Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Timmy Is bad again..Please Pray!

Hello everyone, I am soo afraid we are headed to the end. I had a gut feeling he wasn't doing so good with the pcv count.He had a wonderful day and he was wide eyed,eating and just seemed to be improving.His gums looked a little less pink as the day before so i had it checked at the weekend emergency clinic just to feel safe.Sure enough down to 26 from 32 yesterday.The vet said the human hemoglobin was unlikely effective and the transfusion just bought us a little time.Two weeks on pred 5 mg and less than a week on cyclosporin 25mg. The vet is going to double the pred....as a last ditch effort.I feel so hopeless and helpless at this point. We are going over @ 7.00 in the morning and see where we stand.I can't afford another transfusion.That would be three in a week and a half.She mentioned the kemo drugs as a possibility but she thinks we are running out of time.Please pray for my little timmy as i will be up all night trying to come up with something...like a mircale.... Terry and TImmy

Terry pa

Terry, I know how difficult this can all be, and how overwhelming. If you can, please take a deep breath and try to relax. 26 is not a terrible PCV, and in our experience, is almost to be expected following a transfusion- usually the PCV will drop within a few days post transfusion. What is Timmy's weight? It is definitely possible that a higher dose of Pred is necessary, but also, has the vet tried or considered Aza? What are the other numbers in his CBC? Also, you mentioned Timmy's clinical signs as being quite good, wide eyed, eating, and overall improving. These are very important clinical signs that show that he is feeling a little better. Many dogs here on this forum live with PCV's in the upper teens and 20's for a very long time. I would say a transfusion really shouldn't be attempted again unless there is clear evidence that it is dropping rapidly, and when it is in the mid teens- our vet would not transfuse unless Tiggs got to about a 15. It's good to discuss what the plan should be should this become necessary, but these drugs often take a lot of time (unfortunately) and things do often yo yo for a while. I am sure others will give you good advice, but please don't despair, I think things have a very good chance of improving, though they may not seem that way right now. You guys can do this, hang in there. melissa and tiggs

melissa slc

PS. If you are able, please consider a second opinion ASAP with an internal med vet, or a teaching hospital in your area. Unfortunately, a lot of vets just don't have enough experience treating this disease. Not saying this is the case with yours, but it might help, even if just a phone consult. I have heard mixed reviews regarding the human hemoglobin. Perhaps in your planning, you might consult with Dr. Dodds about a universal doggie blood match, or suggest to your vet, should it become necessary, that you discuss the possibility of cross matched canine blood.

melissa slc

Terry, i totally agree with Melissa, sometimes it gets worse before it gets better. this drop is of course concerning, but 26 is still ok. there are so many things that can affect these numbers. Dehydration, food intake, diarrhea... And like Melissa said Timmy seems to feel better, so that is sure a good sign. the color of the gums can vary from one hour to the other too. I remember racing to the vet at 8pm with a dog that had paler than usual gums. I thought that he would die right there. Turned out his pcv actually rose. I would also recommend consulting with Dr. Dodds. as far s I know, she does not charge for this service. If later on you would donate to her hemopet organization she will appreciate it. Hang in there and try to rest a bit. There is not much you can do tonight, so try and get some sleep. Best wishes, Brigitte & Kahlu

