Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - our schnauzer and imha

Hi. our 12 year old schnauzer Bully was diagnosed w/IMHA on monday after a week of lethargy and low appetite. he was put on prednasone on monday night. On thursday he was wobbly and had trouble standing...we rushed him to vet specialist. she kept him overnite, gave him two transfusion of the globulin stuff (but not blood) and started him on cyclosporine along w/the prednasone. we took him home on thursday. his count got as low as 12. on friday it was up to 14...vet was encouraged it went up at all as he had received no blood in the transfusions. he's been stable all weekend but really low energy, barely moving, not much appetite. seems very depressed. my question: how soon would we see a demonstrable upturn in him with the prednasone if it's working? last night marked exactly five days and i know it can take that long. for all i know his blood count is back up (we're going back to the doc tomorrow). but he hasn't shown any outward improvement at all, though he seems stable which considering the still-present danger, i guess i should be thankful for. should we assume he's not responding to the pred. and cyclosporine since we can't see an improvement, or is it still too early and our expectations are way outta wack? i know the fatality danger is still present but i'm trying to get a handle on what to expect and whether he's even close to turning a corner. i'm sure we'll know more tomorrow after another blood test...

Mitch Goldman Cape Elizabeth ME

Dear Mitch, I am particularly sad to hear about your Schnauzer Bully's sudden diagnosis of IMHA. I own two Giant Schnauzers and am particularly fond of any size of Schnauzer. Because of the age of your dog, I will recommend that they do an abdominal x-ray to determine if there are any masses. If they see something on this that might indicate that, it would also be wise to get an immediate ultrasound. I would also ask them if they did a blood smear and cytology of the cells. This could be very diagnostic as well. I would consider both of these urgent tests and should be done tomorrow. 5 days is a very short period of time. The most important thing now is stabilizing Bully and it seems your vet has taken some very good steps in this direction. The prednisone in high doses is essential to halt the destruction of RBC immediately. Your vet has also prescribed an important long term medication, cyclosporine, that will take some time to become effective. Ask the vet if they would consider a very low dosage of aspirin to prevent inappropriate clotting. You can give good nursing care at home also. Keep Bully quiet and comfortable. Make small easily digestible foods like boiled chicken, ground beef and scrambled eggs, perhaps with some cooked rice. I know how hard it is to remain calm when you don't know what is happening and you want to do something proactive. Take time to read everything you can about this condition. A good place to start is Joanne's website: http://www.cloudnet.com/~jdickson/index.html You can do google searches with "canine aiha imha" I like this site's explanation very much: http://www.marvistavet.com/html/body_imha.html Keep us posted about tomorrow's testing. I will be thinking about Bully. patrice

Patrice NYS

thanks patrice. xrays and ultrasound and spleen aspirates all showed no masses or cancer cells. his spleen is enlarged but no sign of malignancy or masses. doc is pretty sure it's idiopathic IMHA. i'm inferring from yr words that we shouldn't get too depressed after five or six days. i would feel better if we could see him exhibit some sign of feeling better but at least he's stable for the time being (fingers crossed). the doc seemed to indicate that his biggest danger is short term fatal crash (clot or stroke) and not that he wouldn't respond to the steroids at all. she was hopeful that he produced enough RBC to raise his level a couple of pts on friday w/out new blood, so we know he can regenerate. it's just tough to see him like this...i guess my expecations were outta wack and i thought we'd see some small improvement in energy mood or apetite. but not yet. (he's only been on the cyclo. for two days). thanks again for your help and kind words. i'll know more after his RBC check tomorrow and will let you know how he's doing.

