AIHA or IMHA

  Saying I'm sorry doesn't seem adequate; this really stinks. It has to be heart breaking to face the possibility of cancer after everything else you've been through. As soon as her tummy settles down I'd put her back on a balanced diet; she really needs proper nutrition with all the challenges her body's dealing with. Maybe you could get a vitamin supplement from the vet? A good acidophilus supplement might help her digestion; the cyclosporine has probably played havoc with her gut bacteria. NOW makes a good one called 4x6 Acidophilus; you can find it at health food stores. I'll be praying for her. Hopefully the vets at OSU can give you some answers.

GratefulDawg

I just got back from the Vet.  They think Cyclops may have cancer.  I asked about if its an infection due to the Cyclosporine.  I asked if it was too much Cyclosporine in her blood and maybe bubbling up out of her skin.  I asked about food allergy.  They were going to give me antibiotics and see what happened but I asked them to do a biopsy on the spot.  It will take 5 days to get any results.  

Billy's skin was UNBELIEVABLY BAD while on cyclosporine -- it was SO awful the entire time.  His skin had been bad before but he would have huge open sores all over.  Big scabby bumps (just big huge nasty scabs -- some gooey underneath, some just where the scab would lift off and be pink and get bigger).

Skin problems is a HUGE side effect -- now the vet should have known enough to be suspicious of the skin and often vets can spot certain things, but given how little experience they have with cyclosporine, I'm simply going to encourage you that Billy's skin was beyond horrible (and he was an allergy dog and we thot it couldn't GET worse but man .... it sure could).

There were times when his skin was bad on his back -- and then suddenly it would reverse and be bad on his belly.  

Willow had all kinds of lumps and bumps and her skin peeled off in sheets.  And, she lost large areas of fur on her sides and legs--lost meaning right down to the skin.

 Hi Jesses mom!

I did start her on acidophilus.  I had gotten some to make the Slippery Elm Cocktail.  Once I read the label and about how it can help restore the digestive tract I started giving it to her every day.  That bad gas she had went away once I started her on it.  I started her back on kibble this morning.  I had been giving her *** Van Patten's Natural Balance which she never had a problem with.  About a month ago I had changed her to Solid Gold "Barking at the Moon" which everyone on the internet just raves about. All meat and no grains.  Suppose to be one of the best foods you can get.  My border collie Domingo just loves it and its made her coat so nice.  But maybe that has something to do with her loose stool.  The loose stool cleared up as soon as I put her on Chicken and Rice.  So I am going to give her the Barking at the Moon one more time and if the loose stool comes back I will switch her back to what I know works well for her. 

LOL - After I posted this I reread the message and saw that they put astricks in place of Mr. Van Patten's first name.. His first name is short for Richard.. I guess they consider that to be a swear word?!  LOL.. poor Mr Tracy and President Nixon.. can't call them by their names either I guess.

 Well Guys.. Her CBC came back and her PCV is 36.  The best it has been since this all started.  Her normal PCV is 52.  52 is what she was one year ago.. March of 2008 they ran a CBC before they gave her a dental cleaning.  I knew her PCV was going up just because of how much energy she has.

 As far as the skin cancer.  They've never seen anything like this before.  Then again I'm not sure they've seen a dog on Cyclosporine before.  Or a dog that has survived IMHA this long before.  I am just hoping that the biopsy will come back negative.  

Let me try to describe.  The top of her back is covered from below her neck (not on her neck) to rump (to her back ending at her rump, but not on the tail or her actual buttocks.  No outbreaks on her sides, tummy, chest or legs.  Everywhere you can feel with your fingers there are bumps.  Its not like just one spot that you'd expect with skin cancer.  This is covering her.  Very hard bumps.  The bumps are dry, no pus.  They are hard.  The skin is crusting off in layers.  If you scrape it off and get to the new skin the bumps are red underneith.  I am going to try to take a picture and post it today.  Oh no fur loss either.  Her fur is still thick but of course is covered in what looks like "dandruff" because of that crusting that is flaking off the bumps.

She is not showing any sign of sickness.  Her mood is great.  Appetite is huge.

36??? Yay ... that is GREAT news, go cyclops! I'll be thinking about you regarding the skin. Here's hoping it's just a reaction to the Cyclosporine, that's nasty stuff I know. Slippery Elm cocktail is great stuff... do you add the acidophilus, aloe, and cholorophyll? I actually used it as a last resort when there was nothing else I could do for a very sick puppy and it had an amazing effect on his digestive system and he's alive today, which the vet thought was not going to happen! I know it didn't cure him, but it helped him turn a corner and in a matter of two days, got his gassiness, loose stools, and stomach pains under control.

