Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Lu and cocker spaniel Millie

Reposting this for Lu so that more people can see it: Lu, UK, allthatcandy@hotmail.com My cocker spaniel Millie was diagnosed with this heartbreaking disease last Friday. Her RBC was 13 and went down to 11. We were told that if it got to 8 that she was beyond hope. After a long delay (on the vet's part) we located a veterinary hospital an hour away and over the weekend she received 3 blood transfusions and is on a line that feeds her steroid treatment and pain relief. Her RBC raised to 28 and stabilised until yesterday(5 days later) when her blood count has started to drop by 5% and I am desparate for any help, or any treatment ideas. Poor Millie is residing at the veterinary hospital and is severely depressed at being away from home - she is too unstable to be brought home. I am thinking that the steroid combination/treatment is not right/correct to combat this disease. Maris - your story has given me hope that Millie could have a future and would love for her to be added to your husband's 'Get Well' list. I live in hope that her strong personality and undevoted love for us will pull her through.

Kathleen North Ayrshire

Hi Kathleen, Stay strong, this is kind of normal after transfusions with this disease. They can beat it and we have seen dogs survive PCV's of 8 many times. Mine did, but the drugs have to have time to stop the attack. Can you give us more info on what sort of issues Millie has? Was it just red blood cells? How ar the platelets? Did they tell you about Reticulocytes (immature red blood cells), regenerative, poorly regenerative, non regenerative? There are many places in the development of the Red Blood Cells that this disease can attack and treatment and progress can vary significantly depending on how they are being attacked. Please post weight and doses of drugs Millie is on. Anything else too (anything for her stomach, liver. Post the entire blood test results if you can too, we don't mind detail and in fact it will help see the big picture. Prednisone (or related glucocorticosteroid)is the fastest way to stop the attack if it is AIHA/IMHA or related conditions and the immunosuppressants (like Cyclosporine pr Azathioprine) are used along with antibiotics and other things, again depending on what might be the cause and test results for tick disease etc. so the more we know the more we can help. I wish you strength and all the luck in the word for you and Millie and your fight of this terrible disease, but there is hope. Many make it, but it does require effort and time and is a terrible roller coaster of emotional swings too. The more positive you are the better it will be to help Millie, they are strong amazing creatures and fight hard to stay with you. The stronger you can be the better the chances of a positive outcome too. Ask us anything. There are many of us that are here to help you and Millie. Richard and Dog Dylan

Richard Burnaby

Hi Lu, Sorry I mean "Lu" as I see now that Kathleen posted it for you. Wishing you and the Millie a strong and fast recovery, Richard and Dylan

Richard Burnaby

Kathleen, An RBC of 8 is NOT hopeless. My little buddy, also a cocker spaniel, had a RBC of 8, after an overnight delay with the wrong diagnosis, he was admitted to the Vet hospital. He was given a transfusion and his RBC went up to 24 and then dropped over the course of a week, to about 16 or 17. This is normal to a certain extent, it is giving the red blood cells a chance to recover. Eventually it started to rise and keep rising. The depression is normal and should start to fade when the drugs are lowered over time. Be prepared for the long haul. It isn't a short term condition and you will only notice small improvements in the beginning. I'll be praying for you and Millie. May she have the success that Buster has had. Ronda and Buster Drug Free for the last 9 months

Ronda Illinois

i second rhonda's comments about how much of a long haul this recovery is, charlie too was low, pcv of 8 or 9, can't remember and after his transfusion it only came up to 20 and very slowly increased -- now it is finally in the normal range and is 36, but it took months and tons of meds -- charlie at times was so depressed he couldn't even lift his head to recognize us, this too will improve but very slowly. hang in there, this site has been an enormous place of support -- visit it often, the ideas and encouragment are priceless!

charlie

Hi all, Many thanks for all your interest in Millie's story. Kathleen - thank you for reposting my story : ) Richard - I will try and retrieve exact info re: test rsults and drug doses tomorrow. All: Do you believe that Milie is in the 'same bracket' as your pets that had a low RBC as she is continuing to 'kill off' the red blood cells, despite receiving ongoing immuno suppresant drugs? The vet seemed quite pessimistic that it was day 5 of treatment and instead of the RBC continuing to climb, it has now been halted and in fact reversed by a drop of 5%. Is there hope? Lu

Lu UK

Lu, please post all the drugs and supplements Millie is on. Get printouts of the lab results from the vet and post here. There are people with incredible inside knowledge here, that might be able to help, have ideas. check out the Meisha's Hope website that Joanne Dickson has created: http://www.cloudnet.com/~jdickson/index.html You will learn lots there1 Make sure to go to the success stories, they will give you lots of hope. Discus with your vet if it would be possible to consult with Dr. Dodds at hemopet in California. This could be the best and most cost effective thing you could do for Millie! It would also be a good idea to put her on a thyroid supplement. Many dogs are hypothyroid at this point and a thyroid supplement can bring on a turn around. Is your vet a regular vet or a specialist in internal medicine? This is a very serious disease but please always keep in mind that many dogs have recovered from it and live a happy and healthy life today! Best wishes, Brigitte

