Evans Syndrome & hearing

[Beach]

Hi,

My little toy Poodle, Shadow was diagnosed with Evans Syndrome Oct. 28, 2019. On the 26th he was given a shot of Convenia antibiotic (for a loose tooth) and within 24 hours he was in critical condition; platelets at 0 and red blood below 10. After 2 transfusions and a couple of days in the hospital he was well enough to come home. We noticed he was not responding to our voice commands, initially I thought he was ignoring me because he felt bad. After a couple of days I realized he was not hearing anything, loud noises, doorbells, nothing. My question is does Evans effect hearing? Strangely now, 2 months later his hearing has improved but it is not as good as it was prior to the illness. So, is it the Evans or medications that have had an effect on his hearing? I have heard that on rare causes humans can have hearing impacted by antibiotics?
Thank you in advance for any response. We are still hoping to get him well, the DVM is now beginning to wean him off the Prednisone and we are hopeful that he makes a full recovery.

[Patrice]

I am sorry to read about Shadow.

Evans Syndrome is a complex autoimmune condition that may lead to autoimmune hemolytic anemia, immune-mediated thrombocytopenia (ITP) and neutropenia. Each of these conditions are serious and combined together can be challenging to treat.

Hearing loss, at least as much I can research, is not directly related to these conditions normally. But that does not rule them out as an indirect cause.

Since I’ve never talked with an owner reporting this I can draw some conclusions from some of the effects that these diseases can contribute to.

Anemia is a reduced level of oxygen being delivered to body cells. In this case it is due to an extreme loss of red blood cells. Many dogs with extremely low hematocrit/PCV can develop heart symptoms due to low levels of oxygen. Vets do report, esp in small dogs, a noticeable heart murmur. If they recover from IMHA, they may or may not continue to have small murmurs. So from this knowledge I can imagine that loss of oxygen to the delicate inner ear structures might also lead to some tissue death. I’m guessing this is the most likely cause.

But also, looking at the ITP, which is an extreme loss of platelets, I can also see a possible connection. These cells are responsible for important clotting inside the blood vessels. We have tiny damage to our vessels normally all the time. Platelets are very active in protecting and repairing that damage. With low platelets the body gets confused and attempts to provide clotting but ends up doing in many of the wrong places. This can lead to small clots in inappropriate places. If this occurs rapidly all at once, there is a risk of death. But in your case there may have been small abnormal clots in the small delicate vessels of the inner ear. Kind of like a little stroke.

Finally, neutropenia is a low or lack of production of white blood cells in the body. This leaves a dog susceptible to all kinds if opportunistic infections. This is a very serious risk. Perhaps Shadow developed an inner ear infection that partially damaged tissue.

Some antibiotics can lead to allergic reactions so I also see a possible connection to an inflammatory reaction in the inner ear.

These are my best guess suggestions. Please take what I say as guesswork, not a diagnosis.

Regardless, I think that there is partial damage to the delicate inner ear structures.

You might try adding antioxidant supplements to reduce free radicals in the body. Aim to provide a highly nutritious diet. There is some truth that the body can heal itself. Provide extras like small amounts of liver, eggs, yogurt, blueberries, canned plain pumpkin. I give my dogs those foods on a regular basis. Be sure that the rest of the diet contains high quality protein, moderate to low fat and leave out things like grains, rice and other similar foods that dogs can have allergies to. I do not recommend grain free designer dog kibbles. There has been scrutiny recently about their possible connection to heart problems. I am not sure this is true, but in your case just avoid them. If you are up to it the best diet you can feed is homemade. There are several excellent Facebook groups that help you with that.

