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January 2003

Ollie

Ch. Augutine's Black Olive, known to her friends and family as Ollie, is a nearly 9 year old spayed female Portuguese Water Dog owned by Betty and Ray of Wilmington, DE. Ollie was diagnosed with autoimmune hemolytic anemia on August 16, 2001.

When Betty was asked to describe Ollie's symptoms prior to her AIHA diagnosis she replied, "the first thing we noticed was she was very lethargic, she almost seemed depressed. Ollie received her Lymes vaccination on July 26, 2001. By August 1, she was refusing food, was lethargic and had a dark brown/red urine."

Ollie was taken to her veterinarian on August 2, where testing revealed a low PCV. She was given a Dexamethasone injection and started on prednisone, Doxycycline, and Carafate. The next day one bag of Oxyglobin was administered. On August 16, Ollie was seen by a veterinary internal medicine specialist who preformed a number of tests including a test for Rocky Mountain Spotted Fever and an abdominal ultrasound. Blood testing revealed a PCV of 16. Both the Doxycycline and the prednisone were increased and Imuran was added to the treatment regimen. By the end of August Ollie appeared to be getting worse. Betty commented, "Ollie started getting very weak. When she became too weak to climb on the bed, I put a stool next to the bed so she could climb on it and then the bed." By September 13, Ollie's PCV was 25 but she was too weak to climb the stairs without help.

On September 25, 2001 while Ollie was anesthetized an ultrasound guided endoscopy was done which also retrieved liver & spleen samples for biopsy. Test results showed that in addition to AIHA, Ollie was suffering from inflammatory bowel disease, congested lymphatics, splenic congestion, gastric ulcers and steroid hepatopathy. Ollie's vet told Betty that because of these problems, it was her goal to get Ollie off the steroids. She also commented that if the anemia could not be resolved, they would need to consider removing Ollie's spleen. Ollie was still very weak, she was losing her hair, had a voracious appetite and was panting heavily. Because of the problems the prednisone was causing, it was slowly decreased and by early November it was completely stopped. The Imuran was continued at 50 mg per day. By the end of November, Ollie had lost nearly all of her hair, her tail bled from hitting the furniture when she wagged it, her skin was dry and flaking and her PCV remained at 25. Ollie's PCV remained at 25 into January. In early February 2002, Ollie's panting had decreased somewhat and she seemed a little stronger. And then on February 8th Betty received a message on her answering machine from Ollie's vet which stated that Ollie's PCV was 45. A gradual decrease of the Imuran was started at that time. By May 2002, all AIHA medications had been discontinued. At the present time Ollie is receiving no medication for the treatment of AIHA. She does take ˝ Centrum Silver vitamin tablet, a Flexease (glucosamine) and a Derma Renew (omega 3 fatty acids) each day. The veterinary specialist told Betty that Ollie should receive only Rabies, Distemper and Parvovirus vaccinations and that the Distemper and Parvovirus vaccinations should only be given when endpoint titers indicated they were necessary. According to Betty, "titers testing in July 2002 indicated Ollie had sufficient antibodies for a couple of more years."

When Betty was asked to comment on the current state of Ollie's health she replied, "she is doing great. Her PCV at her last blood test was 45. Her coat is beautiful, the flag on her tail is fuller then ever and she has plenty of energy. She can jump onto the bed from the floor and she follows me to the basement. Sometimes she even runs up the stairs. She loves swimming. She could stay in the water forever." Betty continued, "Ollie has been our best friend for over eight years. We were devastated by her illness. We adjusted our work schedules so we could give her medication and get her to the vet. We wondered many times if we were doing the right thing by giving her so much medication and doing so many procedures. When her PCV would not go above 25 for so long and the vet was suggesting possible surgery to remove her spleen we began to think we shouldn't put her through any more of this. It was difficult to tell which symptoms were coming from the illness and which were from the medicine. I don't think any of us are sure about what finally got her blood count up. Maybe just the right combination of things or maybe we were just lucky."

February 2003

Lille

Lille is a 10 year old spayed female Papillon owned by Marilyn of Santa Fe, NM. Lille was diagnosed with autoimmune hemolytic anemia on November 28, 2000.

When Marilyn was asked to comment on Lille's symptoms prior to her AIHA diagnosis she replied, "Lille received her vaccinations in August, 2000. Shortly thereafter, she slowly started exhibiting fatigue followed by anorexia in September and October. Prior to Lille's illness, she had always been a very peppy, boisterous, happy little dog. When she got sick she was extremely lethargic with no interest in anything."

