spinach, but that is good to know. Tonights dinner will be cod with sweet potatoes and green beans, along with us! Thanks so much for your concern and advice. It is so reassuring and nice of you to take the time! Happy New Year! Pat & Juliet!

Pat Vermont

I am very worried...today Juliet has been really exhausted. She is still eating and drinking and relieving, but she's not moving around much. I feel her her is beating very fast too. Her gums are still very white. I know these meds can knock them out, but this is so awful. And I am trying hard not to panic.

Pat Vermont USA

Pat, if you are worried, take her in! You better go once to many that too late. I can not tell you what is wrong with your dog, but you know Juliet better than anybody, so if she is stressed you should have a vet looking at her. A good vet will never complain about having to go in on a holiday or weekend, that is what they are trained to do. Even if it is just for peace of mind, have tham do a PCV. It is fast and should be fairly inexpensive. The test itself at least, them having to come in on a holiday might be expensive:( I took my dog in one time, thinking he would be dead in a few hours. We did a PCV and he was actually higher than ever. Go figure. My vet was very good at coming in at all hours. She gave me her private number and told me she would never be upset to come in, she would just be upset that Kahlu would not feel good. She is a gem. I hope it is just one of those glitches and Juliet will feel better real soon! Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

It might be a reaction to the newly added azathioprine! That's a large dose even for a larger dog! How much does Juliet weigh? I'm with Brigitte in that a quick PCV can help to calm your nerves...This is what I would do...and have done many times in the past with Tessy! Sending lots of healthy vibes for Juliet. Johnny & Tessy

Johnny

Things are not good. Juliet threw up her food virtually undigested and we took her to the emergency hospital. Her PCV is 10. She has been admitted overnight for a transfusion and IV fluids, etc..It was just horrible to leave her there even though I know she is in good hands. Distraught, exhausted, we have just come home and hope to get a positive call in the morning, but the Vet gave us a very sobering run down of the situation. Please send all your positive energy out there for my girl! Pat

Pat Vermont

Just hung up with the ER. Juliet's transfusion went well. The ER had only enough blood to get her through this crisis (not enough for a complete transfusion)but her PCV is up, but only to 16. Vet also said her heart rate was 164 last night and is down to 100. We will talk to her regular Vet tomorrow...she may need a second transfusion. Hopefully we have bought her some time to get the azathioprine to kick in. Going to bring her home and we will talk to her regular Vet tomorrow to decide what to do next.

Pat Vermont USA

Pat, thank doG you took Juliet in when you did then!!! You very likely saved her life! Kudos! Have you had a chance to talk to the vet today to see if the numbers are staying stable? With regards to cyclosporine...if I were you I'd call around to the drugstores (costco type ones would be cheapest) and just ask them for a price on a generic MODIFIED cyclosporine. You can usually get it at a fraction of the cost compared to the veterinary Atopica brand! Might be worth checking out in the meantime! I'll be keeping Juliet in my thoughts and prayers! Johnny & Tessy

Johnny

Hi Johnny and others, We've just come home from the ER. Juliet is much better than last night, but still definitely not great. We talke about the cyclosporine...I am going to call around to see if we can find out about the generic version. I am also going to check with a Pharmacy in Canada to see if the cost is within range. Vet said she may need another transfusion. He is going be in touch with regular vet in the morning. I've just put it all on a credit card and not think about it for now, the cost is a consideration for us even if you love a pet as we do. We'll do our best to see if we can get this turned around...thanks for your support. Pat & Juliet

Pat Vermont USA

Johnny, You also asked about weight - Juliet is 74 lbs as of last night...They also gave her an anti-vomiting med just before she left the hospital. Instructions are to feed a bland diet of boiled chicken and rice. He said pumpkin not necessary for the moment. She is having a nap in her favorite spot at the moment. Thanks again! Pat

Pat Vermont USA

A little update. Juliet's PCV was down 2 points today from 18 on Sunday to 16 today. She only got a 1 unit transfusion on Sunday because they had no time to call a donor or get additional blood from the bank. We are going to do another PCV with her primary vet tomorrow and see if she is going down. The plan is to schedule a complete transfusion on Wednesday. She has an appointment with a specialist on Friday. They sent all her records down for review this week. All the vets consulting say we should give her this chance to see if her system will stop attacking the red cells. At this point they are recommending we stick with Azathiprn rather than switch to the cylcolsporin. They feel the transfusions will give her time for the Azath to kick in. The Cyclosporine, even the generic is out of our reach long term. She is a big do at 74 lbs./34kgs and would need a very high dose daily, I think a 100mg 2x a day. The Petinic arrived tonight and gave her the first dose. Looks like a good vitamin supplement. She is better than she has been for a week even with this low PCV number... And, BTW, my Vet says they have been using Fort Dodge for rabies vaccine. But she is looking into this further based on the concerns I have raised. Thanks all...be in touch soon. Pat & Juliet

Pat Vermont USA

Hoping things improve soon for your sweet Juliet. Glad your Vet is open to your input.

