A Race Against Time: Texas A&M Veterinarians Use Hemoperfusion To Treat Apoquel Overdose

Texas A&M’s Small Animal Teaching Hospital is one of the few veterinary hospitals equipped to provide hemoperfusion, giving critical patients like Freya access to an advanced treatment that can remove certain toxins directly from the bloodstream.

Freya has never been the kind of dog to cause trouble.

The 7-year-old Belgian Malinois is energetic, hardworking, and intensely loyal. While she loves all people, Freya is protective of her owners and their two children; in fact, when the children were babies, she often slept beneath their bassinets. 

So, when her owner, Chris Baron, received a call from her husband one afternoon saying Freya had gotten into the Apoquel, a medication commonly prescribed for seasonal allergies in dogs, it came as a shock.

“The bottles that were up on the countertop were shredded, and she had eaten about six months’ worth of medication,” Baron said. “She had never done this before.”

Baron immediately contacted the Pet Poison Helpline and was instructed to take Freya to an emergency veterinary hospital in Katy. There, veterinarians called the hotline again, which this time recommended Freya be transferred to the Texas A&M Small Animal Teaching Hospital (SATH) for a specialized procedure called hemoperfusion, an advanced treatment that can remove certain toxins directly from the bloodstream.

“I was so scared,” Baron said. “I felt so much guilt for leaving the medication on the counter, and I was just hoping I did not make a fatal mistake.”

Instead, Freya would become one of the latest patients to benefit from Texas A&M’s developing hemoperfusion program. 

Racing the Clock

By the time Freya arrived at Texas A&M, several hours had passed since she had ingested the Apoquel, and that timing mattered.

Apoquel has a short half-life, meaning the body begins eliminating the drug relatively quickly. For hemoperfusion to be effective, the treatment must remove the toxin from the bloodstream faster than the body can eliminate it on its own. 

Dr. Lance Wheeler, a clinical assistant professor for emergency and critical care, had just finished a shift at the hospital when the call came in.

“Knowing that the half-life on the drug is so short, if we waited until morning, there would be no reason to even attempt treatment,” Wheeler said. “I knew we needed to get this treatment done now, so I went straight to the hospital, and we activated our emergency overnight protocol and were able to start the treatment.”

Beginning hemoperfusion approximately three hours after Freya arrived required coordination across the hospital. Freya first had to undergo an emergency evaluation, including diagnostic testing and preparation for the procedure. Because the procedure may require a blood transfusion, the team also had to ensure blood was available before placing the appropriate catheter and preparing the hemoperfusion system. 

Behind the scenes, the SATH had already been preparing for cases like Freya’s, establishing a training program for veterinary technicians interested in participating in overnight hemoperfusion cases to learn this specialized training.

“Having a team that is trained and ready to come in on call was a large part in this success,” Wheeler said.

That preparation made it possible for trained technicians such as Susan Lobit and Kim Koheler, emergency clinicians, and other members of the veterinary team to quickly come together for Freya.

Helping Freya

Dr. Jessica Portela, a first-year resident who was working overnight when Freya arrived, took on the case and stayed by her side throughout the entire treatment.

“We were all just there to support Freya, both from a medical and emotional perspective,” Portela said. “It was really special.”

At first, Freya’s physical examination showed no issues. Her neurologic status was normal, as were her heart rate and rhythm.

But as the treatment began, her condition changed. She became increasingly lethargic and her heart rate rose. 

However, halfway through the treatment, the team began to see what they had hoped for: Freya’s heart rate returned to normal, her awareness improved, and she began trying to stand and interact with her surroundings.

For Portela, who had never been directly involved in a hemoperfusion treatment from beginning to end, the experience was a highlight of her career.

“We are all here to help pets,” Portela said. “When you see it happen right in front of you, it is incredible.”

Freya’s response also helped the team determine when to stop treatment. Rather than relying solely on a predetermined number of hours, veterinarians were able to monitor her clinical signs and determine whether additional toxin removal was necessary.

In Freya’s case, approximately 30 blood volumes were treated over three and a half hours.

A Team Effort

Although the hemoperfusion machine was at the center of Freya’s treatment, the people surrounding it were just as important.

“There were four sets of eyes on the machine and the patient at all times,” Portela said.

The experience also demonstrated why teamwork is particularly important in emergency medicine.

“You never know what is going to walk through the door,” Portela said. “If we work together, we can deal with it better.”

In this case, that teamwork extended beyond the SATH — the referral from the veterinary toxicologist at the Pet Poison Helpline is a sign that the work Texas A&M has been doing with hemoperfusion is gaining recognition, according to Wheeler. 

“It speaks a lot to their trust in us to be able to send us patients that are in a life-threatening emergency,” he said.

The referral also allowed Wheeler to collaborate with the veterinary toxicologist while developing Freya’s treatment plan, bringing together different areas of expertise to give Freya the best chance at recovery.

Back to Normal

After several days of hospitalization and monitoring, Freya was able to go home.

Knowing she would be bringing her best friend home again was a tremendous relief for Baron, who had begun training Freya as a puppy; through their daily training sessions, the two became a close-knit pair.

“She and I built a bond I have not had with an animal before,” Baron said.

Because Freya had given Baron a sense of purpose during some of the toughest moments of her life, when Freya needed her, Baron felt that same responsibility.

“I don’t think I could have been OK watching her suffer,” Baron said. “I needed to take care of her just like she would do for me.”

Today, Freya is back to her normal self. After several weeks of medication to protect her liver, follow-up blood work showed that her blood work had returned to normal. She has no known lasting effects from the overdose.

Freya’s recovery is a reminder of what advanced veterinary care can mean for families when their pets are facing a critical situation.

“I know each case is different and things might not always turn out perfect, but for us, this was worth a shot,” Baron said. “I think this procedure was a miracle for her and for us as a family.”