Help for Dogs Fighting IMT Immune Mediated Thrombocytopenia

This is the blog post I dread writing. I always knew that Cocker Spaniels, more so than most other breeds, are extra prone to IMT, immune mediated thrombocytopenia. This blog post will serve as a journal of my dog’s battle to fight IMT, what we are experiencing, his journey, and hopefully this diary-style blog post will help answer questions about this disease and how it may affect your dog, no matter if the dog is purebred or mixed.

IMT in dogs

Saturday, October 7th, 2017

Immune Mediated Thrombocytopenia Day One

My dog is living a natural, more organic, less chemical life. He consumes an amazing diet, does not get vaccines any longer except for rabies required by law, and he never gets any sort of chemical put onto his coat or skin.

On Saturday, October 7th, my wife and I packed up the car and headed out of town for a day of fun on the beach with the dog in New Jersey. There, the dog played, ran, showed tons of energy, had snacks, and an overall amazing day was had by all.

Upon arrival back home about 11:30 pm, I decided to check my dog’s ear, as I thought he may be battling an ear infection, common in Cockers but only the second time ever for Dexter. I noticed he had some lumpy looking reddish marks on his inner ear flap. I immediately checked Dexter’s gums. They were normal in color and capillary refill was good, but he had some bleeding along the gum line, and in particular between two teeth on the right side rear portion of his mouth. I noticed splotchy red marks on the inside of his upper lip flaps, too.

My spouse and I rushed our dog to the emergency vet/hospital located about 10 minutes from our house.

He looked like this when we rushed him to the vet:

IMT

Panic and Diagnosis

We met with the emergency vet on call and went through the gamut: Discussions, tests, and more. Dexter had a platelet count of zero. Yes, zero. None. His own body’s immune system attacked platelets as if they are threat and thus, he was starting to bleed. The tentative diagnosis of IMT was made.

They did a chest x-ray and abdominal x-rays. Both normal. They do not do transfusions. We were told he would need to be hospitalized for 3 to 10 days and will be getting steroids and a chemotherapy drug to boost his platelets, among other things.

This came out of nowhere. All his other levels are fine. As of this writing, he is not anemic. When a dog is anemic in this situation, a diagnosis of IMHA (immune-mediated hemolytic anemia) is made. When IMT and IMHA are both present, the diagnosis of Evans Syndrome is made.

As of this writing, we are dealing with immune mediated thrombocytopenia (IMT).

Mommy and me

IN A NUTSHELL: I DON’T WANT TO READ FURTHER BUT WHAT HAPPENED?

My dog, Dexter, survived. You can read through everything, but as of 10/12/17 he is home with us, a long road ahead, followup appointments, and blood draws, watching for relapse, but this can be managed. You can read through all of this to see what happened.

Sunday, October 8, 2017

Day Two

We cannot bring him home until platelets stabilize. They generally check platelets when they first see the dog and then not again for 48 to 72 hours. The reason for this we are told is that whether the platelets read 0 or 7,000 that is still low. You want them in the 40,000 and up range and eventually over 200,000. Just as a side note, Dexter’s platelets at the end of June of this year were 459,000. This happened that fast.

Dexter’s red blood cells are good and so far, and praying it stays that way, no signs of anemia. That is a good thing. They are picking him for a small blood amount for in house smears. I checked his gums while there and they are good, but yes, they are bleeding. We are told that is to be expected.

No rectal or urinary blood.

We were allowed to visit twice today.

Dexter ate his food for us, had treats, showed a wagging tail, peed and pooped for Dar outside, and then he lay by me. He literally lay across me. I curled up with him and sobbed til my eyes felt like they may fall out, for an hour at least. I couldn’t help it. He had no idea. He fell asleep, and he definitely is feeling the effects of what they are giving him.

The vet is concerned about watching him over these next 3-4 days, she calls critical, so that there is no bleed into his brain or heart. He has to stay in house to be watched.

He is getting IV fluids, injectable prednisone, got one vincristine injection, doxycycline in case tick related and they don’t think it is, Baytril for infection including in ear, melatonin and Tresaderm for his ear infection.

She did a quick standing up abdominal ultrasound of him today and that was normal. The more in depth one will take place Tuesday with the internist.

His vitals were normal.

They see at least one diagnosis a day of IMT (immune mediated thrombocytopenia). The internist apparently is well versed in this. If we feel good about that, we will keep his care for this disease at that vet and then our regular vet for everything else.

At some point, if none of this works, he can be transferred to a vet hospital for immunoglobulin infusions – but we do this first and see what helps.

This will need to be treated aggressively and with frequent blood work, so I prefer this hospital that is within 10 minutes of our home. They do both emergencies and hospital care plus have specialists on staff.

The vet also said she sees dogs come in with this diagnosis and they are so much sicker outwardly, but Dexter is still guarded.

