AIHA or IMHA

April - Sydney and I are so very sorry for your loss. Just remember that Melvin is somewhere right now where this disease can no longer touch him. He is in no pain, and is playful and full of life. I'm sure he misses you too. Try to concentrate on the good memories, and how sweet your eventual reunion will be. He was a very lucky little man to have such a caring family. Know that what you did in the time since you found he had this disease is so much more than what many pet owners would do. No matter how short his stay, little Mel was one of "ours", and he'll be remembered. Syd and I lit a Candle in his honor. Please know we'll be here for you if you need to talk.

Tara - So happy to hear that Charlie is still looking good. I definitely agree with the more controlled lowering. Everything I've read on the subject here and in other areas state very clearly that a slow controlled wean is very important. It's so strange though - to go from living a life where we follow the advice of our doctors (human and fur ones alike) to second guessing everything. A rude awakening to be sure, but when it comes to the health of our furbabies - an important one too. So keep doing what you gotta do!

Hey Lori! Thanks. Syd just keeps trucking on in the low 20's. I'm really hoping that it's just a matter of time for her before we start seeing a consistent rise, and not a case of "this is as high as she's ever going to get". Right now it's just the worst waiting game ever. I know Sydney would love to be playing with Miss Bella right now instead. Thank you (and everyone) for all the great thoughts and prayers. I tell her all the time about how everyone here is pulling for her.

Biddy

I tell her all the time about how everyone here is pulling for her.

That sounds crazy but it IS important.  When Billy was up in ICU at Univ. FL I used to send him a FAX **every day** (they were 3 hours away).  I would cut out the posts from here (this was before the IMHA thread started) so his students could read to him "Glenda says 'Billy get BETTER' " and "Gina says "Billy 30?? WOW!!"

They LOVE to hear their name -- and because David and I talk about all the dogs on here, they were names that were familiar to im.  David, too, used to send me an email that I printed out to fax up there. Billy's principal student, Eric told me later that at first it was a bit embarassing to "read to a dog" BUT he said Billy LOVED IT -- after he was done he would put the paper in his crate and he'd paw some of them back and forth like he was really reading it! But then other students saw how much fun Billy had and it became quite the cool thing to be the one to read Billy his fax for the day".

 Now -- most of you know my dogs DO read and they DO post (well, Charlie's now learning -- I"m seeing things re-arranged at the computer desk -- as long as he doesn't knock my Kindle off I'm good with it -- but with that he can increase the size of the print!!  Yes, I am NUTS).

++++++++++++++++++++

One ting I want to say in response to the loss of Melvin to Miss April -- IN one of your posts you mentioned in your frustration you didn't WANT to know what caused the IMHA ...

but honeslty, now you *DO*. 

I've said a million times - no one "Knows what IMHA is" until their dog gets sick.  And that's honestly SAD.  Because too often we are simply going along with ANYTHING some vet suggests.  Annual vaccines?  DANGEROUS.  Those of us with IMHA dogs *now* know that.   Systemic chemicals (like spot on fleat/heartworm meds that go thru the skin and STAY in the body -- DANGEROUS).

 If you know what can trigger IMHA you can avoid it better next time.  Not always ... some breeds are super hard-wired for IMHA. 

But often the best ambassador is the person who has lost a dog to IMHA.  We get down right passionate about it.

 

Hi Everyone....So sorry to hear about Melvin.....PRAYERS FOR EVERYONE AND EVERYONES DOGS....

Muffys still doing well.....Eating Great and Everything.....We go back in Wednesday for the next PCV.....I'm back home Monday Afternoon.....

Just stopping by to say HI and Sending Loads of Prayers for Everybody.

Rene & Teri

*waving at Rene* -- missed ya!!  Have a good trip home!

