Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Nollaig-update

Nollaig's pcv has come back as 21.9% which is disappointing as it was 32/34% 12 days ago.However they have said that her reticulocytes are now 0.12 x 10^6 which they class as mildly regenerative whereas before they classed her as poorly regenerative.I dont get a copy of all the blood tests I just get told her pcv so I dont know what her reticulocytes were before(I have asked for the last few reticulocyte counts so as to compare) but that seems still very low to me and clearly not enough regeneration otherwise her pcv would not have dropped so much. Rory has said 'we may just be clutching at straws' by concentrating on this 'little change' and he said her reticulocytes were more or less the same 13 days ago two days after danazol was started but he does believe it is the danazol that has made this slight change and so he said we will keep her on it as otherwise we would be admitting defeat. So to me the danazol hasn't done any more in a further 13 days than it had in 2!! I mentioned doxy again to him and he said 'I honestly dont think it will make a difference' when I mentioned Darcy's story again he said 'it may just be that spontaneously her marrow started working again' and he also said 'America has a lot more tick diseases than we do here' and 'Nollaig's tests came back negative for tick disease' for which I said I believe you can get false negatives and also there are more tick/parasitic diseases than there are tests but he didn't really say anything. He also said that he will put her on soloxine but only because I'm asking for it and I had to ask that he gave it twice a day as he was going to give it once a day and I know that according to the half life of thyroxine it should be given twice a day as per Dr Dodds advice.He said we would need to watch for signs of hyperthyroidism and that her own thyroid could shut down so she would have to be on soloxine for life to which I said 'well that wouldn't be a particularly bad thing compared to what we're dealing with now!'Has anyone else experienced bad side effects or hyperthyroidism from their dogs being put on soloxine?? Feeling down today. Kathleen

Kathleen North Ayrshire

Kathleen, Did you run a thyroid test on Nolliag before you started the Soloxine? When my Meisha did not seem to respond to treatment for AIHA we ran a thyroid test on her and the result was low thyroid function so we started her on soloxine twice per day. The protocol is then to retest in 1 -2 months after the start of the soloxine to see if the right dosage is being given. When one retests it is important to give the soloxine 6 hours prior to the test. After a while (can't remember how long exactly) my vet decided to try and take Meisha off the soloxine. We tested yearly after that and her thyroid function remained in the normal range so for us the soloxine was not a long term thing. My Margo had thyroid levels so low some of them could barely be measured. She was on soloxine for the balance of her life and it did wonders for her. And Maddie developed low thyroid function a couple of years ago (we knew this since we did a baseline thyroid test on her when we adopted her and did the test every year after that). So I have had lots of experience with thyroid testing. We did a thyroid test on Maggie on Monday for baselines and I should have the result of that test by the end of the week.

Joanne MN

Joanne Yes,vet did a thyroid test on my insistence(as he said she had no clinical signs of hypothyroidism) and her free T4 level(active thyroxine) came back 7.7 reference range is 7.0-40.0.I sent the results to Dr Dodds and she said to put her on 0.25mg soloxine twice a day.My own vet said he would not normally put a dog with that result on thyroxine but he would do it because I asked for it. I wanted it in case it was playing a part in her prca.Thyroxine stimulates the marrow to produce red cells. She starts on soloxine tomorrow but I feel she needs more than that to turn the prca around but obviously because of what my vet has said I worry that it would make things worse for Nollaig. He said that it increases the metabolism and therefore the bodies need for oxygen and since Nollaig's bone marrow is not working to produce enough red cells it would make her pcv go down faster which I definitely don't want!!! Kathleen

