Newly Diganosed AIHA in Min. Schnauzer

Arianne

Guest

I am so happy to have found this forum. I’d like to give a little background on what Carsten, my miniature schnauzer, and I have been going through.

On Friday, I noticed that my dog was pretty tired, a little lazy, and not much interested in eating. Our air conditioning had been on the fritz, and I figured the temperature in the house (up to the mid-80s at one point) was the primary cause. When we went to bed and began to cuddle me, I noticed that he was very warm. I decided to take him to the vet first thing in the morning.

When we arrived at the vet, we were unable to see his primary doctor, so I apprised the new vet of Carsten’s severe allergic reactions to vaccinations in the past. (His poor little body just can’t handle them, and they’ve reduced his vaccinations to just the rabies vax every three years.) The vet took his temp., and it read 103.8 and decided to do blood work and a urinalysis. When the results from the blood work and urinalysis came back, his red blood cell count was at 27, which I learned was rather low. The vet also ran a radiograph, and while Carsten’s spleen was slightly enlarged, his radiograph was free from tumors or nodes elsewhere in the body. As such, the vet diagnosed Carsten with AIHA (a completely foreign and terrifying illness to me), injected Carsten with prednisone and pepcid, and sent us home with some prednisone to continue to suppress his immune system.

Meanwhile, I couldn’t get Carsten to be interested much in eating, going without food for about 36 hours at this point. However, I could get him to eat a couple of slices of American cheese. It’s not nutritious, I realize , but I was desperate. We went to sleep without incident.

Sunday morning, I let Carsten outside to do his business, and suddenly he vomited. It was unlike anything I had ever seen–thick and yellow like mustard. This seemed emergent to me, and I rushed him off to the emergency room.

At the emergency room, they ran blood work again, and his red blood cell count had dropped to 22. They explained that this was dangerous and that Carsten was dehydrated. They recommended hospitalization, and informed me that he may require transfusion at some point because the IV fluids would likely continue to diminish his red blood cell count levels.

Later in the evening, they called with an update: Carsten’s RBC had dropped to 20. They said that this was better than they anticipated, and they would continue to keep him overnight. Around 3:30 a.m, another doctor called and let me know that his RBC had dropped to 16, and that they were going to begin the transfusion. Who can sleep after that?

I went to see Carsten as soon as they would let me in the morning. His counts went back up to 21, and they continued to give him the prednisone, pepcid, plavix, and mirtazpine as an appetite stimulant. He was still very tired, as I imagined he would be, but sweet natured. I cried a little because this is all very new and emotional to me, and left him with his care team.

Later in the afternoon, the vet called and said that his counts were still 21, that he had eaten the doctor’s grilled chicken for his lunch, and that he would be okay to go home. I picked him up in the evening.

When he came home, he ate a little more chicken breast, drank quite a bit of water, and went right to lay down and rest. This morning I went to pick up the rest of his medications (the pharmacy was closed by the time I picked him up last night), and gave them to him as soon as I got home again. He is drinking water, but not interested in eating. I’ve had to put the medicine down his throat, unfortunately. When he’s gone outside, he urinates like a puppy, maybe not having the strength to hike his leg like normal. He comes right back in and lays down. All day he’s been laying down and drifting in and out of sleep. He is still pale, which I think is normal, but I am unsure.

I know this is long-winded, and I apologize, but I am just wondering if this behavior is to be expected. How fast does a dog “bounce-back”? What is normal recovery behavior? I’m just terrified. My husband and I don’t have human children yet, so Carsten and his sister, Kali, are the only babies we have.

Carsten has an appointment for blood work in the morning, and I am hoping for positive results. Any thoughts and prayers would be very much appreciated. Thanks for reading.

