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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - Clyde-our Springer Spaniel with IMHA
| Hello All, I am frantic searching online for the causes and what IMHA is and how did my son's CLyde get it. This morning I went over to my sons and he asked if I would check on Clyde today as he wasn't feeling well. My son said that when he got home last night, Clyde didn't greet him as usual. I looked at Clyde and he looked a bit yellow and I looked at his gums...which were almost white and said we needed to get him to the hospital at once...which we did. My vet after doing some blood work referred us to a local vet hospital and I just signed the quote for his care...2700 to 4300. That's for the first few days at the hospital and they said we would know by then what direction he is going. This is so upsetting...one minute everything is going great and the next...this. Everything I read says not to do a blood transfusion and that's what they are doing today. What if this makes things worse??? Any ideas out there? Thanks so much |
| Kathy Northern California |
| Kathy, I am sorry to hear that Clyde is ill. It is very frightening when an owner is suddenly informed about this condition. It is hard to know what to do. I understand your uncertainty and fear. I am guessing that since you are using the term IMHA you heard the vet use that term? That is significant because it is now considered the more "correct" reference for this condition. That tells me that maybe this vet actually has significant background treating this condition. That is always a plus. AIHA means autoimmune hemolytic anemia. IMHA means immune mediated hemolytic anemia. It is splitting hairs to some folks, but it can possibly indicate the difference between a primary cause of the hemolytic anemia and a secondary cause. Primary simply means that the immune system seems to have gone rogue on it's own while secondary means that something has triggered the immune system to begin attacking itself. Why the difference? Because if there is a treatable secondary cause, then it is important to address that with a treatment protocol. There are many good examples of this. Tick diseases can lead to an autoimmune response that causes the immune system to attack the red blood cells that contain the tick spirochetes inside. If a young dog swallows an American penny they can develop a form of hemolytic anemia caused by exposure to high levels of zinc. If a dog is given some left over food that contains a lot of onions it can cause a form of hemolytic anemia. Rat poison is designed to cause hemolytic anemia. Often, a dog will develop this condition from exposure to recent vaccinations, sex hormonal changes, allergic reactions, thyroid gland problems or genetic predispositions to autoimmune conditions. Unfortunately there are certain breeds of dogs that have a high incident of AIHA. Spaniels of certain breeds tends to be on this list. The most important things at this stage are good veterinary emergency care with attentive follow up nursing care. This includes some form of high dose glucocorticoid treatment. In an emergency clinic they may use injections of dexamethasone and follow that up with high dose prednisone pills. They will monitor the blood by taking a CBC, complete blood count. They will monitor the body systems by taking a chemical screen. They may administer intravenous fluids. They really need to shut down the immune system quickly and stabilize the dog. This is a simple list. Many clinics have developed their own protocols to deal with these emergencies. None of this is really written in stone. It is dependent on the condition of the dog. Do not be afraid of transfusions. They can be lifesaving. The first transfusion is considered "free" of any immune reactions in dogs. The second and subsequent transfusions must be typed and matched. But you aren't there yet so don't worry about that now. I can advise that the use of Oxyglobin may not be the best choice for dogs in crisis. But if that is all they have available and they advise you to use it, don't hesitate. Most clinics will have a donor dog available, ask for it. Or offer a friend's easy going lab to donate. Emergency blood can be purchased through www.hemopet.org. Ask about CareCredit. It is a valid service (I have used it) and will allow you to spread out your payments over a period of time, interest free. Ask your vet if, once Clyde is stabilized, you can bring him back to the local vet office to remain. This will save you some money. But only if he is stable. Do you have any questions you need answered right now? my best patrice |
| Patrice NYS |
| Patrice is a true angel ! She knows her stuff. Find comfort in what she says I sure did !! My dog Gunner had a transfusion his RBC was at 8. Gums were pale and he was lethargic... don't be afraid of the transfusion. It saved many dogs lives!! Gunner RBC is now 39 !!! And he seems to be getting better everyday, its a slow process but possible to beat !! Best of Luck this site is AMAZING !!!!! |
| jacki jacki.fusion@yahoo.com |
