New Diagnosis of SLE

[Indiana]

Hello Gail
Yes, he is all black and very handsome if I say so myself, being somewhat biased 

I feel it's going well, so am waiting for someone to cut me off at the knees.....

I have just made a vet appointment for a blood test for tomorrow evening and will also get him weighed to see if we are gaining any ground in that department. Then on Friday, we make our first reduction in the preds. Please keep your fingers crossed that all is OK.

[Indiana]

Some good news.....he is putting on weight...phew! He has gone up from 32.7 to just over 34.  He is still incredibly bony, I guess that is muscle wastage? I can feel the scapula in his shoulder in all it's fine detail...if I was a blind man I could draw it with accuracy! Logic tells me that this is not a normal area where weight loss would occur, so it can only be muscle wasting. It's hard to believe how quickly that happens! He is usually a finely muscled athletic dog, only recently retired from competitive agility, simply because we decided at his age, it was a sensible thing to do to give his joints a rest. He could still do it all and still wanted to. He still (did) fun agility with my husband when my husband was training the new starters at our agility classes, just over the lower jumps so he could have some fun. That'soff the menu obviously, but it's sad to see his muscles wasting. I hope they come back as quickly as they went once we get over the worst of this?  Thank goodness he is long coated, I think I would be getting the RSPCA at my door otherwise....  Should get the results of the blood test tonight or tomorrow, so hope they are OK, and first reduction in preds tonight.
He is still bright and chipper and was very well behaved for his blood test...due to the cheese treat I was hypnotising him with LOL.

[Jo CIMDA]

That'a sounds really positive and upbeat.  He will put back the weight and build up the muscle when the drugs are much lower.

Hope the bloods come back good.
Jo

[gschellinger]

He is doing so well! Don't worry too much about the wt. issue. It will sort itself out with time. I might mention that Lola was all bones too, except for her enlarged belly which was caused by the pred also. When she did start to gain weight, it was more in fat than in muscle. I think because I was still not exercising her. Looking back at pictures she looked so different with that fat on her. Before, she was an athlete in her own right, lots of muscle (pit bull) from chasing her ball around and lots of walks.When the exercise returned the fat was burned off and she got her beautiful body back. Of course with a long hair dog you won't notice so much if that happened.
g.

[Indiana]

Blood results are in and I think something to be concerned about. The specialist said to watch the Alt, which was mildly elevated when she did them at 165, and she wanted to know if it elevated further and it has now come in at 247. So the vet will be speaking to her Monday, she mentioned that we may have to change from the Azathioprine if this went up, I am very concerned about that. I have heard that Cyclosporin is not toxic to the liver?  Anyhow, the other results that seems significant are:
Urea 8.1 high
Alk Phos 176.1 High
Gamma GT 13.4 High
On Haemotology
Red cells 5.09 Low, so slightly anaemic
HCT 0.368 Low
Absolute retic count 178.7 high
Morphological assessment : A few polychromatophilic macrocytes seen
My vet said that the retic count meant that bone marrow was being suppressed, but that immature red blood cells were being produced. I know the Az suppresses bone marrow production. But don't really know whether this is something that he can live with for the next few months, or whether this is damaging?  Any thoughts please fronm those with experience on blood results etc ? I know that I couldn't expect great results while he is ill, but not knowing how bad these are until Monday... From a worried Mum .........

[Jo CIMDA]

Hi

It is usually the steroids that cause the ALT to be high.  Aza can have an effect on the liver but so can so many other drugs, even cyclosporin,  but an increase in liver enzymes is expected when a dog is on high doses of steroids.  As the drugs are reduced the liver enzymes also will reduce. I would guess that your vet doesn't have much experience of using Aza and she is worried about the side effects, which is fair.  When treating AI disease the drug that causes most concern, because it affects most body systems, is prednisolone, and this is limited by using Aza (or another combination drug).  I wouldn't be worried about these liver results.

If his bone marrow was being suppressed by the Aza, then the retics would be low or non existent, so don't worry, his bone marrow isn't being suppressed, it is doing exactly what is supposed to do and you can relax about this because the Aza isn't causing bone marrow suppression.  His red blood cells are just under the lower reference range, so I would expect next blood test will show an increase and therefore he will no longer be anaemic. The retic count is high and this reflects the level of anaemia.  I would expect this to reduce in the coming weeks as his HCT increases.

I hope this makes you feel less worried.

Jo

[Indiana]

Hi Jo
Yes, you have set my mind at rest considerably. The specialist did originally say it could be the pred or the Az that caused the high ALT.  I will see what she says tomorrow. Is there a 'number' at which the ALT would be a real concern? As he has just started his first reduction in preds, should the next blood test reflect a drop in the ALT if it is the pred responsible? These tests were taken on the last day of him being on the highest dose of pred for one month.
Thank you again, I do feel happier.

