Diagnosed in July, looking for support

[Kim]

Hi, my dog Lily (7 year old Maltese/Poodle mix) was diagnosed in July with ITP and then IMHA. We first noted a scab on her head, bruising on her body and bleeding from her mouth. We took her to the vet and her platlets were 2. At that point her RBC were normal and she was started on Prednisone and Azathioprine. When we went back a week later for repeat CBC her RBC had now dropped. Over the last couple of months her platlets have come up and have been above normal for a while now. Her RBC however had not been increasing and her HCT was hanging around 32. Her last CBC however showed that her HCT had finally increased a bit (I was not able to write it down but I think was 35). Vet suggested to wait a month to repeat blood work. Tomorrow is the day we go for her repeat. I check her gums every day and I feel like they are pinker but not as pink as her twin brothers. Over the last couple of weeks I feel as though Lily has become a little more energetic. She comes to sit with us when I’m reading to my human children and she even tried to chase a bunny on our little walk. We did decrease her prednisone dose slightly a little over a month ago because the side effects she was having were awful and they have improved a bit since doing so. She still breaths very heavily and sometimes groans when I pick her up which scares me but I have read these can be normal side effects? Not sure if that is true?
I have been trying to read through the forum and I see that a lot of dogs are taking something for their tummy protection. Lily is not on anything other than the Prednisone and Azathioprine. Should I be asking my vet to put her on something? Also are there any other supplements I should be giving her? If her results are good tomorrow is there something I should be giving to help prevent relapse? I also worry a lot because I have her twin brother as well so if he might develop this one day.
Sorry my thoughts are all over the place. Thank you for reading. I’m so glad I found somewhere for support.

[Patrice]

Kim,
I’m traveling so this will be abbreviated.
I am sorry to hear about Lily, but it sound like she recovered quite well. A HCT or PCV of 35 is quite adequate. No worries, just be sure to see the vet once a month for a quick PCV exam. See the previous topic and the reply from Vally about prednisone reduction link.

Yes you should have been giving him something like generic pepcid a half hour before one meal. Dogs on prednisone are at great risk of stomach ulcers.

In case there may be a stomach ulcer now, ask vet for Sulcralfate, it’s a mucous “bandage” that coats esophagus and stomach and heals ulcers, it is safe to use but give this at least 3 hours before or after meals. An overnight fast is the best time to give it.

In addition I suspect that the liver enzymes are very high and that is probably what hurts her, the liver is swollen. I would like to see the chemical screen and CBC lab tests, please send them via the Urgent Advice page.

To treat the liver, buy Denamarin, a veterinary supplement that contains doggie dosed by weight purified silybin and Sam-e, both excellent for helping the liver heal. For a very small dog it is important to get weight dosed supplements.

I am afraid to say that dogs who have previously had ITP, they are at greater risk for relapse. You know what to look for, pettachia, red spots in groin etc. So keep attentive.

The good news is that if you catch it quickly and start with treatment immediately the recovery is fast.

Lily may not be quite the same dog coming out of this as going in. Little dogs are especially prone to developing mitral valve problems of the heart after prolonged anemia and periods of lower O2 going to the body. Be sure that she gets a complete checkup every 6 m and that they listen to her heart carefully. A chest xray would help to see if the heart is enlarged.

So her life must be different now, more protected from environmental triggers that could set her immune system off again. Avoid congregation with other dogs not from your household. Think about viruses and bacteria and how to protect her from them. DO NOT give her vaccinations again. At the top of this forum is a topic with Dr. Dodds minimal vaccination schedule print it and carry it with you so that no vet mistakenly gives her vaccinations again.
My best Patrice

[Kim]

Thank you so much Patrice for all of the information. I don’t have copy’s of her blood work but I will ask the vet for them tomorrow.

I’m wondering if I should also not vaccinate her brother ever again since they are full blood relatives? We aren’t sure of the cause of all of this but it did occur just a few weeks after she had her routine vaccinations.
We also spend a lot of time at our lake during the summer and usually have them on “Heartgard” and “Nexgard” but after Lily got sick I stopped giving it to both of them. I’m not sure if this was the right thing to do?
Thank you so much for the support.

[Vally]

Hi Kim, and welcome.

I’m so sorry to hear what you, and Lily have been through. It leaves us paranoid forever I’m afraid, but as Patrice said, you will always notice anything amiss quickly and early, which makes things much better and easier to treat.

I would definitely use Dr. Dodds minimal vaccination schedule for both Lily and her brother. And the same with heartworm protection. Use Dr Dodd’s schedule for that, but you must be sure to keep to it. She recommends heartworm dosing every 45 days, instead of 30 days. I note it on a calendar so I don’t miss it and actually do it every 43 days, just just just in case. That’s on the Resources page for Hemopet, which is here:
https://www.secondchanceaihadogs.com/hemopetresources

Ask anything at all, we’d love to help.

Regards, Vally (Angel Bingo) and Saba

[Kim]

Thank you Vally for your advice on the vaccinations and hearworm protection.