| Thank you for the comments! I really appreciate it. I just called to check on Clyde and spoke with his nurse. She said that he is still getting his transfusion. Now they did do a type and cross on his blood and have the donor blood. They also told me that he has been started on his medications...but I didn't ask what ones. She said that after the transfusion they will do another blood test and that will be his baseline. She also said that he no longer has a temperature...it's now normal. I guess now we wait to see how things go over the course of the next few days...would that be your understanding? Thanks again for everything! kathy |
| kathy Northern california |
| Clyde update: I just spoke with the nurse and she said that the transfusion went well. She said they went very slow because his temperature kept increasing and this usually means that his body didn't like the transfusion but she said that it's back to normal and that he pinker and up and walking around. Is there anything I should be asking the vet? I'm doing a check in every two hours...I guess that's ok |
| Kathy Northern California USA |
| Good to hear the transfusion went well for Clyde!!! Did they transfuse him with Gold??? That's some pretty steep quotes they gave you for a few nights...even including the transfusion! If I were you I'd get a printout of all the costs...where the money was spent. While you're there also ask for copies of all the blood work. Things to ask the vet? Patrice covered most things very nicely! I'd be asking them to run a FULL thyroid panel also. You may have to insist on it. If he isn't home yet now would be a perfect time to do house cleaning! DON'T USE CHEMICALS! Chemicals can trigger relapses in some! You'll want a stress free environment for Clyde when he gets home so now would be a good time to get the little things done....running errands, making food, cleaning, yardwork, etc....anything that might cause excitement or stress!!! It's also advisable to pick up some milk thistle (powder if possible) to add to his food once home. Gotta help protect the liver from the damage caused by the drugs. Pet tinic is another good idea. Call around to see if you can find it locally....if not order it online. This is a supplement that helps the body build new blood. Make sure they send him home with a stomach protector also. Pepcid, prilosec (omeprazole), OR sucralfate. The drugs used to treat this disease can easily cause ulcers! Please keep us posted when you hear something! Lots of thoughts and prayers for Clyde. Johnny & Tessy |
| Johnny |
| Good Morning and thank you for the suggestions. It's 7am and I was just woke by the vet asking to do another transfusion. They said Clyde's numbers were--started at 16 and then after the transfusion went up to 20 and then a bit ago was down to 17 so they want to do another one--They are adding $500 for another transfusion but I told them whatever it takes...let's get it done because Clyde is coming home! I'll keep you posted, Kathy |
| kathy Northern California |
| Good thoughts and prayers for Clyde today! Johnny & Tessy |
| Johnny |
| Thank you...they called back and said that another vet came in and consulted with the one who called me and said that they should wait...that Clyde was "stable" and that at this point it might make things worse. They are going to wait for the main vet to get there a Dr. Kruger who is supposed to be very good. Thanks for all the prayers we need as many as you all can give. Hugs, kathy |
| kathy |
| Kathy, I am glad the first transfusion went well. That is a good sign. Yes, the PCV packed cell volume (or HCT hematocrit - same thing) will drop a bit after a transfusion. It is correct that they probably should wait a bit for another transfusion. Stabilizing Clyde where he is right now is the best thing. If there is a precipitous drop in the PCV in a day or two, then the consideration should be made for another transfusion. Please try to get copies of all your lab work so we can help you decipher what is happening. I would be most interested in these values from your CBC complete blood count: HCT, RBC, WBC, PLT, RET (reticulocytes). From your chemical screen: bilirubin, ALKP (alkaline phosphatase), ALT (alanine transferase), BUN (blood urea nitrogen), creatinine (creat), potassium (K) and glucose (glu). my best patrice |
| Patrice NYS |
| Sorry to read that Clyde has been diagnosed with AIHA it is often a long and bumpy road but there really is hope and so many dogs go on to leave happy and healthy lives, mine included. I am glad they did not have to do a second transfusion and he is holding steady that is a good sign, but many dogs have needed more then 1 transfusion so don't be alarmed if he does need another. They just buy them time until the medicines can kick in and do their job. Let us know how much he weighs and what medicines and dosages he is on. Please know we are keeping Clyde in our prayers. Cheryl & Ginger |
| Cheryl & Ginger Pinevile PA |
