Page 21 – Second Chance AIHA Dogs

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Keymaster

Raya,
I have received all the paperwork, thank you. As I suspected, a relatively healthy dog that has had a sudden autoimmune attack on the red blood cells. By this I mean that the chem screen shows perfectly normal body systems (liver, kidney function etc) with only a slightly high blood sugar (probably stress related) and a slightly high monocyte (WBC) level that is bringing the WBC count above normal. There is a higher total bilirubin and that is due to the destruction of red blood cells in circulation. Bilirubin in the coloring of the hemoglobin in those red blood cells. You are also seeing it in the urine, another indication that there is or has been RBC destruction. Because of this be cautious feeding any meats that already have blood in them because it can overload the kidneys and liver to remove this bilirubin from the blood.

I also see a lower than normal platelet count. This could be a simple lab error where the platelets glob together on the glass slide and are hard to read, techs will usually observe “platelet clumping on feather edge, value is normal” to indicate this. I would want to see future CBC’s to make sure that they are not truly low. It is a small concern because it can lead to inappropriate clotting in the body. In this case we often recommend low dose aspirin therapy to prevent this very dangerous thing from happening. Discuss this with your regular vet asap. You can say a friend who is a nurse, doctor, whatever, told you to check.

There are clues in the reports that indicate to me that he may have had some degree of canine atopy, which is doggie allergies, as seen by the ear allergies. Many dogs that develop AIHA IMHA and bone marrow failure have a history of canine atopic allergies. He was prescribed Temaril-P drops for his ears and that is interesting because it provided a small amount of prednisone (along with another medication) and may have possibly contributed a small degree of immunosuppression, which was discontinued a while back. I suspect the camp he went to has multiple trees and grasses, all which WILL enhance allergic (think autoimmune) activity. This could be one strong trigger for what has just happened.

In addition I see that he was in camp for “behavioral issues.” I see this much differently than you do! Perhaps you are a better trainer than you thought because behavior issues can be directly related to a medical condition many dogs have called hypothyroidism. In fact many dogs may be “put down” for behavioral issues that trainers can’t resolve when in reality it can be a treatable medical condition.

Please go to this page where there is a link to an article I would like you to read, click on the picture of the dog and that will take you to a webpage. Here is a quote from this webpage: “Aberrant behavior including aggressiveness, phobias, hyperactivity, poor concentration, and seizures is associated with canine hypothyroidism and feline hyperthyroidism.”
https://www.secondchanceaihadogs.com/canine-hypothyroidism-resources/

In addition hypothyroidism is related to poor bone marrow production of new RBC.

What is the solution? Testing for hypothyroidism is important and must consist of a panel of several values (not just one or two.) What we want to see is if certain values are within a range of accepted values or if they are too low or too high. The thyroid gland is activated and stimulated by multiple hormones in an intricate harmony and the subsequent release of thyroid hormones is complex as well. So each of these steps is evaluated on a thyroid panel. Hypothyroidism in dogs is easily treated with a twice daily dose of thyroid supplement. This is extremely effective and inexpensive.

As I have said, hypothyroidism can be linked very strongly to the development of AIHA IMHA and bone marrow failure. Chance was hypothyroid and he had terrible canine atophic allergies starting at a very young age. He went on to develop profound bone marrow failure at the age of 7. Part of his treatment involved the use of thyroid supplements. We knew that his history of allergies and hypothyroidism were triggers to his later autoimmune profound bone marrow.

Eating is positive and a welcomed sight. I am greatly encouraged by this. That shows a will to live and interest in his family. Do not consider stopping his treatment or giving up right now.

With anemia, there aren’t enough red blood cells to carry enough oxygenated blood to the body. This will result in the body attempting to get more O2 into the body by increasing heart and respiratory rate. Thus the difficulty breathing. It is normal and expected when on high dose prednisone treatment.

In addition predisone has a negative affect on nearly every body system. The best way to describe this so you will understand is that predisone is very much like our own bodies cortisol. When a dog or a human is faced with a stressful situation we attempt to respond to “fight or flight.” We release more cortisol into our blood so we can increase blood flow, raise heart and breathing rates, pump more glucose into the blood for energy and numerous other body systems adjust to ensure we are ready for either battle or escape.

When we give prednisone in immunosuppressive doses for the purpose of reducing the over-activity of the immune system, we are giving the body way more cortisol than it needs. This leaves us in a state of constant alert. If you have ever almost been in a car accident then you know how this rush feels. Imagine feeling this way all day long. This condition is called Iatrogenic Cushing’s Disease, or Cushing’s syndrome CAUSED by giving high doses of medication. Do you not panic, you will see many side effects that will go away once the drug dose is reduced, such as the peeing, thirst, agitation, breathing heavy, weakness.

What questions do you have now for me?
My best
patrice

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Patrice

Keymaster

Zoe,
I am sorry to read about Lulu. There are some unknowns to me that make commenting a little more difficult.

