The Silent Killer All Dog Owners Should Know About: Immune-Mediated Hemolytic Anemia

This cutie is 'Zoey'. Our troubles with her began a couple of days before Halloween 2016. Zoey was extremely lethargic and had no appetite. All she wanted to do is stay in her bed and sleep. This was very unusual behaviour from the dog who usually couldn't wait to eat breakfast and dinner. After we ascertained that she had not sustained any injuries, her belly was soft (so, internal bleeding was not high on our list of potential culprits), and she wasn't running a fever, we checked her gums. They were stark white. As we rushed her off to the nearest emergency vet, my husband and I couldn't help but flashback to the many times our late epi-warriors, Lana and Darren required emergency medical treatment for their canine epilepsy. We feared for Zoey's life. After several days of inpatient treatment at the veterinary hospital, the diagnosis was IMHA or Immune-Mediated Hemolytic Anemia. 

Simply put, Zoey's immune system was destroying its own oxygen-carrying red blood cells.  Her bone marrow still produced trace amounts of red blood cells to replace the destroyed ones. However, once they were released into circulation, her immune system mistakenly recognized them as foreign bodies, such as a virus or bacteria, and eliminated them. I'm the first to admit that my husband and I aren't novice dog parents. Instead, we are, what some might categorize as helicopter pet parents, highly-informed and hyper-aware of our dogs. So, any deviation from Zoey's 'normal' is immediately scrutinized in great detail for possible causes and potential results. IMHA is an autoimmune disease, and is, unfortunately, often fatal because either the initial symptoms go unrecognized, relapse, or complications such as pulmonary thromboembolism (PTE - a blood clot that can travel to the lungs). Based on a cursory search, breeds that seem prone to this illness, are Cocker Spaniels, Springer Spaniels, Finnish Spitz, Poodles, Basenji, Bichon Frise, West Highland White Terriers, Old English Sheepdogs, and Irish Setters, but any dog can be affected. Zoey is a Rhodesian Ridgeback. 

What causes IMHA?

In most pets, the underlying cause of the disease is never identified. Some experts believe IMHA may be caused, in part or because of:

- Blood loss

- Decreased production of red blood cells

- Toxins

- Drugs used for the treatment of another condition. Implicated drugs include antibiotics (penicillin, trimethoprim-sulfa), methimazole and acetaminophen

- Cancer

- Insect bites/stings

- Spot-on flea and tick preventatives

- Vaccinations/over-vaccinating is suspected to be a culprit, although the jury is still out on this. However, core vaccines play an essential role in controlling the spread of diseases like Parvovirus and distemper, so it is never a good idea to stop administering them altogether.

- Infection

The Symptoms

Symptoms include, but are not limited to: 

- Weakness/lethargy

- Dark orange or brown urine

- Yellowing (jaundice) of mouth and/or eyes

- Labored (heavy) breathing

- Refusing to eat

- Pale/white gums

  Note: If your dog has black gums, you can also check their eye  

  membranes. Just pull the eyelids gently up or down and look underneath. 

- Seems a little “off”

Note: Not all dogs will experience these symptoms or all at once.

The Diagnosis

If your beloved furry companion shows any signs of the above, time is of the essence. Get your dog to a veterinarian immediately. He/she will need a full medical history. Be prepared for questions about the symptoms you've observed and how long they have been present, any medications your dog may have taken, when the most recent immunizations were given, and questions about your dog's urine and stool. The vet will want to run several of the following tests to determine the underlying cause for the anemia, such as:

- A complete physical examination.

- A complete blood count (CBC) to identify if your dog is anemic.

- A packed cell volume (PCV) to test for the number of red blood cells present.

- A reticulocyte count allows the veterinarian to determine if new red cells are being made in appropriate quantities. 

- A blood film to look for parasites and blood cell characteristics.

- Chemistry tests to evaluate liver, kidney, and pancreatic functions, along with sugar levels.

- Electrolyte tests to ensure your dog isn’t dehydrated or suffering from an electrolyte imbalance

- Urine tests to screen for a UTI, other diseases, and to evaluate the ability of the kidneys to concentrate urine.

