Patrice - 46. page

[Patrice]

Terri,
That’s a tough call. I guess if it was me, I would first talk with the vet in charge about taking Kodi to a specialist. Sometimes a vet will actually be relieved to have a client ask for another opinion. Other vets will find this offensive and make life even harder for you. You’ve been working with this vet, what do you think they will say about this?

If your current vet says it is not appropriate to move him right now, then a phone call is in order. Be prepared, have all that paperwork that Dr. Hammer is going to want to see and offer to bring it to him. Be polite and avoid being hysterical. He knows that you are upset, what he needs are facts. If he is the kind of vet I think he is, he will go out of his way to help you. You can tell him about our website and that we recommended you see a Veterinary Diplomate.
my best
patrice

[Patrice]

Terri,
It’s always tough to find someone out of the blue to help you and be able to know you can trust them. When you have a very sick dog, it’s not always a good idea to go driving around trying out vets.

Veterinary Diplomates are the equivalent of human specialists. They not only go through up to 6 years of veterinary schooling, they also chose to specialize, taking brutal course work to become the best of the best. They can chose many areas of veterinary specialization.

I have found one person who I think, by looking at his background, education and specialization, that seems like he is “the ONE.” He has actually written textbooks in hematology! He’s been around long enough that he probably has a few tricks under his belt.
http://northcoastvetspecialist.com/dr_hammer
Alan S. Hammer, DVM, DACVIM
Board Certified in Small Animal Internal Medicine and Oncology
Dr. Hammer is a 1985 graduate of The Ohio State University, College of Veterinary Medicine. After two years in general practice, he returned to Ohio State for his residency in internal medicine and oncology. Following his residency, Dr. Hammer stayed on the faculty as an assistant professor.

He has written over seventy scientific articles, book chapters, and abstracts on veterinary hematology, internal medicine and oncology. Additionally, Dr. Hammer has lectured extensively both nationally and internationally. Dr. Hammer and his wife, Barb, live with their miniature schnauzer, affenpincher, maltese and a black cat they rescued.

I can’t guarantee anything to you, but he is close to you and maybe he will even talk to you on the phone before you make the choice to move Koda. According to Google maps he is about 31 min away from you.
North Coast Veterinary Specialist
3375 Blackmore Road
Perry, Ohio 44081
Phone: (440) 259-0063
Fax: (440) 259-1022

Please let me know what you decide.
my very best
patrice

You will need a reference from your vet, and I suspect your vet already knows this fellow. Don’t burn your bridges with your own vet. Be polite and thank her/him for all the help they have given you. You only need to say you would like to see a specialist for a referral. Always be polite, but remain firm, with a smile, that you need to do the best for Koda. Avoid arguments.

[Patrice]

Terri,
I think you need to get a consultation with a specialist. Do you have a specialty vet clinic in your area? Tell me where you live, the city, and I will find a clinic for you that has a specialist.

I know exactly why she thinks this may be cancer, but with this condition there can be a very high white blood cell count for a few other reasons. I have seen this kind response by other vets. Those vets who don’t see this condition routinely are not as familiar with it. They may remember things from their clinical internships and their college education, or they may even quickly look up something. Lab results need interpretation in animals as much as they do in humans. It’s not straightforward.

Am I correct in thinking that the main problem has been that he was showing signs of limping or stiffness? Was he previously eating, pottying, walking and engaging in the household just prior to all this?
my best, patrice

[Patrice]

Terri,
Please stay here. This is the group to be in. We can help you with this.

I understand why the vet is talking about the high white blood cell count. It is not always an indicator of cancer. If I can see the bloodwork and I can explain some of this to you.

Please do not give up hope. We have seen many dogs over the years that were this sick survive. There is hope. We are here to help you.
my best, patrice

[Patrice]

Terri,
Oh dear, you have had a terrible time. This is so unfortunate. I am so sorry you have had to go through this. We are here to support you and help you not only understand what is happening but also provide you with the information you need to make good choices and care for Koda properly.

I wish I could say that this situation is unusual, the way this played out, but I have seen vets sidetracked like this before. But let’s move forward from this point and get Koda healthy again.

If you would please ask your vet for copies of all the paperwork that has been generated, most especially the lab work CBC complete blood count and the chemical screen, and upload those to us using the Urgent Advice page. I will look it over and explain the important things to you that you need to understand right now.
https://www.secondchanceaihadogs.com/urgent-advice/

We have an AIHA Terms page that explains many of the medical terms that are being presented to you now.
https://www.secondchanceaihadogs.com/aiha_terms/

There are two introductory videos in the AIHA Video Library.
https://www.secondchanceaihadogs.com/aiha-video-library/aiha-introductory-videos/

It is unfortunate that any of these medications were administered without first doing a complete health checkup. I can’t say for sure that these are the only factors that are responsible for this sudden anemia, but it’s possible for them to trigger any dog with a genetic susceptibility to develop AIHA-IMHA.

Right now nursing care is very important. Since he is so sick, fluid loss via vomiting needs to be controlled. Undoubtedly, the exposure to so many different medications has upset his stomach. They need to monitor his PCV, packed cell volume, carefully to see if he is still destroyed red blood cells. They may suggest a transfusion if this goes too low and we will help you understand that. They are monitoring other body functions, such as the liver and kidney, as well. I can read these values and help you understand what they are showing.

