Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Maltese with Evan's Syndrome - new case

Starting a new thread for Rebekah so more people will see her note and, hopefully, be able to offer some suggestions: Rebekah, Michigan My 9 year-old Maltese has been diagnosed this week with IMT- non hemolytic / Evan's syndrome. Abby was severely anemic and the er gave her a blood transfusion. Her platelet count did not improve. They have her a second and we have not seen any improvement yet. She is on the drug regimen: Azent.., steroids and stomach protectants plus every other day blood tests.I am so worried. This came out of the blue. Abby had a seizure and we rushed her in when she had another shortly after. What questions should I be asking the Docs? We do not have a lot of funds. We want to do our best for Abby, but this is so scary. When should we start seeing improvements with the meds? What about Vincristine? Any experience?

Rebekah Michigan

Dear Rebekah, I can imagine how scared and worried you must be. This is a serous disease, but dogs can recover! Please go on the Meisha's Hope site: http://www.cloudnet.com/~jdickson/index.html Although it is mostly about Auto immune hemolytic anemia, Joanne also explains ITP and Evans Syndrome. Please go to the success stories, I know there are some dogs there that recovered from Evans: http://www.cloudnet.com/~jdickson/successstories.htm I have no experience with Evans, my dog had AIHA. But I know there are some experts on this board that will help you with some of your questions. I would ask your vet, if she/he has any experience with this disease. I would highly recommend a phone consultation with Dr. Dodds at hemo pet in California. She is the absolute expert in all blood diseases: http://www.hemopet.org/ In the mean time keep Abby quiet, she is probably very tired. It will take a few days for the medications to kick in and then it is a long and slow recovery process. Try and stay positive, because Abby will pick up on your worries and that is not good for her. Take it one day at a time and don't give up hope! Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Rebekah, I am so sorry to hear about Abby. You must be very worried about her and I am sure you don't understand a lot of what is happening. Could you please share with us some of the details about where she is and who is treating her? It would be helpful to know some of the tests that they have done and the results of those tests. There are several things happening of importance right now and they are not necessarily straightforward. Sometimes, for unknown reasons, the body's alert system thinks that it finds "markers" on the red blood cells and platelets that indicate that these two things are not part of "self." You can imagine that it is very important that our immune system understand the difference between our body and foreign items (like bacteria or viruses.) When it does not, it can be a very bad thing. So in Abby's case, the immune system is looking at the red blood cells and the platelets and thinking, "these things are not part of my body, we need to destroy them." Oops. So now the question is, and what your vets are wondering, why is this happening? Very often the cause is simply an autoimmune dysfunction. The immune system has become overly stimulated and makes a mistake. We call this an autoimmune response, or the immune system begins to target "self." This would be called Primary Immune Mediated Thrombocytopenia (ITP), or the cause is simply a mistake of the immune system. Combined with destruction of red blood cells, Immune Mediated Autoimmune Hemolytic Anemia, it is called Evan's syndrome. But there are other causes for Evan's syndrome that need to be checked out as well. These are referred to as Secondary causes. They can still cause the immune system to become overactive and attack the red blood cells and platelets as well. It is very important that your vet check out all of these possible causes because treatment of those things might stop the problem! A vet should include taking a complete history, examining the blood through tests like a Complete Blood Count CBC and Chemical Screen, checking the urine, doing blood tests to look for exposure to tick diseases that are very active at this time of the year (ehrlichiosis and babesiosis), other infectious disease like leishmaniasis and leptospirosis, checking for bacterial and viral infections, checking for certain types of cancer and (at a minimum) x-ray of the chest and abdomen. I understand that you are not prepared to spend thousands of dollars at this point. If this were me in that case, I would make sure that minimally I had a CBC, x-ray and a tick borne diseases test done. It is highly likely that this could be caused by a tick disease as well (and this would be treated by antibiotics like doxycycline.) These should fall in around $100-$250. You most likely have had at least a CBC done at this point, at around $40. You have also had a transfusion done, which may have been around $500? If you can afford it, a blood smear, examined visually by a lab technician would be also a very good choice. These are more expensive, say $30-$70? If your vet has the skill, they can actually do this in house at a reduced rate. Also ask your vet if they are affiliated with the CareCredit program. This is medical coverage given by credit. If you are able to pay off within a certain time frame, you will end up not paying any interest. I have used this myself and it is an appropriate and safe program that many vet clinics offer. The transfusion will help, minimally, the red blood cell count and will provide more oxygen to the body cells. This is a good thing. It will, however, not help the situation with the platelets. Right now they are lasting only hours as the body makes more, not even days. Any platelets that came along in the transfusion were also destroyed. In one study it was shown that the use of vincristine with this severe kind of ITP (along with prednisone) helped bring about a more rapid increase of platelet numbers (in about 5 days as opposed to 7 days). This dosage is indicated to be 0.02 mg/kg or 0.5 mg/m2 strictly IV. If you can afford to use this drug, then it will help shorten the time to recovery. Another transfusion might be beneficial but there are greater risks of transfusion reaction with a second transfusion and so therefore testing must be done before this. This can be very expensive. The use of superwashed universal blood might be the answer to your problem, it is not completely free of risk, but the reactions might be minimal. Have your vet contact Hemopet.org for help with this. If this were me and I had very little money, I would probably use this with the thought that the benefit of another transfusion outweighs the small risks of a transfusion reaction that can be controlled by the use of injected antihistamines. The prognosis is actually pretty good with this condition, if they can get it under control in around 2-11 days. The importance of finding out if there is a secondary cause is the essential element in this recovery. If Abby is at home, keep her very quiet, in her crate if possible. Give her only highly digestible food that is very simple. Provide her with very clean water, or with your vet's permission, use Pedialyte. Potty only on leash for very short walks. She should have no visitors and be isolated from other animals in the family. Rebekah, we are all here to provide you support through this very difficult week coming up. There have many great successes here over the years, we are optimistic that Abby will be one of those dogs. I will be thinking of Abby tonight, patrice