- Fecal analysis to look for intestinal parasites.

- Screening for vector-borne disease.

- Radiographs, ultrasound examinations, or blood tests for potential underlying infectious diseases or internal injuries.

The Treatment

Dogs can and do survive despite a diagnosis of IMHA. It is not an automatic death sentence. It can be costly, and it is a disease that also requires the pet parents to be diligent, especially where the aftercare is concerned. Treatment isn’t easy, and it is ongoing, and it may include, but is not limited to:

- Hospitalization

- Intravenous fluids

- Blood transfusions

- Immune system suppression (immunosuppression) with corticosteroids or stronger immune suppressive drugs when necessary 

- Repeat vet visits and close monitoring

Treatment of IMHA is one battle, and the side effects of those medications can wreak havoc on your beloved pet's already compromised systems. 

The Costs

Like most life-threating diseases, IMHA treatment is expensive! Zoey's overnight stay with intensive care for four days at the emergency vet cost us nearly $5000. Medications ran about $250/month for an additional six months. Not to mention the cost of each follow-up vet visit and blood tests. Treatment costs will vary from vet to vet, and the price for the medication can significantly differ from pharmacy to pharmacy. It's always a good idea to shop around for a budget-friendly drugstore, and it also doesn't hurt to get an estimate from your veterinarian before you agree to any treatment options.

The Prognosis

I am not one of those pet-parents who believes every so-called fact or statistic she reads online. The published survival rate runs the gamut, but dogs can beat this disease. Zoey is living proof. IMHA is not an automatic death sentence. Patients with IMAH require close monitoring. Red blood cell counts must be rechecked every two to three weeks, and the medication regimen and further treatments will fluctuate depending on blood work results. After stabilization, a basic blood panel and urinalysis should be performed every four to six months. Also, keep in mind that it's not recommended to have your dog routinely vaccinated after an IMHA diagnosis since you just don't know what will cause your dog's body to go through another bout of anemia. 

Thankfully, Zoey is still with us, and we are grateful to have this spunky girl in our lives. Miraculously, her red blood cell count stabilized in the normal range after nearly four months of treatment, and she's been in remission for four years. But, I still check her gums at least twice a day for any change in colour from their usual pink, healthy shade to anything that even slightly resembles a pale to white-ish tint. Our favourite colour is now pink! While this illness cannot be cured, it can be managed. There are great resources and online forums available to lend you some much needed emotional support and provide you with information. You are definitely not alone. 

Disclaimer: I am not a veterinarian, just an experienced, well-read, and hyper-observant pet parent. This article is not meant to diagnose or treat any canine illness, nor does it replace professional veterinary care. Always talk to your vet about your dog’s health as health care is an individual matter. 

Resources and further reading:

Petplace.com: 

https://www.petplace.com/article/dogs/pet-health/immune-mediated-hemolytic-anemia-in-dogs-imha-autoimmune-hemolytic-anemia/

petMD: https://www.petmd.com/dog/conditions/cardiovascular/c_dg_anemia_immune_mediated

Pet Health Network:

https://www.pethealthnetwork.com/dog-health/dog-diseases-conditions-a-z/immune-mediated-hemolytic-anemia-dogs-imha  

by A. Piper Burgi

Piper is the author of several non-fiction books, and recently added five historical fiction novels to her ever-expanding collection of published writings, In the Shadow of Her Majesty, The Country Girl Empress, A Life in the Shadow of the Crown, The Perpetual Traveler, and Excerpts from the Imperial Diary. When she isn't busy typing on her computer, she can be found chasing after her furry children or holding on tightly to a good cup of coffee. Follow her on LinkedIn, Facebook, Instagram, and Goodreads.

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#WritersLife: How to Draw on Your Passion for Writing

Would you like to be able to draw on your passion whenever you sit down to write? I'm sure you're familiar with the scenario: An excellent idea for an article, blog post, or book pops into your head. You believe the subject matter is fresh and exciting. You've got your main points outlined in your head, and you're ready to write - or so you think. 

