Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Ollies diagnosis/story anyones opinions?

I am so glad to find this site. It contains more information and experiences than I thought I would find. I found Mieshas Hope site the first week and now three weeks into this I found this site. My 8 yr old black lab Ollie had ingested rat poision on oct.31 and I induced vomiting 2 hrs later, and started with vK treatment. On Nov. 5th he wouldnt eat dinner at home. I have 2 equine vet friends, and one small animal vet friend that also happens to be my roommate. My one friend came over and immediatly noticed pale gums (something I never would have looked at or thought to do, I'm blessed to have such friends in my neighborhood) she took blood immediatly and took it to be tested at my roomates vet clinic. PCV was 13, no visible bleeding, hence we thought he was bleeding internally due to rat poision, so we ramped up the coagulant vitamin K (this is a typical treatment in rat poision ingestion cases). Later in the week PCV was 13 on Nov.6, 18 on Nov. 7. We thought we were on track treating for rat poision. Nov. 10 it was back down to 14, now we knew that it was infact not the poision causing the anemia, we started the pred. The next day I drove 2 hrs to a specialist and did an ultrasound to determine if the underlying cause was cancer. It was a clean ultrasound. The specialist said to do 2 weeks pred, and then see what happens. The following day I went online and I broke down and have been a mess ever since due to realizing how serious this disease is. We tested on Nov13, PCV was 19, then again on the Nov. 17 PCV was back down to 15. We made another appointment to see the specialist for a bone marrow biopsy and transfusion for the next day, Nov. 18th. It was determined through preliminary results to be Pure Red Cell Aplasia. He had a transfusion of matched blood, brining his PCV to 22. We started Cyclophosphomide. On saturday Nov. 22 his PCV was holding steady which is where were at now. He is not doing too well with the pred, breathing heavily in positions while laying down (not while standing though!) His abdomen is swollen and has fluid in it which the specialist is not going to treat at this time. Othewise he is eating normally again, which he wasnt pre-transfusion. I know with red cell aplasia I shouldnt expect to see any results for some time. I have many quesions, maybe I should ask some as separate posts, I feel as if I have been rambling with this, but I'm trying to get my head around all thats happened in 3 weeks and it seems hard to put into words. Some questions: How long has a transfusion worked for those of you diagnosed with Pure red cell aplasia, I understand it can last longer than with dogs with regenerative anemia? Has anyone had experience with fluid retention in abdomen and what have you done about it? The swelling of the spleen has actually gone down a bit thankfully Has anyone had a similar breathing pattern with their dog? Its not panting, just labored breathing when lying down (but now lying down on his side, that postion is a little less labored) I may ask these questions again as separate posts later. I just dont know what to do. Ollie is everthing to me as I know all your pets are to you. I just cant even seem to focus on anything else in my life right now and I'm feeling guilty about the cost, but yet keep pulling my credit card out every time without giving it a thought at the time. Does any one have a ball park cost of this treatment? Im at the 2k mark now, is it going to go much higher? Any thoughts are appreciated, things to try, am I doing anything wrong?

Mj avon

MJ, So sorry that Ollie has been diagnosed with this, but you have found a wonderful forum with caring and knowledgeable people. My beagle Darcy was diagnosed end-July with non-regenerative anemia. That's all the specialist has ever called it. She's had three transfusions, but since her bone marrow wasn't working, they didn't last but maybe 2-3 weeks. However, dogs do adjust to the low PCV levels and last week Darcy was at 13%. A bit scary, but her clinical signs are good. I believe you said that Ollie's clinical signs are good, too. Darcy was started out with Pred., then Azathioprine was added. She didn't do well on the high dose of Pred or the Azathioprine and developed pancreatitist after her last transfusion. We started her on the Neoral (brand name cyclosporine)which is costly, but I'd try anything to make her well. Her body hasn't been absorbing it as it should, so today her dose was doubled. I'm watching for any bad side effects. She's also on 5 mg. Pred. Every dog is different and responds differently to meds. Sometimes it takes a while to figure out the right med and right dosage. Hopefully, you will find a specialist or vet who is experienced in dealing with this horrible disease. I am not an expert by any means. I rely on God and the guidance of others who have gone through this and I'm hoping that Patrice and some of the others who know more than I will respond quickly to your post. My thoughts and prayers are with you and Ollie. Please keep us posted. Karen