He had no vaccinations, nothing unusual, and chest x-ray and abdominal x-ray are normal, all of his bloodwork is normal except he had zero platelets. No tick borne diseases. He’s been bright alert and responsive and played yesterday, has a great appetite and drinks water.

Medications as of Day Two

  • Tresaderm for ear infection
  • Dexamethasone injectable steroid once daily
  • Baytril
  • Doxycycline in case tick mediated disease, but everything coming back negative on that end
  • Melatonin: Something to do with helping boost platelets
  • Omeprazole: Gastric care
  • Vincristine: One time shot

Articles of Interest on IMT in Dogs

I am keeping these articles bookmarked. I’ve learned that sometimes well-intended advice is not helpful. Every dog is different and every treatment route is different. If you read articles online, be sure the medical information is sourced and valid.

IMT Article

IMT Thorough Article

Sunday, October 8, 2017

Day 2-1/2

DEXTER UPDATE, 8 AM EST, 10/09: Dexter’s vitals are stable. He ate some food overnight. His red cell count is stable. He cant come home til his platelets are stable. Normal low end is 200,000. They want him to have at least 40,000 before he is “out of the woods.” As of this morning, he has a grand total of 4 (yes, only 4) platelets on his smear. It can take 3-7 days before effects of the meds they are giving him take effect.There is so much that has happened in the course of 48 hours, that words fail me. Me, of all people: Failed by words. I have decided to arm myself with as much information as humanly possible and stop listening to the negativity and sad/bad stories. Every dog is different. Every treatment plan is different. This is the one thing I have learned. I am really feeling like millions of shards of broken glass. We got permission to come see Dex at noon today and feed him there. He will be in the hospital at least a week, maybe more. Let’s pray he shows improvement sooner and we can bring him home to recover once platelets are stable.

Why is he not getting a transfusion? This is the most asked question I am receiving. Why is he not getting platelets? We found this on a reputable veterinary website on the topic: “Whole blood transfusion (and platelet-rich plasma) Most dogs with primary ITP usually present with peripheral platelet counts less than 20,000, and often less than 10,000. Although these dogs are theoretically at risk for spontaneous bleeding, in truth this is rarely noted. As mentioned above petechiae or ecchymoses or epistaxis are not uncommon, but bleeding into the lungs, pleural space, or CNS is very rare without concurrent trauma. Routine transfusion of ITP dogs with ultralow platelet counts is not recommended for several reasons. First, the amount of blood which would be required to increase a patient’s peripheral platelet count is huge, and unrealistic. Second, transfused platelets are likely destroyed more rapidly than the patient’s own cells because in addition to being targeted by the anti-platelet antibodies causing the ITP, they are also inherently more antigenic (we do not cross-match for platelet compatibility). Finally, platelets have a relatively short half-life, and repeated transfusions would be necessary to maintain the peripheral platelet count above 20,000. Despite these limitations, transfusions are definitely indicated in those rare patients with ITP that present with or develop life-threatening hemorrhage. Whole blood or platelet-rich plasma is required in these cases.”

His care will remain local at the veterinary emergency and referral hospital unless he needs to be transferred elsewhere and/or if we feel his care is compromised or they aren’t able to best serve his needs. We have access to Philadelphia, New York, etc but they are several hours from us. I’d really like a local internal medicine vet to provide care, direction, med adjustments, and the frequent blood draws we faced once Dex is discharged. I will know more by Tuesday evening to that end.

mommy and me

 

DEXTER UPDATE, 3 PM, 10/09

We visited Dexter in the hospital, spent a half hour talking to the Critical Care Doctor who is overseeing his case, and we also talked on the phone to his regular veterinarian, who is apprised and up to date on Dexter’s records, as they were faxed and emailed to him.

Overall Dexter looks great, he drank a bunch, ate for us but spit the veggies, and he ate soft treats. He peed and pooped, and this time the poop was black. We are told it is not internal bleeding, but rather, blood he is swallowing from gums bleeding. He has no internal bleeding and his urinary system is good.

Specialized tick borne disease testing was sent out (blood) and that will be back in a week. In house stuff was negative.

His platelets have not changed, still a total of 4. His red blood cells are low normal at around 35 (41 on admit) but he is not destroying red blood cells: He IS on IV and the red cell slight drop is probably from loss and not destruction. So that’s good news.

The vet called his gums “rosy pink.” The petechiae is still there but not as prominent. I did not see heavy bleeding in gums.

They are testing his blood on a smear twice a day, but they may do a full draw tomorrow with IDEXX machine in house.

He will see an internal medicine specialist at some point tomorrow, Tuesday, whose protocol for treatment that Dex is on was designed specifically for Dex.

