My German Shepherd just diagnosed with AIHA, help! – Page 3

Keymaster

Desiree,
Metrondiazole is a commonly used antibiotic for intestinal tract conditions. Dogs that have unrelenting diarrhea, for instance, would be given this. It can be very effective in resolving conditions like this.

There are some cautions to the use of this antibiotic, most of them relate to long term, high dose use. Most dogs tolerate short term moderate dose therapy quite well.

Chance had very bad diarrhea, loose, large and odorous. I worked with my vet and we found the lowest dose that we could use for a longer time that would help him but not expose him to prolonged high doses. At 93 lbs, he was getting only 100mg a day, which is a very small amount.

So there is more complexity to this topic, especially for German Shepherd Dogs. This breed is prone to have sensitive digestive systems. An owner might say they have sensitive stomachs. They often struggle trying to find the right foods to keep their dog from developing digestive conditions.

One of those conditions is called SIBO small intestine bacterial overgrowth. This condition can lead to malabsorption of proper nutrition. The small intestine can become populated by bad bacteria that push out the good bacteria. Dogs can become malnourished and fail to thrive.

Why is this? Because there are several important nutrients in our diet that must be “helped” through the cell walls of the small intestine and into the blood stream. B12 for instance is one of these important nutrients. There is an area of the small intestine walls called the brush border. This area, along with “helpers”, carefully converts the B12 and allows it to pass through to be available to the body. In SIBO, this brush border (tiny cilia) is attacked by the bad bacteria and becomes inflamed and damaged. Metrondiazole is used successfully in this condition to kill off the bad bacteria.

One of the reasons this is so important is the B12 is a critical nutrient used in the bone marrow to build new red blood cells. Sometimes dogs that have anemia have trouble forming healthy red blood cells, they are malformed and cannot function well. This is additional reason why they may have anemia.

If Kiki is having digestive disorders then this would be appropriate to keep administering. If all seems ok, then specifically ask the vet why they prescribed this. If they can’t give you a specific reason then ask if you need to continue this medication.

OTC generic pepcid is fine if the vet is confused. You do not need special prescribed meds for this. I used 2 pepcids a day for Chance, he was 93 lbs. I gave one tablet, a half hour before each of his big meals of the day. This is sufficient to protect his stomach from the prednisone. I am particularly concerned about stomach protection because prednisone WILL lead to serious ulceration, especially in dogs. They have an extremely acidic stomach acid, sometimes as low as 1 or 2 ph. This combined with prednisone can be very damaging.

To heal any possible ulcers, the use of sucralfate, best on an overnight fast, will do that. It is a simple mucous bandaid that protects and heals the digestive tract walls. This drug is very safe, but remember that it does block absorption of nutrients and MEDICATIONS, so you must dose at least 2 hours before and after a meal. I used it on an overnight fast for more effective healing and to avoid this problem.
my best
patrice

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Sheena

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Hi Desiree

Your dog is producing new cells like crazy trying to replace those that are being destroyed. You vet needs to find the cause of the cells destruction (haemolysis) urgently, which could be infection, or underlying disease. The high neutrophils could indicate infection for sure. Here is some info (some you may know, some you may not) that everyone going through this disease should find useful:

