# Lost my dog last month to AIHA. **LONG POST**



## SaltyMaltese (Sep 17, 2012)

Hello members, I had a 3.5 year old Maltese which I lost last month to AIHA. I've been pretty busy since then trying to find the cause of what could've triggered this, and want to stay active in helping other dog owners that may encounter this. My friend's Dad who is also a vet, wanted to get some info, so here is the copy/paste email which I wrote to them.

During my final semester away at school, my family noticed that
Cookie started to have seizures at night time. This started around the
time of March. This came at a surprise for my family, as our dog was
extremely healthy (9lbs at the time), up to date on all her
vaccinations, had a healthy diet, was walked 3 times a day. My parents
and brother took her to the local vet, where she was prescribed
Phenobarbital (PB).

My brother noticed that on the nights that the seizures would come,
during the day time, our dog would get seizures which are defined as
"petit mal". Basically, the dog would continuously stick her tongue in
and out, for 2-3 minutes or so. My brother would call her name out,
and realize there was no response. Other petit mal seizures included
her licking the carpeted floor for a few minutes. After these
episodes, my family described her as being extremely restless -
walking all over the house, not sitting in one spot - just constant
movement. As the night grew, her "grand mal" (GM) seizure would
eventually appear. The GM seizures lasted anywhere from 20 seconds to
just under a minute. These GM seizures very rarely occurred during the
day time. My family only has noted 4 instances where the GM seizures
attacked at daytime. At the end of this sentence, is a link to her
YouTube profile. I was fortunate enough to be home one day, where she
had a GM seizure occurring during the daytime. I recorded her attack,
so that the vet could visually see what was happening.

Link: 




As you can see, there is no postictal phase at the termination of the
seizure. Cookie would get right up, and continue onto her daily
routine - as if nothing ever happened. However, she did not fully
regain her stance, as her hind legs didn't recover as quickly as the
rest of her muscles. She would wobble and stumble around for a minute
or 2, and then be fully balanced.

Returning to the PB, I don't recall what the initial dosage regiment
was, but the drug wasn't effective in treating her seizure. Rather,
the frequency of seizures increased, to the point where Cookie had
seven, yes that is correct - 7, seizures in a single night. My parents
decided to get the opinion of a second vet, where they suggested
increasing the dosage of PB and adding an additional drug by the name
of Topiramate, sold as Topamax (T). The dosage schedule included 32mg
of PB in the morning along with 25mg of T. In the evenings, another
32mg of PB along with 50mg of T. The regiment was a success, her
seizures were controlled, but the side effects of PB were quite grave
on our dog. Cookie became a food eating macrophage, eating everything
that fell to the floor. This raised her body weight from 9lbs to
16.Xlbs. She was no longer be able to jump onto the sofa, and her
quick jolt up the stairs resulted in her taking almost 2 minutes to
walk to the second floor. At times, my parents would pick her up to
assist her due to her weight gain, instead of letting her walk herself
up. No amount of diet change, treat changes, extra exercises could
combat against the weight gain. Additionally, the personality change
took effect. Cookie became indifferent towards EVERYTHING. Upon my
return back home, not seeing my dog after 8 months, I was greeted with
a mere "meh" type of attitude from her. Lastly, PB metabolites is
extremely toxic to the liver, which resulted in her ALT/AST levels to
be elevated.

Bringing these points up to the 2nd vet, she suggested we slowly taper
Cookie off PB. This regiment included giving Cookie 32mg of PB a day,
with 16mg in the morning and 16mg in the evening. The dosage regiment
for T was unchanged (25mg in the AM; 50mg in the evening). I can't
recall now, but Cookie was seizure free from the tapering for five
days - I think. I was losing my patience with science and medicine at
this point. My Dad's friend recommended going to the University of
Georgia's School of Vet. Medicine (UGA) to seeing the specialists
there. My Mother and I booked an appointment, and off we went, in
search of the pathology behind our beloved dog.

