Page 32 – Second Chance AIHA Dogs

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Keymaster

Hi Matt,
I am really sorry to read about your mini pin Bailie. A PCV of 10% is quite low and it was appropriate for your vet to do a transfusion. This may get her up to around 20-25% PCV immediately. However, it is our experience that many dogs’ PCV % tends to slip a bit in the hours and days after a transfusion.

If your vet is a 24 hour emergency clinic, I would advise you let her stay there so they can monitor her for this decrease and also make sure she does not have a transfusion reaction. This would need immediate care. In addition, there is an increased risk of inappropriate clotting during this period of hemolysis. They can monitor her for this and make sure the risk is minimized by the use of low dose aspirin or othe drugs like heparin. Each clinic will have their own preferred protocol for this.

If you are at a vet clinic that will close and the staff will leave, then you really need to bring her home, do not leave her alone overnight. This can be very stressful on her and may worsen her condition. If this is your choice, then make sure they give you an emergency number and complete instructions. In addition our moderators are available around the clock and can answer questions via the urgent advice emails we get.

I’ve set up the website with a lot of information about these blood diseases. There are two short introductory videos in the AIHA Video Library. AIHA Terms has many medical terms explained as a glossary so that you can better understand what your vet is saying to you. These glossary items will also be underlined in the forum and hovering over a word will pop up a shorter explanation. Under Second Chance Resources you can read about some of the medications that Bailie may be getting. Hemopet Resources link to Hempet.org, a site run by Dr. Jean Dodds, and has extensive information about canine blood diseases, transfusions and hypothyroidism (a condition sometimes associated with anemia.) Dr. Dodds also provides owners with a consultation for difficult cases and that form is available as well. Most of us consulted with her when our dogs were ill and we found that the small fee was well worth the advice and help we got.

When you have time tell us more about Bailie and some of the things going on in her life right now, illnesses, medications, diet, exposure to ticks, recent vaccinations, bites or stings, anything that struck you as different or unusual in the past month is worthy of mentioning. This is how we will help you differentiate the primary from the secondary. I, personally, am of the opinion that most cases of AIHA are actually a result of some insult to a dog’s immune system and thus secondary. Finding those insults can be very difficult.

Be sure you get copies of all lab work and any extra testing that they may do. This paperwork belongs to you, you paid for it. Upload if via the same urgent care page you wrote us. I can look this over for you and explain the out of normal values to you.

Always be polite and thankful to the vet staff, but remember you are her advocate because she cannot speak for herself. You drive the bus. Ask questions, but not so many that they begin to get annoyed. They do know how upset you are and they will appreciate an owner who is calm, interested in learning and is willing to be a partner in her care. She needs you now, so please be strong for her.

We will pick up the heavy lifting in helping you understand what is happening right now. It would be impossible for you to learn everything you need to know in the next few days when you may have to make some difficult decisions. We want to help you make decisions that are based on information and not on emotions.
my best
patrice

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Patrice

Keymaster

Hi Jen,
Sorry for the delay in getting back to you.

This misinterpretation of the the Lyme test is a common mistake that vets make. We have discussed this many times on Tick-L. There is no such thing as a fainter blue color. The test is either negative or positive. It is a screening test. I have mentioned to you several times that once you have a positive test on this screening test the vet needs to have more extensive testing done to determine the degree to which the dog is infected with Lyme. Here is the language from Gil’s website about this. TAB, DVM is the consulting vet for Tick-L and occasionally answers our specific questions.

https://sites.google.com/site/tickbornediseaseindogs/tests
“I’ve said this before but I may as well say it again since many vets do not seem to be aware of it: there is no such thing as a weak positive on a Snap test. Any change in color means that active Lyme disease has been detected. However, the sensitivity of these tests is set high so that as many cases of active Lyme as possible can be detected; the result is that sometimes there will be false positives.

“Sensitivity is the ability to detect all the true positives. Specificity is the ability to detect ONLY the true positives. With tests there is typically to some extent a trade-off: Push sensitivity to the max and the specificity falls a bit with somewhat more false positives as a result. Maximize specificity and sensitivity drops a bit so that some true positives go undetected.” TAB, DVM”

What the vet is saying here is that they make the simple IDEXX SNAP 4DX+ test so that they will screen for multiple tick diseases (and heartworm) and catch ALL degrees of each disease. If there is a color on the test, then that means it is POSITIVE FOR DISEASE. But it cannot tell you WHAT DEGREE of infection the dog has. It’s like pregnancy tests, you will know you are pregnant but it can’t tell you how pregnant you are.

That is why I keep suggesting you contact Dr. Holland at Protatek. You could do the more extensive testing with IDEXX of the Cornell test if you wish. But only then will you know the degree of infection. The SNAP 4DX was never intended to do that.

There is so much information on that page about the tests for Lyme that I am leery of trying to explain all of it to you. It would be best if you print the page and have your vet read about the various tests and the results and the recommendations for how to interpret the results.

If this is truly Lyme Disease, the best thing is to continue to treat aggressively with doxycycline to eliminate it completely from the body.

If there have been complications to the kidneys due to Lyme Disease, then it is possible for her to still live a very complete life with some adjustments. You can learn how to control her food intake so that these wastes do not reach the level where they circulate back into the blood. (As seen by a high creatinine and BUN). Your vet is partially correct, Lyme nephritis is serious, but until further tests are done, we don’t know how much function she may still have available to her. Humans are able to live with one kidney for instance.