Karen NC

Hi. I'm really sorry to hear about Ollie. My dog, Duck, was diagnosed with PRCA in June 2007 and while he is still on meds (at much lower doses), he is living a healthy happy life. So, while this is definitely a serious disorder, please know that there are many dogs who recover and go on to lead normal lives. You are lucky to have so many vets as friends and it sounds like Ollie is getting good care. How long has a transfusion worked for those of you diagnosed with Pure red cell aplasia, I understand it can last longer than with dogs with regenerative anemia? Duck had 2 transfusions. His PCV dropped to 5 at the outset. His first transfusion was a whole blood transfusion that literally saved his life. His PCV went up to 15 post transfusion but had dropped to 13 four days later. At that point he had not seen a specialist and my vet only had him on prednisone. His second transfusion was done at a veterinary teaching hospital in Washington State. They gave him a packed cell transfusion. At the outset his PCV was 11 and after that transfusion it went up to 25. Five days later his PCV dropped to 19 and then started to climb steadily and eventually hit normal numbers. At the time of his second transfusion he was put on azathioprine and cyclosporine in addition to the prednisone. Has anyone had a similar breathing pattern with their dog? Its not panting, just labored breathing when lying down (but now lying down on his side, that postion is a little less labored) Yes. I was told that Duck was breathing rapidly because of his low oxygen levels and because of the prednisone. When we were eventually able to lower his prednisone dosage, his breathing returned to a normal rate. He had this rapid breathing whether he was lying down or standing up. Does any one have a ball park cost of this treatment? Im at the 2k mark now, is it going to go much higher? I remember cringing at the mounting cost and then immediately feeling guilty for even thinking about it. Treatment of AIHA can be very expensive. With Duck, our initial costs were for the emergency transfusion and treatments with our local vet and then all the costs of the specialists plus a good supply of all his meds. This came to $5000. Since then, we've spent a lot more but it has been stretched out, making it easier to pay for. Try not to feel guilty for worrying about the money. It is a factor. Have you asked your vets about sucralfate and Pepcid AC to protect Ollie's GI tract? Prednisone can sometimes cause bleeding ulcers so it is important to give some protection. I'm sure others on this site will have some good information for you. Please keep us all posted and know that we all understand - we've been there. This is an emotional roller coaster, no doubt. Our thoughts are with you. Please give Ollie a hug for me. deb and Duck

Debbie BC Canada

Hi Karen and Deb, Thank you for your thoughts and stories. Good to hear about Ducks recovery, and that Darcy is holding her own. Yes I have been doing pepcid. Just over a week ago, before his first transfusion, for 3 or so days, he was uninterested in food. We started sucralfate, and possibly combined with the transfusion, has jump started the appetite. Now I'm fearful he's being fed too much. Yes, I agree this is such an excellent site, it will take me a few days to sort through posts on here to learn more and get a better grasp of this disease. At about the same time as I found this website this afternoon I got a call from my vet friend with an email address and name of Patrice, I believe we live close by and share the same vet clinic, I am anxious to hear from her, as I hear she is quite knowledgable about this diesase. I was fortunate in that Ollie hovered at PCV of 13, and I was able to do the trasfusion at the specialist clinic with a regular appointment rather than an emergency appt. I just don't know how he did it for 2 weeks with that pcv between 13 and 19, maybe his body did adjust and he had been living with it prior to this poision incedent. He has always been a LAZY loveable lab, but I just cant help but think that the anti coagulant rat poision, and the subsequent coagulant vitamin K treatment must have just wreaked havoc in his hemo system, but I guess how can you know that... I am just so anxious to start the other meds, I feel like 3 weeks of cyclosphomide treatment is too long to wait when it seems other meds have a better chance, but maybe I need to practice patience.

mj avon

Mj, Patrice is a wealth of valuable information and where to direct you to, you can see from my urgent post today asking for Patrice and tick issues. Wylie is only of 20 mg a day of pred at #50 and she has the labored breathing, so as others have said, its one of many side effects of the meds. Praying for Ollie Laurie

Laurie CA

Laurie, The world is so small sometimes. I got a call from a friend this morning about MJ and Ollie and talked for nearly a half hour. She has my ear for however long this will take to resolve. This is nearly the same scenario as Chance, with just a few small differences. I just sent her a long email. Patrice

Patrice NYS

MJ, I just replied in your other post, but please feel free to email me. The world really is small, because though I am living now in Utah, I am from Rochester (Patrice knows this as she is in that neck of the woods too!). Maybe we'll meet soon! melissa and tiggs

melissa slc

Thank you everyone for your responses, yes it is a small world, especially when your world has such caring people! Its good to know about the breathing thing, I'm thinking its labored due to the prednisone, which has caused fluid retention, which presses on the lungs/diaphram? It goes away when Ollie stands up, I'm thinking its released away from those areas when he's standing. I just want to get rid of this pred so badly

mj duckcoop@hotmail.com

Sorry to hear that Ollie has joined our little club. Although there are so many caring people here its sad why we are here. Alex was started on 40 mg of pred initially end of May 2008 and reduced throughout the summer. Although the doc's said with his PCV count in 20's and low 30's at the time he should be up and running around he was not. He is three years old. His breathing was very labored all summer long especially in the heat. Many a car trip in the summer my husband and I had the AC up high and wore coats to keep him comfortable. He longed for "cool" and would only lay on hard cool surfaces which in turn made him develop sores on elbows and hip bones. The doc said pred thins the skin making sores more likely. As the cyclosporine was introduced, and the pred reduced, I noticed the breathing got better. With the high does of pred he had a huge appetite, drank tons of water, and had a huge pot bellied look. We are down to pred 5 mg a day now, along with Cyclosporine, and he has only begun to be more active this past month. Finally, after 4-5 months of treatment he is somewhat running again,and playing ball. Most people on this forum seem to have dogs that have been active throughout. Good luck with Ollie. We are all very fortunate to have found each other and this site to help get us through this. Keep us posted

