Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Tasha diagnosed on Tuesday

I am starting a new thread for Steve's post so more people can see it. Joanne Steve, Virginia, stephen.marcus@att.net I'm glad I found this site, makes me feel better that there are others out there with the same questions. My 6 year old Siberian Husky, Tasha, was diagnosed just last Tuesday with IMHA and is really fighting. I had noticed her lack of energy suddenly and no interest in food. She had originally had a PCV of 14, since last Tuesday after starting drug therapy she rose once to 15 then has dropped today to 12. I don't know if I am looking for improvements too soon or do I need to take more aggressive steps. Tomorrow morning I'm taking her to an internal medicine doctor here in Richmond at the Animal Hospital in Carytown. Does anyone know if this is the best place to go? I'm concerned that time is starting to become a huge factor as I don't want her to become any worse. Her current meds are: Doxycycline 150mg every 12 hours Prednisolone 30 mg in morning, 20mg in evening Azathioprine 50mg in evening Pepcid AC 10mg 2 times a day She weights 69lbs Thanks in advance, Steve

Steve Virginia

Steve, I am very sorry to hear of your Tasha’s IMHA diagnosis this past Tuesday. Since Tasha is 69 pounds it looks like her meds are a bit low. Both prednisone and Azathioprine should be given at a dosage of 1 mg per pound of the dog’s weight per day. The prednisone is usually divided into two equal dosages with one dose given in the AM and one dose given in the PM. Most cases of AIHA/IMHA that I have seen have usually had the Azathioprine given in the AM. It should also be noted that it can take 5-7 days for the prednisone to start to work and up to 6 weeks to see a clinical response with Azathioprine but we do see that drug start to work sooner in some dogs. Lack of energy and as well as lack of appetite are very common when dealing with AIHA/IMHA. But if Tasha were my dog, I would want to get her to that internal med specialist ASAP and see about having more aggressive treatment. Most vets will consider doing a blood transfusion when the PCV is in the low to mid teens. Has your vet mentioned that option to you? If you have not read my Web site on AIHA/IMHA as yet, you might want to do so when you can. The URL is http://www.cloudnet.com/~jdickson/ Be sure to follow the links on the first page to other sites on AIHA/IMHA that will be very helpful to you and do read the Success Stories pages. They will show you what has worked for other dogs in terms of treatment options as well as give you a lot of HOPE. AIHA/IMHA is indeed a very difficult disease but dogs who have been diagnosed with it CAN and DO recover and go on to live happy healthy lives. But they do need to have proper and aggressive treatment by a vet who is very knowledable about the disease and all it’s treatment options. Please know that you and your dear Tasha are in my thoughts and prayers during these most difficult days.

Joanne MN

Steve.. I agree with Joanne...I think it is better to be aggressive with the medications initially and then when Tasha's numbers get better start to reduce the prednisone very slowly when blood tests confirm the improvements. I would add Sulcrafate along with the Pepcid AC. The prednisone is very hard on the dogs stomach and Tasha is going to be on prednisone for quite a while. I think it is better to start the protection early and prevent problems months from now. I learned the hard way...my dog was not put on sulcrafate and had a perforated ulcer, internal bleeding etc. The sulcrafate has to be given an hour or so before the other meds so it doesn't affect the absorbtion, or so I am told. There is a recent post regarding the proper dosage if you go to "search" on this forum. Your instincts to find an internal medicine vet that is very experienced treating this are correct. Once Tasha is better you may be able to go back to your regular vet as long as they stay in close communication with the Internist. Good Luck, Ron

Ron b San Mateo

Joanne, thank you for your quick response. I did actually go to www.cloudnet.com first and that directed me here. I have the appointment with Dr. Dougherty for 9:30am on Tuesday. They told me not to feed or give water to Tasha after midnight tonight. Is the lack of water going to be a problem with her being so thirsty because of the meds? Also her appetite has turned around since going on the medications. It maybe that I am feeding here boiled beef/chicken and rice as suggested by my vet. I have complete faith in my current vet as he has been more than helpful for years with my other Huskies. It is an extremely busy clinic and he has even come in to see Tasha on his own free time. Thanks again for the answers, will keep you updated. Sincerely, Steve

Steve Virginia

My vet did mention a blood transfusion but only if the PCV got to 10. I'm worried that 12 is too close and she could get to 10 quickly. Ron, Thanks for the information also. Steve

Steve Virginia

Steve, I am very sorry to hear of Tasha's diagnosis. Am I reading her PCV right that it is at 12 and she is at home? I would be very concerned about that. If she is that low she really needs to have 24 hr care. Penny

