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September 2007
Angelo
Angelo is a 12 ½ year old neutered male Golden Retriever owned by Jeanne of Lincoln Park, NJ. Angelo was diagnosed with Evans Syndrome (autoimmune hemolytic anemia and immune-mediated thrombocytopenia occurring simultaneously) on November 20, 2005.
When Jeanne was asked to comment on Angelo’s symptoms prior to his Evans Syndrome diagnosis she replied, “On the Sunday before Thanksgiving 2005, I took Angelo and his canine brother, Archie, outside as usual. Angelo did his ‘business’ and we were going to go back inside. However, when I looked at Angelo he seemed to be just frozen. I gave a little tug on his leash and he seemed confused so I dropped his leash and ran inside to get my boyfriend. We carried Angelo to the car and immediately drove to the nearest Animal ER.
”Upon admittance to the ER clinic, blood testing revealed a hematocrit of 9.5 and a platelet count of 64. Angelo was pale, jaundiced and very weak. He also had a hepatomegaly/tense abdomen. Angelo was started on Doxycycline, Prednisone, Pepcid and Carafate. When the vet came out to talk with me, it was the first time I ever had heard the words, autoimmune hemolytic anemia and thrombocytopenia. Blood testing, done later in the day, revealed a PCV ranging from 28 at 6 PM to 20 by 2 AM the next morning. On Monday, when we transferred Angelo to our regular Animal Hospital, blood testing indicated his PCV had dropped to 18. I was advised that if the PCV dropped lower then 17 Angelo would need to be transfused. A cross match was done to insure blood would be available if the need arose. Thankfully, the PCV never went lower then 18 so a blood transfusion was not necessary. Ultrasounds, done on Angelo’s organs, showed no cancers. When the tick titer came back negative, the Doxycycline which had been started in case of a tick disease, was discontinued. After 3 days in the hospital, Angelo was allowed to come home to spend Thanksgiving with us. Although he was weak and lethargic upon his discharge from the hospital, thankfully, he did not need to be hospitalized again. His medications, upon discharge from the Animal Hospital, included 60 mg prednisone, twice per day, 50 mg Imuran, once per day and 20 mg Famotidine twice per day. These medications were tough on Angelo but they kept him alive and allowed him to get into remission. One of the side effects from the medications was a 10 pound weight loss, due to muscle atrophy. Angelo lost so much muscle that he developed sores on his lips from biting them while eating. In addition, he could not lie comfortably on his side due to the swelling of his liver. He developed green pustules ( staph infections) that required months of antibiotics and alopecia (hair loss & thinning). He also needed the assistance of a harness to walk.
”As Angelo’s PCV and platelets rose, we started to slowly lower his medications. The prednisone was slowly tapered down to 2.5 mg every other day and then discontinued on October 6, 2006, nearly 11 months after the Evans Syndrome diagnosis. Days between the administration of Imuran were increased until it was discontinued on April 20, 2007. Prior to the Imuran being discontinued it was being given at a dosage of 50 mg every 4th day. Angelo is currently on no medications for the treatment of Evans Syndrome. He does take a Glucosamine/Chondroitin/MSM tablet twice per day, a Pet Tab plus once per day as well as a Derm Cap once per day to nourish his skin. We give Angelo Interceptor for heartworm prevention every 30-40 days year around. At this time I have chosen not to use any flea/tick preventative, even though we have a heavy population of ticks in our area. In regard to vaccinations, Angelo is no longer receiving any vaccinations whatsoever.”
When Jeanne was asked to comment on the current state of Angelo’s health she replied, “Angelo is continuing to do very well. When his last blood work was done on July 3, 2007, his PCV was 40.6 and his platelets were 195,000. He has not regained the muscle in his back legs but he can still trot a bit after his beloved tennis ball and wrestle with his Golden ‘brother’ Archie. Angelo appears to be in no pain due to this muscle loss. I consulted a canine physical therapist and we are helping Angelo at home by taking him for short walks as well as with an occasional swim in a relative’s pool. The most important thing I learned about this disease is that you need to have a good veterinarian who is very familiar with the disease and who is optimistic (while being realistic) towards you and your pet. We credit our Vet, who has been taking care of Angelo since he was 3 months old, for being optimistic from the get go and making sure that everyone that cared for Angelo in the hospital knew it. We also credit the very slow reduction of Angelo’s medications as one of the positive factors in regard to his survival. To Angelo, every day is a celebration and to us, each day that Angelo is with us, is a gift.”
