Jasper's Story
JASPER'S
STORY


U-CDX Aurum's Vintage Dubl Trouble UDX TDX JH WC CGC
September 13, 1992 -- January 24, 2004
(photo taken January 4, 2004)

Jasper was born September 13, 1992, one of a litter of 5 male and one female Golden Retrievers.  Although we had no idea at the time and it would be another 9 years before we would figure it out, Jasper and his littermates were almost certainly infected in utero with Neorickettsia (Ehrlichia) risticii.   As puppies they appeared perfectly normal and healthy.   

My husband and I had been planning to get a puppy from this litter, to be our second dog.  Our first, Shasta, was from this same bitch's first litter, so the new puppy would be a half-sibling (same *mother*).   When the new pups were just 3 weeks old, 2 year old Shasta suddenly became ill and died after a week of intensive care.  At that time the veterinarians were unable to diagnose this mysterious illness whose symptoms included low platelet and red cells, high fever, and massive destruction of tissue in liver, kidneys, and heart.   Today, I would instantly have recognized those as  signs of tick-borne disease.

Shasta and Jasper shared the same mother, and the presence of multiple siblings from both her litters with symptoms consistent with tick-borne disease would ultimately lead us to surmise that she was herself an asymptomatic carrier who passed this organism to puppies in both her litters, unbeknownst to her owners.   It is important to know that her owner and co-owner are conscientious breeders who would never have knowingly produced sick puppies.   This bitch appeared healthy and asymptomatic, and there was no reason to believe she carried anything as deadly as N. risticii.   The onset of symptoms in puppies from the first litter came after the second litter was already whelped, and it would be many more years before any of us involved would come to make the connection that transmission of this disease might trace back to this one bitch.  How much further back it goes in that direct maternal line is unknown.

 Jasper and his littersister, Sierra, came to live with us when they were 7 weeks old.    The first sign of anything unusual came when they were about 14 months old.  Two weeks before her heat cycle (at time of hormonal stress on her immune system), Sierra had a brief illness.   Her symptoms were light-sensitive eyes, slight fever, low platelet and red cell counts.   Within 48 hours she was recovered, with no treatment.   The lack of treatment is significant as it meant Sierra continued to carry the organism and in her turn passed it to her two litters of puppies, before we knew this problem lurked there.

When Jasper was 5 years old, Doug spent a year living away on an out of town job assignment.  He took Jasper with him, and Jasper spent every other weekend in a boarding kennel while Doug flew home for visits.   Towards the end of that year, Jasper seem unusually quiet and lethargic, but we were not alarmed given that he was not getting a lot of exercise or active training.   The year came to an end and Jasper and Doug returned home.  

About one week later,  Jasper yawned and I was suddenly struck by how pale his tongue was.   My veterinarian happened to come to the house that evening to pick up her puppy; she took one look at Jasper's pale tongue and told me to bring him to the clinic first thing in the morning.    That was the start.

Monday July 20, 1998, we learned that Jasper's pack cell volume was only 10% -- normal is 50%.  The PCV is a measure of the red cell volume, so this meant Jasper was SEVERELY anemic.   When the overnight lab results came in the next day we saw the following:

 

Jasper's

Normal

white cells

7.3

6 - 17

red cells

1.77

5 - 8.1

hematocrit

11.5%

37 -55%

platelets

63

200-500

reticulocytes

0.3%

0 - 1

What did it all mean?  The normal, not-elevated white cell count suggested that it was not an infection, or if it was, his immune system was not fighting it.   The very low red cell count indicated severe anemia, but there was no sign of hemolytic anemia.  Reticulocytes are immature red cells.   Jasper's blood work in the following days would show a zero retic count, indicating non-regenerative anemia ... i.e. he was anemic because his bone marrow was not producing enough new red cells to replace the natural die-off of older red cells.   The severity of his anemia suggested this had been going on for some months.  Jasper was close to the end of the line; much more loss of red cells and he would die.

An initial attempt at a bone marrow aspiration failed because they could not get enough cells.  (Bone marrow hypoplasia (low numbers of cells) is a characteristic of chronic stage ehrlichiosis!)  Tuesday afternoon a bone marrow core biopsy was done.   The results eventually came back confirming that Jasper's red cell production was being halted in the bone marrow.  The good news was he did have stem cells, there was no sign of cancer, and there appeared to be no reason his bone marrow shouldn't resume red cell production if we could just treat the problem.   It was assumed to be an "autoimmune" problem.

