Idiopathic thrombocytopenia in dogs

[SuperWanda]

Thanks for the info -- yes, the steroids are unsettling to use. Great if they are helping the problem but it is upsetting to see the side-effects they cause.

After almost two months on steroids Timber has just wasted away. Lost so much muscle and her sides look bloated. I'm hoping that as we reduce the amount it will make her feel more comfortable -- especially if she is battling another issue here.

It reminds me of how she looked when we first adopted her from the humane society. She was just skin and bones, had a bad cold and smelt like garbage. I couldn't believe that they were going to send her home so soon. They wanted to wait a week to spay her and even then, I felt the surgery would be hard on her and it was. She sure has come a long way since then.

Good luck with your guy -- I will be thinking of you as well.

[SuperWanda]

We feel that Timber is improving. She is eating much better now and she seems stronger in her hind legs and back.

We did notice though that her nose is starting to sound stuffy again -- this is what happened when her platelets dropped the first time and her nose started to bleed. I am worried that stopping the Imuran and cutting the dexamethasone back too much may be allowing her immune system to attack the platelets again???

I would like to find a balance between the antibiotic therapy and immune suppressive therapy but really don't know enough about it.

Am trying to get the vets involved again so we can do another blood test to see where we are at.

[hazelrunpack]

That's good news, SuperWanda!!! When is she scheduled for another check with the vet? I think if I were worried about the platelets based on her symptoms, I'd follow up right away, too. I often take ours in for weird symptoms that the vets are surprised actually turn out to be somethings instead of flukes.... As they put it, they'll never discount an owner's concerns about symptoms, however subtle, because the owners know their dogs better than the vets ever can. So if you have a worry because of the stuffiness, I'd have the do the next blood check early!

[MaxaLisa]

Cautiously optimistic, so glad to hear some good news!

I hope you can get a vet to team up with you now that you are seeing some nudging in the right direction - something to be thankful for!

[SuperWanda]

Thanks Hazelrunpack and MaxaLisa!

MaxaLisa -- You'll be especially interested to know that they are now want to do a tick panel.

I have read that it is more accurate before you start the antibiotic so not sure what this means???

Also read that an antibody test as well as a Polymerase Chain Reaction Test should both be performed, but again, am worried about the antibiotic interference.

Trying to get an appointment now for another CBC and figure out where to send the tick tests. She said Toronto but I was online looking at North Carolina State University.

I'm also being cautiously optimistic because I heard that, although the acute form of tick disease has a good prognosis, the chronic form does not.

She said to increase the dexamethasone a little over the weekend if her nose seems stuffy or we see blood.

She also wondered about some kind of fungal infection in the nose but I feel that the nose problem comes from low platelets.

We are at least sleeping better here -- Timber sleeps through the night now on less steroid -- is eating a regular amount of food -- doesn't have diarrhea -- and is not as wobbly in her back. If we can just get the lethargy and weakness resolved that would be amazing!

[Rgeurts]

I'm SO glad to see Timber is eating again and regaining a bit of strength!! I was almost afraid to open the post. I hope you get a diagnoses soon . As for the fungals, we have to worry about that with Nanook as well. He aspirated with one of his seizures and had a transtracheal wash (they flush the lungs with saline, draw it out and send it in for cultures) which indicated Aspergillius, which is a form of fungus. It can definitely cause the symptoms that Timber has and affects dogs with immune related issues. Below is a link to Aspergillius in dogs:

http://www.gopetsamerica.com/dog-hea...rgillosis.aspx

They believe that in Nanooks case it was just a contaminant and he hasn't shown any real symptoms except the runny nose and occasional respistory infection. As the specialist said, if he did have it, he would be a lot sicker than he is.

I will continue to keep you and Timber in my thoughts and

[MaxaLisa]

So now they want to do a tick panel....I would be concerned, only because if they get negatives everywhere, they will be inclined to state there is no tick disease, when you really won't know. As you say, she has been on antibiotics. On the slim chance there is a positive, it's nice to know what you are fighting. Tough situation!

You're right about an antibody test (looks for immune system response) versus PCR (looks for fragments of the disease itself) - both have their problems, and both can give the dreaded false negative

The problem with this low platelet stuff is that you might be looking at ehrlichia, anaplasmosa, babesia, and I think even bartonella or other mycoplasms. You can actually call NCSU or probably even Toronto and sometimes they will talk to you. I spoke with someone at NCSU before I sent a sample there for their bartonella testing (which, of course, was negative!)

