# hemophagocytic histiocytic sarcoma?



## Ljilly28 (Jan 22, 2008)

Tally went to an internal medicine specialist who says that on Monday at noon, she will look to rule out a particular kind of "hemophagocytic histiocytic sarcoma" before doing anything else, something I have never heard of???????? I looked it up, and it seems that Bernese Mt Dogs get it. Anyone know anything about it? She also said it could be a particular kind of pano that would be self-limiting and no big deal.(I thought dogs with pano had limping and bone lesions- which Tally doesnt???) I am flustered, since my own vets didnt bring these up as possibilities and also bc she thought all the tick tests were kind of a waste of time(that was my take-away message). How I love Tally Sweetface, and I am cuddling& playing with him and channeling good news.


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## moverking (Feb 26, 2007)

G'mornin' Jill and Tally Sweetface
Well, I just poured over 4 articles about this syndrome...and not discounting the IM vet...the symptoms shared by Tally seem to be the anemia and lymph involvement only....not the limb involvement etc that the articles mention.

_hemophagocytosis *(could be the cause of the anemia)*
Pronunciation: hē′mō-***′ō-sī-tō′sis

Definitions:
1. The process of engulfment (and usually destruction) of blood cells by the various types of phagocytic cells; used especially with reference to the engulfment of erythrocytes(red blood cells) and others of the erythroid series._

Take a deep breath....because his symptoms are a bit vague and a definite diagnosis has been evasive, of course an internal medicine doc (who probably has trained under someone or herself been involved in this diagnosis before)
is going to be throwing out ideas....that's a good thing, albeit making you scared and crazy at the same time. 
Second set of PCR runs for Babesiosis will be done when?
I always watch for your posts and think of you and Tally daily, hope you can feel the good vibes


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## Ljilly28 (Jan 22, 2008)

Moverking, thanks so much for watching over this! I am scared, a little bit, and it's extremely consoling. 

She thinks Tally resists in his shoulder at her physical exam, and mentioned that as limb involvement. She said not to panic, but that she'll rule that out first and foremost on Monday, before proceeding. 

She also said some slight pano, a particular kind, could be responsible. She looked at the xrays my regular vets took on a CD (they didnt see anything wrong whatsoever),and thought she saw a little something in his shoulder, but not OCD. She was intensely skeptical about babesia, and that test won't be back for six more days. I am hoping that this is just Tally, and maybe there's nothing too wrong. He's so glossy and playful. The goldens I actually lost to cancer were elderly and had pretty clear,classic symptoms like drastic weight loss- one was 15 1/2. Tally has zero indications, and if it weren't for his routine CBCs, I would never know. It's hard to believe anything that serious could be wrong. 

On the down side, a second ago I just found a cousins on k9data :
Nautilus All The Right Moves (3/21/2006-9/2/2008)
Honorifics:	Hemophagocytic Histiocytic Sarcoma
Nautilus Trouble Along the Way (3/21/2006-12/28/2007)

Okay, this is just the worst idea- no more k9data for me until after tomorrow at noon. 

I am sure he's fine bc he is just too smiley a chowhound.


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## moverking (Feb 26, 2007)

You are hereby BANNED from searching for things wrong with Tally's relatives!!!!  Look instead for longevity and good health...know that those genes are more plentiful, or we wouldn't have these beloved dogs at all.

That said, I'd be doing the same as you, and would hope someone would help me stop wasting minutes worrying.

Hang in there, girl....what a great vet team you have.

Sadie and Loo think Tally is a hunk and send sexy roo's to him, lol


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## Penny & Maggie's Mom (Oct 4, 2007)

Sending good, worry-free thoughts and prayers for you and Tally. We'll be waiting to hear some good news SOON. The Dallas girls (and Cody) send some ear rubs and games of fetch.


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## Debles (Sep 6, 2007)

Jill, I know how difficult it can be not to worry when your beloved baby has questionable scary medical signs. AsI had to with Gunner, don't worry till you have solid facts! Focus on Tally's spunk and sweet joy!!!!
We are sending much postive energy your way!!!!

Moverking!!! You are Magnificent!!!!


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## Meggie'sMom (Dec 24, 2007)

Meggie and me send good thoughts to Tally. It's good they are ruling out the worst case scenario so you can get on with diagnosing something non-life threatening. Always think positive!


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## tippykayak (Oct 27, 2008)

I call zebra on this particular diagnostic theory. Sometimes specialists get carried away and like to look for the coolest, weirdest diseases (zebras), rather than the more common, likely, boring ones (horses).

