Page 58 – Second Chance AIHA Dogs

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Keymaster

Hi Ruth,

I am really happy that this PCV is this high! Wonderful news! You must be beside yourself with relief.

I am, however, peeved about the mistakes with the blood sample. This happens far too often. In a healthy dog, an odd number is clearly a mistake and most vets won’t say anything about it. In a dog whose medication dosages are determined by the results of these tests, it is inexcusable for them not to take great care with these tests.

May I suggest that you do a few things to you to make this situation better?

Make sure that Nula has fasted about 8-10 hours before the test but make sure she is well hydrated, provide lots of water. Trying to get a good blood sample from a dehydrated dog can actually damage the sample, leading to these kinds of problems. Dehydration can skew the results, changing the percentage of some things incorrectly. The red blood cells can also bang against each other due to the slow tube fill and burst causing clotting. Eating too close to the time of the test will increase the number of fat molecules in the blood. These can cause aberrations in the sample that the automated laser will have trouble seeing through. The sample would be referred to as lipemic.

Schedule a time when you know the clinic will be quiet. Try to avoid any stress to Nula. Dogs react to many situations by being over-alert. This can cause changes in the blood that can skew the results as well. If you can, try to get there really early in the morning when it is quiet and she is sleepy.

Always politely ask to be with Nula when they do the blood draw. Be abnormally quiet and reserved so she will not reflect your nervousness. I actually sit on the floor with my dogs petting them and singing to them quietly to relax them.

Carefully observe the behavior of the techs that take the samples. If they are nervous and fumble, seem to not be sure what they are doing, remember their name. When you find a tech that is good and that Nula likes make sure you get their name. When you schedule the next appt ask for her/him. Say whatever you have to in order to make that happen but always be polite and respectful, “oh Nula loves Sam so much, is there any chance she will be available to do her blood sample on thursday morning?” Be agreeable to changing your schedule to have that tech.

Never leave your dog alone with the staff when you are there. Be extremely polite, but nicely insist that you are with her. Say something like you are studying how something is done and you want to watch or be profuse about admiring how clever the tech is. Just make it happen.

This is the only way you are going to find out who and how these samples are getting goofed up. A sample needs to be taken carefully and efficiently, the sample tube needs to be handled carefully, it needs to be taken care of immediately. In all three cases it will clot abnormally.

If you are suspicious, don’t make a big fuss with that tech but in a bit mention you need to talk to the vet before you leave. Be polite to the vet but suggest that “you think that a mistake was made with the blood and could the vet be so good as to check it before I leave? I would be so worried if this happened again.”

You are Nula’s advocate and no one cares as much as you do about her health. Be polite but get what you need. Always be gracious and thankful to the vet, but make this happen.

Prednisone reductions should be made at about 25-33%. They should always be preceded by a full CBC. In between these reductions you should schedule a single PCV, which should not cost you more than $15-20, to make sure she is staying stable. Put at least 2 weeks but as much as 3-4 weeks between changes. When you get to lower doses, figure out the dosage reduction over a week’s average rather than the daily dosage. For instance if is 20mg a day (10mg BID):

multiple 20 by 7 = 140mg per week

140mg * 33% = 46

140-46 = 94

94/7 = 13.5mg

So you could go down to 10mg or to 15mg. I would be apt to go to 15 mg per day. I would have, if this were me, given 10 in the morning and 5 in the evening. Your vet is always the person to ask about this. My reasoning is that dogs need that cortisol early in the day when they are active, it helps them with the stress of the day better.

When you get to much lower doses, your vet may want to try to go to an every other day dosing. This will help “wake up” the adrenal glands that have become inactive while you flooded the body with excess cortisol in the form of prednisone. There is a risk during this time that they won’t wake up as fast as we thought they should and the amount of prednisone is too low. So that is why we go very slow, to give those glands time to wake up!

The Atopica is a good drug to continue providing the immunosuppression that is required. Keeping her at doses that are comparable to what is the normal maintenance dose on the packaging for a dog with allergies.

my best

patrice

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