Patrice NYS

Patrice and Brigitte got it pretty well summed up I believe. Only thing that got me wondering is whay you are calling it NON-HEMOLYTIC? If this were the case it WOULDN'T be IMT but just thrombocytopenia and not IMHA but anemia. I'm assuming this might be a typo? I'd be wanting to know the full chemistry panel if indeed you are right and they should have her on some sort of antibiotic and antiinflamatory. Do they? Please do fill us in some more. My thoughts and prayers are with you and Abby. Johnny & Tessy

Johnny

Johnny, I am not positive but I think that the attending vet might feel that this is a case of arrested development in the bone marrow. Or the precursor cells are being destroyed by autoimmune before they can make more platelets and red blood cells. In this case, there would not be much intra-vascular hemolytic destruction. Since we can't see the results of the CBC, I am just *laboring under my own suspicions.* If there was active hemolysis they might be seeing spherocytes (red blood cells that have a "bite" taken out of them) and either very large or very small platelets (indicating newly made or those with a "bite" out of them as well (and the numbers of circulating platelets would be very low also.) There would be high bilirubin indicating spilled cellular content. And the % of reticulocytes would be very high, indicating massive reticulocytosis as a response to hemolysis. Sometimes one quick look at a blood test can be very revealing. And without it, very frustrating... my best patrice

Patrice NYS

I know what you mean about seeing the CBC and other results. I was always under the impression that in order to be diagnosed with Evans there has to be a immune mediated hemolytic anemia involved. I also always assumed that if the red cells and platelets were being affected within the marrow it would be considered a combo of red cell aplasia and megakaryocytic aplasia. I'm assuming I might be wrong here! Don't suppose you know of any good sites I can read that might explain this to me? (((I'm confused now))) LOL

