Aplastic Anemia

baiceyjo7

We are still doctoring at UW Vet school but Josey's vet will be rotating services so we will have someone new.  I am going to take the weekend to really think about what is the best thing to do for her in terms of all of these vets that I have talked to. 

This is one of the challenges of a teaching hospital, but you can always request that a full-time specialist be assigned to Josie as the primary doctor, esp. since this is such a complex and life threatening disease and you want continuity of care. You can also ask if that doctor will consult with your regular vet and Chinese medicine vet (given their good working relationship, I'd tend to go that way.)

Hugs to you and your pups!

Just finished cooking two weeks worth of food for Josey.  It is so healthy and nutritious for her.  I tried giving her a little bit to see if it sparked her interest.  I think she will enjoy it.  We will find out this evening with her first meal.  She has been able to keep her medications down with meals and I have a feeling the antiemetic medication has really helped.  I feel that I have all of her medications, supplements, and food finally in order.  It's taken a bit of work, but I am finally feeling organized and ready to kick the poo out of this PRCA!!  She sleeps a lot throughout the day and looks sad.  I am having a hard time with this at times because I feel like she is miserable.  But then everyone reminds me that it is temporary and her body needs all of the rest.  My mom has been staying with me for the past two weeks and leaves this upcoming week...Wednesday.  She has been such excellent help with Josey and has taken such good care of her (and me) while I work.  I am feeling a bit anxious for when she leaves and Josey will be alone.  I realize I just have to trust my gut and if I feel she needs to go in...just take her.

Thanks for all of the hugs and prayers! 

I'm glad you got to the 'organized' place before your Mom leaves.  I put meds up for Billy weekly -- and there was a time I did THREE weeks at a time simply because if I had to order something I didn't want to get "out" of it??  It's a monumental task.

Billy was like that for 18 months, Jenn -- but he's a HAPPY boy now - I often think he's healtheri now than he was before.  Don't give up --

For some reason we get this mental thing that it's ok for people to have a chronic disease and make their way thru it to be 'better' on the other side after a long illness, but we don't allow dogs the same courtesy!!  It always makes me SO sad when someone decides in the middle of treating an auto-immune disease to put them to sleep because they won't "put them thru that". 

 In to EVERY life rain falls -- and when a dog goes thru something like this it DOES change them a bit.  But **EVERY TIME** I've seen it change them for the better.  You wind up with a dog that is deep -- and deeply bonded to *you*.  But they 'get it' that when you give them meds you're trying to help them ... that when "Dr. ____ says" we do it!

You'd think with dogs who have each been ill that I'd have a housefull of dogs who hate the vet?

 NO WAY -- that couldn't be more untrue.  They LOVE going to the vet because Dr. ___ is gonna help you!

When Billy swallowed that danged quarter a few weeks ago -- the morning I took him in, Dr. B was at his other office, so the vet that was there was the New Smyrna vet (the one that Megan takes Pirate to).  When Billy saw it wasn't Dr. Bailey his face fell a foot.

 BUT - when she put him up on the table and started palpating him -- 'ahhhhhh THAT's better -- she's gonna figure this out SHE WILL HELP ME" --

I really did see that in his face.  And ... he made a new friend that day --

It's really interesting how they decide these things.  Keep fighting!!

Had another vet visit today with a different Internal Med vet at UW...totally loved her.  She has seen and treated PRCA before and I felt way more comfortable.  Unfortunately she will be alternating every couple of weeks with the other vet that was treating Josey.  I feel confident enough to ask for the other vet though if I don't feel something is in the best interest of Josey.  So I will stick it out for now at UW and stay the course.  Her PCV today was 22 and while it didn't go up, it didn't drop either.   So I am going to take that as a "stable" sign and be happy with it for now.

Josey finished her course of five days on the Cerenia and she did very well.  They have now put her on Reglan to help with nausea related to the cyclo.  I read in an article that you can put the cylco gel caps in the freezer and that it helps with the nausea.  I spoke with the UW pharmacist and they told me I could do that.  Just wanted to see if anyone else has ever heard of that and done it.  We are going to keep her on the 25mg twice a day for another week and see how the Reglan works.  Next Monday, if all is well, we will increase her cyclo dose.

I can't seem to get anyone on board with checking Josey's full thyroid panel and consider thyroxine.  I even looked up, printed, and took journal articles to the appointment.  Apparently here in WI, the vets just don't want to entertain the idea.  So, I am just going to have to trust that they know what they are talking about and doing. 

Josey continues to eat well with the homemade food that I made per her TCMV.  She actually gained a little more weight and I am just happy that we are able to get all of her meds in with food.  She has been rather bright eyed and perky this week and it is so much more comforting when they act somewhat like their old self.   

This new vet is also going to give me a dose for cranberry extract to help keep UTIs out of the picture.  I really do appreciate that.  I rather just be proactive. 

The vet also gave me a sense of hope.  The one prior made me feel like Josey's odds were nothing....this vet really made me feel that she could beat this darned disease.  I ultimately know that there are two scenarios, but as long as Josey is in, I am in too! 

