Welcome, Guest. Please login or register.
Did you miss your activation email?

Username: Password:
Pages: [1] 2 3 ... 26

Author Topic: hello from Merlin and his mum  (Read 76658 times)

Whippets Rule

  • Full Member
  • ***
  • Posts: 222
    • View Profile
hello from Merlin and his mum
« on: May 06, 2015, 11:15:58 AM »

Hi

I have a four year old Whippet called Merlin and he has IMTP. He's at the start of his story with this worrying condition and I hope this site will help us feel less worried and confused about it all. I will post more about Merlin later :)

I treated all four of my dogs with Advocate Spot On treatment a few weeks ago and within 48 hrs bruises had appeared all over Merlin's body. He had bleeding gums and when we looked at him swellings began appearing and disappearing and each time they did,a bruise would appear in place of the swelling. I took Merlin to the Vet's and blood was taken and merlin was given Vitamin K in case he had ingested poison( although we knew he hadn't).
 The Vet said that no other treatment would be given until they knew what they were dealing with. That evening more bruises appeared almost before our eyes and thanks to advice from a lovely Vet friend I took Merlin to the emergency Vet. He was given intravenous steroids and a course of antibiotics and within a few hours his gums had stopped bleeding and no more swellings appeared.
To cut a long story short, Merlin has been very close to dying for three weeks and is still not out of the woods. He's had some terrible bleeding inside his eyes and is on 25mg Prednisolone a day.
During the last three days he has had no visible bleeds and he currently doesn't have a single bruise. However, his platelet count has gone from 1 to 13 to zero to 30 then back to 18. I have no idea what this all means and can only take comfort from the lack of current bruises.

Merlin is having a full blood count on Friday to see what is going on. I have looked at the blood results which were emailed to me last week but they show not just platelet problems, they seem to show high basophils at one point and high neutrophils and a few other worrying signs and something called moderate polychromasia which is something to do with new red blood cells I think.

This whole experience has been extremely stressful and whilst we've been calm and as normal as possible for Merlin, it has taken its toll on us a bit. I do not know what the future holds for Merlin and have everything crossed that his platelet count is going to stabilise and continue to increase now.

Five weeks ago I could not have imagined the course that merlin's life has taken and it is very shocking that this all happened very quickly ie in 48 hrs. At one stage we were offered a plasma transfusion but were told that at best it would buy him a few hours so we decided that the stress of putting him through it would be worse for him than any benefit gained. We have kept him as quiet and relaxed as possible and tried to protect him from being bumped and bashed about. Very difficult with three other dogs in the house!I cannot prove that the Advocate treatment caused this to happen but I suspect that it was probably Merlin's trigger.

To anyone else going through this at the moment, you have my deepest sympathy,it's very hard to explain just how worrying it is and in Merlin's case for three weeks I dreaded coming home from work in case I found him dead :-[
« Last Edit: May 06, 2015, 04:42:37 PM by Whippets Rule »
Logged

Catherine

  • Hero Member
  • *****
  • Posts: 508
    • View Profile
Re: hello from Merlin and his mum
« Reply #1 on: May 06, 2015, 04:37:56 PM »

What medication is Merlin on? If he is given the correct medication and dosage then the platelets should start to increase. Here is a good medicine protocol:

"Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is based on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb’s Veterinary Drug Handbook)

Don't forget the gastroprotectant!"


You can read more about IMTP here: http://cimda.co.uk/smf/index.php/topic,12.0.html
Logged

Whippets Rule

  • Full Member
  • ***
  • Posts: 222
    • View Profile
Re: hello from Merlin and his mum
« Reply #2 on: May 06, 2015, 04:51:53 PM »

Thank you.

Merlin is on 12.5mg of Prednisolone every 12 hrs and from tomorrow they have reduced it to 10mg every 12 hrs. Hopefully the blood test on Friday will show a much improved platelet count.
Logged

Catherine

  • Hero Member
  • *****
  • Posts: 508
    • View Profile
Re: hello from Merlin and his mum
« Reply #3 on: May 06, 2015, 05:13:55 PM »

I would err on the side of caution and NOT reduce the medication until you see on Friday whether the platelets are actually increasing. If he is not suffering from the medication then waiting a day or so to see if it should be reduced seems to me prudent. But check with your vet anyway.
Logged

