Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - More bad news for Reggie :-(

It just seems we can't catch a break. Even though the red blood cells are up due to the transfusion, his platelets are dropping and he's starting to have bruising along his body. He is also filling with more fluid and is having trouble peeing. The vet gave me a whole list of additional testing they could do, but at what point do we give up and stop putting Reggie through all of this? Since this started we've gotten bad news after bad news. I'm not sure we'll be able to bring him home at all - if he's unable to pee on his own he would just be in pain here at home. So frustrated and so very, very, sad . . .

Amy Wisconsin

(((AMY))) Sorry things are going this way for Reggie! Hang in there and keep the hope. These drugs work the same for ITP/evans so give it a little more time. Cyclosporine is usually a better choice when platelets are involved. Ask them about the usage of vincristine if the platelets get lower. It's often used to signal the body to release more platelets into circulation. Do they have any of the blood left from Dr. Dodds? You can also get platelet enriched blood from hemopet! My thoughts and prayers are with you both! Johnny & Tessy

Johnny

The problem now is that the vets are wondering if there might be an underlying reason (like cancer, tumor, etc.) for Reggie's AIHA. Our original plan was to bring Reggie home and wait this out. But, it seems now that there are more and more problems arising that make the vets think there may be a larger issue driving the AIHA. Also, if he's having trouble peeing, we may not be able to bring him home at all. They're not sure if there might be a tumor blocking things or a blood clot. Either way, things are not looking very good today :-(

Amy Wisconsin

Most vets will use words like Cancer when trying to figure out this disease. I think it's more of a .... i don't know what's going on but cancer may be it...type of issue. I don't think i'd worry too much about cancer at the moment. Just worry about getting the blood back in order. Do you have copies of all the bloodwork done so far? Did they do a FULL tick panel? If not make sure they do one really soon. Get copies of bloodwork for us if you can. Hang in there....my thoughts and string healing vibes are coming Reggies way! HUGS, Johnny & Tessy

Johnny

Our main concern today is that we simply have no more money to put into this. But, I don't that we can bring him home either. What would you do? Would you bring the dog home and pray that he's able to pee on his own (he's been having trouble with that today)? Pray that he doesn't hemorrhage from the low platelets? I don't want him to suffer simply because I don't want to let go. Do we bring him home and let nature takes it's course, or weigh the serious health issues and have him put down? I hate these decisions, but that's what we're facing today :-(

Amy Wisconsin

If it were me i'd leave him there until they get the testing done and have him stabilized. It would really depend on what his platelet numbers are. Given you said he's bruising I'd guess they're fairly low.....10,000-20,000??? If you had a way to keep him totally calm and rested without stress then perhaps bringing him home would be a good idea. Have you talked with the vet about setting up a payment arrangement? Most vets are OK with doing this. OR have you applied for carecredit? I had this for Tessy and it really helped...but didn't last long. It was only a $1000 credit for us! Johnny & Tessy

Johnny

Hi Amy, All I know is you have already done way more for Reggie than I could ever have afforded for Dylan. Sticking it out is really up to you and your family. Fortunately with Reggie, unlike for my dog Jagger who I knew they could not fix and who would not recover making the decision a lot easier, Reggie could still stablize. That makes your decision a lot harder, though. But given a choice, I still think I would have preferred the harder choice. Whatever you decide, you have friends here who feel your stress and your pain and who will be here for you no matter what you decide. Sending our love to you both and to your whole family, Richard & Dylan

Richard Burnaby

It's one of those tricky things - we've already put close to $5,000 into this, so it seems silly to not do another blood test or a urinalysis. But, at the same time, we could go on forever testing and trying and still not have a good end result. I'm going to call again in a few minutes to see what the cost would be for the urinalysis (to see why he might be having trouble peeing). They also wanted to take a sample of the fluid building up in his belly to see if they can figure out what's going on there. Endless tests.

