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Help! 5 yr old golden with ITP

Posted : 9/4/2011 2:15:10 PM

Hello, My very beloved 5 yr old golden, Emmet, went through 2 transfusions at the beginning of August and was diagnosed with ITP. He was sent home after 6 days in hospital with an optimistic prognosis and on 300 mg of cyclosporine and 80 mg of pred a day, plus an antibiotic and tagmet/pepcid. He has been home with me for about 3 weeks and the highest his red blood cell count reached was 38 with a platelet count of 245,000. At that point my vet decided to try lowering his pred to 40 mg a day and 200 mg of cyclo a day. After a week, Emmet's red blood count had dropped to 34 and his platelets to 125,000. The vet then pushed his pred back up but kept the cyclo the same. A week later (this past Thursday), Emmet's red blood count was back up to 37 but his platelets had continued dropping to 104,000. The vet said to keep everything the same until this coming Thursday, at which point, if his platelets were still dropping, he would start switching Emmet from the cyclo to azathioprine. In the last 48 hours Emmet has rejected his dog food and many other alternate foods (cottage cheese, sweet potatoes, carrots, canned pumpkin) I've tried to give him. He is however eating as many milkbones as I'll give him and is scarfing down boiled chicken and scrambled eggs. That being said he is much more lethargic and his legs are much weaker. There's also one very small red bruise on his belly. I was able to connect with the vet via the phone today despite the holiday weekend and he said "this is very serious" and told me to bump Emmet's cyclo back to the original amount and called in an emergency prescription for azathioprine for 75 mg a day, starting immediately. I'm beside myself as he previously had a very good prognosis and he has always been a voracious eater. A week ago he was also put on phenylpropinalamine (sp?) because the pred had him peeing so much that his urethra weakened and he lost control of his urination -- that cleared up within a little over 24 hours though. Any advice would be much appreciated. Jeannie

calliecritturs

Posted : 9/4/2011 3:05:32 PM

gosh, I'm so sorry you and your golden are having to go thru this. These immune-mediated diseases are VERY difficult. Particularly when the body is attacking both the red cells and platelets.

I would tell you to have the vet do a FULL "super chem" panel -- you must keep an eye on the blood during all of this but ALL the blood values, not just the platelets and red blood cells. All of these drugs are extremely hard on the liver, in particular and if the liver values get really high it can put them off their food.

Given that he's also had urinary problems a urinalysis is also very very important because what can look like a loss of urinary control may actually be a urinary tract infection in disguise.

I'll be honest -- I'd think it far less likely that there was structurally anything wrong with the urethra but rather that loss of muscle tone/coordination is ALSO yet another side effect of the prednisone.

It's not uncommon for the dogs to have to be on BOTH azathiaprene and cyclosporine and often that's better than the ultra high doses of predsinone (because of the muscle side effects to that).

It isn't just that he's drinking so much that he lost control. It's literally that prednisone messes with muscle control in general -- it can cause muscle weakness OR muscle spasm.

I would also tell you to get this dog on as much milk thistle as you can get in him -- milk thistle helps protect the liver AND it also helps as a detox for the liver. It is actually a critical addition to helping the body cope with the drugs and it helps support the liver so the liver actually processes the drugs better.

The other thing is when you have that bloodwork done -- ask for them ***SPECIFICALLY*** to check iron levels. If you aren't supplementing with iron (or even a general vitamin tonic like Pet Tinic) then one reason for lowering red blood cells can be that the body doesn't have enough iron available (it can be 'hiding' in the body so you don't usually give an actual iron pill) to manufacture blood properly.

You might try him on just plain kibble if he's decided it's more acceptable. Just keep him eating -- or you may want to try home cooking for him (about 50% meat and 50% veggie -- but go more broad with the veggies -- everything from turnip greens to squash -- don't serve these things 'separately' - but mash them to break down the cellulose and mash it all together with cooked shredded or ground meat).

you may want to stop at the AIHA or IMHA thread here -- it's several hundred pages long but you will get good support there. At least two of our members have dogs who have had ITP as well as many fighting IMHA.

this is the last page of the thread Click this

When it is both red blood cells (IMHA) and platelets (ITP) that the body is killing it is MUCH harder. It tends to be called "Evan's Syndrom" then. I'm glad your vet has added the azathiaprene.

Are you anywhere near a vet school? That can sometimes be an excellent place to get further wisdom and often it's not nearly as expensive as you might think.

