Ashki – new thread

[admin]

Hi Tamara

I’m so sorry I’ve been absent for so long but just checking in to see how things are and I see an excellent PCV of 30% – fab! How is the lovely boy doing? I love the photo of him in bed!
How is he getting on with his change in medication doses? I can see that a lot has happened for Ashki since I was last here so I promise to read up on his story as soon as possible, but for now just want to say hello and I’m so pleased things are going in the right direction.

Love, Mary and Mable x

[Tamara]

Hi Sheena and Mary and all —
Ashki and I are doing well. His PCV was 25 this week, very strange how they’re so different at the different clinics. I’ve noticed the different labs have different reference ranges, that is strange too. I haven’t heard how this week’s CBC is yet, last week’s was good as was the chemistry. We are really focusing on his reticulocyte count right now which is what I’ve been concerned about for so long. It was nice and high early June and then dropped and stabilized in the mid 20,000s; the new vet would like to see them at least 50k as would I.

Some very good news, a few days or so after we added the probiotics the mucous disappeared from Ashki’s poop and it has remained mucous free and nicely formed (the things we discuss lol!). I am very much hoping some of the inflammation will resolve and so aid us in our cause.

We also sent off blood to South Carolina to their vector borne disease lab to test for a few things that the doxy would not have cleared up and should have those results back late next week or early the following.

I found something interesting in Ashki’s bloodwork from when I got him at 10 months old; if you remember, he was very ill with severe diarrhea. Well he was mildly anemic and his reticulocyte count was 24k, so not what it should be. I showed it to the vet and she agreed this is of interest. I’ll ask her next week what she thinks it may mean, although I’m thinking it’s evidence of an anemia of inflammation affecting bone marrow response even at that point, as well as possibly some nutrient deficiencies from the long standing diarrhea.

Ashki was released to short walks this week so we’ve gone to the beach to walk along the cliffs where there are not off leash dogs and Ashki has enjoyed it immensely, and I have too.

Hoping you all are well and sending love and hugs —
tamara and ashki xoxox

[admin]

Hi Tamara

An interesting find, that old blood test. Very useful indicator that Ashki has had problems for a while. Great that the probiotics are working well – that should really help – I bet that’s really cheered you up! I am so pleased for you.

His PCV is on the cusp of the slowing down of reticulocytosis (anything over 25 ish) so that is actually a “normal” reaction from the kidneys monitoring oxygenation (otherwise they would actually end up with too many red cells in “normal dog” theory). It would be nice to find a cheat method to speed it up again though – the soloxine should help with this. I know you have been thinking carefully about EPO too, but there’s a lot to consider. You may also want to consider Dr Dodds’ anabolic steroid protocol – worth discussing perhaps? Also, as you so rightly said, there have to be enough “ingredients” available to make these new cells properly and Ashki is going in the right direction with this.Your new lady vet sounds really good, Tamara – finding someone who is genuinely interested & prepared to listen is worth their weight in gold. You are getting further down that road of getting Ashki better every single day.

Incidentally, I was reading it can take a normal male human about 8 years (YES!!!!) to develop iron deficiency anaemia if solely due to malabsorption or poor diet – sorry to bore you but I thought that was very interesting!

Hoping for even more improvement for Ashki – you are doing one brilliant job, Tamara

Sending loads of love & cuddles from all of us
Sheena, Worzel & Ollie xxx

[Tamara]

Hi Sheena, I’m confused, I was just reading this:

https://ahdc.vet.cornell.edu/sects/clinpath/modules/hemogram/retic.htm

And down at the bottom they have a formula and table for determining degree of regenerative response.

I do have one other CBC from 2013 which was normal, so Ashki *can* get there.

No worries about boring me, I find all this very interesting. :) I’m continuing to wonder about increased hepcidin production in response to high serum iron and inflammation and how that affects erythropoiesis; from what I’ve read increased hepcidin can create a functional iron deficiency when in fact there is plenty of iron, and supplementing with iron in this case will cause problems. I am hoping that if this is the case with Ashki that resolving the intestinal inflammation will help.

