Doberman with AIHA – Page 2 – Second Chance AIHA Dogs

Karxlee

Guest

Hi Everyone, wow I am speechless at your kindness and advice, as Sheena has said I have sent a request through to Dr Dodds, my husband thinks it’s clutching at straws and is currently in the mind set of ‘it’s time we’ve done everything possible’, but I cannot allow myself to get there, as I’m sat here Louis is beside me sleeping after having a lovely tea, and I cannot imagine him never being here.

We collected Louis from Liverpool small animal teaching hospital last night and brought him home, the hospital advised due to cost they are not doing anything we couldn’t do at home. He was full of beans after his blood transfusion and his PCV had gone up to 23%, they know the rules about not allowing it to go over 25%.

The sores on his legs are ‘ringworm’ – I was mortified until Sheena managed to talk me down by saying it will be as a result of the drugs, the only problem with we have a little dobie girl called Olga, so we are going to have to watch her like a hawk, although Louis has never let her lick him, she’s more of a leaner like most Dobies, they were pleased to see each other.

Louis had a settled night and it’s the first time in a long time that he actually sleep in his box, just before he started to become ill, he wouldn’t sleep in it, he use to pull his duvet out and sleep on the floor, which when looking back that should have been a signal something was wrong because he loved his box.

He’s been searching for food all day, and has eaten quite a lot, but we are being careful what we give him. He’s been bright and alert, and dare I say it his pee has looked normal, no sign of red. He’s got a spot of the runs because he’s been eating more than normal since the leaving hospital and one of his drugs has this as a side effect.

I’m watching him like a hawk, and any change in his breathing I’m like “Oh god it’s happening – his RBC are going”, but if I carry on like this it will kill me, not sleeping, worrying, everything it’s just awful, and when you read the hospital letter saying “We believe the owners are realistic about Louie’s poor prognosis and they may decide to euthanase him if/when he becomes anaemic again” – Not a cat in hells chance until I’m told we have explored every avenue, and at the moment Dr Dodds is my final avenue.

Louis is currently on the following medication:

• Prednisolone: 60mg PO SID
• Mycophenolate: 500mg PO BID
• Omeprazole: 40mg PO BID
• Paracetamol/Codeine: 400mg/9mg PO BID
• Aspirin: 18.75mg (1/4 tablet) PO BID
• Terbinafine: 1125mg PO SID
• Stronghold Large Dog: Apply one pipette every 2 weeks for 3 applications. Next due 9th April.
• Malaseb shampoo: Bath affected areas
• CLX wipes: Use to wipe affected areas twice daily
• Vetericyn Gel: Apply to affected areas twice daily

