Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Rex

Where to begin?...Our 7 yr old cockapoo, Rex, who I consider my fourth child, was diagnosed less than two weeks ago (2/18/10) with IMHA, which I believe is the same as AIHA. Since then, our family has been on an emotional roller coaster. I have been surfing the internet to find any and all information related to this horrible disease! I'm so thankful to have found this web site, for informational purposes as well as personal reasons. We became concerned that Rex was not eating and appeared lethargic for almost two weeks, seeming "depressed" and weaker each day. It wasn't until our seventeen yr old son observed Rex's urine to look "reddish-brownish" that we called our vet to be seen immediately. Why it took us this long, not sure? I feel guilty about it everyday! We thought he was "depressed" after my parents left our home after a 2 month "holiday" stay. It was common for Rex's eating and sleeping habits to change after their visit. At Rex's initial visit, our vet said his gums were very pale and his eyes appeared "jaundice-looking" and he was experiencing anemia, which could be caused by one of three things - tick fever, internal bleeding from possibly a tumor, or IMHA/AIHA. He took some blood and although the blood was going to be sent out for complete analysis, our vet told us that he suspected IMHA/AIHA because his red blood cells were "clustering/clumping" together. He also told us that his levels were at 20% and could possibly drop even lower by the next day or two. After immediately beginning Prednisone and Azathioprine, his levels went up to 24%...only to go back down and hover around 20%. At one point, we were informed that we should be prepared to make some decisions, should his levels not improve. Last week Thursday, 2/25/10, although his levels had not gone up, our vet said he saw some encouraging news...that the serum was clear and that meds seem to be working in that it appears that Rex's immune system has halted attacking his own RBC's. On Saturday, 2/27/10, decreased Azathioprine dosage to 1/2 pill once a day, cont'd same dosage and frequency of Prednisone. Added Pepcid 2x/day. Rex was seen yesterday, 3/1/10...his levels went up to 24%, no longer observing autogl??? (clustering/clumping),gums and eyes are pinker. Yesterday was a good day, but I'm worried about how decreasing dosages and eliminating medication may have a reverse effect. It's difficult to enjoy today's good news, when you're worried about tomorrow...but I am learning that this is a "day by day" disease and trying my best to deal with it in the most positive way possible! Thank you for letting me introduce you to our Rex...and for helping our family get through this difficult, confusing time!

Kapri Arizona

Kapri, I am so sorry to hear about this sudden illness with Rex. You have found an excellent forum to obtain information and gain support for helping him. Your vet has taken some very appropriate steps in diagnosing and treating his condition. Both of these drugs are normally used in this way. It does sound like he is responding well to this treatment. My own misgivings are that perhaps neither drug should be decreased so soon in this process. Sometimes when you are working with a vet, it is your relationship that guides you in how to proceed. Do you have the feeling that this vet is a bit unsure of what will happen in the future but would be open to the possibility of a visit with a specialist to assist with the treatment? That would be my gut instinct of what to ask for. In most cases, there isn't a significant reduction in the dosages until there is a larger increase in the PCV packed cell volume (towards normal of around 37%) and the dog has stabilized at that level for a bit. However, it's hard to say without knowing his weight and the dosages you are on. He may be on extremely high "hospital" doses right now and it would be appropriate to drop to a lower, but effective, dose. Keep all copies of your records and blood work so you can track what is happening closely. We can help you with this if you post some of this information here. Do not give up hope, there can be great success with this treatment. my best patrice

Patrice NYS

Kapri, I am sorry you had the need to come to this site and that Rex has been diagnosed with this awful disease. The good thing is, you are pro active and seek help. Be assured, no matter what anybody says, there is hope! If you have not already found Joanne Dickson's Meisha's Hope site, please do so. Read and learn as much as you can about the treatment and also the success stories: http://www.cloudnet.com/~jdickson/ this website and the help of all the knowledgeable and compassionate people on this board were the biggest help in my journey with AIHA/IMHA. The fact that your vet has already started to decrease the Azathioprene, makes me wonder how much experience he has with the disease. You should either get a consultation with a specialist (internal medicine) or ask your vet to consult with a specialist or even better Dr. Dodds at hemopet. The fact that Rex is not clotting is a very good sign. Make sure Rex gets a high quality food. I always laughed about people that cooked for their dogs, but it is what I ended up doing! Fish, sweet potatoes, parsley, chicken, pumpkin, squash are good choices. Keep it lean to avoid pancriatitis. Here is a diet that has worked for a lot of dogs: http://www.canine-epilepsy.com/Liver%20cleansing%20diet.htm It felt good to put something good into my dog, not just these awful pills. We also started supplements. Dr. Dodds recommends petinic. This is not available of the shelf in Canada, so we ended up giving Vitamin B 12, iron and Folic Acid. It would be well worth checking Rex's thyroid levels. Even if he had no signs before AIHA, they might be low now and supplementing will improve his ability to build blood. This is it for now, I am sure many more will chime in with lots of suggestions. Don't be shy and ask, tell us what is on your mind. Most likely there has been somebody that has gone through exactly the same thing. Although every dog is a bit different. Stay positive and take it one day at a time. Best wishes, Brigitte