Hello, I hope I'm posting this in the right place. A week ago Sunday evening my daughter's 5 year old Shih Tzu Louie started hacking and couldn't breath very well so Monday morning she took him to the Vet and they kept him there. They called and said he had fluid in his lungs and gave him a diuretic to dry him up. He told us that he thought that Louie had congestive heart failure and we were just devastated. He said that Louie could come home later in the week after he was stabilized. We went to pick him up on Friday and he said that he thought he was mistaken because after he took another x-ray Louie's heart looked fine. That's when he told us that what he though he had was Hemolytic Anemia. We weren't sure if we should be happy it wasn't congestive heart failure or if this disease was worse! He said that Louie's PCV was 25 and that he was putting him on prednisone and low dose aspirin the pharmacy was making up for us. So now he is taking 3 pills of 5 mg prednisone and 2 ml of the liquid aspirin. We don't know of anything that could have triggered this but about 5 days before this happened the Vet put him on prednisone for itching. He was taking 1 pill twice a day of 20 mg prednisone for 5 days and then it was supposed to be reduced to 1 pill every other day for 10 days. I have read about 100 pages of this thread so far and so I seen the importance of him eating so I have been giving him his regular dog food (Blue Buffalo) mixed with lean ground chuck and rice. I have been feeding him about 1/2 cup of this combination about every 3 hours and he has been eating well. His next appointment isn't until Friday and that can't come soon enough! He said that if he needed to Friday he would put him on Azathioprine but after reading all of these posts I'm wondering if he should be weaned off of the prednisone and put on Cyclosporine. I'm so very confused.....I am calling the vet this morning to see about putting him on a stomach protectant as well.

I wanted to add that he is taking the prednisone and aspirin just once a day. He takes the 3 pills in the morning and the aspirin in the evening. I'm also wondering if his prednisone dosage is too low.

I'm glad you posted.  Did you get my email to you?

 DO NOT wait for four days for an appointment.  You may not know if he's crashing soon enough. 

My suggestion to you in my email was to go to a vet school.  Honestly, most regular vets are *not* prepared to deal with IMHA.  And it is more difficult in a small dog (simply because they have less blood!)

Often a vet school is much cheaper than a specialst vet (and often much better).  Don't wait until Friday.  Call the vet school today and see if you can self-refer.

I'm honestly not pushing panic buttons here -- he was mis-diagnosed at first, and they "reduced" the pred thinking they were weaning off something else -- that can rebound.  NO he is *not* taking enough pred to keep IMHA undercontrol.

Whether they can add cyclosporine is another thing that a vet needs to determine.  They don't just take them "off" pred and add cyclo.  All these drugs are extremely habit-forming.  And typically they are on more than one drug at first.  Pred is typically the very first, but when they add cyclo, they don't wean them off the pred until they are a couple of weeks beyond "stable" usually.

If you go to a vet school, they will then give your vet instructions on how to proceed - you don't have to go there over and over.  But with the types of testing they do, you will find the vet school FAR more able to deal with this and less expensive.  But please, please -- don't leave this the way it is -- the lower the packed cell volume (PCV) goes the more difficult and expensive this is to treat.

No I didn't get your email. I talked to my vet this morning and he is going to give us a stomach protectant. We are about 2 hours from Purdue in Lafayette, Indiana. I asked my vet if he thought Louie would be fine until Friday morning and he said he should be fine. We are watching him like a hawk the only time he was left alone was when we went to church yesterday morning. His gums look fine, his urine is clear and his poop is normal as well. We have been feeding him about a half cup of food every 2-3 hours and he is eating fine as well. He just eats goes to the bathroom and sleeps. My gosh I am alarmed now, I think I will call Purdue and see what I can do.

The email would have gone to whatever email you have linked to this messageboard.  OR email me (my address is in my signature picture w/the dogs) and I'll send you my phone number.

 Typically you have their PCV checked MORE than once a week at first until you *Know* it's going up. 

The reason I'm kinda pushing you is because your vet mis-diagnosed this at first.  IMHA is tricky to treat -- and often a vet will kind of back-burner it - and it can either morph into a completely different auto-immune disease (like it can start attacking the platelets) or get worse and you can't see it in the gums.

You want to catch it falling BEFORE it plummets.  You want to have them do a FULL blood panel (I mean a honking HUGE one with **all** the liver and kidney values in it) now so you have a basis of comparison later.  You want to know if kidney values change at all or if liver values rise.  Most regular vets just don't have the "turn on a dime" experience this requires.