• Haematology: regenerative anaemia, RBC 1.85×1012/l (RI: 5.65-8.87), Hct 13.8% (RI: 37.3-61.7), PCV 14%, MCV 74.6fL (RI: 61.6-73.5), reticulocytes 260.7K/ul (RI: 10-110), neutrophils 19.94×109/l (RI: 2.95-11.64), PLT 377k/ul (RI: 148-484). There was no auto agglutination and only occasional spherocytes, marked anisocytosis on the blood smear.
• Biochemistry: ALT 160U/l (RI: 10-125), ALP 349U/l (RI: 23-212), bilirubin 14umol/l (RI: 0-15)
• Babesia PCR: pending
• Urinalysis: specific gravity 1.035, with marked proteinuria, trace blood and trace bilirubinuria
• Urine protein:creatinine ratio: 13.83 (severe proteinuria, RI<0.2)
• ECG: revealed a sinus tachycardia with occasional premature complexes. This could be related to hypoxaemia secondary to the anaemia, if this is persistent once the anaemia is resolved then Holter monitor is recommended in case of pre-clinical DCM.
• Echocardiography: revealed good systolic function (fractional shortening 35%) with normal chamber size and morphology and no mitral or tricuspid regurgitation.
• Thoracic radiography: revealed a small pleural effusion, mild left sided cardiomegaly and a diffuse broncho-interstitial pattern which is most likely to be age related. There was mild sternal lymphadenopathy which is most likely to be secondary to inflammatory abdominal disease, neoplasia could not be excluded. There was also an equivocal pulmonary nodule, this is most likely to be a composite shadow but again, neoplasia could not be excluded.
• Abdominal radiography: revealed hepatomegaly which is likely to be related to recent corticosteroid use and was otherwise unremarkable.
• Abdominal ultrasound: confirmed diffuse hepatomegaly. There was a large portal tributary and splenic vein thrombus. The adrenal glands were atrophied (consistent with steroid use). There was a very small peritoneal effusion.
• Bone marrow cytology: revealed an adequate regenerative response to anaemia with erythroid hyperplasia and left shifted erythroid series. There was occasional erythrophagocytosis targeting the later stages of erythroid cells which may support a diagnosis of IMHA. There was no evidence of neoplasia.
• Spleen cytology: revealed extramedullary haematopoiesis with evidence of erythrophagocytosis which would support a diagnosis of IMHA.
• Liver cytology: revealed marked vacuolar hepatopathy consistent with corticosteroid administration. There was evidence of cholestasis and neutrophilic inflammation which may be secondary to recent drug administration.
• Skin biopsies: Mycotic dermatitis
• Skin bacterial/fungal culture: Pending

I don’t know what any of the above means but I feel we have covered everything.

It’s time for Louis’s drugs, so I better go, thank you again for all your support you are all amazing.

K xxx

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Karxlee

Guest

Thank you Sheena, I can safely say you have kept me sane over the past few days and I will never forget that – whatever happens.

