Newly diagnosed w IMHA and scared

[Samantha]

Hi there,

My 7 year old terrier was just diagnosed with IHMA. He was lethargic and not eating alot, so after a few days took him in. He got one blood transfusion and they just sent him home after 3 days. He’s on 4 meds doxycycline, prednisone, cyclosporine and clopidogrel. He’s eating ok but is still barely moving, he a blood test scheduled for next week but everything I read is really scary. I’m just wondering for the people who have been through this, is it normal for them to be like this and for how long? Thanks!

[Patrice]

Hi Samantha,
I am sorry to hear about your Terrier. You must be very worried as this happened so suddenly. Please do not be scared. We have been helping owners for many years and we can explain many things to you so you will have information to make decisions based on fact, not on emotion. You may not understand everything we tell you but we will try to help you make good decisions. We can take on some of the heavy lifting. We want you, most of all, to be calm around your Terrier and act normal. Your next job is being a good home nurse for him. You will take care of his meds and give him appropriate food. His health depends on you to continue to keep your wits about you. We are here to help you do this.

IMHA is a condition that tends to happen after several triggers activate the immune system to begin destroying red blood cells. The vet hopefully asked you questions about his history and if there were any signs of him not feeling well prior to your first visit. With this information the vet can decide if there are things that are treatable.

So one thing I see is that he prescribed doxycycline. This is now a common treatment in case a dog has contracted a tick disease. This can be one of the triggers that push the immune system to begin destroying RBC. Your vet may not know if this is the case, but is being proactive. You can ask your vet if they did test for tick diseases and what the results were, that would be helpful to know.

The prednisone is always given, at rather high doses, to suppress the immune system immediately. This is intended to stop the destruction of RBC. It is a life saving drug but it does have side effects that become worse over time.

So the vet has also started your Terrier on another drug, cyclosporine, which is also an immunosuppressive drug. It works differently than the prednisone, only targeting the specific white blood cells that are actively destroying the RBC. This drug has less side effects and takes a bit of time to start working effectively.

Both of these drugs are standard and your vet did a very good thing by starting this immediately.

He has anemia, which is a shortage of oxygen to the body cells. RBC have a molecule inside the cell called heme that has an iron molecule attached that “carries” oxygen and delivers it to the body cells. So when there are less RBC in circulation, there is less oxygen going to the cells. This stresses the body organs and will make your dog feel very fatigued. Dogs do not generally feel pain from this condition, they are just very tired. Let him rest as much as he wants and avoid a lot of household activity that interrupts his rest.

Finally your vet has prescribed clopidogrel which is an anti-clotting agent. In the early days of diagnosis, when a lot of red blood cells are being destroyed in circulation, there is a risk of inappropriate clotting because of the amount of debris from the cells. This can lead to problems. So your vet has done another proactive correct thing by reducing the risk of incorrect and massive clotting.

All dogs are different when it comes to this condition. And I don’t know all the tests your vet ran and those results. The vet may have some idea of what the specific triggers are that led to this.

But in general, the early days tend to be the rockiest. Once the drugs kick in, the craziness slows down some but then there may be setbacks, perhaps another transfusion, maybe the vet finds another trigger that needs treating, your Terrier could have a reaction to one of the drugs. So it’s similar but different for all dogs.

What are some common triggers. The four main causative factors of autoimmune disease have been stated to be: genetic predisposition; hormonal influences, especially of sex hormones; infections, especially of viruses; and stress.

What we often see are certain breeds that have a genetic tendency towards autoimmune diseases in general and specific genetic tendencies to IMHA. Another common trigger is autoimmune thryoiditis or hypothyroidism. Many breeds can be affected by this.

So an example is an older overweight female dog of a specific breed for instance a Cocker Spaniel, that has not been spayed, has autoimmune thyroiditis and has received recent multiple vaccine boosters. She had some predispositions and the vaccines set her immune system off.

So the vet is always looking for these kinds of triggers. There may be more specific ones such as a recent insect or snake bite, a lifetime of digestive allergic problems, atophy or canine atopic dermatitis which is an inhaled dog allergy (pollen, molds etc), a bag of bad food. There are really so many that it’s often hard to figure them all out. Treating each one is critical for success.

So sit down tonight and make a list of all the unusual things that may have happened in the last 6 months and also anything that has been a lifetime problem. Let’s do a little detective work to help your vet.

If you are able, please obtain copies of the most recent blood tests: CBC complete blood count, Chemical Screen and other like tick tests, urinalysis etc. You can upload them to me on the Urgent Advice page you see in the menu above to the right. Please don’t send to many at once, and you can fill out the form multiple times to do this.

Start a kitchen diary today and write down each medication, the dosage, the instructions on when to give and then make a small chart to mark off the times when you administered the drugs. On this diary you can note other things such as negative or positive signs, his general overall demeanor.

I am sure you have more questions. Please ask anything.
my best Patrice

[Vally]

Hi Samantha, just wanted to add that yes the first days and weeks are really scary. Ask anything at all as we’d love to help. If you need a help with a medicine chart, I’d be very happy to make one up for you.

Regards,
Vally

[Samantha]

Thank you so much for responding and making this all understandable! I know that they did do a test to see if it was tick related and that came back negative. Everything that they tested him for to see what the cause was seemed to be negative. I will ask next week for the results from all the testing. I’m glad to know that it’s normal for him to still this lethargic. He is eating though so that’s good. I just am so sad to see him laying around all day. Do they usually just start to gradually get more energy as time goes on? Thanks again for all this information!

