AIHA or IMHA

I just want to bump this up for the new people here.....Callie did a great job doing this INDEX to help us find the info we need in this HUGE thread we got going on here. 

 Hope it helps.

calliecritturs

I'm just going to plop the index right here for you -- it's not linked yet (which is why I haven't posted it) but you may want to check out things like the "definitions" and general overview -- Also -- longer term the use of milk thistle is hugely helpful to enable their bodies not to be damaged by the drugs:

 

General Introduction/overview of IMHA  -- Page 1/Post 2, Page 14, Page 65/Posts 12 & 15

 

IMT & IMP (Thrombocytopenia & Pancytopenia) -- Page 1/Post 7, Page 54/Post 7, Page 58/Post 11

 

First post by Gratefuldawg re: Cloppy’s IMHA  -- Page 1/Post 15

 

Milk thistle & Sam-e  and Marin, Denosyl, Denamarin -- Page 2/Posts 3-4, Page 19/Post 6 – mid-page, Page 48/Posts 10 & 12, Page 49/various, Page 88 (later pages contain comparative info)

 

Financial help & description of Care Credit  --- Page 3/Post 8

 

Triggers & discussion of “triggers” of IMHA  -- Page 3/last half of page, Page 26 /Last several posts

 

Dictionary of IMHA terms – helpful for those beginning this journey & signs of relapse -- Page 4/Post 5, Page 34/Post 7, Page 89/Post 1

 

Emotional toll and decision-making difficulties of  guardians  -- Page 4/last 3-4 Posts

 

NRIMA (non-regenerative immune mediated anemia) & description of that specific type of IMHA  -- Page 11/Post 7

 

Pred side-effects (the more severe ones -- beyond drinking/eating -  muscle spasms, sudden arthritis onset, emotional/ muscle side effects of pred (including suggestions & pet massage) -- Page 12/Last Post, Page 15 & Page 39/Post 3, Page 72/Post 12, Page 88

 

Prednisoone & cyclosporine side effects (particularly various– skin problems & UTIs-cyclosporine side-effect &  discussions) -- Page 13/1st half-page of posts, Page 18/Post 9-mid-page, Page 22/Post 8, Page 34/Post  12, Page 38, Page 48., Page 60 & 61/ Page 63

 

Food suggestion helps specifically for IMHA -- Page 14/Post 1, Page 42

 

Stomach protectant  -- Page 14/Post 1, Page 31/Post 3, Page 34/Post 7 & 9, Page  40, Page 66/Posts 14 & 15, Page 67/1^st half pg, Page 87

 

Cyclosporine levels – need to have blood word drawn to check  -- Page 15/Post 8

 

Nose/dry/cracked -- discussion of ultra dry nostril/edges of lips as cyclo side effect -- Page 18/Post 9-mid-page

 

Herbs generally & how to use & choose -- Paged 20/ Post 4

 Cyclosporine Generic– IMPORTANT POSTS -- Page 23/Post 13 & Page 40,, Page 43/Post 11, Page 60 –two forms of generic cyclosporine; Page 97 costs; Page 98 more specifics on modified/un-modified and where to get. 

Doxycycline – IMHA occasionally as mis-diagnosed tick disease or caused by tick disease -- Page 24/first half page &Page 34/Post 7

 

Giving Meds easily - suggestions on giving pills, organizing & training-- Page 25/Posts 4 & 5, Page 40/Post 5 – Page 41; Page 97/Post 11

 

Iron – discussion of serum iron & checking bloodwork for after a few months -- Page 26/Posts 4,6 & 9

 

Rabies vaccine (must not have) – rabies titer discussion (to obtain state waiver) -- Page 27/Post 3 & next several posts

 

Not responding/Obtaining help - going to a vet school vs. specialist – don’t wait! -- Page 28/Post 2+ several

 

Page 30/Posts mid-page, also some page 33– discussions on skin problems as side effects from cyclosporine & pred

 

Aspirin– Baby aspirin doseage  & discussion of stomach protectants - Page 31/Post 3, Page 66/Posts 14 & 15

 

Wean off -- discussions of lowering/weaning off drugs – Page 34/various, Page 46

 

Signs of relapse Page 34/Post 7

 

UTIs– discussion UTIs as cyclo side effect & treatments -- Page 34/Post  12, Page 38, Page 48., Page 63

 

Cyclosporine absorption– general discussion re: dairy inhibition of  absorption Page 39/Last half of page

 

