Split: Split: Nula (5yr old English Cocker Spaniel)

[Ruth]

*vary with a lot of things. Xxx

[admin]

Hi Ruth

I’m sorry to hear this, but good news about her weight and I hope she is still eating well? What do they suggest in terms of her medication? My feeling would be to up her prednisolone to the original 15mg again, which seemed to be keeping her stable. However, please do wait and see what the others suggest as they are better informed on the weaning side of things than I am. Have you spoken with your local vets for their opinion? Is her Atopica still at the same dose?

It is good that she is clinically stable so hang on to this. Have you noticed any change in her at all?

Thinking of you and hoping the others can give you some advice ASAP

Mary and Mable x

[admin]

Hi Ruth

Oh, I’m sorry to hear this, but don’t get too disheartened, please. This has happened to other people & can be sorted out BUT Nula must go back to the original 15mg pred dose twice per day (this is what it was, right?) immediately or higher if it doesn’t meet the 2mg per kilo split into 2 doses 12 hours apart criteria. I totally agree with Mary – this has to be done. Please, I beg you, do not drop it again until she has had a normal range PCV/HCT for a month at least. This is the usual treatment protocol. I’ve looked back through your original posts & am concerned that you haven’t mentioned her platelet levels recently (Evans Syndrome was your vet’s original diagnosis in you early messages) – are they normal now? This is important, as well as the PCV. I am assuming the cause/trigger was an infection as she had a temperature too – again, is there any sign of infection at all now? Does she have other blood test abnormalities, such as raised lymphocytes? Of course I don’t want to worry you unnecessarily, but these are important things you need to be aware of & ask the vets. You know you can post the blood test results on here by using the Urgent Advice message service & we can gladly take a look.

Can I suggest you go to our prednisone link, print it & take  it to the vets? It might help:

https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/

21 is not a “dangerous” PCV, but I know you are disappointed and she will be feeling very tired as it is a bit debilitating at this level. Glad she is scoffing her food well – that’s always good news! How is she in herself? How do her gums look? It’s just a case of a setback caused by dropping the pred too soon, I’m afraid. You were fooled by a “false” PCV, I guess. I suspect you may have to face a little battle with the specialist on this? Don’t forget she is YOUR dog, not theirs – just politely explain that you only want the best for her & want to work with them, not against them. If you need help with this, we can provide you with facts & back-up if needs be and you always have the option of contacting the wonderful Dr Dodds – you can do internet consultations if necessary. Let’s hope you won’t have to do that & the vets will be in agreement – you need them on your side & these situations can be awkward.

Ruth, don’t get too stressed – keep positive as this CAN be sorted – our dogs really pick up on our feelings, don’t they? We are all thinking of you & if there is anything you need us to do, just ask!
Lots of love & a great big hug for Nula
Sheena, Worzel & Ollie xxxx

PS Just to clarify things, can you give us a full list of her medications & her weight when you get time?

[Ruth]

Thank you girls! I only dropped her prednisolone by 5 instead of the 10 DWR said and I only did it Saturday, even though they said to do that from the 12th. I put her back up to 30 last night after getting local vets results. So hoping that’ll be in her system quicker than if we were starting from as low as DWR suggested. Her temperature is normal, and her gums haven’t gone paler. She still has energy to want to play for a little so she is coping much better this time at 21, than last time at 22 when she was first ill. But she’s not got an infection this time. Her platelets were in the normal range on the 13th. And they haven’t called this evening to say that those are low again, so it seems to be just the red cells this time. Can that happen? She’s still on the Atopica at the same dose. They did say if PCV is not up next Fri when they retest, they might add another drug, but didn’t say what. I am definitely not going to reduce any medications at all until she has had a similar PCV and platelet result for a while. I thought it might be a risk, hence not dropping it as much as they said and getting local vet to do a PCV for me. And I’m not going to be pushed into that again. So I’m going to watch her closely and keep checking her gums and any sign of anything suspicious I’m taking her straight to the vets. DWR did say if she deteriorated to take her straight in. Xxxxxx

[admin]

Hi Ruth

I’m really glad that you have already increased her prednisolone back to 15mg twice a day. What did DWR say about this? Did they feel it was adequate? There are a variety of medications which can be added in if needed, and if you look under the “AIHA terms” tab, lots of them are listed.

It might be an idea to give DWR a ring tomorrow and get her platelet results, just to make sure. White cell count would also be useful, although I expect if these were raised, they would have started antibiotics. I also wonder whether you could think about a PCV check locally early next week, so that you aren’t waiting a whole week? This might not be necessary – I’m sure the others will say if they think it isn’t – but if it were me I know I’d struggle to wait a week.