Kathleen North Ayrshire

Kathleen, Dr. Dodds advised to put Kahlu on Thyroid medication without seeing him or having a test done. I was highly skeptical. But since everybody spoke so highly of her we put him on 0.3 mg 2x per day. We were also a bit at a loss, since he was only minimally regenerating. After a couple of weeks he really turned around. Of course we don't know if it was the soloxine. We had his Thyroid tested and it was still very low, so we even upped the dose to 1mg per day in two doses. We will test again in about a month. probably even send the blood to Dr. Dodds. I think that the soloxine has certainly helped with Kahlu's recovery. Good for you to tell the vets what you want and ask a lot of questions! Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Kathleen, Dr. Dodds does do consult only on thyroid tests, for $30. She will provide the consult basically as a bonus if the panel is done by Hemopet. There are conflicting and often confusing opinions about low thyroid and dogs. Dr. Dodds has spent most of her adult life researching and helping dogs, particularly in regards to autoimmune thyroiditis. She has devoted herself to helping as many dogs recover to good health as possible. This may sometimes involve "nontraditional" treatments that come from a different interpretation of the thyroid panel. This has led some academics (but not all) to regard her as a "quack." However, her more recent work with vaccination protocols has led to her world-wide fame among the veterinary community. Needless to say, however, there are certainly going to be members of that community who find it hard to overcome previous opinions of her work. I attended a day long workshop with her last fall. The afternoon was devoted to the thyroid. I can assure you that she presented a scientifically based program, but admits that not all of her work has been born out by double blind clinical tests. In humans, treating without this would be considered a fault. But in dogs, it has helped save many lives. Thus, the problem some veterinary academics have with her work. I can say for sure that treatment with soloxine (as directed by Dr. Dodds) in addition to prednisone and cyclosporine was what returned Chance to a regenerative state. The thyroid plays a significant role in the making of blood at the bone marrow level. Sometimes with this disease, one must study as much as possible, and then make a decision that is not exactly what the attending vet would agree with. I was extremely lucky that my local vets were not only eager to follow Dr. Dodds' protocol but were amazed that someone they considered so famous was personally assisting Chance's treatment. At each blood test, they would say "let's run this med change by Dr. Dodds first." I was able to essentially use my local vets for all stages of recovery, without the need to go to a specialty clinic (2 hours away). This reduced the cost significantly and in addition, was much easier on Chance. He is well liked at the clinic so each visit was pleasant for him. It's not necessary to completely burn your bridges with vets that are in disagreement. They provide valuable clinical experience and nursing skills. In essence, they provide the kind of care that a human might receive while in the hospital to ensure that the patient remain stable. I recently found a short paper on the internet, not written by Dr. Dodds, but referencing her work, that explains how one can interpret the results of the thyroid panel. In essence, you are taking the high and low values, adding them together and then dividing in half to get the median value of each measurement. Using this as a guide can show an overall trend and in dogs that she considers low normal thyroid, indicate that clinical supplementation will most likely be of value. Here is the link to this: http://www.diamondsintheruff.com/HowtoAnayzeYourDogsThyroidTestResults.pdf Of course, each person must weigh how much they truly understand of how this works and make a difficult choice of whether to actually supplement or not. Hyperthyroidism is generally pretty rare in dogs, usually indicating some kind of organic disease. Supplementing with soloxine is unlikely to cause this to happen in the dosages she recommends. She carefully takes into account the breed, sex, age and weight of the dog in addition to the results of the panel before determining a dosage. The database she maintains goes back over 25 years. In any case, a follow up blood test panel in about 3-4 weeks time would be very representative of any hyper supplementation. You may never win a disagreement with your attending vet about this. And even if the results are positive they may attribute it to something else in the treatment. Again, using a multi-team approach will help resolve this kind of tension. As far as the reticulocytes go, a complex formula is used to determine exactly how regenerative the marrow is. It basically compares the ratios of the number of red blood cells, the number of reticulocytes in circulation and the percentage of current packed cell volume or hematocrit. The lower the pcv or hct, the greater the number of reticulocytes there must be to be considered highly regenerative. They like to see this high response to anemia, but that does not downplay the significance of "A" response in a previously non regenerative dog (or human). A dog that seems to be only moderately regenerative may have overcome the autoimmune destruction of the precursor cells in the marrow but may be having difficult maturing the reticulocytes into mature red blood cells in circulation. The cause for this anemia can be possibly determined by examining the "M" values of a CBC: MCV, MCH and MCHC. In some cases it will point to a nutritional disturbance (like poor iron and B12 stores) or it can point to possible bone marrow failure. In one difficult disease, it can point to a liver shunt. These numbers are like a road map to a hematology clinician. In addition a blood smear tells many things that are of great value. This is an often missed lab test not done by general practicing vets. my best patrice

