Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - My 3yr old male cockapoo TOBY just diagnosed IMHA

Our precious beloved 3yr old male cockapoo Toby was just diagosed with IMHA. We're still devastated and reeling from this horrible news. As many of the stories I've been reading Toby's process is similar. He has alway been a very fun energetic verbal rowdy pet. Always very healthy (31.5lbs with big appetite) except for seasonal allergies, minor skin and ear infections, cherry eyes (removed a 1yr). This past week Toby threw up clear green liquid on Labor Day, (as he does once every month or so from playing outside with our two bigger dogs and going for a drink out of the stock water tank). Afterwards he was fine as usual, but the next day seemed a little tired and not his rambunctious loud talking self.(He loves to bark and growl and "talk" to anyone who is around including the other dogs, just so we all know who's "Boss")!Next day (Wed) he was still acting a little tired and not as verbal or playful, and didn't want to visit with everyone like normal, laying in the bedroom by himself. Was going to take him to vet next morning for checkup, but when we got home from work and 10yr old daughter's cheer practice, Toby had urinated on the pottypad in the hallway and there was blood everywhere. We rushed him to the Emergency Vet where they told us after an hour of blood tests (CBC, PCV, ETC.), urine, ivs for fluid - dehydrated, we were told they thought he had IMHA, kept him overnight, to our vet at 7 next am.(Thurs), where they confirmed with more tests, xrays and ultrasounds to rule out other causes, and then transferred him to Intensive Critical Care Pet Hospital, in SA, Tx where he is now (Sat). They diagnosed him with genetic IMHA (though they're stil waiting on official tick/Lepto results back in 3-5 days). He has ranged from an initial PCV count of 20 at the Emergency Vet, to 18 at regular vet, to 17 at Critical Care Hospital, then dropped on Friday morning to 7, after 2 unit blood transfusion, back up to 34. This morning Sat he's holding at 29, but he's extremely jaundiced, and lethargic but alert and interested in what's going on around him. He's also got severe blood clotting (grainy). He's on prednisone, azathioprine plavix, aspirin, iv fluids, etc. He's not eating at all since onset, drinks a lot though. Theyre telling us he's critical and only has about a 40%chance of survival, and will depend on if he starts responding to treatment the next day or so. Any help, support, advice would be greatly appreciated. We are scared to death of losing our beloved Toby, but also do not want him to suffer. Any suggestions would be greatly appreciated.

Donna B Sprng Branch

Donna, I am sorry your Toby has been diagnosed with this awful disease. If you haven't found your way to Joanne's site yet be sure to read up there http://www.cloudnet.com/~jdickson/index.html The only positive to this disease it in itself it is not painful and what you are seeing is the reaction to the low oxygen levels in Toby's blood. I really understood your comments about Toby's talking. We just lost our Caleb unexpectedly in May to another rare disease. He was quite the talker too. It is not unusual to see a lack of interest in food just as we get when we don't feel well. Be sure to read the success story section at Meisha's Hope. The odds are lousy on this disease but many dogs do beat it, many who were in worse shape than your Toby. I hope your Vet is open to suggestions and you are allowed to be Toby's voice. Keep us posted Penny

Penny Lytle Creek Calif

Donna, I am so very sorry to hear of your Toby's IMHA diagnosis. Penny has given you the URL to my Web site on Canine AIHA/IMHA. Please do visit this site if you haven't already. Be sure to follow the links on the bottom of the first page to many other sites on AIHA/IMHA that will be very helpful to you and do read the Success Stories pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. It can take 5-7 days for prednisone to start to work and even longer for azathioprine to "kick in". During the first few days after diagnosis, it can be very normal for the PCV to fall even lower then at the time of diagnosis. Blood transfusions can "buy time" until the meds used to treat the dieaase start to work. I know of many dogs who have been hospitalzied for up to a couple of weeks before they start to recover. Please do read the Success Stories at the Meisha's Hope Web site http://www.cloudnet.com/~jdickson/successstories.htm and know you and Toby are in my thoughts and prayers during these most very difficult days.

