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 Post subject: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 1:19 pm 
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To all of our Cocker Spaniel lovers on this forum. I am on my “high horse” again! Regarding IMHA….. :roll

During my research for Moonbeam's IMHA, I read that Cocker Spaniels represent 1/3 of all IMHA, :OMY Immune Mediated Hemolytic Anemia, canine cases. (Formerly called AIHA.)

Therefore, I am posting the initial signs and symptoms of IMHA. This information will allow you to act quickly and take your Cocker to the Vet or Vet Hospital immediately.

NOTE: Please watch your babies very closely for:

Any small change,
*Did not eat or even if they did not eat all of their food,
*Have pale or grey gums,
*Have yellowing (jaundice) of the eyes or gums,
*Are lethargic,
*Are weak,
*Have labored breathing
*Have darkened urine
*seem a little “off”

Next Step:

Check their gums. If pale, grey or white, go to the Doctor or Emergency Veterinary Hospital immediately. Time is of the essence. :cry (in my opinion, I would query your current Vet now on how versed they are in the treatment of IMHA. If you are not comfortable with the answer, research a local Veterinarian or University of Veterinary Medicine WHO IS).

I am very concerned that our fellow Cocker Spaniel owner’s are still not as versed on this disease as they should be. But, you need to be! This information will help you to act quickly and give you the upper hand against this horrible disease called IMHA! :th-up

At the end of this thread, I have also posted a list of some of the, more important terms for IMHA, CBC (complete blood count) terms and their description for everyone to read.

Note: There are two types of IMHA: Regenerative and Non-regenerative:

These two words pertain to the production of reticulocytes (baby red blood cells). In the regenerative version of IMHA the reticulocytes are regenerating and the non-regenerative means that the baby red blood cells are not regenerating. Obviously, the regenerative version will give your pet a better chance of survival. Moonbeam has the regenerative form of IMHA.

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.

SOME CBC (complete blood count) TERMS

RETICULOCYTES (Baby Red Blood Cells) are immature red blood cells, typically composing about 1% of the red cells in the human body. Reticulocytes develop and mature in the red bone marrow and then circulate for about a day in the blood stream before developing into mature red blood cells. Like mature red blood cells, reticulocytes do not have a cell nucleus. They are called reticulocytes because of a reticular (mesh-like) network of ribosomal RNA that becomes visible under a microscope with certain stains such as new methylene blue.

WBC
White blood cells (WBC) - The body's primary means of fighting infection. Decreased levels may indicate an overwhelming infections (viruses), or drug / chemical poisoning. Increased levels indicate bacterial infection, emotional upsets and blood disorders.

RBC
Red Blood Cells (RBC) - Responsible for carrying oxygen and carbon dioxide throughout the body. High red blood cell numbers usually indicate dehydration but can also indicate uncommon diseases that cause an excess production of red blood cells from the bone marrow. Iron deficiency will lower RBC count. In more reduced count, it may indicate hemorrhage, parasites, bone marrow disease, B-12 deficiency, folic acid deficiency or copper deficiency some immune diseases and toxin ingestion. RBC's live for 120 days so an anemia of any kind other than hemorrhage indicates a long standing problem.

HGB
Hemoglobin (Hb) - normal range: 12.0 - 18.0 The essential oxygen carrier of the blood. Decreased levels indicate the presence of hemorrhage, anemia, iron deficiency. Increased levels indicate higher than normal concentrate of RBC, B-12 deficiency (because there are fewer cells).
.
HCT (PCV)
Hematocrit (HCT)normal range: 37 - 55% or Packed Cell Volume (PCV) - Provides information on the amount of red blood cells (RBC's) present in the blood. The hematocrit is a calculated percentage of red blood cells in the circulation. It gives similar information to the red blood cell count but the value is expressed as a percentage. The other part of the blood is serum, containing enzymes, proteins, electrolytes, etc. Decreased levels means anemia from hemorrhage, parasites, nutritional deficiencies or chronic disease process, such as liver disease, cancer, etc. . Increased levels are often seen in dehydration.

Note: The HCT (above) is the count that represents the PCV % that I discussed almost daily while Moonbeam was being treated. It was the number one count that was checked, at first, daily, then every other day, then weekly and now monthly.

Thank you for reading. I do realize that all this could make you go bonkers, :goof but your beloved Cocker Spaniel’s life could depend on your actions. At least know the symptoms. Please :nw

Kindest regards,
:love Dawn

PS: I just found this important info on the packed cell volume (PCV) test, how it is done and how the results are determined:

Hematocrit: (Packed Cell Volume/PCV) In the CBC, we determine the number of RBC’s in several different ways. The quickest and easiest is called the hematocrit, also referred to as the packed cell volume (PCV). A blood sample is placed in a tiny glass tube and spun in a centrifuge. This device spins the tube round and round at several thousand revolutions per minute. The cells are heavier than the plasma and are compacted at one end of the tube. After the tube is spun, it is examined and the PCV is determined as the percentage of the cellular portion relative to the total amount of blood in the tube (i.e., remainder being the plasma). The normal for dogs is 40-59 and cats is 29-50.

