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September 2004

Seiko

Seiko is a 10 year old spayed female, mixed breed terrier owned by Casey and Donna of Beaverton, OR. Seiko was diagnosed with autoimmune hemolytic anemia on March 26, 2003.

When Casey was asked to describe Seiko's symptoms prior to being diagnosed with AIHA, he replied, "before the onset of Seiko's AIHA, she had always been very playful and happy….then she got very quiet, sleeping all the time. Seiko is a dog who takes great pride in her acrobatic agility so she got very confused when she could not jump onto our bed or the couch. When she started falling over, we knew something grave was happening. In addition to the lethargy and general weakness, Seiko had trouble standing upright, had a poor appetite, disturbed stool (orange in color) and pale mucous membranes. Seiko went from a dog with very normal behavior to being very sick in a matter of a day or two."

Seiko was taken to her veterinarian where testing revealed a PCV of 22. A positive Coombs test confirmed the diagnosis of AIHA. According to Casey, "by March 28, Seiko's PCV dropped to 16. On repeated daytime outpatient visits to the veterinarian, fluids were given throughout the course of the day at 40 ml/hr. The antibiotic, Cefazolin, was given at 150mg, IV. 20 mg prednisone (10 mg twice daily), along with Sucralfate at ˝ gm daily, given to prevent drug-induced (prednisone) gastric erosions, were also part of the treatment regimen. On March 29, Baytril was started at a dosage of 22.7 mg twice per day. Seiko's PCV was checked daily after the outpatient clinic care yielded positive results. As the PCV continued to rise the PCV was checked less often and the prednisone was gradually reduced until it was entirely discontinued."

When Casey was asked about the current state of Seiko's health, he replied, "great….her PCV at her last blood testing was 59. She is 100% normal with no after affects of the disease or drugs used to treat it. She is currently on no medication for the treatment of AIHA. After a lot of research, we asked a number of pointed questions to our veterinarian in regard to vaccinations and other issues. We reached a mutual consensus with the veterinarian to discontinue all vaccinations. This suspension extends to products for fleas and ticks that work by getting into the bloodstream. The flea and tick problem in our neighborhood is manageable, but when we travel south of here we use citronella repellant products. Since we live in a region of the country where heartworm is not a big problem we use no heartworm preventative. Heartworm is an important issue south of here and in Eastern Oregon. Our veterinarians, here in Northwestern Oregon, recommend standard heartworm preventatives for most dogs but think that Seiko will probably be fine without it. This is a calculated risk."

Casey continued, "Seiko's great love and affection for her family were never compromised during the course of her illness. If possible, she is even more affectionate then she was prior to her AIHA diagnosis. She is back to being ready to play, go for a walk or receive a hug at any moment, any day, any time. In celebration of her milestone of recovering from AIHA and marking the one year anniversary of her diagnosis of the disease, we took Seiko to the Oregon coast for a day or two of romping in the sand. I (Casey) took the photo that accompanies this story almost a year to the day after Seiko's AIHA diagnosis during that visit to the coast. It graphically speaks very well to her present state of health and happiness. If it were not our immediate reaction to her symptoms and our veterinarians quick and decisive action she would not be with us today. Never again will we take her for granted, and we give thanks daily that she is well and with us."

Seiko Update, May 2006

Casey recently wrote with the following Seiko update:

"Seiko is doing wonderfully and shows no signs of ever having AIHA. She will be 12 in June and does not act her age ... a new dog in the household has helped keep her levels of activity at a healthy pace. Our veterinarian writes letters to the dog licensing agency in our county every year to exempt her from getting the legally required rabies vaccination. Other vaccinations are voluntary and we elect to not inject her with anything. We also do not give her any heart worm preventative. We do use topical flea prevention treatments (the kind that doesn't get into the bloodstream).

"Seiko is still the darling of our vet clinic and pictures of her are on the walls in prominent places. New employees are told of her Success Story and encouraged to visit the Meisha's Hope Web site.

"Every day that our dear gal is with us is a blessing."

