PREVIOUS SUCCESS STORIES

January 2001

Scooter

Scooter is a 12 ½ year old, neutered male Cocker Spaniel owned by Dianne & Charles of Longwood FL. Scooter was diagnosed with autoimmune hemolytic anemia on December 29, 1999.

Scooter was approximately 3 to 4 years old when Dianne and Charles adopted him from their local humane society in May 1992. According to Dianne, "When we took him to the vet for his checkup the day after we adopted him, we were told he did not have any peripheral vision." A week later Scooter was taken to a veterinary ophthalmologist. Testing revealed Scooter had cataracts, glaucoma and a detached retina. In spite of 4 surgeries to try and save his sight, Scooter soon became totally blind.

When asked about the onset of Scooter's AIHA, Dianne replied, "Scooter had been boarded over the Christmas, 1999 holidays while we flew to Tennessee. When he came back home, he seemed very quiet. We thought that he was just tired and probably did not get much rest at the vet's boarding facility. We knew that the vet had a full house. Scooter really did not seem like himself, he was having trouble climbing the steps from the garage to the kitchen, then he would not take a cookie (dog biscuit). I don't know why I sensed the urgency but I immediately picked up the phone and called our regular vet and was fortunate enough to get an appointment in about 30 minutes. When we arrived at the vet, Scooter had a 104 temperature. The vet started running blood tests and told me that she wanted to hospitalize him and that she was sure that he had AIHA. I was in a state of shock. The disease came on so very quickly. I went from a healthy dog to a very sick dog in a couple of days "

Testing revealed that Scooter had a PCV of 31. He was admitted to the veterinary hospital and started on Cytoxan, 15 mg of prednisone twice per day, 100 mg Tagamet twice per day, 30 mg Baytril twice per day, 250 mg Flagyl twice per day for diarrhea and Viamino, a strong multi vitamin formula, 4 times per day. Later that day, Scooters PCV dropped to 25 where it remained until it dropped to 19 on January 2, 2000. On January 4, 2000, when it appeared Scooter's PCV had stabilized at 19, he was released from the veterinary hospital. The following day Scooter's PCV climbed to 27. Because Cytoxan was causing Scooter to have severe diarrhea problems, it was eliminated from the treatment regime on January 12th. The Flagyl was discontinued on January 20th. The Baytril and Tagamet were discontinued on January 24th. When Scooter's PCV reached 39, a very slow reduction in the prednisone began which continued for several months. Scooter had his last dosage of prednisone on July 3, 2000. His PCV at that time was 48.

When asked to comment on the current state of Scooter's health, Dianne replied, "it is excellent. His last PCV was done on December 22, 2000 and it was 55. Scooter is able to walk a mile a day and he really enjoys his walks." Dianne continues, "Scooter is now starting to lose his hearing, probably as result of old age. The hearing loss, seems to get a little worse all the time, it is almost like he has to think to hear. He cannot hear low pitched sounds so we now are starting to train him with a dog whistle. The hearing problem combined with his blindness makes communication a challenge sometimes, I just have to be patient. Scooter still does have a great life, he is a very happy dog. He is easy going and loves to be pampered. I treasure each day that Scooter is here."

Scooter Update, November 2003

Dianne wrote recently with the following Scooter update.

"Scooter is still doing fine. His last PCV was 42. However, he is beginning to show his age. He no longer has any spring in his back legs and has a little bit of trouble getting up. He has lost his hearing, but that does not seem to bother him. We still continue to talk to him even though we don't think he hears us. He still enjoys his walks - nearly a mile every day. He lets me know when he is ready to head home. We have decided to no longer vaccinate him for anything. My husband, Charles, and I continue to treasure each day that we have Scooter with us."

Scooter Update, March 2005

Dianne wrote recently with the following Scooter update.

"On February 22, 2005 at approximately 9:30 a.m., Scooter was put to sleep. He fought a very brave battle, but finally succumbed to an enlarged heart that was pushing his trachea up. His lungs were also filling up with fluid. Thankfully, he did win the battle with AIHA and did not relapse with the disease. I had his PCV checked on Monday, February 21, and it was slightly elevated because he was so dehydrated. Scooter was at least sixteen years old and could have possibly been older.