My first impression is that the first episode was certainly not “uncomplicated” considering the potential of kidney disease. Dogs especially can lose a significant amount of kidney function without showing any signs until the kidneys are severely impacted. One important function of the kidneys that relates to anemia is that it produces a hormone that is released in response to anemia that stimulates the bone marrow to make more red blood cells.

A single month of prednisone and a single transfusion may not be nearly enough treatment to address the underlying unbalanced immune system. What I am trying to say is that I think it is possible that the original treatment did not resolve her IMHA completely.

If you have not already read Dr. Dodds Immune Mediated Hematological Disease and Bone Marrow Failure protocol please go to this page:
https://www.secondchanceaihadogs.com/hemopetresources/
The article is the 3rd picture down, click on it. If you enlarge it in the upper right corner you can even save it or print it.

Indeed stress plays a large role in the development of canine autoimmune conditions. Dr. Dodds addresses the influences of many kinds of stress on the canine immune system and disease resistance. Please read this article. Go to this page:
https://www.secondchanceaihadogs.com/canine-disease-resources/
And click on the first picture “The Canine Immune System and Disease Resistance.”

At the bottom of this article are tables that list factors that influence and are associated with autoimmune disease. If you look through this carefully, I think you may find some things that sound familiar to you. For instance female dogs are twice as likely as males dogs to develop autoimmune disease. Stress encompasses a broad range of things like environmental, emotional and physiological influences. So for instance a female dog in heat, who has nutritional deficiencies, may have an adverse drug reaction or was recently vaccinated etc has a greater risk of developing an autoimmune disease.

Dr. Dodds also believes that there is a strong link between canine hypothryoidism and AIHA IMHA and bone marrow failure. So you mention she is over-shedding. This is a common sign of hypothryoidism. If Lulu was never tested the first time for this condition, then the risks of her having a recurrence of autoimmune symptoms is greater.

You ask what you can do to help her this time. I think that we need to really dig deeper and find what her stressors are and which of them triggered this most recent relapse.

I recommend to start with a CBC and chem screen. If the vet has not done a comprehensive checkup, which includes palpating the abdomen (checking the health of all the organs) and listening to the heart, then that should be also included. The chem screen will cover the basics of the health of the liver and kidneys, among many other things such as electrolytes and glucose. It would also be good to do a urinalysis. Also include a stool sample and a SNAP 4DX+ test to get a yes/no result for 4 tick diseases and heartworm.

I highly recommend that your vet draw blood and prepare serum to Hemopet for a complete thyroid panel. Go this page:
https://www.secondchanceaihadogs.com/hemopetresources/
And click on the picture of the Hemopet Test Request Form, this will take you to Dr. Dodds website where you can prepare a test form for the Thyroid Profile 4 (T4, free T4, T3, free T3).

Everything you need to do is explained once you click the check box. You can ship this sample yourself from the post office, no need for refrigeration. I do it all the time. Just follow the instructions. Within a day or so Hemopet will email you that they have received your sample and within another day they will send both you and your vet the test results with recommendations for treatment if needed.

Be sure to include a brief but complete history in the “Reason for testing & brief history ” so Dr. Dodds knows that Lulu has had a relapse of IMHA.

I am also concerned that Lulu is not eating well. This needs to be addressed because every day that goes by without good nutrition she will weaken. Depending on the health of her liver and kidneys you can try offering her simple but great smelling foods like skin free deli chicken or scrambled eggs in a little butter. She can get by for a bit with just quality proteins. Cottage cheese and yogurt are also appealing to dogs.

She also needs plenty of water, blood volume is critical to feeling well and if she isn’t drinking she is going to have insufficient blood volume. If she is reluctant to drink and seems dehydrated you may need to syringe water into her mouth. Get a child’s medication syringe from your pharmacy (no needle!) and gently syringe water into the inside of her cheek slowly. Be patient.

Please upload any lab work you have that I can look at on the Urgent Advice page.
Do you have any questions for me?
Patrice

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Patrice

Keymaster

Acadia,
Thank you! The explanation of the lungworm, the subsequent probable scar tissue in her lungs and esophogus, and the continued coughing explains quite well why she continues to eat dirt.

Our body has a type of cell called a mast cell that is preloaded with histamine, it is a partner to our immune system. These types of cells are located in many locations, and line the walls of the whole gastrointestinal system as well as the respiratory system, plus many other areas like skin (which is considered an organ.)

These cells perform an ancient protective function in the GI tract. If the GI tract, along with the immune system alert system, “invaders” trigger the mast cells and their response would be to release histamine in large quantities, it’s purpose is to create irritation and local inflammation. This would cause violent vomiting and diarrhea in an attempt to remove whatever parasite or other bad thing in the GI tract. This would expel the “invader.” You and I know how this works when we get a flu or the cold and our eyes water, our nose runs, we sneeze, cough etc. All due to histamine

This system had to have been activated by the lungworm, leading to the massive release of histamine (creating highly inflamed tissue), subsequent coughing and other various attempts to eliminate the invader, leading eventually to the excessive irritation of the cells of the lungs and associated esophagus (ulcers that erode internal tissues.) The scaring that was left is probably irritated this same mechanism, leaving these areas highly inflamed and possibly continuing the ulceration.

