New to AIHA, dog in trouble

[admin]

Hi Rick

I apologise for not being able to post you a message straight away – I am so sorry about Brandy going through this traumatic time. I can assure you that Patrice’s expertise is second to none & the advice she has given is superb. I think you already have a good grasp of what is happening & you are doing a wonderful job of getting her the right care – she is not old at all, a mere youngster in my view. I am so glad to read that Brandy has now been started on cyclosporine, sucralfate & very importantly, anti-clotting meds – I wanted to back up what Patrice said yesterday & am relieved to see everything has been covered pretty well now. It is so much better to have specialist help with this rare disease, especially with transfusions & Brandy’s previous problems with pancreatitis & cortisol levels – she is very BEAUTIFUL by the way (and I can see the lovely face of her brother in the background).

My dog Worzel (greyhound, who was at least 12 when diagnosed in Dec 2012) would not eat at all either as he had been on various medications including doxycycline & pred to start with (before we had a proper diagnosis). He was not given sucralfate at the beginning, so this upset his stomach to the point of him being in pain, so I really do sympathise with what you are going through. I agree that she probably won’t eat at the vets as it’s quite upsetting for them – BUT she’s in the best place for now as they can take good care of her 24hrs a day. Once the drugs “kick in” (you have to be patient with this as it takes a little time) & her poor stomach settles down, she will be home with you & most likely be ravenous like Worzel was! You already have a great knowledge of what kind of diet she can tolerate, so are already prepared for that.

Please try & get some rest when you can – there is a lot of intense nursing ahead & we are all here to help you through this. The people on here really care about each other & their dogs & cats, so you can be sure we are all thinking about Brandy & sending you all our best wishes. As Patrice so rightly said, specialist help, the correct diagnosis (including finding any possible cause) and the right treatment give the best possible chance of recovery – you have been fantastic in getting Brandy all these things as quickly as you could. Hoping she will soon be home & hungry too!

Sending you hugs & moral support from all of us
Sheena, Worzel (13 ish in remission) & Ollie xxxx

[Rick]

Update:
I just got back from the hospital. Brandy is doing okay. She is still very weak, though her gums do have a bit of colour to them. By tonight she will be 6 full days on Pred.

She has started eating – they are feeding her every 6 hours and she is on pace for a full meal today of her regular food. I brought her doggie treats (Hill Hypoallergenic) and she ate for of those.

We will switch her to oral Cyclosporine tomorrow at 75mg twice a day. I believe she is currently on 2.5 mg (ml?) per kg intravenously. I don’t have the complete list of her meds but will post them when I do.
Her PCV was still 26% this morning which is comparable to what happened after her last transfusion. There is no sign of hemolysis in the clear fluids so far, but I don’t yet have the external lab results from this sample.
Tomorrow will be critical for red cell production. Last time she chewed through the transfused cells in about 3 days.
So for now, we are balanced on the fence, hoping to land on the good side over the next day or so.
Thanks again all.
Rick

[Vally]

Rick, the pred and cyclosporine can take a bit of time to start working (but we never used the intravenous cyclosporine), although having said that, with Bingo, the first test after he started the cyclo he did show improvement and then his bloods went up and down a bit until they stabilised. The transfusions are just there to buy time for the meds to start doing their stuff.

Love Vally & Bingo

[Tamara]

Rick, my Ashki was diagnosed 4/30 and transfused 4/30 and 5/30. He was not regenerative until around 6/9 or 6/10. That first transfusion held him in the teens, between 17 – 19 for the most part, until he dipped down to 16 and then 15, when we did another transfusion and another bone marrow biopsy to see if they had missed anything on the first one to explain Ashki’s ongoing aplastic state. On 6/9 he dipped down to 16 again and we planned to do another transfusion and IVIG, when on the 11th his PCV jumped up to 20. Since the 11th he has maintained in the 20s and his latest PCV was 27 and his internist has declared him in recovery from this terrifying disease. The transfusions definitely bought us the time we needed to wait for the meds to work. I just wanted to share our experience with you. I’m thinking of you and Brandy and sending love and hugs. Hang in there, you’re doing an amazing job caring for her.
tamara and ashki xoxoxo

[admin]

Hi Rick

Glad Brandy has eaten a little & it sounds like she is in great hands. Really good news on the haemolysis – this is a great improvement. Please don’t worry too much if you get a bit of a drop in PCV again – this does happen with transfusions. As Vally says, the cyclo doesn’t work overnight (we all wish there was something that did!) & improvement is gradual in the early stages of this evil disease. It’s very hard to be patient, but we have to be. Transfusions are there if Brandy needs them & some dogs need several before an improvement is seen. It is recommended that tranfusions should not be given to take them over a PCV of 25 (approximately) as this actually slows down the production of new baby red cells (reticulocytes) and we have sometimes come across vets who have forgotten about this, so I wanted to mention it. If you get a minute, have a look at our glossary item on transfusions for a full explanation.
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion/

You may well know all about this, but basically the kidneys monitor blood oxygenation levels & produce erythropoeitin (EPO) to stimulate blood cell production in the bone marrow as appropriate. If the kidneys “think” all is well, they do not produce as much EPO. Do you have any figures on reticulocytes from Brandy’s blood tests at all? Did they say if she is regenerative or non-regenerative? Red cells take a lot longer to produce & mature than any of the other blood cell types, which makes it even more of a waiting game.

Thinking of you & Brandy – I bet her brother is missing her like crazy.
Love & hugs to all of you
Sheena, Worzel & Ollie

[admin]

Hi Rick

Welcome to the site. I am so sorry you and your Brandy are going through this. She is an absolutely beautiful girl and you are so well informed, which is brilliant.

You have already been given wonderful advice by everyone, and you are doing a wonderful job of caring for Brandy. I do hope she is hanging in there and that you will see some positive results soon.

Mary & Mable x

[admin]

Hi Rick – so sorry to hear about Brandy. I do hope they manage to treat the AIHA – it’s an awful illness.
But don’t let them give you the rubbish about age. We recently said goodbye to Meg, a medium size lurcher. At 13, she had a major cerebellar stroke. The hospital nursed her and never once said anything about her age. She quickly learned to walk again, and we took her for many many more long walks. When she passed in March this year, she was 17.

[Rick]

I saw Brandy today at lunch. She is doing better today – more alert, her eyes are focussed, eating, and she is calm. Her PVC was down a bit at 24 this morning and they have sent a sample to the external lab.
Yesterday’s sample showed ghost cells and Spherocytes, and the doc really would like to see a sample with no ghost cells. Very little sign of hemolysis in today’s sample as well -which is quite different from the first transfusion.
Today they did an abdominal ultrasound, 4Dx (whatever that is) and chest xrays and found nothing interesting. Spleen and Liver look normal.

List of medications:
Prednisilone 15mg subcutaneously every 12 hours
Cyclosporin 2.5mg/kg IV every 12 hours
Pantaprazole 0.7mg/kg IV every 24 hours
Sulcrate 1g by mouth every 8 hours
Ondansetron 0.15mg/kg IV every 12 hours
Metoclopromide 0.04mg/kg/hr (constant rate infusion)
Plavix 18.75mg by mouth every 24 hours.