Patrice NYS

Kathleen, So sorry to hear you have not had the best news today. I cannot help regarding your query but I am thinking of you and Nollaig and hoping she makes a turnaround very shortly. Kath

Kath Fife

Patrice I sent copy of Nollaig's thyroid results to Dr Dodds and she said the free T4 for Nollaig should be at 18 and not 7.7 as was.Therefore she said to put her on a dose of 0.25mg soloxine twice a day based on her age, sex, weight etc... The thing was Rory(the internal medicine vet specialist) had faxed Dr Dodds a letter detailing all about Nollaig's case of PRCA, at my request, and when she came back saying get her thyroid tested, but meantime put her on a dose of 0.2mg twice a day,he wouldn't entertain her.In fact she sent him research and info all about thyroid and its role in blood production but he didn't even respond to her. I don't understand nobody in this world knows everything,we can all learn right up to the day we die.The best doctors/vets are the ones willing to learn and open their minds and even then they are NOT GOD... How I wish Nollaig's vet did know everything, cos then Nollaig would be cured!! I'm not interested in whose right or wrong here I only want Nollaig well again!!!! An exasperated Kathleen

Kathleen North Ayrshire

Brigitte Hope soloxine does make a difference, wouldn't that be wonderful!!!! Kath Thanks for your kind thoughts,hows Mitch today, any more news/results? Kathleen

Kathleen North Ayrshire

Hi Kathleen thinking of Nollaig. I would be take the reticulocyte count of 0.12 and mildly regenerative as a move up. Scruffy was always "less than 0.1" and "severe worsening the desciption on his blood tests. Any improvement no matter how slight is an improvement nevertheless. Best wishes to you.

