IMHA grief and how far do I go – Page 2

Keymaster

Samia,
I am so sorry to read about the difficult time you are having. This must be very stressful for you.

First, I agree with Vally. Given Zoe’s history (she was normal one day and not the next) I am confused why they don’t add cyclosporine to the treatment with prednisone. I believe the Imuran, (a harsh cancer drug), is suppressing the bone marrow.

I can’t tell from your writings if they believe she has stopped destroying her red blood cells yet. They would have done some tests to determine this, looking for types of cells in the blood and monitoring her clotting. Without this information it is difficult to decide if she is actually still destroying RBC or if she has STOPPED making RBC. Do you have copies of any of the tests that have been done on her, I would love to look them over to help you figure this out.

Removing the spleen is a treatment that was once very popular. The spleen is an important organ in the body, and a bit more in dogs. It has various jobs, the main one is to store blood and release it when it is needed for stressful situations. It also is the cleaner of blood, it destroys old worn out RBC and recycles the materials. You see this as the coloring in your urine and stool, it is the iron in the heme molecule inside the RBC. And finally it is a companion organ to assist in immune protection. It monitors the blood elements all the time looking for abnormal things that might be parasites etc and activated the immune system to destroy them.

When a dog develops IMHA, the spleen can be suspicious of the RBC ‘s it is monitoring. It may begin destroying RBC in a mistaken belief that these are the trouble makers. But generally now we understand that there are many other factors that are involved in autoimmunity that lead to the destruction of RBC and the spleen tends to be less of a factor than once thought. Other things should be checked for early in diagnosis and treated as possible. The spleen is the less guilty party here.

So the guidelines about spleen removal are pretty clear that this should only be done if the case becomes intractable. Big word. It means you have tried everything and nothing is working. No response. I am a little uncertain about what they exactly have done to this point but if they haven’t tried cyclosporine, they have not done “everything” possible.

Some of the causes for this to happen to dogs are not directly tangible. That means there is no way to look inside the dog and see everything that is going on. In humans, it is a requirement that doctors must do everything possible to determine what is wrong and they may not give treatments until they have done this and found specific results pointing towards a diagnosis. In veterinary medicine this is not the case. Vets often try treatments that they have been successful with previously and they will develop protocols for the clinic to do these things regularly. They may also use treatments that are not approved for veterinary medicine, but are used “off label” in dogs. For instance in canine heart disease there are many drugs given that have only been tested and approved in humans. They work so they are used.

So the research for spleen removal cautions, don’t do this unless you have looked for everything and treated with everything, including the kitchen sink. Below this paragraph is the statement that most aligns with the thoughts from researchers and vets about splenectomies. Since Zoe has been on immunosuppressive drugs she is at great risk for infections. I just don’t think she could recover well from this surgery and it would be a big job for you to take care of a dog with this large of a surgical suture. She would be very debilitated for several weeks. Can you provide this care while you are getting your own care?

“Consider splenectomy only in patients that have not responded to immunosuppressive medications, that require high-dose and long-term medications to maintain a remission or that are experiencing severe side effects from medications. Because there is an increased risk of developing a number of infections after splenectomy, the surgery is not recommended for patients taking multiple immunosuppressive medications. In addition, before performing the surgery in a stable patient, you will want to be sure to have negative test results for infectious diseases or consider empiric treatment for such diseases first.”

A transfusion would be helpful right now and I urge you to again ask them to take her off the Imuran and put her on cyclosporine (in the US it is a veterinary drug called Atopica.)

Please go to this page on our website and print and save it. (Please use chrome to do this if possible) You can expand the panel with the arrow in the right upper corner to open it to a full tab. There will be ways to print and save in the upper right corner.
https://docs.google.com/viewerng/viewer?url=https://www.secondchanceaihadogs.com/wp-content/uploads/2017/12/IMHA.ITP-by-Jean-Dodds-Updated-Feb-2015.pdf

Read this over. Note #3. For severe cases, other immunosuppressive therapy is given. We much prefer cyclosporin. The dosage is given after this.

Please present this to your vet and suggest that they try this treatment, along with another carefully matched and typed blood transfusion again.

This is the treatment I used to save Chance and one that many of the owners who come here have used to save their dogs.

If you have any test results please use the Urgent Advice page in our menus to upload these tests to me.

Do you have any more questions?
my best patrice

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