Worried – Small Drop in PCV

[Trish]

So Max just had a followup with his specialist. His PCV has dropped from a 44 on 8/10/15, taken at our regular vet, to a 42 today. We won’t have his full CBC back until later today or tomorrow a.m. I know I have seen time and time again how everyone says that small fluctuations are normal, but I can’t help but be worried. What is different all of a sudden? I have been adding milk thistle to his food three times a week, as last CBC showed slight elevation in ALT/ALP. We have also started him back on his regular dose of Fluoxetine that he was on prior to this all starting (it was reduced after starting meds to keep from irritating his stomach), of 10 mg daily. He was on .5 mg for awhile. Would any of those things cause a problem? That is the only difference. Oh, and the specialist discontinued his Plavix after his last visit as well. :(

[Trish]

I almost forgot – he had his first Heartgard treatment since diagnosis – our vet gave us the okay to give it to him, I was nervous, but the mosquitos are very bad here during the summer monsoon months, and I don’t want him to have heartworms either. :( Could that be the cause of his drop?

[admin]

Hi Trish. Welcome to the Paranoid-Worry Club. Actually, Sadie’s PCV drops when we reduce – did you just reduce Max? But no worry if not anyway, as everyone continually has to remind me, they can go up or down a few points from one day to the next, depending on hydration, nervousness, etc. A few points is no worry at this point. He’s actually doing GREAT!!!

I give Sadie Tri-Heart Plus and I worry each and every time I give it. She’s due now as a matter of fact. But I do as Dr. Dodds has suggested, and give it every 45 days instead of every 30. The mosquitos are horrible here too, it’s not worth the risk – heart worms would do her in, I’m sure. The lesser of the evils! ;)

I would add milk thistle every day. Why were you giving only three times a week? Are you giving the SAM-e too? If you don’t use the Denamarin (which is milk thistle and SAM-e, but very precise), then you need to give both individually each day, in both Max’s morning and evening food. That will make a huge difference. When Sadie is on the high doses of immune suppressants, I use the Denamarin (again, because it’s precise), but as I wean her down, I use the individual milk thistle and Sam-e. And Sheena just reminded me (and I’m going to start today) that milk thistle can be added daily to the Denamarin. Sadie’s liver values are high and I am going to have to tackle it right on, so will be adding the milk thistle today.

Did you mean to write “Fluoxetine” as in Prozac? I don’t understand. This is not for the stomach, it’s for depression. But he should be on something for his stomach still, even just Pepcid. Best is Sucralfate.

Also, what dose is Max on now, 5mg of prednisone and what else. Wondering about stopping the Plavix too…..

Love and hugs, Linda

[Vally]

Hi Trish. No really truly, that drop is absolutely nothing and you have nothing to worry about there. The up and down rule is to allow 5. 5 up or down is considered a normal fluctuation. As Linda said, if Max has had a bit more water on that day his PCV will be lower than if he’d drunk a little less water the previous time. If he’s a bit stressed or a bit relaxed. So that’s really a great PCV.

Specialist told me once when they have dogs in hospital on drips to hydrate them, their PCV slowly drops because of they are kept hydrated.

Milk thistle, I do twice a day plus I use Denasyl (like your Denamarin). If you can use the Denamarin that’s really the best because, yes, the dose is accurate for dogs. Milk Thistle depends on quality. Denamarin will work to bring the enzymes down.

This is the Amazon link – Linda, do you get it through Costco? Is it cheaper?
http://www.amazon.com/s/ref=nb_sb_noss_2/186-7207305-1196168?url=search-alias%3Dpets&field-keywords=denamarin

Not sure about stopping Plavix either. May not need it but how much pred is Max currently on?

Vally & Bingo
xxx

[Trish]

Hi, sorry about the confusion. He is on the fluoxetine for anxiety, and they reduced it to avoid stomach issues while taking so many other meds. We recently put him back on his regular dose because he is doing fine, and the lower dose was not helping his anxiety. He is currently on 20 mg of prednisone once a day, and 250 mg of mycophenolate. I was giving the milk thistle three times a week because I had read elsewhere that some had noted that the milk thistle had caused drops in PCV, and may have interfered with med absorption?

Thanks for all the kind words – they really help!! Whew. :)

[Brigitte]

Hi Trish,
where have you read that the milk thistle could cause a drop in PCV? That is the first time I heard that. So far I have only heard positive things about this herb and would not hesitate to give it daily. I think it is very important to give the Denamarin. Some people say even with it the liver enzymes are still high, it does not make a difference and is expensive. My answer, if you would not give it the enzymes would be even higher! If you are worried about stomach issues it is best to put these pups on Sucralfate. Is Max already on it? Given away from all the other drugs and food it will not interfere with absorption.
Best wishes,
Brigitte

[admin]

Hey Trish

You can stop worrying. As all have said, that drop is nothing to worry about. It really isn’t. You could do another test a couple hours later after he has had a big drink of water & it will be different again.

The milk thistle should be given twice a day – we all use it because it brings those liver enzymes down & I have never heard of it causing a drop in PCV – it is important to stick to the recommended dose & not exceed that – in very high doses it probably can cause problems, but is considered very safe at usual doses. I agree with Brigitte – sucralfate is vital when they are on pred. Given properly, it is very safe & effective.

The plavix should only be stopped when Max has no longer has any abnormal clotting issues – please could you make sure your vet has done a blood smear to clarify? Some vets also think it should be continued until they are off the pred, but others don’t.

You have no choice with heartworm meds – stick to 45 days as Linda says – Dr Dodds is the bees knees on all this advice. It is a truly horrible disease & the last thing you want on top of IMHA.

Max is doing FINE – he really is. But we all understand this disease makes us worry about every little thing. I still do, I promise you!

Love Sheena & the boys xxxxx

[admin]

Hiya Trish

Thanks very much for Max’s latest blood tests. We can see why your vet suspected an infection on the earlier one, but all is well on the latest test. It is absolutely excellent!!!! Well done, both of you. The MCV & MCHC figures are usually out of range for a while when dogs are recovering from anaemia, so nothing to worry about. Eosinophils are sometimes not seen at all, & this lightly high value on the latest test is also nothing to worry about. Could be the pred? Maybe. Probably nothing.

I noticed Max’s liver enzymes were slightly high, so continuing with the milk thistle as we suggested will help. I also saw at the bottom that they had looked at his blood on a slide & found no clotting risks – yippeee!!!!! He did have rouleaux (& something they didn’t expand on about platelets) on the first tests, so they were wise to give him the plavix – essential actually. So he doesn’t need it now he’s recovering so well.

I am sooooo pleased for you & Max – this is great news!!!

Sheena xxxxx

PS e-mailed this to you as well