Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - My girl Cookie has IMHA

Thursday my dog Cookie was diagnosed. Her PCV at the time was 19%. They said there was a lot of regeneration of the cells. Her energy had gone way up so I assumed she was doing better, but today she was rechecked and has gone down to 15% so she is in for a blood transfusion :( Even today her energy was pretty high; I hope that's a good sign... My 17th birthday is in 13 days and I can't handle losing her. She's on cyclosporine SID, prednisone/Pepcid AC/Clavamox BID. We got her a multivitamin that includes 8mg of iron and 25mg of milkthistle; I haven't checked the dosage yet. Unfortunately she won't eat anything more than twice apparently (this has been the case with hardboiled eggs, chicken, and peanut butter). Is she good for meds? Also any suggestions for food? We got 4 cans of different dog foods (including tripe) so I'm hoping she'll go for them...

Monet Sammamish

hi monet ! first of all, take a deep breath! because there is definitely a lot of good news to be found in cookie's prognosis.. my pup was just diagnosed as well but definitely different situations--cyclosporine and prednisone seem to be the most common drugs to start the pups off on--pepcid is used to keep cookie's tummy protected from all the harsh meds (my pup is taking pepcid as well as a protectant called sucralfate, you may want to ask your vet if she needs more protection but this may not be necessary in cookie's case) and my dog is on the antibiotic clavamox as well..the only additional meds my dog is on is pet-tinic (which has iron and vitamin B) and doxycycline (tick panels can come back negative but can be wrong) --what is cookie's multivitamin called? the fact that cookie's cells are regenerative is GREAT! my pup lola is a very very picky eater so this has been hard for us as well--as you see the meds start to kick in, cookie's appetite should increase a lot--lola has been eating so much (shes only 4lbs) but is still picky--she won't eat dry regular chicken but she will eat those whole cooked chickens that you can get at supermarkets (i make sure theres no fat or skin on it) --also try low fat cottage cheese --lola loves it (which surprised me) and it isn't bad for her--we also boiled liver and beef heart for her but she doesn't really like that.. it seems as though you have a very good doctor who has put her on the right track to getting better--just keep an eye on her and learn as much as you can about this disease so you can read her symptoms (if she has any) -- i'm 21 and it was hard enough for me to deal with this scary sickness, but at 17 you have to be hurting, so try your best to stay strong! Although my dog lola was just diagnosed, this forum and the people on here have helped me get through it and remain hopeful. -Christina & Lola

christina new jersey

Hi, Monet! Like Christina and Lola, Mr. Bentley and I have only been here a short time....he was diagnosed with IMHA on 6-30-11. On that first day, Bentley's PCV was 15 and he was admitted to the hospital for a transfusion as well. He was put on Prednisone, Cyclosporine, Pepcid A/C, Doxycycline, and later, Sucralfate and Mycophenalate. WHEW!! We also have him on Milk Thistle, SamE, and Pet Tinic as supplements. (My vets are also considering an ultra low dose aspirin to prevent blood clots.) So it sounds like your vets are using a very similar protocol. Like Christina said, the Prednisone will probably increase Cookie's appetite....Mr. B eats three smaller meals a day now, and always cleans his plate! I mix a bit of cooked chicken, rice, and a little kibble. He is in heaven with that. Others on here can give more food suggestions as well. I know you want to keep the fat content low, to keep strain off her liver. One friend I met on this forum reminds me to take Baby Steps with this illness....you will find that to be true! I'd get copies of all her labwork and make a folder. I've done this, and I can look back to compare test results to med change times. I also keep a diary of how Bentley is acting each day. The folks here are fantastic, and will offer great info and support. We'll keep you and Cookie in our thoughts and prayers, and please let us know how she's doing after the transfusion! Sally and Bentley