Amy Wisconsin

Hi Amy, I know from my previous dog's fight for life that what is in the fluid in the belly could very well help tell what is actually wrong. In Jagger it did lead to cancer as there was bile in the fluid being pressed into the cavity by pressure from a malignant tumour (or bleeding from that tumour) in her chest near both her liver and her heart and then blood was found in her heart cavity. They removed the pressure on her heart and in her belly and she came home with us for one great day. Later that night I heard her laboured breathing begin again and I knew we were saying goodbye. No treatment and an easy decision. Not easy on the heart though :-( But, on the other hand it could indicate an ulcer, or drug related problem. Maybe find out exactly what they can determine from the tests and what treatment it will lead to. I refused more tests for Jagger as they only led to knowledge (what and why?) and NOT treatment. There was no stopping the bleeding that was crushing her heart. Good Luck, Richard

Richard Burnaby

Hi Amy: JOHNNY IS RIGHT ... get the internists opinion about 1 treatment of vincrisine. This is a chemotherapy drug which will help in the platlets being released much more quickly form the bone marrow than they would under normal circumstances. Unfortunately the platlets which are received fron blood transfusion die off very quickly. They can only use Vincristine once in this treatment (I don't know why but the internist told me this) ...I recall for Crsoby the cost had been under $150.00. I wouls caution against them taking a sample of the fluid in the belly just yet if there is a bleeding problem. Can they not do an ultrasound to monitor the fluid. They'll be able to tell from the ltrasoundultrasound monitoring if the fluid is increasing in which case it may be blood loss becasue of the low platlet count. Amy how is Reggie feeling right now???? Reggi'se condition right now reminds me so much of what Crosby went through. It's in the March string of notes. After the Vincristine treatment ... I think it will all be in GOD'S hands.

ELAINE OTTAWA

This keeps getting more confusing. I just spoke with the vet and the labs they did before lunch show Reggie's red blood cell count is holding at 28% and his platelets have gone up from 26,000 yesterday to 71,000 today. BUT, they now feel he is leaking albumin (protein) and if that is the case it will not resolve itself. The vet was honest with me in saying there is no point in doing the expensive tests to check for it if we would not be prepared to treat it (very expensive albumin transfusion). She said they could work on weaning him from the oxygen to possibly send him home, but that it didn't go very well when they tried during the night. I would love to get him home, but don't want it to be at his expense and discomfort. What would you do? So frustrating to get good news on the AIHA front only the have other areas failing.

Amy Wisconsin

Hi, on another note first, I just read that a side effect ("Some side effects can be serious") of cyclosprine is "unusual bleeding or bruising." Sound like anyone we know? Some side effect seem more common to when combined with Azathioprine. Anyways, working backwards, treat albumin? Only if it is albumin found, yes, no? What if it is not albumin? How do we know? Testing the fluid in the belly? What else might cause of fluid in the belly? What is the likelihood of the alternatives and their severitiy/treatability? What are the other symptoms that lead them to think it is Albumin? If either, or any of the possibilities are "yes we can save him" and "we know how," then you have a choice with good information to know if it is worth trying, given any and all the other presssures and factors including cost (unfortunately we are not all independantly wealthy). I would need to know what the plan was for the alternatives to save my dog and where thye lead not just after the treatment, but past that. More tests only, or getting better? If we think the drug reductions are helping, his platelets and RBC's are coming up, his bleeding is stopping, then an albumin transfusion may save him if that stops the problem causing the albumin in his belly. What is causing that albumin? Overdose on Cylclosporine and the reduction is helping that? I would want to do it if this were the case. If not? Then what to do is probably a lot more risky. Hope this helps, good luck, Richard

Richard Burnaby

In a way, my intuition is saying that by reducing prednisone, azathiprine and cyclosporine, that it may help all of his negative symptoms at some point. They can all be caused by OD on these drugs. Bleeding and bruising, low RBC and platelets, albumin in the belly (liver problems caused by OD?) and what else? I also don't know enough about what an albumin transfusion is and what it accomplishes. Maybe I will soon. Anyone else? Richard

Richard Burnaby

Richard - you're always a help. Thanks for taking the time to weigh in. See, the bruising on his belly led them to think his platelets had dropped further, when, in fact, they had jumped up. At this point I truly feel we are battling the drugs, their side-effects and any permanent (potentially lethal) damage they may have done. I have emailed Dr. Dodds again to see if she might have any insight for me. An albumin transfusion seems out of the question both due to cost and high risks for Reggie. But if it is albumin and we do nothing, the vet said it will not resolve itself and renal failure will be the result. I asked her if they ever drain the fluid in the chest to make the dog more comfortable (and aid his heavy breathing) - she said only if it seem to be causing the dog pain. Not sure what to do - there seems to be too many other things going wrong, just as his AIHA treatment is gaining ground.

