AIHA or IMHA

I'm just finding this as I'm walking out of the house -- please email me and I will try and help you.  Let me know 'where' you are (state and time zone) and we'll try to talk on the phone. 

WHY is the dog on doxycycline??  Did the vet suspect tick disease??  Go back in this LONG thread and read what I've written about it.  It BOOSTS the immune system -- and the more I see the more I think it's not a good idea when you suspect IMHA

Coopbay

Here is the deal.  You don't have the luxury of time.  The only reason my dog is alive is because I listened to the advice I got here and also because I took my dog to a Veternarian Teaching Hospital.

By the meds your dog is on, it sure seems like the Vet is thinking its IMHA.  The Azathiaprine and the Cyclosporine both need time to work.  Your dog has to be ALIVE for the next 2 weeks in order to have a chance.  That means you need to find a place that can type and crossmatch your dogs blood because you need to have another blood transfusion in order to buy the time you need.  14.9 is not good, especially when its heading in the down direction.  If your dog was in ICU they could monitor more closely and wait until the count drops to 10 and then transfuse.  

We need to find the nearest Teaching hospital.  You'll find the prices there are better than anywhere else.  I wasted about a grand screwing around in my home town.  I got 10 days of intensive care for my dog for the same amount of money at a teaching hospital.  

You want to make sure Cooper is on enough pred.  Cyclops was on 2.2mg/kg twice a day (every 12 hours).  How much does Cooper weigh?  Convert Cooper's weight to kg and then multiply by 2.2 and see how many mg that comes out to.  Your vet may very well be correct but you should double check the dosages to be sure.  I'm not sure if its going to make a difference being on Azathiaprine and Cyclosporine at the same time, they both take a long time to do any good so right now its a race.  I wanted to keep my dog on Azathiaprine because of the cost factor.  If money is an issue then I would do Azathiaprine.  My dog is on Cyclosporine alone and its very expensive although the cost will come down as you taper the dosage off. 

Its very important that you have Cooper on Pepcid AC 2x/day to protect his stomache.  All the meds you're giving are very hard on the stomach.  

This thread is very long but I hope you can go back and read Cyclops' story.  Cyclops got off easy with just having 2 transfusions.  Callie's dog had 6 (!).  

Most important thing, find a vet with good blood supply that can type and match the blood.  Preferably a Vet School.

Good Luck and please let us know what is going on.

We are praying for Cooper and hoping the medications work for him now.  Willow has been thru a very similar disease with similar treatment.  So, I know how scary and sudden this all seems. 

Gratefuldawg, thank you for your post. I just got off the phone with Callie and I emailed Hemopet to ask for a recommendation as to which teaching hospital would be good to go to. In the past 2 weeks, we have easily spent $1500 with the blood transfusion, drugs, and the blood tests. Callie told me that I should ask for a PAC cell count instead of getting the CVC like I have so many times lately. I am a teacher and I teach first grade. It's been so hard waiting all night and during the day in school WAITING to find out if his numbers have gone up or down. Then I get the call and I end up crying more. It's awful!

Cooper will be 6 years old in Sept. He weighs 26lbs. The animal hospital where he got his transfusion has him on Doxycycline 50mg twice a day, Prednisone 25mg once a day, and Azathioprine 50mg once a day. Today the vet called and has Cooper taking Cyclosporine 100mg once a day. He also has Cooper taking 150mg of iron once a day.

Callie told me to get some milk thistle tomorrow and get him on something for his stomach. So I will get the Pepcid AC. Did you give Cyclops the Pepsid at meal time and then give the meds?

Being that my husband and I are teachers and we don't have a ton of money, cost is important. I am willing to do anything for Cooper but I would like to make sure I am making the best choices. I am hoping to hear back from the dr. Callie had me email so I can make some phone calls and figure out where the next step will be.

This disease has really scared me and I am struggling. I am so lucky to have found this site. At first I was unsure of whether or not I should post something, but now I feel like there are so many people out there that have been through this and there is so much to learn from all of you. I appreciate every thought, prayer, and bit of information from you guys.

I am going to try to get some sleep. Those 6 year olds are tough to teach on zero sleep. Thanks again!