[Samantha]

Hi there,

My 7 year old terrier was just diagnosed with IHMA. He was lethargic and not eating alot, so after a few days took him in. He got one blood transfusion and they just sent him home after 3 days. He’s on 4 meds doxycycline, prednisone, cyclosporine and clopidogrel. He’s eating ok but is still barely moving, he a blood test scheduled for next week but everything I read is really scary. I’m just wondering for the people who have been through this, is it normal for them to be like this and for how long? Thanks!

[Patrice]

Hi Samantha,
I am sorry to hear about your Terrier. You must be very worried as this happened so suddenly. Please do not be scared. We have been helping owners for many years and we can explain many things to you so you will have information to make decisions based on fact, not on emotion. You may not understand everything we tell you but we will try to help you make good decisions. We can take on some of the heavy lifting. We want you, most of all, to be calm around your Terrier and act normal. Your next job is being a good home nurse for him. You will take care of his meds and give him appropriate food. His health depends on you to continue to keep your wits about you. We are here to help you do this.

IMHA is a condition that tends to happen after several triggers activate the immune system to begin destroying red blood cells. The vet hopefully asked you questions about his history and if there were any signs of him not feeling well prior to your first visit. With this information the vet can decide if there are things that are treatable.

So one thing I see is that he prescribed doxycycline. This is now a common treatment in case a dog has contracted a tick disease. This can be one of the triggers that push the immune system to begin destroying RBC. Your vet may not know if this is the case, but is being proactive. You can ask your vet if they did test for tick diseases and what the results were, that would be helpful to know.

The prednisone is always given, at rather high doses, to suppress the immune system immediately. This is intended to stop the destruction of RBC. It is a life saving drug but it does have side effects that become worse over time.

So the vet has also started your Terrier on another drug, cyclosporine, which is also an immunosuppressive drug. It works differently than the prednisone, only targeting the specific white blood cells that are actively destroying the RBC. This drug has less side effects and takes a bit of time to start working effectively.

Both of these drugs are standard and your vet did a very good thing by starting this immediately.

He has anemia, which is a shortage of oxygen to the body cells. RBC have a molecule inside the cell called heme that has an iron molecule attached that “carries” oxygen and delivers it to the body cells. So when there are less RBC in circulation, there is less oxygen going to the cells. This stresses the body organs and will make your dog feel very fatigued. Dogs do not generally feel pain from this condition, they are just very tired. Let him rest as much as he wants and avoid a lot of household activity that interrupts his rest.

Finally your vet has prescribed clopidogrel which is an anti-clotting agent. In the early days of diagnosis, when a lot of red blood cells are being destroyed in circulation, there is a risk of inappropriate clotting because of the amount of debris from the cells. This can lead to problems. So your vet has done another proactive correct thing by reducing the risk of incorrect and massive clotting.

All dogs are different when it comes to this condition. And I don’t know all the tests your vet ran and those results. The vet may have some idea of what the specific triggers are that led to this.

But in general, the early days tend to be the rockiest. Once the drugs kick in, the craziness slows down some but then there may be setbacks, perhaps another transfusion, maybe the vet finds another trigger that needs treating, your Terrier could have a reaction to one of the drugs. So it’s similar but different for all dogs.

What are some common triggers. The four main causative factors of autoimmune disease have been stated to be: genetic predisposition; hormonal influences, especially of sex hormones; infections, especially of viruses; and stress.

What we often see are certain breeds that have a genetic tendency towards autoimmune diseases in general and specific genetic tendencies to IMHA. Another common trigger is autoimmune thryoiditis or hypothyroidism. Many breeds can be affected by this.

So an example is an older overweight female dog of a specific breed for instance a Cocker Spaniel, that has not been spayed, has autoimmune thyroiditis and has received recent multiple vaccine boosters. She had some predispositions and the vaccines set her immune system off.

So the vet is always looking for these kinds of triggers. There may be more specific ones such as a recent insect or snake bite, a lifetime of digestive allergic problems, atophy or canine atopic dermatitis which is an inhaled dog allergy (pollen, molds etc), a bag of bad food. There are really so many that it’s often hard to figure them all out. Treating each one is critical for success.

So sit down tonight and make a list of all the unusual things that may have happened in the last 6 months and also anything that has been a lifetime problem. Let’s do a little detective work to help your vet.

If you are able, please obtain copies of the most recent blood tests: CBC complete blood count, Chemical Screen and other like tick tests, urinalysis etc. You can upload them to me on the Urgent Advice page you see in the menu above to the right. Please don’t send to many at once, and you can fill out the form multiple times to do this.

Start a kitchen diary today and write down each medication, the dosage, the instructions on when to give and then make a small chart to mark off the times when you administered the drugs. On this diary you can note other things such as negative or positive signs, his general overall demeanor.

I am sure you have more questions. Please ask anything.
my best Patrice

[Vally]

Hi Samantha, just wanted to add that yes the first days and weeks are really scary. Ask anything at all as we’d love to help. If you need a help with a medicine chart, I’d be very happy to make one up for you.

Regards,
Vally

[Samantha]

Thank you so much for responding and making this all understandable! I know that they did do a test to see if it was tick related and that came back negative. Everything that they tested him for to see what the cause was seemed to be negative. I will ask next week for the results from all the testing. I’m glad to know that it’s normal for him to still this lethargic. He is eating though so that’s good. I just am so sad to see him laying around all day. Do they usually just start to gradually get more energy as time goes on? Thanks again for all this information!