Mitch L Goldman USA

Mich, That is good to hear. Indeed, your vet is covering ground that I thought would be important. It shows that your vet is making sure he/she exhausts the diagnostic tools available. Spleen enlargement is common in this condition. It is a very active organ in destroying old blood cells and cleaning up and recycling the material. It is also a very active part of the immune system and can sometimes be a site of great RBC destruction. The side effects of prednisone can be very hard on a dog. You will begin to see these happen. The best term to use is Iatrogenic Cushings Disease. You can research this in google. Remember, Bully will most likely recover from these once the dose is lowered. I, too, am worried about a clot. It seems from experience on this list that low dose aspirin is becoming more important to prevent this than once thought. Your vet may have reservations about using it. I would suggest then that you have a full diagnostic thyroid panel done with Hemopet.org. Many older dogs develop autoimmune hypothyroidism and this can contribute. My Giant is hypothyroid and he developed it when he was older, around 7. He now takes a small pill twice a day. How are Bully's kidneys? Did they do a chem screen? No dog responds the same way to treatment. Some dogs are better in just a short time, others seem to take longer. Early systemic stabilization is very important. Producing new RBC takes about 3-5 days and those reticulocytes can take about a week to mature fully. If you are following the CBC's (that you have copies of), you might see retic % and retic absolute. These numbers in a normal healthy human or dog range around 1-1.5% and in the range of about 60,000 absolute or a bit higher. In regenerative anemia these numbers can be very great, as high as 5% and 500,000! Once these numbers are this high you should see a corresponding rise in the hematocrit (or PCV), red blood cell numbers and hemoglobin. At some point it should level off in the range of 37-55% HCT/PCV and the number of retic should decrease downwards to 1-1.5%. They may fluctuate a bit over time until Bully is stable. If you continue to see a high reticulocyte % with no apparent rise in HCT/PCV, that is an indicator that there could still be hemolytic destruction of RBC. my best patrice

Patrice NYS

Hi Patrice. so Bully went back to the vet this morning. unfortunately his rbc isn't up at all...it's steady from friday. the dr. isn't overly alarmed but he's really not doing great...he's very tired, not eating, very depressed. The dr. wants to do a whole blood transfusion so we're doing that (i simply cannot believe the cost of treating this thing...we have spent 2700 so far and gotten zero effet out of it...too bad vets don't give you any kind of guarantee with these prices!). The doc thinks the transfusion may help jump start his rbc. we just don't know yet. so he's stable but no real improvement. we are very worried still.

Mitch Goldman Cape Elizabeth ME

It's a good sign to at least see the RBC staying stable. It may take some time for the medication to start working. My dog Tessy was on Meds for over a week befor they started to work. I'ld check her RBC daily to see if they increase or decrease. If they begin to decrease then you might need to get another transfusion. Tessy's numbers declined after her transfusion but then they started to climb after 2-3 days. The doctor said that the meds were starting to work. Tessy's doctor put her on an IV drip after her transfusion because like Bully she wouldn't eat anything. She stayed on the drip for almost 2 days. Now, 3 weeks later, I've got to watch my fingers when I feed her! We are starting to see an increase on a weekly basis now. For the time being be strong and make sure Bully gets his medication on time. The first week is always a tough one! We'll keep you and Bully in our thoughts and Prayers. Johnny & Tessy

Jonathan

I'm glad to hear Tessy is responding well. That gives me hope! Bully came home tonight after his transfusion. He seemed more energetic in the vet's office than he has in a week..he actually wagged his tail a bit when he came in to see us. Of course once we got him home he headed right for the couch again and just lay there... The vet is cautiously optimistic that he'll respond soon to the steroids...she thinks it's a bit early to have hoped for a major RBC improvement. he's still in the danger zone however and we are now giving him low dose aspirin to hopefully prevent clots. It was good to see him show a spark of life, however short lived. His appetite is still really weak and we got a drug to help his appetite (can't remember the name, don't have it in front of me but he got a shot of it at the vet's as well)... He still seems prone to peeing in the house...i'm not sure if he's losing his self control or just trying to annoy us! he knows better and has been housebroken his whole life so i'm not entirely sure why he decides to do that instead of walking to the door and signalling us. Anyway we'll do another blood check on thursday assuming he doesn't get any worse.

