Buddy: 13 year old mixed-breed

[Jordan]

Hello,

My dog Buddy is 13 years old. He is a mixed-breed (looks like he has some rat terrier, but I’m not sure beyond that). We are located in Arkansas, USA. On April 28th of this year, everything changed for us. I came home and he was barely able to move. When I was able to get him up he stumbled around. I had him at an emergency vet clinic by midnight. They took x-rays and did blood work. The x-rays showed that his liver was slightly enlarged and that his heart was a bit off-center compared to typical canine anatomy, but that was all the x-rays showed. His bloodwork, however, revealed a lot. His red blood cell count was 3.17, his hematocrit level was 24.4%, his platelet level was 53, and his hemoglobin level was 6.6 g/dL.

The morning of the 29th, I got him to the best vet clinic in the region of the state that we live in. It is over an hour from our home, but I want him to have the best care possible. They took another blood sample and his hematocrit was down to 15, so they immediately did a blood transfusion. During the blood transfusion he threw up some blood, but that was the only time that he has thrown up during all of this. The next day his hematocrit was up to 30. However, in the days following it, his hematocrit dropped again (after going up slightly a few times), and eventually was down to 15 again on May 6th. He had to have a second transfusion. It has gone up slightly throughout this week, and I took him home for the first time this past Tuesday (May 10th).

He did have a Coombs test, which was negative, and a comprehensive PCR looking for tick diseases, which was also negative. He is on sucralfate (morning and night), famotidine (morning and night), prednisone (morning and night), cyclosporine (night), and azathioprine (night). He is also on a prescription diet that is supposed to be easier on his stomach.

Last night my fiancé gave him a Ritz cracker (he did not realize that he wasn’t supposed to have anything besides his prescription food). I have been a nervous wreck since, and am worried that it may have contributed to his symptoms this morning. Buddy acts like he is not feeling well, and I fear that I will need to take him back to the vet clinic. He ate and went outside with me for a few minutes, but his energy level has gone down quite a bit since last night. He wants to lay around constantly, which is different from the past two days (he was more active). The vet clinic does not open for 45 minutes, so for now we are waiting.

On a (somewhat) side-note, I am 22 weeks pregnant and not am not coping well. Part of it is that I am not getting enough sleep by far. I am up throughout the night and I think that I am getting a stomach ulcer from stress and anxiety. I have had Buddy since he was a young puppy (probably around six weeks of age). Currently I am the only one away from the vet clinic who is able to care for him to the extent necessary, and I feel very alone (and downright exhausted). I hate that he is going through this. He does not seem to be suffering. He has a good appetite and has been alert through everything. If he was suffering, I would not prolong it.

Feel free to ask questions – I have probably left some information out by accident. Does anyone have any advice?

Thank you.
Jordan

[Jordan]

More Information I forgot to add:

Buddy had an ultrasound on April 29th which showed no free blood/fluid in his abdomen.

Also, I can’t believe that I forgot to add that I found a live tapeworm segment in his feces yesterday. The vet treated him with a praziquantel tablet at the clinic.

His bloodwork was normal in December.

[Vally]

Hi Jordan and welcome to the site, though I’m sorry you’ve had to come looking for us.

What does Buddy weigh and what is the dosage of the meds you’re giving? I wouldn’t worry about the cracker. I’m certain that would not do any harm.

What drugs are you giving with food and what are you giving without food. Prednisone and azathioprine should be given with food always and the others away from food. I’d be happy to make up a chart for you. I note there’s no aspirin being given. Good to see Buddy is on tummy protection, but there’s no mention of aspirin. That’s normally necessary (but not in every case) to prevent clots. A blood smear would show whether that’s needed.

Buddy will be feeling the effect of the drugs which are very harsh, and whilst we all hate them, they are life savers. Prednisone in particular has a million side effects, but when it’s safe to lower the drugs when Buddy is stable, you’ll see those side effects go away.

Do you have a copy of the blood tests? If so please use the Urgent Advice on the top and send them through. Someone will have a look at them for you and can help you to understand them.

You have to make sure you take care of yourself and bub. I know easier said than done.

We’re all over the place so different people are about at different times, so ask anything. We’d love to help.

Regards Vally and Bingo (diag Nov 2011, in remission)

[Sheena]

Hello Jordan

A big welcome – goodness, no wonder you are so tired out with your pregnancy as well as poor Buddy not being well. I’m really sorry to hear he’s a poorly boy. You are NOT alone now – you have all of us to help & support you with advice & big hugs.

