sassy is relapsing.

[alyssa]

Thank you ladies,

She actually had a self
induced 10 hour fast before these results. She at the night before around 10pm. She would not eat today. It was about 12hrs of no food with the results you have now.

We did not do a snap. We spun the urine, which had bilirubin and no hemoglobin. We did the blood counts. he also took a slide, and a stain, both of which have to be sent tomorrow because the lab was closed. However I asked about… I can never remember. the damaged cells that start with an s and end with lytes? He saw a few in the slide. I think he definitely didn’t see a lot of platelets, but he drew her blood twice and there was no excessive bleeding (none at all).

She hasn’t had any medication since I believe late Oct apart from her thyroid supplement. she had famoditine the entire time. I gave it to her to tonight as well. She was given pred and Aza at the vet – we are loading at 80mg pred and 75mg Aza. these were her original meds.

Would she have developed an ulcer or pred complication months after stopping? She really had no GI upset during her treatment, besides refusal to eat.

Her fever has come down just slightly. My theomonitor read 103.8, while the vets read 104.1. So, mine may be slightly off. It read 103.2 however about 30 minutes ago.

I did get sassy to eat. A boiled chicken thigh, which I needed to hand feed her. She did not vomit and took it willingly from me. But she wouldn’t stand there and eat. I had to hand feed.

I’m so scared because this is playing out exactly as before. Fine one day. Lethargic and fever the next. Slightly skewed counts. we caught it around the same time before I think :( Before it took 3 days for the need of transfusion.

The difference so far is a much higher loading dose of pred, Aza started immediately, no Doxy, and she was not given a shot of Rymdel (spelling?).

[Brigitte]

Hi Alyssa,
how scary, upsetting… this just sucks. Sassy was doing so well and now this. At least you have more knowledge than ever. Obviously you did something right, other ways Sassy would not have recovered. She did it before so she can do it again!
I don’t think Sassy could have gotten an ulcer after months of stopping the meds, but then who knows. However with these high doses she is given now I highly recommend that you also ask for Sucralfate. Famoditine is good, but I believe that Sucralfate just really protects them much better. Some vets don’t like it because it can also interfere with absorption of the other meds. But if you give the Sucralfate away from the other meds that is no problem. Have you brought up Aspirin/heparin, was there any talk of clotting? I think the damaged cells you are referring to are the spherocytes.
I think the SNAP test Patrice mentioned is such an easy and cheap test i would do it for sure.
Now I hope you get some sleep and tomorrow will be an other day that hopfully brings some answers and better results for Sassy!

Best wishes,
Brigitte

[alyssa]

I will have a snap done and ask about the other stomach protectant. Thank you ladies.

Update; I haven’t slept of course. She’s having to pee a lot and she is starving; this is different from last time when she wouldn’t eat for a week. I think the pred is effecting her different this time, so not sure this is a good sign or not. She’s a little jumpy and has a wired look, whereas before it was total opposite.

She randomly wants to be pet & will roll over a bit to give you her belly for a rub.

The fever broke. It was 103.2 around 3 AM. 6:15 it was 102.1. She didn’t get up big wagged her tail a lot when my dad got up.

I have a question about bilirubin. I know you can ‘see’ it in the wine colored urine and also orange poop. Her pee has gone clear, but then she had some mushy poo that was tan-orange. I know this is the bilirubin so my question is will it clear up in the pee first? could the poo have been ‘old’? I just thought it was strange that her pee went from light tea to clear yellow but then she had the orange poo.

[Sheena]

Hi Alyssa

What rotten luck – I’m really sorry this has happened when Sassy has been doing so well up until now. Well done to you for spotting the problem early. Please try not to get too stressed out (says she who worries!) – she has beaten this before & been much worse. You know a lot more about it too.

This looks like an infection to me as well – the high neutrophils / high WBCs and a temperature would indicate that. As everyone says, a Snap test would be the best idea, then doxycycline to make sure whatever it is is killed off. Any infection can cause a relapse & I admit I am pretty paranoid about that myself.

As Brigitte wrote, the damaged red cells can cause abnormal clotting, so you need to ask about an anti-clotting drug such as aspirin, clopidogrel, plavix. If you could ask the vet exactly what he saw, we can be sure. They can also do a manual platelet count or a recount, as Patrice mentioned.

And lastly, I completely agree about her needing sucralfate! It’s vital with these harsh drugs. You know such a lot about this disease now, Alyssa, & you will get through this. Hang in there & please tell us what’s happening – we will all be thinking about Sassy – & you too.

Love & hugs
Sheena & the boys xxxxx

[Sheena]

No wonder you haven’t slept – sorry – we were typing at the same time, so I know you are wide awake when you should be sleeping! I’m so glad to about read the snap test & sucralfate.

You are right about the bilirubin – it’s a good sign if her pee is more normal & pee is produced “instantly” by the kidneys, so it would be “newer” than the poo, which would be hours old.

Orange poo can be caused by Giardia – Worzel caught that & his poo was horrible orangy/yellow diarrhoea which went on for ages. If she keeps having orange poo, maybe it’s worth checking that out. If it returns to normal quickly, it’s the bilirubin, fingers crossed!

Love Sheena xxxxx

[Patrice]

Alyssa,
I am a going to recommend you ask the vet to “palpate” the spleen. Talk also about having an ultrasound done.

Sometimes the spleen can have little bleeds that heal a little and then bleed again. This can account for frequent blood loss, ie anemia. The cells your vet saw can be seen sometimes in this situation. Chance had the same cells when his spleen was enlarged and had a benign growth. The ultrasound showed it.

Mind you this is just doing some proper testing to rule out some causes of bleeding. If this were me that is where I would want the testing to go.
My best Patrice

[Brigitte]

Alyssa,
getting not enough sleep is clearly a symptom of this disease, but you already know that.
One thing that came to mind about the orange poop. I always understood that and the orange pee is the body shedding the dead blood cells. So if it continues there is still destruction going on. I am not sure how long it takes for all the dead cells to be out of the system, I remember it not taking longer than maybe 2-3 days though and then pee and poop getting back to a normal color.
Patrice’s recommendation of an ultrasound sounds like a very good idea. It is not invasive and could give some important info.
Take care,
Brigitte

[Alyssa]

We are going back tomorrow. Dr called me a minute ago and he wants to test her for babesia. while looking at her slide last night he feels he might have saw purple dots in her cells but he isn’t 100% sure and that is why we are going to test for it – babesia also effects platelets and her platelets are being hit this time. i will know for sure in the am what the platelets were from lab results.

i’ll do that snap while i am there.

her dr. has been calling & emailing everyone he knows and he just called me at nearly 7pm to talk about her. im thankful he is trying so hard.

it is hard to say how she is doing when i remember the original attack, the ups and downs. she has moments of clarity where she wants to eat, go pee, drink, or be pet – she even came to my room and was in the kitchen with me. but for 1-5 hours after her pred, she seems awful and it’s scary. then she has that time of perking up. she is still wagging her tail.

her pee isn’t getting darker, it’s a medium-deep yellow. her poo the last 2 times has been tan-orange, though.