Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Millie - what is wrong?

Hi Everyone, We are experiencing another episode of not eating, and now an upset tummy, with vomiting. She is vomiting an orange/brown coloured bile - similar to when she was first diagnosed with IMHA. However, this is not the first time she has vomited this kind of bile since she has been sick, so I'm not saying this is a relapse, but of course this is on my mind. To add to this stress, I am due to fly out for a nine day work trip overseas tomorrow night, so I have so much work to get through today and tomorrow before I go. My husband is good with Millie, but not as vigilant as I am, and we certainly had disagreements when Millie was first diagnosed as to how to proceed (his option was euthanasia, mine was to save her). I have an appointment with Millie's vet tomorrow morning, and after discussions with Patrice on my thread a while ago, I will be investigating the possibility of kidney issues again with her. I am worried about a relapse - last check up a week and a half ago had PCV at 42, and we were due to do a full blood screen tomorrow. I'll be asking about BUN and Creatnine levels then to ascertain if there are kidney issues. I just don't know what's going on, but this is happening more frequently and it's starting to worry me more and more. Thanks for letting me vent, why does the timing of these things always work like this? Sam and Millie.

Samantha Geelong

Samantha, how dare you go on vacation without Millie!!! LOL ...just kiddin. If it were me I'd be stressed to the max to leave Tessy with someone for 9 days...that'll probably be an eternity for you I'm sure! I'm glad you are taking her in for tests. Get the full monty (CBC, morphology, chem panel) done so that you'll know everything is always my motto. Were any of the past tests indicative of kidney problems? Stomach issues?...certain foods that are making her sick? Does she puke only after she doesn't eat for awhile? Pee and poop looking normal? Perhaps you could take a sample of each in to have checked out. Urinalysis and fecal? Tessy did this almost same thing several months ago. She puked a few times within several days...of course I was freaking out. Tests showed nothing and it went away on it's own. I started antibiotics also around the same time so I'm not sure if this did something or not. I hope it's nothing serious. I'll be keeping Millie in my thoughts and prayers. Sending some positive vibes to Millie and to you for a safe, comfy, stress free trip. Johnny & Tessy

Johnny

Samantha, I am sorry to hear about Millie. But I am glad you are seeing your vet for some testing. I think I can give you some help to ease your mind while you are gone. First, I am on a lot of doggie forums and the yellow toss-up, esp in the morning, is one of the most common complaints owners mention. Well, come to find out, most dogs will do this because they slept on an empty stomach. Their system is prepared to eat in the morning at a certain time. Their stomach begins secreting bile and acid to digest food. But no food is in there to digest. It upsets their stomach and they toss it up. The most common solution? Feed a small snack before bedtime. It completely resolves the issue in our house. When I forget to give a small snack, I see yellow toss up on the carpet next to the back door. Now your next problem. She isn't eating. Well, there can be a lot of reasons. If you find even a slightly high BUN, and maybe even a high normal creatinine, this may be enough to make her feel ill and not want to eat. You'll know soon enough. Ask your vet to prescribe Mirtazapine for Millie. It is a special antidepressant that is used most esp in senior adults because it has a side effect of increasing the appetite. It is also special because it doesn't have anticholerginic side effects. You know this as that dry nose/mouth/eye symptom when you take some medications like anthistamines. I talked to the pharmacist and she says she uses this a lot in these seniors because it is so safe. My vet specialist uses it all the time for dogs. Chance is taking this drug now and his appetite has returned to normal. The dosage is a bit tricky. He is around 82 lbs and Dr. B suggested 7.5mg once a day. But he noted that it can make Chance dizzy and it did. So I am cutting the 15mg tabs into quarters and only giving one quarter tab a day. It's working fine and he is not getting dizzy. I think Millie is pretty small? You might ask for 7.5mg tabs and try a half or a quarter of one of these. You will have to get this at your pharmacy, it is not a veterinary medication. Try just a week's worth, while you are gone, so you won't worry about her not eating while you are gone. It's not going to matter what the cause of her not wanting to eat for the one week you are gone as long as you can encourage her to eat some food, right? The only thing you need to be firm with your husband is that Mille get plenty of water during the day. If she won't voluntarily drink, you will need to teach him how to syringe water into her mouth. (ask your vet for a largish syringe, no needle). Fill the syringe and stand over her back so you are looking down at her head. Hold a towel under her chin. Slide the syringe gently into her left cheek and carefully and slowly push the syringe in. She'll figure it out after a bit. Add a little honey to the mixture. Measure out the day's worth and make sure she gets the whole amount! Depending on the results of the testing, your vet may prescribe meds also and they must have some water in the stomach. Your husband will have to do this for her. I hope you are able to organize all this and leave without worrying. Let us know when you get back. my best patrice