Mitch L Goldman Cape Elizabeth ME USA

Our dog Lucy also peed around the house for a couple days after coming home from the hospital. We attributed it to the fact that she was drinking so much more water because of the prednisone and just wasn't able to hold it. She hasn't done it since then so maybe their bladder enlarges and they don't have to go so often, I'm not sure. She also was not eating well the first few days after coming home. We fed her scrambled eggs and my husband baked some chicken and mixed it with rice, carrots and beans...after a few days, she started eating like her old self and now she would eat all day, if we let her. I think once the prednisone kicks in, that may help her appetite. Hang in there...we are praying the meds kick in and you start to see some improvement in Buddy. Lee and Lucy

Lee Florida

we have tried just about everything...chicken and turkey, canned food, some dry food that he likes, treats, cheese, applesauce, eggs...he's just not interested in much. he's eaten a few bites today but that's about it. we ended up crating him again overnite for the first time in a dozen years just so we could get some sleep (we've been staying up w/him the past couple of nights). He's still very very lethargic and depressed. we're getting an iron supplement to give him today. today is only day 8 since he started prednasone so i know it's not reasonable to expect much from him until at least day 10 but of course, as many of you know, it's heartbreaking to watch a vital member of yr family feel so low for so long. we are still just praying we get him through the clot danger period, which i think is about next monday. it's a long six days till then. anyway thanks for all the kind words of encouragement from everyone. we aren't giving up on our Bull. we're gonna get him through this.

Mitch L Goldman Cape Elizabeth ME USA

Hi Mitch, Hang in there with Bull! Tiggs had to wear pull ups for a couple of weeks, there was just no way to contain all the pee. We put a stack of fresh towels near the bed, and changed out one on top of his bed whenever needed. I just bought toddler pull ups, and just sort of wrapped them around his waist. His energy will take a long time to rebound, but you'll start to see baby steps. A little tail wag, a sweet little kiss, a little sparkle back in the eye. They will be small miracles at first, but they will happen more and more. We also had to hand feed Tigs, lots of home cooked food, mixed with boiled rice, and Hills A/D high calorie prescription food. Eventually, his appetite will go through the roof. He may be slightly nauseous, you could ask the vet about adding a five day course of Cerenia, which is an anti-emetic/anti nausea and helps them want to eat a little bit. Good luck, stay positive, you can do it! melissa and tiggs

melissa slc

Good to hear Bully is home now. I thnik the peeing comes with this disease. Tessy had many accidents when she was brought home and still does to this day....just not so much as in the beginning. The main thing to remember is not to scold him for this. He most likely can not help this because of the meds. Scolding or trying to correct this could casuse stress. Stress is NOT good for this disease! I give Tessy all the water she wants whenever she wants it and trust me...she always wants it. I've got a habit now of letting her out for a pee every 2-3 hours. I do whatever I can to make her happy and comfy. I bought a couple of baby gates to help section off the house at night just in case she decides to pee....at least this way I can limit where she will pee (or poop). Hang in there and keep giving him support and befor you know it things will start getting better. Johnny & Tessy

Johnny

Mitch - If you haven't already, you might try giving Bully some pure meat baby food - it's usually labeled Stage 1 (just be sure to read the label and make sure there is no onion or onion powder in it). My first two dogs were mini schnauzers and my family has had six so I have a special soft spot for the breed and hope Bully does well. Bonnie

Bonnie Chicago

Quick Bully update: he's eaten a bit more today, though still not much. He seems the *teeniest* bit better... a tiny bit more alert in his reactions and expression. He's still like 85% not himself, but he seems stable and again a wee bit better. we take him tomorrow for another RBC count. every finger crossed! thanks again for everyone's help and thoughts.

