PREVIOUS SUCCESS STORIES

September 2005

Bella

Bella is a 3 ½ year old spayed female Boston Terrier mix owned by Joyce of Dayton OH. Bella was diagnosed with autoimmune hemolytic anemia on January 30, 2004.

When Joyce was asked to describe Bella’s symptoms prior to being diagnosed with AIHA, she replied, “the disease came on very quickly. She was fine one day and the next day I noticed her ‘hiding’ in the bathroom. She only went in the bathroom when she had done something wrong, so I was unsure as to why she was in there. At bedtime she wouldn’t come out so I had to carry her to bed with me. At other times Bella just laid on the couch, only getting off to go to the bathroom. She had also stopped eating and was running a fever of 104. After two days of her changed behavior, I took her to my vet.

When we got to the vet’s office they thought Bella had hurt her knee and was quiet because she was in pain. However, that did not explain the fever. The vet gave Bella a 2mg shot of dexamethasone and did blood work. The next day he called me and told me to bring Bella in immediately since the blood test results indicated she was very sick. Her PCV at that time was 22 with a WBC of 22. Bella was given 200ml of lactated ringers, a Baytril injection and put on Amoxicillin. She was also started on 10 mg of prednisone twice per day. Two days later when Bella’s PCV had dropped to 20, the Amoxicillin was discontinued and 250 mg Tetracycline twice per day was started. I was referred to a veterinary internal medicine specialist who increased the prednisone to 20 mg twice per day and added 10 mg Pepcid AC, twice per day, as well as 25 mg Imuran (azathioprine) once per day to the treatment regimen. Bella’s PCV continued to drop for a while and fell to 13 before it started to rise.

When Bella’s PCV reached into the 30’s we, started to reduce the prednisone by 25% once a month. We continued to do a CBC every week to make sure that the prednisone reductions were warranted. The Pepcid AC was reduced along with the prednisone and stopped when the prednisone was discontinued. After the prednisone had been totally discontinued we reduced the Imuran to 25 mg every other day. A month later the Imuran was reduced to 25 mg every third day. Bella continues on 25 mg Imuran every third day since her vet feels that she should remain on that dosage for the rest of her life to prevent AIHA relapses. She also takes 500 mg glucosamine and 250 mg chondroitin to rebuild the cartilage in her knees.

Bella’s vet recommended that she never be vaccinated again. She did not receive any vaccinations for a year and half. However, in June 2005, when a dog I was ‘fostering’ became ill, we tested him for distemper & parvovirus and the tests came back positive. Sadly, the dog died after only 3 days of treatment. My veterinarian recommended that Bella receive a distemper/ parvovirus vaccination as a precaution against the diseases. Bella received a steroid injection at the same time as the vaccination. My vet said that some studies have shown that while weakening the vaccine, somewhat, the steroid injection helps to prevent the body from reacting as badly to the vaccine. Bella received the vaccination and steroid injection on a Thursday. We did a CBC on the following Monday and everything was normal. She has continued to have normal CBC’s since that time. At the present time Bella is on no heartworm prevention. I use Frontline for fleas/ticks only if I see that the dogs have fleas. I called the manufacture of Frontline and spoke to their vet who told me Frontline has not been a problem for dogs with AIHA because it is a topical solution.”

When Joyce was asked to comment on the current state of Bella’s health she replied, “Bella continues to do well and amazes me with her forward progress. We continue to do blood work every two weeks. Her last blood check was on August 22, 2005, at which time she had a PCV of 51.4. Bella was a very energetic, playful pup who was always getting into something (chewing shoes, shedding paper, etc.). After she became sick she stopped doing all that. She seemed to have aged overnight. I knew she was getting better when I found her chewing my slippers several months ago. She still rests a lot and doesn’t have the hyper energy she had prior to her illness but she does come out and play with my pug quite a bit and she LOVES sitting on the porch when it is warm enough. This has been a journey with many ups and downs along the way. I feel that Bella would not be here today, if it weren’t for my wonderful and awesome vet. His continued kindness and caring has made this journey so much easier for us both. While I feel this disease has aged Bella somewhat, I look at how far she has come and where we could have ended up and I thank God every day that He chose to let my precious girl stay with me for the time being.”

October 2005

Hamlet

Hamlet is a 6 ½ year old neutered male, miniature schnauzer owned by Marc and Patrick of Princeton, NJ. Hamlet was diagnosed with immune-mediated hemolytic anemia on March 14, 2004.