Firstly, do you know if they examined his liver thoroughly with the ultrasound? It is not unusual for our dogs to develop enlarged spleens & liver with this disease, but normally the liver issues are drug side effects. I’m just wondering why his liver was enlarged before treatment started.

Throwing up blood – sounds like he has had a GI bleed, again, not uncommon, & I’m relieved to see he has stomach protection & that his appetite is OK. The sucralfate is excellent for healing ulceration & inflammation in the GI tract, so hopefully he won’t have that issue again. Has Buddy ever had stomach issues of any description in the past? Wondering if that tape worm has something to do with GI issues of course. Poor Buddy having that as well.

As Vally mentioned, if you could send us anything & everything in the way of test results, blood tests, blood smears, reports, scans, that would help us to help you. Also, could you include the normal December test – it gives us a baseline as to what is normal for Buddy.

I see he had low platelets as well as low red cells – do you know what happened to their levels after transfusion? Sometimes, dogs have more than one line of blood cell affected by this disease – if it is both red cells & platelets, it’s called Evans Syndrome – we’ve had lots of people on here with that & the treatment is just the same, but sometimes with an extra drug added in. I see you have cyclosporine & azathioprine, which makes me think your vet is thinking Evans Syndrome too & has done the right thing on the drug front.

Adding an anti-clotting medication is often necessary for most dogs, but it may be that Buddy doesn’t need anything. Without a blood smear result, we can’t say either way. If you could check with your vets on this point about abnormal clotting, that would be good. Don’t fret about this – he may not be at risk. We want to know for sure though.

It’s great you know he’s not suffering – our dogs are just really, really tired, lethargic & feeling like doing nothing at all because they can’t get enough oxygen around their system because the red cell levels are low so can’t provide enough oxygen for them to be energetic. There is no pain, just total & utter exhaustion – I think you are feeling like that yourself too.

You have to be very patient with this disease in the early stages. The drugs take a while to work. Some dogs are lucky & respond quickly, others just take a bit longer. Transfusions are there to keep them stable until those drugs start to work – small transfusions are best – try not to transfuse over a PCV of about 25 is the general rule, otherwise the body thinks it’s OK & will slow down reticulocyte (baby red cell) production.

I’ve probably tired you out even more reading this, but I hope we’ve helped a little to ease your mind. Remember to look after yourself very carefully too – this was one of the most stressful things I have ever had to deal with myself when Worzel was diagnosed with bone marrow failure – you are in good company with all of us worry gutses on here! You can tell us anything, or ask us anything. We know what it’s like to feel alone too – I did, until I found the lovely people on here.

Forget the Ritz cracker – it’s nothing to worry about.

Please let us know how he’s doing – it’s very early days in this disease – fingers crossed, he will respond soon though. It’s a case of not giving up – I promise you would never have given up unless Worzel was suffering or in pain. There is enormous hope Buddy will make a complete recovery.

Huge hugs from us all
Sheena, Worzel (diagnosed Dec 2012, in remission) & his friend Ollie xxx

[Sheena]

Sorry – typo – that should have read I would not have given up – missed the I out!

[Jordan]

Hello,

I appreciate your support so much – thank you. We just got home from the vet clinic. They went ahead and drew blood for comprehensive testing (CBC, liver, etc.). I will hopefully know something in about two hours. His regular vet is away right now and won’t be back until Monday, so we saw a different one today (and yesrerday). She had me take him home to (hopefully) keep his stress levels down and to keep him comfortable. He is more active now, but it may be due the adrenaline after going to see the vet. Right now I am on my iPhone, but later I will get on my laptop and address what was asked/requested in your replies. He is resting and stable right now, and to be honest I’m going to take a nap as well.

Thank you again, and I will be back on in a few hours.

JJ

[Jordan]

I just noticed several typos – my apologies!

[Jordan]

Hello,

I just talked to the vet. Buddy’s white blood cell count is up. I know that his immune system is suppressed right now, but is it common for dogs with AIHA to get infections? I’m starting to worry that I’ve done something wrong or that something in my house could be making him sick. However, I also realize that he has traveled a lot within the past 48 hours, and that he may have been exposed to more things than I knew about. I have tried to keep him away from other animals, including my four cats and other dog. They are acting normal. At least Buddy is more alert and active right now than he was this morning.