No transfusions yet of anything but time will tell. Again, it takes 3-7 days to see any sort of platelet increase and we have every prayer coming out.

His vitals are good. Our vet said this is a great protocol, stay with it, and he manages a lot of patients with ITP.

We are going back at around 9 tonight to feed him. I don’t think they are taking him out to pee often.

So things are steady, and the one thing the vet said today is she is surprised that he does not have petechiae on his abdomen or on his skin elsewhere. The fact he doesn’t is good.

Our vet said we acted fast, so we did the right thing.

Every prayer, hug, email, phone call, text, and DM are so appreciated. That is about the only thing holding us up.

Love and hugs and major wigglebutt wags from Dexter and his moms.

Here is a pic from today’s visit and the critical care vet talking to us while Dex just chills. He is disoriented a bit and I know he wants out. He has to get these platelets up.

vet visit

Tuesday, October 10th, 2017

Immune Mediated Thrombocytopenia Day Three

DEXTER UPDATE, 10:30 am, 10/10:

The hospital called and I talked to a vet tech. The internist wants to see me at 11:30 to go over everything. She says Dex is stable but that the doctor would go over everything. She wouldnt answer any questions and I understand. So yes, my heart is in my throat. In the meantime….

I have a theory. Cockers have long floppy ears and are notorious for ear infections. Dex only had one ear infection in his entire life and it was caused by meds during his kennel cough bout years ago. I keep them free of debris, flushed weekly, and properly groomed for air circulation. We have been fortunate.

So Dex had this junky stuff for weeks in his ear. I figured an infection was starting to come up, because his right ear canal is super narrow and the vet told us that and recommended curettage to open the canal more at some point. Dex always gets things on the right side of his body it seems. I digress.

In any case, I was flushing it with stuff from the vet twice a week for weeks.

The vet looked in Dexter’s ear 09/22 and said waxy but not infection. At that time, he didnt examine the wax under microscope.

Then on Saturday morning, 10/07, I looked at Dexter’s ear before we left for the beach and it was disgusting so I started his ear antibiotic. I now believe that was dried blood and wax coming out. It was gross. I was going to call his vet Monday and felt comfortable with that at the time because I had ear antibiotic to put in. I thought the red bumps on Saturday morning were bug bites or infection related on his inner right ear flat. It was petechiae I have since learned from IMT.

I wrote to the famed veterinarian, Dr. Jean Dodds, and paid $150 for an email consultation. She got back to me today. She gave me some recommendations I will discuss with the internist today but also said that stress or infection can cause IMT in dogs. So I went looking for more on that note. A bell went off. This bell may mean nothing, but it’s the first bell that went off since this nightmare began.

Again, remember one cause of IMT is bacterial infection. This is what petMD says, “Otitis media refers to an inflammation of the dog’s middle ear, while otitis interna refers to an inflammation of the inner ear, both of which are commonly caused by BACTERIAL infection.”

Now, are any bells going off? Was this brewing from the ear infection? And yes, Dex is on Tresaderm for ear infection and I think they are doing in both ears, even though one is only affected, and he is on antibiotics.

This could be something or nothing, I don’t know. But I know that he had this before the beach now.

More later.

Dog with IMT

DEXTER UPDATE, 1 pm, 10/10: (long, but trying to share as much as I can)

I met with the internal medicine doctor at the veterinary hospital today. They brought Dexter in to be with me, I fed him, walked him, and then we hung out together for a while before he internist came in. I really like him for starters.

Platelets today 98,000 and his platelet count is on the way up. They were zero on intake. 98,000!!!!!!!!!!!!!

This second and complete abdominal ultrasound today was normal.

He ate organic ground meat for me and was major thirsty: He drank nearly a whole bottle of water, thank you steroids. He is on an IV fluids line. He peed and pooped for me and the poop a bit loose but brown. No black!

The internist had me review what brought Dexter to this point.

Doctor says he responded and very quickly. Many dogs don’t and he said we are very lucky. He has had dogs in the hospital for 2 weeks and 8 blood transfusions in house, not a Cocker. He treats a lot of dogs for this. He said this could be way worse.

In most cases, they present because a groomer or pet parent sees a change. Bruising, bloody nose or ears, bloody gums, or bloody diarrhea because the dog is bleeding from their intestinal tract. Basically, anywhere the body can bleed from minimal trauma is where they are going to start bruising.

Belly, ears, gums most likely parts to bleed. Dex had bleeding from ear and gums.

What causes it? Most of the time we never find out.

Anything can do it, including an ear infection.

Anything that stimulates a dog’s immune system can cause this.

The typical culprits are tick borne diseases, and he added more things on the panel to be sent out to screen, or it can be UTI, antibiotics like sulfa drugs and maybe vaccines.

They can respond rapidly which Dex has done so far. Vincristine is the chemo drug and Dex had one shot of that. Some dogs he has seen have had to get 2 doses.