I am so thankful that I did not work this last year and a half since that enabled me to spend so much time with Scooter. He was like my shadow. He would go to sleep in the doorway so that he would know if I left the room. He became very insecure after he lost his hearing.

A friend of mine sent me a card with the following message: 'Never was a "kid" loved more than Scooter. Knowing that he is with 'Hugger' chasing butterflies that he can see, warms my heart. We will all miss him.' She also sent me the following poem.

Rainbow Bridge

Knowing that Scooter can see and hear again, helps me get through the day. That is something that I could not give him no matter now much I loved him."

February 2001

Emmy

Emmy is an 8 ½ year old spayed female Bichon Frise owned by Debra of Troy, New York. Emmy was diagnosed with autoimmune hemolytic anemia on July 2, 1999.

When asked to comment about the onset of Emmy's AIHA, Debra replied; " Emmy and I had been living apart since November, 1998, due to a temporary job relocation. In late May, while on Long Island with her grandparents, Emmy started having a lot of "accidents" in the house. She was taken to a vet on Long Island who diagnosed a bladder infection, and treated her with Primor, a sulfa drug. When we were reunited in June 1999, I knew she wasn't herself. She wasn't as lively as she had been, and taking her for walks was a major challenge. She was also sleeping a lot and no longer followed me around. Emmy had always had a voracious appetite and now was still eating, but not begging for food when I was eating or snacking, which was quite unusual."

By the time Debra and Emmy returned to their home on June 27, Emmy was not eating at all. When Debra took Emmy to her DVM the following day, she presented with a temperature of 104.6. Amoxicillin was prescribed. In the light of Emmy's symptoms, a urine sample was rushed to the lab to screen for Cushing's disease. The test came back positive. Debra was informed this was a terminal disease and that they had approximately a 24 month window. Because Emmy had a full workup ( complete CBC, Chem profile and urinalysis) done on May 25, no blood work was done at this time. However when by July 2, 1999 her fever still had not broken, a CBC was done, which revealed a PCV of 22. 5. Emmy was diagnosed with AIHA.

After the AIHA diagnosis, the Amoxicillin was discontinued. Emmy was given an intravenous dose of prednisone and prescribed 10 mg prednisone per day. On July 6, Emmy returned to her veterinarian for spleen x-ray. The spleen appeared normal. During the next ten days, Emmy's PCV stayed in the 22-23 range, then began a slow steady drop. Emmy's vet consulted with Cornell University, who offered some preliminary good news. They stated that it was common with AIHA to get a false-positive Cushing's result. Cornell put Emmy's vet in touch with a specialist at the University of Wisconsin who agreed that the Cushing's result was a false positive. The advice of this specialist was to run a complete thyroid panel because hypothyroidism is often underlying with AIHA. Following the complete thyroid panel Emmy was started on thyroxine. According to Debra, " As it turns out, it is a natural defense mechanism of the body to slow down the thyroid with AIHA. Since the body is so slowed down by the AIHA, the thyroid follows suit and slows down to remain in sync. In retrospect, Emmy should have never been put on the thyroxine. According to one of the specialists we saw later, this would have self corrected as the PCV rose." Debra also contacted another vet who concurred with the false-positive Cushing's result theory. This vet said she had a treatment protocol for AIHA that had been quite successful. The treatment protocol was faxed to Emmy's vet and Emmy was started on cyclosporine.

The cyclosporine (liquid form) was started orally at 100 mg per day, once per day, for five days on and two days off. According to Debra, "Given this schedule, I was under the mistaken assumption that cyclosporine was a form of chemotherapy, which it is not. It is an immunosuppressant. Also at this time Emmy's prednisone was increased to 10 mg twice per day . We continued on this path as Emmy steadily dropped to a PCV of 17.5 on July 28." Emmy's PCV continued to drop and on August 16 it was 13.9. Near the end of September, Debra contacted another specialist who informed her that the cyclosporine protocol she was using was flawed. According to Debra " cyclosporine has a half life of only 19 hours, which means that it is completely out of the system before the next daily dose, that is why it needs to be given every 12 hours. It needs to "saturate" the system to be effective, that is also why trough levels are necessary." (To learn more about cyclosporine and trough testing see the TREATMENT page.) Emmy's cyclosporine was steadily increased until it reached 300 mg per day. From September until the end of December her PCV fluctuated up and down between 17 and 23. A review of Emmy's lab work indicated that it was plausible that she might also have an underlying iron deficiency anemia. An Iron Profile was ordered which came back normal.

