Forum Replies Created
Kim,
Good news about Lily! I usually tell owners to monitor their dogs by how they behave, not necessarily by what their tests are showing.
Even if tests might show a reduced HTC PCV, dogs adjust to overall lower levels of oxygen over time as a survival mechanism.
Heavy breathing is a response by the body to increase oxygen levels to the body cells, anemia is defined by not enough oxygen going to the body cells. There would be increased breathing rates with anemia whether or not prednisone is being used. Elderly adults can develop reductions in kidney function which leads to less stimulation to the bone marrow to make more RBC. This leads to chronic anemia ans subsequent breathing patterns.
The role prednisone does play is that it is similar to the bodies own natural cortisol but it is dosed in excess of our needs. Similar to when we are in a stressful situation such as a car accident, the body prepares us to “fight or flight” by shutting down unnecessary processes (digestion for instance) and enhancing those systems that would be necessary to “fight or flight.” Increasing blood flow and oxygen delivery would be high on the list. Our bodies cortisol is usually the stimulus that starts this process and is provided by the adrenal glands. When using high doses of prednisone we put the body in a constant state of “fight or flight.” The adrenal glands have stopped working and essentially shrink when there are high levels of prednisone (cortisol) in the body. Because of anemia, the body simply can’t respond with more oxygen properly. The body will try to stimulate an increased heart rate and increased breathing rate to make this happen but the results are still inadequate to deliver enough O2 to the body cells.
This could be considered a “transfusion trigger” that a vet would use to determine if there is a need for transfusion during treatment for AIHA IMHA.
Merck manual states:
“The decision to transfuse RBCs is determined by clinical signs, not by any pre-selected PCV. Animals with acute anemia show signs of weakness, tachycardia, and tachypnea at a higher PCV than animals with chronic anemia. The amount of RBCs required to relieve clinical signs will generally increase the PCV above 20%.”
So Merck recognizes that acute anemia responses are increased heart and breathing rates. As time goes by, chronic anemia, dogs adjust to lower PCV’s and their symptoms are less apparent.
In addition stressful conditions can increase heart and breathing rate. During treatment many dogs develop enlarged and inflamed livers. This is quite painful and can increase a dog’s stress level significantly. Some dogs develop pancreatitis and this too is very painful.
So the changes we see in our dogs during treatment for anemia can be due to a variety of reasons. Thus the need to reduce stressful events in their lives while they are in treatment. Even something as simple as the doorbell ringing is an overly stressful event to a dog.
my best, patrice
Mel,
I really would like to see the reticulocyte value before I say anything. Your vet is failing to request this on the CBC and it is critical to know. Unless he has some other resource where he has received this information, it leads me to believe he doesn’t have a good understanding of regenerative vs non-regenerative anemia.
The Sept CBC does have a high neutrophil count but as I said before it’s not any higher than in other dogs that have recovered.
There is a condition called anemia of chronic disease that can lead to a low grade non-regenerative anemia and has signs of inflammatory responses that might have these high neutrophil counts. This is hard to explain. I would really need to see a chemistry screen to evaluate the body health of organs etc to determine if there is another problem occuring. Has your vet done this test at any point?
My best Patrice
Hi Kim,
Don’t worry about the sucralfate, just give it once a day, better on an overnight fast. That way it simply won’t interfere with the meds or absorption of food. It’s a human medication and traditionally is given twice a day. Right now once a day is better than nothing.
I got the CBC lab reports but there wasn’t a chem screen included. I was trying to see the liver enzyme levels so we could determine if this is what is causing her pain. Also if she had pancreatitis at one point it would be helpful to view other values as well. The chem screen tells us about how the body organs are functioning and the physiology of the body. Things like electrolytes, glucose, liver, kidney, etc. Those are critical to know because they tell us how healthy our dog is. The CBC is specific to blood elements.
Do not worry about small changes in the HCT or PCV, they are absolutely normal in our lives. The test you do, the sample they take, is just a snapshot in a moment of time. Our bodies maintain a homeostasis every second of our lives and things like the blood change all day long as they respond to messages from the body systems. What I like to see are multiple tests so there is a continuum of values to compare. They tell the story better.
