IMHA and ITP: Smokey’s Vaccine Damage

Smokey’s Life and Death Struggle With Vaccination

 

After “annual vaccination” for parvovirus, Leptospira, Bordetella and a rabies vaccination given long before it was due, Smokey fell terribly ill. “Smokey was diagnosed with Immune-Mediated Thrombocytopenia (ITP) — extremely low platelets — as well as Immune-Mediated Hemolytic Anemia (IMHA) — a serious blood disease. The combination together is called Evans’ Disease.  Smokey’s immune system is attacking both his platelets and his red blood cells, bringing his platelet level down to about 4.6% of normal and his red blood cell count far below normal, though we won’t know how far below until this afternoon. As the vet explained it, our 95 pound German Shepherd has the platelet and blood cell count of a sick Chihuahua.” 

On Tuesday, June 5, 2012, I made an appointment to bring my four year old German Shepherd Dog, Smokey, to the vet. The receptionist told me my normal vet was out, but that the owner of the practice was there in her stead. Normally, I don’t allow my dogs to be seen by anyone except one of the two vets in the practice I trust and have a good relationship with. However, there was a nodule on Smokey’s foot that seemed to be growing by the day, and I had a real concern that there was something stuck in his foot and that it could become infected, or worse yet, it was a foxtail, and it would end up in his kidneys or his brain or some equally horrible place. So I consented to another vet seeing him and made an appointment for 5:40 p.m. when we were out of work and could take him.  

As it turns out, I was tied up in meetings all day and didn’t make the appointment. By the time I got to the vet, Joe (Smokey’s daddy), was already sitting outside with him waiting for the bill. He told me everything was fine, that the nodule was a benign histiocytoma and that it should disappear on its own in a couple months. I heaved a sigh of relief, and we headed home. 

When we got home, Joe told me that since Smokey was due for his annual shots, the vet had administered them and given him his physical. I inquired about his weight – 92 pounds, a wonderful improvement from the meager 66 pounds he was when we rescued him two years before.  

On Wednesday, June 6, 2012, I got up to get ready for work. I went to fill up their water bowl and noticed that Smokey hadn’t eaten his breakfast, which is very strange for him. The only time in the two years that we’ve had him that he hasn’t eaten his breakfast was after we had to put our ten-week old puppy Dusty down. He was devastated and didn’t eat well for a couple days, but other than that, I’ve never seen him refuse as much as a kibble.  

I got a sick feeling in my stomach. The dogs not eating is always a huge concern of mine. Dusty had megaesophagus and the first sign of aspiration pneumonia (a common side-effect of the disease) is not eating. The morning that Dusty lost the fight to mega-e, she wouldn’t eat her breakfast. Two hours later, she was at the emergency hospital, unable to breathe and too weak to continue fighting. She died that day. The sight of uneaten food in a bowl has made me nauseous ever since.  

I gave Smokey a couple liver treats, which he ate, though not with his normal enthusiasm. On my way out of the house, I sent Joe a text message, so I didn’t wake him. I tried not to be alarmed, “Babe, Smokey didn’t eat his breakfast, please check on him.”  

When I got home that evening, Joe told me that Smokey hadn’t eaten his dinner either. I started to get slightly concerned. Joe also mentioned that he didn’t seem to be drinking. Red lights started flashing.  

At around 7:30 p.m., Shelby began her normal romp. Smokey wasn’t interested in playing. Another oddity to add to the list. Shelby, however, is nothing if not persistent, and she jumped on his back, trying to entice him to play. Smokey screamed like someone had just covered him in gasoline and lit a match. His knees gave way and there he was, sprawled out on the floor, a ninety pound ball of shaking, screaming fur. 

My eye’s shot up, and Joe rushed over to him, “Buddy, what’s wrong?” He helped him up and immediately began to run his hands gently up and down Smokey’s body. Every time his hand even grazed his right hindquarters, Smokey let out a yipe and moved away. 

I immediately pulled Smokey’s file and checked for the vet report. I scanned through it, then read it closer. As I read through the vet’s analysis of Smokey’s heart, lungs, weight, muscle tone and brain function, I started to fret. He was fine; everything was fine, the report said so, what was going on? I checked Smokey myself and felt a large lump on his right hindquarters, “Did he get a shot here?” 

I went back to my perusal of the veterinarian’s report and looked for the vaccinations administered. There it was – rabies @ RH. Our vet had somehow given him a vaccine he didn’t need until 2014, and we were livid.   

We have never allowed our dogs to receive the rabies vaccination at the same time as their annual vaccinations. We always space their vaccinations out and only send them in for what is required by law and what is required for their training courses.  

The next morning, Thursday, June 7, 2012, Smokey still wasn’t eating or drinking. I called the vet as soon as they opened and explained the situation. The receptionist said she didn’t know what was going on, but she made an appointment for Joe and Smokey at noon. 

