Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Lucy from St. Lucia

Lucy is a mixed terrier breed (we think) that we brought home from the Caribbean island of St. Lucia in 2003. She was being abused by the caretaker of the hotel where we stayed. The caretaker was begging money for food for the dog and we had already given him some money when we found out he was probably using it for drugs for himself and not for the dog. We ended up giving him a little more money and 'bought' the puppy from him. It was incredibly easy to bring her back to the US as there is no rabies on the island - we just had to get a vet certificate and off we went. She has been a wonderful addition to our family ever since and besides a couple of bee stings that needed an emergency benadryl shot, we has been very healthy. That is, until January 28th when she was diagnosed with AIHA. Her PCV was 12%, her heart rate and respiratory rate were very high and they even detected a heart murmur. She spent 3 nights in the hospital on IV, they typed her blood and gave her a transfusion, took xrays and did an ultrasound, started her on dexamethasone and prednisone and gave her sulfracate to ease the stomach issues. She came home Saturday 1/31 and, after a day of picky eating, has been eating voraciously. She continues on prednisone - 30 mg twice a day, and azathioprine, 50 mg every other day. Her PCV is back up to 31% but she is not back to her lively self. After a CBC on Tuesday, the internal specialist we have been seeing suggested adding cyclosporine to the treatment. We, of course, want to do everything we can to help Lucy but this drug is very expensive - the best price we can find is $225 for a 30 day supply (60 100mg capsules/tablets) - and we are having a hard time coming up with additional money. We have already asked our sister to apply for CareCredit, which she did and was approved, but we are nearing her limit...and I have borrowed $500 from my daughter. Are there any ideas any of you might have to get financial assistance? We are considering a garage sale, a jar next to the cash register at the local convenience store and maybe posting a plea on craigslist or something. I have been very touched by the other stories on this forum and would be grateful for any suggestions.

Lee Florida

Lee, First let me say how wonderful it was for you and your family to rescue poor Lucy. I know a lot of people use places like Costco, Sam's Club sort of stores to have their dogs scrips filled. Perhaps some of them will check in and let you know pricing etc. She seems to be responding well based on her rise in the PCV so did the Vet say why he wanted to add the Cyclo? It is indeed expensive to fight but the costs do get more managable especially as she gets more stable. It is interesting that you mention the bee stings and her reactions to them. I believe that is what the trigger was for my dog. The meds will often cause your dog not to be as lively as they were prior to diagnosis. Penny

Penny Lytle Creek Calif

Hi Lee. How kind you were to rescue poor Lucy. I feel the same as Penny in that I would question why the internal specialist recommended adding cyclosporine when Lucy seems to be responding nicely with the prednisone and azathioprine. I'm from Canada and so can't give any advice on cost saving measures for that cyclosporine but know how expensive it is. But like Penny said, as time goes on and you are able to reduce or even eliminate some of these medications, the expense will be more manageable. Good luck to you and I hope that others can give you some cost saving ideas. Please keep us posted and give Lucy a big hug! deb and Duck (my dog)

Debbie BC Canada

That is great news for Buffie, 31 is a good number. I am also questioning why the vet wants to add cyclosporine since she is responding well so far. And the azithioprine can take take up to 6 weeks to work so that may not even have kicked in yet. The prednizone will take its toll so don't be discouraged that she is not her lively self, that will eventually come. How much does she weigh and do you know how old she is? And please check out Joannes site if you have'nt already, on AIHA http://www.cloudnet.com/~jdickson/ Laurie

Laurie CA

Hi Lee, My dog was diagonsed on the 13Th Jan 09. She had 2 transfusion and came home after 4 days on IV. She has been on 15mg pednistone twice a day and half a Imuran tablet every night. She was also on a tablet for her tummy for the first 2 weeks but then she didnt need them any more. After 4 weeks and her PV improving weekly - last check was 36 her medication has been reduced slightly. Even since the reduction she is back to her normal bossy self. She goes walking every night with me, i dont take her as far as we use to go even though she wants to go further and she is back to bossing the other dogs also. She is 7kg's the other are 25kg's and they do what she says!!! She does eat like a horse now though and drinks soooo much.... The treatment has cost a small fortune so i know how much of a stuggle it is to pay the expense. Maybe you can speak to the vet and see if the medication he wants to add is needed as Lucy is doing so well?? Anyway just wanted to say i understand everything you are going through. Samantha