Amy Wisconsin

Amy - I am so sorry for all you are going through. You are doing an amazing job to give Reggie every chance to fight this thing. When my dog was put on the three immuno-suppressants Reggie is on he became too immuno-suppressed and his body couldn't fight an infection and he became septic. His white count was very low - his albumin dropped low too and we did a plasma transfusion to boost his albumin and buy him time - the ER doctors pulled him off all the iMHA meds except for a maintenance dose of prednisone in order to give his body a chance to fight the infection. We were lucky and he pulled through - he was older and, from your picture, definitely not as robust as Reggie. Is this at all similar to what Reggie is facing? I'm asking b/c in Murray's case, the meds were the issue - the doses were too high for too long (and he had just begun cyclosporin a few days before he became acutely ill). And, once we pulled back on those, his body took over and we didn't need to do further treatment or testing. The plasma transfusion was ~$400 for two units. Whatever decision you make for Reggie will be the right one b/c you will make it out of love for him and your family. I will be thinking about you and, again, am so sorry for what you are going through. Bonnie

Bonnie Chicago

Thanks Amy, If the albumin in the gut is from an ulcer caused by the drugs and they can protect the ulcer and stop this then in my heart I am going to want to go on! Especially seeing other good signs the lowering of drugs has helped (the more we know on this the better). I know they can do amazing things with ulcers as my Grand Mother had such serious ulcers and yet well into her 90's she is still going strong and absolutely refused to let go and she is much better. Big huggs for both you and Reggie, Richard

Richard Burnaby

Bonnie - his white blood cell count has held very steady through all of this. They also have him on an antibiotic (doxy-something?) which I would think would help with any infections. I just feel this strong need to get him home. I feel like the vets have done all they can (that we can afford) and now it's Reggie's mamma's turn. I visited with Reggie the past two nights and both times they hadn't gotten him to eat anything all day. Yet, when I offered him food both nights he gobbled it up. If he's not eating for them, how will be recover? They did slightly reduce his Prednisone (from 100mg/day to 80mg/day) and Cyclosporine (not sure what he's on for this one right now), but maybe they should be reduced further? I feel like the vets are trying to kindly tell me to give up. I don't want to hold on to false hope, but I also don't want to call it quits if Reggie's body is just starting to join the fight.

Amy Wisconsin

(((AMY))) I feel your worry and stress ALL THE WAY from Nova Scotia!!! :) I've been the same way many many times in the past few years while treating Tessy's anemia and then lymphoma. Go to the store and get a box of camomile tea...this is for YOU. It tastes yummy and will help to calm the nerves some (and you can share it with reggie if you want). Leaking albumin??? You'd be surprised how many people here have dealt with the exact same thing and likely didn't know what it was cause it wasn't checked. Tessy had it for almost half a year. Her belly was HUGE...from leaked fluid (protein). Usually when it becomes a problem in how it makes them feel they'll drain it. Elaine is right that they want to be carefull the platelets aren't too low IF they do it. One of two things I'd add if I were you....either sucralfate OR slippery elm cocktail. Either would be good but the sucralfate would be easiest and the slippery elm would have more healing benefits. ADD ONE TODAY! The bruising is most likely being caused by the thrombocytopenia (low platelets). While worrysome I'd try not to worry cause as you said the platelets went up so this should resolve. Could you remind me again what Reggie is taking for meds AND the dosages. My memory is bad! :( Is he peeing? Johnny & Tessy

Johnny

Richard - that is why I'm having a hard time just giving up. They finally put him on a stomach/ulcer protectant (starts with an "S" I think) and I don't think it's coincidence that his platelets jumped the days after they did that. Yet, the vet keps telling me that this will not resolve itself . . . in other words, if we don't move forward aggressively he will die. The vets have been great, but I think they've done all we can afford, no matter how much we love Reggie.

Amy Wisconsin

So the only way to have hope though is to make sure that the choices you make include what the outcome will be and I am not sure about the ablumin in the gut and maybe ulcer treatment, which you are doing though. The other things it seems only time will really tell and certainly being with you will help his spirit and help him eat and both are very important too. But what about the albumin? What will happen with it if you just take him home? can it resolve itself? I would consider another drop in the drug concentrations again soon if I thought the first drop was what was causing his numbers to improve (knowing more here is better). If he is overdosing, being at 50 mg prednisone will still be plenty to suppress his immune system. I am thinking the doses of Azathioprine and cyclosporine are important too, but the internist is who you should ask this question again. I am certainly not qualified. If you do decide you are saying goodbye, make sure you have everything you need to keep him comfortable. Hugs again, Richard

Richard Burnaby

Probably Sucralfate and it does protect ulcers so they can heal. Platelets can be made, RBC's can be made, provided he has time to do so and his body has begun doing so. Plaelts look good, do we see reticulocytes? Richard

Richard Burnaby

They told me that this morning he has been dribbling urine, but they had to drain his bladder because he's not peeing it out on his own. Here's what I know he is on for meds, but some of this has been changed by the current vets. Prednisone: 80mg/day (was 100mg/day when we took him in this time) Azathioprine: 50mg every other day Cyclosporine: 250mg/day (I think they have reduced this one a bit) Doxycycline: (no idea on dose) Sucralfate: (no idea on dose) Phenobarbital: 1 grain tablet, 2x/day (on since Nov 2010 after having a few seizures) (I'm not sure on reticulocytes.)

