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January 2000

Andi

Andi is a 10 year old spayed female Miniature Schnauzer owned by Lorrie and Richard of Washington, NC and Yorktown VA. Andi was diagnosed with autoimmune hemolytic anemia on October 12, 1998.

On Sunday October 11, Lorrie noticed a change in Andi. She saw symptoms which included extreme weakness, loss of appetite and swelling of the abdomen. On Monday October 12, Andi was seen by her veterinarians, Drs. Michael and Beverly Silkey. X-rays revealed an enlarged spleen and slight enlargement of the liver. Blood work showed a PCV of 22. A Coombs test was ordered which was negative. On October 14, Lorrie and Andi were referred to Dr. Cook, an Internal medicine specialist. An ultrasound showed gross enlargement of the spleen and slight enlargement of the liver. A spleen and bone marrow biopsy were also done. It was the opinion of Dr. Cook that Andi had AIHA. Unfortunately Dr. Cook was leaving for Scotland, therefore Lorrie was advised to take Andi to NC State School of Veterinary Medicine.

On Friday, October 16, Andi was admitted to NC State. On admission her PCV was 18. Andi had been started on 20 mg prednisone on October 12. The veterinarians at NC State added 100 mg Doxycycline, 15 mg Azathioprine (Imuran), 10 mg Famotidine and 1400 units Heparin 3X day. Andi was tested for Hemobartonella, ANA, Rheumatoid Factor, pre and post bile acids, Ehrilichia canis, Lymes, and Rocky Mt. spotted fever. The results of all tests came back negative. Andi was discharged from NC State on October 22, with a PCV of 22. Lorrie was instructed to take Andi in to see Dr. Cook in one week. By the time Andi saw Dr. Cook, her PCV had dropped to 13. Dr. Cook prescribed 1 unit of Oxyglobin, and IV Cytoxan. 7 days later Andi was started on the first of 2 rounds of Cytoxan tablets. By the end of January 1999, Andi had a PCV of 36.5 and was taken off all medications.

On March 31, 1999 Lorrie notice that Andi was not looking as "pink" as normal. She immediately took Andi in for blood tests which revealed a PCV of 28. By the next day, the PCV had dropped to 20. Andi was given one unit of Oxyglobin and IV Cytoxan. She was also started on 15 mg Azathioprine, 20 mg prednisone every 12 hours, Pepcid ac, as well as 1400 units Heparin every 8 hours. By April 9, Andi's PCV had dropped to 16 and a second unit of Oxyglobin was given along with the Cytoxan. It was at this point that Lorrie and her vets discussed trying Neoral (cyclosproine). Andi was started on Neoral at the dosage of 37 mg every 12 hours. Andi's cyclosproine levels were tested weekly. The Neoral dosage was adjusted according to these levels. After 14 days on the Neoral treatment, Andi went from a PCV of 19 on April 24 to a PCV of 34 on May 10. Andi has continued to improve and is currently taking 50 mg of Neoral every 12 hours. She is off all other AIHA medications. At Andi's last check up on Dec. 7, 1999 she had a PCV of 38.4. Andi's veterinarians plan to lower the dosage of Neoral very slowly and get Andi down to the lowest possible dosage that will keep her in a sustained remission. Because the veterinarians at NC State felt that the vaccination Andi received 10 days prior to becoming ill may have caused the illness, Andi no longer receives any vaccinations. Andi also suffers from a mild case of arthritis. The arthritis is being managed with a glucosamine/chondroitin supplement as well as aspirin as needed.

According to Lorrie, "Andi is back to her playful, loving ways. She loves to swim and during the spring and summer it is a chore to keep her out of the pool. She also enjoys visiting the fishpond so much, I bought her a fish for the house ( Mr. Bubbles). Her all time favorite thing to do is being held and she would sit in your lap all day if time would permit."

Andi Update, July 2001

I recently received the following Andi update from Lorrie.

”It is with great sorrow that I write this note to you. Andi started running a fever on Thursday evening, July 17th. She was started on antibiotics Friday morning. By Saturday, it was apparent that she was in a great deal of pain and she started vomiting. I took her to see the internal medicine specialist on July 23rd and after ultrasound and blood work I decided to let her go. She had a serious infection of the gallbladder. It appears that the drugs she was on to control the AIHA had mask the infection and that to put her through surgery would only prolong her pain. I guess the AIHA did not take my girl, but because of it I lost her. She will forever live in my heart”.

February 2000

Banyan

Banyan is a 13 year old neutered male English Bull Terrier owned by Kerry and Norman of Edmond, OK. Banyan was diagnosed with autoimmune hemolytic anemia on October 12, 1998.

