hello from Merlin and his mum

[DW]

Hello Merlin@s Mum

I am so pleased to hear that, at least, Merlin hasn't deteriorated - and that is such a positive.

I felt I had to write and say just one more thing.....I know exactly how you feel about the body putting up a fight itself and the reluctance (or rather concerns) about giving supplementary medication and sometimes, just sometimes, our gut feelings are soooooo  right.    I remember putting up such an anti, a way back in Harley's illness, about putting him on Atopica.    I know that this drug has worked so well for a lot of people but I personally, did not want him on it.   It had been suggested many many times when all else was failing and he was very ill but still, I looked at alternatives until one day, there didn't seem to be anything left and Atopica was all we had to  try at the time.
So, Harley was put on to Atopica and he was on it for several weeks and my worse fears happened,  the platelets dropped to an all-time low.......God did I reproach myself, I hated myself for agreeing to it but realistically, what I was doing, was hanging on in there with all the hope I could and giving him every chanceI could to live,
so I do know how you feel, really   BUT...
Harley I knew was enjoying life and I just know that he wasn't ready to give up yet.   I had a friend that suggested the kindest thing to do was to have him PTS but I knew we weren't there yet....just as you are.
So, having known that at the start when diagnosed, my own Vet had put him on Azathioprine with the Preds and they seemed to work,  we used them again and they, along with going back to the I.S. dose of Preds again, we managed to lift the count again.   This is now out 3rd attempt of trying to achieve remission and again, he is on 50mg Azathioprine with his lowering Preds and I am scared beyong belief to say this but he 'seems' to be coping o.k.
The Azathioprine stabilised and allowed us to very very slowly reduce the Preds...Aza's were a greatly needed support but still we had to reduce the Preds with caution.
Last year, it was suggested we might give Melatonin a try and again, I was faced with giving another drug to him but these, seem to have little-known side-effects, though long-term, we just won't know.   He is still on the Azathioprine and at some point we will look to reduce them too.
Try not to think about what the drugs may or may not do......if they work and turn him around, yes, they may may, shorten his life (or not) but I'm sure that is a small price to pay.....

Gwyneth

[Whippets Rule]

Thank you. I can accept a shortened life but he's just four years old and I want a few more happy years yet .

Even if he has to stay on a low dose of drugs,whatever they may be,I will settle for that but I know that this time around it is a miracle that he is still here and I don't think he would survive such a close call again. On Sunday he was potentially bleeding out and it was extremely upsetting to watch bits of him swelling up and to see blood seeping through his skin but a little dog with the strength to survive that deserves a chance which is why I have put him on Aza even though it's something I didn't really want to do.

I don't think him or I can go through another episode like last weekend though and I will be insisting my Vet is much more cautious about the pred reduction this time,especially when we get down to 7.5mg per day as that is the point at which they were in too much of a hurry to reduce further and I feel he needed several weeks of good platelets before we reduced.

He is currently on 25mg per day of Aza and 12.5mg twice a day of pred. I am still very worried as I know he's not quite himself ( I can't really explain in what way but something doesn't "feel" quite right about his behaviour today)and some blood vessels seem to be really standing out on his body which worry me. I am very scared for him because as an owner I make a pledge to love,care for and protect them and this illness leaves me helpless and unable to fulfil that promise. If hope that keeping him as quiet as possible,keeping everything as happy and normal as possible and just sheer force of love and kindness will help him have the strength to survive. If it doesn't, then he is simply not meant to be and that's something no one can fight.

[Lovemedogs]

I hope so very hard this is a turning point in Merlin's life and that he starts to steadily improve. I have lost too many dogs over the years, some much younger than Merlin, so I know just how hard it is to see a special friend struggling.

Please keep us updated

Pam

[DW]

Hi

Merlin's just a year younger than Harley and I totally agree, though these horrid diseases are shocking for any dog, whatever age, it seems so much more unfair when they are our ages, as they haven't yet had a life.  Harley's had this since he was 18 months.

You really have had such worrying times with merlin and my heart goes out to you and how you are feeling.....wish I had a magic wand for all of our dogs that are so poorly.

Fingers crossed though, that this has been a set back, a horrible one but a set back and that he (and you) have the strength to continue with some optimisim...hard as it is.

Give Merlin a big cuddle from me.

Gwyneth

[Whippets Rule]

Merlin's platelets are 517 today. Should I be worried? Can you have too many platelets? We are going to reduce pred to 10mg twice a day next week IF platelets are still very high. Does this very high count mean that the Aza is starting to work?
This raises so many questions for me. Merlin has had a small amount of fresh blood in his poo which is a worry as it maybe he has an ulcer?

[Jo CIMDA]

Hi

Yes you can have too many platelets and this is known as thrombocytosis. It is likely to be a reactive response to the steroids.

When the platelets are high there is a risk of blood clots and ironically a low, anti-thrombotic dose of Aspirin is often given. What is his red blood cell count like? How is he in himself?

To increase from 7 to 517 in one week is very unusual but it does prove that is bone marrow is producing.

What does your vet say about this?

Jo

[Whippets Rule]

Vet only texted me the result but made no comment even when I asked if this was too many.