Patrice NYS

Just checking in to see if there's news from the vet appointment. Hopefully we'll hear something before you go on your trip.

Johnny

Thanks for your responses Johnny and Patrice. Johnny - I feel terrible to leave Millie :( - she is very small though, she'll probably fit in my hand luggage! After I posted yesterday morning, I phoned the vet and got an appointment. Millie had the works done, but at least everything possible was getting checked. PCV came back at 47 (highest ever), no sign of spherocytes, no relapse suspected. BUN and Creatnine both came back at the high end of normal (I do not have the number with me, waiting for them to be emailed). Does this potentially indicate kidney problems, even though the values are still 'normal'? Johnny - none of her pasts tests were indicative of any issues either, all values are always within normal range. The BUN and Creatnine have consistently been at the high end of normal however. I am wondering if it is diet. Millie and our other dogs stayed with my parents last weekend, while we holidayed in Queensland for four days. I'd say she was spoilt there, so who knows if all the BBQ chicken and steak upset her tummy. Pee is normal, and poop was kind of runny. This seems to go hand in hand. She stops eating when she's got diarrhoea.... The vet wants to do a urinalysis, which we've booked in for when I get back. When she has these periods of not eating, she doesn't always vomit.... it's strange. Patrice - The vet gave Millie a shot of Cerenia yesterday which she daid was to settle her tummy. Millie at a good meal last night. I didn't read your post until after I got back from the vet, but when I spoke to her on the phone, she agreed to write us a prescription for Mirtazapine for my peace of mind. We can pick it up on our way to the airport tonight. Millie is only small - 9lb. Yes you are exactly right, the most important thing is she eats while I'm gone, and we worry about the rest when I get back. I have a syringe on hand, and John and I practised with the water last night. She didn't like it at first, but then obliged. She has been drinking on her own, so John just needs to monitor her and make sure this continues. The vomit Millie is having is a orange/brown colour, not so much yellow.... maybe that's just Millie's colouring? She certainly had slept on an empty tummy because she had refused her dinner, so I am relieved to hear this is normal! The vet's conclusion is that Millie probably has a sensitive tummy (due to old age, she says this is quite common in senior dogs). I'm not sure, I am still worried about her kidneys. Millie is seeing a specialist at the vet hospital at the end of March to have her heart checked. Our vet did say it was sounding really good though, so hopefully everything is stable there. No sign of fluid build up. Thanks again for your help, I can now go on my trip somewhat relaxed (except that I do not like flying at all!). Sam and Millie.

Samantha Geelong

Sam: I can't remember - is Millie on any medications still? Higher than normal BUN and creatinine levels can be a side effect of cyclosporine. (Not sure about pred.) And of course, levels can be slightly elevated in older dogs. Whatever the case, hang in there and know we are sending positive thoughts your way. Rita, Mike and Sheba

Rita IA

Millie, Chance began having symptoms of poor appetite when his BUN was only slightly above normal and the creatinine was very normal. The cause, in his case, is called pre-renal azotemia. This is due to a reduced heart output of blood to the kidney. There is NOTHING WRONG WITH HIS KIDNEYS. Once he received a slightly higher dosage of two of his heart meds and a small dose of mirtazapine, he began to eat again and felt much better. This means that he is now outputting more blood flow to the kidneys. Start with 1/4 of a 7.5 tab of mirtazapine and only dose up to a half tab if necessary! Look for signs of dizziness. Bile is brownish orange so the throw up can be close to the color you describe. my best patrice

Patrice NYS

Samantha, Ha ha. I do know who "you" are. I wrote the last thing very quickly while working. I know that Millie is your dog and you are the owner. Hope all is well p