Brigitte BC Canada

Terry, I have read numerous literature concerning what conditions should be met for a transfusion to be administered. This is referred to as a transfusion trigger. It used to be at a quite high hematocrit (PCV) for humans (above 25 -30) until blood diseases became more prominent. Then they started lowering the PCV number for the trigger so as to avoid passing those diseases on indiscriminately. Now-a-days, in general, the transfusion trigger is not any magic number but rather the general clinical condition of the dog (or human). A dog with a PCV of 18, but that appears to be stable and has good signs like appetite etc is much less of a candidate for a transfusion than a dog that has a PCV of 30 and is clinically in a poor condition. Why is this? The body likes everything to be in a stable way, called homeostasis. It will adjust every body system to make it that way. In that dog with a PCV of 18, the body might have been fairly healthy to begin with and it was quite easy to stabilize at the low PCV. The dog with the PCV of 30 perhaps was not easily stabilized. Another factor against too many transfusions is that they begin to "confuse" the bone marrow into thinking that maybe there are enough red blood cells in circulation and it doesn't need to make as many as it thought. This is a suppression of the bone marrow by the transfusion. So the question is, how low can you let the PCV go before you consider another transfusion? Well, when the dog (or human) begins to show clinical signs of O2 deprivation, then it is time to consider one. This is purely at the judgment of the attending vets and nurses. One more factor that must be considered is the risk of a transfusion reaction due to a poor blood type match. The gamma globulin shot may have primed Timmy to have a future reaction because of developing antigens. Each transfusion adds more risk that there will be a more severe reaction. If Timmy seems better, then he probably is. What is his weight? 5 mg of pred seems low to me, but that is because Chance was on 80mg at 98 lbs. A week or so of a higher dose will not seriously impact his future health and may be all that is needed at this point to stop the hemolytic crisis. Prednisone, for all the bad press, is a miracle drug and has saved many lives. Perhaps your vet doesn't have much experience with this disease and feels a little lost right now. Most regular vets don't treat this kind of serious autoimmune disease very often. I know you are running out of money. Remember that good plain simple nursing can do an enormous amount of good in this disease. Excellent nutrition, good water, *low stress* and plenty of sleep is very important. I will be thinking about you tonight patrice

Patrice NYS

Hi Terry, Madison has 2 transfunsions within 5 days but not until her pvc dropped to 15. It rose after the transfusion then dropped slowly but after about 4 days began to rise slightly and once medication kicked in it rose graudally over the months until we could wean her off medication. Madison is only 6kgs (small) but was on 15mg pred 2 times a day for the frst month, plus 1/2 Imuran very day. I think Timmy should be on more medication than he is - check with your vet. PVC 26 is still a good reading and it took Madison a month to be that high and we thought it was the best when she ahd that reading. Stay positive and i am thinking of you Samantha & Madison

Samantha Perth Australia

Hi Terry, I agree that the dosage of Pred seems low. Millie was 4.5 kg (I think that's about 9.5 lbs). She was on 10mg Prednisone daily (5mg morning and 5mg night) and 6.25mg Azathioprine at night. I wouldn't have thought that Timmy would be smaller than Millie, so my guess would be that Timmy is on half the dosage he needs to be on (assuming he is similar weight to Millie). Samantha from Perth is saying Madison was on even higher doses than Millie (when considering weight to dosage), so it wouldn't hurt to put Timmy on higher doses. Also please consider the Azathioprine. I also agree with the consensus to seek a second opinion ASAP. 26 is OK for the time being, and Timmy doesn't seem to be dropping quickly either. Millie went from 36 to 14 in two days. I swear that our local vet researched IMHA on the internet. In fact, she originally recommended us to reduce the Prednisone dosage by half after 2 weeks!! That's when I decided we needed a second opinion. Good luck, keep us posted because we are all hoping for the best for little Timmy. I don't know, but like Patrice suggested, increasing the Pred will not impact on Timmy's future health and it is probably what he needs to stop the immune destruction. Please find out about this ASAP. Stay strong for Timmy, Samantha.