Brigitte BC

Lu I have to say your vet seems inexperienced in dealing with this group of auto immune diseases(aiha prca etc)are you seeing a specialist or just your local vet? Nollaig had prca and took more than 7 months for her pcv to stop dropping and eventually rise very slowly..and she had numerous different immunosuppressants(prednisolone azathioprine cyclosporine leflunomide danazol) and none of them worked in her case....in her case her bone marrow needed a push to start regenerating red cells again(as opposed to stopping destruction) and that was achieved by a combination of ronaxan,soloxine,priadel,laurabolin injections,iron tablets and biopreparation(natural superfood). Nollaig was diagnosed February 2009 and her pcv only started rising slowly in Setember 2009 and she is here today healthy and happy despite me being told in August 2009 to take her home and be good to her and then bring her in to put her to sleep....that is when I insisted we try the laurabolin injections,ronaxan,soloxine etc etc...3 weeks later she stopped dropping pcv for the first time since diagnosis. Nollaig's pcv dropped an average of 4 to 5% on average a week as I said she had prca where she wasn't producing the red cells at bone marrow level as opposed to aiha where the pcv drops faster and the destruction occurs in bloodstream...do you know what type Millie has? Dr Dodds was very helpful in Nollaig's case as she was with many other people's dogs on here...make sure you contact her at www.hemopet.org her email is on there. Take care and don't give up Kathleen and Nollaig

Kathleen North Ayrshire

Hi Lu I have just seen your post in the other thread,where you say it is definite aiha is Millie's pcv dropping quickly then?You also mention clotting which makes me think it is aiha and not prca in Millie's case, I believe I have read that in aiha with riosk of clotting the dog should be on aspirin or something?(perhaps others could chime in here with experience of this) as I know that is something that has to be prevented quickly. So glad you have emailed Dr Jean Dodds she is such a nice lady and so knowledgeable and please make sure your vet listens to her advice as mine didn't at start and I just had to insist in the end remember it's your dog and you paying the bills and you are Millie's voice as I said if I hadn't been Nollaig's voice a month before she started improving she would not be here today...Nollaig I have to say was showing no signs of distress or pain and that's how I knew she wasn't telling me it was time so I made sure it wasn't. Please put up doses of drugs etc she's on and weight of Millie as that will help the people on here to advise you. I will keep Millie in my thoughts and prayers Kathleen and Nollaig x

Kathleen North Ayrshire

Hi LU! This is the place for advice. I wish that I had known about it When our little one was first Diagnosed. It's a long Roller Coaster Ride, but so many Success Stories here. I Pray for all of the People on here as well as their Fur Friends.

Kathy Calif.

Hi Lu, Although some dogs like Dylan respond quickly, many, many more dogs take longer and much longer to respond. I am not an expert, but I could probably name a dozen or more dogs I have been introduced to in the last 5, or 6 months. Sally with Mr. B. and Christina with Lola are 2 off the top of my head. This does not include all the others who have commented about their dogs in from previous cases either. Many, many dogs take longer than a week. Many take several weeks and as you have already heard here, months. In fact, I only know of a few dogs who responded quickly, Dylan being one of them. All the cases are different. They all vary a great deal. It does not fit in a predetermined time table. The other thing I have seen a lot, which I don't at all like, is vets who want to give up as a solution when they can't just prescribe a pill and fix it. It takes work and thinking and collaboration from others. It is not a text book disease. Please keep hope, as there is hope. This is a challenging disease and cannot be treated by being average and following the book. It must be aggressive and customized. If something isn't working, make changes, don't give up, please and don't let your vet give up. Praying and hoping for you and Millie, Richard and Dog Dylan

Richard Burnaby

Hi Richard, Thank you for your comments and thoughts. Our biggest challenge is that the specialist internal medicine vet cannot find/locate a source/cause for the AIHA - ticks disease, cancer, etc have all come back negative. You asked about whether the red blood cells were being attacked at regenerative level etc ... I only know that the vet said that Millie's blood sample can actively be seen to clot together (for which she is receiving aspirin) but also, that the red cells can be seen to be destroyed?! All so unclear and confusing. The vet's view I believe, is that the immuno-suppressant drugs have failed to halt the immune system's aggressive activity for which there is no idetifiable cause and thus, there are few options left available. I will update later today. Lu & Millie

