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Frakka is a 10 year old spayed female Standard Dachshund owned by Robin and Bruce of Hattiesburg MS. Frakka was diagnosed with autoimmune hemolytic anemia on April 9, 2002.
When Robin was asked to comment about Frakka's symptoms prior to her AIHA diagnosis she replied, "she experienced lethargy, loss of appetite, anorexia, weight loss, weakness and lack of enthusiasm. She was also very listless and experienced rapid breathing. Once I thought I saw dark urine but because she is so low to the ground, I thought it was just an illusion. The very few times she had a bowel movement, the feces had an orange hue to them. We did not pay much attention to this because this had happened sometimes in the past when she ate carrots. In retrospect, I now know this is also a symptom of AIHA."
Frakka was taken to her local vet who misdiagnosed her with pancreatitis. A return visit to the vet resulted in the diagnosis of AIHA. The vet also detected a heart murmur. Frakka was transferred to LSU (Louisiana State University) where she underwent a number of tests including a Coombs test which came back positive. Frakka's PCV at the time of her AIHA diagnosis was 16. While at LSU, Frakka was started on prednisone at a dosage of 40 mg twice per day. The next day when the PCV had risen to 20, the prednisone was decreased to 30 mg twice per day. By the time Frakka was released from LSU three days after her admission, the prednisone dosage had been reduced to 20 mg twice per day. Robin commented that "while 80 mg of prednisone for a 23 pound dog was very high, the doctor at LSU thought it was necessary because of Frakka's very grave condition. When she started to improve LSU discharged her on the 20 mg bid." At the time of Frakka's discharge from LSU she was also taking Famotidine for nausea. A week to 10 days after Frakka's discharge from LSU, she was started on Soloxine for hypothyroidism. When Frakka started to develop liver problems from the prednisone it was decreased further and azathioprine was added to the treatment regimen. Robin noted "we continued to test the thyroid levels when we went for blood tests. When the thyroid levels stabilized we discontinued the Soloxine." Both the prednisone and azathioprine were slowly decreased until Frakka was off all medications for the treatment of AIHA. Testing in early August, 2003 revealed Frakka had an elevated ALKP (Alkaline phosphatase) level so she was started on Denosyl, a nutritional supplement which aids in managing a variety of liver problems in dogs and cats.
Frakka takes Interceptor for heartworm protection every 45 days. Frontline is used for tick and flea protection every 30-45 days three to four months per year. Prior to her AIHA diagnosis Frakka was given vaccinations each November. In November of 2002, after her bout with AIHA, titer testing was done. It indicated no vaccinations were necessary. Robin plans to do the titer testing again in November 2003. Frakka also takes Dermacaps, Prozyme, C-biotic and Vitamin C daily.
When Robin was asked about the current state of Frakka's health she replied, "it is excellent except for the recurrent urinary track infections. Prior to the AIHA diagnosis Frakka was taking DES (Diethylstilbestrol) for urinary incontinence. After AIHA, the DES was stopped and we tried PPA (Phenylpropanolamine), due to the potential side effect of bone marrow suppression from DES. The PPA caused Frakka too many problems so we put her back on DES." Robin continued, " When Frakka's PCV was close to normal, she began to stand on the deck every morning barking at apparently nothing. We finally realized she was telling the world, "I am back." It warms our heart to see Frakka play tag with her canine brother, Franz. We marvel when she races to the door at an unfamiliar sound or when she runs across the yard to bark at the latest "intruder". Before AIHA we took all these things for granted but now they thrill us."
Robin also noted, "it is important not to overlook anything that briefly catches your attention. If I had told our vet about the dark urine and orange feces, Frakka may have been diagnosed earlier. Be diligent in your knowledge of learning about AIHA. We found that when we were more informed we worked more as a team with our vet. Knowing as much as you can about AIHA, not only serves to help your pet, but it will help you to make informed decisions and give you peace of mind. We are very blessed to have had team of vets who really cared about Frakka-and still do, and who have been dedicated and tenacious. Finally don't forget in our day of modern medicine, miracles do happen. We are very grateful for all the prayers we had. Our church even put Frakka on their official prayer list. God helped me put my trust in the vets and medicine when the prednisone was having terrible side effects on Frakka and because of both faith and medication she recovered."