Nasal issues are tough. They can be fungal (aspergillus, yes!), or tick related (bartonella produces lots of nasal issues), or probably other things. I never thought about the nose bleed and platelet issue. My boy has nose issues - the insides are red and inflamed and often he cannot breath. The "leather" part peels and bleeds. It's not autoimmune. I am still searching for some answers. I am hoping perhaps thought that there are some allergies.

I hope that you don't have to increase the suppressants. I think that yo-yo stuff makes the antibiotics less effective. I am a big believe in using cetyl myristoleate to dampen inflammatory processes by the immune system. My favorite is the Jarrow True CMO product.

I am just happy to have some good news!

[SuperWanda]

Our vet will come on Monday for bloodwork. We are keeping the steroid at the same dose through the weekend so won't increase it.

Yes, a little worried about the tick tests now. Doesn't seem like it is very accurate.

That is interesting about the aspergillius. Timber has always had a runny nose ever since she was youngbut we've never noticed any pus or any discharge that lookedinfected. It has always been clear mucus.

The only reason I thought low platelets = nose bleeds was what the emergency vet said about seeing bleeding in the nose as a first indication because that is where the vessels are close to the surface.

[MaxaLisa]

I see what you are saying about the nose and the platelets. If the discharge is completely clear, hopefully there isn't an issue with the platelets.

Maybe the nose is just more inflamed because the immune suppressants were keeping that down better when at a higher dose. With Max, his is inflamed - don't know why though. Immune suppressants will reduce just about any type of inflammation?

Hope Timber is still doing a bit better this morning.

[SuperWanda]

Thanks everyone!

I just hope we can all get our doggies to feel better.

Timber is still okay thismorning. I am very happy with her appetite and she had a little walk around the yard even though it seemed tough.

Just really sleepy and weak.

I'm a little nervous about the CBC on Monday. I just want some good results and I especially don't want to see that her red blood cells have dropped. She has been getting dog vitamins, liver and had some eggs with spinach. Trying to give her good iron rich foods.

MaxaLisa - picked up some whey protein and l-gutamine today so will see if I can mix that in with some yogurt or wet food today.

[MaxaLisa]

You are doing such a great job with Timber, thank you for giving her a fighting chance when it seems that the vets wrote her off!

Blood tests at this point are scary things, I hope that this one brings some better news too o

I hope that she doesn't have any issues with the glutamine or whey. Glutamine is very well tolerated, I've never known it not to do anything but help. Whey, in general, is just a good source of amino acids to support the body in times like this. The only time I've seen an issue with it, is when there is a severe dairy intolerance. Even my girl, she could not tolerate a lot of dairy, but she could tolerate whey. Max, the GSD, has a pretty bad dairy allergy, so he can't have whey.

All the good iron rich foods have to be helping, and, with the abx, I bet are part of the reason that she is able to get up and around, to the extent that that is possible for her right now.

I am nervous for Monday too!

[SuperWanda]

Thanks MaxaLisa,

No problems with Timber and dairy. It's one of the food groups she loves.

I actually think it was goat's milk that saved her last week because that was one of the only things she liked.

Thank goodness she's back to eating meat!

[hazelrunpack]

Crossin' all our fingers and paws here for good results on Monday, SW.

[MaxaLisa]

Originally Posted by hazelrunpack

Crossin' all our fingers and paws here for good results on Monday, SW.

ditto here!

[SuperWanda]

Thank you Hazel, MaxaLisa,

Might not get any results back until tomorrow because my vet is a mobile vet and the samples go to the university here.

When her blood was taken it was very dark compared to a few weeks ago when it was thin and light colored. Hopefully that means better results

Tick testing to Toronto but just antibody testing for the common ones in Canada. Not for Bartonella or Babesia and it sounds like the specialist doesn't believe we get these diseases here even though I talked to someone from North Carolina State Testing Lab and they have a few cases in their database. The thing is, they just don't have a lot of data from Canada. How can we say something isn't here if we don't test for it? I know it might be rare but think it would be good to rule out especially if they require different antibiotics for treatment.

That's to say IF she has a tick disease I guess. I asked if her RBC came up would that mean it wasn't cancer? It would have to remain elevated and not drop back down.

Still a mystery I guess so one day at a time.

[MaxaLisa]

So hoping for good news?????

[SuperWanda]

Finally some good news!!!!

Timbers platelets are up to 184. Her WBC down from 41.6 to 18.4. RBC up from 2.2 to 2.8 and PCV up from 15 to 23.4 (I don't even know what that is but has something to do with the transfusion range which she was previously in).

