Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Mitch Update

Mitch was taken off the cellcept two weeks ago and after a week(on Monday) he went back for his blood test. The vet struggled to draw blood and he was very pale and his heart murmur was much pronunced so we feared that this week was going to be his last. However he has since then seemed pinker than ever and on getting his results back today his pcv is 25 (up from 15 two weeks ago) and his platelets at the usual 25. His wbc has increased from 2.1 to 4.5. We were quite aware that the cellcept was pulling his wbc down. Anyway Mitch has always been classed as non-regenerative but I have not had the actual figures. I have the print out this time and his absolute retic count is 54.8 - is this a good figure? I believe it is still non-regenerative but not as low as I was expecting.

kath Scotland

Kath, Can't contribute anything about the retic count but I'm glad Mitch is looking better. Chris

Chris Pa

Kath, that's good to hear Mitch's PCV has climbed some. An absolute retic count (ARC) of 54.8 or 54,800 isn't overly bad but it isn't quite where we'ld like to see it....according to what I've read over the months. To be classified as regenerative it has to be >60,000/uL. I'ld have to say...and maybe I'm wrong in which case I hope someone else will chime in...that 54.8 is borderline between regenerative and non-regenerative. The rest of the blood results may help to understand the condition a little more. ex...macrocytosis/microcytosis....high/low mcv? Please do not take this info as correct. This is only what I can remember reading somewhere before. Do you have a copy of the full results? Maybe a morphology report? MCV? etc. I'll continue to pray and will send some strong healing vibes to Mitch. Johnny & Tessy

Johnny

Kath, In a dog (or person) with anemia, any reticulocyte count less than 60,000 absolute and lower than 1% is considered non regenerative. There are complex formulas that are used to determine "how" non-regenerative a dog or person is according to the relationship between the current PCV/HCT, the RBC count (in millions) and using a standard number of days that these cells normally take to mature. So, in more simple terms, the more severe the anemia and the lower number of red blood cells in circulation, the higher the number of reticulocytes have to be to be considered regenerative. Do you understand this? When Chance was first diagnosed, he had a HCT of around 28. Not too low yet, but his reticulocyte count was 13,000. That is considered very very low. In addition, he was not making white blood cells either and had in fact become dangerously low in those as well. From that point on, for about another 4-5 months, he did not have any reticulocyte response. It was only until I contacted Dr. Dodds and she advised me to use cyclosporine that we finally saw a small but highly significant rise in reticulocytes. So, a dog or human with only moderate anemia, a reticulocyte response of around 1.5-3% might be very telling of proper regeneration. A dog or human with severe anemia, say a PCV of 12%, their response has to be greater, say 5%, to be considered regenerative. If you were to look at the actual lab report you would also see it listed as an absolute number, in millions, usually written as something like 5.5. So 5,500,000 red blood cells. All these things, hematocrit, red blood cells, hemoglobin, packed cell volume are related numerically. If there is proper red blood cell production and no deficiencies in production, a rise in the number of red blood cells will be mirrored with a rise in hemoglobin and packed cell volume. Thus these mathematical formulas are describing a relationship. Thus, finally, if you test a normal dog or person's blood and you see 1-1.5% retic and an absolute number of greater than 60,000 reticulocytes, this is a normal range. This is where many dog owners whose dogs have AIHA get confused. When there is a bleeding emergency during the early days of RBC hemolysis and the dog is regenerative, these high counts are alarming to the vet, who sees this as a sign that there is great loss of RBC and a response by the marrow. The vet wants to see the number of reticulocytes go down eventually, indicating that the destruction has come to an end and the body is reaching some level of equilibrium. To us, who have dogs that have autoimmune non-regenerative anemia, we WANT to see the number of retic rise as our dog recovers because that is indicative that the marrow is finally responding normally. Eventually it WILL level out to 1% and around 60,000. And that would indicate that the dog's body has reached a level of number of RBC and hemoglobin that it feels is within normal range. Does this make sense to you? I can try to explain it a little different way if that will help you. It is not an easy topic to understand. Dog owners with these special dogs have a particularly tough task that requires them to be almost as knowledgeable as their vet. my best patrice

