Dallas the Morkie – IMHA outpatient on meds

[Amy]

It was such a relief finding this forum and being able to see so many other fur-parents who have gone through what we’re currently going through.

Our 4 (almost 5) year old Morkie Dallas had been acting sluggish for a couple of days and not eating much, but this wasn’t out of the norm for him. He has been a picky eater since he was a pup and he always sleeps throughout the day while I’m at work. We noticed how bad it was when he stopped running to greet me when I got home. My boyfriend started looking online and saw something that mentioned checking his gums and ears for paleness and jaundice. They were both pale and he instantly took him to our vet (Apr 14). The vet did X-rays and blood tests then sent them out and told us they’d call us the next day with the results.

We got the call the next day and they said he was anaemic (red blood cell count was at 19) and should go to a specialist for an ultrasound. We immediately got in the car and headed to the emergency clinic (Apr 15). The ICU doctor took him in and assessed him and explained that he had IMHA and told us our options (meds, transfusion, or nothing). Nothing was not an option, no matter how much it cost us (we had contemplated getting pet insurance for our two dogs a month and a half ago when we got their checkups/vaccines done but never did.. we are regretting that now as the vet bills pile up).

We opted to go with the meds to see if he’d respond to them. We went home that night with all of his meds and returned to the emergency vet the next day (Apr 16) to get his RBC count done again. It was at 20 and things were looking stable. We continued his meds that day/night and returned to the vet the next day (Apr 17). This time, his RBC count had dropped to 17. We were devastated because we didn’t actually get to see our vet and no one really explained anything to us that day.

We tried despearately to feed him as he had dropped 2 lbs since the illness kicked in and he was only 13 lbs to start with and knew he needed all of his energy to fight this thing.

Today (Apr 18) we went in for our family RBC check and it was at 16. The vet (not the one we had before) seemed optimistic as he had only been on the meds for 2 full days and a 1% drop only meant he was holding steady. She explained that because he wasn’t crashing, that means that his body is still creating red blood cells, but his immune system is destroying them at a similar pace. She also explained that the meds can take a week to really get going so we are very hopeful.

He has been outpatient this entire process and we can’t imagine having to leave him overnight at the vet (he already has separation anxiety as is, and gets severe anxiety at the vet – we have to muzzle him so he doesn’t bite the vets).

This has been such an emotional roller coaster but we are confident that he is strong enough to fight this!

As a side note, these are the meds he is currently on:
– Prednisone (1.1 ml daily)
– Cyclosporine (0.14ml every 12 hours)
– Aspirin (0.37ml daily)
– Famoidine (half a 10mg tablet daily)
– Metronidazole (1/4 tablet every 12 hours)

[Vally]

Hi Amy, welcome to the site. I’m very sorry that you’ve had to come looking though.

Dallas sounds as though he has you wrapped around his little paw and I can just imagine that tiny thing doing his best to bite the vet. He sounds very courageous and a real fighter.

First of all the meds look good. I’m really glad to see pred AND cyclosorine. Plus aspirin and stomach protection. Your vet knows what she’s doing and it’s important to hit this hard straight away. She is right too because the drugs do need time to start and little Dallas hasn’t crashed right down so your very clever boyfriend did the right think by checking gums and you’e acted quickly in getting Dallas the help he needs. Acting quickly, I think, makes all the difference.

What does Dallas weigh? It’s actually quite normal to see the PCV go up or down by a few points, as it can depend on so many things – how hydrated Dallas may be when tested, how stressed, so for it to have gone down by only 1% is a really good thing.

The drugs do take their toll and once they kick in, you’ll see that the prednisone will make Dallas very thirsty and, for the first time, he may not be so picky about his food as he’ll be very hungry. He’ll be feeling very tired too, from the anaemia, but also the pred. There a lot of information in the glossary above (AIHA Terms) about all sorts of things, eg prednisone – see https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/

Famotidine should be given away from the meds as it prevents absorption of them and cyclosporine also should be given separately. How are you dosing them? If you need a chart for your meds, I can make that up for you too, just ask.

Amy, ask anything at all. Any questions, we’d love to help.

[amy]

Hi Amy! I am so glad you found this forum. The people here have been amazing me to and they will do the same for you! Please try and take a deep breath. I know this is so scary but your dog can survive this. Take one day at a time and be diligent with his care and your communication with your vet. Please know we are all here to help and support you through this crazy horrid disease. No questions are stupid and someone is always around if you just need us to lend an ear so you can vent or cry or most importantly share the joy of success where Dallas is concerned. I am fairly new to this journey but I do know how emotionally draining it can be and without this group I am not sure I would have been able to stay the course. Also, don’t feel like you are bothering your vet. Call them as much as you need to keep yourself comfortable through this process. Many prayers for peace during this scary time. I look forward to getting to know you and Dallas!
Warmly,
Amy & Coal the sassy poodle
P.S. We love pictures! So please post one of your sweet guy when you get a chance!