Sending much love and many hugs, give those boys some scritchies :)
tamara and ashki xoxox

[admin]

Hi Tamara

That’s good news about the 2013 blood test retic count. I found “absolute” values a bit confusing to start with too. For example, Worzel’s lymphocytes sometimes appear high as a percentage (which scared me to death), but not the absolute value which is “actual numbers of them” and is calculated from the total WBC. I could never understand what the Specialist was talking about when he told me now to worry as the absolute figure was fine, so I looked it up. Have a look at this human leukemia site under the lymphocyte section.
http://www.cllsupport.org.uk/uybresults.htm

It is the same principle with the absolute retics – a number worked out from a percentage of the actual number of RBCs. Does that make any sense? Let me know if I haven’t explained it very well. I will of course be testing you on this later!

I have to go out, but promise to look at the hepcidin/iron problem later on – it may be an interesting reply after a couple of Margueritas! If I’m not up to it I will look in the morning, promise.

Loads of love to you & that gorgeous boy
Sheena, Worzel & Ollie xxxx

[Vally]

Tamara, enjoy those Margueritas!

I’m glad the poo is looking good and don’t forget if there are too many red blood cells they morph into greyhounds. Isn’t that right Sheena?

Love Vally & Bingo.

[admin]

Vally – yes – you’re absolutely right! One of the vets always says “Oh mon dieu!” (oh my God!) this is is high as they never see greyhounds here.

Hi Tamara
Have you seen this lovely explanation of iron metabolism with nice diagrams?
https://ahdc.vet.cornell.edu/clinpath/modules/chem/femetb.htm

I have read a few articles on hepcidin & it is a relatively new discovery. You are right that it has a huge role in iron absorption & prevention of absorption – looks like a double edged sword indeed. Here are some resources – I know there are a lot of links here but they give a good overview.
http://www.anemia.org/professionals/feature-articles/content.php?contentid=408
In this it says hepcidin effectively stops the action of EPO (even when administered as ESAs) & erythropoeisis is therefore slowed down. This is well worth discussing with your vet as this does sound like it could be a problem for Ashki. And you are right that having high iron stores is a problem as hepcidin will be lower.
A more detailed paper
http://www.ifcc.org/ifccfiles/docs/publications/eJIFCC/vol20/02/eJIFCC-02-02.pdf
At the bottom in number 6, it says hepcidin can be a good diagnostic tool to tell the difference between iron deficiency anaemia & anaemia of chronic disease.
The following says the same as the others, but the last paragraph says it all:
http://cjasn.asnjournals.org/content/4/8/1384.full

What we need to find is a hepcidin reducer or blocker.
I found this
http://www.haematologica.org/content/98/11/1667.full
In Class 1: decreasing hepcidin production – heparin has been tried but there are obvious problems with this. See also classes 2, 3, 4 & 5.
Conversely to some of the others, this article says ESAs do reduce hepcidin:
http://asheducationbook.hematologylibrary.org/content/2011/1/538.full
Experiment information http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208302/
I bet you’ll find more of these if you look around ncbi

I know these article are human & lab research, but maybe your vet specialist may be able to help with some ideas that could help Ashki. In my opinion, you are really onto something here – this seems to be a problem with humans in the same position as Ashki. It is all relatively new & therefore in infancy stages in human treatment.

Well, that should keep you busy – I do think you can get some information across to your new vet – you are a clever girl looking at this & I agree completely that this hepcidin problem maybe exactly why Ashki’s reticulocytosis is not as high as you want it to be. It is also a good diagnostic tool as to finding out what’s happened.

Hope this helps – I’ve learned a lot from reading these articles. This is one complicated disease sometimes!

Have a good weekend

Love to you & dear Ashki,
Sheena, Worzel & Ollie xxxxx

[Tamara]

Sheena, you are the best. Thank you soooooo much! I am so happy to have this information to pass along. Love to you and the boys –
Xoxoxo Tamara and Ashki