I’ll tell you my story…

At the end of Sept 2015 whilst out on his early morning (5am) run, Louis was bitten by another dog, my husband didn’t see what dog it was, but we think it was a staffy. The same dog had attacked a couple of other dogs over a 3 week period. Louis is not a fighter and never has been, he’s a gentle giant. When he came home we were able to see how bad the bite was and that it would need stitching, so we took him to our local vet, and they cleaned the wound and stitched it. We didn’t think anything of it, and Louis recovered well.
Towards the end of Sept Louis started to sleep outside of his box/bed, which was odd because he loved curling up in it at night, and sometimes even during the day he would take himself off to bed, but because he was eating and drinking and still going out for a run, we didn’t think anything of it.
John started to come back from the runs staying Louis had been lazy and hardly run about, he was more interested in chewing his frisbee rather than chasing after it. Again we thought he was either hot because we had a mild winter, or just not as bothered about going out – looking back this should have rang alarm bells, but we had never heard of AIHA.
The run up to Christmas was busy as normal and he seemed ok, still eating although not as much and still drinking loads! – Louis has always been a big drinker, we had him checked for that a couple of years ago and was told “He’s just a thirsty dog”.
Christmas Day came and we had people over, we played games into the night and Louis just wanted to be cuddled by anyone, then around 8pm we noticed he didn’t want to get up and his breathing was different. So we took him straight to the emergency vet. The diagnosed kennel cough! We said he didn’t have a cough,but he did have a high temp, so he was given antibiotics and something to bring his temp down.
Over the next few days he didn’t improve so when our own vet opened on the 27th we took him there, he checked his gums and said he needed to take a blood sample because he looked anemic, he gave him 15mg of pred to take once a day. After a week Louis responded really well and his gums pinked up and or vet told us to drop his pred to 10mg, for a week and then 5mg, we did as we were told and dropped him down to 10mg. He didn’t cope well with this and within a week we were back at our vets, how advised that he would need to either he put to sleep, or referred.
We checked our insurance and it didn’t cover him for this because in the past when he had an upset tummy his notes mentioned Billy Ruben , and because he had Billy Rubin in his poo this time they classed it as a pre-existing condition. I’ve been into battle with them over this and even took legal advise.. the small print is a bitch!
We decided to get him referred because he’s our boy, he’s a rescue Dobie and had already had a hard time when he was a puppy, so when we adopted him we said we would do everything in our power to keep him safe.
So we were referred the same night and set off for Rutland House approx 50 miles away.
When we got there we said we didn’t have insurance and we had limited funds, to be fair they were good about it and said they would consult with us about cost before doing anything.
Louis’s PCV was at 15% when we took him, they said he would have to stay in over night and may need a blood transfusion, but they would start him on 80mg or pred and an immune suppressant. They asked us to sign a document stating the cost to keep him alive £2000. We looked at each other and thought oh my god, but Louis looked at us with his big brown eyes, so I signed and they took him onto the ward. His blood count dropped to 10% overnight so they gave him a blood transfusion, it was a red cell packed transfusion and he was given 2 bags. His PCV went up to 21%, we were told if he maintained this overnight then we could take him home, unfortunately it dropped to 19.5%. We were told he had a 70% chance of survival.
Over the next 3 days his PCV dropped to 15% so he would probably need another transfusion if it dropped anymore, the next day it dropped to 11%, we had no option but to give him the other transfusion. Our bill was raising by the day, we were at £4500 by this point. Louis survival rate went to 50/50, but we carried on.
On the 9th Feb we were allowed to bring Louis home because his blood count went up from 18% to 20%, we were so so happy and drove straight over to collect him. We went to weekly visits and weekly blood counts, on the 18th Feb he was still at 20%, on the 26th Feb we went 23%, we thought things were working!.
On the 6th March we took Louis and Olga (our other dobie) back to FOND (the rescue place for a visit) we were there for 4 days, and Louis was happy and bright and pottered about. But on the way home his left paw swelled up to twice the size, and he had developed a few small sores on his paws, we called Rutland and asked for advise, only to be told to take him to our own vet, I wasn’t happy at all, but he had his appointment with his consultant 2 days later and by the time we got home his paw had started to go down.
When we went to his appointment, we showed him Louis’s paw and the sores, his consultant said they were as a result of all the medication and he didn’t seemed overally bothered. He told us to go back in a week as normal, so on the 14th March we took Louis for his check up and his PCV had gone down 2% so he was now at 18%. His consultant told us he was going on leave for 3 weeks, and advised that there wasn’t any other consultant that could take over his care until he came back , so we could either take him back to our own local vet or have him referred to Liverpool Small Animal Hospital.!! As you can imagine after spending £5500 we felt quite abandoned.

We took Louis back to our local vet for his PCV to be checked on the 21st March and it had dropped to 17%. Then on Saturday 26th March Louis became critical and took him to our emergency vet because he had developed a 3cm ulcer under his tongue, which was stopping him from eating and drinking, we thought we were loosing him. The emergency vet tested his PCV and it was at 16%, she said if we didn’t get him to Liverpool Hospital he would not make it through the night, she called them and they advised it would be a minimum of £3500.

The choice was hard but I couldn’t let him go, so we said we would find the money somehow, we then set off on the 100 mile journey. When we got there they advised he would need a transfusion and they stopped all his medication except his pred, because the one of the medication had caused the ulcer.
After his transfusion his PCV went up to 24%, but by Monday teatime he was back down to 15%, and in need for another transfusion. We gave the go ahead for the transfusion and biopsy’s of his liver, spleen, bone marrow and skin lesions, as well as a repeat of all the imaging that Rutland had done.
They started some of his immune suppressants again, but his PCV just kept falling at a rapid rate, he was given another transfusion before we collected him and brought him home. We don’t know how long he has but we are looking at days I think if his PCV keeps dropping, I’m holding on to the last chance with Dr Dodds. If she says there is nothing that can be done then I guess we have done everything possible for our boy, this whole journey including medication stands us at £12,000 – people say we are mad but if he gets better it was worth every penny.

Love Karyn,

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