It's been awhile, but I did post awhile ago about our Rica. Since then, we've been getting advice from a specialist in the US to help us manage her condition, which is not commonly treated here in Singapore.
She's been dealing with IMPA for nearly 4months now. Went through two relapses while being solely on prednisolone, and is now working through a combination of pred and cyclosporine. We started this new regimen on the 1st of July - 50mg Atopica and 7.5mg pred twice a day for 2 weeks, then 25mg Atopica and 7.5mg pred twice a day for 1 week, 25mg Atopica and 5mg pred twice a day for 1 week, and now at 25mg Atopica once a day and still on 5mg pred twice a day.
What's frustrating is that so much of the reduction/prescription is based on her blood test results, but the numbers just don't make so much sense. When we first took her to the vet mid-March, her wbc count was around 20k. Within 5days it shot up to 46k, and hovered in that region. When we took her in on 1 July, it was at 45k. Once we started her on the high dose regimen above, her count went up to 120k in a week. We then had to run tests to rule out leukemia(about 85% certainty). The following week she was around 67k, and last Sunday, she was back around 47k. And all throughout, she developed anemia, which has improved from hct 27 to about 32.
She definitely is doing better visually, than where she was on 1 July. She has a bit of a limp today, but we are hoping it'll pass. But with all the medication we are giving her, shouldn't her body be in a less inflamed state? We had two immunosuppressants working on her... so does the wbc trajectory make any sense? Our two vets say that it's all improving, but is she really? Aren't we just masking the symptoms temporarily?
In the meanwhile, her liver numbers have started to go up, and she is showing all sorts of side effects from calcinosis cutis, pred head/belly/pant.... I'm lucky to be able to be with her pretty much 24/7. But I have to admit it's not easy, especially when there are no clear answers, and what was deemed so dire in one instance be brushed off as improvement in another.
I do understand that these autoimmune diseases are hard to understand in terms of causes and treatment, but has anyone seen a similar situation with the wbc count? Would love to hear about similar experiences just to help make a little more sense of this.
Hi
Is quite usual and expected for the WBC count to rise during treatment with prednisolone, therefore as the dose is reduced and the glucocorticoid effect lessens you will see a return to normal WBC count. I don't know how much Rica weighs so I don't know if she has been on the correct dose of preds, but it seems like the side effects such as pot belly and skin problems indicate that the steroids should continue to be reduced. You could start giving essential fatty acids such as evening primrose oil and fish oil and also adding natural Vitamin E to her diet in an attempt to restore the skin barrier. Is the anaemia caused by a loss of blood, for example, does she have a gastric ulcer or it is suppression of the bone marrow and production of the red blood cells?
Rica has only been on this new regimen since the beginning of July and it can take between 4-6 weeks before you start to see the effect of cyclosporine, so she may not be up to an immunosuppressive level yet. Your vet could do a blood test to see if the cyclosporine levels are adequate to produce immunosuppression.
The links below are very good. All the articles on the DVM360 website are an excellent resource.
https://endocrinevet.blogspot.com/2012/04/how-glucocorticoids-affect-complete.html
http://veterinarycalendar.dvm360.com/complications-immunosuppressive-therapy-proceedings
https://www.quora.com/Why-do-WBC-white-blood-cells-increase-with-steroids-and-how-can-it-be-treated
Personally, I wouldn't worry about the white blood cells because you know they are being affected by the preds. I would assess Rica by her clinical signs and keep an eye on the anaemia. If Rica isn't on a gastroprotectant such as Omeprazole then I would ask your vet about providing a gastroprotectant.
Jo
Hi Won
if it could be of any help, I can share my story.
My dog was diagnosed with IMPA last January, and we have been struggling to find the right cure.
We have tried Cyclosporine, but it looked as not really good for her, so we are now trying Leflunomide, which seems to be doing well.
Also, Cyclosporine will have to be measured (blood level) cos it might be in the lower range, and therefore not as effective as it could be.
Let me also add that Ripley, my dog, had all sorts of weird results on her blood. She had high WBC and she has also be anemic (that was all due to Inflammation). Also she had a left band shift on her neutrophils, so the vet always suggested antibiotics, but I think it's all related to her condition.
We are still struggling, but it's been now 4 months that she has been improving slowly, so I hope this will work for your dog too.
Speak to your vet about Leflunomide, I had to fight to had it prescribed, and it seems to be doing the trick
Wish you and your dog all the best