The vet caring for him until his regular vet gets back is doing us a huge favor: apparently we both live close to one another, so she is going to have me take him to her house for an antibiotic injection and to give me some other pills. Once I know which ones they are I will update you. Otherwise it would have been another 1+ hour drive through the capital of Arkansas, which has crazy traffic. She has more patience than I do if she goes that way six days a week :-)!

In regards to your questions, he is 31lbs. His medication dosages are: 15mg of prednisone (morning and night, taken with food), 10mg of famotidine (morning and night, taken with food), ½ gram of sucralfate (morning and night, taken with food), 12.5mg of azathioprine (night, taken with food), and 100mg of cyclosporine (night, taken 2 hours after his dinner).

His vet has not talked to us about aspirin, so I will make a note to ask her about that.

The prednisone side-effects are very apparent :-(. He is hungry 24/7 and pants a lot, despite being hydrated.

I have one copy of the blood test done at the emergency vet clinic that I can show you. I will have to look to see if I have a copy of the one from December. If so, I can show that one to you as well. I do not have the others :-(.

I don’t think that they gave his liver a thorough examination with the ultrasound. I believe that they were just looking for bleeds or fluid buildup.

As for his stomach, he doesn’t have a history of GI problems. Usually, if he throws up (which is very rarely), it is near-immediately after drinking a lot of water too quickly. And even then it isn’t much – just some water.

I am curious about the tapeworms as well. He had been on flea prevention and has no fleas on him, so I am not sure how long he has had the tapeworms.

I just thought of something: if there were a lot of tapeworms in his GI tract, I wonder if their death could have set off a reaction leading to an increased white blood cell count? I will ask the vet what she thinks.

As for his platelets, I will have to ask :-/

When his regular vet gets back (she knows his case the best), I will see if I can get more answers. Hopefully I will be able to talk to her on Monday. I hate having to wait, but at least the vet caring for him at the moment is good too. She just doesn’t know his case as well :-/

I really, really appreciate all of your help and support. I thought that I was going to lose him this morning (probably for the 100th time since all of this started…. my hormones have not given my emotions a break). Even though I worked at a vet clinic several years ago, I never saw a case of anemia like Buddy’s. I worked at a tiny, rural clinic, and the only severe case of anemia that I saw was a toy poodle so infested by fleas that I was amazed that it was alive. What Buddy has is very new to me.

[Jordan]

Hello,

My dog Buddy is 13 years old. He is a mixed-breed (looks like he has some rat terrier, but I’m not sure beyond that). We are located in Arkansas, USA. On April 28th of this year, everything changed for us. I came home and he was barely able to move. When I was able to get him up he stumbled around. I had him at an emergency vet clinic by midnight. They took x-rays and did blood work. The x-rays showed that his liver was slightly enlarged and that his heart was a bit off-center compared to typical canine anatomy, but that was all the x-rays showed. His bloodwork, however, revealed a lot. His red blood cell count was 3.17, his hematocrit level was 24.4%, his platelet level was 53, and his hemoglobin level was 6.6 g/dL.

The morning of the 29th, I got him to the best vet clinic in the region of the state that we live in. It is over an hour from our home, but I want him to have the best care possible. They took another blood sample and his hematocrit was down to 15, so they immediately did a blood transfusion. During the blood transfusion he threw up some blood, but that was the only time that he has thrown up during all of this. The next day his hematocrit was up to 30. However, in the days following it, his hematocrit dropped again (after going up slightly a few times), and eventually was down to 15 again on May 6th. He had to have a second transfusion. It has gone up slightly throughout this week, and I took him home for the first time this past Tuesday (May 10th).

He did have a Coombs test, which was negative, and a comprehensive PCR looking for tick diseases, which was also negative. He is on sucralfate (morning and night), famotidine (morning and night), prednisone (morning and night), cyclosporine (night), and azathioprine (night). He is also on a prescription diet that is supposed to be easier on his stomach.

Last night my fiancé gave him a Ritz cracker (he did not realize that he wasn’t supposed to have anything besides his prescription food). I have been a nervous wreck since, and am worried that it may have contributed to his symptoms this morning. Buddy acts like he is not feeling well, and I fear that I will need to take him back to the vet clinic. He ate and went outside with me for a few minutes, but his energy level has gone down quite a bit since last night. He wants to lay around constantly, which is different from the past two days (he was more active). The vet clinic does not open for 45 minutes, so for now we are waiting.