| Kathy, Sorry that Clyde has been diagnosed. If you haven't found your way to Joanne's page be sure to check it out. There is so much info there that is written to be understandable. http://www.cloudnet.com/~jdickson/ Start taking notes now because it is so hard to keep track of things while your head is spinning and then you can look back and see what you need to ask your Vet about. Keeping you and your family in my thoughts and prayers. Penny |
| Penny Lytle Creek Calif |
| Kathy, I am so sorry that you have to go though this ordeal with Clyde. Learn as much as you can over the next few days from Joanne's website! Don't forget to go to the success stories, they will give you LOTS of hope. Many dogs have recovered and Clyde can too! Have a daily calender handy when Clyde comes home. It is good to keep track of when you have to give medications. It can get very confusing and you will be tired. Keep us posted! Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| I just checked on Clyde and his count from 4pm today is 17...down from 20 after the transfusion. Also, the doctor said today that his blood work looked a little off and then asked me again if he recently had any shots and she asked to do xrays and an ultrascan. Of course I said yes and they both came back negative. Ok here are the blood tests from 2/19 Reticulocyte Count 3.8 Reference Range 0.5-1.5 Absolute Reticulocyte 85120 Reference Range 0-60000 Corrected Reticulocyte 1.4 Reference Range-none listed Retic Production Indes 0.7 Reference Range 0.0-0.9 WBC 22.9 Reference Range: 5.7-16.3 RBC 2.24 Reference Range 5.5-8.5 HGB 5.4 RR:12-18 HCT 16.9 RR: 37-55 MCV: 75 RR:60-77 MCH: 24.1 RR: 19.5-26.0 MCHC: 32.0 RR:32-36 NRBC: 2 RR: 0-2 Neutrophil Seg: 87 RR: 60-77 Neutrophil Bands: 3 RR: 0-3 Lymphocytes: 1 RR: 12-30 Monocytes: 8 RR: 3-10 Eosinophil: 1 RR: 2-10 Basophil: 0 RR: 0-1 Auto Platelet: 70 RR: 164-510 See Platelet Comment Polychromasia: slight Anisocytosis: slight **:scanning of the blood smear revealed adequate platelet numbers. Due to clumping and/or large platelets the automated platelet number cannot be accurately determined. Platelet count reflects minimum value Platelets-Clumped Large Platelets present Target Cells-Moderate Next Page: Absolute Neutrophil Seg: 19923 RR: 2000-11500 Absolute Neutrophil Band: 687 RR: 0-300 Absolute Lymphocyte: 229 RR: 1000-4800 Absolute Monocyte: 1832 RR: 100-1250 Absolute Eosinophil: 229 RR: 100-1250 Absolute Basophil: 0 RR: 0-100 Coombs (37 Degree): Negative BUN: 17 RR: 7-27 CREA: 0.6 RR: 0.5-1.8 BUN/CREA: 28 RR: none listed PHOS 3.8 RR: 2.5-6.8 CA: 8.8 RR: 7.9-12.0 TP: 6.7 RR: 5.2-8.2 ALB: 2.9 RR: 2.3-4.0 GLOB: 3.8 RR: 2.5-4.5 ALT 24 RR: 10-100 ALKP: 233 RR:23-212 GGT: 1 RR: 0-7 TBIL: 2.1 RR: 0.0-0.9 CHOL: 246 RR: 110-320 GLU: 113 RR: 74-143 Ns: 149 RR: 144-160 K: 3.4 RR: 3.5-5.8 Na/K: 44 RR: none listed Cl: 110 RR: 109-122 Osm Calc 296 RR: none listed cit-aPTT: 70 RR: 72-102 A.Ph.: Negative E.Canis: Negative HW: Negative Lyme: Negative cit-PT: 13.0 RR: 11-17.0 Thanks everyone for all the help...I really appreciate it! Hugs, kathy |
| Kathy |
| Kathy, the thing in these results that sticks out the most to me is the inactivity of the bone marrow AND even more importantly the severe lymphopenia it's showing! These lymphocyte counts are REALLY low!!! Quick question....are these the blood results BEFORE the transfusion and addition of drugs? Johnny & Tessy |
| Johnny |
| Do you have recent CBC results to compare to? |
| Johnny |
| Hi All, these are the printouts they gave me...yes these are the numbers before the transfusion. Thank you...I just called them and asked for copies of everything after his transfusion...but I am wondering if they re-do everything each time or not. I also asked for a list of the meds they are giving him. I am going to pick those up and then will report back. Thanks again for everything. Hugs, Kathy |
| kathy |
| Kathy, thank you for posting the complete CBC and chem screen profile. First impression is that, overall, Clyde is pretty stable. There are some out of range items which I have noted below. Your vet will look at these items and determine what the possible causes for these low/high numbers are, do diagnostics and then treat accordingly or do more testing. First are the CBC numbers that reflect what is happening with the red blood cells and white cells. You don't see a PCV on this result because this is a separate test. The tech takes a small sample of blood and spins it in a small tube. This separates the white stuff from the red stuff and then it is compared visually to a chart that reflects the percentages of each. This is highly accurate. This lab uses an automated laser analyzer (which is also accurate and very sophisticated) and the result, HCT hematocrit, is very similar to the PCV but is measured as a percentage of the sample. Thus the HCT can be a bit lower than the PCV. HCT 16.9 RR: 37-55 The HCT is out of range. It is low. It is in a moderately severe range. If there was a PCV taken it might show a slightly higher number. This should be higher and in general, if you can get up over 20 into the low 30's you can consider that the treatments are successful. HGB 5.4 RR:12-18 HGB is the protein hemoglobin inside of the red blood cell that contains iron. This number 5.4 is low. This carries the oxygen to the cells. This