Ashki – new thread

[Tamara]

Ashki’s PCV is back up in the 30s, 31, the tech said almost 32! I’m just thrilled. Will have CBC back tomorrow with retics and I’m really hoping for a nice response. I’m thinking this is a result of getting that GI inflammation under control from the addition of the probiotics, as well as the increased soloxine and the reduction in myco (the vet was worried the myco was suppressing bone marrow). I sent a very long email to the vet with attached articles on hepcidin and iron metabolism. Something that I noticed as I was going back through Ashki’s spreadsheet that I made — the last time he had a nicely regenerative response was when he was on flagyl (he also had soloxine on board at that point) and when we ran out his retic count slowly dropped, even with the soloxine. So I am really thinking that the GI inflammation as manifest by the mucousy poo was activating hepcidin along with the high iron and suppressing erythorpoeisis. I’ll let you know how the retics are!
much love — tamara and ashki xoxoxox

[admin]

Tamara

Excellent news! Well done Ashki! It sounds as though things are moving in the right direction and it is interesting that you have noted the higher retics when he was on Flagyl. Are you thinking there was something GI that triggered all this off?

You are doing an absolutely amazing job and it just goes to show what keeping your own records can reveal. Well done!

Fingers, toes and paws crossed for a nice high retic count tomorrow.

Mary and Mable x

P.S. Sheena, my Dad used to say “mon dieu” a lot and I’d forgotten all about it. That really brought a smile to my face! :)

[Tamara]

Hi Mary, it’s lovely to hear from you and sweet Mable! I don’t think the GI issues triggered this, but I think it’s a big piece. Like Worzel, Ashki slid down into severe anemia very slowly, he was coping very well when I took him in though he was not wanting to eat at that point. I actually think a number of insults piled up on his immune system until it finally had it. There were clues that there were problems but I missed them — his reaction to frontline a month before his diagnosis, his GI episode also a month before, recurring ear problems — and of course his undiagnosed hypothyroidism. A very big clue, though, is his mild anemia at 10 months of age with basically a nonregenerative retic count when I got him, and he was having major GI issues then. He did recover; the bloodwork that was done last year was a normal HCT but the same retic count, so it really seems to me that it’s likely his body responds to GI inflammation with that increase in hepcidin that leads to a dampened erythroid response. I think that going forward I am going to have to do everything I can to minimize inflammation for him. I’ve started reading about inflammation, where it comes from and how it manifests, and how it resolves well. It’s clear that temporary inflammation is curative, but chronic inflammation is a problem, especially for Ashki.
Please give dear Mable some gentle chin and ear rubs from me and Ashki.
hugs — tamara and ashki xoxoxo

[admin]

Hi Tamara

What a wonderful results – I’m so very happy for you & Ashki & I too think you are getting there with finding out what is going on. So complicated though, with lots of things contributing, and I agree the GI issues & hypothyroidism are very important here. Reducing the MMF is helping too.Your determination to understand his blood results in relation to what treatment he has had are really paying off – clever girl. I hope he’s feeling better in himself too – he’s such a lovely boy. Keep up the great work, Tamara!

Loads of love & cuddles for Ashki from us all
Sheena, Worzel & Ollie xxx

[admin]

Hi Tamara

Mable says thank you for the chin and ear rubs! I can see exactly where you are coming from with your theory about inflammation and its effect on Ashki. I’m impressed – it feels like you are putting a jigsaw puzzle together and you have been so wonderful in learning so much to help Ashki. Like Ashki, I think Molly also showed warning signs several times before her IMHA but I missed them. Well, not missed them – she was always treated, but I knew nothing about IMHA and had no idea it was coming. In her case, I suspect there was something fundamentally wrong with her immune system and it was always waiting to happen. How wonderful though that you are making these breakthroughs with Ashki and that he is getting on so well. How is he doing today? How was his reticulocyte count? I do so hope you got good news. Give him some belly rubs from us.

Mary and Mable x

[Tamara]

Hi Mary and Sheena — thanks so much. Ashki is doing well, playful and energetic and feeling very well, it’s such a relief. His reticulocyte count is still low, 26,000. I’m going to go back and look at his CBCs and do the math from reticulocyte count to RBC. I suppose I could just be thankful everything is rising and leave it alone but it is bothering me and I would like to understand. Ashki says thank you for the cuddles and belly rubs!
love and hugs from us — tamara and ashki xoxoxo

[admin]

Hi Tamara
He sounds on good form! Brilliant stuff Ashki. Very annoying, that reticulocyte count staying low. Have you reduced the MMF by much? I was telling Hope that Worzel’s PCV was “stable” & then we got him off the pred. There was quite a nice rise in PCV with each azathioprine drop (monthly). Because he is the greyhound variety, although that plateau was just in the normal range for most dogs, it would actually have been low for him – not that I cared too much or thought about it at the time – I was just glad to see a “normal” on his blood test for once! I know Ashki has other issues on top, but just maybe the MMF is still dampening the retic response somewhat? This coupled with GI problems & deficiencies may mean he will be a slower “responder”. Anyway, let’s hope that the fact you are now treating each individual problem will mean an improvement, even if it is still irritatingly slow. He is one complicated but very beautiful boy!

Loads of love & scritchy scratches behind the ears for Ashki from me & the boys, Sheena xxxx

[Tamara]

Hi Sheena, shoot, I thought I had told you all — she dropped the mycophenolate by half, which would have scared me silly of course, except she had a very good argument for doing so! It’s possible of course that Ashki’s iron is still high and we are still dealing with the iron pushing at the hepcidin, and I don’t know how long it takes for the chemistry of chronic inflammation to resolve, I’m sure that depends upon how long it’s been going on, etc. I’ve written to Mary Straus, she writes the dogaware.com website, Patrice reminded me of her. Anyway, she and I knew each other in the late 90s/early 2000s on a couple of dog listservs, and she is incredibly knowledgeable about diet, supplements, and certain health issues, she writes for The Whole Dog Journal as well. She’s helping me with supplements and diet for inflammation, I’m very happy to have her support. And, as you’ve noted, if we stay in the 30s, the retic count will slow down anyway. Ashki continues to feel well and is very happy that the new vet wants him to have more calories. He lost a pound last week and then she and I discussed the restricted protein diet for his glomerulonephritis and apparently a well-designed study was conducted with dogs in his exact situation (proteinuria but normal kidney chemistry) and there was no difference in outcome for dogs on a restricted vs. non-restricted protein diet. So we’re increasing his protein and calories and this coming week we’ll do an urinalysis and UPC as well as chemistry and of course PCV. Thank you so much Sheena — Ashki and I are sending love and hugs, and please give those boys some ear scritchies from me.
tamara and ashki xoxoxo