Beef heart – iron foods Page 42

 

Page 44 – discussion of drugs NOT to use w/IMHA (triggers)

 

Page 45/Post 12, Page 68/Post 3, Page 72/Post 3  – Slippery elm cocktail (suspected ulcer/stomach help)

 

Page 49/Post 3, Page 57 (all)  -- Milk thistle & sam-e , Marin, Denosyl & Denamarin (discussion/contrast)

 

Page 50/Post 3 to Page 51, Page 55/Post 15  – Vaccines as IMHA triggers

 

Page 53/Post 3 – good post regarding Killer T-cells & IMHA

 

Page 53/Post 8 -  Homeopathics to treat & help treat IMHA

 

Page 57 – Various discussions on milk thistle

 

Page 63 & 64, Page 76/Post 6 – discussions about drugs to treat UTIs while on cyclosporine (Baytril particularly)

 

Page 66 – discussions on cyclosporine vs. azathiaprene and how long to work

P

 

Page 72/Post 5 – Pepto Bismol contra-indicated

 

Page 76/Post 6 – Dr. Dodds discussion of IMHA triggers

 

Page 70/Post 3 – TCVM (Traditional Chinese Veteirnary medicine) helpful, acupuncture/ Chinese herbs

 

Page 80 & 81– food discussions (diet with IMHA generally)

 

Page 82/Post 12 & Page 83  – various drugs/recommended drugs for IMHA & general side effects vs. “official stance” of what vets say about side effects

 

Page 88/Post 12 – Knox Nutra Joint to help with arthritis side effects

 

Page 91/Post 15 – More on baby aspirin

 

Page 92/Post 13 – various things that can inhibit cyclosporine absorption

 

Page 95/Post 5 – most of page – discussion of various heartworm preventives/flea preventives use with IMHA dogs

 

Page 97/Post 11 – temporarily lowered PCV can be caused by the spleen re-storing it’s supply of blood

 

Page 98 – discussions throughout page of the weakness some dogs show for several weeks as IMHA side effect

 

Cherylfaz,

I'm so sorry your pup has Evan's syndrome. I don't know too much about what causes it, but I do know there are a lot of triggers for IMHA. If possible, you may want to try to get your pup to a vet school hospital or the animal medical center (there are only two animal medical centers included in the AAVMC list--one in New York and one in Boston. Here are the ones in the Northeast that may be closest to you:

 New York

Animal Medical Center

510 East 62nd Street,
New York, NY 10065
Phone: 212-838-8100

http://www.amcny.org/

University of Pennsylvania

School of Veterinary Medicine

Hospital: Matthew J. Ryan Veterinary Hospital (small animal)

39^th and Spruce Streets

Philadelphia, PA

http://www.vet.upenn.edu/

There are lots of folks here to support you--feel free to let us know how we can help.

Sending love and positive healing energy.

Cherylfaz

  I am wondering if tapeworms can cause an immune reaction because that is the only thing they found.  she had alot of tapeworms in her stool but they said tapeworms are very innocuous.  But if it stressed her for months could it have triggered an over reaction of her immune system like this?  ALso, i had given her sentinel 5 days before symptoms started.

Am at work so this has to be ultra brief but I **will** come back tonight -- but in short, *anything* can trigger IMHA.  Any chemical -- given to the dog or in your home/yard.  Any stressor -- and yep, Tapes *might* be a stressor - but I've even seen such a thing as family trauma, kids going back to college, *change* -- these things can all give cause. 

Why care about a cause?  Because if you can find a cause, so you can be on guard in the future your chances of getting them thru it, and beyond are better. 

Imuran is not often used for IMHA but I don't know specifically for Evan's (which is essentially IMHA and thrombocytopenia together).  Pred is often used at the beginning.   I would have your vet contact Dr. Jean Dodds (http://www.hemopet.org -- the blood donor agency for dogs but she does TONS of work with these auto-immune diseases). 

My other best suggestion for you is to head IMMEDIATELY to your state's best vet school or to one near you that is good.  Often the individal vet offices just don't have the facilitie or time to cope with this and you can often get better help, more cost-effectively at a vet school -- so many of us here have taken that route.

Feel free to contact me -- I'm no one special, but I tend to help be the "guardian of the thread" (no, I'm not even a moderator -- I simply have a dog who has been a survivor for three years!!).  That title and $3-$4 might get me coffee at Starbucks???  i.e., I just care, that's all.  But I seem to have a lot of cumulative experience. 

