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- Romeo (Boxer)
Hi all, Romeo was diagnosed with IMHA on Nov 7. I can’t believe it has taken me this long to find this site. Romeo was diagnosed with a PCV of 28 and immediately put on Prednisone. We switched vets and he was put on Mycophenolate along with the Pred on Nov 11. His PCV never went above 20 from then on. On Dec 1 his PCV plummeted to 11 :( The vet we saw that day mentioned “human euthanasia” at least 3 times. In a “last ditch effort” move, we switched Romeo from Myco to Azathioprine on Dec 5 (He was on both Myco and Aza for almost a week and then taken off Myco). After the switch to Aza, his PCV was right around 14 from Dec 5 – 30. Finally, on Dec 30 his PCV registered 20! It was 20 yesterday. His liver values are through the roof and he is not regenerating. Our vet keeps mentioning cancer, but we have no proof of that. I should also mention, he has had diarrhea since Nov 7. It has subsided when we’ve used diarsynal (twice), but other than that the meds have been kicking his butt. We use milk thistle, SAM-e, melatonin and I just started with a small amount of probiotic. I am willing to try anything within reason. Our largest issue (other than the disease itself) is that we have literally tapped out all our funds and don’t have much left to work with :( Thanks in advance for your help and support!!
Hi Colleen
I’m glad you’ve found your way around the site & posted a message – I’ve sent you another private e-mail not realising you’d put this on & I will be in touch again tomorrow. I know everyone on here will give you all the support & help they possibly can – I’m so pleased you’ve joined us, but sorry it’s because Romeo is such a poorly boy.
Sheena, Worzel & Ollie xxxxx
Hi Colleen, I’m so sorry I didn’t mention this site, I try to remember to do so. Everyone here is wonderful and has helped me so much, I’m so happy you’re here. I did mean to say that Romeo’s retics did not look awful from what I saw, Ashki’s are usually in the upper 20s. But some questions I had re Romeo’s disease were with regard to auto-agglutination and spherocytes- doyouknow if the vet or lab has checked for these? If not, maybe next time they can check.
Sending you and Romeo big hugs.
Tamara and Ashki
Tamara, you did mention the site, I just had a hard time finding the actual web address (user error ☺) so thank you for telling me about it!! I do not know about the sperocytes and autoagglutination so I will need to ask!
Hi again Colleen
This is a long message (sorry folks!)
Tamara is absolutely right in mentioning the clotting risks – I can’t see anything in the tests & info you’ve sent us about blood smears – I presume they haven’t done one. Please could you ask them to do a blood smear as soon as possible as sometimes the pathology of the cells they can see is very important & can also help with finding the cause sometimes. If you print this
https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/
and take it to the vet, you can tick them off. Thankfully I saw on your drug sheet that Romeo is already on half a baby aspirin every other day for his suspected cardiomyopathy /enlarged heart – I presume that is equal to 37.5mg? The normal dose is 0.5mg per kilo per day, so you might need to alter how much & how often you give that. What weight is Romeo? Does he have a cardiac arrhythmia (irregular heartbeat)? I know that certain heart problems (plus other things) go with the boxer breed
http://ic.upei.ca/cidd/breed/boxer
& read in your information that Romeo was on enalapril & lasix for a short while- did the vets say anything about a definite diagnosis?
I had a good look through everything again this morning. I saw that the vets said Romeo’s pancreas “had issues”. Azathioprine can aggravate the pancreas, but this normally happens within the first few days of treatment if it’s going to be a problem. It is very important to give azathioprine with food for this reason. Pancreatitis can be very serious & life-threatening but is treatable if caught quickly, so you need to watch out in case he’s in pain. Personally, I think he’s been on it long enough for you to be fairly confident he’s tolerating it OK, but was just a bit concerned because of what your vet said. I was completely paranoid about Worzel – watched him like a hawk!
