Please help, new diagnosis

[Amber]

Hi everyone, this may be a long post so I apologize in advance. I have a boxer mix who is 7.5 years old and weighed about 100 lbs.

Little background, 4 years ago he got very very sick. His symptoms were all over the place, he lost a ton of weight and muscle mass, stopped eating swollen lymph nodes, hind leg weakness and a bunch of other strange unrelated symptoms, nearly every day was something else. We ran every test in the book, all came back negative his blood count was fine and the vet determined it was some sort of unknown autoimmune disorder. We put him on prednisone and he got better gained weight back and has since been on half of a 20mg of prednisone every other day otherwise he had hind leg weakness.

Last august we found a lump on him, had surgery to remove it but clean margins were not achieved since it was on his leg and it was a soft tissue sarcoma stage 2. Not known for matastizing but for reoccurring in the same spot since we couldn’t remove it all. With the help of a holistic vet and a very awesome drug called artemisinin the rest of the remaining tumor was destroyed and has not came back.

The problem now, on Tuesday night he was fine but I noticed he was moving slower. I chalked it up to his age and how big he is and thought possibly arthritis and would get him to the vet on Thursday. Well Wednesday, again fine just moving slower seemed sore, I checked his gums and they were white and I rushed him to the vet. His RBC was 17, he had lost 15 pounds since his last visit in April which they said was mainly muscle mass which is why you couldn’t tell as much and his lymph nodes were swollen. They thought he had a bleed in his gi tract, hopefully and ulcer from long term prednisone use but they suspected possible cancer due to the other symptoms and his breed. They put him on sulcrafate 3x a day to coat stomach if it was ulcer, advised us to stop prednisone. So Thursday we got him in to a different vet for an abdominal ultrasound and another blood test. They found nothing to confirm ulcer, no masses but they did find “unusual stomach lining” and cystic kidney disease. She thought that was just a coincidental find and not causing any harm because his kidney levels are normal. His RBC was now 15, protein levels normal which made her look as his blood under microscope and then she said she believed him to have regenerative IMHA. They can do blood transfusions there but only one safely because it is not blood matched. The closet place that does do them is 4 hours away, we live in northern MI and he would have to be hospitalized and that that may not even save him it would buy us time to try and figure it out. I’d do anything to save him but he has seperation anxiety, he gets car sick on long car rides and him being hospitalized seems cruel to me since I know he would be freaking out. They said with his blood count dropping the way it is they don’t think he’d make it until Monday. We made the heartbreaking decision to have him put to sleep on Saturday, I asked her how could I put down a dog who I know is sick but seems so fine. He’s eating still, barking at every car that drives by, chewing on his toys etc. she said well will do another blood test to bring you peace of mind that your doing the right thing, she expected his blood count to be down much more and we put him on medicine as kind of a last hope,

Sulcrafte now 4x a day
Azathioprine, a very high dose of prednisone 80mg twice a day.
Prilosec to help his stomach from all the medications.

So Saturday we took him in did his blood count and RBC was now 15.5. So it went up a teeny tiny bit!!! But now his WBC is slightly high, so she put him on an antibiotic and said let’s give him until Monday, test his blood again and go from there. She said he also had a heart murmur now that he did not have on Thursday. So here we are now, I know this is a long story I’m just looking for any advice or input I can get. He is still acting normal today aside from tiring easily, his gums are still white but his tongue isn’t.

Does anyone have any advice? I’m desperate here. We are so grateful to have our baby home with us even if it is just for the time being. :( Thank you all who read this!

[Vally]

Hi Amber, and welcome to the site, although I’m sorry you’ve come looking.

Don’t apologise for long posts, it explains more and that’s always better.

First of all, you are an awesome mum having gone through all this with your boy and helping him so much and to have quickly recognised the white gums and the significance of that emergency. What is his name?

I’m wondering if there may have been a tick issue 4 years ago, with the test coming back with a false negative. It would explain a lot of things. Patrice is an expert on tick diseases as well as all AIHA stuff (and other stuff) and I’m sure she’ll be posting soon.

First of all, I wouldn’t make the decision to put him to sleep yet. If, as you say, he’s eating, barking and still having a good time, then it’s not the time yet. Of course, I understand you don’t want to let him get to a stage where he’s having no quality of life, and delay things, but I don’t think he’s there yet.

