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Author Topic: Bluebell  (Read 1522 times)

Jo CIMDA

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Re: Bluebell
« Reply #15 on: February 25, 2018, 10:50:46 AM »

Many thanks Gwyneth for taking the time to write your personal experience of using melatonin in the treatment of IMTP.  It is certainly worth including in any treatment regimen for IMTP,  and with no notable side effects - why not?

One thing I would like to add, I have known a dog with recurring IMTP to ultimately develop Addison's disease.  Immune mediated haemolytic anaemia (IMHA) is well documented as a precursor to Addison's disease but it seems that IMTP may also precede a diagnosis of Addison's so it is worth considering Addison's as an underlying cause of either IMTP or IMHA.

Jo

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Bbell

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Re: Bluebell
« Reply #16 on: February 26, 2018, 09:07:40 AM »


Gwyneth, thank you for taking the time to write your experience. I am sorry Harley had another ailment thrown at him that he couldn't fight. The stories I read mostly all seem to end up with an underlying cause that maybe wasn't apparent at first :(

I will be asking the RVC about melatonin and insisting she starts it. I totally agree that all these drugs that are the current 'go-to' drugs now, would have been unstudied and new at the time they were discovered, so it does bug me that they say that.

Addisons disease will be added to my list of things to chat through too, thank you Jo.

I am ever so grateful for the advice, we have all been here, totally lost without a clue which way is up xx

Bluebell spent the weekend at Anderson Moores and I picked her up last night. Her platelet levels were 53 yesterday (27 on admission) I dont suppose anything they did in two days made the difference but she was in good hands and has started Mychophenolate. fingers crossed. next battle is the RVC on Wednesday!

Thank you ladies
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Bbell

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Re: Bluebell
« Reply #17 on: March 09, 2018, 06:46:22 PM »


Hi there,

Update on Bluebell - we didn't go to the RVC because of the snow and the fact Anderson Moores had just added the Mycophenolate. So at the moment we are on Pred, Mycophenolate, Leflunomide, Denamarin and Melatonin.

We had one blood test since starting the Mycophenolate and the reading was down from 53 to 39. More bloods on Monday and I am really hoping that the melatonin will have had some effect by then. If not they are talking about Splenectomy - something they have all tried to avoid until now but I believe is a very serious option, as I mentioned bfore though, I would be worried with such low platelets.

Do you think she needs to be on all 3 immunosuppressants? and do you think it may be that that is stifling her readings?

Aurelie


 
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Jo CIMDA

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Re: Bluebell
« Reply #18 on: March 10, 2018, 12:02:19 PM »

Hi Aurelie

Well, does she need to be on all 3 immunosuppressive drugs?  Probably not because one can only suppress the immune system so much.

 I wonder if her bone marrow is able to produce new blood platelets? By them saying that they might remove her spleen, does this indicate that they think her bone marrow is working normally and producing platelets and the destruction is going on in the spleen?  I wonder if a splenectomy is the answer to Bluebell's problem.  If before they remove the spleen, can they give Vincristine to rapidly increase the platelets?  I know she has had Vincristine before that it is usually only given once.    I know a dog who had similar problems, but with the red blood cells and eventually they removed her spleen and she is now well and a totally different dog - not more chronic illness, but I do understand the implications of a low platelet count and surgery. 

Mycophenolate has shown some good results, so this is promising.    I am pleased she is on melatonin now.  You ask if the drugs could be stifling her readings - well they can examine the blood sample on the slide to see if there are visible characteristics of IMTP, and also if she is not showing signs of bleeding and bruising when her platelets are below 40 then it might be that the platelet count is higher than the results suggest, and particularly if there is clumping on the sample.   

Anderson Moores are excellent clinicians and as it is nearer to your home then I think you are right to stick with them.

Hope things pick up very soon.

Many thanks for the update.

Jo

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Bbell

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Re: Bluebell
« Reply #19 on: March 13, 2018, 09:01:17 PM »

Hi Jo,

Thank you for your last email, I was waiting for results before I replied. Unfortunately her platelets dropped again from 39 to 34 (with some clumping)

She has high neutrophil levels, decreased lymphocytes,  and low eosinophils, which I assume, are all related to the effect of the drugs.

we have been on Melatonin since last Wednesday (bloods taken on Sunday) and I had really hoped it would show as I don't think it takes long to get into the system, so that's a bit disappointing.

The specialist mentioned how a long enough time since the last time vincristine had been administered has passed, that it could be tried again? I thought it was a totally one off thing?

Regards

Aurelie


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Jo CIMDA

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Re: Bluebell
« Reply #20 on: March 14, 2018, 09:23:07 AM »


Hi Aurelie

As there is clumping I think you can assume that Bluebell's platelet count is at least the same as it was or even increased.  If she is not showing signs of bruising or bleeding then this more or less confirms it has not truly dropped. Perhaps the lack of decline in platelets is a good sign and the next blood test might show a true increase. Let's hope so.    As you said, her white cells pattern is typical of a dog on steroids.

If you haven't already read the article on this link below, then I think you will find its content very interesting and it might give some ideas about other treatment options and you can also check that Bluebell is receiving the correct dose of melatonin.   

https://www.dovelewis.org/pdf/events/Immune_Mediated_Thrombocytopenia.pdf

"Because IV boluses of vincristine are cleared from circulation relatively quickly, vincristine is sometimes incubated with platelet rich plasma prior to administration (to create “vinca loaded platelets”). This results in increased vincristine delivery to macrophages and potentially improved efficacy."

Ultimately, the removal of Bluebell's spleen might be an option and if it comes to this then perhaps the above combination of Vincristine and platelet rich plasma might be considered as an option before surgery. 

I hope you see an improvement next blood test.

Jo
 


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Bbell

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Re: Bluebell
« Reply #21 on: March 14, 2018, 06:45:17 PM »

Hi Jo

Thank you for your reply. She does have some tiny blood spots but her usual presentation has always been much larger blobs.

I will read the link, thank you so much x
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Bbell

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Re: Bluebell
« Reply #22 on: March 15, 2018, 05:09:22 PM »


Hi Jo,

We're going back to RVC next Tuesday, they suspect Cushings now too.  They say that the splenectomy would be 'dangerous' not only because of the platelets but the immune not being able to heal any part of the surgery properly.

The specialist has said take her off the leflunomide completely and stick with pred and myco until at least next week.

If the immune suppression isn't actually helping the numbers go down, there must be something else going on!?

Lets see what they come up with on Tuesday :)

 
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Bbell

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Re: Bluebell
« Reply #23 on: March 17, 2018, 08:11:39 AM »

Jo, Firstly may I thank you for your time and advice, it is a wonderfully selfless act you carry out, helping others in desperate need x

Sadly Bluebell didn't make it. she had a massive abscess on her elbow that was growing daily, they didn't dare lance it and I was advised that even if I wanted her to have the surgeon take a look, he may well say that's not in her best interest , given that recovery would be substantially harder to achieve on her already fragile body. Her platelets had dropped substantially in that time too, and they found a rare bacteria (but its not actually a bacteria) in her blood, apparently only seen in 2 other dogs.

for now I grieve, but will ever be thankful for you comprehensive advice and support xx
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Jo CIMDA

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Re: Bluebell
« Reply #24 on: March 17, 2018, 04:21:36 PM »

Oh I am so sorry to read this.  I feel lost for words, and I know how hard this is for you.

She is at peace, and it is now your time to heal.  She will be forever in your heart.

My thoughts are with you.

Jo
xx
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