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Author Topic: Diesel - We need help  (Read 58 times)

KaajalTiwary

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Diesel - We need help
« on: August 11, 2018, 04:42:29 PM »

Hello there:

I posted about Diesel a few weeks ago. They couldnít determine if it was cancer or autoimmune. He developed an abcess that was surgically removed. So they also reduced his Prednisolone and decided to go back to the drawing board.

He is currently on 2.5 mg Prednisolone, Clavomox, Omniprezole and vit B 12 supplement. They are looking at another bone marrow biopsy and aspirate soon. Is it possible for anyone on this forum to tell me what we might be dealing with? Any insight you can offer will save my life.

Yesterday his CBC count read:
RBC 5.52 (5.65 - 8.87)
HCT 38.1% ( 37.3 - 61.7)
WBC 3.51 (5.05 - 16.76)
Neutrophil 0.85 (2.95 - 11.64)
Platelets 196 (148 - 484)

I am very worried about Diesel and no proper diagnosis for over 8 weeks since he fell really sick is devastating. We are working with the doctors at UC Davis since he got sick.

Please let me know if you have any additional questions for me. Iím desperate for help.
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Jo CIMDA

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Re: Diesel - We need help
« Reply #1 on: August 11, 2018, 06:54:02 PM »

Hello

He is now on a very low dose of prednisolone and his HCT is just within normal limits so why are they considering a bone marrow biopsy at this stage?

How is he in himself? Is he much better than he was?  Is he showing signs of acute or chronic disease?   

Jo




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KaajalTiwary

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Re: Diesel - We need help
« Reply #2 on: August 11, 2018, 09:02:21 PM »

Jo:

Thank YOU for your help and your amazingly prompt response.

Considering how his CBC count has been trending, they are still thinking it's either auto immune or some form of cancer. At this point they think a Bone Marrow Biopsy & Aspirate and Flow Cytometry will help them know if it's cancer and what form?

He is definitely is looking much better than he was, when he got really sick on the 17th of June but certainly not his old normal self. His appetite is good, no fever, peeing and pooping fine. He's more lethargic than normal.

UC Davis is concerned that he has a chronic disease just by looking at his CBC panel. His WBC and Neutrophils as of yesterday are extremely low and that is indicative of some chronic disease, is what they said.

From your experience, would you be able to tell me - what do you think Diesel is indicating (by his numbers). My research is making me reach a dead end. I am in a state of panic.
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BrookeR

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Re: Diesel - We need help
« Reply #3 on: August 12, 2018, 04:27:52 AM »

Hello,
Iím sorry to hear about diesel. Unfortunately I donít have any ideas of what may be going on.  Iím in a similar situation with my girl Pepper at the moment. My vet is concerned it may be cancer or some other chronic disease. But we canít pinpont what. She has been slightly anemic for a sometime now but has now lost a lot of weight.  She is a staffy and has lost her muscles and now is very drawn. She had a bout of pancreatitis and everything has been downhill from there. I stopped feeding her all treats after the bout of pancreatitis and she was eating a LOT of treats (sheeps ears & carob drops). I have now increased her normal food intake by 40%. But she hasnít gained any weight. Albeit her normal food is kangaroo mince and veggies, so itís not high in fat.

She has had a bad breath & we found ulcers in her mouth and then she had to have three rotten teeth removed. Her breath has improved from what it was but it still is a bit odourous. She still has ulcers in her mouth which we can not clear up. Since then she had an occasion where she got the vomits and became dehydrated and had to have an overnight hospital stay on a drip. We reintroduced salmon oil back into her diet (as we had dropped all supplements when she had the pancreatitis episode) and then after being back on it for maybe a month she got frequent diarrhoea with lots of mucous. We stopped the salmon oil again & the diarrhoea & mucous cleared. Her alt & alp levels are the lowest they have been in a long time. We dropped her back to 2.5mg pred once a day when she had the pancreatitis episode. She now weighs only 14kg & used to be between 16-18. This is the lowest pred dose that we have ever been able to achieve. We did a stool sample, urine test, & bloods a week a go. Her lipase was slightly increased , & again slightly anemic.