When Marc was asked to describe Hamlet’s symptoms prior to being diagnosed with IMHA he replied, “The illness came on overnight. Hamlet seemed fine on the evening of Wednesday, March 10, 2004. He ate his regular dinner and all other indications were fine. The next morning, he vomited his entire stomach contents from the night before. After being coaxed he ate a little breakfast, which he threw up within minutes. He was completely listless and lethargic. That afternoon, when we noticed his urine was blood-red, we took him to our local vet.

Our regular vet, who is ABVP board certified, was unavailable for the first office visit. His associate saw Hamlet, who presented with lethargy, vomiting, fever, discolored urine, and an icteric, anemic appearance. Blood was taken for a full-work up, and we were directed to withhold food, monitor his temperature, administer aspirin for discomfort and fever, and allow him to rest. By the next morning Hamlet’s fever had returned and his symptoms had worsened. We saw our regular vet who immediately admitted Hamlet for IV fluids and monitoring. A battery of tests, including direct Coombs, urinalysis and urine culture, x-rays, ultrasound, and a second round of blood tests were performed. An on-slide agglutination test was negative. Hamlet was given 20 ml. of the antibiotic Baytril, and 10 ml. Reglan, for nausea and vomiting. When the blood work came back, he was transfused with Oxyglobin, and started on 50 mg azathioprine (Imuran) and .25 mg dexamethasone (Azium). At 9:00 pm on Saturday night, March 13th our vet called and told us that Hamlet’s PCV had dropped to 18, and that his clinical signs were ‘not good.’ On prodding, he said he thought Hamlet might not make it through the night. We then rushed him to the University of Pennsylvania’s Ryan Veterinary Hospital. He was admitted to Ryan at 10:30 pm. On admission, his PCV was 13 and he was immediately transfused. At that time there was insufficient information to confirm the IMHA diagnosis. The E/R doctor said she didn’t know for sure if they could save Hamlet, but said she ‘thought so’ and they would do their best. By Sunday, Hamlet’s PCV was up to 21, evidently in response to the transfusion. On Sunday, we also got test results from the brief in-patient admission at our local vet’s. The Coomb’s test was negative, chest x-rays were clean, only incidental ultrasound findings and the tick disease panel was negative. By that evening, the steroidal therapy had brought the hemolysis under control. Hamlet was given another transfusion, and his PCV remained stable at 21. He was (re)started on Imuran. A urine culture was negative for bacterial growth and the antibiotic was discontinued. On Monday, March 15th Hamlet’s PCV was up to 34, his vomiting had stopped and his lungs sounded better. He was also sitting up and looking around. Drug therapy included Imuran and prednisone as well as Heparin, to prevent pulmonary thromboembolism, and famotidine (Pepcid) to decrease stomach acid formation and prevent ulceration due to the prednisone. On Wednesday, March 17th Hamlet’s PCV was 39 and he had ‘a ravenous appetite.’ He was discharged that afternoon on the following medications: Imuran 25 mg, once per day, prednisone 10 mg twice per day, Pepcid 5 mg once per day and Heparin 0.86ml, subcutaneous, three times daily.

One week later, we went back to Ryan Veterinary Hospital for a follow-up visit. Hamlet’s activity level had improved considerably, his appetite was excellent and urine color was normal. Blood work indicated his PCV was 30, platelets 272, coagulation normal, and there was a ‘moderate’ presence of spherocytes. Liver enzymes were elevated from the prednisone therapy. All medications were continued as before, except for the Heparin, which was tapered by cutting the dose in half for three days and then administering that half-dose twice a day for two days, then once a day for two days and then discontinue. We were directed to obtain a CBC with a reticulocytes count and spherocytes evaluation ten days later. The PCV drop from 38 to 30 was likely due to an overlap from the dissipation of the positive effect of the last transfusion and the time it takes the body to regenerate its own red blood cells. Ten days later, Hamlet’s PCV was up to 40, no spherocytes were noted, and platelets were at 369. Reticulocytes were high, but that was to be expected as evidence of blood cell regeneration. The prednisone dosage was halved, to 5 mg twice daily, and the Imuran administration was halved, to 25 mg every other day, while the Pepcid dosage remained unchanged. During the next several months, Hamlet had frequent blood work done. As his PCV continued to rise and stabilize the medications were slowly reduced. On September 18, 2004, slightly 6 months after the onset of the first IMHA symptoms, Hamlet became medication free. His PCV at that time was 41.7."

