Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Raven: A request for hope

I'm so worried. Last week I went in to the vet expecting Raven would post good PCV numbers since her appetite returned and she even had a little "spunk" back. Initially, they said her PCV was 13, and then rechecked it to be 17. Transfusion followed on Thursday, and she's taken a dive since then. Her appetite is down, and her hind legs are so weak she can't get up if she's on a hardwood floor. I called the vet today, and said something must change. We're reducing her pred slightly (from 60 mg/day to 40 mg/day), and starting her on cyclosporine in addition to the aza. I'm begging her to eat, and she's got pretty bad diarrea. (Has anyone found a diet that works? One of the things that scares me is that she's eating less on the pred -- as many of you know, that doesn't really make sense.) Please pray for Raven; this last turn has been devastating.... Thanks to everyone for your words of hope for the past 5 weeks. I love her SO much...and know how everyone here can relate. Sharon

Sharon CT

We are keeping Raven in our prayers. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Dear Sharon, I can sense your anxiousness. I am hoping that this is just the low point and there is an upturn very soon. I remember at one point asking my vet to lie to me if she had to in order to make me feel more optimistic. Chance had been on cyclosporine for about 3-4 weeks and we had seen nothing. We were on our third transfusion. She came back in with the cbc results and said, "I don't have to lie to you, look at how good these results are!" Up until then I had been thinking that it might be time to stop the treatment... It had been over two months and we were all exhausted from worry. No one here can tell you what to expect or what to decide to do. How long have you had Raven on the cyclosporine? It does take longer to work, in our case 3-4 weeks. The good news is that once it begins to work, the side effects will be less than with the prednisone. And then you will be able to slowly decrease the prednisone. I am a little worried by her upset tummy. This can be the one side effect of cyclosporine that is bothersome. Your vet may be able to help you with dosing instructions to ease that a little. If she continues to have diarrhea, you will have to treat it or it will weaken her further. Ask your vet about using metrondiazole for a short period of time and see if they think it will help. I have used this for Chance many times and it always works well. Transfusions sometimes can cause some problems. There can be reactions to the blood that was used. Dog's blood is very hard to match up, there are 11 different types. If you need to do another one, make sure that it is properly matched. Do things around the house that are routine, try to stay cheerful and optimistic for Raven. If she senses you are sad, she will respond in kind. Try making a little egg omelet with some butter. Put some little pieces of meat in it. Cut it in small pieces and try to hand feed her. Very few dogs will resist that smell of butter. Keep the meals small and frequent. Dogs do quite well with protein and eggs are an excellent food for them when they are sick. I wish I could give you a hug to reassure you that you are doing all the right things. This is very very hard, it was the hardest time in my life. You will know what to do, it is already in your heart. with much love patrice

Patrice NYS

Sharon, You and Raven are in my prayers today. I've been through this and I know just how difficult it is. Thinking of you and hoping for the best, Leslie

Leslie Oceanside

Sending positive thoughts to you and Raven....

Courtney SLO

Thanks, everyone. The doctor called today and doesn't want to put her on cyclosporin because of her weight loss, and its side effects. So now she wants to do a spleenectomy. She's so weak...and I'm scared. Has anyone else done this? Thanks again for all the good thoughts...best to you all... PS: Patrice, thanks for always giving such insightful advice.

Sharon CT

Hi Sharon Did the vet say why she recommended a spleenectomy, does Raven have a mass and would it be possible for you to get a second opinon? We are continuing to keep Raven in our prayers. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Sharon, I am sorry to hear that Raven is not responding well. This is from Joanne's website SPLENECTOMY Splenectomy, the surgical removal of the spleen, is occasionally recommended for cases of autoimmune hemolytic anemia that have been nonresponsive to other forms of treatment. This surgery benefits the dog in two ways; less antibodies are made against the red blood cells and the primary organ responsible for the destruction of the red blood cells is removed. so even though she is very weak it could be a help to her. I will be keeping you both in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Splenectomy can be done in these cases. As with any anesthetic procedure there are risks and you should go into it knwoing that all of those ricks are. Having said that..the way my Lola was...had surgery been an option in her case I would have done it. Lola's spleen was just so large and angry and she was too weak for it. Know that whatever decision you make, it is right for you at the time.

Courtney SLO

Sharon, In the many years I have been familiar with AIHA/IMHA, I have seen only a very few dogs have a splenectomy done. However that is not to say that it has not been done in some cases. This site http://www.vetspecialistrx.com/encycEntry.cfm?ENTRY=90&COLLECTION=EncycIllness&MODE=full says and I quote: "In some IMHA-patients that have failed to adequately respond to medical treatment, surgical removal of the spleen may also be considered. This invasive step is seldom performed, although there are some reports that indicate it can be associated with a high degree of success. Because many patients with IMHA are in such critical condition, the risk of general anesthesia may be too high." End of quote You might want to ask your vet how many splenectomies your vet has done for patients with AIHA/IMHA and what his success rate with that procedure has been. Be assured I am keeping you and your dear Raven in my thoughts and prayers.

