Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Keeli/Diagnosed 3 weeks ago with IMHA

Please tell me if my dog is on the right medications at this time. Keeli is a 23 pound Boston Terrier/Dachshund mix. She was diagnosed with IMHA 3 weeks ago. She became lethargic and could hardly walk. We were unsure what was going on so we took her to our local vet and he said she was anemic. Her PVC at this time was 12. He seemed to think he could handle it and gave her a transfusion at that time. This brought her up to 15. She kept getting worse and worse and he had no idea what was going on with her. I then took her to the Neel Animal Hospital in Oklahoma City where they diagnosed her with IMHA. I had not even heard of this awful disease in dogs until then. They immediately gave her a second transfusion which brought her up to 24. She is taking 10mg of Prednisone twice daily. Cyclosportine was prescribed 100mg daily then decreased to every other day because it was causing weakness and trembling at that dose. Azathoprine 25mg two times daily and sucralfate 1/2 gram three times daily because she had some bleeding from the prednisone The bleeding has stopped at this time. She is also taking pecid 20mg daily. Her last PVC was 23 but that was done last Friday when we discovered the black bowel movements. Please tell me if all of this is appropriate. My vet is a great guy and he is open to any treatment I can find to help her. I am a nurse myself and feel completely helpless dealing with this disease. Please let me know if there is anything we need to change or do differently. I noticed some doses of prednisone are higher than what Keeli is getting. Should her dose be increased or should we hold on until the azathoprine starts working.

Joann Binger Oklahoma

Hi Joann, I am so sorry you had to find this board. Good for you to seek help and trying to understand. Being a nurse gives you a definitive advantage! I am certainly no expert, but you are right, the prednisone seems to be on the lower side. My advice is to get in touch with Dr. Dodds at hemopet. You could send her all the lab results and for a small consulting fee she will give you great advice. In our case, since I lack medical knowledge and English is my second language, I had my vet call her. Getting her involved is the best thing we could have done for our dog. At the same time my local vet learned a lot, knowledge that benefits other dogs now. http://www.hemopet.org/ Dr. Dodds contact is on that webpage Best wishes, Brigitte

Brigitte BC

Thank you Brigitte. I will get in touch with Dr. Dodds or have my vet get in touch so they can discuss treatment. I really appreciate your advice. This is really been emotionally draining. I have researched and researched trying to find the right answers and I think I've found the right place. Thanks again!!!

Joann Binger Oklahoma

Hi Joann, Sorry you had to come looking for this place, but it is definitely a good place to get help on issues for Keeli, or second opinions from people who have experience. It sounds like the Oklahoma hospital is on top of it. Dr. Dodds can be very helpful (she helps everyone who asks). I have only been here about 5 months, but will help if I can. It is my opinion that Vets an everyone is always guessing (they have no choice with IMHA) basically, so the more opinions and thoughts the better. Some things are more straight forward, but drug doses and improvment can be elusive. Be patient an try to stay positive. If you ever need help with that, I like to help with that. Most dogs will be on higher prednisone, but I think lower than is usual is actually good for many dogs. Too much in some can be too much and it does seem like you already had issues, glad the hospital staff is paying attention. I did not use any other drugs with Dylan (prednisone only) and she is now off it, but my fingers and toes stay crossed. It is going to be a tough journey no matter what, but the more help you have, the easer it is likely to be. They did the pepcid and sucralfate right away, so Brigitte is smiling big time, as it often takes a fair bit of effort to get doctors to think of these things. That is why I think you have some good care, as they are. Simple things you can do are get Pet Tinic (a vitamin B/B12 + Iron supplement), good for building hemoglobin. Available at vets in the US, or online. Also, Milk Thistle and maybe more for your pups liver. They are working hard to cleanup the dead blood cells and process a lot of chemical stress. Anything you can do to help is probably worth it. Wishing you guys well and hope you see a little progress each day. Try not to get down, dogs beat this from just about any level, They fight naturally and without thinking about it. Careful with too much activity too. A little movement helps blood flow, but they need everything else to fight. Good luck, Richard and Dog Dylan (diagnosed Mar 19, 2011)

