Once in a lifetime, or maybe twice, if one is very lucky, there is a dog whose heart beats as one with yours. Just such a dog is my CeeCee! From the very beginning, when she leapt into my arms at the breeder’s, we became one! As she was my first show dog, we explored the world of conformation together. Cee, the confident one, was to lead klutzy me around the ring and we were to have amazing success together. From those wonderful highs we were to fall to the lowest depths.

Evans Syndrome (ES) is a combination of two conditions, one being Autoimmune Hemolytic Anemia (AIHA) and the other being Idiopathic Thrombocytopenia ((ITP). The immune system, normally the defense against foreign invaders, becomes defective and begins to attack the body’s own cells. In AIHA, it destroys the red blood cells which normally carry the all important oxygen through the body. ITP is a blood disease in which the platelets are destroyed by the dog’s immune system. Platelets control the clotting capability of the blood and when they get too low, the dog, in the worst case scenario, can bleed to death. ES is a serious autoimmune condition that needs to be dealt with promptly and aggressively.

Cee’s problems began shortly after her third birthday. It started one morning with her refusing to eat. That was very unlike her as she had always been a good eater. She was lethargic, barely rising from her bed. This was normally an active girl and something was definitely amiss. Her stool was a very brilliant orange in color, not normal. Her gums were pale with no pink evident. We took her into our local vet right away and he checked her out. She had a normal temperature and nothing unusual showed up in the exam. He took blood and the tests came back the next morning. Red blood cells were very low at 2.28 (normal is 5.5-8.5). Platelets were down to 55 (normal is 164-510).

By the next day, we were at the specialist’s office and he continued tests: urinalysis, ultrasound, x-rays, Coombs, ANA, and observation. He quickly ruled out the clotting disorder, Von Willebrand’s disease; cancer; zinc poisoning; bladder infection; and intestinal parasites. He also had a Tick Panel done because diseases such as Lyme disease, Ehrlichia canis, Anaplasma phagocytophilum, Rocky Mountain Spotted Fever, and Babesia exhibit many of the same symptoms that Cee displayed. Results from these panels took longer to come back, but, in time, all these diseases were ruled out, too.

By the end of the second day of testing, and after a barrage of tests, the specialist was 98% sure that Cee had Autoimmune Hemolytic Anemia and Thrombocytopenia. We immediately started Cee on the corticosteroid drug, Prednisonne…massive doses at 40 mg daily. The idea of such huge doses was to shock her system into stopping the attack on itself. A backup drug, Imuran (Azathioprine), was prescribed.

Her blood numbers showed some improvement immediately, but it was to be over eight months before they moved into the normal range. By then, the goal was to reduce the drugs, which can have harmful side effects, as much as possible while keeping the red blood cells and platelets in the normal range. It was a delicate balancing act which required constant bloodwork. At first, she had twice weekly blood tests and as she got better those tests stretched to weekly and then twice a month.

Her march toward renewed health was not to be a smooth one. There were many potholes in the road as she developed side effects from the prescribed drugs. She was constantly panting and needed to frequently urinate. She had diarrhea from an overgrowth of bacteria in her intestinal tract. This we treated with antibiotics. After months on Prednisonne, she developed an ulcer and began vomiting. She became dehydrated and was placed on IV’s. By this time, we were able to ease off the Pred and support her with medicines which protected her tummy. Finally, she was able to stay off all drugs for nine months. Those were deliriously happy months here at Birchbark.

And then, unexpectedly, she relapsed with ES again. We caught this relapse through her routine CBC (Complete Blood Count) test. There was no outward sign of the platelets diminishing. Often dogs show bruising or excessive bleeding after trauma. This was not to be in Cee’s case as we caught her condition early. I am certain that if we had not continued her frequent blood tests she would have continued to lose platelets and would have ultimately needed a transfusion. This would have been an even more serious state of affairs.

We searched for other ways to help Cee overcome her health issues. After her relapse, we began acupuncture. Her acupuncture vet is certified in this field and did a thorough history of her case before beginning to work with her. At first she saw him weekly and later as her body regained balance she was able to go longer periods between treatments. Recently, we have done two other things to support her. First, she was spayed as her seasons were hindering her health and, secondly, she began to take Chinese herbs prescribed specifically for her case. Her specialist, acupuncture vet, and I work together to design and implement her health regimen. Our philosophy is to blend the Western medicines with the Eastern alternative approaches. It is a team effort all the way and it has paid off. Presently, she is on small doses, every other day, of Prednisonne and she is no longer on the Imuran. She has shed the polyarthritis which attacked her system in August and she is running the fields with the other dogs here at home.

Through researching, we learned that there are certain triggers which cause a predisposed dog to become sick with ES. Stress can be an enormous factor. Cee became a home dog, one who could count on routine. We no longer took her everywhere with us as we once did. One reason was to avoid stress, but the other was to protect her immune system since the steroid drugs had compromised it. She could easily have picked up any stray bug floating around. When visiting her vets she wears her booties to avoid those bugs! Vaccinations can cause problems, too. We immediately ceased all vaccinations and flea meds and administered only the drugs needed to combat her diseases. Because her stomach and intestinal tract became sensitive, Marty began to home cook all of her food. We relied on Dr. Donald Strombeck’s diets and recommendations and she did well on this program. We observed her closely for any signs of change in eating habits, pottying, energy levels, etc. These routines continue today.

When CeeCee was first diagnosed the only thing I knew about her diseases was that dogs died from them. It was a terrifying thought. However, education became a powerful tool! It was with the support of competent and knowledgeable vets in our area and Dr. Linda Aronson, of the Beardie community, that I came to believe that my girl could survive. The internet list, CIMDA (Canine Immune Mediated Disease Awareness), helped me learn about autoimmune problems. It is comprised of people who live with dogs that have autoimmune health issues. These owners possess a huge amount of expertise and information and they provide support for the newcomer who is completely overwhelmed and frightened at the prospect of losing a dog.

The cause of Evans Syndrome is unknown and more research is needed to find out how it comes to affect some dogs and not others. Because it is frequently found in association with other autoimmune diseases that are known to be inherited, it is believed that ES is too. Dr. Anita Oberbauer’s research group at UC Davis, currently looking for a major gene marker for Addison’s Disease in beardies and other breeds, is banking DNA from dogs submitted for that study. It is hoped that these samples will be used to find other autoimmune markers, including those for ES.

CeeCee is no invalid these days. Despite adversity, she has returned to her former outer beauty while always retaining the courage, bravery, and determination to live. In the course of her illness, she has taught me patience, strength, and the capacity to appreciate each day as it comes. If anything, her health problems have brought us closer and our hearts continue to beat as one! There are no guarantees of good health with autoimmune dogs and we may face relapse again, but I have come to believe in miracles for my CeeCee is, indeed, a living, barking miracle!

I wish to publicly thank all of those in the beardie world who have supported us with their love, white light and warm wishes for Cee’s return to good health. Since her illness we have received over 900 messages through BDL and it is those thoughts which have kept us going during the worst moments.