Does anyone know if it takes awhile to produce red blood cells. I really thought it would be higher but am not complaining because at least it is going up!

So, now we just see what the tick testing says. Not sure if antibiotics will affect the antibody test???

If they are negative I'd like to send to North Carolina for Babesia and Bartonella since they don't test for those in Canada.

My regular vet is happy and supportive of us looking at this as a rare case. I hope that the internal vet also sees that something positive is happening and wants to investigate further.

[Rgeurts]

Originally Posted by SuperWanda

Finally some good news!!!!

Timbers platelets are up to 184. Her WBC down from 41.6 to 18.4. RBC up from 2.2 to 2.8 and PCV up from 15 to 23.4 (I don't even know what that is but has something to do with the transfusion range which she was previously in).

Does anyone know if it takes awhile to produce red blood cells. I really thought it would be higher but am not complaining because at least it is going up!

So, now we just see what the tick testing says. Not sure if antibiotics will affect the antibody test???

If they are negative I'd like to send to North Carolina for Babesia and Bartonella since they don't test for those in Canada.

My regular vet is happy and supportive of us looking at this as a rare case. I hope that the internal vet also sees that something positive is happening and wants to investigate further.

Yay Timber!!!!
Even though the RBC isn't a huge jump, it's going in the right direction!!
This link may help you understand a bit more about the CBC. I found it so I would know what everything meant with Nanooks:

http://www.peteducation.com/article....2+1473&aid=987

PCV=Hemocrit

I her results continue to get better with each test!!

[MaxaLisa]

I cannot express how completely relieved I am to see this! I am also glad that it sounds like you have your regular vet in your corner. Do you think your reg vet will continue with the treatment that you have been giving? This may take months, and like mine, may have to be on doxy for a very very long time....

Antibiotics have a great potential to affect antibody tests, and I suspect PCR tests to some degree. While PCR tests, if positive, are definitive, negatives aren't. I keep hearing though that antibodies take a long time to decrease, so if they have the right test, it's possible you could get a positive. If they don't test for the right organism, then back to square one.

I know that the full Bartonella testing at NCSU is expensive. They told me that antibiotics like amoxi and doxy will keep the organism in check (and may skew the test results), but they can't eliminate it. They use azithromycin, the same abx that dropped Max's platelets.

[SuperWanda]

Thanks for the link Rgeurts.

MaxaLisa -- for now we stay on the doxy. I have finished the metronidazole so I will be interested to see what happens because for the past few months, when she was not on the metro, she had diarrhea but when she was taking the metro, she didn't.

I am still confused as to what is increasing the platelets. She was only on doxy for two doses before she had a reading of 141 -- not sure if it you would get an increase that fast. And now it is 184.

I also hope that her RBC will continue to rise and it's not just up because of my vitamin and liver supplementation.

We get another blood test in two weeks so I'll be interested to see where we are at that point.

For now, she is off the Imuran and I have the dexamethasone down to 1mg in the morning and 1 mg at night.

I was also thinking about the time I was 24 years old and got mononucleosis. I was extremely ill and had to drop out of University. Could barely get out of bed or eat for a month. My spleen was enlarged and I was jaundice. It took at least a couple of years after that before the fatigue subsided.

Not saying my dog has mono but is it possible there are viruses that cause these types of symptoms in dogs and that, eventually, they will run their course???

[MaxaLisa]

Just some rambling thoughts...

Great questions to which you may never have satisfactory answers!

Seems to me that Timber is in the chronic stage of *something*. The immune suppressants I am sure played a major role in bringing the platelets up. However, without the addition of the abx, they were also making her sicker in other ways.

The abx, I'm pretty sure, are what brought the WBC down. Whether it was the metro or doxy (or the combination, which is often important).

RBC, at thie point, I bet is anyone's guess.

Your "mono" question, that opens the door to a whole new school of thought, to which a number of folks subscribe to - all the subclinical type of infections that we harbor that make us ill on a grander scale. Knowing the things that different people have done to get better, I could see a ciral component, though I strongly believe that it's a blood infection. I think with viral, perhaps a different type white cell is elevated?

I would be nervous taking the metro off, but since you're watching closely and will be testing, it will be interesting to see how the immune system responds.

[hazelrunpack]

Seems like a lot of positive news since last I logged on Hurrah!!!!

Sending that the trends continue!!

[SuperWanda]

Thanks everyone,

Timber is also going to continue with the metronidazole. It seems like she is developing some runny stool after only a few day off. This seems to be an ongoing thing with her the past few months -- she's been on it for 10 days at least three times now and whenever we stop her bowels have trouble.

