AIHA or IMHA

    • Puppy
    Newby here - this is my first post, so I guess I'll start by answering the questions:


             a.  How old is your dog  - Daisy is a foundling, but we think about 11 or 12 years old (we've had her for 10 years)
             b.  How long has it been since since IMHA was diagnosed?  - July 6, 2009
             c.  What meds are you on:
                   
                       1.  Prednisone
                       2.  Azathioprine. 
                       4.  Aspirin
                     
              d.  Any major complications? Diarrhea as of yesterday, panting, more lethargy than usual and her tongue appears very slightly less pink than when she came home from intensive care. Last blood check a week ago, her PCV was 25, when she was first diagnosed it was 15 and went down to 12, three transfusions later she was released -- she goes back today for a blood test, but I am concerned.

    Is diarrhea to be expected? Will they consider the drug therapy a failure if her PCV count is back down in the low 20s (or worse)?

    Thanks in advance for any replies. This is such a nerve racking disease.

    • Gold Top Dog

    Hi Maiz, sorry to hear that Daisy has this disease.  Diarrhea is very common with this disease.  My Tessy had it really bad in the beginning.  You can help this by giving her a teaspoon of 100% pure pumpkin.  See how her next stoll looks and if it's better you can give it to her a couple times a day if you like.  Like Daisy, Tessy also started out on Pred and Azath.  We started aspirin approx. a month in as well as a stomach protecter.  If you haven't added a stomach protecter as of yet you should contact her doctor and ask them about this.  I don't think I know of a dog with this disease that doesn't take a stomach protectant.  The drugs are very hard on their guts.

    They SHOULDN'T consider the drug therapy a failure just because her HCT drops some.  It may be that the drugs haven't kicked in yet, but considering she's been on them since July 6th then it is possible.  I added Atopica Cyclosporine to Tessy's regiment and have had great success with this drug.  Be sure to ask them about this drug if her HCT continues to drop. 

    You are in a great place for help and others on here are far more educated with this disease than I am.  The important thing for now is to get her stabilized and her HCT climbing.  You can start feeding her a proper diet consisting of more foods that are high in B vitamins, folic acid, and iron (blood builders).  Foods like haddock, spinach, lettuce, sweet potatoes, brocolli, yams, zuccini, italian parsley, etc.  You might also want to look at adding supplements to the diet.  I know some people use pet tinic.  It's not available here in Canada so I can't add much advise on this.

    Others will chime in when they read this so hang in there and stay strong.  You are right about this disease being a nerve wracker but you came to the right place for help.

    You shuold start getting copies of all the results and you can post them here if you wish.  Do you know if Daisy is regenerative or nonregenerative?  This will help.  Also if you can find out her reticulocyte numbers these are also good numbers to know.

    Good luck and keep us posted.

    Johnny & Tessy

     

    • Bronze

     Yeah what Johnny said.  Get some Pepcid AC OTC if you are already not on some sort of stomach medicine.  My vet recommended the normal strength 10mg pills of Pepcid AC.  If your dog is over 75 pounds you might want to get the Extra Strength, which is 20mg.  You can get the generic at Walgreens or Walmart, Walgreens often has 30 pills on sale for 4 dollars.  The name you want to see on the box is "famotidine".

      The Pred + Aspirin are both hard on the Stomach and may be giving her an upset.

    Right now you have to watch her PCV maybe even closer than your vet recommends.  If your gut tells you something isn't right go in and get a blood draw. 

    I also agree with what Johnny said about checking into the Cyclosporine if you get another crash.  Some dogs seem to recover on Prednisone alone with no problem, so you may want to see how the numbers go before adding Cyclosporine.  Azathioprine takes 14 days to have any effect so it should be kicking in just about now. 

    Sounds like you and your vet are doing the right things.  If she loses her appetite, something is drastically wrong.  How do you tell?  For me it was when I offered Cyclops a McDonalds Cheeseburger and Fries and she didn't even bother to sniff at it.  That was when her PCV was 9%.  So keep an eye on that appetite and just her general mood.

    Glad you found us, read the whole thread from the start and you can kinda get an idea of all the things I went through with Cyclops.  Thats what I wanted this thread here for is so people can get an idea of what this thing is like.

    Glad to meet you.

