ITP or IMHA or Both?

Shannon -- it's not unusual for auto-immune disease to "morph" and change form.  The body will sometimes switch so it is attacking something different than before -- or it will attack *both*.

Unfortunately -- your vets have probably tried to wean off the pred rapidly -- with little or not thought to "triggers" so there may be certain things that are triggering relapses.  The problem with prednisone is that it merely suppresses the immune system but not necessarily the right parts.  Some dogs they try to leave on pred forever (which is hugely damaging to the body.

Cyclo works different -- it builds to a level in the body rather than the body immediately responding to each dose. 

Please be using milk thistle to protect the body.  It's a BAD storm here and I must get offline -- will return later.

Bella is gorgeous!  My dog Willow had/has ITP.  And, I think unfortunately that Bella has both IMHA and ITP-that is called Evan's syndrome. 

WAHHHHHHH -- I just spent over and hour typing a response to this and lost the whole darned thing.  I will re-type tomorrow.  darn -- stupid me -- I shoulda done it in Word.

paltinas

until last week when I noticed an issue with her left eye, and a few hours later with her right eye.....A trip to the vet revealed bleeding in the eye....

There are sometimes no symptoms at all but this bloodshot eye thing is the biggie they told me to watch for as well as bruising on the belly.  And, they can get these weird spots of discolorations-different than the bruises-on the abdomen area as well.   I saw absolutely no symptoms in Willow.  And, still don't when she gets low.  She acts totally fine. 

paltinas

, for those of you that experience ITP or IMHA, do you see a pattern or a cycle in terms of timing of crashes?

Willow was first diagnosed in July of 2008 too.  And, she had one small dip where we were watching her the following July as well.  This year she was low in November.  I truly think the summer dips have to do with tick disease-we are in New England too.  But, the vet said these dips are "normal" as long as she is trending upward and not going lower. 

paltinas

Now it is January 2011, and her platelets are at 49 (which they have been at since Oct 2010).  No treatment has been in place since we determined this level to be her "norm." 

I totally get that they figured out a "norm" for her they did that with my dog too.  But, without playing vet here-49,000 is LOW-low that you wouldn't really want that to be her "norm".  Because that is a number that internal bleeding can happen at.  Granted its on that line-but still too close I'd think.  With Willow, if she's in the 70,000, they make me recheck her in a week.  If she is around 100,000 they are OK with that even though for most dogs that would be low-but for her it's OK.

I hope that was helpful.  Please feel free to ask me anything you'd like to know.  I've got lots of paperwork here too. 

I know Callie and Johnny will help with the IMHA-thankfully, I didn't deal with that one. 

Welcome to the forum by the way!

Lori

calliecritturs

WAHHHHHHH -- I just spent over and hour typing a response to this and lost the whole darned thing.  I will re-type tomorrow.  darn -- stupid me -- I shoulda done it in Word.

Callie-

Bummer, I hate when that happens....I know my 2nd try on messages is never as good as the 1st....I am in no rush for a response, so take your time.  Bella is doing ok.....Again I am just looking for feedback and suggestions.....

Shannon

I can almost guarantee you that ANYTHING under 100 IS NOT NORMAL!!!  It's just not....at least I have yet to see it!  This tells me your vet isn't the most experienced with ITP.  That's INSANE to say 42 is normal!!!! 

You've likely got some sorta imbalance reoccuring which is causing these crashes!  The only thing I can think of that would warrant timing of six months would be allergies????  I dunno about the whole 6 month thing.

Couple questions....

• Have you ever had a FULL tick panel done?  Rule out everything (Ehrlechia, Lyme, Bartonela, Babesia, & Rocky Mountain Spotted Fever, etc)  Do you treat with Doxy at the biggining and then stop?
• Any meds Bella takes throughout the year other than what's used to treat this?
• Flea/heartworm treatments?
• Ever have a full thyroid panel done?
• Ever checked for addisons or diabetes?  Cushings?