But when you put pen to paper or your fingers hit the keyboard, you can't seem to instill that initial enthusiasm into your writing. It seems to fall short, and you are confident that your idea is not the problem. Nor is it your writing ability. So, that leaves you wondering: What is the problem?

The difficult transition from idea to execution

Often enough, the shift from idea to execution can be difficult. At times, a story might seem to flow, but it's not really moving forward because you've lost sight of the big picture. That can be detrimental, especially if you are working on something meaningful such as your next great novel. So, how do we stay on course, and if we do stray, how do we get back on track? By drawing on our passion for the topic and writing as a whole.

Don't confuse interest for passion!

You can be passionate about your idea for your next story, but that could just be your interest in the subject matter. It's easy to mistake one for the other. I've heard some of my writer friends talk quite excitedly about their plot, and it might actually be a great idea. But when you take a closer look, you can't seem to find the passion anywhere.

So, what exactly do I mean by passion for writing? To me, it's a strong feeling, conviction, belief that comes from deep within. An idea that this is an important story to tell, a pertinent theme to explore. If you can draw on that joy of shaping words, it will definitely show in your writing.

Return to your first love!

Perhaps self-criticism is the most significant barrier to passionate writing. Instead of worrying about why we write or analyzing our writing half to death, let's concentrate on telling a story instead. Isn't that why all writers start writing in the first place because you love to tell a story? We must not only silence our inner critic that gets in our way, but we also need to reach deep within ourselves to a place where we rediscover the joy of creating every time we write.

Of course, if we have contractual deadlines dangling over our heads like the blade of a guillotine, it can get a little complicated. But somehow, we must push through if we want to get to that place of passion. But can we always write like that every time we dig into our story? I'm going to go out on a limb and say "Not Likely," although some writers come close.

Is this something we should aim for? You might find this shocking, but I'm going to say "no" because I think the brain's emotional and energetic side doesn't always serve us best. There are times when we just have to be silent and reflect. So maybe passion isn't always that lively. Perhaps it sometimes can also look like devotion, tenacity, grit...

So What Does Passion for Writing Look Like?

Here are some of the things I notice in books that scream passion to me:

Enjoyment in the language –  There are plenty of writers out there who lean more toward the cookie-cutter way of structuring their plots, scenes, and even sentences. The lack of depth seems palpable.

Colorful characters – As a writer, I am intrigued by people. Humans are complicated beings. I feel that as a writer, I should at least attempt to capture the human condition in all its facets. Passionate writing detests dull-developed characters.

Enjoyment in storytelling – When you read a riveting story, you can sense even the writer is fascinated by their own story. It's not just a jumble of words that fit nicely together like some a game of Tetris. The writer is actually enamored with the process of storytelling.

Passion might not be necessary for every writer!

Passion is not the alpha and the omega of writing and may not be why you write. Everyone has their own reasons for writing, each of them just as valid as the other. I have writer friends who pump out books using formulaic structure, yet they aren't even a wee bit passionate. They make a modest living at what they do, and they are absolutely happy with their writer's life. And I think that's marvelous that it works for them. And maybe it works for you as well. There is definitely a need in many marketplaces for proficient, non-passionate writing...just think of all those owner manuals.

But then there also needs to be someone to write passionate books for readers longing for such stories. Perhaps you are one of those writers. If you want to be one of those, you need to stir up your passion for words, characters, and storytelling. So push away all those encroaching voices within and without pulling you away from your passionate core. 

Can you think of ways to help you tap into your passion when you sit down to write? If so, feel free to share them in the comments. Let's motivate each other!

by A. Piper Burgi

Piper is the author of several non-fiction books, and recently added five historical fiction novels to her ever-expanding collection of published writings, In the Shadow of Her Majesty, The Country Girl Empress, A Life in the Shadow of the Crown, The Perpetual Traveler, and Excerpts from the Imperial Diary. When she isn't busy typing on her computer, she can be found chasing after her furry children or holding on tightly to a good cup of coffee. Follow her on LinkedIn, Facebook, Instagram, and Goodreads.