You will need to learn a lot, but there may be a lot of things that you will not understand because there isn’t enough time to learn it all. This always makes it very complicated to make good decisions. That’s where all of the moderators will come in. We can help you work through these decisions by explaining things in a way that you will understand. All of us have been through this and we have all of our experiences to guide us.

Stay here with us, throughout the upcoming weeks, and ask as many questions as you need answered.

Have I explained things in a way that you understand?
my best, patrice

[Patrice]

Hi Jen,
I am glad to hear that Maggie’s hematocrit is at 38! That is a good healthy value. How long has she been at this? If it’s been stable for a month or so like this, then it may be time to begin reducing the prednisone gradually. This dose is not extremely high, but it is still high enough to cause some unwelcome side effects.

Do you have a copy of the CBC you could provide to me? There are several types of white blood cells, each one doing their own job. A lot can be interpreted from which type of blood cell is high. When your vet says Maggie may have a parasitic infection, she is thinking about a type of blood cell that is normally not seen in any significant numbers in the blood. But it can also be an indication of an allergic reaction.

If you do have the CBC, scan it, save it as a pdf and upload it on the Urgent Advice page. I will have a look at it.
my best
patrice

[Patrice]

Rica,
Many owners have had variable success with their vets. I often find veterinarians ignorant of the basics of how to diagnose and treat this condition properly and successfully. If I had my wish, and I have had this for a long time, I would make up an “AIHA Clinic Emergency Kit” that contained a step by step chart for what to do and a pamphlet for owners that explained in simple terms what was happening. But, right now, that is not possible for me to do.

That is why I started this web site, in memory of my Giant Schnauzer Chance, to be there to help all other owners who are struggling with the “few jumbled medical-jargon-y sentences.” We have a large number of moderators around the world, in nearly every time zone, to help owners. They all give of their time freely and graciously.

I never want to outwardly encourage owners to be enraged with their vets, sometimes it is important not to burn your bridges. Always be polite and thank your vet for their help. But move on if you need to, we would never discourage that.

Some vets, over time, lose the passion and love they had for the profession. I have no doubt at all they every one of them started in this profession because they love animals and wanted to help them. Years of fighting with uncaring owners probably takes a toll and the “internet” is driving many of them out of their minds.

You may be surprised when you thank your vet for their help saving Vincent that they might just respond back with that kindness that is underneath waiting to come out.

But I am truly sorry you were told that Vincent would not make it. That is just not true from my perspective. Over a number of years I have seen many dogs survive if they received the proper treatment immediately. It is not complicated and it is actually not too expensive if done appropriately.

Chance’s story is there if you want to read it. Nothing about his condition or treatment was easy. He was not expected to live and I had months of trials with him trying to save his life. He survived because I am stubborn and he had an enormous will to live.

Please stay close by to the forum until Vincent is back in tip top shape.
my best
patrice

[Patrice]

Hello Rica,
I just looked over your most recent lab tests that you have sent along.

I am pleased to say that things look very good. What you are looking at is a CBC, complete blood count. I made a little movie about this if you want to understand it a bit better. See here for the CBC:
https://www.secondchanceaihadogs.com/aiha-video-library/aiha-introductory-videos/

The RBC (red blood cell count in millions), HCT (hematocrit, the percentage of red blood cells in the blood) and HGB (hemoglobin, the protein molecule inside the RBC that carries oxygen to the body cells) are all a bit below normal. But not by much.

The RBC is 4.3 million while low normal is 5.5 million. That is very close to normal.

The HCT is 30.4% while the low normal is 37%. This is very close to normal and is not a dangerous level.

The HGB is 11% while the low normal is 12%, again this is really close to normal and means that plenty of oxygen is getting to the body cells.

The new RBC being made are a little larger than normal right now, that is ok, but that is why you see a high RDW. Don’t worry about it.

The RETIC is reticulocyte value as absolute (taking certain things into account), which indicates a very high regenerative response by the bone marrow. This response was driven by the kidneys who monitor the blood for oxygen and “ask” the bone marrow to make more red blood cells. This number will begin to get lower in the next few days and you will see the number of RBC rising. His body is turning baby blood cells into mature red blood cells. This is absolutely normal. Eventually when the HCT reaches about 37% the RETIC value will be about 60,000 or so and remains that way when we are healthy.

The white blood cells, the lymphocytes, are low. This is normal and a good response to the prednisone suppressing the immune system. These rogue WBC, the T-Cells, are responsible for the autoimmune attack on the red blood cells. Right now it is necessary to suppress them to keep them from destroying more RBC. You will eventually gradually reduce the prednisone, over a long time, so that they stay suppressed during recovery.

I would be interested to also see the chemical screen, this tells us about the health of the body organs and other things like electrolytes. From this I could tell if the liver has been impacted yet. However, to me it already looks like a healthy dog that had some kind of sudden autoimmune reaction to some event. If you have this test, send it along too.

These events can be variable and sometimes hard to pin down. But in general things like recent vaccinations, exposure to certain drugs, hormonal changes, bites or stings from snakes, spiders or bees, certain foods etc can lead to an autoimmune attack. Do we always find out? No, sadly many owners never really know what caused the initial attack.

Do we blame ourselves? Sure we all did, but it is important that you NOT blame yourself for things that are out of your control. You would not be here if you weren’t a wonderful caring owner. There are plenty of steps going forward that you can take to make sure there isn’t a relapse and we will help you with those things.

Rica, you are an excellent owner who took action immediately and saved Vincent’s life. Good job.
my best
patrice