Lille was taken to her veterinarian where blood testing showed she had a low PCV. Additional testing revealed she was suffering from autoimmune hemolytic anemia. Lille, who weighted 7 pounds at the time of her AIHA diagnosis, was started on 5 mg prednisolone in the morning, 5.25 mg prednisolone in the evening, Hi Vite ( a small animal dietary supplement) and Carafate for stomach protection. Over time the prednisolone was slowly reduced and on May 14, 2001, Imuran (azathioprine) was added to Lille's treatment regimen. Six weeks later on June 28, Lille started vomiting and having a bloody diarrhea. She was taken to her vet where the Imuran was immediately stopped and IV fluids, antibiotics and additional stomach protectors were started. Lille remained hospitalized until July 5. According to Marilyn, "the veterinarian implicated the Imuran as being the cause of Lille's relapse and serious condition." Lille had two other setbacks in 2001. She was hospitalized from July 16-19 for lack of appetite and vomiting. During this hospitalization, she was again given IV fluids, antibiotics and stomach protectors. On September 22, 2001 Lille was taken to the emergency vet clinic with bloody diarrhea and vomiting. She was given IV fluids, prednisone, antibiotics and stomach protectors then transferred to her regular vet for hospitalization until September 24. Marilyn comment, "2002 was a good year, with no overnight visits to the vet." On January 6-7, 2003, Lille was again hospitalized for vomiting and given IV fluids, antibiotics and stomach protectors. Marilyn reports, "Lille, seems quite well after her latest little blip. We are keeping our fingers crossed and as ever are watchful. When she has these stomach upsets she is fed steamed white rice mixed with a little low fat cottage cheese. It works very well." Lille's current prednisone schedule is 5 mg in the morning, a day off from the drug, then 2.5 mg, once again in the morning, a day off, then back to the 5 mg and the entire cycle repeated. She also takes ˝ dropper Hi Vite morning and evening, 1 ˝ cc Carafate morning & evening and 1 Derm cap every morning. Lille has received no vaccinations, heartworm or flea preventative since her AIHA diagnosis.

When Marilyn was asked to comment about the current state of Lille's health, she replied, "In regard to the AIHA, Lille is doing great. We continue to do blood tests every other week. Because Lille is so tiny, the slightest change in her workup is significant, thus the bi-monthly vet visits. Her PCV at her last blood test on January 21, 2003 was 45.9. Presently Lille is in wonderful spirits, full of bounce and vigor. She is a real joy to have around. Her coat is full, her gums are pink and her appetite is hearty. We watch her like a hawk and spoil her totally. Every day with her is a gift. I think that anyone who has a dog with this disease has to be prepared to spend lots of money and be totally dedicated and disciplined in the treatment and care of their dog. It is expensive and it is nerve wracking, but it is well worth the effort and expense when you can wake up each morning knowing that your beloved pet is happily sleeping right beside you. There is no better way to start the day."

Lille Update, March 2006

Marilyn wrote recently with the following Lille update.

”Lille was euthanized the morning of December 10, 2005. Several months, prior to that Lille started breathing heavily and it kept getting worse over time. A year ago I had her lungs x-rayed and there was a tiny bit of white around them so at that time we did nothing. A few weeks before December 10, Lille was put on a diuretic to relieve the congestion in her lungs. She continued eating well but did not have a lot of energy.

“The week before her death I had her lungs x-rayed again and this time they were totally white. While she was at the vet they put her on oxygen and she felt much better. The vet said at this point the only thing we could do for Lille was either to keep her on oxygen or move to a lower altitude (we live at 7500')...both options were out of the question. I took Lille home and she went downhill rapidly. I put a vaporizer in my bedroom but that did not help her. The morning Lille was euthanized she got to eat a ton of turkey! She loved that since her diet had been so restricted while she was on a prescription dog food. Lille now resides in our garden with all of her other little friends. We ordered a bronze plaque for her grave that is mounted on a beautiful rock. The plaque reads ‘Lille beloved Papillion 1992-2005’ and indeed she truly was beloved!”

March 2003

Pete

Pete is a 10 ˝ year old neutered male Pembroke Welsh Corgi owned by Susan of Naugatuck, CT. Pete was diagnosed with autoimmune hemolytic anemia on December 11, 2001.