On February 21, 2000 Debra and Emmy traveled to VA to see the ACVIM who had been consulting on Emmy's case. A bone marrow biopsy was scheduled as well as a complete CBC, Chem Profile, another Iron Profile, urinalysis, ultrasound, and chest x-ray. The chest x-ray showed no tumors. The ultrasound revealed a healthy spleen and no tumors. The in-house urinalysis was questionable, therefore a sterile sample was sent out to be cultured. Amoxicillin was started as a prophylactic measure while waiting for test results. The bone marrow biopsy showed that Emmy was definitely suffering from AIHA. She was actively destroying her red blood cells, however, the destruction was occurring in the bone marrow rather than the bloodstream. The reason no spherocytes had been seen was because the destruction in the marrow was "complete". No damaged cells were being released into the bloodstream, because there was nothing left of the attacked cells. The results of the urine culture and sensitivity tests revealed a "raging infection" It was suggested that this was probably the same infection that Emmy was treated for in May 1999 and that it had been "masked" by the prednisone and other drugs. The sensitivity test revealed Amoxicillin was not the correct treatment, therefore, it was stopped and Emmy was started on Clavamox. At same time, Emmy also began her first course of Cytoxan. By the end of March, Emmy's PCV had risen to 22.

According to Debra, " our ACVIM began to talk about the efficacy of Epogen treatment. She contacted a colleague who is a pathologist to get some information. To be prudent, because epogen can be fatal, we did a preliminary erythropoietin assay. Erythropoietin is the blood stimulating hormone produced in the adrenal gland. It stimulates production of red blood cells. Epogen is administered to people when their erythropoietin is depleted. The assay was done to see what level of erythropoietin was in Emmy's system. The best way to do this, is to also send a sample of blood serum of a healthy dog, that is the same breed. This is done because normal ranges apparently vary from breed to breed. We did all of this, and sent it to the University of Tennessee at Knoxville. The results revealed that Emmy's erythropoietin was actually quite high. If it were low, then she would have been a viable candidate for this treatment. The reason her levels were high, actually was part of the picture. It meant that Emmy was indeed producing RBC's. Had she been given the Epogen treatment, it more than likely would/could have been fatal, because it would have "overloaded" her system."

By mid April Emmy's PCV was 27.4. At that time she began her second course of Cytoxan. On July 6, 2000, Imuran was introduced into the treatment protocol. Emmy was given 12.5 mg of Imuran once per day. On September 28, 2000, nearly 15 months after Emmy's AIHA diagnosis her PCV was finally in the normal range at 37.9 Since that time Emmy has done quite well. Emmy's last PCV was taken on January 27, 2001 and was 35.8. She continues on 150 mg cyclosporine twice per day, 12.5 mg Imuran every third day, 5 mg prednisone every other day, .2 mg thyroxine twice per day and ¼ tab Zantac twice daily. According to Debra "my DVM, ACVIM, the specialists at Cornell and the University of Wisconsin all agree that the Primor prescribed for Emmy's bladder infection was the trigger for Emmy's AIHA. Primor is a sulfa drug, and sulfa drugs are documented as triggers of AIHA."

When asked to comment on the current state of Emmy's health Debra replied, " Emmy is just DELICIOUS!! She is back to her old self except for sleeping in bed. She is my constant companion, who once again, loves to be held and wash my face with lots of kisses. I am very grateful for the wonderful people I have met and the many lessons I have learned, especially in the area of patience since Emmy's AIHA diagnosis".

March 2001

Duke

Duke is a 2 ½ year old neutered male English Springer Spaniel owned by Bob and Vicki of Lititz PA. Duke was diagnosed with autoimmune hemolytic anemia on Saturday of Labor day weekend 1999.

