Camilla, AIHA-dog from Italy

[Vally]

Eleonora, it’s amazing how different our dogs all are and how much we love them. My boy is a horror when there’s company. As soon as we’re all sitting around, he’ll start to bark and carry on because he wants food or treats. He’s always refused to do anything without treats. He MIGHT do something, like sit, for a treat. Any other time, forget it.

Yes I totally agree with what has been said. The high dose prednisone does a lot of damage to the stomach, and the Sucralfate can keep that all in check.

Also with the thyroxine, yes it’s true that testing them will not show an accurate figure while on the prednisone, but we’ve all seen how they respond when started on it. Whether or not it’s needed for a slow thyroid, it helps produce blood as Sheena explained.

I also agree with Brigitte, I’d be cautious as to what is used to treat any possible worms. We’ve all come to think twice about medications, especially if the immune system is playing up.

My best,
Vally & Bingo.

[eleonora]

Good morning girls! Ciao Brigitte, è bello leggere qualche parola di italiano! It is difficult for me to speak in english on the health of camilla and AIHA because there are a lot of medical terms that i don’t know but I help myself with vocabulary, and I look at the bright side: I’ll improve my english ahahaha! first of all: i’ve just uploaded some camilla’s blood counts. i hope you’ll understand something. her stools are not beautiful: there is less blood but much mucus and these white dots that do not know what they are. stool analysis for intestinal parasites is negative, it could be tapeworm, but tapeworm moves and perhaps is bigger …. her white dots are like grains of sand, and do not move. at 12.00 a.m. I have to call the vet to have the result of the blood count of last Thursday and i’ll speak again with him about these white dots. cross your fingers! Thanks everybody for your precious advices. i have some questions. Milk Thistle: i think i can easily find it as a supplement for human use… is it ok? in which doses i can give it to camilla? Sucralfate: i think i need a prescription of my veterinarian…should i use it with or in place of cimetidine and ranitidine? thanks, have a nice day!

[Vally]

Eleonora, I’ll leave the blood tests up to someone who can understand them.

With Milk thistle, buy the best quality human tablet. The dose for Camilla at 34kg (75lbs) (between 71-100 lbs) would be 75% of a human dose, divided into 3 or 4 doses per day. If there’s any sign of stomach upset, lower the dose.

The white spots, I’m thinking it’s food rather than worms. Worms, when seen are usually wriggling, but see what the vet says about that.

yes, cimetidine and ranitidine are used to lower the acid in the stomach, whereas the Sucralfate coats the stomach and ulcers. They should NOT be given at the same time though.

If you need help with a medicine chart, I’d love to make one up for you. Let me know.

Vally & Bingo (who’s being bad again tonight – I’m trying to wrap Christmas presents and he just keeps barking for food and treats).
xxx

[Sheena]

Hello Eleonora & Camilla!!!

Thank you very much for all the tests. At the beginning, there was agglutination present, which means Camilla should have had an anti-clotting medication, such as clopidogrel, aspirin, plavix. Vets decide which one to use. Please don’t panic about this, but please, please get a blood smear done as soon as possible & ask them to look for agglutination again. It is possible that all is well now as it has been a few weeks since the first test & there is no more agglutination present. Let’s hope so. If there is still agglutination or presence of any type of abnormal blood cells, could you let me know please? Clots are the biggest risk with this disease & I want to be certain she is no longer at risk.

I had to google translate some of it. Most of the symbols & names are the same or similar to French, so apologies for the late reply. Am I right in saying the blood test from the 6th Nov was sent away & they did the tests in a lab on the 10th? They mentioned the agglutination can alter some of the results, so that is why I want you to get her checked again, just to be on the safe side.

Camilla’s latest tests is GREAT!!!!! She is really recovering well & her HCT of 37 is NORMAL. So she has regenerative anaemia – we all love the word regenerative. She has had episodes of high neutrophils, which can indicate an infection, but they haven’t always been high. They are still slightly on the 5th Dec test, and this does make me suspicious she has an infection of some kind.

The white dots in her poo could be worm eggs perhaps, rather than full grown worms (yuk), or as Vally says, maybe she’s eaten something horrible – I’m glad you’ve given the vets a sample. Here is some information on dog poo, including presence of blood:
http://www.dogingtonpost.com/the-scoop-on-poop-what-you-can-tell-about-a-dog-by-looking-at-his-feces/

Can you tell me what the blood is like in her poo? Is it fresh bright red, or darker? If it is fresh red, there is a problem at the lower end of the GI tract, if it is dark, it’s a problem higher up. It could be also caused by a parasite.

