Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Lola at home.

Hello all- sorry for the new threads but I am trying to keep this organized so it's easy to look back to. We have continued with all of her pills (prednisone, atopica, thyroxine, clavamox, doxycycline, and adult pepcid that we're cutting into 1/10ths) since its sunday and the emergency vet didnt have any pet-tinic..i have spent the entire morning calling every vet in nj and surrounding areas-- we finally found a 24hr place an hour away that has it so we faxed the script and my dads on his way to pick it up..the reason that i am not waiting until tomorrow to get it is because lola is so so tired..i am hoping that this will give her a little boost so that she can keep her energy up. does anyone know the recommended dose for a 3lb dog ? lola's gums are still are still pink --she has a vein shaped bloody color red in a couple spots on her gums...is this normal and something we just havent noticed or is it not... her purple bruise that she had is still there..and dark..and scary..the deep color goes from her chest to underneath her arm on her left side ..i took a picture of it as well as a picture of her unbruised right side..i will link it to this feed.. the album is titled lola after discharge http://www.flickr.com/photos/65301226@N04/sets/72157627093735113/ her heart beat is confusing me.. its around 60 per minute which is obviously slower than mine and scaring me a little..i saw that thyroxine can cause this but her heart beat was slow before they put her on it.. she has been eating some chicken along with roast beef turkey and cheese... not a lot of anything since shell turn away after eating enough but at least her appetite is somewhat there.. shes been drinking when we ask her to as well..which makes momma happy.. although very lethargic, she is still responsive to noises and people..she is peeing and pooping normally..not to get gross but her waste was a little softer than usual but we think thats because shes eating food food instead of kibble...she is walking around a little but then goes to lay down..that is the 2 times we've allowed her to be on the ground. she is interested in kissing us in intervals..which is probably because shes so tired. i am very curious to what her pcv is at right now..and her platelets..her temperature is at 99.8 but i took it with another one and i thought it said 100.1 ..either way its a little low.. we're trying to keep our spirits up but everyone is just very sad. After hearing about chance i had a great feeling about lolas future but thinking about her platelets being almost nonexistent, I began feeling very hopeless. I emailed Jean last night asking if shes had cases where everything was low and she said she has. Didn't mention if she had any success though. Any thoughts or advice is always welcomed. Thank you for your continued support, advice, and love.

christina new jersey

Hello Christina, What a sweet little dog your Lola! I am so glad she is home with you, where she belongs. Being at home with you will make it so much easier and better for everybody. I just want to touch on the food issue. I know that you are happy for every little bit she is eating, but now is the time to get her on some high quality food. Not kibble and definitely not Mac Donald's:) Anything that is high fat could give her pancriatitis and you don't want to put her through that. Since she is so little it is easy to give her high quality stuff. When you have a big dog, that really adds up besides all the medications. So you are lucky in that way. I would give her boiled fish, turkey or chicken for protein. Add a little sweet or yellow potato, pumpkin kale or green beans for fiber. You can poach an egg and give her a bit of that too. Here is Dr. Dodds liver cleansing diet that worked well for us: http://www.canine-epilepsy-guardian-angels.com/liver_cleansing_diet.htm Lola is still exhausted because of what she has gone through and her blood is probably still deprived of oxygen. You know how we get very tired just when we have the flu? Well for her it is a little more than that and it is totally normal for her to be very tired. Please try and keep positive around her. Show her that you have the situation under control and tell her to rest and get better. Don't fret, because she will pick up on that and possibly get stressed. She does not need that. She might be a little 3 pound dog, but she has already proven that she is a fighter! Best wishes, Brigitte & the poodle boys

