Slaton – IMHA slow to respond

[Matt]

My 9 yr old mixed lab, Slaton, was diagnosed with idiopathic IMHA in mid-late June. She had been showing symptoms of anemia since the end of May, but all tests were coming back negative for IMHA.Her RBC was steady around 22%-24% for a few weeks and the Vets suggested she handled that well, as she is a very laid back dog. One Wednesday morning, June 24, we rushed her in for a blood transfusion as she went from 24% to 17% in 12 hours and then down to 14% in the next 3 hours by the time they started the transfusion. I took her immediately to the specialty clinic in Pittsburgh, PA (PVSEC) for further testing (at this point all test were still negative for IMHA. The vets were leaning towards internal bleeding; however, ultrasound showed nothing. Ultimately we were literally minutes from exploratory surgery when a report from pathologist came back that said , “CBC with pathology report revealed a regenerative anemia and the presence of spherocytes. Spherocytes are pathognomonic for immune mediated hemolytic anemia. Slaton lacked all other signs of IMHA (agglutination negative, coombs negative) but the presence of spherocytes prompted the start of immunosuppression.”

She started pred and mycophenolate, but did not respond and experienced extremely severe diarrhea. Ultimately she was switched yo cyclosporine and has began to show a positive response. On 8/27/15 her RBC was 30% after continuously hovering at 20-24% for 2 months. I don’t think she is in the clear at all though as she still has a long way to go and over the past 3-4 days she has been weaker than normal. I can’t tell if it is due to lower RBC or the prednisone induced muscle atrophy.

As soon as I figure out how to attach PDF I’ll upload her PVSEC reports.

[Matt]

Here is the Dropbox link to her PDF reports.
https://www.dropbox.com/s/016w7zrayergs40/Slaton-PVSEC-Reports-20150811.pdf?dl=0

Thanks for any advice.

[Vally]

Hi Matt, welcome to the site. I’m very sorry you’ve come looking for us though. IMHA is a sneaky miserable disease and is hard to diagnose, I think because there are no definite test for it. The best news is that word “regenerative”.

Mycophenolate is very harsh on the stomach and is still relatively new in this treatment I believe, so I’m really glad she’s now on cyclosporine. That really is the drug of choice alongside prednisone (which we all hate, but respect) as it has fewer side effects. My boy Bingo was a walking skeleton with a huge stomach for some time and it’s terrifying to see but Slaton is going the right way, so once stable, the prednisone can be slowly lowered and you’ll see she’ll be looking heaps better quite quickly.

If you go into the AIHA Terms, you’ll see heaps of information about all the drugs. Prednisone will definately cause muscle atrophy. https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/

To attach anything, use the Urgent Advice at the top, or here’s the link:
https://www.secondchanceaihadogs.com/urgent-advice/
that sends an email to the moderators.

You can upload a photo of Slaton if you like by Uploading a photo – on the right. It doesn’t appear immediately as it needs to be approved. That’s just to help protect the site.

What does Slaton weigh and what drugs and dosage is she on? If you’d like a chart, I’d be very happy to make one up for you :)

Ask anything at all. We all love to help as much as we can. We’re all over the world, so there’s usually someone around at all different times.

Regards,
Vally & Bingo (diagnosed Nov 2011, in remission)

[Vally]

Matt not sure everyone has Dropbox. If you don’t mind, can I print and email to the moderators?

Vally

[Matt]

Feel free to print as you wish. I will attempt to attach the PDF via the method you mentioned. Also, the dropbox link should work for anybody without signing into or having a dropbox account; if that is not the case let me know and I’ll look at the security settings.

Slaton weighs about 34-35 pounds. She started at 39 pounds, but was as low as 31, if I recall correctly.

