PREVIOUS SUCCESS STORIES
January 2006
Lady
Lady is a 13 year old spayed female Cocker Spaniel owned by Beth of Colonial Beach, VA. Lady was diagnosed with autoimmune hemolytic anemia on February 11, 2001.
When Beth was asked to comment on Lady’s symptoms prior to her AIHA diagnosis she replied, “Her symptoms included extreme fatigue, very rapid but weak heartbeat, pale gums, vomiting and lack of appetite. I started noticing a change in her on Wednesday but wasn’t alarmed. By Sunday, when I saw her nearly white gums, I panicked and took her to an emergency animal hospital. At that point, she hadn’t eaten for almost two days.
”The vet at the emergency animal hospital advised me to take Lady to her regular vet who told me he suspected AIHA and added that I needed to seek special assistance. He referred me to a veterinary internal medicine practice in Northern VA. I immediately took Lady to this clinic where blood testing revealed a PCV of 11. I was advised that Lady’s condition was critical. An ultrasound indicated that Lady had an enlarged spleen while the abdominal and cardiac ultrasound appeared within normal limits. Lady was diagnosed with autoimmune hemolytic anemia and was started on medications which an included intravenous catheter placement, a blood transfusion followed by fluid therapy, steroids and gastrointestinal protectants.
”After two blood transfusions and seven days of immunosuppressive therapy, Lady was discharged from the veterinary hospital on February 19, 2001 with a PCV of 27. At the time of Lady’s discharge she was eating well and had not vomited for 3 days. Her discharge medications included 7 ½ mg Prednisone, twice per day; 25 mg Azathioprine, once per day; 5 mg Pepcid AC, twice per day and 0.3 mg Centrine, twice per day. Lady had blood work done on a regular basis and as her PCV rose the medications were lowered very slowly and then discontinued. At the present time she is on no medications for the treatment of AIHA. Lady takes Interceptor for heartworm prevention and we use Frontline once a month as a flea preventative. In regard to vaccinations, I was told by the vet at the internal medicine practice, ‘we do not recommend further vaccination with DHLPP. Rabies can be given every 3 years as required by law but Lady should be checked one week post vaccine to make sure the immune system is not triggered again.’ We discontinued the DHLPP as recommended by the specialist. Lady has had two rabies shots since her AIHA diagnosis. She was dosed with Benadryl prior to those vaccinations.”
When Beth was asked to comment on the current state of Lady’s health, she replied, “She is sleeping more and has a cataract in one eye but otherwise is in excellent health. At her last blood check she had a PCV of 40.5. Lady still enjoys walks, although they are shorter than they once were. She considers herself the guardian of the backyard whenever a squirrel makes its presence known. I thank the Lord above every day for the years I have had with this beautiful animal since her AIHA diagnosis. Every day has been a blessing. She has lived a quality life due to an early diagnosis and a knowledgeable veterinarian/specialist. For those with newly diagnosed AIHA/IMHA dogs let me tell you there is hope. However, I cannot stress enough that since AIHA is NOT a learn-as-you go disease, early diagnosis and aggressive treatment is crucial, since a dog can die within a very short period of time if not diagnosed and properly treated.”
February 2006
Benson
Benson is an 11 year old neutered male Golden Retriever/German Shepherd mix owned by Aden of Jerusalem, Israel. Benson was diagnosed with immune-mediated hemolytic anemia on September 7, 2004.
When Aden was asked to describe the period prior to Benson’s IMHA diagnosis she replied, “Benson is a large 80 pound dog. He is very sweet and very attached to me. In October 2003, a year before Benson became ill, our alpha dog passed away. She was very dominant and Benson respected her as alpha. Ten months after she passed, I adopted a 7-month old puppy. Benson was not going to let the puppy dominate and he became the alpha dog. Three weeks after I adopted the puppy and two days after his vaccinations, Benson became ill. The first symptom I noticed was dark urine, followed by lack of appetite and lethargy. By the time I got him to the vet his gums were white and his eyes had a yellowish tinge.
