Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Looks like we'll be saying goodbye to Reggie today

Well, Reggie made it through the night and I spent much of it curled up on the floor with him. I took him in to the other ER vet this morning to hopefully see the internist. They put him on oxygen and told me his levels have dropped to 12 again. We could proceed with another transfusion and treatment, but this 2nd vet didn't think his odds were very good since he hasn't responded at all to the heavy doses of meds he's been getting over the past two weeks. To continue pushing treatment would be about another $3,000, in addition to the $4,000 we've already invested. I hate that it somewhat comes down to money, but we honestly cannot handle any more :'( It looks like we'll be saying goodbye today to the best dog I've ever known . . . I can't believe we only had six short years with him. Now if I could only stop sobbing so the kids don't keep wondering what's wrong with mommy . . .

Amy Wisconsin

Amy, I am so sorry to read this note. The financial restraints can be very hard. However, at this point, know that you've done all you could do and it is now in God's hands. Thoughts and prayers are with you, hoping for a good outcome for all. Sharon

Sharon PA

Please know that you and your family are doing all you can. My vet once told me that they would only need a transfusion if they went in to single digits. I am just wondering if they reduce his meds just to see how he would respond. Sending my prayers Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Dear Amy, You did so much for Reggie, more than a lot of people would..... Reggie knows that. your kids will also understand. This will be hard on your whole family and bring you closer together. Remember we are with you all the way, no matter what you do. Thinking of you, Brigitte

Brigitte BC

I should add that Dr. Dodds did email me back early this morning and offered her consult free of charge. So very sweet of her, but in order to try anything more we'd need so much more money to work with. The house already feels empty without Reggie. And my floors are already filthy with six young children and no pooch mop to clean up after them :-(

Amy Wisconsin

Hi Amy, I am so very sad for your loss. I am sure all the good memories will be with you always. Sometimes it is just nice to have some extra time to have those hugs on the floor (I too have spent several thousand just to have one beautiful day of play and hugs with my dog Jagger). You really did work so very hard for him and sometimes there is just nothing more that can be done. I did have that lay on the floor all night with Dylan too and let her know she could let go, as she was so weak, and that she would be with me always no matter what, but fortunately she shose to stay. I hope the memories soon replace the emptiness, Richard and Dylan

Richard Burnaby

Richard - what were Dyland's red blood cell count numbers at her worst? Did she start to rebound all on her own, or was something different tried? I just got off the phone with the internist and she wants to do a number of tests we simply cannot afford at this point (another ultrasound, bone marrow test, etc.). Right now she is doing more blood tests to check the white blood cell count and platelet count. She said if those are low, we may just need to back off the medications so we're not over suppressing. Reggie had been starting to climb (22% after transfusion, then 25% and 26% a few days later), but then started heading in the wrong direction again. I can't tell you how much I'm praying that backing off the drugs may help. I know it's probably a long shot, but at least it's something.

Amy Wisconsin

Hi Amy, I did not measure Dylan’s numbers at her worst, but since she actually suffered brain damage from lack of oxygen, I know she was down around 10, or 12. Although she did have a greater recovery than most dogs initially, I could clearly see steady decreasing PCV from her peak recovery level (39) due to the super high prednisone right from the start. As it continued, my vet also believed this. Although I have not measured PCV lately, I know she is way over 35, her last count, and that this is due completely to lowering her prednisone dose. I have had other stories forward to me recently too, of dogs where lowering prednisone in a cases similar to Reggie’s (where they saw some initial improvement followed by steady decline), resulted in a complete turnaround with PVC climbing right away. So there is a concept in pharmacology called drug “efficacy” and I cannot help but feel that dogs like Reggie are falling victim to the fact that veterinarians are using higher and higher doses than they should be (as in Dylan AND Reggie, double recommended on this very site). More is rarely better in pharmacology. Efficacy of most drugs is a range with an upper limit!!! Also this range varies considerably between individuals. Even ASA and acetaminophen have these limits that when exceeded it no longer does what it was intended to do and cause serious side effects. This is not different than the fact that at low doses, prednisone has more of an anti-inflammatory function and as it is increased it suppresses the immune system and in my opinion, as it increases still further it suppresses everything including RBC production (?), the intestinal muscle (smooth muscle) which is more resistant to its effects than skeletal muscle (striated muscle) and who knows what else. I am currently formulating an email to Dr. Dodd’s on this very subject. Reggie is certainly at a place where if it does not work, the worst case is no worse than what you have posted already. There is nothing worse than losing them and that seems to be the alternative at the moment. Please forward any direct questions to me if you like (remove spaces from email) “Richard @ bullseyeperformance.com” My fingers and toes are crossed for you guys, glad to hear you are still fighting, Richard