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Brigitte

Guest

Hello Arianne,
I am so sorry for what your Carsten and you are going through. Please do not apologize for your long post, it is actually very good for us all to know exactly what has been going on.
It seems you have a knowledgeable vet on board and that is so important. In order to help you understand the disease better, please go to the links at the top of the page if you have not already done so. The video library and AIHA terms will be very valuable to understand the disease better. If you have it, you could download the latest blood results on the urgent advice link. If you don’t have it, please ask for it at the vet. They will be happy to give it to you. Most people don’t want them because they don’t understand what it all means. But it will be good for you to learn to understand it all as best possible. There are people here that are great at explaining where Carsten is at and what is happening. You could also make a list of all the medications, dosage per day, the weight of your dog and we can give you our thoughts. One thing I want to stress right now is that Carsten’s digestive tract is taking a beating with all the heavy duty medications and you want to protect his tummy from getting ulcers. We have found that the best way to do this is with sucralfate 2-3 x per day. It has to be given away from all other medications so it is a bit tricky but well worth it. Could you please ask your vet about that. Also could you ask if there has been a test done to check agglutination, meaning that Carsten could make blood clots. If that would be the case he should be put on aspirin or heparin. Please discus this with your vet.
The way you describe Carsten is very typical. These dogs are usually extremely tired. I remember my dog not even being able to shake his body, that took too much energy. Peeing like a puppy is certainly normal. Their blood is not getting enough oxygen to the body, the prednisone makes them hot, they don’t feel like eating so just lying around seems right. Honestly if I have no appetite and am hot and tired, all I do is lying around. Joke aside Arianne, this is a serious disease, but we have see many, many dogs recover and live a happy and healthy life after this. The recovery is not just a few days, but weeks and even months. But there is lots of hope that Carsten can beat this with you by his side! Now how was that about long winded? Please ask away and post the medications and the blood results, we are all happy to help you getting through this!
Best wishes,
Brigitte

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admin

Keymaster

Hi Arianne, and welcome.

I am so sorry to hear you are going through this with lovely Carsten. All of us have faced this horrible disease and understand just what a difficult time it is. My cat Molly had a rare form of AIHA in her bone marrow. Like Carsten, she’d also had previous problems with vaccinations, although I’m not sure what triggered it. Has your vet been able to pinpoint a possible trigger for Carsten?

First off, it is definitely to be expected that he is quiet and tired. This is very normal when they have a low PCV and the side effects of prednisolone are kicking in (peeing, drinking, feeling hot). Of course, make sure he has easy access to fresh water at all times. Most animals also get a huge appetite with prednisolone, so that may be to come. Like Carsten, Molly lost her appetite too and also had Mirtazapine. I think it affects them all differently, but it made her really quite woozy. The dog owners will be better able to advise you than me on what to feed, but lean protein, low fat (e.g. Chicken breast) is usually recommended. It’s tough when they won’t eat, but I hope this will improve soon. As much as you can, keep calm and positive around him, letting him know everything is fine and normal.

As Brigitte already said, it sounds as though you have a vet who knows what s/he is doing, which is wonderful as this is quite rare and many vets haven’t seen it before. Clotting is a big risk for most dogs with AIHA, so I think this is why your vet has started plavix. Sucralfate, as Brigitte said, can help protect the stomach, and liver protection e.g. Denamarin is recommended in many cases, so would be worth asking your vet about. The only thing which jumps out at me is that prednisolone – whilst lifesaving – is often not enough to suppress the immune system, and many animals need another, longer acting immunosuppressant to go alongside the pred. The most commonly used is Cyclosporine (Atopica), although others are also used. I would also suggest discussing this with your vet.

Finally, look after yourself too. This is a rollercoaster to be sure, but there are many success stories and every reason to have hope. We are dotted about across the globe (I’m in UK) so one of us is usually about, and we will do all we can to support you and Carsten through this.

Best wishes, and good luck tomorrow.

Mary & Mable x

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Alyssa

Guest

I’m sorry you’ve had to find us. It sounds like your doctors know what they are doing and that is very important.

You need to start getting really creative with food, eating is so important, the meds make them feel awful and they really need to eat. I think Sassy went 4 days without eating, and I was losing my mind. I decided to fry some extra lean hamburger meat and drain ALL the fat off and then pat it with towels – you have to be careful with fat on these meds – and that was the first thing she ate. I only had a little bit so I immediately went to a 24-hour store to buy more (it was like 10pm). She ate that a few times, then didn’t want it anymore. After that, she’d eat shredded chicken breast.

Heres the thing also – for at least a week, I had to had feed every single bite. I sat on the floor with her and feed her bite by bite, if she’d turn her head I’d remove my hand and then ‘hide’ the food in my palm and hold it to her nose – this got her smelling. Then she’d eat some more. I really don’t know why that worked but it is something you could try – hide the food in your palm, hold it to their nose and let them smell but not see. Don’t give up too quickly, keep trying to encourage eating. Eat a few bites yourself, right in their face. Baby talk. Sassy would not touch her dry food, either, so I had to make my own food – chicken/turkey or beef, sweet potato, green beans, and carrots are what I started with. It took several weeks before she’d accept dry food ANYWHERE near her homemade food, but now we’re finally back on it.