Our prayers and good thots are with you.  It's unusual (at least in my experience) to see Evan's diagnosed initially, rather than just IMHA or thrombocytopenia (your dog isn't epileptic?  taking phenobarb??) -- but the fact that it was initially diagnosed means they can treat it all as one -- not a bad thing.

But don't be afraid to be your dog's best advocate!!

SELNSF

 Our rat terrier mix, Rita, was diagnosed with IMHA last Monday night.  She was completely fine Sunday morning and then was quiet Sunday afternoon retreating to her crate (which is sometimes normal for her).  She didn't come to go out and didn't eat any dinner.  I had her come out of her crate and sit with us during the evening.  On Monday morning, she had to be encouraged to come out of her crate, went out and pee'd and then sat down in the wet morning grass.  My partner had to encourage her to come in the house.  She then went and sat in her bed in the living room and didn't leave it.  I fixed her some eggs, which she didn't partake in, but I did get her to take some water.  

We got her to the vet that afternoon -- by the time, I got her to the vet, she couldn't hold herself up at all. 

By recognizing this wasn't just "not feeling well"  and getting her right to the vet -- man, that's the best way to give them a fighting chance wiht this wretched disease.

Since you are in California -- if you can get your specialist clinic to consult with Dr. Dodds, trust me -- it is the BEST you can do.  You can send bloodwork right to her -- she's knowledgeable in the extreme about IMHA and any auto-immune blood problem.  She's absolutely awesome to work with and at this point is helping train vet schools all over the country about dealing with IMHA and the other auto-immune blood diseases.  She will work with anyone all over the US (and even has helped Johnny with Tessy up in Nova Scotia, Canada!!) but many of us on here have had incredible help from her.

HOpe the blood eval goes well -- please keep us updated!!

 thanks for your response.  I just got an update from the vet and he said i can bring Sunny home today.  Her platelets rose from 45000 to 65000 and her PCV is hanging tough at 27 two days after the transfusion.  I visited Sunny and fed her some chicken slices because they said they couldnt get her to eat and she couldn't go home until she would eat.  They were trying to give her dog food.  I couldn't even get her to eat dog food since this disease started so no way was she going to eat it there!  She held the chicken down which was encouraging.  She already looks more bloated even though she just started 60 mg of prednisone on Saturday.  She also was dribbling urine on the floor.  I was wondering if dogs with this disease on all these drugs (she is on imuran and prednisone) are prone to dribbling.  By the way, she is a mixed breed rescue dog - more beagle than anything else though.  I think they have her on an anti nausea medication but they didn't tell me the name.  They also told me she has the non-regenerative kind of IMHA which means she is not creating new red cells from her marrow.  this is a concern of course and i am hoping she starts doing that before her bloodcount starts to drop again.  They said it can take a couple of weeks and she may need another transfusion eventually.  I guess i just have to be patient but I am pretty scared for her.   I know about all the complications that can occur.      

I just emailed you -- let me know if you don't get it. 

This is a nasty vicous disease -- and the more knowledge you have the better armed you are to fight it. 

Keeping her eating is HUGE.  Part of what makes them sick to their stomach is the low packed cell.  When they get blood they feel better -- but it is one of the things to watch as far as a falling PCV.

We wound up getting Billy's PCV taken nearly every day -- because he crashed SO fast and so frequently (he had SIX transfusions in 4-5 weeks). 

But as I've said before -- our one fail-safe "tip" that he wasn't feeling good?  His tail!!  He's docked and that little nubbin typically wags about 100 miles an hour.  BUT if he wasn't feeling good it slowed down.  If he was majorly crashing it stopped wagging.  That meant WHOA ---- vet .... like 2 hours AGO. 

Watch your girl -- watch for "signs" -- any little thing that you know usually she does that indicates she's "ok".  It can be a huge help rather than just trying to watch gums (which is not always fool proof.)

I sent you my phone number (I'll give it to both of you newbies) -- FEEL FREE TO CALL ME.  Seriously -- support is huge in this darned disease.  I'm not a vet -- I'm just a lady who cares who has a dog who survived. 

The bright side is -- NOW we have several "regulars" in this thread whose dogs have done VERY well -- dogs who have SURVIVED.  It's a big fat frigging deal ... and any support and help we can give you we will.  Cos we ALL know how scared you are.  We've all been there.

 Hugs to you and your girl!!!

