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Author Topic: Desperate for information!  (Read 21813 times)

Tammie

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Desperate for information!
« on: February 02, 2013, 10:57:31 PM »

Three weeks ago, me and my three border collies, Riley, Hurley and Booty went to visit my mother's farm.  When we returned two days later, I noticed a slimy substance coming from one of Riley's eyes.  Trip to the vet revealed a bacterial infection that presented itself in his eyes.  Was sent home with Doxycyline and three different eye drops 2 times a day.   Went back for a check up, was taken off the Doxy but was told to continue the Eye drops.  Noticed a week later that he did not feel good.  Took him back, vet ran CBC, tick titers and xrays to reveal a possible auto immune disease.  Took him home with pred and doxy two times a day.  Went back three days later, getting better, reduce the pred to one time a day and stay on the doxy twice a day.  He got much better, for a couple of days, then noticed he was beginning to "crash".  Took him to the vet on Monday to reveal AIHI and IMT "Evans Syndrome".  He was losing it quick.  Tuesday numbers fell, Wednesday a blood transfusion, Thursday his numbers were up Platelets went from 79 to 91, Something went from an 18 to a 21 and Red Blood count from a 1.8 to a 2.15.  Friday, his counts went from 21% to 27%, his Red Blood Count went from 2.15 to 2.8.  His Reticulocyte went to 10%.  All is good.  He ate really good yesterday.  Today he is not eating, his platelets went to 100, dont know percentages but his Red Blood count went from 2.8 to 2.7.  I am very worried because I believe the transfusion is wearing off, he started Cytoxan on Wednesday also and today is his last dose for three days (the vet said she would up the cyclosporin slightly to accomodate not having the cytoxan) and I am terrified that the RBC is going to go down again!   Any advice on what to do or not to do?   I am desperate to hear from anyone as I am so worried about my baby!  I am trying to have faith but I am terrified right now.  Also, when he is trying to get up and walk around more but it scares me to death because neurologically he is totally unstable and falls down when trying to walk.  He is getting more steady by the day but I really need some re-assurance here!  I dont care if he is unstable forever as I will do whatever I need to do to help my baby!
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Jo CIMDA

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Re: Desperate for information!
« Reply #1 on: February 03, 2013, 02:08:40 PM »

Hi Tammie

I'm really sorry you and your boy are going through this.  One thing, is he on steroids (prednisolone)  as well as Cytoxan?  Preds' are the main stay of treatment in any of these autoimmune diseases, even if other cytotoxic drugs are used in combination, and steroids (preds') are the only drug that has a rapid onset of action. So if he is only on Cytoxan then I would mention it to your vet or get him referred to a vet specialist. Cyclophosphamide (Cytoxan) is not a commonly used drug but it is sometimes used in combination with preds.

 It is not unusual for the levles to drop off following the initial transfusion and some dogs do have to have one, two or more transfusions.  Transfusions buy time for the treatment to work.  It takes about 5 days for the reticulocytes to migrate from the bone marrow to the circulation and transfusions support the dog during this time, but the medication has to be correct for this to happen.  Please look at the articles about IMHA and IMTP in the files, and  especially the immunosuppressive drug protocol by Michael J Day.  This is an excellent guide for owners and vets and Prof Day has given his permission for his protocol to be circulated. 

 If his platelets drop very low  again there is a drug called Vincristine that you vet can give.  It is usually just a one off injection and it has the capacity to increase platelets very quickly.  At the moment, with a platelet count of 100,  he wouldn't need this. 

If he is on steroids then he needs something to protect his stomach from the excess acid that the steroids produce.

Don't worry about getting him up and walking.  He will feel very weak and it is probably better for him to rest as much as he can during this stage.  The reason why you think he is neurologically unstable is because he does not have enough red blood cells to carry sufficient oxygen to his brain, but this will get better as his red blood cell count (known as, and abbreviated to HCT or PVC) increases.

It is early days but if he were mine I would want him on prednisolone 1-2mg/kg/12 hrs starting at the lowest dose.

Fingers crossed. I know it is stressful but try to be strong for Riley.
Jo

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Tammie

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Re: Desperate for information!
« Reply #2 on: February 04, 2013, 02:26:05 PM »

He is on Prednisone, Doxycycline, Cyclosporin, and finished the last of four days on Cytoxin on Friday.  Yesterday, he actually walked into the room by himself, was very alert, ate 10 oz of Honey Roasted Turkey (its all he seems to like right now).  His RBC went from a 2.29 to 3.02, reticulocytes are 587.7 Platelets are 119.  He had a transfusion on Wednesday so I am thinking that he is producing on his own now.  The BASO is the only normal reading - have no idea what that is but the levels that are really in the high range are starting to drop and the ones in the really low area are starting to raise.  I just hope he doesnt "crash" like he did last Sunday.  It was sooo scary. 

