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January 2005

Tessie

Tessie is a 12 ½ year old spayed female American Cocker Spaniel owned by Becky and Bob of Bedford, NH. Tessie was diagnosed with autoimmune hemolytic anemia on April 19, 1998.

When Becky was asked to describe Tessie's symptoms prior to being diagnosed with AIHA, she replied, "when Tessie became ill we were living in TX. My husband was caring for Tessie while I was visiting a friend in Pennsylvania. He reported that Tessie had a decrease in appetite and seemed a little down. He called the vet and was told this was probably due to my absence since Tessie and I have always had a special closeness. When I returned home Tessie jumped off the recliner to greet me and collapsed. We immediately took her to an emergency animal clinic. Upon admission to the emergency clinic the veterinarian pointed out to us the paleness of Tessie's gums and conjunctiva (the thin, transparent tissue that covers the outer surface of the eye). Blood testing indicated a positive Coombs test and a PCV of 19 which led to Tessie's AIHA diagnosis."

Tessie was hospitalized overnight at the emergency vet clinic where she was given a blood transfusion and oxygen. She was also started on prednisone and antibiotics. Later Imuran was added to the treatment regimen. Becky noted, "Tessie received prednisone and Imuran from 1998-2001. Initially the prednisone and Imuran were given daily and then gradually tapered to an every other day schedule. When we moved to New Hampshire in September, 2000, with the encouragement and guidance of our new vet, we were able to slowly take Tessie off both prednisone and Imuran.

In August 2002, Tessie suffered severe back pain and was limping on her right back leg. When prednisone and anti-inflammatory medications did not control the pain, we took Tessie to an animal neurological clinic in Portland Maine, where she had surgery to relieve these painful episodes. She recovered well from this surgery. Later Tessie developed a urinary track infection which was treated with a course of the antibiotic Clavamox at 250 mg for 2 weeks. Then in February 2004 Tessie became increasingly weak and was not eating as quickly (previously she has usually inhaled her food) as usual. I took her to the vet where x-rays indicated that Tessie had fluid in her abdominal cavity. Surgery revealed Tessie had a tumor on her spleen. A splenectomy was done and the pathology came back positive for cancer. We decided that chemotherapy would be too difficult for her and opted not to proceed with that treatment. When Tessie's PCV dropped to 22, the day following the splenectomy, she was taken back to the emergency clinic since it was thought that the AIHA was again going to be a problem. At that point, we didn't want to restart prednisone because we felt it would interfere with the healing process so we decided to just wait and see what happened. True to her nature and tremendous will to live, Tessie's PCV began to rise and by August 2004 was 45. When Tessie started to show signs of back problems again in July 2004 she was started on 2.5 mg prednisone every other day. She continues on that prednisone dosage to this day and also takes .2 mg Soloxine for hypothyroidism which was diagnosed several years before her AIHA.

In regard to vaccinations, Tessie receives only a rabies shot every 3rd year and that is only because in the town of Bedford, NH it is mandatory. When we lived in TX, a note from our vet to the city permitted Tessie to be exempt from the rabies immunization. After I was summoned to court in NH, I tried through a lawyer, to have her exempt from the rabies vaccine, but the town would not agree so Tessie has had the rabies vaccination in 2000 and 2003. She receives prednisone before and after receiving the immunization. To date she has not had any problems from the rabies vaccine that we can relate to. We do titers for both distemper and parvo. So far they have come back within the acceptable range. However, at this point, I would not immunize her for those diseases even if titers came back low because of her low risk and exposure to these diseases."

When Becky was asked to comment on the current state of Tessie's health she replied, "she is doing great. She had a complete physical exam in early November 2004, including an ultrasound of her abdomen to make sure nothing was lurking there and it came back looking good. She is more active then I have seen her in several years, her appetite is great and she just seems to enjoy life. Tessie is a remarkable dog and a true fighter. She has been through so much illness in her 12+ years and through it all has remained a sweet loving dog. We don't know what the future has in store but we do know that Tessie has a strong will to live and she will be given every chance possible to do so."