Lu UK

Lu Tell your vet they will probably never find/locate a source/cause for the AIHA although I can understand him/her trying to do that in the first instance....it is an autoimmune disorder and her immune system has just started attacking her own red blood cells and in Nollaig's case at bone marrow level.I have autoimmune thyroiditis myself(underactive) and hence why I have now gone on to develop rheumatoid arthritis another autoimmune disorder where I attack my own joints and I am only 38 but sometimes we're just dealt that hand or it's in our genes and that's the same for dogs...now that your vet has found no internal bleeding(I presume they've checked for that)or cancer etc then they should just concentrate on trying different drug combinations etc and as quick as possible.Nollaig had ultrasound scans of her ovaries/womb, bone marrow biopsy,scan of her chest lungs and abdomen and nothing was ever found and then they spayed her too(which I was happy to do just in case hormones were triggering anything)so put her through a lot...but I always found it hilarious(not really at the time!) when I had to more or less persuade internal med specialist to do a full thyroid profile(a simple blood test) as they said Nollaig is showing no outward signs of thyroid disease(i.e hair loss etc etc)however as is the case with alot of autoimmune disorders the dog is hypothyroid and if you read Dr Dodds opinion on thyroid disease the thyroid gland can sometimes be more than 70% destroyed before a dog will show outward clinical signs although I would argue anaemia is a big sign!!As it turned out Nollaig's thyroid was low but only found that out from doing the FULL thyroid profile that Dr Dodds will tell you about. I hope you hear back soon from Dr Dodds and that your vet is willing to work along with her suggestions for drugs to try doses etc....because mine wasn't his ego was too big! but I wasn't going to let that stand in the way of my precious dog's life and as I said before I didn't see him offering to pay the enormous bills so I just stood firm and just said that as I'd tried all his different drugs etc etc and nothing had worked then now let me try something else and thankfully he agreed and it all turned around. How is Millie doing is she still in hospital and what is her pcv today?Is she on a preventative for clotting?

Kathleen North Ayrshire

Sorry I just saw that Millie is indeed on aspirin...having read your above post again I cannot believe your vet is being so negative so early...as I understand it Millie just took ill in the last week and the vet has what only tried prednisolone and azathioprine so far as immunosuppresants am I right?.....well I know for a fact as Nollaig was put on that drug that azathioprine can sometimes take as long as six weeks to kick in the system so it might be better to try cyclosporine as it works faster for some again Dr Dodds is really the one that your vet needs to be in touch with I cannot emphasise this enough there are many other options left for Millie not just prednisolone and azathioprine(as I told you before Nollaig was tried on at least 5/6) ....in aiha you have to act quicker than in prca which Nollaig had as the pcv drops off so quick so the dog's body does not have the same time to cope with the lack of red cells and also risk of clots but prca is much harder to treat so pros/cons with each type. Let us know how Millie is as I do hope she's hanging on in there and fighting the good fight. Kathleen and Nollaig

Kathleen North Ayrshire

Hi Lu, Sorry to say, but your vet does not know much about AIHA. The majority of cases are "idiopathic" where the cause is unknown, so you can search forever, but the disease is still there. Dylan has this form. N known cause, but she is better. KNowing where the condition is attacking and how to fight things is more recent and much knowledge has been gained in the last few years it seems. Another form of this disease is Immune Mediated Hemolytic Anemia and this is often caused by tick born disease, or toxins like heavy metals. If platelets are low, and they likely are, as you are seeing clotting, which you don't necessarily see when just the red blood cells are attacked, this has another name. Please read Patrice's explanation, part way down the page of the post "Thread: Abnormal Clotting In Dogs with AIHA/IMHA" Don't worry about the studies and other stuff, but she explains the variations on the diseases there really well. print it and take it to your vet! 5 days is not nearly enough to tell and stop the issues in the bone marrow and they have NOT failed yet!!! Maybe you should see if you can get your vet to come here and do some learning. It really sounds like they are working with a knowledge level that is more than a decade old!! I seem to know more and I knew nothing 6 months ago. Good luck and don't give up, there is lots to be hopeful for, we have seen this many times, vets like this many times, dogs in worse situations too. Fingers crossed too, Richard and Dylan

Richard Burnaby

If platelets were low you wouldn't see the clotting in Millie's blood that your vets reported as it's the platelets that help clot the blood along with clotting factors....are Millie's white cell levels ok? If Patrice or Joanne is reading this: is heparin being used to prevent clotting in dogs yet or is it still in research stage and therefore is aspirin still the best preventative of blood clots in AIHA dogs? I just want to make sure that the vets are doing the best for Lu's dog Millie as they are seeing clotting in her blood and I know that the clots are often the danger with AIHA dogs and to be honest when they're being so negative after only 5 days of treatment I doubt they have much experience with this disease. Kathleen and Nollaig

