The Reality of a Dog With IMHA

This article originally appeared on FidoseOfReality.com as The Reality of a Dog With IMHA. I check my dog’s gums for any change in color from their usual pink to reddish healthy hue to anything that slightly resembles pale. This routine is performed nightly in conjunction with bedtime teeth brushing. I fear those four letters more almost as much as I do the Big C. In this case, I am referring to IMHA, or Immune Mediated Hemolytic Anemia. Break that down and basically it means the body’s immune system destroys red blood cells. IMHA is a chronic disease, often fatal, and something that I’ve read time and again of which Cocker Spaniels are the poster breed. According to most websites and veterinary literature, breeds that are more prone to the disease, in addition to Cockers, are Poodles, Basenji, West Highland White Terriers, Old English Sheepdogs, and Irish Setters, but any dog can be affected. As a member of one of the biggest online Cocker Spaniel forums, it is with a heavy heart that at least once every few months a member reveals their dog is affected—and then the battle begins—sometimes with victory and many times the disease wins. With all of this information and all of these resources I’ve consumed over the years, the idea of blogging on the topic came to a head when an industry friend’s dog was diagnosed with IMHA. The dog is not a Cocker, not any of the typical breeds affected, and the dog is that of famed veterinarian, Dr. Patrick Mahaney. Mahaney is a regular contributor to petMD.com and has documented his dog’s journey. The road has not been easy, but Mahaney has taken an integrative approach to Cardiff’s treatment by using a combination of Western (conventional) and Traditional Chinese Veterinary Medicine (TCVM). You can follow Cardiff’s journey and Mahaney’s treatments and blog posts here or here. The doc admits he is a “highly-informed pet owner, so any deviation from his normal is highly scrutinized for potential causes and outcomes,” and this is what pet parents must do in order to thwart this disease early on. IMHA, you see, is best battled when caught early on: As in, get the dog to the vet right away if the gums or pale, white, or yellow. That is one of the signs, but not the only and certainly not textbook for all dogs. What Causes IMHA? In most pets, the underlying cause of disease is never identified. Some experts believe IMHA may be caused, in part or because of, infection, vaccination reaction, drug side effects, or even cancer. As a dog mom whose first Cocker Spaniel developed a mast cell tumor (cancer) at the site of then-yearly vaccines. You can read about our mast cell cancer journey here. (note: we beat it)! Dogs that have been diagnosed with IMHA should not be used for breeding, and it is preferable to avoid breeding their close relatives as well. If you are seeking a dog from a reputable breeder, ask about IMHA in the line and any screening. In some cases, it is believed there is an underlying problem: something that triggered the reaction. This is where my ears perk up and I take notice. And yours should, too. Some theories of cause of IMHA include:

• Drugs used for treatment in the dog of another condition. Implicated drugs include penicillins, trimethoprim-sulfa, and methimazole.
• Cancer can cause a reaction and IMHA may result.
• Insect bites.
• Spot-on flea and tick preventatives

In one report, IMHA is observed in dogs with increased antibody titers to viral antigens, which seems to indicate that recent vaccinations or viral infections may be implicated in those cases. Anassociation between IMHA and recent vaccination (, but the cause and effect relationship between IMHA and recent vaccinations hasn’t been widely accepted by the veterinary community. Why Should Dog Parents Care About IMHA? The signs and symptoms may be subtle, and any dog can be affected. I read a post similar to this on a Cocker Spaniel forum about 5 or 6 years ago: “DeeDee is still hospitalized but doing reasonably well. Her RBC was holding at about 28 to 30. She is still receiving hyperbaric chamber treatments along with numerous meds. Marsha has been bringing her food and she is starting to pick at stuff but not really eating/drinking all that much (this is typical since the patient is exhausted as well as the meds often making the tummy iffy).” The dog never made it home. She passed later that week. The posts became more frequent and it seemed to this expert-level Cocker mom that IMHA is an epidemic. The more we know as pet parents, the more vigilant we can be in fighting it, and at the very least in getting a proper diagnosis sooner than later. What Are the Symptoms of IMHA? Symptoms include, but are not limited to, and not all dogs will experience these (nor all at once, though some may):

• Weakness/lethargy
• Dark orange or brown urine
• Yellowing (jaundice) of mouth and/or eyes
• Labored (heavy) breathing

 Get to the Vet If any of the above occurs, time is essential, so get your dog to a veterinarian. One of the tests that a vet should run if gums are yellowed or pale is a packed cell volume blood test. In this test, blood serum will return to an off-white color in the tube if the result is normal; a bright orange color indicates hemolytic anemia. NOTE: Of the dozens of dog parents I’ve connected with over the years who have/had a dog with IMHA, each of them report different initial symptoms, including:

• Did not eat or even if they did not eat all of their food (note: not eating could be a sign of a lot of things. Get a blood panel done as a start)
• Seemed a little “off”
• Lethargic and not wanting to play as usual
• Labored breathing

