Immune-Mediated Thrombocytopenia And Hypercalcemia

[Guest CaspersMom]

Hi,

Well I’ve joined a community that I never wanted to join and I need help. My sweet boy, Casper has been diagnosed with IMT. Casper is a 9 year old greyhound. My husband and I adopted him and his niece over 2 years ago. We didn’t know they were related until we looked at the greyhound breeding website and found that Casper’s father was Phoenix’s grandfather.

Anyway, in mid-May, Casper had a bad bout of diarrhea. I took him to the vet and he was given an anti-diarrhea shot and put on a chicken and rice diet. The diarrhea would clear up but a week later would come back. This went on until early August when it finally stopped, but in between, he was given more anti-diarrhea shots, low-doses (10 mg) of prednisone, antibiotics, Endosorb, and Fortiflora. The antibiotics were mostly metronidazole except for a 7 day course of SMZ/TMP in early June. After physical exams and blood tests, my regular vet thought Casper had Inflammatory Bowel Disease and suggested we try Chinese herbs. By then, he had gone from 81 pounds to 67 pounds. His racing weight was 71 so he had been a little overweight at 81.

On July 25^th, I took Casper to a vet in Port Charlotte, FL who is trained in acupuncture and alternative medicine, as well as western medicines. I’ll call her Dr. A. She examined him, gave him acupuncture, changed his diet to Royal Canin PD, and gave him Happy Liver. She continued him on the metronidazole and the prednisone (with the intent of weaning him off). At first when I would try to wean him off, the diarrhea would come back, but as I said earlier, we finally got him back to normal bowel movements in early August, but still on prednisone. One odd thing… When Dr. A would palpitate Casper’s abdomen below his hips, he would yelp. He did this several times that day. Other times, it wouldn’t bother him at all.

On Sunday, August 12^th, (isn’t it always on the weekend) Casper peed in the house and there was blood in his pee. I took him to the Emergency Clinic and they checked his urine – he did have a UTI. They did an x-ray to check for stones – there weren’t any that they could see, but they did see a mass in his abdomen. They gave me Calvamox and I took him home. I fed him and gave him the Calvamox. He threw it up along with the pill. He just wasn’t right so I took him back and they kept him overnight. They did blood work (his platelets were fine) then gave him an IV cath because his total calcium was slightly elevated. The next morning, they released him to Dr. A. She called around noon and said I could pick him up. She arranged for him to get an ultrasound on Wednesday. She took him off of the Calvamox (causes nausea and diarrhea) and put him on Baytril. He hasn’t had blood in his urine since that day.

Casper had the ultrasound on August 15th…everything looked good. The “mass” turned out to be his spleen and there were no other malignancies that they could see on the ultrasound or check for physically. Dr. A. did an x-ray to check the lymph nodes in his chest that could not be felt. They were all OK. She did more extensive blood work, but it would take 10 days to get it back. In the meantime, Casper must have hurt his back. I think he slid his rear end under our bed and when he tried to get up, he twisted his back. When he would get up, he would yelp and sometimes, he would experience incontinence. When he walked, he would drag his back feet and he was wobbly. I brought him back to Dr. A and she gave him acupuncture, which helped, but having him at home was not conducive to his back healing. Last Tuesday, I asked if they could board him because every time he got excited about something, he would jump up and be in pain again. By then, she got his test results back and his ionized calcium was still elevated (1.65) and his PTH was low. She also x-ray’d his spine and there were no obvious problems like disc disease or spinal cancer.

Dr. A. called me Friday and asked if she could do another blood test. He hadn’t had a CBC in 3 weeks and she noticed petechia in his eyes. His platelet level had dropped from 115 to 56 and he now had bleeding in his gums. She has put him on 70mg of prednisone daily and on Tuesday we will talk to the oncologist to see what their thoughts are as to what our next steps should be.

I don’t mean to sound whiney, but we have had a rough year. My husband, who is almost 80, was very sick with pneumonia during April and May. He finally finished physical therapy last week. But all it takes is a cold and he could be sick again. Casper has been sick since May. Then my stepdaughter passed away in July. Needless to say, my nerves are shot and I cry at the drop of a hat. I saw this forum and thought I could use your help.

I am not ashamed to say that I am very nervous about bringing Casper home. Dr. A. said there hasn’t been any more yelping – and he isn’t dragging his back feet or wobbling. I am worried about the possibility of cancer. But I am also worried about the prednisone side effects, especially the peeing and the panting. What do you do for the peeing? It was hard enough when he was on 20 mg. If I took him out every 4 hours, for the most part, he wouldn’t pee in the house. I can’t imagine him on 70mg. I would never withhold water – he needs it, but he is a big and tall dog. When he pees, he really pees. I don’t think puppy pads will cut it. And I am worried that a belly band may not work. What do I do?

Thanks,

Lee

[galgrey]

I'm sorry you are going through this. I've no experience with IMT, but one of my dogs is in renal failure and is incontinent. I buy the human incontinence pads (the maximum or super absorbency) and put them inside the bellyband. They have an adhesive strip on the back that will anchor them to the bellyband, and if the bellyband is fitting snugly, there is no leakage. I typically change him at lunch time if I can get away from work, after work, before bedtime. Hope this helps.