Penny Lytle Creek Calif

Steve I agree with Penny. Tasha MUST be in a place with 27/7 care. Time is crutial at this stage. My guy , Fitzi, was diagnosed on March 5th. You might ask if Sucralfate 3 x day should be added, to protect his intestines from the pred. By the way my vet suggested giving the pred along with food to help counter the intestinal upset. I started doing this yesterday and its made a big difference. Linda & Fitzi

Linda Asheville

Penny, I have been taking her to the vet every morning since last Wednesday to have her PCV checked and then leave her there for the day. They check it again at 4pm and I have brought her home in the evening. This morning it hit 12 when I dropped her off. She started the meds last Wednesday. Vet clinics in my area are only open during the day. At night I would have to transfer her to an emergency clinic to have her watched during the night. Is she in that critical of a situation? Steve

Steve Virginia

Tasha's PCV was up to 14 at 4:30pm today. I'm going to take her to the vet hospital for a possible blood transfusion. Atleast the hospital is where her appointment is for tomorrow and there will be doctors to check on her tonight. If there is an emergency for her they can deal with it then. This disease really has me confused and worried. Thanks again for all of your help and support, Steve

Steve Virginia

Steve, I'm really sorry to hear about Tasha. IMHA is such a roller coaster ride, and dealing with it can seem like such a whirlwind. I think you made the right decision, taking Tasha into the hospital. When we got the diagnosis with our Lab, Bronwyn, it was 7.30 at night. Her PCV was at 17, and the vet recommended we take her to the ER so someone could monitor her all night, in case the numbers dropped. When I called in around 8 the next morning, her PCV had dropped to 14 and they'd given her a transfusion. I think, in this preliminary phase, particularly before the meds have a chance to kick in, it's best to have her where she can have someone qualified keep an eye on her. I hope everything comes out OK for you and Tasha. I know it's hard - we were not one of the lucky ones. Keep us updated. I'll be thinking of you. Elizabeth

Elizabeth Baltimore

"At night I would have to transfer her to an emergency clinic to have her watched during the night. Is she in that critical of a situation?" Steve, We transferred our dog from the vet's office during the day, to the emergency vet hospital at night, and back to the vet's office the following morning to spend the day, for the first few days after he was diagnosed. I wanted to bring him home with us, but I didn't feel comfortable. At the emergency vet hospital, they were able to monitor him, which we weren't able to do at home. He did need a transfusion at 2:00 a.m., when his hematocrit dropped to 12%. If he had been at home with us, we would have had no way to monitor his hematocrit, and his hematocrit might have dropped even lower by the time we would have taken him to the vet's office around 8 a.m. Our emergency pet hospital was very good about letting us stop in to visit at any time during the night. I sat with our dog from 2:00 - 4:00 a.m. while he was given the blood transfusion, and my husband, daughter and I stopped at different times during the nights he spent there, just so we could spend a little time with him. I felt guilty about not bringing him home with us, but I didn't know what symptoms to watch for, and I was afraid that if there was an emergency at home, that I wouldn't be able to drive him to the emergency hospital in time. Good luck to you. Sue

Sue PA

Thanks Elizabeth. I delivered Tasha to the hospital this evening. I left her with tears in my eyes and a frog in my throat. I feel like I did what was best for her and I'll have to heal my heart. Tasha is a very special dog to me. She had a tough life before my wife and I adopted her from the Pen Pals Program here in Richmond. Pen Pals is a terrific organization where dogs that are about to be euthanized are rescued by the group and put into a state prison system where they go through 8 weeks of training by the inmates. Once they complete the program they are available for adoption. The Animal Planet featured Tasha on a 1 hour segment of Cell Dogs back in 2004. She has turned out to be a terrific companion. The hospital is going to run a blood table and find out her blood type. There is a shortage here of blood but they said that once she was typed they would call on some donors. The doctor said that they would like to monitor her and if she dipped to 12 she would probably get the transfusion. Otherwise they would wait for Dr. Dougherty to see her in the morning. Thanks again for the well wishes and advise, Steve

Steve Virginia

Steve -- I am sorry to hear that your dear Tasha has come down with IMHA. She sounds like a tough girl given the life she had before she met you and your family. I'll keep you in my thoughts and prayers and hope that Tasha comes around.

Brenda VA

Steve...I'm not sure about withholding water? If the dog becomes dehydrated, the PCV test can be distorted as the test measures cell volume to to the volume of the total test sample. When my dog was admitted six months into AIHA for emergency surgery unrelated to the AIHA, she had not been eating or drinking and her PCV was measured at 40. That would have been a blessing except that it was because she was dehydrated. Once they got her on IV fluids and hydrated, her PCV dropped back to 28 where it had been for months.