Mitch Goldman Cape Elizabeth ME USA

Every little positive thing that happens is great, isn't it? Hang in there, hopefully each day gets a little better... Sorry about typing Buddy in my earlier post - Bully and your family will be part of my prayers tonight. Lee and Lucy

Lee Florida

Hi Mitch and little Bully, My Kent, a mini-schnauzer (black and silver) developed this disease 2 1/2 years ago, and I know what you are going through. This list is a great place to be for support as you go through this. I remember it took a long time for Kent to rebound and become 'normal' - in fact, his energy levels and personality did not come back to 100 percent normal until 6 months after his first transfusion. I think its the prednisone, but once you gradually start tapering it, they come back more and more. Kent was also once on cyclosporine but did not react well at all to it - it was like he had been given some horrible hallucigen or something. He staggered, was spaced out, didnt eat, it was too hard on him, and after three days he was taken off it and put on Imuran, which he tolerated much better. Kent was just the rare dog that couldnt tolerate the cyclosporine. Kents spleen was also swollen for a long time, and his liver became swollen by the prednisone, and i then started giving him milk thistle and sAme for this. You are not there yet, i wouldnt start Bully yet, not so soon. Lets have him get better first. Kent's appetite also was weird, and he would reject food he liked, but again this changed as he got better. What is bullys hematocrit? I'm glad the transfusion helped, and i just wanted to write and wish you both well, I am thinking of Bully as he battles this disease.

Christine FL

That's interesting about the cyclosporine...i wonder if Bully is having issues with it? Today he is about the same as yesterday. no worse, but his appetite seems even less today than yesterday. He ate a bit today but yesterday he seemed to eat more, though hardly much at all given his normal intake. He seems about the same level of energy and alertness as yesterday...better than monday and tuesday but not a noticeable improvement over yesterday. We put off the blood test till tomorrow. i'm praying it shows an improvement. his low count last week was around 12...and i think on monday it was 14 or something. still really low but up from the previous thursday. Anyway we'll know more tomorrow i guess. Tonight marks the end of 10 days since his first dose of prednasone so i know it's early to expect much beyond stability. Thanks again for everyone's info and encouragement.

Mitch L Goldman Cape Elizabeth ME USA

Mitch, I am kind of surprised that they let Bully go home with such a low PCV? 14 was what my dog was at when she was admitted. Hopefully you will get better news tomorrow. Keeping you both in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Mitch, Do you have a copy of the most recent blood test? Do you see a number for the reticulocytes or retic? Patrice

Patrice NY

I don't have a copy of the last test. the dr on monday seemed pretty happy w/Bully's generation of cells for some reason. I'll have more info tomorrow. (it's possible his count was 18, not 14, i'm not sure...i know when he was admitted overnite on thursday it was 12 and it had gone up 2 or so on friday and he was sent home). I will report back after his test tomorrow.

Mitch L Goldman Cape Elizabeth ME USA

Then he is regenerative and if the hemolysis has been stopped, there will be a steady rise in his pcv and rbc numbers. The number of reticulocytes will be very marked at this low of a pcv, you may see 5% or more on his cbc. patrice

Patrice NYS

Unfortunately the news wasn't good this morning. His RBC is down to 9 from 14 on monday. he's making cells but destroying more. his retic was 5, i think, for what that's worth. doc recommends yet another transfusion to get him thru the weekend (this'll make 3500 bucks so far with no sign of recovery...unbelievable). She wants to keep him on prednasone and cyclosporine and add another drug (cytoxin maybe?) she also thinks he's now in the less than 30% chance of survival zone. I am devastated. i had a lot of hope before this morning. now i'm really not optimistic he'll get through this. i can't believe with all the money these vets are bleeding from us that they can't get a 12 year old dog back to health. needless to say i'm already experiencing the pain of grief and loss. sorry to be a downer.

Mitch Goldman Cape Elizabeth ME USA

Mitch, Never feel you have to apologize for your emotions while fighting this. I think that is one of the hardest things to understand about treating this. You are doing everything they suggest, you are paying out large sums of money, why can't they make my dog well? We have all been there. It is just different then any kind of treatment/disease that we have ever experienced. It is part of that roller coaster ride everyone talks about. Hopefully you will get better news soon. Penny

Penny Lytle Creek Calif

i just wish i knew what to do. do we keep putting him through this and throw more and more money at it hoping for a sudden turn? seems like a lot of recovery stories have dogs getting better right before people give up all hope. but the vet didn't seem optimistic which isn't helping me. i can't say i'm thrilled with the vets right now. never have i paid so much for no results from anyone, ever.