    • Gold Top Dog

    GratefulDawg

     I love the name Frisby, my other Border Collie, Domingo LOVES to play frisbee.


    The shelter where I "found" her had a policy of naming all dogs before they were put up for adoption, so they named her Frisby. I love the name, but it's quite funny, because she does not have an ounce of retriever in her. After 10 years, she now "gets" that after someone throws a ball or stick, you run to it. We're still working on picking it up and bringing it back. I figure in 10 years, we'll have that mastered, too :-)  She does LOVE her squeaky toys and I can't wait until she feels like playing with them again.
    • Gold Top Dog

    Tessy LOVES any toys that squeak.  She's got all kinds of squeky toys but her vaforite is the squeaky balls!  Don't worry...it's only a matter of time till Frisby goes for the ball and drops it at your feet someday.  Tessy lost interest for maybe the first week of her sickness but then realized she still had squeaky toys! 

    Hugs to Frisby from Tessy & Johnny.

    • Gold Top Dog

    GratefulDawg
    Right now you have to watch her PCV maybe even closer than your vet recommends.  If your gut tells you something isn't right go in and get a blood draw. 

    *Waving and jumping up and down* YES, WHAT HE SAID!!!!!

    Hi -- I'm Billy's mom -- he had IMHA 3 years ago (was on the big drugs for 18 months).

     If she's acting even **A LITTLE** lethargic, a **little** less pink -- VET ... A.S.A.P.

    It can be a good long while before the body is fully responsive -- and if the drugs don't kick in right away (and azathiaprene takes a while to kick in) they sometimes need to do a transfusion.

    I have TONS of cell minutes -- I've been there done that with this disease and I can help you on the phone if you'd like.  It can be easier than trying to pick thru posts.  My husband and I relied heavily on the support of others when Billy was sick -- and this disease is SUCH a kicker. 

    I've emailed you my phone -- I'm not a serial killer, I promise (many others in this thread will testify that I'm passionate, but harmless LOL), but I'm glad to call you if that would be helpful.  I've just discovered, by experience, sometimes phone is much easier.

    Don't try to wait for the weekend, or a paycheck or anything else -- if she's lethargic GO and go now.  Minutes count in this disease. 

    Diarreha, and shoot, every other symptom on the planet -- but the azathiaprene is hard on the digestion too.  A stomach protectant is a MUST -- even Tagament or Zantac -- but you gotta use something and don't wait until the dog shows signs OF stomach distress.  By then you can have damage and you don't need that.

    .The other thing, particularly since you are on azathiaprene is milk thistle -- it protects the liver and that's always the big danger with azathiaprene - it's hardest on the liver.  The past 2-3 pages say a lot about milk thistle.

    • Gold Top Dog

    cerberusdog
    . For those that have had a dog with IMHA:
             a.  How long has it been since your dog was diagnosed with IMHA
             b.  Are you still on any meds (only meaning cyclosporin, not herbs and such)
             c.  How long did your treatment course take til you were off meds?
             d.  Have you experienced any long term side from IMHA or the meds used to treat it?

     

    sorry - - I didn't even see this part.

    a.  Billy was diagnosed in May/June of 2006 (he was about 6 or so then) - we initially caught it the very end of May thinking it was tick disease and he started on Pred, and in a week went from a 20 to 29 PCV.  But just about the first of June we got a faint 'positive' on a tick test and added doxycycline.  In reality his body was reacting to the antibodies formed as a result of the "sick tick" (I knew he'd been bitten in April) and it was literally 36 hours after adding the doxycycline (the day we had the 29 PCV reading) and 36 hours later his PCV was TEN.  He was transfused that Friday night and by Monday morning (still on pred and doxy) his PCV was EIGHT.  That morning I raced him to Gainesville to their ICU (and I honestly never dared ask what his 'crit was that morning but I suspect it was six or less) and they transfused a second time.  He had ** 6 ** transfusions between then and July 5, 2006.

    b.  He's not on any pharmaceuticals now -- it took us 18 months to wean off (the middle of December 2007) and because we knew the trigger (he got bitten by a tick that caused the body to build "antibodies" which then triggered the body to over-react to those and then all red blood cells -- and buffy cockers are somewhat hardwired for allergies and other immune-stuff like IMHA anyway)

     He is still being treated homeopathically essentially to help the body "balance" so he doesn't come up with another auto-immune disease.