I feel that we had a better day today.  I know there will be ups and downs, but having a really good up just feels really good right now.  Here's praying for more!

This is the BEST news I've had all day!

If her PCV **held** at 22 and we know that blood "dies" at variable intervals (I mean you don't know how old any blood cells are in a transfusion -- some will be retics, some will be mature, some will be old) so somehow that would seem to me that if her PCV is "holding" at 22 then there has to be some regeneration or it would have dropped simply because some of those mature red blood cells would have had to die of old age in a week, so somehow the body may be regenerating a little?

Did that make sense?  it's 12:30 and I'm not sure it tumbled out right.

But gosh I'm glad to hear this.  *hugs*

I just received the pet tinic that I ordered from allivet.com.  I was reading through some of the posts on the AIHA/IMHA thread and saw some discussion regarding the Pfizer company.  I could not make heads or tails of the discussion.  The brand pet tinic that I bought is by Pfizer.  Is there anything I should be concerned about before starting Josey on this?

Pet Tinic is a great product to help with hematopoiesis (blood making). 

How's Josey been doing lately?

It's a good brand it's a good product --

Just got back from another PCV check.  Josey's PCV was 22 on Tuesday and it remains at 21 today.  I am happy that it hasn't dropped dramatically.  She has another appointment with her new IM vet at UW on Monday.  We will be doing a complete CBC and retic count.  I have my fingers crossed but understand it may be premature.  It doesn't hurt to pray for a miracle though.

Come to find out, Josey's primary vet and TCM vet (who work together) both have worked with her IM vet at UW.  I feel that I have finally found "my team".  She is also scheduled to have another accupuncture session on Tuesday, but has become very irritable.  So we will see what happens.  The IM vet at UW suggested I discontinue her chinese herbs because of possible drug interactions.  So I phoned her TCMV and she is going to contact the IM vet and discuss this with her.  All three vets have been incredibly helpful and I am just feeling so much better about the situation.  Callie, were you giving Billy the chinese herbs while he was taking cyclo and pred? 

Josey is eating fairly well...still takes a bit of coaxing and she now is starting to hide underneath the kitchen table everytime it is time for feedings.  I don't blame her for being a bit cranky....this is not at all how her life was and she is still adjusting as am I.  The IM vet also started Josey on Reglan to help her keep the meds down....so far so good.  I think her stomach is in a happy place. 

We have been struggling over night though.  She had me up on Tuesday and Wednesday nights at least six times to go potty.  I know she can't help it, but it is definitely a struggle to work the next day.  I know I can't take her water away but it is frustrating that she doesn't go out this much during the day.  I am not sure why the night brings this about. 

We keep taking everything day by day.  She has been such a good little girl about going to the vet and getting poked so frequently.  I know I am tired of going to the vet and yet she gets in the car and walks into the clinic each time.  She's my little angel in so many ways!

You know the one thing that really stresses me is the fact that these vets aren't addressing the inactivity of the bone marrow!  I wouldn't be able to contain myself if Josey were my furbaby!!!  THYROID THYROID THYROID THYROID.....it peeves me just to know they have no interest in even checking it.  Tell them straight up that you WANT to send blood out to either Michigan state or Dr. Dodds.  You can send this directly from the regular vet to make things easier.  How do they feel of Dr. Dodds?  This would be my #1 concern going forward! 

Are you up to the full dosage of cyclosporine again?  AND, did you mention the possibility of pulse dosing it???  Did you stop using the Colostrum?  Are you going to get a Chemistry panel as well Monday?

Reglan is basically the same as cerenia in how it works.  I never used antinausea meds with Tessy until she was diagnosed with lymphoma.  She got use to the meds fairly quickly...and it helped that I made sure she had food in the stomach each time meds were given.....and I gave all the meds apart from each other!

The frequent potty breaks should get better with time!  Are you still giving the pred just once daily?  If it were me I'd split it to give twice daily...every 12 hrs!!!

baiceyjo7

I have my fingers crossed but understand it may be premature.  It doesn't hurt to pray for a miracle though.

and sometimes it isn't one miracle but many and we GOTTA pray for them!!

baiceyjo7

Come to find out, Josey's primary vet and TCM vet (who work together) both have worked with her IM vet at UW.  I feel that I have finally found "my team". 

that's way more than most of us have to work with -- that's great.  and the fact that they'll talk to each other is awesome

baiceyjo7

She is also scheduled to have another accupuncture session on Tuesday, but has become very irritable.  So we will see what happens. 

That can easily be the pred ... we often don't say enough on here about how moody they can become.  And trust me -- they get "sick of being sick" and they get SCARED too. 

Usually the first needle they put in is one on the top of the head that is sort of a "chill out" point.  Will put SOME of us (like me) almost to sleep.  But it tends to really help with stuff like this.

baiceyjo7

The IM vet at UW suggested I discontinue her chinese herbs because of possible drug interactions.  So I phoned her TCMV and she is going to contact the IM vet and discuss this with her.  All three vets have been incredibly helpful and I am just feeling so much better about the situation.  Callie, were you giving Billy the chinese herbs while he was taking cyclo and pred? 

