Low Platelet Count For Lacy - And Getting Lower

[tbhounds]

I have been giving her some pepcid (a half pill every 12 hours) along with her antibiotics, btw. Just to help with her stomach.

 

And no, I don't know about regenerative anemia at all. No one mentioned it. Guess I will ask.

Definetly inquire about the tummy meds. When my girl was taking pred she also took Prilosec and carafate concurrently to prevent tummy woes (prescribed by Ohio state).

You might want to update Dr Kellogg to get their take on the latest--there are other drugs that can be added so you don't have to use such a high dose of pred.

Sorry this is happening-it is what it is but, it still stinks-not going to be an easy road ahead of you :-(

[KF_in_Georgia]

Ask your vet how much you can go up on the Pepcid if you need to. Also ask about other meds you're giving Lacy. And for any meds that have to come from your vet's office, make sure you've got an adequate supply on hand.

 

The thing is...it's a holiday weekend coming up. You don't want to wind up in the ER just because you don't know how much you can adjust meds that aren't working right. And a lot of vets offices will take a long weekend off.

 

I've got a frail old boy with back trouble that sometimes is very painful. I got my vet to tell me the max dosages on Sam's pain meds. We're nowhere near needing that level, but I know what I could safely do if I needed to. And Sam's prescriptions are all filled by my local Walgreens (a mile from my home), and I already know which ones I need to get refilled and whether I'll need a vet's approval on refills. (Things like knowing we're good for one more fill of Tramadol before the vet needs to authorize it again.) But if Sam were in pain and I had to take him to the ER, there'd be a lot of expense, and possibly an insistence on redoing procedures my vet has already done just because they couldn't get hold of my vet.

 

Oh--and that's something else to consider: Ask your vet what paperwork and lab results the ER would need if you had to take Lacy in on the weekend. You can have your vet's office print out a copy of Lacy's records. When Jacey crashed, we'd had bloodwork that had been done 60 hours earlier, and my vet faxed the records to the ER; that was tremendously helpful because that gave the ER vets baseline numbers from just a couple of days earlier.

[greyhead]

When you said the titers were "negative," did you mean that they were positive but not high enough to be considered significant? The vet who keeps watch over the Tick List, Dr, Beckett, has said that even low-positive titers are significant and should be treated if the dog is symptomatic.

 

I know the PCR test is the latest in tick testing techno-whizbang. But I called and talked to NC State about it for one of my greys who had a low-positive titer for Babesia from Prototek. The researcher I spoke with explained that a negative PCR result means nothing, just like a negative fecal, so we can't draw any conclusions from a negative result. (A positive result is quite definitive, which is one reason people like the PCR test, whereas the significance of positive titers can be debated.)

 

The PCR is looking for genetic debris from the disease organism, analogous to microscopically small skin cells shed by humans. The researcher explained that testing a sample with the PCR is like dipping a bucket in the ocean; you know there are fish in the ocean, but the odds of actually bringing any up in the bucket are very small! Some people feel that repeating the PCR a second time will settle that question, but I don't see why the odds improve greatly from dipping a bucket in the ocean twice. I went with the titer results and skipped the PCR that time, treated for the positive Babesia titer, and was never sorry. And the PCR is not considered suitable in testing for Lyme at all, so the lab would only run the titer test for Lyme.

 

Maybe the approach to testing has already been decided, but I thought I'd throw this out there. And I really want to wish you the best.

Edited November 20, 2012 by greyhead

[Guest OurLacyandJax]

Ask your vet how much you can go up on the Pepcid if you need to. Also ask about other meds you're giving Lacy. And for any meds that have to come from your vet's office, make sure you've got an adequate supply on hand.

 

Oh--and that's something else to consider: Ask your vet what paperwork and lab results the ER would need if you had to take Lacy in on the weekend. You can have your vet's office print out a copy of Lacy's records. When Jacey crashed, we'd had bloodwork that had been done 60 hours earlier, and my vet faxed the records to the ER; that was tremendously helpful because that gave the ER vets baseline numbers from just a couple of days earlier.

 

Thanks KF_in_GA - good advice. She is not on thyroid meds anymore. We pulled her off of it as her numbers are fine. So she is just on Doxy (I have enough to cover past Thanksgiving weekend) and Prednisone (plenty as well). Have plenty of generic pepcid with me - and I will call the vet to ask about how much I can give her.

 

And those records - yes, I have some of it, but I will be getting the latest faxed to me today.