”Benson was treated by our local veterinarian for two days and then we were referred to the only veterinary teaching hospital in Israel. Upon admittance to the veterinary hospital, Benson had a PCV of 20. When his PCV fell to 15 he received a blood transfusion. Benson was diagnosed with IMHA and started on 160 mg of prednisone and antibiotics as well as Famotidine and Cytotec (misoprostol) for GI protection. Benson remained in the veterinary hospital for 3 nights. A few weeks later, as we started to reduce the prednisone dosage, Benson appeared to relapse. He had not seemed well for a while but it was hard to know if he was ill or if he was suffering the side effects from the large dosage of prednisone. He had lost weight and was slightly off his food. I thought that he had a tooth abscess because there was a terrible smell coming from his mouth. Benson also suffers from EPI (exocrine pancreatic insufficiency), one of the symptoms of EPI is bad gas and Benson certainly had that. In addition, Benson had an abscess in his hind paw that would not heal. I took him to the vet who, after looking at his gums, declared him anemic. Blood testing revealed a PCV of 25. Based on past experience, the vet was worried that Benson's PCV would drop very rapidly so he did not want to send Benson home with me, therefore we were once again sent to the animal hospital. Upon admission to the animal hospital, Benson was receiving 100 mg of prednisone per day, plus Cytotec, and Famotidine. The prednisone was given subcutaneously because Benson had started vomiting. Imuran was also added to the treatment regimen. On October 14, after 2 surgeries to address the 3 abscesses which had appeared, Benson's PCV dropped to 17 and he was given a blood transfusion. The vets were unable to determine the cause of the relapse and were not sure that he would survive. Benson developed several worrying secondary conditions including abscesses, cellulitis and edema. The vets could not explain why these secondary conditions developed. They felt his chances of coming out of this crisis were ‘slim’ but they specifically advised me to give him a chance. They assured me that he was not in pain but that he probably just felt weak. After a few days in the hospital he was eating well and keeping his food down. Benson was released from the hospital on October 18, 2004 on the following medications: 40 mg Prednisone, once per day; 50 mg Imuran, once per day; 50 mg Augmentin ( an antibiotic), twice per day; 20 mg Famotidine, once per day and 25 mg Ciprodex ( an antibiotic), once per day.
”One week after Benson was released from the hospital and two weeks after he started on Imuran, blood testing at the local vet’s office revealed a PCV of 34. Unfortunately Benson’s liver values were high and my vet was very worried. He thought that the Imuran was causing the problem so he consulted with the internal medicine specialist at the veterinary hospital. The specialist believed that, although the values were high, they were not high enough to be worried about. He recommended the prednisone be reduced to 30 mg per day. For the next two months, we reduced only the prednisone and left the Imuran at 50 mg per day. This combination of medications appeared to be more successful with Benson. His energy and appetite returned and he started to gain weight. The terrible odor from his mouth and the gas disappeared. Once the prednisone was completely discontinued we started to reduce the Imuran. Instead of decreasing the dosage of this drug, we decreased the frequency of the dosage first to every other day, then every third day until it was felt the Imuran could be discontinued. Benson’s PCV never dropped below 34 during the prednisone reduction or subsequent Imuran reduction. As we reduced and discontinued the prednisone, Benson’s liver values gradually returned to normal.”
When Aden was asked to comment on the current state of Benson’s health she replied, “He is doing very well. He is energetic and happy and has even adjusted well to the new dog. His PCV at his last blood check was 44. Benson is currently taking no medications for the treatment of IMHA, however he does receive a medication called Viokase-V which replaces the pancreatic enzymes that he no longer makes himself. Benson was diagnosed with EPI when he was a year and a half old. He has been receiving these pancreatic enzymes for the past 9 years. Because there is no heartworm in Israel, Benson receives no preventative for that disease. We use Frontline for flea prevention every 2-3 months as needed. When I look at Benson, I see a miracle. He is alert, energetic, eating well, and behaving like himself. Benson is a wonderful dog. He has been though a great deal with the EPI and IMHA. I am grateful and truly blessed that he is still with me today.”
March 2006
Sherman
Sherman is a nearly 10 year old neutered male Cocker Spaniel owned by George and G.G. of Clearwater, FL. Sherman was diagnosed with autoimmune hemolytic anemia and
immune-mediated thrombocytopenia (ITP) on June 10, 2004. A dog who has both AIHA and ITP at the same time is said to suffering from a condition called Evans Syndrome.
