UC Davis Veterinarians Lead a Long Journey Back to Health for Hemophilic Dog

“Case of the Month” – December 2024

Otis, a 6-year-old pug, has not had the easiest road in life, but thanks to a devoted owner and a dedicated care team, his future seems brighter. Otis was rescued as a very young puppy by Jennifer Newman, an experienced pug owner.

At just 2 months of age in 2018, Otis was first brought to the UC Davis veterinary hospital’s Emergency Room for evaluation of cough and respiratory issues. Since it was known that one of his littermates with similar symptoms had recently died, Newman asked for a thorough workup to be performed on Otis. It was discovered that he had Hemophilia A.

Hemophilia A is a rare inherited bleeding disorder affecting male dogs, caused by a deficiency of coagulation factor VIII on the X chromosome similar to people. It is an essential protein required for normal blood clotting. Affected dogs have variable presentation of the disease, with mild to moderate bleeding being observed. Additionally, affected dogs may bruise easily or have extended periods of bleeding following trauma. While bleeding is occasionally severe enough to result in death, most affected dogs can have normal lifespans when receiving proper care.

As a result of his condition, Otis has received several blood transfusions over the years at UC Davis. Thankfully, the hospital’s Transfusion Medicine Service runs one of the largest veterinary blood banks in the country. Blood for canine patients is sourced from community volunteers. Every week, dogs from the local area help the hospital meet demand for blood products by donating blood in a similar fashion that humans do. As a result of these crucial canine blood donors, the hospital has transfused more than 850 units of blood this year.

Unfortunately, Otis’ health issues did not end there. Later in life, he developed severe inflammation of his esophagus and stomach and has been under the care of the Internal Medicine Service. These gastrointestinal diseases have required many hospitalizations of several weeks and the placement of a stomach feeding tube several times to gain control, as Otis was continually regurgitating his food and having bleeding issues.

Newman continued to do everything it took to make Otis healthy.

“Otis knows everybody at UC Davis by now,” Newman stated, regarding his many trips to the hospital and especially recalling a time when the technicians made a card for Otis. “They were so sweet to do that – the level of care provided by UC Davis is so above and beyond. As long as I have this dog, I will never take him anywhere else. We are so fortunate to live close to such an amazing facility.”

“Otis is a bit of a celebrity at the hospital,” noted Dr. Steven Epstein, co-chief of the Small Animal Emergency and Critical Care Service and director of the Transfusion Medicine Service. “He has been an amazing patient throughout all of his stays. I was there when he first came to us as a puppy and have seen him multiple times throughout the years.”

To compound Otis’ issues, it was discovered during a fluoroscopy swallow study that he had a sliding hiatal hernia. This congenital condition causes a portion of his stomach to move into his esophagus intermittently causing him to regurgitate fluid. While this condition doesn’t always require surgery, in Otis’ situation it became problematic this year.

In late June, he developed severe esophagitis secondary to acid reflux and regurgitation of food due to multiple aspects of his condition, including his hiatal hernia and bleeding into his stomach. He was hospitalized for a week, as his care team first tried medical management of his conditions, but that did not resolve the situation.

“Although the bleeding predisposition inherent to hemophilia presents substantial complexities for surgical intervention, the correction of the hiatal hernia was considered an important and judicious approach to optimizing Otis' overall condition,” said Dr. Max Randolph, an internal medicine resident.

Newman agreed to proceed with surgery. After careful preparation from the Anesthesia Service, the Soft Tissue Surgery Service repaired his hernia with a preventive gastropexy, which sutures the stomach into place against the abdomen wall to prevent it from moving and to decrease reflux. A feeding tube was also placed in Otis’ stomach to allow nutritional and medical administration.

In her investigation of Otis’ condition, Newman discovered a team of scientists at the University of North Carolina who were researching hemophilia A in dogs. She connected them with Otis’ care team at UC Davis, and the two teams shared ideas for treatment.

Following surgery, Otis required several blood transfusions, but his bleeding issues were finally controlled by a mix of IV and topical medications. Following 12 more days of hospitalization—several of which in the Intensive Care Unit—Otis was able to return home.

By late August, Otis’ feeding tube was removed. Newman reported that his condition improved dramatically since the hospitalization, with an increased weight and appetite. Otis remains on medication to control his reflux and prevent future esophagitis episodes, and his veterinarians are hopeful that he continues to improve.

“Working with our transfusion medicine team and researchers at the University of North Carolina, we were able to give Otis the support he needed including clotting factors to heal the surgery and get him back on his feet,” said Dr. Jonathan Dear, co-chief of the Internal Medicine Service.

Newman now reports that Otis is doing fantastic at home and is back to being a playful dog.

“I just feel so lucky to have found the right place for Otis,” said Newman. “From the client services team to the students to the residents to the faculty and staff – I’ve had nothing but positive experiences each and every visit.”

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