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Henri is a 3 year old intact male West Highland White Terrier owned by Ella and Jeff of Seattle WA. Henri was 5 months old when he was diagnosed with immune-mediated hemolytic anemia on February 26, 2009.
When Ella was asked to comment on Henri’s symptoms prior to his IMHA diagnosis she replied, “Henri’s illness appeared to come on very quickly but since he was a puppy it was hard to tell. The first symptoms we noticed were weakness and lethargy. We thought Henri was simply not feeling well because he was in the process of teething. However, one day when I came home and Henri couldn’t climb up the one outside step into the kitchen, I knew teething was not the problem. I immediately took Henri to our normal veterinarian, Dr. Karen Myhre, who after seeing blood clumping in the test tube (Henri had macroagglutination) diagnosed him with IMHA. We were instructed to rush Henri to ACCES, an emergency animal hospital that had a canine blood bank.
”After being admitted to the emergency hospital blood testing revealed a PCV of 12. Henri was given a blood transfusion and started on several medications for the treatment of IMHA. Henry was hospitalized for 4 days at the emergency facility. He was released from the hospital on the following medications: 25 mg Doxycycline, twice per day; 25 mg Cyclosporine, twice per day; 12.5 mg Azathioprine twice per day; 5 mg Prednisone, twice per day; 1 mg Aspirin twice per day and 2.5 mg Pepcid AC once per day. As Henri’s PCV rose and stabilized we slowly started tapering his medications. We reduced the medications every 4 weeks and during the tapering period we took Henri in for blood work every 3 weeks since we wanted to check him for a relapse one week prior to each medication reduction. We started the medication reductions by alternately reducing the Cyclosporine and prednisone. The Cyclosporine was discontinued first. After we had reduced the prednisone to as low as 1.25 mg three times a week, it was also discontinued. Next we started to slowly reduce the Azathioprine. That medication was discontinued in May, 2010
”Henri’s Internist listed several possibilities as the cause of Henri’s IMHA. After ruling out each possibility, she concluded that it was vaccine induced. This conclusion was based primarily on Henri’s age and the timing of the IMHA onset, approximately 5 weeks after his last vaccination. Henri's most recent vaccine prior, to his IMHA diagnosis, was the 5-way DA2PPV. Henri's IMHA included an extremely severe case of macroagglutination. For a puppy with an undefined immune system to mount such an aggressive immune response is very unusual. We have been told if Henri ever received another vaccine it would be lethal. With that knowledge in mind our veterinarian has gone to great lengths to protect Henri. Whenever, Henri enters the veterinarian’s practice, a special neon collar is placed on him, that says ‘DO NOT VACCINATE’. Henri is not allowed in the building without this special collar. Since we have 2 Westies, that often go to the veterinarian together, we appreciated these precautions, since to anyone unfamiliar with our fur kids they look the same.”
When Ella was asked to comment on the current state of Henri’s health she replied, “Henri is doing great! His PCV at his last checkup was 51. He is a very happy, goofy, fun-loving, little boy who loves a good game of soccer or tug match. He adores his canine sister, Bella, and is always trying to steal a nap in her crate. Henry is now partaking in all the joys of youth that he missed as a puppy. He struts around our neighborhood on his walks and absolutely must say hi to everyone we pass. He has become quite a skilled soccer (football) player and would play with his ball all day if he could. He amazes everyone with his skill and speed as he dribbles the ball all over the field.
”Henri is an amazing gift. His Success Story was made possible by his blood donor and all the veterinarians and their personnel that worked with him as well as all of his other friends and supporters. We could not have made this IMHA journey without this support. Dr. Karen Myhre, at Elliott Bay Animal Hospital promptly diagnosed Henri's IMHA and orchestrated getting him to a veterinary facility with a canine blood bank. Her accurate diagnose, gave Henri a fighting chance. Additionally, the emotional support she provided our family gave us hope and strength. Dr. Jean Dodds provided an enormous amount of support. She guided us through the entire process, helping us to understand the nuances of having a puppy with IMHA. She has freely given her time to Henri's case and for that we are forever grateful. And lastly, several members of the West Highland White Terrier Club of Puget Sound (WHWTCOPS), provided support and continue to assist us in keeping Henri healthy. Henri is a loving, joyful member of our family and we are so blessed to have him in our lives. He is a true miracle. Our family feels blessed for every day, he is with us.”