Richard Burnaby

Hi Amy, I tried to post links to some videos of Dylan at different stages, but they were blocked and then I was blocked. I will wait to try again, as I do not want to be blocked at such a critical time for you and Reggie. I have adopted you both into my heart. I know your pain all too well and I am very much saddened by the thought of losing Reggie. My views on these subjects (prednisone reductions, diet, etc) are often contravercial, but it does stem from 22 years of experience fighting an autoimmune disease in people and having observed how little we (including vets and doctors)actually know and how the standard methods and embedded dogma are not always the best. Uniqueness of individuals is not stressed and when I taught physiology to pre med students and pre vet students, this was the aspect of the labs we did that they could not grasp. Why do things occur in the lab that are differnt than in the book? To me the answer is simple. The book is a generalization of the situation and life is not! The system is slow to respond to unique needs. Doctors need an easily defined protocol. But Dylan is alive today because of my beliefs. It is not an accident (although I am sure her unique case does contribute to her recovery too). I spoke to my vet today about Reggie and high prednisone levels and what they can do and, like me, she understands that every dog is unique and every case is unique and the overwhelming tendancy to treat them all the same way. Now is the time to try as there is nothing to lose that you are not already in danger of losing. Treating each dog individually is required with AIHA, as it is an overwhelming killer! Good luck, Richard

Richard Burnaby

One thing I did forget to mention. With Dylan, who started on 100 mg/day after 3 days I was very concerend about how high the dose was and was immediately concered about what it was doing over and above stopping the AIHA attack. On the day Dylan hit her lowest point, I spoke to my vet about this and she lowered our dose immediately to 80mg per day. WE had been giving 2 X 50 mg out of convenience so that I could use a 50 mg pill. I cannot say that this helped her immediate turnaround or not, but she did start improving the very next day. Was that improvment just due to the very high dose initially and the time it took to act? Did the drop to 80 help? Cannot say either way. What I can say is: The drop to 80 did not hurt at all! Neither did the drop to 50 10 days later. Richard and Dylan Richard

Richard Burnaby

Amy, I am hoping and praying for you and Reggie. If love alone could save our dogs none of us would need this board. Please don't feel you have let Reggie down because you can't afford more tests or treatments. We spent major $$$$$$ and tried everything with our dog and still lost her. It is a very wicked disease. Hugs Penny

Penny Lytle Creek Calif

Amy, I'm so sorry you're having to deal with this. Nobody should ever have to go through what you are! HUGS! if you want to chat look me up on Facebook .... Jonathan R Lambert I'm super busy lately but can free up some time tonight if you wanna chat. My thoughts and prayers are with you and Reggie! Johnny & Tessy