If your dogs have black gums, you can also check their eye membranes. Gently pull up (or down) on the lids and look under the lids. It’s similar to checking for pink-eye. So everyone’s dog is affected differently but acting quickly to get the dog to a vet is essential. This disease, and its symptoms, can come on slowly, but more often, it comes on very quickly. What Dog Parents Say Here are actual quotes from dog parents who have a dog diagnosed with IMHA: I can say that this disease is very tricky. My dog had his first episode in June 2009 and then a second in July of 2010. The first episode,  there were no signs at all…had he not jumped off and hit his eye accidentally I probably would have woke up to find that he had crossed over, his platelets when I took him to the vet for the eye was 1%. He was in the hospital 6 days and had a platelet transfusion. The second episode was exactly like the symptoms say, weak, not eating and very worn out. We got him to the vet thanks to Cherished Cockers and his RBC was way down, he was there 5 days had a whole blood transfusion and thank god has been okay since then. I check his gums 2-3 times a day all the time. He probably gets tired of me doing it but I still do it. I lost my little angel, Lily, on the 24th of October from IMHA. I don’t think there was anything I could have done to save her. It hit so quickly, and hard, I don’t think anything would have helped her fight it. She had a transfusion, which didn’t take. Her gums, eyes, and tongue had all turned yellow, and at the end even her belly skin was tinged. It was just terrible. And she went from healthy to very ill so quickly! I’m thinking the reason Penny contracted the disease was to do with her yearly boosters. The needle bent due to her wiggling and the vet was very new. I guess I’ll never be 100% sure but something seemed off about the whole event, her booster was in late December and soon after she stopped eating as much, it took a while and then her gums went pale on February 13th and she was admitted on Valentine’s Day and stayed in intensive care for two weeks and she had to return a week after she was allowed out after contracting a rather nasty virus. I am currently fighting IMHA with my pup, Annie. She was also started on prednisone and and antibiotic. By the end of the first week my vet also added cyclosporine which is what transplant patients take to prevent organ rejection. She is currently on those along with azathioprine which is a chemo drug. She has also had two transfusions – one of gamma globulin and the second of blood. She is also on a liquid aspirin which is important with IMHA since you need to avoid blood clots. Thankfully she is doing well now and starting to cut down on the pred. This is a horrible disease and if caught early and fought aggressively you can beat it. So you can see that everyone has a path that is different, but it is a disease that can wreak havoc. It is, however, a disease that is treatable and manageable, with an overall guarded prognosis. Treatment Dogs can and do survive despite a diagnosis of IMHA. It is not a guaranteed death sentence. Dispel any thought of that immediately, as a good attitude, a dedicated veterinarian who understands the disease, a specialist who can assist, and a plan in place are all needed. It can be costly and it is a disease that requires diligence on the pet parent’s behalf. Dr. Patrick Mahaney’s dog, Cardiff, is proof of a dog living (and thriving) with IMHA and a cancer diagnosis, too. I encourage you to read his story and the recommendations of things he has done with Cardiff. Talk to your veterinarian and ask questions. Keep a journal/log of any incidents, when they occurred, anything that surrounded the incident, etc. Treatment isn’t easy and it is ongoing, and it includes, but is not limited to:

• Blood transfusions
• Immune system suppression (immunosuppression) with corticosteroid hormones and potentially advancement to stronger immune suppressive medications, including azathioprineand cyclophosphamide. These are very serious drugs reserved for serious diseases and do have side effects to be discussed with your dog’s veterinarian.
• Repeat visits and close monitoring of your dog
• If those gums change in color, get to the vet ASAP. Blood transfusions are needed when the red blood cell level is critically low.

Secondary Complications Treatment of IMHA is one battle and the side effects of those medications can wreak havoc. According to MarvistaVet.com, here are some of the secondary issues: Costs Vickie Olesker Oppenheimer is an incredible resource on this disease, as a Cocker Mom who has faced this illness with her own dog. She sees this time and again in Cocker Spaniels and is a wonderful resource of information on the Zim Cocker Spaniel Forum. She says, with regards to cost: “This – like most serious diseases – is expensive! I’m talking about a $10,000 bill in five days – the FIRST five days. Medications ran $400 a month after that for a year. If you are someone that says you tuck away a little each month, consider how much you need to put away monthly to cover that bill. Thankfully we have pet insurance and received reimbursement. I pay $214 each month to cover five dogs, two cats with a $500. deductible per pet, 80% reimbursement and 100% drug coverage. Research plans and find one that suits you. The only way we could have paid for both Annie and Jennie in that year would have been to put almost $2,000 a month away for them. Is that realistic for you?” For me, yes this is realistic. I save for my dog. I have pet health insurance for my dog. I look at my dog as a family member and this is what I would do for a family member. And most of you would, too. Prognosis I am not a writer who believes every fact or statistic she reads. Survival rates run the gamut, but dogs can beat this disease. A diagnosis is not a death sentence. IMHA patients need very close monitoring. Red blood cell counts must be rechecked every 2 to 3 weeks and medications and treatments will fluctuate depending on blood work results. After stabilization, a basic blood panel and urinalysis should be performed every 4 to 6 months for good. Here is an entire website for reading on success stories of IMHA diagnosed dogs. Bottom line: There is hope and if this was my dog, I’d fight for him or her period. Love is love. If My Dog Acquired IMHA In all honesty, if my dog ever acquired IMHA, I’d be on a consult with the famed Dr. Jean Dodds, Dr. Mahaney, a specialist in the disease, and in regular contact with my dog’s veterinarian. If your dog is diagnosed, I recommend you ask to join the Zim Cocker Spaniel forum and read the many resources from folks dealing with it first hand or who have dealt with it. Never give up. Dogs depend on us for their care and overall well being. This can be dealt with, there are resources, and you are not alone. Thank you for reading this article.  Your questions and comments are completely welcome (I’ll respond). Please feel free to communicate with me through Twitter (@PatrickMahaney) and follow my adventures in veterinary medicine by liking Patrick Mahaney: Veterinarian Acupuncture Pain Management for Your Pets on Facebook. Copyright of this article (2015) is owned by Dr Patrick Mahaney, Veterinarian and Certified Veterinary Acupuncturist. Republishing any portion of this article must first be authorized by Dr Patrick Mahaney. Requests for republishing must be approved by Dr Patrick Mahaney and received in written format.