Maybe I should also up the probiotics. I am only giving 1 capsule between doses of the antibiotic but maybe she needs more.

She is still eating well. I feel if we can get her blood results back to normal it will still take some time to get her strength up again. At least she is showing interest in taking walks again - - she just can't go very far.

[Myka]

Sorry I haven't logged in in a long time. Timber has still been in my thoughts. I just read everything to catch up, and I was very worried for awhile there! I'm happy to hear Timber is improving, and I have my fingers crossed that you get some answers or at least you continue with improvement. Good for you! And please give Timber a pat for me, what a tough girl!

[MaxaLisa]

Has Timber ever had issues with ongoing Giardia? If so, maybe panacur would help? I wonder what the deal with the stools are - if they are related to all the other stuff, or something else.

My Max here has stool issues - I've found some digestive enzymes really help, others not so much.

It wouldn't hurt to play around with the probiotics. I recently found that Max is allergic to dairy, so he has to have a non-dairy probiotic, and I've had to take the yogurt out of the diet. Since Timber's problems seem to resolve with metro, it certainly sounds infectious.

So glad to see Timber still doing well!

[MaxaLisa]

Just ran across this info in humans:

"Chronic Babesia infects only about 1% of RBCs so it isn't all that easy to find."
From here: http://lymemd.blogspot.com/2008/09/babesia-i-hope.html

That means that a PCR test, that looks for fragments of DNA and such, sounds like it is looking like a needle in the haystack. NCSU may have better information.

[SuperWanda]

Thanks Myka --Yes, we thought she wasn't going to make it. She is still sick but showing improvement. We have another blood test on the 14th.


MaxaLisa -- Both my dogs have been on and off metro for boughts diarrhea with mucus. (Probably my fault for allowing them to live a dogs life and swim and drink stinky river and pond water). I'm not sure about giardia in the past but Timber's stool came back clean just recently when it was tested for parasites. I would think that would include giardia???

My vet was wondering about some kind of systemic colitis? I don't know.

Today I read that you shouldn't give probiotics while taking steroids so she has about a week left on the dexamethasone. After that I thought I'd get serious with the probiotics. There is one product called Bio-K that I have used myself and it comes in non-dairy (might be good for your Max) http://www.biokplus.com/ They only use two strains -- this is from their website:

Why does Bio-K+ CL1285® contain only two different strains of bacteria?
Scientific articles show that if there are too many different bacteria in the digestive system, they can compete against one other, limiting the concentration of the most effective strains1. There is a natural synergy that occurs with L. acidophilus CL1285® and L. casei LBC80R® which is particularly effective against pathogenic micro-organisms. The result is a dual efficiency, with each Lactobacillus strain complementing the other.

Now, this is for humans but when I contacted them they said they have had some good results when it has been used with other animals as well.

It is been used in hospitals to treat C-diff and has gone through a number of clinical trials. Also helpful for treating colitis. I'm going to give it a try and see if I can't get her immune system strengthened because I'm sure with all these meds it's been severely compromised.

[rainbow]

I haven't logged on here for awhile but am very glad to hear that Timber is doing better. I did answer your pm about zinc deficiency but after reading your last post I would really check into a diagnosis for giardiasis.

Originally Posted by SuperWanda

Both my dogs have been on and off metro for boughts diarrhea with mucus. (Probably my fault for allowing them to live a dogs life and swim and drink stinky river and pond water). I'm not sure about giardia in the past but Timber's stool came back clean just recently when it was tested for parasites. I would think that would include giardia???

Giardia is very difficult to detect and you have to have several stool samples checked as it is not always shed in every one. I think there is a specific test they have to do and I'm pretty sure if left untreated it can cause mild anemia as well.

[rainbow]

Here's some info on Giardia I just found .....

From http://ezinearticles.com/?Symptoms-o...gs)&id=2524242

There are some clear factors of infection like a big number of white cells or anemia in the blood test. These are quite clear signs of infestation.

From http://www.canismajor.com/dog/giardia.html

If the dog is healthy, the trophozoites may live in the lower digestive tract for years. If the dog has an immature or overburdened immune system, the trophozoites continue to multiply by dividing and can cause the debilitating disease.

Blood tests appear normal with the possible exception of an increase in a type of white blood cells and mild anemia.

[rainbow]

Here is some more info on Giardia ....


http://priory.com/vet/giardia.htm


http://www.beaglesunlimited.com/heal...and-prevention