Savannah IMHA/AIHA Diagnosed 10/6/19

Saturday 10/6/19 I noticed that my pit, Savannah, was a little off. I’ve had it her since she was 4 weeks and is now 8 years young. She was fine at 2PM, but 7:30PM it seemed like night and day in her behaviors. When I took her on walks she was moving slower than usual and wouldn’t even squat when using the bathroom. At one point she wouldn’t move and froze, as if she were having a seizure. I examined her stool, no concerns, and then checked for ticks. Her behaviors struck me as odd, but everything else seemed to be normal. Normally when feeding her she is pretty “ravenous”, but that night she wouldn’t touch it. I gave her one of her frozen treats and she seemed to resume back to normal. The next day I grew concerned when she wouldn’t touch her food after 3 hours of it being in her bowl and could barely lift her head. I took her to the ER and had to carry my 78lb baby up 20 stairs and into the car. Before we got in I noticed her pee was darker than usual. We got to the ER and they did a quick gum check while telling me the wait time, and then suddenly there was no wait time. They took her and put me in a room. They told me that she is anemic and all the reasons that may be causing her blood loss. They completed blood test and stated the following: CBC-HCT was 22%, MCV 82.4fL, Reticulocytes 177k/uL, Neutrophils 15.24 K/uL, platelet 282 K/uLI. I was then told that she would need to stay overnight to monitor this and that she was considered in critical condition since she couldn’t even stand. I was then told that she would more than likely undergo a blood transfusion (she’s had none before and no previous major medical history). They found no signs of blood loss, Thoracic radiographs showed no evidence of metastatic disease, SNAP 4DX was negtive for all four- but her slide agglutination test returned positive. They started her on IVC, LRS at 80 mls/hr, dexamethasone 10mg IV q24h, plavix 75mg tablet PO q24h. Her vet explained the diagnosis and said that she will more than likely be in until Tuesday, possibly Wednesday, dependent on her response and ability to move her to oral medication. Monday they completed an ultrasound to check for all the “scary” underlying causes, none found. Her count dipped to 19% so they completed a double unit (~350mls) over 4 hours that morning and began immunosuppressants. The ultrasound showed no signs for concern, so they continue treatment for intravascular hemolysis that is presumptively immune-mediated. After her first transfusion she lifted to 20%. Later that day she reached 21%, but next test was down to 17%. She was hospitalized Sunday through Friday and her lowest dip was 15%- she was given 5 blood transfusions through this time. Given her lack of response, Friday, they began testing for Barbesia (results will be in either tomorrow or Wednesday). Savannah has failed to have control of her anemia and continues to drop slowly following transfusions. I’ve been spent $5,600 so far on her treatment (i’m a single 30 year old), so they completed a transfusion Friday night and allowed me to take her home for the weekend to help save some money and spend time with her since she had been transitioned to oral medication (Cyclosporin, Mycophenolate, Clopidogrel and Prednisone). You could see a visible difference with her being able to be home, and I haven’t left her side once. Saturday was a good day with her urine still clear-ish, normal stool and alertness whenever I got up, moved or made some kind of noise. Her gums are still extremely pale, but I felt some hope. Last night (Sunday) she began vomiting at 7PM, about an hour before her dinner/medicine. There wasn’t any blood, but called the vet and they had me bring her in. Her count showed her at 22% (Friday night was at 24%). They chalked it up to the Mycophenolate, so they changed her dosage and gave her an anti nausea injection. This morning she vomited at 5AM and again at 7AM, so they are having me store her Cyclosporin in the fridge until given with her food and prescribed Cerenia to help with the nausea. They explained that if I notice a decline with those changes then she’ll need to complete another ultrasound. My heart sunk and I failed to ask- why, that would need to be completed. Again. Around her i’m very positive and optimistic because I believe she can tell when i’m upset, and I want her to have nothing but positive vibes. The vet asked how I was emotionally and financially last Friday, and I was unable to respond because I was just devastated at how quickly this all happened and the intense treatment she had/has to undergo. I finally e-mailed the vet today with those answers: “Emotionally, I’m a rock and source of positivity when with Savannah, but on my own I’m still incredibly torn over what she’s having to go through/endure. Financially, I’m capped at $10,000- including what has already been spent. If it surpasses that I do have a contingency plan in place with my financial advisor to buffer this cap. When you have the moment, could you reach out (phone or e-mail) and share what the rest of this process may look like in regards to her treatment and my finances. What should I expect? Is she in pain? What would be reasons for concerns, and reasons for hope?” I’m waiting on a response, but i’m just at loss. She has failed to stabilize and continues to drop. The vets that seemed optimistic have noticeable concern at this point, but have been incredible through this whole process. I know that this disease brings a long journey ahead and aggressive treatment. I’m willing to move whatever mountains necessary to treat my furbaby, but i’m concerned because she seemed to be fighting hard and now appears to be “down”. Even though her numbers don’t reflect stability or progress, her attitude showed she was fighting and I refuse to maintain any other attitude, myself, when with her. Today she seemed almost defeated. She just lays her head on me and appears as if she’s trying to pretend that she’s okay but I can tell- something is off.

It’s been 8 days since her diagnosis and start of treatment with no improvements. Not even stability. I’m reaching out because i’m in need of advice and guidance. Her change in attitude concerns me most and I want to do what’s best for her. Any feedback would be greatly appreciated so I can ensure that i’m doing what’s best for her- especially after the last week of treatment that she had to undergo.

Thank you