 

Greyhead, good question about the tick titer. Frankly I don't know. They said it was all negative. So I didn't inquire further. I can ask again, and may be get a report faxed to me.

 

Tbhounds, thanks, and Dr.Kellogg at OSU was updated yesterday right after I updated this forum. Have not heard anything back from her. (EDIT : no the email to Dr.Kellogg was not sent yesterday, as I just found it sitting in my drafts folder. Ugh. So it is sent now.)

Edited November 20, 2012 by OurLacyandJax

[carronstar]

Keeping Lacy in my thoughts and prayers.

[juliemac]

Additional prayers and healing light for Lacy.

[Guest OurLacyandJax]

Deworming question to all - OSU recommended a 10 day deworming session. My vet thinks that might be too much, and suggested only a 3 day session. What would you all do, or have done in the past?

[tbhounds]

Deworming question to all - OSU recommended a 10 day deworming session. My vet thinks that might be too much, and suggested only a 3 day session. What would you all do, or have done in the past?

I would listen to OSU--I have seen pets dewormed for 10 consecutive days before.

[Rickiesmom]

You probably know this, but another consideration is that roundworms are transmissible to humans. Another reason to be aggressive with treatment.

[Guest OurLacyandJax]

Ok, good to know.

 

Lacy is feeling the effects of the Prednisone. Yesterday she panted for a while, like an hour. And finally calmed down. Lots of peeing, mostly by volume. She appears tired, and is not comfortable coming down the stairs anymore. Right now though, calm and laying around

 

Talked to my vet, and she said I can lower to 40mg a day instead of 50 mg (split in two doses), if needed. But not any lower, since this is the loading phase. I think I am going to see if she can somehow bear through the first week with the original 50mg dosage. If not, I will lower it to 40mg.

[tbhounds]

Dont forget the gastroprotectants--OSU recommended Prilosec for my girl while she was on pred.

[Guest OurLacyandJax]

I just noticed a large bruise on her hind leg - which I think she got from me picking her up to get her off the back of the car. She hates being picked up and so wriggles like a worm every time.

 

(She limped around noon today, holding up her front right leg, unable to bear much load. I think she sprained it by either jumping off our bed, or walked funny on it since she is a bit off with her gait ever since being on pred. I took her to the vet in the evening to check if she fractured her front leg. No. They think it could be just a sprain. On some Tramadol now.)

 

This bruise is so about 5 inches long, and may be about an inch or so wide, and looks fresh. It looks nasty, and scared the crap out of me when I found it. I am still freaked.

Here's the photo.

https://lh3.googleusercontent.com/-4OcbG-N9jxQ/ULAkMUGV1aI/AAAAAAAAXrM/uhDnwQ91axA/w952-h537-p-k/IMAG1008.jpg

 

Anything to do here? Called my vet and she says just monitor it. Her gum line, eyes, ears etc are good. And if more appears or if this one gets worse (how worse can this get??) we can check the platelet count. No other bruises.

 

Hope you all had a good thanksgiving.

[KF_in_Georgia]

Take a Sharpie and outline the bruise. Then photograph that. That will give you a reference to whether it's really growing or it's just your nerves. (The hospital outlined Jacey's bruises.)

 

And a photo right now, compared to a photo later, will give you something for comparison. Just note the times of each (your camera probably will record that).

 

ETA: You might want to get a good photograph of her whole belly area. If another bruise starts to show, you want to be able to look at the previous photo, because maybe it was starting even then but not showing up much then.

 

ETA (again): Jacey's bruises were much darker than that, so don't freak too much.

Edited November 24, 2012 by KF_in_Georgia

[Guest alannamac]

Sending good thoughts to you and Lacy. It must be very scary. You're doing your very best and Lacy's doing her very best. Hoping things improve and the scary bruises get smaller.

[KF_in_Georgia]

P.S. Yes, watch the gum line. Jacey's gums and ears were fine. Watch her eyes: you may see bruising on the skin in front of her eyes; you also may have a hard time seeing the pupil in her eye if the whole eye becomes dark. Jacey actually was blind for a bit from bleeding into her eyes; no visible blood, so you only knew there was a problem when you realized you couldn't see the brown that should have been there.

 

Also, watch for puffiness in her legs. That would not be a good sign.

 

Thinking of you both...

[tbhounds]

Sorry about the bruising -they usually respond pretty quickly to the pred-hopefully her platelets are up already. Just keep a very close eye on her.