Penny Lytle Creek Calif

Pat, just wondering if you had Juliet in for a transfusion Wednesday or not?!?! How's she been doing? If I were you I'd push them to add a low dose of thyroid supplement. Have you been in contact with Dr. Dodds at all??? Considered sending a sample of blood to her??? Thoughts and prayers are with Juliet. Johnny & Tessy

Johnny

Update on Juliet: She had another 1 unit transfusion on Wednesday. The vets decided to do just that since it brougt her up from 14 to 20% and she was doing well. We saw the specialist today. She was wagging her tail and being her usual friendly girl. The vet found that very encouraging. She said that it is apparent than Juliet's levels were in a slow decline so her body had adjusted rather than going into shock. She did say that the September 21 rabies shot may have triggered it, but of course, with the caveat that we don't know for sure there is a direct link. Her meds now include 300 mg of cyclosporine; 80 mg of prednisone; 75 mg of azathiaprine plus gastri-soothe. They said to hold off on the aspirin for now and will give us some probiotic (I think she said flagyl?) if she gets nausea from the anti-biotic. They say her problem is in the marrow and is a difficult case. The odds are now 60/40. But they urged us to give a try...if it doesn't work in a few weeks to a month, then that's about all we can do. The specialist recommended keeping her on boiled chicken and rice with a few green beans...and to use the pet-tinic to replace the minerals. She was at 15% today so they felt that was a good sign since she wasn't crashing right down after the transfusion. Juliet will need all your prayers and love over the next few days...Best to all also going through this! Pat

Pat USA Vermont USA

Pat, There comes a point where all you can do is wait and see. You are doing all the right things and now it is up to Juliet to turn it around. Stay positive and don't listen to any percentages, don't let them get you down. Read the success stories! At the next blood check you might want to ask if they could check Juliet's thyroid (unless that has already been done) It would be important to check all levels. This can only be done through one of the university colleges or through Dr. Dodds at hemopet. If Juliet's thyroid has not already been low before the ordeal, it is quite possible it is low know and a supplement could kick start the blood building. Keeping you in our thoughts, Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Pat, you said above that the thyroid was at the low end of normal....I'd STRONGLY urge and encourage you to add thyroid supplementation daily and if you can afford to do so perhaps get a breed, age, sex specific thyroid panel done....not just the T4 which is what your vet did. This could be the smoking gun you're looking for! You can get this specific test done by Dr. Dodds for cheaper than your vet I bet....but with the shipping the price goes higher. To send from Vermont I wouldn't think it would cost that much! From Nova Scotia, Can I can send a sample down for the FULL blown blood diagnostics (CBC, Chem, FULL thyroid and Dr. Dodds personal analysis) for approx. $200!!! It took me TWO months when Tessy first got sick to finally decide to send blood to her and that's when things FINALLY turned around for us!!! She's remarkable with what she does!!! Truly! Anyhow, keep us posted on how she's doing. I'll keep her in my thoughts and prayers! Johnny & Tessy

Johnny

Dear Pat, I am most definitely with Brigitte and Johnny in the thyroid advice. Many dogs with non-regenerative IMHA have done well on the thyroid meds, namely Soloxine. I also recommend sending blood to Dr Dodds. Being in Australia, it was difficult for me, but so many others here have consulted with Dr Dodds and had a great outcome for their dogs. All the best, our healing thoughts are with you both, Sam and Millie.

