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Hi I have just found this site and I hope it can answer so many questions I have.
My Doberman Louis was diagnosed with AIHA in Feb 2016 after being referred to a specialist, he is 5 years old and has always been a super strong dog.
His PCV count went down to 10% and he’s had 3 blood transfusions already, the last one on Easter Saturday. He has been on a cocktail of immune suppressants, including 75mg of steroids and cyclosporine for the past 7 weeks. His paws have swollen and he has broken out in sores all over his legs, it’s heartbreaking. I guess I’m asking is there any hope, or are we just putting him through this just so we don’t have to make ‘that’ decision to let him go.
I’m sorry if this makes not sense I guess I’m just looking for a miracle.
xx
Welcome -glad you’ve found us & please know we will try & help you & Louis as much as we can. Louis has a great chance of recovery for sure! All of us have travelled this rocky road, so we understand what you are going through & have seen the effects of the drugs on our babies. The side effects do seem horrible, but the vast majority of dogs make a full recovery & go into remission. We have all wondered if we were “doing the right thing” – we were & we are. This disease can be beaten by following the right treatment protocol – that is my best advice. Following the rules with the drugs, despite the horrible side effects, weaning slowly & carefully after they are stable will ensure a good recovery.
I cannot be 100% certain, but have a strong suspicion that the sores could be a staph infection – this is very common with IMHA dogs because the drugs suppress their immune system to the point where these bacteria thrive – normal dogs have this bacteria & it doesn’t cause them a problem because they are not on immuno suppressants . Have a good read of this:
https://www.secondchanceaihadogs.com/AIHA_Terms/staph-infection/
Do the sores look like this? I promise we have seen this many times & cephalosporine type antibiotics are the usual treatment – very effective. What does your vet say it is?
As Louis is a Doberman, did he also have low platelets by any chance? Or any other blood anomaly such as a bleeding disorder?
If you could provide an exact list of drugs & doses, together with Louis weight, plus send us copies of all the bloodwork including blood smears, plus any other test results on here so we can see what’s happening to Louis:
https://www.secondchanceaihadogs.com/urgent-advice/
So you have every reason to keep going to get Louis better. I am putting some general advice in a separate message – anything you want to ask, please do. And keep positive for your boy – give him every chance to beat this. You only have to look around this site to know that dogs recover & lead a full & normal life.
Sheena, Worzel (diagnosed with bone marrow failure Dec 2012, in remission, now aged at least 14) & his best friend, Ollie
Hi again – hope the following info will help. I wrote this a while ago as a general outline:
AIHA/IMHA – a quick overview.
Although this is a serious disease, it can be beaten with the right treatment.
Onset can be extremely fast or it can happen gradually. The faster the onset, the more difficult it is to treat and hospitalisation is the best option. I hate the fact that fast initial onset is a difficult scenario. It is IMPERATIVE that your Vet does as many tests as possible to determine the cause – I would recommend finding a specialist in internal medicine who has experience in treating dogs with this illness AS SOON AS POSSIBLE. An inexperienced vet could cost the life of your dog. You must have absolute confidence in your vet’s ability – if in doubt, change vets straight away & find the right help. Do not be sentimental about this or your dog could be in jeopardy – your “family vet” might be amazing & wonderful in many ways, but can they treat this rare disease? Be sure, please. If you are unable to find anyone to help, contact Dr Dodds of Hemopet via our website under “Hemopet Resources”
The basic principles of initial treatment;
1. Prednisone or Prednisolone dosage 1mg per pound weight of dog divided into 2 equal doses, 12 hours apart. This is to suppress the initial auto-immune reaction quickly as it is fast acting (5-7 days). Higher doses can be given at onset in severe cases, but should be lowered as soon as possible. Injectable dexamethasone is a more potent immunosuppressant drug used in hospital for severe onset cases. Prednisone/prednisolone is always referred to as the cornerstone of treatment. It is a life saver.
Prednisone and prednisolone can cause dehydration – ensure your dog drinks plenty of water – use a syringe (without the needle of course!) to put water gently into the corner of their mouth & encourage drinking. They will also urinate more frequently & with great urgency sometimes. Accidents on the floor will probably happen & we must forgive our dogs if this happens – they really can’t help it. There are long-term side effects with the pred that we just have to live with – they cannot be avoided & must be coped with to get your dog well again. Eventually pred can be tapered SLOWLY & carefully & the side effects will diminish.
2. On definite diagnosis of AIHA/IMHA – IMMEDIATE addition of a different type (or longer acting) immuno-suppressant, azathioprine or cyclosporine, for example. There are other drugs of this type available for treatment if necessary, although some are not well tested on dogs & should not be used in preference to cyclosporine or azathioprine initially. The exception to this is when platelets are affected as well (called ITP or Evans Syndrome), in which case Vincristineis generally preferred. Your dog may need one, two or even a cocktail of these drugs before they start to produce new red blood cells (called reticulocytes when they are “baby red cells”). Occasionally, it takes time to find the drug or combination of drugs that works best, but this is uncommon.