Amy Wisconsin

Amy: Well crumb. Not sure what to tell you about the complications that seem to have popped up. I think a urinalysis would be a good thing and they are usually pretty cheap. I do know that you can express a dog's bladder but have never done it myself. If you choose to bring Reggie home it might be something you can have the vets show you so that you can at least help him pee. As for trying to decide if it's time to stop - that's a tough one. You have to decide what's best for Reggie. Is he in pain? Does he seem to have some fight left in him? Money I know is also an issue and not a little one in these cases. This is a horribly expensive disease to treat and sometimes it does come down to money. It doesn't mean you love your dog less if it's just not financially possible to go forward with treatment. You have done more for Reggie so far than many others would or could have. Whatever decision you choose to make, know that we are here for you. We will continue to keep you, your family and Reggie in our thoughts and prayers. Rita, Mike, and (angel) Sheba

Rita IA

Amy, This is called volume overload. It occurs after a blood transfusion if the administration rate was not controlled carefully enough. The kidneys simply cannot keep up with the amount of new fluid coming into the circulatory system. It begins to leak into areas like the abdomen. They might administer a diuretic to help. Prednisone, Azathioprine and Cyclosporin are immunosuppressives or in plain English they simply hold down the immune system so it will stop attacking the red blood cells. Each of these drugs approaches this with a slightly different method and are the critical part of this treatment. Doxycycline is an antibiotic that is most likely being prescribed in case this is a tick disease. This is a pretty harsh drugs on dogs and makes their appetite diminish. If the treatment isn't successful in several days to a week, they can probably stop it. Sulcralfate is sort of like a paste that coats the mucosa of the esophagus and stomach and helps any ulcers that might be there to heal. It is very safe but shouldn't be given near the time that food or medicine is administered because it will interfere with absorption. Phenobarbital. Well enough said. It has been implicated in hematological dyscrasias in dogs. The mildest hematological disorder is neutropenia and thrombocytopenia. Phenobarbital in plain English: Can you ask them if they can stop this drug? It may be the cause for low white blood cells and low platelets. If they want a reference, tell them I pulled this out of my Schalm's Veterinary Hematology. Chapter 16 Drug-Induced Blood Disorders. my best patrice

Patrice NYS

Shoot! Reggie was out of the oxygen kennel and seemed to be doing well (scheduled to come home tonight). But the vet called a little while ago and said they put him back in because his breathing was labored. Well, honestly, his breathing has been labored since going on the drugs and retaining fluid in his belly. Wouldn't all that fluid in the abdomen put pressure on his lungs and make breathing harder? I don't know what else would be causing the breathing trouble now that his RBCs are up. I had asked the vet about draining the fluid and she said they only do that if the dog is obviously uncomfortable. Needing constant oxygen seems pretty uncomfortable to me . . .

Amy Wisconsin

Patrice - our regular vet had actually pulled Reggie off the Phenobarbital (cold turkey - and he had no seizures at all) thinking the same thing. But, when we took him in to the ER vet she said the Phenobarbital had nothing to do with what was going on and that you never take a dog off PB.

Amy Wisconsin

Yes, there is too much fluid in the body. The heart is struggling to pump, the lungs are trying to get rid of the extra fluid and the kidneys are unable to keep up. The abdomen is probably rigid and nearly sloshing? I sat through three transfusions and I know how careful my vet was to administer the transfusion slowly to avoid this. It may resolve on it's own. Can you email Dr. Dodds tonight and see what she has to say? Your regular vet was smart. Here is the link to the page in Schalm's Veterinary Hematology. See if someone will listen to you and read this. http://books.google.com/books?id=7h293sAA2JYC&lpg=PA102&ots=c2qZiuWul0&dq=phenobarbital%20canine%20non%20regenerative%20anemia&pg=PA103#v=onepage&q&f=false

Patrice NYS

Sorry, once you click on this link, type into the search box: phenobarbital non regenerative This will bring up two pages, click on page 102.