Ron B San Mateo

Steve, I am so very sorry about Tasha. This is certainly a scary time for you. It is hard to stay calm and think through the things you need to do now. Many of us have been through this very frightening time and I think there is a collective tension from all of us as well tonight as we think about Tasha. I would not second guess your caregivers, but I do want to make sure that in some way they have addressed the possibility of inappropriate clotting tonight and tomorrow. They could use something as simple as a baby aspirin. Ask them if they have taken this into account. You can say an experienced friend has been through this with their dog and asked if you knew what to do. The medical term for this is DIC disseminated intravascular coagulation. The medicines are an important part of Tasha's treatment but also, right now, excellent and appropriate nursing care is a must. You will learn in time how to do some of this at home. It's good that someone can monitor her constantly and take appropriate measures to help her. Taking her blood type and matching her is a very good sign that they know what they are doing. If you find a compatible donor dog, you will be assured of having a good source of transfusable blood in the next few weeks. We had Chance transfused 3 times. We were lucky that our local vet's donor dog was an excellent match for him. I decided, along with our vet's advice, that I would never let him get below 18 PCV. There are some sources that advise not to transfuse until the PCV reaches 11. There are risks associated with transfusions, but both my vet and I were comfortable that the transfusion was more important. I could quote veterinary literature that has both opinions so it is a discussion between you and your vet as to what you feel best considering the risks. Honestly, my criteria was the day Chance could not do his business because he was too weak to squat. I called the vet right there on the sidewalk. Within 2 hours we had him at the clinic being transfused. There is no accepted standard protocol for treating this condition, yet. Vets use their clinical experience to guide them to the best treatments. You may read through all our posts here and find dozens of different protocols, meds and outcomes. We were in a situation where we really needed a bone marrow transplant but that is nearly impossible for dogs in this country. We had to make up the treatment as we went along to see if we could force the marrow to start working again. Today Chance is nearly 100% better. A year ago, he was near certain death. I have been very tenacious in finding answers. I will be thinking about Tasha well into the middle of the night. My best, Patrice

Patrice NYS

Well it's 11pm and I just got off the phone with the hospital. They found Tasha a match with one of the vets dogs and decided that she should have the transfusion. She is resting comfortably right now with the transfusion going on. Hopefully I will get some sleep tonight and I can't wait to see her in the morning. And thank you all so very much for your wisdom, help and understanding with our situation. I feel confident that we will win this fight with everyone's prayers. Steve

Steve Virginia

Just got back from the hospital and got to spend a couple of hours with Tasha. She seems to feel alittle better after the transfusion. Her PCV is up to 18%. She is going to have some more test run today as her body is not producing any red blood cells. Steve

Steve Virginia

Steve, I am glad that they were able to get her back up to 18%. Hopefully she will hold there for a bit while they sort out her tests. I believe the test they are going to do is called a bone marrow biopsy. They use an aspiration-style needle to go into the bone of the shoulder or hip to get a core sample. She will need to be anesthetized for this procedure. From that sample they can determine the kind and number of cells that are in there. This helps them figure out if Tasha has the appropriate precursor cells to make reticulocytes. These are baby blood cells. They are testing her now because they do not see reticuloyctes in her CBC test complete blood count. Any dog, or human that has a packed cell volume lower than about 37% is considered anemic. A complicated set of events occurs that signals the bone marrow that there is a need for more oxygen to the cells of the body. The quantity of blood cells is not enough to bring enough O2 out to the cells. The bone marrow will respond by making more of these reticuloyctes and sending them out a bit earlier than usual into circulation. They are visible to the eye or the automatic blood analyzer because they are a bit bigger and still have the RNA inside them. They do not carry oxygen very well. In about 3 days they mature, drop the RNA and are prepared to carry O2. This process is called reticulosis. The body will respond this way no matter what the cause of the loss of blood. It is a normal body process in response to a low number of RBC red blood cells. In general, in a healthy human or dog there are about .5-1% reticulocytes in our blood circulation on a regular basis. Our RBC get old after about 120 days and are replaced. Right now Tasha should have as much as 5% or more reticulocytes in her blood. In some unlucky dogs, not only is the autoimmune damage occurring to the RBC in circulation, but it is also occurring to the precursors in the bone marrow. In these cases, they often do not find many cells or in fact may not find any cells in the marrow when they do a biopsy. They found no cells in Chance's 5 samples. I have to admit this is very serious and cause for concern. I know this because we had the same diagnosis just about a year ago. But I want to tell you that there is great hope that you can bring Tasha back to good health if you are willing to work hard to care for her. Have they done any kind of x-ray or ultrasound? It might be a good idea for them to look for tumors at this point. Also make sure they have done an extensive tick borne disease panel. Tick diseases can sometimes cause this kind of severe anemia. While we were going through this and we did not know why Chance couldn't make any more blood cells, my wonderful local vet told me that when humans are ill like this and cannot make blood, the medical community gives them transfusions to keep them alive and comfortable. A bone marrow donation would be appropriate. But there are very few places in the country that can give a dog a donation like this. It was not for us. It took us 5 months of high doses of medicine before Chance's bone marrow responded. By late fall last year he was making blood like normal and today we are on a very tiny little dose of prednisone. He is back to normal and can walk for 3 hours with no trouble. It was worth all the work to see him get better. Please let us know what has happened this afternoon. Patrice

