New to AIHA

[Standsmom]

We have come through the first week and a half of AIHA. This included 3 days at the animal hospital and a blood transfusion. My 17 lb dachshund is holding steady at 23%. That level has not moved since the transfusion 5 days ago. She is taking 4 medications. Minnie no longer kisses me hello. She doesn’t respond much when we pet her or talk to her. Occasionally she will perk up. She eats ok, drinks a ton, and is peeing a lot. If I don’t make sure she goes out every 2-3 hours, she will pee in the house. Other than that movement, she sleeps or she lays on the couch with her eyes open. We are torn for what to do. Will this improve after she finishes some of these initial medications? Will it continue with the pred? We don’t want to jump the gun, but we don’t want to prolong something either. We see so little of her personality, it’s disheartening. Can any of you offer suggestions about that part of it? Did your dogs behave the same, distant, etc?

[Vally]

Hi Standsmom, I’m sorry you’ve had to come looking but you’re very welcome here.

First of all, it’s a good sign that Minnie is holding steady. In fact, it’s not uncommon after a transfusion for bloods to drop.

What medications and dosages is Minnie on?

Minnie is feeling very tired right now with a low PCV as that means there is not a lot of oxygen circulating, so she has very little energy. It’s great she’s eating and yes they do drink and pee a lot, that’s the prednisone. Let her rest, and try to to encourage her to play, that may make you feel better, but right now it’s better that she just be kept quiet and conserve her energy.

How old is Minnie?

Will she improve? If the medications are working, then yes she will improve and you’ll see your Minnie’s personality come back.

None of us here would recommend prolonging a hopeless situation, but there is hope here.

Do you know what may have triggered the disease? Sometimes we do know, or have an idea. Other times we never know.

Ask anything at all, we love to help.

Regards, Vally (angel Bingo) and Saba

[Standsmom]

Thank you so much!! Minnie is 6 years old. She’s on 10 mg of Pred every 12 hours, 75 mg of Clopidogrel every 24 hours, 100 mg of Doxycycline every 24 hours and 125 mg of Mycophenolate in the morning and 62.5 mg of Mycophenolate in the evening. They did a blood draw yesterday – sent to pathology – and we’re waiting to hear back if they see improvement. This morning she got excited about a squirrel outside, jumped off the couch and ran down the steps to the grass. That was about all she could muster. But it was a really good sign. As far as what caused it, they didn’t find anything with xray or ultrasound. She was taking Apoquel for about 2 months and then off for a month before she became anemic. She has always struggled with itchy skin, especially under her arms. That’s why we decided to try the Apoquel. It helped her some. Interestingly enough, since the AIHA kicked in, her itchiness is completely gone. Our vet has a theory that dogs with allergies get AIHA and says she sees them come into the hospital in waves, especially during high allergy times, like spring. She did say it’s her own theory and not proven or anything like that. Really, thank you so much for your response and your words of support.
Ann and Minnie

[Patrice]

Ann,
I’m sorry to read about Minnie. It sounds like she has stabilized and that is a good sign.

This is a serious condition and the drugs that are needed to control this have some side effects that are not pleasant. It is completely understandable that she is not very social right now. If there is one thing for sure, dogs that feel very ill will behave in a way that you have never seen before. Every dog that has been treated for these hematological conditions behaves similarly. And each dog has a different tolerance for the anemia and for the drugs. So one dog may be able to tolerate a PCV of 12 quite well, while another dog will be so ill they can hardly stand.

If you look above at the menu items you will see Our Stories, this is a selection of many owner’s stories about their sick dogs. You will see Chance’s Story, who this site is in memory of. Chance, a Giant Schnauzer, had terrible allergies starting at the age of 2. It was a life altering experience for our household. At that time the only effective treatment was to see a veterinary dermatologist and test for allergies with skin and blood tests, just as we do with humans. They developed a special serum for him and I gave him allergy shots for many years. It helped quite a bit and we thought he was doing well.