Joanne MN

We just got back from visiting Toby (Sunday 9:30am) and are hopeful! His PCV count is holding at 29 since packed red blood cell transfusion friday morning (was-7), and he seems to be a little bit more himself. Got up and walked out of cage to greet us wagging his short tail and trying to give kisses (which we can't since he's not confirmed for not having Lepto yet; maybe by tomorrow). He also seems a little yes yellow this morning, and his vet agrees, but he has an extremely high "bilirubin" we're told it will take a while to settle down. His WBC is normal and temp has also stayed down which is encouraging. Still not eating but vomiting that escalated yesterday stopped after vet increased his anti-nausea meds and changed to iv instead or oral. He's also on pepcid? for stomach upset. Evaluation this morning is to just wait, pray, and hope, that he continues to hold good PVC numbers long enough for the prednisone and azathioprine to do its job till he can hopefully start responding to treatment, and new CBC and other blood work is to be rerun tomorrow morning on Monday. We are very encouraged by all of the great information and support this site has given us, to ask Toby's Dr's. and that they seem to be doing all the right and most suggested treatments. Both Dr's treating Toby are canine internal medicine specialists, involved with teaching hopsitals, and seem to be up on all the most reliable treatments for this awful disease. We are cautiously optimistic, and know if Toby pulls through this we still have a long road ahead of us, but as everyone else on this site feels about thier beloved pets, Toby is a very special part of our family, and we are blessed to be able to give him every fighting chance. Thank you all again for the support and advice. Hopefully what we're going through will also give others information that might help and/or be aware of. Please say lots of Toby Puppy Prayers for us!!!

Donna B Spring Branch

Hi Donna. I'm sorry to hear about Toby. This disease strikes so quickly and can be devastating. But it sounds like you are getting excellent care for Toby and the fact that he greeted you with "kisses" is such a good sign so don't give up hope. I would ask the vets if they would consider adding sucralfate as extra protection for Toby's stomach. My dog was given both of those meds and never developed stomach problems from all the meds he was on. Good luck and please keep us posted. deb and Duck

Debbie BC Canada

Donna, I am so happy to hear there is some improvement with your little boy Toby. He is very fortunate to have you in his corner and also that you have a great, knowledgeable vet team caring for him. Like you said, there is still a long road ahead of you and Toby is not out of the woods quite yet. But you have god reasons to be optimistic. Please take the time to read some of the success stories on the Meisha's Hope website. There you will see that many dogs recovered and went on to life a happy and healthy life. I hope you will be able to take Toby home very soon. You will then have lots of questions about food, supplements, medications and lots more. Please keep copies of the lab reports. You will be able to see trends and some people on this board are very good at explaining the numbers. i remember this being very helpful for me. Also get yourself a day planner, you will need it to organize the times and dosages for all the medications Toby is on. Please keep us posted! We will think of you and have all fingers, toes and paws crossed. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Thanks to all for the advice, support, and prayers we're already getting from this site! We'll keep you posted on Toby's progress. Debbie, thanks I'll ask Dr. tomorrow about adding sucralfate for Toby's tummy. Brigitte, thanks also to you, as we're getting "lots" of verbal information that's overwhelming, I'm definitely going to ask for copies of all of Toby's lab reports, treatments, and meds, post what I can, and start a daily planner to try as best I can to keep up with everything during and after, he hopefully comes home to us. I'm so worried about being able to take care of Toby properly if he gets to come home, and can't hardly imagine going through this critical time at home as I'm reading on this forum many have. I have so much admiration and appreciation for everyone going through this awful illness with their blessed pets. Please help us pray for good news at Dr's. tomorrow!:)

DonnaB Spring Branch

Donna, Glad your Vets have experience with this and that Toby is seeming brighter this morning. Will keep you all in my thoughts and prayers Penny

Penny Lytle Creek Calif

Penny~ Glad Toby is brighter today. This is such a roller coast ride, but hang on to hope...and enjoy each and every day with him. Our little girl, Tori is fighting hard to recover since August 2 diagnois. We believe hers was brought onn by zinc toxicity and infection in her stomach. She passed the metal object and has been better every day! Our prayers are with you and Toby. Blessings, Cindi

Cindi & Tori PCB

Thanks again for all the heartfelt thoughts from everyone that has responded on our Toby's illness. Just got off the phone with the hospital and he is sleeping and kept good vitals all day. Please accept my own blessed puppy prayers and good night wishes to everyone on this forum and their own beloved puppies!!!