On Friday, October 9, 1998, Banyan received his annual vaccinations. These vaccinations consisted of the rabies shot as well as the DHLP/Parvo/Corona injection. On Sunday October 11, Banyan and his family went for a walk. Banyan became so exhausted on the walk, he could barely make it home. Kerry & Norman found this exhaustion very unusual so they watched Banyan carefully while he rested the balance of the day. When the exhaustion continued into the next morning, they became very concerned and took Banyan to the veterinarian. Kerry & Norman braced themselves for bad news and were a bit relieved when they learned Banyan was "just very anemic".

On presentation Banyan had a PCV of 17. He also tested Coombs positive. Banyan was started on prednisolone, both orally and by injection. Over the next few days Banyan's PCV dropped to 10. Because Banyan did not respond quickly to the prednisolone, other causes for the AIHA were sought. An ultrasound was ordered on the heart, liver and spleen. Two lesions were found on the liver as well as one on the spleen. There was also the possibility that internal bleeding may be contributing to the anemia. Because an angioscarcoma had been removed from Banyan's stomach several years prior to the onset of the AIHA, cancer was also suspected to be a possible cause of the AIHA. In late October, Banyan had a liver biopsy, which indicated he did not have cancer. A splenectomy was preformed at the same time as the liver biopsy. Prior to the splenectomy, Banyan received one unit of whole blood. Analysis of the spleen indicated while it was only slightly abnormal in size, it was the site of the red blood cell destruction. After the splenectomy, Banyan's PCV still did not rise above the low 20's, therefore a bone marrow aspirate was performed in November. The results were not encouraging, Banyan had a poor regenerative rate. However Kerry & Norman felt that a poor regeneration rate was better then no regeneration rate at all so they continued to have hope. The prednisolone was continued and finally and slowly Banyan began to recover. By February 1, 1999 Banyan's PCV had rebounded into the lower 40's and the prednisolone was lowered to 20 mg per day. On February 24 Banyan's PCV had dropped to the lower 30's and the prednisolone was raised to 30 mg per day. Once again the PCV started to rise and by May, 1999 it was back to 37. In late May, Banyan became ill with urinary crystals and his PCV dropped to 23. The prednisolone was raised again to 40 mg per day. By September 1999, Banyan had been on high dosages of prednisolone for several months and he began to exhibit signs such as a "pot bellied" appearance, skin calcium deposits and wobbly legs all indicative of steroid induced Cushing's disease. It became apparent that if the prednisolone dosage was not lowered the drug would kill Banyan. The drug reduction was started very slowly and currently Banyan is on 10 prednisolone mg per day. In addition to the prednisolone, Banyan takes Synovi-cre for arthritis, Pet-tinic vitamin & iron supplement, Vitamins C & E, and Pet-tabs Plus. Banyan also takes Filaribits daily tablets for heartworm protection. Banyan no longer receives any vaccinations whatsoever. At his last checkup on January 14, 2000 Banyan had a PCV of 44.

Banyan developed cataracts on both eyes several years ago. In 1999 the growth of the cataracts progressed very quickly. When Banyan started to bump into things around the house, Kerry & Norman became worried that Banyan might hurt himself. Banyan had cataract surgery on both eyes on December 8, 1999. He came though the surgery extremely well and is now once again enjoying good vision.

When asked to comment on the current state of Banyan's health Norman replied " After so many months, we again see the real Banyan emerging from the veil of AIHA. This experience with AIHA reminds us that every day with Banyan is a gift to treasure." Kerry concurred when she stated " Norman & I marvel at the turnaround which has occurred in concert with the reduction in his prednisolone. Dealing with AIHA is something I would not wish on anyone, but as a result of having gone through this with Banyan, Norman and I look at every day as a gift. Not only that we are so blessed to still have our darling Bullie with us but in so many ways, every day is precious."

Banyan Update, February 2001

Banyan died on August 20, 2000. According to Kerry, Banyan had been placed on the drug Enacard in June 2000 for blood pressure and heart problems. Kerry noted, "Banyan developed an inner ear infection and we caught it early. Banyan was doing great until the week before his death. In fact the ear infection was markedly improved the day before he died. The cause of Banyan's death was most likely a brain-oriented problem which the ear infection masked. In the end his heart was not up to the fight." Kerry continued, "Banyan did not die of AIHA and he lived to an old age (13+years). I look back on the one year and ten months that Banyan survived AIHA and know that we were luckier than most. We went on to enjoy many more days of fun and love. For that we are thankful and enriched."

