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- Ashki, 3 yo Golden IMHA
Hi, my name is Tamara and I am the lucky owner of Ashki, a wonderful 3 1/2 year old Golden.
He was diagnosed with non-regenerative IMHA 4/30. He is being treated with pred, cyclosporine, and mycophenolate; sucralfate and famotidine for prophy GI; denamarin and hepatosupport for liver support; ursodial for gall bladder support; flagyl for inflammation/thickening of intestinal wall and support for inflammation of gall bladder and liver; soloxine for bone marrow support and hypothyroid; B-vitamins and algae supplement. He’s also receiving acupuncture and reiki.
He’s received two transfusions, the most recent yesterday; two bone marrow aspirations/biopsies (most recent yesterday); two abdominal ultrasounds (also yesterday). His PCV was 11 on 4/30, went up to 27 after the first transfusion, dropped to 24 then 19 then 24, then 19 again for about 10 days, then 18 then 15, when we transfused again and did the other tests. He’s negative for tick and flea borne diseases. I’ve been corresponding with Jean Dodds and am feeding him her liver cleansing diet. We decided to do another ultrasound because he lost 2 pounds this week.
He’s being treated by a veterinary internist and a holistic vet.
Ashki has an amazing, incredible spirit, full of life and love and joy. Even when his PCV was 11 he wagged his tail and greeted the vet and vet nurse. He continues to be engaged with life and would really like it if I would let him dig after the gophers (which I do a little).
I’m so thankful for your website and your stories. This is such a roller coaster, and has been so very difficult.
Thank you —
Tamara and Ashki
Hi Tamara, I’m sorry you had to find this site, and I’m new to this too (Nula was diagnosed Easter Sunday) but it sounds like Ashki is on the right path, from what little I know. Nula too had two transfusions, one at 11 and one at 10. But she’s now at 43! There is definitely hope, she was so close to death but to look at her now you’d never know! The people on this site are incredible and such a huge help! Hang in there. Finger crossed for Ashki. Xxxxxx
Dear Tamara & dear Ashki
Welcome to you both – I’m so glad you’ve found us, but sorry for the reason you are here though -Ashki’s non-regenerative IMHA. Ashki is such a lovely name! He sounds like a really wonderful & sweet boy, full of love & zest for life – and he’s a very young chap too.You will find everyone on here supportive & caring as we’ve all experienced AIHA/IMHA first hand, which is awful – I don’t know what I would have done without my good friends on here when my greyhound Worzel was diagnosed.
We all hold Dr Dodds in such high regard & you could not be in better hands for treatment advice – I am relieved so see you are in contact with her. I assume the dosages of drugs have been check with her protocol? Internists are all different – it is sometimes awkward when they want to do things their own way & you want them to consult with someone else – just go with your instinct is often the best advice! It does sound like the internist is a determined person who really wants to help. You are obviously a great Mum who has been really on the ball with this. Do you have the bone marrow biopsy results? Did Ashki have any previous illnesses/problems or was he vaccinated recently?
I assume other tests & scans have been done to try to find the cause? – many owners never do find out what caused it. Some breeds are more prone to it than others too. Number one plan is to get some reticulocytes (baby red cells) on the go – do you have any test result figures on that? How long has Ashki been on the cyclosporine & mycophenonlate? Are there any other abnormalities in Ashki’s blood results? Sorry about the million questions – we like to know what’s been happening to try & help as much as we can. We only want to do our best to get Ashki better & to support you through mutual experiences – this is a horrible disease & we all need as much support as we can get – as you said, it’s a real roller coaster. Worzel was non-regenerative for a while and it seems never-ending & soul destroying, so I can understand exactly how worried you must feel – it is a very frustrating time when their PCV just doesn’t come up at all. Please stay in touch as often as you can – we will all be crossing our paws & fingers for some new red blood cells to appear as quickly as possible. The drugs do take a while to work, so as much as we hate it, we have to be patient sometimes.
Please let us know how Ashki is doing as often as you can & know we are all thinking about you. If there’s anything we can help with, don’t hesitate to ask.
Best wishes to you & Ashki
Sheena, Worzel & Ollie
Thank you so very much Ruth and Sheena. I’m so happy to hear that Nula is at 43!!
Ok, I’ll try to answer your questions Sheena. His bloodwork has been in the normal range with the exception of liver enzymes and bilirubin, though those are normalizing.
I just got a call from the internist and there’s good news from the initial cytology on his bone marrow — they’re seeing lots of immature red blood cells! This is very different from a month ago when they saw very few. We’ll get the full report Tuesday probably. Now they just need to mature and be released and stay healthy and viable!
This internist is very committed and caring. His nurse is wonderful too, she came in on her day off and sat with Ashki during his transfusion yesterday.
His other health issues are hip dysplasia (Dec 2012); he had a reaction to Frontline Plus on 3/25/2014 (redness, itching); he had a GI upset and was trying to bloat on 3/29/2014 (I thought his gums looked a little pale, but the vet tech said they were fine; they did not do bloodwork). After the GI upset he was not wanting to eat and lost some weight; he was gradually eating more, but then the last week of April he really did not want to eat again and became lethargic. I did not want to go back to the same vet that treated the GI upset, I was not happy with that experience, so I called the holistic vet who had been recommended highly to me. She wanted him to have an ultrasound to make sure all was well, and referred me to the internist. I looked at Ashki’s gums and thought they looked pale and called the internist office and told his nurse what was going on, including the pale gums and she said to bring him in. He had the ultrasound, a bone marrow biopsy, and a transfusion that night.
His last vax was a lyme vax December 2012. I titer for everything, and he will not get vax from here out.
