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Author Topic: Thrombocytopenia  (Read 12691 times)

Alison68

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Thrombocytopenia
« on: May 12, 2015, 02:44:10 PM »

Hello to everyone on here, my 3 yr old whippet bella has had thrombocytopenia since April last year and been on steroids since and started imuran 9 or 10 weeks ago. She had bad calcium deposits 4 weeks ago and my vet contacted Bristol university for advice and said to drop the steroids quickly and she gone from 3 a day to half a tablet a day.  I'm a little concerned about bella's back paws they're looking rather flat I mentioned it to my vet yesterday and she didn't seem to concerned by it and at first she said that bella does have long toes and I said it doesn't explain why they are flat and then she said steroids can cause muscle wastage. I already know this myself and I did tell one of the young vets about 2 months ago that bella was loosing muscle tone in her back legs but the vet I saw then told me it was due to her loosing a bit of weight because she gained alot of weight and then lost some of it. She tried telling me bella's legs looked thinner and it was nothing to worry about. Elaine baker on a facebook whippet group im on suggested I come here.

« Last Edit: May 12, 2015, 03:24:47 PM by Alison68 »
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Jo CIMDA

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Re: Thrombocytopenia
« Reply #1 on: May 12, 2015, 03:22:41 PM »

Hi & welcome

You are in good company here.  I'm sorry Bella had thrombocytopenia.   Why did she recently start on Imuran? Is she in remission now?

It is not surprising that Bella has flat feet and this is typically seen as a result of prolonged steroids use.  In addition to steroids causing muscle weakness they also allow the  ligaments to stretch, this is probably due to the increased excretion of calcium and  inhibition of vitamin D.

I have had this problem with my dogs who have been on steroids and although there is nothing you can do to return their ligaments to normal, it is something you will get used to and accept that it is a drug trade off for getting Bella back into remission.  Her muscles will strengthen in time but you may have to watch the knuckles on her toes to see that she isn't catching them on the ground as she walks.  Now the steroids have been reduced to a very low dose this shouldn't get any worse. 

Jo





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Alison68

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Re: Thrombocytopenia
« Reply #2 on: May 12, 2015, 03:44:25 PM »

She was doing fine upto December last year and then dropped her steroids to 1 a day and 4 weeks later her platelets were low and upped her steroids to 2 a day for and it didn't help so was put back on 4 a day and it slowly started going back up and one of the young vets suggested putting her on the imuran and run it along side the steroids  so they could reduce them down . At first they only wanted to keep her on the Imuran for 6 weeks her platelet count is in the normal range now and has been for 3 weeks.  The vet is hoping to maybe get her on the imuran every other day when she's finally off steroids
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Jo CIMDA

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Re: Thrombocytopenia
« Reply #3 on: May 12, 2015, 05:28:11 PM »

Introducing Imuran was a good idea and it has allowed you to reduce the steroids.  It can take up to 6-8 weeks to really take effect so leaving her on every day dosing for a bit longer has probably been a good thing.  It seems like your vet has a good plan.

Jo

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Alison68

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Re: Thrombocytopenia
« Reply #4 on: May 12, 2015, 10:34:27 PM »

Thanks jo , Elaine baker speaks highly of you she's been following my posts on fb and said you've helped her a lot with her whippets
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Elaineb1624

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Re: Thrombocytopenia
« Reply #5 on: June 03, 2015, 06:47:06 PM »

Hi Jo and Alison
         So pleased you finally made it on here Alison. Just to let you know Jo, Lois whippet finished her steroids and is doing great. (sRMA  case)
       Sorry to interupt the posts. Just good to see Alison getting some answers. I will go now.
    Elaine.
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Jo CIMDA

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Re: Thrombocytopenia
« Reply #6 on: June 03, 2015, 09:08:39 PM »

Horray for Lois!!!!

Congratulations Elaine.  You made it, without too many grey hairs, I hope.

Jo
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Alison68

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Re: Thrombocytopenia
« Reply #7 on: November 18, 2015, 07:13:05 PM »

Hi jo, things aren't too good with bella her liver enzymes have been high for months and she had to scan on her liver today there could be an acquired liver shunt, hopefully I'll have more information on it tomorrow when the vet speaks to the scan lady. Bella is fine in herself and still happy and rough plays with my terrier.
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Jo CIMDA

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Re: Thrombocytopenia
« Reply #8 on: November 19, 2015, 05:21:43 PM »

Hi Alison

Is Bella still on steroids, and if so what dose -  and if not, how long has she been off steroids?

The Liver will enlarge and the enzymes will rise, sometimes very high, when a dog is on steroids but when the steroids have been withdrawn or the dog is on a low dose the liver size and enzymes should return to normal or to an acceptable level over a period of months (this doesn't happen overnight).  This is a usual pattern when a dog has been on immunosuppressive doses of steroids.

I'm not saying this is the case with Bella, but I have known some vets to overreact to the liver readings and want to do all sorts of investigations when all it needs is time for the body to settle down after all the steroids it has had to process. The liver can take a lot of abuse and it regenerates when allowed to do so.  I hope this is the case with Bella, and as she is good in herself I would be more inclined to think this is just temporary, and an effect of the preds.  Liver enzymes have to be significantly raised before the readings are anything to worry about.  How about giving her Milk Thistle to support her liver or SAMe.  I would avoid biopsies etc., unless it is absolutely necessary.