What are you feeding Nula? Are you giving any supplements or additional foods that you don’t normally give? Do you have her current weight? Current medications? So sorry for all the questions, but it’s useful to know these things.

My opinion is that you were very wise not to drop her prednisolone by 10mg a day and to give her that bit longer on her original dose. You are right – don’t be pushed into anything. You know Nula better than anyone, and I am a firm believer in owner’s gut instinct with this disease. Also, very importantly, do not beat yourself up over this. You have done nothing wrong (quite the opposite – you are a wonderful Mum to Nula) and fingers crossed it is just a small setback which she will soon bounce back from. I know it’s already been said countless times, but this illness is a rollercoaster unlike any other I’ve known.

Keep your chin up, hard as it is, and think positive. Nula has come so far and done so well. You and her are a credit to each other.

Mary and Mable x

[Vally]

Hi Ruth, sorry the results dropped. This happened to Bingo too in the beginning when we were lowering, much too fast. I think it’s a standard reduction as far as vets are concerned, but we’ve seen it happen too many times here. Things go better with super slow reductions unless there’s an urgent need due to extreme side effects.

If Nula is looking good and there’s some colour in her gums, that’s good. Watch that. I like Mary’s idea of getting a local check done earlier. Bingo used to have a PCV done 3 times a week until stable. Then we dropped to twice a week then weekly etc.

Good idea to up the prednisone too, let’s not take any risks.

Lots of love, Vally & Bingo.

[admin]

Ruth,

Bless you – you are being one FANTASTIC Mum here & I am relieved Nula is back on the higher dose. I know you won’t let them push you into anything now – very wise – well done you for sticking up for your pup. Platelets & white blood cells are replaced by the body much, much quicker than the red cells, so this may possibly be the reason it’s only a low PCV now. I found a very easy to follow explanation of how long these things take on a UK blood donor site for humans:
http://www.blood.co.uk/about-blood/how-the-body-replaces-blood/
Quote “unlike white cells and platelets, it takes several weeks for all the red cells to be replaced”
I am very pleased you said the platelets are normal. I agree with Mary – our local vets did a blood test every 3 or 4 days in Worzel’s early treatment, as I couldn’t stop worrying – they also thought this was a good idea as you can see if there are any problems more quickly. A week is too long to spend fretting! The only thing that might be a pain is your local vet’s results are different from DWR. Do you know where they took the sample from? I would personally recommend you insist on a neck sample unless her platelets are low – if my specialist says it’s the best way, IT IS! If her platelets are normal, this would be the ideal way. If they are not, there may be good reason to use the leg (bleeding risk).

There are other drugs than can be added, but I would personally see what her blood results are like over the next few tests. She hasn’t been on the cyclosporine very long & it can take a while to reach it’s full effect. That is another reason NOT to reduce the prednisolone until this happens – it could be 6 weeks or more before the full effects are seen. If her results do not improve or go down – yes – you need to do something, then add another drug by all means BUT can I suggest you get Dr Dodds involved if this happens? She has tremendous insight & experience & would be able to advise your vets as to what needs to be done next in the way of medications.

I have seen other people prescribed vincristine to good effect for their dogs with Evans Syndrome, but I’m afraid it’s not a drug I know a lot about. You can also use azathioprine, but than can suppress the bone marrow in the longer term. It can also cause pancreatitis. Worzel was on azathioprine (still has one 50mg per week) & it worked for him very quickly (2 weeks roughly), but the vet warned me to be vigilant about watching for pancreatitis – any vomiting, tummy ache or diarrhea & azathioprine must be stopped immediately. The specialist told me that pancreatis is normally manifests quickly on starting the drug (the first few days) if it is going to happen. Generally, if they tolerate it for the first couple of weeks, they will be fine. So, no need to worry – loads of options open for you. Dr Dodds would also recommend adding thyroxine because it encourages red cell production (haemopoeitic). I have a copy of her protocol on this if you want me to send it to you. Correct me if I’m wrong, but Nula’s not on thyroxine is she?

Anyway, I’m so proud of you Ruth – you are doing ALL the right things – you have just been misled by a blood test error. This shows the importance of using multiple good results, rather than trusting a one-off good one!

Keep on fighting, as you are doing – loads of love & moral support from all of us
Sheena, Worzel & Creaky Bott xxx

[Linda]

Hi Ruth. I am keeping up, reading posts. Still away.

I am SO darn proud of you for standing your ground. I keep saying this and can not say enough, Sadie was weaned too fast – here I am – over a year later STILL trying to wean her because of the relapse.

I am so thinking of you and Nula. I hope too, you, yourself, are doing okay physically. You are going through so much.

Sending our love and huge, supportive hugs,

Linda and Sadie