Page 48 – Second Chance AIHA Dogs

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Keymaster

Mary,
Gosh I am sorry, this is terribly confusing to many owners and it doesn’t seem straightforward and understandable. Let me see if I can explain this in a way that is understandable. I may have to say quite a lot to do that.

When we got Chance in the late 90’s the breeder told me that once we had given him his puppy series of vaccinations and his rabies shot that we should no longer give him yearly vaccinations. She recommended that we titer him thereafter. This was revolutionary for that time. Up until then, not only did everyone vaccinate every year, but the only people who titered dogs for proof of vaccination, for the most part, were breeders who titered puppies to make sure their first series of shots had taken. Sometimes the first series does not “take” in a puppy and that is a risk for the whole litter.

In my simple understanding I thought this meant that every year we go in and check Chance’s blood for antibodies and that would prove that he was ok and didn’t need to be re-boostered. I will explain this better in a minute.

The first problem was that the vet in town refused to titer him. I had so little understanding at that time, I was simply confused. Isn’t this better I thought? But eventually someone recommended another vet clinic to me and I asked them if they would titer. They said they could, but it wasn’t requested very often, they used Cornell labs, would this be ok? Hmm, why is this so complicated?

But I did titer him every year after that. He was also a registered therapy dog and they would not accept titers, but insisted on yearly vaccinations. He, however, had severe allergies and was under treatment for them by getting allergy shots. The vet signed paperwork every year for TDI that exempted him from the re-boosters. TDI said they would allow this as long as we re-boostered any low titers.

Ahh, slippery territory. What would happen if I re-boostered him? And in fact, for some strange reason his parvo would come back low every year. So I dutifully re-boostered that. That was a bad thing I did. I later found out from Dr. Dodds that this was one of those particularly dangerous vaccinations that can lead to serious health issues. I will never know for sure, but it is possible that the last parvo booster he was given in late 2006 was one of the reasons he went on a few months later to develop bone marrow failure. Yes, bone marrow failure is a possible outcome of contracting parvo. However, vets would tell you that a dog cannot “get” parvo from the vaccination and that is true! So what are the mechanisms involved? I research this all the time, still looking for answers.

It was a huge learning curve for me. But around that same time I joined Tick-L, an email list for discussing all things tick disease in dogs. The owner is a an older gentleman who has extensive scientific biological training. He explained titers to me in a way that I understood.

The immune system is really pretty straightforward and incredibly “intelligent.” You expose it to some kind of foreign thing and it remembers it FOREVER. If it considers that thing a threat it makes up a warning signal to let the body know that if it is ever exposed to it again, it should fight it the same way it did the first time.

Vaccines utilize this “memory” method to help our bodies recognize a bad foreign “thing” and learn to fight it off, but without actually giving you the disease itself. Vaccine manufacture is a complicated process and I won’t go into that here, but not all vaccines work in exactly the same way. The basic difference you need to know is that most veterinary vaccines are either “killed” or “modified live.” (And modified live are not used very often anymore.) Here is the first page I found when searching that explains this if you want to read it.
http://www.canismajor.com/dog/vaccine.html

Some vaccinations take a series of boosters to be effective over time and some vaccinations can be considered “life time.” Any of the first puppy series are generally killed and that is why you must return a second time for the second series. But once you have “set” that memory, these are considered life time by those who truly understand vaccinations (like Dr. Dodds).

Other vaccinations like kennel cough must be frequently re-boostered because they lose their effectiveness. Leptospirosis vaccinations, which also need re-boostering, are only partially effective against a set number of strains. You may have different strains in your area that are not in the vaccination. Your dog could be exposed and get Lepto despite being vaccinated! I know of dogs that have received the Lyme vaccination and came down with symptoms of Lyme disease.

So in my case I don’t give Kennel Cough, Lepto or Lyme vaccinations, but I do make sure that I protect my dogs from those diseases. I avoid situations where they could get exposed to Kennel Cough and Lepto and I protect them fastidiously from getting bitten by ticks.

Here is the important take away. The deadly diseases that may kill a dog, and they are those vaccinations that you give to your puppy, generally provide lifetime “memory”. Once your dog is exposed to the vaccination and develops antibodies their immune system develops a life time memory of that.

So why are titers so confusing? It should be really easy, titer your dog and you know they are protected against distemper, right?

Titers really only tell us that there is “MEMORY.” They cannot tell us HOW WELL THE IMMUNE SYSTEM CAN RESPOND IF EXPOSED TO A DISEASE.”

If a dog is ill, they still have memory, but they they may not be able to mount a defense to the disease properly. So there is the difference, the titer may say “yes” but the dog’s (or cat’s) immune system cannot respond and they may express the disease after exposure.

So that is why titers are very rarely accepted by any authority as PROOF of immunity. This especially comes into play with Rabies. This is the one canine disease that can not only kill the dog (since exposure means illness, means death) but the dog can also pass on the rabies disease to the humans in his life and that will kill the human too. Human health departments around the world know this and they have stringent rules about vaccinating dogs for rabies because dogs are the vector for rabies to humans. They are not concerned about your dog’s health, they are only concerned that humans be protected from exposure to rabies!

