Hemolytic Anemia, Low Platelets, Enlarged Spleen, High Wbc's

[kudzu]

Am not sure where to start. So much seems to be going on. My boy Soleil is 11 yo but acts more like 5-7 yo.

 

• Mon., 10/22, seemed to start fine for him. Later in the day my BF saw Sol shaking. We'd never observed that before. By late evening he had lost his appetite.
• Tue., 10/23, morning he was more subdued than usual and had little appetite. Decided to get him to vet the next day.
• Wed., 10/24, he was moving sluggishly, was shivering some and seemed quite uncomfortable. Still no appetite. Loading him into van for vet visit, he yelped & flinched when I touched his abdomen. Saw a new vet who did exam, pulled blood and stool sample. Based on area he seemed painful they decided to do xrays. There was a little spondylosis at a couple lumbar vertebrae but no likely IVDD. They prescribed carprofen & gabapentin. Sent us home to await lab work. By late evening, Sol was moving a bit better.
• Thu., 10/25, Sol woke up seeming better. He was moving better & ate some breakfast, though admittedly slow with a bit of food left. Early AM, vet called with bad news. Sol was anemic with low platelets and elevated kidney values. His retics were only high enough to be "mildly regenerative." Vet mentioned possible IMHA. This scared me badly as I'd lost my first Greyhound to immune mediated thrombocytopenia. and subsequent kidney failure. Took him back in immediately & they started him on IV fluids to flush kidneys and recheck some bloodwork. However, the recheck showed platelets had improved. So vet said it was less likely to be immune mediated. His kidney values were better. "And by the way, he has hookworms." (Where insult meets injury.) Brought him home for the night. Will add, no parasites were seen in blood. I asked for a SNAP4DX test and it was all negative. Vet mentioned tick panel but didn't actually suggest it.
• Fri., 10/26, early AM returned to vet to resume IV fluids. Saw a different vet, one I really. We had a discussion about situation. Gave her my guidelines but let her choose how to proceed with diagnostics. Later got news that kidney values looked good so were backing down fluids to "maintenance" level. Got a call mid afternoon with bad news from xrays & ultrasound. There was a lot of fluid in abdomen, spleen was enlarged and had a mass in or on it. There was also something in/on the bladder. He'd also started showing petechiae. I rushed over. By then Sol's abdomen was showing a lot of bruising. At that point it was suggested that the next diagnostic was an exploratory with likely splenectomy. The thought was this was likely neoplasm that had already spread, something like hemangiosarcoma. My heart was breaking but having gone through this before I was not inclined to opt for the surgery with long recovery only to buy a few months. Decided to bring my boy home for the weekend and keep him as comfortable as possible. For some reason I asked about doxycycline, even though TBD was most unlikely. Vet immediately agreed. We headed home with doxy and Entyce, an appetite stimulant. Vet called soon after and suggested I not give any more carprofen as she wanted to put Sol on prednisone.
• Sat., 10/27, Sol seemed a little worse but not awful. His bruising had spread though. Went back to vet for recheck. Retics were way up. Sol was no longer anemic. Kidney values were good again. We went home with pred & famotadine added to regime.
• Sun, 10/28, we were in holding pattern. Sol was feeling... not bad. Appetite was good. All very encouraging though a bit baffling. Waiting for other shoe to drop.
• Mon, 10/29, Sol is clearly better. Bruising is resolving. Went to vet for recheck. All good or moving in right direction. However, his WBC is high. Looking at bloodwork, I can see it's been steadily rising for days. Vet has added clavimox.

Did ask vet today if there were other diagnostics we should consider. Was worried I am being too cautious. Vet mentioned FNA of spleen. Am seriously considering that. Next recheck is Friday. Crossing fingers we don't need to go in before then.

 

Anyone want to speculate on what is going on? Could it be TBD? Should I opt for the tick panel? Do something else?

[kudzu]

Am going to try to insert his bloodwork. This one is from Wed, It was run at the Idexx labs.

 

 

These are the subsequent tests.

 

 

Note: Didn't bring home copies of kidney values from 9/26 & 9/27 but those were normal. Those values were not run today.

Edited October 30, 2018 by kudzu

[NeylasMom]

Did you start him on the doxy on Friday? The one thing that probably doesn't fit but that was my immediate reaction when I saw kidney and WBC is leptospirosis. Not sure where you are, but there was an article recently that vets are seeing more cases of it and a trainer friend of mine recently lost a client, a puppy if about 5-6 months to it.

 

But I don't think that would explain some of what you're seeing. Lepto testing also takes about a week I think, but you would treat it with doxy. It's not a cheap test, but maybe worth checking?

 

But if there's a mass...though the spleen itself may not be worrisome depending on how enlarged as greyhounds do tend to have larger spleens and if I remember correctly I think an infection might exaggerate that.

 

The anemia certainly fits with the hooks. Are you treating him for those yet?