[Guest OurLacyandJax]

She was restless the whole afternoon.. but slept in the car on the way to the vet and back. She loves her treats, loves the car rides etc.. But the pred is making her pant and pace. And it is a pitiful sight to see her limp and pace..and the worry about the bruise. Anyways, she is calm and dozing off by my side now.

 

Thank you for the thoughts and prayers. We do need it..

 

KF_in GA, I have photos, and I have a sharpie outlining her bruises. Great suggestions. Will do the other checks as well.

[tbhounds]

If she's really having a horrific time with the pred you might want to inquire if she's a candidate for adding azathioprine (which should help to reduce the pred dosage). I feel your pain in all of this-it's just awful.

[Guest OurLacyandJax]

Thank you - good tip on azathioprine. I will ask the vet tomorrow morning in our consult back to see if the counts are up. I hope to God they are.

 

Lacy is holding on in there. Selective appetite. Alert when it comes to her treats. Loves her treats, peanut butter, and raw chicken. Not roast chicken anymore as much.. Not touching kibble that much. Sleeps good enough, partly due to the sedation effect from Tramadol. Last night, I took her out every couple hours. Some panting due to the pred, but much better compared to the first couple days.

 

No other bruising, and the other bruise seems to stay the same size. Still limps a lot, and not weight bearing. Tomorrow I might have to ask again about some x-rays.

 

And here's the reason why I didn't post anything yesterday - my wife, when she was out on a jog, got bit by a dog. Go figure. She's ok, A rather nasty puncture wound just above her knee, back of the thigh. The dog was current on shots etc, and wife ended up with tetanus shots and antibiotics, and a sore leg.

 

May be December would just be a better month. :-)

[Guest mld]

Hope you get some good news tomorrow!

Sorry to hear about your wife getting bit, thats horrible

[Guest OurLacyandJax]

Some good news indeed. Lacy's platelets went up from 20-60K to 40-70K. And the vet is pleased with the good forward step. She also lowered the prednisone dose officially down to 40MG a day.

 

We are going to wait a couple days more before we x-ray her front leg to see why she is limping. There was some limping from the right hind leg as well since yesterday, but if anything, she has lost a lot of muscle mass, and that has made her a lot weaker.

 

Her appetite is there, provided I give her some chicken or beef. Not into her kibble that much, but she never was a voracious eater. Only used to eat when she was super hungry, or if it her fav food. So these days she is living it up with raw/grilled chicken breasts etc. But she has lost some weight indeed - about 6 lbs in a week since she went on Pred. Her vet thinks she is super sensitive on the Pred, hence the lowering of the dosage.

 

More bloodwork results to follow later today.

[tbhounds]

Greyhounds in general are super sensitive to pred (all the ones I'm familiar with that is). Pred just melts muscle mass right off of our hound-seems like it happens overnight.

Glad to hear the platelets are up--they usually respond pretty quickly-the trick is to keep them there. Fingers crossed the rest of the blood work will look ok--might see an increase in the liver values-from the pred.

Also, to keep her tummy well please make sure you are religiously giving a gastroprotectant like priolsec or Pepcid. Also, please consider carafate--the last thing you need to deal with right now is a gastric ulcer.

Update when you can.

[Guest OurLacyandJax]

Well dang it.

 

Got some more news from the vet after some blood work. Apparently not good news now - her lymphocyte counts are up, so she suspects the thrombocytopenia could be a secondary and related to possible lymphoma. She is concerned and so is waiting for a pathologist to review it.

 

I do not know the actual counts yet. Once i know more, I will update. Her last two lymphocyte counts I have from July 15 (1190) and Nov 3 (1961).

 

And tbhounds, she is on 20mg Pepcid every 12 hours, given about an hour before food/other meds.

[tbhounds]

Please try not too worry--an increase of circulating lymphocytes could also mean infection or a tick borne disease rearing its ugly head.

When placing a dog on an immune suppressant dose you need to be careful you do not have an underlying infection ie-Ehrichia.

Is she still on Doxy?

Please consult with Ohio State--send them the complete history and blood work results.

[Guest OurLacyandJax]

Good to know, tbhounds. Yes, still on Doxy. Thanks for the calming words.

 

Dr.Kellogg is in the picture. She does have the history including the last blood work results. Once I have the latest, I will send it to her.

 

The regular tick panel did come back negative - and since she was on Doxy before I knew about NCSU PCR panel, I will have to wait till she finishes the current cycle.