IMHA

Turner'sMom

I'm not familiar with forums and threads and such. I don't know if my question will be posted to the correct thread, which is that regarding IMHA. My dog was diagnosed with IMHA last Wednesday. His body destroys reticulocytes in the bone marrow. He was started on meds right away. Is it typical for an IMHA dog to have some days that are better than others? Turner seemed better yesterday, and most of today, than he has for the past few weeks. This evening, though, it seems his energy is down and he's a bit weak. He did have a very short walk this afternoon. It was a very slow walk, four houses down from us, then right back home. Maybe that short walk wiped him out? Is it normal to have some days better than others? Thanks so much.

We have a huge AIHA or IMHA thread and I'll ask the mods to move this for you.  Currently this is the last page (but I'll have the mods move this to just below that, so it should get you where you want to be. 

http://community.dog.com/forums/p/90432/989441.aspx#989441 

It's just one message after under each one below the last.  My email is in my signature (with the dogs' pictures) and I will also email you my contact information so  I can help you.   My dog Billy had IMHA 6 years ago  -- it took us 18 months to get him "off" all the big drugs -- but then he had the BEST 3 years ever!!  I lost him to a heart attack later (not to IMHA!!!). 

To answer your question -- YES YES YES - it is very very typical to have bad days and good ones.  Don't think that the way he is now is the way it will always be!!  The side effects to these drugs are massive -- and truly truly -- right now you just want to focus on getting him **through** this.  Literally thru and OUT on the other side!!

I can help you with tons of stuff and the support is good here.   You'll learn about stuff like milk thistle - and what to expect and what to ask your vet.  NO question is 'stupid' -- ask absolutely anything you want.

 *hugs* -- IMHA is an awful disease but the mortality rate is FAR better than it used to be.

 Callie

Thank you so much for your response.  I'm encouraged by your success in getting Billy through IMHA.  He was fortunate to have such a committed person as you to see him through and into his best three years. 
I'm also encouraged by your statement that the mortality rate is far lower than it used to be.  I'm studying this disorder like mad, and must keep my head about me.  So many disheartening statistics, which I am not going to pay attention to!   I'm determined my boy and I will overcome this. Your encouragement, and the AIHA or IMHA thread are very helpful. 
I'll get Turner some milk thistle, as you suggest. 
I plan to study some more tonight, once home from work.  
This disorder really messes with your head.  I so appreciate being able to read other peoples' experiences and suggestions of help.  Thanks also for getting my posts where they belong.  I'm not too savvy when it comes to internet forums, as this is my first experience with them. 

The mod will get this moved when she can.  They are just "normal people" like you and I (mods aren't compensated - they're just good hearted enough to help keep the forum moving along).

I emailed you with my phone numbers -- that will help you a lot. 

 You are entirely right "messes with your head" -- which is why i'm still involved.  My husband and I decided early on this was a disease like NO other -- it is SO difficult to keep track of everything, and even **most** vets are not at all experienced with this and many of them are just not equipt to deal with it (and that's NOT saying they are bad -- just that the treatment for this is COMPLEX that they don't have a chance to totally stop their practices to become completely immersed in this ONE thing to the exclusion of everything else).  Knowing when your vet is perhaps "out of their depth" and when should you move on to a vet school can be extremely difficult.

I will say this *now* -- just because people lurk -- typically when I see someone's vet may truly need a hand, I suggest folks go to a VET SCHOOL **not** a specialist.  Specialists can be expensive to the max (and this is a fiercely expensive disease to treat) -- but I have found that often specialists tend to rely on their past successes rather than keeping up with what is *new* in treating IMHA and they like to use what they are familiar with, not necessarily what is truly good.  So most of the time I will suggest if someone wants more help to go to a VET SCHOOL (there are the capital letters again -- just for emphasis - not "yelling";). 

 Vet schools are often more cutting edge and yet cheaper than a specialist. 

Turner'sMom -- very often it is the small things you do -- things like milk thistle and more frequent than required big blood panels (to keep track of the liver and kidney values) that can truly make the difference. 

 Good luck!!  *hugs*  Callie

Hi Callie, Thanks for your phone numbers - much appreciated. My vet actually did refer me to a veterinary teaching hospital, and she wasted no time in doing so. After she diagnosed Turner with hemolytic anemia, she told me that he needed further testing that very day, and that I needed to get him to the vet school right away. This is why she's such a great vet! :-) I agree with you wholeheartedly - if at all possible, go to a veterinary teaching hospital. The vet schools ARE less expensive than a specalist would be. More importantly, at vet school, there are many people looking at your dog. I think all those experts and students looking at an animal helps ensure nothing will be missed. I'm so grateful we have an excellent vet school not too far from us. Callie, God bless you and your husband for this wonderful forum. Turner and I are just starting this journey. I'm so grateful we don't have to travel this rough road alone. I'm about to settle in for an evening of study. It does a person well to know her enemy, and IMHA is truly the enemy.

