Thrombocytopenia

[Helen]

My dear Chula, 6 year old White SP, has thrombocytopenia.  We discovered she had it when after being groomed, I looked over at her and to my horror, saw that she was covered in blood!  My first thought, and for several terrified moments, was that the groomer had accidentally cut her badly.  I frantically searched all over her, while she sneezed blood all over me and the carpet and all the way to the far end of the next room.  I finally tracked down the flow of blood to her nose... she was having an uncontrollable nosebleed.  I rushed her to the vet, and he kept her overnight.  He calmed her down, and ran tests, and gave me the bad news that she had autoimmume thrombocytopenia.  She's been on predisone ever since.  15 mgs a day. 

She gained a huge amount of weight, going from her lovely 42 pounds, all the way up to 102 pounds!  She looks like a sheep.  She doesn't know she's fat though, and still tries to squeeze past us going down the stairs! 

We've been terribly worried about her.  Her breathing is so labored.  For the past year, I've watched her... so afraid... expecting her to leave me at any time.  Chula is only 6 years old!

Well, we finally decided that our vet was simply going to keep her on the high pred forever.  We recently found a new vet, and she is going to try to get Chula off these terrible meds.  10 days ago we lowered the prednisone to 10mgs a day.  Her blood test on Wednesday showed that her platelets had fallen, but not too much.  We are going to keep her on this level for 2 more weeks, and then lower it again if she's doing okay.  The vet also said there are better alternatives to the prednisone if we need it, so that's what we'll try if she has too much trouble.

I'm excited at the thought of getting Chu feeling better again.  But it's also very scary.  I've never loved a dog like I love this girl.

fingers crossed!
Helen

[zefi]

Helen, I really hope you find a way to get her of Prednisone. That stuff will kill her while its trying to keep her alive. I hope there are alternatives that will work for you. Good for you for finding another vet!

[Helen]

Thanks Zefi.  I'll keep you posted on how she does!

Helen

[Helen]

I thought I'd give an update on how Chula is doing.

We brought her prednisone down again, to 10 mgs one day, and 5 the next.  Watched her with this for about 3 weeks.  Her platelet levels stayed up.  So 2 weeks ago, we lowered it to 5 mgs each day.  Checking a week later, her levels had actually gone up a little!  She's at 1/3 of the prednisone that she's been on for the past 3 years.  We're still watching her at this level, and next week I bring her in for another blood check.  If it's still good, we'll lower her to 5 mgs every other day.  And if that works out well.. then the step after that will be to take her completely off the prednisone! 

I'm really happy and hopeful that she's going to be able to get completely off this stuff!  I sure like our new vet.  She's very upbeat, and obviously loves dogs.  She always has to kiss and cuddle Chula and Archie when we bring them in.  Our old vet never once treated the dogs like that.  I don't think I can ever remember him TALKING to them.  I wonder why I never realised it before. 

[zefi]

Thats GREAT News Helen!!!!

I know what you mean. Thats one thing I loved about my vet in Melbourne. The vet here is nice but the guy in Melbourne really loved the dogs. I remember the time Scooter had an infected anal gland on Xmas Eve and I had to take him in and leave him a while. I saw the vet walking around in the back room holding Scooter in his arms and cuddling him and talking to him. It really makes a huge difference when they seem to love them as much as we do!

[auntie c]

thanks for the update, we always like to her how the babies are getting on...

Glad to see you are able to reduce the Prednisone, and we always love a vet that takes the time to love our babies too... (even better when you get there mobile and home numbers)....

love and licks to your babies

carlene and harry who
australia

[pwdohio]

Hi Helen,

I am glad to hear that your girl is recovering well.

My Jaimee (girl please) also had ITP (immune-mediated thrombocytopenia).  She has been in remission about two years.  Hers came on after a short course of a sulfa drug, Primor.  It has been found that Primor had caused a recorded 30-some dogs to get ITP and several died.  Please avoid sulfa drugs like the plague.  My vet told me to even stay away from topical sulfa applications.