Donna B Spring Branch

Dear Donna, I am so sorry to hear about Toby's diagnosis, but relieved to hear your latest update is that he's doing well. Do you know Toby's reticulocyte count? This will tell you if he has regnerative or non-regenerative anemia. Please keep us posted on Toby's progress, we are thinking about you guys and sending positive thoughts your way! Sam & Millie.

Samantha Geelong Australia

Please know that I am keeping Toby in my prayers. It does sound like he is showing some improvement and that is such good news. Keep us posted on how Toby is doing and hopefully he can come home soon. Cheryl & Ginger

Cheryl & Ginger Pinevile Pa

Donna, so sorry to hear your Toby was diagnosed with this terrible disease. Sounds like you are well on the way to arming yourself with the knowledge needed to help him battle and BEAT this disease! If he's holding a steady PCV then that is extremely good news! The "yellowness" will likely go away within a few days....this is just simply the liver working overtime right now. Ask the internist about adding milk thistle daily. Are all the other numbers alright? Liver enzymes, kidney values, pancreatic values, etc? This would be found by doing a full chemical panel. Ask them if they've done one yet. I can't wait to hear an update. My thoughts and prayers are with you both. Johnny & Tessy

Johnny

Thanks once again for all the thoughts, advice and prayers. I'm now fully on the "roller coaster" with my precious Toby. We had two wonderful visits today at the hospital, with Toby feeling much more happy,energetic, and verbal. He actually ate some Purina EN, boiled chicken, and kibble nibbled on throughout the day; first time eating anything in a week! His PCV is down to 22, but Drs said thats to be expected, and is still good this early as long as he continues to eat and show signs of improvement. On the down side they told me today his platelet count is extremely low 14?(60,000)/TS=6.0 gldL , and is showing to also have Evans Syndrome, but more tests have been sent out to confirm. The report that came today said his platelet count is significantly below the lower end of the reference range (<150,000>), and that "Giant platelets are present and may cause the platelet number to be spuriously decreased, and may indicate Thrombopoiesis! I guess that's Evans Syndrome from reading some of the success stories on Meisha's Hope site. Samantha Toby's Reticulocyte total is 0.1 with Absolute Reticulocytes at 3300. OTHER CBC RESULTS TODAY: WBC 55.7 High RBC 3.3 Low HGB 7.2 Low HCT 23 Low MCV 68 Normal MCH 21.8 Normal MCHC 32 Normal Comment Target Cells +2 Echinocytes 1+ Differential Absolute % Bands 1671 3 High Neutrophils 49016 88 High Lymphocytes 1114 2 Normal Monocytes 3899 7 High Eosinophils 0 0 Borderline LowNormal Basophils 0 0 Borderline LowNormal Platelet Estimate Decreased Platelet Count 14 Low Most of these make hardly any since to me, so any help or thoughts would be greatly appreciated. I know more followup tests are pending, and they tell me that if the platelet count doesnt improve the next couple of days the can add other meds to help, and may have to do a bone marrow aspiration? I know most everyone on this site has either been through or is going through similar issues with their own precious pups, for which I send the most sincere prayers and wishes. Any advice or suggestions would be greatly appreciated being so new to this awful illness!