After 3 hours of driving, we met Dr. O'Neil (DON) a neurologist who
took our dog's history (as written above) and performed the
neurological examination & did the CBC. DON diagnosed Cookie with
idiopathic epilepsy. In lay, what was causing her seizures was
unknown. My heart dropped to the floor. I was hoping whatever variable
that was causing the seizure, would be identifiable, and we would be
able to help our dog. DON told us that with these type of seizures
would not go away, and can only be controlled with proper dosing
regiments and proper drugs. We brought up the experience with PB, and
DON recommended using Potassium Bromide (KBr) and Kepra (K) instead of
PB and T. Her seizures wouldn't go away, but should've been controlled
to the point of "having them once every four to six weeks". DON
suggested bringing Cookie back to the full 64mg of PB with 32mg in the
AM, and the other half at night, while we wait for the delivery of
KBr. He gave us a 30day supply of K and would ship us the KBr, as it
had to be prepared. Before I forget, this was on August 30th. While
looking at the CBC everything was normal, besides her platelet count
which came in at 79,000. Normal in humans it is anywhere from 150K -
400K, however according to the vets and specialists it wasn't
something to be concerned about, which I truly regret while I type
this up.

Going back to the recommended dosing regiment by DON, Cookie was
seizure free from September 1st to September 10th. My mother stated
that the seizure on the 10th was mild, and there was no urination
during the seizure, which would normally occur during her attacks. My
Mother got up, made sure Cookie was ok, and put her back to sleep -
not realizing that the next week for us was going to be a downward
spiral.

On September 11th, I decided to stay home and study for the boards,
instead of going to the library. In the morning, I noticed Cookie's
tail was down, but didn't think much of it. As the day progressed, and
it was time to walk Cookie, I went to her with the leash, and she
didn't want to go. I figured she must be sick, as she hadn't touched
her food all day. When my Mother came home, we took her to our local
vet to get their opinion. The vet did a full body check up and didn't
nothing abnormal. The vet suggested doing a blood work, but I decided
it wouldn't be necessary, and we went home instead.

On September 12th, Cookie appeared more listless and lethargic
compared to yesterday. She hadn't touched her food since Monday
evening, and was only drinking her water.

On September 13th, my Dad decided to walk her in the morning. My Dad
picked her up, and Cookie immediately crouched down to the ground. My
Dad was concerned and told me to rush her to the vet. I took her to
our vet, and decided to do the blood panel work up. Receiving the CBC,
my vet showed me the results where her platelet count was now at 50K
and her Hct was at 19. She immediately referred Cookie to Georgia
Veterinary Specialists (GVS) as an emergency patient. Cookie was
admitted at GVS and was met with the ER vet, Dr. Nelson (DN). DN
recommended Cookie overnight for observation. DN with the help of the
Internal Medicine vet (IM) later came to the possible diagnosis of
Evan's Syndrome/Immune Mediated Hemolytic Anemia (IMHA). My dog of
only 3.5 years old was getting attacked by her own immune system. A
reticulocyte count was done to determine whether it was regenerative
or not, and was found to be regenerative. The CBC done at that time by
GVS showed a platelet count of 17K and a Hct of 14.

A blood transfusion was immediately started, and a CBC was performed
to see the results. Unfortunately, everything was shredded, with the
platelets dropping now to 9K and the Hct rising only 1 point.
Respirations were elevated to 80/min, with a pulse ox of 96%. X-rays
showed no clots and lungs looked clean and clear. My father
recommended starting 2 doses of Dexamethasone (D) a day to suppress
the immune system.

On September 14th, I received the call from the IM vet. A second
transfusion was started, and was slightly successful. Hct rose to 19,
but platelets fell to 7K. Respirations remained at 80/min, but now
with pulse ox at 70%. X-Rays showed no clots and the lungs looked
clear and clean. The cause of elevated respirations were never found.
IV-IG was not opted, due to overloading the system. My father was
adamant on D helping to raise the platelet count, as it surely did. We
were fortunate enough to see Cookie in the evening.