Tally has a horse, like a non-typical presentation of pano or an immune reaction triggered by his early anaplasmosis. Babesiosis is unlikely, but worth ruling it because, in my totally uncertified opinion, it's more likely than rare blood cancers.

Theorizing that some hyper-rare cancer is eating his red blood cells is a little out there, a little too "invasion of the pod people" for me. Plus, from what I understand of Tally's symptoms and of this disease (after a little reading), it's not a great fit. He had low reticulocyte numbers, right? If I understand the disease process properly, this disease would push down his erythrocyte count overall but not necessarily his reticulocyte count. 

That is, this cancer eats adult red blood cells, but doesn't necessarily interfere with the production of new ones. Tally's defining symptom was the non-regenerative aspect of his anemia, right? 

Did they x-ray his spleen? Is it enlarged? Did they do a bone marrow biopsy?


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## moverking (Feb 26, 2007)

tippykayak said:


> I call zebra on this particular diagnostic theory. Sometimes specialists get carried away and like to look for the coolest, weirdest diseases (zebras), rather than the more common, likely, boring ones (horses).


That's what I thought, too....along with the working knowledge that Internists always tend to blame an organ, not an introduced organ_ism_.

I've got to read up on anaplasmosis more...


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## tippykayak (Oct 27, 2008)

moverking said:


> I've got to read up on anaplasmosis more...


Well, the pain in the butt about that is that it's poorly understood and under-studied. If you find any really good science on it, throw it my way. All anybody seems to know to do is to see if it's there and then hit it with doxycycline. 

Speaking of doxy, Tally's been on very high, very long doses of it, right? Its relatively safe for a tetracycline, but hemolytic anemia is a side effect of it. Has long term antibiotic exposure been looked at as a possibility?


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## LibertyME (Jan 6, 2007)

Oh dear Tally....such a sweet one...why does your active body cause such mystery and angst?!
Prayers for Tally and his Doctors to find an answer and painless treatment.


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## moverking (Feb 26, 2007)

tippykayak said:


> Well, the pain in the butt about that is that it's poorly understood and under-studied. If you find any really good science on it, throw it my way. All anybody seems to know to do is to see if it's there and then hit it with doxycycline.
> 
> Speaking of doxy, Tally's been on very high, very long doses of it, right? Its relatively safe for a tetracycline, but hemolytic anemia is a side effect of it. Has long term antibiotic exposure been looked at as a possibility?


I will most certainly throw it your way.

And when I looked closer at Doxycycline....a while back....I missed that side effect...even tho I was looking for it. Good suggestion!


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## 3SweetGoldens (Feb 28, 2007)

Jill....keeping Tally and you in my prayers, that they will finally find the problem, and the right treatment to correct it. I know how worried you are, and hope the wait for a correct diagnosis is here soon. Sending many positive thoughts, hugs, and energy for positive results, and a relatively easy fix for the problem. Continuing to keep you both in my daily thoughts and prayers.


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## moverking (Feb 26, 2007)

Here's a thought...have they tested Tally's IgA & IgG (immuno-globulin levels)?

This seems to be an informative site...I've used it before and like it.

http://www.marvistavet.com/html/body_ehrlichia_infection_in_dogs.html


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## Tahnee GR (Aug 26, 2006)

Lots of good suggestions here, Jill. And I am keeping you and Tally in my thoughts and prayers.


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## GoldenJoyx'stwo (Feb 25, 2007)

tippykayak said:


> Well, the pain in the butt about that is that it's poorly understood and under-studied. If you find any really good science on it, throw it my way. All anybody seems to know to do is to see if it's there and then hit it with doxycycline.
> 
> Speaking of doxy, Tally's been on very high, very long doses of it, right? Its relatively safe for a tetracycline, but hemolytic anemia is a side effect of it. Has long term antibiotic exposure been looked at as a possibility?


As an alum of some universities you have access to all those great full-text journals. 

I'm thinking of you and Tally, Jill.


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## Ljilly28 (Jan 22, 2008)

Love you guys! Monday(tomorrow) is spleen xray etc. His reticulocytes(What are those?Components of red blood cells? Types of red blood cells?) are uneven in their shapes, which is somehow signficant. She thinks of "histo" as she calls it, as common it seemed like? As you can see by all the question marks, I got caught off guard and was too flustered to inquire after the science/medicine like I usually do. By tomorrow night, I should know more, and I do think Tally looks& acts in bloom, not sick. However, she was very matter-of-fact about how she would proceed tomorrow. I am hoping for Zebra, and believing Zebra, but the forum is so helpful for being armed with information. Here's the place:http://www.portlandvetspecialists.com/services/services.html, and the doctor is Gail Mason.
Thanks for all the caring for Tally Sweetface!



tippykayak said:


> I call zebra on this particular diagnostic theory. Sometimes specialists get carried away and like to look for the coolest, weirdest diseases (zebras), rather than the more common, likely, boring ones (horses).
> 
> Tally has a horse, like a non-typical presentation of pano or an immune reaction triggered by his early anaplasmosis. Babesiosis is unlikely, but worth ruling it because, in my totally uncertified opinion, it's more likely than rare blood cancers.
> 
> ...