Jacob is an 8 year old neutered male Lab/Pit Bull mix owned by Teresa and Daren of Virginia Beach, VA. Jacob was diagnosed with immune-mediated hemolytic anemia on July 23, 2002.
When Teresa was asked to describe Jacob's symptoms prior to be diagnosed with IMHA she replied, "Jacob was fine one day and sick the next. We had just gone up to bed and I went into the bathroom, when all of a sudden I heard a loud sound. I ran into
the bedroom to discover Jacob had fallen off the bed and collapsed on the floor. Looking back now, I believe, we did have earlier warning signs. We had noticed that Jacob did not want to go out in the heat. When he would go out he would lick the dirt like crazy. It was extremely hot so we just contributed it to the heat and so did the vet when we called him. He was still eating, drinking, and playing like normal."
Teresa continued, "We took Jacob to the emergency vet hospital where blood testing revealed that he had a PCV of 22. All other blood work was normal. Chest and abdomen x-rays were also normal. The vet went down a list of possible causes for the anemia, one being IMHA. Because Jacob's PCV was not dangerously low, we were advised to take him to his regular vet in the morning. The next day Jacob's PCV was 17. His regular vet did a Coombs test and a tick test, both of which were negative. A bone marrow biopsy was done, therefore, Jacob wasn't started on prednisone until the bone marrow results came back. The vet explained that prednisone could hide an underlying infection and throw off the bone marrow results. While we waited to start the prednisone, Jacob had a blood transfusion which brought the PCV up to 32, but it later dropped back to 9 at which time another transfusion was administered. When the bone marrow results came back, they were very discouraging. In addition to IMHA, the pathologist said there were signs of myelofibrosis in the bone marrow. Myelofibrosis is a condition in which the blood components in the bone marrow are crowded out and replaced by fibrous connective tissue, eventually causing bone marrow failure. In the canine world, myelofibrosis is said to be very rare so the prognosis is not really known. Jacob was started on 80 mg of prednisone per day and I was referred to a wonderful internal medicine specialist, who did another bone marrow biopsy. This biopsy showed no myelofibrosis, what it did show was plenty of reticulocytes (young red blood cells). Jacob's red blood cell destruction was happening in the bone marrow itself.
By the end of August, Jacob's PCV had risen to 30. It hovered in the low 30's until the beginning of October, at which time, the vet decided to decrease the prednisone by 10 mg per day. The PCV rose only slightly and remained in the low to mid 30's. Because we did not know what Jacob's normal PCV was, the vet began to think that Jacob's normal PCV may be in the mid 30's. With an all time low PCV of 9 after the first blood transfusion, we were content with a PCV in the 30's. When Jacob's PCV remained pretty much constant, the prednisone continued to be lowered by 10 mg every 4 weeks. By November, the prednisone was starting to take a real toll on Jacob's body. He had lost a great deal of muscle and had a skeletal appearance to his face. In addition, he started having urinary accidents in the house and seemed really depressed. At this point he was still on 40 mg of prednisone per day. 50 mg Imuran per day was added to the treatment regimen in hopes of being able to continue to lower the prednisone. It took about 6 weeks to see any results from the Imuran. By January 15, 2003, Jacob's PCV had finally reached 40. The prednisone was then decreased to 20 mg per day and three weeks later to 10mg per day. By the beginning of February, Jacob's PCV was in the mid 40's. A few weeks later, when the PCV remained in the mid 40's the prednisone was decreased to 5 mg every other day (eod). At the end of February, 2003 the prednisone was completely discontinued while Jacob continued on 50 mg of Imuran every other day. Currently he is on 50 mg Imuran every third day." Jacob takes plain Heartgard for heartworm protection. He uses no flea or tick protection.
In regard to vaccinations Teresa noted, "I have chosen to no longer vaccinate Jacob due to the possible link between vaccinations and IMHA. Although Jacob had his vaccinations several months prior to being diagnosed with IMHA, I have found research suggesting that giving vaccinations to an already immune compromised canine could bring on a relapse and I'm not willing to take that chance."
When Teresa was asked to comment on the current state of Jacob's health, she replied, "Jacob is currently doing very well. He had a PCV of 42.5 at his last blood test on September 29, 2003. He is back to his old self, no limitations. We got Jacob when he was 5 weeks old. When we went to pick him up we were told no one wanted him because he was so small they thought he wasn't
healthy. I believe God wanted us to have this special boy and that's exactly what we got. Jacob is just an awesome dog that we are so fortunate to have as part of our family. He is truly my little fighter and I am so very proud of him."