So for instance if we looked that the HCT or PCV over 3 months and we saw only small 1-3% ups and downs that would be perfectly normal. But if we saw a gradual (or fast) significant drop from one test to another we would want to evaluate that change more closely.
Yes, Aza over a period of time leads to bone marrow suppression. The reason for this is simple. This drug is often used as a chemo drug in cancers. It’s job is to suppress the WBCs in the body that may be responsible. WBC are very short lived cells and are being constantly made. If you begin highly suppressing this action, you can lead to other blood elements being suppressed as well. So Aza works by stopping fast growing cells from reproducing. We want that in cancer treatment, we do not want this in a dog that has anemia. Reducing this now is a good thing. We are going to want to get the pred down eventually, esp if there has been a bout of pancreatitis.
Heartworm, Dr. Dodds has always recommended to me to use Interceptor tablets, for the main reason it contains only one drug not several, and also because it is very good at eliminating many more types of worms, esp the dangerous tapeworms, than some brands do. I use the 45 day schedule on all my dogs.
So I do need to see the chemistry screen if you can get any of the more recent ones.
my best, patrice
Kim,
I’m traveling so this will be abbreviated.
I am sorry to hear about Lily, but it sound like she recovered quite well. A HCT or PCV of 35 is quite adequate. No worries, just be sure to see the vet once a month for a quick PCV exam. See the previous topic and the reply from Vally about prednisone reduction link.
Yes you should have been giving him something like generic pepcid a half hour before one meal. Dogs on prednisone are at great risk of stomach ulcers.
In case there may be a stomach ulcer now, ask vet for Sulcralfate, it’s a mucous “bandage” that coats esophagus and stomach and heals ulcers, it is safe to use but give this at least 3 hours before or after meals. An overnight fast is the best time to give it.
In addition I suspect that the liver enzymes are very high and that is probably what hurts her, the liver is swollen. I would like to see the chemical screen and CBC lab tests, please send them via the Urgent Advice page.
To treat the liver, buy Denamarin, a veterinary supplement that contains doggie dosed by weight purified silybin and Sam-e, both excellent for helping the liver heal. For a very small dog it is important to get weight dosed supplements.
I am afraid to say that dogs who have previously had ITP, they are at greater risk for relapse. You know what to look for, pettachia, red spots in groin etc. So keep attentive.
The good news is that if you catch it quickly and start with treatment immediately the recovery is fast.
Lily may not be quite the same dog coming out of this as going in. Little dogs are especially prone to developing mitral valve problems of the heart after prolonged anemia and periods of lower O2 going to the body. Be sure that she gets a complete checkup every 6 m and that they listen to her heart carefully. A chest xray would help to see if the heart is enlarged.
So her life must be different now, more protected from environmental triggers that could set her immune system off again. Avoid congregation with other dogs not from your household. Think about viruses and bacteria and how to protect her from them. DO NOT give her vaccinations again. At the top of this forum is a topic with Dr. Dodds minimal vaccination schedule print it and carry it with you so that no vet mistakenly gives her vaccinations again.
My best Patrice
Karen,
If you have read Chance’s story you will see that he was seen by the specialist early in the year but he was not responding to just prednisone as late as July. The specialist had upped the dose which really made him very sick and he finally told me there wasn’t much more he could do for chance. I first contacted Dr Dodds after this, we were considering compassionate euthanasia. She immediately requested I put him on her protocol. My vets were delighted to be collaborating with her and were pleasantly surprised when it worked so well.
What is the difference? It is because most likely the autoimmune attack is occurring deep in Georgia s bone marrow, at the level of precursor cells, a very difficult place to treat. Dr Dodds knew this in 2007, long before any vets understood this. Why is this protocol different than what you have been doing it?