Are you in the US or where?

Feel free to email me if you need extra help/support. I've had quite a lot of experience with this stuff.

willowchow

Posted : 9/4/2011 7:30:57 PM

Is he going to see the vet on Tuesday? If he were mine(and this is just my thoughts on this) I'd be getting him another bloodtest to see where his counts actually are ASAP.

Also, until you know where the platelets are for sure be very careful he doesn't bang into anything. When Willow was just diagnosed I cringed every time she ran out the screen door. She has a habit of trying to "beat" it closing.

jeanniemk

Posted : 9/4/2011 7:56:26 PM

He is going in first thing on Tuesday and they will do a whole CBC. He started phenylprolamine (sp?) a week ago and I've read that one of the side effects is anorexia, so I'm not going to give it to him tomorrow (it was for bladder control). I got him to eat more chicken and milkbones a few hours ago (around 5:30) but now he won't take the milkbones or the chicken. I'm hoping by the morning he'll be hungry again... I'm worried about over medication as well. He's very weak, but his gums are still a healthy pink...Still, I'm afraid this may be it. He's very lethargic and not himself. The hospital vet and my local vet both advised that if he started failing again after being on the meds, I shouldn't take any more extreme measures because it likely won't help, which is why I'm not taking him to the emergency hospital again. I used up almost all of my savings on his hospitalization and transfusions. My vet has called me three times to check in today, but without seeing him and being able to test his numbers right now, he doesn't sound very optimistic. My poor boy was doing so well until they started trying to wean his meds... As of tonight he's back up to the original dose of all his meds plus the additional azathioprine. I knew there was a risk of relapse, but is it very common for them to not be able to bounce back from the relapse once the meds are raised again? One of my old friends who is a vet says she is very concerned about the high dosage of prednisone that he is on, saying it's not normal even for ITP dogs (he's on 40mg twice a day).

jeanniemk

Posted : 9/4/2011 8:02:07 PM

I take part of that back. He just got up to get some water and I took him out to pee. When we came back in, he went to the box of milkbones expecting a treat (I often give him one after he goes out to the bathroom), and he ate it. So I guess that's good! They warned me that dogs with this condition are more likely to throw clots -- what would that look like?

willowchow

Posted : 9/4/2011 8:02:24 PM

Willow was also on 40mg of Pred 2xs a day. The thing is(and I am NOT experienced with the other drugs Willow only took Prednisone) they need to wean them SLOWLY. Very slowly-like Willows reductions were 5mgs at a time.

willowchow

Posted : 9/4/2011 8:04:09 PM

Thats great news!!! YAY for treats!! Don't forget, the meds take time to kick in too so things may get even better!!

I think by clots they mean blood clots and that would be internal-like stroke symptoms I believe. But, if his platelets are low its not that likely I'd imagine.

Find me on Facebook if you are on there and we can chat-Lori-Ann DelSignore LaBelle.

jeanniemk

Posted : 9/4/2011 8:09:21 PM

When they lowered his pred, they dropped him from 40 mg twice a day to 20mg twice a day...a week later they hiked it back up but left his cyclo at the lowered dose. The reason I asked about clots is that while he's been panting from the pred, he seems to be having labored breathing, not panting tonight.

jeanniemk

Posted : 9/4/2011 8:10:56 PM

just sent you a friend request - thanks

calliecritturs

Posted : 9/4/2011 9:35:17 PM

It's unfortunate they started to wean his meds like that -- that is *most* unusual. I'm glad Lori posted -- Willow is an ITP survivor (and she watches willow super closely).

The cyclo and the azathiaprene do NOT react fast in the body -- it takes days for the body to build up to the "level" needed for it to be immunosuppressive. So it's not going to respond really fast despite the addition of the extra drug.

Johnny&Tessy

Posted : 9/5/2011 7:41:24 AM

(((HUGS)))

I might have missed it but you said it was only ITP right? Not red blood cell destruction? It's probably the low platelets causing the dips in hematocrit.

To me the drug dosages sounds about right. You might want to drop the pred back to 1mg/pound but other than that i'd keep things the same. Depending on the weight the cyclo could likely be a tad bit higher. I'm not a big fan of using azathioprine to treat ITP cause of the way it works but I guess that's up to the attending vet/specialist to decide. Too much suppression at the bone marrow level.