SELNSF

She had a PCV count of 8.  They did a blood transfusion that night, her initial PCV after was 28 and then it dropped and held steady at 24.  They released her on Tuesday night to us.  She's on 30 mg of Prednisone, 100 mg of Atopica and 10 mg of Pepcid.  We've been home with her every day since then to get her adjusted to her (and us) adjusted to her med routine.  We've had some vomit and explosive diaherrea, but she seems to be on a routine now.  The meds wear her out, she has small bursts of energy, but she's still very much in recovery from this initial crisis.

As promised, I did email you as well -- please feel free to holler at me. 

When she has bursts of energy **do not** let her ram around.  Yours is on cyclosporine right?  (Atopica) -- there's a dangerous thing that can happen in the blood -- a sort of "disturbance" -- so try hard **NOT** to rile her up.  Keep her as sedentary as possible.  "Happy" but a quiet happy. 

Vomiting and diarrhea are both cyclo side effects.  but trying to keep them eating is huge. 

Holding "steady" is a big huge mega deal.  You're doing a LOT right!!!  But we'll help you all we can!!!

Sunny coming home is GREAT news!  Although her platelets are up to 65000 this is still considered a very low number and caution should be exercised on your behalf.  Avoid any unnecessary play so that she doesn't get bumped.  Rest and relaxation might be the best action for now.  The less stress the better!

Tessy used to dribble when she was first sick.  The drugs really do a number on the bodies.  The bodies just aren't used to these high dose drugs (steroids and chemo drugs).  Sunny will probably want to drink like crazy due to the pred.  The pred will also cause the belly to look bloated.  You should however be careful for bloat itself.  With Tessy I used to let her drink all kinds but I'd also make sure she wasn't getting too much.  Expect to take Sunny out at all hours of the night and please don't get upset if you wake to a mess on the floor. They really can't help themselves right now.  When Tessy first got sick she went outside almost every hour or two.

Non-regenerative AIHA is more serious than regenerative.  I've seen lots of cases of non-regenerative AIHA and each case was different.  These are usually but not always the dogs that will need several transfusions.  Do you have a retic count from the results?  Another important thing almost all of us here do is get copies of the results from the vets.  They should have no problem giving you this and if they do... insist them give you a copy.  Did they say that there were spherocytes present?  These are the red blood cells that were marked for destruction and destroyed.  They lack a central parlor and are smaller in size than the regular adult blood cells.  There's a fine line with this disease where AIHA could potentially turn into non-regen AIHA.  You'd have to look at all the numbers to figure out what exactly happened.  The one good thing about the nonregen type is that there is much less threat to the adult RBC's currently in circulation.  This will mean that the PCV will decrease much more slower.  Because she's jaundiced and has blood in the urine this makes me question the nonregen diagnoses.  It'll be interesting to see the numbers on this if you have them  (retics and spherocytes more specifically).

Did they put her on some sort of a stomach protectant?  These drugs are really hard on the stomach and I'd highly recommend you get her on one.  Ask the vets about pepcid.

As far as food goes you can try several things to get Sunny to eat.  Roast beef, scrambled eggs, liver (in small quantities), boiled hamburger, boiled chicken, green/orange veggies, etc.  There's a fine line you'll have to take with several foods cause some will warn about pancreatitis form fatty foods but for now the main thing is to get her to eat.  Small portions more often is usually best.  If you are having problems giving meds you could always hide them in a teaspoon of ice cream and give it to her.  You could also try liverwurst (sp?).  I've never used it but I'm told it works wonders for giving meds.  VERY IMPORTANT------try your best not to miss giving any of her medicine.  I'm assuming you have her taking the pred twice daily now?

Anyhow, I'll keep Sunny in my thoughts and prayers for a quick turnaround.

Johnny & Tessy

 I wish i knew what her reticulocyte count was.  I will ask them for a copy of blood work when I take her in for her first blood check (in a couple of days).  I do know they said it was very low last week.  They also didn't see any spherocytes.  They told me there is a 50-50 chance that she will start regenerating blood cells.  Sounds pretty dismal.  I am doing alot of praying.  Right now she still has yellow eyes but her pee is lighter than it was.  It is more like a dark yellow.  She is also happily eating chicken.  They gave me Carafate to give her along with Pepcid.  I am now giving her 30 mg of pred two times a day.  She is a 45 pound dog so that is alot.  Right now I am glad to have each day with her.  I feel so bad for all that she has gone through.  I don't know if I can afford multiple transfusions.  This one transfusion and hospitalization (sat- mon) cost me 2300 dollars.  Each transfusion alone is 900 dollars and this is not oxyglobin we are talking about.  How can I afford 4 or 6 transfusions?  We are typical middle class and don't have alot of money so this is really hard especially if she ends up not making it after all this. 

