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Petey IMHA Update

Petey and Marina

This is just a quick update on Petey. He went in for his regular check-up yesterday which is now just a CBC (Complete Blood Count) and it was perfect! Everything was in the normal range.  For those of you who have battled or are battling an illness, I know you understand what a wonderful feeling that is.

As always, I have to give many many thanks to Dr. Slusser and the amazing staff at VCA Animal Specialty Group. They are our miracle workers and we are forever grateful. It’s a great feeling to walk in with him when he is happy healthy – especially when we see the all of the wonderful people who helped nurse him back to health when we just didn’t know if he was going to make it. Their caring, kindness and expertise got us through a very rough time.

Canine Idiopathic Epilepsy

Marina August 2011

Marina

There’s nothing more frightening than seeing your companion experience a seizure. The first time it happens, you may not have any warning at all.

Marina had her first seizure approximately three years ago. We were having dinner and heard her nails on the wood floor in our hallway. From far away, it sounded the same as when she runs through the house to go outside, or to see who’s at the door. The odd thing was that the running sound seemed to stay in one place. It was odd enough for us to stop eating and investigate.

The scene we arrived to was frightening. She was lying on her right side and was in a full seizure. Her back legs were completely stiff and her right front leg was stiff, the left was in a continuous “paddling” motion. Her teeth were gnashing and she was foaming at the mouth. Her eyes were open, she did not appear to be in pain, and she didn’t seem to be aware of her surroundings. We kept talking to her in a calming way for what seemed to be an eternity, but in reality it was approximately two and a half minutes.

Her hind legs slowly started to become less rigid, and her front leg followed. The teeth gnashing stopped and she tried to get up, but was too unstable. After her third attempt, she was able to get up and walk a bit. For lack of a better description, she walked as if she was drunk and dazed. This lasted for several minutes, and then she followed us very closely as we prepared to take her to a nearby animal hospital.  To our knowledge, this was her first seizure and new territory for us.

The trip to ER was pretty uneventful, the labs (chem. panel and CBC) showed no evidence of poisoning and no other obvious cause was identified. At this point, we were told to keep an eye on her and document any other seizure and to call immediately.

Her next seizure was two months later and then again a month after that. We worked with her regular vet who diagnosed the seizures as idiopathic epilepsy and put her on a daily dose of Potassium Bromide. Her seizures stopped for approximately six months and then we were back for round two of evaluations. To be continued…

Immune Mediated Hemolytic Anemia ongoing care

Petey on the mend

The last post left off at a critical point in our journey. Petey’s prognosis was not looking good, and we could only hope that the new combination of medications would help turn things around. 

Our follow-up appointment was on October 6th, and Petey’s numbers remained fairly stable. He developed a rash on his hind end which ended up being a reaction to the Metronidazole. We switched to 150 mg of clindamycin, two tablets – twice daily. We were able to decrease the prednisolone to 20mg every other day. We scheduled a two-week recheck.

Progress

October 20, 2009 was the first happy (ok ecstatic) day since Petey’s initial diagnosis. One of the Techs who was now like family, raced out to show me the lab results. I couldn’t believe what I was seeing. Everything fell into or very near the middle column which was “normal”!!!! His red blood count was still a tiny bit low, and the RDW which measures the variation of red blood cell sizes, was still on the high side. This however, was the best CBC result since August. I think even our vet was a bit surprised at how resilient our Petey had proven to be. It was so good to receive positive news.

We were able to stop the clindamycin, Lasix, and prilosec, and scheduled a re-check for one month.

The eighteen months or so since that time have been a series of baby steps moving in the right direction. After a small setback due to a staph infection, Petey is down to two medications. Imuran every other day, and Soloxine .5 mg daily.  The Soloxine was prescribed earlier this year when his lab work showed that his T4 levels were almost non-existent, and he was diagnosed with hypothyroidism. He will be on those two medications for life.

We are eternally grateful for the amazing care from Dr. Slusser and his staff. They are the reason Petey is still here to share his success story. If you are in San Diego and ever need an internal medicine vet, he is the absolute best!

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Immune Mediated Hemolytic Anemia Complications

Petey Shaved for Ultrasound

Petey’s treatment for Immune Mediated Hemolytic Anemia  (IMHA) would prove to be a complex one. His follow-up was scheduled for August 31. Thankfully, things at that point did not get worse, his medication was unchanged, and his drains were scheduled for removal on September 4th.