With bloods, you, or your vet, could contact Hemopet and have them send the bloods to your vet. Dr Jean Dodds is our Angel on this site, having saved many of our dogs with her advice. She runs a canine not for profit blood bank, Hemopet, and the bloods could be accessed there and that way if your boy needs it, it can be done at your vet’s office. If your boy needs bloods, make sure that they are not overtransfused, keep the PCV under 25, or the dog’s body think’s it’s fine and won’t start to make any red blood for itself. See
https://www.secondchanceaihadogs.com/AIHA_Terms/transfusion/

You could even do a consultation with Dr Dodds directly, or again, through your vet. I’ve done this and many of us here have also. She’s brilliant with her diagnoses and suggestions for help.

I’m wondering whether your boy may need some thyroxine to help stimulate the marrow to produce red blood cells. Even if a dog is not hypothyroid when tested, Dr Jean often recommends they start thyroxine. This has helped many many dogs who have been stuck with low PCV results, my boy, Bingo, included. In fact Bingo was on thyroxine, but I wasn’t giving it correctly (without food). When I changed the way I started to give it, he began to finally improve. So that’s a possibility.

Keep up the good work boxer boy. Your tiny improvement is an incredible improvement !!!

My very best, Vally, angel Bingo, and the new pest, Saba.

[Vally]

By the way, “regenerative IMHA” is the best news in this disease !!!

Vally

[Amber]

Thank you! His name is Liam, we’ve been through so much with him and he has truly beat the odds again and again. It’s disheartening reading the statistics on this awful disease, with his cancer there were facts and it was somewhat predictable. He was diagnosed with that last August and wasn’t considered cancer free until December so to have this happen now uh my heart just breaks for him.

We of course do not want to put him down but we also do not want him to suffer, we’ve spoken to 3 different vets last Thursday and they all said that with how fast his RBC was dropping he wouldn’t make it until Monday. Our vet is open Saturday’s that’s why we made the appointment to euthanize him then but also to do the blood test again to give us peace of mind that we were doing the right thing. All 3 of the vets were expecting his RBC to be around 10 because of how fast it was dropping. Low and behold it went up the small percent but small enough for the vets thank god to tell us that they didn’t think it was his time and we should take it one day at a time.. continue testing his blood and go from there. We have an appointment in one hour to get it checked again and I’m praying it’s gone up a little again. They don’t understand how he is acting as fine as he is. He truly is a “pleaser” type of dog and would do anything to make us happy so he could be hiding that he’s not feeling well. However he is a pig! He takes his food very seriously and again thank god he is still eating, if he wasn’t I would know that he was absolutely feeling awful. Aside from acting more tired and weaker he’s fine but this morning he did wake up kind of drooling which is a tell tale sign he’s about to puke I waited a little bit to feed him his breakfast to see if he’d get sick and also worrying because I thought this will be the time he doesn’t eat. The nausea passed eventually and he ate his breakfast plus drank his bone broth with the sulcrafte in it for faster absorption and has been fine ever since. I’m hoping he was just nauseated because of all the medicine he is on and that he hasn’t got any worse.

I’ll mention the Lyme disease again today, 4 years ago when he got sick the vet was convinced that it was Lyme disease. Lyme isn’t found around where we live though but once we mentioned that we do visit the upper peninsula occasionally he said let’s test him because I think it is Lyme. It came back negative though and that’s when he was stumped and said it must be an auto immune disease we put him on the prednisone and he got better quick. He lost a lot a lot of muscle mass when he was sick then, his head looked sunk in.. he wasn’t able to open his jaw all the way and so he was also diagnosed with masticatory muscle myositis, immune related again. That has been 4 years ago now and Liam recovered amazingly fast from that and has had no flares up. He gained muscle back and his head didn’t look sunken in anymore, it really shocked the vet and was totally not a text book case of it. Especially because he is a big time chewer still to this day. The only reason he was kept of prednisone, just 10mg every other day was because of the hind leg weakness not jaw pain.

We are off to the vet, wish us luck. Maybe later I’ll see if I can upload a copy of his blood test? Thank you again I appreciate your reply.

[Patrice]

Amber,
I am so sorry to read how complex and confusing this is and in addition, there is a critical time element making it more stressful.

First. I have seen many dogs do “OK” with very low hematocrit / PCV levels. The critical consideration is if the vet can stabilize the dog so that they are not hypovolemic. Fancy word but it means that the blood volume gets too low, there isn’t enough fluid. Giving subq lactated ringers is a perfect solution to this. You could even do this at home. The blood proteins being at the proper level also contribute to improving this situation. They help the blood from leaking fluids into the local tissues.