I note that they also would prefer Romeo to be on cyclosporine, but this is expensive. Dr Dodds also would have preferred Worzel to be on cyclosporine, but we agreed to give the azathioprine a couple of weeks to work & if he had problems we would change straight away. We were very, very lucky that Worzel responded well & became regenerative, so we continued with the azathioprine of course. I hope you get the same result, but we all have to be aware that some dogs can have a problem with it.
I read that you asked about thyroid testing – I would recommend a thyroid function test too – boxers are prone to hypothyroidism. Correct thyroid levels are very important for red blood cell production & if he is low, he will need soloxine (a synthetic thyroid hormone). Hypothyroidism is a cause of anaemia & many of the dogs on here need to take soloxine. Dr Dodds is able to do this test (she is an expert in thyroid function too) & tell you what dose would be necessary.
How is Romeo’s tummy now? I see he had a lot of diarrhea & sickness – poor lad – that’s horrible for them. He had antibiotics on the 9th December – what were they please? They seem to have made him better though – good news. Maybe now he has got over whatever was making him sick his PCV will go up more – 20 is a big improvement from where he was, which is great. There is a chance that a serious infection may be the possible cause/trigger of the IMHA, but we can’t be sure there isn’t something else underlying that still needs addressing. I read a study about mycophenolate for IMHA – many dogs had to be taken off it because it caused severe diarrhea & vomiting at high doses. Some dogs tolerated it & some dogs got over the d & v on a lower dose.
When is the next blood test? If his PCV hasn’t improved greatly, you will need to get a full blood count, including reticulocytes & thyroid function, plus a blood smear pathology report. That would help us to see how Romeo is progressing. I know all this testing costs a lot – I am hoping someone on here can advise you about how to get help with this in the USA.
Sorry about all the questions – we all want to help to get Romeo better as quickly as possible. I am crossing everything for you to see an improvement on the next test. In the meantime, any questions we can help with? He is not in the worryingly low area, so try not to get too stressed out (ha ha, says Mrs Worry Guts here!!!) & get some rest yourself.
Sending big hugs to you & Romeo,
Sheena, Worzel & Ollie xxx
Thanks Colleen – got the further information – that helps us – any information is useful. Send us any old tests that you can get hold of – you paid for them, so they do belong to you.
Sorry to hear he had a little accident – they get very upset about that, don’t they? Worzel hates it if that happens. Has his tummy been OK apart from last night?
Worzel had ehrlichiosis (we are 99% sure even though it didn’t show up in the blood tests as it is very clever at hiding) from a tick bite & he gradually got more & more poorly. He had diarrhea on & off & was sick too. Is there any chance Romeo could have picked up a tick disease at all? Or have any other dogs in the area been sick? We have always used Frontline for our two, but poor Worzel was unlucky & caught this nasty thing. Just an idea to think about.
The metronidazole should have killed off any GI parasites or anaerobic bacteria, but it does have side effects sometimes & wouldn’t normally be used if the patient is anaemic or has other blood disorders. That is on the warning label. It also can have a moderate interaction with mycophenolate – was it given at the same time? I presume it was. Sometimes the benefits do outweigh the risks with these drugs, especially in life saving situations, so your vet may have thought that Romeo really needed it. The diarsynal I had to look up as I have never used it or researched it – it sounds like good stuff actually & I’m glad it worked for Romeo. I can’t find anything untoward about it at all on-line either, which is good. I am hoping others have used it & can give us more information.
I stupidly forgot to mention that high cholesterol is a symptom of hypothyroidism in dogs & in humans. In dogs, it is virtually always due to hypothyroidism, so I would advise getting a thyroid function test done for that reason alone as Romeo has high cholesterol on the test I looked at. Soloxine therapy can make a huge difference to recovery from IMHA.
Someone else may have an idea that I haven’t thought about. Tamara has also had a very puzzling time with her beautiful Ashki – I’m sure the two of you will help support each other. She’s also a very kind, clever lady who has done a lot of research.
Speak soon!
Sheena x
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