Seiko Update, February, 2007

Casey wrote recently with the following Seiko update:

”Seiko gets upside down with some frequency around here for chest & tummy rubs. It was during such an event that we noticed an irregular bump on her tummy. It was about a half an inch wide, an eighth inch high and reddish in color. It had to have developed quickly. We called our veterinarian the next day and she was seen the day after that. Our vet supplied the following narrative:

’Seiko was diagnosed with a mast cell tumor on January 10th, 2007. Because she had AIHA we took several precautions for her surgery on the 11th. We gave her oral pain medications, Metacam, prior to anesthesia. We did not give injectable anesthetic. She was induced and monitored on Sevoflourine, a gas anesthetic. We placed an intravenous catheter and admitted Sodium Chloride IV to maintain blood pressure and perfusion to her kidneys. We used a carbon dioxide laser to manage bleeding and post-operative pain. To prevent stimulation of her immune system, we did not place any buried sutures. All of the external sutures were removed two weeks after surgery. We used Metacam for post-operative pain control for one week. Metacam is a non-steroidal anti-inflammatory that has very few side effects’.

”Today Seiko is at near 100% levels and the skin on her stomach is stretching nicely to accommodate the missing tissue. She is one tough little trouper and proof positive that AIHA survivors can have serious health issues that are not related to the AIHA and have a full recovery.”

Seiko Update, September 2008

Casey wrote recently with the following Seiko update:

”Seiko turned 14 this summer and is doing well overall. She has a little dementia which is not severe. This is being controlled by Anipryl with no adverse reactions. Our new dog, Muldoon, is keeping her spry and active with daily running and jumping in the yard chasing Frisbee's. Actually it's Muldoon chasing the Frisbee with Seiko chasing Muldoon.”

October 2004

Briah

Briah is a 11 year old spayed female black Lab mix owned by Sharon of Washington DC. Briah was diagnosed with immune mediated-hemolytic anemia on June 29, 2001.

When Sharon was asked to comment on the onset of Briah's IMHA she replied, "Briah went to the vet on May 25, 2001 for a full check-up and DHLPP vaccination. Four days later she experienced difficulty getting up and maneuvering stairs and her hindquarters were sensitive to the touch. When Briah urinated in the apartment the following day I was concerned and took her to the vet for assessment. He thought Briah may have injured her hip, and even though no blood tests were performed, prescribed Rimadyl at a dosage of ˝ pill 2 times per day for 5 days. The Rimadyl was discontinued after 2 days when Briah started moving around more comfortably, however, her thirst and frequency of urination increased dramatically.

On June 2nd when Briah's increased thirst and urination continued in spite of water rationing, she saw one of the vets who thought she had a possible UTI (urinary tract infection). The antibiotic, Clavamox, was prescribed for 7 days, again no blood tests were performed. Having seen no improvement in Briah after 7 days on the antibiotic, we visited the vet again on June 11th to rule out other things such as Cushing's Disease, kidney or liver damage, or senility/aging. Blood tests and a urinalysis were performed at this time. When I pointed out a large lump on the side where the vaccination had been given, the vet said it was normal to see this kind of reaction. An X-ray and 2nd set of blood tests were done on June 19th. By this time Briah's thirst and frequency of urination had returned to normal and her activity level was good. The X-ray showed no signs of liver or kidney damage

Briah's energy level continued to be good for the next few days, but on June 27th she was slower to rise and did not eat her treats or food that evening. The following day Briah was panting more than usual and when she tried to walk was not very steady on her feet. When our regular vet could not see Briah until the following day, we went to the Veterinary Hospital at the University of Pennsylvania (VHUP) emergency service. Briah was admitted with a PCV 15 and given a transfusion and put on fluids. The next morning she was transferred to the internal medicine service and diagnosed with IMHA. Over the next 7 days Briah underwent a battery of tests to determine the cause of the anemia. Her scans, blood tests, and ultrasound all came back negative and it was concluded that the DHLPP vaccination she received in May was the trigger."

