News:

SMF - Just Installed!

Main Menu
Menu

Show posts

This section allows you to view all posts made by this member. Note that you can only see posts made in areas you currently have access to.

Show posts Menu

Messages - Catherine

#571
What thyroid tests did you have done - was it just the T4, Joy? It is best to have more for a more accurate result. This is taken from the files on the site (just in case you have not seen them) :

">>Thyroid disease is not always simple to diagnose but usually a low TT4 (total thyroid hormone) confirmed by a low FreeT4 (thyroid hormone measurement without protein) and a high TSH (Thyroid Stimulating Hormone) is considered to be diagnostic of hypothyroidism.  (In addition, tests to assess thyroid dysfunction may include: TT3, FT3, autoantibody, TSH and TRH response tests).

"Measuring TT4 alone is not enough to make a definitive diagnosis as the dog could be suffering from a non-thyroidal illness (NTI), that is an illness affecting the amount of thyroid hormone within the circulation, rather than a primary autoimmune destruction of the glands.  Non-thyroidal illness should be suspected if the dog has a low TT4 and a low TSH. Note: Several drugs, including prednisolone, will lower the circulating TT4 levels and this should be taken into account when evaluating the results. " <<<

It could be that your dog is Hypothyroid as the "normal ranges" are only a guide. Certainly untreated Hypothyroidism can cause seizures. Does she have any other clinical signs that would point to HypoT?

If she is not Hypothyroid then other things need to be looked into. I trust all the other blood tests she has had included making sure the kidneys, liver, electrolytes, etc. were okay. There is a possibility that it could be a brain disease causing it but I would certainly want to get her thyroid checked thoroughly first.

I can see why they have put her on Epiphen but if it is a thyroid problem and nothing else I personally would not be wanting to be giving her unnecessary medication. It may apparently be controlling her seizures but there were a few months inbetween seizures before so....

Anyway I think you are right to ask for further tests (and full ones!). I know it is not easy going against vets but you may yet prove them wrong, and  make your dog feel better. On the other hand the vets may be right but at least, with the thryroid result being inconclusive, you will feel satisfied that it was ruled out.

#573
What was Skye's PCV?

I would not be wanting to leave testing Skye's haematology for two weeks. Her levels should have increased not decreased so she could need a different medication regime or investigating of the anaemia. Keeping her on the high dose of steroids for another two weeks, in my opinion, could be making matters worse.
#574
General doggy chat / Re: stella pred reduction
March 21, 2013, 03:59:32 PM
Is this happening now Elisabeth or has it been happening over several days? If it is now it could be bloat and you need to rule this out IMMEDIATELY if it is.

Sorry to scare you, but a few of the symptoms could be pointing to it.
#575
>>>>Got the bone marrow core results - no cancer or any other nasty!<<<<

That is good news.


>>>>PCV is slightly up again at 17.5%. So we're heading in the right direction at last!.<<<<

Yes, good that it is going up, but I would have expected it to be increasing a bit more than that. You mentioned that the specialist had not seen this type of thing before with the way she was responding - did you find out any more? Hopefully the Cyclosporin will soon "kick in ".

>>>>She is a little brighter every day and starting to do her unique tricks.<<<<

It is lovely when they can make you smile through all your worry but I hope the tricks are not energetic ones - Marnie still needs to conserve her energy. :)
#576
>>>>her red cell count had droppped to slightly below normal;<<<<

When is her next blood test? What dosage of steroids is she on? You may have to increase again and take the reduction slower.


>>>>the fur is coming out so easily she is swallowing it as she grooms herself Has anyone else heard of this <<<<

This happened with my AIHA dog. Not only did I have to groom her more often (gently because of thinning skin) but I hoovered....and hoovered....and hoovered because she would lick the floor looking for bits of food or anything!

Have you had Skye's thyroid tested recently? I know the fur coming out is due to her illness and the steroids but it can also come out with Hypothyroidism so best to rule that out.
#577
I have had no experience of a dog having a transfusion with AIHA as my dog did not have one but I would think that by now there should have been an increase, even a slight one in the PCV.

Do you have a definite weight for Marnie? Not sure how precise the meds. need to be but the Preds. could be a bit more.