Mitch Goldman Cape Elizabeth ME USA

Mitch, 9 is a pretty low PCV and if it were my dog I would go through with another transfusion. I just couldn't imagine having to put my dog down without knowing I did everything posible for her. Try getting him checked 5 or so hrs later and maybe the PCV may have climbed or was reading wrong or different when it was taken. You'ld be able to tell if he is acting way worse than he did yesterday. Is he acting the same as yesterday or is he more lethargic etc? A transfusion with whole blood would be your best bet. To me...if I had spent that much money so far to save his life then what's a little more. It's up to you but remember to have hope. These transfusions will buy him time till his body and marrow starts to regenerate better-as the meds start to work properly. Whatever your choice I will pray for your little boy today. Good luck and I hope the best for you and Bully. Johnny & Tessy

Jonathan

thanks Johnny. yeah we are doing the whole blood transfusion now. we'll pick him up in a couple hours and start him on the cytoxin tonight. if he shows any improvement over the weekend we'll wait to do the test but otherwise we plan on bringing him back monday to see if there's any improvement. what kills me is the thing that's kept him so healthy, his strong immune system, is killing him now and we can't suppress it enough. i pray we don't have to make any hard decisions next week. i don't wanna let the guy go. i can't imagine our lives without him. i miss him so much already...he's been so "not himself" for the past twp weeks that it's already left a huge hole in my heart. i was hoping a full recovery would just make this a bad memory. ugh, sorry again for being a downer...i don't wanna discourage anyone in the middle of their own personal fight.

Mitch Goldman Cape Elizabeth ME USA

We all know how you feel - no need to apologize. Hang in there - we will be praying for you and your family. I remembered seeing this in another thread and I wanted to share it with you -- Joanne wrote..."I seldom see Cytoxan used in the treatment of AIHA/IMHA any more. It was used quite a bit years ago but now when most vets want to add another drug to the prednsione or Azathioprine he/she will generally use Cyclosporine. Has your vet mentioned this drug to you? If not you might want to ask your vet what his/her experience has been with the used of cyclosporine for the treatment of Canine AIHA/IMHA." Our Lucy was started on prednisone and dexamethasone, then the dex was stopped and azathioprine was started. Our vet wanted to start cyclosporine, but since we felt Lucy was already improving, and the higher cost of the drug and extra testing needed, we didn't start it. I'm sorry your vet is not being optimistic - our vet kept telling us Lucy only had a 50/50 chance and there is a poor to guarded prognosis with this disease - it is all very scary! I wonder if you have another vet you can consult with or if you are comfortable having this discussion of different medications with your current vet. The pharmacy page of www.marvistavet.com has info on many different drugs. I, too, can understand the economic issues...get detailed invoices and make sure they are not double charging for anything (believe it or not, we caught two double charges on our bill...) and question anything you think seems outrageous. Sometimes you may find some of the charges to be negotiable - you never know until you ask. Anyway, just a few thoughts...we will keep hoping the transfusion gives his body a chance to get the drugs working. Please know you are in our thoughts and prayers and that Bully knows you are trying your best. Lee and Lucy

Lee Florida

Mitch, It may be very wise for you to ask your vet to consult with a veterinary internal medicine specialist or a veterinary teaching hospital in regard to Bully's case. This can many times be done as a "veterinary courtsey" with no charge to you. At my request my vet consulted with many such specialists in regard to my Meisha and I was never charged for such consultations. Also sometimes when the PCV is very low a vet will change from prednisone to dexamethasone. Both are glucocorticoids but dexamethasone is said to be 5-7 times more potent then prednisone. Please know that we are keeping you and Bully in our thoughts and prayers.