Johnny

Hi Amy, I have not heard back, so I continue to hold out hope for Reggie. Yes we tried something different with Dylan. And believe me, my choices worried many on this list and certainly with good reason I have no doubt. So despite the fact that Reggie's circumstances are unique to him, I will relate what we (my vet and I) did with Dylan, since just about everything we did was different it seems. I hope you have the time to read this, but it is long because there is a lot that was done differently and it needs to be explained as well. I am still not sure how much can be taken from it as there are many things that were different, including what may have caused the AIHA attack itself. This may be a critical difference. Our differences start before AIHA though and this may be important. The fact that Dylan has been on a raw diet before and after AIHA changes things a great deal, but maybe there is still something valuable in what we did that might help you when it comes to Reggie. For diet I would say to do the best you can on this one, it is a less expensive way to make a big difference and of course for now just getting him eating again is important. Dylan refused food at her worst anemic state too, fortunately it was short lived. Also, I had worked as a scientist many years ago studying pharmacology and drug actions in the brain as they pertain to memory and eplipesy and that and other things in my life led me to be a "minimalist" when it comes to the use of chemicals in treating disease. I know there are complex interactions AND chemical stress is very important in all biological processes. I always minimize physical and chemical stress as a high priority! I stress the word "AND!" Prednisone, azothiaprine and cyclosporine are NOT like aspirin. One of the reasons cylcosporine and azothiaprine were devleoped was because of the serious side effects that accompanied 6-mercaptopurine (an earlier immunosuppressant), a drug my ex wife took back in the early 90's to treat her Crohn's disease. She was put on Azothiaprine later, refused the offer of Cylcosporine, but has tried other experimental drugs for her Crohn's disease. One of which is advertised on TV like it is aspirin, yet it kills a cell type in the body and can cause tuberculosis and death as a side effect. Not apsirin (although it too can cause death). Using these drugs is something to be considered where there are no other choices, like organ transplants, which they were originally designed for and AIHA in many cases too maybe. But these drugs are very hard on the body and I knew that that while they "might" help, I knew for sure they would certainly also hurt her. Having a strong body and minimal chemical stress I considered very important in treating Dylan. Chemical stress impeding recovery is not discussed generally. In all of the expxeriments we did back when I was doing them, chemical stress did change the results we saw and in fact even how we anaesthetized animals we were studying did matter too. Also, I could not afford complex treatments. I had to make the best of what I could afford. My veterinarian is also a minimalist, so no other drugs were started initially. Different than most! The immunosuppressants all take longer to act, so until we knew more about what the prednisone would do, neither of us saw the point in using what I call, "the shotgun" approach. Using multiple drugs would certainly make removing the drugs much more complicated as well. There are reasons to give these drugs and they have value in many dogs treated for AIHA, but again these are very serious drugs, very hard on the body and have some serious side effects (you are seeing the result in Reggie). We chose to hold off until something made us think they were required (opposite to everyone I read about). Yes, we did see early recovery (2 weeks), but I had already reduced prednisone once. I did so again after we saw her PCV was 39 so within 2 weeks she was taking just over 1 mg/pound, 50 mg/day and yet her PCV continued to decline for at least 4 more weeks. From the beginning, I knew I was fighting prednisone. From the beginning I reduced prednisone as soon as I was certain she was stable from the last change. (Again different!) Also, Dylan had a good reticulocyte (immature RBC's) count early on and after a few reductions in prednisone (down to about 1 mg/pound/day), spherocytes were no longer present in her bloodwork, indicating her immune system was not attacking RBC's. Along with the lowering of her PCV, we also saw her reticulocyte count start dropping while still on the higher doses of prednisone. This was clear indication that something was suppressing RBC production and in our case, the likely cause was prednisone (advantage of being on only one drug). I did not wait some arbitrary amount of time between reductions (3 - 4 weeks?). I customized it to my unique Dog Dylan. She had a reduction every week until we got to where she was really getting better. Then, despite seeing no signs of the disease and constant improvement in strength and capability (she is running now), I have been waiting 2 weeks between reductions just to make sure AIHA is not returning, as prednisone is low enough now it may not be inhibiting her immune system. Let me be clear though; each reduction was preceded by observing positive changes and NO signs of increasing anemia, or red blood cell destruction. I have actually not even done a blood test now since she was at 35, because her behavioral improvment is so obvious now annd she clearly has no signs of anemia or the disease (eg her gums are much more pink now). I reduced prednisone every week, 10 mg/day until we reached 20 mg/day because I saw declining PCV (and reticulocyte count) and extreme muscle loss (she was very sensitive to prednisone and this was important in deciding on what dose she should have). By April 17, Dylan could not even lift her head to eat or drink water and I knew if I did not get it out of her fast, she would die from prednisone. Personally I would pick anemia over prednisone any day of the week! I was 100% sure the weakness I saw when she became immobile was from prednisone (her symptoms read exactly from the list on Iatrogenic Cushing's Disease exactly) and NOT anemia (they impact the face, eyes and ears differently), so even when she could not lift her head, it was very different from what anemia had done. I could see this clearly. I am fortunate in that I am a behavioral specialist and can see very fine differences in behavior - Unique again and fortunate for Dylan too. At 30 mg/ day I started seeing positive behavioral changes. Things she could do that she had not done since losing mobility. At 20 mg, those imrovements were more obvious, as the were at 15 mg per day. This is when we started dropping her eveining dose every second day (saw her turna round in her kennel, roll over on her own and sit completely upright to eat), then less than a week later, dropped both doses every second day (15 mg divided in 2 doses every second day). This is when she stood for the first time, then began walking aout my house and outside on her own. Then down to 10 mg (2 X 5 mg) every second day. Tomorrow I start on 5 mg/day (2 X 2.5 mg) every second day. If all goes well, Dylan will be off prednisone completely in 2 weeks. I do have to watch for her adrenal gland function now, as they are no longer inhibited and are required for her to function normally, so this and of course no anemia, will be what I watch very closely for. She continues to improve though. Her stride, her strength, her posture, her expression of love to people, she runs, she goes every where she wants to. Every behavior she lost is returning to normal now, with the exceoption of the changes caused by brain damage during her anemial 3 months ago now (but even that is lessening in how it is expressed). Just like my intuition told me that something was really seriously wrong that afternoon when she vommited the meal she had hesitated to eat, my intuition is now telling me that whatever was causing Dylan's immune system to attack itself, is no longer present. I can only hope I am right, make the necessary choices and be prepared for what to do if I am wrong, or if things don't occur like I hope (eg I have to take the last 2 reductions more slowly to make sure her adrenal glands are working and she is not in pain). Hope this helps, Either way, I am still praying for Reggie and you, Richard

