AIHA or IMHA

 Johnny,

As you know I am having the opposite problem, can't get the Iron high enough.  Now.. this vet I went to is one I hadn't seen before so I don't know really how good he is or not.  He is an old timer country doctor who has seen a lot of things during his career, that much I can say.  He thought I was fussing over nothing on the Iron numbers telling me that it was low because she is producing so many new cells and it would level out when her HCT was finished climbing.  

I then told him that I was worried that these Iron pills would get her Iron too high if I wasn't testing often enough.  He told me that in his entire career he has seen a lot of thing, a lot of dogs getting toxicity from a lot of different vitamins and minerals but he has never seen a case of Iron toxicy.  He didn't think that me giving her the Iron pill would ever put her in danger even if the levels go back to normal range without me knowing.  

As I said before, on the scale Antech gave to me, the high end of the Iron was 220.  So with Tessy at 283 it isn't that far out of whack compared to the scale you used. 

I think your idea is a good plan.  If it were me I'd just stop giving vitamins altogether.  And cut down on the Iron rich foods.  

Thats just my opinion, to me it doesn't make sense to keep pumping in the Iron if its high or the B vitamins if its normal.  Her body can take what nutrients it needs out of the food you give her.

Johnny&Tessy

Given these results I'm just looking for some opinions on what I should do.  I really have no idea what these all mean and if I should be concerned or worried.  Should I avoid certain foods like spinach or liver?  Is 281 high but not high enough to cause problems?  I've read that too much iron is bad so now I'm just overly worried.  I'm finding it difficult to find any literature with regards to these ranges. 

Definitely hold back on the high-iron foods -- those foods are also foods that may make the blood thicker (they do a lot to the blood -- for example, someone taking Cumadin to thin their blood has to also avoid all those same foods because they thicken the blood and work against the drug).

This is another reason why I used the TCVM (traditional Chinese veterinary medicine) because some of what Billy took was a 'blood mover' -- literally to keep the blood a bit thinner and moving properly thru the body.

OK so I'm a little worried and freaked out at the moment.  I just noticed that Tessy's pee is a little on the dark side.  She doesn't seem to be in any pain and I'm following her around trying to get a sample.  I wiped her after her pee and it looked brownish/redish/dark orangeish.....now I don't know what to do.

I'll keep you all informed.

VET ... a.s.a.p.  It may just be an infection but blood in the urine with IMHA can be bad.  Seeing *drops* of blood or a stream of blood in the urine is actually better than reddish urine.  Honestly -- don't let that go -- vet to the vet right away.

Callie....you read my mind!  I got a sample of her urine and off we went.  A urinalysis was done and the results are a UTI.  It was kinda weird cause when we looked at her bottom near where she pees we could see blood.  Doctor said it was a blood clot.  Very odd....never seen that before.  The good thing is that her pee was yellow turbid...no reddish in it!  Here's the results incase anyone is interested...

Refract S.G. - 1.034

Stick:

• ph - 5
• Leukocytes - 2+
• Nitrite - neg
• Protein - 2+
• Glucose - normal
• Ketones - neg
• Urobilinogen - normal
• Bilirubin - neg
• blood - 4+

 Micro:

• RBC - 4+
• WBC - 4+
• Casts - ---
• Transitional Cells - 2+
• Epithelial Cells - 1+
• Sperm - 0
• Debris - 0
• Crystals - none seen

 The results of her skin swab (from her skin condition(green pustules)) also were in and showed the presence of two organisms.  The first was an overgrowth with Proteus Mirabilis and the second was a staph (Staphylococcus Intermedius).

Because of the staph and the UTI the antibiotic Bioclav2 was chosen to combat these infections.  She will have to take 250mg twice daily with food for two weeks.  I'm hoping this will clear both issues up.

Since I was there I went ahead and had them run a CBC.  Her HCT went up from 29.1 to 29.8.  WBC went up from 16.9 to 17.9.  RBC went up from 3.88 to 3.92.  HGB remained same at 10.1.  PLT went up again from 486 to 616.  I guess that everything remains the same so to say.

I probably over reacted but just seeing blood for the first time in her urine kinda had me freaked a bit. 

I'll keep you all informed on any new info or news.

High paws from Tessy.

Johnny & Tessy

Just another quicky....I just had Tessy out for a pee and sometimes she'll pee on the deck.  She had a normal pee and then walked a few steps and squatted again.  This time she only dribbled.  The problem being the dribble looked like blood, diluted some but blood none the less.  Is this a normal thing with UTI's?  I'm going to get some dried cranberried to add to her diet.  The doctor gave us forti flora to add in with her food also.