Patrice NYS

Hi, Thankyou so much for your explanations Johnny and Patrice. I do understand what you are saying Patrice and my own understanding previous to your explanation was just that that >60.000 ARC is considered regenerative. I was thinking pretty much the same as Johnny that we would really like to see more but at least it looks like this week isn't going to be his last after all. His liver values although still high have come down since stopping the cellcept. I have a full blood printout and I will put some here in the hope you can shed some more light on the situation.(Normal range on right) Red Cells *2.84 5.5-8.5 heamoglobin *7.3 12 - 18 hct *0.25 0.38-0.57 mcv *88 61- 80 mch 25.7 20-26 mchc *29.2 30-36 white cells *4.5 6-15 platelet *24 150-450 Absolute retic count 54.8 7-140 (I have no other % count for rectic) Please don't be afraid to tell me if this doesn't look good, each extra day with Mitch is a blessing and how this little dog still strutts about like he has nothing but a chill amazes not only ourselves but any vet that has met him. (Thats terriers for you!) Thank you all so much for the time and effort you put in to help others along the road. Kath

Kath Scotland

Mitch is hanging in there and thats a great thing. You and Mitch have a lot to be thinking positive about. I'm thinking of you both and know that, although it may take awhile, Mitch will pull out of this and be back to his old self. Take care.

Mardi Northern Calif

Kath, do you have any other retic numbers to compare upon? Like Patrice was saying....if they are slowly climbing then that is a really good thing. Have you ever had Mitch's folate or cobalamin checked for a deficiency? My memory is a little sketchy at the moment but I remember someone talking about their nonregenerative dog having cobalamin malabsorption issues. I thought it may have been Patrice but maybe I just heard her talking about it before. Might be worth checking out if you haven't already. If he's been in to see specialists then they must've done full blood reports/analysis....haven't they? Do you have copies of these? I wish there was something I could do to help you figure this all out even more. I'm a little out of my league with the whole nonregenerative side of things. Patrice is by far the most knowledgeable person I know when dealing with this. Most of the time I just ramble what I think might be a possible solution/answer/help in hopes that someone (like Patrice) will jump in and correct me when I'm wrong. We all want Mitch to get better. LikeMardi was saying...You have alot to think positively about. Hang in there and I'll say some special prayers for Mitch. Sending him some strong healing vibes from across the Atlantic. Johnny & Tessy

Johnny

Hi again, Mitch has had countless blood samples taken however this is the first one that I have ever actually had a copy of. It just does not seem to be common practice in the UK to be given the complete lab reports. My husband asked for the values to be written down when he called in to get the results and the vet just ran a copy for us. I will see if I can find out if the absolute retic count has changed over time - it must be on file. However most will be at the vet hospital and not at our own vets who we are back with now. I do not know if he has had cobalamin or folate checked although he has some pretty extensive tests and meds tried so hopefully no stone unturned. Thanks for your ongoing support

kath Scotland

If I were you I'ld at least ask to get copies of all the results. Remember...you're the one who paid really good money to have them done and it SHOULD be your right to have them if you ask. Johnny & Tessy