He has been on cyclo since 5/1; we added the myco 5/15; he just started thyroid therapy this week at .3 mg twice daily, we’ll go up to .5 mg Monday (Dr. Dodds suggested doing it that way as he was restless when I initially gave him .5). Oh and we did test the cyclo level and it is good.
We could not come up with a cause. The only possibilites I can think of are he was hypothyroid and that threw him into it (his FT4 was very low, I had it tested at Dr. Dodds’ lab a little over a week ago) or he got into something when we were on one of our off-lead walks in the woods or at the beach.
He is an amazing dog, I feel so blessed to share his life.
Thank you again, so very much. Let me know if you have more questions. I don’t have his bloodwork results, I keep forgetting to ask for them. I’ll try to remember.
Tamara and Ashki
Oh, and I’ll see if I can figure out how to post a pic!
I forgot to answer your question re. reticulocytes — we are seeing very very few. I’ll see if I can get you numbers!
Tamara,
I am so sorry you had to find us, but glad you did. I am absolutely amazed on how much you already know about the disease and how well cared for Ashki is. having Dr. Dodds on board can make a huge difference, we all think very highly of her. Everything you say about Ashki’s treatment sounds great to me, the only thing that jumped at me was the algae supplement. Is is bio preparation? I would have a closer look at that, if it is the product I am thinking of it claims to boost the immune system. At this point you are still suppressing it so it would not be good to give something that boost it. As far as I know Dr. Dodds does not recommend the bio algae.
It sounds like Ashki is in very good hands and you have done a great job!
Best wishes,
Brigitte
Hi Tamara
It’s lovely to see his photo – he is one handsome lad with a beautiful big smile from ear to ear – no wonder you love him to bits! It’s great news that the later biopsy showed more reticulocytes – wonderful. My Worzel was producing reticulocytes in his bone marrow (seen in the biopsy), but his immune system was killing them off before they actually were released into his blood stream. He was non-regenerative until the azathioprine kicked in – that took a couple of weeks. It takes around 10 days for azathioprine to suppress T-lymphocytes (the guilty party in this killing of retics & red cells) & although I have no personal experience with cyclosporine, other owners have had to wait a little while to see any effect, but at least there are reticulocytes in the bone marrow – they just need to get out into the bloodstream now.
I know Dr Dodds will advise you on what to do next & you have a good grasp of what is going on here, so I know you will do whatever is best for Ashki. I am assuming he has no clotting risks (Worzel was the same), and if his bilirubin is dropping that is great news – less red cell destruction. Do you know if any spherocytes were present at all & did he have a Coombs Test? Sorry – more questions again.
I agree with Brigitte – please, please don’t use the algae unless Dr Dodds specifically wants you to keep it going. Some supplements can actually counteract the good effects of the immuno-suppressant drugs & that’s the last thing you want to do. The cyclo & myco are derived from fungi, so I would not risk using the algae personally. My amateur guess is the IMHA may be something to do with the GI problems Ashki has been having, but it’s hard to say. Noting the reaction to the Frontline, maybe Ashki has a sensitive immune system. Goldens do have a breed predisposition to hypothyroidism (I bet you already knew that!) & adding thyroxine which is haemopoetic can only help. The denmarin should help bring down the liver enzymes too – I think most of our dogs have had raised liver enzymes because of the hepatotoxic drug treatment that we have no choice but to use. Worzel’s came down nicely with the Milk Thistle (it’s in Denmarin).
I am amazed at your deep knowledge – do you have a medical background by any chance? I know you will fight this disease & you are doing the right thing keeping Dr Dodds on board & your vets & nurses sounds very good too. Come on Ashki – get those reticulocytes going & raise that PCV – we are all willing you to do this for you Mum!
If you want to, you can send us any blood tests, other tests results & biopsy results using the urgent advice area – that sends the attachments directly to us. I completely believe in Dr Dodds though, and I assume she has already seen all these things.
Anyway, wishing for some good results at Ashki’s next test – please let us know how things are going & if you want to ask any questions, please feel welcome to do so.
Crossing everything & sending the best possible wishes,
Sheena, Worzel (last PCV 63) & Ollie
Hi Tamara, it’s nice to “meet” you.
Ashki is just gorgeous and looks so happy in his picture. He’s so very lucky to have you for his mum.
First of all I’m thrilled to read that there are some baby blood cells happening. That’s wonderful news. Fingers and paws crossed that Ashki just gets better and better from now on.
You certainly have a drug regime going. If you need help with a drug chart, let me know. I’d be happy to make one up for you.
The bio algae also jumped out at me. I had read that it’s great stuff and ordered some spirulina for Bingo, got it home and read up on it and found out that it works against cyclosporine, so please check on this. It may be safer to drop this one for now.
Also the weight loss could be caused by the prednisone as it affects the muscles. They often lose muscle mass when on high doses of prednisone. Bingo went from 8kg down to 6kg in the first few months. It was terrifying to see. He became a walking skeleton with a huge belly BUT the effects of the prednisone (and there are many) all start to go away when the prednisone can slowly be reduced.
The prednisone also affects the liver and the liver enzymes will be out while on the higher doses, but the denamarin will be doing it’s bit to help the liver cope and the liver is such a clever organ that heals.
You might want to post the results here when you get them, or if easier, you can scan them and use the Urgent Advice tab up the top which will email them. Patrice and Sheena on this site are brilliant at interpreting results and can help you to understand what’s happening.
Your vet sounds great . The early days are crucial and it looks like they are certainly a dedicated bunch. You are brilliant to have noticed the pale gums and acted, even changing vets to get better advice and action. This has probably saved Ashki.
The people here are wonderful. We all hold each others hands through all the worries that we have to go through. We all love our dogs to bits.
Love Vally & Bingo (diagnosed Nov 2011 – in remission)