So nice to hear from you!

Yes I do add all that.  I follow the recipe that Callie posted.  I had to laugh at myself I made a batch and poured it in the bowl and then expected her to drink it!  She came up and sniffed it then gave me the funniest look.  Then I reread the posts and saw that I was suppose to squirt it in her mouth with a syringe.  

I'm trying not to worry too much about the skin thing.  I mean they have never seen this before and actually they made me worry a lot about when she had a nose bleed and it just turned out ot be because her nose was so dry and cracked from the drugs. I've been squirting Vitamin E on her nose every other day and its back to normal now.  Am going to just hope for the best with the skin too.

 Great News from OSU:

When I described the lesions on her skin and WHERE they were on the skin.. the response was immediate and definately reassuring - Cyclosporine reaction.  She dosen't think the antibiotics are going to do anything for it, but until the biopsy comes back we are going to continue the antibiotics.  So very relieved about her saying no way is it cancer.  Well about 99% sure its not and just waiting for the biopsy to be absoultely sure.  What are we going to do next?  She mentioned another drug that started with an M.. which I've never heard before.  She also mentioned lowering her dose back to 150mg x2/day - the level she was on and holding steady and NOT having any problems.  What she said though is that what may have happened is that Clops has developed a sensitivity and we can try lowering the dose but she still may end up having to be switched in the end.

She has seen this in the skin before and my description of it was just as she has seen before.  The fact that Clops is not itching or trying to scratch or bite at it also tells her its probably not an infection.  

Here is the kicker.  She is going to ask people, do research and then come up with a plan.  How great is that?!  I am so happy to have this lady who takes time to check and double check things.. its just wonderful.  Anyone listening.. the treatment you get at a Teaching Hospital.. at least OSU and I'm sure all the rest of them too.. just amazing.  

Whew.. happy day and feeling a lot better.

Got the Selsum Blue and the Tea Tree oil anyway.. can't hurt to use them.  Am going to bathe her tonight in them.

Thanks everyone - once again as in previous pages you've seen me have a freak out.. 

The ups and downs of this thing - terrible but I'm glad I have a place to come and vent.  

GratefulDawg

The ups and downs of this thing - terrible but I'm glad I have a place to come and vent.  

GratefulDawg - you and Callie and all the other contributors here are teaching us all so much about the experience of this disease and we're all learning as a collaborative group because you're sharing your experiences and others are sharing their advice.  THANK YOU!  I suspect this thread will be a resource for many dog owners in the future.

GO CYCLOPS!  We love you, big girl!  And big thumbs up to OSU teaching hospital!

We had Billy on antibiotics many times over the course of his IMHA for **exactly** this.  Now the theory of the vets was that altho it's not *caused* by an infection (but rather by the body kinda trying to get rid of the 'toxins' it perceives in the drugs) IT IS **inflammation**.  And inflammation itself can actually cause more auto-immune junk.

 So what do you do with a dog who is majorly inflamed??  Give it steroids?? (collective groan here folks -- Cyclosporine is considered a sort of "super steroid" type drug -- she's already TAKING steroids). 

This is where we used as much holistic stuff as we could.

 Gratefuldawg -- take some of that aloe powder and reconstitute it.  AFTER you do the bath with the rinses -- pat on aloe.  I'd make it pretty thick (far thicker than you do for the slippery elm cocktail) -- just keep it in the fridge and use it topically as well.  Aloe is GREAT for skin inflammation.  it's benign -- won't hurt a thing.  Even if she does lick it no problem.  But it should help calm the skin down.  It won't 'cure' but it should help calm it down some.

I consulted with a doctor by email.  She was once again kind enough to respond to my questions.  I think we may have figured out now what happened.  This would be of interest to anyone using generic cyclosporine.  This is a problem that happened at the Pharmacy.  The first month of Cyclosporine, the Pharmacy sent me Apotex Generic Cyclosporine (Unmodified).  This is a small pill.  We were giving 150mg 2x/day.  When that only held her at 25 the doctor changed the Rx to 200mg 2x/day and the Pharmacy sent me Sandoz Cyclosporine (Modified).  Now.. here is what happened.  The unmodified version had very poor absorption rates.  So had the Pharmacy sent me the same kind then the change to 200mg might not have caused this.  But lets say she was only getting 100mg of the 150 due to absorption issues.  Then we switched to the Modified (all this unmodified/modified part was unknown to me or the vet at the time).  Now she is getting 200mg at very high absorption rates.  200mg for her weight is over the recommended dose. 