Jacob Update, August 2005
When Teresa was asked to provide an update on Jacob, she responded with the following comments.
”Jacob is now 10 years old. He just had his annual checkup and was given a clean bill of health. He also recently received a 3 years rabies vaccination. This is the first vaccination he has received since his AIHA diagnosis in 2002. He continues to go every two months for blood testing. His last PCV was 49.5 on July 9, 2005.
Jacob did have a AIHA relapse at the end of May 2004. He was immediately put back on 80mg prednisone and 50mg Imuran every day. His numbers bounced back much faster than when he was first diagnosed. He is currently on 5mg prednisone every other day (eod) and 50mg Imuran every third day. Our internal medicine specialist feels that since these maintenance doses work for Jacob he should stay on this course indefinitely. Jacob also takes Plain Heartgard for heartworm prevention.
To look at Jacob, you would never know he had such a dreadful disease. We were given very little hope in the beginning. I hope this can be a lesson to others that AIHA is not always a death sentence. Just because some vets give a grave diagnosis, doesn’t mean that your dog will not prove them wrong and go on to live a long happy, healthy life. Jacob is proof of this, as are so many others. If I could offer any advice from I have learned in the last 3 years, it would be educate yourself as much as possible about the disease. Don’t be afraid to ask your vet questions, even if you feel you are stepping on his/her toes. You are your dog's voice and an equal partner in their care. Realize that it's normal for things to get worst before they get better but the end result is priceless...a dedicated companion that loves you even more than you thought possible. Last, but certainly not least, please donate to the
Meisha’s Hope AIHA/IMHA Fund #338 at Morris Animal Foundation, so one day in the future, AIHA will be a thing of the past and not prematurely take the lives of so many dogs. Thank you to all my wonderful online friends who, throughout the past three years, have been a Godsend to me.”
Jacob Update, August, 2007
Teresa wrote recently with the following Jacob update.
"Jacob turned 12 in March 2007.
His last blood work was done on August 6, 2007. His PCV at that time was 46.5 with all other counts being in the normal range. He is currently on 5 mg prednisone every other day and 50 mg Imuran every third day. There are no plans to ever change this medication regimen. Jacob continues to take Heartguard (plain) for heartworm prevention and gets his rabies shot every 3 years. For being 12 years old and having lived with AIHA for over 5 years now, he is doing remarkably well. Jacob is still a bottle of energy. The only time he tires easily is when we are outside playing in the heat, which is understandable. We have had an extremely hot summer so we haven’t been able to enjoy as many walks and exercise as we would like, but we are hoping to get back to business come fall.
"I still cannot believe it has been five years since Jacob was diagnosed with AIHA. I remember being told the diagnosis like it was yesterday. I was devastated. Through the past 5 years, this disease (and Jacob) have taught me patience, unconditional love, and especially not to sweat the small stuff. To still have Jacob with me, strong and back to his pre AIHA spunkiness, is truly a blessing. He is proof that this disease can be beat. Since Jacob is now 12, this should give those with older dogs hope if they are battling this disease. AIHA does not discriminate. It affects young, old, pure breeds, and mixed breeds alike. Most people do not even know about AIHA until it affects their lives. Please remember to donate to the Meisha’s Hope AIHA/IMHA Fund #338 at Morris Animal Foundation. This Fund sponsors studies on AIHA/IMHA so that, hopefully in the future, no other innocent canines and (their owners) will have to face such a cruel disease."
Jacob Update, February 2008
I recently received the following Jacob update from Teresa.
”I wanted to let you know that I had to let my boy, Jacob, go on January 2, 2008. He went into multiple organ failure. This happened quickly, in just over a 2 ½ day period. It started with mild vomiting that he had had countless times before in his life after eating too fast. A short while after that he also started having diarrhea. He got so weak so fast and then he had a major seizure. I wanted to take him to the vet that day but he got so stressed by me moving him that I just laid there and prayed for the Lord to take him. Well, being the fighter that my boy has always been he held on and the next day his seizures started at 5 am. He had 3 more before my husband came home and was able to put him in the truck. Just the stress of that put him into another seizure that lasted the entire way to the vets. For my own peace of mind, and to confirm I was doing the right thing by my boy, I had them start him on fluids and run blood work. I don’t think I could have let him go without wondering if he had just caught some raging infection that was causing the diarrhea, vomiting, and seizures. The blood work revealed his liver and kidney readings ( all of them) were off the charts. They were both as high as the machine would allow. I am at peace with my decision because I know I did everything I could for my boy. Prior to the vomiting and diarrhea starting, he was my happy go lucky Jacob...playing, eating, etc. In the last 12 hours or so of his precious life, I swear he aged 5 years. He went very fast and very peaceful. I felt every bit of sickness and stress leave his body.