Zildjian is a 5 year old neutered male Boston Terrier mix owned by Rachel of Knoxville, TN. Zildjian was diagnosed with immune-mediated hemolytic anemia on July 29, 2010.
When Rachel was asked to comment on Zildjian’s symptoms prior to his IMHA diagnosis she replied, “On July 27, 2010 Zildjian was not his usual energetic self. He kept going into his crate and lying down, which was very unusual for him. I attributed this behavior to the heat and left to run some errands. I returned a few hours later and Zildjian was still in his crate. When I took him outside for a bathroom break, he tried to hide. Because Zildjian is a food fanatic, I knew something was definitely wrong when I offered him food and water and he refused both. I goggled ‘doggie vital signs’ and assessed Zildjian. His respirations and heart rate were high and when I checked his perfusion/capillary refill time, by pressing on his gums with my finger, I noticed they appeared pale and that the color did not return in a sufficient amount of time after releasing pressure. I immediately rushed Zildjian to our local veterinarian.
”Upon arrival at the veterinary clinic, I asked the veterinarian if she thought Zildjian might have ingested something that could have caused poisoning. She said that was a possibility and asked me if he had been around antifreeze, chocolate, or another substance toxic to dogs. I recalled Zildjian had followed me into the garage the previous night, but that he wasn't there long before I took him back inside. The veterinarian referred me to an emergency veterinary clinic to test for antifreeze poisoning.
”I drove across town to the emergency clinic and explained to the receptionist about the vital signs and pale gums. She took Zildjian to the back and placed him on oxygen. Blood testing revealed a PCV of 16. A Grade IV/ VI heart murmur was also noted. I was told that Zildjian probably had a disease called immune-mediated hemolytic anemia and that I should take him home and bring him back to our regular veterinarian in the morning. When I went to bed that night, Zildjian's breathing and heart rate were very fast. I did not sleep all night for fear that he would slip away. When the veterinarian’s office opened the next morning, I was waiting outside the door. I took Zildjian in, explained what had happened the previous night and asked to see one of the other veterinarians in the practice. The veterinarian checked Zildjian’s PCV and it had fallen to 12. Zildjian was given a transfusion, a steroid injection and started on Doxycycline. He was screened for Heartworm, Lyme disease, Anaplasma, and Ehrlichia (all negative). Zildjian’s PCV rose to 15 following the transfusion but quickly fell to 8. I was called in from work to discuss my options for Zildjian's care. I asked about his prognosis, and the doctor explained that it wasn't good since Zildjian had not responded to the steroid injection or transfusion. He looked like a rag-doll and could not stand up or lift his head. I was told we had several options, one of which was to take Zildjian to the University of Tennessee where he could be treated in the ICU. I chose the University of Tennessee and drove him there myself.
”When I arrived at the University of Tennessee, the doctors took Zildjian to the back very quickly and started working on him. One of the veterinary students called me into an examination room to talk about what would be done and what to expect. I went home that night, without Zildjian, feeling like there was some hope. Zildjian received a cross-matched packed RBC transfusion, was started on 20 mg of prednisone and received a host of additional tests. He received around the clock care from the incredible staff and I was given regular updates on Zildjian’s progress which included the facts that his PCV was rising, his vitals were stabilizing and his heart murmur was becoming less noticeable. Cross-matched transfusions and steroids were continued until Zildjian’s PCV reached 21, an acceptable level to warrant discharge. Zildjian was discharged from the University of Tennessee College of Veterinary Medicine, Small Animal Hospital on August 3, 2010. We took him home with instructions to regularly monitor vitals, administer his medications, 20 mg Prednisone and 100 mg Doxycycline daily and limit his activity. A blood recheck, two days later, showed Zildjian’s PCV had risen to 26. He continued to gain strength each day, but we could see the effects that the steroids were having on his little body. He constantly ‘dribbled’ urine, became very puffy, had frequent diarrhea, and a voracious appetite.