Donna B Spring Branch

Donna, I'm not sure what to make of these numbers. The retic counts would have me concerned as well as the low platelet counts. Do you have copies of the CBC results pre-transfusion? I'm wondering if these numbers are a result of the transfusion. With a platelet count that low you are going to want to keep Toby well rested and still if you can. Even small bangs or bumps can cause BIG problems right now. Low platelets like these have to be taken VERY seriously. YOu should def. add thyroid supplements to the daily drug protocol. Thyroid supplementation will help to stimulate the bone marrow to create new blood cells. I'd also recommend getting some pet tinic to add daily. In the time being ask the vets about B vitamin injections. If the numbers remain low (platelets & Retics) you could also ask about anabolic steroid injections. I'd recommend you contact Dr. Dodds at hemopet. You are in TExas and could likely have blood sent there for fairly cheap and very likely same day maybe. Get her to do the Profile 7200 (I think the name might have changed). This includes almost everything...at least all the important tests you'd need done. Ask to include iron and B levels maybe. I'd be going back tomorrow for another test if I were you. These low platelets have me really worried. These can just cause so many secondary serious problems and Toby might have to be hospitalized temporarily so they can administer the steroids by IV to avoid ulcers and the sort. Please do be vigilent and keep him well rested and stress free. My thoughts and prayers are with you both. Johnny & Tessy

Johnny

Well We Have our Precious Toby Home for now! When I went to visit him in the critical care hospital yesterday (after 6 days) they had taken his IV out the night before since he ate and drank all day holding everything down. His PCV was holding at 23 and platelets up to 60,000 from 14,000. The last two days he seemed to feel better and have a little more energy. The sent us home with diagnosis of Evan's Syndrome, instructions including bed rest, no stress, follow-up with local Vet tomorrow (Friday), and recheck of Toby's CBC before the weekend to make sure he's stable, and then reassessment checkup in two weeks with the hospital, and two bags of medicine including: Prednisone (20mg)- 1 and 1/2 tablets every 24 hrs. Plavix (75mg) - 1/2 tablet every 24 hrs. Famotidine (Pepcid) (10mg) - 1/2 tablet twice a day Atopica (Cyclosporine)- 1- 50mg plus 1- 25mg capsule twice a day(Does this replace the Azathioprine)? Aspirin (7mg) - 1 capsule every 24 hrs. Doxycycline (100mg) - 1 tablet twice a day Talked to local vet this morning and Toby has an appointment at 8am in the morning to go over his illness-IMHA/ITP?- Evans Syndrome, treatment and care while in hospital, medicines, future care, and a recheck of his CBC before the weekend. He seems really glad to be home, but tired and low energy level, goes to the bathroom about every two to three hours. (urine is still bright yellow,but no blood, and feces is orange still but normal). They told us to keep a check on his gums to stay pink not white or gray, but I get so scared and confused, hoping I'm doing the right things, and knowing the difference. He's supposed to be on a normal diet, but came home with Science Diet ID can and dry. He seems to like okay but not great. (We also boiled him some organic natural chicken which he always loved and use it to help get all the medicines down. He keeps wanting to go to his old food Purina One Smart Blend Chicken and Rice, but I don't know if that's okay or not. I'm also worried they don't have him on Azathioprine (50mg) which he was perscribed by our local vet, as well as Dexamethasone SP (4mg), Reglan, KCL?, Cerenia while in the hospital. Not sure what a lot of these were for, but I know from a lot of the discussions on this forum the Azathioprine is highly reccommended to continue with the Prednisone. Anyway, I'm going to discuss all plus your suggestions Johnny which I greatly appreciate. The Vets at the Hospital were very caring and diligent in care, and seemed highly informed on these illnesses, but when I asked for copies of everything, I didn't get anything but a detailed bill, except for the initial blood test report I noted earlier. Your suggestions of Thyroid tsts, suppls, Pet Tinic, milk thistle, etc. were brushed off with, I could look at them as possible options, but "Less is More" in most of these illnesses. (Not that my bill of $3100.00 for 6 days shows that, and another $1500.00 at emergency clinic and local vet so far). Though we are fortunate enough to do it, and wouldn't change a thing to give Toby the best chance we can, we're just so scared and confused as to what's the best chance and treatment plan for Toby. When I talked to our local vet today, she said she would get me copies of everything and we would work out the best plan possible for our Toby, and stay on top of everything with him. ( They have taken care of him since he was 6wks old). Anyway wish us luck and lots more puppy prayers! They seem to be working in ours and Toby's favor right now. God bless everyone, and thanks once again! Sorry I rambled on so.....