Tessie Update, August 2005

The following Tessie update was recently received from Becky.

"It is with much sorrow that I write to you. Tessie passed away on Wednesday, August 17, 2005. Since June her appetite had not been as exuberant and I noticed that she was gaining weight and her abdomen was swollen. Through an ultrasound it was discovered that her liver was diseased with cancer. Tessie had been through so much illness in her 13 years - IMHA, back/disc surgery, cancer of her spleen/splenectomy, and a stroke in April. This little dog just wouldn't give up on life and persisted through it all with such a positive attitude and sweetness that I will never forget. I learned so much from her - about living life to its fullest".

February 2005

Jazzy

Jazzy is a 3 year old spayed female Border Collie/Australian Cattle dog mix owned by Cheri and Tom of Clinton Township, MI. Jazzy was diagnosed with autoimmune hemolytic anemia on October 16, 2003.

When Cheri was asked to describe Jazzy's symptoms prior to her AIHA diagnosis she replied, "at the onset of the disease, Jazzy became very lethargic and sleepy and refused to eat. She didn't walk more then 10 or 12 steps at a time before lying down. We knew that something was wrong, but we thought that she just had some kind of a bug. After she fell over a couple of times, we knew that there was something very wrong. Jazzy came down with AIHA about four days after receiving a live distemper/parvo/coronavirus vaccination along with a rabies vaccination. She was vaccinated on a Friday and by Tuesday she was so ill that we took her back to our vet. They told us that her PCV was 18, gave her a shot, sent her home and told us to come back on Monday. By Thursday Jazzy had so little life left in her we took her to a different vet where she was immediately hospitalized."

While hospitalized, Jazzy received IV fluids, Prednisone, Doxycycline, a Kefzol injection, and Clavamox. An ultrasound was preformed along with a urinalysis and blood panel. Jazzy's PCV at the time of her AIHA diagnosis was 13. Two days after being admitted to the veterinary hospital, Jazzy was allowed to go home. She was released from the hospital on the following medications; 100 mg Doxycycline, given once per day, 40 mg prednisone administered twice per day as well as 250 mg Metronidiazole (Flagyl) per day. The Flagyl was discontinued after two weeks. When about a month later, Jazzy began to have stomach problems and bloating , she was started on 250 mg Cimetidine (Tagamet) twice daily. As Jazzy's PCV began to rise her prednisone dosage was very slowly decreased. In June 2004, eight months after her AIHA diagnosis, Jazzy received her last dose of prednisone.

When Cheri was asked to comment on the current state of Jazzy's health, she replied, "she's back to her old self. She is once again running laps around the house, playing with our socks, hopping up on the bed, terrorizing our other dog and various squirrels at every opportunity, as well as playing tug of war and chasing her ball. In July 2004, when Jazzy's PCV was 38.5, our vets told us we should start her back on 5 mg prednisone every other day. We chose not to do that, since she showed no signs of illness. She's been fine ever since. Her PCV at her last blood test in September 2004 was 37. Because Jazzy developed AIHA right after receiving vaccinations, our current vet told us that she should never receive vaccinations again. Jazzy still carries a bit of extra weight with her, but it just may be that she is growing up and has filled out. All in all Jazzy is a happy, energetic dog that keeps us on our toes."

Cheri continued, "I would urge anyone who has a dog diagnosed with AIHA/IMHA to inform themselves about the disease and realize that it takes a while for a dog with AIHA/IMHA to get better. Most importantly, find a vet that is familiar with the disease! Jazzy would not be here today without the care of our current vet. We had to call around to find a vet that was a specialist, and we are convinced that Jazzy would not be with us without this vet and his staff's expertise. The single best piece of information this vet gave us was 'not to get wrapped up in the numbers - the PCV or everything else. You will know if your dog is getting better or worse, because you know him/her better than anyone else.' With perseverance, patience, and a lot of love, things can work out."

