Jackson 9yo Golden

[Stephanie B.]

Update…Jackson is home. He is very tired but I feel like he is more comfortable here. He tolerated a transfusion much better last night. His Hct at discharge was 25. He is eating and drinking well with some encouragement.

He did develop a clot in his right hind leg and he does not have a femoral pulse on that side. It is affecting some mobility but he is tolerating it well.

He also appears to have a GI bleed as he is having melena. We were suspicious of this but his rectal exam was normal.

His discharge meds are as following:
1. Mycophenolate 250mg every 12 hours
2. Prednisone 20mg in AM and 10mg in PM (concern that higher dose contributed to GI bleed)
3. Plavix half of a 75mg tab every 12 hours
4. Doxycycline every 12 hours until his tick borne disease panel comes back
5. Ondansetron 8mg every 12 hours since he has had some vomiting, though infrequent
6. A proton pump inhibitor every 12 hours for the GI bleed
7. Enoxaparin 30mg subcutaneously every 8 hours to treat his blood clot and hopefully prevent a devastating clot

The plan is to recheck his labs and transfuse one more time if needed. I feel comfortable with this plan but I am still worried. Having him home helps ease the unknown of wondering how he is doing constantly.

Thank you for all the support so far. I am a human Doctor, this doggie medicine is tough for me because he is my sweet pups. I don’t want to take heroic measures but I want to give him a fighting chance.

[Brigitte]

Hi Stephanie,
I am so happy to hear Jackson is home with you! You are right, it is so much easier when they are with you, under your own roof and you can see with your own eyes how they are. You being an MD must help a lot, even though some things will be different, at least you get the lingo: For most of us it was such a steep learning curve when our dogs were diagnosed.
I am not at all familiar with Mycophenolate since most dogs are put on azathioprene or cyclosporin. These are also the drugs that Dr. Dodds recommends. Unfortunately GI bleeds are very common and that is why we always recommend sucralfate or carafate to protect the stomach. Some vets don’t like to give them because they can interfere with absorption. If they are however given away from all other medications and food they are very effective and help to tolerate higher doses. I think even at 30mg per day Jackson should get something to protect his GI tract. Could you discus this with your vet? I am sure Jackson weighs at least 60 pounds so he should really be on a 60 mg dose of pred per day.
I am glad that Jackson is drinking and eating. When the prednisone kicks in he will be drinking lots and hopefully have a great appetite. You might want to look into Dr. Dodds liver cleansing diet and try and cook this at home for Jackson:
https://www.secondchanceaihadogs.com/nutrition-resources/
You will see at the bottom of this article the dosing for Milkthistle. This would be a great supplement to protect Jackson’s liver. You might also want to discus the use of Sam-E (denamarin) with your vet. This would greatly help him deal with all the medications.
I am sure everybody here would agree that we never want to have a dog suffer. But as you say you want to give him a fighting chance. I am so happy to notice you sounding so much more positive and hopeful than in earlier posts! You also have to remember that these dogs are not in pain, just very tired, maybe nauseous and exhausted, but not in pain.
Best wishes,
Brigitte

[Patrice]

Stephanie,
So good to hear he is home and comfortable.

Ah, a doctor, good deal. I was explaining things so you could understand, but I see that isn’t necessary! So yes, DIC is a risk and I wanted you to have that chat with your vet.

Brigitte, Mycophenolate is Cellcept. We have seen some dogs use this here. It is another immunosuppressive drug. Stephanie, we also see cyclosporine used a lot. It has been very successful. Chance had severe bone marrow failure and neutropenia. He survived with the use of Atopica.

I have been on a tick list for 8 years. Doxy is the treatment of choice. Unfortunately dogs really can have a hard time with it, causing inappetance. Be sure to give in the middle of a meal and keep him up and active for an hour after. They tend to associate feeling bad with the food with the doxy in it so you may have to get tricky with treats. Always drop it in a nice treat, wash your hands and then wrap the treat up tightly so he can’t taste it. Then let him go back to his meal.

It’s good to hear he is comfortable. Good job Mom!
My best patrice

[admin]

Glad to hear Jackson is home, Stephanie, and still fighting. Patrice is right, yes, there is a risk of DIC – so keep on fighting, Jackson! All you can hope now is that he wins.
Thinking of you

Lynda B

[admin]

Hi Stephanie

I bet your are thrilled to have Jackson home & it’s great to hear he’s eating OK. A doctor – brilliant! – we have a doctor in training on here too called Hope with her dog Steve. Understanding what’s happening is no problem for you then! I’m sorry to hear about the clot, but the aspirin & enoxaparin treatment are in place. This disease is truly evil.