Patrice NYS

I just returned from visiting Reggie - it was a hard visit. They've had him out of the oxygen kennel for about seven hours and he was panting heavily. He was bleeding a bit from his nose (although his platelets have been going up, so they're not sure why the bloody nose) and his abdomen was definitely more swollen. He was stronger and more alert than I've seen him in a good week though. I took him outside twice and he sniffed around, peed, and tried to head for our van to go home :-( The vet I dealt with tonight strongly recommended we put him to sleep. She said it was time to let him go and that he was obviously suffering. She didn't think it would be a good idea to bring him home because of his breathing since we don't have the oxygen option here at home. I asked if we could bring him home to see how he does and then we can always take him to our regular vet two blocks away to be put down if things worsen and he's obviously going downhill. She didn't think that would be a good idea either. We just keep debating if the fluid and heavy breathing are all part of the recovery process? Would we see positive results if we brought him home and worked on reducing the meds, maybe took him off the phenobarbital, and started things like milk thistle and Pet Tinic? I don't want him to suffer just because I'm having trouble letting go. I'm not a vet and part of me feels I should listen to them and let Reggie go. The other part of my keeps saying, "What if?"

Amy Wisconsin

HI Amy, When I brought Jagger home for her last day, they drained her abdomen and her heart cavity first. When the pressure on her heart came back, she started to breath heavy and just a little laboured. I knew I would be looking to Euthanize her in the morning though, but I could not tell my wife until morning. The next morning, Jagger could hardly move, as the pressure on her heart had returned from the bleeding and her heart could not get enough blood in to pump. She was panting to get oxygen. It was clear she was now working hard all the time (uncomfortable and prolonged would certainly be suffering). That day I found a vet who would come to my house so Jagger could die here with my wife and I and our other dogs. She was certainly uncomfortable all day while we waited, but she spent the whole day hugging with my ex wife and in the end she could take it, she was a strong girl and when she left, it was very peaceful. I am completely okay with how things transpired. The same place I told Dylan it was okay to let go :-) So I don't agree with your vets. Reggie would be okay until tomorrow either way. Probably the panting has nothing to do with the anemia (PCV over 25?) and everything to do with his belly and pressure against breathing. If you want to lessen the suffering and have a chance, have his abdomen drained if you can and then think about getting rid of the phenobartbitol? As for reducing the other meds, I only know prednisone and that it could drop likely. Others? Maybe just ask the internist/vet to give you one last bit of advice on lowering the meds. Tell him this is your choice if you need to. Praying for you both, Richard

Richard Burnaby

Somehow I forgot to mention that after draining Jagger's abdomen and heart cavity, On Fevruary 19, 2009, the next day when we brought her home, I had the best day ever with Jagger. That one February day, the clouds parted and the sun came out and Jagger ran and played ball in a beautiful grass field, like always. That one day was my luckiest day and something the money I had spent without being able to save her, just to know if I could, was all worth it and I would do it again any day. I loved her and I miss her, but that day was worth what happened in the next 24 hours, which I described in the previous post. Richard

Richard Burnaby

oh and the panting is also due to the high prednisone dose he is still on too. Working harder to breath will create heat and prednisone amplifies that. But maybe others can help on this too? I don't know if I could bring him home with a swollen belly, but it would depend on what I saw for his breathing. I have seen suffering and I have seen discomfort and there is a difference. hugs, Richard and Dylan

Richard Burnaby

UGH....I can honestly say that I'd LOVE to dropkick this vet! Nothing ticks me off more than hearing stuff like this. I've heard the exact same thing THREE TIMES with Tessy!!! Each time I gave her time to rest and heal and surprise....she's still here...watching me right now as I type this. They really really should lower the meds some more. The pred should be down to at least 50mg daily and the cyclo should also be lowered to at least 200mg. Those dosages are just too high now. In the beginning (maybe the first week or two) is alright to punch the immune system down but then it's wise to reduce back. I'm really not liking the sound of this vet. Have them run a FULL CBC and FULL Chemistry today and then is the numbersd have not went down I'd decide to bring him home to continue his healing. Work with the regular vet and only use this one on a need be basis. Your absolute best bet would be to have Dr. Dodds consult with your regular vet. It'd likely be much cheaper also!!! Hopefully you'll be able to get a CBC and chemistry today...and get the results for me. My thoughts, prayers and healing vibes are streaming out to Reggie! And HUGS for you!!! Johnny & Tessy