March 2005

Misty

Misty is a 13 year old spayed female Shih Tzu owned by Elaine and J. D. of Wichita, KS. Misty was diagnosed with autoimmune hemolytic anemia on August 11, 2003.

When Elaine was asked to describe Misty's symptoms prior to her AIHA diagnosis she replied, "Misty's AIHA came on very suddenly. It appeared to come on within a matter of 2 to 3 hours. She experienced a sudden onset of seizures, hematuria (blood in the urine), pale gums, tongue and skin as well as extreme weakness."

Misty was taken to her local veterinarian where blood testing revealed a PCV of 6. A positive Coombs test and agglutination on a blood slide caused the vet to tentatively diagnose Misty with AIHA. Misty was given Phenobarbital to control her seizures as well as prednisone and an Oxyglobin infusion. On August 13, Misty was transferred to the Kansas State University Veterinary Teaching Hospital in Manhattan, Kansas. Elaine noted, "when Misty was admitted to the ICU at KSU she had a PCV of 8. She was diagnosed with AIHA and started on Prednisone, Doxycycline both in tablet form and Intramuscularly, Sucralfate, Pepcid, Azathioprine, and Potassium IV. Misty received 2 blood transfusions during her 6 day hospitalization at KSU along with Lactulose and Insulin three times a day due to the development of diabetes secondary to the prednisone and azathioprine."

Elaine continued, "it took a very long time for Misty to slowly regain her strength and stamina after she was released from KSU. As her PCV increased she was slowly weaned off the prednisone and azathioprine. She became totally drug free in March, 2004. Misty's diabetes resolved itself with the removal of the prednisone and azathioprine. Misty receives no heartworm or flea/tick preventatives. She has received no vaccinations since her AIHA diagnosis because our veterinarian feels they could be detrimental to her immune system."

When Elaine was asked to comment on the current state of Misty's health she replied, "Misty's current health is good. Her PVC at her last blood test was 49. She is very alert and guards the front door of the house with her wonderful barking. She loves to go outside for walks. She continues to run, jump and chase her favorite toys as she did before she became ill. We are happy to say that Misty's personality is just as it was before the AIHA…..loveable! Misty is a loving adorable pet and we cherish each day the Lord allows her to stay in our care. It has been a long road back from the AIHA but we feel blessed to have our little girl with us and hope she will be here for a long time to come."

Misty Update, October 2006

Elaine wrote recently with the following Misty update.

“We would like to add the following postscript to Misty's AIHA Success Story. We lost Misty on September 29, 2006 to the increasing problems of age. She had become quite infirm in her rear quarters, although she could still navigate using sheer will power. We feel that the problems with her rear legs was due, in part, to the high doses of prednisone she took for the treatment AIHA. Thankfully, Misty did not have an AIHA relapse, but her health had declined markedly during the past 12 months. She was the light of our lives, our little girl, and she is missed to the very core of our being.....we are hoping there really is a place for these loving animals/family members in Heaven and that we will see her again”.

April 2005

Sierra

Sierra is a 3 year old spayed female Alaskan Malamute owned by Ronda of Reseda, CA. Sierra was diagnosed with autoimmune hemolytic anemia on May 27, 2003.

When Ronda was asked to describe Sierra's symptoms prior to her AIHA diagnosis she replied, "I adopted Sierra from Southern California Alaskan Malamute Rescue in May 2003, after having lost my previous malamute to cancer. Each time I visited SCAMR, I was drawn to watching Sierra run and play. She was so energetic, active and alert and had the clearest eyes. She displayed no symptoms while in Rescue and it's assumed her former owner knew nothing of this. Her prior medical record, which was obtained later, did indicate mild to moderate anemia and low platelets prior to being vaccinated, spayed and placed in Rescue. When I requested her spay and rabies certificates, the veterinary clinic only said that she was 'mildly anemic and this was not surprising'. Within a day of Sierra's adoption she started spontaneous bleeding (drippy, bloody nose & sneezing clots) and I noticed petechia (bruising or tiny, pinpoint reddish areas caused by bleeding) on her abdomen. She was taken to the veterinarian where testing revealed this spontaneous bleeding was due to an extremely low platelet count of 16,000. She was also moderately anemic but the anemia was not severe at this point.