Brigitte BC

Christina, New threads are always appreciated. Some can get very long and people don't realize there are new questions are notes. If Lola's stools get to soft you can feed her some Libby's pumpkin ironically it also works for constipation. Make sure you get the pure pumpkin filling not the pie mix. I second the diet instructions. Pancreatitis a month into treatment with my girl was part of why we lost her. Keeping you both in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Hi Christine Just an FYI you don't need a scpipt for Pet tinic and you can get it on Amazon.com when you need to order more for her in the future. I am not sure about the dosage but I would send Dr Dodds an email and ask due to Lola's small size I see that they have Pet-Tinic Pediatric Drops so maybe this might be better for Lola but again I would check with Dr Dodds. Have you found a new vet in your area to take her in for a follow up visit? Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Pet-Tinic dosage: Dogs (and Cats): Approximately 1/2 teaspoon (2 1/2 mL) per 25 lb of body weight twice a day. atopica can cause some diarrhea for a few days but it most likely will go away. I am hopeful the blood bruising will go away, do you know what the last platelet count was? Chance had this too. Large dog, very scary to look at. vet had never seen so much. but it was not bothersome once he was on meds. I can't say for sure. check gums by gently pressing against them and holding for a few seconds. release. watch the refill time (to get color). if it is very slow to refill write that time down and then try again in one hour. repeat. if it doesn't begin to refill well, call vet. the color may not get very bright but should not be gray. also look at the color in the ears or gently pull the lower eyelid down to check. if it continues gray, call the vet. heart rate can be very variable throughout the day (with soloxine I would worry more about it getting high) as can temperature. take both about 4 times a day and write it down. if the temp goes above 103-104 call vet. p

Patrice NYS

did you put chance on diet? i'm not sure if i should put her on certain foods or not since she is so small...her gums are great...changing from white and quickly to pink..ears are pink...platelets yesterday were 44 based on a reference range of 170-400thousand.. what was i supposed to do in regards to t3/t4?? and patrice, have you heard about danazol? i'll continue checking her heart rate and temp.. she's being such a good girl, i couldn't be prouder. cheryl and ginger, i didn't want to wait until tomorrow to start pet tinic..we just gave her her first dose of pet tinic so fingers crossed!! thanks penny, i'm going to start figuring out a good diet for her now. lola sends kisses

christina new jersey

Hi Christina: You remember when you get a bad bruise how long it takes for the blue, black to go away. This is the same thing with Lola. For peace of mind ask the vet what the plalet count was when she was released. I think if it were at a dangerously low level the vet would not have released her to you. If her plalets are still very low the vet could give vincristine which should result in a quick release of the plalets in the marrow. With the plalets issue make sure to keep an eye on Lola's business to ensure to ensure there is no blood. Blood in the stool fromt he upper intestinal tract will have a dark tarry looking appearance. I am just curious as I have been reading that sometimes a trigger for this illness is hormonal ... thus the reason they see a higher incident rate in female dogs. Is Lola spade and if not when was her last heat?

Elaine Ottawa

Elaine, Lola was spayed over a year ago..and I actually was just reading about vincristine! I was also reading about danazol but i guess i will wait until tomorrow when we go to the vet... thank you for your advice. her platelet level before we left was 44 thous which is way below the reference which is 170-400 thous... i'm sitting her with lola now, and my aunt is holding her...lola has never panted in her life while relaxing..but when she was being rushed to the vet the first day and needed the transfusion, she was panting.. we fixed that with fluids and meds...but now my aunt is holding her and every once in awhile she will open her mouth to breathe which she never ever does. god i am like a psycho right now !! every move she makes is keeping me on my toes

christina new jersey

Hi Christina, Prednisone stimulates metabolic activity, especially at high doses and causes panting as a result (they release heat this way to cool). It will also likely cause her to need a lot of water and need to pee regularly. It means you are seeing the prednisone working in her and is a good sign. There can be panting with anemia, but it sounds like she is just keeping her mouth open to release some excess heat. Thinking of you guys, Richard

Richard Burnaby

wow richard you are beyond awesome! i had a mini heart attack when i saw her panting and flashed back to when she was so dehydrated that terrible day. good to hear christina and (sleeping) lola

christina new jersey

no sleeping tonight! lola just went to the bathroom and i found blood in her stool. the stool itsself was a very dark brown..the blood was what sounded the same as when amy found blood in her pups stool...a bright red it a clear mucous- - it wasn't a whole lot of blood but enough to make me worry.. i realize that the prednisone can cause this without pepcid or something to protect the stomach..but we just started lola on this medicine yesterday and gave her pepcid today..could this have happened this quickly? either way i think i am going to ask my vet for sucralfate in the morning...and i will make sure to give the tummy meds with the thyroxine so that she has a full hour before..what's hard with the pepcid is i had to cut the small pill into 1/8th ---will i be able to with sucralfate? should i be incredibly worried or is this something i can still breathe about.. christina and lola

christina new jersey

Hi Christina, Take a deep breath. I think you are on the right track, the blood is probably a side effect of the prednisone and Lola has some ulcers. The sucralfate will help with that for sure. The pills are huge but you should have no problem cutting them. The sucralfate is much better at protecting the stomach than the pepcid. I remember giving the thyroxine away from all the other medications and food. The Sucralfate can also be given late at night to give the full effect. You are doing great Christina, try and get some rest. There is not much you can do right now, I am sure Lola is sleeping too. Take it one day at a time. Your little girl is a fighter and is in good hands with you! Take care, Brigitte