Johnny

Understand your confusion. Autoimmune can happen in many different ways to many different body parts. For an autoimmune example read this about SLE and how the immune system actually attacks the cellular DNA: "Although there are many clinical similarities between human SLE and canine SLE, there are several differences. Systemic Lupus Erythematosus (SLE) most commonly affects the joints muscles, skin, and kidneys. In SLE, the immune system inappropriately produces antibodies against the DNA material inside the cells. Manifestations of this disease are dependent upon the location of the cells affected, and diagnosis of SLE is often difficult. Reported abnormalities in the dog include fever of unknown origin, polyarthritis, kidney disease (glomerulonephritis), anemia, and skin disease. Skin signs associated with SLE include alopecia, redness, crusting, scaling, depigmentation, generalized exfoliative dermatitis, ulcers on the mucous membranes, ulcers of the paw pads, and seborrhea. Partial symmetry is usually an important diagnostic clue. A possible role of a genetic factor in the development of SLE has been suggested for the Spitz, Shetland sheepdog, German Shepherd dog, beagles, collies and Poodle." So you see that autoimmune can affect just about any body tissue or organ and it can vary in its expression from one organism to another. So anemia and thrombocytopenia (with an autoimmune connection) can happen at the very earliest stage (so thus, not in circulation): in the bone marrow. Arrested development of the precursor cells. It is often autoimmune, but can also be nutritional or in some rarer cases related to kidney disease or liver disease. It can also be directly related to tick disease. It can be caused by neoplasms. But I do believe that Dr. Dodds feels that the most likely cause is autoimmune. Her protocol for bone marrow failure talks about this, do you have that? If not, send me your email and I will get it to you. Here is an excellent paper on IMT: Immune-Mediated Thrombocytopenia-Current Approach Barbara Kohn, Prof. Dr. med. vet., DECVIM Clinic for Small Animals, Free University of Berlin Berlin, Germany http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6504&O=Generic p

Patrice NYS

To answer the question: IMT/ non-hemolytic anemia r/O Evan's Syndrome is what the discharge diagnosis reads. That was what I typed in but fail to see it worded Non when I google this. Abby's RBC was 3.40M/ul, HCT 24.6, 1.0% reticulites ALB 1.9 g/dl HCT 33% HGB 11.0 g/dl Blood Smear--Platelets 1-3/field (oil)Stated No Hemolysis notes. Platelets (PLT) 64 k/ul Abby is taking Pepcid 10mg, Prednisalone 5mg 2x Azathioprine 50mg 1/8 tablet 1xpay Sucrafate Suspension 2.5cc 3x day. Abby seems a little perkier today, we have a hard time getting her to eat. She likes cheese and turkey burger and turkey lunch meat.Are these okay? She seems to do well with these, so I don't know...hopeful. Any ideas on other acceptable foods would be appreciated.She wants nothing to do with dog food, no interest. The vet said anything low-fat and yummy to get food in her is fine. Within healthy parameters, obviously. Blood smears are being done. We go every other day. Not much has improved. 1-2 platelets to 2-3.I will ask about the tick check. We live in Michigan, not very heavily subdivision. No walks off the leash and she does not get exposure to many other dogs. I keep her close, always have. She has not had vaccines for 2 1/2 years. I just felt it was not necessary, so that excluded the vaccine angle. Now with her illness, I carry her outside to potty, let her sniff around and back in she goes. She is in a crate when I am not home. I can't believe it has only been since Wednesday this has happened.

Rebekah MIchigan

Hi Rebekah - I was sorry to see your post about Abby earlier today and completely understand your worry. With respect to food, you can try all-meat baby food - just be sure to read the label and make sure it has NO onions. I'm in Chicago and I can find Beechnut brand (stage 1 or 2), just meat and broth. I learned about it when my dog was discharged - the internist uses it in the hospital when dogs are just getting back on food b/c it's super palatable but very easy on their systems. I would just start slow - a few Tbsp - to be sure Abby tolerates it well. I hope all goes well for Abby and will hope to read good news soon! Take care, Bonnie