AIHA/IMHA – a quick overview.
Although this is a serious disease, it can be beaten with the right treatment.
Onset can be extremely fast or it can happen gradually. The faster the onset, the more difficult it is to treat and hospitalisation is the best option. I hate the fact that fast initial onset is a difficult scenario. It is IMPERATIVE that your Vet does as many tests as possible to determine the cause – I would recommend finding a specialist in internal medicine who has experience in treating dogs with this illness AS SOON AS POSSIBLE. An inexperienced vet could cost the life of your dog. You must have absolute confidence in your vet’s ability – if in doubt, change vets straight away & find the right help. Do not be sentimental about this or your dog could be in jeopardy – your “family vet” might be amazing & wonderful in many ways, but can they treat this rare disease? Be sure, please. If you are unable to find anyone to help, contact Dr Dodds of Hemopet via our website under “Hemopet Resources”
The basic principles of initial treatment;
1. Prednisone or Prednisolone dosage 1mg per pound weight of dog divided into 2 equal doses, 12 hours apart. This is to suppress the initial auto-immune reaction quickly as it is fast acting (5-7 days). Higher doses can be given at onset in severe cases, but should be lowered as soon as possible. Injectable dexamethasone is a more potent immunosuppressant drug used in hospital for severe onset cases. Prednisone/prednisolone is always referred to as the cornerstone of treatment. It is a life saver.
Prednisone and prednisolone can cause dehydration – ensure your dog drinks plenty of water – use a syringe (without the needle of course!) to put water gently into the corner of their mouth & encourage drinking. They will also urinate more frequently & with great urgency sometimes. Accidents on the floor will probably happen & we must forgive our dogs if this happens – they really can’t help it. There are long-term side effects with the pred that we just have to live with – they cannot be avoided & must be coped with to get your dog well again. Eventually pred can be tapered SLOWLY & carefully & the side effects will diminish.
2. On definite diagnosis of AIHA/IMHA – IMMEDIATE addition of a different type (or longer acting) immuno-suppressant, azathioprine or cyclosporine, for example. There are other drugs of this type available for treatment if necessary, although some are not well tested on dogs & should not be used in preference to cyclosporine or azathioprine initially. The exception to this is when platelets are affected as well (called ITP or Evans Syndrome), in which case Vincristineis generally preferred. Your dog may need one, two or even a cocktail of these drugs before they start to produce new red blood cells (called reticulocytes when they are “baby red cells”). Occasionally, it takes time to find the drug or combination of drugs that works best, but this is uncommon.
This is very important – prednisone and prednisolone on their own will not be sufficient and dogs suffer side effects after long term use – I have NEVER come across a dog who has recovered well or completely on pred alone after a definite diagnosis – “simple anaemia” yes, AIHA/IMHA no. A dog’s primary treatment protocol should therefore include more than just prednisone or prednisolone – the dog will be treated for long periods. I have read about too many cases where the vet has not added another immuno-suppressant quickly enough, or not at all, and the dog has had a very difficult recovery or has actually become much worse, sometimes with fatal results. I am not scaremongering – I have corresponded with owners that have been through this terrible experience & I do not wish anyone to have to bear this hurt.
3. If there is any indication, even a vague suspicion, that the dog has an infection they should be tested and THEY MUST BE GIVEN ANTIBIOTICS. If not, recovery can be severely impacted due to a compromised immune system – prednisone will make an infection worse. Ticks diseases are a common trigger for this disease. Antibiotics to be avoided (if possible) are sulfa drugs, penicillins & cephalosporins, although it is sometimes necessary to use these drugs if they are the only available treatment for that particular infection. Doxycycline in high doses & for a long term (6 weeks or longer) is the drug of choice for tick diseases, plus various other infections.
4. Inappropriate or Abnormal Clotting Risk – it is ABSOLUTELY VITAL that your dog is given ultra-low dose aspirin, clopidogrel, Plavix or another anti-clotting drug (or if in hospital heparin). Ask your vet if any of the following are present in the CBC blood test and chemical screen (liver and kidney) and ALWAYS get them to do a blood smear (blood sample reviewed on a slide under the microscope)
A) “Damaged” or abnormal red cells due to immune system partially destroying or biting lumps out the cells, causing them to clump together. Clumping can cause clots.
