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Old 12-17-2011, 07:40 PM   #1 (permalink)
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First simultaneous bilat knee surgery-now AIHA

Sasha, our 4-year-old female rescue is a tough girl. The day after we got her from a neglectful owner, our vet told us she had blown knee(s). She had the simultaneous bilateral knee surgery 4 1/2 months ago, and is doing well with that.
2 nights ago, however, we took her to an emergency clinic, where she was diagnosed with Autoimmune Hemolytic Anemia-- a potentially fatal condition. Numerous blood panels over the last 48 hours have shown some improvement, but she has quite a course of medications to run for the next few weeks--among them, prednisone, immuran, et al.

She continues to get her soloxine (hypothyroid medicine) but we had to discontinue her Novox (arthritis medicine) because it can cause mayhem with the prednisone.

She's only been with us for 5 months, but it feels like we've had her since she was a pup. She has an amazing Doberman spirit. I am in awe of her: severe arthritis of the knees, bilateral knee surgery, hypothyroidism, and now hemolyic anemia. There is no quit in the Doberman Pinscher. I feel small by contrast.
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Old 12-17-2011, 07:47 PM   #2 (permalink)
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The spirit of a doberman never ceases to amaze me. Thank you for taking care of her.
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Old 12-17-2011, 08:01 PM   #3 (permalink)
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"there is no quit in a Doberman" Truer words have never been spoken.

Stay strong Sasha. The brave and noble blood that courses through your veins will see you through, sweet girl.
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Old 12-17-2011, 08:07 PM   #4 (permalink)
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Our thoughts are with Sasha! Get better soon.

Please keep us updated.
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Old 12-17-2011, 08:08 PM   #5 (permalink)
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bless you for taking her into your heart and home.

hope she will be ok.

Hugz to you and Sasha!
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Old 12-18-2011, 09:28 AM   #6 (permalink)
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She's a lucky girl to have landed in a home willing to do all that medical work. I hope she starts feeling better soon.
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Old 12-18-2011, 09:35 AM   #7 (permalink)
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I hope she feels better soon. What a wonderful owner you are. Takes a licking and keeps on ticking...
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Old 12-18-2011, 01:12 PM   #8 (permalink)
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setback?

Sasha is lethargic again. She tired noticeably yesterday, which was her first day on Imuran. The plan was to alternate the Imuran with the Prednisone each day. Given her reaction, however, the vet believes that she will need to take the drugs concurrently on a daily basis.
We gave her the Prednisone three hours ago, and she has shown a little energy, but she is still noticeably weaker than she was when we first brought her to the vet.
If we don't see more improvement by 2:00 PM--three hours from now--we have been instructed to call the vet back.
Thanks to everyone for their kind words and wishes. These situations are so painful and frightening.
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Old 12-19-2011, 05:45 PM   #9 (permalink)
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We took Sasha for another emergency visit, as she was more lethargic than ever. The emergency vet prescribed an antibiotic (Amoxycillin) for a week, owing to Sasha's new blood work, and told us to consult with the regular vet, Re: how much prednisone, how often, etc.
After examining Sasha today, the regular vet conferred with a number of colleagues, and decided to temporarily discontinue the Azathioprine, while continuing to give the Prednisone twice a day. Sasha will still get two palliative gastrointestinal meds for the course of the Prednisone treatment. The plan is to reintroduce the Azathioprine when the blood levels rise, at which point, the Prednisone dosage will be tapered off.
After getting her 2nd dose of Prednisone yesterday, Sasha's energy level and affect picked up a little, though she still tired quickly. Towards that end, we restrict her movement in the house.
Good news: There has been some improvement in her blood levels, and she is a little more outgoing. But we are watching her very closely, as this condition is sometimes fatal. Unless something changes, we are scheduled for regular blood levels on successive Fridays. I'll keep everyone updated.
Thanks so much for your good thoughts and wishes.
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Old 12-19-2011, 09:52 PM   #10 (permalink)
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So sorry to hear about the diagnosis. Good luck and hope the meds help Sasha feel better.
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Old 12-24-2011, 08:32 PM   #11 (permalink)
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Updatate: Sasha's hct levels are rising, which is good. She is responding to the prednisone. However, she has an elevated platelet count, which concerns the vet. I've tried to research the issue, given what lab paperwork we already have, and I believe that Sasha's platelet count rose, in a week's time, from a marginally high level of 513,000 to a much higher level of 700,000.
Possible blot clots are now a concern, for which a daily 1/4 tab of 81 mg aspirin has been prescribed. She can't be given a higher dosage because of the GI bleed concerns, Re: the ongoing prednisone administrations. So, the vet is trying to balance the two problems with their conflicting antidotes. FYI: The vet is also restarting her AZT (the immunosuppressant), while continuing the prednisone and GI-soothing medications.
Unfortunately, we have hit the holiday gap: No vet offices open until next Tuesday, when we will have another CBC drawn to recheck levels. My wife and I are somewhat undone by all this, and would be better able to cope with this if we had half the courage and spirt of Sasha.
Thanks for everyone's concerns and well-wishes.