Sharon continued, "Briah was started on 80 mg prednisone, 4 gm Sucralfate, 20 mg Pepcid AC, and 200 mg Doxycycline per day. Briah was given two blood transfusions during her 7-day stay at VHUP. After the first transfusion, given in the emergency room upon admittance, her PCV rose to 25 then dropped to 22 and later 18. Another blood transfusion on July 1st increased the PCV to 30. Briah remained on 80 mg of prednisone for the next 3-4 days and her PCV increased to 40. On July 5th Briah was discharged from VHUP with the same meds to be taken on a daily basis, except for the prednisone which was decreased to 60mg. The Doxycycline was discontinued on July 12th after the Tick Titer came back negative. PCV's were performed on a weekly basis over the next few weeks and they hovered in the mid-to lower 30's. This made the vet question the discharge result of 40 concluding that the higher result could have been due to dehydration.

Briah continued to be a outpatient at VHUP and in mid-July 2001, her platelets dropped to 34,000 from the previous weeks normal result. One week later, her platelets rose to 90,000. The following week when Briah's platelets had stabilized, but were not yet normal, the vet thought it wise to add 50 mg Imuran (azathioprine) every other day (eod) to the treatment regimen in order to wean Briah off prednisone because of her enlarging liver. By Aug 7th Briah's platelets were normal at 434,000, her excessive eating and drinking were under control and she had enough energy to play and take short walks. As a result, the prednisone and sucralfate were decreased, the former to 40 mg/day while the 50 mg Imuran eod and 20 mg Pepcid AC were maintained. Blood test results on Aug 15th revealed a PCV of 37 and a platelet count of 705,000. That weekend Briah's stool suddenly turned to a liquid (diarrhea). I started feeding her a bland diet in hopes of firming it up, but when that didn't work, we went to VHUP emergency service for assessment. Briah was examined and her stool cultured. Drontal Plus (dewormer) and Metronidazole (antibiotic) were prescribed. The ER vet in consultation with her internal medicine vet recommended decreasing the prednisone to 30 mg/day. When no improvement was seen by the following day, I took Briah back to VHUP emergency services. She was admitted to the hospital and put on an IV due to decreased body fluids and increasing temperature. Once Briah was stable she was transferred to the internal medicine service. Her PCV had dropped to the mid-20's, platelets were 100,000 and clumped and she had developed a urinary tract infection. An ultrasound revealed a large blood clot had formed in her portal vein (85% occluded). Briah was placed on heparin and Baytril with the prednisone being decreased to 20 mg/day. Briah was discharged from VHUP after 3 days with a diagnosis of immune mediated thrombocytopenia (ITP). Briah's vet at VHUP was very surprised by the erratic platelet counts and did not see this as a classic case of ITP, however, ITP was added to her diagnosis. Upon discharge, heparin and Baytril were added to Briah's growing list of medications. Vet visits were very frequent, sometimes every two to three days, to adjust the heparin dosage. PTT's (Partial Thromboplastin Time, a test done to monitor the length of time it takes to form a clot) were performed every 2-3 days to make sure the heparin was doing its job. CBC's or PCV's as well as Chemistry panels, Coag panels, and reticulocyte counts were also done on a regular basis.

Because of the many side effects associated with prednisone, Briah's vet wanted to wean her off of the drug as soon as possible. Labs were performed on a weekly basis and decreases in prednisone occurred every 2 weeks providing Briah's labs remained stable and her behavior consistent. The prednisone was discontinued on December 11th 2001. Briah's PCV remained in the mid-30's for another month and in January 2002 rose to 40. Both Sucralfate and Pepcid AC were decreased as the prednisone dosage was lowered and were totally discontinued one week after the last dose of prednisone. The heparin dosage was changed often in order to maintain a prolonged PTT (50-80%) and totally discontinued January 11th 2002. The Imuran dosage was decreased incrementally from 50 mg eod to 50/25mg on 2nd and 4th days to 25 mg every third day and then completely discontinued April 12th 2002. Once the Imuran was discontinued Briah's vet visits became less frequent.