Bonnie Chicago

Rebekah, Thank you for posting this. It is much clearer to me. I will try to help you understand much of what this says. You have read above what I have to say about non-hemolytic anemia. The r/O (r/o) means "rule out." Or "let's do some diagnostics and find out if this is truly what I think it is." So they know it is non-hemolytic anemia. They want to rule out Evan's syndrome. Do you understand this part? Look for "non-regenerative anemia canine" and also "immune mediated thrombocytopenia canine" in google. (I recommend http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2005&PID=11014&O=Generic and http://www.homevet.com/petcare/documents/ITP.pdf) Non-hemolytic is not an official medical diagnosis. It is referring to some of the signs that they have from Abby's blood test. A sign is a fact that is found from diagnostic testing. A diagnosis is where they use the signs from the testing plus the clinical examination of the dog to determine what the cause of the problem is. Let's look at some of the important numbers from Abby's test: RBC was 3.40M/ul, HCT 24.6, 1.0% reticulites HGB 11.0 g/dl RBC stands for red blood cells. These are expressed in millions. The low normal number is around 5.5 million. 3.40M is below the normal low number. But it is not terrifically low. Each RBC carries oxygen (O2) inside hemoglobin within the RBC to the body cells. This provides vital oxygen to fuel the cell's energy making process. A lower number means less O2 to the body cells. A normal value for hemoglobin is around 12-18, Abby's is 11, not that low. HCT hematocrit (and PCV packed cell volume) are both indications of the quantity of "red stuff" that makes up the volume of blood inside the body. Plasma (the white stuff) makes up the other portion. The easiest way to think of this is to imagine that they can spin the blood so fast that it will separate these two apart. They put this tube in front of a chart and read off the percentage of the red stuff compared to the white stuff. The lowest normal HCT or PCV is around 37-38% and the highest normal is around 55%, with the average being around 45%. Abby's HCT of 24.6 (and PCV of 33%) is lower than normal but it is not currently considered extremely low. It would be considered mild-moderate anemia. A HCT of 11% would be very low. A HCT of 34% would be mild anemia. Many dogs on this list have survived quite well for long periods of time at a HCT of 24%. Reticulocytes are "baby blood cells." They are made from precursor cells in the bone marrow. Believe it or not your kidneys play a large role in this process. The body cells can sense when the O2 coming to them is too low. These body cells will "signal" the kidneys, "hey, do something about getting us more oxygen!" The kidneys respond by sending a hormone to the bone marrow that says, "hey step up the production of red blood cells and send them out as soon as you can." So the bone marrow will go into overproduction of reticulocytes and will actually send them out of the marrow into general blood circulation earlier than they usually do in hopes it will help with the oxygen delivery to the body cells. They can be seen in the blood under a microscope as larger cells that still have their blueish RNA inside. That is how they are counted versus the regular red blood cells. So now we have reticulocytes in the general blood circulation. There are complicated math formulas that clinicians use to determine if there are ENOUGH reticulocytes in circulation for the severity of the anemia. If you don't have anemia, then you would normally see 1% or around 60,000 reticulocytes in circulation. Once you have anemia, vets figure you need MORE reticulocytes than 1% or 60,000 to replace all those RBC that are needed in the blood. In fact, the more severe the anemia the higher those numbers need to be. At 24.6% HCT, you should be seeing around 3% and maybe around 150,000-200,000 as numbers. You are not. Abby has 1% reticulocytes. This is not enough. *This alone immediately classifies this as Non regenerative anemia.* This is the most important item on Abby's blood test right now. You will want to know when this number begins to rise because this will signal recovery. This is just a sign, not a diagnosis. It is only understood that for some reason the bone marrow is not responding to the kidneys when they call for more reticulocytes to be made. Why? Well, in many canine cases, it is autoimmune. The body's immune system (as killer t-cells/lymphocytes) for some reason is attacking those precursor cells and stopping them from maturing into red blood cells and, in this case, also platelets. Why do I know so much about this? My dog Chance was diagnosed with non-regenerative anemia of unknown cause in 2007. He also had stopped making white blood cells. He was still making platelets. Go figure how it can be different from one case to another.... The short of this story is he survived this with special medication and lived another 3 years. Abby should be feeling fairly good. She is not in the danger zone with her hematocrit or PCV, and her hemgoblin is pretty good. I saw this same thing with Chance. He was diagnosed at a PCV of 32%, not terribly low, but there were no reticulocytes. His PCV began to slowly decline, along with his white blood cell count. When his PCV reached 18%, he began to suffer more. And that is when he had his first transfusion. He just started running out of red blood cells. Our body makes, destroys and replaces red blood cells every day, all day long for our whole lives. This is normal. These cells live about 120 days and then they wear out and the material that they are made of is recycled. So Chance had 120 days worth of blood cells to use and they began to age out. I suspect the same thing is happening to Abby. It will be good if you have a tick test done, I certainly did with Chance, but it may in the end not have much to do with what is happening. I can tell you for sure that Chance survived, so I know that Abby can survive too. It will not be easy for you or your family. Sometimes you may be giving medication around the clock. She will pee more and be more hungry because of the prednisone. There are many side effects of prednisone. Ask your vet if they know about the use of cyclosporine as a medication and if they would be willing to use it. This drug will help suppress the immune system and then you can reduce the prednisone slowly. This is the med that saved Chance's life. Do not give up hope. Stay here on this forum and you will receive plenty of support from many, many other owners. If you have more questions for me, please post them and I will try to answer to the best of my ability. my best patrice