Whippets Rule

  • Full Member
  • ***
  • Posts: 222
    • View Profile
Re: hello from Merlin and his mum
« Reply #4 on: May 07, 2015, 02:54:33 PM »

The vet just rang me and she said she is concerned about the platelet drop and is ringing a medic at Idexx to see if she can find out what may be going wrong etc and to adjust his treatment if necessary. Feeling rather thankful that she is doing so and hopefully we will have a clearer picture later today. Clinical signs are good,he looks fabulous and looks and behaves like my normal sparkly little boy. :D
Logged

Catherine

  • Hero Member
  • *****
  • Posts: 508
    • View Profile
Re: hello from Merlin and his mum
« Reply #5 on: May 07, 2015, 03:54:22 PM »

Oh I did not realize you added more information to your original post - have only just seen it!

Do you know what Merlin's HCT (PCV) level was? If it is low he could have AIHA as well. This is called Evan's Syndrome. See here: http://cimda.co.uk/smf/index.php/topic,13.0.html

Do not forget you could add something like Azathioprine. Also Vincristine can help the platelets rise.
Logged

Whippets Rule

  • Full Member
  • ***
  • Posts: 222
    • View Profile
Re: hello from Merlin and his mum
« Reply #6 on: May 07, 2015, 04:17:46 PM »

Hi
sorry i was at work when I originally posted and I updated my first post when i got home.

Haematocrit has stayed between 0.459 and 0.510 when his platelet count was 1 and 13 and zero and 30 but i don't have the lab report for his latest test but this was just a platelet count so I guess it won't tell me anything else.


When his platelets were 30 (ten days ago), his monocytes were high,WBC high,MCH and MCV high and reticulocytes were high. But I have no idea what any of this means. Waiting for the Vet to call is absolute torture.
Logged

Jo CIMDA

  • Administrator
  • Hero Member
  • *****
  • Posts: 2885
    • View Profile
Re: hello from Merlin and his mum
« Reply #7 on: May 08, 2015, 09:55:59 AM »

Hi and welcome

I hope you get better news from today's blood test.

High white blood cells are seen in immune mediated disease, inflammation and infection but they can also be raised as a result of steroid use, especially high monocytes.  So I wouldn't worry about that.

 MCH and MCV and raised reticulocytes all reflect level of anaemia.  His haematocrit (HCT) result is within normal limits which is unusual when the reticulocytes are high because the level of reticulocytes reflect the level of anaemia - and if you believe the result he doesn't appear to be anaemic!  I can only imagine that the bleeds have lowered his HCT but his bone marrow is responding and therefore keeping the HCT within normal levels.  The other possibility is he may be dehydrated and this can give a false, higher reading of HCT.

I'm sure you will find out more today.  Good luck.

Jo
Logged

Whippets Rule

  • Full Member
  • ***
  • Posts: 222
    • View Profile
Re: hello from Merlin and his mum
« Reply #8 on: May 08, 2015, 10:55:40 AM »

Thank you. Strange that you mention dehydration because ten days ago,around the time of that blood test I noticed he wasn't drinking water as normal. He's never drunk a lot but I realised he was drinking nothing so I added water to his dinner to help him. So you're probably right about it being down to dehydration.
Logged

DW

  • Full Member
  • ***
  • Posts: 249
    • View Profile
Re: hello from Merlin and his mum
« Reply #9 on: May 08, 2015, 12:46:44 PM »

Hello Merlin's Mum
I have only just updated myself with the new messages and have read your messages and the first thing I must say to you is to try and remain positive.  These are easy words when your dog is so poorly but believe me you are not alone.   I too have a dog that has IMTP and at the start, I thought I was unique (or at least dealing with something that was rare and hopeless).  Many of the side effects you are experiencing, I have had the same with Harley...it is often part of the course unfortunately and I have to say uncertainty is the worse part..i.e. not knowing what is causing it, what has caused it, what effect this is having on our dogs etc....

When Harley was first diagnosed, we too had abnormal RBC and WBC counts but fortunately this was rectified after a short while.   We have had the odd occasion when his WBC's were elevated but antibiotics resolved this.  They are much more prone to infections when they are on Immune-suppressant drugs, as you would expect.
I wouldn't know if your flea treatment was connected to the onset of Merlin's problems, as I don't use these type of treatments but I wonder, did you use the treatment because you had seen a tick on Merlin?   The reason I ask is that just a few weeks before Harley's diagnosis, he had a horrible Tick-bite localised infection and whilst the tests came back from IDEXX as being negative for 'known' Tick-born disease, I add the 'known' as I still remain unconvinced that there wasn't a connection between the two.
We didn't see the more common 'bruising' on his body but we did have tiny Hemorrhages in his ear flap and bleeding gums - however, he had been chewing on a Nylabone and sore gums wasn't uncommon......I had no idea at all he was so poorly.   Looking back though, I remember that he was such a poor eater and was underweight for his age.   I now realise that this can be one of the symptoms.

