AIHA or IMHA

My dog Cyclops has IMHA.

Diagnosed 8 days ago on Dec 15th. 

CBC Showed 10.6 RBC and we started her on 80mg Pred + Stomach Protectant.

On Weds Dec 17 her RBC dropped to 9.  We added azathioprine.

The next day December 18 we transfused 450ml of whole blood from a universal donor.  She showed immediate signs of more energy and increased appetite. 

 On Sunday Dec 21 her RBC was back to 10.  Not a whole lot of improvement.  

 As I write this late Tuesday Dec 23 she has lost her appetite and can barely walk outside.  Total lack of energy.  I am taking her to the vet at 7:30am.  

 Where do I go from here?  I have heard a 2nd Transfusion might be dangerous.  Oxyglobin is 1000.00 for one transfusion.  I might be able to swing one, but not sure what I'll do 48 hours from now.

 Is Pred and Azathioprine the right thing or should I switch to cyclosporine.  Is there any evidence cyclosporine might help more?  Right now since we are only 8 days out from diagnosis I am just trying to get her to live long enough to see if the meds will kick in.  

If her CBC comes back in the morning and is as low as I think its going to be based on my observations then I guess I have no choice but another transfusion.  I am not even sure if we can get another donor.  Maybe I will have to go with the Oxyglobin and try to line up a donor for Friday or Saturday.  

Right now she does not seem to be in any pain.  She is so sweet and such a loving and trusting dog.  Its hard for me to think about euthinizing her.  Especially since I saw her kinda/sorta back to her old self just a day or so ago.  And this came on so sudden.  One day we were doing our normal walk and she was ahead of me on the leash as always and then the next day she lagged behind.  At first I thought maybe arthritis was setting in - wish I had went immediately to the vet.  But the next day I noticed she had an increased thirst and then she went outside and ate potting soil out of our planter.  I took her temp and her tested her blood sugar, both were normal.  So I went to the vet.  Didn't know about looking at her gums for color.  They were white as a sheet.  They still are white.   I noticed her walking slow on Thursday December 11 and waited until December 15 to take her to the vet.  I wish I had thost 4 days back.  Talk about sudden onset.  

 I've always considered myself a very good dog Dad.  Providing the best food and meds. Turns out that maybe all the chemicals may have triggered this?  Thought it was a good thing that she never had a flea or a tic but maybe the Frontline Plus and the Preventic Collar were not such a good idea?  Maybe the monthly interceptor was no good?  Her yearly vaccines were giving almost a year ago so it wasn't triggered by that.. but now I am doubting those too.  If no preventive medicine is given then fleas and tics and heartworm are all potential killers too.  Not to mention Rabies and distemper.. 

Well I am just going to try to get through the next 7 hours and see what happens at the vet today.  I need a Christmas Miracle.  My gut says she isn't going to make it and I'm heartbroken.  But part of me keeps thinking if I can get her to live long enough for the meds to kick in then maybe she could pull through.  I am not sure if that is foolish thinking or not.  

 I read about this milk plant or something?  Any advice on food or supliments that might help would be appreciated.

Thanks 

Darn, I wish I'd seen this last night.  The thing that makes a second transfusion risky is simply because they have to type/cross-match the blood.  *Any* transfusion is risky  BUT not doing one can cause it to be fatal because of lack of blood.

Billy had SIX transfusions of regular blood.  That was in a month's time.

Cyclosporine is vastly expensive -- and you ***HAVE*** to use the Atopica/dog version, not the human drug (for some reason they can't absorb/tolerate the human one properly).  Azathioprine ... any of the big steroids are risky.

The best thing I did for Billy was TCVM - Traditional Chinese Veterinary Medicine -- it helped hugely with blood builders and getting his body to manufacture enough blood to keep up with his need for it, but we walked a shakey line for WEEKS.

As long as you haven't given stuff that's systemic (like BioSpot or Revolution) just Frontline doesn't go into the body's system.  The preventic collar is amitraz -- that's less good.  A heartworm preventive is pretty much necessity because the risk of heartworm is so huge anymore that it's Russian Roulette without it.

Do whatever you must to keep your dog eating -- try babyfood meat, try sauted liver, try ground beef and rice with a little garlic powder.

Eating is THE BIG DEAL.  Because they HAVE to eat in order to be able to tolerate the meds.  So if you gottta, try liverwurst spiked in the food, or whatever you can possibly give the dog that it will eat to KEEP something IN the tummy.

