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- Staffie X Tiger Diagnosed with AIHA
Adam
I noticed the higher dosage of cyclosporine originally but did not worry about it. Often Dr. Dodds will recommend a “loading dose ” for about 5 days and then a reduction to a standard dose. This drug’s first use in dogs officially was marketed as Atopica for treatment of canine allergies. This same dosing protocol is standard for these dogs as well.
The prednisone is often decreased like this by Dr dodds for dogs coming home from hospital. Keep your eyes open for signs of extreme fatigue and weakness when you decrease the prednisone this way and call your vet immediately if it appears serious. Make sure your vet does a spun PCV within a few days of the decrease. You may see a small decline of a few points. If it is significantly more make sure your vet has a plan of action to treat this.
Food and good nutrition are critical right now. Entice him with small tastes of really smelly tasting stuff. Rub a pan with a bit of butter and a sliver of garlic and saute a skinless chicken breast. This is highly interesting to dogs. Right now while Willie is recovering from surgery I am making him pots of long and slow cooked chicken frame broth.
Good about the cephalexin. This will work quickly so Tiger doesn’t end up looking like a golf course!
I asked Dr Dodds about the freezing of cyclosporine caps and she said she never heard of this and in addition the manufacturer states on the packaging to not allow it to freeze during storage. Just give it with food for a few days to get him used to it. Most dogs in the study needed this to adjust to it. After a few days try it without food 2 hours before a meal and see how he does. In general this is the only side effect of this drug in dogs. That high dose is really making him queasy. But it will save his life.
My best
Patrice
Hi Patrice,
Thanks for all the advice, I a bit confused about the freezing of the cyclosporine. I did confirm again with the specialist yesterday that it was ok to freeze and again today before freezing it.
I noticed online some websites said to freeze it and others said not to? I think the jury is out a bit on this lol.
Adam x
I was originally curious about this and asked Dr Dodds right away. She was puzzled how this got started. Both of us read the storage info on the back of the package. It’s very clear about storing at room temperature and not to freeze.
http://m.medlineplus.gov/druginfo/meds/a601207.html#storage-conditions
“What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not store this medicine in the refrigerator and do not freeze it. Throw away any medication that is outdated or no longer needed. Throw away any remaining solution 2 months after you first open the bottle. Talk to your pharmacist about the proper disposal of your medication.”
Hi Everyone,
I had some alarming news today, I took Tiger in for his PCV and they told me it had dropped to 22. I am very confused however, because when the test was initially done, they said it was still 38 but then I got a call later that day to say that the nurse had done the test wrong and that it was actually 22. They forwarded the result to the specialist who rang me, however I missed the call and am currently waiting for a call back now.
Today has been the most active and alert he has been since he came home from hospital last week but these results are really confusing me.
Could the reduction in his cyclosporine and Pred meds have caused such a rapid drop in 48 hours?
Adam
Hey Adam, that’s a bummer. Yes it could very well be that the reduction in the drugs has caused this, in which case, you’ll need to go back up in dose again and do the reductions slower.
It could also be that the higher readings were just wrong to start with. If he’s had diarrhea, it’s possible he was dehydrated, in which case you do get a higher PCV result.
See what the specialist says, it may be a case of testing again soon to see what the result it.
22 isn’t life threatening, but we don’t want it any lower. Just keep an eye on Tiger. If, as you say, he seems to be acting good, perhaps the lower reading was wrong. Check his gums often, make sure they don’t go to pale and if he’s suddenly lethargic, I’d get him to the emergency.
How is the diarrhea going?
My best,
Vally & Bingo
Adam,
This is the second time you have reported that the vet’s office claimed a value was wrong because the tech did the test wrong. I’ve mentioned this to you before that you should try to get this under control to your satisfaction. This is not a minor mistake. The treatment protocol is dependent on the results of these tests. The next time you go in, please request that the vet do the blood draw. Smile and be polite but remind the vet that this is the second time this has happened (are there more?) and it is really getting on your nerves. (Not to mention mine as well.)
On your end make sure that Tiger is prepared properly for these tests. He should be fasted at least 10 hours beforehand and should have plenty of water to drink. Fat in the blood from a meal can cause artifacts that can alter the values significantly.(The technical reason for this is that fat is light refractory and most clinics now use laser analyzers that can make mistakes when there is fat in the sample – think of how oil looks on a puddle of water.)
Dehydration will also significantly alter the values on a blood test and it makes it harder for the tech to get a proper blood draw, this leads to damaged red blood cells and that can cause these values to be extremely variable (and incorrect).
To technically to understand this, think of these values as percentages of the whole of the blood sample. So they have a relationship to each other. If you take three quarters cup of white rice and a quarter cup of wild rice and put them in 4 quarts of water and then take a small sample you will find very little wild rice and not much white in the sample, in fact you may not even see any wild rice! Take that same cup of mixed rice with a half cup of water and you will see a lot of both rices in the sample, like too much! We want the blood to be properly hydrated, somewhere between these two extremes so that the measurement of the different cells are properly measured.