Patrice NYS

Patrice, thank you very much for providing me this information in a format that I can really digest. It seems that I am completely overwhelmed when the doctor speaks to me. Your knowledge in this seems to be outstanding. And continued best of luck with Chance. You are correct that Tasha is going to get a bone marrow biopsy today. They did tell me that she would be sedated as well. They are also going to do an x-ray and ultra-sound. This was one of the first things that my regular vet did as well. Hopefully something will show up. As I hear from the doctor later, I'll update everyone. My family thanks you again for all you have provided Tasha. Steve

Steve Virginia

Steve, We have all been in your shoes and know how hard it is for you right now. The shock of the diagnosis for a disease you have never heard of takes a while to digest let alone all the things you are hearing from your Vet just adds to the confusion. There are a lot of dedicated people on this site who are here to help you through. Be sure to read the success stories at Joanne's site. Penny

Penny Lytle Creek Calif

This afternoon seemed to be good for Tasha. I only arrived at the hospital at about 5:45pm because the doctor only began the Bone Marrow Biopsy late in the day and Tasha was just coming out from the sedation. The results from the biopsy should be back tomorrow. While she was sedated they did another Ultrasound and everything with that was pretty normal. We also ran tests for Bartonella and Zinc. Those test also needed to be sent off site to a lab. One good thing is that she is still holding at 18% PCV. I would have been encouraged with some improvement but stable is okay with me right now. It seems that she slowly has slipped into this condition and that is why she is not as weak as other dogs may have been with the same low rate. When I arrived she was happy to see me. We got to take a short walk where she tried to trot and pull like a Husky on a leash usually does. She seems to be pretty stong still. We hung outside the hospital for about an hour and just enjoyed the cool spring air together. Dr. Daugherty wanted to keep her another night and tomorrow to just keep a good watch, and wait for the test results tomorrow. I'll check later this evening on her and hopefully get some good news. Steve

Steve Virginia

Best wishes on what is happening with you, your family, and Tasha, Steve. Although its really hard to leave them at the hospital, sometimes it is almost a relief because of the unknown - if something were to happen, they are in the best place they could be. My vet explained to me that the pcv holding is okay! I think we want it to just climb like a thermometer... It sounds really good that she was alert and happy to see you and wanted to be outside. Take care and keep up the positive notes!We're all thinking of you. Gail

Gail SD

Steve -- I am glad that Tasha has had a blood transfusion and has gotten a boost that is holding for now. That is such a big event -- stability when fighting this disease is good, and some dogs take a lot of time to move up, but they do. I also find your observations about Tasha's behavior tonight to be encouraging. She is responding to you and she is walking. That is great news, because it helps you not to focus so much on the PCV numbers, which will fluctuate. I hope we continue to hear good news for you and your special girl.

Brenda VA

Well, Tasha is back home tonight. We left the hospital at about 6pm after Dr. Daugherty spent close to an hour with me. Tasha is holding at between 15 and 16% PCV. She seems to be a little tired this evening after the 1 hour trip. Eating and drinking well though. Hopefully she will have a restful night before we return for a blood check tomorrow morning. Here is what we found out from yesterdays tests: (this is directly from her doctors notes) Patients Diagnosis: Severe anemia: Suspect immune mediated anemia targeting red blood cell precursors within the bone marrow. Prescriptions: Prednisone: 30mg by mouth in the morning, 20mg by mouth in the evening. Cyclosporine: 100mg by mouth every 24 hours Doxycycline: 150mg by mouth every 12 hours Pepcid: 15mg by mouth every 12 hours Mycophenolate: 250mg by mouth every 12 hours (this is an immunosuppressive medication) Azathioprine: discontinued Tasha is 6 yrs & 10 months young, and she weighs 60.8lbs. From what I understood today from the bone marrow results is that Tasha is starting to make cells but they are not fully developing so that they can return to the blood stream. Does this seem to be what we will see for a while or is something else going on? I do have full faith in Tasha's doctors but am always looking to make sure we are doing everything that is available to save her. Steve