is a direct reflection of the severity of anemia. There is less oxygen being carried to the cells and the cells should complain that they need more. The kidneys will respond to this call and stimulate the bone marrow to make more red blood cells. Absolute Reticulocyte 85120 Reference Range 0-60000 The reticulocytes are baby blood cells that are made in the bone marrow in response to this stimulus. They normally (when there is no anemia) are in small numbers in circulation but when there is anemia they will be sent out into circulation earlier in order to help supply oxygen. They take about 3 days or so to mature. The absolute number of reticulocytes is the gold standard for determining if the dog (or human) is regenerating red blood cells properly. In a dog with anemia as severe as 17% HCT, this number should be very high. 85,120 is not quite high enough. There should be numbers like 200,000-500,000. Often, a specialty lab will also show the Corrected Reticulocyte number that is arrived at through a math formula. This is indicated by Corrected Reticulocyte 1.4. It is not very high and should be higher, but even so 1.4% is a bit more than the normal 1% so that is good. In addition they have listed Polychromasia: slight. This indicates the number of red blood cells in circulation that are considered to be these immature baby blood cells. Slight means they are there in small numbers. These would be new cells in circulation, an indication that there is some regeneration. They are also seeing giant platelets and these are baby platelets that have been released from the bone marrow also. Ha ha, baby platelets that are giant, what a contradiction.... The next series of numbers are from the chemical screen. WBC 22.9 Reference Range: 5.7-16.3 Neutrophil Seg: 87 RR: 60-77 Absolute Neutrophil Seg: 19923 RR: 2000-11500 The WBC is a measure of all types of white blood cells, the elements of the immune system. Each type is also reflected separately and we see here that the most numerous type of white blood cell, the neutrophil, is quite high. This can reflect inflammation, severe infection, or in rare cases a type of bone cancer. It could mean the immune system is stressed and fighting something. It could also just indicate that the dog is under high levels of stress. It can also occur in a response to corticosteroid (prednisone) treatments. So the vet is determining what is the cause of this elevation and should it be treated. ALKP: 233 RR:23-212 Alkaline phosphatase is an enzyme that is released that reflects some kind of tissue damage. It can reflect liver damage but is not solely related to just the liver. This number is not high and probably does reflect the liver complaining about the high doses of prednisone. While this isn't good, it is a normal response by the liver. The liver is regenerative and can recover from this kind of damage generally. K: 3.4 RR: 3.5-5.8 This is potassium. It is a vital electrolyte (along with others) that controls muscle function. This is a touch low, but not dangerously so. Humans and dogs tend to have altered levels of electrolytes when they are ill like this. They probably have been giving Clyde a drip to keep these numbers stable. A.Ph.: Negative E.Canis: Negative HW: Negative Lyme: Negative Finally, this is the results of the tick test. This is wonderful that they did this test, as it is sometimes missed. The results are negative and that is good news. So going forward, the test item you want to watch is the reticulocyte number. Ask after each CBC if there has been a significant increase in this number. They probably will do this CBC very soon as they are also very interested to see what happens. It can take a few days for this process to get jump started so it may just be too early to see a proper response. Overall, they have done an excellent job of stabilizing Clyde. my best patrice |
| Patrice NYS |
| Oops. The WBC are not from the chem screen but from the CBC. Sorry p |
| Patrice NYS |
| Thank you so much Patrice...you are a wonderful world of knowledge and I appreciate everything you and everyone else is offering. The numbers from the lab tests are all before they started anything with Clyde...so should all of them be different now that they started him on medication? UPDATE: I just got off the phone with Dr. Kruger (Clyde's Internist) She said that his number went down to 13-14 at midnight and was the same this morning. They said that he is looking more pale so they are type and cross more blood and he is going to have another transfusion now. She also said...and I couldn't write down things fast enough so I am a little confused...she asked to do another blood test for $150...(why do they always talk about money before anything else-it frustrates me more as then I think that they are not doing everything they could because of money...) Of course I said yet...the other things she wants to do is one-do some type of dna test that will show if clyde has this in his system and then she said that there might not be anything we can do and she also wants to do another test which I think starts with a "B"...maybe some type of infection?? and she said that Clyde is not being treated for this now. I'll get the name but it sounded like the recovery from this is extremely difficult. I am getting more confused by the day-- Couple questions and I am typing these out for Dr. Kruger because when I talk to her it seems like everything is always in a hurry and I forget. 