Two weeks with AIHA

[Gus]

Hello,
My Entlebucher suddenly collapsed at 12:00am on November 1st. After a morning and afternoon of wondering if she had an ear infection or vestibular disease, I tooke her to the vet on 11/02. That evening I had to rush her to the ER and get a transfusion. Since then, life has been a whirlwind of anxiety, fear and hope.

Pennie is 7.5 years old. She is/was about 58 lbs. She is a very energetic dog, high-strung at times. She did not just recently have vaccinations, this just came out of the blue. She was started on Prednisone, Mycophenolate and plavix. She was at the hospital until 11/08. She received transfusions on 11/02, 11/03 and 11/05.

I took her home on the 8th and kept a close eye on her, either staying home from work, or bringing her with me. her health improved slightly, but then her appetite kept diminishing…. making giving her pills ever more difficult. on 11/12, she went to see her internal medicine specialist and get her pcv checked again. she has been regenerating red blood cells, but her count was down from 23-25 at the last reading to 21. She spent the rest of that day in complete lethargy… and would not eat. her dr recommended tapering down from the mycophenolate to see if appetite would return… it did not, and she got worse by the next morning. knowing I could not force her to take pills like this on such an empty stomach, and seeing that she was quickly fading, I took her back the hospital.

Her pcv count was down to 18, so they admitted her and gave her another transfusion. At this point her pcv was now at 25/26, but she had developed diarrhea (which she had not had i the slightest till that point) and there was “black tar” in her diarrhea which they say means she is digesting blood. Also, her platelet count is low.

It is too early to say Evans Syndrome, but it is on the radar. She is still at the hospital, and I will her from them around noon today. the hope is that any of the following have some combination of more positive news than negative news: appetite, energy level, pcv count, platelet count, diarrhea.

The stress of this is extreme. honestly, I am happy that she is at the hospital, cause I want her to have every option possible to help her out. on the one hand…. she has made it two weeks. on the other, I need some good news.

She is an amazing dog, and has so much love to give and has so many people who love her beyond words. there is hope. but, I am exhausted. i just want good news.

Thank you to all of you posters. it helps to know I am not alone in dealing with this monster.

Gus

[Vally]

Hi Gus,

I’m so sorry to hear about Pennie and I’ve no doubt you’re exhausted and stressed to the max. I am glad you’ve found us though. We’ve all been through this and don’t want anyone going through this alone.

I’m glad she’s with a specialist. That made a difference with my boy.

First off, we’ve seen a few dogs now taking mycophenolate and having major stomach issues. Practically all dogs need a second immunosuppresent after prednisone and the drug of choice is Cyclosporine as it has much fewer side effects.

Also I think Pennie should absolutely be on stomach protection. The drugs, especially prednisone, is very harsh on the stomach. Can you ask about giving Pennie Sucralfate. That’s the best stuff. Only it’s important to make sure it’s given away from food and meds as it stops absorption. My boy suddenly had black poos and this fixed the problem up within a day. So truly, magic stuff.

It’s great she’s on Plavix. Blood clots are the number one killer of dogs with AIHA.

When she gets out of hospital, make sure you ask for a copy of her blood test results. If you’re not familiar with blood tests, you can post them through the Urgent advice and someone will have a look at them for you and help to explain what’s happening.

We’re all over the world, so different time zones, so someone is usually about at all times. I’m in Sydney. Please post whenever, ask anything at all, someone has been through it. We’d just love to help in any way we can to get Pennie happy and healthy again – and home.

My best,
Vally & Bingo (diagnosed Nov 2011, in remission).

[sheena]

Hi Gus

It is an exhausting & worrying time when they are going through the acute initial stages – hospital is the best place, absolutely, even though you HATE leaving them. I’m so pleased you’ve found us.

Vally has huge experience with helping owners for many years – please read carefully all her suggestions – I completely agree with all she has said – she kept me from going insane with worry when my dog Worzel was diagnosed with bone marrow failure – luckily, he has been in remission for almost 3 years now, with the help of the lovely people on here.

 

Mycophenolate Mofetil is an immuno-suppressant drug used for the treatment of  auto-immune conditions such AIHA, some types of cancer and as an anti-rejection drug for human organ.