Samantha Geelong

Hi Terry Sometimes you just have to give the meds time to do their job, Gingers PCV stay in the 20's until she was on the cyclo for about 4 weeks. Ask your vet about the trough test it is done to make sure the dosage of the cyclo is correct. Here is info on it from Meisha's Hope website. It is very important to measure blood cyclosporine levels when the drug is being used.The therapeutic range for cyclosporine is from 300-500 ng/ml (nanogram/milliliter). One reason that frequent blood testing is necessary with cyclosporine is that there can be a great deal of variability in its absorption. One dog may absorb a larger percentage of the prescribed dosage then another. Cyclosporine concentration blood tests called trough tests are not able to be done "in-house" at veterinary clinics nor do most outside labs run cyclosporine levels. Trough tests are usually sent to veterinary teaching hospitals, to be run. The blood for the trough test must be drawn at the exact time a dosage of cyclosporine is scheduled to be given. This allows the lowest amount of cyclosporine in the body to be measured on the trough test. Since cyclosporine saturates the tissue, the dosage may need to be adjusted from time to time, another reason trough testing is so important. If you have time go back and read some of the success stories as they will show you that their really is HOPE, especially if Timmy is eating and acting okay. Sending our prayers, Cheryl & Ginger

Cheryl & Ginger Pineville PA

Terry, Just to give you an input on Predisone. My dog, Buddy, about 13 pounds were given 10Mg Pred, twice a day. Sending you hope and prayers. Evi & Buddy

Evi Illinois

Terry, You and Timmy are in our prayers. Overall a PCV of 26 is not bad. When my Ren was sick, it took almost three weeks for her to show signs of improvement. I know that these are trying days, but stay strong and show Timmy lots of love. Sue & Ren

Susan delaware

Hello everyone,Thanks for the Great Advise...... Here is where we are today......I got the pcv number wrong yesterday.....It was 24 yesterday not 26.... the vet doubeled the pred.From 5mg twice a day to 10 mg BID He is 11 lbs.. I picked timmy up this morning from the emergency vet and he dropped to pcv 23 We can't afford another transfusion so meds is our only option at this point so hopefully he won't drop into the critical range....I called the vet that did transfusion no.2 and said he would have givin him imuran with pred. from the beginning because that is what this particular vet likes to do.He said trying to switch to imuran from cyclo..at this point might do more harm than good because he already has 5 days of the cyclo.. in him and it may have not kicked in yet.Imuron would take time that he said would not be worth the risk.I talked to Dr.Dobbs and she said to use thyroid supplemention at 0.1mg/10 lb twice daily to stimulate bone marrow andplatelet function eventhough he doesen't have hypothyroidism.She said he should be able to tolerate this.So when i mentioned this to the vet at overnight clinic she donated a part bottle of soloxine that was her own from a dog she had to put down recently.She stopped us in the parking lot with this offering.She said everyone just melts when they look into little timmy's eyes and he lets them do anything to him when hes at these hospitals.She wrote a personal little note on his release today and said "timmy is one the nicest pets they ever had at their clinic and his paw prints are left on all of their hearts". and that is the impression this little guy leaves with everyone he comes in contact with.I am soo blessed to be his owner...I am saddened that he has to be put through this.His tummy is really swollen today from his spleen and liver.We doubeled the pred and started the soloxine....Pcv will be checked late today.I am going to try to get him to eat and rest today... I don't know what else to do... Terry and Timmy

Terry Pa

Just an FYI many dogs are put on Imuran and cyclo, mine included. Please ask your vet about adding Imuran. Cheryl & Ginger

Cheryl & Ginger Pineville PA

When Ethel first had to go to the emergency vet, they started her on pred, but it had little impact for the first few days. They temporarily put her on high-dose IV steroids for a day or so, and that really helped get her stable. The 5mg sounds low to me, too, I think a lot of vets have seen the long-term effects of prednisone and try to lowball the dosage to avoid causing more problems, but sometimes they just have to get hit really hard with the steroids at the beginning.

Brian Vermont

praying for Timmy...

