AIHA or IMHA

Hi all.  Hope all is well with the doggies as of late.  I haven't read much lately so I guess it's like the saying goes.....No news is good news.

Just wanted to let everybody know that I went ahead and shaved Tessy today.  The doctor said it would be a good idea due to her skin problems.  It went fairly smoothly.  She obviously would rather not be shaved but all things considered she handled it well.  I did the shaving myself so I think that might have helped some.

I did notice one thing when I was done though.  Her belly is larger than originally thought.  She had soo much hair and it was so long that it kind of blocked/obstructed the view.  Ive seen her before when she was shaved last year but now she's just huge (the belly).  I've heard you guys say before that it is from the drugs (pred) and that it will go away with time.  I guess I am just wondering if there is anything I can be doing to help or if I should be worried at all.  Should I just leave it alone?  She's down to 12.5mg/day of pred now.  I was hoping that with the reductions the past couple of months that the tummy would shrink a bit.  Does the azathioprine and cyclo play an equal role in this? 

Leave it to me.....there always seems to be something I can find to worry about.

I got another question about her antibiotics she's on right now.  She's taking cephelexin currently for her skin condition and also her UTI she has.  Since she did a two week course of antibiotics before this session and her UTI didn't fully clear up....I was wondering if it would be wise to ask her doctor for another weeks worth of pills just to make sure we get it fully cleared up this time.  She only had enough cephalexin to last two weeks and I guess I'm just a little worried that she might not be fully rid of the UTI when we stop and wait a few days for a urinalysis.  Those few days might make it come back yet again if it's not fully cleared up.  Any thoughts or recomendations would be greatly appreciated.

Thanks,

Johnny & Tessy

Hello everyone.   I was searching information about IMHA when I found this place and I am so glad I did! I see that there is already a post on IMHA, but I did not want to interject into someone else’s post. I have made it up to about the 20^th page of the other IMHA so please let me apologize if I ask a repeat question.

On 5/31/2009 we adopted a 9 month old mix breed from the pound. She had received all of her vaccinations on 5/22/2009. Also at the time she was being treated for kennel cough and was on Doxycyline and Sulfa. She seemed to be getting better, but on 6/11 she became lethargic and would not eat. Her gums were pasty white. At the vet her HCT was 10. Over the course of 3 days she received 2 blood transfusions. She was started on Prednisone 15mg twice a day and Cyclosporin 75mg twice a day (she weighs 36lbs).  She gets Pepcid twice a day to help protect her stomach.  She was also started on low dose aspirin once a day because her blood was clotting and had spherocytes.

Because of her age and the tick disease tests coming back negative, they thought it was related to either her immunizations or a reaction to the sulfa medication.

She was released and sent home by 6/26 her blood level HCT was up to 26. Since it was on the rise we waited 2 weeks before having it checked again on 7/10 it was unchanged (HCT 25.8). The specialist is telling me that we should wait another 2 weeks and check her blood level again and hopefully it will increase.  Her platelet count has always been normal and she does have a good retic count.

Other than the low blood level and pale gums, she seems to be fine. She is playful, eating and drinking well (you would think we are starving her to death thanks to the Prednisone).

I was wondering if other people had experienced this slow of an increased in blood level once meds were started? From what I have read on here is that it seems to be a slower process than we were lead to believe. The specialist made it sound like if she was going to get better that it would have happened by now, but that even once her blood levels were back up that it would still take many months to wean the meds off. I am just worried now that she is never going to get better.

Next question is those with dogs that have had IMHA, do you continue to give Heartworm medication and Flea/Tick preventative like Frontline Plus? The specialist did not mention stopping these, but now I am concerned about them as well.

Thanks!

Hi -- I can't post much now cos I'm at work but Jackie sent me an SOS.  There are several of us on here who have dogs who are IMHA survivors (and other "related" conditions). 

No, it doesn't always happen fast.  don't worry AT ALL about hijacking that 53 page (or more now??) IMHA thread -- that is EXACTLY what it's there for!!!  Post away and then go back and catch up as you can. 

I'm gonna email or pm you my phone number -- IMHA **NEEDS** to have support.  Just knowing others who have been there, been this scared, been this clueless, been this .... ACK!!!!!!!!!!!!!!!!!!!! -- yep, we all understand.  I'm sitting here with my eyes all wet just thinking about the trauma of getting a brand new-to-you dog, bringing it home, finding an infection and TREATING it and then whoops -- IMHA.