Sally Louisiana

Hi Monet, Sorry to hear about Cookie. Hopefully you start seeing a recovery soon, but it will probably drop again slightly first. Her recovery is really dependent on her cells growning and maturing, but the fact that they think it is regenereative is great. The transufusion will buy time for this or to figure out what changes need to be made if they do. Welcome to the roller coaster adult world of saving your dog. I don't think you will find age descrimination on this list. One thing you need to know first. We never give up!!! You will be under some great stress and have to make difficult decisions as this progresses and being a strong leader for Cookie is important, so you have come to the right place for support. No matter what you choose to do, ther are no right or wrong choices. You just do your best and that is all you can do. There are no real facts and your dog and the case is completely unique. Getting too worked up, or panic will not help. Making decisions when afraid and out of fear won't help. Christina has relied on people here and her father and mother for support and strength. We have all needed help and that is why we are still here. We will support you and help you where we can. Since I am not a vet, I will always recommend you consult with your vet over advice I may provide. There are some very experienced people who read the posts here and respond to them, but they will likely need more detail. I am relatively new to AIHA/IMHA, and we chose a slightly different treatment plan, ony using prednisone (Milk Thistle, Pepcid AC (femotidine) and Pet Tinic for vitamin B's/Iron needed for building blood). To provide more help we need to know as much has we can about your dog too, so weight and prior health, any incidents of infection, tick's (most will suggest you have your dog checked fo this), toxins, vaccinations, shots, anything unusual? Behavior can be an important factor too, any aggression or other unusual behavior? Along with weight, doses of the drugs will help make sure that we understand the exact situation. We have seen good recoveries followed by decreases, so this is important too. Doctors tend to prescribe things at the high end, which I am not a strong believer is always better and as a result, my Dog Dylan is off all drugs after less than 4 months (diagnosed 03/19/2011). She has slight brain damage from anemia, as her PCV was so low (way lower than 15), but we are just fine with her right turns. Certainly there have been cases where raising doses has alo helped too. Recovery is more likely to be better with healthy human food over any dog food. In addition to cooked chicken and boiled fish, which are probably best, things like cooked pumpkin (not pie filling, pure pumpkin only) and cooked squash, dairy like low fat cottage cheese or low fat yogurt, but do keep an eye out for allergies and I also fed bioled eggs as well, since they contain 100% nutrient (preferably free range healthier eggs). (I do not feed dog food to my dogs, before or after AIHA). Experiment a little and ask here if you wan to know about safety or what to do regarding diet choices. Low fat levels in food are best. Things like pancreatitis are more likely with high fat food and hight fats require more work by the liver, which is working very hard at the moment. Not too much starchy simple carbs though, as dogs don't really need carbs (cooked yellow potatos, pupkin and squash are easier to digest when cooked and help keep stool soft and easier to pass. Prednisone increases appatite and possibly aggression. I think watching for symptoms of the reaction to prednisone and its intensity are important. This will help guage what to expect in other areas like immune suppression and possibly RBC/platelet suppression if too reactive. It will also become important as you remove prednisone and try to make sure your dog is stil okay later. In addition to aggresison and increased food drive (Dylan's came together and I had to be careful), you will see excessive drinking and peeing, panting to get rid of excess heat (prednisone increases metabolism) and eventually probably others. I suggest you learn your dogs breathing, activity levels, ear positions, eyes and focus, attention, energy, play, etc and keep track of it maybe in a journal. Later you will need to tell you are not seeing anemia when you remove prednisone and maybe cyclosporine, so knowing what anemia looks like will matter. Prednisone induces muscle loss and paralysis at high doses and looks different from anemia. Knowing your dog will help you provide expert advice to your vets about what is going on with Cookie when deciding what to do. This was also important and why Dylan is off prednisone and all drugs (also required that the trigger and cause of AIHA was gone and that is not always true right away). I certainly wish you a full recovery for Cookie, but for now it is day by day, taking one positive step at a time. Hopefully you will have a great 17th birthday, but unfortunatley your journey to save Cookie will only have just begun. Every good day is a great day though. Enjoy every one of them. Best of luck for you both, Richard and Dog Dylan - 4 months nad 4 days AIHA survivor :-)

Richard Burnaby

Cookie is back from the vet and up to 21%. They tested before the transfusion and their results said 18% while our regular vet said 15%. I hope she really is at 21%. Her energy is being very difficult. Coming back from the transfusion was ridiculous because she keeps trying to do everything like a normal dog and I can't help but wonder if that attributed to the drop as she was acting similar Friday. The vitamin we got her is a senior stage med that's petco brand. Thanks for the low-fat diet recommendations. She's still unfortunately passing on the rice (&cottage cheese) but I got her to eat half a can of dog food. I gave her her meds in peanut butter and she loveed it, wish it wasn't so high in fat :( Pumpkin sounds great. We'll get SAMe too.