Josh California

Brian is very right. "IV steroids" is usually dexamethasone and is a very positive step in the beginning days. When Chance went through this, I knew that he was going to be on high dose prednisone treatment for a long time and I knew exactly what the side effects would be for long term use. The side effects of this drug are difficult for the dog and make it very hard for the owner to watch, they begin to doubt themselves that they should be putting their dog through what appears to be very serious side effects. This isn't a decision that is easy to make. If you don't know what the outcome might be in the end, it's normal to feel unsure if you should put your dog through this. And if the vet is expressing uncertainty, well that makes it harder. My vet told me that if this were a human, we could not "put them down," we would transfuse them and treat them until we could find a way to help them make blood again. I remembered that and never looked back. I have always treated Chance with respect to his eagerness to live. He wasn't always comfortable, but he consistently showed his eagerness to be top dog and in control of the house. My vets understood this perfectly and allowed me great control over how the treatment was done. What happens next for Timmy is ultimately your decision and no one can make that for you. And whatever your decision is, *there is no right or wrong decision in this.* I think what people are saying is that each vet's perspective on the "chances" a sick animal has at living are varied depending on the experience of the vet involved and their personal sensitivity to the situation. These feelings they have may not be born out one way or the other in the end result. my best patrice

Patrice NYS

Terry, Just wanted to say I am keeping you and Timmy in my thoughts and prayers and also to comment on what a wonderful Vet Timmy has at the overnight clinic. Penny

Penny Lytle Creek Calif

Terry -- I'm hoping that Timmy stabilizes. But as others have said here, you can't just judge based on the PCV. I'll keep both of you in my thoughts and prayers. Hang in there.

Brenda VA

Millie was given a dexamethasone injection upon diagnosis (pre-transfusion).

Samantha Geelong

Terry and Timmy, I dont have anything to add, but i am thinking of you. I know how hard this is, and i know how expensive this is too - i have been there and am still paying off these bills. Patrice is very right - home nursing and tlc can do a world of wonders. Get started on learning nutrition, and researching herbal supplements like you have with the milk thistle. most important right now is getting the pred and imuran dosages right - keep working on that and do a 2nd consult with someone. to help with bills: there is a freedrug card you get on the internet that works at costco and walmart, and helps subsidize prescriptions - it really does help, and is fine to use for pets - you print it out in timmy's name. Walmart has prednisone on the 4 dollar list, and thyroid meds too. Imuran is least expensive at costco. You dont have to buy all the drugs from your vet - if you are. She seems great, so please have a talk with her about your finances and your options with Timmy - i did so with my vet, who bent over backwards to help me save Kent. You are both in my thoughts, Christine and Kent

Christine Fl

I too am thinking of you. Your in my thoughts and prayers....Take care

Mardi Northern Cali

Thanks everyone for hanging in there with me as my nerves are frazzeled often when i am scrambling to find answers and advise i have found through all of you that has become like family to me.Timmy would not have made it this far if it were not by changes made by being informed by all the great knowlege gained here. Dr. dobbs has been gracious enough to talk by phone a few times and gave me some great input as well.Timmy has held his own for 5 days now with a pcv of 23,26,22,22 that has bounced back and fourth.The pred was doubled from 5mg to 10 mg bid and thyroid supplement was added a day before these last pcv readings.We are 2 weeks total on the pred with the double dose started 4 days ago and 8 days out on the atopica.So i don't know if were just out long enough on the meds or jacking the pred and adding the tyroid supp. that is working.He is eating well and seems to improve clinicly.He just seems to act more himself.He is still pretty weak and bloated from his spleen and liver.I thank God every day that Timmy is still with me. It has been suggested if he remains stable in through the middle of next week to run a CBC and blood smear to check cell generation and just what what is going on now that we are seeing some stabilization.Thanks for being here and my thoughts and prayers are with all of you and your babies... Terry snd timmy

Terry Pa

Terry -- so glad to hear that Timmy is stabilizing and that you have Dr. Dodds on the case. She is such a fabulous resource. I will keep you and Timmy in my thoughts and prayers. And yes, every day with them is such a gift.

Brenda VA

This thread was discussed between 29/07/2009 and 01/08/2009

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