Kathleen North Ayrshire

Kathleen, Good question. You can read my recent post Inappropriate Clotting in AIHA/IMHA Dogs for some more information about the research being done for this. I know that they are doing research with aspirin vs heparin and by all accounts heparin probably is going to be the go-to treatment in the future. However, I can't tell anyone to march in and ask their vet for this treatment. But I can tell you that if this were me and my local vets I would discuss it in earnest with them. The greatest risk is when a dog (or human) begins to develop DIC disseminated intravascular coagulation. This can be a very sudden event or happen over time. There are certainly diagnostic tests that can pinpoint the imminent signs of this beginning. See that link in that post I mentioned above. So discussing this kind of preventative testing with the vet is probably a good thing to do. Again, if this were me, I would have a pointed conversation about DIC with my vet. It must be acknowledged that this is probably the number one reason that AIHA dogs do not win the battle in the early days. Inappropriate clotting is a killer. Joanne might be able to actually contact the person that was conducting this research for a more scientific look at the results. Whether they can recommend a treatment to the public is unlikely. Would a vet look at this research and take anything away from it? I don't know. Sometimes this stuff is mysterious to me. I live in the world where you do *whatever you can* to save a dog. That is what I like about Dr. Dodds. Perhaps she would have an educated opinion about this. my best patrice

Patrice NYS

Hi, Lu..... So sorry to hear you are in need of this forum, but glad you have found it! It has been so of great help to me since Mr. B was diagnosed. Richard is right, Bentley took SEVERAL weeks before the destruction of his RBC stopped (using Prednisone, Mycophenolate, and Cyclosporine), and another three weeks after that before his RBC count started rising. We are JUST now at the low end of normal range, around 37! He had two transfusions in the beginning to stabilize him a bit, while the meds began to work. This can be a VERY long process for some dogs. We aren't sure of the source of Bentley's illness either....He had three possible triggers very close together: tick bite, surgery, and vaccines. But we'll never know for sure. Doesn't really matter, as he is now responding to treatment. We had to "tweak" Mr. B's meds several times to get the optimal dosages before he responded...he's also on supplements for his liver and to help build RBC....This is NOT an easy fix, contrary to what your vet is expecting. We are nearly three months in, and just now qualify as "in remission" (almost!) I'd suggest talking to a specialist at a University Teaching Hospital, and I know you already know of Dr. Dodds. My LSU specialist works with my regular vets, and it has been a great team that cares for Mr. B. DON'T GIVE UP....there's so much more to try to help your sweet furbaby!! Everyone here is happy to help too in any way. Sally and Mr. B

Sally Louisiana

Just wanted to be clear the clotting that your vets are seeing is abnormal clotting caused by the body struggling to rid itself of the large numbers of destroyed red cells in the circulation and therefore there is a build up of all these extra cells collecting and clotting together. Yes the low pcv is caused by Millie's immune system continuing to attack and kill off healthy red cells in her circulation including the healthy red cells that they transfused into her(to be honest the vet specialist should be explaining all this to you in lay man's terms as it's hard enough dealing with your dog being so ill without being left confused as to what is actually going on with her)and so although she's producing healthy red cells in the bone marrow they are then being attacked in the circulation. BUT it can be overcome with the right drugs and it's a case of finding the right combination/dosage that will work for Millie and that takes time. Have you heard back from Jean Dodds yet Lu? Please update us as to how your dear Millie is today? Kathleen and Nollaig

Kathleen North Ayrshire

Yes, I was confused, low platelets mean no clotting. Was just frustrated and thinking about multiple things. I believe I was confusing DIC and bruising in dogs with low platelets. Although I seem to recall once case where they had both. Wish vets would not frustrate me and my brain would work better. It used to before I fought this damn disease anyways. Richard

Richard Burnaby

Know exactly where you're coming from Richard and you're so right a good vet or doctor is one that is constantly learning throughout their career and does not need to quote the letters after their name at you.....I remember after 7 months of Nollaig's illness(and 5 transfusions and £16000 debt and Nollaig nearly dying not from the illness but the leflunomide she had been put on which put her white cells to zero(and did nothing for her red ones) and she had to be put in an isolation tent for 2 weeksas she had a fatal infection) and I was crying when Nollaig's internal med specialist was arguing over his expertise and that of Dr Dodds(whom he knew nothing about) and him saying she was 'only a haematologist'which was untrue anyway and me raising my voice through tears and saying 'I don't care who's right you, Dr Dodds or that bloody wall there, I'm not interested, all I want is to keep my precious dog alive so please put her on these meds'...it really is a emotional nightmare these diseases and does addle the brain! Kathleen and Nollaig

Kathleen North Ayrshire

The study co sponsored by the Meisha’s Hope AIHA/IMHA Fund #338 at Morris Animal Foundation in which researchers at the U of MN are seeking to establish whether aspirin or individually adjusted heparin therapy is more effective in enhancing survival in dogs with IMHA is in the second year of a three study so we don’t have a lot of results as yet. The Meisha’s Hope Fund is also currently co sponsoring another study at the University of Guelph Ontario Veterinary College and Purdue University College of Veterinary Medicine. Researchers are comparing the efficacy of aspirin to that of two newer anticoagulants Clopidogrel and Enoxaparin to determine which is more reliable in decreasing blood clot formations. Because this study is blinded, no preliminary data is available yet. The results of this study will generate evidence based guidelines for clot prevention in dogs with AIHA/IMHA. If you would like to help in the fight against Canine AIHA/IMHA you can do so donating to the Meisha’s Hope AIHA/IMHA Fund #338 at Morris Animal Foundation: http://www.morrisanimalfoundation.org/meisha Every cent of your donation goes to funding studies on Canine AIHA/IMHA. Not one penny is used for fund raising or administration.

