Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Update on Blitz

Hi all. I posted about Blitz 3 weeks ago when she was first diagnosed with AIHA. She was at 14% PCV and in the hospital for 5 days. On Monday 17 January, we didn't have any more money for her to stay in the hospital so we took her home. She started eating for us (didn't eat the entire time at the hospital), and her PCV shot up to 28%, but it has started to level out unfortunately and the vet is worried. It was at 28% on 24 January, up to 29.5% on 28 January, and back to 28% on 2 February. She was taking: 20mg Prednisone 2x a day 75mg Cyclosporine 2x a day 10mg Pepcid 2x a day 1/4 of a baby asprin once a day 25mg azathioprine every other day They put her on doxycycline a week ago because she had a very slight positive for a tick born disease. And because her PCV isn't going up they upped her morning cyclosporine to 100mg. Her muscle wasting is really bad - she feels like skin and bones! She can still get up, but I can tell it is difficult now. She threw up a couple days ago and my husband said it was about 2 days worth of food that was only partially digested and it was really sticky and all came up in 1 ball. I was wondering if maybe her medicine wasn't getting absorbed if she couldn't really digest food. Or maybe one of her medications is making it hard to digest food. We're going back to the internalist on Monday to get her fully checked out instead of just doing a PCV. Also, now she has a sore on her foot that she keep licking? Do you think this could be related? I'm taking her to the vet today to get that checked out. Thanks for reading! Please let me know if you have any advice :)

Liah Charleston

One more thing - she is still icteric, so she is still destroying some blood cells. :(

Liah Charleston

I would contact Dr Dodds about asking your vet to reduce the pred dosage, especially since you are increasing the cyclosporine. Ginger had to have her pred dosage reduced do to the side effects and she was also was stuck in the 27-28 PCV range for about 6 weeks until the cyclosporine was added and began to work. Also try to get some pet-tinic is Blitz is not already on it. How much does Blitz weigh and how long has she been on the 40mgs of pred a day? Keeping Blitz in my prayers. Cheryl & Ginger

Cheryl & Ginger Pineville PA

Liah, what are you feeding Blitz? I always thought that people that are cooking for their dogs are nuts. But guess what...? My dog started to enjoy his food, it was easier to digest and it is way better than kibble. I believe in raw food, but with this disease home cooked is definitely the best. let me know if you need recipes. Like Cheryl I would urge you to contact Dr. Dodds. Her holiday is Saturday, so most likely you would not hear from her until Sunday. Write down all of Blitzes CBC and Chem values, her weight and drugs taken. Be short and concise, she gets LOTS of mail. I know she will write back as soon as she can with valuable advice. The other avenue you could take is to ask your vet to consult with Dr. Dodds. Either way, you will not regret having her on board. The sore on Blitzes foot is most likely related. Many dogs get skin issues as a side effect of the immune suppressing drugs. Once the drugs are reduced the skin will get better. When you see the vet, ask to have a full Thyroid panel done. The skin issues could also be a sign of hypothyroidism. Many dogs that are on steroids become hypothyroid. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

It could be the doxy preventing the hematocrit from rising! Doxy is known to stimulate the immune system which is not what we want right now BUT is likely needed for the tick disease. I've seen dogs before regress while on Doxy BUT the jaundice would have me slightly worried. Does the vet look at the blood under the microscope to check for spherocytes? I'd consider this to be important with each blood draw. The increased bilirubin causing the icterus *might* be a result of the previous transfusion and *might* not be cause for concern IF it's getting better and not worse. I'd really be wanting a FULL chemistry panel done to check everything out and see how the liver is fairing. Are you using milk thistle? Don't suppose you know the latest CBC results? These results might give/show an answer to if the drugs are properly working at sufficient amounts. IMO I think the drugs look to be the right amounts for a dog that size with exception to maybe the cyclosporine. This dose is on the lower side and perhaps you could ask to up the evening dosage to 100mg as well. you could always ask the vet for a trough test to check for cyclo concentration levels in the body. Too little means you need more...too much means you'd have to lower the dosage. This test is done right before the next dosage is to be given and has to be sent out...meaning it can be pricey at times! You should really keep Blitz calm and less active while on larger doses of pred. the more activity, the more muscle wasting will occur. Thoughts and prayers, Johnny & Tessy