This isn't Evans syndrome cause teh red blood cells aren't affected.  It might be hormonal in relation but I know nothing on this.  You absolute best bet would be to contact Dr. Dodds at Hemopet.  You can do phone consults for I think $45!  Could be the best 45 bucks you spend!  She'll be able to help you pinpoint what's wrong.

Gotta run but I'll check in later....

Johnny & TEssy

Johnny&Tessy

I can almost guarantee you that ANYTHING under 100 IS NOT NORMAL!!!  It's just not....at least I have yet to see it! 

It's not that its "normal".  It's normal for dogs with this problem.  For example, Willow often is in the 75-85,000 range.  And, when she is they just recheck her to make sure she is trending upward and not getting too low.  Its just that I think from what I've seen if she was at 49,000 they would be keeping a very, very close eye because that is not a number that you want to hang at-its too close to the danger area.  But, they definately do consider some numbers under 100,000 OK for SOME dogs. 

The lucky thing is platelets usually respond very nicely to the medications. 

willowchow

Willow often is in the 75-85,000 range

I think I remember you saying this before Lori.  Willow is drug free now isn't she? 

I can see being around 100,000 not being so bad but being 49,000 as a normal would drive me crazy with paranoia!

Thank God, she's been off Prednisone since Dec 2008.  We've had a few close calls where they almost put her back on but it never got that far.  And, agreed, anything under 50,000 is cause for panic.  The slightest bump could cause bleeding internally.  It was not fun trying to keep Willow from knocking herself around when she was first diagnosed-she never pays attention to where she is going!

paltinas

In July 2008 her first "IMHA" episode occurred....PCV levels dropped to 24.  By August 2008, her PCV had returned to normal, 42.  Prednesone was the primary course of treatment during that time.

2nd episode occurred 6 months after the 1st (Jan 2009).  Again her PCV levels dropped to 13.  Another round of prednesone.....and in less then one month her PCV was back to normal, 43. 

3rd episode occurred 6 months after the 2nd (July 2009).  In this episode however, and ever since then, her PCV levels have remained normal/within range, now her platelet levels are the problem, In July 2009 they bottomed to 17 (acceptable range 175-500).   Standard treatment, prednesone......it took a little while for the platelets to increase to normal levels. 

There was an espisode or two in 2010, which I need to pull up details on still...

Now it is January 2011, and her platelets are at 49 (which they have been at since Oct 2010).  No treatment has been in place since we determined this level to be her "norm."  She has been acting her normal happy active self.....until last week when I noticed an issue with her left eye, and a few hours later with her right eye.....A trip to the vet revealed bleeding in the eye....

My initial reaction to this is that EVERY vet who has helped Billy has been adamant that "wean off" take MONTHS AND MONTHS AND MONTHS.  Literally that you have to wean off **SO SLOW** that the body never misses the drug.  However -- this is how you "re-train" the body to not abuse itself.  By dropping the levels of the drugs SO slowly that the body doesn't discern the difference. 

I am astonished that you are charting 6 months between incidents.  And you say "Another round of prednisone" like the dog was off it in days or weeks??  Like what ... as soon as the PCV was up they did a quick wean-off??

I truly have a feeling this is what happened -- your dog's body hasn't re-learned how to "deal" -- and the instant there is another small trigger BLAM -- you're back on the merry-go-round.  Honestly you're lucky -- most of the time when there is a relapse it is SO hard and fast there is typically no getting them back.

IMHA typically is cyclical in nature ANYWAY.  And I don't mean recurring in the same dog every 6 months.  But late Dec/Jan/early Feb and then mid-June/July/early August are BOTH high incidence times for IMHA to occur.  No one really knows why -- I know I have my own theories tho.

?? What? 

1.  Seasons -- in the winter months the blood thickens normally in a response to keep the body warmed and in less need of exercise during the shorter days/winter months.  Then in the summer months the blood thins to keep the body cooler and also in response to the greater exercise and longer days. 