    ***DON'T EVER EVER FOOL YOURSELF*** THEY NEVER GET OVER IMHA!!!!!

    YOu are never "safe" - because it can recur or morph into another immune-mediated problem ANY time.

    c.  I think I answered that -- it took 18 months to completely wean off the pharmaceutical steroids and steroid-like drugs.  That was *with* a whole lot of help from acupuncture and Chinese herbals (which helped build/move the blood).

    Had we not had integrated therapies (holistic and regular vet medicine) 1 - Billy wouldn't be alive today and 2 - had I not been so aggressive with the milk thistle and other things his kidneys and liver wouldn't have survived (cos he was on HIGH doses for a long long time)

    d.  Yes -- there is likely both liver and kidney damage.  The liver does regenerate in large part, but we have a tough time keeping the liver values level (I'm one to sporadically do bloodwork and this was NOT the case pre-IMHA). 

    We knew all along the big huge mega battle was for the kidneys.  Because he had such a HUGE problem with urinary tract infections we did a urinalysis pretty much every month -- not *just* a dip test, but a urinalysis simply because there was such enormous inflammation, bloody urine and massive infections (not just staff and protozoan -- but even "unknown bacteria" and things like pseudomonas ... which is virtually unheard of in urine).  Now in an Antech urinalysis you get a reading for microalbuminaria -- and those crept higher and higher and higher all along -- sure sign of DAMAGE in the kidneys (coupled with other blood urine readings).  Now his basic kidney readings are ok -- and for those who know kidney problems by the time you SEE damage in the blood it's pretty well on it's way to fatal.

    So, in all the ensuing months he's been under vet care with the TCVM (traditional Chinese veterinary medicine) vet -- and he gets acupuncture and Chinese herbs that specifically target keeping the kidneys as "happy" and balanced as possible, and he also gets a treatment called "auto-sanguis" which is developed from Billy's own blood into a serum that targets various areas of the body and the kidneys are an area of primary concern.

    So yeah, we have kidney 'damage' -- but it's in what they'd call "early renal failure" and it's holding -- the microalbuminaria are not rising any more.  we do quarterly bloodwork (or more often if the situation warrants) to check thyroid and bloodwork and urine.  Billy had thyroid problems before all of this (which was likely one of those things that put him in a high-risk category for this).

    His last transfusion was July 5, 2006.  The first thing they weaned him off of was the prednisone because the kidneys were such a problem.  But he bobbled a few times on cyclosporine even. 

    • Puppy
    Thank you so much, everybody. I will come back and read these replies more closely (and probably over and over again) this evening, when I have a bit more time. I just got back from the vet and though Daisy's PCV is down 4 points (to 20) her vet wants her to stay the course of the meds he started her on last week. He also put her on a bland diet and wants her to come back in a week for another blood test, unless she appears to worsen in the meantime. He does not want to put her on cyclosporin because of side effects and, apparently, his experience with the drug has not been entirely positive. I did ask, though. Please understand that although I adore this dog and would love to see her live for much, much longer, I have sadly come to terms with the possibility (and probability) that this disease will be her last battle. She is, after all, twelve years old. I appreciate your concern, advice and experience with this awful illness. I wish none of you had to become the experts you so obviously are. Thanks again from Daisy and me, Maiz
    • Gold Top Dog

    Gosh, I'm editing this again to say I **JUST** saw your post.  I was working backwards, not realizing I'd missed so much in a few hours so please don't think the fact that this follows the other two means I didn't care.  I literally was just responding to the posts as I saw them.

    NOW to address this -- which was the most important and I inadvertently left it for last!!  Again, I am SO sorry. 

    cerberusdog
     All I can say is wow Callie. You do not know me or my vet. My personal vet saved my rottie mix from parvo using a homeopathic treatment, so maybe you need to find a better vet if you do not trust yours. Believe it or not I emailed the internal specialist this morning at 11am and by 2pm had a return email stating that they both approved of use of multiple liver protectant and even gave me the name of a store about 30 minutes from my house that they would recommend using if we decided to go with natural herbs vs what they sell at the office.

    No way did I mean to be cutting in any way at all -- most vets are *not* that open-minded and you didn't mention to me that you were at all familiar with homeopathy when we spoke. 