October 2007
Ziggy
Ziggy is a 4 year old neutered male Cocker Spaniel owned by Julie of Kennesaw, GA. Ziggy was diagnosed with immune-mediated hemolytic anemia on March 9, 2005.
When Julie was asked to comment on Ziggy’s symptoms prior to his IMHA diagnosis she replied, “Ziggy did not show any symptoms prior to the onset of the disease other than he seemed to be sleeping very soundly at night. I didn't think much of it, but deep down I knew this wasn't like him. When I came home from work on March 9, Ziggy was not at the door jumping up and down to greet me as he normally did. He appeared very lethargic and his gums were very pale (grayish-white).
”I immediately rushed Ziggy to the vet, where we started an IV and ran a urinalysis. His urine was hemolyzed from the excess bilirubin and would not spin down via the centrifuge. The vet suspected early hemolytic anemia so Ziggy was given 20 mg IV Dexamethasone and 100 mg IV Baytril. Ziggy's PCV that night was 35. He was put on 100 mg Doxycycline, twice per day and 136 mg Baytril, once per day, in case a tick borne disease was causing the crisis. Two days later, at 8 AM, Ziggy's PCV had dropped to 20. He was again given 20 mg IV Dexamethasone. By 2 PM his PCV had fallen to 16. Because of the continued drop in PCV, Ziggy was given a transfusion of Oxyglobin. The transfusion was given at a rate of 3ml/kg/hr and took 5 hours to complete. In spite of the Oxyglobin transfusion, Ziggy's PCV continued to drop and by the next day it was 12. He was started on 25 mg Imuran once per day along with high doses of IV Dexamethasone and 1g Sucralfate 30 minutes before medications. Ziggy remained on IV fluids and IV steroids during this time. He did not respond well to the Oxyglobin transfusion and his PCV dropped to 8. A full body x-ray and ultra sound revealed an enlarged spleen but no other abnormalities. Ziggy received a packed red blood cell transfusion which he rejected resulting in a urine color which was very dark brown, almost black, after the transfusion. His IV catheter was then taken out because of the threat of blood clots forming. Ziggy did not eat for nearly four days and had diarrhea and vomiting around the clock. He had a temperature of 105.3 and was barely hanging on. It took a few days more, but finally, Ziggy started to turn around. He was started on 30 mg oral Prednisone twice per day with the Imuran remaining at 25 mg once per day, 1g Sucralfate was given 30 minutes before the medications. Ziggy was also given 1/2ml Anzemet SQ once per day (an anti-nausea injection used in chemo patients) as well as 800IU of Heparin SQ three times per day (because of the concern of blood clots developing). Over the next few days, Ziggy's PCV slowly started to rise and we began to taper off the heparin injections.
”As Ziggy’s PCV continued to rise we started to slowly decrease his medications. He currently takes 5 mg prednisone every other day (eod). Due to the severity of Ziggy’s case, doctors at the University of GA recommended that he not be taken off prednisone. It is quite likely that Ziggy will be on 5 mg prednisone eod for the rest of his life. Because Ziggy was given a flea/tick preventative about 5 days before the onset of his illness, I have elected to no longer use any flea/tick preventative. Upon recommendations of the veterinarians, Ziggy will no longer be vaccinated.”
When Julie was asked to comment on the current state of Ziggy’s health she replied, “He is doing great. His PCV at his last blood check on August 11, 2007 was 47. The rest of his blood work was normal except for a high level of triglycerides. The only problem Ziggy has had over the past year is a few sporadic seizures. He has not been placed on anti-seizure medication as yet because the seizures do not seem severe enough at this time. Ziggy loves to go hiking and he LOVES to eat. Every night at 9 pm, he will stare at me until I give him his nightly bone. Ziggy has always been the sweetest, most compassionate dog and has such a puppy like attitude. Two plus years after the onset of the disease, his sweet personality shines bright again. You would never believe a dog that was so sick could be so lively and healthy today. We share a bond like no other. I knew when I saw Ziggy being born on my birthday that I was going to raise this puppy for my own.
”I am a veterinary technician and I had never seen a case of IMHA until Ziggy was diagnosed with it. I am so thankful he survived and is doing well. I am lucky that I work in the veterinary field and was able to care for Ziggy overnight in my home. He was hooked up to IV fluids around the clock which helped him greatly. The power of positive thought and prayer also helped tremendously. Recently our clinic successfully treated another Cocker Spaniel for IMHA. No one at the clinic could get her to eat but me, that may have been because she and I shared a special bond.”