”It is very important for me to note that Jacob, in my opinion, did not lose his battle with AIHA. His PCV, white cells, and platelets were all within normal ranges on the day he died. Only 3 months prior, testing revealed his kidneys, liver, glucose, etc all checked out normal so this just hit him real hard and quick. I have peace in knowing that I did all could for my dear Jacob and I take comfort in remembering that he went on to live to the ripe old age of nearly 13 despite having AIHA.”
Maxx is a 5 year old spayed female Rottweiler owned by Lynne of Prospect Park, NJ. Maxx was diagnosed with autoimmune hemolytic anemia on October 26, 2000.
When Lynne was asked to comment on Maxx's symptoms prior to her AIHA diagnosis, she replied, "Maxx was diagnosed with AIHA 6 days after she had Tibial Plateau Leveling Osteotomy (TPLO) surgery. This surgery was necessary after Maxx injured her left rear leg while running with her canine sister, Madison. Prior to the surgery, Maxx exhibited no clinical signs of AIHA. Her appetite was good, she had no fever, and there was no blood in her urine or stool. She was on pain medication for her knee and was often quiet but not lethargic."
Lynne continued, "Maxx's vet did a blood workup the morning of the TPLO surgery. The test results from the lab indicated a PCV of 10. However since the results on several tests from this lab had recently been "off" the vet did an in house test which showed a PCV of 40 and preformed the surgery. Maxx's PCV dropped into the 30's during the first 3 days of recovery. It was only then that the pale gums, lack of appetite and lethargy started to show themselves. Our vet became concerned and sent blood work to three different labs including the one that he thought was way off. Two of the labs came back with almost identical readings while the original one was still showing a PCV of 10 along with other skewed results."
Maxx underwent extensive testing which included a Coombs test, bone marrow biopsy, as well as tests for canine and equine Ehrlichia. She was diagnosed with autoimmune hemolytic anemia and started on 100 mg prednisone twice per day and 50 mg Imuran twice per day. A blood transfusion was administered on October 28, 2000. The Imuran was reduced to 50 mg once per day after 7 days and the prednisone was lowered very slowly. Maxx was tested for low thyroid function on March 29, 2001. When that testing revealed her thyroid function was below normal, she was started on .8 mg Soloxine twice per day. As Maxx's PCV rose, both the prednisone and Imuran continued to be slowly decreased. The prednisone was discontinued on December 8, 2001. At this time the Imuran was down to a dosage of 25 mg every other day. Maxx's PCV started to show a slow steady decline after the prednisone was discontinued. On Feb. 4, 2002 she had a PCV of 28 and was in an AIHA relapse. She was once again started on prednisone and the Imuran was raised to 50 mg per day. Lynne noted, "Restarting the meds made her respond quickly, as her PCV went up to 37 in about a months time. We now think that stopping the prednisone and decreasing the Imuran was too much, too soon for her system and that caused the relapse."
In February 2003, Maxx injured her right hind leg while running and needed TPLO surgery on that leg. This time Maxx needed to have her right femur straightened as well which meant a much longer and much more involved surgery. It was decided to stop Maxx's prednisone, which was at only 5 mg every other day, prior to the surgery, since prednisone has been known to interfere with the healing process. Maxx had her second TPLO surgery on March 19, 2003. According to Lynne, "Maxx made a phenomenal recovery from this surgery with no sign of anemia or other problems that plagued her first TPLO. All together in both hind legs, Maxx has 3 metal plates and 17 screws."
