Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Squidge Pup - Not doing well

My Squidge Pup was diagnosed on 06/22/10 with AIHA. It came on suddenly ;she had collapsed several times over the weekend which prompted a visit to the vet the following week. She is a miniature daschund, my first dog that I can call my own, my original baby. She is overweight, not the most energetic dog, but when she fainted, I knew she was not well. My vets confirmed anemia through blood tests and started her on AIHA treatment before it was confirmed, which I am thankful for(Her crit went from 45 to 20 since her annual check-up May). She goes back to the vet this week for follow-up tests to determine if the current treatment is helping(prednisone and antibiotic). I am a pharmacist so I understand the treatment and her prognosis, and I have kept a close eye on her condition. So, with that being said, I am greatly concerned at her continued loss of energy and her lack of interest in food and bathroom duties. But for financial reasons, we have to be sensible about her treatment. I love her dearly, as do my husband and 2 children who came after her, and we hope to share a success story with all of you soon. My question is, where does one draw the line? Of course I want to do everything in my power to help her, but when do I say enough is enough...there is no more I can do? I am prepared for the worst and hoping for the best, and we are all giving her as much love and comfort as humanly possible, and it breaks my heart to see her too weak to walk outside on her own. I don't want her to suffer, and I don't want all of us to suffer either. Any input would be appreciated as she is my first family dog(with my own family) and I have never had to deal with these types of issues on my own before(my first family dog passed away several years ago when I was at college; she was more my dad's dog in the end). Thank you. Molly and family

Molly Johnson Ohio

Molly, I am so very sorry to hear your most belove Squidge Pup has recently been diagnosed with AIHA. While AIHA is a very difficult disease dogs CAN and DO survive it and go on to live happy healthy lives. My own Meisha was proof of that as are all the dogs on the Success Stories pages at my Web site: http://www.cloudnet.com/~jdickson/ If you have not read these Success Stories as yet, I would urge you to do so. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. At this point I would not even be thinking of "what if this does not work". There many other treatment options in addtion to prednsione and most dogs have to be on another drug such as Cyclosporine or Azathioprine in addtion to the pred. Has your vet mentioned these treatment options to you? Since you are a pharmcist I am sure you are very familiar with these medications. 20 is not that low of a PCV I have seen dogs with PCV's as low as the single digits, one dog as low as 3.. yes 3 who have gone on to recover and do very well. I know this is so hard so be assured you and your dear canine companion are in my thoughts and prayers during these most difficult days.

Joanne MN

Dear Molly, I am so very sorry to hear of Squidge Pup's diagnosis. Please do not give up hope - dogs do survive this disease. I agree with Joanne that you should investigate the use of a second immune suppressant drug - such as Azathioprine or Cyclosporine. My dog Millie is a survivor - she was diagnosed 17 months ago, and is going so well today, you'd never know she'd been so very sick. Prednisone and Azathioprine worked for us. Dexamethasone intravenously can be given at the onset of this disease to give the Pred a head start at suppressing the immune system. Also, is Squidge Pup on a stomach protectant of any sort? I urge you to make sure that your vet has experience treating this disease. It wasn't until I got Millie to a specialist Teaching hospital in Melbourne, that we finally got on the road to recovery. My regular vet just didn't know enough, and I'm sure we would have lost Millie otherwise. One other thing to consider is low dose aspirin to prevent blood clots. Many IMHA dogs are lost to clots in the earlier stages of this disease. Please speak with your vet about this. I'm sure my Millie had a mini stroke after diagnosis, we are very lucky we didn't lose her. As Joanne said, 20 is actually not that low of a PCV! My Millie was diagnosed at PCV 14 - and blood transfusions are an option if the PCV does drop too low. Do not give up on Squidge Pup yet - this is a long journey, but a fight that can be won. Squidge Pup will be lethargic and uninterested in food. It's important to get her on stomach protectants to prevent ulcers from the Pred. Has your vet done any testing to determine the cause? While it is true that a lot of the time a cause cannot be identified, it is important to rule out some likely causes. Has Squidge Pup recently been vaccinated? Did your vet test for tick disease? Did your vet do an ultrasound / X-Ray to check for any cancers? I would suggest regular PCV checks - when Millie was first diagnosed, we were getting checked every day / every second day. Keep an eye on her gum colour, and make sure she gets plenty of rest. Please keep us updated, and stay on here for support and advice. Thinking of Squidge Pup and hoping for a recovery for her, Sam and Millie.