When George was asked to comment on the symptoms Sherman exhibited prior to being diagnosed with Evans Syndrome he replied, “Sherman was very weak and tired. It appeared that he wanted to just stay in one place and try to catch his breath. We took Sherman to our local veterinarian where blood testing revealed a PCV of 7, a very low platelet count and a positive Coombs test. In the first 24 hours after admittance to the veterinary clinic, Sherman received two Oxyglobin infusions. He was started on 136 mg Baytril twice per day, 100 mg cyclosporine twice per day and 36 mg prednisone twice per day. We were told that it was very likely that Sherman would die since the vets saw a 1 in 200 chance of him surviving the first 5 days. Two days after being admitted to the veterinary hospital Sherman was transferred to Florida Veterinary Specialists (FVS), a 24 hour critical care facility in Tampa, where he was hospitalized for 8 ½ days. While at FVS Sherman received 3 transfusions of packed RBC’s. During the first 6 days of Sherman’s illness he had no platelet or red blood cell formation. At one point Sherman had 0 platelets and 0 reticulocytes (immature red blood cells). Thankfully, in time, the medications helped Sherman’s system ‘kick start’ his red blood cell production and he started to get better.
”Over the next year and a half, as Sherman’s PCV and platelet count continued to rise, we slowly decreased his medications. At the present time Sherman takes 1.25 mg prednisone each morning and evening as well as 100 mg Cyclosporine every 3rd day. 1 g Carafate is given 2 hours prior to these medications with 2 mg Imodium given as needed. Sherman takes Sentinel for heartworm protection and Frontline Plus as a flea preventative. We have been advised by our veterinarian to never vaccinate Sherman again. Our veterinarian has sent letters to our county animal control officials and the state of Florida informing them that to vaccinate Sherman again could be an affront to his immune system.”
When George was asked to comment on the current state of Sherman’s health he replied, “At the onset of Sherman’s illness, it was a double blow to our hopes to have him diagnosed with both AIHA and ITP. Having him alive and happy is a special blessing for us. His PCV at his last blood check on February 17, 2006 was 40 and his platelet count was 210k. At 58 pounds, Sherman is still very overweight, his normal weight is about 35 pounds. According to our veterinarian Sherman is back to about 70 to 80 percent of his normal self. Sherman knows he is not 100% but he is the same little puppy-boy as when we got him as a young pup. Our veterinarian believes that Sherman’s illness was triggered by the antibiotic Cephalexin. Sherman was given this drug as a preventative measure after he received some small puncture wounds from being in a fight with a large dog. Sherman is an amazing dog, he is the Rock of Gibraltar, in the eyes of my family. My wife and I loved to hear him ‘purr’ after getting a treat or being petted. His tail can wag so fast it’s a blur. Sherman is very much my wife’s dog, where she is, there he is. When we leave the house, he awaits our return at the door from which we left. For a dog with Evans Syndrome to not only survive, but to be back home and thriving among our 2 other Cockers and our big mixed-breed dog is a thing I never thought I would see when Sherman was first diagnosed. We are especially thankful to our veterinarian and those on the VetNet AIHA/IMHA Forum who gave us HOPE, information and support during our blackest hours."
April 2006
Dobby
Dobby is a 5 year old neutered male Pekingese owned by Susan of Johnstown, NY. Dobby was diagnosed with autoimmune hemolytic anemia on August 5, 2004.
When Susan was asked to comment on the symptoms Dobby exhibited prior to being diagnosed with AIHA she replied, “His symptoms came on very suddenly and progressed very rapidly. Sunday August 1, 2004 Dobby was not eating and was very tired. I had to coax him to go outside to the bathroom and ended up carrying him back inside. Monday morning I had trouble getting him out from under the bed, and he vomited when he did come out. I called the veterinarian and was told to bring Dobby right in. Dobby was admitted to the veterinary hospital with a temperature of 104 and a PCV of 17. X-rays indicated a huge spleen and enlarged liver. During Dobby’s initial hospitalization he was given subcutaneous fluids, prednisone and the antibiotic Clavamox. After three days in the veterinary hospital, Dobby was discharged on Thursday August 5, with instructions that he be given 125 mg Clavamox twice per day and 5 mg prednisone twice per day for 3 days then 5 mg prednisone once per day until his follow-up visit with a veterinary specialist. On August 11, when we saw the veterinary specialist, an ultrasound was performed and the AIHA diagnosis was confirmed. I was told to continue the Clavamox and the prednisone was increased back to 5 mg twice per day. Additional instructions were to ‘keep him quiet and try to get him to eat something (anything)’. Since Dobby would not eat anything, I soft-cooked an egg and zapped it with milk in the blender. I fed him as much as he would take through an eyedropper every half hour or so, sitting on the couch with him, petting him, talking to him and giving him little tiny tastes. Pretty soon he was eagerly taking the food and within a few hours he managed to eat on his own.