Thank you for the reply.  I really appreciate it.

Tamie
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Tammie

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Re: Desperate for information!
« Reply #3 on: February 05, 2013, 02:10:00 PM »

How exactly do you get the reticulocytes to mature to the RBC?   Any help with that would be great!

He may get to come home today.  Chemo starts again on Wednesday.

Tammie
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Jo CIMDA

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Re: Desperate for information!
« Reply #4 on: February 06, 2013, 09:23:41 AM »

Hi Tammy

The reticulocytes form in the bone marrow and after about 5 days they migrate to the blood circulation as immature red blood cells, and from there they mature until they die off and leave the body approximately 100-120 days later. That's the life of a red blood cell.

Jo
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Tammie

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Re: Desperate for information!
« Reply #5 on: February 15, 2013, 09:03:12 PM »

An update on Riley=

Had a scare Sunday when he would not eat.  Rushed him to the vet.  CBC came back good with the RBC being 4.1 and all the highs coming down and the lows going up toward normal range.  Reduced the prednisone to 20 mg in the morning and 10 at night.  He woke up the next morning and about ate us out of house and home.  Was perky and happy.   We have good days and bad days right now.  You never know how he is going to be from day to day and thats the scary part!.  Checkup yesterday revealed the reticulocytes down but the RBC was at 4.6 (5.6 is normal).  Keeping his meds the same this week.  I messed up last night and gave him his Cyclosporine 2 hours after his meal and he has not been perky today at all.  Called the doc- she said that if i didnt give it to him WITH food it would make him really nauseous. I did it again this morning before talking to the vet.  Hopefully he will perk up after the 12 hours it takes for this drug to calm down..... still have high hopes of recovery!  My normal routine is scary- wake up - see if he is wagging his tail as he is sleeping on the kitchen tile - next check his gums - next see if he will eat....its scary every day but it seems we are getting better. Stability is getting much better.  Just wanted to post an update.  LOVE MY RILEY!
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Penel CIMDA moderator

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Re: Desperate for information!
« Reply #6 on: February 15, 2013, 09:38:02 PM »

Stressful isn't it  :( but you're doing ok - keep going  :)
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Penel
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Tammie

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Re: Desperate for information!
« Reply #7 on: February 21, 2013, 02:47:03 PM »

Totally stressed at this point!  His RBC last Tuesday was 4.64.  Went to Dr. this Tuesday and it is only up to 4.65 but the reticulocytes jumped up again which I thought were going down because of the RBC going up.  He has shown great jump in strength over the last week and a great appetite.  Yesterday was early release day at school and everybody knows that I have a sick baby here.  However, all the kids came to our house, knocking on the doors, practicing their flutes, going in and out etc.  I think it has us set back somewhat.  Riley seems to be down and out today.  He has his ears back and is not wagging his tail so much this morning.  Every day I wake up I pray that I see some little improvment but not seeing any today.  Is it typical to have up and down days?  His gums are pink but still it seems that something is wrong.  Hope today's rest helps him out!

Tammie
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Penel CIMDA moderator

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Re: Desperate for information!
« Reply #8 on: February 21, 2013, 08:40:22 PM »

Unfortunately yes it is quite usual to see up and down days.  Stress really must be kept to a minimum which is really hard in a busy household.  If you're at all worried always call and talk to your vet, or take him back to see the vet.
It's really good his appetite improved and he has seemed stronger though.
What medications is he on now?
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Penel
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Tammie

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Re: Desperate for information!
« Reply #9 on: February 22, 2013, 02:29:51 AM »

His 8 am morning regimen is 20 mg Doxycycline, 20 mg Prednisone, 20 mg Pepcid and 100 mg Atopica cyclosporin.  At 8pm he has 20 mg Doxycycline, 10 mg Prednisone, 20 mg Pepcid and 100 mg Atopica cyclosporin.  He muscles have become very wasted from the prednisone but he is no longer bobbling or stumbling.  He can focus and catch his ball now but we dont throw it for him because we are afraid he may fall and hurt himself.  He is a frisbee dog and is totally obsessed with his frisbee.  It is very hard not to throw it for him but we know its best for right now.  He is like watching a baby taking his first steps again.  His old "totally focused" personality is coming back.  Yesterday I was walking him in the field (just for bathroom purposes) and he was trying to do the crawl that border collies do when they focus on cattle.  He hasnt been well enough to even be focused for some time so it is good to see that!    We hope that some day he will be well enough to ride the waves in the lake on our jet ski like he loves to do.  Do you ever hear of them making it all the way back like they were before?  Our doc seems to think that it will take time but that he should pull out of it.  Just so scary right now, you never know what the day will hold. He is eating around 20 oz of wet food mixed with 24 oz of kibble.  We have changed our 3 border collies over to Orijen grain free, all natural, no preservatives etc food in hopes that it may help restore his immune system.  We also are giving an herbal supplment by the name of Optimum Choices - other AIHA owner swear by it.  It is a blue algae concentrate.  He loves it and laps it up when I mix it with water.  Dont know if it actually helps or not but the testimonials seem to be good.   How do you know if he still has IMT along with the AIHA or not?
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Penel CIMDA moderator

