Stella – Page 3 – Second Chance AIHA Dogs

PJ Phillips

Guest

Thank you very much for this!

I will call the vet and send all CBC’s that she has had done in the past month.

Good to know on the supplements- it makes sense.

What about this? I received this message from a Facebook group I am apart of.

The liver values (they only did 3 of the 4 are just into “high” from “normal” – so they are on the rise, but nothing like critical now. If you go ahead and add milk thistle and SAM-e on your own you can get those values down. Denamarin is ok but limited — I will message you info on milk thistle/SAM-e and how they work. Anything you need is available on Amazon Prime.

Your dog is within normal range now — the red blood levels are NOT a race, nor is “the top” a goal. ANYTHING within norm (which is usually 36 to 50) is FINE … you only want it to go as high as “normal” is for your dog (have you ever had bloodwork done before?). “normal” is where YOUR dog feels best — my dogs best was 42. The reason I say this is everyone thinks they want up and up and UP … and you really really do NOT want that. The higher that number the thicker the blood which means it’s harder to push thru the blood vessels!! Unless a dog is a lurcher who runs for a living, or a working dog who works hard chasing animals, or even a dog who lives at an ultra high altitude then typically there is no need at all for anything beyond 40 – 45.

Also — there is a lot of fluctuation that goes on — at some point in the process after the initial crisis is over the body is going to say ‘OK TIME to stock up again’ and the body will take blood from the bloodstream to replace the “store” of blood that had previously been in the spleen (but which is released when the blood is first super low). So there may be more going well than is apparent if the body is diverting some of the blood supply to reload itself as it needs to.
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HOnestly I would HATE to see you go to a specialist which will be more money when you CAN get the liver numbers down on your own. I will message you that info.

If you go ANYWHERE I’d rather see you go to the vet school. The bloodwork says you are in Toledo? That’s about 2 hours from the Ohio Vet School and they are SUPER good with IMHA and will be far far far less expensive and better overall. With a vet school, once you have been there and they treat your dog they will then treat thru your own vet for no additional charge. They will interface with your vet constantly and monitor bloodwork, etc. all for nothing.

It is the vet schools that are leading the way in research on this and Ohio is super good.

you also mentioned Optimum Choice — please don’t use it. It is algae (BioPrep = bio algae) — algae IS bacteria. Yes, it helps build blood BUT it so ramps up the immune system (the bacteria literally makes the body perceive it as something else to be destroyed) that altho it will help build some blood, it will also keep the body destroying red cells long long after it should. My choice is always holistic, and honestly I have tracked BioPrep because I wanted SO MUCH for it to help my dog. My holistic vet and Dr. Jean Dodds warned me against it but it kept monitoring it because they claim it works so well (and they market heavily to folks with IMHA dogs). But as I kept track a really disturbing pattern emerged (I’m not a vet — but I was really wanting to prove my vet wrong here) where it would raise blood levels a bit and the “color” was nice and pink BUT the dog didn’t thrive, and if bloodwork was done the white cells were always way too high (but because the color was pink often bloodwork was NOT done because “why bother”) … and often the BioPrep ramps up destruction so bad that ultimately there is a super bad crash or the immune system becomes frustrated that it can’t destroy enough and it will attack another part of the body.

I know it looks good, but please don’t use it.

The Slippery Elm Cocktail also helps make blood — it uses chlorophyll. I know they push their own chlorophyll on the Optimum Choice website but it is FAR too strong and it can cause extreme stomach distress. A bit of chlorophyll is really useful and it’s balanced in the Slippery Elm Coctail recipe.

Slippery Elm Cocktail — it is *not* a stomach protectant but it prepares the stomach for food (and it helps pancreatitis). Slippery elm itself is nutritious — this should help alot. Be **very** cautious to get “inner fillet” aloe (and I know you can get all this stuff on Amazon.co.uk or at a chemists)
1 — half a cup of boiling water.
2 — add 1 rounded tsp. of ground slippery elm (do not use tincture – use the ground powder) 3 — let cool totally
4 — add 1/4 c of “inner fillet” aloe juice
5 — add 10 drops of chlorophyll (**NOT** ultra concentrated–should come in a 16 oz bottle) 6 — Add 2-3 capsules (open the caps) of acidolpholus
Once you get it mixed up and whipped smooth, it keeps in the fridge for 3-4 days (after that the acidopholous dies). Use a two teaspoon baby medicine syringe and load it FULL. Give about half an hour before a meal.
Just put the tip of the syringe behind the canine tooth and hold the mouth loosely closed. Squirt slowly so they can work their tongue to swallow.
IMPORTANT about aloe: This should be “drinkable” aloe (not a skin cream). The higher quality aloe is called “inner fillet” — it is ***not*** “whole leaf” but rather only uses the “goo” from the inside of the leaf. Don’t buy liquid labeled “whole leaf” – but the good stuff should be called “inner filet” or “aloe vera gel”. If one brand is twice the cost of the other, you can suspect the cheap one is ‘whole leaf’ so do NOT buy that.
Whole leaf aloe WILL cause diarrhea — don’t use it. You want the better quality one here. Ask for help in the store. Online go to “ingredients’ and really look at it.
Also – there is an “ultra concentrated” form of chlorophyll being seen in stores/on Amazon (and it seems like health store professionals are pushing this). DO NOT USE. It’s too strong and will make them purge (vomit). In the dog world you eat a *little* grass to settle your stomach – but if you feel really awful you gorge on grass which then makes you puke up everything in your gut.

