Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Not Responding to Medication

Beau, my beloved 9 year old cocker spaniel, was diagnosed with IMHA in October, 2010. After hospitalization and two transfusions, he came home and responded well to imuran and prednisone therapy, with his PCV going to 38. Tried to take down the dosage and his PCV fell to 33. Back up on the meds, he has been unable to get past PCV 33 and is now at 27. Appears his immune system is overriding medication he is no longer responding. Very confused by the fact that his PCV 27 this time is much better than when first hospitalized with the same count -- at that time he was collapsing from lack of oxygen. Today, he is eating, wagging his tail, even somewhat tustling with our German Shepherd. Vet suggested internal medicine workup and bone marrow aspiration to see what's going on. I opted not to do this for two reasons: 1. if his bone marrow is bad, nothing can be done; 2. if his bone marrow is good, nothing can be done except keep scratching our heads to figure out why he is not responding. I've asked the vet's office to contact herbalist in NY about Chinese herb regimen. In the meantime, does anyone have any input or suggestions or experience with this same roller coaster ride?

Sharon Abington

Hi Sharon, maybe they could try a different drug, the one our cocker was on was cytoxan, or also known as cyclophosphamide, Tori had aiha for most of the 12yrs, that was way back in the 90's. It is just a suggestion that you could ask your vet about. Tori had numerous relapses but like joanne's meisha, fought back, cancer took her in 2002

Bev canada

Add to above... Beau is currently on the following medication: prednisone - 20 mg 2X/day azathioprine - 35 mg 2X/day doxycycline sulcrafate pepcid baby aspirin - 1/8 1X/day Vet conservatively reduced medicine about two months ago - pred to 15 mg 2X/day and two weeks later, azathioprine to every other day. For a month now has been back up to original dosage.

Sharon Abington

Good call on avoiding the bone marrow testing! Not a good idea at all IMO. Do you have copies of all the blood work??? I'd be interested in knowing some of the CBC values. If you can get copies of them all I'll ask you specific questions that might help. There's a slight possibility that this is just the body righting itself from making all the blood in the beginning. Blood has a lifespan of around 120 days give or take and if LOTS of new baby cells were made around that long ago it might be possible that there's a larger number dieing off of natural causes! Again....this is only a possibility but the CBC results would be good to have on hand! His hemoglobin was likely much lower in the first episode which would account for it being easier on him this time around. Again, if you have copies of ALL CBC's then you could compare results to back then! Do they look at the blood under the scope when you go in? Pay close attention to reticulocyte numbers as well as spherocyte counts which are done by looking at teh blood under the scope. How long have you been using te doxycycline? Was this caused by tick disease? I'd avoid cyclophosphamide at all cost if I were you! VERY BAD DRUG! Tessy's taking this now as part of her chemo protocol and it scares the bejijies outta me each time I give it! Cyclosporine would be the best bet for an added drug...BUT get those CBC results before deciding anything! Lotsa love and prayers, Johnny & Tessy

Johnny

Dear Sharon, So sorry to hear about Beau. Also agree that it was a good call on the bone marrow aspiration and urge you to get Beau on the Cyclosporine ASAP. The vets may suggest going through each drug in succession, pred, azathiaprine...then cyclosporine. Cyclosporine is expensive, but in the long run it may be less expensive than successive transfusions to buy Beau time as they move up the scale on the immune suppresion drugs. It is my opinion that we lost precious time with Juliet as we waited to see if the next level drug would work. Talk to your vet about the Cyclosporine and Good Luck to you and Beau. Pat

Pat Vermont

ah johnny why do you not like cytoxan? given that it has been used for years to inhitbit the immune system and is not an expensive drug like some of the other drugs used to treat this disease. take care Bev

