Hector

[Clara]

I have been giving Hector the slippery elm cocktail which has probiotics in it. He hates it and spits it out so I also sprinkle a little Animal Essentials Probiotics/Enzymes. If he doesn’t get back to normal after all of these treatments, I will find out what a therapeutic dose is for him.
Good luck to Ashki this week!!

[Vally]

Clara, with the slippery elm cocktail, are you using aloe vera and chlorophyll in it? You need to be careful with the aloe vera as it is only the actual gel which can be used, the outer part of the plant is toxic and chlorophyll will reduce the effectiveness of cyclosporine. I can’t remember if Hector is on cyclosporine.

With Bingo whenever he has a few days of particularly runny poos, I do a simple version of a teaspoon of slippery elm powder in a glass of water and cook until revolting and add a baby syringe full to each meal. I don’t use any of the other ingredients and toss out after 5 days.

Love Vally & Bingo (who doesn’t know he got it the other day :)

[Tamara]

Clara, the SEC has minimal probiotics; check out http://www.dogaware.com under supplements I think and see Mary’s discussion of probiotics. Ashki is not crazy about the SEC either so I am seeing how he does without it but I am continuing his probiotics (Rx Vitamins) and enzymes and his poops are good so far! Thank you so much for the good wishes!!

Vally, so good to know about chlorophyll and cyclo, the SEC has such a minimal amount of chlorophyll and normally cyclo is given at least a couple hours apart from meals, do you think that is sufficient ? I will remember your slippery elm solution to runny poos when we need it!
love, tamara and ashki xoxoxox

[admin]

Sorry Clara – MMF is just the abbreviation for mycophenolate mofetil & I apologise for not making that clear (thank you Tamara). I am really happy to see Hector’s PCV is up, plus platelets etc – great news. Sometimes, you think results will be worse & get a nice surprise like that! You must be relieved. I don’t blame you for trying to stop that diarrhea straight away either – it really takes it out of them & makes them feel rotten. I like the probiotic idea too (expensive but worth it) – Worzel had a spell of diarrhea (yellow & mucousy) & it really helped settle him down within a week or so. The long term antibiotics must really mess up their natural gut bacteria levels & this can really help in my opinion. I hope your other dogs are doing OK too after catching that nasty bug.

Tamara has done much research on the iron front (the Iron Queen!) and is giving you great advice – some dogs need iron, some dogs have too much – it’s important to know which supplements to use because of this. Ferritin level is the most widely used test – I had a look but I can’t see it in any of Hector’s blood results. You could ask for it next time you go? Here is a human article that you might find useful – it explains it pretty well.
http://www.labtestsonline.org.uk/understanding/analytes/iron-tests/tab/test/
I’m sure your vet & Dr Dodds would be happy to advise you on this too.

Please give Hector a big hug from me – fingers crossed for more & more PCV rises
Love Sheena, Worzel Ollie xxx

[admin]

Hi Clara

How is Hector doing? Good news to hear that his PCV is up. I agree that the metronidazole sounds like a good solution until you have the herbal medicine.

Iron toxicity can indeed be a problem, though I am sure Dr Dodds would not miss that. Tamara’s suggestion of purchasing a multivitamin without iron is excellent.

I am going to agree with Tamara again about the probiotics. They can really help ease the diarrhoea, and we used them with success when my cat Molly had diarrhoea caused by antibiotics. I also added chopped egg and boiled rice to her food which helped, and others here have recommended cooked pumpkin to settle the bowels.

Vally – thank you for the excellent information about the chlorophyll and aloe vera. Really useful to know (“cook until revolting” – love it!)

In answer to your earlier questions, my opinion on Hector’s results is that he is non-regenerative and he is at increased risk of clotting. I am not a vet and am not nearly as proficient at interpreting results as Sheena and Patrice (and of course your vet), but the recent clinical report seems to back this up. Has Dr Dodds suggested an anti-clotting medication?

When is Hector’s next check up? I am keeping everything crossed that the soloxine will give him a boost in the right direction.