I can not understand why they persevered with Cyclosporin when it made her sick and then had to give her more drugs to prevent the sickness. Also it seems a huge amount she is on. With our AIHA dog we used Azathioprine and had no problems with sickness and also our 20kg dog was only given 25mg of Azathioprine a day which was enough to get her better (plus the Preds. of course).

Has Marnie had a full biochemistry blood test recently to check out how her liver, kidneys, pancreas are doing?

Yes you may have to be patient to see some improvement but it is always best to keep an eye on things. I find that keeping copies of blood tests and writing it all down with what medication was given and when started etc. helps.
#578
My dog got scurfy skin whilst on steroids. Not sure whether it was the steroids causing the problem or her illness. Also her fur came out. But it all got better again eventually. I would just leave things as they are and not worry about any supplements.

On a cautious note - scurfy skin can be a sign of Hypothyroidism.
#579
>>>>He is on meds for his under active thyroid and while we were there they took a bit of blood and spun it and his red blood cell count has risen from 22% on Monday to 28% today! <<<<

Is your vet still saying it is AIHA because without medication I can not see how the PCV has risen. Obviously it is good that the PCV is not  going down but if it is not AIHA then what does the vet think has caused the anaemia?

>>>>. He's only on half a tablet for the thyroid at the moment because they want to monitor him carefully in case he has another anaemic crash.<<<<

What mg is the tablet?

Has Benson perked up any?
#580


>>>>His reb blood cell count from Mondays bloods was 22% is that very low?<<<<

Normal is usually in a range between37%-55% so 22% is not good but some dogs with levels of 12% and lower have survived but only with the correct medication. Also if the AIHA is chronic then the level will lower more slowly but if it is acute then within a day or so it could drop drastically.

>>>>Do you think he should have been given a blod transfusion? <<<<

Blood transfusions are not usually given until the level is as low as 12% say. A blood transfusion is usually a last resort and at the moment if Benson's level is still at 22% then he will probably only need the steroids. Blood transfusions carry an added risk.

Can you ask your vet to do another blood test for Benson today to check his HCT/PCV levels? I know it is only 2 days since his last test but it would really help to know if his levels are still dropping and at what rate. Please also tell your vet that Benson is so sleepy.
#581


>>>> He's not on any medication for anything as yet. The vet is going to be calling tomorrow or he day after to advise what the next step is.<<<<

I have only just come on the forum and was shocked to read that Benson is not having any medication. I was then so glad to see that Penel had advised you of the urgency to get Benson started on medication and I do hope you have followed Penel's advice. As she says you can not hang around with AIHA (Autoimmune Haemolytic Anaemia) because the anaemia can get worse really quickly. You need to get him on the correct dose as well. Also if Benson is Hypothyorid he needs medication for that as well.


>>>>I'm not sure what HCT or PCV stands for? Sorry I'm new to all this. I'm also not sure now if its hyper or hypo thyroidism. I know he said his thyroid level was 3.3 which is very low. <<<<

HCT stands for haematocrit and PCV (packed cell volume) is just another name for it and is the volume percentage of red blood cells in blood. If his thyroid level is low than that is Hypothyroidism.


>>>>His last blood test was yesterday and there was no change in his levels.<<<<

Please can you find out his levels so that we have a better idea of how anaemic he is? It is best to get copies of all blood tests but if not then ask for the figures.


>>>>I'm keeping a very close eye on him but quite worried that its taking a long time to get him any treatment started.<<<<

I know it is all worrying, and that we like to wait for our vet to advise us but if your vet has not had experience of AIHA then Benson needs to see a specialist.
#582
Not sure whether you have already seen this but this will explain a bit more about AIHA and the medication.
http://cimda.co.uk/smf/index.php/topic,11.0.html

What medication has your vet put Benson on and do you know what his HCT (or PCV) is? If it is very low Benson should really have another blood test before next Monday to keep an eye on the anaemia. Also Hyperthyrodisim is quite rare in dogs and the more usual thing is Hypothyroidism. Quite confusing when one is very worried, so much to take in.

How is Benson?
#583
>>>>. She is on 1 & 1/2 25mg tablet of prednisolone twice a day - that's 75mg a day in total, and she weighs 21.3kg. Looking at the info on this forum, does that seem too high?<<<<

It is within the medication protocol but I personally feel (unless there is a good reason) that it is better to start at a lower (immunosuppressive) dose. Not only is it better on the system but also if needed the dose can be increased.