Two IMPORTNANT things for you to do. First, make sure they've checked for tick diseases. I'm not sure where you're from but tick diseases are one of the leading triggers for ITP. Second, get some sucralfate and start giving it to him at night before bed. Low platelets, high dosages of meds, and the risk of ulcers can be a very dangerous mix. Head off the development of any ulcers before they become a problem. For a golden you could probably use a gram at night.

Keep us posted on how he's doing please.

Johnny&Tessy

Posted : 9/5/2011 7:45:01 AM

jeanniemk
They warned me that dogs with this condition are more likely to throw clots

Not True. Quite the opposite actually. They can bleed out due to the inability to make clots....due to low platelets. Perhaps once they get higher in numbers there might be clotting irregularities but it's unlikely. Have them take blood from the jugular next visit. This usually yeilds higher platelet counts.

jeanniemk

Posted : 9/5/2011 9:44:59 AM

Thanks -- I'm in Ohio. Emmet originally weighed 78, when the attack happened he dropped to 68, and last Thursday he was at about 72. He's on 200 - 300 mg of tagament with each meal -- is that the same as sulfacrate? Last night he started labored breathing and sounds congested. The labored breathing comes and goes. This morning I also saw a tiny bit of bright red blood in his stool. He ate another chicken breast this morning and a fist full of milkbones. I just think his stomach doesn't feel well or something. His belly is gurgling (it did that a lot at night when he first came home) and he's having gas which is not usual from him -- though it is typical when he eats meat and that's pretty much all he's eaten for the last 24 hours. My vet will see him tomorrow morning at 8:30, but when I talked to him this morning, he seemed very discouraged. If Emmet's in pain, I really don't want to put him through another transfusion. I'm just waiting to see what the numbers say tomorrow. I'm really hoping that his numbers are going to be okay and that this is just a reaction to the phenylprolamine, which I stopped giving him.

Johnny&Tessy

Posted : 9/5/2011 10:04:28 AM

jeanniemk
He's on 200 - 300 mg of tagament with each meal

Tagamet should be alright....it's an H2 blocker like pepcid. Most dogs i hear of use pepcid but this should be OK. The other option is prilosec which is a proton pump inhibitor...supposedly works better. BUT....just stick with the tagamet!

jeanniemk
is that the same as sulfacrate

Nope, sucralfate coats teh stomach and more specifically it adhers to ulcers and protects them from acids and whatnot.

jeanniemk
This morning I also saw a tiny bit of bright red blood in his stool.

Sounds like a lower GI bleed. Those are a bit more difficult to treat and the best bet might be to fast him for a bit. Try to avoid giving food for an extended period BUT make sure ot give with meds. You should go get the sucralfate sooner than later. It'll help some for this. Give him a gram of sucralfate BUT make sure it's at least 2 hrs before...at least cause it can cause absorption issues with the drugs.

jeanniemk
He ate another chicken breast this morning and a fist full of milkbones.

You should start getting creative. If he's being fussy then it might be from the drugs OR it might be GI issues....that might be causing pain or nausea. Again, the sucralfate should help. Try scrambling an egg for him. My Tessy LOVES eggs! Keep things somewhat bland if you can until the bleeding stops....but again....if you can fast for awhile that will be better.

jeanniemk
but when I talked to him this morning, he seemed very discouraged

No need to be discouraged. This disease is treatable!!! Just ask Lori...she's been through it with her Willow and Willow is doing great now! I know LOTS of dogs that have beat this (ITP). It's more easily treated than AIHA. Hang in there and stick around here. We'll help you through it. Just keep him well rested and drinking lots of fresh clean water.

oh...almost forgot...

jeanniemk
I'm really hoping that his numbers are going to be okay and that this is just a reaction to the phenylprolamine, which I stopped giving him

Good call. I've read that proin can cause high blood pressure in humans but there's been no studies done on whether or not it does with dogs. If it does for humans I can't see why it doesn't for dogs. High blood pressure and thrombocytopenia IS NOT a good combo!

HUGS and healing vibes going your way!

jeanniemk

Posted : 9/5/2011 10:24:36 AM

The blood makes me nervous since a major GI hemorrhage is what rushed me to the emergency hospital with him when this all started. Where can I get a sucralfate? Also worried things are closed today. He just went outside and looked so nauseous. He stood there with his tail up a bit like he was going to go but then just lay down in the grass. He was eating eggs the other day but now he's turning his nose up at them.