Night Just Diagnosed With Imha

[Guest sandlot13433]

My dog Night started to have blood in his urine last night (at least, that is when I noticed it). We went to the vet today for 2 hours. Long story short, his RBC count is at 35, and he has a slight fever (103-104). After running a gamut of tests, he has been diagnosed with IMHA most likely set off by a TBD. I have been reading on IMHA online and the diagnosis overall does not sound that hopeful. My vet did not make me feel like it was a dire situation, but Night does have to go back in Tuesday to have all his levels re-checked. What are people's experiences with this disease? Please share both good and bad as I want to have realistic expectations about what to expect. He is on doxycycline and prednisone for right now and we will check on his progress on Tuesday. So far he has a normal appetite. He's a bit sleepy, but gets up willingly to go outside with the other dogs. Thanks everyone for sharing!

[Batmom]

Has he been tested for TBDs?

 

Keeping fingers crossed for your pupper.

[Guest sandlot13433]

They tested him for three that are common around here, but no others. Maybe they will do further testing Tuesday if he's not improving? How dire is this diagnosis?

[Tallgreydogmom]

Where was your greyhound raised, trained and raced? He probably was exposed to other TBD's than those in your local area.

 

We lost our Wally to Immune Mediated Hemolytic Anemia. It is a silent killer. I would put in for a consult with OSU right away. See what tests they would like run and what they suggest for treatment. They have difference choices of medicine than a regular vet. Are you able to get him there for treatment?

 

Email Joejoes mom about available foster homes for out of town greyhounds. I wish I had known about OSU with Wally. It is a very nasty disease.

Edited June 10, 2011 by Tallgreydogmom

[sabrina]

& for Night

[DesiRayMom]

I lost Gringo to IMHA several years ago....

He maintained for a while on pred, but it gave him horrible night terrors; he'd leap up several times a night shrieking like the

hounds of hell were after him. We weaned him off the Pred, & after that he declined pretty rapidly.

 

The day I let him go to the bridge, his RBC was 19 & he was so weak he stumbled getting in the car (one small step from curb to

backseat). Vet suggested blood transfusion, but he was a fair spook who hated the vet's office & would scream if anyone with a

needle even so much as looked at him. I couldn't bear to put him through that trauma, so decided to help him to the bridge where

he could run & play & be normal.

 

I hope you have a much better outcome. I must also add that the vet I had at that time was not all that grey-savy and I had not

yet discovered the amazing support & knowledge of GT.

 

Please keep us posted....my best wishes to Night.

[Guest d0ggiem0mma]

I would have your vet do a full sendout panel for all the known tick born diseases just to be safe. A standard 4DX test only tests for 1 strain of erlichia so the full send-out may be more helpful. If the destruction of RBCs can be attributed to a TBD like erlichia the prognosis is much better.

 

You'll be in my thoughts.

[tbhounds]

One thing I will mention to you is to watch him very closely tonight. Not knowing if he is harboring a tbd and starting him on pred can be risky. Suppressing a dogs immune system (pred) that may potentially have a tbd could have awful results. It's always a tough call for vets-- wait for the tick panel to return or start treatment asap.

IMHA is a tough disease to control--pred does a real number on our hounds-- muscle wasting etc. I would ask about starting your pup on tummy protectants like prilosec and carafate.

I second the idea of contacting OSU--they may have other treatment options to suggest that your vet is not aware of.

[Guest sandlot13433]

Thank you so much everyone for sharing your experiences. I will definitely contact OSU right away. One question I do have is how long was it from the initial diagnosis until you had to let your pups go? I want to be realistic and from what I have read it is not sounding very good. I have a lot of questions for when we go see the vet on Tuesday. Thank you all again and thank you for the white light and prayers! Night is from Ebro in Florida so it is very likely he could have contracted a tick disease. It is my understanding (per my vet) that the doxycycline will treat any TBD that are treatable? Is that correct? I will phone the vet tomorrow about prilosec dosages. She mentioned that today at our appointment but forgot to give me the correct dosage.

[Batmom]

Doxycycline doesn't treat babesia, a TBD whose hallmark is anemia. Doxy might knock it back a bit but won't clear it. For that you need Imizol injections.

