Dickens

My commentary may continue to be irregular. Our 14 year old female Jack Russell, Dickens, has been very very sick since Monday. She has been sneezing, coughing, hacking and retching, which then leads to vomiting. We took her to our Vet (Erhlich Animal Hospital) on Wednesday where she was given subcutaneous fluids and medications. She continued to not keep any food nor any medications down. Finally she stopped keeping water down and so Thursday night we took her back to the vet who admitted her overnight. Friday we got bad news that she might have auto immune hemolytic anemia. She was placed on a course of treatment with prednisone and given IV fluids and she returned home Friday night. She did not keep down any water and this morning we brought her back for a follow up appointment. We left her at the vet where she was given subcutaneous fluids and injection medications. Her blood count had improved overnight. However she still has the vomiting issues. She was supposed to return tonight, but when we went to pick her up, the vet wanted to keep her overnight. We will see what happens. We may be dealing with two things going on at the same time or maybe one thing with two separate types of symptoms . We don't know yet. If she could keep food and water down, then it would simply be a matter of responding to the prednisone.

This dog have already survived to bouts of cancer, with the first, 6 years ago, requiring significant surgery.

This is hard, and emotionally wrenching. We've not gotten a lot of sleep. We may may have hard decisions to make if things don't go well. Given her and Siggy's ages (He is 16) we know their time is limited and over past year we have had multiple discussions on the issues regarding the death of our dogs. Quality of our dogs life is important to us. We do not want to do heroic measures, just to extend her life, for our sake, if it means she will have a miserable life. We are striking a balance between those who put down dogs at a drop of a hat because the dog inconveniences them and those who are so terrified of losing their dog they make the dog's life longer but miserable.

Siggy (left) and Dickens (right)

What is autoimmune hemolytic anemia (AIHA)?

Normally red blood cells live about 4 months in dogs. As the cells age, they are removed and destroyed by other cells that are part of the immune system. New red blood cells are produced in the bone marrow at a rate that matches the destruction of older cells.

In autoimmune hemolytic anemia, the immune system destroys red blood cells prematurely, faster than the rate at which new ones can be produced. The name says it all - anemia (reduced red blood cells) caused by hemolysis (destruction) by the body's own immune system (autoimmune).

What does autoimmune hemolytic anemia mean to your dog & you?

AIHA can occur at any age, but is most common in middle-aged dogs. It may be mild and hardly noticeable, or it may be sudden in onset and severe. Usually the kinds of signs you see are vague - such as poor appetite, weakness, listlessness, lack of energy. You may notice that your dog's gums are pale, or they may be yellowish due to jaundice as a result of the breakdown of red blood cells. Your pet may have a rapid heart beat and rapid breathing. One form of AIHA (cold agglutinin disease) causes circulation problems in cooler peripheral parts of the body, so the ear or tail tips, or feet may become infected and dark in colour.

Reduced levels of circulating red blood cells mean reduced oxygen going to the tissues. Most dogs that die with this condition do so in the first few days due to kidney, liver, or heart failure, or because of a bleeding problem.

How is autoimmune hemolytic anemia treated?

Unfortunately, dogs severely affected with this condition may die even with the best treatment. This mostly occurs in the first few days due to kidney, liver, or heart failure, or because of a bleeding problem. The goals of treatment are (1) to slow the destruction of red blood cells (rbcs), and (2) to support the dog while the red blood cell level has a chance to recover.

1) Corticosteroids are given to slow rbc destruction, initially at high doses which are gradually tapered over several weeks as rbc levels stabilize and begin to rise again. If rbc levels continue to fall despite steroid therapy, other immunosuppressive drugs are given.

2) Blood transufusions are needed when the rbc level is critically low. Although the new cells will also be destroyed at the same rate, the transfusion will buy some time for the dog while his/her own blood cell levels are recovering.

Dogs that recover from an episode of AIHA may experience future relapses.