Johnny

Aghh, I was at work when I typed my response and I just saw what a terrible mistake I made: >A dog or human with severe anemia, say a PCV of 12%, their response has to be greater, say 5%, to be considered regenerative. If you were to look at the actual lab report you would also see it listed as an absolute number, in millions, usually written as something like 5.5. So 5,500,000 red blood cells.< This is NOT right. If you looked at lab report you might see an absolute reticulocyte number as high as 500,000! Not 5,500,500! The 5.5 million number stuck in my brain because that is about the average number for a decent red blood cell count. You are correct, your numbers are all low across the board. What is very telling is the MCV number of 88 (norm 61-80). This is mean corpuscular volume and simply describes the size of the red blood cells, average. You can see that it is very large. This is referred to as Macrocytic Anemia, or anemia characterized by a large number of bigger than normal red blood cells. This can usually indicate one of two things. I have seen this occasionally in the last several years on this forum in dogs who are becoming regenerative. The new reticulocytes tend to be larger than their future form as a red blood cell. They still contain the RNA inside the cell (which is how they are identified by the laser in the automated analyzer) and thus are a bit bigger. So a larger number of these will indicate regeneration. The other condition larger than normal MCV number can indicate is a B-12 (cobalamin) and folate deficiency. This means that there is a nutritional deficiency that is contributing to the maturation failure in the bone marrow. These two nutrients are the most critical in the process of developing the red blood cells properly. Cells that are not the proper size and shape may be more fragile. You can see by looking at the MCH, mean corpuscle hemoglobin, that the cells contain the proper amount of hemoglobin. Hemoglobin is the "carrier" for the oxygen in the RBC. It has a molecular affinity for the O2 molecule. To be made properly is requires a good supply of available iron. The third reference is a combination of the two above: MCHC, mean corpuscular hemoglobin concentration. So for the size of the red blood cell, how much hemoglobin in there inside each cell? This number is just a bit low. This would indicate that this anemia is also hypochromic, but just barely. Again, there are two possible reasons. One is indicative of an iron deficiency (iron poor blood as the commercial used to say). The second can indicate that there are just a lot of immature RBC (reticulocytes) in the blood. So this anemia is classified as Macrocytic Hypochromic anemia. You can read a bit here about this: http://en.wikipedia.org/wiki/Anemia#Macrocytic_anemia You will find it interesting to note in this brief description they tell the history of the discovery of B-12 involved using dogs in a research project. They bled the dogs to create this type of anemia and then fed them different foods to see what would cure it. They found that high doses of liver cured them. No wonder as liver contains lots of iron and *B-12*. The liver normally holds a lot of these two nutrients in reserve. But if the body becomes unable to utilize or metabolize B-12, folate and iron, then the result will be Macrocytic Hypochromic anemia, a disease of maturation failure in the bone marrow caused by a nutritional deficiency. The liver reserves will drop to nothing. What causes this? Poor diet? Probably, though, it points to poor absorption in the small intestine. This is pretty common in dogs and can often be traced to a condition called SIBO small intestine bacterial overgrowth. This interferes with absorption. If you could only look at all your CBC's from the past tests they would point directly to what has been happening and you would know pretty much whether there has been Macrocytic Hypochromic anemia right from the start or if this test just indicates moderate regeneration. For reference, Chance's anemia was Normocytic, or the cells were the correct size with low hemoglobin. For the most part, hemolytic anemia is classified as this type (because the marrow is functioning properly). But in his case, it was complete bone marrow failure, and the cells that remained in his body were there from before his marrow failed. They age out at about 120 days and are then replaced. (In addition, transfusions can alter this on the CBC making the cells appear to be normal). The input I got from Dr. Dodds was priceless. She said that she has been seeing more dogs that have bone marrow failure of an autoimmune nature. Simply, the destruction is occurring at the precursor cell stage in the bone marrow (from these cells all three types of cells are made: red, white and platelets). It's very serious and is why Chance was not making white blood cells either. We were lucky that he continued to make platelets or he would have been dead very soon after his diagnosis. I understand how things are a bit different where you are with your vet. There certainly has been hesitation on the part of American human doctors to give their patients any kind of test results on paper for a long time. I still have to pry these from some of my doctors when I have test done. But these results are YOURS. You paid for them, and a lot of money too. Sometimes I have to be a pain with my own doctors, but I do get what I want eventually. This disease has few reference standards. You can't go to the doggie Merck manual and find a complete diagnostic panel, an emergency protocol, or a step by step treatment protocol. When presented with a bone marrow biopsy that is devoid of cells, most vets will react in a puzzled manner and probably think of some exotic condition like aplastic anemia from cancer. My vet said she knew very little but said she had heard of experimental bone marrow transplants with dogs. I thought to myself, "it just can't be this complex, there has to be a simpler explanation for why this is happening." I would say the positive thing on this test is that the HCT is still so high at 25. This is not in the life threatening range. It's not a comfortable number for you, I am sure, but it's survivable while you sort out what to do. I could never let Chance get below 18, he was just too uncomfortable. So he had three transfusions. Some dogs will do fine with a PCV of 25, others suffer from the low O2 available to the body. I think it's important to understand that there is no one on this list who judges you in any way. You have had a rough time of it and have many difficult choices to make. I had a few days when I thought that Chance would not make it and I do understand in some way how you are feeling right now. It is clear to all of us that you have moved heaven and earth to bring Mitch back to good health. Mitch's only concern, I believe, is to be around his people, rule his household and live within the routine that he has come to expect. If you can provide that for him now, you will have succeeded. my best patrice

Patrice NYS

It was the M values that made me decide to use a better vitamin/blood builder in Pet Tinic. Again...I think it was because of a previous description Patrice gave me on these values that gave me the idea. Have you ever considered writing your own AIHA manual Patrice? I also refer to several online sources (the merck manual being one) and as you were saying they don't really explain anything in full, which kinda sucks. Most sites tend to refer back to the merck or vetinfo sites. I TRY to read some of the studies from schools but unfortunately for me there's just way too much technical lingo in most of these studies. Can be quite intimidating to try to read!