.>>>> He wants to see her again on 25th Feb (10 days since the diagnosis) for another blood test, but I am to take her back sooner if she seems worse, which I would do anyway.<<<<

I feel, also, that this is too far in-between blood tests at the beginning. My experience of AIHA is that dogs can be extremely anaemic – a PCV
of 12% and below and they can still seem fairly well so in that respect if Gyps's PCV was dropping you may not know. If she was my dog I would be taking her back to the vets for another blood test within the next day or two and would not be waiting 10 days. You may not see much of an increase but you would get peace of mind (hopefully) that the PCV has not dropped.


>>>>She is two days into the treatment now, and is still very pale in gums/flews, and she is very subdued (normally she is so bright and breezy),<<<<

It is best that she does rest, but it may also be an idea to have a complete biochemistry blood test as well to check that her liver etc. is coping with the disease and medication.






#584
She should start responding to treatment fairly soon if she is on the correct dose and if she does not then there are other medications like Azathioprine that can be added. What dosage is she on? It is also better if the dosage is split into approximately 12 hours apart.

When is her next blood test? Regular blood tests are essential and at the beginning need to be perhaps twice a week.

Oh and what is her name?  :)
#585

>>>>. Her red blood count is very low (2.1, reference range is usually 4.9-8.2), and platelet count at 122 (reference range 200-500).<<<<

Do you know what her HCT (PCV) count is?

>>>>She's on a lot of meds - metrondazole (65mg), ranitidine (15mg), prednisolone (20mg), sucralfate (1g) and azothiaprine (25mg).<<<<

Do you know why she is having metronidazole and how long she has to have it? If you are not already doing it is thought best to divide the steroids into two doses approximately 12 hours apart a day.


>>>>I wanted to know if there's anyone here with advice on how we can best care for her to ensure the best hope of survival, particularly in the crucial first two weeks.<<<<

I copied below some details that can be found on this site. Also you may like to use the search facility at the top of the page and put in IMHA, AIHA etc. to read past messages with regard to this disease.
When is Buffy having a blood test next? Regular blood tests (if the PCV is very low then every few days, then weekly, if the PCV is rising and do not forget to have a full biochemistry now and again to keep an eye on her liver levels etc.) It is also a very good idea to get copies of the blood tests so that you can see exactly what the figures are.


>>>>Apart from the meds she's been prescribed, are there any foods or natural remedies we should also look at? Should we give her bed-rest and not get her worked up too much?<<<<

I would not bother with anything else at the moment. She does need to conserve her energy so not a good idea to go walking or playing but a gentle stroll around the house and garden is okay.



(AIHA) Non-regenerative Autoimmune Haemolytic Anaemia 

A dog can be anaemic from either blood loss (internal bleeding), or destruction of the red blood cells, or a decrease in their production in the bone marrow. 

There are many reasons why anaemia might develop, eg. autoimmune (or immune mediated) destruction of the red blood cells occurring in the circulation of the blood (regenerative AIHA) or within the bone marrow (non-regenerative AIHA), tick borne diseases such as Lyme disease, cancers, parasites, poisoning (zinc, onions etc), a reaction to drug administration, hyperthermia, systemic disease. However, in the absence of an identified, underlying cause, the most common form of haemolytic anaemia is primary non-regenerative AIHA.

The life of a red blood cell is approximately 110-120 days. After this time the old red blood cells naturally leave the body and are replaced by young red blood cells, (reticulocytes).  Reticulocytes are formed in the bone marrow, and when they are ready they migrate to the circulation where they mature and then exit the body when their life span is complete.  It's a circle of life – as the old red blood cells die off new ones replace them.  This is a normal daily occurrence.

If this normal process is prevented from happening, as in the case of a dog with non-regenerative AIHA, where the dog's own immune system is producing antibodies which are destroying these young red cells in the bone marrow, eventually the dog will become anaemic.  This is a chronic form of AHIA.

The destruction of the red cells in the bone marrow starts some weeks before clinical signs appear and initially, the dog will cope quite well, as their body adjusts to the gradual effects of this form of anaemia.  However, eventually there will come a time when the lack of red blood cells in the circulation shows in various, external clinical signs.