[DesiRayMom]

Welcome, Lee. I'm so sorry you've had such a trying year.

 

I don't have much luck with belly bands, myself. Desi managed to get them "turned" so the protection is over his back instead of where it needs to be.

 

My other thought was to wonder if another immune suppressant other than Pred might be appropriate. The two that came to mind were Azathiprine (sp?)

or cyclosporine. Desi is on Atopica (cyclosporine) every other day probably for life. The first month or so is every day, and there were some side effects,

but now that it's every other day.....none whatsoever.

 

Wishing the best for Casper.

[tbhounds]

Did the vets run any tests that sound like ANA, Coombs or even biles acids (to check liver function). Also-and here's the biggie-did they run a tick borne disease test?

[tbhounds]

I forgot to add that unfortunately with your hounds elevated calcium level the imha may be secondary to cancer. Did they offer an ultrasound?

[KF_in_Georgia]

I forgot to add that unfortunately with your hounds elevated calcium level the imha may be secondary to cancer. Did they offer an ultrasound?

She said ultrasound August 15.

[tbhounds]

I forgot to add that unfortunately with your hounds elevated calcium level the imha may be secondary to cancer. Did they offer an ultrasound?

She said ultrasound August 15.

Humm missed that although it might be worth repeating now.

Edited to add--if Casper did/does have IBD it may have morphed into cancer-pretty tough to pick up on ultrasound (besides finding enlarged lymph nodes -sounds like they ruled out an intestinal mass-aka lymphoma)-really would need a endoscopy with biopsies --Casper doesn't sound stable enough for that right now. My bridge boy Poots had IBD--he had multiple abdominal ultrasounds after he started to become very ill. The ultrasounds showed zip-zero. It was the scope and biopsies that showed the IBD morphed into adenocarcinoma-bad news. Geez, hope this isn't the path that Casper is on.

Edited September 3, 2012 by tbhounds

[Guest CaspersMom]

Wow, its great to get responses so fast.

 

Galgrey - thanks... I bought a belly band and will try it with the human incontinence pads.

 

DesiRayMom - I will ask the vet about using something other than prednisone. She is supposed to call tomorrow with an update on Casper.

 

tbhounds - I hope not either. I know chemo for canines is not like it is for humans, but we're still not sure what we will do if he has cancer. Our vet keeps telling us, "Don't panic." I'm sorry to hear about Poots.

[Guest CaspersMom]

tbhounds - I will ask the vet about the tests you mentioned. Thank you.

[JJNg]

I'd also be concerned about the possibility of tick-borne disease, such as ehrlichia, which can cause a low platelet count. Most of the time when starting a dog on immunosuppressive medication for suspected immune-mediate thrombocytopenia, it's also a good idea to give doxycycline at the same time to make sure the possibility of TBD is covered. It can take several days for TBD bloodwork panels to come back. I agree that cancer is also a concern, but hoping that's not the case.

[Guest CaspersMom]

Hey good news!! Casper’s IMT seems to be responding to the high dose of prednisone and he’s only been on it for 1-1/2 days. The petechia on his gums has disappeared. The petechia in his eyes has decreased. He had the tick borne disease test in February, but Dr. A is going to do it again and check his platelet count at the same time. Even though he is on 70 mg of prednisone, he is not peeing any more than before (about every 4 hours) and his panting has decreased. I asked her about the ionized calcium level which is 1.65 – the range is 1.25 to 1.45. I asked her at that level, what it means. She said that it is not that high. It could mean nothing. Usually dogs (and people) with cancer have much higher levels. She will be talking to the oncologist tomorrow. If all goes as planned, we will pick him up on Wednesday morning. Can’t wait and neither can his niece, Phoenix. Thanks again for all your ideas and support. They’ve helped tremendously.

[tbhounds]

Greyt news! Keep us posted!

[Newgreymom]

I would add Doxycycline. Our Daisy had symptoms of IMT and all that helped was the Doxy. We ran every TBD imaginable and all were negative. Dr Couto suggested the Doxy and she recovered extremely well. Her platelets went to 36. That has been 6 years ago and she's a healthy 11 year old now.

[tbhounds]

I would add Doxycycline. Our Daisy had symptoms of IMT and all that helped was the Doxy. We ran every TBD imaginable and all were negative. Dr Couto suggested the Doxy and she recovered extremely well. Her platelets went to 36. That has been 6 years ago and she's a healthy 11 year old now.

Absolutely, Doxy is cheap as heck and honestly, at this point what would it hurt?

[Guest CaspersMom]

Sad news. We had to put Casper to sleep yesterday. He kept losing weight and was getting weaker and more lethargic. We weren't able to test him, but we and our vet believe he had cancer in the intestinal lining.

[Wonder]

I'm so sorry

[Guest newgreymama]

I'm so sorry.

[tbhounds]

Ugh--so sorry :-(. Fwiw--I think he had cancer lurking too--rip Casper.

[greyhead]

Oh dear, I'm so sorry. All good thoughts to you and your family.

[Batmom]

I'm so sorry for your loss.

 

Godspeed, beloved Casper.