Steve Virginia

Steve, It's good to have her home, isn't it? I can tell you what we had to go through and how long we had to wait for Chance to recover from the severe non regenerative anemia. What happens with Tasha may go very differently though.... Did Dr. Daugherty say that she had "non regenerative anemia?" This would be very important information. If you have your CBC results, post your reticulocyte numbers, the percent and if you have it, the absolute numbers of reticulocytes as well. I can do the math if you don't... include the RBC count as well in that case. Indeed, the blood cell precursors can be destroyed in the marrow before they can fully form. Chance's case was so severe that not only was his red blood cell precursor line being destroyed, but his white blood cell precursor line was being destroyed as well. Do you know what Tasha's white cell counts were like? This would be very important to know. If those are being destroyed as well, she will be much more prone to severe infections. We had Chance on antibiotics constantly for a very long time. And for several months we monitored his temperature every 4 hours. How long does it take? It took longer than I could bear sometimes. As I watched Chance lose his hair and his muscle... As I watched his liver enlarge so much he could not lie down comfortably. He would pant and groan all the time. He sometimes could not walk farther than a half a block and then lie down. I will not lie to you that this could take a long time. But it could take a very short time too! You can have faith in Tasha's ability to heal. I am amazed at the horrible things the drugs can do to these dogs and yet they can recover from the insults most of the time. Think of what we have to do to humans when they have cancer. If there are several people in the household and you can all commit to a complex round the clock schedule, you can do this if you are determined to help her. We are all here to support you and to let you know that you can succeed in this. As far as the science of this severe condition goes, it's a very gray area. I have a 1000 page veterinary textbook and several boxes full of printed pages of information about non regenerative anemia. The drug cocktails we administer to these dogs are for the most part experimental. Prednisone is considered the cornerstone med for this. But in severe cases, a cytotoxic drug of some kind is needed as well. Novartis refuses to acknowledge that Atopica is used or has been tested for any autoimmune diseases other than allergies. But I know that it saved Chance's life. You and your family should have a conference and decide how you feel. We easily spent $5,000-$6,000 for Chance's care. There is no right or wrong way to go with this. Whatever you chose, that will be alright. No one can make this decision but you and no one will judge you for what you decide. I had friends urging me to have Chance put down and I resented it. I called my pet sitter over to visit with Chance. While she was there he managed to charge down the deck stairs to bark at a squirrel. She told me to ignore what everyone was saying and to keep going. I can't tell you how grateful I am to Sue for guiding me in that direction. I hope that Josh will weigh in here about his time caring for Sway. He has had an even harder road to travel than I did. But yet, Sway is alive and she is slowly recovering! My best, Patrice

Patrice NYS

Reticulocyte Panel: Reticulocyte Count 0.1 Value Absolute Reticuloyte 1630 Corrected Reticuloyte 0.0 ERLS 2.5 Comments: nonresponsive marrow <1.0 erythropoietically active marrow 1.0-2.0 marked regeneration >3.0 CBC results: WBC value 24.2 RBC value 1.63 HGB value 4.1 HCT value 12.0 MCV value 74 MCH value 25.5 MCHC value 34.4 Neutrophil SEG value 77 Neutrophil Bands value 1 Lymphocytes value 3 Monocytes value 19 Eosinophil value 0 Basophil value 0 Auto Platelet value 329 Polychromasia slight Anisocytosis moderate Platelet comments: Large platelete present Hope this has the answers, I'm still learning. Slept with one eye open last night. We went out to urinate this morning but does not seem too interested in food or water. I'm going to try again in a few minutes before we leave for the doctor. Thanks, Steve

Steve Virginia

Tasha is going to spend today at the hospital. Her PCV was 17 which is steady but her heart mumor has returned as well as a little higher heart rate and is breathing quicker. Going to transfuse her with 1 to 2 units of packed blood cells. Did get her to take her meds this morning with them hidden in some cooked salmon. She also did eat breakfast. Looks like I've got a fight on my hands. I'll know more later today. Steve

Steve Virginia

Steve, I remember there were days that I wished I could afford to keep Jennie in the hospital all the time -- just so I knew she was being monitored by specialists. I was just so scared all the time! My best wishes to you and Tasha on fighting and beating this illness. Gail

Gail SD

Steve, my thoughts are with you and Tasha. I know exactly what you are going through. Tricia

