Patrice - 39. page

[Patrice]

Meghan,
I absolutely think this blood test is not accurate, if you want my honest opinion. There is a HUGE difference between the value of the hematocrit from the CBC and the value of the PCV (hand spun test.) These two tests are essentially measuring the same thing so should be very similar (but not exactly the same), they are just accomplished in different ways, one with automated laser machines and the other is viewed visually against a chart. The PCV is very accurate and reliable. In very sick dogs the automated is more dodgy and can put out errors.

I’ve seen these kind of mistakes many many hundreds of times in the 8 years I have been helping owners. I get quite irritated that it is still happening to owners who have very sick dogs. Not only that it is very expensive.

To resolve this, always be polite, but get your way. Try to pick out the tech that seems to be the best one of the group and politely request that your appt be with her/him for the next blood draw. Use any excuse you want, be polite and perhaps a bit goofy, but you drive the bus. This is your money and you deserve the best treatment for Gabby. Her treatment protocol depends on these results. You don’t want to change her meds in response to an invalid test.

Be sure Gabby is fasted 8-10 hours before the test to avoid fat in the blood, but make sure she has lots of water. Prednisone can lead to dehydration. Try to get her fluid intake up before they draw the blood. Keep her stress level very low, get there early and find a quiet place to rest her so she is not excited. If you have to be the first appt in the morning or the last one at night, do that.
my best
patrice

[Patrice]

Meghan,
This is something called a syncope. Basically fainting. Chance had syncopes when he developed a heart condition because he had an irregular heart beat. But this can happen to any dog that has low blood pressure.

Why would her blood pressure be low? Well Vally already mentioned that this could be an Addisonian Crisis. This arises when there is not enough cortisol in the body to help the body handle stress. In dogs we know that something simple like hearing the door bell is a stressful event. You know what you feel like when you are almost in a car accident, your heart races, your breathing increase and you feel highly focused and a little buzzed. That’s what cortisol does for us, prepares us for fight or flight.

High dose treatment of prednisone (similar to cortisol) plays a role in causing the adrenal glands to shrivel up and “go to sleep,” aware that their job function is no longer needed. When we start to decrease prednisone there is a risk that during periods of stress there may not be quite enough cortisol to help the body prepare. One of the important things that happens is that the heart is stimulated to beat faster to provide more blood in circulation.

Another cause for low blood pressure is a very low level of albumin in the blood. This protein keeps our blood very viscous and prevents fluid from leaking out of the capillaries. If it becomes low, fluid will leak into local tissues and the blood volume will drop dangerously low. This decreases the blood pressure.

Gabby also has anemia so the blood she is pumping is low in oxygen. That makes this even more complicated. The body simply wants more oxygen to body tissues and if it doesn’t get it then the brain begins to conserve blood to the core, leaving the brain out of loop. Nature built us to basically faint when this happens so we become horizontal and can distribute blood more evenly. So the fancy word is syncope.

This can often be mistakenly confused with seizures. The difference is that with syncope a dog will often recover very rapidly, while a dog that is having a seizure may experience some disorientation long before the seizure and be out of it for a much longer period of time after the seizure.

I am sorry, but they both look very frightening and I have experienced moments of terror for Chance. However, of the two, the seizure is far more serious.

So the best thing to do is enforce absolute quiet in your house. Turn off the door bell and turn down the phone. No guests etc. I wouldn’t let her get up on furniture for now so she doesn’t risk falling off the couch or bed.

Your vet may want to perform a test that measures the levels of cortisol. However a dog can’t be on prednisone before this test so it’s not often practical for dogs in treatment for AIHA. The best thing to do is control the symptoms as best as possible until there is a better red blood cell count and the blood pressure begins to return to normal. Your vet may notice a heart murmur from the anemia.
my best
patrice

[Patrice]

Alyssa,
This perhaps can be several things. I would need to see her most recent chem screen to see if she has a low value for albumin. Low levels of this important protein can lead to Hypoalbuminemia, follow the pop up link to read about this condition which causes fluid to seep out of the capillaries into local tissues. This creates edema in body tissues.

