Ashki, 3 yo Golden IMHA

Keymaster

Dear Tamara & dear Ashki

Welcome to you both – I’m so glad you’ve found us, but sorry for the reason you are here though -Ashki’s non-regenerative IMHA. Ashki is such a lovely name! He sounds like a really wonderful & sweet boy, full of love & zest for life – and he’s a very young chap too.You will find everyone on here supportive & caring as we’ve all experienced AIHA/IMHA first hand, which is awful – I don’t know what I would have done without my good friends on here when my greyhound Worzel was diagnosed.

We all hold Dr Dodds in such high regard & you could not be in better hands for treatment advice – I am relieved so see you are in contact with her. I assume the dosages of drugs have been check with her protocol? Internists are all different – it is sometimes awkward when they want to do things their own way & you want them to consult with someone else – just go with your instinct is often the best advice! It does sound like the internist is a determined person who really wants to help. You are obviously a great Mum who has been really on the ball with this. Do you have the bone marrow biopsy results? Did Ashki have any previous illnesses/problems or was he vaccinated recently?

I assume other tests & scans have been done to try to find the cause? – many owners never do find out what caused it. Some breeds are more prone to it than others too. Number one plan is to get some reticulocytes (baby red cells) on the go – do you have any test result figures on that? How long has Ashki been on the cyclosporine & mycophenonlate? Are there any other abnormalities in Ashki’s blood results? Sorry about the million questions – we like to know what’s been happening to try & help as much as we can. We only want to do our best to get Ashki better & to support you through mutual experiences – this is a horrible disease & we all need as much support as we can get – as you said, it’s a real roller coaster. Worzel was non-regenerative for a while and it seems never-ending & soul destroying, so I can understand exactly how worried you must feel – it is a very frustrating time when their PCV just doesn’t come up at all. Please stay in touch as often as you can – we will all be crossing our paws & fingers for some new red blood cells to appear as quickly as possible. The drugs do take a while to work, so as much as we hate it, we have to be patient sometimes.

Please let us know how Ashki is doing as often as you can & know we are all thinking about you. If there’s anything we can help with, don’t hesitate to ask.

Best wishes to you & Ashki

Sheena, Worzel & Ollie

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Tamara

Guest

Thank you so very much Ruth and Sheena. I’m so happy to hear that Nula is at 43!!

Ok, I’ll try to answer your questions Sheena. His bloodwork has been in the normal range with the exception of liver enzymes and bilirubin, though those are normalizing.

I just got a call from the internist and there’s good news from the initial cytology on his bone marrow — they’re seeing lots of immature red blood cells! This is very different from a month ago when they saw very few. We’ll get the full report Tuesday probably. Now they just need to mature and be released and stay healthy and viable!

This internist is very committed and caring. His nurse is wonderful too, she came in on her day off and sat with Ashki during his transfusion yesterday.

His other health issues are hip dysplasia (Dec 2012); he had a reaction to Frontline Plus on 3/25/2014 (redness, itching); he had a GI upset and was trying to bloat on 3/29/2014 (I thought his gums looked a little pale, but the vet tech said they were fine; they did not do bloodwork). After the GI upset he was not wanting to eat and lost some weight; he was gradually eating more, but then the last week of April he really did not want to eat again and became lethargic. I did not want to go back to the same vet that treated the GI upset, I was not happy with that experience, so I called the holistic vet who had been recommended highly to me. She wanted him to have an ultrasound to make sure all was well, and referred me to the internist. I looked at Ashki’s gums and thought they looked pale and called the internist office and told his nurse what was going on, including the pale gums and she said to bring him in. He had the ultrasound, a bone marrow biopsy, and a transfusion that night.

His last vax was a lyme vax December 2012. I titer for everything, and he will not get vax from here out.

He has been on cyclo since 5/1; we added the myco 5/15; he just started thyroid therapy this week at .3 mg twice daily, we’ll go up to .5 mg Monday (Dr. Dodds suggested doing it that way as he was restless when I initially gave him .5). Oh and we did test the cyclo level and it is good.

We could not come up with a cause. The only possibilites I can think of are he was hypothyroid and that threw him into it (his FT4 was very low, I had it tested at Dr. Dodds’ lab a little over a week ago) or he got into something when we were on one of our off-lead walks in the woods or at the beach.

He is an amazing dog, I feel so blessed to share his life.

Thank you again, so very much. Let me know if you have more questions. I don’t have his bloodwork results, I keep forgetting to ask for them. I’ll try to remember.

Tamara and Ashki

Oh, and I’ll see if I can figure out how to post a pic!

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admin

Keymaster

Hi Tamara

It’s lovely to see his photo – he is one handsome lad with a beautiful big smile from ear to ear – no wonder you love him to bits! It’s great news that the later biopsy showed more reticulocytes – wonderful. My Worzel was producing reticulocytes in his bone marrow (seen in the biopsy), but his immune system was killing them off before they actually were released into his blood stream. He was non-regenerative until the azathioprine kicked in – that took a couple of weeks. It takes around 10 days for azathioprine to suppress T-lymphocytes (the guilty party in this killing of retics & red cells) & although I have no personal experience with cyclosporine, other owners have had to wait a little while to see any effect, but at least there are reticulocytes in the bone marrow – they just need to get out into the bloodstream now.

I know Dr Dodds will advise you on what to do next & you have a good grasp of what is going on here, so I know you will do whatever is best for Ashki. I am assuming he has no clotting risks (Worzel was the same), and if his bilirubin is dropping that is great news – less red cell destruction. Do you know if any spherocytes were present at all & did he have a Coombs Test? Sorry – more questions again.

I agree with Brigitte – please, please don’t use the algae unless Dr Dodds specifically wants you to keep it going. Some supplements can actually counteract the good effects of the immuno-suppressant drugs & that’s the last thing you want to do. The cyclo & myco are derived from fungi, so I would not risk using the algae personally. My amateur guess is the IMHA may be something to do with the GI problems Ashki has been having, but it’s hard to say. Noting the reaction to the Frontline, maybe Ashki has a sensitive immune system. Goldens do have a breed predisposition to hypothyroidism (I bet you already knew that!) & adding thyroxine which is haemopoetic can only help. The denmarin should help bring down the liver enzymes too – I think most of our dogs have had raised liver enzymes because of the hepatotoxic drug treatment that we have no choice but to use. Worzel’s came down nicely with the Milk Thistle (it’s in Denmarin).

I am amazed at your deep knowledge – do you have a medical background by any chance? I know you will fight this disease & you are doing the right thing keeping Dr Dodds on board & your vets & nurses sounds very good too. Come on Ashki – get those reticulocytes going & raise that PCV – we are all willing you to do this for you Mum!

If you want to, you can send us any blood tests, other tests results & biopsy results using the urgent advice area – that sends the attachments directly to us. I completely believe in Dr Dodds though, and I assume she has already seen all these things.

Anyway, wishing for some good results at Ashki’s next test – please let us know how things are going & if you want to ask any questions, please feel welcome to do so.

Crossing everything & sending the best possible wishes,

Sheena, Worzel (last PCV 63) & Ollie

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