Her daily medicines are as follows:
7 AM – 75 MG Cyclosporine
9 AM – 10 MG Prednisone
7 PM – 8MG Aspirin
9 PM – 10 MG Prednosion
10 PM – 10 MG Omeprazole (Prilosec)
Additional Supplements:
Pettinic – 5 ml with breakfast
Fish Oil – 1000 MG in Morning
PetTab in Morning
Dasuquin w/ MSM in morning

We feed her a 50/50 mix of Merrick Classic Real Beef, Whole Barley & Carrot Adult & Orijen Senior.

For treats and snacks, we boil chicken tenderloins and give her small bites.

[admin]

Hi Matt

A big welcome – so glad you’ve found us. I’ve had a good read through what’s happened. What a long journey! This is such a complicated disease & my dog wasn’t diagnosed for months either – but we got there in the end. I am so glad the mycophenolate has been dropped – in one particular trial, most dogs had to stop it because of the terrible stomach issues = diarrhoea/vomiting. Atopica (cyclosporine) is the preferred drug for this disease anyway – so good news on that. Of course, it takes time to work though.

I can see no reason for exploratory surgery – that would be pointless in my view.

One thing struck me in the pathologist’s report – the mention of spicules – have a read of this:
https://www.secondchanceaihadogs.com/AIHA_Terms/spiculated-spike-cell/

I assume you’ve not had a thyroid panel done as it’s not in the report. It is well worth doing as hypothyroidism (yes – another but more common auto-immune disease!) inhibits red blood cells production – and that is a cause of spiculated cells. Thyroxine is recommended as part of the treatment protocol for this disease as it encourages erythropoeisis (red blood cell production). I would recommend you get this test done as soon as possible. On our site, you can go here:
http://www.hemopet.org/hemolife-diagnostics/veterinary-thyroid-testing.html

Some dogs don’t start to recover very well until thyroxine is added in to the treatment – it can make a huge difference, even to those who are not hypothyroid. Dr Dodds of Hemopet will always recommend it’s use regardless.

Could I also recommend getting a Vitamin B12 test – I would recommend adding in Denamarin immediately – it provides red cell building blocks & helps protect the liver from all these drugs too. If the B12 test comes back low, you can get injections. It may be that food is not being absorbed adequately, which won’t help on the nutrient front. We have had dogs on here with anaemia due to malabsorption, often due to overgrowth of bad bacteria, so again worth checking his level.

The great news is that Slaton is mildly regenerative – but I know you want to get him highly regenerative!

So for now, Vitamin B12 test & thyroid panel would be a good start. Hope this helps a bit – don’t hesitate to ask about anything you want to.

Sheena, Worzel & Ollie x

[admin]

Hi Matt – we were typing at the same time – thanks for the info on the drugs etc. Glad you are adding Petinic, but I think the Denamarin is absolutely essential with this disease. Have you stopped the sucralfate now?

Sorry to tell you Dasuquin has some side effects (see link below) & it is not recommend when dogs are on anti-coagulents (e.g. aspirin), so I would discuss this with your vet:
http://www.veterinaryplace.com/dog-medicine/dasuquin-for-dogs/

How is Slaton feeling in herself now? That’s the most important question of all!

Sheena x

[Matt]

Thanks for the Dasuquin link. I’m curious as to the statement regarding the findings being disputed. “It’s often not recommended that owners give this substance to dogs who are taking drugs with anticoagulant properties (for example, aspirin) as some trials have demonstrated blood-thinning effects following the use of MSM, though such findings are disputed.”
Is this specifically in regards to the MSM formula? I hesitate to stop it because she had ACL surgery last summer (2014). The internal medicine specialist at PVSEC is aware she is on it as well. Not trying to argue just want all sides to be aware of full story so best decision can be made.

She was feeling good the past few weeks but the past 3-4 days she has been extremely bloated, lethargic and seemingly uncomfortable.

We are not on sucralfate but I have wondered if she should be on something for stomach and liver protection. She has constant gas at this point as well.

Is the Denamarin on Amazon the same strength and dose as from a vet?