Jazz- Help desperately needed for owner

[kaitythorpe]

Hi, I have a friend who has joined CIMDA, , but is struggling to post. She can log in and read posts, but cannot seem to start a post. So I am posting this here for her, she desperately needs your help . Thanks This is her post, as follows x.                                                                                                            Karen , really appreciate you doing this , here goes .
Jazz was a lively, healthy Working  Cocker who had just turned 7 when she suddenly succumbed to IMHA on 23rd Sept . Her pcv was 31 , dropping to 22, then 21 . She was initially prescribed predn 50mg , atopica and omeprazole . She couldn't tolerate the Atopica after @5days  and has been on mycophenolate  since then . Slowly her pcv steadied and increased to @ 31/2 . It has dropped @ 5 but normally climbs back to lows 30s. She has unfortunately been sick a few times and placed on antibiotics . Almost 2 weeks ago she became poorly and was diagnosed with pancreatitis , prescribed more antibiotics but her pcv stayed at 31 . Since having IMHA her stools became runny and it appeared like constant diarrhoea . Was given Pro-Kolin by vet but it didn't help . She has lost 4-5kg since becoming ill and the bones on her skull/ face very prominent, as is her hip area. I started giving her Dorwest Tree Barks powder which helped firm them but she is now refusing to eat if it's in her food ! She is on a diet of rice and cooked chicken but appears fed up of it at times . Unfortunately , went for her pcv on Mon and it had crashed to 20 from 32 ! I'm so worried and seeking advice . What could cause this sharp plummet and why is her pcv going up and down . After 2/3 wks as she had been okay , her predn was reduced by half tablet but after 2 wks on the reduced dose ,the vet said to return to full dose as her pcv had fallen to 26 but next day was 33! It's heartbreaking to see her like this and feels like a step forward then 20 back ! Any advice much appreciated . Thanks , Jackie .

[Jo CIMDA]

Hi Karen

The one thing that stands out for me is the high dose of pred Jazz is on.  A dose of 50mg should be just right for a dog weighing 25kg. 

I doubt very much that a working Cocker weighs that amount so I am suggesting that the dose of pred is too high.  Also, she has been on a higher dose than necessary for several months, and this is why she has had pancreatitis and also why she likely has depression of the bone marrow causing her PCV to be dropping.

Although the immunosuppressive dose of prednisolone is 1-2mg/kg/12hrs, it is very rare that a higher dose than 1mg/kg/12hrs is necessary.  An extremely high dose for longer than 3-4 weeks, typically cause the problems you describe and can also cause life threatening blood clots. 

I lost my Bonnie to this because the specialist had her on the highest dose of 2mg/kg/12hrs pred. I told the specialist that she was not responding well to the drugs because they were so high and I wanted to lower them.  The specialist told me I must not lower the dose and if I did I would kill her.  I stupidly listened to her and Bonnie developed a fatal blood clot. She was only on this high dose for one week.  I learned the hard way, unfortunately.  This is why CIMDA exists.   

My Bonnie weighed about 24kg.  After she died the specialist said in future they would not put larger dogs on anymore than 1mg/kg/24hrs because they can't cope with the side effects of the drug.  A working cocker shouldn't be considered a large dog but they aren't a miniature either and if Jazz has been on a high dose since September. It is too long.

Please look at this protocol.  It is the best I have come across and it has achieved remarkable success.  It can be used as a guide because all dogs are different and the regime has to be tailored to the individual. Prof Day is among the few top veterinary specialists in the world.

I do hope things improve soon.

Jo


Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day

Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

This example is base 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!

[kaitythorpe]

Jo Thankyou,  I have just had a message saying her PCV has dropped to 17 and she is now critical x

[Catherine]

Could the mycophenolate be causing some of the problems?

Could some other illness be present such as Addison's?

[Jo CIMDA]

Hi

Having read the post again the muscle loss will also be down to too much pred and for too long.

The vet should consult with a vet school.  The Royal Vet College, Glasgow Vet School, Cambridge Vet School or Bristol Vet School are among the best and it is quite normal for a vet in general practice to telephone for advice.  A

Alternatively get a referral to a Specialist or vet school.  Jazz need more expert help than she is getting if she is to survive.  It could be remedied very quickly if they address the source.

Jo

[kaitythorpe]

Update on Jazz.          I know that Jacqueline is extremely grateful for all your advice. Jazz has been taken to a specialist in Edinburgh. The following is what she sent me in a message and asked to be posted here.                       Read Cimda post !!!!! Vet just phoned - she's having a transfusion and so far tolerating it . Heart rate dropping as was too high but breathing still rapid. They have found ulcers , clots in her spleen and somewhere else and internal bleeding ! Said she has extremely critical pancreatitis . Wait for it .... They have reduced her steroids and are monitoring her closely in ICU . She's critical ! They were waiting on the rest of the blood results and giving her a chest X-ray , going to also test for cancer . She's on a drip too , think omeprazole . Said it could have been caused by steroids !!!! Going to phone me @ 10.30 ish , however, if she deteriorates will call before , hope they don't have to !!! Thank you for your kind words , our babies are so special and she really is , such a wee, kind, gentle soul and doesn't deserve this . Our vet said today , this shouldn't be her time as she's too young . I'll keep you posted .

[Jo CIMDA]

Hi

I am so pleased Jazz is at the specialist.  Of course she is in a critical situation, but it if helps, I have known several dogs in her situation and once they stabilise her and lower the steroids, the red blood cells start to increase and they are on the road to recovery.  When steroids are given without a gastroprotectant gastric ulcers are very likely to develop and this is also not uncommon. 

Fingers crossed all will go well from now on and Jazz will turn the corner and not look back!

Jo

[kaitythorpe]

Thanks for all your replies, here is the latest update from Jacqueline.                                            Thanks Karen , once again ! I agree, I think it could have been prevented or at least not got to this stage . Vet just phoned , bloods have gone up following transfusion( forgot to ask to what but I'll ask when she phones later) and seems more stable , has eaten a wee bit but very concerned re pancreatitis and she was very uncomfortable and in pain , so she's on a strong analgesic. Levels are high ,esp  liver and they said bit concerned . I asked re bleed and they are hoping it stops/ lessens but it's a waiting game . I asked if they thought the high dose and prolonged length being on such a high dose was a contributing factor and she said may have ! She was going to be consulting with the emergency medics to discuss a plan going forward .Jazz is still in ICU and remains critical ! Let's pray she makes it and can get bleeding/ pancreatitis addressed. She's been through so much and it's so heartbreaking. Running more tests and awaiting results from further bloods . Michael ( hubby) has spoken to a few people who have dealt with Royal Dick re pets/ horses and they all said it was best place , so that's some comfort . I'll keep you posted and a huge thanks from all of us . If you need to post anything on Cimda or whatever , feel free to do so . I've read the reply from Jo , hope my girl one of the ones who gets through it . xx