Johnny

while the dogs are on intensive doses of drugs, the blood tends not rise in counts very fast, the counts don't get back to their norms until after they have been taken off of them. as long as the blood is not longer agglutinating, it should be fine, the drugs do take a toll on them. this is an ongoing battle as their really is no cure, just remission of this disease. it is with them for the rest of their days, most stay in remission, but a few dont't, it all depends on good old mother nature. it takes a long time, i know our Tori was a year getting back to her old self and off of the drugs. take care

bev canada

I took Blitz to have a full CBC and another blood test to check her liver on Monday. Her PCV was down to 24% and she was showing some liver toxicity, but she was making more blood cells than before. The doctor took her off of the Azathioprine (causing the liver toxicity) and I started giving her Milk Thistle and Sucralfate. She also finished her Doxycycline, so she is no longer on an anti-biotic. On Wednesday her PCV was 25% and today it went down to 23%. She is has been acting pretty chipper and happy this week, but I'm still really worried about her. She is eating and drinking fine. I've been feeding her her regular dog food and I talked to the vet about giving her something different and the vet said it wouldn't really help anything.

Liah Charleston

Liah, have you ever gone to an MD and asked about nutrition? Well if you have you would have found out, most doctors now "diddlysquat" about it. The same is true for your average vet. After all they sell pretty low grade dog food at most clinics. So I dare say that your vet is wrong by stating a different dog food would not improve the situation. I must say I have some doubts about your vets knowledge about the disease. Taking Blitz off azathioprine and not at least increasing the cyclosporin is asking for a relapse I think. Reducing the medications on a downward trend is not a good idea. Would it be possible to check the cyclosporin in the blood? This way you would know if Blitz get's enough. Of course there will be liver toxicity. But the liver is an amazing organ and quite capable to heal itself with the proper food, milkthistle and Sam-E. Once all the drugs are reduced the liver will recover. I still think it would be beneficial to get a consult with Dr. Dodds. I have no shares in hemopet:) I just know how helpful her information was to us and so many others. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Thanks for your advice Brigitte. I've been seeing an internalist, and going to my regular vet for the PCVs (they are talking to each other). They are supposed to call me this afternoon about a plan since Blitz's PCV is going down, so I will definitely ask them about increasing the Cyclosporine and the Sam-E. We upped the Cyclosporine to 100mg in the morning (from 75mg) and left it at 75mg in the evening. I sent my husband to the pet store to look for some better food - I saw the Wellness brand suggested on someone else's post and I told him food with no grains. I wrote down Dr. Dodds email - I'm going to get a copy of all of her tests first and then email her with all the info. Thanks again!

Liah Charleston

Liah, Depending on her weight, the dosage of cyclosporin can start as high as 220 mg per day. Chance was on a special protocol from Dr. Dodds. Start high, dose monday through friday and no dose sat and sun. Then after a week or two of this high dose, reduce according to her schedule to a maintenance dose, still dosed m-f and weekends off. It worked spectacularly. my best patrice

Patrice NYS

Blitz is 40 pounds. She was 45 before she got sick (a little chunky), but she didn't eat the entire time she was in the hospital a few weeks ago, so she dropped 5 pounds. The internalist mentioned adding Leflunomide if she is still not responding to the other meds. Have any of you tried this? The sore on her foot got way worse. She ripped off her bandage last night and licked and chewed the heck out of it. I think we will have to put back on an antibiotic for that. We bought the Wellness brand food for her last night and she loves it. I'm taking her for another PCV on Monday.