Johnny

Wow, thanks for all the info. I can't really comment on it all too much right now as I will need a bit more time to read, digest and understand it all. Patrice - you should def. write a manual! Until I get chance to go through this all again and absorb it some more can I just ask if there are any supplements/feeds I can give Mitch to help? Vit B injections were tried for a while but didn't seem to help any. Also on his lab report it says Red cells show mild anisocytosis but little polychromasia. Marked thrombocytopenia. Mild Leucopenia Anaemia appears slightly improved and no evidence of inflammation currently Cannot thank you enough for your time you commit to this forum Patrice, and Johnny I know none of us can compete with Patrices knowledge but your support is worth so much :-)

Kath Scotland

Hi Kath and Mitch, I just want to say Im thinking of you - your doggie sounds amazing. There is so much to take in with this illness and try to understand. Patrice too is amazing. Best wishes to you. Silka (also trying to work out whats going on with Riley).

Silka Melbourne Australia

Kath, This lab comment: >Red cells show mild anisocytosis but little polychromasia.< "Anisocytosis is a medical term meaning that a patient's red blood cells are of unequal size." >Polychromasia refers to variation in erythrocyte coloration.< What the the lab tech really meant by this, and is a statement without judgment or diagnosis, is that there was a larger variety of cell sizes than normal. When the lab technician wants to examine cells to look for certain cell types it stains the slide with a particular colored stain to highlight certain aspects of the cells. In this case, a blue stain is used to highlight and look for the blueish color of the RNA of an immature red blood cell (the reticulocyte). What the lab tech is noting is that they did not see much variation in the cells, they were all pretty much the same color when stained. This means in essence that they did not find signs of reticulocytes. And this is what they thought they might find, due to the mild variation in cell sizes and shapes. This confirms a non-regenerative state, if combined with the other results that indicate moderate anemia. This would be determined by the vet who is looking at all the blood work from the past and reviewing all the lab results currently available to them. In addition there is a marked thrombocytopenia. This is a reduced number of platelets. More than the anemia, this is the tricky part of this lab report. Internal unchecked bleeding can be risky and needs to be stopped. In some unusual and complex cases, Dr. Dodds does advise platelet transfusions, although her recommendations are to use a greater quantity. They don't last very long, at least not as long as the red blood cells. Mild leukopenia is a reduced number of white blood cells. This can be related as well to the non-regenerative state as all three cell lines come from the same precursor cell. This is what Chance had in addition to low red blood cells. The risk here is that the dog is left open to opportunistic infections. So thus he was on a constant dose of one antibiotic or another depending on what he needed it for. This was life saving, but causes all kinds of havoc for things like the intestinal tract. If you are interested, this on-line source of education for Cornell students is a rich source of photos of what different types of cells look like. http://diaglab.vet.cornell.edu/clinpath/modules/rbcmorph/poikf.htm This module has information from the normal red blood cell to the oddly shaped red blood cells. This particular module link shows the different kinds of odd shapes that a red blood cell might be seen under a microscope and what it might indicate diagnostically. I picked hypochromasia as this is sort of what the lab techs might be seeing on your slide. They indicate that in dogs, this is mostly caused by iron deficiency. The next time you are at your vet's ask them about what they see under the microscope so you can understand more. my best patrice

Patrice NYS

I browsed around the net to see if I could find some good slides of red blood cells and reticulocytes and what they look like when stained. This website has some very representative slides, if they aren't the most modern looking, and you can easily see the difference between a red blood cell and a reticulocyte. Look at the links under the heading Reticulocytes: http://www.lumen.luc.edu/lumen/meded/mech/cases/case7/list.htm This slide in particular shows nicely the difference between a reticulocyte and a regular red blood cell. http://www.lumen.luc.edu/lumen/meded/mech/cases/case7/hp5-15.jpg I think it would be worthwhile for everyone on this forum to at least glance at these slides. It will reinforce your knowledge of what the vet is talking about. my best patrice

Patrice NYS

Just wanted to let you know Kath that I'm delighted Mitch is still not giving up and neither are you.I will continue to hope and pray that this little determined man gets his way and the blood results start to improve. I believe Nollaig's problems with her marrow could have been at least partly caused by a nutritional deficiency. Would there be any harm in trying the anabolic steroid injection laurabolin to try and stimulate the marrow - your own local vet can do this?I know vets said it wouldn't help Mitch but so did Nollaig's specialist vet say this, but something's working for her now, she also gets B12 injection every 3 weeks at same time as anabolic steroid injection and also still on 6 capsules of bioprep.Getting Nollaig to produce any red cells proved just as difficult as it is proving to get Mitch to produce platelets and the vets are amazed at how and why it is happening now!! Did you keep Mitch on the bioprep Kath? Kathleen and Nollaig