”As Zildjian’s PCV rose we started to slowly decrease his prednisone. During this time we had blood work done frequently. Zildjian still goes to the University of Tennessee Veterinary Hospital for IMHA-related testing/issues, however, I started seeing a new holistic veterinarian for Zildjian’s regular care. This veterinarian was able to combat the effects of steroids by using supplements and dietary changes (she even helped get rid of Zildjian’s frequent diarrhea)! Her focus, after Zildjian was weaned from the steroids, was to keep him in optimal health which included no vaccinations, guarded use of heartworm preventative, and a holistic/hypoallergenic diet.”
When Rachel was asked to comment on the current state of Zildjian’s health she replied, “Zildjian is medication free and enjoying life. At his last check up in July, 2011 his PCV was 46. He is back to his usual active self, being a ‘live wire', running, eating constantly, and going everywhere with me! He was a little traveler this past summer, camping in the Great Smoky Mountains National Park and shopping in Atlanta. He also took a trip with me to the North Carolina Outer Banks where he enjoyed swimming, taking long walks on the beach, chasing crabs and catching his favorite tennis ball. Although the thought of relapse is always a scary possibility, I know what my options are now and am always researching the latest on this disease. I feel lucky to have my little buddy back and am thankful for the doctors and staff at the University of Tennessee College of Veterinary Medicine for saving his life!“
Princess is a 7 year old spayed female Chihuahua owned by Jamie of Schenectady, NY. Princess was diagnosed with immune-mediated hemolytic anemia on December 18, 2008.
When Jamie was asked to comment on Princess’ symptoms prior to her IMHA diagnosis she replied, “On December 17, 2008 Princess started acting very lethargic and wouldn’t get out of her bed. She would follow us around with her eyes but couldn’t move. When it came time to eat Princess (who loves to eat) won’t eat at all. I even put a few pieces of kibble in her bed and she just turned away from it. Because Princess would not eat, I really started to worry. I called our veterinarian but learned the clinic was closed since it was 8 p.m. Thankfully I was able to find an emergency veterinarian nearby who would take Princess in right away.
”Upon arrival at the emergency veterinary clinic blood testing revealed Princess had a PCV of 18. She was very jaundiced which led the veterinarian to believe that she either had IMHA or a liver condition. I was told that it would be necessary to leave Princess at the clinic to confirm what was wrong with her. The next day the veterinarian told me that Princess had IMHA and would need a blood transfusion. Her PCV rose to 29 after that transfusion. Princess was also started on prednisone, and an antibiotic and I was hopeful that she would be able to come home soon. However, when her PCV continued to drop she was transfused two more times and remained hospitalized. On Christmas Eve, when I went to visit Princess, she was very jaundiced and sick looking but happy to see me. We had a wonderful visit and she fell sleep in my arms. A couple hours after I left the veterinary clinic, I got a call from Princess’ doctor telling me that her PCV had dropped to 8 and they needed to do another transfusion. The veterinarian was honest with me and told me that things didn't look good. After this transfusion, Princess’ PCV rose to 29 and on Christmas day her PCV held steady at 32 all day. Cyclosporine was added to Princess’ treatment regimen after the 4th transfusion and she finally started to improve. I got a call the day after Christmas letting me know that Princess’ PCV was 31 and that I could come and pick her up. After 4 transfusions and 9 days in the hospital, my baby was coming home. Her condition was guarded and I was told how important her follow up visits veterinary visits would be. As Princess’ PCV continued to rise and stabilize her medications were slowly reduced and then discontinued.”
