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- New to AIHA, dog in trouble
Rick,
It sounds like you have researched very carefully and understand a great deal. I admire you for taking the care to do that for her. What you had go through to get her care was very difficult.
Can you say when the last good meal is that she ate? Has it only been a day or two or did you notice that she lost her appetite about a week ago when she first did not feel well? Was she ever a good eater or is this a rather new symptom? Can you pinpoint anything at all that was different that day?
However, sometimes dogs just don’t feel like eating. It’s a tough decision whether to let this go for a bit of time or to intervene. Clearly it is not ok for them to stop drinking. If you have to use a baby med syringe from the pharmacy to get her to take water then you must do that. If you can make up a little slurry of over cooked rice water (rice congee) with some sugar and a dash of salt then syringe that slowly into her cheek, all the better. I agree that the prednisone is bothering her stomach and it is far better if she is eating something with it. My vet told me to use something very smelly like fish. I had a number of things I rotated through like cream cheese, real canned cheese, liverwurst, canned sardines.
It is difficult to determine how she is reacting physiologically to her meds, due to the fact she has been on prednisone prior to now. Though you did say she was on 1mg of pred per day and that is quite a low dose. Some AIHA dogs continue on with a low dose like this for the rest of there life. Keep some notes in the kitchen so you can recall how she is behaving during the day so you can report when you next talk to the vet.
So she is now on 40mg per day? Are you splitting that BID, twice a day with food? This would be the ideal way to give this.You most definitely want to be giving her stomach protection such as Pepcid or Prilosec an hour before those meals. We can never quite know whether a dog will develop stomach ulcers, but my experience is that it is far better to just plan on that eventuality, be proactive and protect the stomach.
The sucralfate is excellent at healing any possible ulcers that may develop. It is kind of like a mucous internal “band-aid” for the esophagus and stomach. Because of that you must be careful to not give it too close to when you are giving food and medicine because they will not be absorbed properly. Timing meds can become difficult the more of them you give, but I found that giving the sucralfate on an overnight fast was the best for Chance, it had all night to work. If you cannot accommodate that then be sure to give it at least 1-2 hrs before a meal with meds or at least 3-4 hrs after.
I knew that the PCV would drop like this, it is a common occurrence. She may end up settling in a bit lower than this. There are three broad ranges of PCV values. Mild anemia is usually around 30-32 to 37%, moderate is approximately 21-30% and below that is variably considered severe. Each dog is a little different in how badly they feel at certain PCV’s. Some dogs can tolerate 8% and seem as happy as ever, other dogs are just not well off at that value. So determining a “transfusion trigger” point is a variable dependent on a combination of the actual PCV but also the clinical evaluation by the vet. However most vets would probably think of 20% as an acceptable value to consider another transfusion.
The first transfusion a dog gets is “free.” That means, unlike humans who must always be matched, a dog can take any blood type for the first transfusion without reactions. Dogs have approximately 11 different “types.” After the first transfusion a dog must be typed and matched for the next one to avoid reactions. Being in facility that is prepared to do this more complex step in an emergency is good insurance. There are different blood products available too. My vet was able to use whole blood directly from her own donor dog. The next best product is packed red blood cells. In an emergency, super washed red cells will reduce the transfusion risks significantly but the washing does reduce the number of RBC and platelets.
I always think what I would do if this were my dog. I will always be quite honest about how I feel.
So, if this were me, I would consider these first few days a period of emergency. I would find, if I could afford it, the best specialist in town. I am lucky that my own country vet is the best specialist in town, but not everyone is that lucky. If your instincts are telling you that you need to feel a bit more comfortable about a second opinion AND you think she can handle being taken to a new location, then any vet should graciously welcome a valid second opinion and may even be polite enough to refer you. This is not a straightforward case, she has complications with the Addison’s condition, that is reason enough. Never burn your bridges, be polite and thankful for the great care she has been given. You may have to go back there.
There is still a great risk for clotting emergencies right now. Please request permission to give her low dose aspirin therapy. This therapy has been researched and is an approved protocol for treating AIHA canines. A dog that has active hemolysis needs to be protected.
Yes, the accuracy of these blood tests can be variable and there are common mistakes that can result in wrong values. Some vet techs are wonderful, they take great care with their job. Seek out those techs and be sure to ask for them each time you visit. The decisions you will be making are dependent on the accuracy of these tests. You are her advocate, get what you need as politely as possible. I promise you that this will be of value.
If she is resting tonight and is not struggling, why don’t you get a few hours of sleep and then take her in early in the morning, is there someone else that can stay awake while you sleep? That is a good compromise. You will get the morning staff at their best before the rush starts.
my best
patrice
Hi Rick. I am so sorry you are going through this with Brady. I am out of the country, with limited internet access but wanted to let you know I am keeping up with your posts. All here are incredible and helped save my pup, Sadie, whom today is doing well. This wretched disease CAN be best.
