More Feed Back Needed on Harley - Sorry !!!!!

[DW]

Hello

I am so very very pleased (but a little guarded - scared of being too optimistic as we have been here before !!).....We had more bloods taken to day and his Platelet count is now 430.   This, after a week of reducing the Aza's to 25mg every other day - we maintained the dose of steroid for a further week at 10mg every other day.

Please don't think I am being negative - I am just scared.....because we are about to reduce the steroids down to 5mg every other day and I just wanted to sound this out with the Group, as I so depend on their expertise/experiences.

I am just worried that the reason the Platelet Count ha come down to a more 'normal' level is due to the steroid dose being at 10mg every other day and the Aza at 25mg every other day.   If we reduce the steroids, does this mean that it is going to drop again?

I suppose, trying to put my 'logical' hat on, I accept we have to, at some stage, try and see if his immune system can hold it's own without the support of steroids but last time we reduced the steroids, he dropped.   Granted, this was several weeks ago...

My Vet is away over Xmas and what she has said is that I should have his bloods taken again next friday with a view of ensuring that the count doesn't drop drastically.  If it stays about the same, then she suggests we don't adjust the dose at that point and keep him on the 5mg Preds every other day, for another week and re-check.

Does this sound o.k. please?

Harley has changed drastically in the past two weeks....he is so lively, much happier in his self and is inter-acting with my other Golden, as he used to before all this happened.

Incidentally, I found out this week that another dog, by the same Sire, has I.M.H.A.     If this condition is genetic,  why does one dog have
H.A. and another, like Harley, has Thrombocytopaenia and is there a risk therefore that he could still get H.A.?
This other dog has now been referred to a Specialist Hospital, as he is very poorly......I am so sad.....he is such a lovely dog (as they all are).


Gwyneth

[Penel CIMDA moderator]

I wouldn't make another reduction so soon.  I always found that it took between 2 and 4 weeks for my dog to get used to a new medication regime.  That's just my personal opinion and experience but I would not want to keep making another reduction in one drug or the other every week.  I'd keep him on 25mg Aza EOD, and 10mg pred EOD (are you giving them same day - or the "other" day?).  Then I'd consider reducing the pred after Christmas to be honest.  You really don't want things going wrong over the holiday period.  If you really want to reduce, go down to 7,5mg pred EOD (cut the 5mgs in half).

The genetic thing is something that Jo can explain more - she had a litter of puppies that developed different AI diseases.  There appears to be a genetic predisposition to AI disease, but not one in particular.

[Jo CIMDA]

Hello

I am so very very pleased (but a little guarded - scared of being too optimistic as we have been here before !!).....We had more bloods taken to day and his Platelet count is now 430.   This, after a week of reducing the Aza's to 25mg every other day - we maintained the dose of steroid for a further week at 10mg every other day.

Please don't think I am being negative - I am just scared.....because we are about to reduce the steroids down to 5mg every other day and I just wanted to sound this out with the Group, as I so depend on their expertise/experiences.

I am just worried that the reason the Platelet Count ha come down to a more 'normal' level is due to the steroid dose being at 10mg every other day and the Aza at 25mg every other day.   If we reduce the steroids, does this mean that it is going to drop again?

I suppose, trying to put my 'logical' hat on, I accept we have to, at some stage, try and see if his immune system can hold it's own without the support of steroids but last time we reduced the steroids, he dropped.   Granted, this was several weeks ago...

My Vet is away over Xmas and what she has said is that I should have his bloods taken again next friday with a view of ensuring that the count doesn't drop drastically.  If it stays about the same, then she suggests we don't adjust the dose at that point and keep him on the 5mg Preds every other day, for another week and re-check.

Does this sound o.k. please?

Harley has changed drastically in the past two weeks....he is so lively, much happier in his self and is inter-acting with my other Golden, as he used to before all this happened.

Incidentally, I found out this week that another dog, by the same Sire, has I.M.H.A.     If this condition is genetic,  why does one dog have
H.A. and another, like Harley, has Thrombocytopaenia and is there a risk therefore that he could still get H.A.?
This other dog has now been referred to a Specialist Hospital, as he is very poorly......I am so sad.....he is such a lovely dog (as they all are).


Gwyneth

That is very good news Gwyneth.  430 platelet count is much better than before and also 5mg EOD is a good reducing dose.  I think you can be very happy with this result. Dropping the steroids doesn't mean that his platelets will go below the reference range.  It is hoped that Harley is in remission and as you reduce the drugs his platelet level will return to what is normal for him and it will be lower that 430, I suspect.  You can keep him on 5mg EOD for a very long time, in fact some dogs remain on this dose for life, but it is always worth trying to get him completely off the drugs, but you will have to wait and see.

I'm so pleased he is very happy in himself, that is a very good sign.

Autoimmune disease is genetic - no doubt  - and his sire is obviously producing it.  Once a dog is known to have a genetic predisposition then there is always a risk of getting a different AI disease or having a relapse.  Unfortunately there is no way of knowing what AI diseases an individual is predisposed to, but don't worry about it because there is nothing you can do about what may happen in the future.  Be very pleased Harely has done so well and try to enjoy his wellness.  I know it is difficult.

Jo

[DW]

Thank you Jo so much for replying.......I have lowered the dose now to 5mg EOD and this coming Wednesday my Vet has left instructions in her absence, to just ensure there is no radical drop...just a sensible amount.  She then wants me to remain on the 5mg dose till the new year and look again....I am so relieved to have had your response...just to be sure we are on the right track.

Some more good news as well (well sort of).    I have spoken again to the lady that has the dog with the Anaemia and in fact, she has three dogs and the poorly one is not the one that is related to mine.....so, although I can appreciate that he will now be 'sensitive' to other A.I. problems and may well come out of remission - I am not quite as worried as I was.