[christina]

Hi indiana
Just read all your posts about indy!
Keep going !
Sounds,like he is coping pretty well.at the moment
Though its such a worry for you
And bet you n OH are exhAusted !
Best wishes to indy
Christina x

[Indiana]

Thank you Christina! Waiting to find out what the Specialist vet says about the blood tests now.

[Indiana]

The specialist was not overly concerned about the elevated ALT either. She said that it's just something to watch, and they don't get concerned until it is maybe even 4X outside the normal range. So we stay as we are and blood test again in 2 weeks. She also said not to expect it to drop in line with the reducing preds, it may drop later but not straight away so not to worry,  just watch and evaluate. Blood testing every 2 weeks.  Thanks to you all for keeping my worries in check.

[Jo CIMDA]

Hi Indy

I wrote quite a detailed post to you yesterday but I can't it didn't arrive on the forum, so it must have got lost somewhere!  So annoying, isn't it?

I'l try to recreate it.

Jo

[Jo CIMDA]

Hi Indy

Simply, the post I wrote yesterday said, when a dog is on immunosuppressive doses of steroids they get drug induced (iatrogenic) Cushing's syndrome (hyperadrenocorticism - HAC).  The higher the dose of steroids and the longer the dog is on them the more Cushingoid they become.  It is hoped before Cushing's becomes a problem the dog is weaned down to a low dose of steroids and the Cushing's symptoms become less and less. 

You will not notice a drop in the liver enzymes until the steroids are much lower.

I get the feeling you vet doesn't have much experience of Aza.  Most drugs are processed through the liver but it is probably the steroids that are causing the most rise in liver enzymes. Aza can inhibit bone marrow production but the retic count is high and this means that the bone marrow is not suppressed, so you don't have to worry about changing medication. Reticulocytes respond to the level of anaemia and I would think that as the HCT is only a tad under the reference range the next blood test done will show that he is no longer anaemic and when this happens I would expect the reticulocytess to come down in number. 

I'm so please the specialist put your mind at rest.

It looks as if it is all going well.

Jo


The symptoms and the blood values are the same whether it is drug induced or naturally occuring, so I will quote from the BSAVA Manual of Canine and Feline Clinical Pathology, Chapter 18, Laboratory diagnosis of adrenal disease:
Blood profiles:
'ALP:  Serum ALP concentrations are increased in over 90% of cases of canine HAC.  The increase is commonly 5-40 times the upper end of the reference range.......'

The reference range varies from one lab to another and one machine analyser  to another  so you can't really compare but a broad  canine figure  for ALP would be <200 (BSAVA Manual of SMall Animal Endocrinology - Reference ranges and test protocols).

[Indiana]

Thank you so much Jo for all the effort you are putting in trying to explain this to me.  Did you mean ALT? rather than ALP (so many acronyms).  It gets confusing when they use different reference ranges doesn't it?  His ALT was 274 and the range they quote was 5.0 - 60.0 The specialist report originally 2 weeks previously was ALT 165 u/l (10-100 u/l)

It is becoming clear that my local vet (who is the new one......), doesn't have any experience of Aza, or much of immune disease I think. He seems like a very nice man, but doesn't express himself much if you know what I mean, or all that clearly either. I think it is just the way he is and maybe I just haven't got the feel of him yet.   I feel fortunate to have linked up with the specialist very quickly, and also with this website which has so much experience and knowledge.  I also like to think that I am on the ball, so feel that with this support, I can keep everything together and sharp. 
Thanks

[Jo CIMDA]

Hi Indy

Why did I think you wrote ALP?  Sorry.

Either way ALT and ALP are both liver enzymes and both will rise when a dog is on steroids.  FYI, from the BSAVA Manual of Canine and Feline Clinical Pathology, Laboratory valuation of hepatic disease, chapter 12:  'Glucocorticoids can also induce ALT activity; doses of prednisolone >4mg/kg can cause a 10 fold rise in ALT but the increase is proportionately less than the induced rise in ALP.  Increased activity may persist for several weeks following a single dose of steroids due to enzyme induction and steroid hepatopathy.'

There is nothing wrong with a vet not having experience of something as long as he admits it and is willing to learn.  The best vets are those who say, "I don't know but I will find out' .  They are worth their weight in gold.  You can learn about AI disease together, just like me and my vet.

Jo
Jo

[shawkyelisabeth]

Sorry Indy for not having been around  for some time...hope you can getbthe high liver enzymes under control with the reduction of meds...keeping all paws crossed for you here and hope to hear good news soon...Elisabeth