Be sure to pick a quiet time of the day and get there early so that you can get Tiger calmed down with a walk and some relaxation in the waiting room. If this was not explained to you before and they claim that is the reason the tests are variable, smile and say “perhaps you can test him again for no charge since it wasn’t made clear to me.”
All this said, a tech really should know when they have made mistakes, to them it is apparent. They know when they have damaged RBC during the draw and they know if they have mishandle the sample, perhaps leaving it too long before finishing with it so that the sample actually begins to change. Red blood cells that sit like this can absorb too much water and burst, this is hemolysis. Platelets can form clumps.
This isn’t the easiest job with really sick animals, but they need to make an effort to get it right. A sample like this should be throw out and a fresh one taken.
How many times have I had my dogs in for blood tests? At this point I am sure it numbers into the hundreds. I know the difference when I see them taking it. I try to do everything I can to help them manage my dog comfortably. You will see a picture of Willie in the slide show offering his front leg for a blood draw. The techs love him because he just lets it happen, no struggle.
But since these things are really expensive, it’s now in the vet’s court to make this up to you. The vet can do the next draw so you can be sure it is done correctly. Smile and be polite about it, be gracious. But get it done. I want you to also request a simultaneous PCV test. This is a small tube of the drawn blood that is manually spun and held up to a chart that shows the packed cell volume. This is a more accurate indicator for reference since the laser analyzer can make mistakes on blood of very sick dogs because there are many more odd or different cells right now. The HCT hematocrit is going to be somewhere between 2-6 points lower than the PCV. It shouldn’t cost more than $10. When Chance was ill I had one drawn each time we walked in. The amount of blood is tiny. See the glossary item for PCV to see the tiny tube.
I have said for years to owners, the numbers are not the whole picture. When your dog acts like he is feeling a lot better, well… he IS feeling better. Dogs can’t lie. I don’t believe this lower value is correct, or at least Tiger is adjusting to it so that he feels quite good at this value. So the short of this is, don’t worry unnecessarily over the weekend. If he’s acting ok, (is he eating today?) then just enjoy him over the weekend. Spend some happy quality time together. If you worry he will pick up on this and react to it as though he had done something wrong.
I don’t like to see vets reduce both drugs at the same time but sometimes it has to happen like this. Constant vomiting, diarrhea, failure to eat and sometimes even pancreatitis or the worst I saw was a dog that had developed sudden and severe diabetes because of the prednisone. These are reasons for a quicker reduction. In this case your vet has agreed that the dosages he was originally on were very high. I agree. So letting a dog remain extremely sick because of high doses just weakens them and they can’t recover as quickly. We want to keep Tiger as healthy as possible right now.
Please let me know tomorrow how he is doing. I want to know.
my best
patrice
Hi Everyone,
So… the plot thickens. I saw the specialist with Tiger , who asked that I come down and see him before we make any decisions to change/increase meds because he suspected that the result was incorrect (the 22% PCV).
I drove Tiger down an hour ago and just got back now, they did a PCV while I waited and lo and behold its actually 32.
I spoke to my regular vet on the phone just now and she was very apologetic about the result, she said that the machine they are using is brand new and that it may be a calibration error, she promises she will attend to fixing this error.
As to Tigers energy levels, behaviour and eating. He still had diarrhea today, but it seems to be firming up as the last 24 hours were completely liquid.
He is still very picky with what he is eating, right now all he wants to eat is rotisserie chicken and bread dipped in pasta sauce (since we are italian, he has grown up eating red sauces on meat and kibble for years).
I really want to get some rice/fibre into him but can’t seem to find any foods he is agreeable with, the specialist thinks because we are giving him anything/everything he wants to eat, he has become very picky. He said to just persist and at least try and get some white rice into him at some point.
I’ll keep you all updated, but thank you Patrice for the email, I will try not to unnecessarily worry.
Hope you all are having a good weekend, I will keep you posted.
Adam and Tiger x
Hi Adam
This is not what you need right now – I’m sorry you’ve had a fright – I would be furious about this myself. As Patrice so rightly said, the treatment protocol is dependant on the results, so the test MUST be done properly. My specialist was absolutely insistent that Worzel’s blood samples were always taken from the neck & tested immediately by the local vets, without delay. Any anomalies? A re-check straight away & even a manual count. Those were his specific instructions.
I’m really glad the true result was 32 which will stop you worrying, I hope! Give him a big cuddle from me – don’t get too wound up about this as he’s doing fine. I expect he will become less picky as time goes by with the pred & want to eat anything & everything, all at once! But for now, it’s hard finding things they like. Did you know onions are poisonous to dogs? Just wondered if you used them in your sauces – if so, best avoided – stick to the chicken if that’s what he wants. We gave Worzel some horrible stinky Toulouse sausages when he stopped eating – not really good for dogs, but they were all he would eat – I was a bad Mum! Just saying I sympathise. How’s the diarrhoea today?
Love Sheena, Worzel & Ollie x