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Hi Bethany,
I am sorry to read about your 12 year old.
I think that your “RBC 10%” is really Hematocrit 10%. That is the most important measurement of the seriousness of the anemia. This value is very low and she should be in the hospital. Have they discussed a transfusion yet? I think at this point that should have been on the list of things your vet discussed.
Please remove the Iron supplement. I’ve never seen a case in many years that the cause of the anemia was low iron. That applies more to humans that can have a type of anemia due to low blood iron. Dogs do need some iron and that is stored in the liver, but too much can be toxic and lead to serious illness or death. I fear that this is part of the reason she feels so ill.
Prednisone is a very strong medicine. Dog’s stomach acid is much more acidic than humans. If a dog has a prednisone pill in the stomach, the high acid can eventually cause ulcers in the stomach lining. To reduce this risk, always give with food. Also to reduce the risk even more, buy some soft white bread and prepare this to hold the prednisone into a “sandwich.” Prednisone pills are bitter so you must be careful not to handle it directly while doing this. Take the white bread and make a smallish cavity, put something tasty and smelly in the bread like peanut butter or cheese and carefully stuff the pill inside. Rinse your hand and then squeeze the bread tightly. Take a second piece and just add another bit of cheese or pb. Offer the second piece first so she will smell it and take it. Then right after that give her the other ball with the prednisone inside. Prednisone ulcers can lead to pancreatitis as well, which may also cause a poor appetite and extreme pain. I am suspicious that she already has ulcers and maybe even pancreatitis.
To heal this ask your vet for a bottle of Sucralfate tablets or search on line for it. This is not a medication. It is like a thick “bandage” that coats the esophagus and stomach lining. Humans use this as well. It heals and protects from ulcers. The sooner you get it the quicker it will heal any existing ulcers and prevent new ones. Only give this to her at bedtime for an overnight fast. It does interfere with the digestion of medications and nutrition of food. Give one a day at bedtime.
In addition the high prednisone dosage can cause many organs to have severe difficulties. The liver for instance is the organ that processes the prednisone. It can become highly inflamed doing this work. It has to sacrifice liver cells to process the prednisone. We will see several organs showing high enzymes on the vet’s chemical screen, that will make her feel very sick. We recommend that you use Denamarin. You can go to this page on the website and read about it, it’s not a drug, but it will help the liver heal. https://www.secondchanceaihadogs.com/second-chance-resources/supplement-resources
You note that the link I just sent to you also points to many other resources. Hover over the Second Chance Resources and click on one of many pages that explain many different parts of the treatment.
Has your vet discussed going onto any other immuno-suppressants? I am afraid that long treatments with just prednisone are going to diminish her health further. 80mg is a very high dose. On this page the top three drugs are discussed that can be used to help a dog recover. https://www.secondchanceaihadogs.com/medication-resources
If your vet has not discussed this with you do you have another vet source where you are? An emergency veterinary hospital might be a better choice. Please check with us before you chose to move her to a different vet. But do call them and ask if they can help you better.
Vally can help you with your medication chart so you are timing (and properly giving) your meds. She can also point you to the page and explain how to provide a liver sparing diet at home. It’s important to keep the diet very simple.
My best Patrice
Hi Jacqueline,
I’m sorry to read about your Husky. If he is in treatment for AIHA or IMHA, he is receiving high dose immunosuppressive drugs. This decreases their ability to fight off bacteria etc. One of the drugs that is usually given is prednisone. This drug is very strong and can in some cases cause stomach ulcers and in rare case can lead to pancreatitis, both of which are painful. It your vet suspects tick disease your dog may also be on doxycycline, a strong antiobiotic, that can also lead to stomach ulcers. All these drugs have the potential to diminish appetite and cause stomach pain.
Some of these drugs can also increase inflammation of the liver which is very painful. Higher levels of liver enzymes are released into the blood and can make a dog feel very sick.
The best way to feed these dogs is first talk to the vet about providing some type of stomach protection, reduce the acid, against these side effects. We have always recommended something simple over the counter like plain old pepcid, one tablet a half hour before a meal. Do this especially before any meal with prednisone.
A portion of dogs go on to develop severe esophagus and stomach ulcers. We always recommend sucralfate, which is a natural gelatinous “bandaid” that coats the gastrointestinal tract and heals any ulcers. I would use it as a caution against this happening. The best way to dose this is on an overnight fast. It will block the absorption of drugs and food so keep this dosed about at least 1.5-3 hours before or after eating. So that overnight dose works the best.
