Sunny – Page 22 – Second Chance AIHA Dogs

Keymaster

Maura,
While this website is titled AIHA Dogs, it is also titled Second Chance, after my dog Chance who had bone marrow failure. While we talk about AIHA or IMHA most of the time, the reality is that a portion of the dogs that we help have this rarer form of autoimmune diseases: bone marrow failure.

The signs of bone marrow failure include a lack of proper regeneration in the bone marrow. What does this mean?

Each day, in every human and dog, we make new red blood cells in our bone marrow to replace old worn out red blood cells (that are replaced at about 120 days of life). We also make new white blood cells and platelets.

All three of these cell types come from the same stem cell, a template, that goes through various stages of growth to mature. See this diagram that shows this development:
https://www.secondchanceaihadogs.com/AIHA_Terms/hsc-hematopoietic-stem-cells/

In autoimmune non-regenerative anemia, which is what Maura has, at one of these stages of development, the immune system attacks and destroys these developing red blood cells. Look at this diagram carefully and you will note that this attack can be focused directly on the red blood cells, but it could also be directed at the white blood cells or even the platelets. So some very unlucky dogs have losses in all three types of cells, not just the red blood cells.

Why does this happen? The immune system is complex and researchers still study this trying to find answers. So what I tell you is from some of that research. Dr. Dodds has been researching and applying her knowledge of this dog condition for over 30 years.

Many things influence the immune system and can include:
Genetic influences, Pregnancy, Stress, Hormonal Irregularities, Nutritional Influences, Adverse Drug Reactions, Viral Infection, Frequent or Recent Use of MLV Vaccines, Underlying or Concomitant Disease, Other Autoimmune Disorders (such as hypothyroidism.)

This is a large list. Due to this complexity it is often not possible, even with a ton of testing, to find the CAUSE of bone marrow failure! What do we do? And remember, this can happen to humans as well. It can be slightly different, but in a sense it is the same thing.

Well, in humans we just can’t put them down. My vet told me that in humans, if they are not making blood, we give them transfusions and support them until we can figure out how to help them make blood again. This was a wise thing to say to me, personally, because I had been feeling that way about Chance but didn’t know how to express my feelings. Even as sick as he was, he still had a very strong will to live. He was still interested in his family, his yard (which included even barking and running at a squirrel) and in keeping Cassie “under control.”

So here is how Dr. Dodds views the diagnosis and treatment of these special dogs. We may never know, or at least understand the science, of why this happened. So don’t spin your wheels trying to understand it. It took me a long time to actually understand that and accept it.

So Dr. Dodds’ approach is this. In dogs (unlike humans) we can try out therapies to see if they work. Well, it’s not as willy nilly as it sounds. Dr. Dodds’ vast clinical experience has led her to understand what treatments work well. It’s that simple. She can try one on a dog and see if it helps. So that is exactly what we did with Chance, try her treatment to see if it would help. Then she said, if it didn’t, we could go on to further diagnostics or try other treatments.

The Atopica, the first thing we tried, worked. It was that simple. This was 2007 and I could not even find information on the internet for non regenerative anemia in dogs! But she had been applying this treatment, using cyclosporine, since 1988.

And today, long after her first use of this in dogs, cyclosporine is slowly becoming the treatment of choice, not only in dogs with non regenerative autoimmune anemia but also in dogs with regenerative anemia.

If you wanted to target the bad guys who are stealing in your neighborhood, you wouldn’t capture everyone who lived in your neighborhood, you would trap only the bad guys, correct? That is exactly what cyclosporine does, it targets the “bad guys” of the immune system ONLY. Prednisone and Azathioprine target the whole immune system and the side effects are very bad. So using Atopica has the benefit of less side effects. In particular Azathioprine works in a way that can lead to suppression of the bone marrow if used long term, so its not that great either for treating this condition.

So how long do you wait to see if this works? Well, there is no time table, but if, within say 2 months, there is no change, then you do need to look at other causes. Transfusions help while you wait and research.

How long can you go on like this? Well, certainly not indefinitely. In humans it is not possible to “put them down” so we keep them comfortable and support them as best we can, but they may die if the doctors can’t find a good treatment. In dogs, we do have the choice of compassionate euthanasia. Why? Well, at least in the US, dogs are considered property so the law allows this.

How do we feel about this, morally? Everyone has a different thought. We try to honor all those thoughts. We cannot tell anyone what to do. It is their choice alone. We can offer our stories and tell you why we waited, or didn’t wait, or how our dog failed during the treatment and didn’t survive. In some cases a family could not continue treating because of finances.

But the important part is that you understand the condition and you understand why you made the decision you did, one way or the other. If you do this you can be comfortable with your decision and not feel guilt. Guilt is a monster, it can destroy your confidence and lead you to make faulty decisions.

No matter what happens, the important thing is that you are with Sunny and that is all she understands. She does not “know” about death. She can’t fear it. She does not fear future pain. She lives in this moment, right now. Each moment that you are with her, are happy and love her, is all she needs to know or all she understands. She does not judge you. She agreed a long time ago to obey you in all things and your responsibility to her is to make good decisions. Make those decisions with a clear head and out of deep love.
my best
patrice

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