She just said yes to reducing pred next week if still high. I have done some reading around the internet and it's possible it could be a reaction to the amount of bleeding last weekend? and a reaction to the drugs,possibly everything going into overdrive? I am more concerned than ever as I definitely wasn't expecting this as a result. Is it possible that the Azathioprine is working already or maybe causing some kind of reaction?
In himself he seems perfectly normal,active and waggy tailed and a greedy pig.

I think maybe a full blood count is due after this result. He is back at the Vet's next Monday so I will ask for full bloods to be done.

I've just texted the Vet again and she is getting the practise to ring Idexx and extend the blood test to include all the other cells etc as it is such a massive jump in platelet count. We should have further results tomorrow.

[Jo CIMDA]

Hi

No, it wouldn't be the Aza, if anything Aza will suppress bone marrow production.  It is typical of a steroid response but to reach this number so quickly is unusual.  It could be that last week's result wasn't accurate and it might have been higher which could give a false, marked increase in platelets.  Also, one would expect a response from the bone marrow after 5 days of starting immunosuppressive therapy, but Merlin's response seemed to be slow (if I remember correctly) so perhaps the pred had finally kicked the bone marrow into action and it then went bananas!!!

Try to see this as a good result, but it doesn't really want to get any higher.  There are other reasons for thrombocytosis but I think you have to assume it is the preds - and what you say is true when the body is deficient in something it can respond by going into overdrive.  This is quite normal though. 

It is good that he is greedy and waggy tailed.

Jo

[Luca]

Hi - Luca had IMT before she developed her current immune issues, she was treated with pred, cyclosporine and melatonin, platelet count was zero for the first 8 days and she needed transfusion as she bled out half her blood volume into her intestines. She also had vincristine.

She started to improve on day 9 (20) and was having daily bloods until day 11 when I took her home with a count of around 120. A blood test at the vets 2 days later had a count of 1,400 !!!!!

The specialist said it was not unusual to get a thrombocytosis when they start to respond but would only worry if they continued to rise - her count gradually reduced over the next few weeks to around 300 where it has stayed ever since.

He didn't want to give her aspirin.
Hope this reassures you a bit .

She came off the pred and cyclosporin and was just maintained on melatonin.

She didn't tolerate pred very well so when her newer issues started we have just managed them with cyclosporine plus she's still on melatonin.

[Whippets Rule]

Thank you very much, that does help a bit,he had a lot of bleeding in his intestines during last weekend.

[Whippets Rule]

Just heard back from the Vet and apparently nothing major to worry about at the moment. White cells were I think down? something about inflammatory response and we think that's to do with his paw and the pressure sores etc.

The only thing I am questioning is that the Vet spoke to a specialist at Idexx and they have said that it could be his body responding to the bleeding from last week and the Azathioprine and pred combo already kicking in. The specialist said to only keep him on the daily Azathioprine for  a month and then move to an every other day dose because he was doing so well on just steroids alone without any side effects. We're not to change steroid dose or anything for at least two weeks as there is a chance this was just a spike due to response by his body and from the drug combo and that things will level off to a lower more true count in the next week or so.

I did say to my Vet that I understood it to be keep them on Aza and reduce pred first and she said that's what she thought but the Idexx Specialist said no because he was responding really well to just pred so he probably doesn't really need the Aza.

Your thoughts would be welcome. Thank you.

[Jo CIMDA]

Hi

I don't think you can make any plans regarding treatment regime at this stage.  Wait and see and make these decisions at the time depending on how Merlin is in himself and the blood results.

Jo

[Whippets Rule]

Today Merlin's toe stump is all ulcerated and he has pressure sores both sides of his paw and up around his wrist he has sores opening up. I don't know why this has started to happen but I have put him back on antibiotics today and will need to get some more from the vet tomorrow.

Is there anything I can do to help with the sores other than bathing in salt water etc. He cannot walk around without a dressing on his foot or the toe stump breaks open so I have created a dressing which covers his toes and is taped to his leg below his wrist so that all the sores are uncovered apart from obviously his stump. He has to have a cone of shame on or he will just keep trying to lick.

Sadly he is not going to be able to be walked again until such time as he can have his toe stump amputated which is likely to be months away.
I am feeling very sorry for him and very frustrated because if his toe had been properly removed in the first place, all we would be dealing with is his platelet issues and not a horribly ulcerated foot. I have also found today that he has some hair loss and a "swelling" on his other wrist. I sincerely hope the "swelling" is just a fatty lump and nothing sinister.

[Jo CIMDA]

Hi

You could try Manuka honey dressings.  Manuka honey dressings are used more and more these days in conventional medicine, both human and veterinary,  with good effect.  It is worth a try.  Also an alternative might be to use aloe vera gel but you have to put this on about 6 times a day. 

I hope the swelling reduces very soon.


Jo

[Whippets Rule]

Merlin is not well today. The sores around his wrist look infected and keep breaking open. THe lump on his right wrist looks sort of purple and white under the skin and he has thick green pus coming out of his eyes. It's as though overnight everything has started to go wrong. It seems like infection gets bad very quickly when they are immuno-suppressed.