At this point Jasper had seen 2 general practice veterinarians, and one board-certified veterinary oncologist.   Due to his age and breed, cancer was immediately put forth as a possible diagnosis, and we would continue to encounter this throughout his illness ... almost every veterinary specialist Jasper saw would first assume this must be cancer because of the dog's breed and age.  Throughout Jasper's illness, multiple examinations and tests would fail to find any confirmation of cancer.

Only one person ever suggested to me that Jasper might have ehrlichiosis.   Lisa Ducher is a good friend who had dealt with ehrlichiosis in her own Goldens; Lisa is also a talented veterinary technician.   That very first day of Jasper's illness, it was Lisa who suggested he might have Ehrlichia and that he should be treated with doxycycline and prednisone.   As we proceeded, the veterinarians were unable to come up with a positive diagnosis, although they were skeptical and reluctant to consider ehrlichiosis.   Everything I could find on the Internet indicated that Jasper's symptoms were consistent with ehrlichiosis!   Thankfully my veterinarian, Dr. McIntyre, honored my request to put Jasper on doxycycline right from the start.    We were also giving a moderate dose of prednisone, and started Epogen injections to stimulate his bone marrow to produce red cells.

Epogen is synthetic erythropoietin.  Erythropoetin is a hormone, made by the kidneys, that causes stem cells in the bone marrow to become red blood cells (as opposed to becoming white cells or platelets).   Human synthetic erythropoetin is used for human patients in kidney failure, and suffering from anemia due to cancer and AIDS.   It can also be used for dogs.   This is a human product not canine, at some point their immune systems may develop antibodies against the human erythropoetin, thus neutralizing it when it reaches the dog's bloodstream.  At that point it becomes ineffective; but there appear to be no other significant side effects.   Perhaps because of the immunosuppressive effects of the ehrlichiosis and the other drugs Jasper was taking, he never appeared to develop the resistance to Epogen, and we successfully used it throughout his treatment to help boost his red cell count.   Epogen is expensive, about $40 per injection for Jasper (in 1998).   Initially Jasper was getting 3 injections per week, for almost 8 weeks.   Epogen is just one brand name; Procrit is another.   Veterinarians can obtain it, or they can write you a prescription and almost any human hospital pharmacy should have it.  It is given by sub-Q injection.

By Friday, just 5 days into this, Jasper's hematocrit was dropping below 10%.   Late Friday afternoon we decided a blood transfusion was needed.   Off Jasper and I went to the local specialty clinic where blood-typed packed-red cells were available for transfusion.   We saw a specialist whose area of expertise was autoimmune disease triggered by infectious disease.  Even he was skeptical that this was ehrlichiosis, but he did agree to send a blood sample for testing for Ehrlichia canis and E. platys.   Unfortunately he didn't think to ask for testing for N. risticii or any of the other several species of Ehrlichia (or Neorickettsia) known to infect dogs!    It was a long several hours lying there on the cold floor of the clinic beside my dog, watching him just lying there with his eyes shut, watching the blood drip into the IV line.

The transfusion boosted Jasper's hematocrit to about 15%, but over the next 5 days it decreased again to 10%.   Then one morning, Jasper had a nose bleed at home -- his platelet count was still only 80, and he was at risk for bleeding problems due to inability to clot well.    In we went for another transfusion of packed red cells.   The specialist was still convinced this was some sort of autoimmune problem and recommended more aggressive immunosuppressive treatment.  Everything I had learned about ehrlichiosis indicated it could indeed trigger severe autoimmune reactions, which would indeed require immunosuppression.   We upped Jasper's prednisone to the unbelievably high level of 75 mg twice a day (yes, 150 mg per day for a 65 pound dog), added Imuran and Cytoxan to the regime.  Imuran and Cytoxan are chemotherapy drugs that have strong immunosuppressive side effects.  The plan was to use Imuran in the long-term, but as it takes about 3 weeks to kick in, Cytoxan would be used to get a strong immunosuppressive effect immediately.   