You are correct to begin worrying about a transfusion at this point. I am sorry this is so stressful. As Vally points out Hemopet ships safe canine blood products around the world and if you vet can contact them they can deliver this right to their clinic. If your vet feels unsure about how to proceed with the transfusion, Hemopet provides vets support and information about how to safely transfuse. Your vet is correct, dogs get one “free” transfusion, unlike humans who can have transfusion reactions to unmatched untyped blood products. But Hemopet provides universal “doggie” blood that is free of these reactions. They will answer any questions that your vet may have about this. If you go to this webpage, the link to the blood bank is the fourth on the page.
https://www.secondchanceaihadogs.com/hemopetresources/

So it does sound like he is stable. So what’s next? Well it’s hard to approach any treatment protocol without having all the diagnostic information.

Your vet examined a blood smear and found reticulocytes. These cells are immature “baby” blood cells that have been released from the bone marrow early, in response to the body’s need for more oxygen (because of a low number of red blood cells.) With a PCV / hematocrit of 15% we should be seeing a huge increase in the numbers of reticulocytes. In fact they could be as high as 500,000 absolute and anywhere from 2-5%. Normal healthy dogs and humans have a value of about 1% and 60,000 because they are not anemic. So it would be helpful for me to see the results of the last two CBC and chem screens. If you can upload those to me on the Urgent Advice page I will look them over and explain some things to you.

Past conditions are always very interesting and I have often found that owners eventually forget about certain signs and symptoms from the past that really play a large role in the current condition. Any kind of cancer contributes to an inflammatory condition in the body that leads to an increased metabolism and rapid muscle mass loss. This is called cachexia. We also see this in dogs with other conditions like heart disease.

Inflammatory conditions are an increase in the level of inflammatory cytokines in the body. These cytokines are excreted from immune cells like helper T cells and macrophages, and certain other cell types that promote inflammation. They are called interleukin, tumor necrosis factor, interferon gamma and others and play an important role in mediating the innate immune response. Excessive chronic production of inflammatory cytokines contributes to inflammatory diseases.

So these inflammatory cytokines are directly related to some of the problems he has had in the past. Dr. Dodds talks about “anemia of chronic illness.” By this she means that the body systems do not act independently of each other. And a highly inflammatory condition (such as a cancer) can lead to other systems beginning to complain, such as the bone marrow. This can lead to anemia, usually of a moderate degree, for instance with a hematocrit / PCV hovering around the low 20%. (Normal for most humans and dogs is about 45%.) It is possible that he still experiencing this.

Looking at the continued use of prednisone is important because prednisone affects all body systems, some in very negative ways. As your vet may have discovered, especially in dogs, prednisone usually leads to stomach and esophageal ulcers. The sulcrafate was a good idea as it is like an internal bandage that heals. But we also need to look at the negative effects on other body systems that come from long term prednisone. Short term, prednisone can save lives and is a very important treatment in AIHA / IMHA. But at some point there should be a shift to other drugs that have less side effects and are even more effective. One of these drugs is called cyclosporine, my favorite. Your vet probably has some Atopica on the shelf right now. This drug achieves the reduction of the autoimmune destruction of red blood cells in a different way than the prednisone does. If this were me I would want to switch the burden to this drug and begin slowly reducing the prednisone.

On this page, there is a protocol written by Dr. Dodds that I would like you to open and print for your vet. They may find the information very helpful in trying a treatment protocol. This protocol saved Chance’s life so many years ago and continues to save dog’s lives all over the world. Look for Immune mediated Hematological Disease and Bone Marrow Failure and click to open, if you click in the upper right corner it will expand it to a full page and you can save and print from here.
https://www.secondchanceaihadogs.com/hemopetresources/

Ticks generally do not transmit just one tick disease, they are typically loaded with several very serious diseases. Lyme is a very bad tick disease, but it has more of a neurological, tissue damaging action. Other tick diseases like ehrlichiosis and anaplasmosis can cause serious blood conditions such as anemia. The list of signs and symptoms of these two conditions is an arm long. Ehrlichiosis can be contracted, show as a moderate condition and then disappear for up to several years as it reproduces in the body. Then it reappears as a deadly condition, causing hemolytic anemia and rapid decline.

Testing for these tick disease is very simple, the test is called SNAP4DX+, it requires a tiny bit of blood and can show a negative or positive in about 8 min in the vet’s clinic. No kidding. Human medicine doesn’t even have as simple a screening test as this! It shouldn’t cost more than about $30 or so. See if your vet can be convinced to run this for you asap.

Do you have any specific questions for me? Please upload your test results so I can look at them.
my best, patrice