 Many years ago a lady telephoned me, and she was crying saying that the vet college wanted to do a biopsy of her dog's liver because the enzymes were high.  This dog had been on prolonged, high doses of steroids because she had SLE, and the dose was still being slowly reduced.  I suggested she get back to the clinician and say she couldn't afford to have the procedure done and to wait for their reaction.  The vet said, not to worry and to bring her back in 2 months for a blood test!  Two months later - because her preds were being reduced - her liver values were much lower and totally acceptable.  She lived until she was an old girl.

Bella sounds well - which is great news.


Jo
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DW

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Re: Thrombocytopenia
« Reply #9 on: November 19, 2015, 10:08:06 PM »

Hello Alison

Jo has already covered what I was going to say applied to us but I just thought I would write as well, so that you would realise that
others experience similar to what Bella is going through - though I am not saying that both cases are the same.

Harley's liver enzymes shot up significantly at the start and have continue to be higher than they should be but both my Vet and my referral centre assured me that it was to be expected due to the steroid dose he was on.     We used Sam-e for a while, things did improve but then I decided to give Milk Thistle a go and they have worked as well.    I deliberately 'manage' the fat content of his diet and whilst they do need some fat, I am careful to ensure the fat content is as low as possible.   
As far as flat feet and thin legs/muscle wastage goes, I'm afraid we have lived with this for a few years now, as Harley was 18 months when diagnosed and he is over 5 now.   When he was on high doses of steroids it was shocking to see, I could almost see the muscle tone drop away daily BUT as the steroids were reduced, very very gradually it slightly improved.   I have to say that his head shape hasn't regained it's 'normal' shape but then, we have had to revert to the I.S. dose of steroids three times and I feel that what we have now is the best we can hope for.
As soon as it was safe to do so, when his platelet count dictated, I did start to try and use exercise that would benefit his leg muscle but was really careful not to do things too quick or for too long, as this would have been dangerous.      He seems to have plenty of energy and I am always surprised that despite the muscle, he seems to have inner strength/sustainability.

How are the platelets and have any alternative drugs been suggested?     We are using Melatonin at the moment and it may be worth keeping this in mind and maybe asking about it's suitability for Bella?   I am unaware of any side effects so far but we are trialling it, as for Harley to remain on steroids this length of time isn't good I know.

Gwyneth
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Jo CIMDA

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Re: Thrombocytopenia
« Reply #10 on: November 20, 2015, 08:09:14 PM »

Hi Gwyneth

Thanks for replying to Alison.  Your experience of treating IMTP is invaluable.  I think melatonin is definitely worth starting. 

Jo
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Alison68

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Re: Thrombocytopenia
« Reply #11 on: November 20, 2015, 10:26:01 PM »

Bella is still on one 5mg steroid every third day and has been on that dose for about 2 months.  I had her scan results of the vet yesterday and the lady who did the scan said there's a few aquired shunts and her liver is smaller than it should be, her kidneys are brighter than they should be. She told susie the vet that if we biopsy her it'll have to be ultrasound guided because her liver is small and being deep chested it would harder to find the liver and also suggested  ct scan to do these it'll need to be done in n Bristol university.  Last month the lab said there was reason for concern with her liver . I told the vet yesterday I'm not taking bella to Bristol for any tests because what will we be achieving by
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Alison68

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Re: Thrombocytopenia
« Reply #12 on: November 20, 2015, 10:47:52 PM »

I forgot to mention that she isn't on the imuran she been off that probably 5 months or more . They took her off it because her liver enzymes were getting higher and higher and imuran can cause liver damage.  She's on samylin its a liver supplement and  been on it since we stopped imuran. The vet kept saying that her liver enzymes should be coming down now because she's been on a very low dose of steroids for a while . She also said that there's no treatment for bella's aquured liver shunt because you can't operateon it.  Bella has coagulation trouble this week as well.  She's in season at the moment and hasn't been in season since February 2014 it was before she had the thrombocytopenia.  It's 2 weeks tomorrow since she started her season
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Jo CIMDA

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Re: Thrombocytopenia
« Reply #13 on: November 22, 2015, 11:41:35 AM »

Sometimes, especially when on the face of it they are looking well, it is sometimes best to leave well enough alone.  Watch her closely over the next few weeks  because hormones can be a trigger for AI disease and this is another good reason why nothing should be done about her liver at this time.

Fingers crossed.

Jo
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Alison68

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Re: Thrombocytopenia
« Reply #14 on: November 22, 2015, 09:40:20 PM »

Yes I'll be keeping a close eye on her, only thing she'll be having done is her bloods and they're going to check her calcium levels when she has her next appointment on the 30th. There's a few bits in her spleen and was some somewhere else but can't remember where she said, I expect it's probably calcium deposits because there was some bits floating around inside her in may on a scan she had then.  Her legs healed up nicely from the calcium deposits that she had in may. 
      Thanks jo
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