Richard Burnaby

HI Amy; Please know that you have done everything within your power to help Reggie. Sometimes this illness has such a strong hold on our pets that there is nothing that can be done to help. I am glad that you got the second opinion, so you can know you have done as much as you could. This illness affects our dogs with differnet levels of aggressivness ... sort of like children with chicken pox .. sometimes a child gets lucky and has one spot vs the some that alomst die from it. Our family prepared a memory album which helped alot with the grief and closure. You have certainly showed /reggie the return of the love that he has always given you. It is a collosal shame that nobody seems to know anything about this illness until they have first hand experience in dealing with it.

ELAINE OTTAWA

Hi Amy, please remember what I said earlier. You are doing a great job! No matter what your choices and no matter what the outcome! This is by far the hardest thing I have ever done and I am sure it is the hardest for you too. Knowing what to do is impossible, but you are doing the best and the most you can. That is easy to see. There is such great pressure and obviously, such great love. Reggie could never ask for more. As your dog, he would never ask. You are a special mom for sure (hoping able to be with him today), Richard and Dylan

Richard Burnaby

I definitely need to give an update on Reggie today. Before making the irreversible decision to put Reggie to sleep, we decided to run another round of blood work on the Internist's recommendation. Whatever it is they look at to determine regeneration of red blood cells had jumped from 30,000 to 75,000. I'm not a doctor, but I know this is a good sign! This new vet/internist recommended, and we agreed, to start lowering Reggie's Prednisone with the thought that it may be doing more harm than good at this point. My concern all along has been that he was being over-medicated for too long. Now for our miracle! I had emailed with Dr. Jean Dodds a few times looking for input on Reggie's situation. When I took him in yesterday morning it became evident that without a 2nd blood transfusion, Reggie would not make it. Our finances have already been stretched beyond what we can handle, so I drove home in tears yesterday, feeling that lack of funding would ultimately kill Reggie. Well, right after lunch yesterday I got a phone call from Dr. Dodds, offering to overnight two bags of blood for Reggie's transfusion . . . at no charge! There are no words to express how grateful we are to Dr. Dodds for this amazing gift for Reggie! I'm in tears just thinking about it. We went in a spend some time with Reggie last night (he's currently in an oxygen "box" to keep him comfortable and stable while awaiting the transfusion) and he looked very happy to see us :-) They're having trouble getting the meds into him this morning (as I was at home), but I think he'll do better with that after the transfusion when he's feeling better, not to mention tapering the Prednisone. Our sweet furbaby is still critical, but at least there's a little ray of hope and we're not burying him today. I can't express enough how much I appreciate the support and feedback from this group of wonderful, caring people. I felt totally alone and unequipped to fight Reggie's diagnosis before finding all of you. Thank you! http://i266.photobucket.com/albums/ii252/amyk11/IMG_1275.jpg

Amy Wisconsin

Oh, and Richard, we have also been on 100mg/day. Yesterday the new vet lowered it to 80mg/day. I truly think at this point we're battling the Prednisone more than the AIHA.

