Page 18 – Second Chance AIHA Dogs

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Keymaster

Amber,
I am so sorry to read how complex and confusing this is and in addition, there is a critical time element making it more stressful.

First. I have seen many dogs do “OK” with very low hematocrit / PCV levels. The critical consideration is if the vet can stabilize the dog so that they are not hypovolemic. Fancy word but it means that the blood volume gets too low, there isn’t enough fluid. Giving subq lactated ringers is a perfect solution to this. You could even do this at home. The blood proteins being at the proper level also contribute to improving this situation. They help the blood from leaking fluids into the local tissues.

You are correct to begin worrying about a transfusion at this point. I am sorry this is so stressful. As Vally points out Hemopet ships safe canine blood products around the world and if you vet can contact them they can deliver this right to their clinic. If your vet feels unsure about how to proceed with the transfusion, Hemopet provides vets support and information about how to safely transfuse. Your vet is correct, dogs get one “free” transfusion, unlike humans who can have transfusion reactions to unmatched untyped blood products. But Hemopet provides universal “doggie” blood that is free of these reactions. They will answer any questions that your vet may have about this. If you go to this webpage, the link to the blood bank is the fourth on the page.
https://www.secondchanceaihadogs.com/hemopetresources/

So it does sound like he is stable. So what’s next? Well it’s hard to approach any treatment protocol without having all the diagnostic information.

Your vet examined a blood smear and found reticulocytes. These cells are immature “baby” blood cells that have been released from the bone marrow early, in response to the body’s need for more oxygen (because of a low number of red blood cells.) With a PCV / hematocrit of 15% we should be seeing a huge increase in the numbers of reticulocytes. In fact they could be as high as 500,000 absolute and anywhere from 2-5%. Normal healthy dogs and humans have a value of about 1% and 60,000 because they are not anemic. So it would be helpful for me to see the results of the last two CBC and chem screens. If you can upload those to me on the Urgent Advice page I will look them over and explain some things to you.

Past conditions are always very interesting and I have often found that owners eventually forget about certain signs and symptoms from the past that really play a large role in the current condition. Any kind of cancer contributes to an inflammatory condition in the body that leads to an increased metabolism and rapid muscle mass loss. This is called cachexia. We also see this in dogs with other conditions like heart disease.

Inflammatory conditions are an increase in the level of inflammatory cytokines in the body. These cytokines are excreted from immune cells like helper T cells and macrophages, and certain other cell types that promote inflammation. They are called interleukin, tumor necrosis factor, interferon gamma and others and play an important role in mediating the innate immune response. Excessive chronic production of inflammatory cytokines contributes to inflammatory diseases.

So these inflammatory cytokines are directly related to some of the problems he has had in the past. Dr. Dodds talks about “anemia of chronic illness.” By this she means that the body systems do not act independently of each other. And a highly inflammatory condition (such as a cancer) can lead to other systems beginning to complain, such as the bone marrow. This can lead to anemia, usually of a moderate degree, for instance with a hematocrit / PCV hovering around the low 20%. (Normal for most humans and dogs is about 45%.) It is possible that he still experiencing this.

Looking at the continued use of prednisone is important because prednisone affects all body systems, some in very negative ways. As your vet may have discovered, especially in dogs, prednisone usually leads to stomach and esophageal ulcers. The sulcrafate was a good idea as it is like an internal bandage that heals. But we also need to look at the negative effects on other body systems that come from long term prednisone. Short term, prednisone can save lives and is a very important treatment in AIHA / IMHA. But at some point there should be a shift to other drugs that have less side effects and are even more effective. One of these drugs is called cyclosporine, my favorite. Your vet probably has some Atopica on the shelf right now. This drug achieves the reduction of the autoimmune destruction of red blood cells in a different way than the prednisone does. If this were me I would want to switch the burden to this drug and begin slowly reducing the prednisone.