By pairing Doxy and Sulpha it kind of set this up.  The sulpha drugs are among those known well to trigger IMHA.  But in addition, doxycycline also is known as an "immune-booster" so it can combine with the situation to make the immune system go over the top (that's what happened to my Billy -- we were treating for suspected tick disease and it wasn't).

It took Billy over SIX weeks to respond to high doses of cyclosporine and pred -- he had SIX transfusions over the course of that time -- not just two and then the numbers up slowly -- his body just kept killing the blood over and over and over.  it happens!!

Because these meds are so difficult to take -- side effects can be a mega problem longer term.  AND add to that the fact that the auto-immune component can morph into other problems (like cytopenia where the platelets disappear which in IMHA terms they call Evanger's Syndrome)

MILK THISTLE -- that's my big word for you until we talk more completely.  Protect the liver and the kidneys -- that's truly what it's all about.  Several of us simply order it bulk and give it by the spoonful with meals.  Yep -- not even in capsules (much much cheaper that way and it's not a bitter herb at all). 

Yes, I kept Billy on Frontline but on a spaced out dose and since I have other dogs I let them take the brunt of it and would skip months on Billy if HE wasn't showing any flea activity.  For heartworm I use Interceptor and do it ever 45 days.  BUT I use nothing that's systemic -- no Revolution, no Advantage-Multi, nothing that crosses into the blood stream.

Take heart -- others will post soon.  But don't be afraid of derailing that thread -- the whole point of it is to keep it a cumulation of experiences -- of TONS of people and dogs, simply so it is searchable and continuous.  We've had some sad experiences ... but mostly we've had GOOD ones and its really helpful to see LONGEVITY when it comes to IMHA.

 Johnny,

 Even though her dose of Pred is smaller, things won't get better until she is totally off and then it may take a while after that.  

 About the antibiotics, yeah, I'd definitely either have her checked again.  If her UTI isn't cleared up then maybe this antibiotic isn't a good match for it.  Maybe its good for the skin problem but not effective for the UTI.  I guess if it was me I'd have her tested and if still infected then try another antibiotic.  Don't know that if you extend one that hasn't worked in the amount of time its suppose to will do any good.

 I know what you mean about worrying.  Not much you can do about the belly, just keep getting her off the Pred.  But hopefully you can do something about the antibiotic situation.

Glad to hear Tessy is doing well for the most part.

Mike

Hi cerber.  Sorry to hear your dog came down with this horrible disease.  You found a great place to get help.  Calliecritturs has been a godsend and she's extremely knowledgeable....listen to what she says.  Were all here to help you and give advise.

My dog Tessy has been battleing this disease for almost 5 months now.  Trust me when I say it is a roller coaster ride.  The aspirin is a very good idea...especially if her blood is clotting.  Tessy was on this for a couple months in the beginning.  Her HCT (blood %) rose quite quickly at first but then slowed down once she hit the mid to high 20's.  She stayed in this range for well over 2 months until we saw a climb (on her last blood draw actually).

She'll drink lots of water and will want to eat all the time because of the drugs.  Tessy would eat my hand if I smeared food over it! 

Hope she gets better and please keep a good eye on her.  In the beginning I took Tessy for tests on a weekly basis.  Since her HCT dropped just a fraction I'ld set up an earlier appointment to have her PCV checked just in case it is dropping slowly. 

Keep us informed on any news you get.  When you are talking to the doctor it might be a good idea to get copies of all the results you have done.  Most of us do this as it helps for asking/answering questions we/you might have.

I'll keep her in my thoughts and prayers for a speedy recovery.

Johnny & Tessy

We almost had a freaking PARTY when Billy's 'crit went over THIRTY.  Yes, it took forever and a day (especially considering he had SIX TRANSFUSIONS *sigh* over a period of almost six weeks!!! and that was just to keep blood IN him rather than feeling like it was running out thru a hole in the bottom of the bag or something -- like was the tube CONNECTED???.  *sigh*)  Oh it was SO frustrating.

 Thank you both for your replies and support. I do feel somewhat better now. I am still praying that she makes it especially since we unexpectly lost our Great Dane after 11 years to a fast growing throid cancer and our cat to kidney diease complicated by diabetes. We are no stranger to bad things happening with animals. So far we have had: ruputured spinal disc repair, bilateral ACL repair, hip replacement, vaccination related sarcome, kidney failure, kidney stones, diabetes, thyroid cancer....wow that looks really bad in print....LOL. I think St Francis sends us these souls because he knows we will take care of them, but boy I would like a break!

I do have all my lab results except the details of the last draw, I just was afraid of putting down too much information!!!