1) We live on a piece of property that was contaminated and is now under clean up. It is a "superfund" site being cleaned up by the government. It used to be a gas station. We have been told that everything is OK and our water is good because we have a deep well==but we are on a well and clyde drinks well water. 2) I have felt for the last couple years that this property harbors the parvo virus. This is purely my own opinion and I have nothing to base it on except that every puppy that visits us comes down with it if it has been after rain...of course we don't allow any little visitors anymore...also a few years ago we did have litter of puppies and they all came down with it. I am wondering if there is something in the dirt that would have caused this for Clyde. His sister is fine but we now worry about her as well. I'm now wondering if there is somehting in my son's yard that could have triggered or caused this or Clyde... I am off to the vet to get copies of all his blood work since he has been started on his medicine and what medicines he is on. Again, THANK YOU all so much, you have no idea how much it helps to know there are so many willing to help and brainstorm for Clyde and our family. Hugs, Kathy |
| Kathy |
| Kathy, A bit slim on the hints.... But I suspect that your vet is considering a tick disease called Babesiosis. I took a quick look through goggle to see if this is showing up in Northern CA and I found information that it has been identified in this area. There are several "variations" of this tick disease and it was noted that they were found in this area. This disease attacks red blood cells and is normally fought inside of the spleen. It can be a very serious illness. There might be signs of this if they tell you the spleen in enlarged. It is one of the more severe tick diseases. Yes, the results of the latest test can be different. The body likes to be in homeostasis. This simply means that everything inside the body will work to make sure all systems are operating perfectly. So there will be different results on the latest CBC. Cost. Every vet lives with the bulk of the patients determining what treatments they will allow by how much it costs. There is only a small subset of owners who don't care about cost but want results. Vets can get strapped by owners who cannot afford testing or treatments but ok them anyway. I am sure they would love to save all animals, but financially they can't do this. They are just making sure you understand how expensive this will be. Most owners who usually come to this forum are interested in one thing, getting their dog healthy again. Well water can contain especially high levels of various heavy metals. These can be very dangerous in drinking water. A gas station would have probably been selling leaded gas if it is of a certain vintage. Lead is notorious for causing a form of anemia. Studies that have been done about lead in children found that kids that played in their yards that were near expressways were exposed to high levels of lead in the dirt from the leaded gas. Gas no longer contains lead, but lead is persistent and will remain in dirt or paint dust etc forever. If you can afford it, get this water tested. Call your local health dept to start the process. Lead is extremely dangerous to children but can also cause serious illness in adults. Parvo: I "borrowed" this information because I am short on time: http://www.the-puppy-dog-place.com/canine-parvovirus.html "It's important to know that the parvo virus itself is extremely hardy and difficult to 'kill'. It can live on multiple surfaces and in the ground for a long period of time. * Outdoors - When in the soil, canine parvovirus is not dramatically affected by heat, rain, cold, frost or any other climatic condition. If the ground is frozen it basically puts the virus into a 'dormant' state and when the ground thaws there is still a risk of contamination. If you don't treat/disinfect the ground, this is what you can expect.... Areas in direct sunlight: contamination lasts approx. 5 - 6 months Areas in shade: contamination lasts approx. 7 - 8 months * Indoors - Parvovirus becomes inactive much more quickly indoors than it does outside. Normally contamination will last for approx. 1 month inside your home." If it has been several years and there have been no other incidences of parvo, then you are in the clear. However, I highly recommend that all owners have their dog(s) protected from parvo with a vaccination. I have heard all kinds of stories and one that Dr. Dodds related was that a litter of puppies that had been vaccinated against parvo actually passed it BACK to the unvaccinated mother and she died from it. Very sad. my best patrice |
| Patrice NYS |