[Sheena]

A huge welcome, Amy & Dallas

Couldn’t agree more with Vally & Amy – great to have you here – we need all the moral support & advice we can get with this rare disease – I certainly did & the lovely ladies on here kept me sane – they still do actually!

Great to see all the drugs in place – but please could you tell us exactly what milligrams (mg) the predisone & cyclosporine are? Hang in there though – they don’t work overnight (I wish they did) & as everyone has said, Dallas may remain at the same level for a little while until the drugs kick in. I love seeing the that the vets think he is producing new red cells – that’s called “regenerative” – we like that word very much!

The theory is that the prednisone will hold him steady until the second immuno-suppressant (in your case cyclosporine) works. My dog Worzel actually took about 14 days to respond well, so don’t panic if nothing happens for a while – patience is needed, I’m afraid.

Sounds like your vet suspects infection seeing the metronidazole – has he always had tummy issues? From what you said about being picky, I’m taking a bit of a guess here at small intestinal bacterial overgrowth (SIBO) also called small intestinal disbiosis (SID) being an issue. Well worth asking your vet if they suspect this. It’s quite common & can be treated with pre & probiotics, plus good GI diet & an antibiotic when needed. They often need vitamin B12 to keep their levels up.

Do you have any blood tests, blood smears or other test results? If so, please upload them here so we can have a look:
https://www.secondchanceaihadogs.com/urgent-advice/

We always encourage everyone to ask for copies of all the tests because we can take a good look at them for you – it makes it so much easier for us to work out what’s going on. Some of us have medical backgrounds, so it’s no problem for us to try & explain to you what’s happening.

As Vally & Amy have said, please ask anything – however daft you think the question is, it IS important – every little thing is important with this horrible disease.

Hoping Dallas will soon be on the mend – give your boyfriend a pat on the back for spotting this – catching things early is a real bonus – you are doing a brilliant job.

Big supporting hugs
Sheena, Worzel (diagnosed Dec 2012 in remission) & his friend Ollie xxxx

[Sheena]

Sorry – should also have said he could just have picked up a tummy bug – has he had diarrhoea & / or vomiting?

[Amy]

Thank you all so much for your kind words of support!

Vally, to answer your question, Dallas weighed about 13.4 lbs a month before he was diagnosed, and is weighing in at 11.4 lbs now.

Sheena, the metronidazole was prescribed after our second ER visit as Dallas was having diarrhea and we feared he was losing all of the nutrients we struggled to get him to eat. This has hardened his stools a bit more and he isn’t pooping out liquid anymore. We left the test results with the ICU vet but will definitely get a copy from them during our next visit to share on here.

Our discharge papers/medication instructions state the following dosage-wise:

1) Prednisone (10mg/ml suspension) Give 1.1ml once ever 24 hours (at 5pm)

2) Cyclosporin (200mg/ml suspension) Give 0.14ml every 12 hours (9am & 9pm)

3)Aspirin (7.5mg/ml suspension) Give 0.37ml once every 24 hours (9pm)

4) Famotidine (10mg tablet) Give half a tablet daily (9pm)

5) Metronidazole – (I’m at work right now so I don’t have the exact information on me – will update when I get home!) – this is taken twice a day, 7am and 7pm

My vet had recommended the above times for taking the medication but I wonder if I should ask if we should be spreading them out a bit.

It’s been a huge challenge getting him to eat anything and today and yesterday (Apr 18-19) he threw up at 11am (about 2 hours after taking his cyclosporin). His puke was rather large considering his size and was white/foamy (with colour in the middle from his food the night before). He seems to be drinking lots of water and his urine is a normal colour and everything, but getting food in him is a huge challenge. He only seems to eat at certain hours (mostly at 2am) and that food appears to be coming up in his 11 am pukes. We’re worried he’s not getting the nutrients he needs to gain some energy to fight this.

Does anyone have any advice on food that a dog just can’t resist? We’ve done chicken, pizza (with no cheese or sauce), tuna, white bread, white rice, and soft Royal Canin Gastro food but he seems to be over all of these. 2/5 of his meds are in pill form so it’s becoming harder and harder to get them in him (even when we stuff the pill into a chicken chunk, he will somehow eat only the chicken and spit out the pill..he’s a smart little bugger.)