Richard Burnaby

Joann I am so sorry to hear of your most beloved Keeli's IMHA diagnosis. If you have not already read the Meisha's Hope AIHA/IMHA Web site: http://www.cloudnet.com/~jdickson/ I would urge you to do so. Be sure to follow the links on the bottom of the first page to many other sites on Canine AIHA/IMHA that will be very helpful to you and do read the Success Stories pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. AIHA/IMHA is indeed a very difficult disease but dogs CAN and DO survive it and go on to live happy healthy lives. My thoughts and prayers are with you both.

Joanne MN

Dear Joann, I am so sorry to hear of Keeli's diagnosis with IMHA. Some vets don't see very many cases of IMHA so they don't start the drugs quickly and don't offer other possible treatment options such as the azathioprine. As you read and become all too familiar with this disease do not be afraid to bring up or question treatment protocols or lab results with your primarty treating doctor. Even if they think you are a "know it all", who cares? It's your doggy and you can devote all your time to searching out answers, where they have only a small amount of alloted time for you. Each case is so different as is the individual response to a treatment protocol. Don't give up as you never know just when the response to the drugs will happen and Kelli will turn the corner and start fighting the IMHA on her own. You know Keeli best, so keep track of changes in behavior and physical appearance. Many of us have found it helpful to have a daily written log to track things like medication, physical appearance and response and changes to behavior, along with a running log of lab results. I would track labs in the daily log and then staple a copy of the results to the last page of the notebook. We also had a chalkboard mounted in the kitchen that we jotted notes on through the day to make sure we captured all the "lttile" things that went on during the day (I work and my husband is retired, so he would note things like BM and urine color, frequency, muscle weakness, etc You have no idea how important these things become in your life until you manage a dog with IMHA!). I was lucky and had a wonderful vet who was willing to listen and follow advice from Dr. Dodds, the internet or anything else I came up with for treating Buckwheat, Holly and William. Good luck and many hugs to you and Keeli, Liz and... Buckwheat (RIP), William (RIP) and Holly(3 relapses, cataracts and deafness from high dose steroids) - My 3 cocker real siblings (2001 litter- AKC black and tan), all diagnosed with IMHA, Holly complicated with ITP.

Liz Ohio. USA

Richard, Joanne and Liz Thanks so much for your input. I really have been having a hard time with this. Seems all I do is cry. I am the one that pushed my husband to take her to get her vaccinations a week prior to this and I feel responsible for her illness. I was a Paramedic for many years before becoming a nurse and all I know is to fix it and fix it quick. This is a disease that doesn't get fixed. It gets managed. I so appreciate your support. At least I know I can talk to someone who understands. Richard, I have gotten the Pet Tinic as you suggested. Will the Milk Thistle counteract any of the other meds Keeli is on? It won't inhibit absorption of any of them will it? Liz I also started a daily log so I can monitor changes. Have already been monitoring BM and urine color and consistency due to the bleed. Have been giving her pumpkin with her food because she is so constipated on the Carafate. It works really well. Thanks again everyone for helping me with this. Joanne I did read the Meisha,s Hope Website and it' wonderful.I welcome any and all suggestions that anyone has!! Joann and KEELI

Joann Binger

I'm still new to this disorder too and my dog was diagnosed at about the same time, but the cyclosporine sounds a bit high. She is on it too at 100mg a day but she is 45 lbs. Based on the 19 hour life of cyclosporine, maybe your dog would do better on 50mg a day vs 100mg every other day. Also, perhaps a multivitamin. My dog has been doing very well on her multivitamin which includes various things but most importantly Milk Thistle, Iron, some B vitamins, and vitamin K. It is very important to keep them healthy nutrition-wise and I have learned this the hard way as my dog has had a lot of muscle atrophy and lost her vision last week which I think must be because her food is apparently below average protein (natural balance) combined with high dose steroids. So I'm getting higher protein food and some supplements to try to minimize the atrophy (Missing Link, Cranimals VIBE, Dr Carol's Quantum Eye Essentials, nutri-vet H&J liquid)