”As Dobby’s PCV continued to rise we slowly reduced his prednisone dosage. At the present time he takes 5 mg prednisone every third day. With my veterinarian’s permission, I also give him Synflex (glucosamine) to ease a limp caused by a patellar luxation. Dobby has also been on many courses of antibiotics during the past year and a half. We do not use a heartworm preventative at this time, however we do use Advantix, monthly for fleas and ticks, during the flea/tick season. Dobby had his 3 year rabies vaccination in June, 2005 with no ill effects. We have been advised by our veterinarian not to vaccinate Dobby for anything else at this time.”
When Susan was asked to comment on the current state of Dobby’s health she replied, “Dobby is doing very well. The veterinary specialist referred to him as the ‘miracle dog’ and my regular vet frequently remarks how well Dobby is doing while being maintained on prednisone. Dobby does have reoccurring bladder problems. He had surgery on October 31, 2005 and again on March 2, 2006 to have bladder stones removed. Dobby is now taking 2 ml potassium citrate twice per day to, hopefully, curb the formation of these bladder stones. In spite of the AIHA and bladder problems, the vet says that Dobby is ‘actually amazingly healthy.’ His PCV at this last blood check on February 28, 2006, prior to his last surgery, was 58. The veterinarian did mention this number might be a bit inflated because of slight dehydration, but overall this is still a wonderful PCV. I cannot stress enough to those with newly diagnosed AIHA/IMHA dogs, the importance of finding a vet you are comfortable with and who has experience dealing with AIHA/IMHA. My first vet, right around the corner from my house, was very caring and concerned and made the first diagnosis of either hepatitis or autoimmune disease. However, I was not comfortable with the follow-up care and after talking extensively with a wonderful vet who cared for my previous animals, I made the switch to that animal hospital. This has worked out well since this vet and his partners are well-versed in the care and treatment of AIHA/IMHA and they always take the time to explain everything fully to me. Dobby remains my best buddy. I am in constant awe of his recuperative powers. He’s a tough little guy who hasn’t given up even though his health has been a challenge. I am not ready to give up on him either. He makes my life richer, therefore, we will go day by day for however long we have together.”
Dobby Update, June 2006
I recently received the following Dobby update from Susan.
"Dobby was euthanized Thursday, May 25, 2006 at 6:30 p.m. This followed another emergency visit to the vet. X-rays revealed huge bladder stones again, only 11 weeks after his last surgery. Both vets agreed that neither the change in diet nor medication made any difference in this most-aggressive type stone. The life Dobby was facing was surgery closer and closer together to remove progressively larger stones. Although they would have operated again I said, no we have to stop, this is no life for my little guy. I couldn't make him go through any more, only to face in again in a few short weeks, and again, and again.... I fought for him to have quality of life for the past 22 months, and now I had to let him go. In the end it was not the AIHA that claimed Dobby.
"Prior to the euthanasia the vet made Dobby more comfortable and he wagged and wagged as I talked nonsense to him. He died quietly in my arms. There's a special spot in my back yard where some wild raspberries grow. Dobby loved those berries! Half the time I could never find that bush, but Dobby found it every time and waited impatiently for me to give him a berry. Of course there were no berries yet this season, but it's a happy memory for me and I am going to bury his ashes under that bush."
May 2006
Macy
Macy is a 9 year old spayed female Cocker Spaniel owned by Jill and Ron of St. Charles, IL. Macy was diagnosed with immune-mediated hemolytic anemia on August 31, 2004.