I'm in the same boat as you.  I had just lost my job and then 2 months later Tessy got sick!  It's been a battle...that's for sure.  If it makes you feel any better I'm well up over $10,000 so far and Tessy only had the one transfusion.  This counts everything though over the coarse of 10+ months.  Others have gotten off with a fraction of the cost.  Cyclosporine really added to this number.  The drug works wonders but is crazy expensive!

Here's a couple of sites you can check out for finacial assistance...

http://www.imom.org/

http://www.aahahelpingpets.org/

http://www.uan.org/

I'm assuming that you do not have pet insurance.  I did not have it so this really hit me hard.  Maybe you can talk with the vet clinic to see what payment options are available to you.  That's what I did when Tessy first got sick and they were great for it.  You can also get pet cards (credit) that you can pay off slowly if need be.  Ask the vets, they should know of your options.

Another thing you can consider is veterinary teaching schools.  They are usually quite a bit cheaper to go to and they also use cutting edge technology.

Give a shout if I can help in any way.

OH....and I'ld say the chances are better then 50/50 but that's just my personal opinion.

Johnny & Tessy

Johnny&Tessy

Another important thing almost all of us here do is get copies of the results from the vets.

Ditto on this--I have a file that's all of Frisby's IMHA related stuff, so if I have to take her to the emergency room again, I have everything in one place. It's in chronologocal order--so I can just hand it to the vet staff to make copies (because I KNOW I'll be stressed if she has to be rehospitalized).

I imagine the pred will help with the appetite fairly quickly--and they get very hungry after being on it for awhile. (I feed 4 times a day--smaller meals but it helps with the hunger, I think.) And thirsty--I took Frisby out every 2 hours (around the clock) when she was at her most medicated because she needed so much water. Frisby lost a lot of muscle when she was highly medicated (60 mg. prednisone plus others) so I did have to help her up and down stairs and I had to help her stand up on wood floors. Now, she's fine through the night and goes out about 4-5 times during the a day (am, lunch, mid-afternoon, supper, bedtime). That's pretty normal for her.though we did just add the mid-afternoon potty break back in.  

We'll keep you in our thoughts and prayers. We know it can be a really long road.

Notes: Edited for spelling (I can't type today!)

Cheryl and Sean, I'll be praying for your dogs.  This is a tough thing to deal with.  You've gotten perfect advice here already.  You are in such good hands with Callie and Johnny. 

If there is anything I can do please don't hesitate to ask me. 

Lori (and my chow chow, Willow--1 year survior of IMT--low platelets) 

Cherylfaz

How can I afford 4 or 6 transfusions?  We are typical middle class and don't have alot of money so this is really hard especially if she ends up not making it after all this. 

Cheryl I didn't say that to scare you -- Billy was VERY unusual (and if we hadn't come into a small inheritance we never could have DONE that).  Cockers typically don't respond well -- Tessy and Billy are *very* unusual (most buffy coats don't survive -- and they are two of the only three I know to have survived IMHA). 

Most dogs don't go thru that many transfusions (Billy was taking another drug at the time that may well have caused him not to respond even worse than most .... his IMHA was falsely diagnosed as tick disease at first).

Take it a day at a time -- seriously.  It's the only way to deal with this. 

But this is one of the reasons why many of us talk about "vet schools" -- because they tend to be less expensive than clinics and hospitals (particularly specialty vets).  Yes, you deal with students -- but the trade off in the extra knowledge is incredible. 

IF they switch you to cyclosporine -- you'll have to have them change the carafate (it's pretty well established that it inhibits the absorption of cyclosporine).

They are resilient -- truly they are.  And when they get blood they DO feel better.  In fact, it's pretty astounding -- I saw Billy go in feeling SO sick, and give him a little blood and you'd have thot he was ready to tackle the world.  He wasn't -- for sure -- but the change is heartening.

They hit them hard with the drugs because it takes a couple of weeks to stabilize them and have the drugs actually "kick in" and start supressing the immune system.  That's another reason why they often do the drugs in concert -- because different drugs have a different length of time before they are effective. 

 Hi All:

Thanks for all of your advice and words of encouragement and, again, thanks Callie for your email.  