Duke was 13 months of age when he was stricken with AIHA. According Vicki, " During his first year, Duke had 3 to 4 bouts of diarrhea, the last one occurring within two weeks prior to his AIHA crisis." Duke was tested for many things including parasites, but no cause was found for these bouts of diarrhea. He was put on prophylactic antibiotics and Pepto-Bismol each time the diarrhea occurred. In June 1999 Duke had an unusual reaction to an ear powder that was being administered to stop him from scratching his ears. Duke's vet prescribed prednisone which caused Duke's face and ears to become swollen. The prednisone was discontinued and an antihistamine started which cleared up the problem. Five days before Duke's AIHA attack, he was given his 30 day Heartgard, heartworm preventative and the night before the AIHA attack Vicki applied Frontline flea preventative to the back of his neck. When Vicki was asked to comment on the symptoms Duke exhibited prior to his AIHA diagnosis she replied, "He was tired and lethargic. His gums were very pale. It was about 7 AM to 9 AM when I noticed this. I had him at the vet by 1 PM."

Because it was a holiday weekend Duke was taken to the local animal emergency clinic. Upon presentation he had a temperature of 102, and orange colored urine. Testing revealed a PCV of 20. Duke was started on steroids and antibiotics. When his PCV dropped to 10 he was given a blood transfusion. The transfusion brought his PCV up to 15, but within 30 hours it was dropping again. Duke was then give an Oxyglobin transfusion. Vicki noted, " I cannot overstress the importance of Oxyglobin in Duke's treatment. I think it was a key point in stabilizing him".

Duke was taken to his regular vet on Tuesday, following the Labor day weekend. His vet put him on 80 mg prednisone, Azathioprine (Imuran), antibiotics, Cimetidine, Sucralfate and Heparin. When Duke was sent home from the veterinary clinic, the following day his PCV was 15. According to Vicki, "We progressed this way for 3 weeks, his PCV coming up to 19, holding for about a week, then coming up to 25. At the same time, Duke began taking on fluid. My vet thought it was the prednisone, but after a night of Duke not being able to lie down to sleep (he had also been breathing hard for several days), I called and requested an x-ray. (My vet had been seeing Duke every 24 to 48 hrs during this whole period of time). The x-ray revealed Duke was completely filled with fluid. I was referred to the University of Penn Vet Hospital in Philadelphia. We went immediately to the ER. Upon aspiration of the fluid, it was discovered Duke had a severe fungal infection called candidiasis. The fluid was everywhere, including the lining of his heart. He was put in ICU. Prednisone and other drugs had to be stopped to treat the fungus. The prednisone was reduced to 30 mg and completely stopped within 3 weeks. At this time they gave Duke a 20 percent chance for survival. He was on oxygen for 8 days and given the drug Sporanox, to kill the fungus, (he remained on this for 6 months until we had 3 consecutive clear urine cultures). Duke was also on antibiotics since he had developed a urinary infection from his catheter. Upon discharge from the hospital, Duke's PCV was 26. In the weeks to follow, it steadily rose to 37. As we treated the fungus, Duke developed arthritic symptoms and a bacterial skin infection, which were treated. It seemed as we cleared up the fungus, the other problems cleared too."

Two Coombs tests were performed on Duke's blood, one at the onset of the disease and one later at the U of Penn. The results of both tests were negative. Duke also tested negative for Phosphofructokinase (PFK) deficiency . When Duke was tested for tick borne diseases, he tested positive for Lyme disease. According to Vicki, " My local vet said this did not mean that Duke had it, but that he had been exposed. The vet said he had never known of a case of Lyme disease causing AIHA, however my holistic vet indicated that in 85% of immune related diseases she treats in both dogs and horses Lyme is present." Vicki continued, "Bob and I both feel that the candidiasis was instrumental in causing Duke's immune crisis, but only was discovered after his immune system was suppressed and it was able to go rampant. Most vets do not even consider the possibility of a fungal infection, and therefore never check for one."

