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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 32805
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My dog was put to sleep last Tuesday based on the diagnosis

Customer Question

My dog was put to sleep last Tuesday based on the diagnosis of IMHA. I am feeling incredibly guilty since I believe my ignorant negligence has let her down. With hindsight I realise that she was drinking an incredible amount of water; I had a gnawing concern about her front tooth for many months that I never had sorted although a few days before her sudden illness she had a swollen muzzle and was reluctant to let me touch her there. The saddest thing is that last Saturday she was her normal self. The next day I woke up to a dog very subdued, bleeding when passing urine, vomited and almost white gums. In just over 48 hours my dog was no longer with me. Why?
Submitted: 4 years ago.
Category: Vet
Expert:  Dr. Michael Salkin replied 4 years ago.

Aloha! You're speaking with Dr. Michael Salkin
I'm sorry for the delay in responding to you. I suspect that many vets have been puzzled by the history you provided. I've been mulling over Suki for quite some time.

The first scenario is straight forward. IMHA can remain occult for quite some time and then present peracutely (suddenly). My owners can't anticipate such an event.

The second scenario is more uncommon but should be considered. Dogs can develop a secondary hemolytic anemia secondary to the hypersensitivity reaction to an envenomation (bee sting, e.g.). Suki's swollen muzzle may have represented such a reaction rather than dental disease. IMHA, then, wasn't present. A different disease process causes the hemolytic anemia.

Her polydipsia (increased thirst) leaves me puzzled, however. Polydipsia isn't a feature of hemolytic anemias unless acute bleeding leaves my patient severely dehydrated. You would have recognized such profound bleeding while she was polydipsic. Instead, we would consider other causes of polydipsia - diabetes mellitus or insipidus, hepatic or renal insufficiency, hypercalcemia, Addison's disease (hypoadrenocortisolism) and Cushing's disease (hyperadrenocortisolism).

I regret that I can't be more specific for you. I would need to review her diagnostic testing to be more accurate which I would be pleased to do if you could upload the test results to our conversation. Please respond with further questions or concerns if you wish.


It's 11:30PM here and I have to leave my computer but I promise to reply in the morning if need be.

Customer: replied 4 years ago.

Dear Dr Salkin


I would like to give you more information, blood test readings etc to seek greater clarification. I will speaking to my vet tomorrow.





Expert:  Dr. Michael Salkin replied 4 years ago.
I'll look for your next message.

You may receive an inappropriate follow up from the site ostensibly from me. It wasn't and I apologize in advance should you receive it.