Worzel’s Story
I have always adored dogs & always will. I was brought up with waifs & strays coming into our house as Mum & Dad loved animals. My husband is also a big softie, especially where dogs are concerned & we have had 4 adopted dogs so far. We live in France now, but used to live near Oxford where I bought a Post Office. I became involved with the local dog rescue society. We displayed posters in the window of our shop for re-homing “dog of the week” & helped raise money for the Dogs Trust & the local dogs home. I saw some terrible cases of neglect & abuse , even dog-fight victims & am still a member of both the rescue groups.
I wanted to be a vet when I left school, but despite having enough qualifications to enter Vet University, I was turned down because of my allergic asthma – no preventative inhalers in those days! So, I decided to be a nurse and started my training at Guy’s Hospital, London. I still like to try to keep up-to-date with new drugs & treatments. I am by no means a hematologist, but wanted to learn as much as I possibly could to help Worzel survive IMHA.
I will never forget the feeling of loneliness, helplessness & hopelessness that I had at the start of Worzel’s illness until I found a forum on another site where I “met” some of the most amazing people. These people are now Team Second Chance. I cannot emphasize how much I needed their help & support – finding them was a HUGE relief. Worzel & I couldn’t have made it through this terrible time without their experience, knowledge & compassion. I hope that I can now help others whose dogs have this awful disease to understand a little more, provide some moral support & nursing advice and to share my experience of the ups & downs of AIHA/IMHA.
The onset of Worzel’s illness was very slow & the symptoms were vague. He was finally diagnosed when he was about 12 years old (he is adopted so we’re not sure how old he actually is) on the 6th December 2012. About 6 weeks before that, he had started to become more & more lethargic & sometimes didn’t want much to eat. He also had a piroplasmosis vaccination during this time which may have triggered the disease or added to the existing problem.
The vets and I originally thought it may have been his heart as he had been treated for a mitral valve prolapse (heart murmur) for about 3-4 years. This was controlled very well on pimobendane & prilactone but we decided to do another ECG to check if he had deteriorated – but it was completely normal.
He was gradually getting worse & lost his appetite almost completely. We made many, many visits to the vet. I was sure he was anaemic, as his gums looked pale & I was also certain he had an infection of some kind. He became very ill – weepy eyes & strange behavior developed – standing looking into empty corners of the room for example. I asked the vets to please do a blood test & we found his PCV was 28 which is very low for a greyhound.
They immediately started him on high dose prednisone (20mg twice a day), doxycycline (250mg) & sucralfate 1g twice a day (at least 2 hours after the other medicines as instructed!) I absolutely INSISTED on antibiotics being given, even though they were reluctant initially.
As an ex-nurse, I wanted to be totally involved in Worzel’s care & must thank the local vets for their patience with me! I took in a few research papers about anemia with me & they were very open to using the testing protocols & other ideas I had. We were so, so lucky to have a great veterinary practice with open-minded vets – this is VITAL & I would urge others to change their vets immediately if they are in any doubt. They did everything I asked them to do, including x-rays & ultrasound & even asked me into the operating room to be with Worzel whilst the tests were carried out.
They concluded he might have caught a tick borne disease, possibly ehrlichiosis, as by then, he had developed a temperature. His PCV continued to drop & he was non-regenerative – no reticulocytes present at all. I was devastated. Luckily he didn’t have any abnormal clotting problems & so he didn’t require anti-clotting medication. He had virtually stopped eating altogether by this time, which was heartbreaking – Phil & I sat on the floor & tried to coax him to eat just a handful of mince – if he had a little bit, we were overjoyed! It was awful.
The local vets immediately referred us to a specialist in internal medicine in Bordeaux who was very knowledgeable & had trained at Cornell University. He did more tests including a bone marrow aspiration & confirmed Worzel had a very rare form of AIHA (IMHA) in his bone marrow, not in his bloodstream. He had dropped from 25kg down to 18.5kg & his PCV was only 18 at this time.
We started him on 50mg Azathioprine per day which I was told to ALWAYS give with food to prevent side effects as much as possible. We had to be vigilant for the symptoms of pancreatitis etc, which this drug can sometimes cause in the early days of taking it. Tardyferon (80mg) an iron supplement was also prescribed. The specialist assured me that there were many other drugs we could try if the azathioprine didn’t work, or he couldn’t tolerate it. His liver enzymes were raised & I asked if we could add Milk Thistle – the specialist agreed that this was a good idea.
I feel incredibly lucky that we found the right specialist who knew the right treatment protocol – he was more than willing to consult with the wonderful Dr. Jean Dodds who I had contacted previously. I am also eternally thankful that our local vets were not too proud or big headed to refer me to someone else.
About 2 weeks after starting the azathioprine, we received a phone call to say Worzel had become regenerative – lots of reticulocytes – & we celebrated the appearance of those new baby red cells with a bottle of champagne! He quickly regained his appetite & was ravenous with the prednisone. We continued with the doxycycline for a further 6 weeks to make sure the infection was completely gone. He still looked really dreadful & had a sore on his leg that didn’t heal up because of the prednisone and he suffered very badly from the side effects, becoming weak & unstable on his legs. They get very weak & ill before they start to get better because of the treatment, but it is very hard to see them like that.
When his PCV reached 45, he was slowly weaned off the prednisolone completely (blood tests always taken before & after each drop) & after that we lowered the azathioprine very, very slowly, again with blood tests before & after each drop. He now only has 1 x 50mg azathioprine per week, plus his heart murmur medicines. He will probably stay on this dose forever. He will probably never have another vaccination either. Our dogs have always had regular vaccinations for certain tick diseases, but there is currently no vaccination available for Ehrlichiosis. We do not have heart-worm in this area of France, thankfully. I have always religiously used Frontline flea & tick treatment once per month as ticks are rife here but I very rarely find a tick on them. I am vigilant about checking them both for ticks every day, especially now.
Our friends are amazed that he has made such a wonderful recovery, considering how dreadful he looked (like a skeleton with a pot belly) during the treatment. Worzel is now completely back to his normal self, full of energy , cheeky & cuddly – despite his age, he still runs around at 100 miles an hour with our other dog (his best friend) Ollie. Looking at him now, you would never believe that he had been so desperately ill. Worzel’s PCV is now usually between 58 & 63, which is normal for a greyhound. I admit I will always be paranoid about a possible relapse & he will be straight to the vet at the first sign of illness. We will still take regular blood tests too.
This disease CAN be beaten with the right treatment protocol – I hope Worzel’s story gives everyone else encouragement to fight like crazy to get their dog into remission. Find the right vet & the right treatment – most importantly, never give up. I know how lucky we are that Worzel did respond, but we must also face the sad fact that there is not always a happy outcome. All we can do is give them the best possible CHANCE to fight this evil disease.