Anaplasmosis/Rocky Mtn Spotted Fever/ITP

 Thank you. It's just so hard. I live near Boston and I have never known another dog with rocky mountain spotted fever. I didn't even know it was a risk around here!

 Sable is still in the hospital and not getting any better. She's been on antibiotics since Wednesday and they can't figure out why she's not showing improvement. She'll probably need another blood transfusion either today or tomorrow. It's so hard to see her like this. The vet advised us to sign a DNR today and that was so difficult. She hasn't eaten in 3 days so they are going to put in a feeding tube. I don't even know if we should keep trying to fight this. The vet said there is only a 20-30% chance she'll rebound. Of course I want to give her every chance possible. I just don't know if I'm doing the right thing by continuing to put her through all this treatment.

I wish I had some valuable info for you, but I'm afraid I'm not familiar with the diagnoses your beloved Sable has been given.  Some of what you described sounds like the condition of AIHA or IMHA, for which there is a very long thread in the Diseases/Conditions area.  There are some very knowledgeable people who post regularly to that thread, as well as to threads about very serious medical conditions, but since it's Saturday, there are fewer members online right now. 

Hopefully someone will log on soon with some good information for you.  In the meantime, I'm sending lots of strong vibes to you and to Sable.  I can't imagine the panic and upset you're feeling.  Keeping you both in my thoughts, and I hope Sable stabilizes soon. 

 Yes, I think ITP is similar to IMHA, which terrifies me. I work at an animal shelter and we just lost a dog there a couple of weeks ago to IMHA after a long struggle. That's actually how I found this forum, I was looking for info on IMHA and found the thread here.

 Right now, Sable's blood is at 20 (I think? It's hard to remember everything the vet said) which isn't good, but it's holding steady so they won't do another transfusion unless it drops further. They wanted to get a feeding tube in, but she is SO nauseous, she keeps trying to vomit. Nothing comes up at this point because her stomach is totally empty. The nausea is probably from all the meds (doxy, baytril, prednisone). So they are giving her lots of anti-nausea meds now. It's worrying because the last time she ate was wednesday. She is urinating now, which is good. They are still waiting on the results of a PCR test to see if the anaplasmosis is a new infection or an old one.

 I have been visiting as much as I can and I hate leaving her there at night. I'm terrified I'll get a call tonight in the middle of the night. Last night they called at about 12:30 saying she wasn't doing well but she was stabilized by the time we got there. I keep watching and hoping for even tiny signs of improvement. Right now what I really want is for her to stop vomiting so they can get some nutrition into her.

I have already emailed you and I will PM as well so hopefully you will get ONE of these fast.  Boston?  You're in a good place.  But I'm going to tell you that you **MUST** GO right away to either Angell Memorial or Tufts. (Angell, honestly, would be my preference -- and it's the ONLY specialist hospital in the US I'd say that about but they have a really good track record with IMHA).

IMT -- immune-mediated thrombocytopenia is platelets -- NOT red blood. IMHA is immune-mediated hemolytic anemia -- red blood cell destruction.

In honesty -- GO NOW -- don't even wait for morning if you are still up. if your dog is still at the hospital arrange for transport **NOW**.   It scares me that they are merely calling this thrombocytopenia when it's the red blood that is going up and down. If it was thrombocytopenia they'd be talking platelets alone.

 Now it is POSSIBLE it is both and you said the dog had bruising all up and down the back legs? That's possible it is **BOTH**. When it is both IMT and IMHA they call it Evans Syndrome. It has to be handled VERY carefully and they need to get this dog on serious immune suppressors **Right away**. Usually huge doses of prednisone while they get another immune suppressor like cylosporine and/or azathiaprene going (both of those take longer to get them to an effective level in the body).

These diseases are difficult to treat but not at all impossible. But you MUST get the right vet on board and most regular vets (and particularly not emergency vets usually) are just not capable.  I don't know your vet -- but truly most vets just can't handle these, particularly since it looks like Evans which is particularly brutal. 

Get ALL the records -- in particular you want all the specifics of the blood already given to your dog. After the first transfusion the blood has to be typed and cross-matched if they don't have more blood from the same dog.

I've actualy know of THREE dogs treated at Angell -- it's a darned good vet specialty hospital and usually a bit cheaper (surprise!) than Tufts.    One of the very first dogs whose owner posted to the "AIHA or IMHA" thread went to Angel and her dog is STILL doing well like 3-4 years later!!!