Bev

Bev, not to say it doesn't work...I'm just not a big fan of the cytotoxic drugs. This drug works better on diseases like cancer where there's rapidly growing/dividing cells but is used for this disease cause it attacks teh overly stimulated lyphocytes. It's also very much like azathioprine in how it affects and suppresses the bone marrow. It's VERY important to note that this drug shouldn't be used on dogs with any liver or kidney conditions. I'm always worried when TEssy gets it cause of her doses and the risk of cystitis and kidney problems. LOTS & LOTS & LOTS of water should be encouraged with this drug! Cyclo and aza are much more advisable IMHO! The only other drug that TEssy gets with her protocol that scares me more than cyclophosphamide is the doxorubicin/adriamiacin!!! Johnny & Tessy

Johnny

Thank you so much for your words of encouragement and knowledge, especially with regard to the bone marrow testing. I wasn't sure that declining this was the right thing to do, and now feel better about the decision. I just couldn't imagine the toll the stress of being in the hospital again would take on Beau and how that could negatively impact his prognosis. Beau has only had one CBC that I know of -- about two weeks ago -- so there's really nothing earlier to compare it to. He's been on the doxy since the beginning, although they don't suspect it was a tick based disease. I believe it was the Frontline given two weeks prior to his diagnosis that triggered this disease. I will absolutely talk with the vet about changing the immuno suppressing medication. In the meantime -- Johnny, I'm hoping you're right about the blood simply righting itself at this point. Thank you again for your knowledge and support!

Sharon PA

Once Dr.Dodds from CA suggested SOLOXINE and we started it his RBC started going up. Gunner started off at 12 dropped to 8 had tranfusion, went up to 20, stayed there for about 2 weeks. Then soloxine was introduced , RBC went up to 22, then 10 days later went up to 39 and reticulate went up well over 300,000 !!!! I have learned everyday is precious, I opted NOT to do the Bone Marrow aspirate either and glad I didn't. Sharon, I'm in PA also , my vet is in Newtown and very good. I gave her all the info that Dr.Dodds had sent me and she was very open to her suggestions. If you need to talk or anything I'm here. I have gotten lots of good info from people on here and doing endless hours of research. Things with Gunner are looking up and I'm willing to share all that I have learned. Please feel free to contact me personally: My email is Jacki.fusion@yahoo.com BTW Gunner was on the same exact meds as Beau then we added the Soloxine to the mix, he is now slowly weaning off some of the other stuff ... please contact me if you'd like. I totally undertsand what you are going through. This site was a blessing to me !

jacki Phila

UPDATE: Taking Beau this evening for his first PCV since he fell to 27. Been a few weeks! But in the meantime, vet drew thyroid panel and sent it to Hemopet. She then spoke to Dr. Dodds about the low-functioning thyroid result and he is on Soloxine (since last Thursday). Also added Pet-Tinic to his food -- which is now a (mostly) no-grain diet. Hopefully doing everything right will result in a good number! In the meantime, took out the vacuum yesterday and for the first time since October, had to fight a "ferocious" cocker spaniel off the end of the wand! So exciting! Between that and him leaping into the air to grab a bite of my tuna sandwich -- never thought I'd be so excited to see such BAD behavior! Really appreciate the assistance received on this forum. You guys are the best!

Sharon Abington

Sharon~ Your explaining how excited you were to see Beau's actions now helps you to understand our stories about how "spoiled" our pets are while recovering! Best to you all. Blessings, Cindi & Tori (IMHA)

Cindi PCB

Cindi, Looking forward to seeing an update on Beau's Blood work. From his recent behavior descriptions it sounds like he is doing very good. It is always a pleasure to read a post where an owner describes signs of their dogs behaving like they did before being stricken or in most cases a little new spoiled behavior is not bad either. Penny

Penny Lytle Creek Calif

Beau's PCV last night was 28 (total solids unchanged at 7). I really had hoped for a higher reading. But at this point, I'm glad it is going up and not down. Baby steps...

