Lulu

Keymaster

Zoe,
I am sorry to read about Lulu. There are some unknowns to me that make commenting a little more difficult.

My first impression is that the first episode was certainly not “uncomplicated” considering the potential of kidney disease. Dogs especially can lose a significant amount of kidney function without showing any signs until the kidneys are severely impacted. One important function of the kidneys that relates to anemia is that it produces a hormone that is released in response to anemia that stimulates the bone marrow to make more red blood cells.

A single month of prednisone and a single transfusion may not be nearly enough treatment to address the underlying unbalanced immune system. What I am trying to say is that I think it is possible that the original treatment did not resolve her IMHA completely.

If you have not already read Dr. Dodds Immune Mediated Hematological Disease and Bone Marrow Failure protocol please go to this page:
https://www.secondchanceaihadogs.com/hemopetresources/
The article is the 3rd picture down, click on it. If you enlarge it in the upper right corner you can even save it or print it.

Indeed stress plays a large role in the development of canine autoimmune conditions. Dr. Dodds addresses the influences of many kinds of stress on the canine immune system and disease resistance. Please read this article. Go to this page:
https://www.secondchanceaihadogs.com/canine-disease-resources/
And click on the first picture “The Canine Immune System and Disease Resistance.”

At the bottom of this article are tables that list factors that influence and are associated with autoimmune disease. If you look through this carefully, I think you may find some things that sound familiar to you. For instance female dogs are twice as likely as males dogs to develop autoimmune disease. Stress encompasses a broad range of things like environmental, emotional and physiological influences. So for instance a female dog in heat, who has nutritional deficiencies, may have an adverse drug reaction or was recently vaccinated etc has a greater risk of developing an autoimmune disease.

Dr. Dodds also believes that there is a strong link between canine hypothryoidism and AIHA IMHA and bone marrow failure. So you mention she is over-shedding. This is a common sign of hypothryoidism. If Lulu was never tested the first time for this condition, then the risks of her having a recurrence of autoimmune symptoms is greater.

You ask what you can do to help her this time. I think that we need to really dig deeper and find what her stressors are and which of them triggered this most recent relapse.

I recommend to start with a CBC and chem screen. If the vet has not done a comprehensive checkup, which includes palpating the abdomen (checking the health of all the organs) and listening to the heart, then that should be also included. The chem screen will cover the basics of the health of the liver and kidneys, among many other things such as electrolytes and glucose. It would also be good to do a urinalysis. Also include a stool sample and a SNAP 4DX+ test to get a yes/no result for 4 tick diseases and heartworm.

I highly recommend that your vet draw blood and prepare serum to Hemopet for a complete thyroid panel. Go this page:
https://www.secondchanceaihadogs.com/hemopetresources/
And click on the picture of the Hemopet Test Request Form, this will take you to Dr. Dodds website where you can prepare a test form for the Thyroid Profile 4 (T4, free T4, T3, free T3).

Everything you need to do is explained once you click the check box. You can ship this sample yourself from the post office, no need for refrigeration. I do it all the time. Just follow the instructions. Within a day or so Hemopet will email you that they have received your sample and within another day they will send both you and your vet the test results with recommendations for treatment if needed.

Be sure to include a brief but complete history in the “Reason for testing & brief history ” so Dr. Dodds knows that Lulu has had a relapse of IMHA.

I am also concerned that Lulu is not eating well. This needs to be addressed because every day that goes by without good nutrition she will weaken. Depending on the health of her liver and kidneys you can try offering her simple but great smelling foods like skin free deli chicken or scrambled eggs in a little butter. She can get by for a bit with just quality proteins. Cottage cheese and yogurt are also appealing to dogs.

She also needs plenty of water, blood volume is critical to feeling well and if she isn’t drinking she is going to have insufficient blood volume. If she is reluctant to drink and seems dehydrated you may need to syringe water into her mouth. Get a child’s medication syringe from your pharmacy (no needle!) and gently syringe water into the inside of her cheek slowly. Be patient.

Please upload any lab work you have that I can look at on the Urgent Advice page.
Do you have any questions for me?
Patrice

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