So thus Lucy’s attempts to stop this pain by eating dirt make perfect sense. In fact around the world many many humans engage in eating different types of clay in an attempt to heal internal wounds. It can almost be treated like a ritual. the eating of the clay.

In addition to this, the heart is most likely enlarged, as is common in congestive heart failure. In dogs, the heart is located in a location where any change in size can press on and impact the esophagus. So coughing and attempts to clear the throat are very common in dogs with heart disease, in fact it is probably the most defined symptom. As fluid continues to build up around the lungs, this can also cause more pressure and discomfort on this area.

Dogs however, do not express allergies in the same way humans do, with respiratory symptoms, they express allergies with skin and eye issues, biting their coat until they are raw sometimes, eyes dripping copious goop. Chance had terrible allergies, called canine atophy. So your vet was a little misleading about this. The dosing of humans antihistamines does work against the massive release of histamine by mast cells, so it may have made her other throat symptoms better, temporarily. If fact modern stomach acid protection are actually a form of antihistamine drug.

Please be cautious about you read on the internet. SAM-e is not dangerous! S-Adenosyl-L-methionine is a chemical that is found naturally in the body and is made in the body from methionine, an amino acid found in foods. It helps regulate key functions in living cells. It does this by being a methyl donor, in fact it is the most important methyl donor in our body! As we age or become ill it decreases in quantity and all those other processes suffer from this lack. One in particular is liver function. When we take prednisone for instance, the liver metabolizes this drug. Each time this process occurs there is liver cell death. Eventually this leads to an inflamed and damaged liver. SAM-e is used widely, combined with Silybin, the critical purified essence of milk thistle, to help the liver restore new cells and heal.

There is a veterinary supplement called Denamarin, that I have used and many others owners have used, that is a high quality veterinary blend of SAM-e and Silybin dosed exactly for dogs and cats. This supplement can quickly reduce high levels of liver inflammation. You can read about this here.
http://www.denamarin.com/#about-denamarin

A science based explanation of the role of SAM-e in methylation:
“Methylation is the chemical reaction in which a methyl group, composed of one carbon and three hydrogen atoms, is passed from one molecule to another. This simple transfer of a methyl group can activate as many as 40 to 100 different processes in the body, such as the synthesis of DNA, proteins, neurotransmitters and processes that help suppress viruses, promote bone density and protect against heart disease. SAM-e is a methyl donor, it gives up its methyl groups to molecules that are involved in these different biochemical reactions. SAM-e’s donations transform the receiving molecules into active substances that are involved in various vital activities that are responsible for health and well-being.”

I was at my vets this morning and we discussed the rise in tick populations in western NYS. She just attended a veterinary seminar on Lyme disease, and being the proactive vet she is, started a heated discussion with this group about how, going forward, they are going to diagnose and treat emerging new tick diseases along with the current diseases. They agreed there is an end point at which they will no longer be able to dose every dog that has been bitten by a tick with doxycycline, prophylactically, because this will end up creating doxy resistant tick diseases. The message is, dog owners need to be extremely proactive in preventing tick bites. The safety valve of treating after every bite is not going to be there. The kind of outdoors that I once knew is shrinking, the warmer climates are increasing tick populations such that they are in places that never saw them. They are also hitching rides over air transport to countries that were previously tick free. She agreed that my having my three dogs tested with a SNAP 4DX test three times a year, every four months, was one of the best solutions to protect my dogs from tick diseases.

I am cautious about any tick product that also attempts to control fleas. Many of the ingredients used to do this are called insect growth regulators IGR and these have drawn scrutiny by governing bodies who regulate these products, there is talk of removing them from the market because they are not without serious side effects and can make some dogs ill. Fleas can be a nuisance but they aren’t necessarily life threatening.

Thus my recommendation to use Frontline. It’s job is to cause neurological havoc to a tick’s nervous system (and should not be used on Collie breeds). Applied topically this seeps into the oil pores in the skin and coats the body. Ticks slugging through this stuff get coated and are unable to attach to the dog, their mouth parts paralyzed. They will die eventually but some people can be confused why they may still see them wandering around.

Manual removal is also a good technique and an owner has to be constantly alert that this is done properly. I like my method of repelling them with permethrin impregnated clothing, it works on me as well.

The importance of doing another CBC and chem screen is that these values are never stagnant, they are dynamic from one day to the next. I am really looking forward to these current values to see where Lucy is at. I am wondering if improving her overall health will improve her ability to heal. Can we optimize her ability to heal with diet and supplements while we attempt to understand how all of her conditions are contributing to this disease process?

Would you also request a full thyroid panel from your vet? Many dogs that develop these conditions have hypothyroidism.

You can read Dr. Dodds excellent protocol on this page titled: Immune Mediated Hematological disease.

https://www.secondchanceaihadogs.com/hemopetresources/

On this page you can read about hypothyroidism and watch a few videos.
https://www.secondchanceaihadogs.com/canine-hypothyroidism-resources/

What questions do you have for me?
my best
patrice

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