When Jamie was asked to comment on the current state of Princess’ health she replied, “Princess is doing great. She is off all medications for the treatment of IMHA and is very happy, energetic and full of life. She plays like nothing was ever wrong with her. Her PCV at her last blood check was 39.9 and the rest of her blood work was in the normal range as well. Since Princess takes no heartworm or flea/tick preventive, we have her tested for heartworm yearly. Due to Princess’ bout with IMHA, she no longer receives any vaccinations. Princess is now known as ‘Big Red’ around our house because of all her hard working red blood cells. She truly lives every day to the fullest and enjoys running around spending time with her two canine brothers and going for walks. Princess hasn’t been this active since I adopted her. At the end of the day she loves to cuddle with her grandmother and me while we watch TV.”
Bella is a 3 year old, spayed, female Australian Shepherd owned by Kristen Cunningham and her family, of Overland Park, KS. Bella was diagnosed with Immune-Mediated Hemolytic Anemia on May 26, 2010.
When Kristen was asked to comment on Bella’s symptoms prior to her IMHA diagnosis, she replied, “The disease appeared to come on, literally, overnight. We went for a two mile walk the evening of May 25 and Bella was just fine. When we woke up the next morning, Bella was very sick. Her symptoms included no appetite and extreme weakness; she couldn’t stand up. Her gums were pale, and she was panting. Her body was extremely hot, as she was running a very high fever. After I returned home from running an errand and found Bella was still not feeling any better, I took her into the veterinary clinic to have her checked out.
”When we arrived at Fairway Animal Clinic, I learned that our regular veterinarian, Dr. Hires Gage, was not in, so Bella was seen by another doctor. She examined Bella and did blood work, which revealed a PCV of 29. I was told that Bella had a very serious disease called Immune-Mediated Hemolytic Anemia. I left Bella at the veterinary clinic and shortly after arriving home, I received a phone call from Dr. Gage, who explained to me that Bella would be put on Prednisone and Azathioprine. Another PCV would be run the next day. Blood work done the next morning showed a PCV of 18. Later that day, Bella’s PCV dropped to 13. We were told Bella needed a blood transfusion immediately. Since the clinic did not have any blood on hand, Dr. Gage’s wife brought his dog, Doris, in to the clinic to be a blood donor for Bella. Bella received 350cc of whole blood, and immediately after the transfusion, was given 4 mg of Dexamethasone intravenously. We were able to visit with Bella while she was having the transfusion. As soon as she saw us, she climbed out of her kennel and laid down in my lap for the entire visit. Bella remained at the animal hospital for one week, during which time, we visited her, as well as received daily updates on her progress and PCV. Bella was released from the veterinary clinic on the following medications; 30 mg Prednisone, twice per day; 25 mg Azathioprine, once per day and 10 mg of Pepcid AC, once per day. As Bella’s PCV rose and stabilized, we continued to do frequent blood checks and slowly reduced her medications. She was completely weaned off all medications by December 1, 2010.”
When Kristen was asked to comment on the current state of Bella’s health, she replied, “Bella’s current condition is fabulous! She is in perfect health and has been so for over one year. When Bella last had blood work done on October 14, 2011, her PCV was 49. She is on no medication for the treatment of IMHA. Because of the possibility vaccines may further stimulate her immune system, she will no longer receive any vaccinations. Bella is a great dog. She is healthy, happy, playful, and so much fun to be around.
"As you can see from the photo that accompanies this story, Bella is back to playing Frisbee in ‘full force’. She continues to thrive and leads a normal dog’s life. We are so grateful to have Bella with us, and are especially thankful to Dr. Gage for all he has done for Bella and our family.”
Dr. Hires Gage, Bella’s veterinarian, was the recipient of the 2010 Meisha’s Hope Award for excellence by a veterinarian in the treatment of Canine Autoimmune/Immune-Mediated Hemolytic Anemia . To learn more about Dr. Gage, Bella and the Meisha’s Hope Award as well as how you can nominate your veterinarian for the Meisha’s Hope Award Click Here.
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