Tricia UK

Steve, Good news first, looks like she is still making white blood cells by the WBC count of 24.2 (normal value is generally 5.5K/uL to 16.9K/uL) I will sort out the other wbc counts later. Matter of fact the VBC count is a little on the high side indicating a possible infection of some kind. Have they checked her kidney function yet? Be firm on this. The kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Have they also checked the thyroid function? This is a must too. Low thyroid (hypothyroidism) can also sometimes impact the blood making process. Chance takes Soloxine daily for his. I would suggest Hemopet http://www.hemopet.org/services.html as the place to send a blood sample for this. And the test will give you access to Dr. Dodds consultation. This is the specialist who guided Chance's care throughout last year. She has been my higher power. Other good news, the platelets fall within the normal range. This means that this line of precursors in the bone marrow are not being affected by the destruction. This would be a very bad scenario if this line was also being destroyed. Chance had the same test results and I was extremely grateful that he still was making platelets. This is the blood component that stops bleeding. The not so good news is that Tasha is highly NON regenerative or she is *not making red blood cells* to replace the blood cells that are diminishing in numbers. The minimum absolute value for reticulocytes is 60,000. That is a *relative value* that is tied to the number of red blood cells (always measured in the millions). If you can understand what I am saying... A normal number of red blood cells, somewhere between 5.5 million and 8.5 million, along with the proper amount of hemoglobin ( 12g/dL to 18g/dL) will signal the body that all is well and to reduce the number of reticulocytes sent out early into blood circulation. So in general, a dog or human without anemia (pcv or hematocrit hct of 37% to 55%) will have approximately .5% to 1% of reticulocytes in the blood. The absolute number would hover around 60,000. Your absolute reticulocyte value of 1630 is very low, in fact it is much lower than Chance's first test of 13,000. Splitting hairs here though, both are way too low and indicate a condition of non regenerative anemia in the red blood cell line. When you finally see some kind of regeneration, this value will shoot up really high. You may see values as high as 500,000 absolute and 5% or more. A few days later you will see the RBC count shoot up. The M values you see are indicators of the size, condition and hemoglobin carrying value of the red blood cells in circulation. Tasha's values indicate Normocytic, Normochromic anemia. This means that the blood cells that are in circulation are normal sized and carry the normal amount of hemoglobin. Same as Chance's anemia was. Probably an indicator that the cause of the anemia is not something like low iron for instance. There are several categories of this, none of which you need to worry about. The grouping of the white blood cell breakdown is a little more complex and I need to check this carefully before I write anything. I think you have had enough for now anyway.... The heart murmur is happening because she is not getting enough oxygen and the heart is starving for it. The transfusions will help this immensely. Do you have local vet? Do you have a good relationship with them? Is there one in particular in the practice that likes you and seems to spend time explaining things to you? I ask because I have an established relationship with my local vet office of 3 vets. I was determined to do as much as I could with them there, close to home, and avoid long trips to Buffalo to see the specialist. It was better for Chance to be close to home and go where he knows everyone. It was in the long run cheaper for us to have blood work and other tests done there. You will be doing blood tests every week or every other week for awhile. It will help if they have an automated analyzer. Our vets are also very good at doing transfusions and so I was able to schedule them ahead of time, on a quiet afternoon, when there was plenty of time to prepare for them. Dr. M's donor dog, a big happy fat black lab, was an excellent match for Chance. You are probably going to need to do several of these. Our cost was around $300. for each one. Our re-visits were $18, the cbc's around $30, the chem screen around $60 and a mini chem screen for liver only was $20. Start a notebook at home in the kitchen and begin writing down everything, meds, conditions, poops, food. You may need to make a chart for med administration. Ask your vet to prescribe Sucralfate and ask for proper dosing instructions. This will protect her esophagus and stomach from damage from the prednisone. Also ask about Denamarin (should be given on overnight fast). This is a veterinary supplement made of silymarin and Sam-e that helps protect the liver from the damaging effects of high doses of prednisone and doxycycline. Both of these are fairly expensive, the Denamarin can be purchased on line a little cheaper. Continue religiously with the pepcid. My dogs are waiting to go for a walk. My best, patrice

Patrice NYS

First off, I have not thanked everyone for their well wishes in regards to Tasha's recovery in awhile. I can't express my sincere appreciation. With only having to deal with this terrible disease for only a week, the comfort and information has been priceless. To anyone that has to go through this, I will be there for you. That is the best way that I know of to service others during this stressful time. I would love to thank everyone individually and maybe one day there may be a conference where we can all attend to discuss the possibilities of a cure. Picked up Tasha this evening after receiving 2 units of packed red blood cells. Immediately after completion her PCV was at 23% and was expected to rise overnight. I will be taking her to her regular vet tomorrow morning for a general physical and PCV evaluation. One of Tasha's regular vets was at the hospital this morning to discuss her situation with Dr. Daugherty. They have gone above and beyond with her. The only change today in medications is the Cyclosporine has been changed to twice a day at 100mg. This morning her Bilirubin had increased since Tuesday. This evening when we got home her "poop" seemed to be more of a normal color. I hope we are making progress. Tomorrow I am going to discuss the items that Patrice brought up. Well I'm glad to have her home and to see her feeling much better. She has some spunk and ate very well tonight. Matter of fact she is taking a nap and breathing very normally right next to me. I sure do love this dog and will do anything to beat this disease. There is only 1 winner in this game and it's Tasha! Thank you all again and everyone who is currently dealing with this, I wish you only the best. We'll talk tomorrow. Steve p.s. I hope these daily updates will help others on the day to day occurrences we are going through.

