Adorable Kelsey is finally out of the woods. It has been a hard two weeks for this pup going back and forth to the ER to make sure his blood values had not dropped too low. We are continually checking his gums to see if they are very pale. If they are anything but pink, we take him in. The good news is his anemia is regenerative and is improving since his Transfusion.
Kelsey was such a hard dog to crossmatch blood for that I would not want to risk doing that any time soon for fear of a lethal reaction. We got lucky this time, but each time his chances go down. IMHA (Immune Mediated Hemolytic Anemia) is complicated at best. Kelsey is doing better than he ever was with his initial treatment but has to keep improving until his bloodwork is normal.
IMHA is a disease where the body's immune system attacks Its red blood cells. Often we do not find out what initially led the body to attack the red cells; however, diseases such as cancer or infections, drugs, or vaccines have been associated with the onset of IMHA. In Kelsey's case, several tests were performed (heartworm snap test, chest x-ray, abdominal ultrasound, complete blood count, and serum chemistry panel)- no severe abnormalities were found.
The treatment for IMHA when no underlying cause is identified is immuno-suppression. At this time, we are treating with two immunosuppressive drugs, prednisone, and cyclosporine. Kelsey will require long-term (usually months, occasionally life-long) Immunosuppressive medications. Once his Disease is stable for several weeks, we may begin slowly decreasing the dose over time. Currently, he is starting to respond to the medications but still has evidence of active destruction of his red blood cells by his body.
Kelsey also has an oronasal fistula- this is a defect that occurs secondary to dental/periodontal Disease leading to a communication between the mouth and the nasal passages. It can lead to respiratory tract infection by allowing bacteria from the mouth into the nasal passages. This can typically be treated surgically (by removing teeth if needed and closing the defect surgically, along with treatment with antibiotics). Kelsey had recent treatment (both medically with antibiotics and other medications and surgically with the closure of the fistula. It is possible that either 1) infection associated with the fistula or 2) medications needed to treat the condition lead to his IMHA by triggering his immune system.
The original surgical repair failed, and the fistula is opened up right after we got Kelsey- this is likely secondary to both his autoimmune Disease and the medications he needs to treat it (steroids, in particular, are the mainstay of treating IMHA and unfortunately cause healing delays, especially at the high doses required to treat autoimmune Disease). The fistula has shown significant progress over the last two weeks and appears to be closing on its own. We are hopeful Kelsey will not need further surgery.
Kelsey's bills are way out of control because of all the tests we had to do to find out what was causing or not causing the IMHA. The steps that had to be taken to find the best possible match for Kelsey's blood transfusion alone was something way out of the realm of what even we have had to do. Kelsey will still have lots of tests before her Specialists come up with a plan they feel will give her the best quality of Life. We are not going to give up but are more committed than ever to provide Kelsey with the best Life possible. Minimal Donations came in when we first posted for Kelsey. Any amount is greatly appreciated. Your generosity makes his Medical Care and Recovery this possible.
We don't believe Kelsey's IMHA will go away. The best we can do is manage it with Immunosuppressive medications which appear to be working. Dr. Kristin Welch has been over-seeing Kelsey's care and will adjust his medications as adorable Kelsey's blood levels normalize. Dogs can live a long life with IMHA when they are appropriately treated with Specialists that understand the Disease. Based on the results we have seen with Kelsey, we believe this adorable pup will be one of the lucky ones. Thanks for caring about Kelsey and all the other abused, neglected animals we take on.