Liah Charleston

Liah, at 40 pounds you could easily up the meds instead of adding leflunomide. I'm not a fan of leflunomide but some here have used it. Leflunomide wouldn't be a good drug to use with a dog having hapatic *liver) issues. Do a search in the archives and you'll find a big discussion on this drug! Perhaps you could raise the cyclosporine to 125mg in the morn and 125mg in the evening for a week and then if the numbers approve then lower the dosage down some....or perhaps do what Patrice mentioned. Don't suppose you know that the lymphocyte counts are?? With regards to the sore foot....Tessy went through the same thing during chemo and it was hard to keep bandages on! She eventually learned to leave it alone but I was seriously considering using a cone to keep her away from it! I used medical tape also to help hold it in place and then a sock over it and more tape! LOL...she looked pretty funny! Johnny & Tessy

Johnny

I took Blitz to the vet again yesterday to get her foot checked out. The vet said he doesn't think she bit her foot, he thinks her skin is necrotic and if she licks it, it is just sloughing off. He shaved her let and saw a few dark patches of skin. Now we have to go to a dermatologist to check this out because it might be a skin cancer that is causing the IMHA. I'm pretty scared that if this is the case, we might have to put Blitz to sleep. I can't have her living in an E-collar not able to do anything fun for the rest of her short life just because I want to keep her around. I'm planning to see the dermatologist Thursday morning hopefully, and maybe we can figure this thing out.

Liah Charleston

I am sorry Blitz is continuing to have problems and hope Blitz is feeling better soon. I just wanted to tell you about the no bite collar it gives them much more mobility and freedom then the e-collar. When you get a chance check it out on line. I have one for one of my Golden's who loves to lick his back legs and this works just fine when I need it. He can pretty much do everything with it on and doesn't really seem to mind it. http://handicappedpets.com/www/index.php/no-cone-collar.html Sending prayers for Blitz Cheryl & Ginger

Cheryl & Ginger Pineville PA

Liah, Before you get upset, it is important to know that there are skin side effects from both drugs you are using. Prednisone can suppress the immune system enough (too much) such that a skin disease called staph can blossom. It usually includes patches of reddish skin, the hair sloughs off and leaves shiny patches and it may ooze a creamy liquid. Staph is easily controlled with an antibiotic. Cyclosporine can also cause certain skin conditions: "mild to moderate gingival hyperplasia (overgrowth of gum tissue), skin reactions such as verruciform lesions (benign mass of the oral mucosa ) or change of hair coat, red and swollen pinnae (ear), callous-like lesions of the foot pads, cutaneous papillomatous hyperplasia (bengn skin growths)" I can't guarantee that this is truly the case but your vet should be aware of these side effects and examine the spots more carefully with these in mind. Many owners here can speak up and mention the skin issues their dogs had during this treatment. I know that Chance had to fight staph infections a lot and was on antibiotics for that. So for today, please hold off on imagining these dire consequences until the dermatologist examines her. my best patrice

Patrice NYS

Thanks Patrice. The vet mentioned that it doesn't look like a Prednisone side effect to him, but he referred me to a dermatologist to be sure. We'll see what they say! The first sore started because her dew claw curled into her foot, but after a week that got worse because she kept licking it, and on Saturday morning, there was a large new sore on the top of her foot. We cleaned it and kept it covered so she couldn't lick. On Sunday night I saw two soft, dark, oval bumps (about 1cm diameter each) on her upper leg and the skin around them was very red. When I had her in the car on the way to the vet Monday morning, I noticed the two bumps had ruptured and there were two indented sores. The vet shaved the rest of her leg and saw other dark areas, but they were raised bumps yet like the areas that ruptured. If anyone has seen this before please let me know.

Liah Charleston

Liah, an other thing about skin issues comes to mind, hypothyroidism. Have you checked Blitz's thyroid? It will be low at this point for sure and a supplement would probably not hurt. I am interested what the dermatologist finds out on Thursday. Best wishes, Brigitte & the poodle boys

Brigitte BC Canada

Did you get a CBC or PCV test done as well??? If the crit is up enough you could always consider bathing Blitz with a medicated shampoo. Tessy use to get the black/dark patches on her skin! Everytime she had a skin infeciton that area would turn dark afterwards. She'd also get bathed regularly while dealing with these infecitons! I used PanOxyl soap (with benzoil peroxide 5%) as well as the Selsun Blue medicated shampoo (red top). I'd finish the bath with a rinse of tea tree oil to make hte coat feel soft. Again though...this was for the infection and not the color change. She also had a yeast type infeciton that presented itself as dark blotchy skin areas which, again, a medicated shampoo worked to treat. You're using cyclo and cyclosporine is used for dogs with skin problems! HOWEVER, at these larger doses used to treat this disease it makes the worst skin ever. The body expels the toxins from these drugs through the skin! Like the others said...please try not to worry...this is normal with lots of dogs! I agree that having the thyroid checked is important!!! Keep us posted...lots of prayers. Johnny & Tessy