Yes please add the sucralfate & keep the other tummy drug going as well, but remember not to give it within 2 hours of any other drug or food. Vally’s drug charts are THE BEST – it is really hard working out their medications. I found Worzel got most relief from a 1 gramme dose last thing at night on going to bed – it gives the sucralfate a chance to work overnight, but I also gave him 1 gramme late morning. If the bleeding is due to ulceration from the prednisolone, this will help. If it is a parasite, whatever it is will need to be treated. I have been looking at worming pill safety for our AIHA dogs & there isn’t much useful information. My Specialist advised me to carry on using Milbemax as we have always used that in the past, but I know you cannot use this drug if a dog has the MDR1 gene, for example collie type dogs, german shepherds, shetland sheepdogs etc. I’m afraid that is the limit of what I’ve found out. So, let’s see what the vets find in her poo!!!

Overall, her blood tests have been pretty good, apart from the anaemia of course, but that is improving very well. I noticed high C-reactive protein & high monocytes on the early tests – a sign of inflammation. C-reative protein is often high with an infection too. Has she have a temperature at all or any other signs of infection you can think of? The other thing is that they can have a reaction to tranfusions & this can show up in the blood tests too.

Eleonara. your girl is doing really well – we just need to get this blood in her poo stopped & find out what is in her poo & she will soon be improving even more! Adding the milk thistle will help protect her liver too.

Sending love & hugs
Sheena, Worzel & Ollie xxxxx

[eleonora]

Hi Vally, Hi Sheena! thank you very very much! this morning I spoke with the vet who told me that in the last blood count (blood taken last Thursday, December 17) the red blood cells are slightly decreased to 4.2 :( I suspect that she is decreasing prednisone too quickly in fact she went from 6 to 4 tablets of 25mg tablets (-30%) and, after two weeks, from 4 to 2 tablets (-50%). In any case the vet said to maintain the current dose and make a new blood count next Tuesday to see what will happen. On Tuesday i’ll certainly ask him to make even a control of the agglutination, although I believe that the laboratory does every time the blood smear (that’s why my vet sends blood to the external laboratory ) and to this day do not appear specific comments. The first three tests that I have sent (November 6-8-10) were made by the clinic 24 h where Camilla was admitted (at present she is followed by our veterinarian who does not work in that clinic, he has a private practice), the smear of blood on November 6 was made by the external laboratory of the clinic 24 hours. on November 6 camilla had a little bit of high temperature, but in the following days her temperature was normal. also at the last control. however I think i will take an appointment with a specialist (hematologist) at the veterinary clinic of the university of Pisa. Camilla stool: the blood is fresh and bright red.as I told the stool test was negative.It could be tapeworm but maybe not because white dots are very small, like grains of sand, and do not move. however the vet said he would not give worming medicines at this time. i’ll add milk thistle and sucralfate, of course. thanks again!

[Sheena]

Hi again

Let’s hope the blood in the poo will get better with the sucralfate & take it from there. If it goes on too long or gets worse, you will have to get them to investigate further. I agree with your vet – worming meds would not be ideal at this moment in time as she is in early recovery – we don’t want anything to rock the boat!

I completely agree about the drop in RBCs being because pred was reduced too quickly – I would follow these guidelines from now on & she should be fine!

https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/

She is doing so very well – hoping for another increase on the next test. Let us know how she’s doing,

Love & hugs
Sheena & the boys xxxxx

[eleonora]

ops I have a doubt: I have to check her blood cells agglutination or the speed of her blood clots? perhaps I have not been scanned this morning but on November 6 was also evaluated the speed of blood clotting and it was normal….

[Sheena]

It’s great they have checked her clotting time. Clotting is a very complicated process with many different things happening. What we worry about here is that red cells can stick together to form a clump or lump of cells whuch can cause a clot big enough to block a blood vessel & there does not seem to be any indication of a risk from looking at clotting times from the studies I have read. The only certain way to tell is by looking under the microscope at a blood smear.

It is agglutination we are looking for which is a type of abnormal clotting. On a slide or blood smear, this shows up clearly under the microscope & your local vet can look at this easily. Here is our diagram
https://www.secondchanceaihadogs.com/AIHA_Terms/agglutination/

A picture of the problem:
http://www.pathpedia.com/education/eatlas/histopathology/blood_cells/rbc_agglutination.aspx

A picture & explanation.
https://ahdc.vet.cornell.edu/sects/clinpath/test/immun/coombs.cfm

I am really hopeful that the risk has gone for Camilla because of the corticosteroid treatment – this stops the body destroying it’s own red cells because they are no longer incorrectly marked for destruction. Pred should reset the immune system.

I’m sorry this is difficult to understand – I did not understand about clotting risks at all when Worzel was ill, so have spent a lot of time learning about it. I hope I’ve explained it OK

Big hugs
Sheena xxx