When Lynne was asked to comment on the current state of Maxx's health, she replied, "she is doing very well, her last PCV was 46. She has been in remission now since Feb. 20, 2002 and remains on .8 mg Soloxine twice a day as well as 50 mg of Imuran per day. Maxx takes Sentinel for heartworm and flea prevention from April through December. She is no longer given any vaccinations. Maxx also takes 400 IU's vitamin E per day, and two supplements, ProZyme and Life Extension. A Ferrous Iron product is given twice per day. Carrots, potatoes, liver, lentils, ground turkey and ground beef are also part of Maxx's diet on a rotating basis. Her recovery as far as her last major operation has been nothing short of miraculous. I was truly convinced that having this surgery would put her into a major AIHA relapse, but yet again this dog amazed not only me but all of her doctors. Since we have discontinued the prednisone, Maxx has lost 30 lbs. and is down to a svelte 115 lbs! Watching Maxx recover and begin to enjoy life now has brought more joy into my life then I ever thought possible. Her right knee was very bad and she was in constant pain, but her doctors worried about the anemia so she had to endure this pain until everyone felt Maxx would benefit from this type of surgery. Her PCV on the day of
surgery was 46.5 and never went below 42 throughout her recovery period. Now Maxx's days are spent walking the neighborhood, playing with her friends and fighting with her canine big sister Madison. Although its been a roller coaster ride since October 2000 until now, Maxx has been a trooper. One look into those soulful eyes, gives me more joy, love and strength then I ever thought possible. Throughout all the procedures, and endless needle sticks, Maxx never let out a whimper. She's constantly beating the odds and not just surviving but living!! I have had dogs all my life but Maxx is that one very special one. Going through all this with her has made the bond that we have, all the more special."
Maxx Update, October 2005
I recently received the following email from Lynne.
“I just wanted to let you know Maxx is doing very well. No new problems this year, however, last year she ‘caught something’ and lost all her nails. Thankfully, that has cleared up with only 2 nails completely growing back but otherwise no ill effects. She just had blood work done on October 3, 2005 and had a PCV count of 44. Maxx has been in remission for some time now, but yes, I still check those gums everyday! She no longer takes any prescription drugs but is still taking Life Exxtension by Solid Gold & eating Nutro Max.
On October, 21 we will be celebrating Maxx's 7th birthday. We have added a few more canine friends in the neighborhood and Maxx received her own pet parrot over the summer. His name is Jazzy. Once again, I give much of the credit to her vets, God and Maxx's own will to live, but without the Meisha’s Hope web site I certainly wouldn't have gotten the necessary answers and accurate information I needed. Maxx, her canine sister, Maddy and all their friends will light a birthday candle in Meisha's honor and have an extra piece of doggy cake for you and yours.”
Maxx Update, September 2009
Lynne wrote recently with the following Maxx update.
”I lost Maxx on Monday, July 27th, 2009. However, she did not die from anything related to AIHA. Maxx went quickly from bone cancer that had developed several months ago. Maxx had continued to enjoy a long remission from AIHA, with her last minor bout of anemia occurring in March of 2007. She celebrated her 10th birthday in October, 2008 with many canine and human companions.
”While there are no words to convey the depth of my heartache, Maxx was truly a miracle dog. At first I thought her condition was a death sentence. Yet through constant research and vigilant care Maxx blossomed and thrived.
”I want the world to know what a truly wonderful, loving animal Maxx was. The amount of courage she showed for years through countless treatments and tests simply mirrored her personality. Maxx had a heart that was unmatched in its ability to love. Her spirit was unstoppable. I have always said she was my hero and she always will be. I carry her in my heart and soul as a part of me. Maxx was a once in a lifetime companion. I'll never understand what she had or why but Maxx showed me it never mattered. What mattered was that we were a team with a bond so deep nothing could break it.
”Thank you for everything you have done and continue to do for me and all those who are touched by this horrible affliction. I pray for a cure and better ways of treatment. But until then, there is hope, Meisha's Hope.”
Cassie is a 4 year old spayed female Australian cattle dog owned by Cheryl of Chino, CA. Cassie was diagnosed with autoimmune hemolytic anemia on July 28, 2002.
When Cheryl was asked to comment on Cassie's symptoms prior to her AIHA diagnosis she replied, "signs of Cassie's illness began when she vomited her dinner on Thursday night, July 25, 2002. I wasn't aware of this until Friday afternoon since my husband had fed her. Cassie didn't eat on Friday or Saturday. She became very quiet and would go off to one of the gardens on the other side of the back yard and just lay there. I would have to go out to find her and coax her to come in. I attributed this change in behavior to the heat and thought she just had a stomach ache, but I did keep an eye on her. I was going to take her to the vet on Monday if she didn't start feeling better."