I've attached a picture I took of my Mother holding Cookie. I know
this information is irrelevant to the information, but I truly love
this picture. My Mom was never a dog lover, but after surprising my
Mom with Cookie for Mother's Day, my Mom fell in love with her, and
saw her as a daughter instead of a pet. The loss of Cookie has really
taken a toll on my mother. Lastly, I took a video of Cookie at GVS.
The dog crying isn't Cookie, but another dog in the next cage. Little
did I realize, that this was the last time I'd see my Cookie.

Link: 




On September 15th, at 10:15am, we received a call from the critical
care vet (CCV) who told us that the platelets rose to 18K, but her Hct
has now fallen further. Her respirations were elevated, and already
had an arrest. She came out of it, but appeared dazed and unaware of
her surroundings. My parents were in tears, and were told to get to
GVS asap. My brother left his dorm, and was able to arrive to GVS
before my parents and I did. Cookie was on a table where the CCV
couldn't hear a heartbeat. My beloved Maltese, who loved everybody,
never hurt a soul, who gave my parents unconditional love when I was
away for school, who stayed up till late night until my brother or I
came back from partying, who people often described as having a
"divine soul" - passed away. My parents and I arrived 7 minutes after
she passed, and were in disbelief.

The hemodynamic changes in her vascular system resulted in her
throwing clots to her lungs, resulting in her not being to able
properly oxygenate the rest of her body. Thrombolytic agents haven't
showed the same results as they've yielded in humans. Cookie was
cremated yesterday and her ashes were distributed at Lake Allatoona.
The cause of her IMHA was never found. Talking to the vets and
specialists some believe the PB may have initiated it, no recent
vaccinations were administered to trigger the reaction. The
specialists at GVS are certain PB wasn't the cause, as her serum after
centrifuging her blood was icteric. Genetics, with certain HLA
haplotypes? Bacterial screen of Parvo B19, Babesia, all came back
negative.

I don't know, and may never will, but I know that my dog no longer has
to suffer from the pathologies that were affecting her.

RIP Cookie. See you on the other side.

Some pictures of my awesome dog:


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## bellaratamaltese (May 24, 2006)

I am so sorry to hear this sad news


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## Furbabies mom (Jul 25, 2011)

I am truly sorry for the loss of your sweet Salty. RIP little one, run and play at the bridge.


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## Sylie (Apr 4, 2011)

:smcry:Such a sweet angel. RIP, Salty.


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## MalteseJane (Nov 21, 2004)

So sorry :grouphug::grouphug::grouphug:


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## chichi (Apr 12, 2007)

I am so sorry for the loss of your sweet baby.:grouphug:


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## Zoe's Mom88 (Apr 25, 2011)

I am so sorry for the loss of your sweet baby Cookie. I did cry while reading your post. It is so sad when we try everything we can to help them. I lost a furbaby 22 months ago to liver disease and still cry all the time. Losing them is never easy especially when they are ill. Sorry again for your loss. RIP Cookie....as you join the other loved furbabies at the Rainbow Bridge. :smcry:


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## Critterkrazy (Jan 17, 2007)

I am so sorry for your loss of sweet Cookie. I don't know anything about AIHA but I've had 2 dogs with epilepsy over the years and the siezures are devistating. I send you healing prayers. ((((hugs))))

RIP sweet little Cookie.


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## revakb2 (Sep 8, 2006)

I am so sorry for your loss. My thoughts and prayers are with you and your family.


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## SamiPix (Oct 16, 2012)

I'm so sorry for your loss. I lost my beloved Yorkie, Teddy, 15 months ago and I'm still not over it. The last 24 hours have been especially difficult since I adopted a 6 month Maltese yesterday and I can't help but feeling conflicted. 

Hugs to you and if you need to talk feel free to message me. 