At least now I feel like there is s glimmer of hope again, even though I have been balling my eyes out reading the other thread and both of your responses :)

 A question about the Milk thistle, I have been reading about it online. Is there a site to find the dosage based on weight or can someone recommend a dose for 35lb dog? Also I thought I read in the other thread that you could not use it in conjunction with cyclosporin? I am guessing that I am wrong since you are recommending it calliecritturs.

I have read a bit more on the other thread and now see that several different people have posted in that thread , so if the MODS want to merge my thread that is fine too

 OMG 6 transfusions!!! Wow I was stressing over just two! I was just so happy that Calypso had a good retic count that made me feel better about her low HCT.

I am so glad I found this forum, my friends and family just do not understand why we would spend so much money on a dog we just got....but we chose her and she is ours now!

Probably all of you can appreciate this picture of Calypso's gums that I took to email my vet after they got a touch of color back into them!

Sheesh, I hope Willow is OK. Is she doing better? Am I missing something?

Happy Late Birthday, Cloppy. Big hugs and smooches from Auntie Megan in FL :)

Johnny/Tessie, Pirate was a FAT LITTLE TICK when he was on pred. Seriously, like 20-21 lbs, and he normally runs 14-16. It took, probably, a full year to get all of the weight off and for his belly to shrink back down.

Re the UTI, could you do a urinalysis a day before or the day of her last abx dose? That way if she's still got the UTI you can reformulate your game plan without interrupting the drugs.

Pirate is being a weenie about eating lately, he wants me to feed him (yes, with a spoon...) I might scoot him in to Dr. B's office for some quick bloodwork if he doesn't come around soon. Most of me thinks it's behavioral, he's being a brat...but I'd hate to be kicking myself in the rear later.

 That sounds like a great plan of action you gave for Tessy.

 It must be the time of year, everyone is having worries about their doggies.  

 I hope Pirate is just being a brat but be sure to let me know and give Pirate a big hug.

Mike

sl2crmeg

Sheesh, I hope Willow is OK. Is she doing better? Am I missing something?

Thanks, Meg.  She's doing fine.  We just caught the platelets dropping on her yearly bloodwork.  She's going back next week for more. 

cerberusdog

A question about the Milk thistle, I have been reading about it online. Is there a site to find the dosage based on weight or can someone recommend a dose for 35lb dog? Also I thought I read in the other thread that you could not use it in conjunction with cyclosporin? I am guessing that I am wrong since you are recommending it calliecritturs.

My answer (as always) is ... GOBS AND GOBS OF IT.  No, there is no "dose".  It's all about protecting the body.  First and foremost milk thistle is about protecting the liver.  In LARGE doses it helps protect the kidneys.  I generally tell people to give like a teaspoon (a heaping teaspoon) of the powdered herb and if they can do some tincture too, great.

It does not inhibit the absorption of cyclosporine -- in fact, it's very important to USE it with cyclosporine.

Billy took the milk thistle tincture (which is sort of high-powered on it's own).  But he took (no joke) FIVE TIMES the normal "adult human" dose TWICE a day.  (and he weighs 30 pounds).  Let's just say Herbal Ed at Herb Pharm probably knows I'm a strong supporter?  *grin*

Even NOW -- and we know his liver is damaged, and there IS *some* kidney damage, he STILL takes milk thistle!!  And he's been off the drugs for (knock wood) nearly 20 months.  (he was on them for over 18 months)

I was serious when I said I buy milk thistle by the pound from Leaves and Roots.  (at this point I have him on a bit of milk thistle tincture and some powdered herb).  But it helps keep the damaged part of the liver functioning -- and ALL the vets (both regular and holistic) are VERY happy to continue this.

The only dog I've ever heard of that didn't tolerate the herb well was Lori's Willow -- and Willow made out better on Marin (and Denosyl).  Marin is a pharmaceutical grade of milk thistle.  (made by the same company that makes Adequan).  Denosyl is essentially a pharmaceutical grade of Sam-e.  (that's more of a detox where milk thistle largely protects).

Agreed....having a good retic count is a very good thing.  The Retic counts will drop as the HCT rises and Calypso starts feeling better.

I know exactly what you mean about family and friends not understanding how you can spend so much money on a pet.  I'ld sell my house if I had to to make Tessy better.  I almost went fists with my neighbor who got really rude with me about all the money I spent.  He said no animal was worth it and said I was dumb for not putting her down.  Let's just say a few chosen words were said and he's avoided me since.  I think that it's great that there's people out there that actually care for their animals the way all of us here do.  You'll realize one thing in particular about the people in this forum...they'll do anything for their furkids. 

