So Confused about Symptoms and Side-Effects

[KKJ]

Hi:
I am new to this group and am very grateful you are here!

My girl, Stella, was diagnosed with IMHA on 7 January after collapsing at home and being rushed to the hospital.  The previous day had been normal, like any other day.  But that Tuesday, she refused to eat or drink, was panting, and then collapsed when she tried to stand up.  Upon admission to the hospital, her hematocrit was 14%.  Over the next week, she was treated aggressively in hospital.  I won't go into all the details as I'm sure many of you have similar stories.  Suffice to say, she had a rough time - her transfusions didn't hold, she didn't respond well to the meds, and her chances weren't good.  When she was released her blood was at about 30, she was extremely jaundice and weak, but she was back to eating, drinking, and eliminating normally - and best of all - she was wagging her tail and smiling a lot!  She was sent home with several prescriptions, including Atopica, dexamethasone, prednisone, ursodial, baytril, omeprazole, and maybe something else.

Over the next few weeks she continued to improve.  Her blood level got up to 37%, the jaundice was much better, she was gaining some strength, etc.  Then she started to deteriorate again.  On 10 March she went into the hospital after not eating or drinking for a day and stayed for 2 nights on IV fluids.  Her blood was at 27% and her liver readings were very poor.  I took her home 2 days later (no improvement in her numbers) with a new medication regimen - azathiaprine, prednisolone, ursodial, and something to protect her stomach.  I was told the prognosis was "very poor" and to watch her gums for increasing paleness.

And here is where I'm having trouble - since her medications come with lots of side effects, I'm not sure which symptoms are side effects and which could be indications of her worsening condition.  She was on a very high dose - 30 mg - of prednisolone for 9-10 days; for the last 2 days she's been on 20 mg.  She was on 12.5 mg azathiaprine every day, but is now taking it every other day.  She's very alert and interested in things, she's eating and drinking lots, no vomiting, no diarrhea, but her body is very floppy (no muscle strength), she has little stamina, although I think her energy is a bit higher - she's tempted to run off after a bird and pulls on her leash at times.  Her body is quite bloated (from the medication, I'm told) and lately she's been peeing in the house.  I assume she's having more difficulty holding her bladder.  And her gums are basically greyish-white.  So I'm confused about what's going on.  Her gums indicate she's extremely anemic, right?  And yet she's walking around, going outside, eating, drinking, etc.  I wouldn't expect her to be able to do these things if her anemia is as bad as it seems. 

I'm sorry to go on and on here, but has anyone had similar experiences?  Or have insights into what's happening?  I would appreciate any feedback you can provide, as it's all confusing to me.  And thanks for being here - it's a great comfort to know there are others struggling with the same issues.  Stella is wagging her tail for you, too!

Kate

[Clover]

Mine has a different disease so I can't comment on that part of it, but I do know the pred makes them drink a LOT more and also urinate a lot more, and more frequently. It is not uncommon for them to have accidents in the house.

[Jo CIMDA]

Hi Kate

I'm sorry you've been through so much with Stella.  I can understand the stress and your concern, and so many others here can identify with how you are feeling. 

From what you have written I wonder if Stella had regenerative anaemia.  Do they know if there is an underlying cause of her anaemia?  Although one would expect greyish-white gums to indicate amaemia sometimes pale gums can be misleading and the blood test proves all is ok, so it is not always a reliable indicator of anaemia. 

Dogs with regenerative anaemia (anaemia within the circulation of the blood) become anaemic quickly, sometimes within 24 hours and they are usually very ill,  but dogs with non-regenerative anaemia (anaemia caused by a destruction of the young red blood cells within the bone marrow) can take as long as 6 weeks before the dog starts to show signs so it doesn't always follow that a dog who is going anaemic will be lethargic etc.  Other clues to anaemia are orange stools and orange or dark urine.

It can be so difficult for us, or the vets, to know if the symptoms seen are as a result of the disease returning, side effects of the drugs or a secondary infection or unrelated problem. A blood test is often the only way to know for sure if a dog is anaemic or if there is an underlying problem. Muscle weakness, bloated tummy, weeing loads is all to be expected when a dog is on high doses of steroids but the good news is when the steroids are reduced to every other day the muscles start to regain strength, the liver starts to reduce and regenerate,  and slowly everything returns to normal.

  You still have to watch her like a hawk. I do hope she settles down and improves very soon.

Jo

[polly]

Sorry to read that your dog is so slow to improve in regard to the red cell levels. My whippet Jasper who was diagnosed in February has had a much better outcome in regard to overcoming the anemia.
It is so hard to understand  how are pets are feeling when they are ill. They can't tell us.
A human friend told me that she felt awful when she was on  similar medication to Jasper even though it was a much smaller dose.

She was amazed at the high dosage our four-legged friends require in order to  suppress the symptoms of IMHA.
 
The common and manageable side effects of the medication include a need to drink and urinate frequently.  As it is summer here I leave the back door open all night so that he can go outside to urinate rather than struggle with the doggy door and I also leave containers of water in several rooms so that he can drink whenever the need arises.  He sleeps on my bed at times  so I  put a waterproof mattress protector on my bed after he had an "accident" early in his illness.

The medication can also cause muscle wastage and mood changes. Before Jasper's medication was reduced he was often agitated and he did not want to be patted, even by me.  He would pace around the room or come and stare at me but I couldn't figure out what he wanted.   Now that the medication has been  reduced he is much happier in himself and enjoys a cuddle again..

I hope that everything improves soon for your dog.

I