November 2007
Tess
Tess is a 5 ½ year old spayed female Jack Russell/Beagle mix owned by Claudine and Corey of Milton, Ontario, Canada. Tess was diagnosed with Evans Syndrome (immune-mediated hemolytic anemia and immune-mediated thrombocytopenia occurring simultaneously) on December 19, 2004.
When Claudine was asked to describe Tess’ symptoms prior to her Evans Syndrome diagnosis she replied, “On December 14, 2004 Tess vomited after her evening meal. The next day she was lethargic and had no appetite. When she did eat, she vomited bile that was a bright orange/yellow color. After Tess vomited for a third day, we took her to the vet where a physical examination produced no abnormalities. X-rays revealed a thickening of the gastric lining and the spleen appeared moderately enlarged. Blood work indicated a hematocrit of 41.4 and a platelet count of 61. Tess was sent home and we were told to bring her back if the vomiting occurred again. The next day, when Tess was too weak to come down the stairs, we took her back to the vet. She was lethargic, shivering and exhibited pale mucous membranes. Blood testing revealed Tess’ hematocrit had dropped to 20.2 and her platelet count had fallen to 20. We were immediately referred to Ontario Veterinary College (OVC) at the University of Guelph.
”Upon arrival at OVC Tess exhibited a bloody stool and was very weak and pale. We received a call from OVC the following day telling us that Tess had deteriorated overnight and that things were very bleak. Tess was started on IV fluids and a number of drugs including Immunosuppressive drugs such as Dexamethasone, Cyclosporine and Vincristine; gastric protectants; antiemetics for the treatment of vomiting; antibiotics and analgesics. Tess also received a packed red blood cell transfusion and heparin. Over the next few days Tess’ clinical condition remained poor. She continued to have intermittent bloody diarrhea and vomiting and remained lethargic and dull. When we visited Tess on December 22, she urinated all over herself. Her urine was a wine red color and thick like syrup. She also was bleeding from her nose and her bilirubin had climbed to 1100. After a blood transfusion her PCV rose to 22 and the heparin therapy was discontinued because the clotting time was now over 5 minutes, Over the next couple of days Tess received two more blood transfusions. She was also placed on oxygen to help her breathe. OVC called us every 12 hours and we visited Tess every day.
"On December 26, we went to the ICU to let Tess go since the vets told us that she would have responded by now if she were going to recover. I have never shed as many tears in my entire life as during those difficult days. We cried all the way to the hospital and upon arrival were told that Tess had finally shown some clinical response and had eaten. Our hearts lifted, but seeing Tess so weak and breathing so heavily as well as urinating a dark colored urine, left us confused. We did not want her to suffer but if she was trying to recover, we were not going to give up on her. We decided to give her a few more days. Tess’ PCV continued to drop and by December 28 it was down to 12. We made the choice to transfuse her one last time. After the transfusion Tess’ PCV rose to 25 where it held overnight and through the next day. The vomiting stopped and Tess started to eat. Imuran was added to the treatment regimen and the heparin therapy was restarted on December 30. It was suggested a spinal tap be done but we declined this procedure since we felt Tess was too weak to undergo the test. On December 31, Tess’ PCV was 27 but she had become septic so antibiotics were started. By January 3, Tess’ PCV had risen to 34 and the sepsis had passed. She was weaned off fluids and anti-nausea drugs and we were told she could go home the next day if she did not vomit overnight. On January 4, Tess was bright, alert and responsive and her temperature, pulse and respiration were within normal limits, She was eating and drinking well, with no further vomiting or diarrhea. Her jugular catheter was removed and she was released from OVC on the following medications: 25 mg prednisone, once per day; 0.7ml Cyclosporine, twice per day; 5 mg aspirin, twice per day; 75 mg Doxycycline, twice per day and 3 ml Sucralfate 3 times per day. When Tess was released from OVC she almost 7 pounds lighter then when she had been admitted. During her 2+ week hospitalization, she had lost nearly 1/4 of her total body weight. Over the next several months, Tess’ PCV and platelets continued to rise and her medications were slowly reduced. It took until May, 2006 for her to become medication free.
”At Tess’ regular checkup on August 17, 2006, it was discovered she had a fractured molar on her upper left jaw which needed to be extracted. After the extraction Tess’ platelets fell to 78 and she experienced an ITP relapse. She was started on 15 mg prednisone twice per day as well as 25 mg Imuran once per day. Tess’s platelets rose quickly and by December 1, 2006 they were 459. The prednisone was slowly discontinued and the Imuran was reduced to 25 mg every other day. Tess has had a few health problems in 2007 including an episode of vomiting in February and the diagnosis of folliculitis (inflammation of the hair follicles). We saw a dermatologist in July who tested for hypothyroidism and hyperadrenocortism. When both tests came back negative, Tess was put on a special diet and 28 days of Cephalexin to treat the bacterial skin infection.”