Monet Sammamish

Monet, I am so sorry to hear abot cookie, you mention giving her senior vitamins, how old is she and what type of dog. YOu want to feed a low fat diet, I think it was mentioned in a previous post as this is essential since you wan to give th eliver as much rest as possible. ANother thing is to add a little chicken broth to the food to get her to eat. What dose dose of pred is she on and her weight? Laurie

Laurie CA

She is 9 years old about (we've had her for 6 years and she was estimated to be 3) and she's a BC mix I think. She weighs 45 pounds. I just noticed that she's only taking 40mg a day of prednisone, and 100mg of cyclosporine. Is that enough pred? Maybe can I boost it?

Monet Sammamish

Pred is about right, at onset its usually given one meg per pound. Have no experience with Cyclosporine, but I if I recall form reading here, you want to make sure you you give it not with other meds and hopefully your vet gave this info and someone here with experience wit it can chime in. Because of her age, you might want to do an ultrasound of her spleen, My internest said most senior dogs with AIHA are caused by growths on the spleen, we did this for Wylie and she did have a growth, small one though and not sure if this was the cause of her AIHA but did decide to have it removed. I second what Sally says about the stomach protecntant and I don't think pepcid will do it but sulfricrit. (sp) If you go down the posts look back about 3 months and Patrice posted on the importance of this. Also ask about Pet tinic ( b vitamin and iron supplement and milk thistle. Take care Laurie

Laurie Ca

Thank you, that was the first thing that our vet talked about and when we did xrays, the spleen came up large, but the ultrasound didn't show any growths. We were told a large spleen is common with IMHA. I have been giving it with her other meds. I looked online and I read now to give it on an empty stomach. So I will give it an hour before her breakfast/other meds.

Monet lowchen_lion@hotmail.com

Hi Monet, Some vets use more prednisone, but I am not for that. Too much prednisone for Dylan was dangerous too. Are you seeing excessive drinking and peeing? Panting? Just trying to guage the sensitivity to prednisone. You should be seeing these side effects of its use. Dylan was just over 10 years old when diagnosed and about 50 pounds when we started. She was a rescue, but at a young age after being wild for a while. She handled it all just fine and came through strong, but she is fed a completely different diet than most dogs and in my opinion, that is something that makes her DIfferent. I believe she is healthier and more capable of fighting AIHA than most dogs fed dog food, including the workload her organs like the liver, spleen, and pancreas were under as a result. Dog food likely adds a lot of work to these organs. We did not use sucralfate or other stomach protectant's either, only Pepcid AC. I prefer not to do everything just for the sake of it, as it really can complicate the picture too. I had no plans to be on prednisone long term and if that were the case I would have considred something that coats the stomach for sure. We never did see any signs of ulcers. Because Dylan never did take cylcosporine or other drugs, she did not need as much protection from damage either. I am currently trying to learn more about cyclosporine and azathioprine, but I don't know their doses well. I think from the fact that your vet is using 1 mg/pound prednisone, that they do likely know the correct dose for cyclosporine. Patrice explaines some of this to Sally in a recent post I believe. I think if my dog was taking the cocktail of drugs like in most cases, I would want more than Pepcid AC too. Sucralfate/Carafat (sp) is the substance generally used. Hope you see signs of gaining strength and many postive steps. Throughout her treatment you will need to protect her as she tries to do too much. This is the nature of dogs. They don't understand they are weak, or why, so keep care of Cookie, Richard & Dog Dylan :+)~

Richard Burnaby

HI Monet: I recall someone once mentioning on this website that their dog was a fussy eater and they were able to feed him baby food. Check to make sure it does not have onion or garlic in it. It would be very gentle on the tummy. As Laurie mentioned you should avoid anything with high fat content. Predisone interacts with many internal organs and you do not want to dogs organs stressed anymore than necessary. Does your veterinarian know about the vitamins you are giving Cookie. Again you do not want to create any stress within the body more than necessarry and at this point in time the focus should be on supressing the immune system. I have not heard nor read that a vitamin deficiency is a trigger for aiha. I state without any doubt in my mind that vitamins with iron can be very hard on the stomach ... then add the effects of prednisone in the stomach. This could also be why Cookie is not eating .. upset tummy. I myself cannot take vitamins which iron in them ... I get stomach pains and throw them up about 1 to 2 hours after ingesting.