After the removal of his drains, we continued to monitor his progress and scheduled a follow-up appointment for September 14th.  In the days prior to the follow-up he seemed a bit lethargic, and his appetite dwindled. We discussed this at the recheck, and as normal, a CBC (complete blood count) was performed. The news we received was not positive. His hematocrit was 21, down from 31 the week prior. He was given another ultrasound to rule out or confirm any other complications.  A blood clot in the vein to his spleen was discovered. The only way to remove the clot for certain would be surgery and we were all in agreement (including his vet) that it would not be a good option as he would likely not survive the surgery.

Our only other option was to give Petey daily heparin (anticoagulant) injections. At this point we needed a miracle. I tried to prepare for the worst, and contacted Forte Animal Rescue to give them the sad news. They are an amazing Rescue Group, and like anyone familiar with Petey’s story, huge supporters. I wasn’t prepared for the news and my heart sank, but I wasn’t ready to give up hope. When I left the office with Petey, our new regimen was:

Baytril (antibacterial) 136mg tablet once per day, Metronidazole (antibiotic) 500 mg (1/2 tab twice per day). Imuran (immunosuppressant) 50mg 1 tablet every other day. Prednisolone (corticosteroid) 20mg, two tablets every other day, Lasix (diuertic) 50mg ½ tablet daily, Baby Aspirin ¼ tablet daily, Heparin (anticoagulant) injection .4ml every twelve hours, subcutaneously. Prilosec (acid reducer) tablet, 1 per day.

I created a daily chart and used two pill organizers to keep his medications straight. Getting him to take that many pills was a challenge that involved pill pockets, peanut butter, deli meat and an occasional piece of cheese. The next week would be the telling week, and as grim as it was, I still had to hope for the best.  To be continued….

Immune Mediated Hemolytic Anemia Treatment

After Petey’s diagnosis of Immune Mediated Hemolytic Anemia (IMHA), we began our journey into treatment. He had been in the hospital for several days and was released on August 17th, 2009.  He was prescribed: 50mg of Azathioprine daily, 1 ½  20 mg tablets of Prednisolone, twice daily, ¼ 80 mg baby aspirin daily, and 100 mg of cyclosporine, every eight hours.  A follow-up was scheduled for August 19th.

On the 19th, we continued all medications as previously directed and a recheck was scheduled for August 26th.  In the days in between appointments, Petey’s abdomen started to show signs of what appeared to be bloating. I called our vet and found that it was most likely Ascites, an accumulation of fluids in the peritoneal cavity. Unless it gets considerably worse, we were given the ok to wait until our next appointment. At the appointment, he was prescribed 50mg of Lasix for the swelling. His CBC showed slight improvement.

A few days later his abdomen was the same and now one hind leg and front leg was very swollen. On the 28th, we were back in ER. It was determined that the swelling was part of the ascites. By the 30th, we were in ER yet again. The swelling was so severe in his front leg that we didn’t feel we could safely wait until the next day (Monday). This time, a Penrose drain was recommended to drain what had become an abscess in his front leg.  We were sent home with the dreaded e-collar, 375mg of Clavamox and 50mg of Tramadol for pain and we were to see Dr. Slusser as soon as possible. We were able to get an appointment on August 31st and Petey was given an ultrasound to check his heart – to rule out any other causes for the swelling. Cardiac problems were ruled out and a recheck and drain removal was scheduled for September 4th.  To be continued….

Immune Mediated Hemolytic Anemia Diagnosis

After receiving an initial diagnosis of Evans Syndrome and an estimate of 2,000 to confirm the diagnosis, we sought a second opinion. We opted to take Petey to a long-time family friend who is a veterinarian.  Although we respected the opinion of the initial hospital, we just felt more comfortable having another consultation with someone that we knew. We were then referred to Dr. Slusser, an internal medicine specialist.

We took Petey in immediately for evaluation and treatment, knowing by then that he was a very sick boy. His energy level was non-existent, and I was worried that he might not make it through the night. He was seen by Dr. Slusser who confirmed that he was in very serious condition. He was given a complete ultrasound and additional blood work was ordered. His red blood count was so low that he was admitted into ER for blood transfusions. Without them, it was doubtful that he would pull through, and even with the transfusions, there were no guarantees. After the final round of blood work, it was confirmed that Petey had Immune Mediated Hemolytic Anemia (IMHA). Like with Evan’s Syndrome, IMHA is a disease that attacks its own red blood cells. Evans has an additional component that also attacks the platelets which thankfully was not the case with Petey.

Petey was given a 30% chance of survival, with the first few weeks after diagnosis being the most critical. It was not a good prognosis, but Dr. Slusser worked with us in terms of what our best options for treatment would be.  To be continued…

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