Immune Mediated Neutropenia?

[Jo CIMDA]

Hi

I don't know what dose of preds Mabon is having but he should be hungry and if he is not then this is not right.   I presume he was put on immunosuppressive doses of preds that is starting at 1mg/kg/12 hrs.  If he is on less then it is not immunosuppressive.  If he is on more then it might be that he is not coping well with the side effects of the preds and this needs to be looked at.  Check out the immunosuppressive drug protocol in the files by Michael J Day.  This is an excellent guide.  I do hope you see real improvement very soon.

Jo

[gsdsian]

He's only on 2.5mg every 12 hrs. He weighed 5.2 kg when he started them.  So he was on a very low dose. Before starting preds he was insanely hungry but within 12 hrs he was back to a normal for him appetite.  He's always been a really fast eater always interested in food. But if the dose isn't high enough to be immuno suppressive his neutrophils are back up in normal range.

He's been brighter over the last few days although still not eating normally.   I'm not entirely convinced this is just an auto immune problem but will talk to the vet from Langford tomorrow.

[gsdsian]

I've spoken to the vet in Langford and she in turn has talked to the senior that was involved with his case.

Because Mab has perked up significantly in the last few days we're going to keep monitoring him and keep him on the metaclop. and omeprazole.  If he continues to do well the hope will be we can wean him off them.

As to why.  The honest answer is we're not sure.  It could be related to him helping himself to the extra pred, but that was 9 days before he started having problems.  It could be a reaction to the pred (not too likely given the low dose he's on but not impossible) or it could be that he has more than 1 problem going on.

If he loses any more weight or deteriorates in any way then we come up with a new plan and investigate further.

[Jo CIMDA]

You can't do much else but wait and see but at least you have the experts at Langford you can call on.  It is so frustrating when they don't conform to the norm'.  There is something to be said for a text book case.

Good luck and I hope he improves.

Jo

[gsdsian]

Mab had his weekly weigh in and has put on 150g.  Not much but its the first time he hasn't lost weight in ages.

I've spoken to Andrea again today and for this week we're not changing anything, partly because he's only really been eating properly for a few days and partly because I'm hoping to go to Crufts on Wednesday and Mabs is supposed to be staying with my parents.  I don't want to alter anything while I'm away, just in case.

Andrea is still concerned that we may still be looking at something else alongside the neutropenia but if he is ok this time next week we'll try weaning him off the metaclopromide and seeing how he does. 

[Jo CIMDA]

You have got to be doing something right for him to be putting on weight.  This is such good news and I don't blame you for not changing anything.  I do hope he has turned a corner now.

Have a good time at Crufts.

Jo

[gsdsian]

Oh he turned a corner but not necessarily in the right direction.

Monday night he was up all night with diarrhoea.  He settled during the day Tuesday and then started again Tuesday evening but this time passing blood as well.

So his preds are being tapered.
It may be that the problems he's having are now related to the pred.  Or it could be related to whatever was going on at the beginning.  The vet is reluctant to run more tests until we've made sure its not something as straightforward as a reaction to the meds.  We've had bouts of diarrhoea on and off through the week, but less blood.  In himself he's quite happy.

What I wouldn't give for him being straightforward.

[Jo CIMDA]

Hi

It is so disappointing for you.  Has Mabon been on a gastroprotectant whilst he's been on preds?  I wonder if the preds have caused a gastrointestinal bleed? Can't your boss pull a few strings and ask a veterinary colleague or perhaps he has a specialist friend he could ask about Mabon's case?

I do hope  he improves soon.

Jo 

[gsdsian]

He's been on gastro protectants all along. 

Thankfully he's passed no more blood and the diarrhoea does seem to be settling after a few sleepless nights where he needed to go out almost every hour.  He hasn't lost any more weight this week and is brighter.

He still needs the metaclopromide.  I was late with it last night because of an emergency with a friend's dog.  By the time I got home he was showing signs of nausea and was shaking but it settled within 20 mins of the metaclop.

He's had an off lead walk today and although we had to stop a couple of times for him to have a breather he looked so much more like his old self.

I think the plan is to see how he goes over the weekend, repeat bloods next week and see if he can manage without the metaclop.

[Jo CIMDA]

I'm so pleased he is showing some signs of improvement.  Fingers crossed.
Jo

[gsdsian]

Blood test result day. 

Mab's neutrophils have dropped since the last dose.    But they are still within normal range, albeit at the bottom end. 
So steroid dose is staying the same for the time being until his next lot of bloods.

Andrea wants to try stopping his metaclopromide again (we stopped it Monday but after only 12hrs needed another dose).  This time she wants me to see how he is for 48hrs without it and see if the nausea and shaking settles.  If it doesn't or if the vomiting gets unmanageable  then I'm to restart it.

In himself he's pretty bright, wanting to go for walks, eating well etc and his weight is stable.  I am popping him over to the vets this afternoon to get his skin/coat checked.  He's lost a lot of coat (but most of that was wiry top coat that would have stripped out anyway).  But he's also got some bald patches where he's lost undercoat as well.  I'm wondering if its related to the steroids but want to make sure he's not got anything else going on.

[Jo CIMDA]

Hi

It's very good news that Mab is feeling well and bright. It maybe that his neutrophils are finding their own level - let's hope so.

There are many reasons why a dog can develop hair loss but the most likely reason for Mab's hair loss is steroids. Some breeds, often the long coated breeds,  experience more hair loss than others.   Steroids also can also cause coat texture and colour changes. The good news is that when he is on a very low every other day dose of steroids his hair will start to grow back but it may take some months.

Hope he got on well at the vets yesterday.  What is the plan if his sickness doesn't settle down?

Jo

[gsdsian]

Vet did skin scrapes to rule out demodex but thankfully he just has a bacterial skin infection.  Think the steroids caused the coat changes and he then introduced infection by scratching.

Because he's now on antibiotics which could cause nausea we've decided to wait a few days before supping the metaclop.  If the nausea vomiting doesn't settle off the metaclop. I'll re start it and see if there is a new plan.

[Jo CIMDA]

Thank goodness he doesn't have demodex.

Hope the vomiting stops.

Jo

[gsdsian]

Not much has changed over the last week or 2. Mab has put some weight on and is really good in himself.  But he's still dependant on the metaclop.

Andrea in Langford wants him back for more tests but I'm hoping to go away over easter and don't need a poorly Mabon.

I've agreed that if he's still needing the metaclop after easter I'll arrange to take him back in.

I chatted to my boss about him and she wonders if there is some problem with his sympathetic nervous system.  Some things she suggested would fit with the shaking and slow heart rate.  So this week he's having a consult with one off the vets in work with a view to trying acupuncture and possibly chiropractic.  It may help with the nausea and gut motility.  It may not but shouldn't make things worse.