Samantha Geelong Australia

Dear Pat, I just wanted to let you know I am routing for you and Juliet. Keep pressing forward and listen to all the advice about having blood sent to Dr. Dodds. You can e-mail Dr. Dodds expressing a few concerns and she WILL call you in less than 24 hrs. She didn't charge me for this call and it was a Sat. morning! I was amazed! Make a list of a few questions ahead of time so you won't forget during the call. I have since written her with questions and she replies quickly. I am not sure Gracie has a thyroid issue but the nagging doubt in the back of my mind prompted me to take action. I just had Gracie's blood drawn yesterday to be sent to Dr. Dodds. It is $120 for the Thyroid 5 profile which includes a full chem. analysis. I am sure their is a shipping cost as well. My vet was very open to doing that even though they send their blood to the University Of Michigan normally. You can find all the information on hemopet.org. hugs to you and Juliet, Gwen and Gracie

Gwen Rhinebeck

Juliet is back in the ER for a third transfusion...Juliet vomited about 2 hours after her first mega dose of cyclosporine last night. She was just whipped and when I came down to let her out at 3AM I knew her heart rate was elevated...frankly, she hardly moved at all. By 6AM I knew she was heading for trouble again, but although weak, she went out to pee and ate some chicken when offered it. I called the vets, primary and ER...It was snowing this morning so I took her to the local vet about a mile away to test her PCV. It was down to 12...after a lot of discussion and soul searching we decided to give her one more transfusion so that we could see if the cyclosporine, along with the other drugs would finally take hold. I adore this dog, but we can't afford much more for emergency treatments and we and the vets agree that this is as far as we can go. They are typing and cross-matching this transfusion. If the cyclosporine takes hold and we can get this licked with the meds in the next 5 days..we'll deal with the expense of the meds. Discussed the thyroid issue and Vet felt that we should hold off for the moment. That the med can cause a thrombosis by revving up her metabolism too fast. Which she had bad result with on another dog. If we can get her to start generating cells on her own, this is definitely something we will do. And I will definitely have a test sent to Dr. Dodds as well. We will pick her up in about 4 hours. We'll see what happens.

Pat Vermont USA

Dear Pat, I am SO sorry that your sweetie Juliet is having a difficult time. You are both in my prayers and I will be thinking of you and Juliet through out the day. I am so hoping for good news about Juliet and that this transfusion will take hold. It sounds like you have both been through so much. You are such a good Mommy and you are doing everything right. It is up to Juliet now and her poor tired body. Please know that we are all routing for you and Juliet. hugs and many many prayers, Gwen and Gracie

Gwen R

I am so sorry she is having a hard time. It's so stressing and heartbreaking. I agree that there comes a time when we can't afford to help them any further. I am pulling my hair out worrying about if Lucky is going to need future transfusions and treatment. I am already late on all my bills. Juliet is in my thoughts and prayers.

Jerry

Pat - I'm so sorry to read about Juliet. My dog did not take cyclosporin for long but I remember reading from others on the board that some dogs do take a bit of time to adjust to it and vomiting is not uncommon. Typically, they are able to tolerate the medication well after some time. Hopefully, someone who knows more about this will chime in with more information for you soon. But, I wanted to at least mention that in case you hadn't heard - hopefully, the vomiting was nothing more serious than that and the transfusion will buy Juliet time to allow the cyclosporin to kick in. Best Regards, Bonnie

Bonnie Chicago

Pat, For what it is worth, Dr. Dodds has not been opposed to lowering the dosage of cyclosporine briefly in the early days to allow an adjustment to the med when there is this kind of gastrointestinal response. This is typically the worst side effect with this drug. Do not give up. my best patrice

Patrice NYS

Hi Pat, I am so sorry your sweet pup is going through all this. Unfortunately, I do not have much time to post but I wanted to add at this point the transfusions might be responsible for making Juliet worse. A red flag went off when you said she is having her third transfusion and this time they are cross matching it. That should have been done after the first transfusion. I am not saying this to scare you but it is fact and at this point I would strongly encourage you to seek out a specialist with more experience treating this devastating disease. My thoughts and prayers are with you and your sweet girl. I am sorry I cannot add more at this time. Teresa

Teresa va

We are back from the ER Julie is in great shape...,now it is just a matter of getting the Cyclosporine and evertything else to work. We got serenia (sp?)for nausea/vomiting. She had a shot this morning; pills start tomorrow AM. We changed the cyclo dosing to spread it out a bit which should help. The vet is a specialist and assured us that the transfusions were universal donor blood, but this was typed and matched. I hope I have not been mislead. She is resting, had her chicken and rice...The next few days are critical...keep us in your thoughts. Thanks all, Pat

Pat Vermont USA

Dear Pat, You and Juliet Are in my thoughts and prayers. Hopefully the meds will kick in soon. She seems like a little fighter. hugs and prayers, Gwen and Gracie