Brigitte BC Canada

Hi Kapri, I'm so sorry that you have to deal with this terrible disease with Rex. It surely is a roller coaster of a ride. You've got some great advsie above. I too would be concerned with reducing the meds too fast. Never more that 25-35% and only after the patient has been stable for more than two weeks (and usually only if the destruction has stopped). Unless there's something serious that would warrant a quicker reduction (liver/kidney/pancreatic problems/etc.). You should seriously look into adding milk thistle to the daily diet. You can get the powdered type in most health stores and this works really well to help protect the liver and in larger quantities the kidneys to a degree. Lots of dogs with this disease will inherit liver problems secondary to this disease due to the medications. Lots of us give all our meds to the dogs with lots of food also. Makes it easier on the body. What exactly have they ruled out thus far? Have they done ultrasounds/xrays, tick born disease tests, poisons/toxins (onions, rat poisons), recent meds (sulfatri antibiotics, estrogen, nsaids, etc), RECENT VACCINES, or any other concurrent health problems lately. If you can find a cause that would be super great. Idiopathic forms of this disease (no known cause) are sometimes harder to deal with cause we don't know what caused the disease so can't treat or prevent as easily. Nutrition is another biggie you can start picking at. Try to feed a higher protein lower fat diet with absolutely no corn, soy or wheat and always have fresh clean water available for Rex. Brigitte included a great link above to a liver cleansing diet created by Dr. Jean Dodds. Lots of us on here use this diet not only for the health benifits but also it is packed with blood building nutrients as well. You'll probably hear Dr. Dodds' name quite a bit on this site. She is literally the best in this field at what she does and most of us here would recommend sending blood to her for analysis and interpretation. I live in Canada and send blood to her occasionally! She also does breed specific thyroid testing!!! If you haven't had this checked yet then I'd also recommend you do this. INSIST on the vet to do this actually. Sometimes they say that the pred will alter the results but they have to do a FULL panel to get the whole picture. That's where Dr. Dodds comes in handy. Michigan State also does this breed specific testing of the thyroid. Anyhow, like Patrice was saying above...it's a very good idea to ask for and keep copies of ALL tests. Feel free to post results here if you'd like. There's sometimes things that the vets don't notice that maybe someone here might. I used to always post my results here for others to see and compare upon. Our resident expert Patrice is excellent at explaining the things we don't understand! Hang in there and know that you're not alone with this battle and that we're here to help in any way we can. Keep Rex calm, rested and stress free for now. This is key. Thoughts, best wishes and prayers for Rex. Johnny & Tessy

Johnny

Thank you Patrice and Brigitte for your best wishes and responses! It sounds like my gut was right...in telling me that I should be concerned about how quickly Azathioprine is being tapered. Honestly, at first I was concerned about Rex being prescribed Azathioprine (50mg/half a tab 2x/day). According to his complete blood screening, his bone marrow was working great and cranking out new RBC's, and I didn't understand why he would take a medicine that might affect that. Now that we've seen some positive results, I'm scared to make any changes involving his medicines. (Azathioprine reduced to 1/2 tab (25mg) once per day) Although we have been seeing the same vet for seven years, he had informed us that this is a rare disease, it's very serious and life-threatening, has only seen about 12-15 cases in his thirteen years as a vet, some more severe than others (requiring blood transfusions, hospitalizations, surgeries)in which most cases, the outcome has been poor. From a financial perspective, is it much more expensive to be treated by a vet internal specialist? I've gathered some contact info for several internal medicine specialists in our area. Wasn't quite sure how to approach this with our vet. Do I ask if they will consult with an internal medicine specialist or simply ask for a referral? I've seen the name Dr. Dodds mentioned, but can you tell me more please? It's funny you should mention cooking for Rex. Never did that before, but began cooking egg whites to increase his protein levels, and I agree that it does feel good to give him something he looks forward to. From what I've been reading, a special, nutritional diet is almost a necessity for dogs with IMHA. Also, thanks for the "heads up" about checking Rex's thyroid levels. Thank you for sharing your ideas with me! Kapri