Paige must be REALLY busy today (I did ask her to combine the threads).

The one thing I would Strongly suggest is milk thistle -- get the best *quality* you can find -- and I don't mean just whatever is expensive at Whole Foods.  Go for a "bulk" milk thistle (unbelievably MUCH cheaper) but a "certified organic" one. 

http://www.leavesandroots.com  -- look under "M" -- you want the milk thistle seed powder (not the "whole seed";)

or

http://www.mountainroseherbs.com -- again you want the milk thistle seed powder *NOT* the whole seed (unless you want to grind it all in a coffee grinder - too much time!!)

Both are good quality -- the customer service at Leaves and Roots is amazing.  But Mountain Rose carries a good quality product (and is actually cheaper but a bit slower).

Tell me how much Turner weighs and I'll tell you how much to use.  Probably 2 teaspoons twice a day IN food (you'll have to stir the powder into something wet -- steamed beef heart, or babyfood or most anything).  It doesn't taste bad at all.

Hello Turner's Mom. I am fairly new to this forum and IMHA as well. We were diagnosed two weeks ago. I have spent a lot of time "googling" the mess out of this dreaded disease!! But in answer to your question, YES, it is completely normal to have good and bad days. That is why I assume so many people refer to it as a "roller coaster" ride! My Bella had a couple of really good days, and then she will stumble onto a so-so day, or a not so good day. My vet did confirm that this would be normal. So far my Bella is responding well to her meds. She is putting on the weight rather quickly. In conjuction to the meds causing weight gain, muscle weakness is very common as well. She can no longer jump on the bed without assistance. I am praying for a full recovery. I really miss her personality!!!! Hope Turner is doing well. Best advice: love, love, and more love!!!! SORRY JUST REALIZED YOUR THREAD WAS OLDER.....LOL. I AM A LITTLE CONFUSED ON THIS SITE, BUT HOPE TO GET THE HANG OF IT!

Yeah these never did get combined .... the "roller coaster" can be   even a lot wilder than what you're seeing - some dogs crash repeatedly before they stabilize and the PCV can go up and down wildly.  And this is just plain a DIFFICULT disease to deal with -- very work intensive.

HELP!!!!! My 14 yr old Chiweenie diagnosed Primary Non Regenerative IMHA on Oct 4, 2013. 14% PCV and received blood transfusion on 10/4. Came home 10/5 at 23%.  Cyclosporine, Dexamethisone, protonix,  minocycline, baytril. Everything went smoothly and the follow up was Oct 9 and she was still 23% and reticulocytes went from 12000 to 18000. That night Maggie started vomiting. The next morning we added Crenia for the nausea and it worked but Maggie stopped eating. She does look through her food like she's looking for a pill. After trying all kinds of foods and the pill gun I was absolutely unable to get all these pills down her. I've been taking her to the vets office 3 times a day so they can pill her. An appetite stimulate was added to the mix on Oct 10 and hasn't worked.  She's so sick today with a tummy ache and trying to poop when there's nothing to poop. At tonight's vet visit to be pilled she ate a little when the vet fed her. They checked her for pancreatitis but that came back ok. Diagnosed with colitis and given another med!  When she was pilled she bit the vet tech. It was just a little nick but it broke the skin.  Well the VET informed us that in NORTH CAROLINA  a dog bite has to be reported and the animal will be quarantined for 10 days! Doesn't even matter that she is current on all of her vaccinations! They wanted to keep her but I refused! OMG! What am I going to do? Animal Services will come to get her Monday! I cant get these pills down her throat! I can't be away from her during what could very well be her last 10 days! I don't know what to do!  If I have her hospitalized and she bites someone again who happens to have their fingers inside her mouth then she could seriously be in danger of being put down by the county! I'm in Charlotte NC. My vet said NC has the strictest rabies law!

Dogs can be quarantined at home at the discretion of the Animal Control, they can be quarantined at a veterinarian's clinic.  Animal Control is not going to take your dog away and she is not in danger of being put down unless there is something else you aren't sharing.  Calm down.

charmeck.org/.../Animal%20Bites.aspx

Oh dear -- I am so sorry.   IMHA is a tough tough thing -- but I brought my own dog through it and it *can* be done. 

Jackie's link is directly the the NC website and it *does* state that she *can* be quarantined at home.  

It does matter that she's current on vaccines because it means she can be quarantined at home.

In honesty -- and I'm going to be *very* honest with you only because I think you need to be prepared for this.    This may seem harsh and I don't mean it to be, but I work with IMHA dogs (and their owners who love them) a **whole lot** and I have to make you understand a few things.

