Honey

[admin]

Lynda
What a tricky question.
Things to consider
1. Has the azathioprine made any improvement to Honey’s PCV?
2. Has the azathioprine slowed down the haemolysis (red cell destruction) after the transfusions?
If the answer is NO, then the azathioprine has done nothing to help her so far, hence you have to try the cyclosporine – no choice there.

If it were me, I would start the cyclosporine & keep the azathioprine going for now. But I am not you & I am renowned for being very, very cautious! The big HOWEVER – If you continue the azathioprine AND the cyclosporine and Honey becomes regenerative – we all go whooopeee, but you will be in the position of not knowing whether the cyclosporine worked on it’s own, or whether the combination of the two had done the trick. If it were me, I wouldn’t care – as long as those reticulocytes turned up in abundance. If she only takes the cyclosporine & she becomes regenerative, it’s obvious what has happened – again we all go “whoopeee”. In the worst case scenario, the cyclosporine doesn’t work, you add the azathioprine back in. Eenie meenie miny mo! Here is Dr Dodds treatment protocol that she sent me when Worzel was ill – we suspected he may have had Ehrlichia:

1. Prednisone 2mg/kg PO BID divided; start at same time as Dex SP is given
2. +/- Azathioprine (Imuran) 2mg/kg PO SID if dog is not responding to
the prednisolone.
3. +/- Cyclosporine (Atopica) starting at 10mg/kg SID for the first
week, then 5mg/kg thereafter, if patient is refractory to the above drugs.
4. Pepsid–AC to prevent gastric ulcers from the prednisolone.
5. Doxycycline 5 mg/lb bid just in case it is Ehrlichia
*Do not use Cytoxin, Oxyglobin – studies show a decreased survival rate
with these drugs.
6. Thyroxine (0.1 mg / 12-15 lbs. of optimum weight BID), to stimulate
hematopoiesis, or if patient is hypothyroid

So there you go! Bear in mind that these are only my thoughts – I hope the others will give you some ideas & opinions too. All I want is to send you the biggest whoooopeeeee! message as soon as possible.
Hope I’ve helped, or at least given you something to discuss a bit more.
All the best wishes possible from us to you, Honey & Dora
Sheena, Worzel & Ollie xxx

[lynda]

OK, thanks. I think I will ask the vet to add in the Atopica to start with rather than substituting it for the Imuran, and take it from there. We already have everything else on your list except the Doxycycline!! I’ve read about ehrlichiosis, but I don’t think it’s a factor.
I was interested to see what you said about oxyglobin, as I was wondering if we could sometimes use that. We did do it once, as it was available and whole blood wouldn’t arrive from the blood bank till the following day.

[Patrice]

Lynda,
My opinion, and I am not a vet, is that the Imuran has done nothing so far. I feel, again my opinion, that is is suppressing the production of the bone marrow. The lymphocyte values on the last CBC are still very high. The cyclosporine will target these within about 2-4 weeks and you will see a decrease in them on the blood test.

If, in 2-3 weeks you still see no response, either shown by regeneration or a significant decrease in lymphocytes, you can go back to the Imuran.

Chance was as profoundly non-regenerative as Honey is. I had to make a choice what to do. It was very difficult emotionally for me to make any decisions, but I trusted Dr. Dodds at that point. He was going to die if I did nothing. The specialist was out of ideas and my vets were beyond their expertise. Remember, at that time I had no idea what this drug was and I knew nothing about how it worked or when to expect results. Since then I have seen many miracle dogs recover with this drug from profound bone marrow failure.

Dr. Dodds is correct, these cases are difficult. I can’t pretend that they are not. But I know a little more now and I have seen some amazing results in dogs.

Remember you drive the bus. You have Dr. Dodds as a passenger, keep in touch with her.
my best
patrice

[lynda]

Oh, OK, thanks Patrice. Maybe we should substitute then

[admin]

Lynda
It is extremely unlikely that Honey has ehrlichiosis in the UK, but it is seen frequently over here in France – sometimes there’s no choice about using oxyglobin – if it’s that or nothing, it HAS to be used & it does it’s job. You have no need to worry about the oxyglobin/ehrlichiosis scenario at all. Doxycycline is also used for ehrlichiosis & many other infections – just a different type of antibiotic which has a good success at killing off ehrlichia, which can be a sod to get rid of.

[admin]

Hi Lynda
If Patrice thinks the Imuran is a problem for bone marrow suppression, I would go with her opinion on this & drop it too. I trust her judgement implicitly – she helped me with Worzel more than I can say & she was always right. Substitution, it is then. As she said, you can always add it in again if necessary.
Sheena & the boys

[admin]

Thanks Sheena! Of course right after writing it, I read the terms on Cyclosporine. D’oh! :)

[admin]

Thank you so much for this information Patrice. It has certainly been very informative for me and I am sure it will be for Lynda as well