Samantha Perth Australia

Thank you all so much for responding so quickly - it really means a lot to know there are others out there in a similar situation and are willing to give their support. The price quoted for the cyclosporine *was* from Cocstco but thanks for the suggestion. Lucy weighs almost 60 lbs. and is 5 1/2 years old. I have visited Joanne's site - it is *very* helpful. The cyclosporine was suggested as her recovery did not seem to be as good or as fast as the internal specialist had hoped for. The CBC showed the MCV wasn't as high as she'd hoped. I think she was also trying to use it as extra help since she told us we could drop the prednisone dosage to only once a day. Actually, now that I think about it, first she told us to drop the prednisone dosage, then the next day when the CBC results came back, she suggested the cyclosporine. When we called her back to find out if the hospital has a better price on the meds, she said she has no control over the price but said Lucy would probably have to be on it for 4-6 months or we could just keep her on the full prednisone dosage for a few more weeks and see how it goes. Our thought is that if we don't try the cyclosporine and she gets worse, or worse, we would feel horrible about it, so we are probably going to get it and sacrifice in some other part of our lives. Thanks, again, all, for being here - it is very reassuring.

Lee Florida

Lee, I can understand feeling that you will let Lucy down if you don't try everything that is suggested. We spent almost 25k of our savings on our AIHA dog and her sister that developed pancreatic cancer over a 10 month period and we were not able to save either one. It might not hurt to get a second opinion before you start the cyclo because it has to be monitored very carefully with blood tests that have to be sent out to vet hospitals as your Vet cannot do it in house nor do the usual labs deal with it. Some dogs on here did not respond well or in some cases at all to the drug. It is something you really want to look into. Going from 12 to 31 PCV in the short time since diagnosis is really good so I am still wondering why the doctor wants to introduce another drug? We are all just regular folks on here not doctors, but usually we are arguing our cases the other way. You might want to contact Dr. Dodds at hemopet and ask her opinion. She is so very giving of her time and a truly fine person. hemopet@hotmail.com She responds very quickly too. Penny

Penny Lytle Creek Calif

Lee, This might be helpful to you. I was reading up at the Morris Animal Foundation site and found this section. If the link doesn't work just go to their website and look under resources. They have a large list of organizations that might be able to help you with the costs of Lucy's care. http://www.morrisanimalfoundation.org/resources/financial-support/ Be sure to read up on Meisha's Hope while your there! Penny

Penny Lytle Creek Calif

Charlie was diagnosed the same day Jan 28 he also started with PCV of 12. His last check one week ago was 37. The vet was thrilled that he was doing so well so fast. He is on pred and azathioprine and is slowly getting his energy level back. Just yesterday he played with his squeaky toy for 10 minutes . Be patient, reading these posts has helped me so much with what to expect and what to question.

carol wa

I forgot one more thing. My vet told me the normal range for pcv will vary based on age and the size of dog. He thinks Charlie's normal would be In the mid 40's. Charlie is a 1 year old labradoodle

carol wa

Hi Lee, If you decide to add cyclosporin to Lucy's treatment, I have a box of unopened 100mg Neoral (it's a brand name of cyclosporin) and twenty-four 25mg Neoral capsules that are in sealed blister packs that I would be happy to send you (at no charge of course). We didn't get very far with cyclosporin before my dog had to be taken off all IMHA meds. The caveat is that the expiration date stamped on the package is July 2008. You may want to ask your internist or pharmacist if they would still be usable. I've been told repeatedly (for other meds) that the expiration date does not affect the efficacy of the medication. But, I would ask for a professional's opinion as I'm not one. I would be thrilled if someone could use them and would be happy to send them off to you asap. Best of luck to you and Lucy. Bonnie