Joanne MN

Mitch, Our thoughts and prayers are with you and your family- we are rooting for a turnaround for Bully. Sometimes vets can approach things a little bit scientifically (read= pessimistically), and it's up to us as their caregivers and guardian angels to leave a few things to faith. I know it's so hard, try to stay positive. Look for those little signs from Bully- look into his eyes. If he's willing to fight, then go for it. All our prayers, and huge hugs, melissa and tiggs

melissa slc

Mitch, it sounds to me as if the medication hasn't quite kicked in yet. This transfusion might be your answer. I find it weird that they would send him home right after a transfusion. He should get as much rest as possible when he gets home. If he has no appetite I would recommend keeping him at the hospital overnight and possibly putting him on an IV drip. This will give him the nutrients his body needs. Have you asked about azathioprine? If you get this before you go to the vet then you should ask them for a copy of his tests. This way you can get better answers from all of us on here. We can help you to better understand what the numbers mean. Give Bully a hug for me and Tessy. We'll be praying for him tonight. Johnny & Tessy

Jonathan

thanks as always for everyone's comments. very helpful as always. OK we just picked him up. he seemed perkier after the transfusion. the vet said he ate a bit. she's keeping him on prednasone and cylcosporine and adding four days of cytoxin. she's also taking him off the cyclosporin for just the weekend. i asked about azathioprine...she had considered it but was worried it would affect his liver adversely. his spleen is smaller...good sign. she thinks there may still be an underlying cancer causing this, but she can't find any so that's more of a intuition thing. no lab data backs that up. she was very clear that it's too early to give up on him but thinks his condition is "guarded". I told her that i've read a ton of success stories, many of them here, from folks whose dogs were at this exact point Bully is..and they turned a corner. so we don't really know what combo of factors could make him turn a corner. how can i live w/myself if i don't try everything within reason to get him better? anyway he's home, he's resting, if we see any change in either direction we'll take him monday for another check. otherwise we'll probably wait till tuesday. I'm still very very depressed and not optimistic, but i also can't give up on my guy just yet. he's always been there for us...so now we have to be there for him. Thanks again everyone.

Mitch Goldman Cape Elizabeth ME USA

Dear Mitch and Bully, I am following your thread, and i agree that you should ask about a vet teaching school or at least consultation with a internal specialist. You may consider calling Dr. Dodds, at hemopet.org - the number is there and she is wonderful and open and will consult with you. Just have all the papers with blood tests etc ready. I'm very surprised they let bully go home already after the transfusion, Kent was always kept for 3 to 5 days, and checked throughout that time. Bully needs you to fight for him now, he doesnt have the energy. Expect him to just want to rest alot, and eat a little til he feels better. I wish there was more i could say, you are doing all you can. I cant tell if you posted the pred doseage and bullys weight, and the amount of the drugs he is getting? that may help some of us help see if there is something. Was he tested for any tick diseases? Please hang in there, Thinking of you both, Christine and Kent

Christine Fl

Mitch, I am really sorry you are having such conflicted feelings. It's really hard to be so happy about her eating and seeming to perk up and then hearing the vet be so negative. I, too, would not recommend the cytox. It is out of disfavor for the most part. Your vet seems not to understand how cyclosporine takes a bit of time to actively suppress the t-lymphocytes. It's different for each dog, but it took almost a month for Chance to respond to this drug. That said, when Dr. Dodds prescribed this for Chance, she had us on a monday through friday schedule at a very high dose with no doses given on saturday and sunday. This is called pulse dosing and is meant to help the body respond better to the med. Perhaps that is what your vet is thinking. If your reticulocytes are around 5%, then he's very very regenerative. That is a positive thing. Sometimes a side effect of frequent transfusions is a kind of "suppression" of the bone marrow's production. It thinks there are enough rbc in circulation so its not as prone to attempt high levels of regeneration. Has this vet asked about doing a bone marrow biopsy? This would rule out one type of cancer. Has a blood smear cytology been done? I would consider this essential. You said they already ruled out abdominal tumors with an ultrasound? I think your vet may be feeling this way because they may not be exposed to such an aggressive autoimmune case very often. If they are not board certified as an internist, they may have little actual official training other than generalized exposure in hematology. Vets can develop very good clinical skills from experience so being board certified isn't always necessary. If this were me, I would try to gently "sound out" the vet to see what level of experience they really do have. If they only treat a few cases a year, you may need to find someone who has more experience and training. I would find out what they think plan b is for the weekend. If they seem a little lost, try to develop your own plan b. my best patrice