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PJ Phillips

Guest

From internists:

I find Stella’s condition rather interesting. Her original lab work had a strongly regenerative anemia, but the saline agglutination test was negative. This saline agglutination test is actually the test that we use to screen for immune mediated disease. When there is an immune mediated process, antibodies are created and displaced throughout the surface of the red blood cells. These antibiotics then cause the red blood cells to stick together under the microscope. So the fact that this test was negative, would actually suggest the anemia was not due to an immune mediated process. With that being said, however, I would say approximately 10-15% of patients with an immune mediated hemolytic anemia have a negative saline agglutination test. Perhaps a bit more intriguing is the fact that when Dr. Roger repeated the lab work on the 10th, her red blood cell count had actually improved without treatment…yet her platelet count dropped substantially. So while I’m not entirely sure whether she suffers from an immune mediated condition against her red blood cells, platelets, or both….Stella has clearly responded to treatment for an immune mediated process.

Immune mediated disease has been linked to a number of different causes, including but not limited to: infection, recent vaccinations, recent medication administration (antibiotics, proheart injections, etc.), exposure to chemicals, and cancer. More often than not, however, immune mediated disease is a diagnosis of exclusion. Meaning, we rule out what we can with blood tests for the common infections, chest x-rays, and abdominal ultrasounds. If no obvious cause for the immune mediated process is identified, we then call the condition “idiopathic”. This means there is no rhyme or reason, other than the patient’s condition is not working properly. This actually may be the case in Stella’s condition, as she wasn’t recently vaccinated and hadn’t been on any medications. Her age makes cancer very unlikely, and I’d expect her condition to be declining. An infection is also unlikely, particularly since the tick test Dr. Roger performed was negative; not to mention she would be expected to get worse as well with suppression of her immune system if an infection was present.

The most recent elevation in her liver enzymes is primarily the reason for Stella’s visit today. Admittedly, we are uncertain to the cause, but have a few theories. One possible cause is the recent Doxycycline administration. Doxycycline has been reported to cause liver issues, and the significance of this has not yet been determined. In fact, approximately 40% of dogs / cats receiving Doxycycline can experience an elevation in the ALP and ALT. So for now, we are going to stay the course with her current treatment plan and see where her values are in one week. If her values improve having stopped the Doxycycline, then we’ll assume that was the cause. If, however, they continue to increase the other considerations include both the Prednisolone and Cyclosporine therapies. While all dogs receiving Prednisone see an increase in their ALP, it does not typically cause an increase in ALT. The reason for this has to do with the effects of Prednisolone. Prednisolone causes protein degradation and muscle breakdown. In addition, it causes mobilization of fat and redistribution throughout the body. Fat will then be deposited within the liver and result in vacuolar changes. So the damage isn’t to the liver cells themselves. ALT is an enzyme that is stored within the liver cells, and it can only increase in the blood stream when there is damage to the liver cells….again not consistent with the Prednisolone. Since Stella’s ALT is much higher compared to her ALP, I think the Prednisolone is the unlikely culprit. Rather, I would worry more about the Cyclosporine therapy. Hepatoxicity has been reported in dogs and cats, but is uncommon. We discussed submitted a Cyclosporine level on Stella but ultimately decided against it. We also discussed the idea of an ultrasound to evaluate the liver, but this too is currently on hold. I think the plan of rechecking her lab work in one week having stopped the Doxycycline is appropriate. At that time, we’ll consider making changes to either the Prednisolone or Cyclosporine therapies.

When managing a patient with immune mediated disease, there are a number of factor to take into consideration. Primarily, we have to focus on the patient’s health and quality of life. As you can see, most patients have more side effects from the Prednisolone than the Cyclosporine. The increased thirst / urination, panting, lethargy, and accidents in the home are all Pred related. That is why most clients chose to taper this medication first. However, the cost of the Cyclosporine can become significant quickly. So with Stella, I think I would consider tapering the Cyclosporine first…at least partially. If we can then get down to 100mg once daily, I would consider reducing her Prednisolone at that time. Remember, there is no recipe on how to manage a patient with immune mediated disease. It is all dependent on the patient’s condition and client concerns / priorities.

Going forward, I want to be clear that no vaccinations should be administered until further notice. However, it is important to continue the heartworm, flea, and tick preventatives. I typically recommend limiting contact with other dogs you are not familiar with, to avoid exposure to other organisms (bacterial, viruses, etc.). This includes at the groomer, so I often encourage clients to have the grooming done at home (there are mobile groomers in the area) and the patient should be done first (so that there haven’t been many other dogs in the groom van). You can take Stella to the groomer, but I also then suggest that she be done first and you wait until she’s ready to go. That will also limit her exposure to other dogs. If there is a place that she can stay off to herself without exposure / interaction to other dogs, this could be fine. The groomer just needs to understand that Stella is immunosuppressed and will easily pick up infections.

As we mentioned today, immune mediated is very common and we see it in a variety of forms. Most patients can do well long term and eventually be weaned off all medications. I would say that I have perhaps 10-20% of patients relapse as we are tapering the medications. However, there is usually an inciting cause for this (medication administration for example). So I would say that Stella’s prognosis overall is very good. Her liver enzyme elevation is fairly mild, and I think it will resolve down the road. We just have to come up with a plan on how you’d like to taper her medications next week.

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