Donna B Spring Branch

Donna, I can barely keep my eyes open and was going to respond tomorrow but didn't want to miss you tomorrow. Couple things...how much pred total?? 30mg/daily or 20mg/daily? The later seems a little low. Aspirin....give with food! Pred with food also. Doxy with food. Atopica is optional to give with food...I always gave it with food but I know they recommend without food. Food...the better quality the best! Hands down! Home cooking is even better! Liver cleansing diet if possible...with high nutrient ingrediants. Thats totally alright and actually good that he's off the azathioprine and other drugs. Aza is known as a bone marrow suppressor and by now the dexa kick started the suppression and the cyclo is kicking in. DON'T WORRY about these. Money doesn't seem to be a big issue for you so perhaps you could INSIST them send a sample out to Dr. Dodds for analysis. Ship it overnight if you wanted. That way the thyroid gets checked properly. YUP...gotta get copies of tests! Keep him calm and well rested and avoid any bumps to him... low platelets + bumps = not good (sometimes) My thoughts and prayers are with you both! Johnny & Tessy

Johnny

Donna Please let us know how Toby does with his vet visit today and how he seems to be feeling and eating. I was so glad to read that Toby was home. Sending my prayers Cheryl & Ginger

Cheryl & Ginger Pineville PA

Hi Johnny and Tessy, Cheryl and Ginger, and everyone else that has wished us well, and is going through this same terrible disease, We have promising news on Toby today. Our local vet Dr. McCarty examined him showing good vitals, and ran new CBC with positive results for the weekend. She confirmed Toby's current treatment/medications plan is good for now (faxing results to Dr. Books and Alvarez at Hospital), and will stay on top of his care together. She wants to run a complete CBC blood analysis on him next Tuesday so his results will be in for his appt. on the 30th, back at the ICU Specialty Hospital in San Antonio. I will ask them to send off a sample to Dr. Dodd at the same time, for comparison, and advice. We're to just keep him quiet and rested,(he's sleeping a lot, but alert and tail wagging when he's awake, he's eating pretty good, little bits throughout the day (natural, organic, and home cooked,(thanks for the suggestions), drinking often, and going on potty breaks about every 2-3 hours. We have him on a leash whenever he goes outside (as we have one other inside baby a 3 1/2yr old miniture poodle, and 3 big outside baby's 11year old 90lb chocolate lab, 3 1/2yr old 75lb boxer mix, and a 2 1/2yr old 60lb white border collie), all wanting to play, as does Toby, but he doesn't have a lot of energy, so we trying to keep him as quiet as possible. Here's his latest blood work (not complete since it's only been a couple of days since the last one): Results 091710 - 1stRslts(pre-trnsfsn)090810 - 091310 HCT - 22.8 21.4 23 HGB - 7.0 g/dL 8.2 7.2 MCHC - 30.7 g/dL 38.2 32 WBC - 51.1 X10 9/L 26.18 55.7 PLT - 538 X10 9/L 368 14 PLATELET EST 400,000 ? 60,000 PCV - 21 22/6(Pst Trnsfsn 34) 23 TS - 6.0 8.0 g/dL 6.0 Analysis is he's slowly improving and will take time. Not well by any means but will recover better at home. Once I go back to work our local vet has offered to let us drop him off each morning for "doggy day care", so they can keep an eye on him and I won't worry as much whenever I'm not at home, at least until he stabilizes! Please keep those prayers and well wishes coming as will we!