Sucrylfate can sometimes block the absorption of the drugs (they wouldn't let me use it for the Atopica -- I used Prilosec TWICE a day instead).

Don't be terribly afraid of the next transfusion -- simply because if the pack cell volume is THAT low you don't really have a choice.

I'm gonna email you my cell number.  I have "been there" and I so understanddd where you are!

I know Callie has responded and I hope you email or call her, she can help with some suggestions.  I just wanted to say I'm sorry that your dog is so ill.  Please don't beat yourself up that you didn't take her in sooner.  Don't give up on her just yet, I will be praying for her and hoping that she can hang in there.  Please keep us posted, we know what you are going through.

GratefulDawg

 I read about this milk plant or something?  Any advice on food or supliments that might help would be appreciated.

Callie must have missed this - she knows a LOT about IMHA and she REALLY WON'T MIND if you call her. I felt a little shy about calling a complete stranger - but trust me. She can HELP.

Milk Thistle is an herb - somehow someway it protects their liver from being 'beat up' by the drugs. They NEED the big medicines to make it but it's a fine line - you don't want to do long-term damage. There is a little place here in Orlando called 'Leaves and Roots' - they have it powdered and she'll ship it right to your door.

As for eating, try ANYTHING. Literally, anything - eggs, liverwurst, roast turkey, PLAIN mashed potato, mashed sweet potato, baby food (read the label here! make sure there isn't any garlic in it)...ANYTHING. And this is going to sound crazy - Callie told me it would - but talk to Cyclops. Tell her it's the PILLS that are going to help her feel better. Tell her she needs to EAT to feel better. Even if it's just a bite or two - celebrate that and leave her be for 10 minutes and try again.

It is certainly after 7:30AM Wednesday so I am hoping your sweet girl is doing better today. We will pray for a Christmas miracle for you and Cyclops.

Sorry -- I was just too rushed this morning.  Yes, Megan is absolutely right -- milk thistle is an herb -- you can ask for "milk thistle" or "silymarin" (that's the Latin name).  ANY health store is going to carry it -- just get the best brand they have (so it's good quality). 

What Megan said about talking to Cyclops is SOOO true.  When you give the meds say "This is gonna help ... Dr. ____ says so!" and then when you feed the dog say 'Now .. you gotta eat for me, babe because your tummy has to be able to handle those medicines so eat up for me willya???"

The pred in such high doses is HARD on the tummy -- But even if you have to water down babyfood so you can put it in a baby syringe -- yes DO IT.

Hold the dog's mouth mostly closed but not tight.  Park the tip of the baby syringe behind the canine tooth and just squirt slowly -- the food will hit the tongue and you want to hold the mouth loosely enough so they can work their tongue to swallow. 

Don't feed LOTS at once.  Sometimes the sight of a bowl of food is enough to turn them off.  So keep it in small amounts but OFTEN. 

Please feel free to call me.  It's a busy night for all of us but I will make time to talk to you.

 Callie, JackieG, and sl2crmeg:  Thank you all for your thoughts and prayers.  I am such a mess right now.  At times I am ready to accept it and let her go (an emergency vet today called me selfish for not doing so.. more on this in a minute) and other times like after reading Callie's nice email I am ready to fight.

 I've been reading the forum since Dec 15 but only signed up to post last night.  I read many stories here some positive and some rollercoasters like the dog Snickers.  I'm not sure I could go through what Snicker's guardian went through.  I'm only 9 days into this and already feel exhausted.  

This morning I went to my vet.  He is a really good vet.  He is caring and he does all he can for the size of his practice.  He does not have equipment to type and cross match blood.  He did have a universal donor for our first transfusion.  He could have gotten OxyGlubin for about 1000.00 (he quoted me the right price for the size of my dog).  We could have went that way but this morning he sent me to the emergency vet.  

This place was like a car dealership.  I went in and they would not let me be with my dog.  They spoke to me like I was an idiot.  They came out with a price sheet and said 2400.00 for the blood transfusion and 3 nights in the hospital.  I told them Cyclops was going home with me tonight.  They said that even at 2400.00 they could not guarantee Cyclops would be alive to pick her up at the end of the 3rd day.  I told them I wanted her to have enough energy to get home and be with the family and if these vets were so certain she was going to die anyway then what difference did it make.  So at that point I felt I was being held hostage because they are the only people who have the ability to type and match blood.  

