Page 22 – Second Chance AIHA Dogs

Forum Replies Created

Keymaster

Acadia,
This has really been difficult for you to manage all these conditions and the medications. I am really sorry to hear about the vaccines as well. There are many things going on and I want to try to focus on a few in the time I have.

Dogs and humans eat dirt around the world, called geophagia. It is certainly the most outstanding sign of all the things you have mentioned. Humans, esp in developing countries, eat (and often crave) dirt to provide certain missing nutritional elements like minerals (for instance iron) and also to eliminate parasites (such as worms like tapeworm), bacteria, viruses etc in the gastrointestinal tract. Esp in dogs, it can be a sign of hypothyroidism. It can be related to IBD inflammatory bowel disease in dogs. Bleeding, such as tumors or ulcers can also lead to dirt eating. So yes there can be some need for iron or other mineral like magnesium.

From my viewpoint this is worthy of tracking down with some targeted tests to see what is the trigger for this geophagia. So first a stool sample, if not done yet, would be very important. If there are intestinal worms it would be important to treat them immediately. Some of these can cause severe anemia.

I would also want to have a special blood test performed to measure B12 (cobalamin) and folic acid. Adding in ferritin would also be of benefit in your case. This lab has extensive information about gastrointestinal disease related to B12 and folic acid deficiencies. Be sure to read it all, skim it when you don’t understand, and ask me questions.

http://vetmed.tamu.edu/gilab/service/assays/b12folate

http://vetmed.tamu.edu/gilab/research/cobalamin-information

Please note that B12 deficiency is especially related to serious gastrointestinal disease (called SIBO small intestine bacterial overgrowth) in the small intestine that can lead to malabsorption of this important vitamin. Without proper amounts of B12 the bone marrow does not have the proper elements to make new blood cells properly and they are not able to mature properly. In many cases in dogs (and humans), oral ingestion of B12 is not absorbed properly and requires injection. This is easily done at home and is very safe, any excess is peed out. It can be very beneficial to any dog that is possibly having trouble making red blood cells. Also treating the SIBO with either metrondiazole or tylan powder (see our Second Chance Resources page for Medication Resources on tylan) can help reverse the SIBO.

I recommend you begin supplementing each day with the highest quality probiotic you can afford. I have used and recommend Natures Way Primadophilus, Optima or any brand with 14 strains and at least 35 billion CFUs per capsule. Make sure you buy a refrigerated brand.

Chance had heart disease and was on these drugs you mention. Heart disease complicates things and the side effects of these drugs complicates things. They do not act independently of each other. Probably the most important thing my vet told me was that the heart likes things dry, while the kidneys like things wet. Two of the drugs you are using are attempting to remove excess fluid from around the heart, and in excess can cause havoc on the kidneys as they desire fluid to work properly. It is a very careful balancing act to dose these properly. To complicate this the prednisone completely redistributes body fluids around, causing dehydration and muscle wasting. Grab the skin at the nape of the neck and gently pull it up fully, let it go and watch to see how long it take for the skin to flatten. If it is a long time, your dog is very dehydrated. There may be drinking and peeing all the time.

I’ve given you a lot to think about but I do want to try to help you understand what may be happening, why the PCV HCT is hovering around the middle 20’s. This is not an easy thing to explain. It’s called anemia of chronic disease. We’ve see this with many dogs that have come here for our help.

“Anemia of chronic disease is a multifactorial anemia. Diagnosis generally requires the presence of a chronic inflammatory condition, such as infection, autoimmune disease, kidney disease, or cancer. It is characterized by a microcytic or normocytic anemia and low reticulocyte count. Values for serum iron transferrin are typically low to normal, while ferritin can be normal or elevated. Treatment is to reverse the underlying disorder.”

“In response to inflammatory cytokines, increasingly IL-6, the liver produces increased amounts of hepcidin. Hepcidin in turn causes increased internalisation of ferroportin molecules on cell membranes which prevents release from iron stores. Inflammatory cytokines also appear to affect other important elements of iron metabolism, including decreasing ferroportin expression, and probably directly blunting erythropoiesis by decreasing the ability of the bone marrow to respond to erythropoietin.”

I know this is a mouthful. Inflammatory cytokines are released into the blood stream for many reasons. You may have heard of this in relation to cancer, but there are many inflammatory conditions that can up these levels as well. This is the chronic condition that the body is reacting to. It could be a virus or bacteria. It could be any number of things like gastrointestinal disease.

So the body, in an attempt to alleviate this chronic inflammatory condition will withhold iron stores. Why? Because it knows that things like viruses or bacteria for instance also need iron to successfully reproduce. As you read above you see the word erythropoiesis, this is the medical term for the making of red blood cells in the bone marrow.

So the thought is that the body tries to self preserve and starve the “invaders” by depriving them of iron stores. This in turn, blunts the process of making blood and you end up with a mild to moderate anemia that doesn’t seem to respond to medications.