When Jill was asked to comment on Macy’s behavior prior to being diagnosed with IMHA she replied, “For a period of several years prior to Macy’s anemia, I could not shake the feeling that something was wrong with her. She never seemed to have the physical stamina of our previous Cocker Spaniel and appeared to only have a few peak times during the day when she was energetic - early morning and early evening. Although we fed her a premium dog food, her coat was thin. Macy also exhibited cold intolerance. Early on, the vet advised us to feed a low fat diet because of Macy’s weight gain. This weight gain seemed odd to me because she was walked daily and frequently taken to the forest preserve to run off lead. Macy also seemed to have other health issues that had not plagued our other spaniel including constipation, trouble swallowing which led her to bolt her food and very deep sleep with shallow breathing. Although I brought these matters to the attention of our vet, she dismissed them as the norm for our particular dog. I even requested some blood tests just months before Macy’s hemolytic crisis. Unfortunately, our vet never discussed nor tested for hypothyroidism which, in retrospect, I've come to believe played a huge role in her anemia and pure red cell aplasia
“After a period of several days of weakness, lethargic behavior and lack of appetite, we took Macy to the vet on August 28, 2004. She had a temperature of 104.2 and blood testing revealed a PCV of 22. An abdominal x-ray was taken to determine if the low blood count was a result of internal bleeding, however, nothing abnormal was found. When an auto agglutination test was negative, the on-call vet prescribed a single dose of Baytril to be given daily. We did mention to the vet that Macy received her DHLPPC and rabies vaccinations on August 13, 2004. When we saw no improvement in Macy’s condition on August 30, we returned to the vet. He indicated that he believed Macy had IMHA even though another auto agglutination test and the Coombs test were both negative. On August 31, Macy had a PCV of 18 and was diagnosed with IMHA. She was started on 10 mg prednisone twice per day, 5 mg prednisolone twice per day and 10 mg Pepcid. Tests for Babesia, Ehrlichiosis and Hemobartonella all were negative. When another blood test indicated no negligible reticulocyte count (immature red blood cells), a bone marrow aspirate and core biopsy were done to determine if Macy’s bone marrow was the cause of her deteriorating blood count. Although we hated for Macy to go through the biopsy procedure, we were desperate for answers. For fear of exacerbating her condition, the vet sent Macy home without any pain killers after the core biopsy. My husband and I laid on the floor with her all night as she struggled to sleep. At our insistence, the vet began conferring with a veterinary internal medicine specialist on September 1. On September 3, the specialist recommended that Macy's medication be revised to include 30 mg prednisone twice per day, 10 mg Pepcid once per day, 50 mg Doxycycline twice per day and one Pet Tab Plus per day.
”Macy’s condition continued to deteriorate and when she experienced labored breathing on September 5, we took her to the Veterinary Specialty Center in Buffalo Grove, Illinois where she was admitted to their emergency facility. The admitting veterinarian indicated that she suspected Macy's recent vaccinations had set this chain of events in motion. We directed the veterinarians to do whatever they deemed necessary to save Macy’s life. She was given a transfusion of packed red blood cells after which, the vet indicated Macy was stable and her PCV had risen to 23. The bone marrow aspirate and core biopsy had to be redone because of a poor first sample and an ultrasound was also done. Reticulocyte counts continued to indicate no significant red blood cell regeneration. Macy was released from VSC on September 8 with instructions that she be given 20 mg prednisone twice per day, 50 mg Doxycycline twice per day and 10 mg Pepcid once per day, pending the biopsy results. The results of the biopsy indicated that Macy's anemia had taken the form of pure red cell aplasia, an extremely rare condition and the most severe form of hemolytic anemia.
”Macy’s PCV soon began to slowly decline again. September 14 test results indicated erythroid hypoplasia with mild plasmacytosis suggestive of immune-mediated hemolytic anemia, infectious or toxic insult such as drugs, vaccinations or systemic metabolic problems. 25 mg Imuran, once per day was added to the treatment regime to tamp down Macy’s immune system. September 15, Macy's PCV was 16 with no significant reticulocyte count. She received a second transfusion of packed red blood cells and was sent home late that day with PCV of 22. We transferred Macy to another veterinarian when our research suggested that many of the symptoms brought to our previous vet should have prompted her to do an in-depth evaluation of Macy's thyroid function. This research also suggested that endocrine disease can contribute to anemia. Our new vet immediately scheduled Macy for an appointment with another internal specialist for evaluation. This specialist, at VCA Animal Hospitals, initiated another round of tests including thyroid testing on October 4, 2004. By the time the tests confirmed our suspicions that Macy was hypothyroid, we had already begun to see her PCV rise for the first time in six long weeks. Once Macy's blood count began to rise, she mounted a slow and steady recovery. Macy remained on Imuran, prednisone and Pepcid until Spring 2005.”