If they've been pilling this dog three times a day -- and she **still** got snarky (in other words, typically an animal will get used to it) then it's possible she's more than a bit difficult for *the vet* and the vet's office has just decided they may not want to  do this for you any more.  having the dog there round the clock?  They may decide to sedate her a bit or they may think it would be easier if she was dependant on them rather than coming and going with you.  

As it stands -- they are the 'bad guys' all the way around.  

The threat they gave you scared you -- so it worked -- but it also means they don't have to deal with your or your dog right now.  

You must stop saying "i can't" - because honestly ... you *must*.  

Your dog is afraid -- and to, again, be very blunt, you must calm yourself down - because you will ramp the dog up.  Much of successfully giving an unwilling dog meds is how you approach that dog.  

You must not "pooor pooor baby" the dog.  You must be confident, totally non-emotional.  If you allow yourself to get all nervous and flustered and fearful then the dog will react to all of that.  I know this sounds harsh and "impossible" but you have to take emotion out of the equation because if *you* are overset, the dog will be freaking out.  And right now, **more than any other time** she needs you to be strong and "in charge" for her.

She's scared -- it goes with the disease.  And every time she goes to a vets office they poke her, stick her with needles and put nasty stuff in her mouth.  

A.  **Never** put medicine in an IMHA dog's food.  They will smell it -- they **will** stop eating.  

B.  Don't try to 'fool' the dog by *hiding* a pill in something.  This is a dog.  Their nose makes ours look merely decorative.  They ***know*** from feet away that the piece of hot dog or cheese has something in it.  If they want the treat badly enough they will take it -- but don't fool yourself.  They **know** it is there so you're not kidding anybuddy -- and they then feel they have to distrust you.  Meds are meds and being very matter of fact "this is what we have to do" works better..  

C.  You can put the pill in something slippery --  and give it to them.  But don't lie about it -- "this is your pred -- it's bitter.  Just swallow" --  (a bit of liverwurst works great -- so does a bit of riccotta cheese

Put your hand  over the dop of the snout - with your thumb and index finger (one on each side of the snout)  squeeze gently **right behind the canine teeth* -- there is a natural indentation there --  you can open the lower jaw (the trick is holding that pill squished in the blob of liverwurst in two fingers of that same hand while you do this.   Once you get the jaw open just continue to push inside the mouth gently  and stick the blob of goodie with the pill to the back of the throat and PUSH the blob over the back of the tongue..  Close the jaw and hold the mouth *loosely closed* now and tip the head up and stroke the throat.  Allow the mouth just enough room so she can work her tongue to swallow

It works.  Eventually I can teach you to get her to take that willingly -- but that takes a bit more time.  

But if you are fearful -- then your dog loses.  Because you have to get the meds in there in order for her to get better.

Most of the meds for an IMHA dog can't be crushed -- but some (like cyclosporine) can be gotten in a liquid.  But there are a *lot* of meds to give.

My email is callieatcritturs@yahoo.com -- if you will email me, I have an article to send you that specifically deals with how to give the meds more easily. It's something I learned while I was giving my IMHA dog all his pills.

Callie

Can't improve on what Jackie and Callie said about all the issues you are dealing with;  but I also have some questions of my own.  Maggie seems to be on an awful lot of meds and yet no prednisone or baby aspirin at all in the mix.  Were the "colitis" meds added to what you listed at the beginning of your post or is that the grand total?  Seems like a ton.  Plus Cerenia is a very-limited time med and while Reglan provides steadier nausea suppression, but hey that's another pill.  Shayna started out at the exact same PCV as Maggie and stayed in the hospital for several days post-transfusion while they tried to stabilize her.  I know when she was at her sickest that they did a lot of meds IV because these pups are so miserable and their tummies hurt and then people keep stuffing things into them. I'd get kind of cranky too.  But just as Callie said, you have to reassure and reassure that she might feel temporarily worse but she WILL feel better when the meds start to work.   Also pred all by itself usually makes them HUNGRY.   So I do have questions about the medical decisions made by your vet and also your decision to take Maggie back and forth with -- as Callie said -- the vet becoming only the guy who always pokes and pills.  I found pill pockets invaluable myself for getting things like cyclo in Shayna (though with a little dog I would definitely consider the liquid version... Shayna is a moose)  but again, I always tell her there are pills in 'em and to swallow them fast.

Typically you don't see them use the anabolic steroid (the Dex) instead of pred totally ) -- and why *two* antibioitcs I'm not sure.  Reglan *does* come in a shot --which you should be able to administer yourself (it's just sub-cutaneous which doesn't hurt and works fast). -- on her other thread I suggested she may want to go to the NC Vet School in Durham -- it is a good one.