Jasper was still taking doxycycline, and a pepcid A/C every day to combat the stomach irritation that all these other drugs could cause.   I started adding fresh foods to his kibble every day, using a lot of red meat and leafy green vegetables to help provide the nutritional building blocks he needed to regenerate red cells:  protein, folic acid, iron, vitamin C, B-complex vitamins, and vitamin B-12.    Jasper was getting a kelp-based vitamin supplement plus extra brewer's yeast (for folate and B-complex) and extra B-12.   I was also trying to give a little extra active culture plain yogurt to help his digestion and add extra calcium since prednisone can deplete calcium.  Timing all the supplements and medications was a problem.   Calcium can interfere with doxycycline  so the yogurt had to be given as a snack two hours apart from the doxycycline.   The pred and doxy needed to be given with a meal to minimize stomach upset.  The pepcid was best given about 30-60 minutes before meals.   As difficult as it was to manage this schedule and make it to work on time every day, I knew there was no point in trying to fight this thing with Jasper if we weren't committed to doing everything possible and that included giving his medications correctly to maximize their effectiveness.   We were also going to my vet for CBC's every few days.   By the end of the first month, Jasper would walk in, go right to the scale and get on to be weighed then pull me to an exam room.  Once in the exam room, he'd sit down and offer his left foreleg ... that was always his best side for drawing blood!   For the rest of his life, he would repeat that routine anytime he entered that clinic!

By now Jasper had shaved patches on both front legs and one rear leg, from the IV's, plus shaved patches on both shoulders and his rump from the bone marrow aspirate attempts and the core biopsy surgery (rump).   The prednisone and Imuran didn't cause his hair to fall out, but they did cause it to stop growing.   For the next 10 months while on these drugs, Jasper's toe nails didn't grow and his coat didn't grow.  He didn't shed.  The shaved patches remained bare!   He was definitely a candidate for "Worst Grooming Job."   Talk about your "bad hair days!"

Over the next weeks Jasper's red cell and platelet counts slowly but steadily rose.  There were no more nose bleeds, and things were looking promising indeed.    His retic count was rising every time we checked, suggesting the return of normal bone marrow function.   

We were so optimistic.   Looking back, we should have known better!   N. risticii is one tough bug and it wasn't going to be that easy to beat it.   One thing I had learned:  everything published about chronic stage ehrlichiosis said it was terminal.   The prognosis was .. well, there was none.  Dogs at this stage died and sooner than later.   There was ONE published case history of ONE dog surviving this stage of this disease.   I had lost one young dog to "autoimmune disease"; I was determined NOT to lose another and especially not this very special dog.   Throughout his ordeal, Jasper NEVER looked at me with eyes asking to be released from this world.   He was as determined to live as I was to save him.   In the end that determination on both our parts is probably why he did survive; but it would be almost a year before we'd know he was going to survive. 

Meanwhile, at the end of August, 6 weeks into this, Jasper's red cell and platelet counts were back to normal and we thought it was time to start to withdraw the medications.   Here we made the first critical error.   I now believe we tried to withdraw too many of medications at once and too quickly.   Traditionally, prednisone is withdrawn by cutting the dose in half for a time, then cutting in half again, etc.   Jasper was taking 150 mg of pred a day; we started with a drop to 120 mg a day!   Probably TOO sudden and steep a drop, given the magnitude of his immune system dysfunction.   I now believe his immune system needed to be let down off the immunosuppressant drugs much more slowly and carefully.  Hindsight is a marvelous thing.   Lacking it, within a couple of week time span we stopped the Cytoxan, reduced the pred dose, reduced the frequency of Epogen injections, and stopped the doxycycline (finishing a full 60 days on it).   Too much, too fast.

Initially Jasper's red cell and platelet counts continued to rise, but his retic count was dropping -- a warning sign that all was not well.   We continued to step down the prednisone dose, eventually stopped the Epogen.  Then his red cell and platelet counts started slowly declining.   By the end of November his hematocrit was back down to 25% and still declining.   We felt it was time to go back on the prednisone (150 mg daily) and Epogen injections three times a week, and this time stay on longer was our plan.    