Brigitte BC

Thank you so much brigitte..i appreciate it ..so does lola! i'm going to go lay with her now. have a great night all :)

christina new jersey

Christina, The vets just put Bentley on Sucralfate as he vomited with a bit of blood in it. I asked THEM to cut the pills (his were in fourths)....they did. I put one-fourth of a tablet in a large syringe, then draw in a tiny bit of water to slurry it (per their instructions)....it dissolves the tablet portion. Then I just administer that to Mr. B like any other liquid med. Mr. B and I are sending you and Lola big HUGS! Sally

Sally Louisiana

Sally, What dosage do you think I should give lola based on her weight? Jean said to add sucralfate to her meds along with pepcid! Were waiting in vets office now..these people are going to get sick of me very fast! Lola jyst growled at a boxer shephard mix and scared it away. Arent dogs great? Christina & lola

Christina New jersey

The bruise is spreading..but her gums are still pink and the recovery time when pressed is less than 2 secs.. The low platelets are giving me heart palpatations ..thinking about going to U penn..

Christina New jersey

Hi Christina, It looks like Sucralfate dosing is often broad, eg 1/4 tab (1 g/tab) for "small" dogs and Bentley at 11 pounds is taking a quarter pill. Lola is a really small dog, so you might cut that in half. Ask your vet about this. Because it needs to coat the lining, this may not be necessary to cut it below a quarter pill. Don't worry about anyone being sick of you. They have seen this before with this disease if they have treated it before. We all come running back, phoning etc. My vet was very dgood at dealing with my phone calls, answering questions, relaxing me and thus avoiding trips to the vet every time I was conerned. This disease has plenty of complications and successful treatment depends on dealing with things as they arise, so it is better to ask than not to. Keep up the great work though and hugs to you both, Richard

Richard Burnaby

Christina, Richard has our dosage for Bentley exactly correct, and his weight too....He takes 1/4 of a 1g tablet, and he is 11 lbs. I'd definitely check with your vet about Lola's dosage. I was worried at first about calling/visiting my vets so much....but that feeling passed quickly. Just remember, you are doing all this for Lola. You need to feel secure in your understanding of what is happening, and what you are supposed to do to care for her. I LOVE that she growled at that big dog!! You GO, LOLA!!! Bentley sends her big puppy HUGS :) Praying for you both, Sally

Sally Louisiana

Christina, The University of Pennsylvania vet hospital is a wonderful place to be. I actually worked at Penn for 10+ years. You should be aware, however, of what I cautioned you about before with Dr. Klag at VSEC -- they may not be very receptive about following Dr. Dodds' protocols. Especially not at Penn where they perceive themselves to be the "mecca" of veterinary care. I suggest you give them a call first, perhaps talk to one of their techs about which internal med specialist would be the best one to see given Lola's condition. And if the only way you can be comfortable is following Dr. Dodds' treatment plan, discuss that with them as well so you know prior to spending the time -- and an incredible amount of money -- and not have a comfort level with Lola's care. I am not discounting Dr. Dodds' research and protocol at all -- as a matter of fact following suggestions on this forum I insisted on a T4 for Beau and lo and behold discovered hypothyroidism during the early stages of his IMHA -- but I am quite impressed with the recovery he has made under Dr. Klag's care once I transferred to VSEC when he wasn't getting any better with my regular vet. Good luck! Thinking healing thoughts for you and Lola! Sharon

Sharon PA

How is Lola this morning? Please know we are sending our prayers. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Christina, I agree with Sharon. She has some excellent advice. Dr. Dodds has an very successful treatment protocol and is very good at evaluating test results. But, as of necessity, this is done long distance and she is unable to examine Lola. Thorough clinical exams are very important. If Sharon has an excellent recommendation for a specialist then that is something worth looking into. My local vets are excellent in this regard and I knew that they had frequent contact with our specialist and also with Cornell. If they had any questions they could call them or have me ask Dr. Dodds. This was a team effort. But they performed all the hands-on treatments locally, got me the meds I needed and helped evaluate test results. All the techs knew Chance, had a good relationship with him and were motivated to see that he survived. I had a little more knowledge than most owners so my vets were pretty comfortable doing it this way. So we didn't spend $10,000 helping Chance. (But he probably got $10,000 worth of treatment!) Not every local vet is prepared to handle a complicated case like this. A good approach is to see a local vet who has a close relationship with a specialist and is confident doing it this way. This provides all the benefits of specialty care with a lower cost to the owner and less traveling stress to the patient. Not everyone can find this perfect combination. So in those cases it is best to see a specialist. my best patrice