On a (somewhat) side-note, I am 22 weeks pregnant and not am not coping well. Part of it is that I am not getting enough sleep by far. I am up throughout the night and I think that I am getting a stomach ulcer from stress and anxiety. I have had Buddy since he was a young puppy (probably around six weeks of age). Currently I am the only one away from the vet clinic who is able to care for him to the extent necessary, and I feel very alone (and downright exhausted). I hate that he is going through this. He does not seem to be suffering. He has a good appetite and has been alert through everything. If he was suffering, I would not prolong it.

Feel free to ask questions – I have probably left some information out by accident. Does anyone have any advice?

Thank you.
Jordan

[Jordan]

More Information I forgot to add:

Buddy had an ultrasound on April 29th which showed no free blood/fluid in his abdomen.

Also, I can’t believe that I forgot to add that I found a live tapeworm segment in his feces yesterday. The vet treated him with a praziquantel tablet at the clinic.

His bloodwork was normal in December.

[Vally]

Hi Jordan and welcome to the site, though I’m sorry you’ve had to come looking for us.

What does Buddy weigh and what is the dosage of the meds you’re giving? I wouldn’t worry about the cracker. I’m certain that would not do any harm.

What drugs are you giving with food and what are you giving without food. Prednisone and azathioprine should be given with food always and the others away from food. I’d be happy to make up a chart for you. I note there’s no aspirin being given. Good to see Buddy is on tummy protection, but there’s no mention of aspirin. That’s normally necessary (but not in every case) to prevent clots. A blood smear would show whether that’s needed.

Buddy will be feeling the effect of the drugs which are very harsh, and whilst we all hate them, they are life savers. Prednisone in particular has a million side effects, but when it’s safe to lower the drugs when Buddy is stable, you’ll see those side effects go away.

Do you have a copy of the blood tests? If so please use the Urgent Advice on the top and send them through. Someone will have a look at them for you and can help you to understand them.

You have to make sure you take care of yourself and bub. I know easier said than done.

We’re all over the place so different people are about at different times, so ask anything. We’d love to help.

Regards Vally and Bingo (diag Nov 2011, in remission)

[Sheena]

Hello Jordan

A big welcome – goodness, no wonder you are so tired out with your pregnancy as well as poor Buddy not being well. I’m really sorry to hear he’s a poorly boy. You are NOT alone now – you have all of us to help & support you with advice & big hugs.

Firstly, do you know if they examined his liver thoroughly with the ultrasound? It is not unusual for our dogs to develop enlarged spleens & liver with this disease, but normally the liver issues are drug side effects. I’m just wondering why his liver was enlarged before treatment started.

Throwing up blood – sounds like he has had a GI bleed, again, not uncommon, & I’m relieved to see he has stomach protection & that his appetite is OK. The sucralfate is excellent for healing ulceration & inflammation in the GI tract, so hopefully he won’t have that issue again. Has Buddy ever had stomach issues of any description in the past? Wondering if that tape worm has something to do with GI issues of course. Poor Buddy having that as well.

As Vally mentioned, if you could send us anything & everything in the way of test results, blood tests, blood smears, reports, scans, that would help us to help you. Also, could you include the normal December test – it gives us a baseline as to what is normal for Buddy.

I see he had low platelets as well as low red cells – do you know what happened to their levels after transfusion? Sometimes, dogs have more than one line of blood cell affected by this disease – if it is both red cells & platelets, it’s called Evans Syndrome – we’ve had lots of people on here with that & the treatment is just the same, but sometimes with an extra drug added in. I see you have cyclosporine & azathioprine, which makes me think your vet is thinking Evans Syndrome too & has done the right thing on the drug front.

Adding an anti-clotting medication is often necessary for most dogs, but it may be that Buddy doesn’t need anything. Without a blood smear result, we can’t say either way. If you could check with your vets on this point about abnormal clotting, that would be good. Don’t fret about this – he may not be at risk. We want to know for sure though.

It’s great you know he’s not suffering – our dogs are just really, really tired, lethargic & feeling like doing nothing at all because they can’t get enough oxygen around their system because the red cell levels are low so can’t provide enough oxygen for them to be energetic. There is no pain, just total & utter exhaustion – I think you are feeling like that yourself too.

You have to be very patient with this disease in the early stages. The drugs take a while to work. Some dogs are lucky & respond quickly, others just take a bit longer. Transfusions are there to keep them stable until those drugs start to work – small transfusions are best – try not to transfuse over a PCV of about 25 is the general rule, otherwise the body thinks it’s OK & will slow down reticulocyte (baby red cell) production.