If her white blood cells are high on her last CBC she could have an infection. Or this could be even be a symptom of allergies. Many dog suffer those at this time of the year. Chance had life altering allergies and his lymph nodes seemed to be chronically enlarged during the spring and fall. He eventually received shots for this. Allergies are often implicated as a trigger in autoimmune diseases.

Another cause can be Canine Lymphomas. Follow the pop link to read more about these conditions. The most notable initial symptom is paired enlarged mandibular lymph nodes (under the neck).

Post me a picture via the Upload Photo box on the upper right side of the page and I would suggest you make an appt with your vet much sooner than 2 weeks. This could be nothing or it could be something.

If this were my dog I would want Dr. M to give me her opinion. And in fact I just went through this with Cassie about 4 months ago. I was frantic for a week. A simple biopsy of the enlarged back leg (popliteal) indicated it was an “unfortunate place for a fatty tumor.” Dogs are just very prone to them. However, this was on only one side, not both. The two sided swelling in Sassy concerns me a bit more.

Please let me know what happens. Good luck and let’s hope it is nothing!
my best
patrice

[Patrice]

Meghan,
So good that Gabby is coming home! She must be so happy to be with you…

Your test results did attach to your urgent advice request. Looking it over I see that the vet is noting that there may have been some problems with this blood sample.

One possible problem that is mentioned is lipemia. This is fat that was in the blood from a recent meal. It is usually a good idea to fast 8-10 hours before the test to avoid this. The fat can make the blood sample difficult to read. Think of what oil floating on water looks like, for instance in a puddle of water. It can refract light changing the thing underneath the oil

Another thing that was mentioned was that there could be sample hemolysis. This means that the blood could have been damaged at any time while it was being handled. For instance if a dog is severely dehydrated the blood draw can be difficult to get. Cells can bump around against each other and become damaged. This can also happen if the tech is not careful with the sample tube, red blood cells will break. If the sample sat around too long before they worked with it, then there could be “artifacts” or abnormalities in the sample.

What to do? At this point the vet should take another sample. Evaluating Gabby’s condition with this sample in mind might lead to incorrect conclusions about her condition.

I do note that the glucose is a bit high. Again this could be incorrect, but it can also be a side effect of the prednisone. Sometimes, not very often, high dose prednisone can create a temporary diabetic condition. In those cases it is often a good idea to reduce the prednisone as quickly as is practicable. Your vet should be thinking along these lines.
my best
patrice

[Patrice]

Alyssa,
On Second Chance we like to follow Dr. Dodds’ advice on many things veterinary. Her advice for heartworm is well written and based on many years of working with dogs that have or had AIHA IMHA and non-regenerative anemia.

You can read her column on this here in our Hemopet Resources:
https://www.secondchanceaihadogs.com/hemopetresources/

Click on Dodds Heartworm Recommendation

This will open a new page where you can read this article!
my best
patrice

[Patrice]

Pam,
Chance had liver enzymes 18-20x normal after months of non-regenerative anemia. Once I was in contact with Dr. Dodds the treatment protocol was changed. Part of his treatment was Denamarin and I considered it one of the most essential parts of his recovery. Within a short time his liver values dropped to within only 2-3x normal. Once he was drug free, his enzymes were normal.

You can read Chance’s story under Our Stories. This website is in memory of him.

I promise you this will help. The liver is highly regenerative, and if there was no organic disease of the liver prior to this illness, the liver will generally recover.

Make sure you are feeding a simple diet similar to Dr. Dodds liver sparing diet. Some kind of steamed white fish, cooked potatoes or yams, and some simple vegetables steamed and minced. She likes to add a bit of Italian herbs after a short time and also an egg now and then.
my best
patrice

[Patrice]

Pam,
Try reading this and see if it helps you some.
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone-dose-reduction/
My best
Patrice

[Patrice]

Lynn,
I would need to see the CBC to be sure, but I am pretty certain that this is a normal collection problem where the platelets “clump at the feather edge” in the smear on the slide. If you look somewhere on the bottom of the sheet you may see something like “platelets adequate.” Usually if the dog is healthy in all other ways or previous tests have shown them to be normal, they will view them under a microscope and make an educated guess that they are actually in normal numbers.
my best
patrice