Patrice NYS

(((Christina))) Sorry you're having these problems with little Lola! She's absolutely BEAUTIFUL!!! I'd go ahead and give 1/4 gram sucralfate to her (2-3 times daily as needed). Keep it AWAY from food and meds. At least 2 hrs before meds or an hr after. If you can manage to give her a dosage right before bed then even better. That way it coats and heals all night. Were you not using pepcid or prilosek (acid reducers) from the get go??? eeeek This is a must for ANY animal on these meds. How's her stool looking today? Any signs of blood? What kinda food do you feed? Do you have a copy of recent bloodwork? 44,000 is getting near the critical range for platelets. By now the meds should be working so hopefully you'll start to see a steady rise in the platelets. For the time being keep her extremely well rested and stress free. The smallest of bumps can cause bruising and with platelets that low it's reasonable for the bruise to spread some. Do you know where they are taking the blood from...a leg? Neck (jugular)? If they aren't already ask them to take from the jugular at the next visit. I wouldn't ask for vincristine just yet. This is a serious drug with like potential side effects. Usually reserved as a last case scenario. I also would avoid the danazol route. There's much better drugs that can treat this...cyclosporine (Atopica) being one! I'm not always around but look me up if you need to chat. I'll keep both of you in my thoughts and prayers. Healing vibes streaming out to Lola!!! :) Johnny & Tessy

Johnny

shoot i thought my comment posted earlier but it never did!! well lola and i had a really nice day--i'm sorry i didn't get to post earlier..this is the first day i haven't been doing crazy research on my comp!! anyway, it seems as though her pettechai is going down on her gums as well as around her injection and biopsy sites---the bruise also seems to be slowly receding (but that could just be me imagining good things!!) she woke up energetic and spritely! ! although we are trying to keep her from moving unless she has to go to the bathroom--her appetite is also up and shes drinking a lot --- thanks richard, i hope the ones at upenn tomorrow are a little more compassionate than prior ones we saw---with our local vet..he is super kind and caring and we really like him, unfortunately he doesn't have the equipment to take care of her. when i spoke with jean about going to a different doctor she said if i go to penn id have to see her colleague and friend who is great--of course he is on an awesome vet sabbatical until august 8th-- she said that she is sure that his colleagues are great and to still go--so we held onto our appointment for tomorrow (wednesday) at 1pm .... Thank you Sally and bentley !! sending love back your way !! Thanks for your thoughts Sharon--I am definitely going to go to the consultation tomorrow at Penn but I did fax all of lolas up to date info to dr. klagg and actually spoke with them today--so If i do not like what they have to say over at penn ..that is my next stop. thanks for the thinking about us cheryl and ginger !! i'm sorry i didn't get on here until now! ! my friends came to visit us so i got a little break from non stop researching and worrying! Patrice--yes money is definitely something to worry about..i mean i'm going to do what is necessary but this seems to be a very scary and uncertain journey as well as an expensive one. the overnight stuff is proving to be the most costly thus far. i just made the decision to give up my internship with nbc --i'm not sad though, i know that lola needs me and i would not feel happy or comfortable leaving her. i just hope she gets a little better before i have to go back to school in september. i know that there is a big big bigggg chance that she will not, i am just not telling my parents these negative thoughts yet. Hello Johnny! Thanks, we think shes pretty darn cute but then again I'm of course very biased ! I think I have more pictures of her than of myself, family, and friends combined lol! --Lola just started on all of her meds this past saturday and we got her home saturday night- we started her on pepcid on sunday since everywhere that sold sucralfate was closed--on monday we switched her to sucralfate and took her off of pepcid- we have been giving lola the thyroxine and sucralfate 1 hour prior to her other meds--and we don't feed her food with the thyroxine and sucralfate- we feed her with the other meds- she had a little bit of blood in her stool a couple of nights ago , but last night there was no trace of blood- her urine is also normal as well- we have been feeding her chicken, turkey, and cheese- - she really wont eat anything else..lola is the pickiest eater you will ever ever meet! she wont eat liver, and jean dobbs asked us not to feed her beef anyway her platelets were at 44 thousand on friday when she last had her bloodwork done, but doctors suggested not getting her bloodwork done until weds or thurs since she was so low as it was.. i sure hope the platelets are rising!! we are doing what we can to keep her as still as possible..she hasn't gone poop since last night (monday) at 530pm ..she often poops on her puppy pad but also in the hallway outside of my bedroom door (which we think she started doing out of spite when i left for school) We are obviously allowing her to go number 2 wherever her little heart desires right now but since we're not letting her walk around except when going on her puppy pad, i'm worried that she has gotten constipated or something- she is urinating a lot a lot, and i know thats from the medicine -- i'm not sure where they took her blood- i thought it was her front leg but that may have just been where they gave her fluids- - i will ask for the jugular tomorrow - and lola is on atopica !! :) i hope you and tessy do stick around my post awhile! you seem to be very helpful just like all the others that have been helping us through this scary time! with all of that being said, there are still some concerns i have- obviously the lack of stool since last night, and she is breathing very very quickly at times -- this is not making her heart beat go up (still at around 80 beats per minute) but she never breathes like this--i think i recall someone saying it can be a side effect of the meds but i can't remember (everythings starting to blurr together) she also has been panting slightly but i notice it right away and when i shift her of take a blanket off she stops (i think someone said thats from the prednisone)-- -lola is still gagging ONLY after drinking water--she is fine while eating and even taking her liquid meds, but the water is a problem for her--its like a cat coughing up a hairball, but nothing comes up, its so pitiful!! :( does anyone know how to get ahold of laurie and wylie ?? when i googled the gagging thing, a link to this site came up and i think it might have been hers but the thread is no longer there!! i would love to hear if she experienced this with her pup.. my mom is coming with me to u penn tomorrow so hopefully they take what i have to say seriously! i would much rather my marine father who served in vietnam to stand behind me during consult tomorrow, that just might make the doctor pee their pants. it sure did when the he came up to tinton falls vet after i called him crying about lolas doctor! you guys have no idea how great it is to log on here after being with lola all day and having such a great support system asking about how we are..beyond thankful--my family sends their love too. i know youll all be with us tomorrow -Christina and lola