| You might want to consider contacting Dr Jean Dodds http://www.hemopet.org/ email hemopet@hotmail.com Send her a copy of Lincoln's latest blood also ask your vet if would be willing to work with her even if it is just a phone call. Dr Dodds is also located in Calf. I think it is Garden Grove and I have no ideas if that is anywhere near you as I am on the east coast. Also make sure you get the list of the med's Lincoln is on and send her that information too. I think she charges $40.00 for a phone consult if you would like to speak with her. Have you had a visit with Lincoln today and if so how does he seem, is he eating?? Please keep us posted Cheryl & Ginger |
| Cheryl & Ginger Pinevile PA |
| Hi Cheryl and Ginger...did you mean Clyde? I just spoke with the hospital and Clyde is in about an hour into his second blood transfusion. They said he would be done about 5:30 or so and we will speak to the doctor then. The nurse also just told me that Clyde threw up after docicillin (spelling) and I think that's the drug she said about midnight. She said that they didn't give him any food after than but I told her that if my son and I need to we will sit by his pen 24/7 and give him morsels every 10 minutes or so...he needs to eat. I'm on my way over to pick up copies of recent blood work and the meds he is on. They did send off a PCR test today as well but they said we won't have the results for 48 hours or so... |
| Kathy |
| oops yes I meant Clyde, sorry about that. I hope he is doing better this evening. Cheryl & Ginger |
| Cheryl & Ginger Pinevile PA |
| Dear Kathy, I am so very sorry to hear about Clyde's diagnosis. As Patrice and Johnny said, at this stage, Clyde is not regenerating enough new red blood cells, which is why his count is continuing to drop. Dogs with this kind of non-regenerative anemia do take longer to stabilise than those that are highly regenerative. Quite often, they require several blood transfusions, before they turn around. One thing quite often advocated on this forum is thyroid testing. Many non-regerenerative dogs on this forum have benefited positively when a thyroid medication has been added to their treatment regimen. I strongly recommend you discuss this with your vet also. It will be good to see what Clyde's latest results show, and what medications he is on. Please stay here on the forum, there is a lot of help and support here for you and Clyde. Thinking of you, your son and Clyde, Our very best wishes, Sam & Millie. |
| Samantha Geelong Australia |
| Kathy, Doxycycline, an antibiotic often used to treat tick diseases. It can be very hard on the stomach and this is a common side effect. Yes yes yes, it needs to be given with plenty of food to cushion it in the stomach. PCR Polymerase Chain Reaction test. Tests for tick DNA. So the long wait. patrice |
| Patrice NYS |
| So sorry to hear about Clyde. You will receive great advice from folks like Patrice, Johnny etc. The best advice I can give after losing my Juliet in January is to get a consult with Dr. Dodds at Hemopet in CA right away. DO NOT DELAY. Go for the Cyclosporine ASAP. Time is of the essence and although it is an expensive drug, it may offer quicker results in suppressing the immunce system. Like you, we went from no symptons to crisis making it all that much more shocking and difficult to come to terms with. All the bes to you and praying for a good outcome for you. Pat in VT |
| Pat Vermont |
| Thanks Pat...I totally agree...everyone on this site has been so wonderful, uplifting and have provided more information than my vet hospital. I just got back from seeing Clyde...he had his second transfusion today. Dr. Kruger said his number was down to 11 and that he needed another one. She also said that his CBC didn't look good as it was worse than the original one taken two days ago. They didn't have the copies ready so I will pick them up later when I go over to check on him. I sent an email to Dr. Jean Dobbs who is out of the country until March 2nd. I offered to pay a consultation fee if she would just talk with Dr. Kruger. After reading her website...boy oh boy there are so many red flags there (dry dandruff skin, dull coat, puppy coat). Maybe I'm just reading too much into it. His coat is dull and dry on his back but the hair on his chest feels soft...I don't know. SO maybe I'll have a response from her tomorrow. I did talk with Dr. Kruger again about testing his thyroid but she said it would be low anyway because Clyde is sick...I think she would run the test to pacify me...maybe I should insist very nice. She said that we are early in treatment and that as long as the funds hold out then we can continue. Thank you all again from the bottom of our hearts for all the help. Hugs, kathy |
| kathy |
| Hi Kathy, Your vet is right, you are early in the treatment, and hopefully Clyde does turn things around in the coming weeks. You have done a very wise thing in consulting Dr Dodds, I'm sure she will respond to you as soon as she can. If Clyde cannot turn things around in the next couple of weeks, then do insist on a thyroid test and supplementation if required. Be prepared that more transfusions might be required. Can you ask what his latest reticulocyte count was? I really hope Clyde can turn things around soon! Hugs, Sam & Millie (my darling IMHA dog, 2 year survivor!). |