With very best wishes,

Mary and Mable x

[Clara]

I am second guessing everything. Is it possible that the immune suppression was not the way to go? This is from January 31st, nine months after his first symptoms surfaced:
CYTOLOGIC DESCRIPTION: Peripheral smear reveals decreased red cell density with minimal anisocytosis/polychromasia and scattered spherocytes. The white cell estimate and differential is consistent with automated findings. Reactive lymphocytes are present. The platelet estimate is 75,000-95,000/ul with scattered large platelets and small clumps present. CONCLUSION: Non-regenerative anemia, mild thrombocytopenia
BM aspirate and roll of core biopsy sample CYTOLOGIC DESCRIPTION: Samples contain infrequent hypocellular unit particles with abundant amount hemodilution. Unit particles are lack dark globular material (iron). A role of the core sample is highly cellular with minimal hemodilution. Erythroid precursors comprise 72% of the total nucleated cell population with erythroblasts being 1% of the erythroid precursors. The erythroid series is left shifted with numerous metarubricytes and rubricytes. Morphological changes include late stage mitoses and occasional irregular nuclear margins. Polychromatic rbcs are not observed (maturation arrest). The M:E ratio is decreased at 0.3:1. The myeloid series comprises 25% of nucleated cells with myeloblasts accounting for 1% of myeloid cells. The myeloid line shows complete and orderly maturation. Also noted are scattered small mature lymphocytes, well-differentiated plasma cells and macrophages, accounting for 3% of total nucleated cells. CONCLUSION: Probable erythroid hyperplasia with maturation arrest COMMENTS: The core biopsy is needed for evaluation of the cellularity and iron stores in the marrow. Based on the aspirate an adequate response to the peripheral cytopenia is expected. Further monitoring of CBCs is recommended.
The results of the bone marrow revealed that despite the fact we are not seeing regeneration in his peripheral blood, there does appear to be appropriate red blood cell precursors within the marrow that are capable of regenerating new red blood cells. There were no cancerous cells or signs of infection within the marrow sample. This makes us most suspicious that Hector has a condition called red cell maturation arrest. This is generally thought to be an auto-immune disease where the immune system attacks these late precursor cells before they can be released into the blood stream. We still have the core biopsy sample pending through the lab to look for any other signs of scarring or fibrosis within the bone marrow that could impact recovery. These results should be available early next week. These findings also go along with the results from the splenic samples that showed what is called extramedullary hematopoesis. This means that the spleen is trying to help regenerate the red blood cells that the bone marrow is not doing effectively at this time. The splenic involvement in this type of disease will frequently cause the organ enlargement that is present. It is also very possible that the immune activity within the spleen is the driving force that caused the immune disturbance in the first place.
The typical therapy for red cell maturation arrest and immune mediated diseases involves the use of medications designed to suppress the immune systems ability to mount a response against these otherwise normal cells. Hector’s previous Babesia status does raise some concerns about the use of immune suppressive therapy. In dogs that are asymptomatic carriers of this disease, suppression of the immune system can cause relapse or worsening of the clinical symptoms of disease. We are most suspicious that this current episode of immune mediated disease is unrelated to Hector’s prior Babesia.

[Clara]

His coccidia infection appears to have subsided, but I plan to do another round of the herbal coccidia remedy just because he had/has a severe infection, a suppressed immune system, and my other dogs had the coccidia also.
I have been lowering the prednisone by 5mg every two weeks and he is now on only 5mg per day. His calcinosis cutis is out of control, his skin is peeling off, and his head is almost bald.
He is still on 100mg of Atopica and I am considering lowering it. Dr. Dodds says to add mycophenolate, but it feels wrong to me.
I added soloxine, Pet Tinic, and liver cleansing diet 3 weeks ago. Last week his PCV dropped from 31 to 25.
I am pretty fed up and I don’t know what to do anymore.

[admin]

Hi Clara
I really feel for you. This is so frustrating & I appreciate just how much he is suffering from the drug side effects. I have quickly read the report. As see it, this is very similar to Worzel’s bone marrow biopsy – rbc maturation arrest. so he was producing red blood cells in his bone marrow, but they were being killed off before maturity & they never reached the bloodstream. This is quite rare, as you know. Worzel didn’t have an enlarged spleen though, so I’m no expert on this but am thinking his spleen is actually helping him along at the moment by assisting in rbc production. Worzel became regenerative with the azathioprine & antibiotics & I know damn well we were lucky finding the right drugs. He had a slow, slow decline to an awful state before that though. I need to chat with Patrice about all this. She is far more knowledgeable than I am. I also picked up on the lack of iron. I know you have added supplements, but the essential building blocks need to be available for successful RBC production.
I will get back to you later – I’m sorry his PCV has dropped again – you must be tearing your hair out. Sorry this is rushed – I will read it everything through again later.
Love Sheena xxx

[Clara]

I have been giving Hector the slippery elm cocktail which has probiotics in it. He hates it and spits it out so I also sprinkle a little Animal Essentials Probiotics/Enzymes. If he doesn’t get back to normal after all of these treatments, I will find out what a therapeutic dose is for him.
Good luck to Ashki this week!!