My real vet allowed me to stay with Cyclops for the transfusion.  

 I know I'm not making much sense right now.  This emergency vet is transfusing her right now.  I dropper her off at 11am and they said 6-8 hours.  Its 3pm CST right now.  I am hoping to just get her back tonight.  I have gifts for her under the tree.  

Assuming she makes it out of there alive - I can hope for a miracle from this transfusion.  Then I have to decide whether to euthanize her at my home the next time she crashes OR try to get her into 1 of 3 teaching hospitals that are 5 hours from me.  The 3 closest are:  Oklahoma State University at Stillwater.  Kansas University at Lawrence and University of Missouri at Columbia.  If any of you have a favorite between those 3 let me know.  

Here is the problem.  And something that I haven't come across yet on this forum.  Something I haven't heard discussed much at all.  The problem is money.  I am about 2000.00 in so far.  I think taking her to a teaching hospital sounds like a great idea.  I guess first I will call and see what kind of money I am looking at.  

 I feel terrible for thinking about money but I really have no idea where I can get the funds that quickly. I can do some things to get money but I don't think I can do it in time to save her life.  Also.. I don't want to throw good money after bad.  Both vets have said that Cyclops is an extreme case and is basically hopeless.  But I've read here of people having multiple transfusions.  Why would it be hopeless if I could afford to keep transfusing?  Would endless transfusions keep her alive indefinately or is something else going on too?  They mentioned fluids building up in her belly and that she has developed a heart murmor.  When they pulled out the blood for the CBC today is was almost like water.  It had an orange tint to it.  They literally have no idea how she is still alive.  The one nurse said that she must really have the will to try to stay with me to still be here.  They called her a fighter.  That makes it even harder to euthanize her.  

 Have any of you had to weigh the financial aspect into your desision making?  They make it sound that even if I was Bill Gates I might still lose her. 

Guilt - thats what it comes down to.  

My immediate plan is:  see if she makes it home tonight and if there is any sign of improvment from the transfusion.  Then friday morning I will call one or all of the teaching hospitals and have a discussion about cost and what their policies are.  

I'm still in this shock that many here have expressed.  Unreal that 10 days ago she was walking and playing and now she is at deaths door.  Even more unreal because its Christmas Eve and I have a father who has no understanding about dogs - can't really share my feelings with anyone except my wife - which is why I'm glad I found this forum.  Wish you all a Merry Christmas.

This is strictly my opinion concerning the money aspect and it's PROBABLY what I would do if I were in your shoes.  IF I could arrange financing AND if I believed (based on research and advice from Vet (s) ) that my dog's life could be saved and with the belief that the quality of life could be acceptable again I would do what it took to get the money.  That's me and I think we all just have to do the best we can based on what we know.  Guilt shouldn't come into play if you are making the decision that's right for you at this time.  It's obvious that you love your dog.  Do what feels best for both of you.  You are in shock and it's hard to think clearly when all this has happened so suddenly.  I wish there was a clear answer and you knew she would be ok if you can pay for treatment.  I have no experience with this condition other than casual reading but I have faced difficult decisions about very ill dogs and I truly feel for you.  Sometimes the situation is taken out of our hands.  Sometimes that means a miracle.  I hope your dog survives long enough for you to feel like you are making an informed decision about her future.  I'll be praying for a Christmas miracle for you and Cyclops. Keep us posted.

I'm praying for Cyclops and hoping you get that Christmas miracle.  My dog Willow had/has a similar disease and I know exactly what you are going thru. 

GratefulDawg

Here is the problem.  And something that I haven't come across yet on this forum.  Something I haven't heard discussed much at all.  The problem is money.  I am about 2000.00 in so far.  I think taking her to a teaching hospital sounds like a great idea.  I guess first I will call and see what kind of money I am looking at.  

GratefulDawg

Have any of you had to weigh the financial aspect into your desision making?

No, trust me...if I recall correctly (it's all a little blurry) I had a similar conversation with Callie when Pirate was sick - I was 20 years old at the time and in my 2nd-ish year of college. I had to decide to take Pirate to a less-great 'specialist' vet that was local than to take him up to University of Florida - I knew in my heart UF was THE best place but I financially couldn't do it. UF doesn't take Care Credit - AVS (the specialist) did.

Which brings me to the Care Credit - google it and you will find their website. BF got approved for the Care Credit literally 10PM on a Saturday - we got approved for $3500 and they will read you your account number over the phone so you have it ready for the vet's office right then.