 

How do they explain the fluid they saw on the ultrasound? As I read I started to think hemangio too, but I wouldn't expect him to be getting better. Unless some of the symptoms are from something else that you're treating. I know, I'm no help.

Edited October 30, 2018 by NeylasMom

[XTRAWLD]

Did he have a fever? (Which would lead me to think a possible infection of some sort that he's suddenly trying to fight). If the platelets are low that explains the bruising (as I'm sure you know). I'm just thinking aloud.... The mass on the spleen doesn't sound very promising though. His alarm when you touched his abdomen is key too - related to the spleen I assume?

 

Thinking of you two.

Edited October 30, 2018 by XTRAWLD

[Remolacha]

I have no real advice, just Anything with a mass on the spleen or fluid in the abdomen scares me, hope it isn’t that bad.

[kudzu]

He is much the same as yesterday but with a little more energy. I've stopped checking him every few minutes to make sure he is still breathing. [Wrote that to be funny, but it is a bit too close to truth.] Appetite has now kicked into overdrive. Quit giving him the Entyce as the prednisone increases appetite plenty enough already. To look at him, anyone unaware of the full situation wouldn't think him very ill at this point. He's definitely not his usual self, but really not too bad. I'm just fearful he'll have another bleed. At least, we assume he had a bleed.

 

NeylasMom, he did start doxy Friday, which would be 4 days after he first started acting ill. Also started deworming that day. (3 days of dewormer; repeat 3 weeks later; then again in 3 months, I think) Lepto didn't even cross my mind. He doesn't really fit the typical descriptions. Lepto is in our area but he doesn't get exposure to areas of higher risk. Not sure how much any of that means. These vets do have a lot of Greyhound clients & know how Greys differ from other breeds. Guess that's not a guaranty they'd be positive when a Grey's spleen is enlarged. I think the mass was their biggest concern. They didn't offer any strong opinions on what the fluid in abdomen was. Bleeding was one possibility. They would have examined the fluids during exploratory surgery. The surgery would have been down at a specialty hospital because of the likelihood of splenectomy and the ICU that could/would require. Since I declined surgery they didn't do further diagnostics that late on a Friday. They actually left his IV catheter in, since we feared I may have to rush him to e-vet over weekend. We honestly didn't expect him to improve. They took catheter out yesterday. If I ask for the FNA of spleen while we're there Friday, it would be done in conjunction with ultrasound. Vet told me they'd be happy to do that sooner if I wished. They could check status of fluids in abdomen and try to get a sample for examination. (I'm speculating on the latter. Vet didn't specify that.)

 

Xtrawld, he has not had a fever. They did offer that the enlarged spleen could explain his response when I touched that particular area.

 

Thanks, Remolacha. Have lost one dog to a ruptured spleen from hemangiosarcoma, confirmed on necropsy, I'm still very scared but a bit of optimism is trying to sneak in. Never thought I would be praying for a TBD.

[NeylasMom]

If it were me I would do the ultrasound and FNA. I really do wonder if you're not dealing with more than one thing. Hopefully it's just the world's worst worm infestation!

[MaryJane]

You might want to consider a tick panel to rule that out.

 

It seems (my opinion) that some of the hookworm infestations are not receptive to the usual treatments and as a result, the dogs with long-term hook damage can develop what can appear to be inflammatory bowel disease (IBD) which in conjunction can bring about protein loosing nephropathy (PLN). Did they ever do a urine?

[robinw]

You might want to consider a tick panel to rule that out.

 

It seems (my opinion) that some of the hookworm infestations are not receptive to the usual treatments and as a result, the dogs with long-term hook damage can develop what can appear to be inflammatory bowel disease (IBD) which in conjunction can bring about protein loosing nephropathy (PLN). Did they ever do a urine?

I was thinking a tick panel would be a good idea, too.

[cleptogrey]

It's so difficult dealing with all of the development in technology. Sometimes it seems so unfair looking at what vets recommend and the price tags attached.

 

Going what you feel you can afford and what YOU feel comfortable with is never easy.

 

I'm not sure of how quickly the Doxy will kick in, that sounds very logical and affordable. But a mass on the spleen is most worrisome. I'm sorry to hear this. Personally I agree with you about not proceeding with surgery.

 

The lepto would not result in a mass. Sleep on it, you sound like you will make the very best decision.

[EllenEveBaz]

No expertise here, just sending tons and tons of good thoughts to your good boy.

[Rakete]

Lack of appetite,anemia, low platelets, englarged spleen and bruising, getting better while on doxy - sounds a lot like Ehrlichiosis.

[kudzu]

Okay, so I've moved his appt up to tomorrow. They will do the FNA of spleen. Will also sound out to IDEXX for a tick panel. The vet stated, "for the anemia PCR panel". When I looked on the IDEXX site, in their list of tests there is the "Anemia RealPCR Panel-Canine" which tests for Anaplasma spp., Babesia spp., Canine Hemotropic Mycoplasma, Ehrlichia spp., Hepatozoon spp., Leptospira spp., and Rocky Mountain spotted fever. Interesting that it doesn't include Lyme.