There is a hospitalin Urbana.  Heard nothing but good reviews about it.  I know that Urbana is far away (I used to live in SW Michigan and am very familiar with Chicagoland).  This summer a place in Chicago will open.  Its called the Chicago Center for Veterinary Medicine.  Its just West of the old Cook County Hospital and the University of Illinois at Chicago. 2242 W. Harrson.  That is about 40 miles from you.  Unfortunately this summer is not going to do you any good NOW.  Urbana is 148 miles from you.  The phone number is 217-333-5300  There is also a teaching hospital in Madisson, WS about 110 miles from you.  From what I read on the internet Urbana seems like a great hospital.  Here is a review:

---------------

"I have a special place in my heart for this hospital. We used to drive to this hospital every week to get chemotherapy for our beloved child (dog). Our vet in Chicago recommended we go here because they are the best.

The doctors and staff treated us with utmost respect and compassion. Anyone who has been through sickness of their pet knows how hard it is.  Unlike many vets that try to make money by instituting unnecessary treatments, these doctors were honest about the prognosis and outcomes from the very beginning. They treated our dog like their own.

I encouraged my friends and relatives to donate to the hospital for the care they provided to our dog. I will always be thankful to them. "

---------------------

I know about the money thing, trust me.  If you read my posts you'll see its been a constant factor for me.  I think you will get the most bang for your buck at the Veternary Hospital.  It was hard for me because I had to take my dog on a 4 hour drive each way to the nearest hospital.  Had to leave her there for 10 days.  But the medical students were so good.  They called me twice a day and gave me updates.  They had her in ICU where she got 24/7 care.  I can't say enough about it. 

Dr Dodds is great, she may or may not have had any personal expeiences with the hospital in Urbana or Madisson.  With me her advice was that any Teaching Hospital was good but that she had some interaction with Oklahoma which was what my deciding factor was. (I had the choice of 3 which were all about the same distance, one in Kansas, one in Missouri and one in Oklahoma).

The Pepcid AC is so important.  You can get the generic from Walgreens, thats what I do, often Walgreens will have a 2 for 1 special and when the do I stock up.  I give the Pepcid AC with her morning meal and then give the Cyclosporine 2 hours after.  In the evening I give her another Pepcid AC with evening meal and then Cyclosporine 2 hours after.  You want to give the Cyclosporine either 1 hour before a meal or 2 hours after to get the most out of the drug.  The Milk Thistle, Callie got me a huge container of powder and I give her a teaspoon in the morning and one at night.  This is probably like giving her 20 pills.  I used to give 8 - 275mg pills per day but the powder has been much easier.  I just put a spoon in a slice of deli shaved turkey breast and fold it up and she wolfs it down.

Right now any amount of eating Cooper will do is a good thing, feel free to spoil him right now.  The scariest moment I had with Cyclops was when she refused to even look at a McDonalds Cheeseburger and French Fries (I got desperate trying to get her to eat so I went and got her those).  

Well good luck.  I think you're in a good area to be in.  I love Chicago and I love teachers.  I still think about my 2nd Grade teacher from 1977.  She is someone I'll never forget.

Keep us posted please - thinking about Cooper.  

And listen.. this disease is hard because they are not in any pain, they are just tired.  So its harder than normal to think about putting the dog to sleep.  Feelings of guilt are common.  I came so close to putting my dog to sleep that I don't even want to think about it.  But in my case things have so far worked out.  My dog is back to normal with the exception of giving her Pepcid AC, Cyclosporine and Milk Thistle.  But I prepared myself to do what I need to do if it got to the point where she was just miserable.  Cyclosporine is a very harsh drug, my dog had some severe reactions to it until she got used to it.  100mg 2x/day is a huge dose for such a small dog.  My dog is 70 pounds and on 150mg 2x/day.  You may look into generic cyclosporine. I have the name of a pharmacy where you will get the best prices I have found in the country.  275 dollars a month for a 300mg per day total dose.  That is better than the 450 that most want for the generic and better than the 800 they want for atopica.  Your dog may or may not tolerate the generic but I would at least give it a try.  

I have to call my pharmacy for a refill and I'll ask the price of 200mg per day for a month and let you know. 

Just find a place that can get your dog a transfusion if nothing else.  You can't have another transfusion without cross and match.  You can only have one transfusion from a universal donor.  That is very important.  

Coopbay

He said Cooper could have bone marrow cancer but he doesn't know if doing a bone marrow biopsy will be worth it. He said it's painful and it might not give us any more info.

