Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Mercedes' Diarrhea

Hi Everyone Well, after giving copious amounts of kaopectate the last few days we continue to have a major diarrhea problem. It is "through the eye of a needle" which causes me great concern. (ie how much nutrients she is absorbing from the food and of course dehydration) We also seem to be having a bladder control issue as she will go out and pee and 15-20 minutes later, she will run to the door and squat and begin peeing before I get a chance to open it. The vet felt it probably had more to do with the urge to defecate, than a bladder control problem, that was prompting her to squat. I questioned whether she may have a UTI, but he didn't seem to think so. I will take a urine sample in to be checked, just the same. She is also not as bright and perky as she was at the start of the week so I have moved our appt. with the vet to this afternoon. He is thinking that she should go on some antibiotics and see if that helps with the diarrhea. We will draw blood today to check the PCV and see if there is anything else going on that we should know about. I think I will request a "complete" CBC (including chemistry). My question to one and all is: When your dogs developed diarrhea, was it as severe as Mercedes seems to be?? If so, what did you do to remedy the problem?? What drugs, natural products, etc. did you use?? How successful were they? My vet is a good guy, but he is young and inexperienced. I need to be careful not to insult him or "overstep my bounds"---I want to be tactful, but I also want to be sure we are doing everything possible to help Mercedes recover. YOU ARE THE PEOPLE WHO HAVE THE FIRST HAND EXPERIENCE, so I need to know how this went for you, and all the different ways your individual dogs were treated, so I can address this problem with my vet, and find a solution for Mercedes. Any recommendations you have would be "greatly" appreciated. My appt. is at 2:30 Pacific Standard Time. If you have time to respond before then I would be forever grateful. Thanks In Advance for any help-----Maureen and Mercedes

Maureen BC Canada

Hmmm, if I were you I'd drop the kaopectate and just stick with the PURE pumpkin and add squash to the daily diet. Ae you home cooking for Mercedes? Ask the vet for a course of metronidazole (flagyl). You don't have to stay on this drug for long either....it's fairly hard on the body and escpecially the liver. Five to seven days should do the trick. Lots of us here have used this for our dogs for the same reason! The peeing issue could be muscle related. Not entirely sure though. Good call to have a urinalysis done...can't hurt any and it will help put your mind to ease! Maybe you could also consider a fecal exam??? Good luck and keep us posted. Looking forward to hearing the CBC results. My thoughts and prayers are with Mercedes. Johnny & Tessy

Johnny

Oh, I should say that having the liver values checked before using Metronidazole would be very wise. Here's some info for you... http://www.petplace.com/drug-library/metronidazole-flagyl/page1.aspx "The typical dose of metronidazole ranges from 5 to 30 mg per pound (10 to 60 mg per kilogram) one to four times a day." If you do go with this drug perhaps a smaller dose would be best and make sure to give it with food.

Johnny

LOL...leave it to me to leave things out! Ask the vet for a course of Denamarin if you haven't already done so....I can't remember. That should be all.

Johnny

Hi Johnny I plan to ask for the denamarin, for sure. I looked up the "metronidazole" after our last conversation, and did notice that it is processed by the liver and not recommended for dogs with liver issues. I agree, it would probably be better to wait till we get the bloodtest results tomorrow, before proceeding with that particular drug. I will begin adding the pumpkin "today". I wanted to give the kaopectate a chance to work----obviously it is NOT! I am not cooking for Mercedes---she is on Royal Canin "gastro" (a prescription food) for dogs with digestive/intestinal problems. It digests in the small intestine, so at least she should be getting some nutrients from it. She's not really fussy for it (probably because it is so bland) but at least she is eating and that is sooo important with all the steroids she is on. So far, no tummy problems, re: ulcers, bleeding etc.!!!! I am "very" concerned about this diarrhea though as I think if we cannot halt it, it could begin to take its toll. Such a worry! Will let you know how we fare at the vet today. Thanks for your quick response. Maureen and Mercedes

Maureen BC Candad

I remember VERY CLEARLY when Tessy had her SHOOTING diarrhea!!! It was just like water shooting from her! Poor little things!