On May 25, Sierra received an injection of Vincristine to cause a release of platelets from the bone marrow. She was also placed on 80 mg prednisone twice per day, Doxycycline (in the event of a tick related problem since this was before results of the tick titers were known) and Flagyl for stomach upsets. Sierra's prognosis was very poor at this time and neither veterinarian treating her held out much hope for her survival for any moderate length of time. Within a couple of weeks, it became clear that the standard treatment of prednisone was not working in Sierra's case. She had lost 10 pounds in 2 weeks, despite eating more than twice a normal ration of food for a young dog her size. On June 17, I noticed the inside of Sierra's ears were white and her gums were nearly white. Blood testing revealed Sierra's PCV had dropped to 15. In addition, all her other blood counts and chemical values were out of the normal range. She was given a blood transfusion and a bone marrow aspirate, ultrasound and x-rays were done. Even though Sierra had little energy and didn't want to move around much, she was still interested in what was going on around her. She seemed to be telling me that she wasn't going to give up. 100 mg Cyclosporine twice per day was added to the treatment regimen and we started to quickly wean Sierra off the prednisone because of all the side effects she was experiencing from that drug."

Ronda continued, "Sierra was on a variety of antibiotics during the first year of her illness due to minor to moderate infections. Many of these infections were skin infections, some of which were accompanied by high fevers (up to 105.5). I became increasingly frustrated with the cycle of antibiotics. There were times when no infection was outwardly apparent, yet her white blood count was high and tests indicated some kind of bacterial infection so she would be placed on antibiotics again. When I felt that Sierra's anemia had been stable for several months, I began to make inquires about finding a local holistic vet. One of these inquiries led me to meeting a holistic vet who I added to Sierra's health care team. Since the addition of a holistic vet to Sierra's health care team, she has not had an infection and the infection that was showing in her blood tests was resolved without the use of additional antibiotics. We changed her diet from kibble to homemade (though not raw meat), and added vitamin and mineral supplements and a couple of Chinese herbals for her itching problems. Sierra also receives an acupuncture session once a month when we go for blood tests. It should be noted that I am not against antibiotic use. What was troubling was that we could not seem to get out of the antibiotic cycle for any length of time and I felt this was a harbinger of trouble looming directly ahead. The traditional group of vets, whom I respect, simply offered no real guidance other than, 'well, it is what it is and this is all we can do for it.' No consideration was given to possible dietary changes or additional bathing or anything not found in a pill or injection. At the present time Sierra is taking 50 mg Cyclosporine per day as well as the following Vitamins/supplements: Fish Oil Capsules, 2 per day, 1 am & pm; Vitamin E 400 mg, 1 per day; Ester C 500 mg, 2 per day, 1 am & pm, Mezotrace, 3 per day, 2 am & 1 pm; Pectin, 1/4 tsp each meal, am & pm; Animal Essential's Digestive Enzymes with pro-biotics, 3/4 tsp each meal am & pm, 1 kelp tablet, am and Vitamin A 25,000 mg ,1 per week. The following Chinese Herbal Supplements for itch control are also a part of Sierra's regime: Skin Balance, 6 per day, 2 am, 2 at noon, 2 pm; Xanthium Relieve Surface, 4 per day, 2 am & 2 pm. Sierra receives no heartworm or flea/tick prevention. She has not been vaccinated since her illness and will not be vaccinated in the future. A letter from one of our vets is on file with Animal Control officials in our town exempting Sierra from the rabies vaccination as well."

