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IMHA and ITP

Posted: Mon May 27, 2013 6:08 pm
by sebb0191
Hello everyone - it's been quite a while since I've been here! I have an almost 5-year-old pit bull named Koda. He's always been a generally healthy dog, so the past few weeks have been a saga that I'd love to get some feedback/input/advice on!

A month ago today, making it April 29th, we returned from a long walk in the park. My fiance stayed with Koda while I walked more around our neighborhood. After 30 minutes, I returned to this:
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We treated with Bendryl and ice. It went down that evening and was gone within 3 days, allowing us to assume it was a bite or sting of some sort.

Three weeks ago today, exactly a week after the bite, he went three-legged lame overnight. There was some localized swelling in the joint, but not terrible. He went to the vet that day, was x-rayed and ruled out any fracture. The vet figured it was a soft tissue injury and he was given Rimadyl for 10 days. He recovered well without issue.

On the following Friday, the day after the Rimadyl stopped, he went three-legged lame again overnight. The vet refilled my Rimadyl for another 10 days and gave him cephalexin just in case there was an infection.

On Sunday (a week ago yesterday) we woke up to swelling in his left lymph node. During the day, it grew fairly quickly and looked like this by Sunday night:
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We went to the vet a week ago yesterday. I told the vet about the bite/sting from earlier, and she figured it may be a reaction to the sting. Since he was already on cephalexin, she added Baytril and we left.

By Thursday, both lymph nodes were the size of golf balls, if not larger, and were hard masses. There was significant swelling, almost like both lymph nodes were touching. Ignore the Instagram filter :)
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We went back to the vet first thing Friday. She did a CBC and aspirated the masses. The CBC was not good: 21% pack cell volume, 20,000 platelets, 27 WBC, 3 RBC. She determined that something was going on systemically to cause IMHA (immune-mediated hemolytic anemia) and ITP (immune-mediated thrombocytopenia). She took him off the rimadyl and cephalexin and put him on 200 mg doxycyclin twice daily and 40 mg prednisone twice daily.

This Saturday, his gums turned grey in the afternoon and we went to the emergency vet. The CBC there was slightly different. Same pack cell volume, but the platelets had tripled in a little over 24 hours, which was good. The bad news was that the WBC had tripled as well, putting it at 54 (should be between 6-17). His monocyte levels were insane too at a 4.9 (should be between .3-1.5).

We have another CBC tomorrow afternoon. I'm hoping for lower WBC and a higher pack cell volume. Mostly, I wanted to post to get some feedback about these two diseases. What can I expect, what have you experienced, what can I do? I also wanted to see what some of the vets on here thought about the diagnosis and whether any or all of these events within the last month could be related. Is it possible to have IMHA and ITP as the primary concern, and not a secondary reaction to something, like a cancer or infection? Any/all advice is welcome and appreciated - thank you!

Re: IMHA and ITP

Posted: Mon May 27, 2013 6:10 pm
by sebb0191
I forgot to mention that, with the pred, the swelling in his face has gone down significantly. However, the lymph nodes remain slightly enlarged and hard.

Re: IMHA and ITP

Posted: Mon May 27, 2013 11:16 pm
by freezingbear
I don't have any experience with IMHA, but my dog Turtle had ITP last February (primary concern, not as a result of another condition). The recovery wasn't bad; she stayed at the emergency vet for a few days and was on strict crate rest for about 2 or 3 days after she came home. She was on prednisone, immunosuppressants, and antibiotics for quite a while, but I don't remember exactly how long, and had to have weekly CBCs. We still have to check her daily for spontaneous bruising, but she hasn't had any problems since stopping the medication. All in all, it wasn't bad or a difficult recovery, it was just a ton of medication and testing.

This probably wasn't all that helpful since I don't really have any information about IMHA, but I hope it helps a little. Sending good thoughts for Koda!