March 2000

Myles

Myles is an 8 year old neutered male Cocker Spaniel owned by Denise of Edmonton, Alberta, Canada. Myles was diagnosed with autoimmune hemolytic anemia on August 17, 1998.

Denise and her family were on holiday in Winnipeg, Manitoba, 800 miles from home, when Myles became ill. On Monday Myles was eating well but vomiting. By Thursday, Myles was so weak that he needed to carried. Both of Myles eyeballs as well as his mucous membranes were jaundiced at the onset of the AIHA. His urine was a dark, rusty-red color. Myles also became anorexic (this following 3 days where he did eat but threw up after each feeding.) His coat became dull and his personality indicated the desire to be left alone.

Upon presentation Myles had an elevated temperature and a PCV of 10.8. He was hospitalized and given IV therapy for dehydration. Myles was started on 25 mg prednisone twice daily. Cytoxan was prescribed in the dosage of 50 mg daily for 4 days, off for 3 days and then repeat for 3 rounds. In addition Myles was given seven injections of metronidazole (Flagyl) for "stress colitis" which manifest itself as a brown, mucoid diarrhea. According to Myles veterinarian, the "stress colitis" was likely due to the AIHA. Myles was discharged from the hospital 4 days after admittance on prednisone, Cytoxan and the antibiotic Clavamox at a dosage of 125 mg twice daily for 10 days. The Clavamox was prescribed for the kennel cough which Myles contracted during his hospitalization. Myles had his blood checked every 3 days for the next 2 weeks while Denise and her family remained in Winnipeg. Upon returning home Myles was seen by his own veterinarian. Over the next 18 months Myles' PCV continued to rise and the prednisone was decreased very slowly until it was down to a dosage of 2 ½ mg every 10th day. The prednisone was discontinued on January 29, 2000. At Myles' last check up on February 9, 2000, he had a PCV of 51 with all other values being within normal limits. Since Myles prednisone has so recently been discontinued he will continue with monthly PCV checks for the next several months. Myles is currently taking Visorbits, a vitamin-iron supplement and Arthritis Relief, a supplement which contains glucosamine, chondroitin sulfate and shark cartilage.

Four months prior to become ill, Myles received vaccinations. Denise recalls; "in looking back during the ensuing 4 months he was never quite himself again- a little lethargic, a little quiet, a little depressed-just not Myles". Since the AIHA diagnosis Myles has received no vaccinations. Myles receives no flea preventative. Prior to Myles illness, he had never received any heartworm preventative. His geographic location makes such prevention unnecessary. However Myles did receive one Heartgard chewable in the summer of 1999 before the families annual vacation since they were traveling into an area known for heartworm.

Myles is presently in very good health. When Denise was asked to comment on the current state of Myles' health she replied; "Myles illness matured him (and us) greatly. Until the AIHA, we took his good health for granted. Myles' illness helped us clarify some values around what it means to have a family pet. There is no question that the bills have escalated since he was first diagnosed, but to see him today-robust, healthy, bossy, playful, has justified every penny we've spent. Like marriage, its "for better or for worse" when you take on a family pet. Now, I don't let a day go by without "loving up" my dog and saying a prayer of thanks that he's still with us and thriving."

April 2000

Molly Bea

Molly Bea is 10 year old, spayed female, Cocker Spaniel owned by Katherine of Atlanta, GA. Molly was diagnosed with autoimmune hemolytic anemia on December 8, 1997.

According to Katherine, " Molly is sweet and expressive, a very merry little dog who smiles constantly and loves her daily routine. The first symptom of AIHA that we noticed was Molly's lethargy, in particular, a visitor to our home noticed that she didn't seem her usual "waggy" self." Other symptoms that Molly exhibited at the time of diagnosis were pale (yellowish) mucous membranes, lack of appetite, enlarged spleen and an upset stomach.

Upon presentation, Molly had a PCV of 18. A Coombs test was done which came back negative. However, the lab reported "marked spherocytes and autoagglutination" present in the blood sample. Molly was initially started on prednisone and Tagamet. After one week, Molly's energy level and appetite returned but neither the PCV nor platelet count had improved substantially. On December 16, 1997, Molly was referred to a veterinary internist in Atlanta, where she was hospitalized for 3 days. The internist conducted the following tests; complete blood count, chemistry panel, thoracic/abdominal ultrasound, abdominal radiographs, reticulocyte count and bone marrow aspiration, while treating Molly with basic fluid support. After receiving the test results, the internist diagnosed Molly as having AIHA. Molly was treated with cyclophosphamide (Cytoxan) and prednisone as well as famotidine as a prophylactic measure for gastric ulceration. After Molly was released from the hospital, her PCV was rechecked again on December 22, at which time it had risen to 23. A CBC preformed on December 30, 1997 showed a PCV of 32. By January 6, 1998, Molly's PCV had risen to 38.3. Molly's PCV continued to rise and by spring of 1998 it was in the 40's. Molly's prednisone was slowly reduced and by June, 1998 Molly was completely off the drug and was referred back to her regular vet.