Johnny

Johnny - what you're saying is exactly what my husband and I were thinking. I just spoke with the current vet on duty and she also told me she felt it was time to put him down. They haven't taken him out of the oxygen chamber at all due to his breathing. My frustration is that they have not done anything or told us what might be causing the fluid in this abdomen. They strongly advise that we do not bring him home because of his breathing - we obviously don't have an oxygen chamber here at home. The vets there feel he is suffering. I asked about draining the fluid in his chest/abdomen and they said it would only be a temporary bandaid to the underlying problem (which they have not identified aside from the AIHA which seem to be doing better). I did just call and told them we would like full blood work and maybe even a urinalysis done this morning to see where things are at. If his RBCs and platelets have dropped, that will help us make our decision. But, if they are holding or rising, we'll try to bring him home. I'm just worried about the breathing and bloody nose. I don't want to cause him more pain - he's been through so much already.

Amy Wisconsin

Amy, I haven't posted but have been listening to your entire journey. PLEASE email Dr Dodds ASAP--she will guide you on how to proceed. She will be checking her email today and is very prompt. You, also, might ask her for her direct phone number. She is always offline from sun down Friday to sun down Saturday, as she is Jewish...she should be back now. Healing Thoughts! Ella and Henri

Ella Seattle

Amy, I think our biggest regret was that we did not bring our girl home. It sounds like your vets have just given up. A lot of vets think the initial diagnosis is a death sentence anyway so seem reluctant to entertain anything we may suggest. Get Reggie's numbers and talk to your local vet and if you can to Dr. Dodds. If it is Reggie's time you will know and where better than surrounded by the love of his family. Still hoping for a turn around for Reggie. Penny

Penny Lytle Creek Calif

Hi Amy, My vote is with Johnny and Reggie! I also think the initial high does of the meds should be short lived. Punch the immune system with a high dose, then reduce to a better level to stablize (like with all the othe diseases they use these drugs on). 50 mg pred is still 1 mg per pound and sitll considred a high dose and with Reggie it is much better. Draining the abdomen is not a bid deal. If the critical factors in his CBC is improving it makes choices a lot easier. Still wishing you the best and very happy everyone is fighing with you for your beautiful boy! Richard

Richard Burnaby

The vet told me that if they drain the abdomen they then also need to put him on IV fluids. She said that we either stop treatment, or continue aggressively. At this point we simply cannot afford aggressive treatment, but she said she's not comfortable sending him home with his current breathing (heavy panting) - she feels he might not make it home. Yet, he was off oxygen for a good six hours yesterday before I came to see him last night. He was panting, but no more than he had been at home. I guess I just can't imagine he would die on the car ride home, yet was able to go outside with me to pee and sniff around. I'm quite sure the vest think I'm completely crazy at this point (and a bit irritating as well).

Amy Wisconsin

His heavy breathing is not caused by anemia in my opinion, espcially if his PCV is still up in the 20's. It is caused by the pressure in his abdomen and having to fight to pull his belly down to let the diaphram pull in air. Pulling in air takes effort and if there is resistance, like someone sitting on your chest or your stomach, it is harder. Simple! I really don't think the oxygen is doing that much, but might be helping since he can take shorter breaths. You saw what happended when you took him out at the oxygen tent at the hospital. I do agree draining the abdomen is temporary, but it may be enough time to help either heal ot find the cause. I am not sure how much fluid is still going into his belly and what the exact cause is, but I am fairly certain his laboured breathing will stop at least for a while if his belly is drained. I never once saw laboured breathing in Dylan and her PCV was as low as 10 or lower. And if the rate of filling the belly is slow (been happening now over 3-4 weeks?), he will have time to heal. Not that you are, but if you were to take him home just to have some time with him and the laboured breathing returns and you decide that is the end, then what have you lost, except the chance to see and see him! I hope the others have some thoughts on this too. Richard

Richard Burnaby

I brought Jagger home so she could have a better last day, week, month, whatever (no saving her) and if we were lucky, more than that. We were not lucky, the bleeding returned, I had to euthanize her and I am forever grateful she passed with us here on our kithchen floor and not some hospital kennel or lieing on some strange metal table. I would have preferred my own vets office, over the hospital too. This was MY choice!!!!! Not some emergency vet's!!! She was okay, the discomfort she could deal with and then it was over! We hope'd for more, and we prayed for more, but it was not meant to be. When she passed, despite her problems, it was peaceful and pleasent. Richard