Bonnie Chicago

Bonnie, I will ask my vet about the expiration date - thank you *very much* for the offer. Carol, I am glad to hear Charlie is recovering so well and I will ask my vet what Lucy's normal range should be - good point. Penny, thank you for the link and Dr. Dodds' email - I will take time to go through the financial support sites this morning and compose an email to Dr. Dodds. The Meisha's hope site was where I got the idea for a garage sale - I might even add a bake sale component - I can whip up a mean banana bread and some cookies to sell! I can't say thanks enough to all of you, again, for your support and ideas. You are all in my prayers.

Lee Florida

Lee, I am so sorry to hear about Lucy. She is a very lucky do to have found you as owners. One thing of interest in her history is your brief mention of bee stings. The immune system is quite complex and there are many things that can urge it to attempt to protect the body. Bee stings are one of those odd things that can alert the immune system. It is then further possible for the immune system to actually go overboard from this exposure and bring about the sudden attack of the immune system on "self." While most folks will never know what actually caused their dog's immune system to begin to attack their red blood cells, this is one case where you might have a connection. I had a similar reaction to a bee sting a few years ago. You are asking about why your vet would suggest cyclosporine. This drug was developed a number of years ago for humans in organ transplantation. When they put a "not self" organ in the body, the immune system launches an attack on that organ, attempting to eliminate it from the body. Doctors found they had to give high doses of prednisone to patients to suppress the immune system so they wouldn't reject their new organ. However, they discovered that the side effects of these high doses of prednisone over long periods of time were devastating because suppressing ALL of the immune system left these folks open to all kinds of infections. Cyclosporine is a drug that is able to modulate just one particular element of the immune system, the killer t-cells (lymphocytes). These particular white blood cells can be very good at their job but they can also become overzealous and begin attacking "self." The side effects from this drug are far less than with prednisone and the immune system can remain somewhat intact during treatment. This was a miracle drug for organ transplant patients and has saved many lives. It has recently come to veterinary medicine for use in canine atophy, or allergies. It has an extremely successful treatment rate with this. The brand name is Atopica and is made by Novartis. Vets struggling with treating dogs with other immune system illnesses began to realize that this drug might also be very effective in autoimmune disease. So cyclosporine has been added, off label, as drug for treating AIHA. The same thing applies to dogs as it does to humans, prednisone is a miracle drug but long term use has too many side effects. Using cyclosporine suppresses just the killer t-cells and stops the destruction of red blood cells without all the side effects. That is why your vet is suggesting this drug. I can tell you that it saved my dog's life. It is very expensive. There are alternative generics that are less costly and others here can help you find those substitutes. The benefit to using it is that the prednisone can be slowly decreased, lessening the side effects. However, once this drug begins to work, there is a finite amount of time you will need to be on it and the dosage will decrease over time. The first month or so will be at a higher dosage and then will decrease. I can urge you to consider it, but I also understand the financial burden that this brings to your family. Seek out unusual ways to obtain this drug. When Chance was in treatment, our vet had offered us a very expensive drug used to treat anemia in humans for free. She obtains these drugs from the local prison where they must discard drugs that are out of date. You may need the help of a local congressperson to circumvent all the paperwork involved in getting prescription drugs that are expired. If you stay with just the prednisone, you may very well be successful in treating this condition, but you will need to understand the side effects of long term use. Your vet can help you with this. my best patrice

Patrice NYS

Lee, Here are an abstract that contain info on AIHA/IMHA and bee stings you might want to take a look at http://www.ncbi.nlm.nih.gov/pubmed/10200797 You might want to take a look at this abstract as well http://www.ncbi.nlm.nih.gov/pubmed/2176693?

Joanne MN

This thread was discussed between 19/02/2009 and 20/02/2009

Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) forum index

This thread is from the Vetnet archive. The live Vetnet forum is active now.