Wednesday, May 7, 2014

Frank's Big Scare

I apologize that it has been awhile since my last post, April was a crazy month and I am still recovering from it.  The 8th Annual Fashion forPaws Runway Show was on April 12th and it was a huge success.  The event raised over $425,000 that will directly provide care and medical attention for the 43,000 animals that the Washington Humane Society cares for each year.  Frank was a star of course and I was honored to speak at the event this year as Executive Committee Chair.

Our delight in the Fashion for Paws afterglow was put out quickly when Frank became sick a few days after the event.  I first noticed that he was eating a bit slower than usual and he seemed tired out on our walks.  When he didn’t get up for his treat one morning I knew something was really wrong and we rushed him right into Friendship.

Dr. Calabro who is one of Friendship’s two amazing critical care specialists examined Frank and found him to have a low grade fever and back pain.  Screening bloodwork was submitted and he was started on intravenous fluids and pain medication.  Friendship’s radiologist Dr. Hankin performed radiographs and an abdominal ultrasound to rule out an infection of the vertebrae called discospondolytits as well as look for any additional underlying abnormalities.  Thankfully these were all normal.  We also submitted tick titers to make sure this wasn’t from an infectious cause such as Lyme disease or Ehrlichiosis. 

Being a good dog for his IV fluids
His bloodwork came back with a slightly elevated white blood cell count indicating systemic inflammation.  Additionally his platelet count was low; platelets are the blood cells that are responsible for clotting blood.  The decreased platelets could be from an infection destroying his platelets or again systemic inflammation.  We added doxycycline to his treatment and he spent the night in the hospital.  If his symptoms were due to a tick borne infection it should resolve quickly on the doxycycline.

The next day his fever had come down a bit, he was eating well and seemed to be feeling better so we took him home.  Over the next day he was fine but still acting very quiet and not himself.  I brought him back to the hospital about 36 hours after discharge to have his bloodwork rechecked.  Friendship’s other criticalist, Dr. Gonzales took a look at him and found that in addition to back pain he was now painful in his neck and multiple joints.  The follow up bloodwork showed that his platelets had not improved at all and his white cell cont was now higher.

At this point my husband and I were beside ourselves worrying. Frank is only 4 years old, how could he get this sick so quickly and how could we not know what was wrong with him.  Our next step was to have Friendship’s orthopedic surgeon Dr. Glassman evaluate his joint pain and take samples of joint fluid to see if there was evidence of infection or inflammation in his joints.  Frank had to be sedated for the joint tap procedures, as it is painful to enter the joint and collect the samples.  Analysis of the joint fluid did not show any abnormalities so we returned to looking at his neck and back pain as the primary problem.

Waiting in Dr. Talrico's exam room
The next day we headed out to Southpaws for a neurology consult with the amazing Dr. Talrico.  The very first day Frank was sick Dr. Calabro discussed his case with Dr. Talrico who thought it sounded like a textbook case of Steroid-Responsive Meningitis-Arteritis (SRMA). The cause of SRMA is unknown but it is auto-immune in origin meaning that for some reason the body creates inflammatory cells that attack the central nervous system.  After a complete neurologic exam Dr. Talrico recommended a CSF tap that would hopefully confirm her suspicion of SRMA.  For this Frank was put under general anesthesia and a needed was passed between the vertebrae in his neck to collect the fluid that surrounds his spinal cord.  He recovered well from the procedure and we headed home to wait for the analysis of the spinal fluid.

Here is where medicine can get frustrating; the results from the CSF tap were suggestive of SRMA but not definitive.  Unfortunately we can do all the testing in world and still not have an exact answer of what is causing the problem.  In this situation it is critical to work with a doctor that you trust and has experience with the suspected disease process.  Veterinary medicine is often a puzzle; you have to take the history, exam findings, test results and response to treatment and piece them all together to get an answer.

 Dr. Talrico felt given his clinical signs and the results from all of his testing that we caught the disease very early in its progress.  This was actually good news because it meant with aggressive treatment Frank has a much better prognosis for complete remission with no future relapses.  We started steroids that day and within a few days he was feeling much better and his platelet count was almost back up to normal.

This is not a disease he will ever be cured of and it always has to be in the back of our minds as he can relapse at any time.  Frank cannot ever be vaccinated again as this could over-stimulate his immune system resulting in a relapse.  I am most worried about not being able to vaccinate him against leptospirosis.  I can monitor his immune protection against rabies, distemper and parvo viruses with titers but not with leptospirosis.

My family is so thankful for all the amazing care Frank received during this ordeal and that he is back to his normal crazy/loving/adorable/playful self.  Drs. Calabro, Gonzales, Galssman, Romsland, Hankin and Talrico are brilliant veterinarians and dedicated themselves to helping me figure out what was going on with Frank.  All of the technicians that took care of him while he was in the hospital were gentle and caring.  I am lucky to count all of these wonderful people as my friends and am grateful for Friendship and the excellent care that is available to all of us here in DC.  So go home tonight and give your pets a big hug and a kiss, each day we have with them is truly a gift that should be treasured.

He has a new haircut to even out all his shaved areas and is feeling much better!