Any advice would be greatly appreciated and thank you all for being so supportive!

ps. I’ll try to upload some picture later today, but I have attached a link to Dallas and his sister Clover’s instagram page!

https://www.instagram.com/dallasandclover/

 

[Karxlee]

Hi Amy, oh my goodness we all feel what you are going through, my doberman Louis has been going through this since Christmas Day 2015, and we are just (FINGERS CROSSED) going into a form of remission, but your story sounds so much like Louis’s.
We tried everything from buttermilk to ice cream, just anything to get calories in him, the only thing that worked was liver for some reason dogs love it, but it is very rich so should only really be given bits.
The ladies on here will let you know what’s best to give, they really do become your lifeline, so keep them up to date.
Louis had shocking liquid poo, and SIBO seemed the perfect fit for his symptoms, our vet gave him canikur pro biotic and it worked a treat.
Don’t try to hide their medicine in their food because the cotton on very quickly and won’t trust any food you try to give them, sometimes you just need to throw the pills to the back of their throat and make sure they swallow them. When they are sick you worry that the medicine hasn’t had time to work, but you will be suprised how strong our dogs can be, Louis Has had 6 blood transfusions so don’t be afraid of them, they saved Louis’s life on 6 occasions.
Take each day as it comes, and read everything the ladies on here give you, educate yourself and ask for your blood results, unfortunately because I’m in the UK we don’t get any results which is frustrating, because Sheena is the blood lady and she will be able to help.
Stay strong, take deep breaths and you will get through this. Xxxxxxx

[Sheena]

Hi Amy

Oh, the puking is just a complete nightmare. I feel for you as we had the same thing at the begining, plus refusal to eat a damn thing – horrible for you & I have been through this myself. I’m with Karyn on this – shoving pills down their throat is the best way for the sneaky ones – my non-IMHA dog Ollie will find a pill at 100 yards in food & spit it just as far – he has a vice-like jaw you cannot open! Worzel thankfully was a good pill popper with the shoving very gently down the throat. I always felt happier this way because I KNEW for certain he’d had the dose.

A couple of things – the famotidine must be given 2hrs away from the other medications – this is important as it can prevent the absorption of those vital drugs, plus it is more beneficial for tummy protection that way. Prednisone must ALWAYS be given with food to prevent excess gastric irritation. I am a bit confused as the dose is normally split into 2 equal amounts, 12 hours apart to maintain the blood level of the drug at a more constant amount to maintain immuno-suppression. The only other person I’ve come across so far with 1 dose a day is Karyn, and I also commented to her on this – I’m not personally happy about it. I really feel it should be split as this is the usual protocol. Please have a good read of this:
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/

Can I please urge you to get some sucralfate as soon as possible – this to me is the most important thing. 2 doses per day, 2 hours away from any other medication could be the answer to calming Dallas’s stomach issues – it is absolutely unique & I know Karyn will back me up when I say it stopped her poor Louis from having terrible stomach problems – he started turning the corner after that (Karyn, please join in!!!). My poor old Worzel was in awful pain before we got this added & we fight on here like goodness knows to get vets to use this wonderful soothing drug:
https://www.secondchanceaihadogs.com/AIHA_Terms/sucralfate/

Some dogs are also puky on the cyclosporine to start with – this usually resolves :
https://www.secondchanceaihadogs.com/AIHA_Terms/cyclosporine/

BUT although it is recommended that you give cyclosporine on an empty stomach, those who puke can be given it with food – I think you should try that. And the metronidazole with food too.

Can you imagine having all these drugs on an empty stomach? I bet we would all feel dreadful. So, apart from the famotidine, all drugs with food please!

As Karyn says, I am just one of the blood ladies on here (maybe I should call myself Vampira or something!) – if we can help you with anything, please ask. I think our wonderful Vally would be very happy to do a drug chart for you – she is our fantastic Drug Chart lady (the drugs are a nightmare to organise when there are so many!) AND she is the supplement queen too. But everyone on here is a caring owner of a dog or cat with IMHA, bone marrow failure, or other type of anaemia who wants to help & support you, so hopefully one of use will have come across any problem you might have.

One last thing – please be careful about feeding. I appreciate Dallas is not eating, but don’t be tempted to give non-dog food as it can aggravate the stomach & pancreas. For now, stick to chicken, turkey, pumpkin/sweet potato/green beans (boiled & mashed), organic rice, lean lamb & white fish which are all easy on the stomach. I am being truthful here – the only thing Worzel ate to start with were horribly fatty Toulouse sausages which I KNOW are bad for dogs, but we were so desperate for him to eat something as he lost 5kg, we were a bit naughty. As soon as his appetite was back, I gave him what I’ve listed. During haemolysis stage (red cell destruction) it is better to avoid red meat as this adds to the poor old liver’s work in breaking down red cells into their component parts- overload!!!! You can check with your vet (or we can see from blood tests) if Dallas still is haemolysing red cells.

NEVER give peanut butter unless you have checked it for an atificial sweetener called xylitol – it is TOXIC to dogs. Also, onion & garlic are toxic too in larger quantities- some people have used baby food, only to find it contains onion, which is absolutely to be avoided as they cause anemia.

Right! I think that’s an information overload – sorry.

Number one priority – get the sucralfate as a matter of urgency & make sure all meds are given with food, except the famotidine.

Off to bed now – forgive me – I’m in a different time zone – hope we’ve helped a bit. Hang on in there, Amy – you have us all to help you through this – we are all around the world, so someone is usually awake!

Sending massive hugs & support

Sheena, Worzel & Jaws of Steel Ollie xxxx