I’ll give you a human condition as an example to help you better understand. As we age our kidneys become less efficient. There may even be some degree of mild to moderate kidney failure. This can lead to anemia of chronic disease. You’ve seen this, I am sure, in an elderly relative, the pale and flaccid skin, clearly anemic. These people are treated with injections of erythropoietin. This is a hormone produced by the kidneys. When the body senses that there is not enough oxygen coming to the body cells it calls out to the bone marrow to make more red blood cells. This hormone is erythropoietin. So the making of blood is directly related to the health of the kidneys. Isn’t that fascinating? Unfortunately for dogs, this drug may work, but it is very difficult to obtain for veterinary use.

So what is the answer here? More testing and targeted treatment of any possible condition that is contributing.

And the heart disease is one thing that will contribute to this. The heart is less able to pump oxygen rich blood to the body because the mitral valve keeps flopping partially open and regurgitating some of that blood back into the chamber. It’s not making it to the body. So humans or dogs with heart disease also live in a state of moderate anemia. (Anemia, medically, is defined by the lack of enough oxygen making it to the body cells. While this is directly related to the number of red blood cells, it is really the amount of hemoglobin in each red blood cell that truly defines the ability of the body to provide this oxygen.)

The other things you are worried about are also other triggers. I don’t like ingested flea and tick products. For now, you need to protect with topicals like Frontline. I also recommend that you reconsider activity in areas where there are a lot of ticks. If this were your grandpa and he had emphysema you would not take him into a city with severe smog. Avoid worrying about ticks by avoiding the areas where they linger. If you do go somewhere like that, add a bandanna and even a doggie body suit, that is impregnated with permethrin. This is a very safe way to repel ticks. We wear clothing like this when we walk in the woods. Our dogs have Frontline on and wear impregnated bandannas. I also towel them off immediately once we leave the trail, before they get in the car, to remove any wandering ticks. They all get a good pet down after this and maybe even a bath with Ivory dish soap, known to remove seed ticks that are not attached yet. For those of you reading this, you cannot imagine what it is like to walk out your door and find ticks all over your pant legs and this is what Maine is like. Each tick is a time bomb waiting to infect you and your dogs.

I am also a bit concerned about the reverse sneezing. This can be simply that, just plain old doggie sniffles. But it can also be related to something like a nostril tumor or a fungal infection. The nasal infections are very tenacious and can lead to serious illness. I would want a particularly careful examination of the nostrils if possible. You are in an area where there can be dirt containing these particular fungus. Snuffling the ground is all it takes to inhale a spore. I know someone I see every day whose dog had this and Cornell tried to treat it, unsuccessfully.

You mention Clopidogrel and this is to protect from clotting dangers. I am concerned about low platelets and need more information.

If you are able I would like to see any of the recent CBC’s and chem screens you have had done. I would like to review several other values on these tests as well.
You can upload these to us via the Urgent Advice page. Please only upload 3 files at a time, we are on a share server. thank you.

I am sure you have many more questions, please ask away.
my best
patrice

Details

Patrice

Keymaster

Julie,
I am really sorry to read this.

I am still not sure what the diagnosis is without looking at some of the lab results and discharge papers, are you able to upload those to us?

Here is a brief “AIHA Terms” description of what IgG does to help our immune system.
https://www.secondchanceaihadogs.com/AIHA_Terms/humoral-immunity/

I’ve researched the use of human IVIG in canine treatments of IMHA. There aren’t many studies but here is one. It is about the use in treating canine IMT immune mediated thrombocytopenia, a condition where the immune system attacks the platelets which can lead to serious internal bleeding. It is good to scan this study because it discusses the action of the treatment and how dogs in the study responded.

See it on this page:
https://www.secondchanceaihadogs.com/medication-resources/
Look under the bottle of prednisone and click on the picture of the research study, it will open the pdf and you can further open that to a full page and even print or save it if you wish.

The real take away from this study is twofold, this is human IVIG and there is a risk that a dog may have a negative reaction to the human proteins. Second there are few studies done on dogs to determine if this would be a successful treatment for IMHA, and the paper recommends that more studies must be performed before it is recommended for IMHA.

Most of the success or failures of this treatment, or any IMHA AIHA treatment, comes from anecdotal use in veterinary clinics. And indeed this is the case for many veterinary treatments, the clinicians develop protocols that have worked for them, thus they become unique to that clinic. Often they have to rely on human medications for treatments. This is quite accepted in the industry and can improve the success of canine treatments. So I can’t say to you this will definitely work or this won’t work, only that your vet has experience with this and feels it will be helpful. And actually, so do I. If this were me, I would accept the risks and agree.

Why do I say this? Because veterinary science actually developed a canine IVIG product a while ago. Using canine IVIG would reduce the risks of a reaction to the proteins. But it was so expensive that it wasn’t viable in the market and the project was dropped. You are going to find that this is still a very expensive treatment using human IVIG. And that makes this a very difficult decision. How much experience do you have with this vet and do you trust them implicitly?

There are a few people who have posted to the forum whose dogs received this treatment and some had success with it. You can find those posts by using the Search Forum on the upper right of this page. Type in IVIG to get the correct results.

Please let us know what you decide to do, we are thinking about you.
my best
patrice

Details