| Samantha Geelong Australia |
| Thank you all again for everything...you are helping me keep my sanity throughout all this. UPDATE: Clyde had his second transfusion that ended about 5:30pm yesterday. His "pack" cells were 23 after that. His blood test this morning at 8am-his pack cells were 24. Good news...however Dr. Kruger said tht Clyde now is accumulating fluid in his belly. She said it's because of all the waste that is going through his body. She said she won't drain it because it will just come back. They have cut down on his iv fluids to half to try to slow things down. She thinks that his pack cell number many actually be lower because of this. They will be testing him again at midnight again. I did get an email back from Dr. Dobbs and she recommended that we do a profile 5. This blood will be drawn at midnight when they do his other test and my daughter is going to drive it down to Long Beach to be there at 9am when they open. She'll be driving all night...but she's young. :) I have also asked Dr. Dobbs if she could consult with Dr. Kruger but haven't gotten an answer on that yet-I think because she is in Europe. I will update you all again at midnight with his new numbers. We did some very heavy duty praying yesterday here and would sure appreciate any extra that you all can share for Clyde. Hugs, kathy |
| Kathy |
| When you say you will do EVERYTHING you can, you mean everything! It sounds like your vet is willing to do everything too. I think consulting with Dr. Dodds will shed some light on a lot of the problems. Your vet will learn so much from her and that in turn might help other dogs. Clyde is so lucky to have you, your daughter, your family, your vet and now pretty soon Dr. Dodds as his support. Keep reading the success stories! Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| Sending our prayers for for Clyde too. Hopefully he can turn this around soon. Ask your vet about the cyclosporine as I that is what really turned Ginger around, it does take time to work. Cheryl & Ginger |
| Cheryl & Ginger Pinevile PA |
| Hi Kathy, You have discovered a very knowledgeable and helpful board with many wonderful people here who genuinely want to help others who have dogs with IMHA. You are doing everything you can to help Clyde. Remember the transfusions are helping Clyde to get his PCV count high enough to help him until the meds kick in. My 5 yr. old cocker spaniel, Gracie just celebrated her 4 month anniversary since her diagnosis. Those initial few weeks are the most difficult but there are many success stories and reading them can help get you through this difficult time. Penny posted the link in her post above for Meisha's Hope. It is a great site. Gracie was chasing her tennis ball in the snow in a big field this past weekend. Jumping and frolicking like a puppy. I put it on video tape. Her PCV had dropped to 9 before her transfusion in Oct. and although she is still on a lot of meds she is doing terrific. Remember that there can be a way out of this disease. Yes, it is up and down but there is hope. Your family and Clyde are in my prayers. Big hugs and blessings, Gwen |
| Gwen Rhinebeck |
| Kathy~ You and Clyde are in our prayers. This is not an easy journey...but remember many of us are on that same journey and are here to support you the best way we can. Blessings, Cindi & Tori (IMHA) |
| Cindi PCB |
| First and formost...thank you to everyone on this site...I am eternally grateful and I will do everything I can in the future to help others who find themselves in the same position as we have. UPDATE: Clyde's pack cell number is staying the same 23!! YAHOO. My daughter drove all night and Clyde's blood serum is down in Los Angeles this morning for thyroid testing at Dr. Dobb's clinic. Clyde still has the fluid in his belly but Dr. Kruger said his weight was the same this morning so she doesn't think that he is storing more. I am cooking for Clyde now...lean ground turkey--he seems to like this better than the baby food they are giving him. Dr. Kruger did let me know that the technician/nurse giving him his medications last night mis read one of the measurments of the aspirin and instead of giving him .20 something he gave him 200--so they now have started him some type of GI because of the possibility of ulcers in his stomach. We are jumping up and down around here and are so happy that Clyde has finally turned the page in the right direction. I have been in contact via email with Dr. Dobbs and she has agreed to a telephone conference if it could be after hours with my vet. I asked Dr. Kruger this morning if she would take an after hours call from Dr. Dobbs and she told me that they have two different trains of thought. She then said that let's wait to see the results. I told Dr. Kruger that I certainly would never step on anyone's toes but felt the need to pull at any straw that is sticking up because we never know where insight will come from. So that's where we stand on that front. I could speak with Dr. Dobbs but don't feel I have the knowledge base to communicate to the fullest. So...we'll see. My son and I were talking this morning and are thinking that maybe when Clyde comes home we should take him and his sister to my daughter's house. Since we haven't identified what the trigger was...I'm scared that whatever it is might still be here and needless to say--we couldn't go through this again ($). I know we still have a road ahead of us in the next few months. What do all of you do? I thought of scrubbing everything down, having the carpets cleaned and having my son's yard gone over with a fine tooth comb...any thoughts? Hugs, Kathy |
