Immune mediated disease.
Breed: Mutt - Beagle / Terr
Age: 8-11 years
Our dog was taken to the vet on July 3rd after 2 days of lethargy and falling over after a very short walk. Her gums were also pretty pale. They did a CBC & Chemistry provile and urinalysis. She also has a slight fever. The blood test showed that her red blood cells were low and her platelets were off. The doctor gave her a shot of Dexamethasone and Lincocin. She also gave us a prescription for Vitamin K1 - 50mg, Prednisolone 20mg, doxycycline 100mg, and Cyclophospamide - I think 25mg. Over the next several days she had a couple issues of falling over after a short walk outside to pee. Her breathing became more labored with several instances of heavy panting (side effect of prednisolone??). We took her back to the vet on July 6th and the doctor said she was looking better and continue what we were doing. We went back again on July 9th for another check up. They did another blood test and xrays (I can upload copies if needed). Her blood test showed that her platelets were back to normal and the red blood cells were a little better but the doctor said something was still attacking them. The xrays showed no signs of cancer but did show a little fluid around the heart. The doctor continued all the medication listed above and added Enacard 10mg and Lasix 20mg and a Lixotinic VIT Minneral supplement. At this time our dog seems to be showing a little improvement. She hasn't fallen over anymore, her appetite is great, her urine and bowel movements are normal. She is still very weak and lethargic and has heavy breathing and gets winded by just walking outside to pee. We are concerned about the heavy breathing. Sometimes when she is laying down on either side her breathing becomes a grunt and she has a hard time getting relaxed. Our vet has also not given us a definate diagnosis of what our dog may have. The vet said it could still be cancer or an Auto-immune disease from a tick or other parasite. I guess our main questions are: Is our vet treating our dog properly or should we be seeing another vet? Any ideas of what our dog may have? Is the medication causing some of the breathing issues? And if so do you have any recommendations? Thank you for any and all advice!
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Dr. Marie replied:
Poor Amber...it sounds like she is really having a tough fight!
I have had cases very similar to what you have described with Amber and they can indeed be tough. From what you have described, it really sounds like your vet is doing all of the same things I would. I don't think you could ask for any better care.
There are several things that could cause these problems with Amber and it is often hard to pinpoint the diagnosis in cases like these. When we see low red cells and platelets then there are ways we can interpret the blood work to determine these decreases are due to blood loss, blood cells not being created or blood cells being destroyed. It sounds like your vet has determined that something is destroying Amber's red blood cells and possibly platelets.
The most common reason for this is an autoimmune condition. Usually, when a dog has this, we don't know the reason why. Sometimes we can pinpoint it to a reaction to a vaccine or a particular drug that had just been given but most of the time it is a mystery. Several of the drugs that Amber is being given are meant to stop her immune system from destroying her blood cells. These include the dexamethasone shot, the prednisone and the cyclophosphamide.
One possible reason for platelets to be destroyed is a tick borne disease. Sometimes we can pick up these diseases on bloodwork but not always. So, when we have a dog with low platelets we usually treat with doxycycline which is good at treating most tick borne diseases.
Sometimes certain cancers can cause the body to destroy blood cells such as a spleen cancer. Often if there is spleen cancer we can see evidence of this on xray, but sometimes we need an ultrasound to determine if there is cancer inside the spleen. And even then, there is no guarantee that we'll get a diagnosis.
The weakness is concerning. It's hard to say whether it is because of the prednisone. My guess, however, is that it is because of the low level of her red blood cells. Red blood cells carry oxygen and so if the number of red blood cells is decreased then this means there is less oxygen in the blood. This can definitely cause labored breathing and lethargy.
If the breathing issue seems to be getting worse then it is possible that Amber has developed some internal bleeding. If the platelet level drops to a certain amount then we can start to see more internal bleeding issues. However, as you mentioned that the levels are improving this is probably not the case.
High doses of steroids can cause some labored breathing. But, it would not be a good idea to decrease the dose of steroids as it seems like they are working.
I have seen cases like this go either way. Sometimes we plow through and the medicines help the body get through this and stop destroying blood cells and eventually things get better and better and as the cell levels come up, we decrease the steroids. But I have had cases where we lose the battle despite using the best medicine we have available.
It really does sound like Amber is in good hands. I hope she continues to improve!
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Thank you so much for the quick response. We feel much better now that we got your opinion. Amber goes back to the doctor today for a check up.
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