My Billy had IMHA -- he had SIX transfusions the first month. They thot he had tick disease as well (he had a faint positive for Ehrlichea - another tick disease).  Honestly just the tick disease could trigger the IMT and IMHA.  It was what triggered Billy's.  And he hadn't had vaccines in several years.  But that "history" of the bad reaction likely set the stage with the body for later trouble.  The immune system sometimes takes a while to get so dreadfully confused.   

The anti-nausea meds are good -- but you will have to syringe feed her. She won't eat voluntarily. When the blood gets really low they get really sick to their stomach.    But she MUST eat.  They have to have food in their gut to tolerate the meds.  Take a baby medicine syringe -- meat baby food or canned dog food and add water in a blender.  Put the tip of the syringe behind the big canine tooth and hold the mouth loosely shut -- squirt gently so they can work their tongue to swallow. 

For a while don't even OFFER food -- just plain syringe feed them frequent small meals.  It can be really upsetting to them to "want" food but be "afraid" of it making them sick.  So just plain syringing food in can really help -- they typically start with cerenia and then move to Relan or similar (micophenolate) which they can be on longer term.

In my email to you is my phone number -- I'll be home tomorrow after noon -- CALL me or I can call you (I have zillions of cell minutes).  This is scarey stuff and I can help you not feel so scared.  DO go over to the big IMHA thread -- it will help you.  On page 1 of it there is an index the mods put in the very first post -- that will help you as well.

*hugs* -- I know this is scarey.  But you can do it!!

Have they done a FULL blood panel -- so you can see the liver and kidney levels?

They CAN also give her a SHOT of steroid to hold her until she can be treated. That bypasses the gut all together and can REALLY help.

 Hi Callie, thank you for responding. My dog is at Tufts, has been there since wednesday. We took her there as soon as her regular vet looked at her and said "I don't know what this is". She is in ICU there, all hooked up to IVs. I've had a couple bad experiences at Angell, so I went to tufts instead. She has been on prednisone a couple of days now. Not sure what else she is on besides the antibiotics. It is all being injected or put in her IVs because she isn't eating.

 I honestly dont know if they said blood or platelets or what. The have my mother's cell phone because mine isn't working well, so my mother gets the update calls and then relays them to me and I think some of it gets lost in translation.

 They did get her blood type so she is getting the correct blood. Apparently dogs only have 2 blood types and she has the more common one.

 I don't think they'd let me syringe feed her in the hospital... I really wanted them to be able to get the feeding tube in but she just wouldn't stop retching and they don't want her to aspirate.

 They have done full bloods, and they keep testing things like her kidney values (because she wasn't urinating for a little while, but they tweaked her meds and she started up again).

 I do wonder if her immune system has always been bad, since she had such a severe reaction to her vaccines way back when, and also that the anaplasmosis keeps rearing its ugly head.

 Thank you so much for responding, it is just so hard to see my dog sick like this and not getting better. I miss her terribly even though I visit her at least once a day. I will go to see her again soon, and I will post an update on what is going on.

sable's mom

My dog is at Tufts, has been there since wednesday. We took her there as soon as her regular vet looked at her and said "I don't know what this is". She is in ICU there, all hooked up to IVs. I've had a couple bad experiences at Angell, so I went to tufts instead. She has been on prednisone a couple of days now. Not sure what else she is on besides the antibiotics. It is all being injected or put in her IVs because she isn't eating.

If she's at Tufts she's in a good place!!  Specialty hospitals can be good ... and sometimes they may not be as good this year as they were last year (it's becoming increasingly common to see big specialty vet hospitals "bought" by big corporate entitties -- and suddenly you see all the "good" vets leave and suddenly it's not a good place any more!  So let me know what you hear about Angell please!  Like I said, I've seen other IMHA dogs go there).

Often they are in ICU for a while -- and it's really scarey.  If she's on IV then hopefully she's getting her steroids via IV (some of them they CAN do that -- and that way it bypasses the stomach).  ASK THEM. 

As I said in my email -- it is **critical** for YOU to know.  Don't disconnect and let your Mom handle this.  CALL THEM -- **YOU** need to know what she's being given.  You need to know if they are changing meds or if they NEED to.  It's ok for you to suggest things -- or for you to query and say "if she's not eating then how is she getting nourishment. CAN ***I*** DO ANYTHING??  Can I come in and try to syringe feed her??"

don't just assume you can't.  This honestly can be life and death to her -- because most of the fatalies result from dogs that don't eat and so then they can't take the meds.  Usually they won't volunteer to eat when they feel like this  and a student may not have the time to do hand-feeding.  ASK ASK ASK. 

sable's mom

 I honestly dont know if they said blood or platelets or what. The have my mother's cell phone because mine isn't working well, so my mother gets the update calls and then relays them to me and I think some of it gets lost in translation.

