Happy New Year! We wish you and your current or future rescues a fantastic 2012!
Last month Petey gave us a bit of a scare. As I was walking through our front door, our eldest son let me know that “Petey was walking funny.” Now, this was a bit of a concern because Petey has a permanent limp, partly from his osteo-arthritis and partly from a bone infection quite a while back. I wasn’t sure what “walking funny” meant given his normal limp.
When I made it all the way through the door, Petey came to greet me as he always does when I come home. My son wasn’t kidding when he said he was “walking funny.” The best way I can describe it is that he was high-stepping with every step, his head was tilted to one side and he seemed to want to tip over. It was as though he didn’t have any sense of balance or perception of where the floor was. So many things ran through my head – did he have a stroke? Did he lose partial eye sight? Did he have an ear infection or something worse? I examined him and he was able to follow my finger so it seemed as though his eyesight was ok. His limbs all seemed to move normally so it didn’t appear to be a stroke.
Being a researcher, I went to my laptop and started the search. There were several posts from people that had a dog with similar symptoms. After reading through several responses from vets, I started to feel a little better. The diagnosis of “canine vestibular syndrome”, “vestibular disease” and “old dog vestibular syndrome” seemed to come up time and time again. Our vets office had already closed for the evening and based on what I was seeing and reading, I opted to wait until the office opened. With Petey’s very long history, I felt more comfortable waiting for Dr. Slusser.
I called the office in the morning and described his symptoms – the initial thought was – canine vestibular syndrome! He was due for his annual check-up later in the month, so we decided to move it up a and check him out all at once.
I was able to make an appointment for later that week and by the time I took Petey in, he was almost back to “normal”. I found out that in some dogs, the symptoms are so bad that they can’t even walk, they literally “roll over” to move. The good thing about canine vestibular syndrome is that it typically resolves itself in approximately two weeks, and once they’ve had it, it usually doesn’t come back. In some cases, the head tilt can remain but it doesn’t seem to bother them. If the symptoms are severe, your dog may not have an appetite – imagine being sea-sick and trying to eat. If this is the case, anti-nausea medication can be prescribed. Hopefully your faithful companion won’t encounter this syndrome, it is difficult to watch. If the symptoms ever appear, please contact your vet for a full exam and proper diagnosis.
And now for the happy ending to the story – All of Petey’s labs came back as “normal”. No sign of his immune mediated hemolytic anemia, and his thyroid (T-4) levels are normal as well!
Petey on the mend
The last post left off at a critical point in our journey. Petey’s prognosis was not looking good, and we could only hope that the new combination of medications would help turn things around.
Our follow-up appointment was on October 6th, and Petey’s numbers remained fairly stable. He developed a rash on his hind end which ended up being a reaction to the Metronidazole. We switched to 150 mg of clindamycin, two tablets – twice daily. We were able to decrease the prednisolone to 20mg every other day. We scheduled a two-week recheck.
October 20, 2009 was the first happy (ok ecstatic) day since Petey’s initial diagnosis. One of the Techs who was now like family, raced out to show me the lab results. I couldn’t believe what I was seeing. Everything fell into or very near the middle column which was “normal”!!!! His red blood count was still a tiny bit low, and the RDW which measures the variation of red blood cell sizes, was still on the high side. This however, was the best CBC result since August. I think even our vet was a bit surprised at how resilient our Petey had proven to be. It was so good to receive positive news.
We were able to stop the clindamycin, Lasix, and prilosec, and scheduled a re-check for one month.
The eighteen months or so since that time have been a series of baby steps moving in the right direction. After a small setback due to a staph infection, Petey is down to two medications. Imuran every other day, and Soloxine .5 mg daily. The Soloxine was prescribed earlier this year when his lab work showed that his T4 levels were almost non-existent, and he was diagnosed with hypothyroidism. He will be on those two medications for life.
We are eternally grateful for the amazing care from Dr. Slusser and his staff. They are the reason Petey is still here to share his success story. If you are in San Diego and ever need an internal medicine vet, he is the absolute best!
Petey Shaved for Ultrasound
Petey’s treatment for Immune Mediated Hemolytic Anemia (IMHA) would prove to be a complex one. His follow-up was scheduled for August 31. Thankfully, things at that point did not get worse, his medication was unchanged, and his drains were scheduled for removal on September 4th.