When asked to comment on the current state of Duke's health, Vicki replied, " Duke is doing very well. His is not on any medications at all. His last PCV was 46 on October 23, 2000 with other blood work appearing normal. There is no sign of the fungus. He is very energetic and playful as well as eating well. We take him on two nice walks a day. I watch his coloring daily and he always seems very pink. He is a very sweet and lovable boy. At this point he seems healthier then we ever remember him being. We are very thankful for his recovery and pray that it will continue."

April 2001

Aussie

Aussie is a 12 year old spayed female lab mix owned by Lissa of Richmond VA. Aussie was diagnosed with autoimmune hemolytic anemia on January 3, 2000.

When asked to comment on the symptoms Aussie exhibited prior to her AIHA diagnosis Lissa replied, "She had been running on the beach just a week earlier, then suddenly she wouldn't get up in the morning. She was extremely lethargic and wouldn't touch her food."

Aussie was immediately taken to her veterinarian where she remained hospitalized for 2 nights and spent several days as an inpatient for observation. Testing revealed a PCV of 11. Other initial testing included urinalysis, Chemistry profile, Bile Acids test as well as x-ray and ultrasound of the abdomen. Aussie was immediately placed on IV fluids which continued for 4 days. She received Baytril and Dexamethasone injections. Upon diagnosis of the AIHA, Aussie was started on prednisone, Imuran and Carafate. Seven days later when she began vomiting, she was placed on Pepcid AC. In June and August 2000 Aussie experienced acute colitis. She was treated with Amoxicillin and Metronidiazole for two weeks each time and her diet was changed to one of strictly dry dog food and treats.

In Both April & October, 2000 as the prednisone was decreased, Aussie's PCV fell. Each time the prednisone was increased by 5 mg for a duration of time and the PCV rose. Aussie's PCV reached a high of 38 in January, 2001. Shortly after that testing the prednisone was decreased, and once again, Aussie's PCV started a slow steady drop. On March 16, 2001 Aussie's PCV had fallen to 28. The prednisone was increased from 10 mg per day to 15 mg per day with the Imuran remaining at 50 mg every other day (eod). By March 23, 2001 Aussie's PCV had dropped to 26. The prednisone was increased to 30 mg per day on March 28 with the Imuran remaining at 50 mg eod. At Aussie's last blood test on March 30, 2001 her PCV had risen to 29. She remains on 30 mg prednisone per day and 50 mg Imuran eod. In addition, Aussie takes Filaribits daily for heartworm protection, glucosamine for arthritis and is administered Frontline once per month for flea and tick protection.

When asked to comment on the current state of Aussie's health Lissa replied, " Aussie's activity level continues to be excellent and she is one happy dog, so her behavior is not necessarily matching her drop in PCV. The most compelling aspect of Aussie's success story is that it has not been a steady course at all. Many of the "success" dogs seem to have handled steady decreases in dosage (relatively speaking). Aussie has remained on somewhat high dosages of both prednisone and Imuran because she seems to have hit a wall with both. Her PCV's have dropped after crossing somewhat of a high invisible line with prednisone (10 mg), and Imuran(50mg)." Lissa continues, "Aussie turned 12 on St. Patrick's Day and she has always had luck on her side. Eleven years ago, I was walking through one of those dreadful pet shops in a shopping mall in Chesapeake, VA. I ventured upon a "yellow lab with full papers", on sale for $350, who was visibly shaking sick and was NOT a full bred lab. The clerk took this poor little guy out of the cage and handed her to me. That puppy licked me, licked me, licked me and would not go. I had never owned a dog in my life. Never trained one, cared for one, etc. Well, needless to say, I couldn't just leave her there!!!! I negotiated for her and went home with one sick puppy. My dream vacation had always been a trip to Australia. I told everyone that I was sure she would cost me SO much more during her lifetime that I would never make it there. Thus Aussie. True to her name since I have had here she has been hit by a car, had numerous teeth surgeries (she was originally exposed to distemper) swallowed my name tag from work and have to have the pin surgically removed from her stomach and been diagnosed with AIHA. She has battled back each time. And I wouldn't trade this little "Brinks Truck" called Aussie for anything in the world. I've absolutely loved owning a dog; she is truly my faithful companion, and she's stood by me through thick and thin. I love her beyond words."