 

He seems really uncomfortable tonight & that is scary. However, his energy level is the best it's been since this started. So I'm hoping this is a side effect of the pred & not the beginning of another bleed.

 

How does anyone with children survive all the scares? The pet health scares are as much as I can handle. If I had kids I'd be having constant anxiety attacks!!

[NeylasMom]

One of the many reasons I will never have them!

 

TBD does make sense. I just chalked the anemia up to the hooks, but that was dumb. Hopefully you get some clear answers soon.

[kudzu]

The name of the panel surprised me. I went & looked it up because I thought I'd misunderstood or misinterpreted. The hooks could certainly be a contributing factor.

[XTRAWLD]

Lack of appetite,anemia, low platelets, englarged spleen and bruising, getting better while on doxy - sounds a lot like Ehrlichiosis.

I am intrigued by this. Pursuit here would be a good direction. You'd think there would be a fever though? Hmmm.

 

Gotta tell you, it doesn't sound like PLN or Lepto (even though there are tonnes of strains). If he's been vaccinated for Lepto in the past he might call in a false positive on this. A urine sample would be good if not done already.

 

I'm not familiar enough with Ticks or Hookworms to be helpful.

 

Please keep us updated! Glad you are pursuing FNA.

Edited November 1, 2018 by XTRAWLD

[kudzu]

Back from vet. Short(ish) summary:

• CBC today shows everything is now well in the normal range except WBC, which remains unchanged since Monday
• Blood & urine samples collected to be sent off to IDEXX
• PCR panel results should come back early next week
• Aspirate from spleen pulled to be sent off to UGA
• Cytology results expected last next wwek
• Vet said mass on spleen appears noticeably, but not dramatically, larger. (somewhat of a paraphrase)
• Despite now having a ravenous appetite & eating heartily, Sol has lost 4 pounds since last Friday

Our next appt is a week from today. We'll repeat both CBC & blood chem then. Didn't do chemistry today. Right now my thoughts and feelings are turning very dark. I think we're headed down a road of no real return & little hope. Sorry for sounding so pessimistic. Can't help it after that visit. And yet, for now he is, for the most part, holding his own. Will just hold onto that & wait for test results.

 

So what is the current thinking on feeding & maintaining weight with a cancer dog? Will do research but am curious how folks these days are handling this. Is high protein, low carb still the recommendation?

[XTRAWLD]

Personally, spoil him. Feed him whatever he wants to eat. Well let me back up, feed him his normal food, and if he starts turning up his nose to that, move on to something else at that point. He's 11. He deserves it. If he's still acting like a puppy, (relatively speaking), and he looks to be holding his own, treat the patient and not what's on paper. I wouldn't move away from the food that he has traditionally been doing well on. Plus you'd risk getting into stomach issues if you deviate too much or too suddenly, etc. I'm really not sure that a change in diet is going to help the spleen mass, so if it were me, I'd keep it status quo. If anything, I'd probably add in some lentils or spinach, something like that to help keep the platelets happy because they take a long time to regenerate.

Edited November 1, 2018 by XTRAWLD

[MaryJane]

Don't change the food he is currently on as that might create more issues and cause additional confusion. As noted above, only try different food if he won't eat.

[Remolacha]

I agree with keeping on with his regular food. If you want to add more food to try and keep the weight up, more smaller meals. Extra treats and/or add ins, lean protein is best, whatever he likes.

[kudzu]

Cachexia... Am watching it happen. He is visibly thinner each morning and again in the evening. Had a rough night and then vomited once this morning. It was mostly liquid but did contain what appeared to be some of his "midnight snack" form last night. He has zero appetite so I won't offer any more food until this evening. Won't reintroduce added snacks. I don't think I could get enough into him to offset the weight loss by much.

 

Feeling like we're doomed. He's mostly sleeping & am hoping I can keep him reasonably comfortable for the next few days as we await test results.

[FiveRoooooers]

Ive been following and hoping for a better update. There are so many underlying causes for cachexia, sigh. I know that you will stuff your good boy full of love.

 

[Rakete]

Is he still on Doxycycline?

[NeylasMom]

Cerenia can work miracles. Might try that rather than withholding food.

 

To add weight, try cooking whatever the main protein in his kibble is and adding that to his meals (could make it 3 meals instead of 2 so they're not huge). Remove fat first. Also make sure you're not giving ABs or pain meds on an empty stomach.

 

Sorry it's not looking good.

Edited November 3, 2018 by NeylasMom

[XTRAWLD]

I'd try some Ensure or Boost. It will get at least some nutrition into him. Hopefully he's interested enough in some of that liquid protein.

 

He seemed to be rallying there for a bit. I hope he remains comfortable.