She is the same as you say diesel is. Her appetite is good, no fever, peeing and pooping fine now. She's more lethargic than normal. She also has a bubbly stomach. No letting off of gas, just if you are near her in a quiet room you can hear soft bubbles in her belly.
There is a number of conditions that we are tossing up including cancer in the digestive tract/ pancreas , epi, ibd to name a few, plus other nasty muscle wasting auto immune disorders. My vet is also worried about her bone marrow (like you have said) & that since we have dropped the pred back we may have allowed other immune disorders that we have previously had kept in the back of our minds, to have now been allowed to progress. Particularly in hindsight of her muscle wastage.
We are going back for more bloods in a week and then deciding what to do from there.
My vet wants to do an ultrasound but I really canít afford it. We have spent more than a new car on her since she got impa and my partner is putting his foot down. Anything we find on an ultrasound i imagine is going to be not an easy fix and I would rather not know if itís something horrible like cancer. As she is too old to have treatment and I will not put her through that.
Also Pepper doesnít seem to give very accurate results in tests. We have ran so many in the past & never get reliable results. 

Have you had any other similar systems to us?
I really hope you get some answers soon. I too have been doing so much reading & research to try work out what is going on with her. But she is so hard to read. She never seems to follow the Ďnormalí with her symptoms that she displays for any of her health problems. So it is so hard to pin point anything. I was pushing for the diagnosis prior to her last bloods of EPI but then my vet said she should have regular loose fatty stools same for ibd. Which she doesnít have?. I wish they could talk and tell us whatís going on.

Best of luck!
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Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Jo CIMDA

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Re: Diesel - We need help
« Reply #4 on: August 13, 2018, 07:40:08 PM »

Hi

Sorry I couldn't get back to you sooner. Brooke has given an interesting account of Pepper's problem, which you may be able to relate to.

It is not always easy to differentiate between some cancers and autoimmune diseases and this is why the vets have to treat speculatively sometimes.  Personally, unless Diesel is very unwell and needs further treatment, I would wait until the preds are out of the system (at least a couple of weeks) before doing a bone marrow biopsy because the effect of steroids is likely to mask the results. Also, a bone marrow biopsy is done mainly to rule out cancer as opposed to diagnosing an AI disease. A diagnosis of immune mediated or autoimmune bone marrow disease is often arrived at (assumed)  by eliminating other conditions.   

Long term glucocorticoid (pred) administration can cause a drop in some of the white blood cells.  See this link for more information: 
https://endocrinevet.blogspot.com/2012/04/how-glucocorticoids-affect-complete.html

When do you go back to UC Davis?

Jo


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Jo CIMDA

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Re: Diesel - We need help
« Reply #5 on: August 13, 2018, 07:54:41 PM »

My vet wants to do an ultrasound but I really canít afford it. We have spent more than a new car on her since she got impa and my partner is putting his foot down. Anything we find on an ultrasound i imagine is going to be not an easy fix and I would rather not know if itís something horrible like cancer. As she is too old to have treatment and I will not put her through that.
Also Pepper doesnít seem to give very accurate results in tests. We have ran so many in the past & never get reliable results. 


Hi Brooke

Thank you for your detailed reply for Diesel.  I am very glad you have written the above because it illustrates that some tests are done because they 'can be' and they don't necessarily enlighten or give a definitive diagnosis. 

I am not saying this is the case with Diesel but many years ago someone called me on the telephone and she was crying.  Her dog had been on high doses of steroids for a prolonged period of time and the vet college specialist was weaning her down.  This girl's liver enzymes were high and the vet wanted to do a liver biopsy.  This lady had spent thousands on her dog  (they could afford it) but she didn't want her to go through an invasive procedure if it was unnecessary, so she called me.  Considering the high doses of preds this dog has been on one would have expected her liver enzymes to be very high, but they were reducing the tablets and therefore the levels would start to reduce, so I suggested that this lady told the vet that she couldn't afford to do the liver biopsy and the response from the vet was, that's OK bring her back in two months to have her blood checked.  So this was not a necessary procedure and when they took the dog back in two months, as predicted, the liver enzymes had significantly reduced. 