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## Debles (Sep 6, 2007)

I will be praying for sweet Tally tomorrow and you, Jill. I agree with Brian.


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## Ljilly28 (Jan 22, 2008)

tippykayak said:


> Well, the pain in the butt about that is that it's poorly understood and under-studied. If you find any really good science on it, throw it my way. All anybody seems to know to do is to see if it's there and then hit it with doxycycline.
> 
> Speaking of doxy, Tally's been on very high, very long doses of it, right? Its relatively safe for a tetracycline, but hemolytic anemia is a side effect of it. Has long term antibiotic exposure been looked at as a possibility?


Such a good call on the Doxy. I keep thinking how, if we hadnt decided to be ultra responsible bc of that anaplasmosis and do CBCs every six months, there really wouldnt seem to be anything amiss. Tally was a hoot at Rally class and then was the demo dog for Elizabeth's new CGC class that she's teaching today. He was very prancy dancy and normal. I wonder if this is really neccesary? I really dont want him sedated or xrayed, but I feel I have to follow it up. Thanks for reading about the "histo"; I just can't bring myself to look.

The other good Zebra thing is that this drama has been ongoing for more than a month. If it was something evil, then I would think symptoms would show by now. I'm going to read about the


> IgA & IgG (immuno-globulin levels)


 now. I'm not sure if they tested for that or not, but I am sure this specialist is going to be competent and conclusive.


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## moverking (Feb 26, 2007)

_Reticulocytes
Reticulocytes ("retics") are young, anucleate erythrocytes. They are released to the blood in increased numbers as a response to anemia caused by hemolysis or blood loss in most species (horses are a notable exception). 

Evaluation of the reticulocyte response is an initial step in characterizing anemia in species other than the horse. If the number of retics is increased in an anemic animal, it is a sign that the anemia is "regenerative" in character. Regenerative anemias are caused by loss (bleeding) or destruction (hemolysis) of erythrocytes from the peripheral circulation. Anemias without increased reticulocytes are termed "non-regenerative", and are due to conditions which decrease the production of erythrocytes by the marrow. _

I'm searching Retic. Morphology(shape) and am not getting any good hits yet:no:


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## Debles (Sep 6, 2007)

moverking said:


> _Reticulocytes
> Reticulocytes ("retics") are young, anucleate erythrocytes. They are released to the blood in increased numbers as a response to anemia caused by hemolysis or blood loss in most species (horses are a notable exception).
> 
> Evaluation of the reticulocyte response is an initial step in characterizing anemia in species other than the horse. If the number of retics is increased in an anemic animal, it is a sign that the anemia is "regenerative" in character. Regenerative anemias are caused by loss (bleeding) or destruction (hemolysis) of erythrocytes from the peripheral circulation. Anemias without increased reticulocytes are termed "non-regenerative", and are due to conditions which decrease the production of erythrocytes by the marrow. _
> ...


I have a degree but that is about as clear as mud to me! But I have brainfog too. 
Good thing you are on the ball, Moverking!


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## Ljilly28 (Jan 22, 2008)

Ohhhhhhh. His anemia is nonregenerative. . . so I guess he's not releasing tons of those new young blood cells. He isnt losing blood anywhere though, so maybe he wouldnt need to produce a zillion?


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## Ljilly28 (Jan 22, 2008)

Debles said:


> I have a degree but that is about as clear as mud to me! But I have brainfog too.
> Good thing you are on the ball, Moverking!


That is exactly how I feel! And it's why I am so grateful for the help. The little waves of fear/adrenelin get in the way of processing the info.


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## moverking (Feb 26, 2007)

Awww, sure you can understand! They're just new baby red blood cells that are spit out from healthy bone marrow because the body has sensed the anemia (from a bleed). This is regenerative. If there are no extra retics found, there's probably something wrong with the bone marrow or a disease process thats not allowing the the red cells to come back to normal #'s.



