Aplastic Anemia

So Josey's primary vet actually started her on Clavamox....it's similar to the human antibiotic Augmentin.  It can be hard on the stomach but so far she is tolerating it with food.  Does anyone know much about this antibiotic?  Should I be concerned that she is just starting to regenerate and now we started an antibiotic plus started to taper the prednisone?  I am feeling very anxious about all of this,  When I look at her gums and tongue today, they are not as pink as they were.  Am I just being crazy?  This is such an emotional mind game!

It's a combo drug of amoxicillin & clavulanate (an inhibitor) that helps prevent resistance I think.  I've never used clavamox on Tessy but I have used amoxicillin on her with success.  Amoxy on it's own is a broad spectrum antibiotic meaning it targets more bacteria than most.  It's of the pennicilin class...I usually consider them among the safer ones to use.  I'd be using a good probiotic with it if you aren't already.

Isn't she taking Cipro???

baiceyjo7

Should I be concerned that she is just starting to regenerate and now we started an antibiotic plus started to taper the prednisone?

I'd be more concerned with a lingering bacterial infection somewhere. 

Just curious why they're reducing the prednisone already.  If you think she's starting to crash then by all means take her to the vet sooner rather than later.

Thanks Johnny for the info.  They initially told me they were going to start Cipro but instead started the Clavamox.  I am just really concerned that we are doing so many things at once.  I completely realize that the infection, whether it be the skin sores or otherwise, needs to be addressed.  Infection is the last thing she needs right now.  I did buy some Calendula/Echinacea/Hypericum cream for the sores.  It is working wonders on the sores.  I highly recommend it for both human and animal use!

 They have been wanting to taper the Prednisone as soon as possible.  She has been on 20 mg a day since February 11th and they told me that as soon as they could slowly decrease it they would.  She is now tataking 15 mg a day and if her counts remain stable on this dose, they will keep her at it for three weeks and reassess at that time.  We recheck on Friday. 

I am not concerned that she is crashing, she is still very alert and active.  This is a huge change that I have noticed since last weekend.  It's been a nice change.  I am just obsessed with checking her gums and tongue and they have been really nice and pink since last week Tuesday.  I just feel they may be a bit more pale, not dangerously, today and that is bothersome to me.  I just want her to keep making red blood cells and the not knowing just makes it that much more difficult. 

Clavamox is a much better drug to start -- usually well tolerated ... pricey but a good drug (it's essentially amoxicyllan with a stomach buffer).

This is TYPICAL, hon -- remember, she's officially "immune-suppressed" so you will need to watch for **alll sorts** of weird infections.  If she acts "off"  **GO TO THE VET** (not yelling -- literally it will become your hue and cry!) -- and at times it seems like they are taking gobs and gobs of "stuff".

At one time, with 3-4 teapills of this and 4 of that and supplements and herbs, as well as cyclo, stomach protectant, whatever lesser dose of pred we were on PLUS d'mannose and some antibiotic most of the time for all the infections Billy ran -- he was literally taking upwards of 50 pills a day.  No joke. 

BUT it kept him balanced.  You *have* to fight the infections because she has *no* immune system to fight them -- so a tiny infection can become massive in a couple of heartbeats.  And then ... more inflammation can then lead to a relapse.

This is why they traditionally go with the "least" drug possible.  I have seen them use cephalexyn (Keflex) on Billy for a urinary tract infection?????     

I mean that's a **skin** infection drug -- NOT a UTI drug??  But yep -- they did it often (sometimes it would take him 3 weeks to completely "kick" an infection with it) but it was a gentler drug and they always wanted to leave the stronger drugs **in case** something got worse or he got 2-3 infections at the same time!  There was a Chinese herb/antibiotic we used a *lot* (Ba Zhang) that they'd have me use (and the regular vets were *thrilled* to have it take some of the brunt of infection fighting).

Are you using pill caddies?? (I *think* we've had this conversation but I am not totallyl sure and I'd rather mention it than not).  Very helpful to organize all the meds.  (In fact, if you need some I can send them to you -- cos Luna and Tink have their own)

It is mind-boggling all the "stuff" they are on -- and at times I wondered if all the supplements and herbs were good -- but they kept him feeling good, and that was the big fat deal. 

*hugs*  You're doing SO good, and so is she!! PINK is the most awesome color, isn't it?