When Jill was asked to comment on the current state of Macy’s health she replied, “Macy is better than ever - playful, happy, and entertaining us with her silly dog antics. Her PCV at her last blood check on April 7, 2006 was 55. Most of this improvement can be attributed to the fact she now receives a daily dose of 0.3 mg Soloxine for hypothyroidism and a 500 mg glucosamine/400 mg chondroitin capsule. Macy’s immune problems are still evident by her licking of her paws, and scratching of her head and ears (which thickened noticeably when her hypothyroidism went undiagnosed for an extended period of time resulting in a condition called myxedema). At the present time, we are trying to balance Macy’s immune system with a plant derived sterol and a canine adrenal support supplement. We also supplement her diet with a daily Pet Tab, Omega 3 and Omega 6 oils, and Ester C. Recent blood work indicated that the ALKP remains elevated but the veterinarian attributes this to metabolic stress. Macy takes Interceptor Heartworm preventative on a 42 day cycle. According to our current veterinarian, the preventative is effective for 42 days so he recommended that time frame in order to minimize Macy's exposure to the drug. We have discontinued using any type of flea prevention and Macy no longer receives vaccinations of any kind. Our veterinarian received a waiver from any future rabies vaccinations for Macy due to health concerns. Shortly after Thanksgiving, 2005 Macy began to limp and the vet initially suspected a muscle strain. However when things did not improve with rest he took x-rays which indicated some degeneration in Macy’s hips. After some Internet research to educate myself on ways to exercise Macy without damaging her hips and joints, I found a hydrotherapy facility for dogs very near our home. After a month of swimming 2-3 times a week, our vet was amazed at her muscle development and the resultant stability in her rear legs. While in the throes of IMHA, we simply prayed for Macy’s survival but she has regained a level of fitness and quality of life that has surprised us as well as our vet. With the arrival of spring, we walk 2-3 miles every day to maintain her fitness level and ‘blow out’ some of her cocker spaniel energy! We are so grateful Macy survived her IMHA ordeal and we now concentrate on enjoying every precious moment we have with her. When Macy was diagnosed with pure red cell aplasia, we struggled to understand how our dog could go from walking 2-4 miles a day to blood transfusions to save her life. She proved to be a very tough little dog who never quit fighting and neither did we. Although Macy's anemia took a rare and deadly form, it proved to be a temporary condition. Because of the emotional and financial toll, many pet guardians have given up in similar circumstances, thinking they have no hope. Macy is here to prove that hope exists in even the worst cases.”
To learn more about pure red cell aplasia and the other basic forms of autoimmune hemolytic anemia from The Merck Veterinary Manual Click Here
Macy Update, April 2007
Jill wrote recently with the following Macy update.
"Macy is doing very well. She continues to swim weekly to maintain muscle tone and has resumed daily walks now that winter has loosened its grip on Illinois. Her daily meds are limited to thyroid medicine, a glucosamine supplement and the plant derived sterol to keep her allergies under control. Thankfully, she has not relapsed after her initial bout with hemolytic anemia, however, we remain ever vigilant about her diet, medications, and exercise. In return, we are rewarded with a happy, busy spaniel that still makes us laugh every single day. Our vet never fails to comment on Macy’s amazing recovery and subsequent quality of life. I know he learned much from her experience and uses that knowledge to better serve his patients."
Macy Update, June 2008
Jill wrote recently with the following Macy update.
"Macy celebrated her 11th birthday on May 22! It’s been almost four years since her bout with IMHA without any relapse. We count ourselves among the truly fortunate!
"Macy continues to enjoy weekly hydrotherapy to maintain her fitness level, especially during the winter months. She also enjoys a walk, most days, with the hope of spotting a squirrel or rabbit to chase. Her daily medication is limited to thyroid medicine, a glucosamine supplement, and the plant-based sterol to keep her allergies at bay. We’ve expanded her natural food diet to include some fresh fruits and vegetables and this meets with her approval!
"It’s hard to even pinpoint when we finally quit worrying about her health but are thrilled to report we no longer live with the daily fear of relapse. We simply enjoy our time with her."
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