Johnny

Maureen, I used metrondiazole with Chance on many occasions. Short term use in lower doses is generally not considered harmful. It is actually more important to settle out the digestive tract and stop the diarrhea. This can lead to nutrient loss and dehydration. My vet had no problem with me using a low dose of 250mg per day (weight 90 lb) for long term use. That is 1/8 to 1/4 a regular dose. In any case it should be started at a loading dose for the weight of the dog. Your vet can definitely advise you about the safety of this drug and explain how it will help. If you have not gone to the vets yet, talk about testing for giardia. However, that said, just treating as though it might be the case (with metrondiazole) will immediately begin treating the giardia. This is a microbe that can easily be passed by fecal matter. It is most commonly contracted by drinking water in a natural setting or getting fecal matter on the body and then ingesting it somehow. (Stepping in poop, licking paws) Some municipalities in the US have struggled with epidemics of giardia in the water supply. The filtering they use allows this microbe through. They must move to a tinier micron filtering system. I used to hike in the Adirondacks often and I was good friends with some serious hikers. In the mid 70's giardia (commonly known as Beaver Fever because it was passed by fecal matter in the water) began to pop up in this area. Hikers would commonly fill water bottles from the stream. They told me that they almost wished they had died because giardia was so painful. There are many other causes for diarrhea. However many of the bacteria related ones can be treated with metrondiazole well. If your vet approves, *if this were me* I would not be frightened to try it for 8 days to see if it helps. If it does not then you can stop it. If it helps then you can discuss what to do at 8 days. It will clear the body fairly quickly. my best patrice

Patrice NYS

Maureen, When Tootsie had diarrhea it was always like pudding, never watery. I hope your vet can find a solution for Mercedes. We are thinking of you. Barb and Tootsie

Barb Ohio

Maureen, So sorry to hear about Mercedes, and the toilet issues. I hope you can get it figured out. Just a comment on your vet. My vet is also a young, new vet. He graduated last year. I found with this new breed of vets that they are very open and willing to listen, and don't seem to get offended when you come in with info from outside sources, and know what treatments you want. My clinic also had an older vet, and they are like night and day. I am so glad when my vet came on board I was one of the clients who was switched. My vet was willing to do what I said I wanted to do, whereas the older vet felt that the best thing, from day 1, was to put Toqua down (he kept medling in our business)! Good luck and keep us posted. Jessi & Toqua

Jessi Merritt

Maureen, I don't really have a lot to add to what has already been said. Kahlu had watery diarrhea on one occasion and the metrondiazole took care of it. Like Patrice said, the diarrhea is the bigger problem that the liver right now. As for cooking for your dog, I always thought that people that are cooking for their dogs are a bit crazy..... well, guess what? It felt so good to put good stuff into my dog, not just the pills. I realize you have more than one dog, so it is no easy task. Royal Canin gastro is not bad, but I think you can do better. Just because it is sold at the vet does not mean it is good. I am assuming you feed the can, I happened to have one and looked up the ingredients and it is not bad, I think the dry food has corn in it, something you want to avoid. I started to be a good customer at the fish counter, Snapper and Cod can be fairly cheap and then potatoes, yellow and sweet, kale, Omega3,parsley, carrots, green beans, scrambled egg. I made it for a couple of days and it just got to be a routine. I would definitely get Mercedes urine checked. UTIs are fairly common and it could be one of the reasons she has a problem peeing in the house. Also, just like Johnny said, it could be because she is loosing control because of muscle loss. I have to agree with Patrice, giardia is VERY nasty. I had it a few years back, no idea how I got it because I was not a big water drinker then. I was sure I had a terminal disease. One pill and I was fine. I probably got it on Vancouver Island but I know somebody who got it in the Okanagan. I doubt that Mercedes has it, but then you never know. Keep us posted how that poodle girl is doing! Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Hi Everyone Well we're back from the vet and the news isn't really positive. We have drawn blood and will have a full work-up done at the lab. The vet did an in-house PCV and her numbers had "dropped" a bit---very distressing. She was at 23.2, only down a bit from 2 weeks ago, but down just the same. Now, I will qualify that with what he said about this reading----every machine can be calibrated a little differently and we need to see what the reading is from the lab at the coast, (whose numbers we have used up to now)! I agree, but it seems to me that at best we will be at a standstill, over the past two weeks. I also took in a urine sample, and that was all "fine". We will remain at the same level of treatment for the time being (ie-70ml of pred, and the azathiopine.) He has suggested that if we are at a standstill that he would like (with my permission) to confer with the staff at the University of Saskatoon Veterinary School. I have suggested that I would rather send blood, and confer with Jean Dodds. He has no problem with that. We talked about "antibiotics". He did mention the Metronidazole but felt that it may be risky with her high liver numbers. He opted instead for a drug called Tylosin which is used widely and with much success, on small animals with this type of problem. He also suggested I could use some "Imodium"---1.3mg, along with this, to firm up the stool. I have begun feeding pumpkin today, and he agreed it "couldn't hurt"! He felt the denamarin was a good idea and I will get a prescription for that tomorrow after we get the bloodtest results. So that is where we stand until tomorrows bloodtest results. Thank to all who responded earlier today. It was very helpful. Maureen

