For Hope and Steve

[admin]

Hi Hope.  I am starting a separate post for you, I hope you don’t mind.  I am so sorry that you had to find this site, but glad you are with us, as our goal is to help AIHA/IMHA pets and their owners through this roller coaster ride.

As many of us here on this forum, I had never heard of AIHA/IMHA before.  When Sadie was diagnosed over a year ago, I was the infamous deer in the headlights – total question marks.  You, on the other hand, seem to already have a grasp on what is going on AND you reacted immediately, which is so important.

My name is Linda and my dog is Sadie (her story is under “Our Stories” at top of forum page).  I know, as we all do here, what you’re going through because we all have animals, dogs and cats, that are dealing with or have dealt with AIHA.  Some, many, go into remission.  Let’s get Steve there, okay?!

We are not vets, but as we do have animals suffering from this horrible disease.  And because of this, through the years, have made it a mission to acquire some very important knowledge and advice from some incredible vets across the country that unselfishly have given their time and professional knowledge to the help AIHA/IMHA animals.  We want you to get the best medical attention possible for Steve and work with you and your vet to get him back to health.  This disease CAN BE BEAT and Steve CAN get back to being his happy, go lucky self again.  Just no more chicken bones Steve, okay?!?!

I am really glad you have Steve on anti-clotting medications.  Can you give us a list of all medications and dosages Steve is on currently?  Also, the blood work, if you can scan it and send or even post the results, there are those here that can look it over and give you their opinion.   You can post this to the “Urgent Advice” page.  Patrice, Sheena and a few others will look it over and let you know their thoughts.

Let’s go on from here.  We are here for you 100%.

Love and huge supportive hugs, Linda and doing pretty darn good, Sadie

[admin]

I have copied this from Hope’s other topic so we can all read the story in both places

Written by Hope:

“Hi everyone!

I’ve been reading this forum over the last few days as my pup, Steve, was diagnosed monday with primary IMHA. I am completely devastated and overwhelmed as I am sure all of you understand too well.

Saturday, he was acting kind of funny and I noticed his gums were pale. I took him to his general vet and she said she thought he had a stomach ache b/c he had gotten two chicken bones Thursday evening and I had made him throw up… terrible! She sent him home with medicine for his stomach but did run a CBC and x-ray and said everything was good (including PCV was 36%). He kept looking more and more lethargic Saturday and that night he had a raging fever and was breathing very fast and shallow. I took him to an emergency clinic first thing Sunday and they said that his PCV had dropped to 15.4% (!!!) in just 24 hours. They wanted to keep him for tests to see if one of the bones had perforated his GI tract but said that IMHA was also a concern. I left thinking it was the former, which almost would have been the “better” of the two. After barium contrast tests and more xrays they came back with the diagnosis of primary idiopathic IMHA. His PCV that morning was 21%, and hey started him on prednisone. I’m not sure I understand how his PCV went up from 15 –> 21% without anything ? I moved him to my general vet because he just loves her and I thought she’d give him more one on one care. His PCV went up to 25% Monday PM and stayed stable until Tuesday. We went to visit him and he was SUPER alert, jumping, tail wagging, running around, trying to escape. AFter we left she said he acted up for hours, and she called to say we should come get him because she thought he was stable enough and he obviously wanted to be with us. Against my better judgement, I went and got him. He was fine when he got home, acted a little tired but I thought that was to be expected. He urinated at 8:30 and it looked like there was a little blood but I didn’t catch any so I decided to wait for another. At 10:30, he urinated again and it was DARK red. We rushed him to the recommended 24 hour emergency vet/specialist clinic and they said his PCV was actually at 27%. We didn’t know what was going on. They said that based on the blood in the urine, they knew he had intravascular hemolysis, which is the worse of the two types. Again, we were devastated. They added on Mycophenolate + 2 anti-clotting meds, which I am so happy for because I’ve been reading non-stop about the risk of clots in these patients. His PCV yesterday AM and mid-day was 18%, which the vet said was somewhat to be expected because he had urinated out so much blood the night before. Late yesterday afternoon, it had gone up to 24%. We are waiting to hear on an update from overnight.

Do any of you have experience with the intravascular hemolysis “version” of IMHA? The other is extravascular, which is when the spleen and liver are involved and the dogs are jaundiced.

I’m so glad I found this board because i’ve been an absolute wreck and it makes me feel a little better that there are others out there who know what our little family is going through. Hope & Steve”

[Hope]

Thank you so much to everyone… we called the emergency clinic where he is and the doctor has to call back. I like that this office seems more equipped to handle Steve and treat him as he needs to be, but I’m not in love with the time it takes to hear ANY updates at all. My husband spoke with a tech though and she said that his PCV is now at 20% (this was at 11:00am). His last one (11:00 pm last night) was 24%. Is that bad? The tech said that fluctuations like that are okay but I’d like to hear that from the vet or someone with more experience with this.