A couple of things – has anyone suggested cyclosporine being given along with the prednisone? This was the turn around for Sadie. I didn’t see it mentioned.
Also, I still keep on hand, Cerenia, for Sadie when she shows tummy problems. She has had noore than 6 in the 1 1/2 years of her battle with AIHA, but when she got to where she could not settle down (repositioning, stretching out constantly like in pain, etc.), I would give her one tab and it helped tremendously. A motion sickness drug, but helps the upset tummy well.
Also, and very hard to do, we all know this as gospel – please try to get some sleep. As Patrice said, you are Brady’s only advocate, and you must stay healthy. Pease take care of YOU too.
My best to you and Brady. Stay strong. You are already doing an amazing job. Patrice is a master with her knowledge and the rest of us are with you too. Here for you always.
Love to you and your precious Brandy, Linda and Sadie
Hi Rick, I am so sorry you had to find us, but I am glad you did as the people here are the best and will give you such good information, advice, and help that is invaluable. I’m going through the fight right now too, my Ashki was diagnosed 4/30 and he is finally stable. Those first few days and weeks were so scary and overwhelming.
I also want to encourage you to seek a specialist if that is what your gut is telling you that you need for Brandy. I am fortunate in that Ashki’s care from day one has been managed by a veterinary internist at a clinic that is a combination specialty/referral clinic and ER vet. It’s been wonderful because no matter what day or night if I’m worried I can call and take Ashki in (and I did several times, to get his PCV checked and have him looked at). The internist had a flag on Ashki’s file to call him whenever I called or came in so he was updated immediately and had access to all the notes when we were in.
I also want to say that I am so glad you are fighting for Brandy — you know her best. It sounds like she and you are both fighters, she is so fortunate to have you for her advocate and to have persisted on her behalf int he past, that persistence will serve you well now.
I am thinking of you and Brandy and sending you both hugs and love. Take care of you, rest when you can. This is a marathon, you can do this.
Tamara and Ashki
Rick, I also wanted to mention something that has helped me a lot — you may already be doing it because you are so on the ball — keep a notebook on Brandy’s meals, meds, behavior, pee, poop, PCV, etc. This has helped me a lot. Also, you may want to build a spreadsheet with her bloodwork to keep an eye on trends. I’d be happy to set that up for you, I made one for Ashki and it’s been very helpful.
sending you and Brandy love and hugs —
tamara and ashki
Thanks to everyone for the support.
Brandy crashed again around 11pm last night and I took her to a different veterinary hospital that includes specialists. They spent a lot of time understanding her history and it is obvious that they really care.
Her PCV was 17 when admitted.
They were quite concerned about the blood match and gave me the sample and pigtails to take to the lab 30 miles away at 2am. They started the transfusion shortly after they got the results and went very slowly to ensure no complications. They also started her on cyclosporine to try to more quickly stifle her immune system.
She is still in the ICU and it has been 12 hours since completing the transfusion and she is doing well. PCV is up to 22%.
She still isn’t eating, but it is unlikely she will eat at the hospital. At home her meals are very closely regulated in quantity and time. Any extra fat or protein will give her an upset stomach. They are treating her with Sulcrafate and an acid reducer. They have also started her on a an anti-coagulant.
She last had a full meal on Thursday evening, but she was very reluctant to eat.
When her stomach is upset she will only eat pancakes, peas, and crackers so I will take these in to the hospital tomorrow. Hopefully she can come home tomorrow and will eat.
I will try to get some sleep tonight.
Regards,
Rick
Hi Rick!
I’m sorry that you had to join us here with Brandy’s diagnosis; however, you are in a great great place. This forum has kept me sane thru my pups treatment and everyone is beyond kind and patient and knowledgeable.
I’m of limited help but I can say I am super happy you are seeing specialists — I think that was very important for my own pups improvement. Also.. Super glad to hear they started him on anti-clotting meds. I think that’s super important and like you, it wasn’t until I moved to a specialty clinic that we started that.
I know it’s hard but try to get some rest — you can’t help brandy get better if you don’t take care of yourself. That’s something everyone on here reminds me of on a normal basis and it’s too true.
Hugs to both of you!
Hope
Hi Rick. Just checking in on you and Brandy. I hope you were able to get some sleep.
I am VERY glad to read Brandy is now on cyclosporine. And the anti clotting meds, tummy and liver protection too, are a must. Sounds like THIS team is doing all the right things, very cautious AND listening to YOU (this is key). Way to go – you are doing a fantastic job and so glad you’re bypassing her age and doing all and everything you can for Brandy. She’s a lucky girl to have your love and committment.
The cyclosporine will take a while to kick in, but I’m sure they have told you that. The combination of the two, prednisone and cyclosporine, really got Sadie going, as has it with other pups here. What is her dose do cyclosporine?
Hang in here. You’re doing ALL the right things and your diligence is to be commended.
Love and hugs to you and your Brandy,
Linda and Sadie