Absolutely -- He was getting (right from the beginning when he was first on cyclo and pred) the gui pi, dong quai, and then later they added the "Calm the Stomach" (that's a Plum Flower teapill and I forget the Chinese name).

Remember -- the Chi Institute actually has folks on staff at the Univ. of Florida so make sure your vets know they are **definitely** available to help them work thru drug interactions.  Dr. Xie has a University email (tell your TCVM vet to contact the Institute directly and Barbara will hook them up).  Dr. Chrisman is retired from UF but at the Institute most days as well (and she's one of the herbology gurus).  And Dr. DiNatale is in Orlando (and she's still Billy's vet but she IS on the staff of the Institute).

But tell them to contact the Institute directly because I know they continue to work with immune-mediated stuff.  Between Drs. Chrisman and Xie they can tell them anything they need to know about how the herbs work with the drugs -- that is exactly WHAT the Institute wants to be able to do.

http://www.tcvm.com (look at Faculty and you'll see all of them)

We have been watching Josey's PCV all week and finally she was transfused last night.  Her PCV dropped to 18 and after the transfusion jumped up to 34.  I could not believe it jumped this high considering the last two times it only went to 24 and 22 respectivley.  Can anyone tell me why this is the case?  I have not had the opportunity to speak with her UWIM vet yet because it occurred over night and I was working unfortunately.  She will be rechecked on Monday.  I am hopeful that this transfusion will carry us a little bit farther.  She was transfused two weeks to the day. 

She has been tolerating her Cyclo 50 mg twice a day and the Reglan really seems to keep her stomach at bay.  Although, I think overall the Cyclo really makes her feel like yuck.  If all is stable on Monday, they are talking about starting to slowly taper her Prednisone down.  It would only be a 5 mg decrease over a month's time, but she has been very moody and not herself.  I don't blame her.  She's has been through so much and continues to be such a good girl despite.  Any decrease in the Pred is a welcomed change. 

We are continuing her chinese herbs and accupuncture.  She had her second session and again did very well.  Its amazing how relaxed she becomes from the accupuncture.  I was wondering if anyone has ever used any of the Cranimals products.  I would like to get some cranberry extract but don't know if I should just get human stuff or an actual dog product.  Any suggestions?

We keep putting one foot in front of the other, day by day.  I have so much support from my family, friends, and the forum.  I am not quite sure how I would be dealing with this without it.  Thank you, thank you, thank you.

Ask them if they gave her the same amount of blood as before?  It may simply be because this transfusion went better and they were able to complete it. 

 The pred makes them moody -- it absolutely sux, but ... *shrugs* it's one of those drugs that can save lives. 

The support from a place like this CAN literally be a salvation -- I know i'd have lost my mind had it not been for this place while Billy was sick.

 So a bit of good news and a bit of bad news today. 

The good:  Josey is regenerating ever so slightly.  She is actually making reticulocytes and her hematocrit is 33.7 (her PCV 34).  This is up from last week, PCV 31.  I am very hopeful that this is a step in the right direction but still feel very, well, guarded I suppose you would say.  So the decision was made to start to taper her prednisone down from 20 mg each day to 15 mg each day.  We will recheck her again next Friday.  If all is stable next week, we will continue the pred at 15 mg for a total of three weeks and then reassess for further tapering. 

The bad:  Her WBC is 28 and her bands are also elevated.  She has some nasty looking skin sores which I am cleaning and treating with triple antibiotic ointment daily.  The decision was made to start her on an antibiotic, Cipro, for the next two weeks.  I am really hoping this will help any infections that may be brewing but worry about adding yet another medication to her regimen as well as effect any progress we have made. 

She is eating exceptionally well and acting more like her sassy terrier self.  I remain hopeful for her and continue to take it day by day.  I did take a deep breath though for the first time in a long time....it felt good!

Cipro is HARD on the gut so give it **with** food.  I'm a bit surprised they didn't start her on a lesser anbiotic like cephalexyn *first*.  They typically don't jump to a strong drug, usually preferring to give themselves somewhere to 'go' if they have to.  Cipro is at the top of strong drugs. 

I would bathe her -- pretty frequently -- in the Selsun Blue -- this was something my *regular* vet told me to use, and man it helped control a TON of skin problems.  Skin problems are just plain a common side effect of these drugs. 

 I also then did a 'final rinse' in about a gallon of water with about 30 drops of tea tree in it -- it helps close the skin down 'clean' and it has marvelous antiseptic, antifungal and antibacterial properties.  Not to leave much on the skin but just rinsing it over and over (put her in a dishpan and just pour it over and over her til it cools.)

Glad she's regenerating.  that is GOOD news.  They must feel the cyclo is supporting the immune-suppression if they are beginning to wean the pred.