Monet Sammamish

Hi Joann, Please try to put the past and guilt behind you. There is no way to see the future, so there is no way for you to prevent somthing like this. There are many things that cause it and yes, contrary to what many vets tell you they are not 100 safe. Unfortuantely the vaccine companies cannot be sued for their lies though either. There are other factors though too. My last 3 dogs have been vaccinated much more carefully than Dylan was, so all you can do is learn from the past, good or bad. We can talk another time about vaccinations though. We all cry and sadness is just fine, just try to remember your love for Keeli and it can bring you sttrength. Please remember that you are under great stress, whioh is making these feelings worse and everything will be better for both of you if you focus forward on the future and what you need to do next. It will distract you a little from the feelings of what has happened. No matter what you choose to do in the future, plese remember there are no certainties, you don't have control (opposite of your nurse experience I know), so let the blame go and just keep a close eye always on anything and if it gets better, stay calm, if it gets worse, stay calm. If you are uncertain, ask for help. If you know something, write it down and make sure you deal with it. You can do it and you are doing great. If you can handle being a paramedic, you will be just fine. It is easier on you if you focus forward and enjoy every moment you can with Keeli. Hugs and smiles are great therapy for both of you. You can beat it and things are going okay. And although it may never be gone from your mind, it may be gone from your her one day. Unfortunately you can never be certain, so despite Dylan's recovery, I keep a close eye on her as she eats and pees and does anything. I have a plan for her if she relapses. I am currently rehabbing her muscles to gain strength and I intend to keep her a bit fatter than I used to so she has a reserve for another fight if necessary. I enjoy and treasure every moment with her like she was born yesterday. She is my baby. And I do mean every moment. Our walks together are very special and evoke incredible happiness for me today. She fought for life; I am now preparing for a counter attack should I see an attack on her again. I know how she responded to prednisone, which will hopefully help. There are no certainties, but are there really anyways? I just do my best and try to be happy for each day. I am not a vet, but most people here are on Milk Thisle with any med you have mentioned. Consult your vet to make sure, but it is well used as safe liver supplement. It sounds like you are geting good and well rounded care. Before Dylan got sick, she was eating a raw meat and bone with veggie diet which was very high protein and since prednisone increases metabolism so much, diet is the first thing to consider outside of the meds and symptoms. I beleive Dylan's voracious appatite (before and after pred too) and diet contributed to her recovery. Raw is not for your dog now, but there are lots of things that you can look at changing and adding. I personally feel the same way about dog food as aI do about vaccinations. Toxic and low nutritional value. At least find well made dog food and add some cooked human food to it. More on that maybe later, or sooner as it is a good topic to keep your mind busy. Personally, I resolve I will not let this beat us and if it does, then my Dog Dylan will always be with me close by, like Jagger before her. Our fight together has made our relationship even more powerful than before and it has changed my life in good ways too. You are doing great and I wish you good luck each day, day by day, moment by moment, Richard and Dog Dylan (clear of AIHA for now AND Enjoying Life :-)

Richard Burnaby

Richard thank you so much for your response. It really helps to know people are out there who understand. Last night we had to take Keeli back to Neel Clinic. I noticed she has some pustules on her abdomen and thought it might be something that could go systemic. We got there and the vet told us it was from the steroids and it was just dermatitis. We are now on cephalexin 250mg 2x daily for 7 days. I hope this takes care of it. Will start the Milk Thistle after the anibiotics if you think that's ok. Don't want to mix any other meds at this point. It's a juggling act trying to make sure everything gets given at the appropriate time. I start at 4am with carafate then 6am we get pred azathioprine and pepcid. Then breakfast of 1 scrambled egg 2 slices of turkey bacon apples and pumpkin. 7am Cephalexin 10am carfate 12pm lunch and cyclosporine every other day. Then 4pm carafate 6pm pred and dinner 7pm Cephalexin. Would you look at this routine and tell me if anything is off as far as you can see. I would appreciate any input into this. Seems to be working and I hope I am staggering everything the right way. Thanks so much!!!! Joann and Keeli