Suz aka Sami


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## SweetMalteseAngels (Oct 16, 2011)

I am so sorry for your loss. I feel so heartbroken reading your story. I can imaging what you and your family must be going through. May you and your family be at peace at heart as you remember the memories of Cookie and also knowin that she is no longer suffering. RIP dear Cookie. Hugs to you~~~


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## PrinceMickey (Jun 20, 2011)

I am so sorry for the loss of your sweet baby.
RIP sweet little baby.
My thoughts and prayers are with you and your family.


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## Snowball Pie's Mommi (Oct 16, 2008)

I am so sorry. Cookie was so beautiful and such a loving little angel. Now she is at the Rainbow Bridge ... in Heaven.

Thank you for sharing the videos. They are sad to watch ... but, at the same time, important to see. 

Also, thank you for sharing the pictures of your beautiful Cookie.


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## Snowbody (Jan 3, 2009)

:smcry: I'm so sorry. I read your whole post and it was heartbreaking. I never heard of AIHA and don't know a lot of the medical terminology you used (are you studying medicine? - I saw you were studying for boards and you seem to be very fluent in medical terms) but I do know how much your heart must ache from losing Cookie and seeing her go through what she did. I really think you did everything that you could and sometimes it's just not enough. And it's just not fair. At least Cookie was loved by your entire family and you were lucky enough to experience her unconditional love. :wub2: I hope that your hearts will heal. Cookie isn't feeling any pain or having seizures. She's free from it all and I do believe you will see her again some day.
Please extend our sympathies to your family. I was crying my eyes out watching your mom caressing Cookie at the end. :crying: Thank you for sharing your story. It might help another family.


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## Maidto2Maltese (Oct 19, 2004)

I'm so very sorry for you and your family with the loss of your precious little Cookie! 
Tears filled my eyes and my heart ached as I read your post and how you all tried your very very best to do all possible to help your little girl. Sadly we sometimes face those times when things just aren't 'fixable'. 

It was obvious in that last video that Cookie knew how very much she was loved.


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## socalyte (Nov 15, 2010)

I am so sorry about the loss of your sweet little girl. It's so hard to understand and deal with our little ones' health issues. She was such a beauty and I'm sure your heart is aching. ((hugs))


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## sassy's mommy (Aug 29, 2005)

I am sorry for your loss.


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## ladodd (Jan 8, 2012)

I'm so sorry for your loss. You did everything you could. Your precious little Cookie is playing with all of our other fluffs that left us and are at Rainbow Bridge.


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## SaltyMaltese (Sep 17, 2012)

Snowbody said:


> :smcry: I'm so sorry. I read your whole post and it was heartbreaking. I never heard of AIHA and don't know a lot of the medical terminology you used (are you studying medicine? - I saw you were studying for boards and you seem to be very fluent in medical terms) but I do know how much your heart must ache from losing Cookie and seeing her go through what she did. I really think you did everything that you could and sometimes it's just not enough. And it's just not fair. At least Cookie was loved by your entire family and you were lucky enough to experience her unconditional love. :wub2: I hope that your hearts will heal. Cookie isn't feeling any pain or having seizures. She's free from it all and I do believe you will see her again some day.
> Please extend our sympathies to your family. I was crying my eyes out watching your mom caressing Cookie at the end. :crying: Thank you for sharing your story. It might help another family.


Yes ma'am, I'm taking my boards to become a physician in 6 weeks (Nov 29th). AIHA is *A*uto*I*mmune *H*emolytic *A*nemia, where her immune system is seeing her red blood cells as foreign, and are attacking them. This is the same mechanism of action when we get infections from something. However our antibodies know that not to attack our body or components of the body. My family and I felt blocked in every direction we went. If we started a certain treatment, her body was responding to the treatment, but causing a side-effect where the cons were outweighed by the pros.