Steve Virginia

Steve -- glad to hear that Tasha is responding and her behavior was much improved. I'll keep you in my thoughts and prayers.

Brenda VA

Steve, It's great to hear the daily responses it makes us(reading this forum) that much closer to you and your pet - it's like we're family!! My sincere wishes on Tasha's recovery!! Gail/SD

Gail SD

Steve...Im am so glad Tasha is home with you. If any one was reading our posts who had not gone through our common experiences with AIHA they would think we are all crazy. It is so hard to be the caregiver because dogs cannot tell you in words what they want, and you have to be such an observant owner to monitor their needs. Only you, really know how your dog reacts normally, and it is such a grind to try to stay ahead of their ups and downs. This forum is a great wealth of knowledge and support. We are all hoping Tasha the best.

Ron B San Mateo

Ron, You are so correct when you say people would think we are crazy. I have felt that since Molson was diagnosed in Dec. with IMHA. Unfortunately, I didn't find this site soon enough. I had to put Molson down on Tuesday, March 25, 2008 as a result of liver disease, a complication of his IMHA. This is a very difficult disease to deal with, understand and keep on top of. Some of the symptoms Molson had in mid-Febraury that were signs of liver disease, I thought to be the effects of the Prednisone. We really are the only ones who really now our furry companions and their ways. I am so thankful that dog owners have this site and others like Meisha's Hope. Thanks Joanne. AM

AM FL

Sorry I missed the dialy update on Friday but everything is going well for Tasha. After receiving 2 units on Thursday afternoon her PCV on Friday morning was 24. Her skin, ears and gums have returned to almost their normal color. She seems to be breathing a little bit easier. Not that her breathing was labored but quicker than normal. Lots of short shallow breaths. She stayed with me at the office yesterday and I think enjoyed the view much better than the hospital. She may have missed all the attention though. Tasha seems to be one of the favorites as I hear she hangs out front sometimes at the front desk and always has technicians and doctors that play with her. Friday evening went well also. She has continued to eat fairly well and drink plenty of water. I was warned that she would have to release this water often but just a couple more times a day. Her stool has remained a light brown color, not orange and not dark brown. Her urine is still a bit darker but not as bad as it was a week ago. No upset stomach and she seems to not be in any pain. Saturday morning is the same, no signs of things not going well. She has hung out in the kitchen this morning waiting for scraps. Well our goal is to stay stable and see what her blood has done on Monday when we return to Dr. Daugherty. Remain positive and have a successful weekend. One day at a time. Regards, Steve

Steve Virginia

This is great news. She is responding immediately to the treatment. How awesome for you all. Have a great weekend and give her lots and lots of love. Gail

Gail SD

ive been trying to post here for a couple days but the site blocked my IP... sorry about that- anyways, patrice told me to stop in here and lend my 2 cents. she told me this is all new to you and you were having a really tough time with all that comes with this disease, my dog sway has had a very difficult and long road down the AIHA trail so if you would like to talk to someone and bounce questions or just hear someone else's story then give me a call. nine, three, seven - five, two, four - one, eight, five, nine please hang in there, it is a worthy fight and it seems you are doing a great job. josh

josh / sway california

We had pretty much the same regimen but with agglutination our Border Collie diagnosed in New York in December was also placed on fragmin...a type of heparin to prevent the possibility of stroke or pulmonary embolus... otherwise...it was the same... warmest wishes on this journey

Chris Connecticut

Steve - I hope this finds Tasha having a good weekend. I just wanted to chime in and let you know that my dog was diagnosed with non-regenerative anemia at the level of the bone marrow in March 2007. He showed absolutely no sign of notable regeneration until late June when he began slow, steady progress and is stable today. If you find that Tasha needs to be on the immuno-suppressant drugs long-term, I would suggest you have a complete CBC run regularly to be sure her WBCs are staying at normative levels - if they drop too low, she becomes very suseptible to infection. In our case, Murray became septic and was critically ill because he became too immuno-supressed due to the meds. I wish I would have pushed harder on the internist at the time. In some of the lucky cases, if you can keep them stable, it gives their bodies the time needed to begin to heal. Wishing you and Tasha the best.