Chris

MJ, Sorry to take so long to post but when I read that Ollie was a black lab it kind of took me back to my loss of my black Lab Salome to this awful disease. It sounds like everyone so far has given you excellent suggestions and I hope you take comfort in knowing there are so many people on this board that will offer support and answer with our experiences to help in any way we can. Just try to take things a day at a time and keep believing that Ollie can beat this. Penny

Penny Lytle Creek Calif

MJ, you've got my prayers, especially, since I have a soft spot for labs, black ones especially. The costs are high for this disease, so you just have to be prepared for that. I'm jealous you have Patrice nearby -- she is A wealth of information! Please know that I'm pulling for the well-named Ollie. It is a roller coaster, but he will lead you through it. Thinking of you often, Sharon and Angel Raven

Sharon CT

Ollie has taken a turn down today, labored breathing is faster, and panting. He was doing ok for a week. His PCV this am was 19ish, not so bad, but we're thinking fluid in his abdomen, maybe now lungs, making things harder. Hes not intersted in food this am, and has that look in his eye, he was doing this pre-transfusion, and perked up after some sucralfate that time. Basically its an upset stomache, (no vomiting though) or fluid problem due to pred, wer'e doing some diuretic. His CBC did't show anything else alarming. At least his PCV is high(19), he was 13-18 for 2 weeks before his transfusion, so I can take heart in that. His white blood cells are through the roof, but has no temperature. His specialist isnt worried about the white blood cell count saying that means the marrow is stimulated. Of course its the holiday, and Cornell clinic and my regurlar emergency clinic are on expensive rates (cornell quoted $6,000)! If I spend that, I have nothing left for long haul treatment. I am blessed that my roomate is also a vet, although she is as perpelxed by this as I am, she's trying hard. I really am hoping she comes around to wanting to try Imuran, and Dodds protocol instead of cyclosphomide. I keep reading success stories where this drug is mentioned. This is a rotten disease

mj avon

Hi MJ. When Duck was on the high doses of prednisone his white cell count was high. I asked the internist about that and she said it was because of the prednisone. As we decreased the prednisone, his white cell count settled down. Glad to hear that you have been in touch with Dr. Dodds. She is very knowledgeable and should be able to steer you in the right direction. Ask your vet friend about this but from what I understand Imuran is a key player in the treatment of Pure Red Cell Aplasia because it suppresses the immune system at the bone marrow level where the destruction is taking place. Please keep us posted and know that we are thinking of you. deb and Duck

Debbie BC Canada

MJ, I'm thinking of you and Ollie and praying the little guy hangs strong and gets the meds he needs to bring him around. It is a good sign that his is holding at 19%. Sending hugs and prayers you way, Karen

Karen NC

MJ, Keep hanging in there! We've all said here that sometimes when they look their worst, they turn it around! It's not uncommon for the PCV to drop after the transfusions, the transfusions can only last a couple of days. Pred can cause panting too, especially in the immunosuppressive doses. Along with peeing constantly and leaking (we bought toddler pull ups for the overnights). Also, Tiggs was very nauseous at this point, and needed to get a shot of Cerenia, followed by a five day course of pills for that. We fed him A/D by Hills, it's loaded with calories and protein, and is easy for them to digest. Also, boiled chicken and steamed white rice helped alot too. Good luck, it's so stressful during the after hours/holiday time. You are fortunate that your roomate can help a little. We're thinking of you guys! melissa and tiggs

melissa slc

My little dog had severe non regenerative anemia and his packed cell blood transfusion lasted nearly five weeks. Good luck with your treatment. Imuran and pred stopped the destruction but unfortunately he was unable to regenerate. I was unable to access cyclosporine which gives much better results.

Julie Australia

my dog who was a black lab died this morning with the same symtoms. his white blood cells were eating up his red blood cells as fast as he was making them. i pray that your black lab survives. we had him tested for everything, but everything was negative. i remember about six weeks ago he came in and was beginning to show signs of chills, he then threw up a liquid with a little black stuff in it. i gave him some peroxide mix with his water according to his body weight, and by that evening he was okay. two weeks ago i notice he was having problems, this is when we took him to the vet. he had began to recover, but thursday he took a turn for the worst, and died sometime in the night. the vet called me this morning, i and my husband are devastated. this dog has been our baby for 10 1/2 years, and never has been sick. you will certainly be in our prayers. one word of advice if they asked to keep your dog at the vet, and it is not a 24 hr service, do not do it, it is better to take him home and he dies with the one he loves then by himself. this is what we regret. blessings, maryj

mary j alabama

This thread was discussed between 24/11/2008 and 19/12/2008

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