Jaimee was on prednisone a total of about six months.  She is fine today.  But, I have been told that anything could potentially cause her to come back out of remission, hence I am extremely careful what I give her. 

I do give Interceptor w/o any problems.  I was very worried about doing that.

My understanding is that Jaimee has two cousins who also have/had ITP, so there is some familial association with it.

I am sure that your girl will do well, and again, so glad she is well on her way to recovery.

Barb
Jaimee & Sailor, Comrades in Crime

[Helen]

I'm thinking there is familial association to it too, Barb.  I found out through the grapevine that Chula's relatives have had some thrombocytopenia show up too.

Well, we've had her on only 5 mgs of pred, every other day, for the past 2 weeks.  There is a little concern, because this time her platelet count has gone down.  It's not scary low, but still some concern.  However, our vet says that this low of a dose shouldn't even be helping at all.  So she opted to take her completely off it now.  This is because, over the past few weeks, I'm seeing things that have me quite worried about Chula.

She's just not herself.  She's having a VERY hard time getting up from laying down, or even sitting.  I keep having to help her up, and this isn't easy with a 100 pound dog.   She's laying around sleeping a lot, and often doesn't bother to follow me into the other room, but stays where she is, all alone, even though the whole family is in the other room.  This is completely unlike her.  She has always stayed where I am, and follows me no matter how often I move around.

I really think that she doesn't feel good, and I'm concerned about her hips.  The vet said that often the prednisone masks other problems.  That's why she wanted to take her completely off the pred, so she could give her something for the pain (if that's what it is). 

I'm supposed to take her in on Monday for a better checkup and get some anti-inflammants.  Mu hubby is against it though.  He says that will thin her blood even more.  He got her some natural super-duper miracle vitamin formula, and he wants to try her on this for a week before I bring her in to the vet.  So that's what we're doing. 

I'm VERY worried about my girl, and keep expecting the worst.  Sigh.

[zefi]

Helen, fingers crossed for your darling girl. I really hope you find whats wrong and can get her feeling better again. She's had such a bad time poor baby.... I really wish I could give her a big hug. In fact I wish I had some good suggestions! Please let us know how she's doing.

[Helen]

Thanks Zefi.  I feel so awful for her.  I was rubbing her back legs, and I saw that she was really tensing up as I rubbed her back left leg.  Tonight she has gone off to lay by herself in the bedroom.  As I said, this is utterly unlike her.  She's been doing that a lot.  I have to go look for her and I'll find her off in some quiet corner by herself.  Just before she went back there, I was kissing and petting her, and I saw that her legs were visibly shaking as she was standing there.

Richard just told me that he wants us to go ahead and do the vet appointment tomorrow.  He also knows this is unusual for Chula and he said he doesn't want her to suffer.  So I'll see what the vet says tomorrow.  I hope she can help her feel better.

[zefi]

Thats awful Helen. I hope the vet can help!

[pwdohio]

Helen,

Please INSIST that your vet do an ACTH test on your girl for Addison's disease.  You MUST rule this out.  She might also do another blood panel to look at her electrolyte levels but this is not always diagnostic, but an ACTH test is.  That test can save her life.  The pred would pick her up if she has Addison's, dropping the dose might cause her to backslide, but she likely needs Florinef if she is an Addisonian.  Addisons is also an auto-immune disease and it comes on during times of stress.

I was told with Jaimee that if she did not respond to prednisone (some don't completely) that we would have to add another drug that is used in transplant patients to keep them from rejecting their new organ, also used in chemo patients, and in auto-immune diseases.  My mind is not quite working this morning...I can't think of the name of the drug, starts with a "C".

Blood work will also tell her kidney functions which can be affected if this is Addisons that you are also dealing with.

Is she interested in eating?  Any incontinence?

Barb

[Helen]

She's eating okay, but doesn't have the appetite she used to have.  There was a bit of incontinence last week, but seems better right now.  If anything, she seems to be going less than usual.

However...The vet just called.

Chula's platelet count totally CRASHED.

She told me to put her back on the prednisone, at 20mgs twice a day, IMMEDIATELY!