Patrice NYS

Mitch I am keeping you and Bully in my prayers and hope and pray he can turn the corner soon. Try not to be to depressed around him as I think dogs can sense this, I do know how hard it is to be happy when your best friend is fighting for his life. When Ginger was first diagnosed in 2007 her PCV did not go up at all while she was on the pred. only so her vet added 50mg of the azathioprine and after about a week it slowly began to rise. When she had her relapse this summer due to vaccinations and surgery she was put on cyclosporine and that took about four weeks before it really began doing its job. I might mention the azathioprine again to my vet and consult Dr Dodds. I think you did the right thing in allowing him to have another transfusion as that buys time for the meds to begin to work. Keep us updated. Cheryl & Ginger

Cheryl & Ginger Pineville PA

If you are having a problem getting him to take his meds try putting in the middle of a teaspoon of icecream. Tessy loved the icecream idea. Try cooking him a roast or some liver....she also really loved this when she wouldn't eat anything else. Boiled chicken could be another option. Keep a good eye on her this weekend and try to keep her rested and try to minimize excitement. When Tessy came home I told all of my family and friends to stay away for awhile until Tessy started coming around. This helped her to rest more. I also made a makeshift bed up on the livingroom floor so the both of us could lay there at night and watch the TV. She also thought this to be a treat. Remember that he will probably be really thirsty. Try to keep some clean cold drinking water near him at all times. This will help....but be prepared to let him out often for pees. Anyhow, if you have any questions just ask. We'll do what we can to help. Johnny & Tessy

Jonathan

OK lots of good info here. lemme see if i can answer some of the q's and maybe it'll help. 1. Bully was about 24 lbs when diagnosed. he dropped about 3-4 lbs in the past week. 2. He's been on 20-25mgs of prednasone a day since Monday before last...about 11 days. He's also been on cyclosporine for about 7 days (not sure of the dose, currently out). 3. He was tested for tic born diseases. negative. he's been on an antibiotic for them just in case. yesterday was the last of the 7 day course. 4. He has had xrays and ultrasounds of his abdomen. his liver and spleen were both enlarged. aspirates were tested from both. no cancer cells. no masses. nothing malignant could be detected. 5. His rbc was 18 11 days ago...12ish when he nearly crashed four days after that. his rbc went back up to 14 one week ago after two transfusions of gammaglobin (sp?). that day he was sent home after staying overnight and started on the cyclo. 6. he's been on an iron supplement liquid for about four days. i don't think bone marrow tests were done. don't know about the cytlogy but i would assume it has been done. i'll try and find it on the paperwork. These vets (we've dealt with a couple different ones at this clinic) do seem to be very familiar w/the various forms of IMHA. So it is dangerous for him to be on the cytox? she's already given him one dose and we were just scheduled to give it to him three more days. If it's really fallen out of favor i'm a little shocked our vet would be suggesting it. (she's also mentioned spleenectomy as last resort but isn't sure it'll help and doesn't think Bully would survive it in his current state.)