Common, initial 'telltale' signs of chronic anaemia:
Your dog may have a craving to eat the earth or compost, or chew on concrete or bricks.  Another indicator could be bright orange coloured faeces and dark coloured urine (this is the blood pigment leaving the body). Your dog may become weak or lethargic, or even collapse for a few minutes through lack of oxygen to the brain, especially when excited. Take a look into your dog's mouth and see if the gums appear pale. If the red blood cell count is extremely low, the tongue and whites of the eyes may have a blue tint to them. Occasionally the dog's gums, skin and possibly whites of the eyes, will look yellow with jaundice. Other signs to consider include loss of appetite, high temperature, inexplicable limping and depression.  Consideration must be given to recent potential trigger factors such as hormone imbalance (recent season/whelping), vaccination, drugs, pesticides, flea treatments etc., also predisposing factors such as breed and age.

The family history of your dog is very relevant to any investigation, and can contribute towards achieving a diagnosis of an autoimmune disease. Dogs with a primary autoimmune disease have a genetic predisposition to one or several autoimmune diseases. Autoimmune disease runs in families so it is possible if one dog in a litter, or a relative, develops autoimmune disease the others may follow. 

Non-regenerative haemolytic anaemia is the most common form of primary AIHA but your vet should not assume this diagnosis. As stated previously, a dog can become anaemic for a variety of reasons and these will need to be investigated.  However, it appears some vets don't consider that AIHA can be a primary disease occurring in the bone marrow and very often a grim, incorrect diagnosis of leukaemia is given.  Blood testing and examination of a blood smear is vitally important to a diagnosis of AIHA. A bone marrow biopsy, though very intrusive, may give a firm diagnosis but sometimes a diagnosis of non-regenerative AIHA is achieved by elimination of other primary or secondary causes of anaemia.

Autoimmune disease is often a 'fight against time'.  If the red blood cells are below 12%, a blood transfusion is likely to be necessary to 'buy time' for the treatment to work.  The dog needs to be sustained through this early period of the disease. It is not necessary to have 'typed' donor blood for the first transfusion but subsequent transfusions need to be compatible therefore the recipients blood should be taken and sent away for blood typing before the first transfusion is given so that the type can be determined should another transfusion be necessary. Obviously, blood transfusions carry risks but they can also save lives. Early diagnosis and treatment may avoid this procedure. 

Once treatment has started, an increase in red blood cells will hopefully be seen in approximately 5 days (the time it takes for the reticulocytes to develop and migrate to the circulation). The level of reticulocytes seen in a normal blood smear is very low. When a dog is recovering from AIHA the levels should be very high and this reflects the level of anaemia.  Correct dosage and duration of treatment is absolutely crucial to a favourable outcome.

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h                         10-28 days
0.25mg/kg/q24h                         10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!


WHAT TO EXPECT ONCE TREATMENT HAS STARTED

If a dog has a serious autoimmune disease, then the sooner treatment commences the better chance the dog has of survival.  The main delay to starting treatment is obtaining a diagnosis or at least your vet being sure that he hasn't missed anything that could be made worse by giving high doses of steroids.  Achieving a diagnosis can be a fight against time. 

If your vet has decided that in all probabilities your dog has an autoimmune disease, then to a certain extent, which autoimmune disease your dog has, as far as treatment is concerned, is irrelevant because with the exception of a few diseases, they are all treated the same, that is, with immunosuppressive drugs.  The main objective is to 'knock out' the immune system and virtually stop it from working (or near enough) so the destruction will cease and give the body a chance to recover.  As previously stated, this treatment regime works in most cases, that is, if it has been given early enough and the dosage is correct.  All dogs are different and some can tolerate the drugs better than others. In proportion to their size, small dogs seem more able to tolerate higher doses of steroids than large ones. Some diseases are more serious than others and carry a poorer prognosis. So the initial crisis is a crucial time, however anecdotal evidence shows that many more dogs survive than die if correct treatment is administered in good time.

It is hoped that a positive response can be seen within 4-6 hours of starting treatment (depending on the disease), but in a serious, life threatening situation, the first 2-7-14 days can be a very worrying time.  Assuming the dog has stabilised he will quickly feel much better, and if he is in hospital may be allowed home within a week.