Steroids: Doxycycline and other immunosuppressants depending on how the dog responds.

He has responded better than most dogs. That is a direct quote and my favorite quote of the day!

The last dog he saw in house for this became anemic he bled so much. Would not stop. Another one belonged to a doctor and was rescued. Dog is okay now but lots of transfusions – he was bleeding into intestinal tract and no outward signs but that.

Dexter’s blood panel: On the 8th all was good, the alk phos was a little high but that was up since he was 2 years old. Vet says that’s weird but maybe a liver biopsy down the road to know what’s that about if we want.

He asked me what meds Dex was on at the time and I reiterated. Don’t give any of the meds any more. Stop them. He says try another drug, so another form of glucosamine for example.

Heartworm preventative – don’t use that one again. Try another one. Don’t give anything. It’s unlikely but it’s possible. No fish oil. Stop anything for now.

Most of the time we will never know what caused this.

We can treat this and it can come back, it can happen again. He had one dog, every time he got a UTI he had IMT flare up. His platelets would go down every time. I will be finding out about things like immune strengtheners and milk thistle. But I cant add anything in that could make his tender immune system tank again.

He says this is like when we get the flu vaccine…it stimulates the immune system and you may get a fever. The vaccine stimulates the immune system and the immune system does things it is not supposed to do. Other pathways get stimulated and they start doing things like killing the platelets or kill red blood cells.

If cancer were causing this, usually the dog is very sick. Dex is not and no evidence of cancer on scans and xrays.(bone marrow cancer, leukemia); it’s rare he finds cancer.

He looked up Dexter’s blood panels to date: He has responded quickly and he doesn’t see that often. #GoDex

RCC is a little low and that is okay. His white cell count is high and that is because his body is responding to the low platelets and saying “hey I have no platelets, the bone marrow needs to be active” so they start shooting out white cells at the same time.

His red cell count is 29.9, and when Dex came in it was 47. It has come down quite a bit. He says when dogs have immune mediated disease to one cell line, it can also go to the other.

He says IMHA can happen. I told him I don’t want to hear it (laughing, but I don’t want to hear that).

He says the same treatment and can’t really separate it sometimes. He says Dex has not bled enough through his gums for his red blood cells to have gone so low. So it could be IMHA. He would not be surprised. It will be watched. He is just seeing Dex for the first time today so he said we will monitor this. So now, the platelets need to keep rising and the red blood cells need to stay steady and not drop!

For IMHA, if that is what it ends up as, and with IMT that is called Evans syndrome. We aren’t going there yet. You give vitamins, iron and couple other things. He would handle it. Right now he is adding B12 and folic acid for Dex.

He has to be on steroids and if he becomes too anemic, they have to transfuse him and he is not at that point.

The meds are making him tired and they are watching his red cell count close. He is sending out a blood smear to a lab so they can look under a microscope and he will look to see if evidence of IMHA.

In terms of discharge, if his platelets keeping rising and he wants his red cell count to be stable and not dropping. If he gets to 15, they are going to transfuse him with whole blood.

When the critical care doctor saw Dex over the weekend and Monday, she felt the red cell count was dropping from loss and not from destruction, so I am hanging onto that.

The internist will be in the rest of the week every day and will see Dexter. I will go back tonight at around 9 pm to feed him and see him.

Tomorrow we see how things are going. Maybe discharge depending on how things progress.

Oh and while there, he had a sneezing fit. He sneezed like 20 times. Not sure what that was about.

I firmly believe the power of prayer and love is working. Whatever this is, we have to manage it. He said it will be a roller coaster, he can end up with more episodes and anything can trigger it. We have to be diligent and have blood draws and watch him. We shall.

In all honestly, it is you, the ones who care and are praying and sending love who are watching him. Thank you a million times over.

More to follow tonight.

Oh and on the way out, I stopped at the reception area to tell them I’d be back later. The gal says to me, “I see Sexy Dexy is back.” I started laughing; she loved him and remembered him from the ACL surgeries performed there. She shared that this is a roller coaster of a disease but can be handled. I love her.

And Then

I received a note from Dr. Laurie Coger who asked, “Is he autoagglutinating?”

Auto what?

You can see the red cells clumping together, she explained, with the naked eye. Here’s a pic of a slide agglutination test — see how the red cells look grainy and clumped:

IMHA blood slide
Photo courtesy Dr. Laurie Coger

Dr. Coger says treatment is very similar for both IMHA and IMT. She suspects the drop in Dexter’s red blood count is fluids and some blood loss. Plus, he’s shifted to making platelets and WBC — his body can only churn out so many. The pathologist’s review of the slides will be a good way to see what cells he’s making.