I went to the Atopica website and found this in the literature.  "doses higher than the recommended dose can cause raised skin lesions"

So now I need to get with the Pharmacy and the vet and get Cyclops' Cyclosporine level decreased to 150 but make sure the pharmacy uses the Modified version.  Or if Price were not an issue stay at 200 but use the unmodified.  Either one will probably lower the concentration of Cyclosporine enough to stop the skin lesions.

Those of you who use Atopica this won't be an issue for you.  But if you use a generic make sure the pharmacy isn't switching back and forth between the modified and unmodified capsules.  Unmodified are very small little capsules and solid.  Modified are big fat ones and are filled with liquid.

 Callie.. back when we were talking about Vitamin E for Cyclops' nose.. I kept wondering why you were saying " *** the pill with a needle" and I kept thinking "I wonder why she is saying ***" Then yesterday I was talking about dog food names and when I posted I got the *** in my message.  I then went back and read your messages and figured out what word you must have used for *** (!).  Wow this bulletin board has a dirty mind!  LOL

Thank you so much for this inspiring (and heart-tugging) thread.  It has meant a lot as we also start down this journey into the unknown. 

We noticed on Friday that our normally inquisitive, independent and spunky 2 1/2 year old female mini schnauzer (Poppy) was ‘suddenly’ lethargic, not interested in food or play (which she loves), more attached than normal (always wanting to be in my lap/arms), hotter than usual, and was being 'obedient' outdoors (normally she likes to run away when we try to leash her, as she prefers to follow us home from walks – but now she’ll let me catch her.)

We were naturally worried and monitored the situation closely, she seemed better on Saturday (ate half her food but was still tired) and Sunday morning.  However instead of greeting us with her usual enthusiastic barks and wiggles when we arrived home that afternoon, she wobbled towards us - we immediately went to the vet. 

After a series of blood tests, the vet determined she was anemic (he also showed us her pale gums) including a low red blood cell count.  His initial thought was she had Tick Fever; more tests and a second opinion from another member of staff however did not pick up signs of this in her blood, I think they were looking for the actual parasites in the sample (we understand signs aren't picked up sometimes and/or might show up later in tests).  So he sent us home with some vitamins, anti-inflammatory pills and antibiotics, with instructions to come back in a week for a check up/more tests or to come back ASAP if things got worse. 

It's been less than 24 hours since she has taken her meds and so far she is showing some signs of improvement (interest in food, more energy) - knock on wood!

Since we have just relocated to Hong Kong from the States, and Tick Fever is new to us (apparently common here), I started "googling" to educate myself in case, and came information about IMHA or AIHA too.  One of my aims is to present information I find to the vet in the hopes of helping to get a confirmed ‘answer’ on Poppy’s condition soon!

I have some questions for this experienced forum:

1. Is there a difference between Tick Fever and IMHA, if so what (from what I’ve read it sounds like IMHA is the name of the condition, with Tick Fever being one of the possible causes)? 
   

• I suspect Poppy's profile may fit with IMHA also as per the above symptoms + age/gender + had Heartguard shot within past 4 months + had annual vaccinations a week before developing the above symptoms [they don't do titters here] + 'over vaccinated' (when she arrived they gave her a 3 year rabies shot anyway despite having already had one in the States 6 months prior - part of HK’s quarantine policy.)  
• We have not been able to find a tick on her yet (have checked between her toes too), although my sister did find one about 4 months ago but this was removed and we go for hikes regularly.

1. Are there other conditions to consider which may have symptoms similar to IMHA and/or Tick Fever? 
   

• Our vet has ruled out worms (as she is not bloated/thin) and malnutrition (as she is obviously well taken care of)
  

1. If IMHA is caught early does this improve Poppy's chances of a quality life (I understand a dog never truly is ‘cured’ but that this is a condition to be managed)?  Also what is considered 'early'?
2. If Poppy has IMHA, will she be on drugs for the rest of her life?
3. Is IMHA passable to humans/dogs from day-to-day contact (e.g. touching, handling food bowls etc)?  
4. Poppy has some appetite at the moment (lapping up most of her favorite foods), is there anything special we could be giving her to boost her energy?  To help keep her energy constant and to ‘fight’ through this, we have started giving her smaller portions throughout the day
5. Is there anything else we should be doing for Poppy?

Your thoughts or any additional comments/directions would be much appreciated!  Many thanks all in advance.