Thanks

Johnny & Tessy

Ok, NOW I'll tell you - the reason I so strongly urged you to go to the vet (aside from the very simple reason that UTI's HURT like the very devil -- they literally hurt TOO bad to continue a stream so they stop, go a few paces and start again -- it's pain that causes that) -- but when you see pink-or-tred-tinged urine RATHER than blood clots or just drops of blood in a stream it can mean that the body is attacking the blood in a different way and blood is spilling into the urine from the kidneys and that can be mega bad news.

Getting the dx of the specific uti erased that worry.  I didn't want to give you a heart attack -- and because of the strong color of the urine it *sounded* like just a UTI but you just plain don't EVER want to risk it with an IMHA dog.

Part of this is a side-effect of the cyclosporine.  The immune system is lowered so infection is easy anyway and for some reason the cyclosporine targets the kidneys as well as the liver.  You're already using milk thistle, right??  If I were you I'd double the amount you're using -- given that the urinary tract is being targeted you need to help protect the kidneys as well as the liver and you can only do that with *large* doses of milk thistle.

Now -- UTIs -- cranberry helps because it is a form of glucose that the body doesn't process -- but essentially it helps the urinary tract be too "slippery" for infection cells to stick.  So yes -- cranberry capsules for sure.

However, the thing *I* found most helpful with Billy (and Billy ran truly heinous uti's -- I saw blood clots, I saw RIVERS of blood up the center of a pee accident - scared the tar out of me) was D-Mannose.  Now Brand Foods is in Canada so it should be pretty easy for you to find.  If you go to their website you will find a locator that will tell you the nearest store that sells it.  It is one of several brands of D-Mannose.  It's pricey but *very* helpful in reducing UTIs and the pain they cause.

Now Solaray makes one that is combined with cranberry (Cranactin) -- and honestly I found it over-priced and NOT at all helpful.  Somehow the proportion of cranberry to d-mannose just wasn't helpful at all. 

Billy took a heaping half teaspoonful twice a day of NOW D-mannose (and there were days when I gave him a full teaspoon of it).  Like I said, there ARE other brands and that IS more than you'd typically give, but quite honestly I gave him what it took to help him.  It isn't digested by the body anyway.  You will need to give cranberry and d-mannose ALL THE TIME.  It's more preventive than 'cure' -- it will help reduce the infection now, but it will help more to prevent it from returning once the antibiotics get it gone.

 Do you have any Vit C??  Give her just a bit -- say maybe 250 mg several times a day if you can.  It will help acidify the urine and will help reduce some of her pain.

Also -- you need to get more water in her -- Add water to her food, LOTS of water in her food.  Syring water IN her mouth.  Anything to get more water in her -- part of the reason shes in so much pain is that she's not drinking which makes the infection more concentrate in the urine.

You know to give the Forti-Flora NOT at the same time as the antibiotic right?? You have to leave about 2 hours at least between any probiotic and an antibiotic or the antibiotic just kills the probiotic.  Forti-Flora is a good one tho made just specifically FOR dogs.

 Good job getting to the vet quickly.  You know Tessy is on a LOT of immunosupressents.  I forget how much maybe you can list the immunosupressants again and the doses.  I remember in particular the amount of Cyclo you are giving her compared to her weight.  I hope you can get her off at least 2 of the 3 immunosuressants.  I mean she is just wide open to everything right now.  Not meaning to give you more to worry about but we saw this in Val's dog Cooper and he is doing so much better already by loweing the drugs.

 Callie.. once again here with great info and every bit of it being right on.  We are lucky to have her here to lean on.  

 Johnny.. great job looking at the pee.  I have to remind myself to find places for Clops to pee.. but usually I remember and try to get a good look at it once a week at least.  

Thanks for all the advise.  You are right Grateguldawg....Callie ALWAYS has great info.  A big THANK-YOU goes out to everyone for their help and support and especially to you Callie for being so helpfull.

I usually follow Tessy around at least once a day if I can to check out her urine & stool.  My neighbors probably think I'm nuts!  Can I give her the human Vitamin C or does it have to be a specific kind?  I have not been giving her any milk thistle.  When you recommended it awhile ago I was going to add it but asked Tessy's doctor about it and she said it wouldn't be necesary because all her values were normal.  Dr. Dodds also said to hold off for a bit because of everything in her body at the moment.  I wonder if I should insist to them that I put her on it?  To me it sounds like a VERY good idea.

Tessy drinks LARGE amounts of water daily.  An hour doesn't go by that she isn't drinking...which also means I have to let her out to go potty at least every couple hours.  Lots and lots of sleepless nights I can say.  She knows all she has to do is come to me and paw at my leg and she goes out.