Kapri Arizona

You know veterinary teaching hospitals/schools are usually much cheaper than specialist and better some would say! I do think though that your best bet would be to contact Dr. Dodds. She'll do phone consults with your vet for fairly cheap. Just tell your vet that you'd like to consult a internal specialist and Dr. Dodds is the one you'd like to consult with. Here's her web info... hemopet.org Check the site out and send her an email. Try to keep it brief but precise because she's a busy lady but she'll always find time to respond! She's truly a great woman and a Godsend ot many of us on here. Good Luck. Johnny & Tessy

Johnny

Thanks Johnny! I can't believe how much I've learned in one day! Such great information! Milk thistle & thyroid check on the list now. So far, ruled out tick born disease/fever. Rex was initially prescribed Doxycyline for tick fever and told to finish prescription (two weeks), as this was an antibiotic that wouldn't hurt to take. Rex hadn't received any vaccines or prescribed new medications lately. Ultrasound/xray suggested, but not done. They did draw liquid from belly to be sure of no internal bleeding. Urinalysis showed kidneys functioning ok. I'm not sure if diet or stress was a factor. My parents, who he's very attached to, stayed with us for two months and his diet & sleeping patterns changed during their stay. My mom would "add" to his dry food. Honestly, I haven't had the courage to ask my mom if she ever fed him onions. She has been questioning herself if she is to blame for changing his diet already. Also, not sure about a bee sting. We do have several bushes out back that I frequently notice bees, and it could be a possibility. Are there ways to check for toxins after several weeks of onset? Does Dr. Dodds have a web site or link? Thanks again, Kapri

Kapri Arizona

I'd be asking for an xray and ultrasound so that you can rule out certain things (neoplasia, cancer, pneumonias, zink toxicity (coins), pyometra, etc.). I'd also be wanting to know if the mother might have fed onions to him. How long after your mother left did the symptoms show up? Yeah, stress can be a trigger for this disease as well as a simple little bee sting. The body may have had a reaction to the bee sting. I'm not sure what tests could be done to determine this. Check the body maybe for sting sites? You should get full copies of all blood tests done....CBC's and chemistry panels. Dr. Dodds email is ... hemopet@hotmail.com I put the website above in case you want ot check out some prices of certain tests. I usually ge the profile 7200 done. It's basically everything you'd need for only $115!!! Can't go worng with this! www. hemopet .org/files/TRF.effective_2010.01.01.pdf ...remove the spaces

Johnny

Kapri, Sorry that Rex has been diagnosed with this awful disease. Don't beat yourself up for not noticing things sooner. We have all been there. It is quite possible you may never learn what the trigger was so let go of that too and concentrate on the now. It can be an expensive disease to treat but it sounds like Rex has avoided a lot of things one can experience early on that require lengthy ER stays. I am tired of vets saying this is a "rare" disease. All you have to do is look at this board and count the number of new diagnoses constantly. Start a journal either on a spread sheet or even the old fashion notebook way, There is so much you will be learning and hearing it is nice to be able to chart it so you can have a reference mark. Be sure to write down your observations of how Rex looks and acts on any given day. You will be surprised at the clues you pick up on and don't be afraid to be Rex's voice if you feel you need an outside consult do it. Hopefully your Vet will be open to this. Keep us posted. penny

Penny Lytle Creek Calif

dear Kapri, I am so sorry to hear of this scary diagnosis for Rex. I can't add anything more to the great advice above, just take it slow with the med reductions. All the best and keep us updated, Sam and Millie.