Kathleen North Ayrshire

Wouldn't the retic percentage be absoluteretics/rbc# or 54800/2840000 ? If so the retic% would be 1.9% ....is this right I wonder? This doesn't compensate for the anemia so you'ld have to do a CRP (corrected retic %) which would be CRP = retic% X (current crit / normal crit). I'm not sure if you know what the normal crit is for Mitch or do you? If we were to say it was 45% the the corrected retic% would be around 1%. If the normal crit was above 45 then the retic % would be lower...normal; crit below 45% and the retic% would be higher. If Mitch were a grayhound then it would probably be likely the normal crit would be above 50%....thus the retic% would be lower. With these #'s one could then do a red cell produciotn index but I'm not overly sure if it would be accurate or not. The red cell prod index (RPI) is supposed to show the rate of production in regards to the anemia but I'm not sure if it's different in non-regen and regenerative animals. Here's the link to where I found all this info in case you want to read it... diaglab.vet.cornell.edu/clinpath/modules/rbcmorph/reticf.htm I was looking at these slides and now it's all starting to make a little more sense to me. I remember the doctor showing me slides at the vets but I literally had no idea what was going on. He even showed me the process they did to stain them and again I had no idea what they were doing. Wish I would have known then what I know now. You know Kath....when it stated on the "Anemia Slightly improved" ...I would have been tickled pink with excitement. Like they said....the main thing is Mitch is improving. I'm assuming you probably won't be sending the blood to hemopet for analysis. I'ld at least talk with the doctors about adding a supplement to his diet. Lots of us on here have used pettinic with great success. You can order it online from several sources. If not maybe they could recommend something similar for you. I wish I would have done this sooner with Tessy. I think the pet tinic really helped her. oh...gosh....here chatting and forgot tessy's meds... Johnny & Tessy

Johnny

Thanks again all, have little time so I will hopefully get back to answer things more fully in a day or two. I think I am just about following everything that is said here and whilst I accept that Mitch is probably non-regenerative it still confuses me how he has gone from pcv of 15 to pcv of 24 in two weeks if this is so. I guess I am being overly simplistic. I will have to go now but will look over all the detail you have provided me with - thanks. Oh I can't discuss blood smears etc with vets as the bloods get sent away for testing to a lab in England somewhere.

Kath Scotland

Hi again, Patrice, I had a look through the slide examples and it's interesting to see what the lab is seeing with the blood samples. Still seems odd to me that he has gone from pcv 15 to 25 in two weeks and is non-regenerative but I am being to simplistic i guess. Hi Kathleen, so good to hear that Nollaig is doing well, and so sorry to hear of your recent loss. I have occasionally popped in to keep up with news but work has been manic and now my husband has been sent away to work for a year! Lifes just gets more crazy. The cellcept Mitch was on was an anabolic steroid which the vets were very hopeful would work and it didn't work. He came off it after a couple of months as it was affecting his liver badly and is not as harmful to the liver as the nandrolone which we were stringly advised against due to the state of his liver already. I stopped the bioprep when Mitch liver values were really bad as we needed to try something and they did actually decrease although this doesn't prove the bioprep caused it I have decided not to put him back on them, we saw no increases in blood values over the time he was on them. In fact he is at the best he has been for a while as he is now. Johnny, I am afraid I don't understand a lot of what you mention at the start of your post, other than I don't know what Mitchs normal crit is. I will look at the web site you mention thanks and see if I can understand it. Thanks again Kath

Kath Scotland

What Johnny is referring to are the formulas I mentioned that use the relationships between the HCT, RBC and Retic to determine the level of regenerative response. Most labs now use automated analyzers that do this mathematical formulation as part of the test. So, in most case now, you see the reticulocytes on the test listed as "absolute retic." This takes in to account all the math so there is no need for the vet to do it. But vet techs need to understand this relationship, thus it is in the Cornell training module. I, too, am puzzled at the increase in HCT and wonder if there was some error in drawing previous blood samples that damaged the sample that returned an HCT of 15. It may have been 25 all along. If you can, ask them to spin a separate PCV in a little tube to examine visually. This would be the best way to check from week to week and be positively sure of an accurate number. This test should cost no more than $10-$15, or whatever the equivalent is in your country. I ask for this *each time* I have Chance's blood tested. my best patrice