Last edited by forager; 12-24-2011 at 08:37 PM..
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Old 12-24-2011, 08:42 PM   #12 (permalink)
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Lesson my Julian taught me when she was battling cancer... I was never really the strong one in our relationship. She just let me think I was

The three of you will get through this together. It works because it has to, because you love each other. Roll with the tide as best you can, and it's ok to lean on the ones who love you.

Merry Christmas Sasha, stay strong sweetie. My family is pulling for your full recovery.
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Old 12-25-2011, 12:53 AM   #13 (permalink)
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update

Thanks for the reply. Actually, there are five of us: My wife and I, Sasha, Soames, and Dimity. Like Sasha, Soames and Dimity are red dobes.
Looking back on what I wrote, I may have skewed the numerical platelet levels. I didn't directly get today's report; but my wife, who did, tells me that the vet was very concerned about the platelet level. I tried to compare the CBC panel results from different veterinary office visits (yesterday's panel with the panel of the first emergency visit of the week before). But I think the two offices use different numerical scales for their values, so the comparison--at least my amateur execution (and reading) of it--isn't helpful. Sorry if I confused any lab folks or vets on the forum.
I've read numerous articles on the web about the myriad causes and projections of platelet levels, and am still mystified about Sasha's condition. I was hoping to find more information about how high platelet count levels relate to AIHA. There is certainly a lot of information about AIHA and low platelet counts.
Sasha is still moving a bit slow, but is holding steady. She crashed once after the initial emergency visit; we're bound to keep it from happening again.
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Old 12-25-2011, 01:28 AM   #14 (permalink)
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Update

Correction: The vet restarted the AZA (a.k.a. Imuran), not AZT as I wrote earlier.
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Old 12-31-2011, 05:09 PM   #15 (permalink)
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Changes

There are some positive and negative changes in Sasha's condition.
Positive:
HCT has slowly risen from 20 to 31
gums are noticeably pinker
nucleated red cell occurrences have decreased
continues to eat voraciously and takes and/or demands water
Negative:
lab values reveal that her immune system continues to kill red blood cells, albeit at a slower pace
platelet count remains high
occasional, brief head tremors
and a new development: considerable weakness in her hind legs, as she cannot support her weight on them.

Re, her legs: 5 months ago Sasha underwent simultaneous bilateral ligament repair. The vet believes that the prednisone, which was recently decreased from 80 mg. per day to 60 mg. per day, has weakened her already surgically-compromised legs, and she probably will not recover until it is safe to lower the dosage of prednisone even more. According to the vet, the prednisone is the main reason that Sasha is still alive. Because she is still critically ill, they cannot adjust the prednisone until lab values dictate. She will have her next blood draw on Tuesday, Jan. 3.