You will **need** to know.  AS this disease progresses -- you will need to know and remember **everything** done for her in the hospital.  You'll need to know which was the bigger problem -- platelets or red blood.  Which began to respond first. 

This disease requires more owner cooperation and help than anything I have EVER encountered.  And trust me -- I've done "sick dog rescue" for YEARS.  Everything from mange to cancer to renal failure and beyond.  But never in my life have I encountered anything as difficult to deal with as IMHA.  The worry day by day is incredible.  Not just now -- you may look back on the time when she was in ICU being taken care of by others as the "easy" days for you.  But you'll need to keep your head connected with what's going on so you will be able to help her when you get her back home.  This disease is not short -- it can take many many many MONTHS (Billy was on the big drugs 18 months and then his actual healing BEGAN) but you can triumph over it many, many times.

sable's mom

 I do wonder if her immune system has always been bad, since she had such a severe reaction to her vaccines way back when, and also that the anaplasmosis keeps rearing its ugly head.

It isn't so much that the immune system is bad -- it gets wrong-headed.  It literally gets CONFUSED.  I hope someone has explained to you by now that with the immune-mediated diseases the body is literally pushing the immune system SO FULL SPEED AHEAD and so "ON" that the body keeps looking for things to attack. 

The immune system should go "on" and then "off".  It should go "on" when an invader (like a bad bacteria) is present - it should battle and defeat that bad bacteria and then turn off.  Then the body builds something called an "antibody"  -- which is the body's own little DNA/genetically formed "warrior" specific to that thing it just defeated so if it ever encounters this disease again it will bring this little disease-specific warrior out to "defeat" that thing again.

But with immune-mediated stuff, sometimes the body sees those antibodies and gets confused -- the body says "oh .. that's too much LIKE that bad thing I just killed.  I must kill THIS too!" and it begins to kill it's own antibodies ... and then the antibodies look a whole lot like it's own regular blood so it kills THEM too.  That's an over-simplification of what happens -- but in an immune-mediated disease the body is literally killing its OWN cells. 

Now somehow in some animals (and people) the immune system can be both inferior -- and confused.  It's very complex -- even things like allergies are immune-related.

sable's mom

it is just so hard to see my dog sick like this and not getting better. I miss her terribly even though I visit her at least once a day.

I do understand -- my Billy was in ICU "on and off" for about five weeks (and he was 3+ hours away) -- so I'd be able to bring him home ... and he'd crash and I'd have to race him back up there ... he'd be ok for a few days and then crash again.

We eventually discovered he did NOT have tick disease at all -- his body had built antibodies TO the tick disease (which the antibodies were what presented the "faint positive" tick results) and it was actually the doxycycline itself that was causing a problem (it is often used in human medicine to *boost* the immune system).  It took four weeks to get the tick panel (a honking huge tick test) back to determine he did not have tick disease and they took him off the doxycycline.  SUDDENLY then his body kicked in and the immune system backed off.  For some reason with Billy's consistution the push he got from the doxy was equal to the push down from the immune suppressors (and he was on a TON of immune suppressors)

If you are to a point where she is just not responding to the immune suppressors ask them to take her off the doxy for 24 hours and SEE if it makes a difference.  It doesn't often happen, but if the vets feel the battle is 'lost' anyway it can be a last ditch thing to try that can be successful.  They want the doxy because it's the gold standard drug to fight tick disease.  But there ARE others that can be used.

 Good luck!!

 (((hugs)))

 I'm so sorry; ((( hugs)))

 Thank you, all of you. It was so so difficult, but it was time for her to go. She was so sick and not getting better. Today she went downhill in the few hours between visiting sessions and it was terrible to see her so sick that she couldn't even pick up her head. I know this probably sounds crazy, but I had an animal communicator talk to her. This woman had talked to Sable before and was really accurate (and there's no way she could have known the things she was telling us). Since I was having such a hard time with the decision, we asked if she could talk to Sable and let us know what she was feeling. The communicator said Sable was ready to go and wanted us to help her pass. It helped make the decision a bit easier for me. It was all very peaceful. I'm very sad right now and I'm going to miss her more than words can say, but I know that she's no longer sick and suffering.