When Ronda was asked to comment on the current state of Sierra's health she replied, "Sierra is doing great. Her PCV at her last blood test on March 16, 2005 was 48 and her platelet count was 308,000. We have not been to an emergency room in over 6 months! She has not taken antibiotics in 7 months! Her energy and enthusiasm are as high as ever and sometimes I just have to sit back and let her zoom around the house with her 'puppy crazies.' At 90 pounds, she can be a little hard to stop. Sierra was diagnosed with Evans Syndrome, AIHA plus immune mediated thrombocytopenia (ITP), within a couple days of her adoption at 15 months of age. Now, at just 3 years old, she has already battled this for over half of her life. Despite the 5+ months it took for her PCV to climb to low normal levels, it has not dropped below 'low-normal' for over a year. She is happy, full of life, enjoys her daily walks and playtime in the house. We continue to go to a weekly obedience group and she always looks forward to playtime with her canine friends. In November, 2004 Sierra participated in the Rescue Showcase at the Alaskan Malamute National Specialty Show in Utah. At this event rescue dogs are highlighted in the show ring with an announcer telling the dog's story and anything else the owner wants the audience to know about their dog. Each dog is called into the ring one at a time and gets to individually parade in the show ring. Everyone applauds every dog and the good feelings really are quite tangible when you are in the ring with your dog. Once the applause began, Sierra got even more excited and happy. You could tell she felt great and enjoyed the attention. She held her head high and had quite a bounce to her step. Of course, there are sometimes tears when a dog's story is told, but that only makes it more special. In Sierra's case, I made it a point to have her AIHA battle highlighted since I wanted everyone to know that this can happen to any dog. When people hear your dog has an auto-immune disease, often the comments are 'how sad, that's terrible, or I'm so sorry'. I wanted to show that in spite of the odds, there are often good times and great times still to be had. Living with AIHA can be a large investment of not just money, but of time and of emotions. The upside is, each good day is a blessing. My awareness of what is truly important has somehow become more crystallized as we have gone through Sierra's illness and continue to live with her condition. I believe I have become a better guardian of all of my pets health and well-being than I previously was, therefore, I am indebted to Sierra for the things she has taught me since was diagnosed with AIHA and ITP."

Sierra Update, June 2008

Ronda wrote recently with the following Sierra update.

"In 2005, Sierra was diagnosed with Auto Immune Corneal disease and dry eye syndrome, which became severe. Despite aggressive treatment, this resulted in a corneal transplant in her right eye, and sadly, the loss of her left eye. She was also diagnosed with mild renal dysfunction. In 2006, Sierra underwent a parotid duct transposition for her right eye, after 7 months of escalating treatment failed to stabilize her limited tear production. This surgery was very successful for her. Dietary changes ultimately brought her kidney values back to normal and they remain there thus far. In 2007, prior to surgery to remove some benign small lumps, Sierra was diagnosed with chronic bronchitis. Her symptoms included some exercise intolerance and a small amount of coughing when excited or getting too warm from exertion (long walks). Monitoring her activity level, shorter walks, and ensuring she gets adequate rest when we travel or go visit friends for the day have worked well to manage this. She will not be given prednisone (common for this condition) as she does not do well on it. Her most recent blood work in March 2008 showed HCT 43; Platelets 278K, which are great numbers. We plan on participating in the "Rescue Parade" at the Alaskan Malamute National Specialty again in November of this year, where her AIHA battle will be highlighted. And for the third year in a row, I will again take out an ad in the show catalog hoping to educate attendees about AIHA/IMHA. I am hopeful this ad will result in some donations to the Meisha’s Hope AIHA/IMHA Fund #338 at Morris Animal Foundation as well as open some discussion among dog fanciers/breeders about this disease.