Joanne MN

Sharon, I don't have much time to write now but I wanted to respond to your question asap. Chance had a splenectomy first, before developing AIHA. He had a very large mass on his spleen that was benign. The surgery was successful. It was about 2 months later that he developed his non-regenerative anemia. Were the two things related? We will never know. The most important thing you should consider is if Raven can actually handle this very complex and difficult surgery in her condition. If this were me, I would want to know absolutely for sure if there is a mass. If there is, I would want to know how big it is and if there is a danger of rupture. You are weighing the danger of leaving a mass in versus the danger of a very complex surgery. The other scenario is that in some veterinary texts, the recommendation is to remove the spleen to stop the destruction of red blood cells. The spleen provides (as one of it's functions) a function in the body to help eliminate foreign invaders like tick diseases. It does this by damaging red blood cells that it identifies as carrying something "not self" like a tick disease. The spleen and the immune system can become confused sometimes and begin destroying red blood cells when it can't tell what is "self" and "not self." This is why, in theory, some texts recommend the removal of the site of the most destruction. The textbook that I have read: Schalm's Veterinary Hematology, mentions this operation, but advises that it has not been shown to be highly successful. I would ask your vet if this is the reason they want to do this surgery. If it is, is your vet a specialist? If not, ask if they can set you up for a second opinion (very quickly) with a specialist. If you have time, ere on the side of caution. If you do decide to go ahead with this surgery, ask your surgeon if they are prepared for a safe transfusion. Also ask if they understand DIC disseminated intravascular coagulation and if they are prepared to treat this emergency during surgery. my best patrice

Patrice NYS

We are thinking of you and Raven in this difficult time and wishing you both the best. Chris & Alex

Chris PA

This is an excellent article about DIC, but is very complex to read and understand. If you are interested, just scan it to get the general idea of what happens and note the treatment advice at the bottom to understand how vets prepare for this possibility. http://www.vin.com/proceedings/Proceedings.plx?PID=2596&CID=WSAVA2002 patrice

Patrice NYS

Hoping and praying for the best for Raven, you are in our thoughts~ hugs, melissa and tiggs

melissa slc

Sharon, I'm so sorry that Raven has had this backset. I will be praying for both of you. Karen

Karen NC

Thanks, everyone. You are all so helpful and so kind during this incredibly difficult time. We had a meeting with two specialists and both are recommending the surgery. The tough part is that they think they might find cancer, which as they said, "would help me make a better decision." In short, we'd stop torturing her with these drugs and know the end is inevitable. If they don't find cancer, then it's a tougher decision on what to do next and wait-and-see how an 11-year-old lab will recover from such an invasive procedure. Without it, she likely won't recover at all. As they said, no easy decisions here. I have to make the decision before 7 a.m. tomorrow. (Surgeons only operate Wed/thurs, so can't do it next week due to Thanksgiving holiday.) Two weeks delay may be too much. Please pray I make the right decision...it will be a long night....

Sharon CT

We are praying for you and Raven. I'm so sorry you are faced with such a decision. I have faith that your heart will tell you which way to go. Whatever the decision it will be the right one for Raven. Take Care, Chris & Alex

Chris PA

Sharon, I am confused. Have they seen an x-ray or an ultrasound that leads them to believe that there is something on the spleen? Or do they just think that there is something in there? Has Raven's weight increased quite a bit in the last couple of months? Look, Chance had a visible mass on his spleen on his xray and I was told by my vet it could be an hemangiosarcoma and to expect the worst. But they wanted me to have the specialist do an ultrasound. When he did the US, he said that he didn't see the kind of things he usually sees with this kind of splenic mass. He advised us to have it removed immediately. My local vet did the surgery.... we waited a week for pathology... and it returned "benign hematoma." My vet said removal was curative. Chance was fine for about 2 months. I have done plenty of research on these splenic masses and in many case *they are benign.* Removal is a good thing and a dog can live quite well without a spleen. If I was a betting woman I would say that there is a 60% chance this will be benign. They can be malignant and they will know right away as soon as they see it during the surgery. If it is a hemangiosarcoma they will want to know if you want to close her without removal and let her go home for the short time she has left or if you will want to have her put to sleep right then. I was prepared for this eventuality with Chance. Once I saw the mass, I knew that it wasn't a malignant tumor. They didn't have to tell me they thought the same thing. I wish I could help you make this decision. This is something your family will have to talk about tonight. I will be thinking about you most of the night. patrice

Patrice NYS

Our thoughts and prayers are with you and Raven. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Hi, Patrice. Yes, they see something abnormal on both her spleen and her liver now (that's new). The main thing of concern is that she's lost so much weight -- and that she has no appetite. In short, she's sick, and they said most IMHA dogs are acting fine. She can barely get up now because she's so weak. If it's cancer, you're right -- they would take Raven off the drugs and send her home with me to love her until the end. At this time, I'm leaning toward the surgery with the small hope that she may be able to stick around for just a while longer...even a few more years. I just don't want to be selfish or naive about this.

Sharon CT

This may be a silly question, but if they are seeing things on film that lead them to think you may be dealing with cancer, is there any chance they could do a biopsy instead of going straight to surgery? I know you're concerned about how such invasive surgery could affect an older dog; it's just a thought. I'm thinking about you. Elizabeth

Elizabeth Baltimore

Sharon, I know whatever decision you make will be the right one. Raven knows that you love her and she will help you decide. Thinking of you both Penny

Penny Lytle Creek Calif

Praying and hoping so hard for you and Raven tonight. melissa and tiggs

melissa slc

This thread was discussed between 17/11/2008 and 20/11/2008

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