Gwen Rhinebeck

I hope your Juliet continues to hold on. It took a while for the cyclosporine to kick in for Chloe, many weeks in fact. But it kept her stable enough until she became regenerative. Chloe had 4 double pediatric units of packed cells (8 units) over two months. The units kept her going until she started making her own red cells. The cyclosporine stopped the destruction. Our internal medicine specialist also refused to consider thyroid medication but I persuaded our regular vet to start it. When I sent Chloe's blood to Dr. Dodd's, it turned out that Chloe really needed the thyroxine. I took it hour by hour. At the worst point Chloe was on 400 mg of cyclosporine and 80 mg prednisone. As long as Juliet doesn't destroy the new RBC's from the transfusion, the blood will keep her going. Think of the transfusions as buying Juliet time! It really does take a while for all the meds to kick in. I hope your girl has stopped vomiting.Is she drinking a lot? The prednisone makes the dogs crazy thirsty. I missed whether Juliet is on aspirin which is a must. You also need to make sure she is on sucralfate which will help protect her stomach lining. Hang in there! It is a little by little race with lots of ups and downs. Cheri and Chloe

Cheri Maryland

Hi Cheri, Juliet has stopped vomiting thanks to med that is helping her tolerate the cyclosporine. She is thirsty and hungry and resting in between. Juliet is on a med calle gastri-soothe, which I imagine is something like sulfacrate? She is not on aspirin or thyroxine. The internist felt that there was no agglutination (or stickiness of blood cells so it was not needed) and the primary vet said that she was concerned about the thyroxine getting her metabolism too revved up which could actually increase her chances of a heart attack. The vets feel that there is a small possibility of something more sinister going on at the bone marrow level. The only way to find out was by taking a "core" sample of the marrow...but we chose to go with treatment versus the cost of yet another test, when the chances of something other than IMHA were very small. She has had 3 transfusions since last week. They are $650.00 for each hospitalization...I pray that she doesn't crash again this week. Between that and the specialist and the testing and the regular vet and the meds,I just cannot afford any more...so I am praying for a miracle...that she will just stabilize and we can struggle along to just pay for the meds until she starts making her own red cells. Keep her in your thoughts. Pat

Pat Vermont

Pat, I don't blame you! I would have done the same thing and opted to not have the bone marrow tested. Perhaps much later down the road when all other avenues have been explored! Lots of vets assume there's something else going on when they can't find a reason for the sickness! Try not to let them worry you! Take it day to day and make sure Juliet is getting all the proper food and vitamins. I'd STILL strongly urge you to consult Dr. Dodds. The addition of thyroid supplements is totally safe and has been known to turn dogs around and save lives! I won't bother to mention it anymore as I don't want to irritate you into choosing something you don't want...just keep in mind that many here have hesitated in making this decision only to have regrets afterwards for not doing so later! ANYWHO, give her some hugs and scritches for me. Johnny & TEssy