Lily had her repeat blood work this morning and I’m feeling a little crushed. Based on her mood the last few weeks I thought for sure there would be vast improvement and we would be weaning the prednisone. I don’t have a copy of the latest results but the vet said her HCT is down 1% so I guess it’s 35% as it was 36% last month.
Our vet is suggesting we try lowering the Azathioprine dose by half as they are wondering if it is causing bone marrow suppression. We will be leaving her prednisone dose the same and also starting her on a tummy protectant.

I sent copy’s of her first 2 sets of blood work as well as a copy of the set from a month ago as I don’t have today’s copy yet. I’m feeling down and scared. I trust our vets but I can’t help but being worried that maybe we are missing something. Last December Lily got very sick, had a very tender abdomen and stopped eating and drinking. She was hospitalized for almost a week on IV fluids and was dx with pancreatitis as her canine pancreatic enzyme was abnormal. When she came home she was still very off and would only eat from my hand. Then one morning she woke up and was totally fine and back to her old self. A few months passed with no concern and then I noticed that one of the dogs was having pee accidents in the house (totally out of character for either of them). I took them both to the vet and vet thought maybe one just needed some re training as nothing else seemed off. They received their yearly checkup and booster shots and we went home. Two weeks later Lily was back at the vet with bruises, bleeding and no platlets.

[Vally]

Hi Kim, first of all, 1% drop is, I promise, absolutely nothing to worry about. Lily may have just been slightly more hydrated than her last test. It can be as simple as that. The more hydrated they are the lower the result will be, the less hydrated they are, the higher the PCV. Sometimes it’s also how difficult the blood draw is, it can stress a dog, and another reaction to the blood result. It’s sudden big drops or continuous drops that are more worrying.

So I think you’re right and Lily IS better because you can tell a lot by how they are acting. The lowering of the Azathioprine, I think, is a good idea, as yes it does suppress the marrow production, so that might just start getting the numbers better.

The blood tests have come through, but I’m not good with them. Patrice will also have received them, so I’m sure she’ll let you know what she sees in them. She’s very clever about understanding them.

Pancreatitis is dangerous, so you did the right thing in getting her to the vets quickly. Prednisone can also make them more susceptible to it, so keep Lily’s foods, low fat while she’s still on a significant dose of prednisone.

I promise, 1% is nothing to worry about and she’s stable, so you enjoy your day/night. I’m in Australia, so most likely a different time zone, so there may always be a delay before I see your posts and respond, but I’m always checking.

Vally

[Kim]

Thank you so much for the support Vally. That makes me feel a lot better knowing that I shouldn’t be worried about the 1% drop. Lily did seem more nervous before the blood draw yesterday and was trying to hide behind me from the tech.
I picked up the latest copy of her blood work today so I will send that. I also picked up the sulcralfate but I’m a little concerned about the timing of how I’m going to give it to her so that it doesn’t interfere with her meds. I thought it would be a once a day thing and I could give it before bedtime but it says to give ever 8-12 hrs. I’m not sure how I will give it to her twice a day on the days I work. I give her prednisone in the morning with food and then prednisone and Azathioprine in the evening with some food. She might just have to get it in the evenings only on the days I work.

[Patrice]

Hi Kim,
Don’t worry about the sucralfate, just give it once a day, better on an overnight fast. That way it simply won’t interfere with the meds or absorption of food. It’s a human medication and traditionally is given twice a day. Right now once a day is better than nothing.

I got the CBC lab reports but there wasn’t a chem screen included. I was trying to see the liver enzyme levels so we could determine if this is what is causing her pain. Also if she had pancreatitis at one point it would be helpful to view other values as well. The chem screen tells us about how the body organs are functioning and the physiology of the body. Things like electrolytes, glucose, liver, kidney, etc. Those are critical to know because they tell us how healthy our dog is. The CBC is specific to blood elements.

Do not worry about small changes in the HCT or PCV, they are absolutely normal in our lives. The test you do, the sample they take, is just a snapshot in a moment of time. Our bodies maintain a homeostasis every second of our lives and things like the blood change all day long as they respond to messages from the body systems. What I like to see are multiple tests so there is a continuum of values to compare. They tell the story better.

So for instance if we looked that the HCT or PCV over 3 months and we saw only small 1-3% ups and downs that would be perfectly normal. But if we saw a gradual (or fast) significant drop from one test to another we would want to evaluate that change more closely.

Yes, Aza over a period of time leads to bone marrow suppression. The reason for this is simple. This drug is often used as a chemo drug in cancers. It’s job is to suppress the WBCs in the body that may be responsible. WBC are very short lived cells and are being constantly made. If you begin highly suppressing this action, you can lead to other blood elements being suppressed as well. So Aza works by stopping fast growing cells from reproducing. We want that in cancer treatment, we do not want this in a dog that has anemia. Reducing this now is a good thing. We are going to want to get the pred down eventually, esp if there has been a bout of pancreatitis.

Heartworm, Dr. Dodds has always recommended to me to use Interceptor tablets, for the main reason it contains only one drug not several, and also because it is very good at eliminating many more types of worms, esp the dangerous tapeworms, than some brands do. I use the 45 day schedule on all my dogs.

So I do need to see the chemistry screen if you can get any of the more recent ones.
my best, patrice