Sharon PA

LOL @ the vaccume story!!! That's a good sign! Tessy stayed in the high 20's for what seemed to be an eternity. Keep a good eye on all the numbers to watch for trends. If it continues to remain stable in this range for another couple weeks then a med reduction may be advised. Do you have copies of CBC results or are you only getting PCV's done? I'll keep Beau in my thoughts and prayers. Johnny & Tessy

Johnny

Thanks for the reassurance Johnny! I usually only get PCV's done - that's what is suggested by the vet (and my bank account). He had a CBC done about a month ago - but I'm not sure it was even all that complete (no retic count available). We've been using the PCV and total solids results as the barometer for improvement, as well as physical activity and general demeanor. The latter has been great! Thanks again for your thoughts and prayers, and for all those on this forum who have made this process a bit simpler! Sharon and Beau

Sharon Abington

So, went for another PCV last night after receiving a 28 two weeks ago. Beau is now down to 25. Vet and I both shaking our heads... we are doing EVERYTHING right and NOTHING is happening! Referred to local large hospital for an internal medicine consult, which will be on Thursday. Vet seems to think acupuncture could help. Anyone have any info on this? From what I've read on this forum and others, I am also expecting a trial with cyclosporine. Enough with the baby steps already! I'm ready for leaps and bounds. At least one!

Sharon PA

Sharon, I am so sorry Beau is not improving. It sure is a long haul. I am surprised cyclosporin as not yet been added. It takes a while for it to take effect, so i would think the sooner the better. Have you considered a consultation with Dr. Dodds again? I think acupuncture and TCM could help, but I would not rely on it alone. As much as we hate it, for this disease you need the heavy duty drugs. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Do you have copies of recent and past CBC's??? It would be good to look for trends inthe numbers. Like I said above, Tessy stayed in this range for at least 2 months and would fluctuate a few points. It wasn't until Dr. Dodds had us add cyclosporine that she finally climbed above 30%. Then she slowly climbed ot normal range! Are you using proper diet and supplements to compliment the therapy? Lots of thoughts and prayers for Beau! Johnny & Tessy

Johnny

Beau hasn't had multiple detailed CBC's done since his hospitalization in October, but I'm sure he'll have one done on Thursday. And the internal medicine guy he is seeing is at the hospital where he was in October and I'm sure they have good detailed results for comparison. These, coupled with the one he had done a couple months ago, will hopefully tell them a story. And it sounds like cyclosporine could be the answer. I gravitated Beau to a (mostly) grain free diet, delicately flavored with Pet-Tinic and milk thistle. And despite the decrease in his numbers -- he continues to enjoy EVERY bit of it! Thank you all - again!!! Sharon

Sharon PA

Sharon, This sounds like it may be bone marrow failure. I treated my Chance for this in 2007. Please send me your email address and I will send you the complete protocol for this treatment. You can share it with your vet and they can decide if they want to proceed with this. my best patrice

Patrice NYS

Hi, our Pepe, an 8 yr old papillon, was also diagnosed with this awful disease in Oct '10. Constant battle--blood marrow test, 3 transfusions already and CBC still drops in between. His count was 9 when he was diagnosed and he had his first transfusion the next day. Since then it's been the same thing--get it up to 45 and watch it drop, then repeat. I have been following these threads for some time now and have really gotten some good ideas on meds but since we have a regular vet and an internal med vet--both have been great, I didn't get in touch with this Dr. Dodds I'm reading about. I'm really wondering if I should ask my vet about maybe consulting with her instead of the internal medicine specialist. I feel so defeated and so sick over this. Pepe's meds are just about like what most of you are doing--pred, cyclosporine,aza, pepcid, PetTabs plus iron, Denamarin (which I started after reading posts here--but nothing is stopping it. He's taken doxy before, too. I haven't heard of the Soloxine you mention, so I'm going to ask the vet about that...waiting on his call right now. Pepe had his CBC drawn yesterday and it's dropped to 27. By next week, we'll be looking at another transfusion. I really appreciate all of you sharing what you are going through--it does help so much. I pray for all our sick furry babies. Any advise will be greatly appreciated! Jackie