Amy Wisconsin

Amy, I am so happy for you too (I have been in tears many times for you both (AIHA makes me very emotional still) and this time they are tears of happiness), but I know it is just a small step, but it is a great step too. I have heard so many great things about Dr. Dodd's and it just keeps getting better. He's so cute, such a beautiful boy! Thanks for the update, we are still pulling for both of you. What a wonderful person you are to keep fighting so hard. Cheers to you both! Richard

Richard Burnaby

Please know we have our fingers and paws crossed for you and hopefully things will turn around for your beautiful boy Reggie. I hope in time they can get the pred even lower soon, as Ginger is 75 lbs and the highest dosage she was ever on was 80mg it is usually 10mg per pound, but often the start out on a higher dosage for a few weeks. What did Dr Dodds say about reducing his pred at this point. Dr Dodds is truly a wonderful person, she is so compassionate about her work and saving others. I will try to send a donation to hemopet and hope a few others who can will follow, we owe her big time. http://www.hemopet.org/ Do they Reggie on asprin to prevent clotting? Please let us know how Reggie does after his transfusion, sending our prayers and hoping for a miracle. Thanks for sharing the beautiful photo. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Hi, I don't know why I see 2 mg/pound all the time, when I also see 1 mg/pound recommended regularly. I think the more is better and fear just keep pushing Doctors to err on the high side (or maybe they see it as recommended dose, I wonder about this) and with prednisone and the sensitivity of some dogs, it is just too much. It clearly was for Dylan. Some dogs this works for and some, but others are more sensitive and it clearly shuts down everything and burns everything. I too hope you can drop to 50 mg (about 1 mg/pound I would think) very soon. If you see positive results on 80, I would not wait too long to begin dropping. At this level there is no worry about adrenal gland function, as they are completely suppressed at these levels. Still praying, but much happier for you both - one step at a time :-) Richard

Richard Burnaby

oops I meant to say the pred dosage is usually 1mg per pound NOT 10mg per pound yikes that would really be too much!! Cheryl & Ginger

Cheryl & Ginger Pinevile PA

I think Dylan would have been dead had I let her stay on 100 mg for 3 weeks. Every dog is different and sensitivity to drugs is one of those things they differ on. I also think every day at that level matters more than at any time, so if they are not oversensitive, go three weeks, maybe more if you have to. Other signs can be used to tell how reactive they are to the prednisone and should be used to lower it if necessary (as my vet allowed me to do with Dylan after only 3 days and then again another 10 days later). Dylan was very reactive and it had stopped the attack, so I would never wait an additional week or even an additional day, given how fast it was ravaging her body. I am pretty sure if you were walking into a nuclear reactor, you would want to leave as soon as you were able to. This is how 2 mg/pound of prednisone should be thought of, not like it is aspirin and "the schedule" says 3 - 4 weeks. Yes many dogs do need longer treatment at high levels and if their bodies are less sensitive to it, then that is what is necessary. Drug efficacy varies between individuals and has an upper limit and we need to respect that and use it to stop AIHA. Such a tough balance anmd sometimes very hard to know where you sit between AIHA and prednisone, but as I have said many times, the battle is against both. Just my opinion :-) Cheers, Richard

Richard Burnaby

I just spoke with the vet taking care of Reggie today and she said the vet tech noted a bloody nose this morning :-( They're now concerned about his clotting and platelets. I guess it all comes down to WHY the AIHA was triggered. Could he have some other illness that is nearing end stages? We just don't know. We're just hoping and praying all of the work put in by so many will not be in vain.