Start making your meals at home, make them smaller but more frequent, with low or no fat. If a dog feels ill after eating they will not eat that same food again. Try to use simple protein like chicken breast or white fish. Dogs don’t need carbohydrates in their diet, but to provide simple calories while he is ill, make rice congee. Put the rice in a pot with a lot of water and simmer for a long time until the rice is quite mushy. You can save the liquid to put in his drinking water. Mix the mushy rice with some protein. Homemade chicken broth is also a good source for something that smells and tastes good. Do not add any salt, onions etc. Just plain chicken broth cooked on the stove. I make mine in a pressure cooker by putting the chicken carcass on a strainer inside the pot and pour fresh water into the pot. Pressure cook for 35 minutes.
Tell us more about your dog and what is happening.
My best, Patrice
Jared,
I am really sorry to read this. While this may seem unusual to you and possibly your vet, we have seen this many times. My website is named after Chance, as he had the exact same thing happening to your girl.
It’s not particularly easy to describe this to you. Splenic accessory growths of a benign behavior can seem useless and worthy of removing the spleen and growths.
However when we removed Chance’s spleen and very large benign growth he was later diagnosed with bone marrow failure. He was not making red blood cells or white blood cells, he was very sick.
It was a puzzle to my vet and the board certified veterinary specialist. He could only tell me that his marrow had very few cells. He thought it might be autoimmune and put him on prednisone but it wasn’t working, he got worse. He upped the dosage of prednisone but finally he said to me, you have a beautiful dog. Essentially he was unable to save him.
Through a friend, they recommended I contact Dr. Dodds, all the way across the country from me in California. Apparently she knew, as a veterinarian, why this was happening and even had a protocol that would target the autoimmune destruction of the precursor cells in the bone marrow.
My vets were delighted to work with Dr. Dodds, though many vets weren’t at that time. We implemented it immediately and within about 3-4 weeks he began to start making red and white cells. His body was a mess because of all the prednisone and it took months until he began to look normal. You can read his story under Our Stories.
I am at work right now and I dont have access to my files right now. I’m hoping Vally will hop on and get the protocol to you.
Please use the Urgent Advice page to send us via email the cbc and Chem screen.
Don’t lose hope, we can do this.
My best Patrice
Jude,
I’m sorry to read all these difficulties.
I want to reassure you that a HCT or PCV of 34% after being treated for IMHA is actually quite normal for these dogs. Chance early recovery showed, I believe, a HCT of 42. But as time passed he settled into a quite normal 34-36%.
You should not worry about that right now. You are suppressing the immune system and Inca can’t fight infections very well or even not at all.
Here is what I suggest. Ask your vet to decrease both drugs to achieve a non suppressive dose. For instance prednisone at low doses treats inflammation, but doesn’t suppress the immune system. As soon as you can get below a suppressive dose, try again to treat cryptosporidium. Your vet can monitor the PCV during two or so weeks to ensure he’s stable. He may waiver a bit, I would consider low 30’s fine.
I learned this when helping an owner whose dog had tick diseases and needed to fight them with doxycycline. It was a clever vet who balanced the doses of both in order to destroy the tick disease. Do not be afraid and let your vet manage these doses carefully. Otherwise he is going to begin to get very sick. This is tricky, if your vet isn’t comfortable ask for a reference to an internist who is board certified and diplomats. They receive extra training and can handle difficult cases.
My best Patrice
Gwenn,
Thank you for giving such a complete history for Molly. This is important in order to determine if the treatment protocols are correct.
They’ve done a very complete, but pricey, exam to check for all the routine things.
What we know here after years of helping owners is that sometimes the vets aren’t as clear about explaining certain things, like why did this happen, why we are giving these specific treatments, what do all these meds do, what are the side effects, and home care. We’re here to help you understand better what happened and what it will be like going forward.
It’s important to understand that these cases are not all identical and that there are usually multiple triggers that reach a tipping point, where the last trigger topples into sudden severe disease. Some owners are able to help us find all those triggers while other owners will never know the causes.
What is important also is that the clinic apply a standard emergency protocol immediately. There are many vets, we have discovered, that are not up to speed with these canine blood diseases and the advanced treatments that now exist.
I like to see the CBC (with a specific anemia panel) and the chemical screen which tells us how healthy is she internally. Relatively healthy dogs have a great survival capability if the protocol is administered rapidly with the proper meds such as prednisone, dexamethasone, cyclosporine, some form of anti blood clotting med like heparin etc. All of these are strong drugs with significant side effects. Its important to understand we want this to be a strong attempt to work rapidly and successfully. Prolonged treatments weaken a dog over time.
