Dealing with Immune-Mediated Hemolytic Anemia
How it all started
When our dog was diagnosed with Immune-Mediated Hemolytic Anemia we fell upon the internet in a desperate search for information because the vet sounded so grave when she imparted the news.
We knew that our darling little doglet, Fudge, was desperately ill. We found lots and lots of hard cold facts about the disease but nothing that prepared us, even slightly, for the horrendous journey we were all about to embark upon, Fudge most of all. We had no inkling of the costs involved or the side effects that we would all have to deal with either.
It started on the Friday – in the early hours of the morning Fudgie hooched. Foul smelling stuff it was too. I cleaned it up, gave her a few smooches and took us both outside for some fresh air and a drink of water. I figured she had eaten something dodgy.
She was fine the whole of Friday and I never gave it another thought. She ate her dinner that night and we all went to bed. Again, in the early hours of Saturday morning, she threw up. Seriously revolting smelling stuff. I muttered crossly to myself that I had to get her some different food and racked my brains as to what she could have eaten that was not agreeing with her. She looked at me most apologetically and we went outside again for a widdle and air.
Her behaviour was not particularly any different from normal, nor were her poops – and those are always an indication that her tummy is upset, so once again, I did not pay it too much attention.
Although I started to have that sinking feeling in my own stomach.
I get neurotic when my dog is even slightly sick. But she did not appear particularly ill in any other way. On Saturday morning we went for a walk in the veld, as we usually do. It was a beautiful day. Fudge waltzed up the little hill and then sat down to rest. Most unusual. She trudged along, not really looking her normal lively self. After perhaps twenty five meters or so I looked at her and asked her if she wanted to turn around. (Yes, I know you are probably thinking this woman is mad, but Fudge and I have a pretty good relationship and we understand each other.)
Without a second invitation she turned around and headed back to the car.
The cruddy feeling in the pit of my stomach intensified. But the rest of the day passed without incident. Fudge played ball, ate the food I gave her (special titbits like liver and chicken) and whilst looking a tad off colour, she was not exactly Miss Pathetic either. She kept down her lunch, devoured her dinner and I figured the crisis was over.
Once again in the early hours of Sunday morning she vomited - the smell was beyond disgusting.
I barely slept the rest of the night. We called the vet first thing Sunday morning and made an appointment for 10h00. I noticed that when Fudgie was at the top of the stairs that she swayed and looked as though she was about to pass out. Chris carried her down.
I had also noticed that her gums were a horrendous yellowish colour.
The vet (the first of many) was wonderful. She checked everything and ruled out several possibilities. She probably had a good idea of what it was, but needed a blood test to be sure. She said that Fudge would have to stay in hospital for a while to check things out. She would give us a call when she knew more.
She called within two hours.
Fudge had been diagnosed with Immune-Mediated Hemolytic Anemia. She told us that she would have to stay in hospital for the next few days and that she was critically ill. We were welcome to come and visit her a bit later.
We googled immediately and came up with many web sites that told us what this disease was, how it was caused (although what causes it is not always clear) and how to treat it. We also found out that there is a scarily high death rate.
Anemia is when the red blood cells fall below the normal count. (The same happens to humans.) In a nutshell Fudge's immune system was destroying her own red blood cells. Rapidly.
In fact, apart from the last two of the nine days that Fudges was in hospital, not one of the vets was ever prepared to vouch for an outcome. They were not even sure that she was going to be coming home, let alone still be with us in six months’ time. That’s the nature of the disease – there are no guarantees.
But lots of information was still missing - we were in no way prepared for the journey ahead and had no clue what the final costs would be either.
We did a rapid calculation, figured out how much credit we both had on our cards and decided we were good for the next few days in hospital.
A few days turned out to be nine. Seven of those were in intensive care.
“Your dog may have to have a blood transfusion – or maybe even more than one” said the articles. Fudges had two. After the first one her red blood cell count went encouragingly up. But it did not stay there. Two days later the vet called and said she needed another. I asked for some time to chat to my husband. How many transfusions could we afford at around R5000 a shot? We agreed to a second one but decided that if it did not work, we were not going to put her through any more trauma.
Although the thought of making any kind of decision boggled my mind.
She responded well to the second transfusion. Great jubilation. We went to visit her on Saturday morning and were told her red cell blood count was 28. (Normal is between 42 and 50). We celebrated by buying her dried sausage and roast chicken (her favourites) to snack on in hospital! We figured we were over the slump. Our precious doglet was going to survive.
On Sunday, visiting hours are a bit different and we decided we would only visit once, instead of the twice-a-day routine we had been maintaining. (Well – Chris was at work so I would go and sit with her outside in the visiting area, or hold her paw in intensive care if she was unable to go out.)
Around 11am the phone rang. It was the animal hospital. I looked at the phone in horror. My first instinct was to fling it over the balcony – but I donned my big girl knickers and answered. The vet on weekend duty told me that there had been a bit of a set back and Fudges blood count was down to 12.
My world came crashing around my ears. We had decided not to put her through the trauma of any more transfusions. The vets knew this. They told us they were going to give her Vitamin B boosts and a few other things.
The tears which had been temporarily at bay came cascading down again. Were we ever going to beat this horrendous disease?
We hurried off to the animal hospital to visit Fudge. Amazingly she seemed okay for her low blood count.
She looked at me with her big brown eyes. My heart shattered into little pieces. I wondered if I was seeing my beloved dog for the last time.