 

Has blood been drawn for a more comprehensive TBD panel? The best are the new fast, comprehensive PCR panels from Idexx and Antech labs. These test for many tick diseases at once. Once you start antibiotics, it may be harder to diagnose a tick disease by any means (PCR or titer).

[Tallgreydogmom]

Doxy did help Wally for awhile. Then he went downhill again. OSU will have the stronger drugs to work with. They have a microbiology department and entire source of Doctors to consult with. Are you able to get him to OSU? After my experience with Wally, I would have him at the clinic on Monday AM. The clinic is open 24 hours. It is a regular clinic from 8 - 5, then turns into an emergency clinic from 5 - 8, the hours are something like that. They are emergency all week-end.

 

Wally raced at Derby Lane in St Petersburg, FL.

 

Wishing you and Night well.

Edited June 11, 2011 by Tallgreydogmom

[Hubcitypam]

 

Well, you said you wanted good and bad....

 

I lost my first grey, Little Girl to IMHA. She went from seemingly fine to dead in about 48 hours. She went off her food one morning, then started both pooping and vomiting blood. She spent a night at the e-vet for vitamin K and I can't remember what else, then to my vet at 7 a.m. The next day I went to sit with her for an hour or so and her eyes and gums were solid yellow. I don't think she knew that I was even there.

 

I asked the vet if we could let her go and she said, no she wanted to wait for the Coombs test to come back, but I had to leave as they were closing for lunch. They closed and Girl died alone while they were at lunch. I will never forgive that vet. They called when they got back from lunch and said she was dead and that the Coombs test just came back positive.

 

Evidently what what research I did certain breeds like Cockers and Poodles are more inclined to get IMHA, but it most often kills middle aged bitches like Girl (she was 4). My niece is a nurse and says something similar happens with young Hispanic women with Lupus -- once they are admitted they seldom leave. Lots of guys and white women live with Lupus for long periods but not young Hispanic women. Maybe being male is working in Night's favor. I hope so.

 

Like Batmom says you have to have Imizol for Babisia and I don't think it would be advisable in a compromised dog, but I'm not a vet. You've got access to lots more resources. I wish you and Night the best and will keep you in my thoughts.

 

Here are a couple of studies that might help you breathe a bit easier --

The 2002 Study by Drs. Anthony Carr, David Panciera, and Linda Kidd at the University of Wisconsin School of Veterinary Medicine reviewed 72 dogs with IMHA looking for trends. Here are their findings:

 

• The only predisposed breed they found was the Cocker Spaniel.
• Most patients were female.
• The mean age was 6.8 years.
• Timing of Vaccination was not associated with the development of IMHA.
• 94% of cases had spherocytes on their blood smears.
• 42% showed autoagglutination.
• 70% also had low platelet counts.
• 77% were Direct Coombs' positive.
• 58% were suspected of having Disseminated Intravascular Coagulation.
• 55% required at least one blood transfusion.
• Mortality rate was 58%.
• Of those that died, 80% had thromboembolism present on necropsy (autopsy).

Prognostic Factors for Mortality and Thromboembolism in Canine Immune-Mediated Hemolytic Anemia. A.P. Carr, D. Panciera, L. Kidd. Journal of Veterinary Internal Medicine. 2002; 16: 504-509.

 

Another study:

 

The 2005 study looking for trends, by Drs. Tristan Weinkle, Sharon Center, John Randolph, Stephen Barr, and Hollis Erb at Cornell University, reviewed 151 dogs with IMHA. They found:

 

• Cockers spaniels and Miniature Schnauzers were both overrepresented (i.e., felt to be predisposed). These breeds, however, showed the same mortality rate as other breeds.
• Unspayed female dogs were overrepresented.
• Neutered male dogs were more commonly affected than unneutered male dogs (begging the question of whether male hormones might have some protective effect).
• The chance of survival either long term or short term was significantly enhanced by the addition of aspirin to the treatment protocol, especially when combined with azathioprine.
• Adequate vaccination information was not obtained for enough patients to comment on association with vaccination.
• 89% of affected dogs showed spherocytes on their blood smears.
• 78% showed autoagglutination.
• 70% of patients required at least one blood transfusion.
• Of the 151 dogs studied, 76% survived, 9% died, and 15% were euthanized. Survivors were hospitalized an average of 6 days. Non-survivors were hospitalized an average of 4 days.
• 100% of dogs that died or were euthanized showed thromboembolism on necropsy (autopsy).
• Of the dogs that survived 60 days or more, 15% experienced relapse. Most dogs treated with corticosteroids, azathioprine, and ultra-low dose aspirin did not experience relapse.

