AIHA or IMHA

 Yes we have been getting full blood work done. Kidney levels are good, liver levels are high but we have known that for a while. She IS drinking tons and tons but was a bit dehydrated for some reason. Thank you for the recipe, I will have to try that.

Tracy -- you may want to use SAM-e if you aren't already.  CellFood SAM-e is the best I've found (and you can add it to Denosyl with no problem - it **WILL** help bring down the liver levels which is likely what is causing the oral sores.  It's not uncommon.  But you really need to pull out lall the stops to try to get the liver levels down more.

Try Amazon and E-bay -- just be cautious that the e-bay isn't too expensive for shipping. 

We have had her on Denemarin for the last month, but her levels haven't dropped.

Denosyl is usually NOT enough and you can't take "more" of it.  But you CAN add Sam-e. (I'm never fond of Denosyl, Marin or Denamarin -- they are just not sufficient usually and are pricey)

https://www.swansonvitamins.com/lumina-health-cellfood-sam-e-liquid-formula-1-fl-oz-liquid

 Swanson will ship to Canada so I'm sure they will ship to you in Alaska.  Get a couple of bottles -- one will only last you about 2 weeks. 

 You may want to try Dr. Dodd's liver-cleansing diet.  In fact, to be honest I REALLY would suggest you emailing her and having your vet talk to her .  She's often SUPER helpful.  She'll work via email -- it's not a big deal  hemopet@hotmail.com

Honey has tested positive for hemotropic mycoplasmae - she could've gotten it from one of her transfusions but that is very unlikely I guess.  The treatment is doxycycline and we're hoping maybe this will make the difference in her ability to keep red blood cells.  Does anyone have any experience with or knowledge of this parasite? 

When the emergency vet was first trying to diagnose her last June, we did have a tick disease panel done (at Antech I think) and it was negative.  Since then, another vet at that practice told my vet that he'd seen a case like Honey's and suggested that we do a pcr at NC State. Who knows whether she's had it all along or contracted it since, but it's something.  Luckily, they are trying to build up a database and the test was half price.  I thought it was worth mentioning if anyone else is at a loss for triggers/reasons treatment isn't working. 

Starting doxy tonight, with fingers crossed  

Oh I am SO GLAD they've found something to treat!!!  And I am SO GLAD you shared this.  I've never heard of it, but this could be a huge help to you!"! 

 Be sure you  keep in touch with Dr. Dodds about this -- she will tell you how it stacks up "transfusion wise" -- to be honest I would think that if she'd gotten it FROM a transfusion it would have caused a further drop in the red blood -- as it stands you have just never had any luck getting her PCV above a certain level. 

 Doxy can be taken for a long time -- some tick-borne diseases take a long long time to respond.  I know you know I often caution people against Doxy when they give it simply as a "matter of course" because IMHA dogs are immune-suppressed and a vet doesn't want to deal with the infections that result from the drugs.

But TYPICALLY when the doxy is actually fighting tick disease you don't see the pseudo immune boost -- because the drug is being actively used to kill the parasites. 

 Good luck!!  I am SO glad just to hear from you!  Honey's got another pink sticky on my printer RIGHT NOW

 I ordered a bottle of the Cellfood Sam-E from amazon, it should be here any day. How much should I be giving June? She is at 66.8 lbs now. June's PCV has been holding steady at 36-38% (the higher was when she was a bit dehydrated). We have been sending her CBC and total chem panel to a pathologist since they can read more into liver values. They also did a test to see if she is regenerating RBC and she is. Her Kidneys levels are fine. Our vet is just really concerned about her liver levels not going down, and she has been working with an outside internist on all of this. She mentioned that they are concerned there may be an underlying liver problem, but since her liver levels were great when we first started out, couldn't most of this be due to the IMHA and pred? I really need to talk to her about consulting with Dr. Dodds, I will do so this next week when we see her.

 We brought June in today for another PCV, and have labs done on all her liver levels and bilirubin (it was a bit high the last time). Next week we will be taking her in for another full panel. The vet also mentioned possibly putting her on Cyclosporine if we don't see much more improvement. I am really hoping we don't have to do that. She has been responding pretty well with just the pred, and I don't want to pump her with more drugs if we don't have to. BUT, we will do whatever we have to do if it helps her get better in the long run.