The vet tech explained that he had inadvertently given the vet a rabies vaccination to administer, and he was extremely sorry. The receptionist was not as forgiving, declaring loudly that her Beagle had been given two rabies vaccines within the span of three days and, “he was just fine”. Well, Smokey wasn’t, and Joe made sure everyone in the office knew it from what I understand. 

The vet saw Smokey and prescribed him some Tramadol and Benadryl. 

When I got home at 6:30 p.m. that evening, Smokey still wasn’t eating, and he looked worse. He still couldn’t lie down, he would circle and circle in his favorite napping places, then put one foot down, yelp, and stand back up. By 9:30 p.m., he was literally falling asleep standing up. He was panting heavily, his ears were pinned back, and he just stared at one spot for hours. Anytime anyone touched him he cried. 

He was getting worse, not better.  

Friday, June 8, 2012, at 7:30 a.m., I was on the phone with the vet. Smokey had finally managed to settle down on our bed for approximately one hour the night before and get some rest before he woke up in more pain and proceeded to stand and stare at the bedroom wall the rest of the night. I woke up every forty-five minutes to an hour and sat with him for a little bit before exhaustion overtook me, and I had to crawl back into bed and get some sleep. 

When I got up that morning and felt Smokey over, I noticed his stomach was distended. It felt like there was a bag of liquid sloshing around in his stomach, almost like a separate entity had taken up residence in his stomach. The lump at the injection site had all but faded, leaving this swollen stomach in its wake. 

At 1:00 p.m., I finally got my normal vet on the phone, who said she was concerned and wanted to see Smokey right away. By 2:00 p.m. when I got home, Smokey’s stomach was so distended that it looked like he had thrown a litter of puppies an hour before. Instead of greeting me at the door like he usually does, he was standing in the dining room when I walked in, just staring at nothing, ears pinned back, panting heavily. He still hadn’t eaten. 

Riding in the car is Smokey’s absolute favorite thing in life.  And while his ears pricked up at the sight of the car, he hesitated on getting in. He was in too much pain to even lift his feet the foot or so to get into the back of my Mustang. I let him ride in the front instead and tried to help him as gingerly as I could. 

At 2:30 p.m., we made it to the vet, who saw us right away. After feeling Smokey, noting a 105 degree fever, and seeing the state he was in, the vet decided to triple the pain killers, get him on a steroid and an anti-acid to help the steroid go down easier and keep a constant watch on him. If he wasn’t doing significantly better by Sunday, I was told to take him to the emergency hospital in nearby Norristown. When I read the vet report from that visit, I noticed that the vet had described the bag I’d felt in Smokey’s stomach as “softball sized”. 

I got the medicine and left, feeling hopeless and confused. 

By the next morning, Saturday, June 9, 2012, Smokey was showing significant signs of improvement. He was eating again (albeit slowly and carefully) and drinking like a fish. He was finally able to lie down and get some much needed sleep, but he was dopey and just generally out of it. 

We decided he didn’t need to go to the emergency vet when his stomach swelling improved, and he started to act more like his normal self. By Sunday, June 10, 2012, he was even able to play with Shelby for a few minutes before passing out again. 

I don’t know what the long term effects of this incident may have on him. I’m not sure if he is going to have organ damage or complications later in life. I’m not even one hundred percent sure what went wrong with him, as he has never had a negative reaction to a vaccine before. I don’t know if it was the double dose (that’s six years of vaccine in one, for those keeping score) that hurt him or the fact that the rabies vaccine was administered at the same time as his other shots. I don’t even think the vet knows. What I do know for sure is that in three years, when he is due by law to have another rabies vaccine, I cannot and will not put Smokey through that nightmare again. Something has to be done. As Pennsylvania has a bill sitting in the Agriculture department that will help me get an exemption for Smokey, I intend to do everything in my power to make sure that bill gets passed, sooner, rather than later, before the rabies vaccine decides to take my dog’s life instead of potentially saving it.  

One Day at a Time

Some days, there are just no words. Some days, the pain wells up inside you until you feel like you are going to cry or scream or both, but you do neither, because no outward expression of the inward misery will suffice, and you don’t have the energy to try. Friday was one of those days, today is one of those days.

Of course I was assuming he was going to die young. Unfortunately, that has become the natural assumption in our lives.

And of course when I got out of work on Friday, I called Joe to find out what the vet had said. I sat in my car and listened while he explained that the vet was almost positive Smokey had an auto-immune disease.  They were doing blood work, they put a rush on it, and it would be back tomorrow.