Jill, your comment about "...is this really necessary?" struck me....I thought the same as you. 
But I have my Loocie, mid thyroid therapy...who with her last bloodwork after supplementation showed way lower values than ever...WTH??? She's gained weight, grew a glorious coat, and is sparkly as always.
My vet looked at me and said 'Sometimes you just have to go with your clinical result..is she better than before thyroid meds?'
"Yes"
Now what, keep digging till I find something that satisfies me, afraid I'm missing some process that will hurt her more? Or enjoy my furry monster till she gives me a symptom other than labwork....I just dunno.


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## Ljilly28 (Jan 22, 2008)

Love to Loocie. Glad she looks&feels much better, but the uneasiness of limbo is understandable when her tests are off. It is so hard to make good, sane, responsible decisions under pressure.


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## origin8or (Sep 7, 2007)

So sorry to read about Tally and sorry to bring up an old thread but how is Tally doing? I didn't see any new posts.

Our 2 1/2 yr old Golden was recently diagnosed with histiocytic sarcoma as well.


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## Penny & Maggie's Mom (Oct 4, 2007)

Oh, I'm so sorry to hear of your pup's dx. I will keep you in my prayers.


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## tippykayak (Oct 27, 2008)

Hey guys - I think Tally is fine now. I can't remember the timing, but he had Bartonella (likely from a tick bite) at one point, and I think this might have been our speculative thread before it was diagnosed properly. He's totally great and healthy right now.


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## Karen519 (Aug 21, 2006)

*Tippy*

Tippy

I'm glad you are on your toes!!

Thanks!


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## Ljilly28 (Jan 22, 2008)

Thanks Brian- 

Oh jeez, this was from a scary time, and I am so sorry your dog has it. My regular vet did every test under the sun, and ruled out autoimmune and everything else for Tally's anemia, which kept worsening. He gave a tentative diagnosis of this cancer- so I was beside myself. In the end, it was caused by a somewhat obscure dog version of Cat Scratch fever that ticks carry. I took Tally to a board certified internest available only by referral once they wanted to do a bone marrow biopsy to confirm this cancer. It is most common in Bernese mountain dogs, and also found in some young male goldens- 2 from Tally's family line- so I was petrified.

Tell us about your dog- the diagnosis and how things are going.


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## Debles (Sep 6, 2007)

I too am sorry about your pup and am praying for him.


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## origin8or (Sep 7, 2007)

I am so glad to hear that your pup is doing great!!!!

Well, our story starts off a few months ago when I was bathing Butters and he had a lot of small bumps all over his body. One of my neighbors has a chocolate lab that had similar bumps and he assured me that they would just go away on their own, "his dog got them all the time." So I didn't pay much attention as many of the bumps did indeed go away, except for the cluster on the bridge of his nose and at the base of his ribcage. 

Against everyone's advice I just didn't want to chance it so I took him into the vet a few weeks ago and after a syringe withdrawal and a half hour wait on pins and needles my vet called me back in from the waiting room. He explained to me that the cells were not normal and looked quite "ugly" so we booked an appt for the next day so they could put him under and do a biopsy of the lumps. The biopsy was sent off to the University of Guelph (one of the leading vet schools in Canada) for analysis where 5 doctors had a chance to go over the samples. It was a crazy week waiting for the information to come in. About a week later we got the diagnosis of Histiocytic Sarcoma. It devastated us and my wife and I took a day off to just be with Butters and try to compose ourselves. This was on a Wednesday, so Thursday I made the appt to get him in for an X-ray on Sunday so we could see how far the cancer had progressed. They checked the lungs, liver and spleen and fortunately they didn't show any major issues. The blood work came back fairly normal with the exception of low white blood cells. They also removed his stitches at the same time.

Our vet sent us home with some pills, steroids (sorry I am at work right now, I will post what they are later on) that I will be giving him forever and in a few months I will go back for more blood work to see if there are any changes. In the meantime all we can really do is watch him, make sure he doesn't show any discomfort and hope he stays as happy as he always is and lives as long as he possibly can. It's extremely difficult knowing what is to come and at such a young age. We're trying to stay as positive as we can, give him all the love he deserves and just let him be himself having fun and living a great life.

I posted a couple photos in my gallery of the bumps if any one is interested.

Thanks for the support!


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## Ljilly28 (Jan 22, 2008)

Butters, my friend, I am so glad you don't know about your diagnosis. You live in the moment, and every day you feel well, you will enjoy, unlike us humans who are born to worry about the future. You are a lucky dog to have owners who adore you and will see you through your medical challenge, but I am so sorry about everything.


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## Debles (Sep 6, 2007)

Praying for sweet Butters!!!


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## origin8or (Sep 7, 2007)

The drug that they have Butters on is Prednisone.


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