New to AIHA, dog in trouble – Page 2 – Second Chance AIHA Dogs

Keymaster

Rick,
It sounds like you have researched very carefully and understand a great deal. I admire you for taking the care to do that for her. What you had go through to get her care was very difficult.

Can you say when the last good meal is that she ate? Has it only been a day or two or did you notice that she lost her appetite about a week ago when she first did not feel well? Was she ever a good eater or is this a rather new symptom? Can you pinpoint anything at all that was different that day?

However, sometimes dogs just don’t feel like eating. It’s a tough decision whether to let this go for a bit of time or to intervene. Clearly it is not ok for them to stop drinking. If you have to use a baby med syringe from the pharmacy to get her to take water then you must do that. If you can make up a little slurry of over cooked rice water (rice congee) with some sugar and a dash of salt then syringe that slowly into her cheek, all the better. I agree that the prednisone is bothering her stomach and it is far better if she is eating something with it. My vet told me to use something very smelly like fish. I had a number of things I rotated through like cream cheese, real canned cheese, liverwurst, canned sardines.

It is difficult to determine how she is reacting physiologically to her meds, due to the fact she has been on prednisone prior to now. Though you did say she was on 1mg of pred per day and that is quite a low dose. Some AIHA dogs continue on with a low dose like this for the rest of there life. Keep some notes in the kitchen so you can recall how she is behaving during the day so you can report when you next talk to the vet.

So she is now on 40mg per day? Are you splitting that BID, twice a day with food? This would be the ideal way to give this.You most definitely want to be giving her stomach protection such as Pepcid or Prilosec an hour before those meals. We can never quite know whether a dog will develop stomach ulcers, but my experience is that it is far better to just plan on that eventuality, be proactive and protect the stomach.

The sucralfate is excellent at healing any possible ulcers that may develop. It is kind of like a mucous internal “band-aid” for the esophagus and stomach. Because of that you must be careful to not give it too close to when you are giving food and medicine because they will not be absorbed properly. Timing meds can become difficult the more of them you give, but I found that giving the sucralfate on an overnight fast was the best for Chance, it had all night to work. If you cannot accommodate that then be sure to give it at least 1-2 hrs before a meal with meds or at least 3-4 hrs after.

I knew that the PCV would drop like this, it is a common occurrence. She may end up settling in a bit lower than this. There are three broad ranges of PCV values. Mild anemia is usually around 30-32 to 37%, moderate is approximately 21-30% and below that is variably considered severe. Each dog is a little different in how badly they feel at certain PCV’s. Some dogs can tolerate 8% and seem as happy as ever, other dogs are just not well off at that value. So determining a “transfusion trigger” point is a variable dependent on a combination of the actual PCV but also the clinical evaluation by the vet. However most vets would probably think of 20% as an acceptable value to consider another transfusion.

The first transfusion a dog gets is “free.” That means, unlike humans who must always be matched, a dog can take any blood type for the first transfusion without reactions. Dogs have approximately 11 different “types.” After the first transfusion a dog must be typed and matched for the next one to avoid reactions. Being in facility that is prepared to do this more complex step in an emergency is good insurance. There are different blood products available too. My vet was able to use whole blood directly from her own donor dog. The next best product is packed red blood cells. In an emergency, super washed red cells will reduce the transfusion risks significantly but the washing does reduce the number of RBC and platelets.

I always think what I would do if this were my dog. I will always be quite honest about how I feel.

So, if this were me, I would consider these first few days a period of emergency. I would find, if I could afford it, the best specialist in town. I am lucky that my own country vet is the best specialist in town, but not everyone is that lucky. If your instincts are telling you that you need to feel a bit more comfortable about a second opinion AND you think she can handle being taken to a new location, then any vet should graciously welcome a valid second opinion and may even be polite enough to refer you. This is not a straightforward case, she has complications with the Addison’s condition, that is reason enough. Never burn your bridges, be polite and thankful for the great care she has been given. You may have to go back there.

There is still a great risk for clotting emergencies right now. Please request permission to give her low dose aspirin therapy. This therapy has been researched and is an approved protocol for treating AIHA canines. A dog that has active hemolysis needs to be protected.

Yes, the accuracy of these blood tests can be variable and there are common mistakes that can result in wrong values. Some vet techs are wonderful, they take great care with their job. Seek out those techs and be sure to ask for them each time you visit. The decisions you will be making are dependent on the accuracy of these tests. You are her advocate, get what you need as politely as possible. I promise you that this will be of value.

If she is resting tonight and is not struggling, why don’t you get a few hours of sleep and then take her in early in the morning, is there someone else that can stay awake while you sleep? That is a good compromise. You will get the morning staff at their best before the rush starts.
my best
patrice

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