The Zim Family Cocker Spaniel Forum

What a wonderful post. My sweet Leyla died of this disease 03/05/09. It was a matter of 24 hours and she was gone. I wish I new of these symptoms and maybe I could of saved her. They go so quickly with this disease. Thanks for posting !!!

Oh, MaryLou, I remember that. I can't remember the situation that you got Leyla and Eddie from, but I remember what a great story that it was!!. I did not realize that Leyla passed away from IMHA. I was so sad when I read your post about her going to the Bridge. Please accept my belated sympathy. On a happier note, how is Eddie doing? We love to see pics you know. It's good to see you back on the forum-don't be a stranger.

Yes, I too lost my 2 yr old Benji to this horrible disease, it was 8 days of pure hell for both of us!!! MaryLou adopted Leyla and Eddie from us at Cherished Ccockers, that is probably why you remember them.

Thank you for posting that information.

Thank you for taking time to post this - I hope I never have to go through it with Rudy or any of my other dogs, but just in case, this will be handy. I'm so sorry for the people who HAVE or had to go through it.

Dawn, thank you so much for posting this!!!

After seeing so many of our forum friends go through this one after another, I have begun to feel that I need to educate myself on this horrible disease before I am possibly faced with it.

Next time I am at the vet, I will ask how many of these cases they have handled and where they feel is the best local place for treatment.

Thank you for you knowledge as well as your time and energy to post this information.

Now....here is my question....does anyone know of a program that studies dog diseases such as this to find a cure? I have been thinking of all the sweet pups lost to us each year. I would like to make a donation in the memory of all our loved ones (not just those that we lose to this disease) to somewhere were they study dog illnesses and treatments/cures. Does anyone know of a research hospital or vet school where this is done?

Thanks

From what I understand there is no cure, there is remission,that is why there is a need to stay on it, watch the gums at least once a week, I check Muffin's daily

Dawn,

Thank you so much for posting this! Definitely information we all need to know.

I didn't realize cockers were such a high percentage of cases! If you don't mind me asking, are there other breeds also highly represented?

Dawn, thank you so much for this information. I'm so sorry that you needed to have it....

Okay, excuse my ignorance, but I have a question. You talk about always checking the gums to make sure they are pink. WELL my cocker girls have BLACK gums So would I be able to tell with black instead of pink gums? Maybe I need to check closer to see if they are pink in places?

Muffin is also Black but there is pink, you can also look at the tongue

VetInfo.com also says:


These are the known causes of immune mediated hemolytic anemia (IMHA) that I know of:

•Genetic predisposition to this condition is known to occur in the following breeds:American cocker spaniels (most common breed to develop IMHA), English Springer Spaniel, Old English sheepdog, Irish Setter, Poodle, Dachshund(list from "Textbook of Internal Medicine, 5th Ed., Ettinger and Feldman)
•Drugs that might induce IMHA:sulfonamides, cephalosporins, penicillins, methimazole, procainamide
•A higher incidence of IMHA is seen in dogs within a month of vaccinations so it is presumed at the present time that some dogs react to vaccination by developing IMHA.
•Metastatic cancer, especially hemangiosarcoma, is a common cause of IMHA in older dogs.
•Tick borne illnesses, usually ehrlichiosis but possibly Rocky Mountain spotted fever and Lyme disease can lead to IMHA.
•Severe bacterial infections (sepsis, for example) and some viral illnesses(more common in cats) can lead to IMHA.
Most cases of immune mediated hemolytic anemia are still unexplained (idiopathic) at this time. Hopefully, it will be possible to identify more and more causes of this condition as time goes on and perhaps some day to beable to definitively identify a cause in individual patients for which an obvious cause, such as metastatic cancer, is not present.

Debbie, Parker has pink right around the outside of his mouth and it turned a gray color along with his gums. Chris, also, Old English Sheepdogs, Irish Setters, and poodles are listed in some of the literature that have a higher chance of IMHA. But, cocker spaniels are the No. 1 breed for IMHA. I have seen percentages of 33% of cockers. Dawn, thank you for posting the information. It can strike at just about any age. Check those gums, please!!!!!

Thank you for posting I will definetly ask Dr Morrison who educated he is with this disease when we go in, prayers for all the puppers affected by this disease.

I have lost three over the years to this horrible disease (many years apart) and I seem to find it's different each time I see it.

1991 Cookie, my first Cocker, literally collapsed on my back patio and I watched the color drain from her gums as I was trying furiously to get her to the emergency vet. Sadly she lasted three days on IVs and a few transfusions. She wouldn't ever even eat her favorite cottage. At that point the doctor had said it was mostly likely from a tick bite she may have had in the last two years.