It's just so nice to have him almost all back to his old self......naughtiness included !!!


My Xmas wish this year?    Not just for my own dogs health but all the other dogs out there suffering with more serious problems than I have had to contend with......I wish they all get better I really do.   best Xmas prezzy ever.

Thankyou Jo

[DW]

Hello

I wonder if it would be acceptable to print off the sheet that shows the recommended steroid reduction plan to show my Vet?

I truthfully have a lot of faith in my Vet and I do have a really good relationship with at least two of the vets at the practice - they don't talk-down to me or treat me like an idiot and are really receptive to suggestions from outside.
However, as I have said before, because this Group I feel, hold collectively, far more experience in these Immune problems - I do place more faith in the advice that comes from the Group.

The week before Xmas, Harley's platelet count had dropped by about 200 to 237     .     As this figure was within the acceptable parameter
I wasn't unduly concerned.  In fairness, the previous week his count, at 435 was felt to be too high and we had reduced the Preds from 10mg EOD to 5mg EOD.     The resultant drop at the end of that week concerned the Vet for one reason...whilst stressing the 237 was nothing to worry about, she said that due to the fact that it had dropped by so much in just a week of EOD meds, she was worried that if it continue to drop,we may have a problem  -    So, as a precautionary measure, we put him back up to 10mg EOD>

What concerned me at the time, was that we were taking backward steps and what if this was actually a sign that Harleys system was starting to work for itself and what WAS his 'normal' platelet count......did we know?
Anyway, we increased the Preds and yesterday, went for another blood test.    Platelets up to 540 (so higher than when he was on the same dose two weeks previously).

The Vet is going to have the count checked (send them off - no charge) as she wants to make sure that she is not getting false readings before deciding what to do.
She 'thinks' that if the readings are agreed, we will reduce the Preds to 7.5mg EOD but keep him on this dose for a little longer.

Is this something others would expect/agree with?

Please don't think of me trying to take things in my own hands but part of me feels that I want to drop the dose now - rather than wait.
The reason being that at 237 (when on 5mg) that was acceptible and by doubling the dose, we have added 300 to the count!
Surely the worse that could happen is that they drop back to 380'ish - or doesn't it work this way?

Many thanks for advice again....

Gwyneth

Incidentally, I notice that there is someone else on the forum that had Goldens......it would be so good to talk to them - is there a way of doing this?

[Penel CIMDA moderator]

Hi Gwyneth,
Yes it's fine for you to print off the protocols - Jo has asked Professor Michael Day if he minded us putting it on here and he was fine about it.  So by all means print it off and show to your vets.
I'm going to let Jo reply to the other bit as I'm not sure what the right answer is.
We've turned off the private messaging facility for various reasons - I think it's probably Chris you want - if you email me on woofmiaow@hotmail.com I can pass on details to Chris for you.

[Jo CIMDA]

Hi Gwyneth

This proves to me that his body has a high response to  preds and personally I wouldn't want his platelets as high as 540.  There was nothing wrong with 5mg EOD and a platelet count of 237.  That is quite normal and is exactly what you are working towards.  In a way this is as we predicted, and by going to 5mg EOD you are allowing his body to reach a level that is normal for him.  I think there is a good chance that you can wean him off altogether and hopefully he will remain in remission.

Jo

[DW]

hello again

I am so sorry to be a nuisance but I just wanted to talk through the results of Harley's bloods - as I am so confused.

I had written to say that his steroids had been put up to 10mg EOD because the platelet count had dropped and though within the range, the Vet had been worried about the size of the drop within a week and that was why we put them back to 10mg from the 5mg he had been on the week before.

When the bloods were taken again at the end of the week, they had gone up to 540 but we were told to keep the steroid dose as it was until she had sent the bloods off to be checked.
The Vet phoned today whilst I was out and left a message to say that they had come back and were 178 !!!     My Husband realised that this was quite a significant change but was told that the scale was different and that they used a scale of between 150 and 450....consequently they were pleased with a count of 178 !!!!
I don't see that this is good.

If the Vet had said previously that 270's was within their range and was o.k.   but  500's were high  - I would expect a middle-range figure comparable to their scale (hope I am making sense) and therefore surely his count should be around 250-300 mark?
I tried to get back to the Vet this evening but she had left and I can't speak to her personally until Monday.
#I just wondered what others thought...

Thanks

Gwyneth

[DW]

Hello Jo

How funny....your response to my previous posting has crossed with the latest one.

I'd welcome your response to the latest feed-back please....

Gwyneth

[Jo CIMDA]

Hi Gwyneth

Is the blood from this latest lot of results from the same sample as the one that was 540? If it is then I would say there is something wrong with the sample and it could be that the sample used in the 2nd blood test could have been clotting.

If the reference range is 150-450, that means that some dogs would have a normal sample and their level would be 150 and other dogs would be normal with a level of 450.  It doesn't mean that an average dog should be "around the 250-300 mark" because the reference range is wide because research has shown normal dogs to be at either end of the scale.  I'm not sure if that makes sense.

Jo

[DW]

Hell Jo

Yes totally sense...thank you.

Do I need to be concerned about clotting though?   They have kept him on the 10mg EOD for the time being you see and I'm concerned about that, in view of your previous comments relating to Harley finding his own level now (which makes total sense to me).

[Jo CIMDA]

Hi Gwyneth

Clotting can occur if there are too many platelets. That is not to say it will.  I find it hard to believe that both blood tests are correct when there is such a difference between the two.  I think you should find out which, if any, is correct.  I'm glad it is making sense to you.  It is all very confusing, I know.

Jo