Hector

[Clara]

I’m not sure how much to share in Hector’s intro. I am also new to this type of forum so I hope I am doing it right!

We first noticed Hector’s pale gums and anemia in April of 2013. His spleen was large and abnormal looking, but several ultrasounds have been done and they always look different so they ruled out cancer.
At first we assumed the anemia was caused by his babesia finally affecting him. He had tested positive for it several times in the past. So we treated it twice with atovaquone, azithromycin, and artemisinin. Nothing changed and his babesia PCR tests were coming up negative. I don’t believe we have ever really successfully treated it. We have to consider it in the big picture, but know that something more is going on.
So we explored the possibility of autoimmune anemia. His bone marrow biopsy and bloodwork led the vets to conclude “Suspect late stage erythroid maturation arrest, immune mediated anemia”.
Hector went on prednisone February 1st and we added Atopica in early April. The highest PCV we’ve seen is 34%. He has stayed pretty stable so we have been slowly weaning the prednisone. He has the usual muscle atrophy and newly developed calcinosis cutis.
I’m not sure what else to do for him. He has never crashed to the point of needing a transfusion, but he has never gotten well either. Now a portion of his spleen appears to have “died” without blood supply so we are considering a splenectomy.
I have tons of bloodwork results, but I’m not sure how much to share or where to go from here. We have been battling this for 16 months.

[Patrice]

Clara,
I am really really sorry to read this. You have had quite a time with Hector. I do have some good information for you to research. You should be commended for all you have done up to this point. You must love Hector very much.

What is important to understand is the the spleen in considered to be the organ that is most active in fighting Babeseosis. Without a spleen, humans and dogs alike are virtually defenseless against this tick disease. So in fact, a relatively healthy human or dog exposed to this should, by all accounts, be able to fend off the disease and recover. The US recommends that humans that have had a splenectomy do not travel abroad for this reason so it stands to reason that dogs should not either. My dog Chance had a splenectomy and my vet warned me of this danger of his inability to fight this tick disease.

What can alter this ability to fight it off? Well, other illness can reduce the ability to muster the immune system properly to fight, say perhaps co-infection with another tick disease at the same time. The fact that his spleen was enlarged is a good clue that it has been working hard to fight this for a very long time. And subsequently, his marrow is having a hard time making blood right now too. This is a very specific cause for this non-regenerative anemia.

The attending vet may feel like they are tasked to fight two things, the autoimmune anemia and/or the tick disease and it is hard to figure out what to do in this case. It is definitely not straightforward. But the reality is if a dog is not making blood there is only so long that you can allow this to continue. And if they decide to forgo the immunosuppressive treatments in order to allow the immune system to fight the tick disease, there is a risk of death from anemia before you have successfully completed the treatment for the tick disease. So it may be appropriate for an expert to treat for both conditions simultaneously.

Your vet has missed one particularly highly recommended treatment for Babeseosis, Imidocarb Dipropionate (Imizol). In fact, I would, if this were me, try this next. It is quite expensive and requires two shots to be effective.
http://www.merck-animal-health-usa.com/products/130_163327/productdetails_130_163631.aspx

But first I want you to read one website page very very carefully and follow all the links provided on this page carefully. Gil Ash developed this website over many years while on a tick disease email list called Tick-L. I have also been on this list a long time. It is moderated by a scientist and there is a vet who helps from time to time with discussions. Gil started collecting this information we talked about and gathered from many sources. She is a consummate researcher and her information is the best on tick disease.
https://sites.google.com/site/tickbornediseaseindogs/babesiosis

The most important information for you on this page may be that a dog with Babesiosis can remain sub-clinically infected and may have relapses.

Whether or not to remove the spleen is extremely complicated. It is not healthy to have a diseased and necrotic spleen, but is it still protecting Hector to a certain extent from the Babesiosis? I think in this case you need an expert opinion from a veterinarian hematologist. I recommend you request a consultation with Dr. Jean Dodds of Hempet.org. Her on-line consultation form is easy to use and the cost in inexpensive. She will review all your paperwork, your detailed history and will give you an expert opinion on the continued treatment.
https://labordatenbank.com/cake/hemopet/onlineorders/hemopet_add

Getting Hector to better health is the critical matter. The healthier he is the better he is able to fight this disease, as he may be a carrier for life. His life should be one of low stress and generally reduced exposure to disease. Dr. Dodds can discuss this with you.

If you have questions, please ask away.
my best
patrice

[Patrice]

This article is quite complex to read but does have excellent information with just about everything you need to know. If you don’t understand something in here, ask. (there are 4 pages to this article)
http://veterinarynews.dvm360.com/canine-babesiosis-continues-create-challenges-practitioners

my best
patrice

[Clara]

Thanks, Patrice. We are certainly keeping the babesia in mind, and maybe it is what triggered the autoimmune response in the first place, but I do believe we did the best we could to treat it and we did 3 PCR tests last fall and they were all negative for babesia. I still think it’s “hiding” in there somewhere, but we are kind of keeping it on the backburner for now. However, that is definitely one of the reasons I have been so hesitant about a splenectomy. When Hector first presented with anemia and an enlarged spleen, we scheduled the surgery and then changed our minds because of his history of positive babesia tests. We definitely discussed Imidocarb, but after some research and in talking with our vets we decided on the atovaquone/azithromycin combination.
My next step is talking to Dr. Dodds. I at least want her opinion before we go forward with a splenectomy. I have heard that she has a great understanding of both babesia and IMHA. It has been interesting trying to navigate through the babesia diagnosis because it’s not at all common where we live (Minnesota) and IMHA is also so tricky.
I’m not sure if he has responded to the immune suppressants at all. His PCV is the same as it was when this all first started in 2013, but it did dip down to the low 20’s in January so maybe the drugs did help him get through that crisis. All I know is that he’s not getting back to normal and we have been battling this for way too long.