Saying you can't afford it (whether it be true or not) is sometimes a good way of finding out if the procedure is necessary or not and also it might provoke  'plan B' which could be much less invasive. 

Hoping Pepper is still enjoying her life regardless of her problems. 

Jo
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BrookeR

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Re: Diesel - We need help
« Reply #6 on: August 13, 2018, 10:44:58 PM »

Thanks Jo. Back before Christmas when Pep got the diagnosis of plasmacytoma that had metasized there was possible suggestions going around from pathologists saying to amputate her toe, do chemo, X-rays, & ultrasounds. Iím so glad that I chose not to venture down those paths and went with my gut. Miraculously it disappeared! Although itís constantly in my mind that cancer may reappear again somewhere else. But Iím glad I didnít put her through any of that unnecessarily.

Pep has had so many possible diagnosisís over the years and so many tests have been suggested. Usually we wait a bit longer and things normally change anyway and the tests werenít needed.

Yes Pep is still happy in her self and seems fine other than being a bit more lethargic than normal (but she is 11 now) and she looks frail due to the muscle wastage. It has taken her some time to come to terms with having no treats. But I have now made her slow baked sweet potato chips that she enjoys.

I have been reading about supplementing digestive enzymes for senior dogs & other dogs with compromisesd immune systems. The idea seems to follow more of a holistic approach as itís been discussed in natural books & journals. I mentioned it to my vet but without the diagnoses of EPI she doesnít believe there is any proven evidence to back the use of them.
So I am going to wait until our follow up bloods and weigh in on Friday and see what that brings.

Iíll be interested to hear how diesel goes.
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Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

KaajalTiwary

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Re: Diesel - We need help
« Reply #7 on: August 13, 2018, 10:54:30 PM »

Hello Jo:

Thank you again for your time on Dieselís case. We are currently at UC Davis. Diesel has his follow up appointment today.

RBC 4.8 (below normal range)
Hematocrit 31.7 (below normal range)
WBC 3760 (very low)
Neutrophils 745 (very low)
Platelets 386000 (normal)

They want to do the bone marrow aspirate and biopsy in the next 2 to 3 days so they can get a clear understanding of Ďwhat nextí. I asked what theyíd do differently from the last time. They are looking to do Flow Cytometry and also send the sample to Colorado State University for a second opinion.

About Prednisolone: She said since Diesel has been on 2.5 mg for the last 10 days and we are seeing low CBC counts, sheís certain it wonít mask anything. Your thoughts?

Thank you again for all the time you are investing in Dieselís case. I am very grateful.
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Jo CIMDA

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Re: Diesel - We need help
« Reply #8 on: August 14, 2018, 09:23:05 AM »

Hello

The low level of pred will not be having any therapeutic effect. 

Diesel's HCT had dropped so I can understand why UC Davis is concerned and the need to find out why.

I presume Diesel was initially put on a correct immunosuppressive dose of prednisolone and this has over time been reduced to his current dose.   I can only suggest questions for you to ask the vets but with limited information these might not be appropriate, so I apologise.  I  presume that his bone marrow has been functioning to reach an HCT of 38.1%.  As there has been a drop in HCT, does Diesel still have non- regenerative  haemolytic anaemia or is his bone marrow producing red blood cells (regenerative anaemia) but the red cells are being destroyed within the circulation of the blood or by the spleen, liver or gastric ulcer  etc...? 

Another really long shot but it might be worth mentioning to your vet,  is Addison's disease (adrenal insufficiency).  Sometimes a dog prior to being diagnosed with Addison's disease will become anaemic and diagnosed with AIHA, and the white blood cells will be opposite to what one would expect in a poorly dog and that is: low neutrophils, increased numbers of lymphocytes and eosinophils (known as a reverse stress leucogram).  UC Davis has done a lot of work on Addison's disease so they will be aware of this. 

You may have no choice but to go ahead with the bone marrow biopsy but just check what answers the vet hopes to get from the results and how will they go forward from there.

All the best.

Jo

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