We saw the internist this morning.  She was very pleased with how Rita looked, how was she behaving, how her gums looked and how her little rectal exam went.  Before the Dr had come in, they had taken Rita for the blood draw.  While I was hitting the Dr up with all of my questions, her PCV test came back -- still at 24.  I think the Dr saw I was a bit worried, but she was very affirmative with me that she was fine with that number especially with how Rita is looking and feeling in general.  We'll return next week for another blood draw and hope that the PCV is up.  They are keeping her on the med regime as is for now. 

I forget who asked, but Rita is 21.2 lbs.

The thing we'll struggle with this week is the amount of water and the going out routine.  One of us has been home pretty much since the hospital release.  Today was the first extended period as we both had to be back at work (and I didn't leave the house until almost mid-day) and I returned to a kitchen floor full of urine.  We are going to try to reintroduce the litter box that our chi used when we lived in the city.  It wasn't too successful when Rita was a puppy, so we'll try it.  We have a dog walker that comes a couple of times a week, so we're going to see if we can incorporate a potty break visit routine.   Our dogs are crate dogs, so they sleep in them at night -- we've left Rita's door open at night, so we can listen for when she's up (thanks to the wooden floors), but she's done well the past couple of nights and didn't go out (I fully expect that I'm jinxing myself now!).

And, I know about the $$.  We're up at about $2500 so far.  Our 2010 hasn't started out with a bang as we are also having to replace our sewer line from the house to the city line this week, so it's been an expensive two weeks.  I was mixed on the pet insurance -- we had it for a couple of years and it was a challenge with them for even the basic claims, so we go this route instead -- it is what it is and we hope we get her back up and running fully and healthy.

Thanks again for all of the great info.  Will certainly be checking back in...

Per my email -- the huge incontinence IS a side effect of the pred.  It makes them drink like fiends (and DON'T restrict water -- they **must** drink like that to help wash out the kidneys -- give her ALL the water she wants) but it **also** messes with the muscles so her ability TO hold it is sporadic.

 Honestly crating her is probably the best option -- even an x-pen to set up an area with plastic underneath and a TON of very absorbent material underneath -- but also an area where she can get away from it and not lie in her urine (that creates more problems with UTIs).

Get creative -- this calls for extreme measures because it IS a side effect of it until you get the disease process under control.  You really don't want her to be active **at all** during the day -- so containment is often the best option.  I wouldn't expect her to want to do litter -- she likely won't have enough control for that.  But a large area of plastic, with several layers of absorbent material (like hospital bed pads can work well or even several puppy pads) may help you out.

Oh wow -- we've got another IMHA dog -- darn this disease (and read a whole lot stronger word there than "darn" ok??)

January and February last year it was super active -- and then again in the early summer.  There IS finally some acknowledgement among the vet community that there are things that are seasonal triggering this -- STRESS is a biggie, as is any sort of chemical (and that's both home & yard chemicals and chemicals in/on the dog)

The page prior to this 114 has an index that I did.  Unfortunately it's not linked in but I will *try* this weekend (that's hugely time intensive).  I will also try to add the last 15 pages of anything notable. 

Frisby's Mom has compiled an AWESOME list of vet teaching hospitals in the US -- that absolutely ROCKS (and K, if you wouldn't mind PLEASE post that -- it's awesome -- or at least tell folks where they can get it).

None of us are vets -- we are all just owners who have battled this disease.  We try to support each other -- and I think I can say most all of us are fine with emails and reaching out.  I honestly am absolutely available to talk to anyone on the phone (and I will call you so it doesn't cost you money on a land line phone) -- I'm no vet, but I can point you to information and help you figure out how to deal with this (just cos I've been doing it successfully with Billy for 3 1/2 years now and I've got some good contacts).  I'm also just plain the friendly type -- and my husband and I have pretty much dedicated ourselves to helping folks deal with this. 

I'm no one special on here and I'm not trying to "control" anything.  But the way this board is set up, if you *request* email notifications you only get the first one after *you* post (unless you turn it on repeatedly at the top of the page every time you check it).  But I'm a long-time member of this board and I tend to be blunt enough to try and get information out there.  So don't think I'm pushy -- well, maybe I am, but I'm just trying to get the information out there for folks.  The most difficult part of this disease is the emotional one -- both for  the humans and the dogs -- it's financially and emotionally draining and trying to figure out HOW to do things and what to do next is overwhelming to say the least.  But it can be manageable with some help.