PET TALES Page 3
Jasmine is a 7 year old female spayed cocker spaniel. She presented to the Veterinary Medical Associates with a two day history of lethargy, shallow breathing, and poor appetite. On her physical exam she was found to be jaundiced (yellowing of the skin), dehydrated, and had a fever of 104.4˚ (normal being 100˚-102.5˚). Her bloodwork showed she was anemic (low red blood cell count) and she was also thrombocytopenic (low platelet count). In addition to not having enough red blood cells, there was evidence her immune system was destroying these cells. This is opposed to other causes of anemia, such as bleeding or lack of production in the bone marrow. She was diagnosed with immune-mediated hemolytic anemia (IMHA) and thrombocytopenia and hospitalized for six days.
In order to treat this disease, we needed to suppress her immune system to stop the red blood cell destruction. She needed fluids and nutrition while giving her body time to produce more red blood cells and platelets. A healthy dog has a percentage of red blood cells in the range of 37%-55%. When Jasmine initially came in her percentage was 25%. As the medication takes several days to start working, her count continued to fall to a value of 19% before finally climbing to 26% a few days later. Once we were sure her RBC percentage was holding, we sent her home where she would eat better and be more comfortable with her family.
Once home, Jasmine responded immediately by eating much better. She went home on Prednisolone and Azathioprine to suppress her immune system, Zantac to prevent stomach upset, aspirin to prevent blood clots, and two antibiotics. One antibiotic was for the bladder infection she developed from suppressing her immune system, and the other was to cover for tick borne diseases that can sometimes cause this disorder. Initially she needed to come back for weekly rechecks until her values returned to the normal range. After achieving this, her rechecks were decreased to every 3-4 weeks..
Now the goal is to taper the immunosuppressant drugs to help her live a healthier life. It needs to be done slowly so that her disease doesn’t relapse. She will always likely need some form of therapy, but hopefully her medications can be kept to a minimum.
IMHA is a disease that usually affects middle age to older dogs. Females are affected more often than males. Cocker spaniels, Poodles, Shihtzus, Lhasa Apsos, Old English Sheepdogs, Border Collies, and Springer Spaniels are predisposed. Clinical signs include weakness, inappetance, vomiting and diarrhea, dark orange urine, and collapse. In animals that are predisposed, certain things can act as triggers. These include: drugs, cancers, tick born diseases, or recent vaccination within 4 weeks. Often times no particular trigger is found.
The main treatment for this disease is suppressing the out of control immune system. Medications that suppress the immune system can be hard on the stomach so drugs to protect its lining are often needed. As these animals are often not eating properly, IV fluids and nutrition need to be provided to avoid dehydration and negative energy balance. Occasionally blood transfusions are performed if the anemia becomes severe enough. The transfused blood cells provide the body’s organs with oxygen so they don’t start to fail as well. Another very serious complication of this disease is the formation of blood clots. Animals with IMHA are at an increased risk for blood clots because of all the inflammation that is occurring within the blood vessels. If a clot forms it can cut off the blood supply to an organ and this organ can then fail. Numerous medications, including low dose aspirin, are used to help prevent this common and life threatening complication. This is the most common cause of death from IMHA. If a trigger for the IMHA can be found, this underlying cause also needs to be treated. Lastly, because the immune system is being suppressed, secondary infections can sometimes develop. We need to monitor for the development of these complications and treat them if found.
Today, Jasmine is doing well. We are currently trying to taper her immunosuppressant drugs to help her live a healthier life. This needs to be done slowly so that her disease doesn’t relapse. She will always need some form of therapy, but hopefully the medications can be kept to a minimum. Her values are holding in the normal range and she is being weaned down on her prednisolone. She enjoys a relaxing life with her owners, Diane and Richard Schultz. Without their care she would not be here today. Jasmine’s appreciation for their care however, seems to have faded. When she first returned home she was very relaxed and permitted them to do things such as regular teeth brushing which she used to not allow. Now she’s back to her old, spunky self, growling at any attempt to do this. Glad you’re feeling better Jasmine!!
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"Your duck is dead" -a joke sent to us by a client
A woman brought a very limp duck into a veterinary surgeon. As she laid her pet on the table, the vet pulled out his stethoscope and listened to the bird's chest. After a moment or two, the vet shook his head and sadly said, "I'm sorry, your duck, Cuddles, has passed away." The distressed woman wailed, "Are you sure?" "Yes, I am sure. Your duck is dead," replied the vet. "How can you be so sure?" she protested. "I mean you haven't done any testing on him or anything. He might just be in a coma or something." The vet rolled his eyes, turned around and left the room.
He returned a few minutes later with a black Labrador Retriever. As the duck's owner looked on in amazement, the dog stood on his hind legs, put his front paws on the examination table and sniffed the duck from top to bottom. He then looked up at the vet with sad eyes and shook his head. The vet patted the dog on the head and took it out of the room. A few minutes later he returned with a cat. The cat jumped on the table and also delicately sniffed the bird from head to foot. The cat sat back on its haunches, shook its head, meowed softly and strolled out of the room.
The vet looked at the woman and said, "I'm sorry, but as I said, this is most definitely, 100% certifiably, a dead duck." The vet turned to his computer terminal, hit a few keys and produced a bill, which he handed to the woman. The duck's owner, still in shock, took the bill. "$150!" she cried, "$150 just to tell me my duck is dead!" The vet shrugged, "I'm sorry. If you had just taken my word for it, the bill would have been $20, but with the Lab Report and the Cat Scan, it's now $150.