Patrice NYS

Rebekah, how close to Michigan State are you? Perhaps you could have blood sent there for analysis. They also have a breed specific thyroid panel there. Might be worthwhile having this checked also. Patrice got it summed up nicely so I'll just add that she's in my thoughts and prayers! :) p.s. ...Had to have the ole dictionary out for that paper Patrice! LOL

Johnny

We are 2 hours away from Michigan state. Abby's blood tests went out yesterday. The vet thought she looked pretty good and her smear told us her #'s were up. I did not get the #'s from the Doc, but she looked much better yesterday. Today is a different story. Abby was in her kennel for a few hours while I was at work. She had her morning meds, but refuses to eat food. I have Science Diet that she gobbled at the Vets yesterday, she will not touch it today. She is tired, drinks water and 20 minutes ago threw up. Not sure if it was the pepcid that did it or just meds and empty tummy. I tried enticing her with cheese, chicken and lunch meet. Nope. Her gums are still pink, she does not feel overheated...hopefully we are just having a low day. She was so peppy yesterday. :-(

Rebekah Michigan

Rebekah: Try not to fret too much about Abby's lack of interest in food today. It could be related to any number of things. Do you free feed her? If not - can you leave her food out/down for a little while to see if she takes an interest a little later after it's initially offered? Just a thought. Hang in there - we'll keep you in our thoughts and prayers. Rita, Mike and Sheba

Rita IA

Rebekah, have you tried any home cooked food for her? Try some boiled lean hamburger and rice, scrambled eggs, boiled chicken, sweet potatoe, lean roast beef, or anything low in fat and sodium. These foods were saviors when Tessy was first sick! How does her stool look? What did the puke look like? Any signs of blood in either? Are you giving the meds with food? If not you should! Are you planning on having a chemical panel done anytime soon or is this what's being done now with the blood being sent out? Keep her calm, well rested and stress free for the time being. If she continues to not want to eat and pukes anymore let us know. Hopefully she was just feeling a little down. My thoughts and prayers are with her. Johnny & Tessy

Johnny

I think at this point, I would give her any food you can find that she is interested in, it will be trail and error and hopefully you can try some of the ideas listed above. All my dog would eat was dog cookies and I thought I would never get her back on her regular food, but eventually she went back once she felt better and it did take some time. I hope Abby is having a better day today, please let us know how she is doing. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Rebekah Buster wouldn't eat when he came home from the hospital either. We finally found out he would eat canned cat food to take his medicines. This wasn't long term, but it helped at the time. I didn't think he would ever eat again, but with all of the prednisone he is taking, his appetite came back with a vengeance. It just took his stomach some time to adjust to all of the drugs and his illness. Hang in there!

Ronda Illinois

Abby's puke was clear, probably water and her pepcid. I try to give her food and meds, but she does not cooperate.Her stool is very dark, the vet said as long as it does not look like coffee grounds. They are doing a blood panel. Her energy level is lower today,but I know that is due top the anemia, and lack of food. She is drinking water, I am sure that is due to steroids.

