Charlie's fight for life

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It will be impossible to fully illustrate Charlie’s personality and her will to live in this short story, but you can see her spark and spunkiness jumps out of her photos! (Click here).

 Charlie’s fight started back in the middle of October – her breathing was fast and heavy, she seemed drunk and dis-orientated and she had no energy to move. All of this had developed quite quickly over a few hours and when her owners called us at 8pm via the emergency number, she was in a bad way. Over the phone, her gum colour was described as white. This was serious!

Charlie’s owners rushed her down to the clinic where we performed several tests. These in-clinic tests showed that her red blood cell level was 16%. The normal level is 35% and higher and levels below 18% indicate imminent death. Her blood was clotting normally so we knew that she didn’t have a bleeding disorder but her serum (the watery/fluid component of her blood) was a red tinge and when placed on a microscope slide, her blood separated into little clumps. These findings all suggested that Immune-mediated Haemolytic Anaemia (IMHA) afflicted Charlie.

This disease (IMHA) is caused by a mal-functioning of the immune system. Essentially, Charlie’s immune system thought her red blood cells where foreign and shouldn’t be there, so her immune system was actually destroying her red blood cells. When the red blood cells are damaged or destroyed, the red haemoglobin pigment from inside the cell is released, hence the reddish tinge to her serum.

Red blood cells transport oxygen, so when they’re destroyed and there are not enough around, the body no longer has enough oxygen to function and then eventually to live. This was happening to Charlie – first her muscles didn’t have enough oxygen to function so she was becoming sluggish and lethargic, but at her low level of 16%, even the heart and brain would not be getting enough. Damage was occurring to all her vital organs (liver, kidneys, heart and brain).

She was breathing faster and harder to try and compensate – but all this does is get oxygen into the lungs but the red blood cells weren’t there to actually transport it!

IMHA occurs spontaneously and is triggered off by stressors on the immune system. This can be as simple as a vaccination, or a medication, through to a reaction to a food protein or an insect bite. Charlie hadn’t received anything unusual or any vaccination recently, so the trigger of her IMHA remains unknown.

The first step in Charlie’s rescue was to give her an immediate blood transfusion. This is not a cure, but for Charlie it would give her a little boost and maybe let her live for another 2-3 days to allow medications to work to bring her immune system back under control.

Charlie’s blood transfusion went well and her red blood cell level was increased to 30%. There were no signs of a reaction – dogs can receive any other dogs’ blood for their first transfusion – there is no need for blood matching (typing) for this initial transfusion.

Charlie had also been started on Prednisolone (to suppress her rampaging immune system).

Unfortunately, within 2 days of her transfusion, her red blood cell levels had plummeted down again. Her levels dropped to 27%, then 20% AND THEN 11%!!

At this point Charlie was still showing signs of active red blood cell damage – i.e. her immune system was still out of control, despite her medication. Basically, Charlie still needed more time for the medication to work (with no guarantees that they would do enough for her) but she had no time left from the transfusion effect.

We had serious worries – should we perform a second transfusion (rarely done due to escalating costs and risks of a reaction) with no guarantee of success or should we admit defeat. This was heart wrenching for Charlie’s owners – their beloved baby was suffering; close to death, yet still fighting and she still had options on the table.

After much deliberation and discussion, the decision was made for Charlie to receive her second transfusion. This blood came from Baxter, one of our nurses’ dogs – but this time a lengthy and laborious process had to be undertaken first to ensure that the blood matched Charlie’s profile and wasn’t going to cause a life threatening reaction.

The blood matched!

After the second transfusion, Charlie’s red blood cell level had increased to 20% - still critically low but enough for her to hang on (strictly rested and confined to her bed, with an intravenous catheter in place and on a range of medications).

Over the next few days, Charlie was admitted to hospital each morning, tested and monitored and administered all her medications. She was on two medications to control her immune system, anti-biotics, milk thistle to protect her liver, and two medications to protect her bowels from the effects of her immune-suppressive drugs.

Despite all of this medication, her second transfusion, all the love and attention that had been bestowed on her, she continued to slide backwards. Her blood level slowly dropped to 16% and blood tests showed liver changes. Her bowel function was up and down (diarrhoea and vomiting) and her energy levels depressed.

Throughout all this she remained bright eyed and alert!

There was nothing more her owners could do for her – we were now in a terrible place – hope diminishing but too early and too far in to pull the pin - it was a waiting game.

And then on day 7, her red blood cell level increased – from 16% to 18%. From there, it increased to 20%, then 22%, then 25%. Over a period of 5-10 days, it hovered in this region. It also slowly cleared in colour – losing its reddish tinge. Charlie had turned the corner. Her immune system was no longer attacking her red blood cells!

She remained on all her medications, at massive doses, and we began to check her liver via further blood tests and an ultrasound. Things appeared ok so her treatment schedule remained the same.

By this stage, Charlie was showing some of her character – barking and running to greet her family, eating voraciously, playing games and wagging her tail. Her energy levels were creeping back up. It was important her owners continued to keep her quiet and monitor her closely, but the journey through the woods was beginning to become more open and light!

By Christmas, Charlie was able to do her own thing (still on medication and regular red blood cell and liver checks) and she particularly enjoyed her new bed and Santa suit.

As I type, Charlie remains on a low dose of immune-suppressive medication. We trialled her off cortisone but a reddish tinge to her serum recurred, so as a precaution, she re-started this at a low dose again. She is no longer on bowel protectants or anti-biotics but her milk thistle has been continued (to help her liver).

Many cases of IMHA remain on medication for long periods (12 months+) and some pets require it for life. Time and tests will tell us how Charlie will fare and what she will need. At this point, she is stable and full of life. She should have a big role to play in her Mummy and Daddy’s upcoming wedding!

Charlie is only here as a result of her tenacity for life and her parents desire to give her the best chance of surviving. Their decisions had to factor in Charlie’s wellbeing and quality of life throughout her treatment, the prognosis for survival, finances and their own time and health. There was nothing simple or easy about this process and the key to a good outcome was full and complete disclosure and honesty from both sides, us as Charlie’s physicians and Charlie’s parents. The road certainly had its ups and downs and Charlie will always require a level of attention that most pets do not need but her parents are dedicated and we have no doubts as to is #1 in their lives!

We’ve all fallen in love with Charlie and we hope to see her face in those wedding photos!

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