 I did not know about the Forti-Flora and giving it near the same time as the antibiotics.  Thanks for letting me know.  Makes sense.

Tessy started to lower her pred last Thursday from 50mg to 40mg/day.  Tomorrow I will be doing another reduction from 40mg to 30mg/day.  We will reduce every week until she is down to 10mg/day.  Then we will target the azath.  She still takes 37mg of azathioprine a day as well as 200mg of cyclosporine/day.  Dr. Dodds wants the cyclosporine to be the last drug to start weaning because it does the best job at fighting this disease.  Tessy's last trough test showed good levels of the drug in her system so she's not over doing it with regards to the dosage.

Tessy is doing better today.  She's a tough little girl.  She seems to be a bit more lazy but I think it's from the antibiotics.  Her pee is looking better and no little dribbles anymore...so far.  Her gums a pink and she still loves her food!  She likes cranberries so I guess that's a plus!  Are too many cranberries a bad thing....is there a limit that should be given I wonder.  The only ones I could find in the stores are the lightly sweetened dried cranberries.  Are there foods that should be avoided with UTI's?

Anywho, Thanks again Callie for the info.

Hugs and high paws from

Johnny & Tessy

The biggest benefit of milk thistle is as a *protectant* -- yeah, it can help bring liver values down if they're up but it's BETTER as a protectant so waiting until there is a problem is kinda like shutting the barn door after the horse gets out.  At least in MY opinion.

These drugs are unbelievably hard on the kidneys -- if you read carefully they now admit that cyclosporine is hard on the kidneys and renal failure can be one of the possibles.  That's why I didn't just give billy *some* milk thistle.  I gave him GOBS of it.  Because in normal doses it helps protect the liver, but in huge doses it does actually help protect the kidneys from damage. 

We know that Billy did suffer *some* kidney damage while he was on cyclo -- but we maintained it pretty well. 

Vit C -- you can give the human variety -- smaller doses given often are more effective than larger doses less frequently because it exits the body just as soon as she potties.  But it will acidify the urine slightly which will help reduce the pain.

I'm going to go ahead and look for the milk thistle.  Like you were saying...better to prevent than to wait for a problem to come.

Are there limits to the amounts of milk thistle given?  Is it possible to give too much?

 Thanks,

Johnny & Tessy

Start with the adult human dose -- and build from there.  It likely will actually help the drugs be better absorbed ... so keep up monitoring them.  I have told Val ... to be completely and brutally honest, every time Billy would have **another** UTI or *****another***** skin infection that indicated the kidneys/liver might be weak (particularly the UTIs to be honest --- the constant blood in the urine and the constant problem for him broke my heart) I'd get scared and give him "just a little more" milk thistle. 

I've never heard of "too much" AS LONG AS IT IS WELL TOLERATED.  Dr D  told me several times about milk thistle being used at UC Davis to help treat humans who had suffered the bite of a spider that caused nearly immediate renal failure.  They literally would put people on an IV of silymarin (which is the latin name for milk thistle) of gi-normous doses -- my biggest fear thru the whole thing was that his kidneys would fail (remember we lost Muffin the Intrepid to renal failure because the vets encouraged us to leave him on chemo too long).  So every time I'd get scared (every 3 months or so??) I start adding just "a little bit more".  *rolling my eyes* 

When it started I was giving him 2 droppersfull of Herb PHarm milk thistle tincture (that's the adult dose) twice a day.  by the "end" of him being on the drugs?  He was taking 5 droppersfull twice a day.  (no, I"m not usually obsessive about things, but I probably was about this)

I have had at least three vets tell me since that I likely made sure that his kidneys didn't fail.  Both the liver and the kidneys did sustain hits -- we know that because since he's still showing microalbuminaria in his urine ALL the time and some albumin.  *sigh*  His liver is touchy unless I keep after it.  But ... he's been OFF the drugs totally 19 months.  He was ON them 18 months.  So I figure we did something right. 

No vet told me to do this.  I want to make that perfectly clear.  Yes, Dr. DiNatale wanted him on milk thistle -- but the high doses were pretty much my idea.  She KNEW, but she also knew how close watch I was keeping on him. 

He still takes milk thistle.  (in fact he takes Sam-e now) He still takes a poop-load of meds & supplements -- cos he's got crappy skin, and it left the liver a bit damaged and he's always been thyroid deficient. 

I still cannot say enough about Denosyl and Marin.  Willow was on high doses of human milk thistle and her liver values still went high.  We used the Denosyl in combination with the Marin and within 2 weeks it was down.