When Claudine was asked to comment on the current state of Tess’ health she replied, “Tess is doing great. She is in remission and completely back to normal. Her last blood work was done on September 5, 2007. It revealed a PCV of 54 and a platelet count of 336. Tess is currently taking 12.5 mg Imuran every other day to prevent further relapses. She is living life to the fullest and is a happy, healthy (and spoiled) little girl who shows absolutely no signs of illness or lingering side effects from her treatments. Because we do not know what caused Tess’ illness, she has not and will not receive any further vaccinations. Although our city requires the rabies vaccine, we have been able to get a waiver letter from the doctor and provincial law states this is sufficient for a medical exemption. We also have chosen not to give any heartworm or flea preventatives for the past 2 summers. Tess goes for blood rechecks every 2 months and she bounds into the building at OVC joyfully to see all the friends she has made over the years. She was truly our holiday miracle, overcoming so many odds. It amazes us, every day, to think of everything she has been through, including 6 blood transfusions and a cocktail of drugs. When we look at photos from that time, it is hard to believe she is the same dog. Although fighting this disease is so difficult in so many ways, we would not change a thing. We are so thankful to have Tess with us almost 3 years after we nearly lost her. Every day is a gift and we live to ensure that there are no regrets, treasuring every moment in a way that cannot be expressed in words.”
December 2007
Djin-jin
Djin-jin is a 14 year old neutered male Miniature Schnauzer owned by Jessica of Lake in the Hills, IL. Djin-jin was diagnosed with autoimmune hemolytic anemia in August, 2000.
When Jessica was asked to describe Djin-jin’s symptoms prior to his AIHA diagnosis she replied, “Djin had not been eating well and had been vomiting occasionally for 4-5 days. He was also very lethargic. When he became too tired to even go outside for a ‘potty break’, we took him to the veterinarian. By then he also had very pale gums as well as dark urine.
”Initial blood testing at the veterinarian’s office revealed Djin-jin had a PCV of 18. He was diagnosed with AIHA and started on 20 mg prednisone twice per day as well Imuran and Cyclosporine. Cimetidine was administered for the prevention of drug-induced gastric erosion/ulceration. Djin’s PCV continued to drop and about a week after his AIHA diagnosis it fell to 8. He had already been given several blood transfusions by then. The veterinarian made it clear to us that we could continue to give transfusions, which we chose to do, but that we might just be buying time with Djin. Thankfully this was not the case and Djin’s PCV finally started to climb. As his PCV continued to rise we slowly decreased the medications. The Imuran and Cyclosporine were decreased and discontinued within a matter of months but it took exactly a year before Djin was weaned off prednisone. Djin-jin is currently on no medications for the treatment of AIHA. He does take one fish oil capsule per day and that seems to relieve some of his age related stiffness. In early October 2007, we started Djin on 25 mg of Tramadol, twice per day, to alleviate arthritis pain. Djin has done great on this drug. It has really brought back his ‘schnauzer personality’ and he thinks he can take on the world now! Djin has received no vaccinations since his AIHA diagnosis.”
When Jessica was asked to comment on the current state of Djin-jin’s health she replied, “Djin celebrated his 14th birthday in October, 2007 and is doing well for a dog of his age. His PCV remains in a range from 45-50. He hasn’t had any major problems as a result of his AIHA but he has slowed down a lot. This may be due to aging or prednisone usage or a combination of both. Djin has massive fatty tumors throughout his body which makes it more difficult for him to run and he has become deaf and is starting to get cataracts but he still enjoys life and his morning sniff/walk. The veterinarian told us that because of Djin’s immune problems, we needed to be very careful and not let him get around other dogs, so for a long time, we would only let him run around in our back yard and bark at dogs on the street. A couple of years ago, I started walking him around the neighborhood and he absolutely loves it. He loves the interaction from the other dogs we meet walking through the neighborhood and I frequently take him to the park with my two kids, where he gets lots of loving from the other kids. Djin still loves to eat and steal food off the table. We used to be militant about not letting him have ‘people food’, but now with two young boys in the house, he gets plenty of hand-me-downs from the dinner table. He loves babies because he knows they are the source of many good treats! Djin is old, but he is such a blessing. I never thought he would live this long. I feel so blessed to have him in my life. Every day he’s with us is a joy and I am so glad we didn’t give up on him when the going got rough.”
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