Amy Wisconsin

Amy you are so right. Not knowing what triggered it and what else may be going on is difficult. Maybe start an new thread about bloody his nose. It may attract attention of someone who has seen something like this before? I can only guess about it and that is not what you need really. Big hugs to both of you, Richard

Richard Burnaby

Amy, Ask them if they ever tested for tick diseases. If they have not, insist on it now. This would definitely cause a symptom like extremely low platelets and the anemia as well. Treatment depends on the particular tick disease, but many are treated with doxycycline at high dose therapy. my best patrice

Patrice NYS

i am an old timer on this forum and sometimes it is so sad to read of all the struggles with this disease. most of the time the triggers are never found hence the perplexity of this affliction. i wish you nothing but good vibes and i will be thinking of you and reggie, we have all walked in your shoes. Bev

Bev

I still look in every now and then, lost my Springer girl Holy to this awful disease almost 3 years ago, was sudden and devastating. It gives me such comfort to know the support that others are being given, @ Johnny: what a kind and wonderful offer, sometimes our friends that have not experienced AIHA don't quite understand the technicalities and associated issues. Everyone on here is a real source of warmth and true caring. Praying so hard for you here that Reggie will put through! Thoughts are with you. x

Keri Lynn Wales

Amy - Just wanted you to know that we are sending all good wishes to your family for Reggie to pull through this - he is such a handsome boy! I am thrilled to see your note this morning that he has another chance - Dr. Dodds is amazing, as are you for all you are doing for him. I hope it brings you comfort to know that you are doing everything that you can for him. All the best, Bonnie

Bonnie Chicago

I just spoke with the vet again and Reggie should be finished with the transfusion by now. The labs today show that his white blood cells have gone up, but his platelets have gone down to 26,000, so now they're thinking Evan's Syndrome :-( The did say his blood is clotting just fine (checked because of the concern with his bloody nose this morning). They FINALLY gave him something to coat/protect his stomach. The vet said either his system is now also gobbling up platelets along with red blood cells, or he could be losing blood through an ulcer or some other internal bleed. They have not seen any evidence that he has thrown blood clots. So, I guess now we just wait and pray. As for the bloody nose - when we visited last night he had a very dry nose and they did not have water in the oxygen "box" with him. Isn't it possible that the slightly bloody nose this morning was from being in the oxygen box for more than 24 hours? I don't know - I guess now we just wait and see if Reggie's very tired and worn down body can pull through this.

Amy Wisconsin

Amy, Still keeping good thoughts and prayers for you and Reggie. If you need a shoulder or just some place to scream feel free to email me. Penny

Penny Lytle Creek Calif

Hi Amy: I have Reggie in my thoughts and prayers. I recall you had mentioned blood in his stool earlier this week and had wondered about evans syndrome back thenI It is a shame that the original vet didn't seem to do the legwork as ITP very frequently runs consecutively with AIHA and this is called Evans syndrome. It sounds like now you are working with a very competent vet. Dr. Dodds seems to be so very caring about all of these cases. I recall after Crosby had passed that I had asked about any possibility if the illness being genetic (because I wanted to get a puppy similar to him as he was the best) and she had answwered my questions right away. She has such a huge heart. Wow, how things can turn around so suddenly when things seem at there worst. Truly a miracle is happening for Reggie. Best wishes,

Elaine OTTAWA

Sending our prayers too!! Please let us know how the transfusion went. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Amy, it really sounds like Reggie is in very good hands now. Good for you to take him there! If he has it in him, he will recover. You really did everything in your hands. Sending all the good vibes and best wishes! Thinking of you, Brigitte

Brigitte BC

Reggie's 2nd transfusion went well and the vet seemed very happy that his count is now up to 28% . . . the highest it's been since this all started was 26%. He has eaten a bit and is more comfortable (he was at 11% before the transfusion). They will check numbers again in the morning and hopefully let him come home. It's all up to Reggie now. Come on, baby!!! I'm heading out right now with a few of the kids to give him some much-deserved hugs and kisses. Oh, they also now have him on a stomach protectant and an antiobiotic. Praying, praying, praying!

Amy Wisconsin

Awesome news!!! I think you might need to start a new thread with a different subject as Reggie is a figher and not ready to give up. I know he is not out of the woods yet, but is sounds like he is getting the proper care. Eating is a very good sign. I hope you and your childen have a wonderful visit with Reggie and tell him we are all praying for him. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

I too hope we have a new thread subject soon! Go Reggie Go! Go Amy! Yeah Amy and Reggie!!! Praying for you both as well! What a great Mom and glad you found someone willing to work for Reggie's life and very happy we have people like Dr. Dodd's. How does she help everyone? Good luck, Richard and Dylan

Richard Burnaby

This thread was discussed between 23/06/2011 and 25/06/2011

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