Debbie -- there is a massive thread on here for you "AIHA or IMHA" - This is the last page as of today: community.dog.com/.../90432.aspx
This is the very first page -- and in that first post there is an index that should help you with some of what you're going through.:
community.dog.com/.../90432.aspx
My email is callieatcritturs@yahoo.com -- and I can help you a lot.
IMHA is difficult -- I've got tons of experience with "sick dogs" generally and my husband and I have never encountered anything quite like IMHA. You're absolutely right -- you worry yourself through the first few weeks.
If the vet hasn't really explained it (particularly in words you can understand??) -- what happens is the immune system for some reason gets confused -- and that's honestly about as good a word as any.
"Confused" because it has forgotten how to function normally. The immune system should turn on in response to a threat ... and then, when that threat is dealt with ... the immune system should turn OFF. Relax ... Stop ...
But it doesn't -- it literally trolls the body looking for things to kill. And along the line it crosses a very very critical line -- it doesn't just kill real threats ... it begins to kill it's own cells. In the case of IMHA it kills the red blood cells.
It feels like it came on so fast -- but usually it actually doesn't. Often the final straw is vaccines -- which may have been given 2-3 months ago -- but it takes a couple of months for the body t really fully form antibodies in response to a vaccine ... but then ... the immune system ... when it can't find anything else .. it sees those new antibodies ... and somehow those antibodies (which **do** have DNA from the disease it was formed to combat) look too much like disease cells and the body starts killing those.
Well antibodies are also baby red blood cells .. so ... then the body starts killing regularl baby red blood cells (because they are a lot like antibodies) ... and from there it also kills adult red blood cells. One piece at a time.
When they say "not regenerating" what they really mean is -- the body is probably making *Lots* of baby red blood cells (called "reticulocytes";) BUT the body is killing them while they are still in the bone marrow ... before the blood is "born" into the blood vessels.
So it usually isn't that blood isn't being made -- it's that what is being made is killed before it makes it to the bloodstream.
So the initial answer is -- you can't really relax until she's stable. And that is a tricky word because it can mean different things during the course of this.
Right now -- "stable" means that you've got the immune system to **stop** killing the blood and some of the new reticulocytes begin making it into the bloodstream. So the PCV (packed cell volume) or hematacrit [PCV and the 'crit are measiuring the same thing -- but the PCV is a hand-done value and a hematacrit is machine done - usually as part of a CBC or "complete blood count";)
See -- ti's like you need a medical dictionary next to you!
And along with all of this, the meds typically make them quite sick -- so it's a delicate dance of giving meds and keeping them eating.
1. Don't give her medicine in her food. Just absolutely positively do *not* do that. You can use something like yogurt, liverwurst, ricotta cheese, babyfood meat - and put meds in those (or a spoon or a lump of it in your hand). Don't try to "hide" it -- she **will** smell it. Show there that it's there but she *must* take it because that's how you get better.
Putting meds in their food may work for a few days. But then, ***trust me*** suddenly they will stop eating.
Don't do it. Do the meds before a meal -- in something (and honestly try liverwurst -- it is yummy to them and it's high in iron as well). Then feed after.
2. Keep this dog eating. Don't worry about gaining weight -- it takes so much energy to get well from this many lose weight. Usually the pred eventually makes them hungry -- and they may eat you out of house and home. Don't worry about that -- if that happens it is a blessing!!
3. Let her sleep. Encourage her to sleep.
OK -- now I'm going to tell you the truth about IMHA
It's a nasty, awful disease. But ... is it that .. a disease. Right now there is still a high mortality rate -- but MANY dogs live thru this. Many *more* live now than did 6 1/2 years ago when my Billy had it.
This is not permanent. The can get better. In fact they can return to a good, healthy life. What you are seeing is a sick dog. Today this dog is very, very sick. But you get better.
My point is this -- you will hear people say "why do you put her throught his" -- and there **IS** an answer to that.
You go **through** something to get to the other side. You go through "sick" to get "well".
But you must be patient. This takes a long, long time -- many months. Even the easiest cases take six months or better to get them off the drugs. My Billy took 18 months to get off ALL the drugs.
And my Billy had a horrific case of IMHA. He had six transfusions the first month. SIX. AT the time he was the only buffy cocker I could find anywhere who had survived.
But not only did he survive -- but his 3 years after IMHA were the BEST years of his life. He had a happy, fun life after IMHA (and he had fun DURING IMHA too!!)
My point is -- your dog is not going to be sick like this forever -- so be patient. You have a lot of work at first to cope with all the meds and the feedings, and just plain care for a very sick dog.
You will find support on the thread (and I'm going to ask the powers that be to merge this into the AIHA or IMHA thread -- it will help you to read what others have done. Do not try to read it all in a day.. It's too much -- and frankly it's too scarey.
See -- this is the other big thing right now -- YOU, Debbie, need support. If you will email me at callieatcritturs@yahoo.com I will help you. I can help you make sense out of bloodwork, and know what to do next. I will tell you about milk thistle and things to help make this journey a little easier.
Her poop is discolored form the drugs and the inflammation.
You will see lethargy for a LONG time -- and honestly that is a *good* thing not a bad thing. Her body is trying SO hard to cope -- the heart is having to beat so much more/faster in order to turn the blood around and around and around so the body has **enough** red blood/oxygen to survive. Her body is working SO hard it equates to you trying to run the Boston Marathon TWICE before breakfast.
IMHA is hardest on the heart because the heart has to provide enough oxygen for the body to do all it needs to do just to survive. So her body shuts down what it doesn't need -- it makes her SLEEP a lot -- just to conserve energy.
Even when she starts holding blood you don't want her to be active. All the drugs for IMHA cause weirdness in the blood -- things like "clumping" (which can turn into blood clots all too easily) -- so let her sleep. Encourage her to sleep. And don't worry about it -- she **NEEDS** it badly. For a long long long time. It is the biggest place for healing to start.
"Your dog" will be back. You **will** see her ... just be very very patient. This is normal.
There are not stupid questions -- if you will email me I will even give you my phone number. Back when Billy was going thru this a couple of people helped us. And my husband and I promised ourselves that we would help others. Because you do need it.
You can exhale now. In fact you *must* Debbie. Because if you are all upset, it makes her upset.
And if you think about it -- when are ANY of us ever guaranteed to wake up tomorrow? We aren't. I could get hit by a bus on my way to work tomorrow. But I probably won't. In fact, I'll be really cautious and try not to be.
So we take it one day at a time. *hugs* You are NORMAL. Trust me on this!!
Let me know how I can help.
Callie
Good luck!! I know this is hard!!