Johnny

Please know that we are praying for Juliet and hope she can turn the corner soon It took a few weeks for the cyclosporine to begin to work on Ginger so give it time. Plese keep us updated on how Juliet is doing. How much does Juliet weigh and what is her dosage of the cyclosporine? Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Pat, I just wanted to reassure you that I felt, after the fact, that we probably could have treated Chance for his non regenerative anemia without the need for a bone marrow biopsy. It would have saved $500 and exposure to anesthesia. Dr. Dodds was able to pinpoint his condition and advise me of the proper treatment (that included cyclosporine). We were very successful. So you are correct. This "could" be some kind of bone marrow disease related to cancer and your vet would probably like to reassure him/her self that this is ruled out. But it seems that many dogs that develop non-regenerative anemia seem to have this autoimmune component that is responsible for destroying the blood cell precursor cells in the marrow. In Chance's case, he also stopped making white blood cells. This is explained simply by the fact that all three lines of blood elements; red and white blood cells and platelets, all originate with the same precursor cells. Autoimmune destruction of these precursor cells can affect one line (cytopenia), two lines (bicytopenia) or all three lines (pancytopenia.) Penia means little, none, absence of. Cy is cell. Bi is two, pan is "all around" or everything. When one line, the red cells, are affected, the dog (or human) simply stops replacing old worn out red blood cells (they live about 120 days) with new ones. The lowering of the hematocrit (PCV) is a slower process. You don't see these dogs have hemolytic crises. But there is a gradual loss of red blood cells and sometimes these dogs can adjust adequately without strong, noticeable symptoms. It would not be surprising to see a dog with non-regenerative anemia walk into a clinic with a PCV of 18 and not be very symptomatic. A dog with bicytopenia is also at risk for serious infections if the second line affected is the white blood cells. These are the kind of infections that folks with some kind of immune system disorder suffer, usually called opportunistic. Healthy dogs or humans can and do fight these bacteria and viruses off without ever noticing. A human with HIV might have a serious infection from normal levels of e. coli. A dog with pancytopenia is at very serious risk. If the platelets are very low, they will be at immediate risk of death from internal bleeding that is not stopped by the platelets. So, the risk of death is different for each of these dogs. Dogs that have only cytopenia of red blood cells can survive a long time with good nursing care and transfusions while the vet attempts to tailor the correct treatment regimen. There is a subtle risk of actually negatively impacting the bone marrow's regenerative process by administering transfusions too frequently. The bone marrow is stimulated to make blood by a hormone produced by the kidneys. Go figure. The human body (and a dog's body as well) are a marvel of interconnected systems. There is a great need by the body to always be in /Homeostasis/, or simply, all systems stay within a certain operating range. When one system begins to tip too far in one direction, another body system steps up their job to get things back in order. Thus there is some concern by your vet about adding too much "push" to the thyroid glands in case it tips too much in one direction and negatively impacts the metabolism. So there are many things that start, continue and stop the production of blood cells. In general though, for your understanding, it is the *amount of oxygen that makes it to the cells of the body* that is the trigger for making blood. So a lack of enough O2 to the cells causes symptoms of anemia and this leads the vet to determine if they are bad enough to be considered a "transfusion trigger." So it can be *different* from person to person, dog to dog. One dog may be clinically ok with a PCV of 15, while another dog may hardly be able to lift their head. If you supply the hemoglobin (carries the O2) to the blood cells via transfusion, then the body cells are happy, they are getting enough O2. They stop complaining, the kidneys slow down production of erythropoietin and the bone marrow gets the signal, "ok, all set out here, go take a break!" This is why multiple transfusions very close together that "top off" the number of red blood cells in the body may lead to a *suppression* of the bone marrow. Some medications can behave this way also, suppressing the bone marrow. This is a tricky business. Vets that treat these kinds of serious blood disorders must study a very long time to be proficient in the understanding of them and obtain the kind of long term clinical experience that is necessary to be able to provide appropriate treatments that are timely. The vet techs that work with them are also very clever and have worked hard to understand how to treat these special cases. If you are working with a specialist of this type you are working with someone who has spent many years studying and probably spends many hours a week reading supplemental journals, in their "free" time. Bless them for this dedication. So Pat, I think you are doing just fine and have made good decisions. my best patrice

Patrice NYS

Monday - Juliet is pretty quiet today. She slept almost through the night, but I feel her heart rate is elevated somewhat. She is hungry and ate her breakfast and I got her pills into her. She is sleeping again on her pillow behind my desk chair. I guess I shouldn't expect her to be bounding around, but she seems steady enough when she is on her feet. She had diarrhea this morning although her diet has been boiled chicken and rice with pet-tinic. I guess this is normal from what I have read here. We'll talk to the primary vet later today...

Pat Vermont

I just e-mailed Dr. Dodds using the link from her website. Hemopet@hotmail.com I'll let you know if I hear from her. Thanks all. Pat

Pat Vermont

Pat, I am so glad you got Dr. Dodds involved! I know you will not regret it. to help with the diarrhea, try and add some canned pumpkin. About a table spoon per meal should help. Make sure it is plain pumpkin, not the pie filling. If it does not help, talk to the vet about it. my dog needed (some more!) meds for it at one point. The diarrhea can zap their energy so don't let it go on for too long. Best wishes, thinking of you and Juliet, Brigitte & the poodle bouys

Brigitte BC Canada

Pat, something to keep in mind, with the diarrhea Juliet could become dehydrated. make sure she drinks enough. This could even influence the PCV, it could seem higher than it is. Best wishes, keep us posted, Brigitte & the poodle boys