When Marc was asked to comment on the current state of Hamlet’s health he replied, “Hamlet’s last blood work was done on August 27, 2005. His PCV at that time was 50.6 and everything else, including platelets, were in the normal range. Hamlet is currently on no medications for the treatment of IMHA. We do give him a fish oil supplement to help control high triglycerides, which is a common problem with miniature schnauzers. He receives Heartgard for Heartworm prevention and Advantix as a flea/tick preventative. The Ryan Veterinary Hospital discharge instructions specifically stated that we should ‘not have him vaccinated unless we feel he is at high risk’. A follow up conversation indicated that we should avoid future vaccination of Hamlet due to the possible link between vaccination and IMHA. We did, however, do titers to determine immunity to parvovirus, distemper, and corona, all of which were adequate."

Marc continued his comments by saying, “Hamlet is 100% back to his old self -- he’s energetic, sweet, insouciant, care-free, and utterly charming. It’s virtually impossible to believe that he was ever as ill as he was. In writing up Hamlet’s story, two things stand out to me. The first is discolored urine as a symptom; any pet with discolored urine should immediately be taken in for examination. Whether or not the diagnosis leads to IMHA, the symptom is always extremely serious. Secondly, in dealing with a potential IMHA diagnosis, it is vitally important to have a lead veterinarian experienced in treating IMHA, and to have a care facility with the capacity for 24 hour monitoring. While there are many wonderful veterinary practices, a university veterinary hospital is optimal for a number of reasons, including likely familiarity with the disease, 24 hour care, and the capacity to generate immediate on-demand diagnostic test results. Ryan Veterinary Hospital at the University of Pennsylvania is a particularly excellent resource. It’s a top-notch facility and everyone there was kind and concerned. We were very lucky to have had Ryan to deal with during the acute phase of the disease, and then to have a committed local veterinarian who cooperated fully with the doctors at Ryan to monitor and treat Hamlet through the post-acute phase."

November 2005

Shelby

Shelby is a 2 year old neutered male, Black Lab/Catahoula mix owned by Teri and Brent of Stonewall, LA. Shelby was diagnosed with autoimmune hemolytic anemia on December 28, 2003 at the age of 4 months.

When Teri was asked to comment on events leading up to Shelby’s AIHA diagnosis she replied, “On December 10, 2003 Shelby became ill after chewing up a shoe and was taken to a vet close to our home. After he recovered from that incident, we returned to the vet on December 17th for a checkup. The vet inquired as to whether or not Shelby had been vaccinated and I replied that he had, that we had purchased the vaccine from the farmer’s co-op. The vet responded that he did not like the co-op’s vaccines and that he wanted to revaccinate Shelby. When I asked him if he was sure this would not hurt Shelby, he replied ‘that they did it all the time.’ Eleven days after the revaccination, Shelby became ill. His symptoms included weakness, to the point of hardly being able to get around, very heavy breathing as well as gums and tongue that were so pale, they were nearly white.”

Teri continued, ”I took Shelby to the Animal Emergency Clinic in Shreveport, LA. where they immediately started running tests on him. Results of these tests indicated that Shelby had a temperature of 101.3, abnormal respiration rate, heart rate of 88 and that his pulse was strong. His gums where pale white with yellow tinges. X-rays showed Shelby’s spleen appeared to be enlarged, while blood testing indicated that his PCV was 10.5. The vet informed me that in order to keep Shelby’s vital organs from shutting down they were going to have to give him a blood transfusion, however, all they had available was Oxyglobin. Shelby received three 125 ml bags of Oxyglobin to keep him alive until we could get him to his regular vet the next morning. The vet at the Emergency Clinic said it looked like Shelby had AIHA. The next day my husband took Shelby to the animal clinic to confirm the AIHA diagnosis and start treatment. When Shelby arrived at the clinic his PCV had risen to 22. The vet did an ultrasound on the spleen to see if it would need to be removed. The vet felt he could treat Shelby with medications, without removing the spleen, so we started him on prednisone and were told to bring him back one week later.