We're here to help, advise, and support you in any way we can.  Don't worry about merging the two threads together or waiting for the Mod to do it.  Just jump right into the other thread and tell your story or say hello.  The people are great and WILL NOT MIND ONE BIT.

You got a BEAUTIFUL dog there.  Good to see the color is coming back to her gums.

Take care and keep us updated.

Hugs from Johnny & Tessy

David and I talked about this at length last night at dinner (our very LATE dinner *grin* -- midnight for those of you who know I was up late LOL) -- but we were traipsing down memory lane on this one.

Usually a transfusion will get them above 20 -- sometimes to 24 ... and Billy would hover there for a bit (sometimes a day sometimes several days) and then ZOOM he'd crash.  As I said yeah, SIX transfusions and over SIX weeks with FIVE emergency trips to the University of Florida up in Gainesville (2 1/2 hrs away at all hours of the day or night and on holidays).  But then he simply hovered in the mid-20's for a while.  Now for us, this was a flurry of more tests -- they actually had to do a bone marrow aspirate on Billy (big huge deal -- they have to drill into the hip or shoulder) to get bone *marrow* to see where the reticulocytes - a/k/a "baby red blood cells" -- were disappearing.  and for ages, it seemed, he'd get to the mid 20's and crash.   Then came that one time it went up to 27 and WOW -- then we really WERE on tenterhooks  ... then 27.5 ... and then ... 28 ....

When WE hit thirty I can remember we were SO excited -- and it was WEEKS.  Because whatever part of the blood the IMHA targets (and sometimes it will target ONLY reticulocytes, sometimes ONLY older cells and sometimes ANY part of the blood) the body has to not only make the normal amount of cells, but the body has to replace (and strives to get TO that target that is 'normal' for that body) but you also have the situation that the transfused blood eventually dies and those cells have to be replaced.

Ok -- so right here and now, if you haven't already read enough to know what some of us have done -- if you are treating this JUST via your "regular vet" -- or even a bigger vet practice where you live -- CONSIDER ****PLEASE**** going to either your state's vet teaching college hospital or one near you. 

Honestly?  This is NOT a disease you can just let a local vet treat easily.  There is so much cutting edge stuff happening with this disease that you need the collective wisdom of vets who know not only what's going on today, but ALSO vets who are up on the various side effects of all the different drugs.

Not to be critical of your vet -- but honestly, THREE things contributed to Cerberus getting IMHA and maybe more. 

1.  Vets just do NOT prescribe sulfa drugs any more -- hardly not at all and CERTAINLY not for puppies or young dogs.  Sulfa is one of the many drugs that have been specifically targeted as triggering auto-immune problems/IMHA

2.  Pairing antibiotics can be touchy -- it's something only recently (within the last few years) done -- but in this particular case they set Cerberus up BIG time for IMHA.  Doxycycline is typically the drug of choice where any sort of tick disease is suspected -- but it is also used specifically to BOOST the immune system and make it more sensitive.  So in this case they combined a drug known to trigger an auto-immune response with a drug that makes the immune system go into overdrive anyway.  Wow -- not good.

3.  AND this was a dog that had JUST had vaccines.  Vaccines alone will trigger IMHA -- even **just** bordatella can trigger IMHA in the wrong dog.  And my best bet is that they gave this dog the "combo" shot AND maybe rabies AND maybe bordatella??  THEN  within a short time gave those drugs?  Wow.   To those of us with IMHA dogs we're all cringing just reading this.

 ***critical stuff*** I know you're already questioning stuff like chemicals -- But has anyone plain told you that Cerberus can NOT be vaccinated for ANY reason -- literally NOTHING -- not ever again??

No rabies.

No parvo/distemper/adenovirus

No "combo shot"

No Lyme nor Lepto

No bordatella

NOTHING.  Not ever.  Even tho she is a puppy -- it could kill her.  You can have a dog who survives IMHA and even 2 or more years later the wrong thing happens and it will trigger another auto-immune response.  Literally it may not even be IMHA -- it could be something else. 

Billy can NEVER have another vaccine.  My vet gets a waiver from the state for rabies.  That literally takes vet intervention to do and we get rabies titers done every year from Kansas State (and you have to have a vet's order to even GET a rabies titer == it's nearly never done).

Some states don't accept waivers -- and then you honestly have to make the decision of whether or not you want to stand on your principles enough to be a rogue and not vaccinate anyway?  This is a public message board and I can't tell you to do something illegal -- but it's a no win situation.  (If the dog bites someone, flatly you're screwed -- but if you vaccinate the dog likely will die.)