Richard Burnaby

Amy, By now you may have noticed, but this is a group of fighters. Even those here whose dog's have past away, it is not because they did not fight, rather just that they lost the fight. Welcome to the group Amy. YOu are a very tough woman and a wondreful companion and guardian for Reggie. All of the decisions are yours and your families and you are clearly the best persn for the job. I know my alpha male is coming out just thinking of dealing with your vets. I can let things go, like I had to with Jagger, but it still was on my terms! Big big hugs for Regigie, you and your family, Richard

Richard Burnaby

Well, they're running a blood panel and urinalysis this morning just so we know where things are at. I keep asking about draining some of the fluid in his belly, but she says they then need to put him on IV fluids . . . was that your experience with Jagger? I also told her we really want to lower some of the meds, which she is going to look at as well. There just are so many unknowns . . . has he started throwing clots? Is he bleeding internally? Where is all the fluid in his abdomen coming from? It has been building gradually since he was first admitted on June 9th. Does he just need time, or would more extreme measures be necessary (which we can no longer afford)? So many questions, and in the meantime Reggie sits in an oxygen box wondering why he can't go home :-( It nearly broke my heart when I had him outside last night and he kept pulling toward our van because he wanted to go home :-(

Amy Wisconsin

Hi Amy, No it was not, despite the tumour still being in her body and still putting pressure on her heart and her liver. Her belly would eventually fill again since there was no way to stop the cause. All we could do is hope that it would stop on it's own. But no, no IV at all. How long it buys would depend on how much fluid they were losing and how much they are drinking maybe. How long has it been going on now? If he is deteriorating, it won't take as long maybe. If he is healing, it might take longer and then if you need to do more, at least you know the drugs are better, his blood is better and he has a chance. Again, if he gets dehydrated, you can decide then if euthanasia, or treatment is the answer. Having him at home will also make it easier to let go if that is necesary. There is no vet on this planet that could have stopped my wife, or myself from bringing Jagger home!!!!!!! Richard

Richard Burnaby

Thanks for all the encouragement - the vets keep making me feel like I'm doing the wrong thing by not just writing him off. But I know MY dog - he's very introverted and very scared and skittish when not with his pack. When he was hospitalized the first time the vet didn't want to let him come home until she saw how he behaved around us. She said he didn't look like a dog who was feeling better until he was with his people. The vets where he is now keep saying things like, "By observation we can tell he's suffering." I think they forget to take into consideration how frightening lengthy treatment is for dogs and how depressed some dogs get when not with their people. If we can even have a few hours to love and snuggle him at home, it would be worth it.

Amy Wisconsin

Is Reggie on IV now? Why not? If he is leaking into his belly now? How is this going to change? Back pressure does nothing to stop fluid going into his belly. Whatever is bleeding is under the same pressure likely whether it is drained or not. That argument makes no sense to me. If he is on IV now, then maybe, but if he is drinking to maintain fluids levels now, what is going to change? Richard

Richard Burnaby

just a quick correction, whatever is leaking (not bleeding) is under the same pressure...

Richard Burnaby

Amy, You are the expert. Absolutley!!! Stress and location and people MATTER!!!!! There is no doubt he is still in danger. It was Johnny, or patrice who said they had their dog's belly drained (look back). I don't recall them saying anything about IV either. And if the phenobarbitol is involved and stopped, and all the other iussues are not as bad as sa result of lowering the drugs. He needs to let that effect takeover his whole body. I hope you have emailed some of this to Dr. Dodd's. Sometimes vets will respect other vets even if they don't respect guardians YOU are Reggie's expert. YOUR knowledge of him and how he handles foreign situations is critical. Important note! When I took Dylan in at her weakest from prednisone, she was nervous and panting all the time. The vets asked me if this was normal and happeing all the time. I said No, it is just that we are here and she is nervous. Everyone there understood and accepted and agreed!!!! Stay strong Amy, you are doing great!!! Richard

Richard Burnaby

Is there any way to know if a dog is throwing clots rather than experiencing the "normal" fluid retention associated with Prednisone and AIHA? Reggie's bleeding from his nose has me worried than he may be throwing clots in his lungs.