She's going to call me again tomorrow after she gets the rest of the results back.  Good thinking on the Addison's.  We rescued an Addison's poo some years back. 

That's all for now...  My heart is in my throat.

[pwdohio]

Helen,

Please give us a daily update.  I know how you feel.  Just always closely watching your girl, and with your heart just so worried for your girl.  You so just want to wrap your arms around her and protect her.

I am thinking two things (but, I am NOT a vet, I am simply guessing what might be wrong) ...either she is still just battling ITP and needs more than just the pred to get back on track (which I understand is not unusual), or she might also have gotten Addison's through the stress of the ITP and it was hidden until now by the higher dose pred.

Either way, proper treatment (once you know for sure what you are battling) should set her back on the right track again.

Your girl's ITP was not found until she was bleeding.  I caught Jaimee's ITP when her platelets were still at 50,000, she did not even have any signs of petechiae at that point.  She was lethargic and running a temp, I took her into the doggy ER (it was a Sunday) and they started immediate treatment (dexamethasone shot) .  Even so, her platelet continued to drop to 30,000, but adding prednisone started them rising again.  Initially when she was tapered off the pred, her platelet count dropped a tiny bit I think to about 175,000, but today it is back up to around 250,000 on its own.

It seems there is a big variety in how dogs do with ITP.  I am assuming all her other blood work was fine initially when you started treating for ITP?  Jaimee's blood work was all fine except for the platelets.  The vet commented that was a good thing that if ....something else was out of whack....we would have been dealing with AIHA  (auto-immune hemolytic anemia) rather than just ITP.  I was very glad for Jaimee it was only ITP.  However, there are also some good success stories with AIHA, it is just a tougher battle.  But, since we are dealing with an SP, and with the history of Addison's that this breed seems to have, I wonder how many ITP dogs went on to develop Addison's and maybe that was never identified? 

After Jaimee recovered from ITP, I commented to the vet that it would seem that we were home free from her ever being an Addisonian....she said "it would seem so".  Now, I still have to remind myself that even though it would seem to be so....I don't think we ever really know and I can't say 100% certainity in my heart that it would be the case.  Auto-immune is auto-immune and I know Jaimee is still only considered in remission, but she is doing darned good!

Hopefully, Chula is stabilized and feeling better already this morning from the increased prednisone and will continue on that same course.  It sounds like you have a great vet and she will be on top of what is going on.

Please, again, keep us updated daily.  Take care of yourself....I know you must be worn out -- emotional battles wear you out physically.

Barb

[Helen]

Hi Barb

I don't know why I didn't see this post before.  I check for new messages, but it wasn't there.  Finally just now I was wandering through all the "latest posts" and found you.

Let's see..

Chula is feeling much better on the higher prednizone.  She's not secluding herself anymore like she was.  I watched her getting up a few times, and I can see that it's easier for her.  And tonight she spent a little time being excited and happy with Archie.  More like my girl again.

The vet was supposed to call me yesterday, but finally called today.  She said that it's clear that Chula will have to be on the prednisone for the rest of her life.  I asked her how long we'll have to keep her on such a high dose, and she said it depends.  She wants to test her again in a week.  I think it's awfully high, but she said that 40 mgs of prednisone a day isn't so much for a 100 pound dog. 

I also asked her about Addisons.  She was shocked that I'd even ask.  Acted like I was out of my mind for even thinking about that.  yeesh.  But when she finally got over that, she named off a bunch of stuff that "proved" she doesn't have Addisons, and said there is no way that's a factor.  I don't understand half of it, but she seems sure. 

I don't know how I feel about this vet anymore.  We've spent a fortune over the past few months with all this, and not only is she back where she was, but she's taking more drugs than ever!  She also has me giving her these giant antibiotic pills, which supposedly will clear up the sores on her back.  These are the sores that for the past few years, the vets (the old one and this one) has kept telling me were NOTHING. 

Oh well, the important thing is my girl is feeling better right now.  Thank God.  I hated seeing what was happening.  It's so frightening.