Mitch L Goldman Cape Elizabeth ME USA

Mitch, Pred dosage is correct: 2mg/kg divided into two doses. The one thing that I missed asking was about any tests for thyroid function? At this advanced age, that would be extremely important and can significantly contribute to this. My dog was hypothyroid and is now on two small pills a day. Here is a snip from Dr. Dodd's AIHA protocol: "*Do not use Cytoxin, Oxyglobin - studies show a decreased survival rate with these drugs." If you would like the whole protocol, email me and I will send it to you. Some vets love to have this to reference and would enjoy conferencing with Dr. Dodds. Other vets will look aghast that a patient would advise them to consult with her. It's never easy to tell which reaction you will get. Dr. Dodds saved my dog's life and my vets were ecstatic to be working with her. He might just be too sick for such a complicated and extensive surgery. My dog had his spleen removed along with a large mass several months prior to his developing IMHA. It was a long surgery and the recovery was over several days. This procedure, to remove the spleen in cases of autoimmune destruction, is sometimes used, but not widely. A vet hematology textbook I have says that there isn't sufficient evidence that this really is beneficial. How much iron is in each dose? Be cautious of an overdose. Doxycycline is the med that they used to treat the possibility of a tick disease. It is a very tough med on dogs, making them feel ill and inappetant. It can create the conditions for stomach ulcers as well. However, it is generally the only effective drug against most tick diseases and must be used at a high dose to be effective. Often the dog will respond very quickly to this drug if there is a tick disease. If nothing has happened in 7 days it was either too low a dose or indeed, the diagnostics were correct that there was no tick borne diseases. It's no wonder he has lost his appetite. Gamma globulin is generally a human med but can be used in animals in cases like this. There is a canine version that is pretty pricey. I was given this option, but Dr. Dodds advised that we wait on it. Here are two references I was able to find on the internet: http://www.cababstractsplus.org/abstracts/Abstract.aspx?AcNo=20043015672 "Intravenous administration of human gamma globulin (IVIG) combined with other immunosuppressive drugs (such as prednisolone and azathioprine) has been recently reported to treat canine IMHA. The efficiency of the IVIG was uncertain and the therapeutic mechanism was still not clear." http://www.find-health-articles.com/rec_pub_7540607-treatment-nonregenerative-anemia-human-gamma-globulin-dogs.htm "Human immunoglobulin may be an effective treatment for some dogs with immune-mediated anemia that fail to respond to conventional treatment." In general you are not going to find a standardized treatment for this condition. Drug companies have not done extensive research on "off label" drug use for canine AIHA. Most treatment protocols come from clinical experience using these drugs off label. If a certain practice uses something and it is successful a number of times, they will continue to use it. Your vet has probably had success with gamma globulin and cytoxin, so thus they are using it now. It's hard not to want to second guess their every move. I know I would. But you should get a feeling about them, do they seem to care and appear knowledgeable? my best patrice

Patrice NYS

I can't really tell how much the iron dosage is. it's a 2 ml dose twice a day of a liquid. I'm a little worried about the cytoxan now that you mention Dr Dodd's reference. I did some sniffing on the web and it seems like it is used with some regularity so i get the feeling that there isn't great consensus on it. In any case he's had one dose and he's supposed to get another tomorrow along w/the prednasone. I have a feeling the antibiotic you mention wasn't helping Bully's appetite. He's actually eaten a bit tonite..he had some ice cream (great reccommendation!) and some chicken baby food. and a couple of treats. the vet said he ate in her office as well, so this is the most he's eaten in like a week i think. (part of the vet's pessimism was his loss of appetite...his "condition" as she called it, his age plus being weak and suffering from weight loss and no appetite, made her less sure of a recovery, vs. a younger, better-eating dog). btw i made email contact with Dr. Dodds' assistant who sent me mail within minutes (amazing!). the Dr is out of touch till sunday but bully is stable so if we don't talk till then i think it'll be ok. Finally, do our vets seem to know what they are doing? they do, to me. this is a "specialist" clinic, not our regular vet. these same vets treat another dog of ours with a very rare disease, polycythemea...ironically she makes way too many red cells....anyway these vets had actually treated cases of this before, and it's so rare our regular vets had never seen it outside of textbooks...so that gave me some confidence in them. they specialize in advanced treatment..they're not the vets you go to for regular checkups and vaccines. So yeah, they seem smart and caring. that doesn't mean they'll get Bully better, of course. btw i just wanna say thanks again to everyone who has posted here or sent me mail. it is unbelievable to me to get so much support from a discussion group. i only hope i can repay the favor in the future and help someone else get through this a little bit easier.

Mitch Goldman Cape Elizabeth ME USA

This thread was discussed between 08/03/2009 and 14/03/2009

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