The Enemy Within

So, today, after the rain I took a tour of my back yard to survey the damage (those winds were vicious!)  No severed tree limbs today.  Lots of new green leaves strewn about, but that’s it.  My Columbines are blooming.  Are you familiar with them?  (outside the Colorado kids shooting spree?)   The kind I have are the Texas Superstar gold ones, they’ve got the most exotic looking flowers in a zero care plant you can get.  My Irises are blooming in big gaudy blotches of blue.  The scissor-tailed flycatchers are back, their return is supposed to herald the proper time to plant tomatoes.  (I couldn’t stand it anymore and planted mine a couple of weeks ago just prior to the last cold snap…they did survive).  My dog has killed two baby bunnies.  The swallow family that lives in my front porch is back.  The martins are back; and the doves that insist on laying eggs right next to my pool so their babies can grow up all cute then drown when they try to fly are back.  My sinuses feel like somebody has shoved a handful of cotton up my constantly running nose.  Looks like spring is here. 

I love spring but hate the pollen. It’s the most beautiful time of the year, but when you go outside to enjoy natures splendor, these nasty evil little  entities are floating around unseen waiting to wreak havoc in the form of  itcy eyes, snotty nose, hacking coughs, dull headaches, sore throats (and in the case of my patients, itchy, itchy skin).   I stand outside and just imagine these thousands of little pollen grains getting all up in my nose and eyes and it oogs me out almost as much as good old fashioned germs.  Springtime.  Guess you have to take the good with the bad eh?

This blog isn’t about allergies, because that isn’t weighing on my mind at the moment.  I will expound on them at some point, but not today.  Today, I think I’ll talk about Molli the Collie.  She is one of the dogs I talked about last Thursday.  The one who is the youngest and (was the healthiest) of three pets (the other two have cancer).  

Molli is a 4 year old Collie.  She is one of a handful of dogs who I recognize by her bark.  Her owner is always mortified when Mollie arrives because she is ALWAYS barking her fool head off at the top of her lungs.  She LOVES everybody and everything and wants EVERYONE to know it (over and over again, really loudly). 

Molly has, what one can reluctantly describe as a face only a mother can love.  When she was a puppy she developed these weird, hard, bony masses on her jaw, I’ve never seen anything like it.  Eventually they went away, and as she grew up (and I think this is unrelated) her nose kinda came in crooked.  It’s not the straight, Lassie nose, it’s more hooked, (in a cute way)kind of like Gonzo from the Muppets (dating myself here). She had severe malocclusion, where her canine teeth were all wonky and the bottom ones were growing up into the roof of her mouth.  We sent her to the dentists to have them try and fix it, but ultimately she ended up losing both bottom canines.   The big mane of Collie fur sticking up all around her neck gives her this funny, Quasimoto-esque look.   But OMG, when she comes bounding in, yapping away, you just can’t help but give her a big ol’ hug. 

Despite her less than star-worthy appearance and her incessant barking (which frankly, bugs the owner way more than it bugs me, I have two little boys, I’m the queen of tuning out excessive noise…probably why I get such dirty looks at restaurants).  This dogs joie de vive  (sp?) makes me just want to give her a big fat hug every time I see her (I know, I just said that, but it’s true).  She’s just so damn HAPPY.   Her owner loves her with every fiber, bone and nerve in her body.  She has told me from day ONE, that if anything ever happens to this dog, she’d never get over it…and she means it.  This dog is her heart and soul (she has a husband, I’ve met him, he is super cool too, but you know, the love of that special dog is different and more pure than the love of the husband…the dog will never leave you for some young, blond, secretary…not that this husband ever would, like I said, he’s super cool)

So Molli came in last Thursday for shots and a dental.  I should have known something was up because, usually her bugling interrupts whatever I’m trying to say to whatever client I’m with at the time.  I never heard her come in.  Now that I think about it, she’s usually barking the whole time I’m in the exam room trying to talk to her mom, but this time she didn’t.  What I did notice was that her gums were pale. 

Long story short, Molli has Autoimmune Mediated Hemolytic Anemia (AIHA)  and Thrombocytopenia (IMTP).  Her white blood cells have launched an all out war against her red cells and platelets.  Go after the red cells, and the victims run out of blood, go after the platelets and they can’t clot.  Bad combo.  Bad disease. 

Most cases of AIHA and IMTP are idiopathic (fancy word for nobody knows why it happens).  Sometimes you can trace it back to something that “over stimulated” the immune system.  Vaccines have been implicated (within a month of the disease happening), antibiotics can do it,  tick borne disease, bladder infection, other diseases, cancer Most of of the time you don’t get to figure out the inciting cause.  

For whatever reason, the white blood cells (they’re like your body’s military) decide that the red cells (the pack mules for oxygen) are the enemy.  They attack mercilessly, even down to the level of killing the baby red cells, down in the bone marrow, before they get to mature.   The war rages on, the red cells plummet, the resultant havoc makes the dogs feel like crap, robs them of their oxygen carrying capacity, collateral damage makes them more likely to form fatal blood clots in the lungs (PTE or pulmonary thromboembolism), or the body starts to shut down and go into DIC (dessiminated intravascular coagulation or “death is coming” to the ER folks).  50% of the time, despite our best efforts, the patient loses the battle. 

My job is to use immune suppresants (steroids and other meds) to wipe out the white cells and give the reds a chance to recover. Meanwhile fighting the side effects of the eventual handfulls of drugs the owners have to give.  Drugs to supress the white cells, drugs to combat the side effects, drugs to prevent blod clots.  Piles and piles of drugs.  The meds don’t work immediately, so often the dogs need blood transfusions to bridge the gap til the drugs start working.  Blood transfusions just add fuel to the fire…foreign RBC’s for the whites to attack.   It’s a race between the drugs, and the disease, while we all sit helplessly and wait to see who wins.

We see that patients daily, counting red cells.  Each CBC (complete blood cell count) is a little emotional roller coaster.  How many red cells?  Will we need another transfusion?  How are the platelets?  Are there baby red blood cells yet?  The white cell numbers keep climbing, when will they stop?  The serum is more yellow, is the liver trying to crap out now?  High blood sugar, are the steroids making her diabetic? The emotional toll on everyone is high. 

I call specialists, read articles.  We’re doing absolutely everything we can.  We just have to bite our nails and grind our teeth and wait.

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