1998 Sissy was different and was acting lethargic and had horrible labored breathing almost immediately. We rushed her to the same emergency animal hospital and unfortunately we were too late.

2009 My last one, Brady, was the hardest. We were vigilant with checking his gums since we had lost two. Brady was always a super healthy boy and never really had anything wrong with him. One morning he woke up and peed blood - and we immediately rushed him to the vet. The vet dismissed it as a UTI and possible kidney infection, gave us meds, and sent us on our way. I had never seen anything like that so I agreed with the vet. I had a nagging feeling but his gums looked ok. I should have demanded a CBC. The next morning I got up and he could barely get up. He climbed up our stairs and just sat there. I don't know how he even got up the stairs but it was his favorite spot. He was peeing blood still, even worse. We took him immediately to the emergency vet hospital and unfortunately lost him that day. I cannot remember what his PCV was but I never expected to leave that day without him. Needless to say, that vet is no longer my regular vet.

My advice: watch your dogs like a hawk for anything out of the ordinary (like Dawn mentioned above) and always demand a CBC test. I really feel that is my biggest regret with Brady when he went to our family vet. I maybe could have gotten him to the emergency vet a day sooner.

I found some pink on their front lower gums of both girls!! Very BRIGHT pink.

To Dawn's info I would add: females tend to get it more than males.

If your cockers have black gums, you can also check their eye membranes. Gently pull up(or down) on the lids and look under the lids. It's similar to checking for pink-eye.

I feel very blessed that Mia is in full remission. When she was diagnosed, we had to carry her into the vet's office because she was too weak to walk.
We almost lost her because I didn't call the vet when she became lethargic, first because I thought she was just hot (we were having 100 degree temperatures) then I didn't think it was an urgent until she collapsed. I think if I had been better informed of how susceptible to this disease Cockers are I wouldn't have done something sooner. So Thank You Dawn!

I haven't been here in a long time *sheepish smile* - sorry.
I've had 2 girls diagnosed with this. We lost one, and one survived.
If you want to make a donation to sponsor research, a great place to donate to is the ACVIM Foundation, an ofshoot of the american college of vet internal medicine http://www.acvimfoundation.org/ They have a grant program for funding researchers studing a wide variety of diseases; IMHA would fall under this.

Dawn, thank you so much for posting this information. I had never heard of this horrible disease until I became a member of the forum back in 2006, I think. It is so scary, but you are right, educating ourselves is so important. The information is very important to all of us, and for those of you who are going through this right now, thank you for taking the time to share with us. Know we are keeping you close in thoughts and prayers.

Hi Everyone,

I have added this article that was provided to me by Julie Hydro. Thank you Julie!!! This is the best and easiest to read article on IMHA that I have ever seen. I looks to me like that this document is provided to each patient that contracts IMHA. It would have been very helpful to me in the beginning. There is so much to learn, and no time to react.

IMHA, A VERY CONCICE DESCRIPTION OF THE DISEASE AND TREATMENTS:

Immune Mediated Hemolytic Anemia Veterinary Specialists of Rochester

Immune-mediated hemolytic anemia is an immune-mediated disease in which the body sees its own red blood cells as “foreign”. Therefore, the body attacks and destroys the red blood cells. Subsequently, the dog’s red blood cell count drops. When their blood cell count becomes too low, animals start to show signs of anemia (low red blood cell count).

Symptoms include decreased energy, weakness, collapse, pale gums, lack of appetite, and yellowing of the eyes. This disease, and its symptoms, can come on slowly, but more often, it comes on very quickly.

Causes:

IMHA can have a variety of initiating causes. While anything that stimulates the immune system can trigger IMHA, the most common causes include:

 Medications:
o Antibiotics:
 Cephalosporins including Cephalexin and Simplicef
 Penicillins including amoxicillin, ampicillin, and Clavamox
 Sulfa drugs including trimethoprim-sulfa
o Vaccinations
 Infections:
o Tick-borne diseases
o Heartworm infection
 Cancer
 Inflammatory (non-infectious) diseases
o Pancreatitis
 Idiopathic
o This means that no underlying cause of the disease is found. In the majority of cases of IMHA, no underlying cause is determined.
To look for potential underlying causes of IMHA, numerous tests are performed. We obtain a thorough history see if any medications or vaccinations have been given recently. Heartworm and tick-borne diseases are tested for using blood tests. An abdominal ultrasound is performed to look for signs of infection, inflammation, or cancer within the abdomen. Radiographs (x-rays) of the chest help us to rule out disease there.