At the start, Harley's platelets were terribly erratic.   They started at 30 but we waited for the blood results at the vets and came home with an immediate Immune-suppressive dose
of Preds.  Harley weighed around 30kg and we were on 30mg twice daily (60mg a day).    Unfortunately, going back, I now realise that we lowered the dose too prematurely probably.

We are currently on our third attempt, we have three times returned to Immune-Suppressant doses of Steroids.   Supplementary drugs haven't always helped i.e.Atopica for a while...this resulted in an all-time low in Harley's blood count (20) but in fairness, I have heard of many that have had really good results from this.   Azathioprine worked much better and we are still on 50mg EOD whilst lowering the steroids very very gradually.  No two dogs are the same and each may respond differently to any one drug.   Steroids seem to be the one thing that he is responsive with at the moment and I personally think we may have to face remaining on them for life - though hopefully, we will fine-tune to try and keep them as low as we can.
One thing, in our case, I am insisting on at the moment and that is to resist lowering the Preds at all until we have a very positive increase in his platelets and even so, I insist that we stay on the last dose of Preds for at least one month before lowering them.   Time and time again, we have experienced an increase in his platelets but were soon to realise that it was a temporary bleep and they soon dropped.   I feel more comfortable doing things this way - even though my Vet thinks we could afford to drop a little more than my .5mg at a time.
Also, we are trialing another drug that hasn't commonly been used for IMTP.....too early to know if they are effective so won't comment on this.

I do hope you get a positive result soon, on what is really causing the problem and confirmation if it is IMTP or IMHA (or both).

I will try and keep an eye on the messages, as if I can reassure you on purely things like side-effects that you may see.....knowing that someone else has experienced the same can only comfort I'm sure.  You may well see insatiable appetite and thirst and as you would expect, visits to the loo are numerous (matchsticks keeping our eyes open from disturbed nights' sleep...small price to pay though), muscle wastage was a big problem in our case....risks of infection,  skin sores and loss of coat sometimes.   Hopefully, you may not get any of these or maybe just one or two but most are reversible as soon as the meds can be safely lowered.   The big rule is....don't rush it.   Let the drugs take time, providing of course that Merlin is o.k.on them obviously.

I do hope all goes well for Merlin.
Logged

Whippets Rule

  • Full Member
  • ***
  • Posts: 222
    • View Profile
Re: hello from Merlin and his mum
« Reply #10 on: May 08, 2015, 05:00:14 PM »

Thank you for your kind reply.

Just back from the Vets and according to Idexx the fluctuating platelet count is not ideal. Our vet wanted to start him on Cyclosporine today but I have asked her to wait until we see the platelet count tomorrow. If his count is still low then we will start him on cyclosporine but I want to wait because I don't want to stuff him full of drugs IF this fluctuation was a blip. Again today there is no bleeding or swelling after blood was taken. Although he didn't bleed or swell last time blood was taken, he still had small capillary bleeds in his ears and on his legs. For five days he has been bleed free with no visible bruising at all.
He is still on the 12.5mg Pred every 12 hours and we are not dropping his dose for the moment until we know what his platelets are.

The Vet said whilst they think he has Primary IMTP they would need to do ultrasounds etc to see if he had a tumour if his count is still low but he obviously can't have anything done unless his count is brought much higher. Our options are wait until tomorrow and if the count is much higher we stay on Pred  dose another week and then begin to drop. If the count is still low we add cyclosporine and if that works, then we know for sure it is Primary IMTP. If not, the thought of tumours etc doesn't bear thinking about.
We are worried that he has lost some weight.In four weeks he has dropped from 12 Kg to 11.25kg. I am giving him some extra food to see if he builds up a bit but he is a spindly whippet anyway but the weight loss is a concern.