When Susan was asked to describe Pete's symptoms prior to his AIHA diagnosis she replied, "I noticed Pete had a problem on the evening of December 10th when he refused food. At first I thought he might have a tooth problem. I fed him some soft food and he ate that for one meal, after that he refused all food. He was lethargic and weak. He let me pick him up with no resistance (very unlike Pete). He had loose dark stool and dark urine. The next day he seemed worse, but I still thought it might be a bad tooth. I went to work and once there I began to worry more about it. I called our vet and got an appointment for that afternoon. When I went home to get Pete, he didn't want to get out of bed. I had to pick him up and carry him. His gums and tongue were pale gray. These symptoms came on so quickly, he was fine one day, the next day he was so sick."

Pete was taken to his veterinarian where blood testing revealed a PCV of 17 and a positive Coombs test. He was diagnosed with AIHA and started on 15 mg prednisone twice per day, 25 mg Imuran twice per day, 200 mg Amoxicillin twice per day and 200 mg Tagamet, one hour before meal time. Once on the medications, Pete began vomiting and was unable to keep any food down. He was then started on Metoclopramide for a short time to get the vomiting under control. Susan commented, "Once he began the medications, things got ugly quick. He couldn't keep any food down or control his bladder or bowels (diarrhea). I was most concerned about the vomiting. I gave him rice and boiled chicken for weeks. It took about a month for this period of terror to be over. I felt so bad gating him off in the kitchen-- so bad that at times I would sleep in there on the floor with him! It is so hard having a sick pet... I guess it must be like having a sick child. At times I felt helpless. I would just let him rest his head in my lap and I would cry."

Over the next few months, both the prednisone and Imuran were slowly decreased. The Imuran remained at the same dosage of 25 mg, but the frequency was changed from twice per day, to once per day then to every other day. Both the prednisone dosage and frequency were decreased until it was down to a dosage of 2.5 mg every other day, at which time it was discontinued. By June 1, 2002, Pete was off all medications. Susan noted, " It was an extremely hard decision to stop all the medication. Pete was doing well, and I was so afraid of a relapse. But I was also worried that he might be taking drugs he didn't need. I needed to give him a shot at a drug free life. Our vet was wonderfully supportive, allowing me to take my time with the decision. To my surprise his PCV actually rose once the medication was stopped. It had been 38. At two weeks post medication it was 42. I knew I had made the right decision for Pete." Pete has received no heartworm or flea preventative since his AIHA diagnosis. According to Susan, "Pete's veterinarian called Pete's AIHA "idiopathic" and explained it was of unknown cause. She also told me that dogs with AIHA do not tolerate vaccinations, so we won't ever vaccinate Pete again."

When Susan was asked to comment on the current state of Pete's health, she replied, "Pete's PCV was 48 on February 10, 2003. Pete is back to his old self and shows no signs of long term side effects from the drugs or AIHA. He's back to defending his territory (the upstairs of our house) and herding any small children that might visit. He stands up to Buddy, our Rottweiler mix, who is 3 times his size. The only difference I see is that Pete has a hard time going up and down the stairs. But I attribute that to his age, and pathetically short legs. When the drugs weakened his muscles I carried Pete up and down the stairs for months. Believe it or not, Pete can speak English-- ok, it's not the Queen's English, but nonetheless he can make himself be heard. One day I went to pick him up and carry him down the stairs and he looked up at me and growled "I DO IT." And he did. That's when I knew he was feeling better! The best advice I can give anyone facing this disease is to find the support of others who have been through it. That was the most valuable tool I had to get through the rough times. We also have a wonderful vet who allowed me to be an equal partner in Pete's care. When I adopted Pete he became my companion, when he needed me I became his voice. Of course I would prefer that he had never gotten sick, but AIHA has taught me a new appreciation for my companion. I cherish every day, healthy or not, that I have with him."

Pete Update, October 2005

I recently received the following email from Susan.

”Pete continued free of AIHA and in good health until the fall of 2004. However, we noticed he was dragging his back paws a bit. In the spring of 2005 he was officially diagnosed with Degenerative Myelopathy (DM) which is another immune disease. It affects the spinal column, causing rear quarter weakness and eventually paralysis. Pete was doing what we would call his ‘drunken sailor walk’ for most of the spring and into the summer of 2005. He was becoming progressively weaker and in late summer he was dragging his back legs most of the time. Unfortunately there is no treatment for DM. Instead Pete was treated with kindness and compassion. He wasn’t tolerant of a cart, which is an option for DM dogs, but we did get a pet stroller which he absolutely loved. The stroller gave him a nice surge of happiness during the last months of his life. His last vet visit was in mid September, 2005 when we discovered that he had lost more than a third of his body weight. The vet was very certain he had cancer. The time had come for hard decisions, it was time to let him go. I promised Pete that I would never knowingly let him suffer, so before it would be too late we had a mobile vet come to our home and euthanize Pete while he lay in my arms. Pete lived 13 years. I miss him terribly.”