    Please understand -- it is heart-breaking in the extreme because I get to talk to a ton of people and so often I've seen vets belittle people for wanting to do something 'extra' or herbal.  One person (who will pipe up if they want to) was flatly bullied by an emergency room vet because he pushed for a transfusion and the emergency vet told him it was 'cruel" to even try. 

    I've seen vets turn a blind eye because it was "a holiday weekend" and tell people to "bring the dog in Monday and we'll take a look" because they didn't want to see a dog with a packed cell volume of 12 on a Friday or the dog who has been vomiting all week and the vet doesn't even suggest a bloodtest or tell someone it can be done.

    So honestly, sometimes I'm standing out here on my soapbox trying to make sure that someone doesn't read what someone *else* posted and draw the wrong conclusions from it.  It is abundantly clear to me that you go way above and beyond for your animals, and igven your own medical background that is an *awesome* thing.  I wasn't trying to say you weren't taking care of yours, but mostly I was trying to let lurkers know that there is a real sense of urgency about some of this stuff.

    Just as a case in point **sigh** I spent a couple more hours on the phone Saturday nite with a lady who's on dial-up and she hasn't been able to stay online long enough to read the whole thread (and she has no cell access out where she lives).  And one of her queries was that since others were waiting to see what the vet says was there any real reason to do milk thistle now or just wait until she saw a problem. 

    It was a classic case of the thing that can be my waking nightmare -- someone reading a post really quick, and walking away with a conclusion that's not quite accurate.

    It isn't because anyone has said anything 'bad' or negative -- it's just a fact of human nature ... sometimes we have to read things quick and decide.  So mostly I'm just trying to make sure that people don't get the wrong impression and sometimes I screw up and gie *others* the wrong impression. 

    I apologize profusely -- I did NOT in any way mean to make you feel bad or give *you* a hard time.  I am SORRY, and I truly hope you accept my apology in the true spirit I mean it

    I'm not one to just say "sorry" -- an apology doesn't just need to be blindly offered -- when you've truly wounded someone you need to wait for acceptance and make sure you repaired it as much as possible..

    cerberusdog
    Just like you mentioned giving Calypso's pills with liverwurst.....why would I chose to give a high fat and salt product to a dog that has the potential for kidney problems...salt intake needs to be monitored very closely. But do I bash you, no I respect your opinion and then form my own.

    You're absolutely right -- and the simple reason for it was the fact that at the time I was absolutely **desperate** to keep him happy about food, happy about taking this enormous wad of medicine/herbs and STUFF and suddenly I couldn't use dairy any more to do it.  Part of the concern was that cyclosporine so easily causes a stricture and I was cautioned beyond belief to make SURE the pill slid down the throat so I was looking for slippery -- those big 100 mg pils were difficult for Billy to swallow so "slippery" was huge.

    At the same time -- I had an elderly sheltie-corgi mix go thru a huge liver infection and between the meds both dogs took it was taking me about 2 hours a week just to divide them up into daily batches sorted out but because they were mostly meds that dissolved too quickly I had to give them their meds after their meal not IN their meal.  I had to keep it do-able for all 4 dogs and make sure that the meds went down the hatch and were completely swallowed and digested.  I could *cut* the liverwurst up, push the pills in and not have to touch it (I have severe psoriasis and gloves are awkward with sticky stuff when you're dealing with 50 or more pills at a time -- and with all the tea pills that was the quantity -- danged rolly little things -- that's just by way of explanation -- the skin thing is a *me* thing that I have to cope with).

    I absolutely agree with you that liverwurst does have added salt (WAY too mcuh salt and it's a human deli meat -- it has more preservatives and yuck in it than is my preference too) BUT it worked.  The amount given was pretty minmal overall -- and best of all -- he was excited to take it and so were the others.  No hesitance, no reluctance to take it.  It could also be cut up ahead of time so it wasn't a huge mess to deal with a meal times.

    As soon as practical I moved to using baby food meat and veggie -- but that has to be done with a spoon.  That wasn't workable while Foxy was around, but it is probably my favorite now.  Far better quality for them - not as "slippery" but it works for most things.