Evaluation of prognostic factors, survival rates, and treatment protocols for immune-mediated hemolytic anemia in dogs: 151 cases (1993-2002). T.K. Weinkle, S.A. Center, J.F. Randolph, K.L. Warner. S.C. Barr, H.N. Erb. Journal of the American Veterinary Medical Association. Vol 226, No 11, June 1, 2005. 1869-80.

 

 

 

 

[DesiRayMom]

Awesome research, Pam!!!

 

That's exactly what I mean about the awesome knowledge & advice in GT.

 

To Sandlot: You asked about time frame......I first realized "something was wrong" in the fall...his diagnosis came between Thanksgiving & Xmas....

I let him go the next February.

 

Looking back now, I wonder if I should have treated more aggresively; but in all honesty, considering his spookiness, I still don't think I could

have put him through the transfusion.

 

I'll be thinking of you & Night.

[Guest d0ggiem0mma]

For the time frame question... you have to understand that will very much depend on if this is a TBD or if this is true IMHA with no other cause. I have no experience, but from what I can gather the prognosis for TBD related IMHA is much better.

[Guest Stripeyfan]

Sending good thoughts...

[Guest sandlot13433]

So I guess a good next step would be to have a full panel of testing done for TBDs? I can request that on Tuesday so we have a better idea what we are looking at.

[Batmom]

That would be useful. Just be aware that results might not be optimal since he's already on antibiotics (but you sure don't want to take him off if they're helping!). Sending lots of good thoughts for your pupper.

[NancyB]

Sending good thoughts and prayers for Night.

[tbhounds]

Looking for an update on Night. Hope he's stable.

[Guest sandlot13433]

So far so good...Night's fever went from 104 on Friday night to 99.7 the next morning and has stayed stable ever since (I believe due to the high prednizone dose). He is eating and behaving normally and there's not been any more blood in the urine thus far. We go back to the vet tomorrow at 4 pm for blood work, so we should have a better idea what is going on then. I believe we also might begin tapering the prednizone dose? Not sure. I email OSU so hopefully they can give me some ideas as well. Thank you again everyone for sharing your experiences and for all the prayers and white light. I will definitely keep you all updated. Sometime today or tomorrow I will get a photo of Night posted

[Burpdog]

You need to know whether you are dealing with erlichia or babesia. You can overnight to Protatek and get results asap.

 

Other choice is to do an imizol shot. Does your vet have experience with tick borne diseases?

[Guest sandlot13433]

We are going to the vet today at 3:40...I was able to move the appointment up. Not sure how much experience anyone around here has with TBD since they are uncommon up here in New York. However, I am going to bring this information along for her and I put in an e-mail to OSU Friday, so I am hoping to get some guidance there as well. If there is any other information, links to articles, etc that I should bring with me to the vet's let me know and I will be sure to print it off. Thank you everyone!

[Batmom]

Some useful tick disease info:

 

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/reference-laboratories/diagnostic-updates/vector-borne-disease-panels.pdf

 

http://cvm.ncsu.edu/vhc/csds/ticklab.html#ehrlichia -- be sure to click on the link re babesia diagnosis and treatment, too

 

Babesia, ehrlichia, and Lyme are perhaps the most common tick diseases in dogs, but there are others. The NCSU tick lab's home page http://cvm.ncsu.edu/vhc/csds/ticklab.html has links leading to more info for most of them. These folks are true TBD experts and would be happy to speak with your vet if need be.

[Guest FullMetalFrank]

Sending prayers and hoping you get some answers; hang in there Night!

[Guest sandlot13433]

UPDATE: Night went back to the vet today to get another blood and urine test. Good news! There is no bilirubin in his urine and his red blood cell count is back up to 41! (RBC count was 32 on Monday) I know we are not out of the woods yet as we still have not identified what set off his IMHA, but at least the steroids have started to work and produce more red blood cells which his body is no longer attacking. We go back to the vet for another test next Friday, and if his RBC count is back to normal, we will slowly slowly start to taper the steroid. Anyhow, keep sending the prayers and white light as it seems to be working so far.