Baylee the Standard Schnauzer

Kara Maytag

Guest

In searching the internet to learn more about IMHA and treatments, I found this forum and have been reading historical posts. Since each case of IMHA is unique, I thought I would share what is happening with my girl Baylee.

Baylee is a 12 year old Standard Schnauzer. She was spayed when she was 6. Her current weight is 32 lbs, but at her peak agility career (very well muscled) she was around 35 lbs. She has been fairly healthy throughout her life (2 past incidences of HGE at about 7 and 9 yrs). Our current issues started in Feb of this year. Sorry for the looooong note, but I feel all of this may be related.

Round 1: Baylee started presenting with diarrhea and some vomiting in early Feb 2016 (no blood). With the history of HGE, I always react quickly if things don’t resolve in a day or so after switching to a bland diet. Trip to the vet with bloodwork and exam. Vet felt it might be the early flare up of pancreatitis and put her on metronidazole. Bloodwork showed WBC 16110, HCT37.5%, PLT 129000 and BUN 4. She ate the next day, but became very lethargic over the weekend and didn’t even want to move. Was walking like she had a great deal of pain in her abdomen. Off to the ER vet on Sunday. Abdominal ultrasound done which did show some slight changes to the spleen. Needle sample taken and they came back as a normal process called EMH. There were 2 small nodules that were on both sides in her groin area. Aspirates were taken and cytology revealed only the presence of fat cells and signs of inflammation. A CT scan was then performed to make sure there wasn’t more extensive internal disease present around these nodules. Nothing found so the diagnosis was given as Panniculitis…or inflammation of the subcutaneous fat tissue which from my research can be triggered by the immune system. Treatment was 400mg Pentoxifylline 2x/day, 250mg Clavamox 2x/day and 15mg Prednisone 2x/day. Baylee responded well, the nodules went away and over the course of the next 3 months, we weaned her off the prednisone.

Round 2: At one of our followups in May 2016, I had a lump that had been present on Baylee’s side aspirated as it’s appearance and texture had started changing. It had been previously aspirated 2+ years ago and found only to be fatty. Well, this time my gut feeling was right. It came back as a soft tissue sarcoma. The tumor was completely excised with clean margins and came back as a low grade. No further treatment such as chemo or radiation was done. Her (HUGE!) incision healed well and she seemed to be back to herself..even back to dabbling in agility at a reduced jump height.

Round 3: During a road trip from Minneapolis to Texas for our SS Nationals in late July, I noticed Baylee was becoming less active and didn’t want to jump up on furniture anymore. She also had some difficulty navigating stairs. At almost 12, I wasn’t sure if some of this might just be old age/arthritis setting in. Anyway, scheduled a vet appt for the first Fri when we returned home. Exam was unremarkable, but the blood values showed some liver values a bit high. No CBC at that time. By Sunday she was completely lethargic and had stopped eating. Trip to the ER vet. Her temp was 104 when we arrived. CBC was done: WBC 10990, HCT 40%, PLT 121000 and BUN 13. They did a quick ultrasound. Discharge report noted mildly low level of platelets and mildly elevated neutrophil count. Mildly low Albumin and mildly high globulin. Slight elevations noted in ALP and AST also. Proteinuria noted in urinalysis test. 4Dx test was negative for tick disease. Quick abdominal ultrasound was done and no obvious abnormalities seen. Her abdomen was tense/painful when palpated and periphereal lymph nodes enlarged. We were sent home with 60mg Maropitant 1x/day and 0.4mL Buprenorphine 2x/day and instructions to follow up with regular vet.

Called my vet on Monday and discussed the fever. They prescribed an antibiotic which I can’t remember. For the next couple of days, I monitored Baylee’s temp closely and her fever would come and go with her temp in the 101-104 range. She wasn’t eating (I started syringing some food in her to get her some nutrition) but she continued drinking water until Tuesday evening. Took her back to my regular vet Wed morning and they admitted her to give her fluids and some IV antibiotics to see if she would respond. An abdominal ultrasound was performed by a specialist with nothing to note but a little “sludginess” in the gallbladder. Xrays performed and again, nothing found. Baylee was still running a fever (spiked at 105 on Thurs) and not interested in any food. They had kept her at the clinic to keep her hydrated on IV fluids. She was wasting away…down to 28 lbs!! Her case had been reviewed by about 7 different vets and they were stumped. The vet said the next step would be to get her back to the vet hospital for further CT scans looking for a tumor in the brain or ???. Otherwise, thinking this may be a immune related response (based on the earlier Panniculitis) we decided to give her a big dose of steroids to see if she would respond. Thank God we found the silver bullet. Within 3 hours, her temp was down to 101. She was discharged on Friday and we were sent home on 20mg Prednisone 2x/day, 250mg Amoxicillin 2x/day and 70mg Baytril 2x/day. Final diagnosis was “Fever of Unknown Origin”.

Her appetite returned but as we would start cutting the dose of prednisone down, the fever would come back. After a dose of Pred, it would go back down. After about 3 weeks of these ups and downs, made an appointment with an Internal Medicine specialist. To our surprise, this is when the next curve ball came.

Mon, Sept 12: Baylee is feeling well going into our appointment..eating, drinking, good energy, weight back to 31 lbs. To our surprise, the CBC reveals anemia and elevated white blood cells. WBC37570 (81% being Neut), HCT 29.3%, PLT371000. Liver values remained off, but the first concern was dealing with the anemia. Blood smear did not show any obvious signs of immune-mediated destruction. No evidence of cancer circulating in her blood stream and no infectious agents identified. Over the weekend, Baylee did have some bright red blood smeared on her stool perhaps due to ulcers from the pred. Since Baylee was feeling well and was asymptomatic, the Int Medicine doc decided to be methodical about finding the underlying cause. Anemia appeared to be non-regenerative in nature. She thought the fever, the proteinuria and anemia may all relate back to an immune mediated origin. Test for Blastomycosis came back negative. Meds now: 5mg Prednisone 2x/day and 500mg Sucralfate 2x/day. In 7 days, reduce Pred to 5mg 1x/day. Plan to recheck CBC in 10-14 days.

Sept 23rd: CBC showed anemia getting worse. WBC31620 (81% being Neut), HCT25.9%, PLT335000. Internal Med Dr recommended bone marrow biopsy to try and get more information on how to treat. Otherwise, it would be trial and error to see what medications may serve her best.

Sept 28th: Bone marrow biopsy performed. No evidence of cancer and appears that her condition is more consistent with an auto-immune condition called Erythroid Hypoplasia or maturation arrest. Her bone marrow is making new red blood cells, but they are not maturing. Meds: 5 mg of Prednisone 1x/day, 125mg Mycophenolate 2x/day and 500mg Sucralfate 2x/day.

Oct 8: CBC showing some positive movement for RBC count, but WBC increasing too and Platelets going down. WBC40300 (83.5% Neut), HCT28.8%, PLT177000. Recommendation was to stay the course and recheck in 2 weeks.

Baylee continues to be doing well…eating, drinking and being spunky. The Pred has gotten her in the mode to think she is always hungry and needs to be fed! Throughout this time, we also have been working with our Holistic Vet. Baylee has been getting chiropractic care, acupuncture and some herbal supplements to help protect the liver and support her immune system. This year has been quite the journey health wise for Baylee and I sure hope we can get things under control and keep her feeling good. She isn’t ready to give up yet and neither am I!! Sorry this post has turned into a novel, but I believe the background is important. I sometimes wonder if it is sarcoma that triggered this whole immune response of first the Panniculitis on now the IMHA. If anyone has any advice or recommendations, I am all ears!

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