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- Help and advice – Experience with Acute Respiratory Syndrom in AIHA dog
Hello everyone,
Just wanted to give you some quick updates. I just spoke with the vet, and it’s a mixed bag. Let me know what you think.
So the results show that Bilbo is indeed still regenerative, and that his reticulocites and spherocytes are about the same as last time, when he was doing well (!). So that’s kind of a good news, as he doesn not seem to be going through a relapse. However, she said that even in the height of his crisis, he never showed a lot of spherocytes, so she said that maybe the test results are not perfect;y reliable (?) and should be trested cautiously.
What she saw though, with the other test, was blood in his stool, so she thinks it’s most likely that he has an ulcer or a gatro-intestinal bleeding caused by the cortisone. She suggested right away to reduce the dose by 5mg, to see if this will help.
As you can imagine, I was somewhat defensive. First, she tells me that PERHAPS the test is not reliable and that we might be missing something, and then she suggests to diminish the dose of cortisone. Had she been more confident and assertive about the bloodworks, I might have agreed, but I’m afraid of creating a crisis here.
The issue I’m considering too is the fact that David is away on a business trip and will only be back Monday morning. We only have one car, so basically, should an emergency occur, I cannot react quickly and go to the vet in a matter of minutes. Bilbo has respiratory distress with his last crisis, and I certainly want to avoid that. We also just started this afternoon the new medication she recommended for Bilbo’s stomach.
I emailed her to ask her for a copy the detailed report. But right now, we agreed together to keep the dosage the same. I made an appointment for Monday morning 9am so that Bilbo can get new blood work done.
Now, I feel bad that I argued with her. I’m not a professional. I tried to explain to her that I was scared of reducing dosage, that I didn’t mean to contest her authority so much as trying to make the best decision for Bilbo in my current situation. What do you think? If it were that life-threatening, she would have insisted more to reduce the cortisone, right? I’ll send you the results and will try to contact Dr. Dodds when/if we get them before she leaves for the weekend, but in the meantime, I feel insecure about my decision to wait until Monday morning to reduce the dose. ANy thoughts?
Hi Anne-Marie,
my suspicion is that there is internal bleeding from an ulcer. this is of course not good but also not uncommon and the sucralfate should take care of it in a few days. i think it has been mentioned that you have to make sure it is given away from all other medications and food because it can interfere with absorption. these medications are so harsh on the intestines and the sucralfate will protect them and even heal the existing ulcers.
I would leave the medications where they are at right now and see what happens in the next few days. I would not worry about Bilbo having to stay on these high doses, he is regenerating and as soon as he is stable and in some higher values you will be able to reduce. To wait a couple of days to reduce will not make a difference right now as long as Bilbo’s tummy is protected. How often do you give the sucralfate? I would give it at least 2x per day. We gave the last one at the very end of the day before going to bed. This way it had time to really work its magic over night.
I am happy that you have decided to contact Dr. Dodds. Her weekend starts tonight until Saturday, she observes the Jewish holidays and usually works on Sunday. I got emails from her on Sundays and Christmas:)
Best wishes,
Brigitte
Anne,
I am sorry you are experiencing this difficulty with your vet. This, unfortunately from my experience, is not unusual to see from a vet that has limited experience with this rarer condition. The difficulty arises because AIHA has become fairly well known and most vets tend to think only of those signs when evaluating dogs. This is where their experience has led them.
For instance, most authoritative resources mention spherocytes as one sign for AIHA that is diagnostic. However, when a dog has anemia and does not have spherocytes, the vet is in territory that they don’t understand well.
Most dogs with AIHA ARE regenerative, it is actually one of the signs to look for that a dog is HIGHLY regenerative in an attempt to replace the massive number of red blood cells being destroyed in circulation. In fact, in some literature you will read that this is a particularly ominous sign because it means that the body is still destroying red blood cells.
So why are we worried about regeneration in Bilbo? Because he has been wavering on the lines of not being regenerative. This is a different condition from AIHA and is not diagnosed or treated in the same way.
Yes, blood loss can be one reason, other than AIHA, that a dog is losing red blood cells and has anemia. But even in that case, with normal bone marrow, the dog will be regenerative!
If the bone marrow is failing to produce red blood cells, well then that is just a different condition and needs a different approach. I need to see your last two blood tests to figure this out for you. I am positive that I can tell in about 5 minutes exactly what the issue is here.
I agree, don’t argue with your vet. They already are lacking in their own confidence, still feel they can figure this out, and will find any criticism particularly annoying. Let’s educate you on what is happening and then we can make a decision about where to go next.