On this page, there is a protocol written by Dr. Dodds that I would like you to open and print for your vet. They may find the information very helpful in trying a treatment protocol. This protocol saved Chance’s life so many years ago and continues to save dog’s lives all over the world. Look for Immune mediated Hematological Disease and Bone Marrow Failure and click to open, if you click in the upper right corner it will expand it to a full page and you can save and print from here.
https://www.secondchanceaihadogs.com/hemopetresources/

Ticks generally do not transmit just one tick disease, they are typically loaded with several very serious diseases. Lyme is a very bad tick disease, but it has more of a neurological, tissue damaging action. Other tick diseases like ehrlichiosis and anaplasmosis can cause serious blood conditions such as anemia. The list of signs and symptoms of these two conditions is an arm long. Ehrlichiosis can be contracted, show as a moderate condition and then disappear for up to several years as it reproduces in the body. Then it reappears as a deadly condition, causing hemolytic anemia and rapid decline.

Testing for these tick disease is very simple, the test is called SNAP4DX+, it requires a tiny bit of blood and can show a negative or positive in about 8 min in the vet’s clinic. No kidding. Human medicine doesn’t even have as simple a screening test as this! It shouldn’t cost more than about $30 or so. See if your vet can be convinced to run this for you asap.

Do you have any specific questions for me? Please upload your test results so I can look at them.
my best, patrice

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Patrice

Keymaster

Nikki,
How did you make out with this? Vally was correct that I don’t recommend some of the newer products on the market that try to be “everything” in the way of parasite protection. “Getting it out of the way” by dosing every three months really means that there must be a higher dose of pesticide and there must be enough internally to continue to supply the skin with it. I am reluctant to use my dogs as “internal dispensers of pesticides.”

Bravecto is the brand name for fluralaner. This drug is an inhibitor of the arthropod nervous system. So I want to search out how this drug works and what side effects it may have. We have a resource on our website where I can do just that.
https://www.secondchanceaihadogs.com/parasite-resources/
On this page click on the National Pesticide Information Center to open that website.

So I did that and was surprised to not find fluralaner in the database. So after research I discovered that “Potency of fluralaner is comparable to fipronil (a phenylpyrazole ectoparasiticide).” So now I can search for fipronil in the database.

But I also happen to know that fipronil is the active ingredient in Frontline, just as Vally mentioned above, I use it topically on my dogs to prevent tick bites. I do not give in internally.

So let’s look at what the database says about this pesticide.
http://npic.orst.edu/ingred/fipronil.html
“Fipronil kills insects when they eat it or come in contact with it. Fipronil works by disrupting the normal function of the central nervous system in insects. Fipronil is more toxic to insects than people and pets because it is more likely to bind to insect nerve endings.’

In more detail they describe what happens when you apply this to the skin and what happens if you ingest it.

Tests have shown that applying it on the dog’s body using a vehicle of oil allows it to gather in the hair glands where it coats the hair or fur. Ticks slugging through oily pesticide develop neurological dysfunction. They simply aren’t able to move well and they are unable to effectively get their mouth parts to grab hold of the skin and attach to the body. They are paralyzed and won’t be passing on tick disease.

Yes there are certain dog breeds, mostly the Collie’s, that do have a sensitivity to this pesticide. They can have neurological symptoms that are similar.

I have always recommended getting flea and tick products from the vet because of this. Not all dogs can tolerate these products. In addition, some owners think if a little is good, then more is better. These products need to be used exactly as the label recommends. Some dogs or cats who are given too much can become ill.

As for heartworm, I use what Dr. Dodds recommended to me years ago, Interceptor. It can be used for very ill dogs in 45 day dosing cycles, but there is NO WIGGLE ROOM if you dose this way. It must be exactly 45 days. The label says 30 days because owners can forget to give it and probably remember sometime in the window of 30-45 days.

For trips into tick infested areas I also use, not only on the dogs but also on us, permethrin impregnated clothing (we have shirts, pants, socks and hats as well.) This is a powerful insect repellent that is very effective but should not be used directly on the skin and it can’t be ingested. So the clothing is impregnated with it and doesn’t weep onto the skin. Tests done by the military show the only place they can find where this leaves the fabric is in dryer lint. It won’t weep in water or in the wash. We tie bandannas on the dogs’ necks securely to keep ticks away from their faces. This is one place where you can’t apply Frontline and the location where we would find ticks.