[Vally]

Clara, with the slippery elm cocktail, are you using aloe vera and chlorophyll in it? You need to be careful with the aloe vera as it is only the actual gel which can be used, the outer part of the plant is toxic and chlorophyll will reduce the effectiveness of cyclosporine. I can’t remember if Hector is on cyclosporine.

With Bingo whenever he has a few days of particularly runny poos, I do a simple version of a teaspoon of slippery elm powder in a glass of water and cook until revolting and add a baby syringe full to each meal. I don’t use any of the other ingredients and toss out after 5 days.

Love Vally & Bingo (who doesn’t know he got it the other day :)

[Tamara]

Clara, the SEC has minimal probiotics; check out http://www.dogaware.com under supplements I think and see Mary’s discussion of probiotics. Ashki is not crazy about the SEC either so I am seeing how he does without it but I am continuing his probiotics (Rx Vitamins) and enzymes and his poops are good so far! Thank you so much for the good wishes!!

Vally, so good to know about chlorophyll and cyclo, the SEC has such a minimal amount of chlorophyll and normally cyclo is given at least a couple hours apart from meals, do you think that is sufficient ? I will remember your slippery elm solution to runny poos when we need it!
love, tamara and ashki xoxoxox

[admin]

Sorry Clara – MMF is just the abbreviation for mycophenolate mofetil & I apologise for not making that clear (thank you Tamara). I am really happy to see Hector’s PCV is up, plus platelets etc – great news. Sometimes, you think results will be worse & get a nice surprise like that! You must be relieved. I don’t blame you for trying to stop that diarrhea straight away either – it really takes it out of them & makes them feel rotten. I like the probiotic idea too (expensive but worth it) – Worzel had a spell of diarrhea (yellow & mucousy) & it really helped settle him down within a week or so. The long term antibiotics must really mess up their natural gut bacteria levels & this can really help in my opinion. I hope your other dogs are doing OK too after catching that nasty bug.

Tamara has done much research on the iron front (the Iron Queen!) and is giving you great advice – some dogs need iron, some dogs have too much – it’s important to know which supplements to use because of this. Ferritin level is the most widely used test – I had a look but I can’t see it in any of Hector’s blood results. You could ask for it next time you go? Here is a human article that you might find useful – it explains it pretty well.
http://www.labtestsonline.org.uk/understanding/analytes/iron-tests/tab/test/
I’m sure your vet & Dr Dodds would be happy to advise you on this too.

Please give Hector a big hug from me – fingers crossed for more & more PCV rises
Love Sheena, Worzel Ollie xxx

[admin]

Hi Clara

How is Hector doing? Good news to hear that his PCV is up. I agree that the metronidazole sounds like a good solution until you have the herbal medicine.

Iron toxicity can indeed be a problem, though I am sure Dr Dodds would not miss that. Tamara’s suggestion of purchasing a multivitamin without iron is excellent.

I am going to agree with Tamara again about the probiotics. They can really help ease the diarrhoea, and we used them with success when my cat Molly had diarrhoea caused by antibiotics. I also added chopped egg and boiled rice to her food which helped, and others here have recommended cooked pumpkin to settle the bowels.

Vally – thank you for the excellent information about the chlorophyll and aloe vera. Really useful to know (“cook until revolting” – love it!)

In answer to your earlier questions, my opinion on Hector’s results is that he is non-regenerative and he is at increased risk of clotting. I am not a vet and am not nearly as proficient at interpreting results as Sheena and Patrice (and of course your vet), but the recent clinical report seems to back this up. Has Dr Dodds suggested an anti-clotting medication?

When is Hector’s next check up? I am keeping everything crossed that the soloxine will give him a boost in the right direction.