I would like to emphasise what Brigitte says about the prednisone – he should be on a higher dose in my opinion too, even though I appreciate the reluctance because of GI issues. Also sucralfate – it really is wondrous stuff & allows the GI tract to heal. 2hrs before or after any other meds is best. My dog Worzel had terrible tummy ache from the doxycycline – adding in the sucralfate made a big difference to his comfort – no more tummy ache. Also the denamarin – prevents liver damage from the drugs. MMF can cause GI problems as you know, but you always have the option to change to cyclosporine or another drug if necessary.

Hoping with all my heart that DIC will not manifest itself – being aware of the risks, I know you will be on the ball if you see any signs.

Come on Jackson – keep getting better.

Love Sheena. Worzel & Ollie xxxxx

[Rachel Schreiner]

Stephanie B., my 5yo female Australian Kelpie/Pit Bull mix, Sydney, has IMHA. My husband, Jim, and I rushed her to the vet exactly one year ago today. Her symptoms seemed rapidly onset, but after careful thought, they actually began way before that. She presented, as Jackson did, with the extreme lethargy and the diminished appetite. We weren’t sure if she was going to make it to the vet in only a few hours. We were initially told that she had rat poisoning. The vet that saw her said that, with an RBC of only 12.7, it was possibly IMHA, but she had only seen it twice in her 30 years of experience. The vet went on to say that it was a terminal illness, there was no hope, etc, but she was sure it was rat poisoning. She took blood for a Coomb’s test, just to make sure. She prescribed my 52lb dog 80mgs of prednisone a day with iron supplements. We received the dreaded call six days later, confirming the IMHA diagnosis and a referral to an internal medicine specialist ( Dr McCord).

I took Sydney to the specialist who confirmed the diagnosis. But, he said that he didn’t see why she wouldn’t survive. Her RBC had already gone up to 23 and she was eating like a pig. He reduced her prednisone to 50 mgs (25 mgs 2x daily), stopped the iron, added azathioprine, Pepcid (to help prevent ulcers from the prednisone), and 20 mgs of baby aspirin per day to help prevent clotting. Her prednisone has been discontinued, along with the aspirin, but she still takes 50 mgs of azathioprine every other day along with the Pepcid. Her RBC is at 52% (very high energy dog), and her WBC is finally within normal limits at 12,000 (original WBC was 48,000). Her reticulocytes are still decreasing now that she’s not on prednisone any more. The first month was the hardest, but every day I saw improvement.

Some good tips that I can offer are to keep Jackson quiet and low stress (duh, right?). He’s going to sleep a lot. With his low blood count, he’s going to feel cold, so make sure he stays warm. Sydney had some difficulty with breathing, so I made sure that she had pillows. Put any food way up, away from the prednisone hungry dog. Syd never stole anything, ever, but she started stealing anything that she thought was food. The packaging is obviously dangerous. Sydney also started digging in the kitchen and bathroom garbage.

Keep track of your dog’s med schedule. Writing everything in a ledger (including Jackson’s daily health and moods) is helpful. I keep Sydney’s ledger, medical records, and vet bills together in a folder. Those really come in handy for going between vets. Write down any questions you have before you see the vet and write down the info they give you. It can be overwhelming at first. I was able to save some money by getting Sydney’s blood drawn at her regular vet and having them forward the results to the specialist who reviews them for me for free. Ask the vets if they will do this for you. It saves me quite a bit of money every visit.

Don’t give up. I know how hard it is, but this disease can be managed.

I also got Sydney a St. Rocco pendant for her collar. St. Rocco is the Patron saint of dogs. Lol. It all helps! If I can help you, please let me know.

[Stephanie B.]

I am so sad to post that Jackson passed yesterday. He was home with us through the weekend and was loved on a lot. We were able to do some family photos yesterday morning and capture the last of his spirit. This terrible disease and its complications proved to be too much for this sweet pups. He had a seizure yesterday evening. We don’t know if it was from the anemia or if he had more clots. I had already decided that the first sign of a neurological or respiratory complication, we would let him pass and not let him suffer. He passed peacefully with my husband and I snuggling with him. He was my first dog ever. He came into my life with a ring around his neck asking me to marry my now husband. His sudden illness and death have broken my heart. I feel we gave him the best chance we could over the last week. Thank all of you for the support, suggestions, and being there as new found friends to help us try and tackle this terrible disease.

[Brigitte]

Dear Stephanie,
I am so terribly sorry that your sweet and special boy was not meant to beat this disease and spend some more time with you. I am sure your heart is broken and no words can ease your pain right now. If you feel like it, go visit “the bridge” reading it might help a little. You did everything possible for Jackson and he had a wonderful life because of you!
With sincere condolences,
Brigitte