Jackson 9yo Golden

[Stephanie B.]

Jackson 9 yo Golden, new AIHA

[Stephanie B.]

Jackson is a an almost nine year old Golden Retriever, previously healthy, with a new diagnosis of AIHA on 9/24 that has been rapidly progressive. His story begins on Monday, September 7. We picked him up from our usual boarding/grooming location after Labor Day weekend. He did well boarding and was only reported to have a decreased appetite. When he got home, he spent the next 24 hours vomiting. This has never happened before so we took him to his vet. His back legs were slipping a little as well. The vet attributed the vomiting and legs slipping to stress from boarding and arthritis from playing too hard with my in-laws dog. He recommended rest and some meloxicam for pain. He has previously had meloxicam without any problem. We gave it for three days and stopped when he appeared to do better.

The following week we were awakened on September 12 early in the morning to Jackson having a seizure. He has never previously had a seizure. We took him to his vet that mornings where labs revealed an elevated GGT, total bill, and alk phos. His Hb and Hct were normal at 17 and 46. He was started on antibiotics (clavamox and a fluoroquinolone) and a steroid taper. He did well initially. Perked up, started eating, looked well. He even had a couple of days that he ate ravenously. As we tapered to every other day steroids, he started looking less well. Since we didn’t have a follow up appointment for a few days, we combined daily steroids since he has previously had trouble coming off steroids.

On 9/24 we returned to the vet and we were diagnosed with AIHA. His Hb and Hct were 5.8 and 18.5. His abnormal gallbladder labs were mostly resolved. He had a white count of 50, a left shift of his neutrophils, and a retic % of 22.8. He was diagnosed with AIHA and his steroids were increased to 50mg/day. We were to follow up in a week. Jackson had some ups and downs over the next few days. He had some wavering appetite and energy.

On Monday, September 28, I noticed that he was particularly lethargic and had spent hours hiding in a low traffic bathroom. He was twitching a bit as I pet him. I had a sense that something was very wrong though nothing appeared completely obvious. I took him to our vet where his Hb and Hct were 3.8 and 13, with an elevated white count in the 30’s. We were sent immediately to a specialty clinic.

That night the plan was to transfuse him 4 units of blood. He only tolerated 1.5 units before his temperature started to spike. The following day he had an abdominal ultrasound, a chest X-ray, and a spleen and liver biopsy that did not reveal any obvious underlying cancer. A repeat attempt at transfusion followed and he tolerated most of a unit of blood before his temperature started to increase.

On Tuesday, September 29, his Hct reached 31 and he was looking well. The decision was made to restart prednisone at a lower dose (don’t know dose).

Wednesday, September 30, mycophenolate was added (also don’t know dose). Jackson started eating and drinking well again.

Thursday, October 1, Hct was only 22. We decided to watch it, with a repeat in the PM, only Hct of 19. Vet decided to be conservative and still not transfuse. Our options for treatment were 1) splenectomy (given his anemia and thrombocytopenia) we decided this was not a good option, and 2) immunoglobulin infusion that was both expensive and unpredictable. We decided to wait out the steroids an oral chemo one more day.

Today, October 2, repeat Hct was only 16. Our plan had been to take him home this evening but we were encouraged to transfuse again tonight and bring him home during their discharge time tomorrow, between 9-11am.

Are there any recommendations from here? We feel we have reached an end. We plan to bring him home tomorrow. We have a vet available to come to our home Sunday to help him pass peacefully if necessary. Are we missing anything? This happened so quickly and unexpectedly. I am heartbroken.

[Brigitte]

Hi Stephanie,
I already wrote to you privately to please not give up on Jackson. I believe there is still lots to be done before throwing in the towel. In my opinion the initial prednisone dose was too low, too low to stop the initial attack of the body on the red blood cells. Then the prednisone was lowered before Jackson was stable. A AIHA diagnosis with a follow up in a week, tells me that this vet is not very familiar with the disease. Where did the blood for the transfusion come from? I know the vet was right to not transfuse a third time, this is usually only done at a PCV of 15 or lower. I am also glad that a splenectomy was NOT performed. I believe that would not have been the solution. I think that if you want to give Jackson a fighting chance, you need to take him to a teaching veterinary hospital or an internal medicine specialist. In my opinion it is crucial that you are dealing with a vet that is experienced with this disease if you want to have a chance to win this fight. Many on this forum were close to giving up but their dog recovered with the help of a specialist or Dr. Dodds at hemopet. Please don’t forget I am not a vet, but I have seen many, many cases on this forum. Many have recovered and led a happy and healthy life after beating this disease!
Best wishes,
Brigitte

[Stephanie B.]

Jackson is at a specialty vet clinic being followed by a vet who is board certified in critical and emergency care. There is a hematologist in that clinic as well. It is a very nice clinic with several sub specialties. Most of the vets have trained at Texas A&M. That is close to us but since most of the vets have trained at that university, we feel comfortable with them. Getting him somewhere over the weekend seems hard when so many facilities aren’t open on Sunday’s. I can try to email a hematologist at our facility overnight to see if they have anything to offer for care. They do teach interns at this clinic. I’m overwhelmed and sad. And scared that I won’t do something that could save him.

[Brigitte]

Stephanie, sorry if I over reacted, wanting you to change vets. I guess I missed that Jackson is already at an emergency clinic. The points I stated earlier just made me question if the understanding is there. I think contacting a hematologist would be a great idea. Hopefully he/she would have some educated input.
Best wishes,
Brigitte

[admin]

Hello Stephanie – we all know only too well how awful you must be feeling, but please don’t give up on him yet. It has happened very fast, but Brigitte is right – some have beaten the disease. Keep on talking to the haematologists….. and please let us all know how Jackson is doing.

with best wishes

Lynda B

[admin]

Dear Stephanie

I’m really sorry to hear about what’s happened & completely understand you are worried out of your mind. I promise each & every one of us has been in this situation & we will do our best to give you advice & support – it was one of the worst times in my life when Worzel was diagnosed – I also felt hopeless, but Worzel is in remission now. I have read Jackson’s story – I see Patrice & Brigitte has written to you & I hope that has given you HOPE – this disease really can be beaten, but the treatment must be right. I sent some information for you – some of it is repeating what others have said, but could you please have a good read, especially the abnormal clotting section. I know Patrice mentioned this – Jackson does have indicators on his blood results to show he is at risk & your vets can easily decide what to give him for clot prevention.

I noticed the presence of Target Cells. These are usually an indicator of iron deficiency &/or liver disease, coupled with the high liver enzymes, which would fit in nicely with Patrice’s comments about liver injury too. I was completely unaware that kennels in the US gave vaccinations – wow – I am shocked.

Brigitte is right about the prednisone dose probably being too low at the beginning – hoping the higher dose will help stop the red cell destruction. To give the drugs time to kick in, sometimes small transfusions are necessary to keep them comfortable. This is usual & normal, so try not to worry (easy for me to say!)

As Brigitte says, we are all here to support you with huge hugs & much love. Getting Jackson’s treatment protocol right is really important, so the more info you can give us the better.

Sheena, Worzel & Ollie xxxxx

[Stephanie B.]

Jackson was given an IV dose of iron that should last a month. When we pick him up in a little while, I will have his exact drugs and dosages. I asked yesterday about aspirin or plavix to prevent clots and he wasn’t on anything. I will have more treatment r given details very soon. Thank you so much for the suggestions and support.