 Your vet may be trying to save you a bit of money by testing less --

It also ramps up the whole thing because he's so little -- it can be a huge challenge in a small dog

When my Billy was being treated -- we had him on pred alone at first, then they thot maybe he had tick disease.  His PCV had gone from 20 all the way up to 29, and then the vet added the antibiotic for the tick disease and within 36 hours his PCV plummeted to TEN from 29 (and then his body spent the next 4 weeks not wanting to regenerate).

You can always tell your vet "I understand this disease can change awfully fast and I'm not sure *I* will catch it soon enough to tell you.  So having Purdue in on it helps me feel more confident in what I'm doing for him."

In short, I'm not telling you to dis your own vet -- and pride can sometimes be an issue.  But it sets you up better.

Do email me tho -- I can help you.

Louie has an appointment at Purdue small animal hospital at 11:30 on Wed. I'm hoping all goes well until then. They told me to to have him fast after 10:00 tomorrow night and bring his meds with him. I think I'm also going to take some food with me because he will be starving after all that. My Vet is doing the referral and said if things didn't look better for Louie by Friday he was going to send me there anyway. So he's good with it. Purdue also said that if he starts going downhill before then then to bring him in as an emergency. Is there anything specific I need to watch for to know it's an emergency situation?

If he gets ANY more lethargic or weaker, if he wobbles when he walks, if he acts 'slower' or becomes reluctant to eat.  You mentioned his tail was wagging "slowly" I think you said -- NOT good.  A lot of dogs, their "heart" is in their tail and you can often tell better by their tail than anything else.  The slower it wags the worse they feel --

Don't *only* go by how pink the gums are - that can be misleading.

Also -- watch his eyes either for a yellow color or any blood, and watch his belly for any red splotches (or bruising). 

 Now I'm going to tell you the IMPOSSIBLE. 

 Don't act worried. 

Seriously -- it can scare them if they think YOU are overly concerned.  So keep it light and happy with him.

 Purdue is a really good vet school -- Jessies_Mom takes Jessie there (Jessie has chronic pancreatitis). 

Hello, welcome, and so sorry that you have to deal with this issue.  Purdue Univ also guides my dog's care (Blue has immune-mediated thrombocytopenia, similar family but different than IMHA).  He stayed there for three days in early February while Purdue figured out the diagnosis and treatment plan.  First steps for Blue included:

1. Blood test ("CBC" or complete blood count and "SP2" or serum chemistry -- it wasn't the biggest panel but had 20+ items)
2. Tick disease blood test ("Snap" test with results in 1-2 days)
3. Tick disease culture (results in 5, 7 and/or 14 days later to see if any bacteria grows in the culture)
4. Urinalysis (sounds like you aleady did this one)
5. Urine culture (results in 5, 7 and/or 14 days later to see if any bacteria grow in the culture)
6. Abdominal ultrasound

We first saw Dr. Rebecca Lee (as a rotating med student) and now Dr. Laura Tonkin (a more "permanent" resident).  They all talk to each other and work together, and I have found Purdue to be pretty open to my questions and my own research from this board. They were also very clear with me on cost of the initial work-up -- unforuntately that is a serious component in this evil mess. 

As a side note on the meds, I think most of our dogs here pair the immune-supressing drugs (prednisone, etc.) with either famotidine (generic Pepcid) or omeprazole (generic Prilosec) as a stomach or gastro-protectant.  Blue was also on doxycycline 'just in case' the tick disease or urinalysis tests came back positive (they did not).

Best of luck and healing thoughts to you and your pup.  ~Keka

 P.S. I found this website very helpful as an overview on this disease, and many other related issues (prednisone, skin issues, etc.)  http://www.marvistavet.com/html/body_imha.html

I took Louie to the Vet today to see what his HCT was and last Friday it was 25.6 and today it was 25.7 so they think that Louie will be okay to wait til Wed. to go to Purdue. They called me today and told me what the office visit and what the cost could be for the 2-3 day stay and the tests. It sounds like it's going to be around 1800.00 but it's worth it. I feel so bad for our little Louie bug, he is such a sweet boy. This disease is horrible....

Louie's grandma-  why did the vet put him on asprin?  I also live in Indiana, and I know Purdue is a great school.  Its only 2 hours from my house.  If Bella ever needs to be treated again, I am taking her there and not the ER here.  I  hope Louie gets feeling better, and if you need anything just ask and we are all here for you !!!  Take care.

Lori