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Why I Love to Write and Read Historical Fiction

Someone recently asked me why I decided to write historical fiction. I had, after all, up until just a few years ago, written nothing but non-fiction. What is it about historical fiction? What makes it so charming? And what ensures its continuing popularity? I will gladly admit that I’ve always been a bit of a history buff and enjoy researching different eras and cultures.  But my love of this genre goes well beyond that.

Why does anyone even bother reading books? What pleasure do people derive from a well-spun tale? I think most would argue that a good story takes us away from our daily hum-drum. We trust the author to provide us the opportunity to immerse ourselves in a completely different world as soon as we turn the pages of a book to the first chapter.

Who among us has not imagined ourselves or our alter ego, living in another period? Perhaps we think we were born in the wrong century and believe we would have felt more at home way back when. Or maybe it's a yearning for a simpler time, or a desire to live in another country. Perhaps we're looking for an opportunity to meet our cherished heroes. Or we wish to right one of history’s horrific wrongs. After all, there have been many! If that’s you, then you are probably already a fan of historical fiction and many of its sub-genres. There are so many to choose from: Romance, horror, mysteries, tragedies, westerns, etc. set in history ready to captivate their readers and bewitch them with a sense of another time and space.

Stories from our past expose us to unfamiliar cultures, and sometimes even the strange aspects of our own. It shows us who we were as a people, but also provides a map to our future. An astute reader might even pick up on the commonality of all faiths and nations when our basic needs were exposed, rawer.

Historical fiction affords a writer the rare opportunity to right wrongs. We can create a story starring historical figures in a new light. We can restore them to life although theirs was stolen, or exact justice although they received tragic condemnation. We can even award posthumous accolades to the heroes who left us all too soon. After all, it is fiction, and nowhere does it say we can't ask: What if...? 

For a storyteller, this genre requires more research than most other forms of writing. This is my favourite stage of the writing process! I get to transport myself to that time and place in history and "experience" (albeit second-hand) the same things as the people of that time. Using modern-day phrases, or mentioning inventions that have not yet been discovered, could negate all of my efforts. However, despite the extra challenges, or possibly because of them, I feel it is also the most rewarding type of writing. It allows me to introduce the relatively unknown people and periods in history while indulging my inner history buff and storyteller in the process

by A. Piper Burgi

Piper is the author of several non-fiction books, and recently added five historical fiction novels to her ever-expanding collection of published writings, In the Shadow of Her Majesty, The Country Girl Empress, A Life in the Shadow of the Crown, The Perpetual Traveler, and Excerpts from the Imperial Diary. When she isn't busy typing on her computer, she can be found chasing after her furry children or holding on tightly to a good cup of coffee. Follow her on LinkedIn, Facebook, Instagram, and Goodreads.

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Strategies for a Happier, More Productive #WritersLife

A productive writer is a happy writer - or so they say. But at some point, you might find something missing from your writer's life. Or perhaps your work is not progressing the way you think it should. It happens to the best of us. Here are some strategies that have helped me along the way to a happier, more productive writer's life.

Set Goals

As with all writing, I like to set goals along the way. If I'm working on my next book, I might designate daily taskers, like printing my manuscript and reading the current draft - maybe a chapter or two per day. When I complete said task, I move on to the next goal to get closer to publishing that book.

Establish Deadlines

Whether it is reaching a certain word count by the end of the day or meeting a submission deadline for an article, setting deadlines can help you keep on track. 

Read 

Reading is not just a relaxing pastime. It can also show you what's already available and quite possibly give you ideas for your next story. Plus, you support your fellow writers and the literary community as a whole. 

Modify Your Writing Habits

I continuously revise my writing habits, looking for ways to improve. My latest obsession is keeping notes on my phone. So far, it's worked quite well for me, consolidating my ideas, references, and information all in one place. And just to make sure I don't lose everything, I like to back up those notes to an external hard-drive regularly. If something doesn't work for you, then change it up, find out what does. 

Take Baby Steps

Even on my craziest days, when time to write is nowhere to be found, I like to challenge myself to get at least one writing-related activity done. Be it reading a book about the art of writing or brainstorming ideas. Every little step will bring you closer to your goal.