Elaine Ottawa

I just added the vitamins yesterday after we made a stop at the pet store. We got 4 cans of different dog food and so far that seems to be all she'll eat. She ate 1 1/2 cans today which is much better than she's been doing but I offered her chicken/eggs which she ate Friday but still turned her nose up at it. Maybe she's associated all of the bland food with an upset stomach b/c it was my mistake to give her all the meds with her food. Tomorrow is her recheck. I want to be prepared for another bad result but I don't think anything could prepare me. Heart breaks more every vet visit.

Monet Sammamish

Hi Monet, I'm sorry to hear that your Cookie has been diagnosed with IMHA. My senior dog Millie was diagnosed 2.5 years ago, and is a happy and healthy 13 year old today! Seniors CAN and DO survive this disease! The food is definitely challenging, but once the pred kicks in, her appetite will definitely improve! She'll be more than happy to eat whatever you put in front of her. Low fat is important for sure, but when Millie was first diagnosed, I just wanted her to eat SOMETHING - she was fussy like Cookie, so if she is eating the canned food, that's OK for the moment. I definitely recommend sulcrafate/carafate to line the stomach - this must be given at least an hour before her meds so as not to affect absorption. The good things for Cookie is that she is regenerating red blood cells - so as soon as the immune system is supressed, you should start to see improvement. Your vets certainly seem knowledgeable on IMHA - and sometimes it's a challenge to find a vet who does. Ask your vet about the present of spherocytes in Cookie's bloodwork. This will indicate the presence of immune destruction of the red blood cells. This should improve as the prednisone suppresses the immune system. If there are spherocytes, then the immune system is still destroying red blood cells. The meds do take time to kick in - prednisone around 7-14 days. So the transfusion just buys Cookie some time until then. It took Millie 6 weeks before we saw any improvement in her count, a LONG six weeks I can tell you. But it did go up. I am sure you will have good news tomorrow from the vet. Take care, Sam & Millie.

Samantha Geelong Australia

Cookie had her recheck today at the specialty and was at 20%. Saturday night she was at 21% after her transfusion, but the two vets (regular vs specialty) seemed to vary in their readings so I'm wondering if she might be unchanged. I guess she must've stopped regenerating, but I'm so relieved that there isn't a big drop like before. She's still eating canned dog food. I asked my dad to get some more because she's going through about 1 1/2 cans a day now. The dog food is 4% fat I believe so I'll try to find something better. She did eat a can of tripe yesterday and that was only 2.5% fat so maybe I'll go back to it. Additionally, we got some plain fish filets that I'll try to boil for her. Even though she for now is stable I am not unfortunately. I have always been one that just floats on cloud 9 but since she's fallen ill I've found myself to be very depressed/irritable. She usually glows and has a knack for making people smile. Now that's there only 10% of the day. Her is a pic of her from December: http://postimage.org/image/16sz2dg04/

Monet Sammamish

Monet, I know it is hard on you but try not to let your feelings get the best of you. Our dogs pick up on our feelings and it could add to Cookie's stress. A lot of times PCV readings can be affected by stress, dehydration etc. so don't let a minor drop alarm you or different readings confuse you. Take each day as it comes and you will find each step forward so much more enjoyable and if there is a step back leave it in that day. Sending prayers and thoughts your way. Penny

Penny Lytle Creek Calif

Hi Monet, We live in the same area. Where is Cookie being treated? Our pup, Henri, was treated at ACCES in Lake City. They have a canine blood bank there. Any idea what caused the IMHA? Dr Deena Sadek, at ACCES, understands IMHA. Healing Wishes, Ella and Henri

Ella Seattle

Cookie is being treated at SVS in Kirkland but her PCV checks are being done at our local clinic. My only idea as to what it was caused by is maybe from a tooth extraction in June or she also has a spot on her leg that she has been licking at since November, we were going to do a biopsy of it in Aug or Sept...

Monet Sammamish

Monet, take a deep breath, staying at 20 does not mean she is not regenerating. Many, many people have posted here since the 3 1/2 years I have been reading have had dogs in your situation and hover around these number for quite awhile (weeks) before they see an improvement in the number. Sometimes it just takes longer for the drugs to kick in and do their job. Hopefully a few can chime on their experiences. If you want a great success story ready Ellas previous posts about Henry. Take care Laurie

Laurie CA

This thread was discussed between 23/07/2011 and 26/07/2011

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