Joanne MN

Kathleen, I just reread one of your posts and saw this question: If Patrice or Joanne is reading this: "is heparin being used to prevent clotting in dogs yet or is it still in research stage and therefore is aspirin still the best preventative of blood clots in AIHA dogs?" I have seen heparin used to prevent clots for many years now. You will see it mentioned in many of the Success Stories. Recently I have seen asprin used often as well. I think that whether a vet prescripes aspirin or heparin depends on his/her training or what he/she has seen work. That is why I think the U of MN study I mentioned above is so important. Under controlled crcumstances we will see which works more effectivly. So to answer your question, I have seen heparin used for clot prevention for many years.

Joanne Mn

Hi Lu, Hoping that today finds Millie doing better.....I wanted to share that Bentley's PCV was checked twice today, and averaged 37!! So please hang in there, and don't give up! Sally

Sally Louisiana

'I am posting this on behalf of Lu as she emailed me and asked me to post the following about Millie'd medication' For some reason the Vet Net site says that I am not permitted to post on my thread?! And the post that I put on the site earlier has since been removed?! If I list Millie's medication below, could you please paste it on to Millie's thread so all can see and offer their thoughts - I would be extremely grateful to you. Prednisolone Ciclosporin Low-dose aspirin Benazepril (reduce protein lost via the urine) Potentiated amoxicillin Trama doll (I have to write this like this as if you write it the conventional way the spam filters on this site will block you as Lu and I just found out so beware of that in future everyone) Maropitant (stopped today) Omeprazole Many thanks in advance, Lu I have emailed Lu and asked her to provide Millie's weight and dosages of above drugs and also asked her about the drug to reduce protein lost in urine and if Millie's kidneys are not working properly so hopefully she will post this later on forum herself.

Kathleen North Ayrshire

I was somewhat curious in the initial post that said Millie was on pain medication, and now see that this medication is "trama doll." My experience, and anecdotal information, has been that this is a very painless disease. One that causes extreme lethargy due to low blood count, but painless. I wonder if the introduction of pain meds are a bad thing, slowing down functions the body needs to get past the initial onslaught?

Sharon PA

Yes Sharon I agree I was wondering the same thing myself about the 'painkiller'...I just didn't know if they were covering in case the dog had pain from cramping in its muscles due to lack of oxygen supply(although Nollaig's pcv was at 8% and she never had any pain) or pain from kidney issues or suspected urine infection? Lu has the vet has explained why the 'trama doll'? Kathleen and Nollaig

Kathleen North Ayrshire

Anemia does not cause cramping. Cramping is muscle contractions and requires lots of oxygen. You get the opposite with very low PCV and I even saw Dylan lose the ability to curl her tongue. Once again this kind of thinking worries me about the vets level of knowledge. Even when I look at side effects for Cyclosporine, I don't see pain specifically. Maybe there is a dietary deficiency in K+ or Ca++ that could cause cramping, but then one should definitely be treating that directly, not randomly. And that would mean connsuming oxygen that could be used elsewhere. In 6 months here I have heard many things, but never about pain. The only pain would likely be on withdrawal of prednisone, if the adrenal glands don't kick in, then they can get achy. Maybe other side effects, or after long term prednisone. Even my arthritic dog was better with treatment as prednisone is an anti inflammatory drug and likely also reduces pain. This is now what I call the "kitchen sink" approach. Don't know, so I will do everything. This sounds dangerous. Combinations of meds produces results that are unexpected, complicated and even worse. Richard and Dylan

Richard Burnaby

Infections in various organs can cause pain, although I have not seen a complaint about it. But would you not prescribe pain killer if there were obvious signs of pain, behaviorally? It is not hard to see pain either generally, or in response to touch. Usually it is just antibiotic that is prescribed for this I think. Richard & Dylan

Richard Burnaby

I am so sorry to hear about Lu, I am with others to why tramdaol was prescribed, It is for very serious pain it is the "Big Gun of pain therapy) and has dangerous side effects. My dog being one of them. I did not know about it, until after I did research. I wonder too if this is interfering with the other drugs effectiveness Are you dosing the drugs at different times? I know the cyclosproine needs to be taken seperately than the others. Laurie