Maureen BC Canada

Maureen, I am so sorry, the results were not what you expected. You are right, the PCV from the vet office and the hematocrit checked at the lab, although basically the same thing, can have quite different results. It would be interesting to find out tomorrow, if there are still spherocytes and reticulocytes. I am not good with the numbers, but I am sure Johnny or Patrice could explain. All I can say is this would show if Mercedes is regenerative or not. The pathologist will most likely mention it too. As for consults, Dr. Dodds versus Saskatoon Vet School, I think Dr. Dodds would be the better choice. Your vet can call her and get advice without even sending any blood. I can almost guarantee you, Dr. Dodds will recommend to put Mercedes on a Thyroid supplement without even checking. If her values have not been low before, they will certainly be now. Thyroid supplementation will help with the blood building. My vet has learned so much from Dr. Dodds. She even went to a seminar after talking to her on the phone. Dr. Dodds is held in high regards by everybody on this forum. Don't forget Maureen, Mercedes is still in the beginning of this rotten disease. I think the waiting for results and the being patient was one of the hardest things of this ordeal. Stay positive, Mercedes will beat this! Keep us posted! Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Bridgette Thanks for your reply. Your encouraging words made me kind of tearful. I am really beginning to feel a little stressed with this darned diarrhea, that just will not go away! I guess if I had seen even a tiny bit of an improvement in either the symptoms of the diarrhea or the PVC I wouldn't have felt so "negatively" today. I will shake it off----and tomorrow WILL be another day---it's just that today was sooooo disappointing. My poor Mercedes!!! I wish I could do more for her. Maureen

Maureen BC Canada

Maureen, It has been said on this forum many times: Take it one day at a time. Wise words.... Please go to Meisha's Hope website and read some of the success stories. There are some of Standard Poodles! Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Hi Maureen I dont have a lot of advice, but just to say that it IS hard, every day seems to bring a new symptom and its amazing how much we look to those numbers to give us hope to go on. I know full well how wise those words are that Brigitte quotes "a day at a time". My best wishes to you and Mercedes; I sincerely hope you both beat this, praying for you. Silka

Silka Melbourne Australia

Hi Maureen Ginger had diarrhea really bad a few weeks ago. She started on Friday and it gradually got worse until she as going once an hour by Monday. I took her to the vet on Monday as she was beginning to become lethargic and up to that point she was not really acting sick and still eating her boiled ground meat and white rice. Our vet advised we take her off all foods for 24 hours (which was hard to do with her meds) and gave us a five day supply of Metronidazole and Sulcrate and after 24 hours begin to give her very small meals of chicken and rice and within a day or two she was back to normal. During the time she was going every hour I was afraid she would dehydrate so I forced fed her water, pedialyte and gave her ice to chew on and when she went to the vet they also gave her some fluids. I tried pumpkin and petobismal over the weekend without any luck. Maybe you should run holding off food for 24 hours by your vet as Ginger is not on a high dose of prednisone she is on 10mgs a day and 200 mg of the cyclosporine. Speaking of Cyclosporine has your vet mention it. Ginger's PCV was stuck in the 27-28 range for at least 2 months but once we added the cyclosporine it began to raise but it took a month before we saw that improvement. I hope Mercedes is feeling better today and please let us know how she is doing today. Cheryl & Ginger

Cheryl & Ginger Pinevile Pa

Maureen, As Brigitte mentioned. please do visit the Sucess Stories at the Meisha's Hope AIHA/IMHA Web site: http://www.cloudnet.com/~jdickson/successstories.htm some of these dogs had very bad diarrhea and there are also several Poodles on these pages as well. AIHA/IMHA can be a very difficult journey but never forget that dogs who have been diagnosed with it CAN & DO recover and go on to live happy, healthy lives. The Success Stories pages will show you that. They will also show you what has worked for other dogs in terms of treatment options and provid you with a lot of HOPE.

