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September 2002

Sophie

Sophie is a 7 year old spayed, Wire-haired fox terrier owned by Carol of Tampa FL. Sophie was diagnosed with autoimmune hemolytic anemia on June 4th, 2001.

When Carol was asked to describe the symptoms Sophie exhibited prior to her AIHA diagnosis she replied, "Sophie's personality change dramatically when she became ill. She had a loss of appetite, became depressed, lethargic, and generally uninterested in anything or anyone. She stopped greeting me when I arrived home from work, and was reluctant to go for walks outside. I also noticed that she began licking the sidewalk and dirt which was very strange. Within the next few days she became increasingly more reclusive, hiding around the house. Her appetite continued to decrease, and she was even refusing her favorite doggy treats. One morning I woke up to an awful smell in the house and found puddles of bloody diarrhea. I have 2 dogs ( Sophie's' mommy Annie has bouts of colitis) so I wasn't positive who was responsible, but my gut feeling told me it was Sophie. I called the vet and took Sophie in that afternoon. The doctor felt she may have "gotten into something," or possibly had an intestinal parasite. Blood testing showed slight anemia. Sophie was given an antibiotic and Val syrup for the anemia. Several days passed and she was becoming more and more lethargic, and began refusing food completely. I took her back to the vet, and more blood was drawn. Her PCV had declined, and the doctors seemed increasingly concerned about the anemia. An x-ray of her intestines showed a small spot which normally shouldn't be there. They feared that she may have an intestinal tumor, which could be causing the anemia. Exploratory surgery was done the next day, which revealed not a tumor but a pebble that had been ingested. The doctor said the pebble was very small and would probably have passed naturally. I attributed it to her eating the dirt. Sophie spent the night at the vet hospital, and when I picked her up the following morning, she showed no signs of happiness to see me, not even a wag of the tail. She also appeared very weak and disoriented. I expressed my concern about this, but was told she was still under some pain medication, and may be somewhat sore from the surgery. When I asked if the pebble could possibly be causing her anemia, the doctor said he didn't think so. He would check her again in 5 days to remove the stitches. Sophie was very listless on the car ride home, never lifting her head once. She looked so weak, I resorted to trying to entice her with "people" food. She refused even that. After another day of the same behavior, I called the vet and said I was bringing her in, something just wasn't right. She was having trouble walking and at times seemed confused and just stood and stared into space. It was very visible that she had lost several pounds. The vet noted that her condition had worsened, and ordered more blood work done. Sophie's PCV had dropped to 18 and her gums were a very pale pinkish/white. Her weight had dropped from 23 lbs to 17.5 lbs. My vet suggested that Sophie was critically ill, and referred me to an internal specialist."

Sophie's first visit to the veterinary internal medicine specialist included many tests including a reticulocyte count, a blood smear, a test for Lyme disease (results were inconclusive) as well as more blood work. Upon diagnosis of autoimmune hemolytic anemia, Sophie was started on 20 mg prednisone and 50 mg Doxycycline. 2 days later, her PCV had fallen to 15. 25mg Cytoxan was then added to the treatment regimen. The following week Sophie's PCV fluctuated between 15-17 at which time the doctor discussed the possibility of a transfusion if the PCV dropped again by the next office visit. However, 15 days after the initial AIHA diagnosis and after the second round of Cytoxan, the PCV increased to 23. Sophie continued with the prednisone and a 3rd round of Cytoxan was administered. She was showing improvement each week, although at times it was minimal. When her PCV reached 31, her prednisone was decreased very slowly every 4-5 weeks. Blood tests continued on a weekly basis, while Sophie's PCV remained in the 30's range for quite sometime. Finally, in early September, her PCV was in the normal range between 40-42. At the end of December, 2001, the doctor decided that they should try taking Sophie off of all meds. Her prednisone had been decreased by then to a very minimal amount (5mg every 3rd day).

Currently Sophie is on no medications for AIHA. The only medication that she does take is Interceptor heartworm preventative. According to Carol, "living in Florida makes heartworm preventative necessary." Sophie receives no flea or tick preventative nor has she had any vaccinations since her AIHA diagnosis. Carol commented, "Sophie was diagnosed with AIHA one month before she was due for her vaccinations. Needless, to say, she never received them that year." At the present time, Carol is considering doing titers testing to see if additional vaccinations are necessary.