We had a yard sale on Saturday, the first measure to raise money for Smokey’s vet bills, which we can only assume will be colossal. At 10:30 I called the vet, the blood work wasn’t back yet. At 11:00 they called me, the fecal sample was negative but still no blood work. At about 1:00, they called us again.  

Smokey was diagnosed with Immune-Mediated Thrombocytopenia (ITP) as well as Immune-Mediated Hemolytic Anemia (IMHA). The combination together is called Evans’ Disease. Long story short, Smokey’s immune system is attacking both his platelets and his red blood cells, bringing his platelet level down to about 4.6% of normal and his red blood cell count far below normal, though we won’t know how far below until this afternoon. As the vet explained it, our 95 pound German Shepherd has the platelet and blood cell count of a sick Chihuahua.

The first step was to start him out on a high dosage of prednisone. Prednisone is a steroid which imitates the body’s stress hormone cortisol. Prednisone serves to suppress the immune systems in dogs with self-destructive immune systems like Smokey’s. Prednisone is sort of a miracle drug when it’s used properly, because you see almost instant results. Within the first twelve hours of his first dose of prednisone, Smokey’s temperature had gone back down to 101.4 where it belongs, he was eating again, drinking again; he seemed to have a little more spring in his step. His gums stopped bleeding; he even got up the energy to play a little tug. Unfortunately, those results were only temporary and superficial. As of this morning, his temperature was back to 103.6, and he wasn’t eating. He is no longer bleeding orally however, so hopefully that means his platelet levels are going back up, and he is able to clot blood again.

The long term use of prednisone can be dangerous in and of itself, however. Prednisone over the long term can cause digestive ulcers, diabetes, muscle degeneration, behavioral changes, inflammation, Cushings Disease and Addison’s disease, not to mention serious damage to the internal organs, most notably the kidneys and liver. Without the prednisone, Smokey’s platelet levels could drop, and he could start bleeding internally. Most notably, if his ability to clot blood is dramatically reduced, he could bleed into his brain, which would kill him very quickly, and we may never even know it happened. Without the prednisone, Smokey’s red blood cell count could drop, and he would lose his ability to transport oxygen to his organs, essentially suffocating him from the inside out.

Blood transfusions, which he will most likely need over the course of his life now that the Evans’ Syndrome has been triggered, have complications of their own, including fever, shock, septicemia, vomiting, cough, hypothermia and heart failure. The complications only increase as the dog gets older and the complexity of the blood transfusions increase due to the frequency of the mixing of blood.

It’s hard not to let the guilt get to you. Joe says we’re bad dog parents, because we let it wait too long. Smokey started acting strange a few weeks ago. We couldn’t quite put our finger on it. If we’d gone into the vet’s office, and they’d asked us to explain his symptoms, we probably would have fumbled around, trying to put words to, “He’s just not quite right.”

The first sign of his not-quite-rightness, was that he started sleeping in Shelby’s kennel. Smokey almost never seeks out a tightly enclosed spot to rest in. He doesn’t like kennels or corners, probably because he had to live in them for so long. So it was strange when he stopped sleeping on our bed and chose to huddle in a corner of the room instead, and even stranger when I walked downstairs each morning only to find him sleeping in Shelby’s kennel in the kitchen. Something about that made me anxious. I just kept thinking about those stories of dogs who try to find solitary places to die.

The next sign was that he stopped taking an interest in Shelby. He didn’t want to play with her, he didn’t want to sleep with her; he just didn’t want to be near her. Every time she play bowed and ran toward him he tucked his tail, turned his body and started screaming before she even got to him. When Joe and I felt him over, he didn’t cry. There was no sign that he was in pain, and while we worried, we thought we were just being paranoid because of the rabies vaccine scare we’d just had.

A couple weeks ago, he started limping in his front. First it was his left paw, which we poured over, looking for any signs of fractures or cuts or maybe a thorn stuck in his paw. After a day or so, the limping went away, and we thought, “Well, maybe he just got stung by a bee or something bit him or Shelby stepped on him the wrong way or something.” Then the limping started again, but this time in his right.

Everything started spiraling downward after that. His limping got worse, he started panting, he got incredibly lethargic, he couldn’t keep up with me on our short bike ride, and I actually had to turn around and walk back when I was only maybe a sixteenth of a mile in, because I was essentially dragging him behind my bike. His temperature started slowly rising, he stopped eating, and then he stopped drinking. Not even the sound of the clicker seemed to wake him up, and instead of trying to get in on the training exercises I was working on with Shelby, he just laid in the corner and stared. On Thursday night, his temperature hit 104.4, and we started to get very worried. All of our little excuses didn’t seem to be working anymore. The not-quite-rightness had evolved into something else. We discussed calling the emergency hospital. Joe opened Smokey’s mouth to see the color of his gums, looking for any indication of what was wrong. When Joe opened Smokey’s mouth, it was full of blood. At first, we’d thought maybe he’d lost a tooth at some point, and maybe it had gotten infected. After a thorough examination however, we realized the blood was simply pouring out of his gums. As he’d been so lethargic, we knew he’d just woken up from a nap and hadn’t been chewing on anything, so there was no way he could have cut his mouth open.