Joann Binger Oklahoma

Hi Joann, You are so right it is a juggling act! As far as I can tell your routine looks pretty good. As for food, I think I would leave the bacon out, it is pretty fatty and could cause pancriatitis. Here is a good recipe that I followed with variations: http://www.canine-epilepsy-guardian-angels.com/liver_diet.htm it was easy for me, because I have easy and cheap access to fish. Chicken or Turkey are excellent sources for protein. Just keep it as lean as possible. The Milk Thistle will be good and no worries, you can't really over dose it and it does not interact with any of the other meds. Hang in there Joanne! You are doing great! Take a deep breath, it WILL get better. Best wishes, Brigitte & the poodle boys

Brigitte BC

Hi Joann, I did not do Cylcosporine, but I recall there being some restrictions on when it is taken. I believe it is best on an empty stomach, maybe an hour before carafate, or it it is already scheduled for an empty stomach, then great. Are you giving the pepcid 15 min before the meal? It is best that way. I would give it, then start preparing meals, but I had 4 dogs to do, so that took at least 15 minutes. Maybe before you cook the egg. Other than that, it looks like you have your schedule down. My milk thistle said after meals, so I gave it as desert, as it was not a pill, or capsule. You are doing great. There will often be swelling in the belly and skin issues that occur from prednisone, but keep an eye on them. There are others too, but for now, just deal with your schedule and getting to know the situation, so it is easy to notice changes. Take care, I am still lurking, good luck :-) Richard and Dylan

Richard Burnaby

Hi Joann, Hi Brigitte, is Turkey bacon fat too? Just asking ,as I would not sacrifice real bacon for myself, but curious for my dogs maybe. I usually cut the fat off the meat I fed Dylan. Richard and Dylan.

Richard Burnaby

Richard, Ups.... You can tell I am not a big meat eater:) I have never eaten or even seen turkey bacon. To me bacon is pork so when I read turkey bacon I assumed Joann forgot a comma. Brigitte

Brigitte BC

Hi Joann, So sorry to about your dog Keeli who has got this dreadful disease and like you i had never heard of it before my Cocker Spaniel Molly got it 3 weeks age but unfortunalty she didn,t survive it but my prayers and thoughts are with you and Keeli and i hope she gets better soon, its heartbreaking to see your beloved pet go through this, take care Karen & (Molly RIP)

Karen UK England

Hi Joann, So sorry that you needed to locate this group, but glad you have found it....sorry your sweet girl is battling this illness. I am a pretty new member, as my Pomeranian was diagnosed six weeks ago now. These folks have been AMAZINGLY helpful in supporting, explaining, and helping me in every way possible :) The meds Keeli is on are all ones commonly used in treating IMHA....as the others have said, each dog varies in what meds they can tolerate, and at what dosages. So far, Mr. B has had only some loose stool from all his meds...and he's on quite a few. Just Keeli closely for any changes, and I agree with the diary....it was especially helpful for me in the beginning in keeping track of his symptoms. I've got Bentley on a mix of boiled chicken, boiled hamburger meat, rice, boiled carrots and green beans, sweet potatoes, carrots, and plain yogurt, mixed with a tiny bit of Science diet kibble....All these from the recommendations of the folks here and on the Facebook IMHA group. He's also on the Pet Tinic and Denamarin (Milk Thistle and SamE)....his recent liver and kidney function tests looked great, and I really think it was from the food and supplements. Mr. B takes Cyclo, and we were instructed to give it on empty stomach, either one hour before meals, or two hours after. Richard is right about that! He is also on carafate, and he takes that two hours before meals, so about the same as what you're doing....my vet helped me with this schedule. I think you're doing a great job with everything so far....Like you, I've found this is a long road of managing things, not a quick fix. And like you, I felt very guilty....Mr. B developed his IMHA after surgery and vaccines, which I told the vets to do. Richard also helped me to see, I was doing what I thought was best for Bentley at the time. I never imagined this could happen, had never even heard of IMHA. So please stop blaming yourself, and know you are doing the best you can for Keeli, and she knows how much you love and care for her. Keeping you and Keeli in our thoughts and prayers, and Mr. B and I send our hugs!! Sally and Bentley