This is very important – prednisone and prednisolone on their own will not be sufficient and dogs suffer side effects after long term use – I have NEVER come across a dog who has recovered well or completely on pred alone after a definite diagnosis – “simple anaemia” yes, AIHA/IMHA no. A dog’s primary treatment protocol should therefore include more than just prednisone or prednisolone – the dog will be treated for long periods. I have read about too many cases where the vet has not added another immuno-suppressant quickly enough, or not at all, and the dog has had a very difficult recovery or has actually become much worse, sometimes with fatal results. I am not scaremongering – I have corresponded with owners that have been through this terrible experience & I do not wish anyone to have to bear this hurt.
3. If there is any indication, even a vague suspicion, that the dog has an infection they should be tested and THEY MUST BE GIVEN ANTIBIOTICS. If not, recovery can be severely impacted due to a compromised immune system – prednisone will make an infection worse. Ticks diseases are a common trigger for this disease. Antibiotics to be avoided (if possible) are sulfa drugs, penicillins & cephalosporins, although it is sometimes necessary to use these drugs if they are the only available treatment for that particular infection. Doxycycline in high doses & for a long term (6 weeks or longer) is the drug of choice for tick diseases, plus various other infections.
4. Inappropriate or Abnormal Clotting Risk – it is ABSOLUTELY VITAL that your dog is given ultra-low dose aspirin, clopidogrel, Plavix or another anti-clotting drug (or if in hospital heparin). Ask your vet if any of the following are present in the CBC blood test and chemical screen (liver and kidney) and ALWAYS get them to do a blood smear (blood sample reviewed on a slide under the microscope)
A) “Damaged” or abnormal red cells due to immune system partially destroying or biting lumps out the cells, causing them to clump together. Clumping can cause clots.
B) Complete breakdown (haemolysis, the H in AIHA) of LARGE numbers of red cells (erythrocytes), overloading the liver and kidneys with their component parts (haemolysis) – the faster the drop in PCV the more likely this is. Presence of large numbers of spherocytes (abnormal red cells) can be a problem – they are destroyed in the spleen as they are too big & wrong shape to get through.
C) Thrombocythemia/thrombocytosis – high platelet levels of 1,000,000 or above (this usually resolves when the cause is treated and is the least likely clotting problem)
D) Auto-agglutination – clumping due to antibodies “joining” erythrocytes together (Coombs Test positive – but test is NOT 100% reliable)
E) Blood transfusions – risk of clotting due to increased auto-immune reaction to “foreign” blood.
PLEASE ALWAYS GET A BLOOD SMEAR DONE!
Blood smears sometimes reveal abnormal cells (red or platelets) that can effectively diagnose the cause or root of the problem, or spot clotting risks – ALWAYS request a blood smear.
There are STILL too many deaths from inappropriate clotting because dogs are not being given an anti-clotting medication and it really upsets me to think that some vets are not up to speed with such a dangerous scenario.
5. Stomach protection – sucralfate and famotidine (brand name pepcid) are extremely important in preventing & healing stomach ulcers which are caused by the medications like prednisone. Again it is VITAL your dog receives this to prevent /stop bleeding in the stomach. Sucralfate is particularly effective as it acts almost like a bandage to the GI tract, healing ulceration & preventing further damage.
6. Transfusions (if needed) – The general “rule” is that transfusions should be avoided until the PCV drops to 15 or below, unless the dog is really unable to cope at a higher level. Every dog is different. Vet should evaluate the patient very carefully before transfusing a dog to a PCV/HCT level of more than 25%. If it goes over this level, your dog may not produce new red blood cells on their own as their body thinks they have enough cells already, therefore SMALL transfusions are best. This is very important and some vets forget this basic fact from their initial training.
7. Very basic blood test facts & figures for most breeds:
HCT, haematocrit, is the percentage of red cells present in the blood – normal levels are between 35 – 55. PCV, packed cell volume, is a direct visual measurement of this same value. These values can be slightly different to the use of an automated analyzer to measure HCT. Some dogs such as sight hounds have a higher value naturally – 55 to 65 is normal for them.
Haemoglobin normal is 12-20 roughly depending on the particular lab’s value ranges & the breed of dog.
Platelet count normally around 170,000-400,000, again, some breeds are naturally lower, such as greyhounds.
Total White Blood Cells 4-15 mm/m3 – breeds vary again.
The term regenerative means reticulocytes are being produced in the bone marrow. The term non-regenerative means they are not being produced in the bone marrow in sufficient quantities to replace those being destroyed. Regenerative is GOOD – the dog is responding to treatment. However, if there is large value of reticulocytes and there is little increase in the number of red blood cells, there may be blood loss, perhaps due to an ulcer or tumour, or ongoing haemolysis. Cornell University consider a figure of 80,000 to be a good regenerative figure.
8. Pancreatitis can be a common side effect of prednisone with this disease – look out for vomiting &/or diarrhea, refusing food and dog in stomach pain, perhaps arching their back and groaning, stretching out full length or crying. Take them straight to the vet. Azathioprine can cause pancreatitis – it should always be given with food to lessen the risks – stop giving it immediately if you think your dog has pancreatitis & go straight to the vets. Keep food fairly low fat – fat can also aggravate the pancreas. Do not give peanut butter, even to get pills into your dog – it can often contain a sweetener called xylitol which is proven to be harmful to dogs as it can cause pancreatitis.