As everyone knows, prednisone promotes frequent and voluminous urination. I am struggling to find ways to accommodate Sasha's urinating, given her inability to support herself on her rear legs. The bladder expression techniques shown on Youtube.com have not worked. I'm going to try lying down on the back lawn with her for extended periods of time; perhaps she will urinate then. Fortunately, the recent decrease in Prednisone has resulted in less urination and water consumption. Any ideas from forum members would be appreciated.

These are Sasha's medications (inc. additions and changes):
Prednisone 30 mg. 2/x daily
Azathioprine 50 mg. x1 (in A.M.)
Cyclosporine 75 mg. 2/x daily ***
Famotodine 20 mg. 1/2 tab twice daily
Sucralfate 1 gm. twice daily ***
Aspirin 81 mg. - 1/4 tab in A.M.
Tramadol 50 mg. for pain (up to 3x/day)
(*** Taken 1 hour after meals)
Sasha also takes an ongoing 0.8 mg. Soloxine 2X/day for hypothyroidism

Last edited by forager; 12-31-2011 at 05:14 PM..
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Old 01-30-2012, 12:19 PM   #16 (permalink)
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Setback

Sasha had progressed significantly since my last post: Last week's lab registered everything in the "normal" range, including her HCT, which was 44. Indeed, everything: her movement and general well-being was improving.
On Friday morning, however, she was disinclined to walk (toe-y right hind leg), which we attributed to a more-than-normal vigorous hydrotherapy session on Thursday. We had been nursing her back to strength on Friday and Saturday--with improving results--when yesterday evening (Sunday) she became lethargic and weak.
Her gums remain pink and she will eat, though only while laying on her stomach. She seems only moderately aware of her surroundings, and is, I believe, growing progressively more lethargic. She lays quite still, for the most part.
Sasha remains on her drugs: prednisone, azathioprine, cyclosporine, famotidine, asa, sucralfate, glucosamine, soloxine (thyroid medication), and tramadol (for pain). In fact, today she was due for a decrease of 25% in her prednisone, given how well her labs had been going.
We see the vet, who is in surgery as I write this, in about 1 1/2 hours.
AIHA-IMHA is an insidious disease.
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Old 01-30-2012, 01:18 PM   #17 (permalink)
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I am so sorry. You are sure fighting a long hard battle.

I am just curious if LDN (low dose naltrexone) might give her a boost. Your vet has probably never heard of it - mine didn't. There are not too many things that you cannot dose it with, and it seems to help with pain immensely.
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Old 01-30-2012, 10:25 PM   #18 (permalink)
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Angry Update

We're back from the vet's office, where Sasha had a chest x ray, an abdominal x ray, a CBC/Chemistry blood draw, and an enema.
The X Rays revealed the presence of gallstones and a seriously impacted Gastrointestinal tract. The enema took care of the latter. The vet prescribed a motility medication to help with any ongoing impaction issues.
The Chest Ray showed no pericardial fluid sacs, which ruled out pericardial effusion. Sasha's heartbeat sounded muffled, and the vet and my wife (an R.N.) were concerned that fluid may have accumulated. Luckily, that is not an issue, though there is no explanation for the muffled heart beat.
We have only a partial result of the CBC, as the vial and slides are sent to a pathologist for a report. Sasha's hematocrit is down a little, approximately 5 points: from 44 to 39. Both values are in the normal range, but given Sasha's sudden lethargic state, the vet is concerned that she is in the initial part of a downward slide. We'll have the precise report from the pathologist tomorrow.
Once home, Sasha seemed very comfortable. However, after I administered her medication, which includes prednisone, the fast respiration started again, and she appears very uncomfortable. I've put a call into the vet to see what we can give her, given all the meds she is taking, to help with the side effects of prednisone. She's already taking sucralfate and famotodine to protect her GI tract from irritation. Perhaps there is something safe for the anxiety.

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Old 01-30-2012, 10:39 PM   #19 (permalink)
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I am so sorry for what you and your girl are going through. It sounds really scary and complicated. Hugs to you and Sasha.
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