I know how hard this is. Believe me, I do. I will be thinking of Cyclops tomorrow and hoping the transfusion can help her. I feel comfortable enough to say to feel free to PM any of us who have had a dog with an auto-immune disease - it's so unbelievably different from anything you have ever experienced.

Quite honestly the problem with Care Credit in *my* mind is that specialty vets SEE IT COMING.  "Oh boy, they have $5000 to spend!" and magically it can somehow wind up being a target amount. 

If you have to keep the $$ way down and you only have one shot, honestly I'd try and find either a good homeopathic vet or a TCVM vet -- both can help the body respond better but it takes a good vet to do that.  It's not the radical treatment that a transfusion is ... but they can maximize normal chances.

Can't get this dog off my mind. Praying for good news.

 Last night I picked up Cyclops from the e-vet.  They made a huge production out of it and made me sign waivers that it was against medical advice.  This place is like a cold jail cell - will never use it again. 

Pre-transfusion she lost her appetite and could barely walk outside to go to the bathroom.  Now she is eating very well and although not much energy she is stable on her feet enough for potty breaks outside.  

 She got to take part in the tradition of her doggy stocking last night with our other dog.  My other dog definately knows something is wrong with Cyclops.  Cyclops didn't really show much interest in new squeeky toys as she normally would have but did eat her treats.

 OK moneywise I cleared out about 4000.00 on a credit card.  I am still trying to decide between the 3 teaching hospitals that are within 5 hours drive from me.  Don't know how to make the choice.  I did see that some students did some research at KSU, Lawrence and at U of Missuri, Columbia.  The third choice is OSU, Stillwater.  I am going to try phoning all 3.  Since its Christmas Day I'm not sure if I'll have any clear answers today but will try again first thing in the morning.  

I'm not sure if 4000.00 will be enough to get her through this.. just hoping to give her the time to get the meds to work.  

Its very difficult with IMHA because its hard to euthanize a dog when you see she is doing better and you know that some dogs can recover.  If it were termanal cancer or something that does nothing but go downhill it would be easier.  This rollercoater of a disease makes it much more difficult to choose euthanasia.  

Thanks to all of you for your kind words and support.  

And the rollercoaster continues a LONG time because it's fraught with peril the whole way.

 I know Kansas does a lot with titers because if you have to have a dog titered for Rabies you have to do it thru Kansas. 

I took the liberty of emailing Kris Christine -- this lady is working on the Rabies Challenge study being done nationally (with Dr. Schultz and Dr. Dodds) and she has a far far better knowledge of the different vet teaching schools than I do - and I have a feeling, IF she's around, that she might be able to give you some good input.

After they get blood they feel better.  Billy got to the point where he thot that the ICU at UF Gainesville's vet school was the "FEEL BETTER" place.  He'd feel horrible, I'd take him there and they'd give him blood and he'd FEEL better.  He used to get so excited when I took him in there that everyone knew him by name!!  They'd greet me in the halls with "BILLY!!! What's his PCV??"

I was hoping you would have posted.  I'll see if I can get some info for you.

JackieG

Can't get this dog off my mind. Praying for good news.

Me either, I'm so sorry this has to be happening at all, let alone on Christmas. 

I'm still praying and hoping and I'll check in later.

Lori

 two things I have been reading about today.

#1 is a drug called liposomal clodronate which is given by IV 0.5ml per kg or weight.  5 dogs were injected and all 5 dogs left the hospital.  I'm not sure what the long term outcome is but apparently it stops the dogs immune system from eating the red blood cells at least temprarily.  

 #2 might be a little "out there" at least the rational part of my mind saying it can't possibly be true but there is a website called optimumchoices which sells bottles of "biopreperation" pills that suppose to help with IMHA.  at 45 dollars for a bottle it would be the cheapest investment - at the very least I don't think it could hurt.  

 ---------

i don't have a traditional chineese medicine or homeopathic vet anywhere nearby.  at this point i am thinking KSU, Lawrence or UofM, Columbia.  Both are closed today except emergencies.  I am going to call first thing tomorrow.  I may ask if they might consider trying the liposomal clodronate. or at least their opinion of it.  

Cyclops is eating today.  I have been feeding turkey breast but am going to take the beef heart advice tomorrow when stores are open.   at this point i just don't see any choice but one of the teaching hospitals.  

  willowchow thanks for your support.  of course cali, jackieG everyone..

thank you all