Laurie CA

I am posting this at Lu's request as she's managed to get herself blocked again lol but she's contacting Joanne to resolve this for her(no doubt due to trama doll again!!)Please help in any way you can especially those with experience of agglutinating red cells(Nollaig did not have this issue so don't have personal experience with this myself)as I know that can be a big concern.Lu does your vet have any experience with heparin as opposed to aspirin for this(you will see Joanne has seen this used many times over but as you also read the research is still ongoing as to which most successful maybe your vet has heard of this research?)I'm still no wiser as to why the trama doll but maybe Lu you can let us know that?Good news that protein issue improving and the pcv holding at a very respectable level...when has Millie to go back for a check on her clotting issues? Yesterday I brought Millie home which has improved her mood greatly. However, we were told that Millie has still got visible agglutinating of her red blood cells - after 7 days of treatment, which the vet said is a bad sign. We are told that her protein loss via her urine has improved ('13' from '37') but is still abnormal. Her RBC is holding around the '28.' I have documented her meds and amounts below: Prednisolone 5mg - 2 tablets twice daily Atopica 50mg - 1 tablet twice daily Atopica 10mg - 1 tablet twice daily Aspirin - 1ml (Diluted in water) once daily in the evening Benazepril - 5mg - 1 tablet, once daily in the evenings Noroclav 250mg - 1 tablet twice daily for 5 days Trama doll (special spelling!) 25mg - 1 tablet twice daily Trama doll 10mg - 1 tablet twice daily Omeprazole 10mg - 1 capsule once daily in the mornings If you could re-post this I will have a go at emailing Joanne! Many Thanks, Lu

Kathleen North Ayrshire

Although I don't remember being told the specialists saw agglutination in Bentley, I have read that it is a common sign of the destruction of the RBCs due to IMHA....it would seem that seeing this would mean that Millie is still suffering destruction, and the meds haven't gotten the IMHA under control. If I understand correctly, it is damaged red blood cells that stick together that are seen on a slide. Mr. B had spherocytes present in his blood for several weeks, signaling that his IMHA wasn't under control. It can take quite some time and tweaking for the drugs to work. MANY dogs do not respond after only a week....Bentley took almost TWO MONTHS before his destruction was halted. I'm not sure of Millie's weight, but the Pred dose seems low for a Cocker Spaniel....Bentley weighs 11 lbs and is on 10 mg 2x day....So there may be room to up that if necessary. He is also on Cyclosporine, 50 mg 2x day. Again, I would suggest PetTinic and Denamarin or Milk Thistle as good supplements. After reading so many stories about IMHA, frankly I would be surprised to hear of a dog who recovered so well after a week....for most, it takes longer. Best of luck, Sally and Bentley

Sally Louisiana

Hi, Lu! Just last week Tori's platelets were so low (called ITP)her condition became guarded and in danger of internal bleeding, so much so that all her toys and hard chews had to be removed. Her dry food also is being watered down. I was told that her blood, when drawn was very thin and water-like, not the normal consistency as when her platelets are in the normal range and the clotting agent is in the healthy blood. She is now in the normal range for her platelets and the blood is now showing too high WBC and too low RBC. Also, low retic%. Now we know for sure she has relapsed and the IMHA is our problem once again. Please hang-in there, as it just takes some of our dogs longer to respond to the meds. We are doing more immunosuppressants this time than last, but praying for a good outcome for our little girl. Praying for you and your Millie! Stay positive and full of hope. Blessings, Cindi & Tori (Evans Syndrone)

Cindi Fl

Lu, I realize I didn't mention this in my earlier post.....Bentley is also experiencing protein loss in his urine. The inflammation from this illness can affect the filtering of the kidneys and protein is able to escape. Bentley was just put on Benazapril also, to help control the protein loss. It has helped already, and the specialist is hopeful that the damage to his glomeruli (part of the kidneys) is minimal and won't be a long-term issue. We have gone from 4+ level of protein to 2+, so much better, but still room to improve. Many dogs live happy lives on some type on kidney meds, so I'm not worrying too much about that, as long as Bentley's chemistry panels don't show kidney failure. So far, his kidney functions on blood work look fine. I have learned, though, that kidney problems only show up on blood work when the kidneys have lost a significant amount of their function. So always have full urinalysis done, checking protein level, specific gravity, and protein/creatinine ratio. Will talk again soon, and Mr. B sends Millie a big puppy hug! Sally

Sally Louisiana

Dear all, Millie went to her vets today - we await her blood (RBC)and urine (protein levels) results - due back this evening. On a plus note, Millie has visibly improved - interested in food, sounds, tv, cooking! lol. The vet also seemed positive that the level of agglutination has also diminished - but we await test results to confirm this. The vet we saw today also asked why Millie was on tram doll (special spelling!) so we await the 1st vet's explanation for this... J. Dodd did reassure me however that the pain killer shouldn't lessen the potency of Millie's other medication. Also, with regard to aspirin - Millie is receiving this as a 1ml soluble dose daily - there is much debate between aspirin and heparin but those who I have asked assured me that aspirin was the right thing for Millie. Fingers crossed for this evening's test result update. Many thanks to you all for your continued interest in Millie's story. Lu

Lu UK

Some good news for Millie's followers: RBC is 36! Woop! N.b. Still awaiting urine/protein results and agglutination findings. Lu x

Lu UK

So delighted for you all Lu.... go Millie! I just hope her protein and agglutination findings bring you some positive news too...but the fact that Millie seems better in herself is the main thing.Be good to find out if the 'trama doll' is necessary...onwards and upwards Millie! Kathleen and Nollaig