Jackie Pitts Alabama

Sharon How is Beau doing today, please know that he is in my thoughts and prayers Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Thank you Cheryl and Ginger! Beau is hanging in there. PCV down rather low -- 22% -- and attempting to clear up some complications at this point, including damage to internal organs from the high dose of prednisone (40 mg for 5+ months). His prednisone has been lowered (since Sunday), and this has already resulted in a better quality of life for him. We are still working to stabilize him, but in the meantime he is happy and we are taking the requisite baby steps! Thank you for your concern, thoughts and prayers! I would be lost without the support I've received from this forum's members!

Sharon PA

Glad to read that Beau is taking some baby steps in the right direction, that is always encouraging. Is Beau on Cyclosporine and if not have you thought about asking your vet about it? I personally think it is not as hard on the body as the pred and Ginger has been on it for over three years along with a small dose of pred. Ginger's pcv was stuck around 28 for a few months and adding the cyclosporine brought it up to the normal range after about 5 weeks. Please know we are keeping Beau in our prayers and thank-you so much for the update. Sending a BIG hug!!! Cheryl & Ginger

Cheryl & Ginger Pinevile PA

Sharon, did you get the CBC the other week like you were hoping for? I'd be interested in seeing the results if you have them! I'm assuming he's off the doxy by now....am I right to assume? If not get rid of it. I'm also wondering about the azathioprine dosage. Is he still on high doses? Perhaps this is suppressing the bone marrow too much! Has the doctor looked at the blood under the microscope to determine if there's still destruction occurring??? This is a MUST for them to be doing at each visit!! You've got to know if there's still anything going on! I've got a feeling the AIHA is under control now but the bone marrow is slightly suppressed. This is where the CBC results come in habdy cause by looking at specific readings it will give a REALLY REALLY good idea if this is in fact happening! Five months on azathioprine is too long IMO. Let me know what he's on for a dosage. Lots of hugs, thoughts and prayers. Johnny & Tessy

Johnny

Johnny, Beau's blood results are a good news/bad news story that I'm still trying to come to grips with. I've listed it below. The vet at the animal hospital took him off the doxy, cut his prednisone in half (to 20 mg) due to a suspected internal bleed, added misoprostol and Clovomax (for a suspected bladder infection). Still trying to pinpoint exactly what's going on with Beau, but in the meantime he has the bounce back in his step and an appetite suggesting my old guy is back! He is still on the 35 mg azathioprine each day. Either the prednisone drop or the antibiotic is definitely making a difference. Total Protein 5.4 Albumin 3.0 Globulin 2.4 AST (SGOT) 58 ALT (SGPT) 382 (high) Alk Phosphatase 11953 (may set a record for high!) Total Bilirubin 0.3 Urea Nitrogen 33 (high) Creatinine 0.6 BUN/Creatinine Ratio 55 (high) Phosphorus 4.5 Glucose 113 Calcium 9.5 Corrected Calcium 10.0 Sodium 147 Potassium 5.1 Na/K Ratio 29 Chloride 108 Cholesterol 378 (high) CPK 123 Hemoglobin 7.3 (low) Hematocrit 22.8 (low) WBC 36.8 (high) RBC 2.64 (low) MCV 86 (high) MCH 27.7 MCHC 32.0 Platelet Count 432 (high) Platelet Estimate - Increased Differential - Absolute Neutrophlis 32752 (high) Bands 0 Lymphocytes 1840 Monocytes 1840 (high) Ecsinophils 368 Basophlis 0 Hypochromia - slight Anisocytosis - slight Spherocytes - none seen Polychromasia - slight Blood Parasites - none seen Reticulocytes 2.5 (high) Absolute Reticulocytes 66000 (high) Corrected Reticulocytes 1.2 The above results are from March 18th. This past Monday, he was still at a 22% PCV.

Sharon PA

This thread was discussed between 12/02/2011 and 24/03/2011

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