Also, when I made chicken breast, I just boiled it for a very long time and then I saved the broth which I would cool with ice chips and let her drink. Because she was so thirsty, she would drink this, and I felt it was better than nothing. She also really enjoyed ice chips on their own because she was so thirsty/the meds make them hot.

I had to hand feed food and hold the water bowl to her mouth – she was so weak. My dog needed two transfusions before she was stable, so please do not lose hope if you find Carsten needing another one. A lot of these meds can take up to 2 weeks to suppress the immune system enough to start recovering.

The steroids are going to make you question if you are doing the right thing. It is like someone going through chemo. You will likely see rapid muscle wasting, very tired, not wanting to eat, having to pee every 2-3 hours, no interest in play/cuddle, panting, heavy or fast breathing especially when sleeping – these are all things we went through and it is so hard to watch but you have to hang in there and let the meds do their work. Things WILL get better and WILL go back to normal, but you will have to go through a lot of fighting to get there!! That’s what this place is for – lean heavily on the ladies here. You are not alone!!

Also please get the jump on protecting the liver if you haven’t yet – even if the liver values look okay now. These meds are hard on the liver and you really want to prevent them from getting bad, rather than repair. Others are more knowledge on the med names here – I also personally use a pure milk thistle powder, but there are things you can get in pill form from your yet.

Another thing — you MUST check with your vet before trying this and make SURE you can crush your pills, but even my doctors could not get pills down Sassy. They tried for nearly an hour and she would NOT NOT NOT swallow. They were able to give some via IV, but some of them didn’t come in IV form and I couldn’t do that ever 12 hours at home. So we crushed her pills in a spice grinder, added a tiny bit of chicken broth and a really moist wet food and sucked it up in a baby syringe. That we stuck behind her canine tooth and slowly squirted the meds in. It was the only way for 2 weeks we could get them in her. Once the steriods kicked in and she was starving all the time I was able to stop doing that. It sounds like you are still able to get him to swallow pills so that is good, but I just wanted to mention this if it got to the same point it got with my dog. Please please please don’t do this without making sure your pills can be crushed though – some can NOT be altered at all.

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Vally

Keymaster

Hi Arianne and Carson,

Well reading your last note, I can tell who is the more worried, you or your tail wagging Carson. He’s sounding good and that’s a really important thing. How a dog is acting is, I think, a big big sign in how they’re feeling.

We’d all love to see a picture of Carson, and it’s not hard. All you do is go to the right side of the forum posts where it says Upload Your Photo, straight under all the pictures. Click on “Choose File”, and find the picture on your computer, give it a name and then click on upload for approval. It doesn’t upload instantly as, for safety of the site and to keep spammers away, it has to be approved before going on.

You’ve got good advice from everyone and your vet sounds as though they know what they’re doing. That’s very important. My vet couldn’t work out what was wrong with Bingo and sent us off to a specialist, who got it right.

With the different medicines, it’s important that some are given with food and others without. Some drugs need to be given away from other drugs. So if you can list all the information that was mentioned above it would be good. Carson’s weight, his medicines, what time you’re giving them. I’d be happy to make up a chart for you if you like.

Usually you’ll find after a blood transfusion, it’s not unusual for bloods to drop down again, but it’s important not to do a transfusion bringing the PCV up any higher than a PCV of 25. That is because if too much blood is given, then the body thinks it’s got enough and won’t both making any new.

How old is Carson? May have missed his age. Another drug that is often used is thyroxine (thyroid medication). Even if Carson doesn’t actually need thyroid medication, the thyroxine can help stimulate the making of red blood cells. Often we see dogs who are not responding to the medications who suddenly start making red blood when they are put on thyroxine.

We happily discuss all sorts of things here. Coloured poo is a fine topic of conversation. The fact that he hasn’t poo’d much is probably because he hasn’t been eating a lot. Bingo was in hospital for about 10 days in the very beginning and refused to eat the whole time. They ended up syringing food into him. When the prednsione kicked in though, he was constantly hungry. You’ll most likely see the same thing. You’ll be worried about how much food he’s eating. Also he didn’t poo at all for a few days after he came home.

Rapid breathing or panting is very normal with prednisone too. Prednisone has a lot of horrible side effects. You can read about them here: https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/
but it’s a life saver. Also you’ll see that when the dosage can come down, all the side effects start to go away.

Ask anything at all. More prayers for you and Carson,

Vally & Bingo.

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