She doses cyclosporine (Atopica) at higher doses and pulse doses. This hard hitting dosing protocol completely saturates body tissues and reaches deep into the bone marrow. The pulse dosing (m-f, ss off) she gets from herbalists who understand that this short break prevents the body from getting used to the drug and not responding to it over time. (Cyclosporine is a fungus) She cycles like this for 3-4weeks until dogs begin to respond. In her protocol you see she mentions for protracted cases (not responding to treatment) ,adding azathioprine will further jump start the attack on the highly overactive T-cell lymphocytes that are destroying the very early stages of cell development in the marrow. And no, doing a bone marrow biopsy won’t tell us anymore than we already know. I could show you a breakdown of which cell lines are being attacked now. It is that common in dogs.
Georgia body has become “used” to the cyclosporine and probably needs to have the aza added. I know Dr Dodds could advise you better than I can. You can request a second opinion from her and she will jump at the chance to help you. See the Hemopet Resources under Second Chance Resources and click on Owner Consultation. You can fill out the form on line. Do you have all copies of blood tests? I would like to see them and so would Dr. Dodds.
Vally has actually used this form more recently and knows a trick to get all tests sent to Dr Dodds.
Chance reached a point after months when he too was totally drained and exhausted from the anemia. The prednisone had elevated his liver values extremely high and it was painful for him. I know the disinterest you mention. I can never forget how Chance was. It is because of his pain and my grief that I promised him I would never let another owner go through that grief alone.
So here we are, you are desperate and frightened to do the wrong things. But your knowledge base is pretty skimpy and it’s very hard to make your own rational decisions when the vets are urging you to spend all this money.
Vets, especially those who work in universities, like to collect data, possibly so they can publish. But also because they are also very curious, especially if they are seeing something like this for the first time. They are attempting to figure it out, when Dr Dodds had nailed this 25 years ago.
She truly cares about each dog that develops this and that is the true miracle. Vally and I, plus many hundreds of others, consider her our guardian angel. She has saved dogs that were at deaths door. This is our 12th year on line, check out the photos of all the dogs we have helped in the slides how on the right side of the forum.
I have faith that you will succeed in saving her. She is very resilient. You are very tenacious. Good match.
My best Patrice
Karen,
I am very sad to read about Georgia. I know you must be worried about what is going to happen.
Please don’t do a bone marrow biopsy. There are a number of reasons right now why that should be put off. We have been helping owners for 12 years and I can’t believe how many vets believe this will resolve the problem.
This is what Chance had, you can find his story under Our Stories on the menu above rh the forum.
This does sound like it could be bone marrow failure which is actually common in dogs. They have stopped making blood cells. There are only a few reasons for this. I can go over them in detail for you later today.
The bone marrow biopsy will tell us what we already know, he’s not making RBC, but knowing this will not improve or change the treatment protocol she should be on! It is quite common in veterinary medicine to try a treatment before spending a fortune in diagnostics and see if it helps. If it begins to work, we know that we were right.
As you have read Chance’s story you know I went through the same things but at that time 2007 there was not much help on the internet. I was pretty much alone as the specialist was as confused as your vet’s are. I connected with Dr. Dodds and used her protocol. My vets were delighted to work with her.
We gave a great deal of Dr. Dodds information on our site. I would first like you to read her protocol, that I and many others have used to treat bone marrow failure. On this page
https://www.secondchanceaihadogs.com/hemopetresources
Look for the second picture and open this, it will come up in a box, click upper right hand arrow to open in a tab that you can print and save.
Immune mediated hematologic disease and bone marrow failure.
Save your money now for future needs like transfusions, blood tests and medication.
We will be explaining more to you. Please have great hope that you will succeed. I have seen this many times and know that it is possible.
Try to be cheerful around Georgia, she reads your emotions and will think she has done something wrong. Be strong for her, you have our support and we can explain things to you in a way you will understand. Some of this is difficult but we try to make it easier.
The most important thing now is that we would like to see you make your decisions based on knowledge not on emotions and fears.
They have overdone the expenses to you in a way I find objectionable. The treatment is the critical part. Again please don’t let them talk you into a bone marrow biopsy right now. I will explain in detail later.
My best Patrice
![bingo-14-5_1200x775](https://www.secondchanceaihadogs.com/wp-content/gallery/aiha-dogs_2/bingo-14-5_1200x775.jpg "Vally\'s Bingo \\"Smile\\"")
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