Rebekah Michigan

Rebekah, Are you able to get the drugs down Abby? The first week Buster was home he was puking within the hour all of his meds. This was not a good situation. I was terrified. Just keep trying anything you think Abby will like to get her to take the medicine. I cooked chicken legs and rice and he ate that for 2 days before he wouldn't eat it anymore. I just kept at it until we found the cat food. You never know what she may eat. Good luck

Ronda Illinois

Our Casper has survived Evans Syndrome since 2006. He relapsed a year later but has been doing pretty well since. We are sorry to hear you are going through this with Abby. Such a terrible disease. You are getting really good advice from what I have read of the posts. We hope Abby will be able to beat this.

leslie ca

Leslie mentioned in the previous post about her dog Casper. Casper's Evans Syndrome Success Story can be found at this URL at the Meisha's Hope AIHA/IMHA Web site: http://www.cloudnet.com/~jdickson/archives20.htm Scroll down to the May 2008 Story

Joanne MN

Abbys platelet count is 153 and RBC 170. Vet says low ends of normal on RBC and below low on platelets. Liver enzymes seem affected. Suggested starting her on Denamarin. Any thoughts? She ate this a.m. chicken had her pills, 1 hour later threw up.

Rebekah Michigan

Rebekah, sounds like the numbers are looking a bit better! Are you sure the RBC number is 170? Any idea what all the other numbers are? For the chemistry panel was the liver enzymes the only high numbers and what were these numbers? Denamarin works great for detoxing the liver. You should also look into adding milk thistle after you use the denamarin. Milk thistle will help to protect the liver whereas the denamarin will actually help *fix* the liver. Both really good choices. So, yeah, the denamarin is a really good idea to use if the liver values are high. Good to hear that Abby is eating now. When do you give the stomach protectants in relation to the meds? It might be a good idea to give pepcid a half hour before the meds. OR there's a slippery elm cocktail that rocks for stomach issues. You can get most of the ingrediants at a health store fairly cheap. Here's the recipe and instructions for the Slippery Elm Cocktail.... SLIPPERY ELM COCKTAIL 1) half cup of boiling water. 2) add 1 rounded tsp. of ground slippery elm 3) let cool totally 4) add 1/8 c. + 2 tablespoons of aloe juice 5) add 10 drops of chlorophyll 6) Add 2-3 capsules (open the caps) of acidolpholus Mix it up and whip it smooth. It will keep in the fridge for 3-4 days (after that the acidopholous dies). Use a baby medicine syringe and load it FULL. Give about half an hour before a meal. Just put the tip of the syringe behind the canine tooth and hold the mouth loosely closed. Squirt slowly so they can work their tongue to swallow. Rebekah, this will work wonders for Abby!!! If you want you can try the pepcid before eating first though. Let me know if any of this helps. My thoughts and prayers are with you both. Johnny & Tessy

Johnny

Forgot to say that the pepcid or slippery elm will help to prevent puking! The slippery elm would be the FAR better choice though if it were me!

Johnny

Rebekah, you got some really good advice from Johnny. I have no experience with the slippery elm. My dog was on sucralfate to protect the stomach. This worked very well too. It had to be given 2 hours before food and other medications. We gave 2-3 (big) pills per day. Like Johnny said, Denamarin and Milkthistle for the liver is definitely a good thing. I hope you have read some of Meisha's Hope success stories. I have no doubt that Abby can beat this! best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Yes Denamarin and milk thistle is good. Casper is on both of those for his elevated liver enzymes. Also it helps to feed less amounts but more times during the day so as not to tax the liver so much during mealtimes.

leslie ca

Yes Leslie, small meals, good thought! Hand feeding sometimes helps too. Good luck! Brigitte