I see there are plenty of websites selling these bandannas (and human clothing too.) Pick one that is within your budget. Most of these must follow government regulations to sell them. Here is one study that shows a 93% reduction in tick bites.
https://www.insectshield.com/Tick-Study.aspx

When we finish with walks in the areas where we know there are ticks, before the dogs get in the car, I rub them down briskly with towels, focusing on their beards, eyebrows, between the toes, armpits and groin. All places where ticks may be able to get away from the Frontline.
my best
patrice

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Patrice

Keymaster

Janiesmom,
I am sorry for the delay in writing.

As I mentioned, it is often after coaxing and owner for more detailed history that an important nugget of information is discovered. You mention that before you adopted her she was diagnosed with Ehrlichiosis. This is critical information and may be the reason for her illness now.

This tick disease is extremely complex and invasive. A friend has built an extensive website with tick information. On her page for Ehrlichiosis she describes the initial symptoms:
“The acute stage is brief and the symptoms are easily missed; it may appear as if the dog has a mild and passing viral infection: snotty nose, diarrhea, fever, a general lack of his usual oomph. In a stoic dog especially, a change in behavior may be the only alert he gives you to get him to the vet.

It’s in this stage that the outlook for a cure is best. Very early on, however, testing is probably useless; until ten days to two weeks after infection, the immune system will not have had time to make sufficient antibodies for the tests to detect.”

So Gil has described the early stages of this. Most likely she was not even your dog when this happened. Most owners would not even consider taking their dog to the vet if this is all they see.

So Gil goes on to describe the second stage:
“The acute stage over, the disease passes into the subclinical stage. This simply means a stage in which no symptoms are present. Cure, or at the very least, containment of the disease so that it cannot progress, is still a good possibility in this stage which may last for years.”

So here is where you probably adopted Janie. In the subclinical stage. NO SYMPTOMS.

So the final stage of this disease is described this way:
“If the disease progresses to chronic, the outlook is grave, particularly in E. canis and N. risticii. Symptoms show up with a vengeance at this point. A lengthy, probably still incomplete list of symptoms and the diseases for which ehrlichiosis is often mistaken, can be found in the right column.”

Your thinking about the Lyme vaccine having something to do with this may be partially correct. Since you have read Dr. Dodds paper on the Lyme vaccine, you know why she is reluctant to encourage this vaccine for dogs that are not in hot spots of disease because there can be issues with this vaccine. Some dogs can actually express symptoms of Lyme after they are vaccinated (and in fact when tested the rest of her life she will show a positive titer for Lyme exposure.) Every time you administer any vaccine to a dog or human you challenge the immune system negatively. It has to work hard to develop immunity. What if she already has a sleeping Giant of Ehrlichiosis in her body now?

All the symptoms you describe are what we see in Ehrlichiosis. If you read Gil’s page from the beginning you see that there are actually now identified several genus of this disease and that through research they are now identifying them with different names and attributing them to differences in how they infect the body. So it isn’t simply Ehrlichiosis she may have, but one particular genus of this.

“The genus Anaplasma group infect granulocytes, platelets, red blood cells” This would be the trigger for the immune response you are seeing for severe anemia. The immune system knows that the Ehrlichiosis is inside the red blood cells (and platelets and white blood cells.) So it is mounting an attack on those cells in circulation, causing hemolytic destruction of the cells. Thus the black stools and probably blood in the urine.

What are we going to do? First you must have the vet test for this. Here is the test he must run immediately. It takes a tiny amount of blood, like a half teaspoon and the results are ready in about 8 minutes in the clinic. It shouldn’t cost more than $30. A vet tech can run this, you do not have to have a vet visit to run this test. Please do it.
https://www.idexx.com/small-animal-health/products-and-services/snap-4dx-plus-test.html

If this is positive, then the next step is to determine the titer or “how infected” she is.