Wednesday, October 11th, 2017

Immune Mediated Thrombocytopenia Day Three

Dexter is discharged today. His platelets at 6 am came in at 197,000! He was at zero on Saturday the 7th of October. YAY and hallejuah. We spoke with the Internist on discharge today. He said that Dexter was doing great. He was sent home with multiple meds. One of them is melatonin, a nutriceutical, and he will keep him on it for a long time, even after this crisis has passed down the road. It helps the platelet production. He is also taking the steroid, prednisolone; doxycycline, an antibiotic; and Baytril, an antibiotic in case he has something called bartonella, for which the blood test is pending. He is taking omeprazole, which is for his stomach on the sterioids. He is also sent home on Liqui-Tinic, which is a vitamin and iron supplement for mild anemia. His red cell count is in the low 30s, which is fine.

At some point he had some blood (melena) in his stool while there. The steroid will make him eat, drink, and pant more. Not all dogs experience the symptoms, but many do. He can be lethargic from it.

Activity wise, he is not allowed long walks or anything extreme for a while. He expects things to continue to improve. Back to his regular diet. He will be seen on Friday, 10/13, with a CBC check, too.

Dexter came in with an ear infection and is going home on Tresaderm, which was used in the hospital.

I can continue teeth brushing. If he bleeds, we need to know.

Diagnosis is for sure IMT.

Sidebark

My ear theory on this is above. I am still really getting a strong vibe on that, but I will wait to see if any of the obscure tests and tick-borne diseases mitigated this.

sleepy dog

DEXTER UPDATE, 10/11: 9 pm:  Dexter is home, where he belongs. He rested, buried his bone, ate a bit, is now having a treat. We have to give him a bunch of meds and my spouse made a chart. Next internist visit is Friday morning and a blood draw. In the meantime, my Cocker friend Ellen Toomey, sent me these keep-track-of sheets she uses for her dog’s eye medications. Feel free to download and print for your own dogs if they receive multiple medications.

Dexter was discharged with platelets around 197,000. Mild anemia but not IMHA. He has IMT. We found out he started bleeding internally day two but we had him in the hospital so meds caught that. His poop was black. Thank God we got him to the hospital when we did.

I’m encouraging all of you to know what is normal in your dog, look now. Take photos. Pink gums. Ear flaps. Eyes. Then if abnormal happens, you act. Know that any change in urine or bowel movements Should be checked. Don’t wait. Moments matter. Don’t judge someone else’s dog’s illness with your own dog’s issues. Every dog and every treatment plan is different. Trust your gut. Don’t wait. I share to help others and so you feel better prepared as a pet parent and questions to ask, things to watch for.

On another note, today is the day our previous Cocker Spaniel, Brandy Noel, left this earth and crossed over the rainbow bridge on October 11, 2008. I do not think this is a coincidence And I truly feel she watched over her brother.

Dexter dog with IMT

Thursday, October 12th, 2017

DEXTER UPDATE, 10/12: 1 pm: Dex is holding steady, had a good night, and a long road ahead, but day by day. He sees the internal medicine specialist tomorrow and has a blood panel done at that time. We are waiting for some special blood tests to come back on him, too. Bad gas and not too thrilled to eat so I tried to put some plain cooked turkey atop his food. It worked! He ate lunch and then a treat.  His tracheal scarring cough has flared big time. I will talk to the internist about that tomorrow. I was up 6 times last night – just bolted up out of bed to check him and his gums, etc. He is on nine meds and several things a day.

As fellow pet parents, I feel I can be frank and say this without causing eye rolls, and oh well if I do. He has some bad gas and loose poops, but to be expected with the meds he is on. The dog mom in me gets flashbacks to my previous Cocker’s IBD struggles, but I know that this is different. At least his bowel movements are brown and not black.

Cocker Spaniel

Dr. Jean Dodds: Amazing Veterinarian of the Highest Order: Consultation

For a fee, Dr. Dodds would do an email consultation. I wrote to ask her a ton of things about IMT. She is the founder of Hemopet and one of the best veterinarians in the world for me and millions of others. I am excerpting a few items of interest in her reply to me:

Q: Any thoughts on reasons for ITP?

A:  Any thoughts on reasons for ITP? Does he have bad gingivitis or dental disease? One of the most common causes of ITP is bacterial gingivitis and tartar – as platelets end up being mopped up as so-called “innocent bystanders” in the bacteria + cell based immune response.   Recent stress ?  Any physical, physiological or emotional stress event can trigger an episode of ITP in genetically susceptible animals or breeds. Is he a parti-color  or buff?

Q: What is a typical post emergency protocol to treat this?

A: See attached. BUT, importantly , he needs a complete thyroid antibody profile run to be sure as a cocker that he doesn’t have underlying autoimmune thyroiditis of familial hypothyroidism.

Note: Dexter can’t have this tested right away because he is on steroids and that would affect the test results.