When Carol was asked to comment on the current state of Sophie's health, she replied, "Sophie's health is great. Her most recent blood work was done on July 6, 2002 at which time she had a PCV of 42. The doctors said her AIHA is in sustained remission, and the outlook is good. Seeing her today, one would never know just how sick she had been just one year ago. I am enjoying the "old" Sophie that I worried I would never see again. Once again, she is first to the door (racing her mommy Annie) when I say "Let's go bye-bye," or she hears the jingle of the leashes to go for a walk. It is a pleasure to see her enjoying some of her favorite pastimes again: going for car rides, spreading her body flat on the grass and giving her belly a good rub (affectionately called the "commando crawl",) eliminating my need for an alarm clock when she pounces on me at 6:00 AM, and seeking new places to hid when it's time for a bath. I've noticed that she has also become a little more "clingy" to me when I am home, always just a few steps behind or sitting nearby. I am so thankful for her recovery and pray that it will continue. I hope that in some small way Sophie's story can bring hope to those continuing to fight the battle with AIHA."

Sophie Update, May 2003

Carol wrote recently with the following Sophie update.

"Sophie passed away on February 19, 2003 after 6 days in the hospital battling renal failure. This was very unexpected, since she never really acted sick until a few days before her hospitalization. My first thought, of course, was an AIHA relapse. However, blood work showed only slight anemia, it was her BUN and Creatinine levels that were off the charts. The doctors tried everything to save her, but she never really responded well to the IV fluid treatments and meds. Her levels seemed to "plateau," and after 6 days in the hospital the doctors decided to try to lower her IV fluids to a manageable level so that I could administer the Sub Q fluids at home. Immediately, her condition began to decline, and her kidneys as well as her other organs began to shut down. She had been vomiting throughout the night, and experienced a seizure that morning. I knew the end was inevitable, and the decision to euthanize was my only humane option.

I had and still have many questions about this sudden onset of kidney failure. I asked the doctors if it could possibly be secondary to AIHA or long term prednisone use. As expected, those answers are unknown. One thing I am certain about, is that Sophie lived her life to the fullest during her 1 1/2 years in sustained remission from AIHA. She swam in the ocean, went for trips in the mountains of North Carolina, and spent endless hours tormenting the neighborhood squirrels. She was without a doubt "all terrier," and will live in my heart always."

October 2002

Tzoe

Tzoe is a nearly 8 year old spayed female Shih tzu owned by Donna of Staunton, VA. Tzoe was diagnosed with autoimmune hemolytic anemia on April 14, 1999.

When Donna was asked to comment on Tzoe's symptoms prior to her AIHA diagnosis she replied, "The disease appeared to come on very suddenly. Tzoe experienced extreme lethargy and would not eat, although she did drink a lot of water. The skin on her belly was white and her gums were very pale pink. She was also very very weak. She started hiding in corners and under the bed."

Tzoe was taken to her veterinarian where she tested Coombs positive. Her PCV at the time of diagnosis was 18. Because oral prednisone caused Tzoe to vomit, she was switched to Dexamethasone injections for the two days she was hospitalized. Tzoe also received IV fluids during her hospitalization. When Tzoe was sent home from the veterinary hospital she was on 5 mg prednisone twice per day (her weight at that time was 10 pounds). Later the prednisone was decreased to 5 mg once per day and several months later the prednisone was dropped to 5 mg every other day. Further drops in the prednisone dosage occurred over time and currently Tzoe is on 1.25 mg prednisone every third day.

When Donna was asked to comment on the current state of Tzoe's health, she replied, "she is doing great! Her PCV at her last blood test on January 2, 2002, was 48.7. I attribute this to very few follow up vaccinations, no flea or heartworm preventatives, no antibiotics. In other words, we are trying not to do anything to stimulate her immune system. Also being on a lower dose of prednisone has helped her stomach problems. At 5 mg every other day, she was having frequent bouts of vomiting, and decreased energy and appetite. She had to go back to the vet for Reglan injections and Tagamet to calm things. We were also worried about pancreatitis. But now that the prednisone dosage is only 1.25 mg every third day she has very infrequent stomach upset and when she does, I give her Tagamet and she is just fine. I am grateful for every day of her continued health. She is the joy of my life."