I was taught that most autoimmune manifestations occur in females of "child-bearing age", as pathology books describe. Learning that dogs are also susceptible to this condition, just made me appreciate medicine that much more. The best vets/specialists did all they could for her, and couldn't help her. I remember leaving GVS angry at choosing medicine as a career path. So much that goes wrong out there, and medicine couldn't save my dog. Bringing this up to my parents, my parents mentioned that I should take control of the situation, and help others. I want to start a foundation for other dog owners who are going through what Cookie went through.

This thread will eventually move from the first page to the end somewhere, but it'll show up in search engines when dog owners try to find answers for what pathology is affecting their and what can be done and what shouldn't be done. Same with the breeder's information, which I've posted in the "Breeder" subsection. I hope that nobody has to go through what my family and I had to go through. 

More pics of my doggah. 









Her monkey which she loved, and which was cremated along with Cookie.









Always wanted to sit in the driver's lap...


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## zooeysmom (Aug 1, 2011)

I'm just heartbroken for your loss of your sweet Cookie :smcry: Sending you love and comforting hugs during this very sad time. Thank you for sharing her story in hopes that it will help others.


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## Snuggle's Mom (Jan 3, 2008)

There are just not enough words to tell you how very,very sorry I am upon the loss of your precious Cookie. Please know in your heart that you did everything that you could for Cookie and that she is not running free without any pain at the Bridge.


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## TLR (Nov 13, 2011)

I am so sorry RIP little Cookie. Thank you for sharing this very informative story. I hope it will be helpful to others. Take a look at the new "Calling Our Angels Night" You may want to join in on this.
http://spoiledmaltese.com/forum/48-news-announcements/122435-calling-our-angels-night.html


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## aprilb (Jul 9, 2010)

I am so sorry about Cookie...:crying:This is so sad..I have heard of AIHA before...unfortunately, according to my research, it is not known for sure what causes it, but it could be triggered by too many vaccinations, a recent vaccine, or certain medications.. the mortality rate for AIHA is high and it sounds like Cookie received excellent care. Again, I am sorry you and your family are dealing with such a tragic loss.


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## Deborah (Jan 8, 2006)

I am so very sorry for your loss. I think you went above and beyond what you could do to help Cookie.
Try your best to remember the joy she brought to your life.
With deepest sympathy,
Deborah


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## Snowbody (Jan 3, 2009)

I think you're going to make an amazing doctor. You have the passion for medicine and the compassion for patients. It's so evident in your passages about Cookie. 

It is so hard to lose one to an illness. We feel so helpless as family but we always have hope in the emerging medical procedures...things change so quickly and some illnesses that were death sentences can now be treated and managed. A friend of mine diagnosed with breast cancer has reacted amazingly well to a drug that didn't exist a mere 2 years ago. So I'm hoping you might be the hope for the future. Maybe even to go into research so that you can be the one to perhaps save a child or discover a cure. And if not that, then to care for someone's loved one and help try to make them better.

Thank you for joining us to warn us about Cookie's condition and I do hope it will help others. Our wonderful member Pam (Pammy 4501) lost her amazing Lola a few days more than a year ago to a horrible disease called NME. You might want to take a look at her link to a fund she started to help forward research on NME and GME: http://spoiledmaltese.com/forum/59-...se-related/122431-lolas-fundraising-page.html It was a wonderful tribute to her Lola. It might give you an idea if you want to start a foundation or maybe do something similar to what Pam did - the Morris Foundation seems to be a very reputable organization interested in helping animals.

Again, I'm so sorry for you loss but please don't turn away from medicine; turn towards it. I think you have a gift. :grouphug:

Forgot to add...good luck on your boards!


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## maggieh (Dec 16, 2007)

I am so very sorry for your heartbreaking loss! She was adorable!


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## Furbaby's Mommie (Jul 10, 2004)

SaltyMaltese: Do you have any idea what started this for Cookie? I'm sure you have tried to come up with a cause. Thank you for posting the details, even though they are so heart rendering to read.
My sweet boy, Shoni was just diagnosed with Fibrosarcoma, and it is just killing me to think that it can return and could kill him. He is the light of my life as I know Cookie was to your Mom and you and your entire family.