Brigitte BC Canada

Hi Leslie, My Kent had AIHA, then recovered and was off meds, until one day he had red spots and it turned out to be IMT, and he relapsed with Evans Syndrome. He was transfused and hospitalized for 4 days, and thankfully recovered but was back on meds, almost a year after the he developed AIHA. The slippery elm bark is good - you can always make this without the chlorophyll etc. Some health food stores sell it as a powder or a bark - the powder is the best. It is nutritious and works as an internal 'band aid'. I gave this to Kent frequently, but I also always gave sucralfate. Be sure to give it two hours before eating to help prevent vomiting. I used to hide Kents med in hotdogs or cheese. He humored me, but at a point just wanted the goodies and not the pills, and then i learned to just put it in his mouth and get him to swallow. Everyone here has given you very good input and advice. One thing i can help to contribute is regarding money. Aiha or Evans, things add up. Here are some ways to cut some costs: Compare drug costs from costco and walmart - some drugs like pepcid are on the 4$ a month program at walmart and vet can call in the prescription. Other meds, like azathi..are least expensive at Costco. You do not have to be a costco member to use the pharmacy, though they have a discount in the pharmacy for costco card holders. They no longer accept whats called the 'free drug card usa' but other places do - like walmart. There is a website and you print out both cards with your dogs name. I was receiving over 50% discount on some of Kents drugs. Make sure you have the clerk look it up and add it into the database for your prescription file then you know they take it and you only show it once. Ask your vet if he has a friends and family discount and see if he will extend it to you (can be 15%). Blood testing done through my vet was around 200$ but done through Doctor Dodds Hemopet was less than half that plus overnite shipping and a couple packs of cooler (1$ each from walmart). Re food - Kent liked apples and bananas and loved carrots, hotdogs, meats, - just experiment, and try different things - liverwurst even (though high in fat can be good for giving pills). I would also ask your vet if it is a good idea to give your pooch pet-tinic to support the blood cells - it is around 10$ a bottle and Kent did get this twice a day. If vet charges much more than this, you can order it online for around 10. I hope this helps a little bit, I know how you feel. These are horrible diseases but many dogs get through and thrive - Kent did recover from this. Christine

Christine Florida

Denamarin contains the extracted essence of milk thistle: silymarin. It is a special veterinary product that is made to be of higher quality. It also contains SAMe (S-Adenosylmethionine). These are both very beneficial to the liver when it is processing high doses of meds. See this website for a simple explanation: http://www.nutramaxlabs.com/vet/products/Denamarin.aspx So it is not necessary to give both Denamarin and milk thistle at the same time. If you use milk thistle you would need to use a very high quality source that has been processed to contain higher levels of silymarin (or silybin). Sucralfate is a veterinary product that coats the esophagus and stomach to help heal ulcers. Slippery elm does essentially the same thing but requires a bit of preparation. Using it while giving high doses of meds will heal any ulcers that may be developing. Because it coats the inside surfaces it is best to give it with a good bit of time on either side of administering meds, otherwise they will not be absorbed properly. An overnight fast is the best. my best patrice

Patrice NYS

Well, Going from getting "better" to not. Abby's PCV was 15% the other day, pale gums and tired. Vet gave 4 options, transfusion, Michigan state, increase her meds or humane euthanasia. I chose meds. We are up to 1 1/2 pills pred 2X a day azathi.. every day (we were every other), denamarin every day and wait and see + pepcid and sucrafate. Money has become tight so Michigan State not a option and after 2 transfusions already, not able to do it. Abby is eating well, pooping and peeing. Her tummy looks bloated a bit, Doc thinks partly due to lack of moving around and licking the air ALOT. I rub her belly, sprinkle metamucil in her water and see that she poops regularly (she does). Doc was not thinking she would make it through the weekend, she did. Abby is carried around, not allowed to get too excited, and I keep checking her gums to see if she pinks up. Without another transfusion, can they come around once they get so low (15%) using meds? She seems like a fighter, the Doc thinks so too. Am I wrong to keep doing this? Any thoughts on her bloated belly? Vet was not too concerned, she doesn't seem in any pain when I massage it to try to move any gas along.