Upon full disclosure from her vet as to the pros and cons of vaccinations, Katherine has opted to no longer vaccinate Molly for any disease. According to Katherine, "Our vet reported to us from a seminar that the mortality rate for AIHA in general is approximately 40%, whereas the morality rate for AIHA when triggered by vaccinations is more like 70%.The odds that vaccinating Molly Bea would trigger an autoimmune response in the first place are probably remote, but we have decided not to take the chance." Molly has been on Filaribits for heartworm protection all of her life. Katherine has used Top Spot on Molly's neck a couple of times since her diagnosis to eradicate fleas. Prior to her AIHA diagnosis, Molly was not exposed to any flea preventative.

Molly is currently in very good health. She is on no medication for AIHA, but does take .3 mg soloxine twice daily for low thyroid function. She also receives Otomax ( a topical preparation) for ear infections. Molly is on no regular check up schedule, but her blood is checked a couple of times a year prior to receiving dental cleaning. Her last measured PCV level was 47.7 in May 1999. Katherine reports that "we keep a very close eye on Molly's energy level and mucous membranes." Even though Molly has remained healthy since she has been off the prednisone Katherine says "we have not taken that for granted. Molly was very lucky to have received excellent, aggressive medical intervention on a timely basis from all involved."

May 2000

Lex

Felix Von Lucknor (Lex) is a 12 year old, intact male Rottweiler owned by Judith of Westville, NJ. Lex was diagnosed with autoimmune hemolytic anemia on December 31, 1993.

On the morning of December 31, 1993 Lex woke with difficulty breathing, increased heart rate, increased lung sounds, skin cool to the touch, white gums and extreme lethargy. Lex was immediately taken to his vet where he was examined and hospitalized. Upon presentation Lex had a PCV of 12. An emergency exploratory lap was done to rule out abdominal mass or active bleeding. Lex was diagnosed with AIHA and started on 60 mg prednisone b.i.d. (twice per day), 750 mg Amoxicillin b.i.d., 300 mg Tagamet b.i.d. and Cytoxan 150 mg daily, all given intravenously. Lex was hospitalized for 5 days and released from the hospital on January 6, 1994 with a PCV of 18. On January 8, Lex had a PCV of 20 and his prednisone was increased to 120 mg b.i.d. Over the next few days Lex's PCV yo-yoed up and down. By January 15, 1994, the PCV was at 22 and Lex was started on 100 mg Cytoxan for 4 days. After the completion of this round of Cytoxan Lex's PCV rose to 26. On January 22, Lex was started on 100 mg of Imuran. His prednisone dosage continued at 120 mg b.i.d. for 17 days. Over the next few months the prednisone dosage was lowered until it was completely discontinued on March 24, 1994. The Imuran was discontinued 3 weeks later.

Lex is on no medication for AIHA but does take .6 mg soloxine twice daily for low thyroid function. Lex continues to suffer from calcinosis cutis, which is an abnormal deposit of calcium under the skin. This is due to the high doses of prednisone. According to Judith; " My vet tells me she has never seen a case like ours. It never went away and covers such a large portion of his back. You can't notice it at a distance but he is known in the neighborhood because the kids can knock on it and it sounds like wood. Every now and then a small area will open and it looks like an abrasion, otherwise it doesn't bother him at all. When it first appeared it was whole body and draining. That's when he started wearing shirts to protect him from dirt and infections. He has worn a T-shirt ever since."

When asked about the current state of Lex's health Judith replied; "Lex is in good general health. He is, of course, older, slower and wiser, but still in remission from his AIHA. His last check up was in December 1999 and all his labs were normal (except his cholesterol was slightly above normal, but has been for the last 5 years)." Lex's PCV at the December 99 checkup was 36. Judith continues " Every time I look at Lex, I am grateful. He was such a wonderful patient. The first three weeks after he came home from the hospital I was drawing his blood everyday. I am a nurse and had all the equipment and the lab at work let me run a hct. Lex was so trusting and he knew what my favorite vein was!! I know we are fortunate to not have suffered a relapse like many do, but you tend to always be watching out. I know every mark on Lex's gums because not a day goes by I don't check to see they are pink."

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