Treatment:

If an underlying cause of the disease is found, it is treated appropriately. For idiopathic IMHA, immunosuppressive medications are used. There are a variety of drugs that can be used to suppress the immune system and often a multi-modal approach.
 Glucocorticoids including prednisone, prednisolone, and dexamethasone: These medications are the most common type used for immune-mediated diseases. They suppress the immune system in a variety of ways and are the first line medication for immune-mediated disease. The most common side effects include increased urination and drinking (A LARGE BOWL OF WATER SHOULD BE AVAILABLE AT ALL TIMES), and increased hunger (you do not need to feed more food). Some dogs will pant with steroids. Some large breed dogs will show hind end weakness with steroids. Steroids can cause gastrointestinal ulceration. Therefore, you should notify your veterinarian if you notice any vomiting, diarrhea, decreased appetite, blood in the stool, or dark tar-like or coffee-ground like stool. Steroids can increase the risk of forming blood clots (see thromboembolism below). A life-threatening crisis can develop if you stop this medication too quickly. Therefore, you should only change the dose of this mediation under advisement of a veterinarian. While on the prednisone, it is important that you do not give any aspirin or non-steroidal products (Rimadyl, Deramaxx, Metacam, etc) as giving these two types of medications together will result in GI ulcers.
 Azathioprine: This immunosuppressive medication is often used as second line therapy. Side effects include: liver disease, pancreatitis, and bone marrow suppression. Please notify a veterinarian if your pet has any of the following symptoms while on this mediation: vomiting, diarrhea, yellow color of the skin/whites of the eyes/gums, abdominal pain, weakness, or collapse. Wash your hands after giving this medication.
 Cyclosporine: This immunosuppressive medication can be used as a second or third-line treatment, but is more expensive and is more likely to cause GI upset.
 Cellcept/mycophenolate: This immunosuppressive medication can be used as a second or third-line treatment, but is more expensive.
 Overall, your pet will likely be on these medications for at least 4-6 months. We will slowly taper the medications, checking the blood work prior to each decrease. If your pet has a relapse during the taper period, he or she may need to stay on life-long therapy.

Complications:

 Thromboembolism: Patients with IMHA are at increased risk of developing blood clots. Therefore, we place patients on low doses of aspirin. It is very important that you do not change the dose of this medication, as higher doses can cause ulcers. If a clot forms, it can go anywhere in the body. The most common location is that it goes to the lungs so please monitor for increased respiratory rate and effort, collapse, and weakness. Blood clots can also go to the brain, kidneys, heart, GI tract or legs.
 Infections: IMHA is treated with immunosuppressive medications. Therefore, your pet will be at increased risk of infections. The most common area of infections is the urinary system, but they can also get infections of the skin or respiratory systems. Please monitor for the following symptoms and have your pet evaluated by a veterinarian if you see any of these symptoms: straining to urinate, painful urination, bloody urine, red skin, itchy
skin, increased respiratory rate or effort, or cough. Raw food diets pose a risk of causing infections and, therefore, should not be given to pets with immune-mediated anemia.
 Relapse: your pet is at risk of a relapse anytime in the future. He or she may start attacking the red blood cells again or the body may start attacking other areas such as the platelets (immune-mediated thrombocytopenia) or the joints (polyarthritis). This may happens while your pet is still on the medication or it may happen years in the future. Therefore, if you think your pet is sick in any way, take him or her to a veterinarian sooner rather than later. The body is more prone to attacking itself whenever the immune system is stimulated. Therefore, pets with IMHA should not receive any further vaccinations as this could spur another attack. Usually a letter can be written to get your pet out of having to be vaccinated for rabies. Certain medications are more at risk of causing a relapse as well including: cephalosporins (Cephalexin, Simplicef, cefazolin), penicillins, and sulfa drugs. These medications should be avoided.

Monitoring:

IMHA patients need very close monitoring. We will be rechecking your pet’s red blood cell count. At first, the red blood cell counts will be monitored every few days. Then we will cut back to monitoring every 2-3 weeks. If the values are holding, we will then decrease the dose of one of the medications by about 25%. We will decide the exact amount of the decrease depending on how your pet is doing at home and on blood work. Since your pet will be more susceptible to infections, we will also be checking urinalysis and urine cultures every few months. We will also be checking full chemistries periodically. Once your pet is completely off of all medications, we recommend rechecking basic blood work (complete blood count and serum biochemistry) as well as urinalysis every 4-6 months long term.