Boston Terrier COCO – IMHA – Day 21

[Jen]

Hi there, I will preface my story by saying I’m not sure the difference between AIHA and IMHA. I’ve googled this but some websites say they are interchangeable and other sites attempt to explain the differences using medical terms that I just cant wrap my brain around.

My Boston Terrier, Coco, is 3 years old and was a happy healthy spunky dog until 6/4/21.
On 6/4/21 she seemed a little not herself but I tried to shrug it off. On 6/5/21 I was sure something was up but didnt know what so I kept a very close eye on her. She slept most of that saturday, June 5th. I did call the vet but without vomiting or anything they said to just keep an eye out. Then I saw it. Her urine was dark. My stomach dropped. I tried to stay calm for a few hours and tell myself it was a UTI. I knew I would need a sample for the vet so I waited. Next time she went out I slipped a cup under her and gathered the sample of urine. It was the color of coffe. At this point it was 5:30 pm on a Saturday night. My vet was no longer open. I began calling the closest emergency vets that I could. One was at a 10 hour wait. TEN HOURS. The next was available but said they didnt have an ultrasound that was working. Third one was a charm. They are 45 minutes from my home. Coco and I jumped in the car and headed there. They took her in (still on curbside service since the pandemic) and called me 20 minutes later. They told me her PVC level was 14 (little did I know I would become obsessed with this number in the next several days) and said they needed more tests. I had them bring her back to me to kiss her goodnight and I headed home without my Coco. I was so scared. Over the next two weeks Coco and I made the pilgrimage back and forth many times. On 6/7/21 she had her first blood transfusion. PCV went to 26. On 6/8 she was at 22. I was prepared to pick her up on 6/9. On 6/9 they called and said she had dropeped to 17…this continued on for another week with her PCV bottoming out to 12 at one point, and she ended up have three transfusions. After her third transfusion on 6/14 her number went all the way to 43 and I finally had some hope. On 6/15 she was at 38 and I got to bring her home. We went back on 6/17 for a recheck of PCV and she was 35. Vet was still happy and I got to bring her home for a whole week so I was pretty happy. We had her one week recheck yesterday (6/24) and she was at 33. Her CBC is 36%. In three weeks they want to check her urine protein and run another CBC. Her gums are pink and she is getting her energy back a small tiny bit each day. I have hope now, but I am terrified. I am hoping to begin feeding her fresh food but I am finding so much conflicting information on what she would benefit from. Any suggestions??

PS – I was going to upload her labs but the thing says its for urgent requests and it’s not really urgan right now. Except for figuring out what to feed her.

[Patrice]

Jen,
I’m sorry to read about Coco. You had a difficult time getting care but you kept at it. Good job.
AIHA is an older term meaning autoimmune hemolytic anemia. Sometimes vets felt that the condition was caused by the immune system attacking the red blood cells without a credible reason.

IMHA means immune Mediated hemolytic anemia. The difference is that now there is more research and its most likely that the condition is caused by several cumulative triggers, some of which can be tested for and treated. Some triggers are breed related, as in a genetic predisposition.

The vet paperwork would help me look for testing that should have been done to look for triggers. It also highlights the dogs history that may have clues that led to this.

An example would be a cocker spaniel female that has a breed disposition. She may also be in heat, received multiple vaccines during a precheck for spay surgery and then there was unusual bleeding during the surgery.

So knowing Cocos history from your perspective is important. We are also looking for many triggers such as tick disease, foods or poisons, recent vaccines, spider or snake bites, medications, canine allergies, sensitive stomach from a young age. The list extensive, and something you probably know better than your vet.

Right now we also need to know each medication and the dosages and times they are administered. There is a routine protocol most clinics use no, along with any tests done such as a test for tick diseases. The vet may want to do an ultrasound in an older dog for unusual growths, as tumors can also be a trigger. Hypothyroidism is a very common contributor and a full thyroid panel should be done.