Sadly we have been here before with Immune problems and I had a Whippet pup called Felix who had a severe anal stricture from birth and  inflammatory bowel problems and developed perianal fistula's and he was on Cyclosporine but he was put to sleep at seven months ( when Merlin was a year old) as the prognosis from the RVC was very poor. I also had  Beagle with epilepsy and liver disease who was put to sleep aged 6 years.The stress of the uncertainty is awful and I can't believe we're having to go through these worries yet again with another sweet little dog.

This was Merlin when his platelet count was zero.......you can see the bruises









This is him on his fourth Birthday last Saturday.....

Logged

DW

  • Full Member
  • ***
  • Posts: 249
    • View Profile
Re: hello from Merlin and his mum
« Reply #11 on: May 08, 2015, 05:24:04 PM »

Oh I feel so for poor Merlin - he looks such a sweetie.


Hopefully it is primary - in most cases it is but if you have to have an ultrasound, I wouldn't think there would be a problem whatever hois platelets were.  I know thatit can be stress related but we are under Cambridge with Harley (jointly with my own Vet) and the first day we went to see them, his platelets though not very low, were around 100.
One thing they may say is that he has an enlarged liver but I was assured that this was to be expected and caused by the drugs.

I hope that you find the platelets much improved at the next blood test.      Presume you are giving Merlin something for his tummy (Gastro).   

Do Whippets tend to have a lower platelet count than some breeds?   I know that it does depend on the breed.
I wonder if the 'weight loss'  is through muscle wastage?   If you think how much muscle weighs and the degree the dog could lose whilst on Preds.   Just a thought!

Logged

polly

  • Full Member
  • ***
  • Posts: 167
    • View Profile
Re: hello from Merlin and his mum
« Reply #12 on: May 08, 2015, 11:42:20 PM »

So sad to read about Merlin's illness.

Such beautiful photos -  his face is similar to that of  my 11 year old whippet Jasper. Jasper  was diagnosed with IMHA 15 months ago  but he is now stabilised on a small dose of  pred every second day. 

Keep positive, read everything relevant on this web-site, and do not be afraid to tactfully inform your vets about  information you read on this web-site which they seem  not to have taken into account.
 For example I have not had Jasper vaccinated since he became ill after reading here that it might  trigger a relapse and I bought an over-the counter gut protectant (Zantac) when my vet did not prescribe one.

It is important to mitigate  the  side effects of medication.  While on high doses  of medication Jasper needed to drink more than normal so I left multiple bowls of water  around the house so he could stagger to them when very feeble due to muscle wastage ( another  side effect of the medication).  I fed Jasper boiled chicken with rice  which helped him gain weight and  muscle mass.   The side effects of medication made it seem that Jasper was getting worse instead of better  but I learned from here  that it is unwise to  rush into reducing the medication too early.

Co-incidentally, two days ago I noticed a small  bruise/inflammation  on Jasper's eyelid  similar to those on your photos of Merlin and would have taken him to the vet yesterday if it had seemed worse.  It is better today but after  reading that IMTP and IMHA can occur together I will monitor it closely and get a full blood test done if I notice the any other bruises/inflammation patches.



Logged

polly

  • Full Member
  • ***
  • Posts: 167
    • View Profile
Re: hello from Merlin and his mum
« Reply #13 on: May 09, 2015, 03:25:58 AM »

I should have written such a beautiful dog - not  beautiful photos. Some of your photos are very graphic  and not at all beautiful  - but it is very  useful to know what the symptoms of this disease look like.   Especially as  I recently noticed  a small similar bruise on Jasper. On breeds with thick fur would not be possible to see these symptoms so hopefully you have caught the disease in its early stages. 
Logged

Whippets Rule

  • Full Member
  • ***
  • Posts: 222
    • View Profile
Re: hello from Merlin and his mum
« Reply #14 on: May 09, 2015, 07:24:28 AM »

Thank you. Sorry I often forget that my pictures might be too graphic. I'm rather practical and not at all squeamish.I worked at my Vet surgery for 3 years and witnessed all manner of things and it has helped me to deal with all manner of things which might put a petson off. I thought if I posted them they would help people to recognise the condition. Under his coloured fur he had dozens more.
He has a small bruise where blood was taken last night so my hopes of a higher platelet count seem futile. I suspect he'll go on cyclosporine tomorrow. Does anyone know if they can be weaned off cyclosporine like they can steroids or will it be for life?
« Last Edit: May 09, 2015, 07:27:00 AM by Whippets Rule »
Logged
Pages: [1] 2 3 ... 26