Thanks for the words of encouragement Callie.  It's hard to know if I am doing everything I need to or if there is more.  I am going to talk to my TCMV about that herb you mentioned for infections. 

I wanted to get your opinion on the pred taper.  Josey was really pink last week Wednesday and Thursday.  Now, over the weekend, I can definitely tell she is not as pink as she was then.  She is still acting so much better but I am just really concerned about the taper issue.  It's not an issue that I need to get her to the vet, but I am just noticing a difference.  Her reticulocyte count was not zero but it wasn't off the charts either.  The absolute was 74,000 and the percentage was 1.6.  When the pred is initially tapered, how does this all work?  Is it a not so good sign to see her gums and tongue be less pink than before?  When did they first start tapering Billy's pred?  I know they have wanted to start the taper because Josey was so miserable on the pred, but if she still needs the 20 mg a day, then I want her to have it and keep making red cells.  Can she still be regenerating and have gums that aren't as pink?  I apologize for the million questions.  I am going to call her docs tomorrow to discuss this issue, but of course, I am driving myself nuts just thinking about things in my head. 

Thanks again Callie....you are so helpful. 

baiceyjo7

  Now, over the weekend, I can definitely tell she is not as pink as she was then.  She is still acting so much better but I am just really concerned about the taper issue.  It's not an issue that I need to get her to the vet, but I am just noticing a difference

The gums are NOT a wonderful indicator -- that's why I have, on the IMHA thread, gone to such lengths all the time to talk about how we actually wound up using Billy's tail wag as the "best indicator" of how he was --

I've seen the time that I would check his gums and FREAK OUT because they were less pink -- only to find out that Mr. Fluffy Paws had been resting his chin on his paws and had shut off his own circulation to his mouth!!!  Check it again later and it was fine.

If the light changes? It can look different. 

At times once the body has begun regenerating, the body will take some blood and put it back into the spleen (which is a storehouse for red blood) -- and the PCV can actually fall by several points due to that. 

Don't *not* use the gums but don't let it be your sole gauge.

When we tapered Billy off the pred it was *because* he was having a hard time kidney-wise so they yanked him off pred pretty danged quick (like a month and they took him off it completely!! -- but it was being mostly immune-suppressed at that time by the cyclosporine.  Typically once they figure the cyclo is handling the immune-suppression then they wean off the pred a bit faster.

I've used cephalexin for Tessy quite extensively!  For just about everything...including UTI's.

calliecritturs

The gums are NOT a wonderful indicator

CRT....Capilary Refill Time!  This is another great way to determine blood flow.  Just press on your the gums with a finger and then release the pressure.  This forces the blood out of the capillaries in the gums and turns it paleish whitish.  In a healthy dog the refill time should be around a second and a half (1.5s).  Prolonged refill times means there isn't adequate blood circulation (low blood counts).

SOOOOO, I gotta ask again....have you gotten around to having them check the thyroid yet?

I'm wondering how this dog is doing? would like to see an update.

Josey is doing fairly well.  Her last PCV check was this past Friday and she was at 39, up from 34 the week before.  According to previous lab work when she was spayed, her normal PCV was 45.  She is almost at her norm....thank goodness.  She continues to take Prednisone 15 mg once a day and Cyclosporine 50 mg twice a day.  If she remains stable this Friday, then we will look at tapering the prednisone down to 10 mg once a day.  She is eating well and acting more like herself.  She is definitely feeling much better than she has been.  I continue to be cautiously optimistic and hopeful but realize that at any given time she can relapse. 

I have finally been able to get her out of the house a bit.  I bought her a stroller so she can walk her one block (per the vet) and then ride the rest of the way.  She is definitely enjoying being out....riding in the stroller...well, she would prefer walking!  It's a work in progress but at least she is getting some much needed fresh air  Plus it allows me my daily exercise as well. 

She is still seeing her TCMV and actually has accupuncture again tomorrow.  She continues to take her chinese herbs and I really think it is the combination of eastern and western medicine that has gotten her through all of this thus far not to mention the countless number of folks here on the forum.  Again, we are cautiously optimistic, taking it day by day. 

HI --

There are lots of iron-rich foods -- asplastic anemia can be part of the IMHA/AIHA array of problems (auto-immune -- the body is actually killing it's own red blood, often in the bone marrow before it is even "born" as blood into the bloodstream).

Does your vet have your dog on any immune-suppressor?  please give me a shout via email -- I can likely help you.