In April 2002, the vet discovered that Briah's RBC's were smaller than normal which could indicate a GI Bleed, however, there was no visible blood loss and Briah's energy level had not deteriorated. August blood tests revealed Briah's RBC's to still be smaller than normal despite a PCV now in the mid 40's. The vet felt the AIHA could have been masking a problem or this could just be the result of the steroid use. A CBC, Chemistry panel and Iron panel were performed in September 2002. The PCV and Chemistries were normal while the Iron panel revealed one test to be slightly abnormal. After consultation with a hematologist, it was decided to just monitor Briah since there were no outward signs of a problem. In January 2003, Briah visited VHUP for the last time and was given a clean bill of health. Her PCV was 47 and chemistry panel normal and the vet concluded at that time that the small RBC's were probably normal for Briah."

When Sharon was asked to comment on the current state of Briah's health, she replied, "Briah's last PCV was 54.2 on March 12, 2004 and she also had a normal chemistry panel at that time. Briah has been medication free for 2 ˝ years and all her hair has grown back quite gray. She has developed a few skin tags (some before her diagnosis) and a benign cyst on her leg, however none have been a concern. Briah has shown no signs of long term side effects from the various medications she endured over the 10 month period. Briah has received no vaccinations since 2001. VHUP recommended discontinuing all vaccinations and our current vet agrees with that recommendation. We discontinued Heartworm prevention when Briah was diagnosed with IMHA, but after due consideration and consultation restarted Interceptor in April 2004 with no visible side effects to date. No flea preventative has been used since 2001 and we do not plan on reinstating any. Overall, Briah is a happy, healthy, playful girl. She has slowed a little with age and sleeps a bit more, but Briah still loves going outside and rolling in the grass. And now that we are home with my parents she gets to do that whenever she wants. Briah fought so hard to stay here and I did everything that I could to help her do just that. I am just thankful for every extra day that she has been given to still be on this earth. Briah has brought so much joy and love to so many people. She will always be my puppy girl."

November 2004

Precious

Precious is a nearly 5 year old spayed female Cockerpoo owned by Amy and Patrick of Jupiter, FL. Precious was diagnosed with autoimmune hemolytic anemia on August 24, 2003.

When Amy was asked to describe Precious' symptoms prior to being diagnosed with AIHA, she replied, "we were away, on the West Coast of Florida, and our regular 'sitters' were caring for both our Cockerpoos at their home when Precious became ill. They called us Thursday, August 21, to let us know that Precious was lethargic and had thrown up in the morning. We thought she had just eaten something that disagreed with her and told them to call us back Friday morning if she wasn't better. On Friday morning, when the sitters noticed that Precious' feces were orange and her urine the color of coffee, they took her to our vet immediately. He gave her some shots, took a blood sample and told them to bring her in first thing the next morning, regardless of her demeanor. When we received this news from our sitters, plus learned that Precious was now really inactive and hardly walking, my husband flew home that night and I returned home the next day. By the time I arrived home, Precious had already seen the vet again and he had told my husband that he was 95% sure she had AIHA. We were also told that the survival rate for AIHA was not good."

Precious was hospitalized at the vet clinic where she was started on twice daily IV's as well as prednisone and antibiotics. Amy continued, "our vet met us at his office Sunday morning and by this time Precious could not move and was very jaundiced. She just laid on our shoulders when we held her. The vet told us that Precious was not responding well and that she had about a 10-15% chance of survival. He also said that he had confirmed the AIHA diagnosis, and that when we reached the 'last resort', he would do a blood transfusion. Since it looked like Precious might die, we asked if we could take her home and bring her back to the clinic for IV's in the mornings and evenings. If she was going to die, we wanted her home with us, not in a kennel, alone. The vet agreed and gave us phone numbers to reach him. He told us to call him if anything changed, no matter the time, and assured us he would come to the house or meet us at the clinic if necessary. That night I lined the bed with a plastic sheet so Precious could sleep in bed between us. We were thankful when she held on till morning."

