Irish Terrier with Evan's Syndrome

[Poseygirl]

My 5y/o IT, Posey, suffers from Evan's Syndrome. She developed it in April 2016 right after she turned 4. She was severely anemic and needed two blood transfusions. After a week in the hospital she pulled through and was on 40mg of pred a day, azithropine, and doxycycline. After a few months of slow recovery she began vomiting bile non-stop. I took her to the emergency vet and she needed surgery to remove her gallbladder. It was gallbladder mucocele, so bile wasn't being processed properly through her body. She did well in surgery and it was almost a blessing because the pred was taking such a toll on her body. The pred was lowered drastically so she could recover from the surgery and she went into remission and back to her usual self for about 8 months. Unfortunately, while she was having a routine blood test this May 2017 we found out her platelets were extremely low again so she had to go back on medication. She was put on 40mg pred a day and mycophenolate. She was doing well and her blood was responding to the medication so we were able to lower it quickly. She got back to 146,000 after just a few weeks, but this past week dropped back down to 106,000. She is currently on 20mg prednisolone/day (switched to prednisolone to save liver stress). Her muscle wasting is pretty severe and happened fast, she also has minimal energy while on these medications. Does anyone have any thoughts on this? I hate the effects the pred has on her, but at the same time know it's saving her. Any advice on how to increase platelets without as much prednisone would be greatly appreciated.

[Jo CIMDA]

Hi and welcome

I'm really sorry Posey has this problem.  For her to go 8 months into remission she must have met another trigger factor to set off the disease process.  Can you think of anything that could have triggered the relapse?  It is a good sign that she responds well to the drugs but of course it is very disappointing that the platelets have dropped again.  I have known platelets to drop and without an increase of meds rise again, so it may not go below 106,000.  I hope the next blood test will show an increase.

There is something that might be worth adding to the drug regimen. Recent studies suggest the addition of Melatonin to immunosuppressive treatment increases platelet count and is safe and effective in the treatment of refractory IMTP with little or no noticeable side effects. I have known Melatonin to be used successfully in the treatment of IMTP, alongside prednisolone and other immunosuppressive drugs,  and as it has no noticeable side effects it is certainly worth adding it to Posey's regimen.  It is also something that you can continue with after the steroids have been withdrawn. See these links:

http://www.dovelewis.org/pdf/events/Immune_Mediated_Thrombocytopenia.pdf

https://www.mspca.org/angell_services/melatonin-for-primary-immune-mediated-thrombocytopenia-itp/


If her platelets drop very low then one shot of a drug called Vincristine has the ability to increase platelet production, but this is only used when the platelets are struggling to regenerate.  See these links:

https://www.vetinfo.com/vincristine-for-dogs.html

http://www.cliniciansbrief.com/sites/default/files/attachments/CoC_Canine%20Primary%20%28Idiopathic%29%20Immune-Mediate%20Thrombocytopenia.pdf

I do hope you see an improvement in the platelets next time.

Jo

[Poseygirl]

The only thing I can think of that may have triggered a relapse is possible a tick bite? We had pulled a couple ticks off her. She has received no vaccinations since her initial diagnosis. She is now on a tick medicine called Bravecto which is supposed to protect them better. I live in PA outside of Philadelphia and we often visit family in the Hudson Valley region of NY, both of which are known for lyme disease and a lot of ticks. So due to this, I don't think we can go a completely non-chemical route to prevent ticks. She also seems to have allergies and every now and again gets these sneezing/coughing type attacks where she would then throw up mucus. We are currently looking into making her food from scratch.

Thank you for the melatonin suggestion. We will add this to her regimen. Is there somewhere online you can order this or is it something you get prescribed from the vet?

And I'm also glad to hear her numbers may pop back up without an increase in the pred. Fingers crossed!

[Jo CIMDA]

Hi

I realise the difficulty you have with ticks, especially in the US. It certainly puts someone who has a dog with a life threatening AI disease in a very tricky situation.  However, I have heard some bad reports about Bravecto, and you can read some of these on the internet, so if you can possibly avoid the use of chemicals then it might just prevent a relapse of Evan's or IMTP/AHIA. 

I attended a seminar at the Royal Veterinary College, given by Prof Brian Catchpole, and I asked him if a dog with an AI disease should ever be vaccinated again, or a spot-on treatment used, and he said "No." He went on to say that the  benefits must outweigh the risks and it most certainly doesn't if your dog has an AI disease.

I do sympathise with your situation.

There is something called diatomaceous Earth that might be worth a try.  DE is a powder is safe to use on pets and in the home but it is lethal to fleas, ticks and other pests.

http://wolfcreekranch1.tripod.com/no_flea.html

https://www.diatomaceousearth.com/natural-tick-control-dogs/

Another tick and flea repellent can be made from essential oils.  It does not kill the pests but it can repel them.

15 drops in total of essential oils such as lavender, eucalyptus, rose geranium, citronella, clary sage, lemon........ (perhaps a mix of three different oils) with 500ml water and then sprayed on to the coat.

My vet once told me if I ever got a problem with fleas or ticks, to buy the spray Frontline and just spray the coat of the dog (not the skin) and he said if a tick or flea jumped onto the coat it would drop down dead.  This always worked for me but it might not work for everyone.

The essential oil combination I used to make into a grooming spray with a little hair conditioner and again, it seemed to work for my dogs.
See the information below.

Jo



http://www.nutriment.co/worming-fleas-and-ticks/

Flea and Tick Product Ingredients: What You Should Know

"In 2000, the Natural Resources Defense Council released a report called Poisons on Pets: Health Hazards from Flea and Tick Products. The report also demonstrated a link between chemicals commonly used in flea and tick products and serious health problems in both people and pets."



Fleas And Ticks


1. Rosemary Flea Dip
Steep two cups of fresh rosemary in boiling water for 30 minutes. Strain the liquid, discard the leaves and add up to a gallon of warm water depending on the size of your dog. Wait until it cools but is still warm and pour over your dog until he's soaked. Allow your dog to dry naturally. Works especially well on hot summer days.

2. Lavender Essential Oil
Wash your dog thoroughly and towel dry. Apply a few drops of lavender essential oil to the base of the tail and another at the neck.

3. Brewer's Yeast
Add a small Brewer's yeast tablets to your dog's food. Much like prescription meds (but much healthier), this is excreted through Fido's skin making him less attractive to fleas. Check with your veterinarian for the proper dosages depending on weight.

4. Apple Cider Vinegar
A spoonful of this stuff added to your dog's water makes their skin more acidic and not-at-all tasty to fleas. If apple cider vinegar is not your dog's cup of tea, you can dilute it 50/50 with water, pour into a spray bottle and use as a repellent.

5. Lemon Spray Repellent
Cut a lemon into quarters, cover with boiling water and let it steep overnight. In the morning, spray all over your dog, especially behind the ears and around the head generally (be careful of his eyes), around the base of the tail, and under your dog's legs.