If the PCV is low, there are fewer red cells in the body than we would expect. This condition is referred to as anemia. In severe cases of anemia, the animal would probably have pale membranes in its mouth and seem weak and tired, since its body would be getting less oxygen than needed. Anemias are further classified as either regenerative or nonregenerative. In the former, even though the number of red blood cells is lower than normal, the body is responding by releasing new reticulocytes into the circulation. In the nonregenerative anemia, there are no or very few immature RBC’s in the sample and the body continues to lose red blood cells, but no new ones are produced. A nonregenerative anemia is very, very serious and will quickly become life-threatening.

Here is the link if you want to see the description chart as well.

http://www.peteducation.com/article.cfm ... 73&aid=987

Thanks so much for reading this post. It could help save your Cocker Spaniel's life and you from the immense grief of loosing your baby to IMHA/AIHA.

:paw Dawn


January 12, 2012, PLEASE NOTE: Another great (easy to read and understand) article on IMHA. This article was sent to me by Lisa R and is truly appreciated. This article was Kevin's first introduction to IMHA when our Moonbeam contracted this nasty disease. He totally understood the language and the gravity of Moonbeam's plight. :cry

Thanks Lisa!


http://www.veterinarypartner.com/Conten ... C=0&A=1390

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Last edited by dawn & kevin on Sun Aug 18, 2013 4:18 pm, edited 13 times in total.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 1:36 pm 
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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 !!! :hp :hp

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 2:35 pm 
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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. :hi

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 3:03 pm 
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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.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 4:07 pm 
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Thank you for posting that information.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 4:41 pm 
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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. :hp I'm so sorry for the people who HAVE or had to go through it. :cry


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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 5:44 pm 
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Dawn, thank you so much for posting this!!! :Clap

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.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 5:51 pm 
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Jackie H wrote:
Dawn, thank you so much for posting this!!! :Clap

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.


Hi Jackie,

So nice to hear you say that you will be asking your Vet about this! :hp Much better safe than sorry as when this comes, there is not enough time to say ahead of it. IMHA :bang

:Clap Dawn

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 6:18 pm 
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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

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 6:35 pm 
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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

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 7:53 pm 
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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?

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 7:58 pm 
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Dawn, thank you so much for this information. I'm so sorry that you needed to have it....

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sat Feb 26, 2011 10:19 pm 
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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 :dk 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?

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 Post subject: Re: *COCKER SPANIEL'S REPRESEMm NT 1/3 OF ALL IMHA CASES! *
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Muffin is also Black but there is pink, you can also look at the tongue

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sun Feb 27, 2011 6:51 am 
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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.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sun Feb 27, 2011 6:57 am 
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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!!!!!

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Sun Feb 27, 2011 12:45 pm 
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Vickie wrote:
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


Hi Vickie,

Dr. Jean Dodds work on IMHA/AIHA is well known throughout my AIHA/IMHA forum. Her name is constantly mentioned and, I am told, that she has done extensive work on IMHA. I believe, even Holistic Medicine as well. You just have to Google her name and she will pop up. She even takes questions by the net, maybe phone calls too and she even takes in blood samples, sent to her, for testing.

Great thought Vickie!
:hp Dawn

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Mon Feb 28, 2011 7:11 am 
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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.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Mon Feb 28, 2011 8:43 am 
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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.

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My sweet Brady at the Rainbow Bridge 9/5/09. You are missed every day!


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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Mon Feb 28, 2011 10:11 am 
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I found some pink on their front lower gums of both girls!! Very BRIGHT pink.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Tue Mar 01, 2011 9:27 pm 
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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. :sad
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!

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Tue Mar 01, 2011 9:49 pm 
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Naomi wrote:
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. :sad
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!


Thanks Naomi,

I did not know about checking the eyes by gently opening them to see the pigment. I did know that yellowing of the eyes is the sign of jaundice and might be a little late in the detection of IMHA. Also, I did forget to mention that females are more prone than males. So much to remember, but so very important too!

Naomi, you have gone through so much with your Mia. I am so glad that she is in full remission. I think that your statements here will further the cause for information about this nasty disease called IMHA.

Thank you so much and :smch :smch 'S to little Mia,
Dawn

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Wed Mar 02, 2011 1:37 pm 
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Vickie wrote:
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


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.


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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Wed Mar 02, 2011 7:08 pm 
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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.

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 Post subject: Re: *COCKER SPANIEL'S REPRESENT 1/3 OF ALL IMHA CASES! *
PostPosted: Wed Mar 09, 2011 6:15 pm 
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8/18/13: Edit, I have moved all of this info into my very first post on this thread. I will leave this here as well. I felt that this very important info might get lost being separated from the original post.

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.

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Chloie Pearl~Babybutt~Tri~2/16/08
Muraco Misun~Red/Wht~4/13/11
Moonbeam~Ms.Moonlight~Buff~7/24/00~8/14/11
Persalina~Big Bright Eyes~Buff~10/92~5/12/08
Willamina~1981/1996

JUSTICE FOR OREO: http://www.justice4oreo.net/


Last edited by dawn & kevin on Sun Aug 18, 2013 3:44 pm, edited 2 times in total.

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