I’ve probably tired you out even more reading this, but I hope we’ve helped a little to ease your mind. Remember to look after yourself very carefully too – this was one of the most stressful things I have ever had to deal with myself when Worzel was diagnosed with bone marrow failure – you are in good company with all of us worry gutses on here! You can tell us anything, or ask us anything. We know what it’s like to feel alone too – I did, until I found the lovely people on here.

Forget the Ritz cracker – it’s nothing to worry about.

Please let us know how he’s doing – it’s very early days in this disease – fingers crossed, he will respond soon though. It’s a case of not giving up – I promise you would never have given up unless Worzel was suffering or in pain. There is enormous hope Buddy will make a complete recovery.

Huge hugs from us all
Sheena, Worzel (diagnosed Dec 2012, in remission) & his friend Ollie xxx

[Sheena]

Sorry – typo – that should have read I would not have given up – missed the I out!

[Jordan]

Hello,

I appreciate your support so much – thank you. We just got home from the vet clinic. They went ahead and drew blood for comprehensive testing (CBC, liver, etc.). I will hopefully know something in about two hours. His regular vet is away right now and won’t be back until Monday, so we saw a different one today (and yesrerday). She had me take him home to (hopefully) keep his stress levels down and to keep him comfortable. He is more active now, but it may be due the adrenaline after going to see the vet. Right now I am on my iPhone, but later I will get on my laptop and address what was asked/requested in your replies. He is resting and stable right now, and to be honest I’m going to take a nap as well.

Thank you again, and I will be back on in a few hours.

JJ

[Jordan]

I just noticed several typos – my apologies!

[Jordan]

Hello,

I just talked to the vet. Buddy’s white blood cell count is up. I know that his immune system is suppressed right now, but is it common for dogs with AIHA to get infections? I’m starting to worry that I’ve done something wrong or that something in my house could be making him sick. However, I also realize that he has traveled a lot within the past 48 hours, and that he may have been exposed to more things than I knew about. I have tried to keep him away from other animals, including my four cats and other dog. They are acting normal. At least Buddy is more alert and active right now than he was this morning.

The vet caring for him until his regular vet gets back is doing us a huge favor: apparently we both live close to one another, so she is going to have me take him to her house for an antibiotic injection and to give me some other pills. Once I know which ones they are I will update you. Otherwise it would have been another 1+ hour drive through the capital of Arkansas, which has crazy traffic. She has more patience than I do if she goes that way six days a week :-)!

In regards to your questions, he is 31lbs. His medication dosages are: 15mg of prednisone (morning and night, taken with food), 10mg of famotidine (morning and night, taken with food), ½ gram of sucralfate (morning and night, taken with food), 12.5mg of azathioprine (night, taken with food), and 100mg of cyclosporine (night, taken 2 hours after his dinner).

His vet has not talked to us about aspirin, so I will make a note to ask her about that.

The prednisone side-effects are very apparent :-(. He is hungry 24/7 and pants a lot, despite being hydrated.

I have one copy of the blood test done at the emergency vet clinic that I can show you. I will have to look to see if I have a copy of the one from December. If so, I can show that one to you as well. I do not have the others :-(.

I don’t think that they gave his liver a thorough examination with the ultrasound. I believe that they were just looking for bleeds or fluid buildup.

As for his stomach, he doesn’t have a history of GI problems. Usually, if he throws up (which is very rarely), it is near-immediately after drinking a lot of water too quickly. And even then it isn’t much – just some water.

I am curious about the tapeworms as well. He had been on flea prevention and has no fleas on him, so I am not sure how long he has had the tapeworms.

I just thought of something: if there were a lot of tapeworms in his GI tract, I wonder if their death could have set off a reaction leading to an increased white blood cell count? I will ask the vet what she thinks.

As for his platelets, I will have to ask :-/

When his regular vet gets back (she knows his case the best), I will see if I can get more answers. Hopefully I will be able to talk to her on Monday. I hate having to wait, but at least the vet caring for him at the moment is good too. She just doesn’t know his case as well :-/

I really, really appreciate all of your help and support. I thought that I was going to lose him this morning (probably for the 100th time since all of this started…. my hormones have not given my emotions a break). Even though I worked at a vet clinic several years ago, I never saw a case of anemia like Buddy’s. I worked at a tiny, rural clinic, and the only severe case of anemia that I saw was a toy poodle so infested by fleas that I was amazed that it was alive. What Buddy has is very new to me.