A Mini Schnauzer’s Battle with IAHA - Gilbert’s Odessey
Gilbert Gooligas
Many of our friends are aware that Gilbert has been suffering from AIHA (autoimmune hemolytic anemia). This is a fancy and scary term for when the immune system short circuits, goes into hyperdrive, and begins killing red blood cells. You can find out about it online, both in humans and dogs.
His symptoms included lethargy, pale tongue and gums, loss of appetite, and physical collapse. In dogs, we want a red blood count (RBC) of 40-50% or an actual count of 30. Gilbert’s initial presentation and tests showed him at 17, far below the median goal.
The most aggressive and sure treatment is the use of steroids in high doses to shut the immune system, coupled with aspirin to thin the blood in case of clots resulting from steroid treatment. All of this in a 14-pound dog is a challenge under any circumstance. According to the vet, about 40% of dogs presenting with AIHA get through treatment, are done, and never look back. Another 40% find a level place in the treatment to manage the disease but are on maintenance drugs for life. 20% succumb to the disease.
Steroids are serious, but effective drugs. Again, in a small dog, dosages are tricky. So, over the last several months, we have monitored Gilbert’s RBC and, when it reached 30, began slowly decreasing steroid dosage. This has been quite frustrating for me because of some of the side effects of the steroids – most notably skin issues. However, these side effects have proven to bother me more than Gilbert. Initially, we were giving Gilbert 150mg of prednisone daily and have most recently gotten him down to 37.5mg daily. During this time, his weight has dropped about .75 pounds – mostly due to loss of muscle mass – and he has developed the pot-belly appearance of a dog on steroids. He will eat anything placed in front of him.
This Wednesday, he developed a nosebleed. When I discovered this and began trying to clean him up, I believe he became more frightened which caused his heart to pump harder, which in turn caused the blood to flow faster. His nostrils were both full of blood, which he kept snorting to clear them out, which also likely prevented the blood from clotting. Testing at the ER later that night showed that his RBC was slightly lower, but likely due to the loss of blood itself. His blood pressure was high, but this was likely due to a combination of steroids and his being scared. Tests for clot time were also performed and found to be normal. So this was one of those odd things that happened.
But since he’s a dog and not a human, dealing with nose bleeds is different because you can’t explain what’s happening to him and the fear factor plays a big part in how he responds. Currently, we’ve removed the aspirin from his cocktail for a few days until we recheck his blood pressure as he’s hypertensive right now.
We’ve added a 10-day course of medication to deal with hypertension. Hopefully, we’ll get through the next two months and put an end to this once and for all. Gilbert overall has responded well to the treatment.
This little guy has been a trooper through it all, though, and I’m so very grateful for that.