After the removal of his drains, we continued to monitor his progress and scheduled a follow-up appointment for September 14th. In the days prior to the follow-up he seemed a bit lethargic, and his appetite dwindled. We discussed this at the recheck, and as normal, a CBC (complete blood count) was performed. The news we received was not positive. His hematocrit was 21, down from 31 the week prior. He was given another ultrasound to rule out or confirm any other complications. A blood clot in the vein to his spleen was discovered. The only way to remove the clot for certain would be surgery and we were all in agreement (including his vet) that it would not be a good option as he would likely not survive the surgery.
Our only other option was to give Petey daily heparin (anticoagulant) injections. At this point we needed a miracle. I tried to prepare for the worst, and contacted Forte Animal Rescue to give them the sad news. They are an amazing Rescue Group, and like anyone familiar with Petey’s story, huge supporters. I wasn’t prepared for the news and my heart sank, but I wasn’t ready to give up hope. When I left the office with Petey, our new regimen was:
Baytril (antibacterial) 136mg tablet once per day, Metronidazole (antibiotic) 500 mg (1/2 tab twice per day). Imuran (immunosuppressant) 50mg 1 tablet every other day. Prednisolone (corticosteroid) 20mg, two tablets every other day, Lasix (diuertic) 50mg ½ tablet daily, Baby Aspirin ¼ tablet daily, Heparin (anticoagulant) injection .4ml every twelve hours, subcutaneously. Prilosec (acid reducer) tablet, 1 per day.
I created a daily chart and used two pill organizers to keep his medications straight. Getting him to take that many pills was a challenge that involved pill pockets, peanut butter, deli meat and an occasional piece of cheese. The next week would be the telling week, and as grim as it was, I still had to hope for the best. To be continued….
After Petey’s diagnosis of Immune Mediated Hemolytic Anemia (IMHA), we began our journey into treatment. He had been in the hospital for several days and was released on August 17th, 2009. He was prescribed: 50mg of Azathioprine daily, 1 ½ 20 mg tablets of Prednisolone, twice daily, ¼ 80 mg baby aspirin daily, and 100 mg of cyclosporine, every eight hours. A follow-up was scheduled for August 19th.
On the 19th, we continued all medications as previously directed and a recheck was scheduled for August 26th. In the days in between appointments, Petey’s abdomen started to show signs of what appeared to be bloating. I called our vet and found that it was most likely Ascites, an accumulation of fluids in the peritoneal cavity. Unless it gets considerably worse, we were given the ok to wait until our next appointment. At the appointment, he was prescribed 50mg of Lasix for the swelling. His CBC showed slight improvement.
A few days later his abdomen was the same and now one hind leg and front leg was very swollen. On the 28th, we were back in ER. It was determined that the swelling was part of the ascites. By the 30th, we were in ER yet again. The swelling was so severe in his front leg that we didn’t feel we could safely wait until the next day (Monday). This time, a Penrose drain was recommended to drain what had become an abscess in his front leg. We were sent home with the dreaded e-collar, 375mg of Clavamox and 50mg of Tramadol for pain and we were to see Dr. Slusser as soon as possible. We were able to get an appointment on August 31st and Petey was given an ultrasound to check his heart – to rule out any other causes for the swelling. Cardiac problems were ruled out and a recheck and drain removal was scheduled for September 4th. To be continued….
After receiving an initial diagnosis of Evans Syndrome and an estimate of 2,000 to confirm the diagnosis, we sought a second opinion. We opted to take Petey to a long-time family friend who is a veterinarian. Although we respected the opinion of the initial hospital, we just felt more comfortable having another consultation with someone that we knew. We were then referred to Dr. Slusser, an internal medicine specialist.
We took Petey in immediately for evaluation and treatment, knowing by then that he was a very sick boy. His energy level was non-existent, and I was worried that he might not make it through the night. He was seen by Dr. Slusser who confirmed that he was in very serious condition. He was given a complete ultrasound and additional blood work was ordered. His red blood count was so low that he was admitted into ER for blood transfusions. Without them, it was doubtful that he would pull through, and even with the transfusions, there were no guarantees. After the final round of blood work, it was confirmed that Petey had Immune Mediated Hemolytic Anemia (IMHA). Like with Evan’s Syndrome, IMHA is a disease that attacks its own red blood cells. Evans has an additional component that also attacks the platelets which thankfully was not the case with Petey.
Petey was given a 30% chance of survival, with the first few weeks after diagnosis being the most critical. It was not a good prognosis, but Dr. Slusser worked with us in terms of what our best options for treatment would be. To be continued…