Rebekah Michigan

Rebekah, Good to hear that Abby is still fighting. The prednisone will cause unusual fat distribution. It will also cause fluids to shift around in the body and possibly gather in the abdomen. In addition the liver is most likely enlarged from the prednisone and it is swollen and uncomfortable. All this contributes to the belly looking bloated and distended. Transfusions do not necessarily have to happen at some magic number. The PCV is one part of the assessment for a transfusion trigger, but the other part is the clinical evaluation by the vet. Dogs that don't seem overly distressed, are breathing normally, eating and passing urine and feces are probably not candidates for immediate transfusion. This could change. Can you get any of the most recent CBC complete blood counts and post some of that here? I want to see what the reticulocytes are doing this week. If you have had a chemical screen done, I would like to see at least the liver enzymes: alk phos and alt. Tell me what her weight is now and what dosage 1 1/2 pills is (prednisone?) It should be something like "30 mg tabs" (so 30 + 15 = 45) This depends on her weight. It would be great if you could afford Michigan, but that doesn't mean that you can't succeed doing it with your local vet. I did it that way for the most part. Chance was happier going to visit with his "girls" at the clinic (all the techs) and it was an easy 15 min drive for him. My vets were great, the costs were lower, all around it worked fine. But you need a protocol in place with Dr. Dodds to succeed at this. Have you contacted her? If you tell her you can't afford any contribution right now, she will still help you. I would skip the metamucil. It might be causing gas, I know it gives me horrible gas. Try some lightly steamed veggies like carrots and green beans, squish them up a bit and put a little plain yogurt on them. If that is too exotic, get a can of plain pumpkin and give her about one or 2 tbls or so a day with her food. That should be enough roughage. If the denamarin and sucralfate are getting expensive we can help you figure out a way to do this will cheaper stuff. Ask your local vet if they use CareCredit. This is a valid credit service for health services and includes veterinary care. If you can pay the total by a certain date, usually a few months out, you don't pay any interest on the amount. I used this for Chance's knee surgery. I had 3 months to spread out a huge purchase and was able to get it paid off with great care and no interest payments. my best patrice

Patrice NYS

Rebekah, ditto everything Patrice said. The care credit is a life saver...have you considered applying for this? I'm going to assume that Abby is somewhere near the borderline of being non-regenerative/regenerative and I only say this because in a previous post you said the retic % was only 1. Like Patrice I'd be really interested in knowing the other numbers. If you can you should get copies of all the tests done thus far. Pretty well ALL of us here ask for and get copies of testing done so that we can compare notes and discuss results. It makes things so much easier....and it's really cheap to do! :) That being said..if i were you i'd insist that they add a small dose of thyroid supplement to the daily schedule. The recommended starting dose regardless if the dog is hypothyroid is 0.1mg per every 10 pounds of weight given twice daily. I'd consider this a very important step for you cause this drug helps encourage the blood building process. There's a very good chance the vet won't agree and if they do I'd INSIST they do this. It's completely safe and Dr. Dodds even recommends this. Another thing you can do is look for a vitamin supplement called Pet Tinic. This also aids in the blood building process by providing the proper micronutrients needed for the bone marrow to work (folic acid, B vitamins, iron). You can buy a bottle (it's a liquid) for fairly cheap and this also works wonders. Get this today and start today if you can. Very important for the body to have the right nutrients. I'm also going to assume that since she's a Maltese she probably weighs under 10 pounds. Does this mean she gets 7.5mg pred twice daily? Her weight would be good to know as Patrice pointed out. Anyhow, to sum up...Thyroid supplement (0.1mg/10lbs given twice daily), Pet Tinic, and copies of testing done thus far. If you can do all this today then you will likely increase her chances of survival by quite a bit. I'll be keeping Abby in my thoughts and prayers. Johnny & Tessy

Johnny

Dear Rebekah, I am sorry to hear that Abby is still struggling with this. Don't give up on her - you are absolutely not wrong to keep fighting. I would have done anything to keep my Millie alive, while I could tell she was fighting for her life and still wagging her tail, I had to keep going. Abby can come around without another transfusion, though I guess you've got to hope the PCV doesn't drop any lower, as it might get to a critical point where she needs another transfusion. The suggestions as always from Johnny and Patrice are sound. You can get good advice on this forum that you sometimes don't even get from your vet. As Patrice said, posting results and getting advice on here is free! :) Keep us posted on Abby's progress. Fingers and paws crossed for you both, Sam & Millie.

Samantha Geelong Australia

This thread was discussed between 13/06/2010 and 30/06/2010

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