 

Husband tried to get the other lab results and she wouldn’t give them to him. He also tried to get dosages and she said he’d have to wait for the vet to call back.

 

I know he’s on:

Prednisone 20mg – 2 tablets by mouth every 12 hours

Sucralfate 1gm – 3 times a day

Metronidazole 250mg – 1 tablet by mouth every 12 hours

Famotidine 10mg – 1/2 tablet by mouth every 12 hours

Clavamox – 1 tablet by mouth every 12 hours

Mycophenolate 500 mg – 1/4 tablet every 12 hours

Low dose aspirin

Lovamox

 

Any advice would be SOO appreciated! thank you everyone! i will post as soon as we get the other results and dosages

[Hope]

From reading I’ve noticed steve seems to have been started on a lot more pred than other dogs. He’s a Dalmatian, 48#, so isn’t that kind of a lot?

[admin]

Hi Hope

I’m sorry this has happened to poor Steve, bless him. It is such a traumatic thing to go through & we are all here to support you & help in any way we can. We have all been in this awful situation & I was also stressed out beyond belief when my dog Worzel was diagnosed.

I admit I am a bit mystified by the up & downs in PCV (unless transfusions have been given which you didn’t mention?) – red blood cells cannot replace themselves very quickly unlike other blood cells  – but it’s nothing for you to worry about for now – I suspect the machine analysis may be a bit inaccurate because of the large amount of intravascular haemolysis which can skew the results!

I am really pleased to see he is on anti-clotting meds plus an immuno-suppressant on top of the prednisolone. The “usual first choices” are azathioprine or cyclosporine, but there may be reasons why your vet chose mycophenolate instead. I am NOT a vet, but I am concerned because of the side effects of mycophenolate on the GI system, where Steve’s problems appear to have started. I am not trying to scare you in any way and I know you are already stressed out (like we all were, I promise you!), but I have to mention these possible side effects as I would never forgive myself if I hadn’t told you about them. It’s just something you need to be aware of. There is not very much information / research available about dogs on this drug. Please take a minute to read our glossary item on Mycophenolate

https://www.secondchanceaihadogs.com/AIHA_Terms/mycophenolate-mofetil/

If Steve is feeling good in himself, which it seems from what you’ve said that he IS, things sound OK so far, so please do not get stressed out over what I am saying, just have a chat with the vets about it. Intravascular haemolysis is pretty common with IMHA & your vets look like they are on top of this side of it. The theory is the high dose prednisolone & longer acting immuno-suppressant (MMF) will stop the T-lymphocytes from killing off the red blood cells, but this does take time to start working. What did they give him for the original raging fever, by the way? An infection can often be the culprit for triggering IMHA. Is Steve on stomach protection (sucralfate and famotidine – I think you call it Pepcid over there)? This is also important as these drugs are hard on their tummies.

Please, please feel positive that Steve seems to be producing new red cells (called regenerative) if he hasn’t had transfusions – lovely news!!!!  When the haemolysis hopefully slows down & stops due to the effects of the drugs, he will feel much better too. I know how frightening this is, Hope. Please keep doing what you’re doing – being a fantastic Mum who did exactly the right things. Forgive me if I have scared you, but you do need to know absolutely everything.

I’m sorry I’ve had to rush this a bit – I promise to get back to you later on

In the meantime, please know we are all thinking of you & we want to do our best for Steve so he can better.

All the very best wishes, Sheena, Worzel (Diagnosed Dec 2012) & Ollie

[admin]

Just seen you recent post on meds etc – have to go out – will be back later

Love Sheena xxx

[lynda]

Hi Hope – sounds like Steve is getting all the right treatment.     I wish you luck, and really hope that Steve fights the disease.  We are all very glad you found this site – it really is a rollercoaster ride with IMHA.  But,  most important, he is obviously getting lots of love: nothing is more important

[Hope]

Hi all!

Thanks again for everyone’s support and kind words… I truly appreciate it. All the info I can know the better, no matter how scary.

 

I believe (though I’ll ask him later when i talk to him) the reason they put him on the mycophenolate is simply bc that’s this internists preferred second immunosuppressant drug. When we brought him into the ER the emergency vet said that. I’ll definitely speak to him about the side effects though bc they sound awful. So far he is eating and drinking, peeing (no blood as of last collection) and had a BM this morning. He told me yesterday though that the mycophenolate is supposed to work within 24 hours.

 

He has luckily not had to be transfused. The vet said they don’t do it until the PCV is at 15%. I’m praying we don’t have to obviously!

The vet spoke with my husband a few minutes ago and said he feels the drop from 24% (11:00pm last night) to 20% (11:00am today) is a “suitable fluctuation” and not a cause for concern at this time. I told him not to but husband told the vet I was reading forums and wanted copies of his lab results. He said the doctor wasn’t thrilled by that at all and said it’s a bad idea but would send them and medication list anyway. I could hit husband but I will post them as soon as I get them.

Thank you again everyone!!!