Aussie Update, January 2003

During June 2002, Aussie's eating and drinking habits, and activity levels began to deteriorate. After discussions with Aussie's Vet and based on Aussie's age, Lissa made the decision not to increase the dosage for either prednisone or Imuran, nor impose or escalate treatment regimes. On the morning of July 13th, 2002, Aussie was lethargic, unable to stand, and had vomited during the night. She ended her courageous, two-year fight with AIHA on that day. Aussie was a kind, smart, gentle dog, and Lissa's best friend. During 2003, Lissa will fulfill her lifelong dream of a trip to Australia--in honor of Aussie dog.

May 2001

Cindy

Cindy is a 15 year spayed female Cocker Spaniel owned by Nan of Mesa, AZ. Cindy was diagnosed with autoimmune hemolytic anemia on January 12, 1997.

When asked to comment on the symptoms Cindy exhibited prior to her AIHA diagnosis Nan replied, "she was lethargic, had no appetite, was vomiting intermittently and had pale to white gums and membranes." Nan continued, "Cindy started exhibiting signs a week before she was diagnosed. We took her to a vet that we had used and she kept giving her antibiotics (pills & shots) and running tests. After one week this vet was still not able to diagnose the problem. On the night Cindy was diagnosed we called this vet and told her Cindy was dying and asked what could we do. The vet replied that, it was time for Cindy to go, there was nothing more that could be done, and she had to go for the evening. We loaded Cindy up and started looking for an emergency vet; luckily we found one. She took one look at Cindy, listened to our story and said she was sure it was autoimmune hemolytic anemia."

Cindy was started on prednisone at the emergency veterinary clinic and remained there overnight. The following day she was transferred to another veterinary clinic. Upon presentation at the second clinic, Cindy was quiet but alert and responsive. Her mucous membranes were pale pink with a Capillary Refill Time of approximately 3 to 4 seconds. Initial testing included CBC, Chemical profile and urinalysis. The initial blood work revealed a significant anemia with evidence of regeneration and spherocytes. The Chemical profile was fairly unremarkable at this time. Further evaluations included thoracic and abdominal radiographs. Thoracic radiographs revealed no abnormalities while abdominal radiographs revealed mild hepato- and splenomegaly. A cardiac ultrasound was performed and determined to be normal. Cindy was diagnosed with primary immune mediated hemolytic anemia. She started on 35 mg prednisone once per day, 50mcg misoprostol three times per day and ½ gram Carafate three times per day. Within the first 12 hours after presentation, Cindy was given a blood transfusion. Cindy was discharged from the veterinary hospital three days after she was admitted on the following medications; 35 mg prednisone once per day, 50mcg misoprostol three times per day and ½ gram Carafate three times per day X 14 days. Over the next few months, Cindy's prednisone was reduced and then completely stopped.

In January 1998, only a few days after she had her teeth cleaned, Cindy had her second onset of AIHA . The veterinarian had given Cindy an antibiotic prior to the teeth cleaning procedure to insure that she did not get an infection. According to Nan, "this second onset was very rapid, almost overnight, with the same symptoms occurring as before, except this time she did not vomit bile". Cindy was immediately taken to her veterinarian where she was given a transfusion and the same medications she had received at the first onset. She was hospitalized for 6 days. Once again, Cindy's prednisone was slowly reduced until it reached 5 mg every other day. Cindy continues on that dosage to this day. Due to Cindy's age, she no longer receives vaccinations or heartworm or flea preventative.

When asked to comment on the current state of Cindy's health Nan replied, "At her last blood check 8 months ago, our vet told us the PCV is right where it should be. She is as spunky as a 15 year old dog can be. Her appetite is always good, and she does her daily patrol of the yard to roust out the neighborhood cats. She has to be by one of us at all times. She is almost totally deaf, but she does know sign language (ours). She is a special little lady and we are so totally blessed to have her. If there is anything I can say to others facing this disease, it is do not give up. Do not hear that it might be best to just let them go. Get second opinions, if you do not feel right about what you are being told. We almost waited too long. We were told Cindy's chances were slim both times, but here she is doing well at 15 years old, 4 years after the initial AIHA diagnosis."

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