Pirate had the bone marrow biopsy as well - it really wasn't that awful. They put a little hole near their shoulder blade and suck a little marrow out - Pirate was stiff for the first 72 hours but he was staying in the ICU, so they kept him comfortable with a lot of pain meds.

I can't stress this enough -- GO to the teaching hospital. I with I would have taken Pirate to UF.

And OT: I'm majoring in education, and I want first grade too! Hopefully you'll stick around here (we're nice people!) and when I graduate I can commiserate with you :)

I'll keep Cooper in my thoughts, for sure.

 Thanks for pointing that out about the bone marrow asperate.

I agree with meg, the bone marrow test isn't that big of a deal.  My dog was asleep for it.

I'm going to update a little because she copied ME on something.  I told her two things last night -- I told her to go to a teaching hospital AND I told her to email Dr. Jean Dodds for a recommendation of WHERE to go.

Surprisingly **this** time Dr. Dodds came back and said "Go to THIS vet___________ at THIS specialist________".  As it happens one of the two she recommended is the vet she's been working with on Sadie (Oprah's dog) but both of these clinics are places she's had in-depth communication with them on auto-immune/hemolytic anemia and in *this* case in **this** place she recommended them over teaching hospitals.

The better I get to know her the more impressed I am with Dr. Dodds.  She truly goes to the mat for these dogs -- and she's jumped in really BIG into the whole auto-immune/anemia thing (because Hemopet IS all about being a blood donor bank for dogs). 

This lady needs support so any of you who may feel so inclined even just a word or two of support means the world to her right now.  I-doggers you ROCK anyway ... and the collective experience here is SO valuable.  Gratefuldawg's experience with the human cyclosporine has been AWESOME -- and it's an updated thing since Billy was sick that makes this disease (a very expensive disease) just a little more do-able.

I just thot it was so kewel Dr. Dodds answered her right away and gave her a solid recommendation.  AND told her "Passover starts tonight so I won't be online for a few days so if you need me contact me before then!!".  How truly awesome is that?

  I don't have any advice but wanted to let you know I'll be praying for Cooper.

 I'm with you Janice.  Hoping for the best but very worried about Cooper and Cooper's mom.

I am doing OK. Not having the best luck with trying to get my husband on board with everything. I have gotten so much help from a bunch of you and I really am lucky for that assistance and guidance. All the support you guys give is so heartwarming.

Right now I am stuck. I am willing to do anything for Cooper but money is a problem. He is feeling great and acting like himself. He is barking and howling and he doesn't do that when he doesn't feel well. I've gotten the Pepcid, Milk Thistle, prunes, liver, and taken him off the Doxycycline. I think I am going to get a PAC cell today to see where he is at. Then, either go to Arboreteum View, a specialty animal hospital in the area recommended by Dr. Dodds, tonight depending on his number or take him tomorrow to have them check him out.

I will keep everyone posted. I wish things were different.

Cooper's Mom, I hope things improve.  I can't imagine if I were dealing with this without my DH's full support.  The money issue is unreal for this condition.  I will continue to send my thoughts and prayers for you and Cooper and your hubby too.  Hugs

 They'll run a blood test again no matter where you go.  So really if you are going, save the money and get the test done when you get there.  Because no matter what the PCV says.. lets say it went way up.. thats great but you still need to see a doctor who knows how the meds work with IMHA and have them set the dosages for you.  That is a bare minimum. 

Cyclops wasn't responsive to the Prednisone.  You'll notice on Dr Dodds attachment she sent that some dogs do respond to the Pred and some dogs are treated ONLY with Pred.  Hopefully what is happening is that Cooper's PCV is going up because of the Pred.  Its certainly not the Cyclosporine or the Azathiaprine since you've only been on those for 48 hours.  So that would be great news. Of course all we are doing is guessing at this point.  

I just talked to her a bit more -- he's been on the Azathiaprene for over a WEEK *and* he's been off the Doxycycline for 2 days.  She went this afternoon and his 'crit is up (I think she said 16.5 but I'm not sure and that's up from 14.5 *I think*) -- she's going to try to get him in tomorrow.  She's pretty drained ... it's all pretty difficult so prayers and good thots are a big deal for her -- but Coop's seeming pretty darned good.  She does understand that he needs to be diagnosed -- that's probably the biggest deal.  But if he's not crashing that will reduce the amount they have to 'spend' by a great deal.