Donna went on to add this postscript to Tzoe's story. "In 1995 my mom who lived with me was diagnosed with myelodysplasia, a blood disorder where she made very few of her own red blood cells. This disease required that she have frequent blood transfusions. A few months later she developed AIHA. She was on IV steroids and oral prednisone. She also had monthly then weekly blood transfusions. When Tzoe was diagnosed with AIHA in 1999, we were devastated, how could she have what my mother was going through. It seemed too bizarre, until I learned more about the illness and its frequency in animals and humans. Tzoe was very close to my mother, they shared oral prednisone side effects as well as a common bond of illness and hope. My mom died in December, 2000. My hope now lies in better treatment and ultimately prevention of the AIHA."

Tzoe Update, March 2007

Donna recently wrote with the following Tzoe update:

”Tzoe is doing well and now is 12 years old. She has been off prednisone for 2 years now and has had no relapses. She is truly my miracle baby.”

November 2002

Flicka

Flicka is a 7 year old spayed female Italian Greyhound owned by Joy of Cotait, CA. Flicka was diagnosed with autoimmune hemolytic anemia in early April, 2001.

When Joy was asked to comment on Flicka's symptoms prior to her AIHA diagnosis she replied, "her symptoms literally came out of the blue. The first thing I noticed was a dark colored fluid on the linoleum floor. At first I didn't attribute the fluid to Flicka. Initially it was a mystery as it didn't look like vomit or urine and there didn't seem to be any odor. Since there are other dogs and cats in the house, I was not sure who this fluid belonged to until the next morning. Flicka, who has never been entirely housebroken, has a space with a small area rug where she does toilet things. I noticed the next morning that her rug was covered with large bloody areas of urine. I immediately took her to the vet I work for in Petaluma, CA. Flicka did not seem sick, maybe just a bit more quiet then usual. Since Flicka looked so good and seem so normal a urinary track infection was suspected. X-rays were done and a urine sample was taken and she was put on the antibiotic, Clavamox. While at the vet, Flicka was given a jar of baby food which she ate, but not with her usual gusto for food."

When Joy brought Flicka home that evening, she vomited the baby food she had eaten earlier that day. Joy continued, "Flicka's condition began to deteriorate though the night. She became extremely quiet and her mucous membranes became pale. I took her back to work with me the next morning. A blood sample was drawn and her PCV was 10. She was immediately started on IV fluids. She was also given 15 mg prednisone acetate, a Vitamin C injection and Reglan. When the lab reports came back the next day, the Coombs test was positive and all other results indicated a diagnosis of AIHA. Flicka was not improving and her prognosis was grave. The doctor prescribed 5 mg prednisone 3 times per day, 50 mg Doxycycline 2 times per day and 1/3 Cytoxan, 50 mg tablet once a day for 4 days, then 3 days off and then repeat. Flicka was also started on slow drip of Oxyglobin. Over the next couple of days she began to improve, her PCV began to slowly rise and her color became better. Her appetite came back with a vengeance due to the prednisone. The prednisone was continued for the next 6 months with gradual decreases in dosage until it was entirely discontinued. Flicka's PCV continued to rise and was 56 by December, 2001."

In January, 2002 Flicka dislocated her rear leg due to some over enthusiastic jumping. Four days later, Joy notice little red splotches all over Flicka's chest. As the day progressed the spots began to spread and grow. Even though Flicka's appetite and spirits were fine, Joy decided to take her to the 24 hour emergency care hospital that evening. Blood tests revealed Flicka had a very low platelet count. She was given a cortisone shot and prescribed Doxycycline 2 times per day. The next day, Flicka went to see her own veterinarian where additional testing revealed a diagnosis of Immune-Mediated Thrombocytopenia. Flicka was started on 10 mg prednisone twice per day. Over time the platelet count improved and the prednisone was gradually decreased. At the present time, Flicka is on no medications for either autoimmune hemolytic anemia or immune-mediated thrombocytopenia. "Because Flicka is totally a house dog, she will probably never be vaccinated again", according to Joy.