Brigitte BC Canada

Juliet update - We saw regular vet today. Juliet's PCV is 12, but she seems not to be in distress. The transfusion on Saturday got her up to 20 and didn't last long. She's still eating and drinking and has the life force in her so we and our vet have taken a wait and see if the cyclosporine will work - we are only on beginning of day 4. We have added thryroxine at Dr. Dodds suggestion and an anti-diarreal, plus a pro biotic. What a pill box we have going now! We are hoping that she stabilizes here and begins to generate new red cells. Vet recommended Pet-tinic or Centrum Silver as a substitute. I had the Pet-Tinic. Dr. Dodds had emailed me back to have our vet Call her to consult for free. What a wonderful person to do that. They missed each other yesterday, hopefully they will talk today and as my vet said, "see if she has something else up her sleeve to turn this around." Keep us in your thoughts and prayers as the next few days are critical. Pat & Juliet

Pat Vermont

Juliet's status is the same as stated in my previous post. My Vet spoke to Dr. Dodds today. Dr. Richards was so pleased that Dr. Dodds would take the time to consult with a general practioner on this. If nothing else we are reassured that the course of treatment that Juliet is on is just as Dr. Dodds would have prescribed. Juliet's case is difficult because it is at the bone marrow level rather than the blood stream. All agreed the best plan was to see if the cyclosporine and everything else including the thyroid hormone does its job in the next few days. We continue to have hope...

Pat Vermont

Sending our prayers and crossing our fingers and paws that Juliet can turn this around soon. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

We are still hanging on. Juliet was so weak last night that I was afraid what awaited me this morning. When I came downstairs she was on her feet wagging her tail to greet me. She went out, had big breakfast and her meds and went back to her favorite sleep spot. My husband said she has been very quiet all day, but eating well...again got up to greet me when I came home. She has a strong will and it seems as if she is holding her own since yesterday. Keep us in your thoughts and prayers that the Medicines are beginning to work. Pat & Juliet

Pat & Juliet Vermont

Pat, good to hear you added the thyroid supplement!! Juliets chances of surviving just went up some cause now you have Dr. Dodds on board!!! Do you get CBC's done at each visit or just a PCV? I'd love to know some of her other numbers if you have them! Continued thoughts and prayers for Juliet. Johnny & Tessy

Johnny

Heaven is the place where all the dogs we have ever loved come to greet us. Juliet went to heaven this afternoon. She had barely moved overnight and wasn't eat on her own, only hand fed little pieces of chicken. She was so weak to today that she could barely stand up. She went very peacefully and very quickly. We did all we could. Her case was difficult because it was at the bone marrow. She was the best dog either of us had ever known. We all took good care of each other for over 7 years and will cherish that time. Thank you all for your expressions of love and kindness. You and all those who are on this journey with the pets will always be in our thoughts. Juliet's Mom, Pat

Pat Vermont

Pat, I just found this site this afternoon and read your post now.. I am sorry for your loss. I feel your pain... RIP Juliet..

Meg

Oh no Pat...I'm so sorry! It's such a hard thing to deal with...especially when they're so close to us! Many don't understand the strength of the bond some of these dogs have on us. Juiliet is romping with some pretty special friends at the bridge now. you're absolutely right...she's in Heaven now running and playing till the day she sees you again. My sympathies, Johnny & Tessy

Johnny

Dear pat, I am so terribly sorry that you had to let Juliet go. I know first hand that sometimes no matter what you do it is no meant to be that they stay with us. Remember the good times you had with Juliet and your heart will heal in time. With sincere condolences, Brigitte

Brigitte BC Canada

Dear Pat and Family I too am very deeply saddened to read that your precious Juliet crossed over to the rainbow bridge today. Please know that you and your family are in my thoughts and prayer during this difficult time. RIP Juliet you have earned your wings. Please accept my heartfelt condolences. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Dear Pat, I am so sorry to hear that you have lost your darling Juliet. You both fought so hard, and you did everything possible for Juliet. Please accept our sincere condolences on your loss of your baby. Sam and Millie.

Samantha Geelong Australia

Pat, I was just getting caught up on some of these threads. I am in shock after getting to the bottom. Juliet was so blessed to have such a loving family. As God prepares his room for you, I am sure there is a doggy bed in the corner, and Juliet is patiently waiting. God Bless you, Carrie and Summer

Carrie DFW

Pat, My heart breaks for you and your family. I too know how difficult it is to lose a dog to this awful disease. I hope that the memories of better times with your sweet Juliet helps heal the large hole in your heart. Juliet has joined a lot of very brave dogs at the bridge and will play there until you meet again. Hugs Penny

Penny Lytle Creek Calif

This thread was discussed between 24/12/2010 and 15/01/2011

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