Kathleen North Ayrshire

Lu, YAY for that PCV of 36!!! That is a great number, and so glad that Millie is feeling better!! Keeping fingers and paws crossed that the rest of the numbers look better too! GEAUX Millie!!! (that's Go in Cajun!!) Sally and Bentley

Sally louisiana

Hi all, Millie has not had a good day today... she has started vomiting anything she eats - the longest food was held down was 5hours - but then this food 'reappeared' and just looked undigested - no bile, just small, chunked up food - has anyone else experienced this? Thursday, Millie started vomiting and was taken for an anti-sickness injection which helped for 24hours but today has been bad. Millie seems to have 'interest' in food and sniffs, turns the food over and then leaves it - have tried a wide range of food and sometimes she goes for it and others not. She has become suspicious of food generally because of all the meds we have to give her but at times, it appears like she has difficulty eating - sorry for the rambling, just exhausted and desperate to help Millie... Any thoughts, as always, gratefully appreciated. Lu & Millie x

Lu UK

Lu, It's possible that she has developed pancreatitis. It is not unusual in a dog on high dose prednisone therapy. A dog with this feels very ill and will avoid food. There are tests to determine this, but you can treat her now as though this might be the case. Usually a 24 hour fast is a good thing, but offer water or crushed ice. I know that's really tough when you are trying to get meds down. Can you call your vet and find out which meds they think you could skip for a day or two? Then after that offer something simple like boiled chicken and a potato, pouring a little of the cooking water into the potato and mushing it up. Stick with non fat or extremely low fat for a bit to see if that helps. In any case, do not feed her while she is still vomiting up undigested food. If it's not going forward, there may also be a blockage and extra food will be dangerous. If she develops a fever (103 or higher) and seems very very uncomfortable and bloated consider that an emergency and take her to the vet immediately. will be thinking about Millie tonight patrice

Patrice NYS

Lu, Wylie had this before AIHA. I had her in a few times during the week because of vomiting, they put her on meds, and then when she threw up undigested food from eating 11 hours previously from breakfast. I took her in again, They suspected pancreatitis, and then did xrays and something called the duodnum was swollen, not letting food down into the stomach. it is lcoated between the esophogus and stomach. Because it had been 4 days since she had first thrown up, they kep her three days in IV and no food also treating for pancreatitis because the the pacreatitis test took 3 days, but it came back negative, swellling went down and she was fine. Laurie

Laurie CA

Hi all - Millie has continued to be sick - it seems to coincide with 30min to 1hr and half after the Atopica - we have had to separate the meds in order for some to be absorbed before the inevitable vomiting ensues. Any thoughts? It seems the very meds she needs to combat AIHA are now turning on her and stopping her entire recovery... Lu&Mills x

Lu UK

This is the major side effect of Atopica, gastrointestinal upset. In most dogs the problem resolves after a few days or so. Some options, with doctor's approval, are to give with food for a few days to see if that helps. Or decrease the dose for a short period of time. There is a chance that this is due to ulcers and inflammation caused by long term use of prednisone. Discuss this with your vet. However, a few dogs just can't tolerate this drug because of this side effect. If your vet is not sure what to do, try contacting Dr. Dodds and ask for her advice. my best patrice

Patrice NYS

Lu~ Tori also, vomited her food shortly after the Atopica. The capsules were quite large and she didn't like taking it at all and would quickly "spit" it out. I also decided to give her daily dose between 2:30-3:30 every afternoon to avoid losing other meds/food. I "tricked" my gal into taking the capsule by using a very tiny bit of cooked lean ground beef (which I don't give her, except then)that wets her appetite for more meat. After that first bite, I put the capsule as far back as I can and with one hand hold her mouth in slightly closed position and really fast, get the other piece of meat to her nose...waaaalaaaa she swollows so she can get her meat! I told her vet today about my method and she said, "keep doing it, it works"! It's amazing how creative we can get. For smaller tablets, I use a very small piece of Veggie Mozerella Cheese (without any dairy, but some soy (some dogs to not do well with soy though)and the vet said she liked that choice rather that regular cheese. Also, you can use Non-fat. One slice lasts me a couple of days because I use the smallest amount to get the pill hidden so she will take it. (Sometimes it takes a couple of tries, so don't get discouraged. Praying your little girl continues to heal. Blessings, Cindi & Tori (Evans Syndrome)

Cindi FL

Hi everyone!... I am so grateful to have found this site!.... Today is exactly a week as well that my pet Toby was diagnosed with IMHA. He had two blood transfusions and on Thursday they sent him home because the doctor says there isn't much she can do considering that he dosent want to eat. I thought bringing home was gonna make him feel better. The doctor said of he continued throwing up there isn't much we can do for him. So far he hasn't been throwing up. He docent have appetite though, he is very thirsty and his stomach is bloated. I'm worried for him because is breathing is very rapidly. He is cold and shaking do you know of anything I can do to makehim feel better