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## pammy4501 (Aug 8, 2007)

I have to say that so much of what you are describing sounds like what my dog experienced that is't strange. But GME/NME is also an autoimmune condition. But the seizures? Is that part of AIHA? Most dogs get the acute version of AHIA, but I know there is a more chronic version. Well, I am so sorry for your loss. Hope you find the answers you are looking for. Let me know if I can help.


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## hoaloha (Jan 27, 2012)

I am so sorry for the loss of Cookie/Salty, especially after everything your family went through to get her the best care. I can certainly relate to you in having lost our first puppy without a certain diagnosis and also through being a physician myself. Being in the medical field sometimes makes it more difficult in the fight against illness. I know that Cookie's story will bring comfort to many and hopefully help others to avoid unethical breeders/brokers. 

Having read through your story, it still seems unclear why Cookie was having seizures. Was an MRI or lumbar puncture ever performed? The link to AIHA is difficult to determine as there are many causes. I hope that more research will be done.

Good luck on your boards! Are you taking Step 1? (I am so glad to be done with those  It gets so much better afterward! hahah  )


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## educ8m (May 19, 2010)

Your story is heartbreaking. We never expect to lose one of our babies when they are only three years old. I have two friends who have lost small dogs to AIHA, and their stories played out much like yours. All the pictures of your fur baby are adorable. You have my deepest sympathy.

Good luck on your boards!


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## edelweiss (Apr 23, 2010)

With heartfelt condolences & misty eyes for the loss of this precious baby! May God grant you comfort at this sad time. I truly hope your story will unlock solutions for others who may be in your situation. Warmest hugs.


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## CorkieYorkie (Apr 10, 2012)

I am so sorry for your loss..  RIP sweet Cookie  she was just darling.... and yes, you are going to great doctor for sure!


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## lynda (Oct 11, 2005)

:grouphug:I am so so sorry for your terrible loss. I am typing this through tears after reading your long and informative post. I have never seen a dog have a seizure but after watching your video of Cookie having one it was very sad and scary at the same time. I hope I never see anything like that in my four babies but god forbid if I do I will hopefully recognize it and know what is happening.

I am sure this was not easy for you to write but I think we all here on SM appreciate the information you have shared with us.

I hope that time will help to ease your pain and the pain of your parents.

My sincere condolences go out to you and your family.


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## Bibu (Jun 3, 2010)

Your post brought tears to my eyes. I can't even imagine how hard it must have been to go through all of this not knowing the cause. Cookie is now resting in a better place and I always believe we will eventually meet up with our beloved fur kids one day.


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## SaltyMaltese (Sep 17, 2012)

hoaloha said:


> I am so sorry for the loss of Cookie/Salty, especially after everything your family went through to get her the best care. I can certainly relate to you in having lost our first puppy without a certain diagnosis and also through being a physician myself. Being in the medical field sometimes makes it more difficult in the fight against illness. I know that Cookie's story will bring comfort to many and hopefully help others to avoid unethical breeders/brokers.
> 
> Having read through your story, it still seems unclear why Cookie was having seizures. Was an MRI or lumbar puncture ever performed? The link to AIHA is difficult to determine as there are many causes. I hope that more research will be done.
> 
> Good luck on your boards! Are you taking Step 1? (I am so glad to be done with those  It gets so much better afterward! hahah  )


Thanks for the sympathy and warm posts by everybody here. I hope to become an active member on the forum, and hopefully network with other dog owners in forming a foundation for my puppah (mis-spelled on purpose).

Yup, studying for the Step 1. Unfortunately, a MRI/LP wasn't done, as talking to a few specialists they felt that it most likely wouldn't have yielded anything. I forgot which disorder they said, but if they felt that she had it, other neurological manifestations would've been present allowing to clinically diagnose Cookie.


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