“Dr. Cynthia Holland, Ph.D has written an excellent and brief article on the importance of titers in determining treatment for canine erlichiosis that addresses the various stages of the disease. Dr. Holland is an expert on tick-borne disease and she states emphatically: “The magnitude of antibody titers resulting from infection with Ehrlichia canis is directly correlated with the chronicity of the disease (i.e., the length of time the dog has had it). This information is extremely important in determining the treatment protocol since dogs which have been chronically infected for some time will require a more rigorous and lengthy treatment with doxycycline and, possibly, imidocarb in order to successfully clear the infection. This is in contrast to treatment during the initial acute phase, which generally requires only 3 weeks of doxycycline therapy.” ”

Of course, titering is a more expensive test and if you decide to do this the best lab to do this at is Dr. Cynthia Holland’s lab Protatek. She is a compassionate researcher and often consults on the phone with vets treating dogs with tick disease. She can recommend which tests to perform when considering the condition of the dog and the vet’s test results.

However, once you have the blood drawn to do these tests there is nothing from preventing your vet from actively treating your dog as if she does have it!

So keeping in mind your expenses, I would recommend a high dose doxycycline treatment immediately.
https://sites.google.com/site/tickbornediseaseindogs/treatment
Gil does not mince her words, if there is tick disease then it must be hit hard and long. Tick-L, the forum I have been on for 10 years, recommends this treatment protocol:
“The dosage we recommend on Tick List is an aggressive one: 5 mg. of doxy per pound of body weight given every 12 hours for 8 weeks. For those who prefer to figure body weight in kilograms, this is approximately the same as 10 mg per kg, the difference being not enough to mention.

This is twice as high as the dose that is generally recommended – and here I should probably remind you that I am not a veterinarian or a medical professional. Well, that’s true. At the same time, I should tell you that your vet is the one to decide what dosage to use. Well, I would concur if your vet is familar with tick-borne disease and knows it inside out. If not, he or she should consult with a colleague who is before deciding on the dosage.

In my opinion and that of everyone on Tick List, to my knowledge, ehrlichiosis and Lyme must be hit hard the first time out, if at all possible, and lower doses and/or shorter treatment times all too often mean recurrence. Unless your dog is one of the few that cannot take doxycycline or take it in this higher dose, my best advice to you is to insist on it. In the experience of a great many of us on Tick-L, each time ehrlichiosis or Lyme recurs, it’s harder to stop or contain it.”

If you see continued decline then you must switch to a more aggressive treatment:

“Imizol (imidocarb dipropionate) is used to treat Babesia canis and has been used off-label to treat E. canis and A. phagocytophilum. It is given in a series of two injections two weeks apart, either under the skin (sub-Q) or in a muscle (IM). Imizol burns, so a vet would be well-advised to minimize any discomfort the dog is going to have – and he is going to have it at the moment of the shot – by drawing the drug up with one needle, then changing the needle on the syringe for a clean one that has none of the drug on its outer surface. From my own experience and that of others whose dogs have been given Imizol, the worst that happens is a very loud yowl of protest, soon over, a drippy nose or excessive drooling, restlessness and/or a large desire to lie down and go to sleep later on. Once the shot has been given, the dog should remain in or very near the vet clinic for several hours just in case he does have a serious reaction, in which case atropine sulfate is antidotal and your vet will have some on hand. I have never seen anyone on Tick List say that the antidote was necessary for their dog.

Imidocarb dipropionate does carry cautions which may prevent its administration to dogs with lung, liver or kidney problems until they are under control but your vet should be aware of this as they are plainly noted on the product label. Imizol is manufactured and sold by Schering-Plough and is now readily available in the US.”

This is an expensive treatment, but it can be highly successful.

Please send me any CBC’s and chem screens that your vet has done. There are some indicators I can look for that will indicate whether there may be tick disease or not. You can upload them on the Urgent Advice page. No one but the moderators sees these and we do not share any information about you with anyone. Your privacy is important to us.
my best
patrice

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