     Liverwurst is simply attractive enough and slippery enough that it *works*.  In the early days of this disease it is so unbelievably critical to keep them eating and keep them *excited* about food and happy about all the extra attention that the benefits outweighed the difficulties.  I know many folks battle that same thing which is why I offer it as a suggestion -- it's less dangerous than pilling them (as cautioned by a vet).

    But by all means -- when you disagree or see a glitch with something don't hesitate to mention it.  That's part of what the discussion i for.    That's where good learning takes place for all involved here -- we try hard not to bash here -- I can't emphasize that strongly enough.  And if you felt I was heavy handed above I TRULY am sorry, for it was not in any way my intention. 

    But mentioning stuff  like this -- that's GOOD input.  But a lot of times people just think they can't do anything other than what they've always done.  They've always put pills in cheese or cream cheese, or they've always "hiddne" them in hot dogs (eww, nitrite city *sigh*) -- but simply to try to give folks more options and techniques.

    cerberusdog

    I have dealt with more diseases and injuries that any one pet owner should ever have to in their life time, but I know St Francis does not give me any more than I can handle so we just keep doing what we can for them.

     

    No you are absolutely right -- He *doesn't* give us more than we can handle -- but I do think (seriously) that sometimes St. Francis has a short list of those of us -- like you and I -- to send these animals to because there is a purpose in all of this.  Sometimes for the animals.  Sometimes for the people.  I don't mean "short list" to say over-burdened (because I tend to find that when I'm called on to go the extra mile for an animal that's been 'sent' to me that the money will be there to do the right thing for them, and the energy and time will be there for me as well -- thankfully!)

    those folks like you and I who have experienced a lot of severe illnesses and injuries -- sometimes we 'get' those simply because WE respond where other folks dont.  Because we're not afraid of them.  That's one VERY GOOD thing. 

    **IT IS BECAUSE** you are so experienced that you are valuable. Because Heaven knows there are a ton of problems out there and sometimes people are very short on wisdom of how to deal with this stuff. 

    I've seen folks battle IMHA who have never had to take a pill in their own lives, much less give one to a dog.  The very idea for some folks is terrifying -- but knowing that folks exist like we see on this thread, and elsewhere in this forum who simply roll over and do what needs to be done -- that's encouraging in a big way for folks.

    and boy, you said a mouthful in that last line I couldn't agree more!!! -- "so we just keep doing what we can for them".  And sometimes, even if that isn't perfect the *best* we can do is fine .. until we can do better, or until we know better or until we have another hand or a little more money.

    cerberusdog
    I have written this response 4 different times today as I have calmed down. Maybe this is not the best place for me to find support. 

    I appreciate your efforts more than you can know.  I've done that a million different times in other situations.  I truly hope you can accept my apologies and find support here. 

     

    • Bronze

    calliecritturs

    One person (who will pipe up if they want to) was flatly bullied by an emergency room vet because he pushed for a transfusion and the emergency vet told him it was 'cruel" to even try. 

     

    Funny you would mention this about the blood transfusions....it was the Specialist that was encouraging the 3rd blood transfusion and it was ME refusingSmile At that point she was "acting better" and had a high retic count so I saw no purpose in giving her a transfusion that she was just going to lysis and do her no good. And thankfully she blood level came up without the need of a 3rd transfusion.

    • Gold Top Dog

    GratefulDawg

    cerberusdog
    I am using Atopica Cyclosporin. Calypso takes 75 mg twice a day which costs $200 for a 30 day supply. So I think that is the correct form from what I read and is it a good price Mike?

     

    Cyclops is also at 75mg 2x/day.  We are paying 150.00 for a 30 day supply.  But we're using a generic.  I think that 200 is a GREAT price for Atopica.  If you feel like switching I can give you the info.  Some dogs do not tolerate the human generic, my vet at OSU said 90% of her cases do just fine on it.  Cyclops and Val's Cooper are on it with no problems.  But I think you're getting a great deal on Atopica.  When I first started out at 150mg 2x/day the best price I could get was 800.00 a month for Atopica.

    Mike's right - if you are getting Atopica for THAT price holey smokes!!  It was $850 a month for the 150 mg a day Billy was on 3 years ago. And even as we began to go down in amounts, the fact that I had to get several pills to make up the graduated amounts (like a 100, a 25 and a 10 to make 135g rather than 150 when we first started to wean off) was no cheaper because it was more pills.