Bonnie Chicago

Sounds like things are going fairly well. Just wanted to point out, the WBC shows infection in the blood system, lower counts are better, the higher they climb, the more infection she has. My GSD puppy went up to 58,000 while she was on the highest doses of Pred, finally returned to normal values of around 6,000 when the pred was at its lowest. My girl was kept on Doxycillian for 6 weeks to help keep the infection at bay. As long as they are on pred, their immune system is very compromised, hence the high WBC. One thing to remember, while she is on Pred, she is highly vunerable to any infections, so she should be kept away from areas when other dogs are as much as possible, dog parks, dog shows, etc. Keep her in her home environment as much as possible, you don't want her to have the stress of another illness to combat while fighting AIAH also.

Joanne Wyoming

Steve I am so glad to hear Tasha is at home and sounds like she is stable. Linda

Linda in Asheville NC

It was a pretty good weekend for Tasha. She seemed to rest pretty comfortable, even came upstairs to sleep last night. Tasha is starting to know when we get ready to leave for the vet as she starts to stay clear of me. Definately more energy as she scooted up the steps and onto the bed after eating breakfast. We arrived at the hospital at around 8am for her appointment. Some of the test results that were sent off arrived back over the weekend. All were negative except she tested positive for Rocky Mountain Spotted Fever. We don't know if it is active or inactive so we are just going to treat it with the Doxycycline until she can be retested in 1-2 weeks. PCV is still holding at 23%. Gums, ears and skin seem to show no signs of jaundice. Her bone marrow biopsy was suggestive of mild myelofibrosis. We may need to do another bipopsy later for further evaluate the situation. Tasha is hanging out with me at the office today and will rest until Wednesday when we return again for a checkup. We look to be stable, hope this keeps up or improves. Steve

Steve Virginia

Steve, It's good that she is feeling better! Yes, doxy will resolve this issue almost immediately but treatment should be aggressive and lengthy. Please take the time to visit a good friend's web site: http://blackgsd.googlepages.com/rmsf You will find this page full of information about RMSF. It has been gathered by Gil Ash from years of research. If you write to Gil and mention my name she will correspond with you privately and answer any questions you have. There is also a wonderful forum that has been active since the late 90's called Tick-L. I have been a member of this forum for about 2 years. You can join this forum and post questions and read the archives. We have several experts in tick disease, including a vet specialist. Go to:http://saluqi.home.netcom.com/ticklinks.htm Click on: Managing your TICK-L subscription options, etc. Subscribe, sign off, change options, or search the list archives from the TICK-L home page I am grateful that your vet is forward thinking enough to explore tick diseases as a possible cause of this severe anemia. You are very lucky, there are many vets who are not as aware of this relationship. My best to you and Tasha! Patrice

Patrice NYS

The following is a link to a picture of Tasha taken a few weeks before her diagnosis. http://webmail.aol.com/35304/aol/en-us/Mail/get-attachment.aspx?uid=1.19920121&folder=Inbox&partId=4&saveAs=get-attachment.jpg

Beth Virginia

Tasha seems to be feeling good. Here interest in what is moving around the yard is back to normal. Last night I watched her chase field mice for 30 minutes. I had to almost chase her back into the house. Just got back from our scheduled visit to Dr. Daugherty this morning. It was to check Tasha's PCV which was 22%. Just down from 23% and not yet making good cells. I left her at the hospital because I had noticed her stomach starting to enlarge. Seemed like she has some abdominal fluid that she is carrying around. They drew a small amount of fluid while I waited. The fluid was kinda clear with a slight yellow tint, almost like urine. A sample was being sent out and another ultrasound is going to be performed. We also ran another blood test to check on the amount of Cyclosporine that is in her system. She was to receive no morning meds until the test was done. Poops are light brown and urine is almost normal in color. Her gums and skin have not changed since my last update on Monday. Well, we have been treating this for 2 weeks today. Looks like the fight is still on. Here are her blood results that came back from the lab on Monday: (she does look to be improving in most areas) WBC 16.3 RBC 3.14 HGB 7.7 HCT 22.7 MCV 72 MCH 24.6 MCHC 34.1 LYMPHOCYTES 6 MONOCYTES 11 AUTO PLATELET 168 POLYCHROMASIA SLIGHT ANISOCYTOSIS MODERATE POILKILOCYTOSIS MODERATE ABSOLUTE NEUTROPHIL SEG 13529 ABSOLUTE LYMPHOCYTE 978 ABSOLUTE MONOCYTE 1793 RETICULOCYTE COUNT 0.1 ABSOLUTE RETICULOCYTE 3140 Still nonregenerative Hug your fur gang, Steve

Steve Virginia

This thread was discussed between 24/03/2008 and 02/04/2008

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