Dr. Dodds will advise on the drugs -- TRULY she will.  But honestly I would bet the first thing she would do is tell your vet to put this dog on a thyroid supplement (you're perhaps too far away to get blood to Hemopet -- it has to take less than 10 days to get it there for the Thyroid 5 Profile).  That ALONE can often make a massive difference because it's the thyroid that tells the body how much blood TO make -- and the prednisone screws that up totally.  But Dr. Dodds CAN make that call.

Cell Food SAM-e - about 15-18 drops.   You will likely wish you'd bought two bottles.  At 15 drops twice a day it will only take about 2 weeks to go thru the bottle.

The big deal is for the vet to fnd out via the bloodwork (and they will have to ASK to know if there are any spherocytes present) if she is A) still destroying or B) Not regenerating.

That's the whole story -- If NO reticulocytes are making it into the blood stream that's one thing -- but if you see NO spherocytes in the bloodstream at all but only a small number of retics coming in from the bone marrow -- the EASY THING is to supplement the thyroid FIRST rather than *assume* there is destruction in the bone marrow.  usually there won't be destruction ONLY in the bone marrow.    Usually if you aren't getting a lot of retics "born" into the blood it's because the thyroid is not asking for enough blood to be made.

 I do believe on the last lab they checked to see if June was regenerating RBC, and she was. I will ask about the spherocytes on her next appointment also. I had brought up the thyroid issue with my vet a while back at she had mentioned something about how the IMHA and Pred will show that there are thyroid issues, when there really aren't. I will ask her again and write down what she said so I can remember it better! Along with that I will ask her about talking with Dr. Dodds regarding the thyroid. She has been pretty good about seeking outside help and opinions so that shouldn't be a problem.

 Should I give her 15-18 drops of the Sam-e while still giving the Denamarin? I would like to use up what I got from the vet since we paid $100 for it. I only ordered one bottle to try it out, it is free shipping and arrives pretty quickly. 

YES you can give the Sam-e in addition to the Denamarin -- give her about 10 -15 drops twice a day.  Then when that runs out you can do the 15 (or a bit more) drops of the SAM-e until the liver values are **NORMAL**.

 They always USED to teach vets that there was no use to testing the thyroid when giving pred because the pred made the results weird.

About 6-7 years ago Michigan State (back when Dr. Dodds was still there and heading the Endocrinology dept) did a study on the effects of Pred on the thyroid and thyroid testing.  You CAN read those tests properly -- particularly when it's the breed specific testing that both MS and Hemopet do (which is FAR more accurate).

This is one of those places where *most vets* just don't know ALL they need to know because the thyroid gets SO suppressed and they can't regenerate properly.

Specifcally I would email Dr. Dodds yourself and COPY your vet and ask Dr. Dodds to explain to your vet why sometimes with IMHA dogs on pred that additional testing is important and is the ONLY way for some of these dogs to fully regenerate.  You can tell Dr. Dodds you've got me nipping at your heels on this (she knows me very well)  trying to get you to get her involved with your vet on this. 

Tracy -- this is SO important **becase** the problem is for them to go on month after month with LOW red blood makes it very very hard on the HEART.  WE don't thik about this -- we think about the liver and how stressed it is ... but no one thinks about how hard the heart has to work to pump MORE blood because the body can't get enough oxygen with less red blood.  Often times the blood has gotten thick thru all this & the drugs -- and it's a recipe for disaster.

Remember -- my Billy survived IMHA.  He survived it for several (three) years.  But it was hard on his heart -- the week I got him off all the drugs he suddenly had a grade 5 heart murmur.  He died of a heart attack ... not IMHA.   But it has made me so aware of how hard this whole disease is on the heart.

You honestly may need to be a little pushy with your vet -- TELL your vet to email Dr. Dodds.  Heck -- print out this post and send it to her.  Dr. Dodds is SO giving of her time -- she's not at all snarky.  She is the one who teaches vets all over.  (she's less of a pain in the butt than I am!!)

 I just want to echo everything Callie says about Dr. Dodds.  She has always responded very quickly to my emails about Honey-even when she's traveling abroad-and is anything but pushy.  My experience is that Dr. Dodds will happily answer questions and defer to your vet....what I do is take advice from Callie, possibly read up a little more and then email Dr. Dodds and relay what she's said to my vet.  She's very generous with her knowledge and doesn't step on toes.  Although, after enough time with an IMHA dog, you can't really worry about that anyway

Honeysgirl

and doesn't step on toes.    Although, after enough time with an IMHA dog, you can't really worry about that anyway

Nichole -- one one hand I'd love to do this in cross-stich -- on the other I want to say it in NEON about 100 feet hight!!!