With very best wishes,

Mary and Mable x

[Clara]

I am second guessing everything. Is it possible that the immune suppression was not the way to go? This is from January 31st, nine months after his first symptoms surfaced:
CYTOLOGIC DESCRIPTION: Peripheral smear reveals decreased red cell density with minimal anisocytosis/polychromasia and scattered spherocytes. The white cell estimate and differential is consistent with automated findings. Reactive lymphocytes are present. The platelet estimate is 75,000-95,000/ul with scattered large platelets and small clumps present. CONCLUSION: Non-regenerative anemia, mild thrombocytopenia
BM aspirate and roll of core biopsy sample CYTOLOGIC DESCRIPTION: Samples contain infrequent hypocellular unit particles with abundant amount hemodilution. Unit particles are lack dark globular material (iron). A role of the core sample is highly cellular with minimal hemodilution. Erythroid precursors comprise 72% of the total nucleated cell population with erythroblasts being 1% of the erythroid precursors. The erythroid series is left shifted with numerous metarubricytes and rubricytes. Morphological changes include late stage mitoses and occasional irregular nuclear margins. Polychromatic rbcs are not observed (maturation arrest). The M:E ratio is decreased at 0.3:1. The myeloid series comprises 25% of nucleated cells with myeloblasts accounting for 1% of myeloid cells. The myeloid line shows complete and orderly maturation. Also noted are scattered small mature lymphocytes, well-differentiated plasma cells and macrophages, accounting for 3% of total nucleated cells. CONCLUSION: Probable erythroid hyperplasia with maturation arrest COMMENTS: The core biopsy is needed for evaluation of the cellularity and iron stores in the marrow. Based on the aspirate an adequate response to the peripheral cytopenia is expected. Further monitoring of CBCs is recommended.
The results of the bone marrow revealed that despite the fact we are not seeing regeneration in his peripheral blood, there does appear to be appropriate red blood cell precursors within the marrow that are capable of regenerating new red blood cells. There were no cancerous cells or signs of infection within the marrow sample. This makes us most suspicious that Hector has a condition called red cell maturation arrest. This is generally thought to be an auto-immune disease where the immune system attacks these late precursor cells before they can be released into the blood stream. We still have the core biopsy sample pending through the lab to look for any other signs of scarring or fibrosis within the bone marrow that could impact recovery. These results should be available early next week. These findings also go along with the results from the splenic samples that showed what is called extramedullary hematopoesis. This means that the spleen is trying to help regenerate the red blood cells that the bone marrow is not doing effectively at this time. The splenic involvement in this type of disease will frequently cause the organ enlargement that is present. It is also very possible that the immune activity within the spleen is the driving force that caused the immune disturbance in the first place.
The typical therapy for red cell maturation arrest and immune mediated diseases involves the use of medications designed to suppress the immune systems ability to mount a response against these otherwise normal cells. Hector’s previous Babesia status does raise some concerns about the use of immune suppressive therapy. In dogs that are asymptomatic carriers of this disease, suppression of the immune system can cause relapse or worsening of the clinical symptoms of disease. We are most suspicious that this current episode of immune mediated disease is unrelated to Hector’s prior Babesia.

[Clara]

His coccidia infection appears to have subsided, but I plan to do another round of the herbal coccidia remedy just because he had/has a severe infection, a suppressed immune system, and my other dogs had the coccidia also.
I have been lowering the prednisone by 5mg every two weeks and he is now on only 5mg per day. His calcinosis cutis is out of control, his skin is peeling off, and his head is almost bald.
He is still on 100mg of Atopica and I am considering lowering it. Dr. Dodds says to add mycophenolate, but it feels wrong to me.
I added soloxine, Pet Tinic, and liver cleansing diet 3 weeks ago. Last week his PCV dropped from 31 to 25.
I am pretty fed up and I don’t know what to do anymore.

[admin]

Hi Clara
I really feel for you. This is so frustrating & I appreciate just how much he is suffering from the drug side effects. I have quickly read the report. As see it, this is very similar to Worzel’s bone marrow biopsy – rbc maturation arrest. so he was producing red blood cells in his bone marrow, but they were being killed off before maturity & they never reached the bloodstream. This is quite rare, as you know. Worzel didn’t have an enlarged spleen though, so I’m no expert on this but am thinking his spleen is actually helping him along at the moment by assisting in rbc production. Worzel became regenerative with the azathioprine & antibiotics & I know damn well we were lucky finding the right drugs. He had a slow, slow decline to an awful state before that though. I need to chat with Patrice about all this. She is far more knowledgeable than I am. I also picked up on the lack of iron. I know you have added supplements, but the essential building blocks need to be available for successful RBC production.
I will get back to you later – I’m sorry his PCV has dropped again – you must be tearing your hair out. Sorry this is rushed – I will read it everything through again later.
Love Sheena xxx