Julie Australia

Kathleen Most improvements seem to come in baby steps with this disease and I think the increased reticulocytes maybe be a small step in the right direction. Remember the cyclo can take about 4 weeks to work. I would ask your vet nicely again to please begin giving her the soloxine (1 hour before a meal) two times a day as you feel it is in the best interest of your dog and if he will not comply ask to speak to the director. Ginger has been on it for about 3 years and has not had any side effects from it at all. Keep positive and know that we are all praying for your Nollaig. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Kathleen, I do understand your vet's reluctance to treat without specific cause. I am attaching a link to a paper written by a group of vets in a Veterinary Clinical Pathology Clerkship Program at the College of Veterinary Medicine, University of Georgia, Athens, GA. http://www.vet.uga.edu/vpp/clerk/bell/index.php You may want to try to browse the paper, but it's pretty hard read for the layman. In essence they give an overall look at what canine hypothyroidism is, what tests are used to diagnose it and how it is generally treated. They mention that there seems to be an over representation of diagnoses of hypothyroidism in the US. They explain why treating without looking for underlying causes may prove to be faulty logic. I can give you an excellent real life example of what is meant by this statement. We had a receptionist at work a number of years ago that was well liked. J began to complain of numbness and tingling in her hand and arm. We talked about it casually, as I had carpal tunnel for many years. However I am also trained in PT so I know that it's always best not to assume something without appropriate testing. Her doctor made these assumptions: she's a secretary, she types all day long, holds the phone on her shoulder and is a woman. He diagnosed carpal tunnel without doing appropriate testing. When she worsened despite wrist braces etc, I suggested she make an appointment on her own with a neurologist and I gave her a name. She eventually did go, against the recommendations of her doctor, and the resultant diagnosis was an inoperable tumor of her spine. She died not quite a year after her first symptoms began. So what is wrong about treating low thyroid from test results that indicate a low thyroid? Well, some clinicians don't like to do that for specifically the reason I have mentioned above, you could be treating the wrong thing. And you would have to read this whole article I have attached the link for to understand how the thyroid interconnects with the body systems and that one of them could be faulty, not the thyroid. And supplementing with thyroid hormones might hide the actual cause of the low thyroid. However, sometimes if it smells like fire, it is. Dr. Dodds has worked for many years with hypothyroid dogs and has a strong working knowledge of what presents when she examines and treats them. This is what upsets many academics and working vets: the ART of clinically examining a dog. It seems unscientific. They forget though, that they often go through the same process when they examine dogs in their clinic, and mentally skip steps because they are pretty sure they know what the problem is. A lame dog could have bone cancer, but more often than not, it is just a thorn in the pad. A dog that is throwing up probably ate some bad thing in the garbage and will be fine in a day or two, not that they may have gotten into rat poison. So lets look at the specific things that present when a dog shows up with anemia at the clinic. Well, anemia is just a symptom, not a disease, so what would be the number one cause of blood loss? Injury of some kind. Did your dog have an accident, eat something sharp? They do a blood test and then they see that things are not right. Hmmmm. What does this mean? They flip open their veterinary minute consult book and find a huge list of possible causes. They haven't seen this too many times and they aren't quite sure what is the first thing they should do. They start doing tests to try to sort out what is wrong, but the dog is in crisis and they could lose it. They know that transfusions are tricky, they may have done one last month, so should they risk it now? An experienced vet will be able to mentally go through a check list of what needs to be done immediately, what this probably is and get on with the treatment quickly. So in your case they get a note from a vet they probably don't know, telling them what to do, asking them to immediately put this dog on thyroid supplementation and it ruffles their ego. If you read through this paper carefully you find out why Dr. Dodds does recommend immediate thyroid supplementation in *some* cases. See this snip: "Nonspecific clinicopathologic abnormalities: The severity of these nonspecific abnormalities usually correlates with the severity and chronicity of the hypothyroid state. These abnormalities may be associated with many other diseases, but their presence adds supportive evidence for a diagnosis of hypothyroidism in a dog with appropriate clinical signs. The classic hematologic finding associated with hypothyroidism is a mild, normocytic, normochromic, nonregenerative anemia." This simply says that if you study the blood of a dog with anemia and you find that the cells are normal sized (MCV) with the proper amount of hemoglobin in them (MCH), but the dog is not responding to the body's request to make more red blood cells (non regenerative) and there is worsening anemia with no replacement of red blood cells, it's a pretty good chance that this dog has hypothyroidism. The clinician should probably take a chance and supplement with soloxine to see if they can reverse the non regenerative state. What is left out are the words, "to save this dog's life." It is implied, not said. If this dog does not start to make blood soon, it will die. This was exactly where I was 2 years ago, reading this statement from this paper and understanding fully what needed to be done. Not all vets have time to tool around the internet researching things like this on a regular basis. But I can assure you that when you do your research and present your vet with academic material like this, they should respect you highly for your help. I did the leg work for my vets and they did the clinical interpretations for me. I am sorry that you are having this difficult time with your vet and I know you are frustrated. Perhaps it might help to approach them next time with great thanks for all the help they have provided so far and how much you respect them for the work they do. This might soften the blow of having Dr. Dodds make a request such as this. i will be thinking about Nollaig tonight. patrice

Patrice NYS

I'm curious with all this conversation regarding Thyroid and AIMA treatment/correlation. Oliver had a blood test back in October of 2008 and it came back that his T4 was 0.7, which is low and considered "euthryroid sick". Could this have, I may be grasping at straws, anything to do with his situation now(see other threads as I don't want to have to repeat all the information....Let me know if you could please! Thank you. I am hoping and praying that Nollaig is doing well(awesome name by the way)

Mardi Northern Cali

Mardi Please email Dr Dodds at hemopet@hotmail.com with details of Oliver's thyroid results. Thyroid can play a part in AIHA/IMHA,according to Dr Dodds.Is Oliver on thyroxine(soloxine)? The reference ranges for thyroid results are: T4 basal 15 -45 nmol/l TSH 0.01 -0.69 ng/ml free T4 7.0 -40.0 pmol/l Nollaig's free T4 was 7.7 so a little on the low side so Dr Dodds recommended immediate commencement of soloxine treatment. Hope this helps Mardi. Kathleen and Nollaig

Kathleen North Ayrshire

This thread was discussed between 12/08/2009 and 15/08/2009

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