Recovery with steroids alone?

Keymaster

Hi Janie,
I am sorry to read this. The details are sketchy so it’s hard to say what exactly is going on. It would be helpful to see the blood work the vet did to determine this diagnosis. You can upload these on our Urgent Advice page.

AIHA and IMHA are relatively complex conditions that result from a series of triggers that “influence” the immune system to “fail to tolerate self.” This simply means that the immune system attacks the red blood cells as though they were invaders. But these triggers can be different from dog to dog and there can be multiple triggers! Some breeds are genetically susceptible and experience it more than other breeds. Common general triggers are stress, hormones, viruses, vaccine reactions, environmental influences. Under those categories you would find things like tick disease, tumors, infections, over vaccination, chemical and pesticide exposure, snake or spider bites, the list is extensive. The more triggers together, the more influential they are in leading to IMHA AIHA.

Sometimes there is an outside influence or a group of influences that can be identified as directly related to leading the autoimmune attack on the red blood cells. For instance if a dog is bitten by a tick and gets a certain tick disease that hides inside the red blood cells, the immune system will begin attacking the RBC to get at the tick disease. In a case like this treating the dog with a certain antibiotic will eliminate the tick disease from the body and eventually the dog will get well again. So treatable triggers are important to identify.

You clearly are aware of tick diseases, you gave her the Lyme vaccination. I am somewhat unsure about this vaccine, there can be some problems with it. Look on this page.
https://www.secondchanceaihadogs.com/vaccine-resources/
for this article and click on it:
Dr. Dodds Canine Non-Core Vaccines
She discusses the Lyme vaccine in this article.

Lyme vaccine is not usually directly related to triggering AIHA IMHA, but rather some dogs can express symptoms of Lyme as though they actually have it. Those early symptoms in dogs usually begin with some kind of shifting lameness, an overall malaise, neurological symptoms like facial nerve paralysis or changes in the iris of the eye, extreme kidney failure can happen quickly if the Lyme spirochete invades the kidneys. So Lyme is a nasty disease but doesn’t usually influence blood integrity.

Back to what you asked. Prednisone and its much more powerful kin dexamethasone can completely suppress the immune system quickly if given in high doses. That is why all of us moderators know that prednisone is a life saving drug, it works quickly to stop the destruction of red blood cells. But how about 5 days out, 10 days out, one month out? There are extreme side effects of high dose prednisone over time, that can make a dog feel very sick.

So it would be preferable to actually figure out why she is destroying red blood cells and treat that if possible. A CBC is a great tool to examine some important details. An oral history is incredibly important. A lot of owners skip over the details and if I coax them to tell me more then suddenly we find out some amazing tidbit that is treatable.

When I read your description of her the next morning I thought how this seemed similar to a condition called Addison’s Disease, often called the “great pretender.” Hard to diagnose but a key element is that it always improves with dosing with prednisone (though there are far more appropriate drugs that are used to treat it long term.)

If you are unable or unwilling to look into this further with your vet, you could continue to treat with prednisone but eventually those side effects are going to impact her quality of life. I would not quickly reduce this high dose, it isn’t good to do that in any circumstance, human or dog, and can actually lead to a drug induced Addison’s Disease. Vets use prednisone all the time and they have certain protocols for how to safely reduce the dosage. You can read what I have recommended about reducing prednisone, based on our experience with dogs that have been under treatment for AIHA IMHA.
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

Dogs certainly don’t know why they are sick, but they are aware when they don’t feel good. They count on their humans to care for them for everything from shelter to food to vet care. Your vet can help you make these important decisions about how to care for her going forward.

I can answer any questions you have for me,
my best
patrice

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Patrice

Keymaster

Janiesmom,
I am sorry for the delay in writing.

As I mentioned, it is often after coaxing and owner for more detailed history that an important nugget of information is discovered. You mention that before you adopted her she was diagnosed with Ehrlichiosis. This is critical information and may be the reason for her illness now.

This tick disease is extremely complex and invasive. A friend has built an extensive website with tick information. On her page for Ehrlichiosis she describes the initial symptoms:
“The acute stage is brief and the symptoms are easily missed; it may appear as if the dog has a mild and passing viral infection: snotty nose, diarrhea, fever, a general lack of his usual oomph. In a stoic dog especially, a change in behavior may be the only alert he gives you to get him to the vet.

It’s in this stage that the outlook for a cure is best. Very early on, however, testing is probably useless; until ten days to two weeks after infection, the immune system will not have had time to make sufficient antibodies for the tests to detect.”

So Gil has described the early stages of this. Most likely she was not even your dog when this happened. Most owners would not even consider taking their dog to the vet if this is all they see.

So Gil goes on to describe the second stage:
“The acute stage over, the disease passes into the subclinical stage. This simply means a stage in which no symptoms are present. Cure, or at the very least, containment of the disease so that it cannot progress, is still a good possibility in this stage which may last for years.”

So here is where you probably adopted Janie. In the subclinical stage. NO SYMPTOMS.

So the final stage of this disease is described this way:
“If the disease progresses to chronic, the outlook is grave, particularly in E. canis and N. risticii. Symptoms show up with a vengeance at this point. A lengthy, probably still incomplete list of symptoms and the diseases for which ehrlichiosis is often mistaken, can be found in the right column.”