April 2003

Hansel

Hansel is 4 year old neutered male Doberman owned by Kathy and Rod of Ukiah, CA. Hansel was diagnosed with autoimmune hemolytic anemia on December 31, 2001.

When Kathy was asked to comment on Hansel's symptoms prior to his AIHA diagnosis she replied, "the first indication that Hans was not feeling well was his absence at my side. Dobermans are Velcro dogs, and Hansel is the ultra-sticky variety; he is ALWAYS near me. Wherever I am in the house, Hansel is as close as he can get. Friday night, Dec. 28, I sat outside watching Hansel and Gudrun (our other Doberman) race around the backyard, jumping, running, bumping chests, etc. Hansel was going full throttle. Saturday he was a little off, and by Sunday he was moving as little as possible. It was that sudden. He was on the bed in the bedroom, and basically stayed there all Saturday and Sunday. I took him for a walk on Sunday and he had no energy--he didn't pull with his usual enthusiasm. I thought to look at his gums, which were grayish. He did get somewhat excited about the prospects of food, and he did eat. However, Monday morning he vomited his dinner of the night before and I noticed the food was not digested."

Hansel was taken to his veterinarian where blood testing revealed a PCV of 23. When all other signs including the blood agglutination test pointed to AIHA, steroid therapy was begun immediately. Hansel was given an injection of Dexamethasone the afternoon of his AIHA diagnosis. Kathy returned to the veterinarian's office that evening to learn how to give Hansel another injection of Dexamethasone later that night. Hansel, who weighted 65 pounds at the time of his AIHA diagnosis was given 120 mg of prednisone for 2 days. When his PCV rose a couple of points, his prednisone dosage was dropped to 80 mg for two days then to 60 mgs. Kathy commented, "by Jan. 7 his PCV had not risen again, and the vet, who was not my usual vet, prescribed Imuran. However, I felt that although Hansel's PCV had not risen dramatically, he seemed better. I did not start the Imuran, and discussed this decision with my regular vet. Along with the prednisone, Hansel took Pepcid, for his stomach. On January 15, Hansel's PCV was 48, on January 23 it was 39, and on Jan. 30 it was a whopping 51. Hansel stayed on 60 mg of prednisone till Feb. 7, and then we began the SLOW process of lowering the dose by 25% every 2-3 weeks. In April we were down to 15 mg, and we started an every-other-day (EOD) regime, then 10 mg EOD, 5 mg EOD, then 5 mg 2 times a week. Hansel was given his last prednisone on June 9, 2002. My vet also suggested, and Hansel received, vitamins A, E & C, alfalfa tabs, CoQ-10, Milk Thistle, ProZyme and probiotics. Someone with whom I corresponded during Hansel's illness suggested sesame seeds, so Hansel got these also."

According to Kathy, "In August 2002, Hansel's fur began falling out, and was dull and dry. His thyroid was checked, and he was found to be borderline low. My vet spoke with Dr. Jean Dodds, and we started Hans on Soloxine. He is currently taking .4 mg of Soloxine twice per day. His coat improved in a matter of weeks. Hansel takes Heartgard (plain not the PLUS) for heartworm protection. He receives no flea protection and on the recommendation of his veterinarian will not be vaccinated again. Along with dog food, I supplement Hansel with lots of organic steamed veggies and fruit, yogurt, eggs, chicken liver, canned and cooked fish. He still gets ProZyme and some probiotics, Vitamin E, A, C, Alfalfa tabs, CoQ-10, Milk thistle, Olive oil and flax oil, essential fatty acid tabs, Missing Link with Glucosamine, and MSM."