"Sierra still has an incredible amount of joy and love of life despite her many set backs. She is always ready to go and do ... anything. Nothing has changed her exuberance and happiness at just being. The discipline I've had to apply to Sierra regarding nutrition, medication, rest, complementary therapies - and which I've applied to all my other pets as well, I now apply to myself too. So again, I have to thank her for all the things she's taught me."

May 2005

Casey

Casey is an 8 year old spayed female, Shetland Sheepdog owned by Heather of Aiken, SC. Casey was diagnosed with autoimmune hemolytic anemia in August 2003.

When Heather was asked to describe Casey's symptoms prior to her AIHA diagnosis she replied, "there were no super-scary symptoms like collapse or panting or anything that I've read that other folks have seen. I noticed three small things over the course of 24 hours: 1) She had a little bit of a runny nose-not like a cold, but just a clear discharge 2) her left eye was watering a little bit and she was rubbing it and then the next morning 3) she wasn't eating much. I've had Casey since she was 12 weeks old and we are rarely apart for more than a few hours while I am at work (unless I am traveling and can't take the dogs) so I feel as if I really know her. I just felt like something was 'off' and immediately called the vet.

When we arrived at the vet, Casey was weighed and I was shocked to learn that she had lost 7 pounds, which brought her weight down to only 15 pounds. Casey was given an injection of antibiotics and blood was drawn for a Coombs test and CBC. Based on the results of the CBC Casey was started on high doses of prednisone. When the Coombs test came back positive, the vets started her on a combination of prednisone and Imuran. As Casey's blood work improved, we gradually reduced the prednisone until the dosage was zero and then we started to reduce the Imuran until her blood levels were stable for three monthly checks in a row. Casey currently takes 20 mg Imuran (azathioprine) twice per week. Casey had all of the typical side effects from prednisone such as weight gain, panting and thirst. The day after she took her last dose of prednisone she had an incidence of colitis. This may have been completely unrelated to the prednisone but it did result in bloody diarrhea. She was again given an antibiotic injection and some anti-diarrhea meds. The next day she was fine. Once the prednisone was discontinued, Casey became much less bloated. My veterinarian was able to arrange for me to have Casey's Imuran made for her at the compounding pharmacy at our local hospital. It took them a few days to locate fillable capsules that were appropriate for canine use but since then I've been able to get the capsules within 24 hours whenever I've called for refills. I recommend this to folks whose dogs use this drug because it saves some money and it saves having to break pills apart. Casey has gained back four of the seven pounds she lost at the onset of her illness, which puts her at her ideal weight of 19 pounds. She had her three year rabies vaccination on March 28, 2005 and had no adverse reaction to it, but she will not be vaccinated for any other diseases. For heartworm prevention we use Heartgard Plus. I have read some of the information 'linking' AIHA with use of ingredients in this medication but I'm not at all convinced that there's a statistically significant link between the two. I feel that the benefits of heartworm preventative outweigh the risks especially in the South. If I am taking the dogs camping, I use BioSpot for flea and tick prevention but otherwise I use nothing for fleas and ticks since they have not been a problem for me in this area."

When Heather was asked to comment on the current state of Casey's health, she replied, "I am so happy to report that she is doing very well. She is a typical Sheltie who loves all people. She's attentive and follows me around as an escort in and out of the house. She especially enjoys playing with a flashlight (sort of like a cat does!) and squeaky toys, which she knows by name. I take her with me everywhere I can because she really does love riding in the car. I'm a biology professor and I occasionally bring her to class to represent the mammals and she often comes to weekend review sessions to help relieve some of my student's stress. Her blood work has been within the normal range for the last 10 months. She did undergo a slight personality change after the onset of AIHA but I'm not sure if that's related to disease or it's attributable to her age. At 8 years of age, she is a little slower and tires more easily then she used to but she is back to ruling the house with full force. I feel so lucky to have gotten an accurate diagnosis as quickly as I did so we could begin proper treatment. Sheltie's often live to be 15 years old and I am optimistic that Casey will have a great, healthy rest of her life."

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