Your thinking about the Lyme vaccine having something to do with this may be partially correct. Since you have read Dr. Dodds paper on the Lyme vaccine, you know why she is reluctant to encourage this vaccine for dogs that are not in hot spots of disease because there can be issues with this vaccine. Some dogs can actually express symptoms of Lyme after they are vaccinated (and in fact when tested the rest of her life she will show a positive titer for Lyme exposure.) Every time you administer any vaccine to a dog or human you challenge the immune system negatively. It has to work hard to develop immunity. What if she already has a sleeping Giant of Ehrlichiosis in her body now?

All the symptoms you describe are what we see in Ehrlichiosis. If you read Gil’s page from the beginning you see that there are actually now identified several genus of this disease and that through research they are now identifying them with different names and attributing them to differences in how they infect the body. So it isn’t simply Ehrlichiosis she may have, but one particular genus of this.

“The genus Anaplasma group infect granulocytes, platelets, red blood cells” This would be the trigger for the immune response you are seeing for severe anemia. The immune system knows that the Ehrlichiosis is inside the red blood cells (and platelets and white blood cells.) So it is mounting an attack on those cells in circulation, causing hemolytic destruction of the cells. Thus the black stools and probably blood in the urine.

What are we going to do? First you must have the vet test for this. Here is the test he must run immediately. It takes a tiny amount of blood, like a half teaspoon and the results are ready in about 8 minutes in the clinic. It shouldn’t cost more than $30. A vet tech can run this, you do not have to have a vet visit to run this test. Please do it.
https://www.idexx.com/small-animal-health/products-and-services/snap-4dx-plus-test.html

If this is positive, then the next step is to determine the titer or “how infected” she is.

“Dr. Cynthia Holland, Ph.D has written an excellent and brief article on the importance of titers in determining treatment for canine erlichiosis that addresses the various stages of the disease. Dr. Holland is an expert on tick-borne disease and she states emphatically: “The magnitude of antibody titers resulting from infection with Ehrlichia canis is directly correlated with the chronicity of the disease (i.e., the length of time the dog has had it). This information is extremely important in determining the treatment protocol since dogs which have been chronically infected for some time will require a more rigorous and lengthy treatment with doxycycline and, possibly, imidocarb in order to successfully clear the infection. This is in contrast to treatment during the initial acute phase, which generally requires only 3 weeks of doxycycline therapy.” ”

Of course, titering is a more expensive test and if you decide to do this the best lab to do this at is Dr. Cynthia Holland’s lab Protatek. She is a compassionate researcher and often consults on the phone with vets treating dogs with tick disease. She can recommend which tests to perform when considering the condition of the dog and the vet’s test results.

However, once you have the blood drawn to do these tests there is nothing from preventing your vet from actively treating your dog as if she does have it!

So keeping in mind your expenses, I would recommend a high dose doxycycline treatment immediately.
https://sites.google.com/site/tickbornediseaseindogs/treatment
Gil does not mince her words, if there is tick disease then it must be hit hard and long. Tick-L, the forum I have been on for 10 years, recommends this treatment protocol:
“The dosage we recommend on Tick List is an aggressive one: 5 mg. of doxy per pound of body weight given every 12 hours for 8 weeks. For those who prefer to figure body weight in kilograms, this is approximately the same as 10 mg per kg, the difference being not enough to mention.

This is twice as high as the dose that is generally recommended – and here I should probably remind you that I am not a veterinarian or a medical professional. Well, that’s true. At the same time, I should tell you that your vet is the one to decide what dosage to use. Well, I would concur if your vet is familar with tick-borne disease and knows it inside out. If not, he or she should consult with a colleague who is before deciding on the dosage.

In my opinion and that of everyone on Tick List, to my knowledge, ehrlichiosis and Lyme must be hit hard the first time out, if at all possible, and lower doses and/or shorter treatment times all too often mean recurrence. Unless your dog is one of the few that cannot take doxycycline or take it in this higher dose, my best advice to you is to insist on it. In the experience of a great many of us on Tick-L, each time ehrlichiosis or Lyme recurs, it’s harder to stop or contain it.”

If you see continued decline then you must switch to a more aggressive treatment:

“Imizol (imidocarb dipropionate) is used to treat Babesia canis and has been used off-label to treat E. canis and A. phagocytophilum. It is given in a series of two injections two weeks apart, either under the skin (sub-Q) or in a muscle (IM). Imizol burns, so a vet would be well-advised to minimize any discomfort the dog is going to have – and he is going to have it at the moment of the shot – by drawing the drug up with one needle, then changing the needle on the syringe for a clean one that has none of the drug on its outer surface. From my own experience and that of others whose dogs have been given Imizol, the worst that happens is a very loud yowl of protest, soon over, a drippy nose or excessive drooling, restlessness and/or a large desire to lie down and go to sleep later on. Once the shot has been given, the dog should remain in or very near the vet clinic for several hours just in case he does have a serious reaction, in which case atropine sulfate is antidotal and your vet will have some on hand. I have never seen anyone on Tick List say that the antidote was necessary for their dog.

Imidocarb dipropionate does carry cautions which may prevent its administration to dogs with lung, liver or kidney problems until they are under control but your vet should be aware of this as they are plainly noted on the product label. Imizol is manufactured and sold by Schering-Plough and is now readily available in the US.”

This is an expensive treatment, but it can be highly successful.

Please send me any CBC’s and chem screens that your vet has done. There are some indicators I can look for that will indicate whether there may be tick disease or not. You can upload them on the Urgent Advice page. No one but the moderators sees these and we do not share any information about you with anyone. Your privacy is important to us.
my best
patrice

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