Lupus is a condition, one of many, that involves an overactive immune system. It isn’t exactly like the human lupus. Here are two excellent discussions about Canine Lupus.
http://www.veterinarypartner.com/Content.plx?P=A&A=2475&S=0&EVetID=0
http://www.veterinarypartner.com/Content.plx?A=2470

My humble opinion is that Lyme often looks like many conditions and can throw a vet off onto another path of diagnosis, such as thinking it is hip dysplasia (know someone who spent thousands of dollars tracking that down, only to find it was Lyme).

If there was a positive SNAP 4 DX test for Lyme, then there is some degree of Lyme disease. The only thing that would confuse this is if at any time in her history she received a Lyme vaccine. And there are tests mentioned on the page that can determine if what is reacting to the test is the vaccine and not the actual disease.
https://sites.google.com/site/tickbornediseaseindogs/tests
I assure you that Dr. Holland knows how to determine the degree of Lyme and whether this is a reaction to a vaccine, not the disease.

I would love to see any test results you have, just upload them using the Urgent Advice page on our website. They come to all the moderators in our emails.
my best
patrice

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Patrice

Keymaster

Jen,
I am glad that your other vet agreed that the higher dose is more important than the first vet did. Some vets stay on top of the current literature and apply it quickly to their clinic protocols. My own vets attended a conference a few years back and at one of the presentations about treatment, she told me that there were such variable opinions that it broke out into a “brawl” as vets argued about dosing protocols. She told me “it’s a no brainer, hit the tick disease hard, fast and long the first time out so there won’t be a relapse.”

The length of the high dose treatment is important for the long term “suffusion” of the body tissues as it can get to ALL the spirochetes hiding in the body. If you want to think of this as something like a fire you want to put out, imagine how you keep spraying water on it for a long time until all embers are completely burned out.

I am not sure if you have mentioned if either of them contacted Dr Holland at Protatek Labs? It’s important to monitor how “well” the doxy is working with testing. She could advise them of the steps they need to take to determine if the disease is diminishing.
http://www.protatek.com/reflab/contact.html

It is well known that in dogs the kidneys can lose a significant amount of function before symptoms are even noticed. I hope you will read this information written by Mary Straus at DogAware about kidney disease. Mary is a consummate researcher and I trust everything that she has on her website. Here is her webpage devoted to canine kidney disease.
http://dogaware.com/health/kidney.html

Specifically I am pointing you to her information about the new SDMA Idexx lab test, please read this information carefully so that you understand it. I suggest that you encourage your vet to use THIS test.
http://dogaware.com/health/kidney.html#sdma

And note that Mary has a specific section under SDMA, devoted especially to proteinuria, that explains this topic. Please read all of this carefully.
“If your dog has protein in the urine (proteinuria), that calls for additional diagnostics.”

Also read this section carefully;
http://dogaware.com/health/kidney.html#protein

I’ve not seen any of your lab tests so I am blind about what your vet is seeing. However I know that spilling protein into the urine is not normal and should be carefully examined.

There are other reasons, for instance a dog with a UTI (an infection that is causing the problem) or an older dog that has a heart condition (may spill some protein into the urine as the heart fails to pump enough blood to the kidneys.)

Chance developed some degree of uremia when he had heart failure. He began to spill protein into his urine and the goal was to adjust his meds so that his heart would function better and get more blood to the kidneys. So his problem was not related to kidney disease.

So follow me carefully, there can be uremia due to “pre-renal” causes (heart disease), renal causes (damage to the structures of the kidneys), and post-renal causes such as infection or structural damage to the kidneys or bladder or associated ducts. For instance scar tissue or neoplasia.

So it important to follow up on what is really wrong.

Out of all the conditions that Lyme can cause, I am always most concerned about kidney symptoms (protein in the urine) and neurological symptoms (such as facial paralysis). This means that the spirochetes have managed to invade areas that are more sensitive. The earliest signs tend to be general musculoskeletal such as pain in a limb, areas that are easily reached by the spirochetes.

So the kidneys have delicate filtering structures that perform all the work. What Mary is trying to explain is that nearly 75% of them can be damaged before there may be signs of kidney disease.

Lyme nephritis is one condition that can cause this kind of damage. Once these structures are damaged, they cannot be recovered. However the long term use of doxy can protect the kidneys from further damage. Many many dogs live a long time with carefully managed kidney disease. And there are several groups on the internet that have true experts in helping owners care for their kidney dogs. I have read all the information, but I am not an expert. Diet is incredibly important, especially when it comes to managing protein intake (there are many misconceptions about this). Mary covers this in detail on her website.

Please read this information and have a chat with your vet about it. They will appreciate that you have taken the effort to educate yourself and will be willing partners in providing Maggie the best care.

One last thing. My vet is an incredibly smart and compassionate person. When we were discussing Chance’s problems, she told me that the kidneys are so incredibly smart that in comparison her own knowledge about them is extremely tiny. She indicated the tiniest tip of her pinkie what she knows. Your vet will probably agree that they are very complex organs.

Let me know what you find out asap.
my best
patrice

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