Monday morning Amy & Patrick received a call from the veterinarian telling them to bring Precious in for a blood transfusion immediately. Blood test results indicated Precious had a PCV of 4.9. Precious' blood donor was the veterinarian's own Golden Lab, Maggie. Amy noted that, "according to our vet a PCV of 4.9 was not compatible with life. However, after the blood transfusion Precious started raising her head, drinking water and showing other signs of alertness. The vet encouraged us not to look at statistics and numbers but to pay attention to Precious' behavior. By Tuesday evening, Precious was eating well and quite active. When we went to the vet clinic for the evenings IV's and medications she tried to jump out of the car."

Precious continued on the prednisone and antibiotics. After her vet consulted with specialists, Cyclosporine was added to the treatment regimen along with Pepcid and Carafate to protect her stomach lining and prevent an ulcer. The twice daily IV's were given for a total of ten days before they were totally discontinued. As Precious' condition improved and her PCV rose, she was slowly weaned off all drugs over a period of 7 months. She has been medication free since March 2004.

When Amy was asked to comment on the current state of Precious' health she replied, "she seems more healthy and active then before she got sick. She runs like lightning and is actually a better behaved dog then before her illness. At her last blood test on July 30, 2004 Precious had a PCV of 40. We now know how truly precious life is and we thank God for our gals current stability. This dog has the spirit of a warrior. This was by no means an overnight recovery. Even though she seems great today, it was a long 7 months watching her get stronger and SLOWLY better. We are also thankful that we were blessed with a vet that cared, answered questions and consulted with other 'experts' when he made decisions. We will never take Precious or our good fortune for granted. We never saw this illness coming and it hit like a thunderbolt. At times we felt almost hopeless, however, the concern and caring of our vet and other people pulled us through with suggestions, information and encouragement. We remain hopeful for the future and want to convey to everyone to NEVER lose hope. Our experience is living proof that things can hit rock bottom and with hope, medicine and research, miracles do happen."

December 2004

Jessie

Jessie is a 9 year old spayed female Blue Merle Australian Shepherd owned by Jo-Ann and Dan of Santa Barbara, CA. Jessie was diagnosed with autoimmune hemolytic anemia on August 22, 2003.

When Jo-Ann was asked about Jessie's background prior to her AIHA diagnosis she replied, "We adopted her from the county animal shelter when she was about a year old. She had had three homes in her first year of life. The people at the second home were not even kind enough to take her into the shelter when they no longer wanted her, they simply dumped her in the overnight bin in the shelter yard. Our first year with Jessie was difficult since she had, understandably, the kind of attachment disorder suffered by children who are moved from one foster home to another. In time, however, she formed a bond with us, and we become a close-knit 'pack'. True to her breed, Jessie has always been an active, athletic and boundlessly energetic dog. From the moment I get out of bed, Jessie keeps nudging me to hurry so we can get out the door for our long early morning walk. On August 22, 2003, however, Jessie continued to lie down, long after I got up. I teased her about being old and lazy. She slowly got up when I picked up her leash, but showed none of her usual enthusiasm. I knew that something was terribly wrong! I called the veterinarian and was given an appointment for later that morning."

Upon arrival at the veterinarian Jessie's temperature was 105 and blood testing revealed a PCV of 22. The veterinarian diagnosed Jessie with AIHA and told Jo-Ann "that it was good that she had brought Jessie in when she did, had she waited even a few hours more, Jessie might have died. As it was, she had only about a 50% chance of surviving."

Jessie was immediately given a massive dose of prednisone and a dose of Imuran. Since it was thought that Jessie might need blood transfusions, the vet arranged to have Jo-Ann move Jessie to a critical care facility where she could be monitored and cared for 24 hours a day. Jo-Ann commented, "Jessie was started on 80 mg prednisone and 50 mg Imuran per day at the critical care hospital. Because her PCV fluctuated between 28 and 32, thankfully, she never needed transfusions. Jessie stayed at the critical care facility for five days. When she returned home, we thought that the worst was over and that she would continue to improve. How wrong we were! The prednisone had a devastating effect on Jessie. Even though, the dosage had been reduced to 60 mg a day, by September 5, Jessie was having difficulty getting up and staying up. She would struggle to get on her feet and then just collapse, unable to support herself. The vet told us that one side effect of prednisone was loss of muscle, and this was obviously happening to Jessie. When she could not even get up to urinate, my husband would pick her up and carry her outside. Her beautiful coat became dull and brittle, and her hair fell out. Her weight dropped from 67 to 52 pounds and still, the worst was yet to come.