When Kathy was asked to comment on the current state of Hansel's health she replied, "Hansel is once again my sweet and goofy red Doberman boy. His PCV at his last blood testing was 44. He's happy, healthy and spreads joy and love in my house. I cannot look at this dog without smiling. If I was to give any advice to those with newly diagnosed AIHA dogs it would be, be patient! Hansel was diagnosed with AIHA on Dec. 31, 2001. He took prednisone for a half a year as the dose was SLOWLY reduced. While he was on prednisone his body and personality changed. He became completely food-obsessed. He was cranky, I mistakenly stepped on his paw one day (because he was under foot constantly while I was in the kitchen, begging for food) and he growled at me and bared his teeth and his eyes looked crazed. He was very weak, as prednisone wastes muscle. He could not jump up on the bed or couch, and he couldn't even make it up into the car. His legs and neck got skinny and spindly. During the first month he could hardly make it across the street and back on a walk. He also had very loose stools. He could not play with Gudrun at all, and she was bewildered and bored. Soon after lowering the prednisone he became a little more energetic. On April 18, 3 ˝ months after diagnosis, he finally was able to jump on my bed. I wrote the day on my calendar, because it was monumental for me; it meant that my sweet Hansel was returning. Prednisone is a blessing and a curse: it's a wonder drug with nasty side effects. Also--if you're close with your dog and know his/her personality, follow your heart. I took Hansel into the vet's although I was told that the clinic was very busy, and only one vet was on duty, etc. My usual response in a situation like this would be to wait. But in my heart I felt that Hansel was in trouble. And, because I acted so quickly, his PCV wasn't as low as some, and he did not need transfusions or other drugs besides prednisone. AIHA is a horrible illness, but your dog can make it through, and you will share a special bond because of the experience."

Hansel Update, April, 2007

I recently received the following Hansel update from Kathy.

”From spring 2002 until spring 2007, Hansel was healthy and happy. He did not have a relapse of AIHA. I watched him like a hawk for any signs or symptoms. He turned 8 on March 1, 2007 and shortly after his birthday, slipped while playing catch. For several days he limped and favored one of his rear legs. I was worried, because I thought he had torn a cruciate ligament, so I made an appointment with my vet. While I was worrying over him, I felt a lump near his throat, actually a lump on both sides. I immediately thought lymph nodes. I made an emergency appointment and took him to the vet on Sunday, March 4. A needle aspiration was done, and the results looked suspicious, so a biopsy was performed on one of the enlarged nodes behind the stifle. My worst fears became a reality when Hansel was diagnosed with Lymphoma.

”I was not sure about putting Hansel through chemotherapy, but my vets all seemed very positive about the results of chemo in dogs. Left untreated, I was told Hansel had 2 to 4 weeks to live. After the first round of chemo, the nodes disappeared, and I was elated. But a week later he was feeling pretty low and we decided to hold off the second treatment for a couple of days. In that amount of time, the nodes returned, and he did not achieve remission again. We did four more rounds of chemo and he was resistant to every one. Hansel was a trooper all the way through treatment. The last chemo treatment was a drip which lasted half an hour, and the entire session was close to 4 hours, yet Hansel never complained.

”I, along with my vets, decided that Hansel had had enough. He suffered the bad effects of the chemo, but was not getting any of the benefits. I decided I would put him on prednisone, and estimated I had about a month to be with my boy. I made that decision on April 14. On April 16, Hansel was obviously ill, and I took him to the animal hospital. He had developed an infection, and due to the side effects of the chemo lowering his immune system and white cell count, he was in sepsis. He was immediately put on a drip of fluids, given a shot of antibiotics and pain meds. He was in distress, and he cried out when the tech tried to move his leg. After 4 or 5 hours, his heart rate did not decrease, nor did his temperature; a bad sign. An x-ray revealed enlarged lymph nodes around his rear quarters, something we hadn't known before. It became obvious to me, and then to the vet and the techs, that even if he made it through the infection, he would have very little time left, as well as a poor quality of life. Also, he would probably end up very sick again. It was heart wrenching, but we made the decision to let him go. As I held him in my arms, I smelled him for the last time and stroked his wonderful soft coat, and then he was gone.

”Hansel was a very special boy, and I was blessed to have lived with him. I miss him terribly.”

May 2003

Emma

Moore's Emerald Jewel, known to her family and friends as Emma is a 4˝ year old spayed female Shih-tzu owned by Susan and Pat of Franklin TN. Emma was diagnosed with autoimmune hemolytic anemia on February 12, 2002.