There is much more, but I highly recommend you look up Dr. Dodds for email consultation. She is in California. Her fee is worth it and is a donation to the blood bank she runs for dogs, I believe.

Friday, October 13th, 2017

DEXTER UPDATE, 10/13: 1 pm

Dexter saw the Internal Medicine veterinarian today who is handling his case. More blood tests came back and we are waiting on a few more. He also had a blood draw today. Here is where things stand:

  •  Diagnosis is definitely IMT: Immune-mediated thrombocytopenia with mild anemia. He does NOT have IMHA (praise the Lord).
    * His platelets today are 539,000!!!!! (He was at zero six days ago, friends.)
    * A blood panel came back from an outside lab, testing for specific tick-borne levels in his blood.
  • * While his in-office SNAP 4Dx Plus Test that screens for 6 vector-borne diseases came back negative, but he had outside lab serology studies. POSITIVE for A. phagocytophilum (E. equi). What the hell is that, you ask?

“Anaplasmosis in dogs is caused by the bacteria Anaplasma phagocytophilum. It used to be known as Ehrlichia equi and Ehrlichia phagocytophilia. The more complete name for the disease is “canine granulocytic anaplasmosis.” It commonly affects the platelets in the blood, which are small cellular components found in the blood which help clots to form. Anaplasmosis causes thrombocytopenia, which is a lower than normal number of platelets in the blood.”

Dexter has immune-mediated thrombocytopenia and look above at what a potential cause is! An effing tick!!!! T-I-C-K! He is being treated with doxycycline for this and that was started last week in the hospital when he was admitted. The vet says it can rear its ugly head after sitting in bone marrow. He also received an injection of Imizol and will get another in 2-4 weeks to treat this. The only way to know is to re-infect the dog, and no, that is not happening – he was just saying.

Other things could be contributing to this, even his ear infection that he had on admit to the hospital. That is only the second ear infection he ever had in his life.

The Internist tells me that they see IMT rear its ugly head with change of seasons! No reason why.

Of all the cases the Internist sees at a very busy veterinary hospital in one week, HALF(!) of his patients are IMT or IMHA or both. Paying attention to your dog’s normal so that you can act on abnormal is crucial.

Nothing you can do to prevent it but just be an aware pet parent. Trust me, we are aware.

Dex lost a pound since earlier this week, which is fine and expected. I actually want him losing 2-3 more pounds.

I will continue to use what we use on Dexter from a flea and tick perspective, as there is nothing that is 100% preventative. I will screen him more closely with a flea and tick comb. I will not use toxic chemicals, as they harmed our last Cocker Spaniel. Extra due diligence will be our course of action.

Dexter has a cough and that is from tracheal scarring from his previous episode of kennel cough. When he pulls, gets excited, or drinks too fast it flares up. We will address that down the road.

He will be on steroids for months and slow wean down. Plus a ton of other meds. My credit card is on fire, but he is well. We have vet insurance but I’d work 10 jobs for the dog if I had to. He goes back in a week for blood draw and recheck unless any changes.

Must Watch Video

On Friday, October 13, 2017, I went live on Facebook with Dexter. Here’s what you need to know and how to watch for this and any other diseases in your dog:

Tuesday, October 17th, 2017

Dexter Update, 10/17: Dex is holding steady. He is eating, drinking, playing, walking, is bright/alert/responsive and handling his medicine regime better than I would if faced with the same. He sees the Internal Medicine specialist again on Thursday and will have blood drawn at that time. Thanks for the prayers, hugs, messages, and everything else. We are loved and blessed.

Some questions I have received:

  1. Can he still travel? Yes, but not soon. We want to be close to the emergency hospital should anything go awry, especially with all the meds he is on.

 

  1. Will he be getting vaccines? We stopped getting vaccines years ago and do titers. I follow Dr. Jean Dodds’ Hemopet, Petlifeline, Hemolife & Nutriscan on this. I am not anti-vaccine; I am anti over-vaccine. I will also be petitioning for a waiver for life for rabies vaccine. He had it last year and no,I won’t allow that.  Again, following Dr. Dodds.

 

  1. What flea and tick control do we use? We will never use chemicals on our dog. It’s a personal choice. The number of dogs who have this same disease as Dex and had tick issues while on toxic chemicals is alarming. Nothing is 100%. We use what you see here in this post: https://fidoseofreality.com/safe-ways-to-prevent-fleas-and-ticks-2017-edition/  (I won’t put toxic chemicals on or near or in my dog who already has a weakened immune system; to each their own, but it’s not for us; oh and a chemical spot on nearly killed my last Cocker Spaniel.).

 

  1. Is anything else changing with Dexter? Any meds or supplements he was on pre-IMT diagnosis will be stopped for a while. When we start him on supplements again, the internist suggested we do not use the same ones in case any of them contributed to his immune system gone awry. He is eating the same diet, healthy.