Sally Louisiana

Thanks everyone for letting me know about the cyclosporin. I was giving it with food. Changed it to 3pm right in the middle of all the rest of it. Will give the Denamarin ( that I got at the vet for the Milk Thistle) right at bedtime). I am learning so much from all of you. Sally I am sorry to hear about Bentley. Richard has been extremely helpful to me also in coming to terms with the guilt. Karen my heart goes out to you for losing Molly to this terrible disease. I am so sorry. It know it rips your heart out. Please feel free to join in with us so you will have support while you go through this. Richard will these skin issues keep returning as long as she is on the prednisone? When we go Friday we will see what her pvc is but I'm a little afraid of lowering the dose of prednisone at this point. What do you think? Also I was not giving the pepcid 15 min beofre but will start now. That makes sense so it has time to work before the food gets there. Sally I also give Keeli chicken breast, 93/7 hamburger meat and lots of vegetables and even apple. She's not much of a fish eater so I usually don't buy it. I agree the diet is very important. I check her gums so many times a day that I don't even realize I'm doing it as I walk by. She is looking better but am just waiting to see where we are at on Friday. I pray everyone's babies get better and stay well. Thanks everyone for being there for us!! Joann and Keeli

Joann Binger Oklahoma

Joann, I did the exact same thing with the cyclosporine at first...was giving it with food. No worries, just change it now. As a friend on here (Sharon) told me, this is all about baby steps!! Its a big learning curve, and it takes awhile. I actually made a spreadsheet for Bentley's meds until I got used to the times and what to give when....and I have all his lab reports on spreadsheets as well! Vets have different opinions on when to lower med dosages....alot depends on the dog and the side effects to the meds. Once Keeli is stabilized and in remission, you can talk to your vet about what med to lower and at what pace...It's tricky, as you don't want the immune system to flare back up again. We've had such a tough time stabilizing Bentley (still not totally there), that our specialist has indicated he doesn't plan to reduce meds for quite awhile. Of course, that is IF Mr. B can tolerate the meds with manageable side effects. You're doing great! Just remember, deep breaths and baby steps :) Please keep us posted on how Keeli is, and what you find out Friday!! Sally and Bentley :)

Sally Louisiana

Joann You wrote: "I noticed she has some pustules on her abdomen" I believe this may be a staph infection. It is common when using high dose immunosupressive medications like prednisone. You are decreasing all types of white blood cells, including those that help us fight off the staph bacteria. When we are healthy we throw off staph on our skin easily. There is an excellent antibiotic that will clear this up quickly and safely. Staph usually looks like oozing red spots and the hair may come off those areas as well and the skin might look shiny. It is important to keep the skin clean with very gentle soap and dry it carefully. Wash your hands before and after touching Keeli. Avoid exposing Keeli to other dogs or humans that have compromised immune systems. They may introduce bacteria to the environment or you may pass staph bacteria to them. My dog had this and I can tell you I was horrified when I first saw it. His coat was so severely impacted by the months of high dose prednisone treatment. Eventually his elbows were bare hairless sores that cracked and bled. However, once he was better and the dose of prednisone was reduced, his coat returned to normal. my best patrice

Patrice NYS

Patrice I was thinking the same thing and even ask about that. The vet said no its simply dermatitis but we are taking precautions anyway. It is drying up and she is not losing hair in those areas. I am giving the cephalexin faithfully. Will definitely keep an eye on it. So do you thing the cephalexin will do the job or do we need something stronger? Thank you!! Joann and Keeli