None of us who have gone through these terrible autoimmune diseases gets exactly the same dog back that we went into these diseases with. They are a bit more fragile and we tend to be more cautious. That you beat this particularly complex condition is a testament to your great dedication to Shadow and his strong will to live. You’ve done a super job. The hearing difficulty is a badge of honor to a warrior that survived a terrible disease. Enjoy the extra time you have earned.
My best Patrice

[Beach]

Hi,

My little toy Poodle, Shadow was diagnosed with Evans Syndrome Oct. 28, 2019. On the 26th he was given a shot of Convenia antibiotic (for a loose tooth) and within 24 hours he was in critical condition; platelets at 0 and red blood below 10. After 2 transfusions and a couple of days in the hospital he was well enough to come home. We noticed he was not responding to our voice commands, initially I thought he was ignoring me because he felt bad. After a couple of days I realized he was not hearing anything, loud noises, doorbells, nothing. My question is does Evans effect hearing? Strangely now, 2 months later his hearing has improved but it is not as good as it was prior to the illness. So, is it the Evans or medications that have had an effect on his hearing? I have heard that on rare causes humans can have hearing impacted by antibiotics?
Thank you in advance for any response. We are still hoping to get him well, the DVM is now beginning to wean him off the Prednisone and we are hopeful that he makes a full recovery.

[Patrice]

I am sorry to read about Shadow.

Evans Syndrome is a complex autoimmune condition that may lead to autoimmune hemolytic anemia, immune-mediated thrombocytopenia (ITP) and neutropenia. Each of these conditions are serious and combined together can be challenging to treat.

Hearing loss, at least as much I can research, is not directly related to these conditions normally. But that does not rule them out as an indirect cause.

Since I’ve never talked with an owner reporting this I can draw some conclusions from some of the effects that these diseases can contribute to.

Anemia is a reduced level of oxygen being delivered to body cells. In this case it is due to an extreme loss of red blood cells. Many dogs with extremely low hematocrit/PCV can develop heart symptoms due to low levels of oxygen. Vets do report, esp in small dogs, a noticeable heart murmur. If they recover from IMHA, they may or may not continue to have small murmurs. So from this knowledge I can imagine that loss of oxygen to the delicate inner ear structures might also lead to some tissue death. I’m guessing this is the most likely cause.

But also, looking at the ITP, which is an extreme loss of platelets, I can also see a possible connection. These cells are responsible for important clotting inside the blood vessels. We have tiny damage to our vessels normally all the time. Platelets are very active in protecting and repairing that damage. With low platelets the body gets confused and attempts to provide clotting but ends up doing in many of the wrong places. This can lead to small clots in inappropriate places. If this occurs rapidly all at once, there is a risk of death. But in your case there may have been small abnormal clots in the small delicate vessels of the inner ear. Kind of like a little stroke.

Finally, neutropenia is a low or lack of production of white blood cells in the body. This leaves a dog susceptible to all kinds if opportunistic infections. This is a very serious risk. Perhaps Shadow developed an inner ear infection that partially damaged tissue.

Some antibiotics can lead to allergic reactions so I also see a possible connection to an inflammatory reaction in the inner ear.

These are my best guess suggestions. Please take what I say as guesswork, not a diagnosis.

Regardless, I think that there is partial damage to the delicate inner ear structures.

You might try adding antioxidant supplements to reduce free radicals in the body. Aim to provide a highly nutritious diet. There is some truth that the body can heal itself. Provide extras like small amounts of liver, eggs, yogurt, blueberries, canned plain pumpkin. I give my dogs those foods on a regular basis. Be sure that the rest of the diet contains high quality protein, moderate to low fat and leave out things like grains, rice and other similar foods that dogs can have allergies to. I do not recommend grain free designer dog kibbles. There has been scrutiny recently about their possible connection to heart problems. I am not sure this is true, but in your case just avoid them. If you are up to it the best diet you can feed is homemade. There are several excellent Facebook groups that help you with that.

None of us who have gone through these terrible autoimmune diseases gets exactly the same dog back that we went into these diseases with. They are a bit more fragile and we tend to be more cautious. That you beat this particularly complex condition is a testament to your great dedication to Shadow and his strong will to live. You’ve done a super job. The hearing difficulty is a badge of honor to a warrior that survived a terrible disease. Enjoy the extra time you have earned.
My best Patrice