    So WOW -- if you are getting Atopica at that price that's awesome.

    • Gold Top Dog

    sheesh -- please make sure you re-read that darned epistle I wrote up there -- you're replying to part of it and I'm still editing it to make sure I said what I was trying to say.  (is there an emoticon for tearing my hair out??)

    • Bronze

    calliecritturs

    GratefulDawg

    cerberusdog
    I am using Atopica Cyclosporin. Calypso takes 75 mg twice a day which costs $200 for a 30 day supply. So I think that is the correct form from what I read and is it a good price Mike?

     

    Cyclops is also at 75mg 2x/day.  We are paying 150.00 for a 30 day supply.  But we're using a generic.  I think that 200 is a GREAT price for Atopica.  If you feel like switching I can give you the info.  Some dogs do not tolerate the human generic, my vet at OSU said 90% of her cases do just fine on it.  Cyclops and Val's Cooper are on it with no problems.  But I think you're getting a great deal on Atopica.  When I first started out at 150mg 2x/day the best price I could get was 800.00 a month for Atopica.

    Mike's right - if you are getting Atopica for THAT price holey smokes!!  It was $850 a month for the 150 mg a day Billy was on 3 years ago. And even as we began to go down in amounts, the fact that I had to get several pills to make up the graduated amounts (like a 100, a 25 and a 10 to make 135g rather than 150 when we first started to wean off) was no cheaper because it was more pills.

    So WOW -- if you are getting Atopica at that price that's awesome.

     

    I just checked my bill to make sure and I get 25mg x60 capsules and 50mg x60 capsules for $200, I purchase right at the specialist. I called around to local pharmacies and the cost was $280 for the same amounts. I am in a co-op with some other animal rescues and even our discounted price was $20 more than what MedVet sells it for. Maybe prices have decreased for it....

    • Gold Top Dog
    calliecritturs

    cerberusdog
    Just like you mentioned giving Calypso's pills with liverwurst.....why would I chose to give a high fat and salt product to a dog that has the potential for kidney problems...salt intake needs to be monitored very closely. But do I bash you, no I respect your opinion and then form my own.

    You're absolutely right -- and the simple reason for it was the fact that at the time I was absolutely **desperate** to keep him happy about food, happy about taking this enormous wad of medicine

    Remember, Callie, when I first brought Pi home from the ICU -- he wouldn't eat ANYTHING. I made chicken and rice. Beef and rice. Added broth. Tried to feed him. Tried stinky canned food. Turkey slices. Cheapo ''Beneful'' wet food. Baby food. Puperoni. And then, OOOOOOOOH, and then, came the pills. I fought this poor dog for an HOUR to try and get him to take medicine. How he had the strength to fight me for a full hour, I have no idea. I caved and went for liverwurst. I put pills in it, mashed it into his food, mixed it with water and syrniged it into him, you name it, LOL. It was the only thing he'd eat!!! Sometimes, with these stupid immune diseases, a girl's gotta fight DIRTY :)

    Cerberusdog, Callie can just be a little...well...bossy sometimes *grin*. I can say that I'm sure she meant no offense by ''esplaining'' really well, LOL.

    • Bronze

    Maiz
    I have sadly come to terms with the possibility (and probability) that this disease will be her last battle. She is, after all, twelve years old.

     

    Maiz,

    Age is something I took into account also.  Cyclops was 10 1/2 when it hit.  I'm not sure what your money situation is and how much that is playing a part in your decision making.  The drugs you are using are definitely less expensive.  Your Vet has a point.  A lot of dogs are treated with Cyclosporine and die anyway.  My internet searches have found that no drug has a better outcome than any other.  Dr Dodds, although we are following what she taught my vet at OSU and we are using Cyclosporine ALONE with no other drug, has a study saying that the rates of death are pretty much the same for all 3 of these drugs (or combinations of the 3). 

    Cyclops did not respond to Prednisone and her PCV came up immediately after taking Cyclosporine.  So I have a feeling that every dog is different.  What works for one dog might not work for another.  All I can do is just hope for the best for you and Daisy.  12 years is a pretty decent age for a dog, and lets be honest even if she lived to be 20 it would still be too soon, right?  

    Please come back and keep us updated.

    All my best

    Mike