What is his PCV right now? If you are anywhere above 22% then there isn’t an emergency for the weekend. Please take a deep breath. Chance slowly dropped slowly down to 18% before I decided it was time for a transfusion. However EACH DOG has a different experience with low PCV’s. Some dogs can be walking and doing fine at a PCV of 8%. In general this is part of a medical term called “transfusion trigger.” This is not a clearly defined value. It is a SUBJECTIVE decision that is made by the attending vet that takes into consideration the condition of the dog as well as the values on the CBC. There is no magic number that says “we need to transfuse now.”
Upload your test results to me at the Urgent Advice form so I can look at them. I want everything you have already. We can talk about this once I see these things so I can help you make some educated decisions. Right now you only have emotion as a guide to make these decisions.
my best
patrice
Hello everyone,
OK, so I just received Bilbo’s bloowork. I’m emailing them to you all right away (the preceding one as well). It’s in French, but the figures should be easy to read. Let me know what you think
Patrice: Bilbo had a RBC of 21 yesterday. He only received his first transfusion when he was a 13. He had 2 overall.
Giving the sufalcrate before going to bed is a good idea. It’s mentioned twice a day and I gave it to him at noon. This should be easier to do.
Anne-Marie, the results have been received through email, so Patrice will no doubt be going through them.
The sucralfate worked magic on Bingo immediately so fingers crossed, but I’m sure this will help Bilbo heaps too.
If it were me, I wouldn’t lower the prednisone dosage until Bilbo’s bloods are back in the normal range, or are close to them, and have been there for a little while. I think we started reducing when Bingo was in the low 30s because it didn’t seem as if he was going to go any higher. I don’t think it’s a good idea to reduce the prednisone when the last HCT was only 21. Also usually if a PCV test is done, it generally comes out slightly higher than the HCT. Can anyone explain that – I’ve always wondered.
Bingo’s lowest PCV was 15 and he came home with me with more drugs at that time, so don’t stress too much about the HCT of 21, that isn’t life threatening. Do you check Bilbo’s gums and eyes for colour? I still do that so very often.
Lots of love, Vally & Bingo
Hello everyone,
Just a quick update to let you know that your replies reassured e a lot. Thanks you so, so much Patrice for doing such a detaileed, lenghty analysis of Bilbo’s reports. Sheena looked at it too, and the fact that both of you had positive things to say about it helped me calm down. I admit that I woke up a few times last night to check up on him, though…
I’m very puzzled that they never prescribe sucralfate before, as it seems (now that I know!) it should have been mandatory, with the prednisone. It’s too late now, but at least I could start it yesterday. I’m being ultra careful with the timing of his medication.
I emailed Dr. Dodds this morning, including Bilbo’s last 2 reports along with everybody’s thoughts and suggestions. Hopefully I’ll get her input before our appointment on Monday. But at least now I don’t feel like I have no grasp of what’S going on, making decisions based on my gut feeling about my dog.
Bilbo seems to be doing very well: his breathing seems fine (I’m obsessed with it since his respiratory distress episode and his lung pattern), and he eats with his usual appetite. He’s resting comfortably now, very calm.
I think the sucralfate is already starting to help: I do not hear gurgling noises coming out fofhis belly this morning, whereas I could hear some of them 2 days ago.
My mum and sister are coming to visit me today, so I’ll have guests to keep me updbeat – and Bilbo loves my sister, so it should be good for him too.
Thanks everyone for being there for us when we need you. I’m very humbled by everyone’s generosity. Bilbo sends love to you all as well – even though he’s sleeping right now. :-) I’ll give you some updates when I hear back from Dr. Dodds.
Anne, I’m so glad that you feel better after having gotten more information from Patrice and Sheena. Knowledge is power! One thing, and I’m hoping someone else will offer their understanding — I think to get an accurate picture of spherocytes it is recommended that a pathologist review a slide. Do you know if this is being done?
I think it will be wonderful too to have Dr. Dodds’ input as well.
I’m also happy to hear that Bilbo is feeling well, and that you have visitors this weekend! It is wonderful to have some pleasant distraction, and I know Bilbo will love having your sister there. Ashki has his special friends that he loves too, and it makes him so happy to see them.
I agree, we all do, that sucralfate should be started immediately when on these immunosuppressive doses of prednisone. Unfortunately not all vets do this; it seems some take a ‘wait and see” perspective. I’m so relieved that Bilbo is on it now.
Sending you love and hugs and hoping that you are enjoying your weekend.
tamara and ashki xoxox