When Susan was asked to comment on Emma's symptoms prior to her AIHA diagnosis she replied, "Emma didn't appear ill until she was very sick. On the Sunday before her AIHA diagnosis, she had been a little sick to her stomach. My plans were to take her to the vet on Monday morning if she wasn't better. On Monday she was not sick to her stomach, but she was very lethargic. She didn't want breakfast which is not too unusual for her since she's not a big eater. Quite by accident, I noticed that she had blood in her urine, so we immediately rushed her to the vet. My regular doctor wasn't there, the vet we saw thought Emma had a bladder infection (admittedly, a quite extreme infection since her urine was DARK red). He gave me some antibiotics and sent us home. The next day, she was no better. She was very jaundiced - her gums were pale and the skin on her "tummy" was yellow. When I rushed Emma back to the vet office as soon as it opened on Tuesday morning, my regular veterinarian was back in the office. He took one look at Emma, grabbed her and took her back to their critical care area. He immediately did a Coombs tests and determined she had AIHA. Her PCV level was 20 when the first CBC was done."

The day after Emma's AIHA diagnosis, her PCV dropped to 9.5. She received a blood transfusion which increased her PCV to 30. Over the next 2˝ days her PCV declined to 14. A second transfusion was given which brought the PCV back up to 33. According to Susan, "Besides the transfusions, Emma received cortisone injections while she was on round the clock vet care. She was on an IV for about four days; there may have been other medications provided through the IV that I am not aware of. When Emma came home, we gave her regular doses of Prednisone. We started with one 5 mg tablet twice a day and gradually reduced the dosage." Emma is currently on no medications for the treatment of AIHA. Susan noted that she and her veterinarian discussed the likelihood that Emma's AIHA was in "reaction to her vaccinations which were given on January 16, 2002, approximately one month before she was diagnosed with AIHA."

When Susan was asked to comment on the current state of Emma's health she replied, "she is happy and healthy. Her last PCV was 44.1. Emma is a special dog to a lot of people. At least two of our friends have adopted a Shih-tzu after meeting Emma….she's just that personable of a dog. Emma is now the "mom" of an English Bulldog that my husband and I adopted in November, 2002. Leo is currently 6 months old and already weights about 25 pounds more then Emma. But Emma and Leo are best friends. They chase each other around the house and whenever Leo misbehaves, Emma puts him in his place in a heartbeat. We call her the Princess and she definitely rules this household. When she's not playing with Leo, Emma enjoys playing with people and loves it when friends come over to visit. She also enjoys chasing squirrels or rabbits in the backyard and vacationing in the Smokey Mountains."

Susan continued, "my first Shih-tzu, Annie, died 14 years ago with an illness which I believe was AIHA. While 14 years ago, the vet didn't call it AIHA, all the symptoms and clinical impact were the same - she was weak and lethargic and her body was destroying its own red blood cells. Annie had multiple blood transfusions after her diagnosis, but never was able to recover. She died only a couple of weeks after the vet determined that she had a red blood cell problem. So, based on my past experience, I was not optimistic about Emma's future when the doctor told me that she had AIHA and explained what AIHA was. The first 10 days were tough. Emma was under constant veterinary care but we are lucky in that we have a pet emergency clinic near our house. My husband and I transferred Emma from our regular vet's during the day to the emergency vet's at night. During that time, I lived from day to day looking forward to the brief drive from one vet's to the other so that I could spend some time with my Emma. I will never forget that she has had this experience, and the possibility of her becoming ill a second time will always be in the back of my mind. Yet, I feel very lucky to have her healthy and happy right now."

Emma Update, January 2005

Susan wrote recently with the following Emma update.

"Emma passed away on July 17, 2004 as the result of her fourth bout with AIHA. Emma's second bout of AIHA occurred in July 2003 and was combined with immune-mediated thrombocytopenia. She recovered from this bout of the disease in a timely fashion only to be struck with another bout of AIHA in February, 2004, from which she also recovered.

With each episode of the disease, I always wanted to know 'what caused it'. I could develop a theory behind each of Emma's episodes except the last. Her first illness happened shortly after her vaccinations; the second episode happened shortly after I gave her a flea treatment (Advantage, or another similar type of chemical); the third happened shortly after her monthly heartworm tablet. The last episode happened for no reason that I can determine. It came on very suddenly, and by the time I got her to the vet, her PCV count was 10. We went through the usual treatments, which included blood transfusions and high doses of prednisone as well as other drugs. While her blood count was on the rise, I believe that she ultimately died of a blood clot that went to her heart. She died at home peacefully, in my arms."

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