Johnny

So we went to the dermatologist. She thinks it it more likely that it is an infection than cancer because she has been on so many immune suppressants right now. We had to send off cultures for aerobic and anaerobic bacteria, fungus, and they did a biopsy. They do not think it is a result of the medications because of the way it started at her small wound and is traveling up her leg. They started her on an anti-biotic and anti-fungus (?) just to stop it from spreading as we wait for the results. Another super expensive vet bill! They also checked her PCV and it went down to 18% :(. I'm not sure if it is because she is bleeding or maybe her immune system is fighting against the medicine to fight off the infection. I'm waiting for her internalist to give me a call and tell me what to do. I'm afraid she is going to put her on the Leflunomide, but I'm pretty much ready to try anything at this point. I really love this forum! It's so nice to have a place to just say all of this stuff because it is pretty much the only thing I can think about. Thanks!

Liah Charleston

Liah, what are the values for the liver enzymes? I'm just wondering how bad the damage is. Do you have a recent copy of the CBC and a previous one to compare to? Would you be willing to ship blood out to Dr. Dodds??? I really think you should be checking the thyroid as well as getting an RBC morphology done. For under $200 you can get a LOT or answers to your many questions!!! I can't remember ...are you using Pet Tinic? It's important to supply the body with the needed micronutrients to actually build new blood in the bone marrow. I'd also be pushing REALLY REALLY hard for them to add either sam-E OR denamarin to the mix to combat the liver damage. The liver plays an integral role in the development of new blood and any impairment can slow the process. The longer you put off certain tests and meds, the worse a case can become. For example,testing the thyroid, adding needed nutrients (pet tinic or similar), or even adding liver detoxers. I've seen far too many times owners that stall or procrastinate and then when they finally decide to do things it's usually too late. Did you get recent copies of CBC's or are you only getting PCV's each time? I'll keep Blitz in my thoughts and prayers. Johnny & Tessy

Johnny

Hi everyone, We had to put Blitz down this weekend. He PCV kept dropping, and she couldn't stand up on Saturday morning. She was back to square one but she was already so weak and her leg looked terrible. We decided it was the best thing for her to let her go. Her regular vet told us that we did everything we could, and he really didn't think she could get better. We miss her so much. I'm glad we have our other dog and kitty to keep us company. We are still going to get the results of her biopsy and cultures from the dermatologist when they come in. I will let everyone know what they say in case it can help anyone else that has noticed sores on their dog. Thanks for your support through this horrible month.

Liah Charleston

Dear Liah, I am so sorry..... You have my heartfelt condolences on the loss of Blitz. I know that in time your broken heart will heal and you will find comfort in all the great memories you have of Blitz. Best wishes, Brigitte

Brigitte BC Canada

Liah, I am so sorry that you have had to say goodbye to Blitz. I hope that the happier memories that you shared with your girl will help you through these terrible days. Keeping you in my thoughts and prayers. Penny

Penny Lytle Creek Calif

(((LIAH))) I feel your pain Liah! It's such a difficult decision to make. You did everything you could for Blitz and I'm sure he knew that! He always be watching over you wherever you go! My deepest sympathies and condolences. Run Free Blitz. Johnny & Tessy

Johnny

Dear Liah and Family Please accept my heartfelt condolences in the loss your beloved Blitz. Sometimes our pets earth suits just can't be fixed no matter what we do and you should feel comfort in knowing you did everything you could for him. Blitz will forever be in your heart until you meet again. My thoughts and prayers are with you and your family during this difficult time. Cheryl & Ginger

Cheryl & Ginger Pinevile PA

So sorry to hear about Blitz, Liah. We pray you will find comfort in the LORD. HE knows your pain and Blitz is running free and happy now. No more pain for her! Blessings, Cindi & Tori (IMHA)

Cindi PCB

This thread was discussed between 04/02/2011 and 23/02/2011

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