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Extremely high white blood cell count--114,000!!
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alaskamom17 posted:
Hardly know where to begin. Overwhelmed and grieving. My 5 yr old Shih Tzu is pregnant for the first time. 6 wks today. for the past 3 weeks+ she has had varying degrees of dirrhea. It is what prompted my first visit to the vet. looked at stool sample and said bacteria balance was out of wack. Put her on Prostora. Problem persisted so put her on amoxycillin. Today is last day. Has possibly helped some. Stool is better formed but the tail end of it always starts to revert to the wet gooey stuff and if she tries to to go some more, it's always sloppy or dribbly. Because problem persists, went back to vet. Did another stooll sample as well as blood sample to be sent out of state for anaysis. Blood came back yesterday with outrageously high WBC of 114,000! did not see results so don't know what the breakdown on types of cells except that vet said they were the kinds that indicate infection as opposed to leukemia. We did full abdominal ultrasound becasue vet thought perhaps something was wrong with one of the puppies that was causing the high count. Found 4 active babies, bladder looked fine, one kidney looked fine, couldn't see other and presence of gas in intestine prevented seeing liver this time. Saw nothing of concern so collected urine sample. Sample full of white cells floating freely, not casted. Sample also sent out of state for anaysis. Waiting to hear on stool and urine now. Of course the specter of pyometra looms. Vet said is very rare to have pregnancy and pyometra. Obviously, hoping it is not the case but do not know how they will be able to determine if it is. Pixie seems to have no discharge although she does lick down there from time to time, I have periodically checked and have never seen anything. She occasionally does some scooting which I have wondered if from itchy vulva or irritated anus due to the diarrhea. Do dogs get vaginal infections? The two times I have taken her temp it is normal (99.6 99.9) but need to do that again today. Also, her appetite has changed through all this. With the altered stools came a loss of interest in her normal food. It was her lack of eating or drinking for a day on a couple of occaisons that prompted calls to the vet. They found her hydrated and since she was always interested and happy to eat any food we were eating (we didn't give it to her) they said to make her some rice and boiled chcken or beef. She ate that with relish at first, but since then it has been a revolving door as to what she will eat. Does not want anything to do with the rice anymore. will eat pasta, potato, carrot, one day it's chicken the next day beef. We never know. One night she finally ate some of her old regular dry food, a high quality holistic kibble, but by 5am, she threw up and then again at 7. Don't know if it was too much for her system to eat it. Of course I wonder if the random diet could be continuing to cause her stools to be abnormal, but the vet said to try to get her on puppy chow or combine it with whatever she will eat to get the calories in her. Worried about proper, complete nutrition for her and the puppies. Otherwise, despite the fact that the vet says a dog with this high a WBC would be practically comatose normally, Pixie is pretty happy and normal for a 6 wk pregnant dog. Seems a little sleepier than usual but otherwise very excited and happy to go on any walk or ride in the car. Often cries for us to toss her toys so she can run after them and bring them back. It is all very baffling and scary! I am deathly afraid of losing Pixie and the litter. Our vet is consulting with other vets but presently, everyone is scratching their heads. How do we rule out pyometra? Amnio? What else could cause the high WBC count? Vet feels way too high for simple bladder infection. How are the inappetance, stool irregularities, and high WBC related? Please HELP!! I'm scared and heartbroken.
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AMERICAN VETERINARY MEDICAL ASSOCIATION
Bonnie Beaver, BS, DVM, MS responded:
It sounds like Pixie has a wonderful, caring owner. And what a mystery!!! Pyometra and live pupplies do not co-exist so it is very likely that pyometra is not the problem. In addition it sounds like she feels relatively good which is also not common for a dog with pyometra. So the question of the high white count continues. I am not sure you can totally rule out leukemia (but I haven't seen the results either). The reason I say that is because any infection that generates that high a count is almost always also associated with a very sick dog. Another possibility of the problem is "lab error" and that her count isn't really that high at all. When things don't add up, recheck the steps to be sure the numbers are really true.

Your veterinarian is doing the right things and is talking to specialists to try to solve the mystery. Just know that I hope things go well and that Pixie has some nice, healthy puppies.
 