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Re: Desperate for information!
« Reply #10 on: February 22, 2013, 10:34:17 AM »

It sounds like you're doing everything you can.  I know that collies do find it hard to relax too.  Orijen is a brilliant food.  Can you give it to him from a kong or something that will encourage him to lay down, but also use a little mental stimulation? maybe one of the Nina Ottoson puzzles would be good for him?
I don't know about the Algae supplement but will try to read more about it.
When they test his blood they can tell whether his blood has clotting cells in it, as well as how much red blood cells there are.
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Penel
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Jo CIMDA

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Re: Desperate for information!
« Reply #11 on: February 23, 2013, 11:03:20 AM »

I think Rilely is doing well.  Penel has said it all.  the lab will be looking at the platelets and the red blood cells.

Jo
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Tammie

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Re: Desperate for information!
« Reply #12 on: February 25, 2013, 02:24:01 PM »

He has had more zest in the past 3 days than ever.  However, I noticed last night that the ooze out of his eye is back.  Going to the vet again this morning as his immune system is suppressed and I am scared to death of him going down again.  I am taking the other two collies also so she can see if they have something that is transfering between them.  Also,  I have read tons of information lately regarding Evans, IMTP and AIHA or IMHA.  Everything I read says it is rare HOWEVER, upon speaking with my vet, she says she sees probably at least 5 new cases a week.  Also, I received a call from a friend of mine last night - she has been praying for Riley to recover.  She noticed lethargy in her 10 year old Shit Zhu last night and rushed him to a different hospital - diagnosed with IMHA with a RBC of 1.5 and  a HCT of 12%.  Since I have been talking about Riley I have heard tons of reports of this and it seems to be somewhat of an epidemic.  Even the other hospital reported at least 4 new cases last week.  Is there some type of animal Center for Disease Control that you know of? Thank you so much.
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Jo CIMDA

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Re: Desperate for information!
« Reply #13 on: February 25, 2013, 07:37:19 PM »

Hi

Autoimmune disease is rare in the general population but it is not so rare within pedigree breeds that have shown to have a genetic predisposition to autoimmunity.  Check out this link.  It is a joint venture between Liverpool University and Manchester University and they collect DNA from companion animals with certain inherited diseases.  IMTP and AIHA are listed.

http://www.liv.ac.uk/dna_archive_for_companion_animals/disease.htm

I can't remember if Riley is on antibiotics but it is wise to have them on a broad spectrum AB when they are on the high doses of preds.

Triggers for AI diesase should be limited as much as possible too.

I hope he gets on well at the vet.

Jo
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Tammie

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Re: Desperate for information!
« Reply #14 on: February 25, 2013, 07:46:56 PM »

He actually had an awesome checkup today.  The oozing from his eye is totally unrelated to the prior issue of Uveitis before.  Today she said that it was from pollen and allergies (Kentucky is the worst state in the US for exterior allergies due to its topography being shaped like a bowl)  His numbers are up to a 4.9 RBC, platelets are at 384 and HCT is at 39.8.  She is reducing the pred to 10 mg am and 10 mg pm.  Still the same on the Atopica and the doxycyline.  I asked if he is not considered Evans anymore because his platelets are up still but she said he still does have IMT but is "working through it".  I swear my vet is amazing.  I love her for all the hard work she had done with studying the protocols of this disease and her knowledge.  She did a CBC way back when his eye was just oozing and said that everything was in the normal range but low normal range and that is when she started investigating other things, like underlying tumors, titers, etc to rule out underlying causes.  I am so thankful that my baby is getting close to being normal.  I am hoping with the pred reduction that some of his muscles in his hind quarters start to build up again.  They were huge - he is a frisbee dog.  I am hoping he gets back to almost new again soon.  I really dont know what I would do without this forum.  My vet even looks at it for info since I told her about it.  You guys are incredible!  Thank you so much for letting us know that there IS hope!  I am hoping to be a success story!

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