We want to see all the basic preliminary tests plus specific tests looking for triggers that could be treated. A big one right now is to ensure they have tested for tick diseases using a SNAP4DX+ in-house test. Some tick diseases are very dangerous and can cause abnormalities in the blood.
In general there are a few well-known triggers. Dog breed is important as some breeds are predisposed to autoimmune diseases. Your mixed breed really has two breeds that have each contributed their own specific known diseases into one breeding. This increases the risks of autoimmune diseases. Other known triggers are hormones, such a female that has not been spayed. Combine this with unnecessary frequent “vaccine boosters” and add in stress as another trigger and finally add bacterial and viral infections and it’s a perfect storm. So Molly is an older female and that is another trigger as age increases the risk of tumors and other conditions like diabetes, pancreatitis, liver or kidney diseases. Her heart condition can be parallel treated with her usual protocol, just keep in mind that low blood volume and significant anemia does challenge the heart more. If this is a weakened mitral valve then the risk of decompensation is higher in congestive heart failure. You may need to alter heart med doses to accomplish the same control you had prior to her autoimmune condition. If you have a specific internist you see for this, get in touch immediately to go over the meds she is on. I have experience so I can help you as well.
Vally will be along soon to help you develop a med chart. Scheduling can be complex and she’s a specialist at this.
Are there more questions you have?
My best Patrice
Natalie,
One of us is always watching our emails. No worries there.
I am so sorry how lost and heartbroken you are. We know how this feels and that is why this is here, for you to get advice and friendship.
I can tell you that we have seen great successes here with hundreds of dogs, so please don’t panic right now. We try to help you understand the most critical things you need to know in the first few days. That’s when the correct protocols are critical to the survival of your dog. Years ago, those protocols weren’t really thought out well, but now most vets are more sophisticated.
The transfusion is necessary and you can expect his hematocrit to drop again after the transfusion due to the rapid destruction of red blood cells in circulation. Do not let this worry you. The vet is trying to stabilize him with a transfusion. It helps buy valuable time while he waits for the significant immunosuppressive drugs he has been given such as prednisone and possibly injected dexamethasone. I know these are scary sounding drugs but they will save his life. It’s important to get his blood pressure up to avoid hypotension and he is getting dripped fluids with this transfusion for this.
The next thing I want you to talk about with your vet is the serious side effect of DIC disseminated intravascular coagulation. This is inappropriate clotting in the first days of IMHA. It can be life threatening. Most protocols now recommend something to slow down and control the clotting. We used to recommend baby aspirin but in hospital they can give heparin or other drugs to get him past this risky time. Please ask about this as soon as you can. We want to stabilize him.
I want you to sit down and write out a timeline of anything unusual that you have noticed about him in the past few months. We have found, as most vets have, that immune mediated hemolytic anemia is a condition of a combination of triggers that suddenly tip the balance. It’s not just one thing that did this. I want to also reassure you that none of this is your fault, you have done the best thing you can, get him to a vet immediately.
So what are the triggers. Here is a short, succinct look at the main factors of autoimmune disease in dogs.
“The four main causative factors of autoimmune disease have been stated to be: genetic predisposition; hormonal influences, especially of sex hormones; infections, especially of viruses; and stress.”
So we look at the breed. Two distinct common GSD conditions come to mind. Hypothryoidism and Von Willebrand’s Disease. Both of these can be implicated in what’s happening now. A 6 year old GSD may very well have decreased thyroid values to their genetics. And Von Willebrand’s Disease can be a serious bleeding disease in some dogs. My Giant Schnauzer Chance carried a mild form of this condition, Factor VII, where severe bleeding may only occur during some kind of an emergency like surgery or a serious accident. Please ask your vet to test him for this condition. There is a protocol to treat this in these dogs.
I want to know about any tests that the vet may have done to determine if there are tumors or if the spleen in enlarged.
We want to know if there have been any tick bites, and this is easily tested right in the vet’s office with a SNAP4DX+. Certain tick diseases can lead to abnormal bleeding.
Has there been any history of gastrointestinal disease in his life? GSD tend to have very sensitive systems. It is possible he has internal colitis or even ulcers that are bleeding.
Do you live out in the country? Could he have gotten into the older types of rat poison? They would cause serious internal bleeding. The usual treatment is injected Vit K.
Write all the things you have noticed that caught your attention but you couldn’t put your finger on what they were.
I’ll contact you by email so you can send me the CBC and Chem screen tests. I can send you papers for you to read.
Do you have specific questions right now?
My best, Patrice
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