"On Sunday, September 21, I noticed that the skin on Jessie's front elbows was very thin. I knew that it would be very dangerous if the skin cracked, because her suppressed immune system would not allow her to fight an infection. When the skin did crack, I put on antibiotic ointment and bandaged it, however, by the time we got to the vet, an infection had set in deeply. The vet cut out the infection, but because Jessie's skin was so thin and brittle, from the prednisone usage, she could not close the wound with stitches. Jessie had to spend another five days at the critical care facility so that the staff could constantly monitor and clean the wound. When Jessie returned home, both her front legs were totally bandaged. For almost a month, we had to return to the vet everyday to have the bandages changed. It was quite obvious that we had to eliminate the prednisone, but it had to be done gradually. We moved from 60 mg a day to 40, then to 20, next to 10, then to 5 mg with the last prednisone dose being given on October 20, 2003. For the first several weeks of treatment, while on high doses of prednisone, we also gave Jessie Pepcid AC. When her legs became infected she was given the antibiotic Baytril.

"There were a few times during that dark period when my husband and I wondered whether euthanasia would be a kindness. It was so distressing to see poor Jessie in the condition she was in and know that she was unable to understand why we and the vets kept doing unpleasant things to her. Finally the vet was able to stitch the wound. However, it was not until the end of November that the bandages were removed from Jessie's legs and the Elizabethan collar from her neck. She was beginning to regain her muscle strength, but her coat was still dull and thin. For the first time in over three months we were able to feel optimistic about Jessie's recovery."

When Jo-Ann was asked to comment on the current state of Jessie's health she replied, "Her PCV at her last blood test was 53. The Imuran was reduced to 25 mg per day on October 3, 2003 then totally discontinued on May 28, 2004 so Jessie has been medication free for a number of months. She has regained the weight she lost, and her coat is once again full, soft, and shiny. She has also regained her enthusiasm for life. It is so good to see her bouncing through the yard again. Since Jessie had vaccinations about two months prior to her AIHA diagnosis and vaccinations are a suspected AIHA trigger, we will never have her vaccinated again. Our veterinarian agrees with this decision. Jessie seems to be back to normal -- always eager to play Frisbee, always running way ahead of me on our walks and looking back as if to say, Why are you so slow? The vets and staff at the critical care hospital told us that Jessie has a very strong will to live. She certainly exhibits a great love for life for which we are very thankful."

Jessie Update, July 2007

Jo-Ann wrote recently with the following Jessie update.

”It is hard to believe that it has been almost four years since Jessie was so ill with AIHA. She is 12 years old now and has been very healthy since 2004. She has lost her hearing and is also a bit arthritic, but still very active. We continue to take our long walks every morning. Those many long months of struggling with AIHA and the ill effects of the Prednisone now seem like a nightmare. Jessie has not received any vaccinations since her illness.

”We have a second Australian Shepherd now. I rescued her after she had been abandoned in the hills near us. She and Jessie get along very well.

“I am so appreciative to you for setting up the Meisha’s Hope Web site. It was such a comfort to us when Jessie was so ill. I continue to read the Success Stories and I am so pleased to see that so many dogs are surviving this terrible disease.”

Jessie Update, July 2008

I recently received the following Jessie update from Jo-Ann.

”Jessie is now 13 years old and still very healthy. She is deaf and has some arthritic stiffness, but remains eager for our daily two mile walk. She has not received any vaccinations since her successful struggle with AIHA. I continue to read the Success Stories at the Meisha's Hope Web site and I am delighted to know that so many dogs are surviving this devastating disease. I am so grateful to you for setting up and managing this Web site. It has given owners of AIHA/IMHA dogs the hope and encouragement that they need during the darkest moments in the fight against the disease.”

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