We did the obvious thing, we called the emergency hospital. They told us to keep an eye on him and monitor his temperature and that if it went above 105 to bring him in, but since we already had a vet appointment for the next day, to save ourselves some money and wait for that.

Friday, when Joe got home, the spot where Smokey had been laying was soaked in blood. Joe took him early to his appointment and called me on the way. I sat at work and tried not to panic, but all I could think about was my Smokey Dokey dog, lying on the floor all alone, slowly bleeding.

Smokey goes in for a PCV (packed cell volume) test today. The test will let us know how badly his red blood cells have been compromised and whether or not he will need an emergency blood transfusion to stay alive. Fortunately, the test results are instant. Unfortunately, we may be forced to make some tough decisions. No matter what we do, we’re going to have to choose the lesser of two evils. No matter what we do, Smokey is going to suffer.

When we asked the vet whether or not he thought the rabies vaccine that Smokey was given in error caused this, he said that he believed it triggered it, yes. We don’t have the luxury to look back now, we have to keep looking forward. Forward is scary, forward could be xrays and biopsies, bone marrow aspirations and blood transfusions. The financial consequences pale only in comparison to the suffering that may be ahead for our family.

I sat on the floor with Smokey this morning while he struggled to breathe, and I thought back to Saturday, when, despite how sick he was, he visited with the neighbors at the yard sale and kissed a seven year old autistic boy on the face. The boy laughed in delight and cried, “Doggie!” while his parents stood back in shock. They explained that they were working with a speech therapist to help their son vocalize better, so we took the boy’s hands and touched Smokey’s ears, “Ears.” “Ears.” He repeated. He tried to grab onto Smokey’s tail which was wagging furiously and clapped while saying, “Tail!” Then said, “I want to pet the doggie.”

I buried my head in Smokey’s fur and cried for the first time.

Update 8/3/2012   We rushed Smokey to the ER vet tonight. His tongue swelled, his nose started bleeding and his tongue and his gums and his stomach was super distended. The ER vet thinks Smokey has lymphoma. They did lymph node aspirations on both his back legs and are running another CBC. We will have his results in a few days. 

Update 8/4  Smokey is not doing well. He started vomiting last night. This morning we took him into the vet. They put him on 3 more medications, but he isn’t eating so I can’t get them into him. He won’t even eat any of his favorite foods. Just now he threw up again and about 2 centimeter pieces of what appears to be his stomach tissue came up. He is bleeding like crazy from his nose and mouth. I’m waiting for a call from the ER vet, he may have to go back again today. I don’t think he is gonna make it.

Several hours after the update above, Smokey passed away.

UPDATE: We requested $2500 [from Merial] to reimburse us our medical bills from the time of vaccination until his death, including his cremation. It wasn’t going to give us our dog back. It really wasn’t the money, it was the relief that they recognized that he existed, that he was worth paying for. In some ways, it was to assuage our own guilt, that if they gave us even something that it wouldn’t seem as if it was all our fault, that they claimed some of the responsibilities. I think it may be silly, to expect a big corporation to pluck this pain off your shoulders. They never could have done it anyway, I suppose. We will live with this forever, unfortunately. All we can do now is push forward and try to keep others from the pain, in Smokey’s memory. That is going to help us heal more than any monetary sum could anyway. Which is why we are so very grateful for all the support you have given us through this very trying time. It’s been 8 months now and I still cry from time to time, but working toward helping other families and animals helps and every day it gets better.

Not a day goes by that I don’t miss him and this just made me feel like he was murdered without remorse. I guess that is pretty extreme and not the case but there’s this intense anger over this. I just kept holding back tears on my way home. I felt like screaming he MATTERED to us. He wasn’t just a statistic or some damn casualty number. He was a part of our family and we will never get him back and now they won’t even help us pay for what their stupid vaccine did to him. Ok now I am sitting in the grocery store parking lot writing this and just sobbing.

Related video: Learn more about IMHA at http://healthypets.mercola.com/sites/healthypets/archive/2012/07/30/vaccine-causes-autoimmune-hemolytic-anemia.aspx  If the video won’t play, click Visit the Pet Video Library.

Related Articles:

Immune Mediated Hemolytic Anemia: Bella’s Story
Questions to Ask Before Vaccinating
How to Report Vaccine Reactions

 

Tags: AIHA, canine, dog, Evans Disease, IMDA, immune mediated hemolytic anemia, ITP, Thrombocytopenia, vaccine