Joann Binger Oklahoma

That is the drug. It will work very well. Funny how vets see things so differently. I saw these oozing spots, took Chance to the vet and asked "is this staph?" My vet said yes, we can test it if you like or we can just treat. I chose to treat. I already knew what it was. Prednisone is a very strong suppressant of all types of white blood cells and staph infections is a common side effect. In addition Chance had stopped making certain types of white blood cells. It was inevitable that he would develop a staph infection. I was very worried about a new strain of this called MRSA. It means that it is resistant to drug treatment. This is a form of staph that can be passed from humans to dogs and dogs to humans. It is a very serious form of staph. That is the only reason I am advising you be cautious with this now. It most likely is not this, but why take any chances with Grandma Emily? my best patrice

Patrice NYS

Patrice You are right. I don't want to take any chances so I ask the same question and we are treating it like it is staph. I am familiar with MRSA. I work with patients who develope this also. I just returned from the Clinic and Keeli's PVC has risen from 23 last Friday to 31 today. Am so relieved that we are improving. I really think starting the carafate and getting the bleeding under control helped alot. Great to know she is regenerating though. I has prepared myself for the worst and at least this time it was good news. I really am glad I found this forum. Everyone has been so helpful and encouraging. I know we have a long way to go but at least we are headed in the right direction. Patrice if you have any other suggestions please let me know. Thank You!!! Joann and Keeli

Joann Binger Oklahoma

Joann, Going from 23 to 31 indicates a highly regenerative state. Excellent. If there are no signs of current auto destruction then this would indicate you are well on the way to recovery. Perhaps there was some internal bleeding that contributed to this as well? Cyclosporin was recommended to me by Dr. Dodds when Chance was diagnosed with a very severe case of non-regenerative anemia and neutropenia. He had been on very high doses of prednisone for several months with no results and the prognosis was that he would not survive unless he began to make blood again. Within 3 weeks of starting the cyclosporin (at a high dose usually recommended for beginning treatment for canine allergies) he started to regenerate both red and white blood cells. The beauty of this drug was that once decreased and removed, there were no continuing side effects. It really saved his life. He suffered many lasting side effects from prednisone for several more months. Are you continuing to work with patients at this time? If so, step up your protection at home for the meantime. I have some limited experience with breeders with kennels who maintain a high standard for antibacterial/antiviral protection. You probably don't have to go crazy, but at minimum, wash up before leaving work and don't enter your property with the same shoes you have worn at work. A change of clothing or just wearing a smock at work might help. Chance was a therapy dog and once he recovered I wanted to see if it would be safe to take him back to the nursing home for visits. That is when I stumbled across an article about a (healthy) therapy dog in Toronto that was exposed to MRSA in the nursing home and eventually died from it. I talked it over with my vet. There have been a small number of canine MRSA cases in Western NYS, treated by Cornell. They have a protocol but it is still a very difficult treatment. So I felt that MRSA might be in our area too. I just didn't want to risk going to the nursing home with Chance. My general feeling is that dogs that develop autoimmune conditions may have a genetic tendency to express them and things in the environment are sometimes the tipping point. I was just more cautious with Chance after he recovered. He had 3 years free of any autoimmune conditions but did develop a heart condition and passed at 12 years. my best patrice

Patrice NYS

Patrice I do work with patients and I am glad you mentioned the precautions. I will take a change of clothes and shoes so as not to bring anything home with me. I definitely don't want to expose Keeli to anything that would cause her problems. We discussed decreasing the cyclosporine but the vet wants to wait until she is at least 37 before we do that. I agreed. Am afraid to start taking her off until things are more stable. I think its great that you had a therapy dog. They do amazing things for patients. We have a small dog at the nursing home I work at part time. I work as an advantage RN full time. I assist with safety equipment and different services that keep people out of the nursing home. I usually am on the road traveling alot but I don't get exposed to alot of the things I would in a hospital or nursing home on a daily basis. Thank you so much for your advice. Thanks!!! Joann and Keeli

Joann Binger Oklahoma

This thread was discussed between 15/08/2011 and 21/08/2011

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