Samantha Geelong Australia

Just checking in to see how Rex is doing. Hoping he's getting better. My thoughts and prayers are with him. Johnny & Tessy

Johnny

Dear Kapri I am so sorry about Rex's diagnosis - I think we all remember when our dogs were diagnosed, not having a clue. I wish you all the best with Rex and his treatment, and I hope he is one of those who will do really well. All the best, like others say, keep records to help you better keep track of results and treatments, it will help you identify possible trouble spots, also the improvements, you will become an expert. This is a great site, lots of well informed dog owners here. Silka

Silka Melbourne Australia

Hello Everyone, First of all, I would like to apologize for not getting back to you sooner. I've been attempting to return some "normalcy" to this family, and I've only been able to work on that because I'm happy to report that Rex has been improving over the past week and a half. At his last vet visit this past Monday, 3/8, his PCV level was 35%. Thank you everyone for your prayers, best wishes and great advice! It has definitely helped Rex and our family get through the past month. Although I'm ecstatic about his improvements and happy to observe the "life" return to Rex, as I observe behaviors I haven't seen since the beginning of February, I'm still very nervous, concerned and not confident in our plan to reduce his medications. I contacted Dr. Dodds and she replied very quickly with her recommendations and some valuable information to share with our vet. If you don't mind, I'm going to outline his past visits and hopefully update you on Rex. As usual, I would welcome and appreciate any feedback. Thursday, 2/18 - Initial visit. Suspected dx: IMHA/AIHA, possible tick fever. 33.5 lbs, PCV-20%, autogglutination (sp?)observed Rx: Doxycycline (100mg, 1 tab 2x/day), Prednisone (20mg, 1 tab 2x/day) Friday, 2/19 - 35.4 lbs, PCV-24%, autogglutination Add Azathioprine ( 50mg, 1/2 tab 2x/day), increase Prednisone (20mg, 1-1/2 tab 2x/day) Sunday, 2/21 - 37.5 lbs, PCV-21%, autogglutination *Tuesday, 2/23 - BEHAVIORALLY, WORST DAY! 39.7 lbs, PCV-20%, autogglutination *Thursday, 2/25 - MARKED IMPROVEMENT! 41.1 lbs. (gained 8 lbs), PCV-20%, No autogglutination-clear serum. First day observed pinker gums, eyes-not yellow. Moving around a little quicker! Decrease Azathioprine (50mg, 1/2 tab 1x/day), Add Pepcid (10 mg, 2x/day)

Kapri Arizona

Cont'd outline of visits... Monday, 3/1 - 38.2 lbs, PCV-24% Discontinue Doxycycline, Add iron supplement. Vet recommended liquid iron, but Rex didn't cooperate. Vet recommended to try PetTab vitamin supplement. Thursday, 3/4 - 36.6 lbs, PCV-30% Asked about thyroid testing. Vet confirmed already done and negative. I mentioned concern about thyroid and liver damage and inquired about adding milk thistle per recommendation. Add SAMe supplement (1 tab, 2x/day) Monday, 3/8 - 36.1 lbs, PCV-35% Decrease Azathioprine (50 mg, 1/2 tab every other day) - (HAVEN'T DONE THIS YET) *Informed we can reduce visits to 1x/week (Next appt: Mon, 3/15) Current concerns: Reducing Azathioprine too quickly, not reducing Prednisone dosage yet (currently taking 60mg/day), Dr. Dodds felt Azathioprine should not be reduced yet, but Prednisone should be decreased in "step-wise fashion", losing weight w/active appetite (due to increased energy or frequent urinating?), weak hind legs (can't jump on couch, shaky or some difficulty when defecating), abdomen appears swollen (like pregnant) Sorry if this is TMI (too much info), just wanted to get caught up and see if there's any flags out there or suggestions or advice for the next few weeks. Once again, thank you for sharing your experiences and knowledge! I can't express to you how relieved I feel to be informed versus "lost" and "hopeless." I've been trying to read older posts so that I may come to know each of you and your experiences, so that I can hopefully return the favor and be there for you as well! Many thanks & best wishes to all of you, Kapri & Rex

Kapri Arizona

Kapri, that's great news! A PCV of 35% is very good to have and I think you and Dr. Dodds is right about reducing the pred first. That's quite a large dose to deal with. If I were you I'd be wanting to start reducing htis first. You could start with going from 60mg to 40mg. That's only a 33% decrease so fairly safe. Dr. Dodds had Tessy doing weekly reductions in pred. I kept it fairly conservative to prevent complications. Tessy at her max was only on 50mg pred and she weighs the same as Rex. With such large amounts it's important to lower this before the symptoms become worse. Is REx still taking 50mg azathioprine daily? or is it 25mg now?