 

  1. Can Dexter be around other dogs? Yes, of course. I am more concerned what other dogs may be carrying, so I am keeping him away from dogs in general for a while except for his Bestie, Zola, and his Blondie, Coco Chanel Bella.

 

  1. What meds is Dex on? The regimen for now can be found on my blog post on the topic: http://fidose.com/FightIMT

 

  1. What can I do to prevent my dog from getting IMT? Read the above post and watch for a special video I will be posting tomorrow.

 

  1. Is this an expensive disease? Yes. We have vet pet insurance but would do whatever we had to for our dog’s well being and care.

 

  1. Did a tick cause this? It is likely because he tested positive for anaplasmosis. Dexter saw the Internal Medicine veterinarian last Thursday, 10/12, who is handling his case. More blood tests came back and we are waiting on a few more. He also had a blood draw today. Here is where things stand:

 Diagnosis is definitely IMT: Immune-mediated thrombocytopenia with mild anemia. He does NOT have IMHA (praise the Lord and hope it stays that way).

* His platelets today were 539,000!!!!! (He was at zero six days ago, friends.)

* A blood panel came back from an outside lab, testing for specific tick-borne levels in his blood.

* While his in-office SNAP 4Dx Plus Test that screens for 6 vector-borne diseases came back negative, but he had outside lab serology studies. POSITIVE for A. phagocytophilum (E. equi).

What the hell is that, you ask?

“Anaplasmosis in dogs is caused by the bacteria Anaplasma phagocytophilum. It used to be known as Ehrlichia equi and Ehrlichia phagocytophilia. The more complete name for the disease is “canine granulocytic anaplasmosis.” It commonly affects the platelets in the blood, which are small cellular components found in the blood which help clots to form. Anaplasmosis causes thrombocytopenia, which is a lower than normal number of platelets in the blood.”

Dexter has immune-mediated thrombocytopenia and look above at what a potential cause is! An effing tick!!!! T-I-C-K! He is being treated with doxycycline for this and that was started last week in the hospital when he was admitted. The vet says it can rear its ugly head after sitting in bone marrow. He also received an injection of Imizol and will get another in 2-4 weeks to treat this. The only way to know is to re-infect the dog, and no, that is not happening – he was just saying.

 

  1. What about heartworm medication? He has been on heartworm preventative for years and years – year round. He used to take Interceptor and then that was hard to come by, now on Heartgard. But I am going to take him off it for the winter months and then go back on in the spring. Dr Dodds suggests every 45 days instead of 30 in the active months. I am following that. We are told not to use the same anything. I worry about that, too. I will say that this flared up days after getting his monthly heartworm tablet, but I can’t prove that did it either. That’s one of the shitty parts of this IMT disease. Lots of unanswered questions. I also do not want heartworm, so there’s that. TY for asking. I am updating above.

Note

This blog post will be updated regularly through our journey in diary style. Stay tuned and any prayers are needed and appreciated.

Comments

  1. Only you could deal with what you are going through with Dexter to inform others. It’s truly selfless. If it happened to me I wouldn’t be able to think of anything else except my dog. That’s why I’m praying (something I really don’t do) so hard for you and Dexter. Not to mention I have a Cocker also that I’ve learned so much from you on how to take care of. Thank you.

    • Thanks so much. Sandra. I am emotionally drained and so much on the horizon this week. Your kind words mean so much.

    • Keeping Dexter in my prayers. If he has living litter mates, have you made contact with the
      owners to see if there is any family history?

  2. While I didn’t comment there, I did see your Facebook posts and we have been thinking of you and your family, and praying for Dexter. I appreciate your writing this post, especially at a time when you must be totally consumed with worry. When reading something shared, I noticed Labrador retrievers were on the list of dogs prone to this, and since we have a Lab mix, I feel it is something I should stay aware of.
    I also read this could be caused by vaccines, but immediately knew that wouldn’t be the case here, since I know and admire the natural lifestyle you live. We try to do the same, and I only wish it could be a guarantee of health!
    It seems like a good sign that Dexter is feeling well outwardly, and we hope and pray that will continue to be the case, and he fights through this.

  3. Oh Carol & Darlene,
    What an horrific weekend you’ve all had. Thank you for being so alert and acting quickly for Dexter – he is so lucky to have such wonderful & savvy parents. We are hoping that your quick action has minimised any trauma he may have experienced and he will quickly be much improved and home with you again.
    Sending strength & love,
    Annette & WeK, Betty & Finn

  4. We send Dexter tons of purrs and cross our paws for a quick recovery. You’re a Wigglebutt Warrior, Dexter, and so are your moms (except for the wiggle butt part maybe), let’s fight ! Purrs and hugs from Claire

  5. Alice and I are sending Dexter, Darlene and you healing thoughts, prayers, and hugs! Thank you for keeping us up to date and we hope he is able to come home soon!