B) Complete breakdown (haemolysis, the H in AIHA) of LARGE numbers of red cells (erythrocytes), overloading the liver and kidneys with their component parts (haemolysis) – the faster the drop in PCV the more likely this is. Presence of large numbers of spherocytes (abnormal red cells) can be a problem – they are destroyed in the spleen as they are too big & wrong shape to get through.
C) Thrombocythemia/thrombocytosis – high platelet levels of 1,000,000 or above (this usually resolves when the cause is treated and is the least likely clotting problem)
D) Auto-agglutination – clumping due to antibodies “joining” erythrocytes together (Coombs Test positive – but test is NOT 100% reliable)
E) Blood transfusions – risk of clotting due to increased auto-immune reaction to “foreign” blood.
PLEASE ALWAYS GET A BLOOD SMEAR DONE!
Blood smears sometimes reveal abnormal cells (red or platelets) that can effectively diagnose the cause or root of the problem, or spot clotting risks – ALWAYS request a blood smear.
There are STILL too many deaths from inappropriate clotting because dogs are not being given an anti-clotting medication and it really upsets me to think that some vets are not up to speed with such a dangerous scenario.
5. Stomach protection – sucralfate and famotidine (brand name pepcid) are extremely important in preventing & healing stomach ulcers which are caused by the medications like prednisone. Again it is VITAL your dog receives this to prevent /stop bleeding in the stomach. Sucralfate is particularly effective as it acts almost like a bandage to the GI tract, healing ulceration & preventing further damage.
6. Transfusions (if needed) – The general “rule” is that transfusions should be avoided until the PCV drops to 15 or below, unless the dog is really unable to cope at a higher level. Every dog is different. Vet should evaluate the patient very carefully before transfusing a dog to a PCV/HCT level of more than 25%. If it goes over this level, your dog may not produce new red blood cells on their own as their body thinks they have enough cells already, therefore SMALL transfusions are best. This is very important and some vets forget this basic fact from their initial training.
7. Very basic blood test facts & figures for most breeds:
HCT, haematocrit, is the percentage of red cells present in the blood – normal levels are between 35 – 55. PCV, packed cell volume, is a direct visual measurement of this same value. These values can be slightly different to the use of an automated analyzer to measure HCT. Some dogs such as sight hounds have a higher value naturally – 55 to 65 is normal for them.
Haemoglobin normal is 12-20 roughly depending on the particular lab’s value ranges & the breed of dog.
Platelet count normally around 170,000-400,000, again, some breeds are naturally lower, such as greyhounds.
Total White Blood Cells 4-15 mm/m3 – breeds vary again.
The term regenerative means reticulocytes are being produced in the bone marrow. The term non-regenerative means they are not being produced in the bone marrow in sufficient quantities to replace those being destroyed. Regenerative is GOOD – the dog is responding to treatment. However, if there is large value of reticulocytes and there is little increase in the number of red blood cells, there may be blood loss, perhaps due to an ulcer or tumour, or ongoing haemolysis. Cornell University consider a figure of 80,000 to be a good regenerative figure.
8. Pancreatitis can be a common side effect of prednisone with this disease – look out for vomiting &/or diarrhea, refusing food and dog in stomach pain, perhaps arching their back and groaning, stretching out full length or crying. Take them straight to the vet. Azathioprine can cause pancreatitis – it should always be given with food to lessen the risks – stop giving it immediately if you think your dog has pancreatitis & go straight to the vets. Keep food fairly low fat – fat can also aggravate the pancreas. Do not give peanut butter, even to get pills into your dog – it can often contain a sweetener called xylitol which is proven to be harmful to dogs as it can cause pancreatitis.
9. Liver enzymes often become raised. Giving Denamarin (contains Milk Thistle) will help. Denamarin also contains other ingredients which help protect the liver so is a great supplement for this disease. Prednisone & other drugs can raise liver enzymes, so Denamarin, milk thistle, Sam-E etc are all useful in preventing / lowering these enzymes.
10. Thyroxine (soloxine) is always added as part of Dr Dodds Protocol, regardless of the dog being hypothyroid or not, at the dose of 0.1mg per 10-12lbs of optimum body weight to promote new red cell production (haematopoeisis). It is also advisable to get a full thyroid panel done as hypothyroidism causes anaemia.
PLEASE REMEMBER – THIS IS JUST AN OVERVIEW.
THIS DISEASE CAN BE BEATEN – HOPE IS ALWAYS THERE.

Please upload every possible test result you have – CBC, blood smears, scans etc – to our Urgent Advice area. They can be interpreted for you & advise you if they have clotting issues or other problems. Blood reveals a lot!
Best wishes for a speedy recovery
Sheena

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