By mid-January 1999, we tried stopping the Epogen, but Jasper's hematocrit fell almost immediately, so we resumed.   By early February Jasper was in bad shape.  He was losing weight.  The prednisone was taking its toll ... his whole body was distended from the swelling of his liver caused by the prednisone.   His muscles were wasting, another effect of both the prednisone and ehrlichiosis.   Despite no change in his medications, now his hematocrit was dropping and platelet and retic counts were erratic, but seemed to be falling.   We knew that long-term use of prednisone could cause bone marrow suppression, and we feared were at the point of not being able to continue prednisone at this dose for much longer.   Jasper also developed severe diarrhea, due to a coccidia strain that shouldn't have caused a problem in a dog; but due to the severe immunosuppression, it hit Jasper with a vengeance.

We took Jasper to Texas A&M veterinary school, hoping they could help.  Unfortunately their initial preconceived notion was that he must have cancer (his age and breed after all), yet after a day of testing, and another bone marrow biopsy, they conceded they could find no cancer, could find no cause, no diagnosis.   We again asked if could be ehrlichiosis, but were assured that wasn't possible, we didn't have Ehrlichia in Texas (funny thing, the Texas State Health Department shows quite a few cases of ehrlichiosis in humans reported in the state that year!).   One long day, and one $400 bill later, we were kindly told to take Jasper home to die.

Home we went, back to my regular veterinarian, and together we decided that perhaps most of Jasper's current problems were due as much to the drugs as to the initial infection.   Whether he was cured or not, we felt he had to come off the drugs or they would be his death.  We determined to start weaning him off SLOWLY this time.  First we reduced the pred, this being the most significant cause of side effects.  Then decreased the Epogen to twice weekly and stayed with that for the next several months.  We opted to keep the Imuran dose the same until we'd first weaned Jasper off the pred.  A daily baby aspirin was added to the medications to counter risk of clotting from leakage of protein in his urine (one useful thing we did learn from the Texas A&M workup).

Things were looking OK, when another disaster struck.   I'd made a habit to let Jasper out to potty in the backyard, rather than walk in the neighborhood where he might be exposed to disease from other dogs.   What could happen to him in our small suburban backyard?    A SNAKE BITE!   Poor Jasper.   The snake must not have seen Jasper step over him until it was too late.   It can't have been a large snake -- two small punctures on the inside of his rear pastern.  Clearly a venomous snake from the amount of swelling and tissue damage.    He needed to be on an antibiotic, so back on doxycycline he went.   Fortunately, with immediate care, and careful attention to the wound, it healed with no further mishap.   This time Jasper was on doxycycline for about 3 weeks; if any Ehrlichia remained, we figured more doxycycline wouldn't hurt, and perhaps it did help.

Slowly we continued to decrease the prednisone dose.   About the time Jasper finished 3 weeks of doxycycline, amazingly his red cell and platelet counts began to rise again.  His platelets were now well within normal, and STAYED there!   His red cell count was steadily rising, and his retic count was the highest it had been since this all started.   Through March and April his CBC values wavered, but the overall trend was a steady rise towards normal.   By early April Jasper was taking only 10 mg of prednisone daily, still getting twice weekly Epogen injections, was off doxycycline totally, and his CBC values were looking good.   We began to reduce the Imuran, going to once every 3 days.   We continued stepping down the prednisone but every so slowly now, from 10 mg to 5 mg daily to 5 mg every other day, then 5 mg every 3rd day, and then finally on May 24 Jasper took his LAST 5 mg prednisone dose!  During those last 3 weeks we'd also first decreased the amount of Epogen per injection, then the frequency of injections, and finally stopped by that last prednisone.   Imuran had been decreased to 1/2 dose every 3rd day, and then stopped just before the last step down of pred.   With the last of the Imuran and pred, we also stopped giving the baby aspirin.   After May 24, 1999, Jasper was a DRUG-FREE dog!  

Click here for Jasper's complete blood work and medication records

We held our breath, and watched his CBC values closely.   Platelets and white cells were normal, red cells were just in normal with hematocrit of 38% and stable!   With our vet's blessing, we packed up Jasper, his sister Sierra, and Sierra's son Brass, and headed to Colorado for a 3 week camping trip.   We knew there was some risk with Jasper's precarious health, but he so loved the mountains and we wanted to share one more time there with him, just in case.   We also hoped that high altitude might serve as a natural red cell production stimulant.   During the trip we visited a local vet for weekly CBC's.    Jasper had a wonderful time in Colorado.   His CBC values bobbled, but stayed within normal.