  6. i am so sorry to hear abt Dexter. i pray that he will be okay. your blogs are so informative. thank you for sharing. please keep us updated. i checked the fb page and did not see anything.

  7. Praying for Decter and thanking you for educating us all. I am sorry you are dealing with this. So hard to have our babies be sick. He is so fortunate to have your love and it sounds like a good medical team

  8. Sending many good thoughts and prayers your way. Dealing with these things is difficult but Dexter has the perfect advocate in you, and that will be of great help. He is a lucky boy to have such a good dog Mom! Always work from a position of knowledge and hope and remember to take care of yourself while you are caring for Dexter. You all are in my thoughts.

  9. Purring and praying for Dexter. I know this has to be awful for both Dar and you. I appreciate you taking the time to keep us updated on his daily progress. I have a friend who has the human equivalent of this. She gets shots every two weeks and her immune system has a hard time fighting off illnesses.

    I know you are doing everything you can for Dexter. Take care of yourself, too.

  10. We have our paws crossed the meds kick in and those platelets zoom back up to normal within a couple weeks. The worst part of it all is how fast a dog goes from normal to terrible ill. Mom could see Bailie fading away in front of her which is when she said, enough, and took her to the ER. Know your dog! That is the most important thing. A good dog parent knows when something is terrible wrong, just as you all did. Hugs to you guys and Dexter.

  11. Carol and Dar I’m praying for your strength to be there for Dex and for each other. I’ll continue to pray and send positive thoughts.

  12. I’m not sure how I found this blog post. I wasn’t even searching for IMT. My dog went thru something very similar in January 2017 and I thought you might find my documentation helpful or at least hopeful. She too had no strange scans and healthy blood test except for her platelets being very low. The day before all this happened, she was hiking for an hour and a half which is a typical exercise we do weekly. Reading about Dexter really reminded me of what an ordeal this was for my dog and I. If you get a chance, read my documentation.
    She is doing very well and we are 8 months post diagnoses. Such a scary disease. Hang in there. I know things on the internet about IMT is so scary. I remember being so afraid to read it because they were awful stories that often ended in their pet being put down. Have hope.
    http://barkingchef.blogspot.com/

  13. First and foremost, thank you for all the love and dedication . I know from personal experience how hard this must be for you all. It was the scariest thing to hear those words when my first sweet cocker was diagnosed. I was blindsided really, as she was only at the vet for her regularly scheduled check up and out of the clear blue!. The next day we were at the NC State Vet Hospital. She was 7 at the time and we went through almost every step you described, periodically through the rest of her life. Jazmine was a fighter and lived one week shy of her 15th birthday. We learned alot from it all and the two sweet males we have now, we watch like hawks. Jazmine was a parti-color btw. I could go on and on, just know this is do-able. Hold and cherish your sweet boy and bless you for all you do!

  14. Thank you, Carol (and Sexy Dexy) for the diary. I’m going to keep it bookmarked “just in case.” I’m so glad you were able to get him into the vet and diagnosed quickly. I hope things continue to look up for your very handsome boy.

  15. I am so glad Dex is doing better. I had no idea he was sick and thank goodness he has two mommies who are aware of any minor changes in him. Your swift action saved his life! I pray he continues to improve and am so thankful he has the best two dog moms in the world!

  16. I had a client, A Golden Retriever, diagnosed & die with IMT this last week. I missed it when I talked to him, but I get how tehy feel & I knew he felt like crap. I feel for this disease because my Lucie had IMHA. Both can come back at any time. Vets need to get on this and cancer and find out WHY it happens.

    I remember when Lucie was slated to die- the odds werent with her (IMHA) and I talked to an artist friend who’s dog had had IMHA. She said that her dog had completely recovered, and was fine for 5 years. Then it came back out of nowhere. They did a blood transfusion, and her dog died. I remember feeling that I would be SO GRATEFUL for another 5 years with Lucie. I NEVER saw her being as healthy as she is now again. Lucie got Valley Fever AFTER she had IMHA. she didnt use her left leg for a year. I am just SO GRATEFUL that she made it thru, and we have time together.

    Luckily, Luice has the brightest pink ears inside, so I know IMMEDIATELY that she doesnt have IMHA. Once they have an auto immune disease, you can never totally relax or act like everything is normal.

    Good luck Dexter. You have a world of love on both sides, but none of want to lose you yet. Stay strong & help your humans understand.

    • What I have learned is every dog and every treatment plan is different with immune diseases. Paw prayers for sure and thanks for stopping by, Ann Marie!

Leave a Reply

Your email address will not be published. Required fields are marked *