Samantha Geelong

I too am sorry your dog has been diagnosis with AIHA. And I agree 20 is not that low of a PCV and you must give the drugs time to work ofter a few weeks or perhaps longer. It really has only been a very short time since your dog was diagnosis and treatment began. I would ask you vet about adding another drug such as Azathioprine or Cyclosporine, Ginger received both along with the pred. Would it be possible for you to get her to a specailist in your area, someone who has had experience with AIHA. Don't give up yet, there is plenty of hope for Squidge. Any improvement will come in very tiny baby steps, so don't look for a drastic change one day. Do all the reaserch you can and be the voice for your furbaby. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Molly, I am sorry you have had to come to this board but you will find excellent advice and most important support. Take a deep breath and prepare yourself for a roller coaster ride. Things can change day to day and sometimes it is just the littlest thing that will give you hope. Keeping you and yours in my thoughts and prayers. Penny

Penny Lytle Creek Calif

Buster's PCV was 8 when he got to the emergency hospital. He has done wonderful. I remember talking to the vet before we went to see him for a visit and she told us that he was doing very well, he had improved. When they brought him to the room for us to visit, I was so shocked. I was really looking for the old Buster and what I got was this very tired, sick, panting dog. I had no idea how this illness worked. They thought improvement, I thought he was going to die any moment, he looked to me like he was. All of the things you are worried about are fairly normal at this stage of Squidge pups illness. I realize that for some, cost may be a problem, and if it is, I truly sympathize with you. It can be staggering. Please hang in there if you are able to afford it. This is a long, long road, but it's worth it. Good luck.

Ronda Illinois

Molly, how's Squidge Pup (is that her name?) doing today? You've got great advise above. Make sure you have her checked sooner rather than later cause this disease can take a turn rather quickly. If you think things are heading south then by all means take her for a checkup. Every couple days the PCV should be checked...at least for the first week or two. Ask for copies of all tests done at the vet. That way you can answer questions more easily. Do you know any of the other numbers? Is she regenerating blood cells? Look at the retic numbers to help determine this (another reason to have copies of bloodwork). Have you considered sending blood out to a specialist? It is always wise to have a full rbc morphology done early in the treatment. Is she eating food yet? This is so super important. Make sure she gets her meds on time also. You don't want to miss a dosage this early in treatment as it could potentially be damaging. Do you know the cause? Know what tests have been done so far? Have they checked the thyroid? If they haven't checked the thyroid have them do this...in fact you could have them place her on small dose thyroid supplement at 0.1 mg/10lb given twice daily....THIS IS TOTALLY SAFE and also stimulates erythropoiesis in the bone marrow. Very important IMO. Anywho, fill us in with whatever other info you have. Her chances of survival have just gone up by finding sucha great place to get help, advise and support. My thoughts and prayers are with her (and you). Johnny & Tessy

Johnny

Dear Molly, I am so sorry to hear of Squidge Pup's recent diagnosis. Many dogs can and do survive. This illness is awful, with nothing to do in the beginning but give meds, stand by and hope they work. I understand your concern of deciding when enough is enough. We elected not to transfuse as I worried about the additional burden of non cross matched blood would have on the immune system. Synthetic blood, while available, is not common where I am located in Ohio. There is lots of good advice above about adding additional meds and really pumping the prednisone. I emailed Dr. Jean Dodds at Hemopet, a wealth of caring expertise, and even though she is so busy she responded the same day I emailed her. She had me double the dose of pred that my vet had advised. It made a huge difference. I have had three cockers diagnosed with AIHA in the past 15 months, all in the same litter, all 9 years old. All my investigation led me to believe that pred is the drug of choice, so that's what we have used exclusively. William was just diagnosed. Holly survived 15 months ago, Buckwheat passed away from AIHA with 24 hours of diagnosis, and we are still waiting and praying with William. I hope Squidge Pup turns around quickly and you don't have to worry about decisions. Take care, Liz

Liz Ohio

Hi Molly, I do hope that Squidgy pup is coping as well as can be expected. Do use this site as I found it so helpful because the people on here do know what you're going through and most of them know more about IMHA than many vets. Archie was diagnosed on the 1st March with a pcv of 17 this fell to as low as 10 but he is on the mend. We visit the vet again this afternoon for another weekly blood test, I am no longer frightened of the results as we know he is doing so well. The vet says that some of this is due to his age as he is still a pup, I also feel that because the vet had experience of imha she treated for it immediately before she had the coombs test result so this saved delay. Keep in there and I hope it isn't too much of a rollercoaster ride for you all. Archie and Sue

Sue Cambs

This thread was discussed between 27/06/2010 and 29/06/2010

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