Over the next year Jasper had CBC's run every 3 months, then every 6 months for the 2 years after that, finally going to yearly blood work until the last 6 months of his life.   For the first couple of years off the medications, his red cell and platelet values oscillated, but stayed within normal range.  Gradually the variations were less and his cell counts stabilized.    Some of the side effects of the enormous prednisone dose resolved:   his thyroid values returned to completely normal, and his swollen liver reduced back to normal.    Other side effects were permanent:  the liver swelling had pushed his rib cage wider and that was permanent.   His ligaments suffered and in several toes became "hyper-extended"; this effected his ability to jump.   His teeth decayed at a rapid rate and he eventually had to have one premolar removed.  The enamel was extremely fragile on his molars and easily chipped off.   Within a year of coming off the medications, we could see the cloudiness in his eyes from prednisone-induced cataracts;  fortunately they didn't seem to cause any noticeable vision problems.

Jasper enjoyed another wonderful 4 years of relatively good health.   Then his red cell count started dropping again.   A brief round of doxycycline and a low dose of prednisone had no effect.  Ultrasound found a 4 cm mass next to his spleen.   We feared the worst -- hemangiosarcoma is a common cancer in Golden Retrievers, with a possible hereditary predisposition.  Jasper's sire died of hemangiosarcoma.   Hemangiosarcoma is also one of several cancers that seems to frequently show up in dogs that have had tick-borne disease.  

Fortunately for Jasper, the ultrasound found NO other problems.  In fact the veterinarian was amazed at how good his liver looked, knowing Jasper's medical history and the amount of prednisone he'd taken for so long.   As Jasper's health was otherwise good at that point, there were no indications of other tumors, the mass on ultrasound looked more like a hematoma than a hemangiosarcoma, and we knew Jasper was a strong-willed dog who had fought hard (and WON) for his life before -- the decision was made to operate and remove the spleen and associated mass.   Jasper came through the surgery with flying colors.  Pathology showed the mass to be a splenic hematoma -- BENIGN!   Yet another miracle for our  "miracle dog!"

At first following the splenectomy, Jasper's red cell count rose and we were sure the hematoma had been the cause of his anemia.   Then his red cell count started dropping again, ever so slowly.   Meanwhile, PCR test results on the spleen came back positive for Ehrlichia canis (for which Jasper had been tested in the past, always negative!).   We tried doxycycline again, but with little effect.   One morning in early December, Jasper collapsed in pain.   We rushed him to the vet.   He was clearly in pain, experiencing body spasms.  Blood work looked normal, no masses could be palpated, in short no obvious cause was found.  He was put on IV fluids and by afternoon appeared to have recovered.   Another ultrasound was done.

This time it appeared our "miracle boy" might be running out of miracles.  This ultrasound found a small lesion on the right atrium of Jasper's heart, in addition to fluid buildup around the heart.   This had not been present at the time of his last ultrasound 4 months earlier.   This time the most likely diagnosis was hemangiosarcoma.   The pain and spasms were most likely a minor heart attack due to the fluid buildup.   Due to its location, the tumor could not be surgically removed.   Surgery was suggested to relieve the fluid buildup around the heart, but it would do nothing for the tumor itself.   Sadly, one week after Jasper's ultrasound, we learned that his litterbrother had collapsed and died suddenly, only weeks before; necropsy found a tumor on the right atrium.   There was little doubt that Jasper's time was short, measured in days or weeks now, no more years.  

We brought him home and treasured every day we had with him.   Then our "miracle dog" ran out of miracles.   Early the morning of January 24, 2004 Jasper experienced another heart attack and this time there was no time to get to the clinic.  He passed away at home in our arms.    Pathology confirmed it was hemangiosarcoma.   Jasper was 11 years old;   he had lived almost 5 wonderful years after winning his battle with ehrlichiosis.    Those "extra" years, those hard-won days, were well worth the price paid for them ... Jasper had such love of life and he clearly enjoyed every day to its utmost right up to the end.


In the beginning

The last Jasper photo - January 4, 2004 Snoozing after his last hunting trip!

Click HERE to view Jasper's Blood work and Medication Records

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