On Sunday, when Cassie appeared to be getting worse, Cheryl took her to the emergency vet. Cassie could barely walk by that time because she was so weak. On examination, the vet found that Cassie was quite lethargic, her abdomen was distended, her gums were white and she had a temperature of 103.4. Her weight at that time was 30 lbs. The doctor drew blood and took x-rays. Her PCV was 22 on an in-house test and her abdomen was distended because of an enlarged spleen. According to Cheryl, "the ER vet knew right away that she had AIHA. He started treatment with an IV of Normosol 100 bolus, Cefalexin 300 mg, Vibramycin, and 30 mg Prednisone injection. The blood work that was sent out that day returned with a PCV of 16.6, RBC of 2 and WBC of 24.3. Cassie stayed the night at the ER vet and the next morning I took her to her regular vet. Her temperature had gone up to and stayed at 106 during the night. After the vet examined Cassie and looked at the x-rays and blood counts, she suggested exploratory surgery to remove her spleen and hopefully find out if there was any other infection going on that was causing her fever and her white counts to be so high. At first I said okay and Cassie was scheduled for surgery late that afternoon. But as I was going back to work, my heart was just breaking for my girl and I couldn't put her through it. I called the vet back and told her not to do the surgery. She put Cassie on 250 mg Keflex, along with 30 mg Prednisone and 200 mg Tagamet. By the time I got to the vet's office after work her fever had broken and she was feeling a bit better. Her labs from that morning had her PCV at 22, and her WBC at 46.4. We again took her to the ER vet for the night and she remained stable. I brought her home the next day and she seemed a little better, although, she was quite weak and slept a lot. Her urine had some blood in it for a couple more days. Her appetite and thirst increased dramatically because of the prednisone."
Cassie had CBC's done weekly the first month, then every two weeks for several months. Her PCV continued to climb, however her white counts stayed high. Prednisone tapering was started in January 2003 while antibiotics were continued until March 2003. Cheryl remarked, "Cassie did give me two scares that required trips to the ER vet in March and April, but both times turned out to be gastro problems. We continued tapering her prednisone very slowly until she was down to 2.5 mg once per week. That dosage was discontinued on September 7, 2003. Our vet has recommended that we no longer vaccinate Cassie for anything including rabies. We use Advantage for flea/tick prevention during the summer months but nothing for heartworm protection."
When Cheryl was asked to comment on the current state of Cassie's health she replied, "she is currently doing wonderfully. Cassie's last PCV was 54 on October 24, 2003. She has regained her vitality and playfulness. Being a cattle dog, she likes to run and her speed and agility are almost back to normal. Seeing her not be able to run was one of the hardest things to watch when she was so sick. I almost cried the first time she rolled in the grass once she started feeling better! At times she has such a clownish personality, I just laugh at her because she brings me such joy! And of course, she has become quite spoiled. She hasn't lost any of the weight she gained while on the prednisone, as yet, but I'm not real worried about it, in time I'm sure she will. I'm just so happy that she is still with me and I enjoy her immensely. I didn't realize how attached I had become to her until I almost lost her. I'm so thankful that she has recovered so far and I pray she continues to do well. As I continue to read other "Success Stories", I realize Cassie's treatment and recovery was relatively easy compared to what a lot the others go through. My heart goes out to those who have to go through this ordeal. I encourage those with new diagnosed AIHA dogs to learn as much as you can about the disease, make sure your vet is knowledgeable about it or will consult with someone who is, and as far as possible, stay strong for your baby. My hope is that Cassie's story will be an encouragement to let AIHA caregivers know that not all AIHA battles are difficult ones. I am so grateful that Cassie responded so quickly and so well. I pray one day they all will. I encourage everyone battling AIHA with their fur babies to make a contribution to the Meisha's Hope AIHA Fund #338 at Morris Animal Foundation so that a cure can be found for this terrible disease."
Cassie Update, July 2012
Cheryl wrote recently with the following Cassie update.
”I wanted to let you know that Cassie is still going strong. She will be 13 in August and has never had an AIHA relapse. Cassie is slowing down a bit because of her age, but she is very healthy. I am so thankful to still have my girl with me and for her continued good health.”
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