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Anemia         

   Mr. Johnson had just called in requesting some medication for his dog.  It appeared that Misty had started having difficulty getting up the stairs in the past few days  and he figured her hips were sore and she could use some pain relievers.  Although I was glad that he didn’t decide on his own to just give her some Advil, which would probably  have given Misty a bleeding gastric ulcer and liver failure for us to treat next week, something didn’t seem right about this sudden onset “arthritis”.  We had seen Misty for most of her life, and orthopedic problems had never been an issue before, so it seemed unlikely that hip pain severe enough that she couldn’t get up the stairs would develop over the course of one week.  Rather than just dispensing the requested medication we recommended Mr. Johnson bring Misty in so we could make sure exactly what the problem was.  He was a little annoyed by the suggestion because the whole point of the phone call had been to avoid the inconvenience and expense of an office call for a situation that he felt he had already sufficiently diagnosed himself,  but when we insisted he grudgingly acquiesced and brought Misty in to be checked out.

            Misty staggered through the door and just barely made it into the exam room before she collapsed exhausted on the floor with no intention of getting up again if she didn’t have to.  Usually this was a dog who was a bit challenging to examine because she was so actively devoted to jumping up and cheerfully licking the boogers out of my nose.  I don’t think I had ever seen her so still before.  When I lifted her lip up to look at her gums they were completely white, rather than the normal bright pink that I could usually just glimpse as her tongue came launching at my face.  Immediately it became clear that Misty’s lack of energy was a result of anemia, not arthritis pain.

            Anemia is a general term for lack of red blood cells, but the reason that Misty was lacking red blood cells still needed to be uncovered.   Dogs and cats can become anemic if they are not making red blood cells, if they are losing red blood cells as a result of bleeding, or if their immune system is erroneously destroying red blood cells because it has mistaken them as foreign invaders.  Each process requires a different type of treatment.  In Misty’s case we had an additional clue because her abdomen seemed particularly swollen and rounded.  A quick abdominal tap revealed that her belly was full of blood, so her anemia was most likely due to blood loss.   On further investigation we found out that about two weeks ago Misty had found the rat poison that Mr. Johnson had just put in an absolutely unreachable dog-proof place, had pulled it out, and had eaten it all.  She didn’t seem to have any ill effects at the time, so he had figured that it wasn’t a problem.

             Most rat poisons work by stopping the production of vitamin K in the liver, which is one of the components in the complicated chemical chain that allows the blood to clot.  When vitamin K finally disappears from the system about 2 weeks after ingestion of rat poison, even small breaks in blood vessels inside the body can lead to major hemorrhages, often contained inside the abdomen or the chest where the blood collects, but can’t be seen.  Because death from bleeding occurs a long time after eating the bait, rodents don’t associate the bait with the death of their comrades and therefore don’t learn to avoid the bait themselves.   Unfortunately because it doesn’t cause immediate symptoms in pets, many people don’t realize that it is a problem either.

              At this point a blood transfusion and some vitamin K supplementation would likely save Misty’s life, but it would still be touch and go for a while.  Thank goodness we had not decided to be accommodating and just dispensed some anti-inflammatory medication for Misty. 

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