When Joy was asked to comment on the current state of Flicka's health, she replied, "she is doing great at this time. Her last blood testing was done in August of 2002. At that time her PCV was 55.6 and her platelet count was 498,000. Of course, we tend to over watch her. We probably look at her gum color once a day. I am very fortunate to work for a vet and my co-workers were and continue to be a great support. I could never say enough thank-yous to the Doctor and staff who stood by Flicka and loved her during her most difficult hours."

December 2002

Zudnick

Zudnick is a 10 year old spayed female Dalmatian owned by Jen and Scott of Bristol, Vermont. Zudnick was diagnosed with autoimmune hemolytic anemia on January 4, 2001.

When Jen was asked to describe Zudnick's symptoms prior to her AIHA diagnosis she replied, "Zudnick had always been a very energetic and curious dog. When we noticed her slowing down a bit we were concerned but thought it was just because she was getting older. As the weeks went on, she continued to slow down and her energy level seemed to be gone. I started to think that maybe this wasn't just because she was getting older, that maybe she was sick. I made an appointment with the veterinarian and that very night I noticed she had blood in her urine. I immediately called the vet back and we discussed the situation. She asked me a number of questions about Zudnick's symptoms and asked me to check her gums and tongue color. I thought this very strange but everything seemed fine to me. Because it was late in the evening and we didn't think it was anything too serious, we decided to wait until morning to bring her in for the full checkup."

The next morning Zudnick was taken to the vet. Jen continued, "I was asked to leave her for the day so tests could be run. By the time I returned that evening they had, with almost certainty, diagnosed her with AIHA. Her gums and tongue were very pale and her PCV was 18. They had started her on prednisone, Tagamet and an antibiotic for a bladder infection. We brought her back into the vet the next morning and she was noticeably slower. It was amazing how quickly her energy level was decreasing. Again she spent the day at the vet's office so they could keep an eye on her levels and run more tests. Her PCV was now at 15. The prednisone was increased to 60 mg twice per day and cyclophosphamide (Cytoxan) was added to the treatment regimen. The Cytoxan was to be given on a schedule of 4 days in a row with 3 days off. If her PCV level didn't increase or at least stay the same in the next few days they were preparing her for a treatment of Oxyglobin or a blood transfusion. Everyday for the next 2 weeks we brought Zudnick into the vet for PCV checks. Since her PCV stayed the same or even increased a little, no transfusions were needed. Also during those weeks, test results were coming in. The Coombs test had been negative but the thyroid testing revealed Zudnick had a thyroid problem. She was started on .6 mg L-Thyroxine twice daily in addition to the other medications. Over the next few months Zudnick slowly started to get better. It was a very long recovery process and the medications that were making her better were also giving her a number of side effects. She lost a lot of weight and muscle, at times had horrible bouts with diarrhea and had days where she had blood in her urine and stools. It was awful to see her like this and many times we questioned ourselves as to why we were putting her through all of this. But even with all of the side effects, her blood work was getting better and because of this we were able to decrease her meds. As the meds were very slowly decreased, the side effects got better."

Over time Zudnick was slowly taken off the Cytoxan and the prednisone with no relapses occurring. The veterinarians were unable to tell Jen and Scott why or how the disease was brought on but did say Zudnick's thyroid problem could have been a factor. Zudnick is currently taking no medications for the treatment of AIHA. She does take .5 mg of L-Thyroxine twice daily for the thyroid problem . In addition she takes a daily woman's multi-vitamin supplement with iron.

When Jen was asked to comment on the current state of Zudnick's health she replied, "She is doing great and completely back to her normal self! Her last blood work revealed a PCV of 40. She receives Heartgard for heartworm prevention during the summer months, however, she will no longer be receiving any vaccinations whatsoever. She was due for her Rabies vaccination this spring but we chose not to give it to her. My vet spoke with our town officials explaining the situation so Zudnick could still be licensed. Zudnick is truly a miracle dog who loves and lives life to its fullest. She brings joy to our lives and every day we are so lucky and blessed to still have her with us. I am so happy we did everything we could for her and hope she has many healthy, happy years left to come."

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