Re: IMHA and ITP

Posted: Mon May 27, 2013 11:27 pm
by Misskiwi67
Did you do a test for lyme disease? If not, I would have one done. I think you should wait for the lymph node aspirates to come back, this will be the test most likely to tell you what the next step will be.

Re: IMHA and ITP

Posted: Tue May 28, 2013 7:25 am
by sebb0191
We did a tick panel and everything came back negative. The cytology for the aspirations came back as reactive lymphnodes. Basically, they were filled with monocytes.

Re: IMHA and ITP

Posted: Tue May 28, 2013 11:29 pm
by Misskiwi67
sebb0191 wrote:We did a tick panel and everything came back negative. The cytology for the aspirations came back as reactive lymphnodes. Basically, they were filled with monocytes.


Good, then its less likely lymphoma, great news. Continue with the immunosuppressants, time will determine how things will go. Also make sure you have her on some antacids, I've seen a lot of dogs get better, then go down hill with gastric ulcers from the steroids.

Re: IMHA and ITP

Posted: Wed May 29, 2013 7:34 am
by sebb0191
He's on Prilosec once a day. They also gave him Lixotinic yesterday too. He hates it, but we'll get it in!

His PCV came back at 24% yesterday, which is up one percent from Saturday. We're waiting on an opinion from a pathologist to see what he can make of all of this.

Thanks so much for your help!!

Re: IMHA and ITP

Posted: Wed May 29, 2013 8:44 am
by jamielvsaustin
No advice or experience but wanted to sending happy healing thoughts!

Re: IMHA and ITP

Posted: Wed May 29, 2013 4:31 pm
by sebb0191
Thank you! I truly appreciate all the positive vibes :)

Apparently, we did not do a full tick panel yet, so that's happening tomorrow morning. The vet said if all of that comes back negative, we need to go to an internal specialist. I'm not sure what to think of all of this - it's al developed so quickly!

Re: IMHA and ITP

Posted: Wed May 29, 2013 8:25 pm
by FransterDoo
My friend Liz almost lost her bitch Emma to IMHA. It took a lot of care. I'm not sure how much of it she's posted publically but I can ask.

Good luck!

Re: IMHA and ITP

Posted: Wed May 29, 2013 8:47 pm
by sebb0191
Thank you FransterDoo! I'm always happy to hear of survivors, even though it may have been difficult.

We've got some petechia happening in his mouth this evening. I know that was something the vet had told me to look out for. I took pictures to show her tomorrow. Hoping its not a sign of bad things to come

Re: IMHA and ITP

Posted: Thu May 30, 2013 12:56 pm
by sebb0191
PCV was down to 20% this morning. Petechia occurring in his mouth and small bruising on his stomach. We are starting him on azithromyacin and cloisporone (spelling may be wrong) today. Should have the tick panel back by Saturday. I've been told that we are doing everything we can, but it still may not be enough. My heart is sad today :(

Re: IMHA and ITP

Posted: Thu May 30, 2013 3:51 pm
by dogs4jen
:hug: hang in there.

Re: IMHA and ITP

Posted: Thu May 30, 2013 7:27 pm
by jamielvsaustin
Thinking about you guys.

Re: IMHA and ITP

Posted: Thu May 30, 2013 8:49 pm
by sebb0191
Thank you. I really appreciate everyone's prayers and good thoughts.

I'm clinging to his behavior right now. He's not even acting like anything is wrong. He's more tired, but he's still hounding me for food and playing with his toys. I'm hopeful that his lack of demeanor change is a good sign.

We're starting to Cyclosporine tonight. 150mg twice a day added to the prednisone and doxycycline. Oh, and azithromyacin on top of that. He loves getting all the cheese that comes with the pills!

I want to make sure I'm really doing everything I possibly can for his body to fight. Is there anything I can be feeding him right now to help? He's been taking the Lixotinic liquid for a few days in white rice and gobbles it up. Any ideas or suggestions for ANYTHING I can do would be greatly appreciated. Thank you, again, for everyone's support.