Connect with Other Writers

Although I'm a bit of an introvert, I am happiest with my writer's life when I've got a group of writers to fall back on. Granted, not all writers want to sociable. Still, if you are fortunate, you can find a few writer friends out there that you can trust to commiserate with you when you're having a bad day or ask for a second opinion. You don't even have to meet them in person; you can always connect with other writers online - which definitely feeds into my introverted nature.

Attend a Workshop

Traveling isn't always easy, especially these days. But planning a trip to attend a workshop can give you something to look forward to. And should traveling be impossible, you can still participate in a virtual event. Plus, some of those expenses involved can be tax-deductible. 

Believe in your abilities

We are all our own worst critics. Telling ourselves that we're out of our league. But no matter what you believe, you never truly know until you give it a whirl. So, no matter the dream, give it your all, work hard, and stop belittling yourself!

by A. Piper Burgi

Piper is the author of several non-fiction books, and recently added five historical fiction novels to her ever-expanding collection of published writings, In the Shadow of Her Majesty, The Country Girl Empress, A Life in the Shadow of the Crown, The Perpetual Traveler, and Excerpts from the Imperial Diary. When she isn't busy typing on her computer, she can be found chasing after her furry children or holding on tightly to a good cup of coffee. Follow her on LinkedIn, Facebook, Instagram, and Goodreads.

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Month in Review - August 2020

Pumpkin Spice season is already here. Can you believe it? Where did the time go? Although the weather still blesses us with unseasonably warm weather, autumn is right around the corner. But before I get sidetracked by thoughts of what costume to wear for Halloween, it's time to recap last month. So now, without further ado, here's the list of the most popular blog posts for August 2019, chosen by you, the readers:

1. #WritersLife: The Good and Bad of Working with Beta Readers

You’ve finished writing your story. You’ve self-edited it to the nines, and elicited family members and friends to read your manuscript. It's ready for beta readers. The purpose of beta readers is not to stroke your writer's ego. Their job is to find your story's shortcomings before it is published. While it can be painful to receive feedback filled with a laundry list of issues, it's preferable to see that list in a private message, rather than plastered on the internet as part of a book review...

2. Dog Bakery: Lip-Smacking Birthday Pupcake Recipe

Birthday Pupcakes. Quick, easy, and packed with flavour. These lip-smacking pupcakes are my dogs' favourite treats - soon, your furry friends will crave them, too!

3. #WritersLife: Misconceptions about Self-Publishing

The publishing world has changed dramatically over time, but especially since online self-publishing became popular. Viewed by many as inferior, publishing your own work can be intimidating. However, all those myths floating around about it don’t help the situation. To uncover the truth about self-publishing, we should explore some of the most prevalent myths...

4. Self-Editing Basics: 9 Simple Ways to Edit Your Manuscript

As most of my readers already know, I'm in the midst of editing my next three historical fiction pieces that are part of The Country Girl Empress series: AT THE CASTLE OF DREAMS (book 5) and two yet untitled projects (book 6 and 7). With that in mind, I thought this would be the perfect opportunity to share some tips and tricks that help me along the way to polish my manuscript...

5. The Emperor's Gugelhupf

Sometimes I think that I take my love for the characters in my books a little too far. A couple of days ago I had such a craving for Gugelhupf (a yeast-based Bundt cake, which often contains raisins) that I decided to bake an Emperor's Gugelhupf just like my grandmother used to make. Her recipe is based on the one from the famous pastry shop Zauner in Bad Ischl...

by A. Piper Burgi

Piper is the author of several non-fiction books, and recently added five historical fiction novels to her ever-expanding collection of published writings, In the Shadow of Her Majesty, The Country Girl Empress, A Life in the Shadow of the Crown, The Perpetual Traveler, and Excerpts from the Imperial Diary. When she isn't busy typing on her computer, she can be found chasing after her furry children or holding on tightly to a good cup of coffee. Follow her on LinkedIn, Facebook, Instagram, and Goodreads.

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