Patrice NYS

Hi Patrice Thanks for the quick response. I appreciate the result of 15 may have been wrong although the day we got that result we took him in for an emergency appointment as he was very lethargic and very pale. He has certainly been a lot more active over the last week and looking much pinker so the results certainly seem to tie in with what we see clinically. I have listed his more recent results below and I see the pcv of 15 does not seem to fit although it was no suprise at the time because of how he seemed to be. Oct 1st pcv 28 platelets 2 wbc 3.2 Oct 6th pcv 22 platelets 8 wbc 2 Oct 14th pcv 25 platelets 18 Oct 23rd pcv 24 platelets 17 wbc 2.6 Nov 14th pcv 15 platelets 25 wbc 3 liver enzymes v high - stopped cellcept Nov 30th pcv 25 platelets 24 wbc 4.5 liver enzymes reduced

Kath scotland

Hopefully the platelets and WBC continue to go up. If I was you I'ld do what Patrice was saying and get a spun PCV done next time you're in. They're the most accurate. I'ld also consider adding a blood building supplement. Check online for Pet-Tinic or maybe your vet might have something similar. I'ld consider this a VERY important thing to do/try. I'll continue to keep Mitch in my thoughts and prayers. Johnny & Tessy

Johnny

Hi If I get a manual sample also done it is another £10 each time and although not a vast amount it adds up. When he was first very ill the vet did always do a manual count as it always took a minimum of 24 hrs to get the results back from the lab and the results from both always agreed within 1 pcv difference. Johnny, I was looking last night for a blood building supplement and I found one in the uk which is primarily Vitb etc. How about this one? http://www.provet.co.uk/Nutrition/ProvitB%20Canine%20R.htm I have just had a quick look for pet tinic in the uk but can't find it.

kath Scotland

The link didn't work for me Kath. If you are interested in getting the pet-tinic you could always order it online and they SHOULD be able to ship it from the USA to the UK. I ordered it from a US site and had it shipped ot me in Canada and I'm pretty sure it stated something about worldwide shipping. Good luck Johnny & Tessy

Johnny

Kath, I think what you are looking at is Vitamin B only. When I was not able to get pet-tinic Dr. Dodds recommended 250 mg B12, 150mg iron and 5mg folic acid for my 60 lbs dog. It is a lot of pills to give, but it really helped Kahlu. If you can get the pet-tinic it would be easier to give to Mitch, but this could tie you over until you get it. I got the regular people supplements. Always talk it over with your vet before adding supplements. Best wishes, Brigitte

Brigitte BC Canada

Kath- Patrice asked me to join this thread and although technically I can't offer anything near the info and breakdowns that she brings -- I have had a scenario very similar that took place with my dog Sway. She held between a 16-25 for almost 2 years and we came to find out that after all that time she ended up having multiple liver shunts that were discovered in an ultra sound and then verified through a scintigraphy test. this was most likely present (or created over time via treatments) and went undetected during her entire span of AIHA issues. this is important because plainly what a shunt does is it shuts down the correct path blood is supposed to travel and instead diverts it around the liver and directly into the heart. therefore, the liver is unable to properly break anything down, clean the blood etc... potentially rendering the medications and food given partially or fully worthless. this is pasted from a site- In the normal animal, food and other ingested materials are broken down or digested in the intestines and absorbed into the portal blood stream, where they are carried to the liver. The liver stores some of the food for energy, processes some of it into safe chemicals, and uses some of it to make proteins and other substances. Because the blood bypasses the liver in dogs with shunts, toxins may build up in the bloodstream or kidneys. Additionally, the animal lacks the necessary materials to give it a ready source of energy and to help it grow. --- im not saying this is what Mitch is experiencing but it is worth pointing out or running it by your vets. this might explain some of the issues that you are having, which were similar in regard to some that i had with my girl. rare cases are possible and this surely is... it seemed as thought everything Sway experienced was 'unexpected' or 'rare' etc... but point being, that still isnt reason that it couldnt be happening. if you aren't in contact with Dr. Dodds already, please begin that and attempting to get her opinion as well as i will always find her an amazing resource...

Josh California

I can get pet tinic shipped to the UK but the site I was looking at it was $36 for shipping! I am sure I can get an equivalent here. I felt the vit b supplement might be a good idea as it is so important to blood production. I will need to check but I am quite sure that Mitch was checked for liver shunts when he was at the vet hospital a couple of months ago. I don't remember it being called liver shunts (does it have another name)but I know there were investigating to see if his liver was the cause of some of the problems he was having - i do remember the cost of doing so was around £300! Kath

Kath Scotland

This thread was discussed between 04/12/2009 and 10/12/2009

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