christina new jersey

Hey there kid, I know there are still doubts as to whether you are seeing improvment (I hope what you are seeing is true), but you are definitely seeing prednisone at work so maybe they are. Drinking a lot and peeing a lot mean she is reacting to it strongly. Panting and appetite are also part of pred. Likely so is her fast heart rate. In my opinion, guaging her reaction to prednisone is important so you can make better choices about doseage later. If you are having trouble remembering what is going on at what time with Lola, use a journal and keep track of what you see and do. Poop does slow with anemia (keep an eye on this, but she is probably fine). Anemia can make it difficult to curl their tongue the way they are used to so drinking is harder and dylan did get water in her windpipe often, the reason for coughing, but I have not heard of gagging specifically (remember I am new too). This is much like a dog swimming for a toy that absorbs water and when they swim back with it, they often cough water up from their windpipe as they squeeze the toy (not Lola I know :-) Keep water handy for her so it is easy to get when she needs it (I am sure you are). I suggest you take it easy on the cheese, it is really fatty. Better than nothing for sure, but it is something you will want to be careful with. The liver has a lot of work to do and fatty foods are harder for it to process and can cause pancreatitis. Low fat cottage cheese or low fat yogurt is better (some fat is necessary). I think Brigitte also mentioned pumpkin. This is good for stool and easy to digest. Not the sweetened pie filling, just regular pure cooked pumkin, often found beside the pie filling. I will try to find some other ideas from my canine diet books tomorrow. Cooked people food is probably best for her and chicken (remove skin and fat) and other meat like cooked white fish are good for her. You may need to try a few new things to find out what she will eat. Dylan had a great appatite always, but she eats a raw meal like the wild dog that she was long ago. With prednisone I had to start watching how I carried food as she would steal it from me. Myabe prednisone will help Lola find a new appetite. Take care and try to get some rest too :-) Richard and Lola's other fan, Dog Dylan

Richard Burnaby

Hi Christina, just a little hint, you could try ice chips, may help the gagging, and it does get fluid into them, or they do sell doggie popsicles, or they used to, i just can't remember the name of them, i was going thru this quite a number of years ago with our Tori, take care Bev

bev

This thread was discussed between 17/07/2011 and 20/07/2011

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