When we returned to the clinic the following week, Shelby’s PCV had fallen to a level lower then it had been prior to the Oxyglobin infusions. We were told that Shelby needed a blood transfusion. The nurse at the clinic said her dog was a donor dog and that her husband could bring him to the clinic within 15 minutes. During the blood transfusion, Shelby started standing up and barking before the blood transfusion was even complete. It was recommended we take Shelby to Shreveport Veterinary Internal Medicine Clinic to have a specialist determine exactly what was wrong with him so we could begin proper treatment. On January 12, 2004 we took Shelby to the Shreveport clinic for an emergency examination. We were informed the only way to find out exactly what was wrong with Shelby was to do a bone marrow biopsy. Results of the bone marrow biopsy indicted that Shelby did indeed have AIHA. He was started on 100 mg Doxycycline, twice per day; 150 mg Clindamycin, once per day and 60 mg prednisone, twice per day. He was also given an Oxyglobin infusion to get him through the weekend. On January 22, 2004, the Doxycycline was discontinued and the Clindamycin tabs were finished. At that time, Shelby was started on 50 mg Imuran once per day. When we took Shelby in for follow up blood work on January 26, 2004, the vet said, ‘Shelby's CBC looked good.’ There was minimal evidence of RBC destruction so his prednisone was reduced to 40 mg twice per day, while the Imuran remained at 50 mg daily. 2 ml of a liquid Vitamin supplement of Amino B-plex, given orally by syringe twice daily, was also added to the treatment regimen.

In February, 2004 Shelby started to have trouble walking so we took him back to the animal clinic. X-rays revealed he had pulled a ligament in his back leg due to the weight gain from the prednisone therapy. The vet decided to try and wean Shelby off the prednisone. Blood work on March 24, 2004 revealed a PCV of 38 which encouraged the vet to reduce the prednisone even further to 5 mg every other day while the Imuran remained at 50 mg every other day. On April 26 2004, Shelby’s prednisone was completely discontinued. On May 11, 2004 the PCV had dropped a little since the last blood work so the Imuran dosage remained the same. Because Shelby had been on such large doses of prednisone, he was started on 20 mg Pepcid once a day for two weeks to make sure he did not have a stomach ulcer. During the next several months Shelby’s PCV continued to rise. On August 9, 2004 Shelby’s PCV was 35 at which time he was taken off Imuran and scheduled for a checkup in one month. Over the next several months Shelby’s PCV continued to slowly rise into the 40’s.”

When Teri was asked to comment on the current state of Shelby’s health she replied, “ Shelby is doing just wonderful. He is showing no signs or symptoms of AIHA. His PCV at his last checkup was 47.2. He is completely off all medications for the treatment of AIHA. He receives Interceptor for Heartworm prevention and Advantage for flea protection. The vets feel that it would be unwise to ever vaccinate him again. Shelby likes to swing on my porch swing with me when I sit outside, he jumps on the swing and we swing together. Since Shelby was never really a puppy because he was so sick during that time in his life, he now is really enjoying being a healthy dog. When Shelby looks at you with those sweet eyes of his, it seems that he knows that we loved him enough to help him get well so he could live a normal life. We were told by the staff at the vet's office that Shelby was a ‘miracle dog’. He was so sick, they did not think he would make it. I feel that prayers along with correct medications is what kept Shelby alive. We and others prayed for Shelby and are so thankful that those prayers were answered."

Shelby Update, June 2008

Teri wrote recently with the following Shelby update.

”I can hardly believe that it has been nearly 5 years since Shelby was diagnosed with AIHA. He is still healthy and continues to do wonderfully.

”Shelby is now on a diet medication, which has recently been approved for over weight dogs. He has been on this medication for 6 weeks and has lost nearly 10 pounds. Our veterinarian is very encouraged by this weight loss and wants to keep Shelby on the medication until he reaches his goal weight and then wean him off the medication. The veterinarian believes that all the medication Shelby was on after his AIHA diagnosis affected his metabolism and caused him to gain weight.

”Shelby now has his brother Jake with him and the two brothers spend much of their time together playing. When you watch the two brothers playing you can tell Jake loves Shelby and never tries to be aggressive with him. We are so thrilled to have our dear Shelby still with us and are very thankful, he continues to do so well.”

December 2005

Ravioli

Ravioli is a 3½ year old neutered male Maltese owned by Katie and Chris of Morristown, NJ. Ravioli was diagnosed with immune-mediated hemolytic anemia on July 4, 2004.