Amy Wisconsin

I don't know about this, but I do know there are serious conditions that involve this. Start a new thread so it is not burried in this one!! Richard

Richard Burnaby

Amy, This is not normal fluid retention. This may have happened because they administered a huge bag of fluids during the transfusion. The volume of fluid in the body is greater than it should be. In order to get rid of that extra, organs like the heart, lungs and kidneys are working overtime to do this. Extra fluid is spilling into extracellular spaces like the tissue in the abdomen. This is called ascites. It is complicated by the lack of any form of exercise that might help get some of this moving out of the body. In a sense, this is a condition not unlike congestive heart failure, which I am intimately familiar with. I juggled multiple heart drugs and diuretics with Chance the last few months of his life so that his heart could pump effectively enough to remove fluid from his body. Reggie is probably very uncomfortable. He is probably wondering why he is not with you. But dogs don't have the same kind of emotions and thoughts that you and I have. They do not fear death, nor do they fear pain that may come in the future. They live in the here and now. They do maintain some strong memories of past negative events but only to the extent that they have learned to try to avoid the circumstances that surrounded that event. Watching a dog that is in treatment for AIHA can be dreadfully hard on the owners. The side effects of the prednisone are so awful, but so necessary. Any one of these side effects you are seeing can be lumped under a condition called Iatrogenic Cushing's Disease. It means that the body has too much cortisol. The body likes to regulate that hormone very carefully. It can't right now because it is being administered by mouth. Every system in the body that is controlled by cortisol is thrown out of whack. The list of side effects is longer than my arm. You just have to trust that many of the things you are seeing are due to that. Everyone on this list has seen these and agonized. And many of us have seen our dogs when they are finally free of them, healthy and happy again. Please call Dr. Dodds today if you can. I know she has the answers that I seem unable to give you. my best patrice

Patrice NYS

Patrice, what about whether the fluid in the abdomen is drained versus the body getting rid of it itself? Obviously an IV would not be required if it is fluid retention from the transfusion, as you describe plus fluid from side effects. Richard

Richard Burnaby

Amy, Dr. Dodds is working on Sundays. Call her! She has given you free blood so she clearly wants to help! Best wishes, Brigitte

Brigitte BC

Yes that is an option but the risk is that blood volume will drop significantly, they will have to administer fluids again and if they can't get whatever is causing the fluid to leak out into the abdomen to stop, it will just start happening again. This is really hard on the kidneys. I am not sure why they have not administered a diuretic so far. Or perhaps they have and I am just out of the loop? It's not my place to second guess these folks on a Sunday in an emergency clinic. I just don't have the kind of clinical experience they have. The clot thing is somewhat related. The heart is really struggling right now and Reggie is, for the most part, not moving around a lot. The blood volume is really low and that means it is thick. That is a recipe for clot formation in the heart. This fluid thing is what makes treating congestive heart disease patients so hard. Remember this: The heart likes things dry and the kidneys like things wet. But also too, the liver may be compromised from the prednisone (essentially cirrhosis). Portal hypertension (high pressure) and a decrease in albumin could be making it very difficult for fluid to move into the liver. So it just escapes where it can, leaking into the abdomen. Or, there could be a blood clot in the portal vein. The blood volume is probably low in general circulation (because a lot of fluid is in interstitial tissues and not in circulation) and this confuses the kidneys into believing they need to conserve more salt in order to preserve fluid! Thus the recommendation that they might need to IV Reggie to get more fluid into circulation. This is a complicated treatment and even human medicine has a tough time juggling this. This is what nurses do so well in the hospital, (among many things), control body fluids (mindful of the delicate balance of electrolytes). And they do this 24/7. I know for sure that Dr. Dodds has probably treated something like this hundreds, if not thousands, of times and probably has a good idea of where to go with this. For that matter it sounds like the local vet is pretty experienced to me. I know mine is. I would even trust her with my life... Clinical experience is worth its weight in gold in situations like this. That is what I would want, someone who has (successfully) treated this thousands of times. my best patrice

Patrice NYS

Amy- I am so sad about your Reggie. Try to hang in there. Chloe was so sick after needing 100% oxygen, multiple transfusions (8 units total), and a bone marrow to rule out lymphoma that I went right to prayer. I am not even religious! I bet Dr. Dodds would understand though. I probably had the only dog prayers for health ever put into the Wailing Wall in Jerusalem. It took weeks for Chloe to become regenerative-more like two months. I can't give you any tips on medication or care though just some hugs and positive thoughts. I hope Reggie is a fighter and you take comfort in the fact that you are doing the best you can for him. It is hard to know when to stop though but Reggie will tell you. I am thinking of you as you fight for his life. Cheri and Chloe

Cheri Maryland

This thread was discussed between 25/06/2011 and 26/06/2011

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