Donna B Spring Branch

Donna, keep a good eye on Toby just in case he oes downhill. According to these numbers the rbc, hct/pcv,hgb, mchc all went down! I'd be keeping the hawkeye on him just in case the numbers continue to drop. The platelets are going up nicely!! That;s good! I don't understand why it takes so long to get blood results back. Even if they had to send it out I can't see why it would take more than a few days max for results. Good call on sending blood to Dr. Dodds! You won't regret it one bit! Give Toby some hugs and scritches for me. Johnny & Tessy

Johnny

Sooo very happy to read that Toby is showing some improvement. Sounds like he is heading in the right direction and just needs more time for the meds to really kick in. What a nice vet you have to let you drop Toby off for the day, I know that will cause you a lot less worry while you are working. Please continue to keep up updated and we will continue to keep Toby in our prayers. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Johnny and Cheryl, Thanks for keeping in touch. Toby had a good weekend, still slept a lot, but had more waking periods and more energy. One of the things I've noticed is he has a hard time and can't jump up on the couch and bed like he used to. Seems like his muscles in his back legs may be weak. Not sure if this is from being sick and confined in a hospital cage so long or from the Evans Syndrome. Otherwise we had to actually sidetrack him a few times, barking at his yard buddies at the door wanting to go play. We kept him in and quiet(except for potty breaks and short walks down the driveway), but not sure exactly how much or little we should be letting him do. He's already showing signs of his old rowdy self, and his appetite has returned almost back to normal, relishing the special treats of chicken, pork, steak, potato's, carrots, etc. that we have cooked special for him! We know we have to really watch him and keep him calm, but we had no expectations that he would be showing such positive signs this short time later, as severely sick as he was just a week ago. I'm so afraid of him overdoing and having a setback, which I know is a very real possibilty. I am going back to work a while tomorrow and dropping Toby at Puppy Day Care at our local Vet. Your right Cheryl, we are very blessed to have this option. I'm so afraid to leave him at all, and wonder what everyone else does with there pups during work, chores, errands, etc., that don't stay on hold during their illness'. Anyway we're continuing our journey filled with prayers, hopes, hugs,scratches,and loves, and the same back to you and your own special pups!!! PS. Johnny our vet is going to let me know in the morning if they got more bloodwork test results from the ICU Hospital, as they've asked to have his complete file sent over. I'll let you know. Have a good evening, and bless all the pups going through this, survived it, or are enjoying each other in Puppy Heaven!!!

Donna B Spring Branch

So glad to hear the Toby is eating and moving around more. Our poodle, Tori had the same problem with jumping up, but she seems to be stronger now as the vets have been decreasing the Prednisone every two weeks. Keep up the prayers. Our doggies need them! Blessings, Cindi

Cindi & Tori PCB

Donna, I am so glad Toby is showing some of his playful self. the muscle loss is most likely from the high doses of steroids. It will take a while to build them up again, but it will happen. This muscle loss also means that Toby could fall or slip easily when he plays with other dogs. He could get seriously insured when playing with a dog, who of course does not realize how weak Toby still is. You really don't need that to happen. I would try and keep him from playing with other dogs for now. I know that is not easy, but it is in his own interest. Maybe you can come up with some games he can play with you. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Donna, Great news! When you have him in doggy day care is he kept away from other dogs? You have to be careful with his immune system compromised that he is not exposed to anything. I was lucky I could take my dog to work. We've often thrown people out but never dogs. LOL!

Penny Lytle Creek Calif

Donna, I know my experience with Chance and my observations over the past few years on this forum is that many dogs do develop rear end weakness. I am quite sure it is related to the high doses of prednisone. Prednisone creates high levels of cortisol in the body. This is a normal hormone in the body, but in doses as high as this it causes all kinds of side effects. One of which is severe muscle wasting. It was particularly damaging for Chance and later, after he recovered, he began to hesitate putting weight on one back leg. It was eventually diagnosed as a partially ruptured cruciate ligament in his knee. We had this repaired and he had one good year on it before his heart failed. So I advise caution with any kind of jumping or exercise while your dog's body is so deconditioned. It may show up later as some kind of orthopedic injury. my best patrice

Patrice NYS

This thread was discussed between 11/09/2010 and 20/09/2010

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