When Katie was asked to comment on the onset of Ravioli’s IMHA she replied, “it was extremely sudden, from the first sign of illness to diagnosis was only 36 hours. When I arrived home from work on Friday of the 4th of July 2004 weekend, Ravioli did not greet me at the door as he usually did and I noticed patches of vomit on the floor. After I called out ‘Ravioli do you want some cheese’ and he still did not come to me, I knew immediately something was very wrong. I found him under the bed and he slowly walked to me. He was very lethargic and didn’t seem like himself at all. I immediately called the vet’s office and asked that the vet call me back. When the vet returned my call, he told me the blood work from Ravioli’s appointment earlier that week (we had taken him in for an ear infection) had come back and that I should bring him into the office. I asked if we needed to come in that night and he said he thought so. When we arrived at the vet office additional blood testing revealed Ravioli had a PCV of 23.The vet, who was extremely inexperienced, told me to take Ravioli home and watch him. On our walk home Ravioli collapsed twice, so I carried him. When Chris got home from work, I was crying hysterically. He calmed me down and we decided we would get Ravioli to eat and watch him throughout the night. He ate a few pieces of boiled chicken and then slept.

The next morning Ravioli was still extremely lethargic. We decided to take him back to the vet’s office as soon as it opened. When we arrived at the vet clinic, the vet indicated he wanted to keep Ravioli for the day to give him IV antibiotics and steroids. Blood testing indicated the PCV was now down to 20. Later that afternoon, when Ravioli had not improved, the vet suggested that we let him spend the rest of the weekend at their office. When we were informed there would be no one in the office overnight to monitor Ravioli we were confused as to why should leave him in an empty office. We discussed other options and were referred to Oradel Animal Hospital if we thought Ravioli needed overnight monitoring. We decided to take Ravioli to Oradel. It was the best decision we ever made and it definitely saved his life. We arrived at Oradel at about 6 that evening. Thankfully, there was an internist on call and she came in to examine Ravioli. She stated that Ravioli had IMHA and would probably not make it unless he was given an immediate blood transfusion. With the transfusion, she gave him a 50/50 chance of surviving. She went over the costs with us and left us in a room to decide if we would try and save him. The decision to pay for treatment and try to save Ravioli’s life was easy to make. We knew we would do anything to help him survive. When the vet came back, we signed the papers, and she gave us a moment with Ravioli. We took a picture with him and sent him to have his transfusion. Prior to the transfusion, Ravioli’s PCV was 15 and a Coombs test was done, which later came back positive. The next morning Ravioli’s PCV was up to 23 and it never fell again. Ravioli spent two more days in the hospital during which time we visited him as often as we could, bringing boiled chicken to encourage him to eat.

Ravioli was released from the hospital on the following medications: 5 mg Pepcid AC, once per day; 10 mg prednisone, once per day; 50 mg Doxycycline every 12 hours and 25 mg cyclosporine every 12 hours. The Doxycycline was discontinued after the tick test came back negative. After three months the prednisone was reduced to 5 mg per day while the cyclosporine dosage remained the same. Three months later the cyclosporine was discontinued and the prednisone remained at 5 mg per day. Over the next two months the prednisone was slowly reduced and then totally discontinued. Throughout this time, Ravioli had regular blood checks and his PCV improved each time the blood work was done. Ravioli is currently taking no medications for the treatment of IMHA. He takes Interceptor for heartworm prevention and Frontline for flea protection when we feel it is needed. He is mainly an indoor dog, so we give the Frontline only if necessary. Ravioli will not be vaccinated again for anything.”

When Katie was asked to comment on the current state of Ravioli’s health she replied,”he is doing wonderful. His PCV at his last blood check was 48. We have recently moved to the suburbs from the city and Ravioli is enjoying the open spaces. Our new neighbor has a Maltese and Ravioli has been playing with him and truly enjoying life and our new home. We just had our first baby and Ravioli has taken to our new child, Colin Anthony, with great pride. He sleeps under his crib and is constantly on high alert guarding our young son. Ravioli is back to his normal energetic self and we thank the Lord each day for allowing him to be with us. We are also very thankful for Ravioli’s veterinarian, Dr. Laura Lee Sartor, DVM, DACVIM whose expertise was indispensable in aiding in Ravioli's recovery.”

Ravioli Update, February 2008

I recently received the following Ravioli update from Chris.

”My wife, Katie, and I have put off writing this email to you for about 6 months, since, I believe, neither one of us wanted to admit out loud that we lost Ravioli on August 19th, 2007. Ravioli had a relapse and after several months of treatment, he finally lost his battle. We miss him each and everyday and wish we could have just five more minutes with our little buddy. We had several wonderful years with Ravioli after his IMHA diagnosis and neither one of us would trade those years for anything in the world.

”Joanne, you and the Meisha’s Hope Web site gave us Hope, when we thought Hope was not possible. Thank you so very much for the work you do. May God bless you and Meisha's Hope.”

Go to the next archives.

Go Back to the "Success Stories" page.