A PCV that wavers is normal after a transfusion. What we would look for now are signs of a continuing drop over time with no recovery. I dont see that from what you describe.
My best Patrice

[Jen]

Patrice, Thank you. I can’t believe how calm your note here made me feel. For the past three weeks I’ve been told over and over by several doctors that there just isnt any way to know what comes next and I have felt so lost and honestly…alone. I’d never even heard of IMHA and now it’s consuming my entire world. Thank you for your time and your help. It’s so interesting to me that you mentioned sensitive stomach from a young age. I adopted Coco a year ago and I have her original papers and she has several notations and medications for GI upset since she was a puppy. You’re the only person to have thought that could mean anything at all. Is there somewhere I can send all of the results and history? Thank you again. you’ve truly given me so hope here tonight.

[Patrice]

Jen,
This website has been up for about 13 years, I lose track. Valley and myself both went through a terrifically difficult time with our dogs many years ago. So I developed this site to help owners to understand the medical information being thrown at them, educate them and help them make decisions without emotional influences. I disliked social media sites like FB because the information wasn’t always accurate, most of it is guesswork. I wanted to make sure everything I wrote was accurate.

So what you perceive, vet confusion, is something we are used to seeing. Its discouraging to us to this day. There are well known step by step protocols that focus on immediate treatment and doing proper diagnostics. The sooner a dog in emergency care gets the proper care, the better chance they have of surviving. In the first days the risk of uncontrolled improper clotting is very serious. There are protocols how to treat potential DIC, disseminated intravascular coagulation, which can lead to death. If we are able to intervene at that point we can provide advice what to specifically ask the vet to do.

Some vets don’t do proper diagnostics quickly. Not all hemolytic anemia cases are autoimmune, some are related to things dogs have swallowed, such as foods poisonous to dogs (onions for instance.) Tick diseases can cause IMHA. Treatment is doxycycline.

So in Cocos case we need to make sure your vet is actively researching those things they can test and treat. I am a firm believer in success if a dog is treated properly immediately.

But don’t sweat this, we can help you understand the things you need to care for Coco. Your job is to be calm and cheerful with Coco. We never can absolutely predict everything will be fine, but we do want to not worry around him. Dogs pick up on our emotions and will think something is wrong.

Please upload any testing paperwork to the Urgent Care page. Please try to keep the page size small but also readable. If you have trouble getting copies, tell them you need them for your book keeping. You paid for this, it belongs to you. Be polite but get it. Be gracious when working with the staff but also be determined that you drive the bus. You are an equal partner in Cocos care, you are the one giving him meds, feeding, monitoring etc at home.

We will look it over and help you understand what is happening and what to expect.
My best Patrice

[Vally]

Hi Jen, welcome to the site, although I’m sorry you had to come looking.

Coco is sounding as though she is doing great and I’m so pleased. Your work to get help I’m sure saved her life.

As Patrice said, so many times we’ve come across vets who just didn’t know what they were doing and did so many unnecessary tests and the right treatment wasn’t implemented fast enough and what became apparent was that fast hard treatment was so important.

Foodwise, stick to what Coco normally eats, although make sure it’s not too high in fat. I wouldn’t change her diet too much, especially if she has a delicate tummy. One thing I would do is make sure she’s getting good quality lean meat food. You want to avoid any chance of pancreatitis, especially while she’s on prednisone.

Do upload the paperwork. Patrice is amazing at understanding it all and can help you understand what’s happening. And yes, if you don’t have a copy of all the tests, ask for them. I always said it helped me to get my head around it all if I could compare the tests to see progress.

Coco, you are a very lucky girl to have such a great mum.

Regards, Vally.

[Jen]

Thanks so much Patrice AND Vally! I am unfortunately not able to upload through the urgent advice thing because the “captcha” isnt showing for me. I tried two computers and my phone. Any other ideas?

[Patrice]

Jen,
It worked, I have the pdfs. No worries.

[Jen]

Oh! I’m so glad! Thanks