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alaskamom17 replied to Bonnie Beaver, BS, DVM, MS's response:
Thank you so much for your reply, Dr. Beaver.Your comment about the pyometra was reassuring, although the report from the lab that did the blood work said that they were "concerned about pyometra in this pregnant dog", so I am a little confused. I would rather go with you and, as you say, she is not acting as sick as a dog with pyo would be. Since I posted last, vet started Pixie on 125mg Clavamox 2x/da. Got a copy of the lab report today. Says Adj WBC Total 114.5 K/uL. The RBC, etc. was normal. Breakdown on WBC's as follows:
Bands 2% 2290/ul Polys 83% 95035/ul
Lymph 9% 10305/ul Monos 3% 3435/ul
Eos 3% 3435/ul Baso 0% 0/ul NRBC 3/100WB
Comment: Platelet estimate adequate
Slide review: Neutrophils non-toxic. Slight left shift (2-5%). Cells appear mature and significant neutrophilia is more consistent with an inflamatory response (leukoid reaction) than a granulocytic leukemia. Lymphocytes are primarily small and mature, few slighty larger and reactive.
They request sending along freshly made smears to assess for left shift and toxic change. Also, the Chemistry Screen showed out of range values for ALT 92 U/L and AST 65 U/L. Are these significant? Everything else normal.
Any feedback you might have have would be appreciated. We have another ultrasound tomorrow with more of a specialist. Hoping to get a good look at everything, especially lots of live puppies! Not sure of net effect of antibiotic at this point but appears we will be doing another blood test. Wish Dr. Ann Hohenhaus from the Web MD Community would weigh in on this too with her specialty in hematology and oncology, she seems to be exactly what we need. Thank you so much!
 
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AMERICAN VETERINARY MEDICAL ASSOCIATION
Bonnie Beaver, BS, DVM, MS replied to alaskamom17's response:
Thanks for the additional information. There is a significant problem, that is a given. The problem is to find the source of the problem. All the cell values are off but like, the Slide review commented, it seems to be consistent with the bone marrow responding to some souce of inflamation. The 2 values in the Chemistry Screen are not significantly abnormal so they are not something that I would worry about. Like I said, pyometra would be my first thought too and you commented that the vet saw "4 active babies" plus the dog was not feeling particularly bad. Letting an expert in ultrasound give you a better picture of what the problem migh be hopefully will solve this puzzle. If not in the uterus, there is something big going on somewhere else. I hope things go well.
 
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MaxNugget replied to alaskamom17's response:
Hi,

Did they ever diagnose the problem. My pup has a similar issue with WBC of 111,000. Tests for pancreatitis, ticks, lyme are negative. Ultra sound shows no tumors or obstructions and radio graphs are also negative. Prednisone isn't bringing down the count.

At this point they are thinking Addisons or bone or stomach lining cancer.

Another possibility online might be AIHA.

How did it end and did Pixie's count come down?
 
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alaskamom17 replied to MaxNugget's response:
Hi. Unfortunately, I do not have a definitive resolution to this issue at this time. Happily, Pixie is alive and well, but not without issues. This is what happened. Pixie delivered her litter of adorable puppies on Thanksgiving day. We had them with us until March. Pixie nursed and mothered the puppies perfectly. She lost a lot of weight through the nursing. Afterward, her blood picture was still out of whack.The doctor wanted her to get a chance to stabilize and get her hormones back to normal so we waited a while. As time went on, she was not thriving, her hair was thin, and she was skinny. We made plans to get her fixed and do some other exporatory things. The problem was that in preparation, we discovered that her clotting factor was dangerously low and the doctors wanted to wait for an improvement. When they finally made the decision to proceed, she was only minimully better and they advised I might like to purchase some plasma to have on standby in case of bleeding, which I did (after robbing a bank to cover the exorbitant price!) They worked as a team to accomplish everything as quickly as possible. They removed her uterus, took a biopsy from her intestinal trac, and looked around for other signs of inflamation or tumors. Due to the fear of bleeding, they only took one biopsy, but everything came up negative including the pathology on the uterus and pancreas. However, her health and demeanor changed dramatically for the better after the surgery, so I don't know what to say about that. The doctor wanted to let her recover, not test and prod her for some time after the surgery and during that time she became more the old Pixie we knew before than she had been in months. We never have gone back to get more blood work done, I have to confess. She is seemingly healthy and happy, energetic, playful, but we still deal with loose stool all the time. it is such a pain, but there is no blood in it to the naked eye, except on rare ocassion and I have learned that that is likely due to the irritation of the diarrhea, and at least the first one is fairly firm--it is at end or subsequent ones that are messy. My instincts tell me there is an allergy going on (also has some flaky skin despite special Omega fish oil drops she gets on food) or maybe an irritable bowl situation. Don't know why something like that suddenly appears after you go along for 6 years perfectly fine, but they say it can. She is on a holistic kibble that is designed to be simple and for delicate GI issues (Holistic Select Radiant Salmon, Sardine etc), and we eliminated chicken from her diet because the vet said it is surprisingly allergenic, but don't really feel it changed anything. She is due for shots soon and when I take her in I will discuss pursuing things further. Long ago, vet thought we might try a more exotic protein in an effort to bypass any allergy issues (kangaroo, beaver,??) and I am curious how her blood looks, although I do not relish opening that Pandora's box again since we had stumped every doctor that came in contact with her case! If I learn anything else I will let you know and you let me know if you get any clues! Thanks for the message.


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