Joanne MN

~~~Sitting here patiently waiting to hear news~~~ The tylosin sounds like a good idea Maureen. Getting Dr. Dodds on board is also a GREAT idea! Are you planning on sending blood down to her? If so you should get the "Profile 7200" as it includes pretty well everything....CBC with differentials, Full chemistry panel, full breed/sex/age specific thyroid panel, and RBC morphology as well as Dr. Dodds own personal analysis!!!! Pretty good considering the test only cost $115!!! Any change in the diarrhea today? Don't get overyly worried or stressed over the crit drop....this has happened countless times with Tessy! In fact she remained in the mid to high 20's for months before breaking the 30% mark! Have you been using Pet Tinic? Have you added thyroid supplements? If you want to add the thyroid supplement it is completely safe for the dog to go on and actually stimulates the bone marrow! Keep us posted. My thoughts and prayers are with Mercedes. Johnny & Tessy

Johnny

Hi Everyone Well the news is not too bad this morning. PVC is holding at 25 and the white blood cell count is down. Still waiting for the final bit of the report, but it appears that there are no spherocytes present. The vet wanted to decrease the prednisone as he feels the immune system is shut down but the bone marrow does not appear to be generating new RBC's. He felt decreasing the pred would help. I asked about "thyroid meds" and he felt he didn't want to do that without a full thyroid panel---that opened the door to a discussion about Jean Dodds. I asked that we leave Mercedes on the same pred. doseage, and draw blood at the beginning of the week and send to Jean Dodds for analysis. He was very open to that and so we will send a sample down on Tuesday (Monday is his day off), and leave her meds as is, until we get a report back. In the meantime he intends to research Jeans website, as well as email Dr. Dodds and consult with her----YEAH!!! I am feeling better already! It is so nice to work with a vet who is open-minded and not so egotistical, that he is not willing to admit, when he needs to consult a specialist-----soooo refreshing. He actually thought it was a "great idea"! It is a relief to know that we will be dealing with a "specialist" in auto immune diseases. I am feeling very positive this morning! Mercedes is about the same today, although somewhat brighter than a day or so ago----hopefully that is a sign that she is feeling better. I will continue to keep you all updated. I "knew" you would all be pleased to hear that we are bringing in Dr. Dodds to consult on Mercedes case. Talk soon.........................Maureen and Mercedes

Maureen BC Canada

Sounds like all is good then...with the exception of the crit staying stable. How has the poopies been? It sounds like you have a very good vet! Those are the best ones to have....the ones that are open to learning new things and aren't stuck in their ways! YUP, having the knowledge and expertise of someone like Dr. Dodds on board goes a long way! She's a savior in so many ways! As far as the crit remaining where it is. Did you look into adding a Hematinic like Pet Tinic? This may help some as well as the thyroid supplement. Might be just the boost you need! If I were you I'd get the thyroid supplements tonight and start them. Dr. Dodds usually recommends to start with 0.1mg per every 10 pounds. This is totally safe to add and can not do any harm to the dog! I can almost put money on it that she'll recommend you do this regardless the thyroid results! Are the numbers supporting non-regenerative bone marrow? Johnny & Tessy

Johnny

Should also state that if the numbers support bone marrow suppression then the azathioprine should be tapered first. Bone marrow suppression is an often side effect of azathioprine! Just a thought for you to ponder!

Johnny

Hi Johnny I'm not sure what numbers I would look at to see if they support non regenerative bone marrow!! I am still a real neophyte when it comes to all the bloodtest analysis. At any rate, I do not have a copy of the results yet---I just spoke to the vet by phone this a.m. and he merely gave me a condensed version. He was quite happy with everything except the crit, which he would like to see climbing. The white blood cell count was down (to 17 I believe) so very close to normal. I asked about spherecytes and he said he didn't think there were any present, but would have to wait until the full analysis was back from the lab. I don't think he will prescribe the thyroid meds without a full thyroid panel. I did ask about that and he was opposed to doing anything without a full screen. I think he will want to consult with Jean or wait for her analysis of the blood samples before he takes any action in that regard. I did tell him most of the dogs on the discussion group seemed to be on a thyroid med though. I am picking up some denamarin this afternoon, along with all the other prescriptions for Mercedes. Hopefully that will help to get her numbers up too. Gotta run. Thanks for the input. When I get a copy of the lab results will post for you to take a look. Maureen

Maureen BC Canada

Maureen, I am so glad you feel better. I am sure you and your vet will not regret getting Dr. Dodds on board. She is (or was?) Canadian btw.! Make sure you read all the instructions for what needs to be done to send the blood to California. I remember, having to go back and get more blood drawn at a different time. Looking back I think this was because Kahlu was on Thyroid meds though. I also remember this was the first time they took blood from Kahlu's jugular. They need quite a bit and it is easier to get lots from there. Don't be alarmed, it sounds worse than it is. Just insist on staying with Mercedes, she will be calmer with you there, even if you just get to talk to her. In our case it took a week for the blood to get there. This was true agony for me. I don't know if it was because of the way it was sent or because it was before Christmas. Just ask to have it sent the fastest way. Once it is at Hemopet, it will not take long for you to get the results. tell them at the vet to get hemopet to e-mail you a copy of the results too. Best wishes and a special poodle hug to Mercedes from, Brigitte & the poodle boys

Brigitte BC Canada

This thread was discussed between 29/04/2010 and 30/04/2010

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