Sometimes, people are just in the right place at the right time. Thankfully for Aika, neurologist Dr. Christine Toedebusch happened to be in the Emergency Room at the UC Davis William R. Pritchard Veterinary Medical Teaching Hospital (VMTH) when the 5-year-old corgi arrived. While she was checking on another patient, Dr. Toedebusch noticed Aika from across the room.

“When she was placed on the exam table, something felt wrong,” said Dr. Toedebusch. “She stayed on her side and never tried to get up. For a young dog, that’s not normal behavior – I immediately suspected something was affecting her brain.”

And she was right.

Upon closer examination, Dr. Toedebusch’s initial thoughts were amplified. She and neurology resident Dr. Kimberly Worland noticed that Aika did not appear to be aware of her surroundings and did not interact with the veterinary team the way a young dog would.

“It was late afternoon at this point,” said Dr. Toedebusch. “Work shifts were ending, but I knew we needed to investigate Aika’s condition that night rather than in the morning. We would need the anesthesia, diagnostic imaging, neurology, emergency, and laboratory teams to all come together quickly to properly diagnose Aika.”

Everyone stayed after hours. Aika was placed under anesthesia, and an MRI of her brain was performed. Diagnostic imaging residents Drs. Mathew Boscia, Alex Chapple, and Hannah Nagel, along with the imaging technicians, performed Aika’s MRI, which showed significant brain disease throughout multiple brain regions. Spinal fluid was collected for analysis.

Aika quickly started to decline after coming out of anesthesia. Anesthesiologist Dr. Wei-Chen Kuo noticed that Aika’s chest wall was not moving well – she was hypoventilating (breathing too slowly), which traps CO2 in the blood. Aika’ CO2 level was 100. The normal level is 35. She would need to be placed on a ventilator soon.

“Ventilation requires significant time in the ICU and becomes costly rather quickly,” said Dr. Toedebusch. “I thought, ‘before we can ask this client to commit to that, we need to figure out a definitive diagnosis…and quickly!’”

The MRI findings from Aika raised concern for an autoimmune disease known as inflammatory brain disease. Even though Aika was a young dog, brain cancer was also a possibility. Corgis are predisposed to histiocytic sarcoma, an aggressive cancer that does not respond to radiation or chemotherapy. The disease was so diffuse throughout Aika’s brain that surgery was not an option either. Inflammatory brain disease can be treated successfully, while dogs with histiocytic sarcoma typically succumb to their disease within several weeks.

“So, if we’re going to ventilate Aika, we need to know if this is histiocytic sarcoma or inflammatory brain disease,” Dr. Toedebusch said. “We owe it to Aika’s owner to be as informed as possible before making the decision to ventilate.”

Spinal fluid analysis can help distinguish between inflammatory brain disease and histiocytic sarcoma. Pathology resident Dr. Yael Keinan came to the VMTH late in the evening to analyze the cerebral spinal fluid. She determined Aika had an inflammatory brain disease called meningoencephalomyelitis, not the cancer.

“Interestingly enough, even though this is not a cancer, it is responsive to a chemotherapy drug called cytarabine,” Dr. Toedebusch stated.

Knowing this, Aika’s owner Hanna Lao chose to continue treatment. Critical care specialist Dr. Kate Hopper placed Aika on the ventilator in the ICU, and oncology resident Dr. Anett Szczepanek prepared an IV infusion of cytarabine for Aika to receive overnight.

Aika responded positively to the treatment and made a remarkable recovery. By the morning, she was weaned off the ventilator. Dr. Worland, along with another neurology resident Dr. Lexi Brown, and neurology staff member Marcy Vaughn, RVT, treated Aika for the next four days until she regained enough strength to be discharged home.

“We’re so grateful for everyone at UC Davis,” said Lao. “They treated us so well. Dr. Worland was always concerned about us personally. Dr. Brown would share fun news about Aika, like telling us that Aika kept smiling at her and got excited whenever they would check on her in the ICU. And Dr. Toedebusch talked with me from the perspective of another pet parent.”

For the indefinite future, Aika (Japanese for “Love Song”) will continue with monthly infusions of cytarabine and long-term corticosteroids. She has already received two infusions, and her outlook is positive.

“She’s walking, running, playing…doing all the normal things a dog should be doing,” said Lao. “She’s back to the dog that I know.”

Lao acknowledges her partner’s family, the Halogs, for their support and everyone who helped her to save Aika.

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