9. Liver enzymes often become raised. Giving Denamarin (contains Milk Thistle) will help. Denamarin also contains other ingredients which help protect the liver so is a great supplement for this disease. Prednisone & other drugs can raise liver enzymes, so Denamarin, milk thistle, Sam-E etc are all useful in preventing / lowering these enzymes.
10. Thyroxine (soloxine) is always added as part of Dr Dodds Protocol, regardless of the dog being hypothyroid or not, at the dose of 0.1mg per 10-12lbs of optimum body weight to promote new red cell production (haematopoeisis). It is also advisable to get a full thyroid panel done as hypothyroidism causes anaemia.
PLEASE REMEMBER – THIS IS JUST AN OVERVIEW. If you want more detailed information, please do not hesitate to ask – someone on https://www.secondchanceaihadogs.com usually knows the answer.
THIS DISEASE CAN BE BEATEN – HOPE IS ALWAYS THERE.
Please upload every possible test result you have – CBC, blood smears, scans etc – to our Urgent Advice area. We can interpret them for you & advise you if they have clotting issues or other problems. Blood reveals a lot!
Best wishes for a speedy recovery
Sheena
Hi Karxlee
Welcome to the site. I’m sorry you’ve had to come looking though and I’m sorry Louis is so ill right now.
Sheena is right. We’ve been where you are now and we’ve all asked ourselves the same questions. I’ll be forever grateful to my specialist who told me to wait before making “that” decision. Bingo looked so very bad, I really thought it was cruel to keep him going, but I listened to the specialist and slowly there was improvement. That was in November 2011 and he’s beside me right now. He’s actually a bit annoyed with me today because he hasn’t been fed this morning (he’s due for a check up today).
Karxlee, if you can give us as much information as you can, that would be great. I too was thinking about a staph infection. It happens quite often, as Sheena said because the immune system has been shut down right now to get it to “reset” and switched on slowly again.
Yes the drugs take a shocking toll, and until they can be safely lowered, he won’t be feeling too good, or looking too good, but the drugs are life savers. We’ve all come to respect them despite the ravage they take.
Ask anything at all. Of course you have a million questions. But between us, we’ve been through it.
We’re in different parts of the world too, so we’re about at different times. Sheena is in France, I’m in Australia.
My very best,
Vally & Bingo
Karyn
Okay I checked the site before emails. I can see you’ve sent the Urgent Advice through. Do you have copy of blood tests? Is Louise home with you or in hospital at the moment?
Can you give us the exact name of all the medications. I’m wondering if he’s on thyroxine. Whilst it’s a thyroid medication, it helps the marrow to make red blood. Many of us have seen a turnaround when this was started. Thyroxine MUST be given away from food though. I made that mistake and it wasn’t until I stopped giving it with food that it started working.
It’s really important to see the blood works though. If you don’t have a copy, ask for them. Remember you have paid for them, they are yours. I must admit I felt funny asking for them from my specialist, but in the end simply said, I need to see the actual blood results to take it all in. And they were absolutely fine with giving me a copy.
Vally & Bingo
xxx
Hello Karxlee. Sheena and Vally have already given you awesome advice, just as they did to me over four years ago. I was literally a dear in the headlights and without these great people here, I would have gone totally bonkers AND Sadie would not be here. You have come to the right place.
Just remember, the more information we have, the better. You can not give us too much information. Just get your meds out and copy what they are and the dosage. And the labs are very important, and can be downloaded on the Urgent Advice page.
Is Louis on any protective supplements? I.E.,
1. liver protection (usually Denamarin made by Nutramax, a must and/or Ursodiol, Sadie is on both),
2. stomach protection (usually Sucralfate or the like, and,
3. something, to coat the tummy to protect from stomach ulcers, which can be very bad) and an anvil-clotting med (Sadie has been on human Plavix, but there are other options).
All three of these are VERY important. Louis is a big boy and he will be on high doses of immune surpressants (usually TWO are necessary). So, having protection is very important. I stress, VERY important.
We will be looking for the additional information. In the mean time, try very hard to take care of you too. Louis needs you right now. We’re here too, ask away. Nothing is too trivial or silly – we have all been right where you are right now.
Love, Linda and Sadie
Sorry – rushing as usual and on my iPad, the numbers 1, 2 and 3 – you will figure it out. Just be sure Louis is on protection for liver and stomach protection and an anti blood clotting med.
Oh, just thought too, it’s actually quite normal for bloods to drop a bit after a transfusion. I know that’s frustrating, but it quite normal. The transfusions aren’t doing anything to stop the disease, that’s what the drugs are for. The transfusions are there to buy time FOR the drugs to kick in.
It’s very important that the transfusions are not give to a PCV over 25, otherwise the body thinks it’s got enough red blood, and won’t both trying to make any. Do you know what the PCVs have been?
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion/
Vally (again)