2.  Seasonal toxins -- most cities and municipalities now spray for mosquitos,e tc.  -- surely could be a trigger in nicer weather.  Dogs swim in summer and often lakes are simply  dumping grounds for heavy-metal toxins that wash down thru the fields and yards and dump into the lake.  Dog swims, absorbs toxins and BOOM -- IMHA happens ... again! 

In the winter time we have forced air heat, and things that prod the immune system hard -- like everyting from mold/mildew in a basement to cleaners to salt/sand tracked into the house from outside.  All toxins.

But I'll bet the tale is told in how much time your vet uses to wean-off the pred.  Even the holistic vets I know STRONGLY encourage that when you wean off the pred you do it incredibly slowly and painstakingly because you don't want to just keep inside "norms" but you want to go absolutely as slowly as humanly possible literally so the body doesn't realize it's being hoodwinked.

That is a good point too, Callie.  For Willow with just ITP she took 5 months to wean and then once we were done weaning there were very frequent checks to make sure she was holding steady and then they were slowly spaced out more and more too.  (an expensive ordeal)

paltinas

If we treat with pred for 4 months, she still crashes ~6 months from the last episode, not from when the pred is stopped.

I would have thought also that it was a problem with weaning too quickly but this makes me think otherwise!  Usually when a dog crashes from being weaned too quickly it crashes sooner rather than later!  (unless it's a refractory/nonregenerative case)  I'm thinking that there's something triggering these relapses during these times of the year.  If you can't figure out what the trigger is after doing all the necesary tests then you might have to keep Bella on pred long term.  This sucks but these reoccuring relapses have to be managed somehow.

Perhaps you could consult with a homotoxicologist!  Callie knows lots about them and maybe she might agree it to be a good idea and offer more advise about it.

Can someone give me an idea of the appropriate weaning process for pred?  Duration and dosage?

Pred has always seemed to bring her out of her episodes rather quickly.  My vet has recommended leaving her on it long term, but I HATE the side effects.   Even low doses (<10mg) lead to increased appetitie, thirst, urination, body temp (heat), and personality change.  I have always wanted to get Bella off pred sooner than later, as from a quality of life standpoint, I do not care of it.  However some of the herbal treatments (i.e. Cool the Blood) has helped.

Right now I have Bella on 10mg of pred every OTHER day.  She has only had 4 doses to date.  She is also on 100mg Doxy and  200mg Atopica per day.

What about Atopica?  Right now my vet recommends 30 days of 200mg per day.  Is there a weaning process needed with that?  Are most dogs be kept on that long term but at a lower dose?  What do people typically see as side effects with Atopica?  I was instructed by a Speciality/Emergency vet to place the Atopica in the freezer as it decreases the tummy upset.  I have done that for the 1st week, but I am always catious about storing meds under conditions in which the manufacturing packaging instructions do not support.  What impact does the freezing have on the effectiveness of the drug?  I have a new box that I was going to keep at room temp and try that starting today.

Again, thank you in advance for answering any of the questions above :-)

Shannon (& Bella)

my dog is on Atopica. I think it makes him  feel horrible. Ideally its supposed to be given on an empty stomach. My "Nuckles" would be out for the day if i did that. so i give him the Atopica then feed him a small meal, he is much happier the rest or the day as long as he gets food with it. He is on 300mg 1x day and he is currently 61lbs. He is supposed to be 75lb and Atopica could be one of the things making him loose weight. He is on prednisone too and thats supposed to make him gain weight so either his liver is just that messed up or the Atopica is causing weight loss. Its also very expensive.  Your supposed to take blood often to determine if the right amout of Atopica is in the body. I was told over $350 for this test, but it is necessary. My dog has been on it for @ month now and i think he is getting too much, so the only waty to find out is to do that test. Callie explained to me that unlike the prednisone the Atopica builds up in the body so weaning won't be as touchy as the pred.

hope i was a little bit of help

karla