Sunny

[maura]

Dear Sheena, Vally , Hope , Tamara & ALl,
Sunny is pretty much the same this morning. Her gums appear pink but she must dislike me lifting them up every hour.
I did talk to the tech at the specialty clinic yesterday and gave him my email so he could send me the lab results but they haven’t gotten to my email yet. Our appointment is wed. at 1230 with the specialist. I do think I will take her today to the local vet for the PCV.
It is warming up here in western NY so I am keeping the air conditioning on. Sunny pants more when it is hot and humid.
Sunny is 6 years old. When she was 3 she had bladder stones and had a cystotomy. Since then I had always suspected she had panting issues some nights and possibly a hypothyroid as she seemed to gain weight easily. I found her sister from the same litter is hypothyroid. I do not know if any of these past events are related to AIHA.
I am not happy with my local vet’s office because a week after Sunny rec’d her distemper June 16 her hair did begin to fall off her face and that seems like a big red flag. I took her in and they said it was fungus and gave her ketoconizadole (sp). I think they missed the obvious that she was becoming anemic. But being angry is not going to change anything.
So I have to wake up my daughter (who is grumpy 13) and possibly drive our Sunny to get the PCV checked.
I will be writing often throughout this.
TTYS, Love,
Maura & Sunny

[maura]

Sheena and everyone , The dose is 20 mgs 2 x per day and the vet tech ( who knew it was me before asking) said that yes it is 40 mgs per 24 hours as Sunny’s condition was so bad. Her PCV was at 8 on Aug 12.
She seems a bit more down the last few hours. Seemed like picking her up to go outside to potty made her uncomfortable. HOW LONG does the lethargy last?? If she is to regenerate new red blood cells when should it be happening? How long can a pup stay down? I feel like we aren’t going to be that lucky 20%. My heart feels like it is sinking . I pace back and forth and can’t seem to do anything but watch her.
TTYS , LOve,
Maura and Sunny

[admin]

Oh, Maura

Please, please don’t despair. I can see you are very upset & I understand completely how ravaging the effects of the prednisone are. Sunny is in the very early days of treatment still, so it’s a waiting game.I wish I could tell you that those new red cells will appear overnight, but I can’t. It takes around 10 days for azathioprine to suppress the T-Lymphocytes which are the naughty things that are responsible for killing off the red blood cells. It can take up to 6 weeks for it to take complete effect. Worzel was a very lucky boy – he was producing new baby red cells after a couple of weeks. BUT there are many people on here who waited a long time before their dogs started making new cells and you have to be patient – there is no choice, I’m afraid.

This 20% survival rate you’ve read about is not accurate in my opinion or experience. I read some similar things when Worzel was diagnosed & was glad to find some of the folks on here who gave me other ideas. The 80% death rate is greatly due to dogs dying from blood clots. Please read this study which was carried out by my Specialist’s best friend at Cornell University quite a while ago – my Specialist assured me things have improved even further since then as so many other drugs are available now. Please cheer yourself up with the survival figures here – It clearly states that dogs have a good survival rate when treated with prednisone, azathioprine & ultra-low dose aspirin:

http://www.ncbi.nlm.nih.gov/pubmed/15934255?dopt=Abstract

The most important thing is that the treatment is right. Sunny is on prednisone & azathioprine, but NOT anti-clotting medication. That is why I have been FRANTIC about getting your vets to look at this. I beg you to print off our abnormal clotting glossary item
https://www.secondchanceaihadogs.com/AIHA_Terms/abnormal-clotting/
and take it with you to the vets . I can’t do any more for you without seeing the blood tests & blood smear results. I cannot stress how important this is, especially as Sunny has destroyed her own red cells & has also had transfusions.

Hypothyroidism is a known cause of AIHA & Sunny definitely needs to be checked for thyroid function. It runs in families & in certain breeds. She may well need soloxine (thyroxine – a hormone produced by the thyroid gland) & many AIHA dogs are put on soloxine because it encourages blood cell production anyway. It can make a huge difference to the production of those much needed baby red blood cells. I am suspicious that the hair loss & flaky skin might be due to this. The cream they gave you for fungus has a tiny, tiny risk of causing blood problems, so I wouldn’t worry about that. Have a look at our hypothyroidism information:
https://www.secondchanceaihadogs.com/AIHA_Terms/hypothyroidism/

I think the high dose of prednisone is really ravaging her poor little body. Worzel was in an awful state too – weak, feeble, wobbly legs. I had to lift him onto the bed & sofa (yes-spoilt!). Greyhounds are thin anyway, so you can imagine how quickly he went downhill. Also panting & very hot. I was beside myself with worry too, but they DO get over it when the prednisone can be reduced. I understand exactly why Sunny was on a high dose at the beginning, but I am concerned that this is too high now – hence the quick decline in her musculature. This is DOUBLE the usual dose & I am a little worried about this.

You need to be completely happy with the specialist care Sunny is getting too. This is a rare disease & expert help is needed. Some outside help would be a good idea at this stage – I am thinking now that you should contact Dr Dodds. She has vast experience & a great reputation with AIHA/IMHA and has helped many of us through this awful experience. Her fees are very reasonable ($100 for a consultation I think) & I feel she can help you get Sunny the best possible treatment. She cares deeply about dogs & is also one of the nicest, kindest people you could meet! Here is the link to her consultation page:
http://labordatenbank.com/cake/hemopet/onlineorders/hemopet_add

So, Maura, don’t give up – please, don’t get too despondent. Many of us have thought it could be the end of the line, only to be surprised by our dogs recovering slowly but surely.