Mycophenolate mofetil is not well tested for dogs but in our experience (and a veterinary clinical trial) it can cause serious & intolerable gastro-intestinal upset – diarrhoea & vomiting. I would also urge your vet to use cyclosporine instead for this reason. I am so glad to read they have given plavix to prevent Abnormal or Inappropriate Clotting of the blood is also called Thromboembolic Disease.This is one of the most important risks to understand about AIHA/IMHA. Clotting can be caused by:1. “Damaged” or abnormal red cells due to immune system partially destroying or biting lumps out the red cells. Can I emphasise the impact of the drugs on the GI tract too – sucralfate is also vital, especially if you suspect blood in the poo – it is the BEST way to prevent & heal ulceration that we know of.

That’s the ‘lecture’ bit over! Now I want to say that we will always be here to help & support you – each & every one of us has struggled through this devastating disease, especially worrying in the don’t eat anything phase, and we have learned an awful lot about how to combat the problems. That means we can now help you – you must never feel alone – one of us is usually awake to comfort & advise you.

Vally mentioned that you can upload blood results & any other results on the Urgent Advice page. A blood smear would be very informative too – always ask for one when you get tests done as it can reveal fine detail about what is happening to blood cells – even indicating the cause or trigger in some instances.

Please keep us in touch with any news you have. I would recommend using a Specialist in Internal Medicine with as much experience as you can find – getting the correct treatment protocol is the most important thing. If you can’t find anyone you are completely & utterly confident in, you can contact Dr Jean Dodds through the Hemopet Resource page. Even though I was lucky enough to find a wonderful specialist, I also consulted with Dr Dodds the internet -she is incredibly knowledgable – She is always happy to work with our vets too – local or specialist – and has helped many of us get our dogs in to remission.

Big hugs (needed at this stressful time!)

Sheena, Worzel & his friend Ollie

[Gus]

thank you both so much!

she is still at the hospital, and I should get another call in about 3 to 4 hours. dealing with this alone is taxing beyond belief. I have had some dark moments.
I absolutely adore Pennie, and will do everything I am able to in order to save her. I will check to see which meds she is currently on, as her Platelets</h4>Platelets (thrombocytes) are clear, disc-shaped cells which are part of the line of white blood cells. Platelets are a vital part of the clotting mechanism of the blood system. When tissue damage occurs, platelets are activated by clotting factors to form a clump or aggregation to stop(…) Term details‘ class=”glossaryLink ” target=”_blank”>platelets seemed to be holding last night, but hr PCV was low. I did not get a call, so she may not have needed another transfusion. we just need to find a way to deal with her GI issues. diarrhea and more recently vomit, along with her lack of appetite worries me. she is TERRIBLE at taking pills, so getting her appetite back would be huge.

I will update, when I get the call.

thank you for your support in this.

much love all around,
Gus & Pennie

[Gus]

Pennie has not eaten in 36 hours. she is getting a feeding tube through her nose today to get some nutrition into her body. her BP is way up, and she has some fluid (scan) in her belly. she also has something with her kidneys… I did not take good notes.

she is on a “full spectrum of stomach medication” she did not need another transfusion last night. she has an edema on her back leg.

they want me to come and look at her…… ( I already want to visit her, but I read the underlying message to be “to see for myself and see if we should continue treating her”)

my heart is absolutely broken.

[Gus]

it really sounds as if they all believe she won’t make it, but won’t tell me that. I can’t bring myself to euthanize her.

but I’m starting to think that it is unavoidable.

[admin]

Hi Gus – I am so very sorry to hear this about Pennie. It does sound serious. This is, as you know, a really really vile disease. She is in the best place, and they will know how to make her comfortable. I know – only too well – how very hard it is for you, too, but try to be strong. She needs you to be strong. When you go to visit her, see if you can try to keep your head clear and calm. I appreciate that that is extraordinarily difficult, but it will help her if you can do it. You will know – because she will tell you – if they should go on with the treatment. Please be as open to her as possible; focus on her before you listen to what the doctors have to say. Maybe she still has some fight – and everyone here hopes so, and will pray for her (and you).
Whatever she tells you, Gus, we are all here with you.

Lynda B

[admin]

If they talk about euthanasia, listen first to Pennie, and then to your heart. It is one of the toughest decisions we ever have to make, but sometimes we have to let them go. If that happens, just be there for her, giving her every ounce of love. She will know; I believe that with every part of my being. Just know that she will understand how much she is loved

We are here for you, don’t forget that

Lynda B