But she rallied and the next morning her count was slightly up. After 7 days the twice-a-day visits were beginning to take their toll, but I felt that I was abandoning her if I did not visit. I imagined her sitting there wondering what on earth had happened to mom.
Amazingly, I had a chat with the vet on the Monday morning and he told me that Fudge would be able to go home the next day if all went well - low blood count and all.
She was released nine days after she had been admitted – and yes R22,000 later.
But our journey had really only just begun.
Large vet bills...
Would you pay loads of money to save your furry child?
Constantly starving... as a result of the cortisone pills.
The long haul...
The vet, a medicine specialist, who is an absolute darling and loves all his sick animals to bits and does his utmost to cure them, told me that I should still not be too optimistic. He could not guarantee that Fudges would still be with us in six months.
We’ll take it one day at a time and enjoy every moment with her - was my response. He cautioned me. She’s going to be weak. She’ll be thirsty and she’ll be hungry. She will need to widdle a lot. These are all side effects of the cortisone.
Of course, I said blithely. We’ll deal with it. No problem! Little did I know.
He handed me a brown bag. Inside were pills. Lots and lots of pills. He took me through them slowly. Three of the baggies were going to be keeping her alive each day.
- 12 cortisone pills in the morning;
- 1 immuno blocker (a little yellow pill)
- 1 immuno blocker – a big bastardly bomb of a pill.
In the evening we had another
- 12 cortisone pills
- an anti-ulcer pill,
- ¼ of a disprin to stop blockages (apparently the biggest cause of death).
I was to return on the Friday for a check-up so he could see how Fudge was doing.
Great jubiliation. Fudge was home. Both Chris and I were ecstatic.
The first slight problem that cropped up was that I realized Fudge could not climb up the 15 steps to the second floor of our house. That’s where my office was situated - I work from home. No problem. I’d take the rest of the day off and spend it with her outside. (A few days later we moved my office down to a corner of the lounge to make things somewhat easier.)
When I put all those pills in a little bowl that evening I wondered just how I was going to get them into her. Plans needed to be made and stocks of interesting tiddy-bits needed to be accumulated. Fast!
The first night was interesting. Not only did Fudgie need to widdle several times, but she panted horrifically, snored, grunted and made some rather interesting noises. Every time she moved I woke up and wondered if she was okay.
She managed to go down the stairs herself, but I had to carry her up.
It was exhausting. She weighed 26 kgs. Hefting half my weight of solid doglet up the stairs was no joke. I thanked my lucky stars that Emma (my daughter) had got me into hula hooping which had strengthened my spine and legs – otherwise I would never have managed.
It started off well, for a couple of weeks. Fudge thought she really had died and gone to heaven – she enjoyed the treats and did not really notice the pills hidden inside. Then she got wise. She would spit out the pills. I would wrap the pills in a piece of meat and dangle another piece above her nose to distract her.
Getting my fingers caught between those fearsome fangs was like shutting them in a car door.
I tried ham, liver spread, sausages, cheese, peanut butter.
Because she was constantly hungry she was picking up weight. The cortisone was saving her in one way and destroying her in another.
It got so that I could not sleep at night, wondering how I was going to get the next batch of pills into her. The vet had clearly explained – these pills would be keeping her alive.
Slowly the cortisone pills dropped. From 12, to 11, to 10. Then we hit a bit of a slump. Fudge is a big dog on short legs. Her little furry elbows were taking a beating – yet another side effect of the cortisone and the fact that she was on immune blockers stopped them from healing. The one elbow was infected... back to the vet.
I nearly died. More pills. Antibiotics. Huge things. One and half in the morning and one and half in the evening. For seven days. On top of all the other pills!
I went home and wept. My poor doglet and poor me!
It was like having a baby in the house. Fudge woke up several times a night wanting to go outside. I’d blearily stumble down the stairs and let her out. She’d widdle, then fill up with water again and dash off to the kitchen expecting a midnight snack to keep her going until morning.
We considered moving to a house that did not have any stairs - but the thought of packing and finding a place was beyond comprehension.
That was not the last lot of antibiotics that we got either.
Finally we discovered that if we braaied a nice chunk of fillet or rump steak, we could nibble a small piece of it and I'd thinly slice the rest up to roll around Fudge’s pills.
It was the only way to get them down her.
Each time we went to the vet (started out twice a week, then weekly, then every second week, eventually working our way down to once a month) he would adjust her cortisone pills. (Although they are tiny little things – pretty easy to sneak into stuff.) It was the immune blocker that was the real pain to get down. Often she would crunch it and half the insides of the pill would trickle onto the kitchen floor. I’d try to mop it up with something edible to try and get the medicine back into her.
The day the vet declared that we no longer needed that pill I jumped up in the middle of the waiting room and screeched “YESSSSS” to the mirth of everybody present.
Whenever Fudge was a bit "off" I would anxiously check the colour of her gums. She got so sick and tired of me tweaking her lip and saying "Oh phew – lovely and pink Fudgie!" (Yellow or pale gums are a sure sign your dog is sick.)
It took more than 6 months and literally thousands of pills for us to reach the magical blood count number of 40.
The cost of it all would have covered a nice overseas holiday for Chris and myself (much needed by that time too). Many family members thought we were totally crazy - but how do you put a price on your furry child?
Throughout the whole experience I continued writing the weekly Dog’s Blog from Fudge's point of view in the Springs Advertiser (been going for more than 9 years). Each time I half wondered if it would be the last blog. Fudge also had a Facebook page and she had people from all over the world rooting for her. This support made an incredible difference to us – which probably was felt by Fudge too.