Johnny

Kapri, I also concur with Dr. Dodds and Johnny in slowly reducing the Pred first if in fact Rex is handling the Aza without undue side effects. It is very surprising to see his PCV rising this quickly after only three weeks Your vet seems to be right on target with his treatment. you are most fortunate to be in such good hands. also rest assurd that the side effects he is experiencing is normal considering the medications and doses he is on. One last thought, the more information you provide the more any of us can help. Never feel you have given TMI. Keep up the good fight, we wish you the very best. Ron & Cooper

Ron Florida

Good morning Johnny, Rex is still taking Azathioprine (50 mg, but 1/2 tab...so 25mg) 1x/day, but wants to reduce it to 25mg every other day. Like you, I'm also concerned about the high dose of Prednisone. Our vet mentioned that we may reduce it in one to two weeks. If his PCV continues to rise or remains steady at 35%, do you think it would be okay to ask about reducing prednisone at next appointment, which is this coming Monday? Which symptoms in relation to high dose of Prednisone are you referring to?

Kapri Arizona

Yeah, I'd be asking about reducing the pred Monday at the appointment. Usually larger doses are only needed in the initial stages of treatment to help control the disease and then are usually tapered off after the PCV becomes stable for a couple weeks. 60mg is a large dose and even if you were to be down to 20-30mg that would IMO still be considered an immune suppressing dose. Especially considering you are still giving the azathioprine. I'd focus on getting the pred to a lower dosage before you adjust the azathioprine. It is HOWEVER important to get blood wrok just to make sure the numbers are all good with respect to HCT, RBC, HGB, etc. and also that there are no spherocytes present. In either case though I'd say that 60mg is just too large a dose for the situation you are in with a PCV of 35. It's important to get to the lowest possible dosage that results in an adequate clinical response. Symptoms of pred.....usually the noticable ones would be musculo-skeletal issues (muscle/ligament wasting), liver damage, kidney problems (from salt retention), gastrointestinal issues, ..... to even other less common problems like diabetes, fluid/electolyte disturbances, endocrine problems (cushings, secondary adrenal insufficiency, hyperglycemia, etc), neuropsychiatric (usually not seen by the parents but often present probably...headaches, psychosis, mood changes, etc.), dermatologic issues (Tessy had these but I suspect the cyclo was the culprit...pimples, staph, thinning of the skin, etc), eye probelms (glaucoma, blindness, etc)...............these are all fairly rare but a possibility none the less. All the more reason to reduce meds when safe to do so.

Johnny

Hi Kapri, I just wanted to wish you and Rex all the very best with this illness, and hope the next stages go well for you - the numbers sound like good improvement, which is very hopeful. Good luck! Silka

Silka Melbourne Australia

I took Rex in yesterday and his PCV rose to 40%. Our vet reduced the Prednisone to 40mg/day (20mg-1 tab 2x/day). He still thought we should reduce Azathioprine to 25mg every other day, but I convinced him (showing Dr. Dodds email and report) to hold off a little longer. At our next appointment, which is in a week, planning to do a full CBC again. Is this similar to the 7200 test that Johnny has referred to? Will a CBC provide lymphocytes, spherocytes and thyroid information? Also, I've seen some recent threads about Pet Tinic. At one point, our vet recommended this, but wasn't sure how to give it to Rex, as it was in liquid form. Instead, I bought a multivitamin, Pet Tab, that he gets 1 tab daily. Almost the same regarding milk thistle...instead of powder form, he was prescribed SAMe which has milk thistle in it. Should I reconsider these and be mixing both Pet Tinic and milk thistle (powder form) with food or water? I'm happy to report that several "normal behaviors" are returning...running and barking with sound of doorbell, stealing socks that are left around, doing his "dance" when excited about eating or playing, and don't laugh...even trying to hump my husband's leg. However, I am still very concerned about his apparent weakness in legs..not able to jump up on couch, unstable when going #2 (shaky legs), sometimes laying down because he seems too tired to stand...Is this leading to something else? I know that the Prednisone can cause muscle weakness, but should I be concerned about something more severe? The weakness I'm observing is different from the lethargy observed in the beginning. When he was at his weakest stage a month ago, he was still able to jump on couch. I miss seeing him "comfy" on the couch and cuddling with him each night after everyone goes to bed. @ Ron...our vet has been very supportive, encouraging, and enthusiastic, but he has honestly told me that he has never had a dog make such quick progress and this is new territory for him. In fairness to him, he informs me that he does consult with an internal specialist, does his research, and is open to me asking questions and sharing what I've learned from all of you and Dr. Dodds. As grateful as I am to have a cooperative and supportive vet, I'm very thankful such an educated support group that include all of you!

Kapri Arizona

This thread was discussed between 02/03/2010 and 16/03/2010

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