I wish I could be beside you & give you a huge hug – I am sending it across to you now! We are all here to help you – keep posting & asking questions. Don’t ever let Sunny see you upset – keep positive & your good vibes will rub off on her.

Much love & loads of support from us in France

Sheena, Worzel & Ollie xxx

PS I posted something similar to you earlier, but it completely disappeared. I have tried to reproduce it, so apologies if you get 2 versions!

[maura]

Hi Sheena,
Thank you for the quick response. I guess you know how frantic it seems to the dog momma who feels helpless against this disease.
I called the vet tech at the specialist clinic and she says she can’t email me the results. Should I just ask her to read them for me on the phone and then write that info here?
The tech last eve said Sunny’s blood was the better of the 2 types and she did not have cytopenia-( i swear i have no idea what he was talking about). He stated that the clotting was normal . The specialist we are scheduled to see on wed did say she plans to reduce the prednisone. Sunny has been on it since Aug 13th.
I believe I will have to take her tomorrow to the clinic just to check her PCV as I can’t wait till wed. The drive is very long but they supposedly have the newest things and advances. The nights are the worst because I feel there will be an emergency.
She was transfused on Aug 12 so the duration is up , right?
—I will work on getting those labs.
**Maura

[Tamara]

Maura, I just want to echo what Sheena wrote about it taking time. We all understand that frantic, helpless, panicked feeling, that worry that something is going to happen at night, and checking the gums constantly. Ashki is like Sunny, he doesn’t really like it either.

Ashki was non-regenerative (not making enough red blood cells) for 6 weeks after diagnosis. He was mostly in the teens for a very long time, it took forever for him to be stable in the 20s. He was very very tired and not himself at all, it was so distressing. But now, almost 4 months later, he has been stable and in the 30s (though not to normal yet) for 4 weeks!! And is very much acting himself again. He had many things going on, including being very hypothyroid and having some GI inflammation that was hindering his progress.

In addition to having a consult with Dr. Dodds, you can have her lab test Sunny’s thyroid; her lab is able to interpret the results even with the prednisone on board. If you go to her lab’s website, http://www.hemopet.org, you will see a tab for testing or forms (can’t remember what it’s called). You just ask your vet to give you a couple milliliters of serum in a tube and ship to Dr. Dodds’ lab; I suggest the Thyroid Panel 5 I think it’s called. That will give you a picture of how Sunny’s thyroid is doing, and the veterinarians at Dr. Dodds’ lab and Dr. Dodds will make a recommendation if soloxine is necessary. On the form there’s an area for meds, I had to put Ashki’s in the comments section, he was on so many! And he did come up very hypothyroid, we think this was a piece of his IMHA.
Thinking of you and Sunny and sending you much love and many hugs.
tamara and ashki xoxoxx

[Vally]

Maura, I totally understand how freaked out you are.

I remember so well thinking Bingo is just not going to make it. In fact twice at the vets in the early days, I thought it would be better to let him go, he looked so very bad. He couldn’t walk without falling over. But his vet (and I can’t say this enough, I love his specialist) said to me, he’s not in pain, he’s just very tired, let’s give him a bit more time to let the medicine do it’s job. I’m actually pretty sure he lied to me about Bingo’s PCV because one time Bingo’s life hung in the balance on his results . It really upsets me now to think of this. I knew nothing about this disease (like everyone else), I didn’t find the old forum for some time and, as you say, I was searching the internet and I also found that there was little hope. He was diagnosed in November and I remember being upset at Christmas telling someone I don’t think he’s going to make it.

NOT TRUE!!! The meds did start to work – but it didn’t happen instantly. So I’m telling you the same thing my very favourite vet said to me – lets give the drugs a chance to work.

I also suspect hypothyroidism could be a very real possibility from what you say about hair loss, weight. It is a known trigger for AIHA and whilst I’m not certain it was the cause in Bingo’s case, he was hypothyroid when diagnosed and had only just started on thyroxine. As Sheena said, Dr Jean Dodds of Hemopet runs the very best thyroid testing laboratory. The results are a lot more detailed than most thyroid tests carried out. She is a wonderful lady and her consultation fees are incredibly reasonable. Everyone that has ever dealt with her has always commented on how very kind she is.

I am still very worried about the pred dosage. As Sheena points out, that is pretty much double what is usually recommended, even when their bloods are very low. Please raise that with your vet and, again PLEASE check about clotting. That is actually the biggest killer of dogs with AIHA – not the disease itself.

Another thing, if Sunny’s gums look okay, and hopefully the next test will show she’s holding, then I would definitely think she’s regenerating, because the transfusion was a whole 2 weeks ago. I think that’s sounding very positive.

Lots of love and big hugs,
Vally & Bingo

[maura]

Dear Vally, Bingo , Tamara, Sheena , Brigitte and everyone who is helping me,
I am keeping the faith–my Sunny deserves all of my energy and hope.
I see the vet tech for the blood draw tomorrow with Sunny. I cannot wait till wed.
I will be better able in person to have all these great questions answered. Most importantly the wobbly legs from this high pred . dose and the blood clotting med. The tech said she did not show for Evans syndrome–if I knew what that meant that would be great. I feel very small in knowledge in the midst of this disease. The specialist was to see us wed so tomorrow it is a tech app’t just for the PCV. If it is low I am uncertain what they will do.
THANK YOU ALL SO MUCH.
i will post her labs tomorrow
Maura & Sunny

[Vally]

Maura, you’ll see a lot of explanations for heaps of topics up the top in AIHA Terms. Here’s a link.

https://www.secondchanceaihadogs.com/aiha_terms/

When you have time, you can wander through and it will help to understand this foreign language that vets talk.

Love Vally & Bingo