The current Rabies Challenge research study being run by Dr. Dodds and Dr. Shultz is attempting to determine if the rabies vaccination provides “memory” for 7 years. The results would hopefully mean that a dog would only need to be vaccinated every 7 years not every 3.

But the reality is that both my dogs (and maybe even any puppy I might get in the next few years) will be long gone before this study is done, challenges are made to this by more studies, the results are released and health departments around the US (and world) accept and put into practice this change. It took many years for the “yearly” recommended veterinary vaccine booster protocols to be changed to every three years. The leaders for this change were veterinary universities. But, in fact, some localities still insist on yearly boosters and don’t honor the standard compendium recommendations. When it comes to rabies, the local authorities usually rule by how they handle the emergency, not by what laws are on the books. They may, and actually have, killed a dog on the spot that was suspected of having rabies just to protect human health.

So Mary, for you as a cat owner, you have similar but different considerations. First, you must identify those diseases that will result in serious illness and death in cats and are considered active in your area. If you refine it this way, it should be a relatively short list. Then you must decide if you actually provided this immunity to them at some point in their life. Using a titer test for those diseases is perfect. If you see “any” level of titer (as Dr. Dodds reminds me) then you can be sure that there is “memory.” In my case, I don’t have to, but I do repeat this test about every three years for each of my dogs. I do this mostly to make my vet feel better, not to reassure me that my dogs are protected.

Secondly, you and your vet should determine if there is an opportunity for your cat to be exposed to these diseases. In my area, our county is an active rabies area. I would never risk them being exposed to rabies without having a current vaccination. Am I worried about distemper etc? Not really, but I do have a healthy respect for how deadly this disease is. It just doesn’t exist in my area due to “Herd Immunity.” This is immunity in the general population due to most of that population being protected by vaccination.

Then you and your vet determine the overall health of your cat. Have they had previous illnesses (esp autoimmune) or seem to have a sensitive constitution? I am more cautious about Cassie because she is older but not because she has ever had illness.

Then you must look at the reactions that cats have in general to vaccinations. I know that they have a much higher rate of cancer related vaccinosis at the site of vaccine injections, far higher than dogs. Is this for certain vaccinations or is it all of them? What does your vet know about this and what do they recommend?

So, use titers as a tool, but don’t rely on the results too heavily. If your cat is perfectly healthy, then the titer is telling you that they are protected and will probably have the ability to summon the immune system response they need if they are exposed. If your cat is not healthy then you need to think about how to protect them that doesn’t involve another vaccination if possible. There is nothing wrong with making a dog or cat a “house pet” to avoid exposure. Modify their lifestyle for their health.

Try to partner with your vet to find an in-between ground that isn’t totally tipped in favor of heavy vaccination but doesn’t totally avoid them either. Some vets will welcome this, other vets will find any challenge to their authority offensive. If this were me, I would just step away and find someone who can partner with me. And that is exactly what I did with Chance in 1998!

I hope this lengthy response helped?
my best
patrice

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Patrice

Keymaster

Anne,
I am sorry you are experiencing this difficulty with your vet. This, unfortunately from my experience, is not unusual to see from a vet that has limited experience with this rarer condition. The difficulty arises because AIHA has become fairly well known and most vets tend to think only of those signs when evaluating dogs. This is where their experience has led them.

For instance, most authoritative resources mention spherocytes as one sign for AIHA that is diagnostic. However, when a dog has anemia and does not have spherocytes, the vet is in territory that they don’t understand well.

Most dogs with AIHA ARE regenerative, it is actually one of the signs to look for that a dog is HIGHLY regenerative in an attempt to replace the massive number of red blood cells being destroyed in circulation. In fact, in some literature you will read that this is a particularly ominous sign because it means that the body is still destroying red blood cells.

So why are we worried about regeneration in Bilbo? Because he has been wavering on the lines of not being regenerative. This is a different condition from AIHA and is not diagnosed or treated in the same way.

Yes, blood loss can be one reason, other than AIHA, that a dog is losing red blood cells and has anemia. But even in that case, with normal bone marrow, the dog will be regenerative!

If the bone marrow is failing to produce red blood cells, well then that is just a different condition and needs a different approach. I need to see your last two blood tests to figure this out for you. I am positive that I can tell in about 5 minutes exactly what the issue is here.

I agree, don’t argue with your vet. They already are lacking in their own confidence, still feel they can figure this out, and will find any criticism particularly annoying. Let’s educate you on what is happening and then we can make a decision about where to go next.

What is his PCV right now? If you are anywhere above 22% then there isn’t an emergency for the weekend. Please take a deep breath. Chance slowly dropped slowly down to 18% before I decided it was time for a transfusion. However EACH DOG has a different experience with low PCV’s. Some dogs can be walking and doing fine at a PCV of 8%. In general this is part of a medical term called “transfusion trigger.” This is not a clearly defined value. It is a SUBJECTIVE decision that is made by the attending vet that takes into consideration the condition of the dog as well as the values on the CBC. There is no magic number that says “we need to transfuse now.”

Upload your test results to me at the Urgent Advice form so I can look at them. I want everything you have already. We can talk about this once I see these things so I can help you make some educated decisions. Right now you only have emotion as a guide to make these decisions.
my best
patrice

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