Patrice NYS

Hi Samantha, You are probably in the air by now I would guess, but I wanted to send you my best wishes for Millie - her results sound great - perhaps she picked up on your stress about being away from her, you worried about her, her worried about you - you sound very close. Lets know how she is, and have a successful business trip. Silka PS. Im a little worried about Patrice though. :):)

Silka Melbourne Australia

Hi Patrice, No problems about calling me "Millie" - sometimes I feel like she's the one that runs our household anyway! :) I was thinking maybe Millie had pre-renal azetomia due to the high normal levels of BUN and Creatinine. I should not have said 'worried about her kidneys', because after your detailed explanations in my previous post, I did know that this was not a problem with the kidney itself, just the blood flow to the kidneys. Millie has been on the mirtazapine - no problems with her appetite while I was away, thank goodness. She is well and now a permanent attachment to me since I've been back. We see a heart specialist the week after next to get the full work up you suggested. I am actually looking forward to this and getting some more feedback on Millie's condition. Rita - Millie is 12 years old, only on 6.25mg Imuran every third day. My vet also said that as dogs get older, they can have more sensitive stomachs and maybe this is Millie's problem. I will know more in a couple of weeks when we see a specialist in regards to Millie's heart condition. Silka - my trip was great - went to Uganda to visit a community that our Foundation here at work supports. My problems seem so trivial in comparison to what I have seen over the last week and a half. I couldn't believe it when Millie started to refuse food before I left - perfect timing! All was good though, and now she won't leave my side. I think we are very close, she's a very sensitive dog - she picks up on feelings, and will look you right in the eyes as she trys to work out what's going on (whether we are angry, upset, happy etc). Thanks again to all for your support, I'm continuing to catch up on what's been happening here since I've been away. Sam and Millie.

Samantha Geelong

Samantha, I am so pleased that the Mirtazapine has helped so much. I get so much pleasure from feeding my own dogs and it was very difficult for me to watch Chance refusing to eat. I think this may be the "worst" symptom of illness for owners. To know that it worked for Millie has made me very happy! Please let me know what the tests show. Try to get a print out of the doppler results if you can and ask for the vet to explain to you what the ECG shows. (And if they will allow you to be present for all of these tests, all the better!) May I share with you a video I made from last Sunday morning? Just a min or so in our lives with Giant Schnauzers. Chance is the one with the sweater on, Cassie is the other Giant. http://www.cybergiants.com/PatricesBlog/?p=524 my best patrice

Patrice NYS

Boo hoo Patrice, I cant see that link. Saw a giant schnauzer being walked the other day on my drive home from work, and realised I had never seen one before, only recognising it from your posts and pictures. Samantha, welcome home, I was wondering how little Millie coped without you; she sounds delightful. I know about the "eyes" thing - they are so amazing. Glad all is ok, and I can imagine your trip must have been emotional in a number of ways. You must feel proud to be working with an organisation who is helping, and to be able to see that help first hand. Good luck with the heart specialist and full workup.

Silka Melbourne Australia

Silka, Open a google window and do a search: patrices blog Winter Sunday With Giant Schnauzers This should put the link at the top of the search. p

Patrice NYS

What a wonderful "Yard" your dogs have. :)

Penny Lytle Creek Ca

Hi Patrice, The mirtazapine has been amazing, it's like she's back on the high doses of Pred again! I am continuing to give it to her now.... When Millie does not eat, it is definitely upsetting and stressful, so I'm grateful to have a solution that takes the worry away! I will let you know what the tests show next week, and I will request the doppler results and an explanation of what the ECG shows. I will ask to sit in. I was also relieved and excited to read in another post you wrote for Cheryl that Vetmedin is a 'revolutionary' drug that can extend dog's lives significantly. It's just a shame it's so expensive, I imagine this puts it out of the reach of a large number of owners.... Thanks for sharing the video - Cassie and Chance are just adorable! It looks like it was hard going through that snow for Cassie, but playing around in the back yard - they were having a ball! Sam & Millie.

Samantha Geelong

This thread was discussed between 03/03/2010 and 17/03/2010

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