[admin]

Hi Clara

Welcome to the site, although I am sorry you have had to find us. May I ask what breed Hector is and how much he weighs?

Patrice has already given you lots of excellent information and I would absolutely support the idea of talking to Dr Dodds for advice. I have to admit to being a newcomer to Babesia, so please forgive me if I ask things which have already been considered or which are not suitable in his case.

I wonder if Hector has any stomach protectants? How is his eating? I’m also wondering about anti-clotting agents, as clotting is a great risk of IMHA. However, it may be that the type Hector has does not carry this risk, and I am sure others can advise on this.

If you have any of Hector’s results, you can upload them on the “urgent advice” page and we will have a look. We are not vets but Patrice and Sheena are excellent at interpreting them.

This is a difficult time for you and it sounds as though you’ve been fighting it for a long time, which is credit to you as Hector’s owner. Please feel free to ask anything and we will do our very best to answer. All of us have been through this horrible disease with our pets and one of us will usually have some advice to share.

Mary & Mable x

[Patrice]

It is a big complex to describe, and I am a bit tired at this point, but the lowish PCV most likely has two connections.

One is that Babesiosis is a disease of red blood cells. It is possible that this disease, as like many other tick diseases, does not restrict infection to just the RBC in circulation. All body tissues are fair game after all this time. Thus, the reason they say that dogs can be carriers. You will see this mentioned specifically with Pit Bulls. So the bone marrow, which is considered an organ, is susceptible to infection as well.

In addition there is a condition called Anemia of Chronic Disease. Trying to shorten this for easy understanding, the body when confronted with invaders like bacteria, viruses or even parasites may attempt to alter the environment in the body to make it less hospitable to these invaders. What research is beginning to reveal is that the body most likely modifies and moderates the amount of iron available to the body in order to restrict it to bacteria etc that also need iron for survival. So the thought goes, reduce iron and the bacteria etc fail to thrive.

However this also shorts the bone marrow from receiving the proper amount of iron to make new red blood cells. So you may find a moderate chronic anemia as a symptom of chronic disease. A PCV of 34% is fine. Chance, once his spleen was removed never topped over about 36-38%. That is acceptable.

I think in addition to Dr. Dodds, who will provide you with more information on the blood aspects of this condition, you probably should become familiar with Dr. Holland at Protatek Labs, she is the Dr. Dodds of the tick world and has been known to take phone calls from owners who have questions about testing and treatments.
https://sites.google.com/site/tickbornediseaseindogs/testlaboratories

Here is a part of that page I posted the link to that discusses Dr. Holland’s opinion of how to view titers and continued testing.
“Continuing, low positive titer for B. canis

EG was actively involved in greyhound adoption for many years. Many of the dogs her group placed were positive for B. canis and of the 600 they titered, more dogs than not had titers as low as 1:80, possibly indicating exposure only. E tells me the ideal thing to do with low positive dogs showing no symptoms is to run a number of PCRs to see if any of the blood serum samples has the B. canis organism in it. Otherwise, continue doing regular bloodwork and the occasional titer to see if there are any changes.

In 1996, E spoke with Dr. Cynthia Holland of ProtaTek about one of her own greyhounds, Molly, who was asymptomatic but continued to have a low titer for B. canis. She asked Dr. Holland the question she had heard from many others: What do I do now?” Read the answer here:
https://sites.google.com/site/tickbornediseaseindogs/b-canis-what-now

By the way it is important to know whether Hector was infected with Babesia canis or Babesia gibsoni, Do you know what your test results showed?

my best
patrice

[admin]

Hi Clara

I’m very sorry to read about Hector (he’s a handsome lad!) and his long battle with this disease. Patrice has given you some really good information to look at on anaemia of chronic disease & I’m pleased to see you will be contacting Dr Dodds too. She has been a huge help to many of us & is highly experienced.

We are very glad you’ve found us & hope we can be of help. My greyhound Worzel probably had ehrlichia “hiding” in his system, although tests were negative, like you actually. The Specialist & I were 99% certain that this was the cause of his non-regenerative anaemia because of the symptoms, so I sympathise with you. We went on the assumption that he had this disease & treated accordingly.

Sending all our best wishes
Sheena, Worzel & Ollie

[Clara]

Thanks, everyone. Mary, Hector is a pit bull and he weighs 50 pounds. I recently started him on a slippery elm cocktail recommended by someone on a FB group. He isn’t on any stomach protectant meds. He had a terrible GI something a couple of weeks ago. It wasn’t caused by his chronic illnesses or meds because our healthy dog Angus had the same thing, but I don’t doubt that Hector’s condition made it worse. He was hospitalized a few times at the end of July. He has never had a problem with his appetite. He wants to eat constantly.
Patrice, Hector has b. gibsoni.