When he comes home he will probably have a 'goody bag' full of drugs.  He will be on a high dose of steroid, usually prednisolone, and he may also be on another immunosuppressive drug, such as Azathioprine.  Your dog will be weaned off in a controlled manner according to his wellness and clinical observations. 

Note: High doses of steroids must not be stopped abruptly.  Your dog could go into an adrenal crisis if the medication is withdrawn too quickly. 

In addition to immunosuppressive drugs he should have something to protect his stomach from excess acid.  The last thing your dog needs when he is feeling poorly is a bleeding stomach ulcer caused by the drugs.  Sometimes, Antepsin is given to coat and protect the stomach (but this must not be given within two hours of other medication otherwise it will stop the drugs from being absorbed).  Zantac (Ranitidine) may also be prescribed to take away the excess acid. Zantac does not inhibit the absorption of the drugs. Another gastroprotectant used is omeprazol. To minimise irritation to the stomach it is usual for the daily dose of steroid to be split into two doses and given with food, one dose in the morning with breakfast and the other dose with his evening meal. I have known several dogs, who did not receive a gastroprotectant as a part of their treatment regime, who went on to develop anaemia. This is not autoimmune haemolytic anaemia but iron deficiency anaemia caused by bleeding stomach ulcers. Using a gastroprotectant is a good preventative measure. When the steroids have been significantly reduced to a low dose, a gastroprotectant may not be necessary.

Excess acid produced because of the drugs may make a dog prone to developing pancreatitis. A dog with pancreatitis will appear in pain and his back may be arched as if he can't straighten up.  He may be lethargic, seem bloated and have a tender abdomen. Dogs usually go off food and water, may vomit and look depressed.  If you suspect that your dog has pancreatitis, don't try to feed him because it will make the condition worse. Take him to the vet as soon as possible as he may require treatment or need to go on an intravenous drip to stop him dehydrating.  Again, the risk of pancreatitis should be minimal once the dog is on a lower dose of steroids.   A low fat diet is best when your dog is on high dose steroids or prone to pancreatitis. 

As your dog's immune system is being significantly suppressed, he will be more likely to pick up infections, and will not have the ability to fight against them.  As a precaution a broad spectrum antibiotic is often prescribed. Also it is sensible not to exercise him in areas where he is more likely to encounter infections, for example, a park or a popular dog walking area. 

Whilst your dog is on high dose steroids he will want to eat and drink excessively. However, this also means that he will want to urinate more and this can sometimes cause temporary incontinence.  You may have to get up to let him out during the night and if you leave the garden door open during the day, it may save some mopping up!  He cannot help it and won't like it either, so don't be too hard on him, it's only temporary. You will notice as he is weaned off the drugs the unwanted side effects will subside and he should return to normal habits and behaviour.  Urinary tract infections and/or bacterial skin pustules are not uncommon when a dog's immune system is suppressed, and this is often the reason for a dog to be off colour during this time.  Note: Always consider a urine infection if your dog seems under par.  A course of antibiotics will usually sort this out quickly.

Depending on what autoimmune disease your dog has, he will probably need to have regular blood tests.  Biochemical blood tests will also keep an eye on other body functions, such as those of the liver and kidneys, which is important at this stage.

Assuming good progress is being made, the clinical signs of his illness are diminishing and positive signs of improvement are apparent, your vet will want to start weaning him down from the high doses of steroid.  This process can take 3-6 months or more, and usually begins anytime after 10 - 28 days from the start of treatment, depending on the results of his blood tests and his clinical signs.
Relapses are not uncommon, especially in diseases that are difficult to control, for example SLE.  A relapse may mean that initially, your dog needed to be on a higher dose of immunosuppressive drugs for a longer period of time, or your dog may have been weaned off a little too quickly and then the dose withdrawn too soon.

If a relapse occurs he will probably show similar clinical signs to his initial crisis.  He will have to go back on an immunosuppressive dose of prednisolone, but it may not have to be quite as high as before. A combination drug may need to be added at this stage. The weaning process will then have to start all over again. Returning to an immunosuppressive dose will mean that he has to go back on a gastroprotectant.


« Last Edit: April 04, 2012, 06:08:47 PM by Jo CIMDA »