However, when he was about 7 he seemed to slow down, he was sluggish and gained weight. I was not sure what was happening to him and eventually we discovered that he had a large growth on his spleen. This (7 lb)benign growth and the spleen was removed and the vet felt this was curative. However, within a month, his blood tests showed he was not making red blood cells or white blood cells. It was indeed a very ominous diagnosis. This is actually one of the forms of canine autoimmune hematological disease, similar but different to AIHA IMHA.

Chance was on prednisone, the same as Minnie, but he did not respond well. It was several months of treatment and he became more anemic. I was in contact with Dr. Dodds and she sent me her protocol. Once we started him on cyclosporine he improved and eventually recovered even from the side effects of prednisone. Chance lived another good three years to the age of 12 and passed from an unrelated heart condition. Chance was not the same dog coming out of this that went in, as is the case with nearly every dog who is treated, but his will to live and his enjoyment of life was not reduced one bit. We gave him a good life and he wanted for nothing.

What I do know now, after studying these canine hematological diseases for a very long time, is that dogs are genetically prone to expressing these diseases if they are of certain breeds and or they are prone to autoimmune diseases. This includes allergies and many other autoimmune condition that affect dogs. Chance was set up from an early age because of his allergies to go on to express a far more serious autoimmune disease later in life.

Why? Because dogs have an accelerated metabolism and thus they live shorter lives. They develop the kinds of age related conditions that humans might at a much younger age. If they have a genetic makeup that is more fragile the environment will most certainly challenge their immune system. And by environment, I include all aspects of a dog’s life, from diet to veterinary care (flea, heartworm and tick prevention included) to where they walk, parasites, viruses, bacteria and other diseases they may be exposed to. Dogs with allergies to their environment are at high risk when exposed to pollen and molds etc.

Minnie is 6 and a Dachshund. This breed has a genetic disposition to canine atopic allergies and autoimmune diseases, among other conditions. In addition AIHA IMHA are more prevalent in middle-aged spayed female dogs. The risk of acquiring the disease is more common in May and June, this is widely know throughout the veterinary community (and we know this well here on Second Chance as the number of owners who need help skyrockets.) She has had multiple triggers to set off her genetic predisposition to autoimmune disease.

While this sounds very discouraging, we have been through this and many owners we have helped have experienced the same thing. There is great hope to recover from this and you got help quickly which was a critical advantage, good job Mom! Once this she has recovered we can help guide you through the lifestyle alterations that are necessary with our more susceptible dogs.

Your vet is surprised that for some reason her allergies seem to be abating. This is not a surprise to me. She is being given high doses of prednisone. This is similar to our body’s cortisol. When given in these high doses it suppresses the immune system, as a whole, and that also suppresses allergic reactions. It also makes arthritis feel better, and may improve digestive disorders. It is used for many of these kinds of conditions. So it makes perfect sense that she suddenly has no allergy symptoms. Why your vet doesn’t understand this, I can’t be sure. Never-the-less, when you begin to decrease this drug, you will see the allergic symptoms return.

One drug that is commonly used to treat AIHA IMHA is cyclosporine or the brand name Atopica. This drug is marketed for canine allergies but it is used “off label” for the serious autoimmune destruction of red blood cells. You might as your vet if you can add this drug into your treatment protocol, as is commonly done, and then slowly decrease the prednisone. The Atopica will be effective at the suppression of a certain type of white blood cell that is responsible for the AIHA as well as the allergies.

Once she has improved you could go to a lower maintenance dose of Atopica to treat the allergies. Many dogs use this lower dose for this.

Vally can help you set up a medication chart, which she is a master at. We can both help you with her diet and how to evaluate the side effects of the drugs vs the disease. In some cases the drugs make the dog feel worse than the disease!

I would like to see her CBC and chem screen to help you understand what those numbers mean. Please upload the latest test results on the Urgent Advice page, see the menu items at the top of the page.

What questions can I answer for you?
my best, Patrice

[Standsmom]

I’m overwhelmed with gratitude for your response and all of the information you’ve shared with me! To clarify, my vet wasn’t confused about the lesser allergies, I was. I just hadn’t had a chance to talk to my vet about it. Your explanation makes perfect sense. I will be happy to upload a copy of her stuff – I will just need to see what I have copies of. I am expecting a call from the vet hospital today or tomorrow with her recent pathology, and I will ask them for a copy of that also.