Isa Miami

Hi all, Apologies for my absence from the forum... Millie is continuing to fight bless her and is back home now - the good news is that her RBC is 44 and that her blood has stopped agglutinating. She is off the 'Atopica' as it made her so sick and so far this has not been dtrimental to her recovery. Also, the steroid dosage has been reduced to 10mg daily. However... Millie was re-hospitalised a week ago for 4 days as she suddenly went off her food again - blood tests revealed that her kidneys were failing - we were told she was stage 2 of 4 of renal failure and that they would put her on an IV line again to help her kidneys remove the high levels of urea that were present. We are told that this is a progressive failure but it can be regulated at the current failing rate so to speak - fingers crossed. She is back home and has a good appetite. She is still 'flat' compared to how she used to be and it is so sad to see the muscle wastage that has occurred due to the steroids. Has anyone else experienced kidney related problems in respect of the AIHA disease? Btw Jean suggested that the kidney issue could have been underlying to the AIHA as opposed to a result of all the medication. Hope everyone's pets are fighting strong and continuing to bring you all love and happiness. I pray for all the special companions on here. Regards, Lu & Millie.

Lu UK

Lu, I went back and checked prior posts but don't see an age for Millie. Beau (also a cocker spaniel) is experiencing renal issues as well. The specialist thinks it could be age-related (he's 10 years old) and not IMHA-related. He is on a special low-protein kidney diet to assist in recovery. I believe many of these issues are found because of the intense thorough blood testing that's done continuously in the IMHA battle. Perhaps they could live out perfectly normal lives without us knowing of these age-related issues were it not for IMHA? Just a thought. Best wishes for a speedy recovery for Millie! Sharon

Sharon PA

Lu, Tori has had a urinary infection, but no known kidney problems. Praying for you and your little girl, Millie. Blessings, Cindi & Tori (Evans Syndrome)

Cindi FL

Lu, Yes, we are having protein loss through the urine. Last check was 3+ protein, but his specific gravity had improved from 1.012 to 1.030. However, his last blookwork showed his Albumin (Protein) had increased from 2.1 to 4.0, so hoping that means less protein is being lost. Bentley is on Benazepril to help with this.....So far his blood kidney functions look fine, so he has some kidney damage, but is not in kidney failure. If we can limit the problem to where it is now, he will be able to live with this with medication. Our specialist feels this is a result of his IMHA, not a cause. We usually do a chem panel and urinalysis every month, to check his organs. We are considering the kidney diet, but don't want to change it just yet, as he has also had some tummy issues that are just now easing. Maybe soon. Bentley also has the muscle wasting....an awful side effect, but without those meds, he wouldn't be here. Millie's RBC numbers sound great!! Hang in there....this is a roller coaster ride, for sure. Sally and Bentley

Sally Louisiana

Lu~ How is Millie doing? Do you have her current CBC numbers? And how is the renal issue? Blessings, Cindi & Tori (Evans Syndrome)

Cindi FL

Hi all. Millie's RBC has continued to sustain at a decent rate of 44 which is fab! However, her renal issues persist and will only progressively worsen. She now has 150ml of saline administered daily, under her skin in order to help with the high urea levels (as a result of her failing kidneys). Test results yesterday showed that her kidneys had leveled off at their current rate (she is past stage 2 of 4 renal failure)so we are pleased that at present we have stabilised her. Personality wise Millie is brilliant - wanting to go for walks, eat, drink, hang out with her family etc. As long as Millie continues to exhibit such behaviour and has a 'quality of life' then we are happy to treat her such. Has any one else experienced renal complications with AIHA? Best wishes to all as always, Lu & Millie x

Lu UK

Lu, If you are interested there are renal support supplements for dogs on the market. http://www.amazon.com/Renal-Essentials-Kidney-Support-count/dp/B00076NTBE/ref=sr_1_1?ie=UTF8&qid=1319863777&sr=8-1 http://www.amazon.com/Azodyl-60-Capsules/dp/B000MSVR66/ref=pd_sim_petsupplies_2 http://www.amazon.com/Epakitin-Dogs-Cats-50-gm/dp/B000COAE2I/ref=pd_sim_petsupplies_2

Monet Sammamish

Dear all, Just to update all Millie's followers... Her RBC has continued to stabilise at 44 and her failing kidneys seem to have stabilised for the moment (at the lower functioning rate). Millie is now on a strict renal diet which thankfully, she appears to love! We have not experienced any more issues re her pancreas. Although we are given no timeframe re: her progressive kidney failure, we prayer and remain thankful for every day we have with Millie. In addition, Millie has started going for short walks and has once again, taken up her position as sous chef in the kitchen! I continue to say prayers for all the special people and furry companions on the vet net forum. Lu & Millie x

Lu UK

Lu~ So glad to hear that Millie is stable! Keep us updated and we will keep you all in our prayers. Blessings, Cindi & Tori

Cindi FL

This thread was discussed between 21/09/2011 and 20/11/2011

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