| Kathy |
| Kathy, I am so happy Clyde has turned things around! You will see once you get him home where he belongs, he will improve even more. It is great that you are cooking for him, you will see, that this can be a lot of work, but also very rewarding. There is at least something you can do, put some good wholesome nutrition into him. If the turkey gets too expensive, chicken is good too. I also cooked some Snapper or Cod. You can add sweet or regular potatoes and veggies like carrots, green beans and kale. Have some cans of plain pumpkin (not pie filling) ready in case he will get diarrhea. You can just add a table spoon to his food anyway, it is good stuff. I am also glad to hear that Clyde is given some sort of stomach protectant. You will have to continue with that as long as he is on the immune suppressing drugs. Maybe you can get some supplements for him, petinic has been recommended many times. Not every vet likes or agrees with Dr. Dodds, I totally respect that. Fact is, she knows her stuff and maybe it would be worth while to do a consultation, see what she says and then take it from there. Although she would be considered a senior, her knowledge is very up to date. I don't think you need to freak out about environmental pollution. I would definitely not move Clyde to a different place. He needs to be stress free and in his usual surroundings. By all means do a thorough cleaning of the house (and while you are at it come over and do mine:)!) But I don't think that is where you will find the trigger. Most people have never found the trigger with 100% certainty. Once ticks, cancer, ingested onions or a penny are excluded, it gets into a guessing game. Immunizations and flea, tick and heartworm preventions are at the top of the list and also stress. Early spay or especially neuter could be a factor and then of course Clyde's breed is a "risk factor". The sad thing is, we can do EVERY thing right, feed the best food, hold back with neutering, don't over immunize and over do the pest control and our dogs can still get sick. So try and relax when Clyde comes home, he does not need a totally stressed our mom rushing around and in turn stressing him out. Your main concern will be how to get Clyde's PCV up to a normal range, stabilize it and then to slowly start weaning him of the drugs. It is a long and rocky road, but I know you, your family and Clyde can do it! Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| Again...thank you for insight! My son asked me to wash his paint ball clothes a bit ago (spoiled...I know) Anyway, while I was putting them into the washer at my house I noticed that they had a very strong chemical smell. I looked up the ingredents online and this is what I found: Paintballs • Paintballs, which contain sorbitol and harmful chemicals, are toxic to dogs. Paintballs also contain ground pigskin, which may be why dogs are so attracted to and likely to eat paintballs. Michigan Veterinary Specialists suggest that because of the sorbitol, the "chemicals within paintballs will pull water from all parts of the body into the gastrointestinal tract resulting in an increase in sodium in the bloodstream." The combination of water removal from the brain and increased sodium in the body, may result in neurological symptoms. Ingredients are: Propylene Glycol, Sorbitol, color dye and sometimes a little wax. I have a call into Dr. Kruger right now. My son thought these were totally harmless and I know I have picked them up more than once when at his house. Any thoughts on maybe this could have been the trigger...or am I reaching? It said that Propylene Glycol is the same thing that's in anti-freeze. Hugs, kathy |
| Kathy |
| Kathy, this is just gut feeling, but I think it is quite possible that this was the trigger. Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| I just got a partial message from Dr. Kruger who is in a procedure...I called to find out what Clyde's Pack cell number was at the 4 o'clock draw. It has gone down to 22...done one number. The doctor who relayed that message said that Dr. Kruger has concerns about the fluid that is building up in Clyde's belly...do any of you have experience with that? She is going to call me back when she finishes the procedure...heavy sigh...... |
| Kathy |
| Propylene Glycol is used in safer versions of antifreeze. You are thinking of Ethylene glycol antifreeze which IS very dangerous to pets and wildlife. "Tufts Veterinary Newsletter reported that a medium-sized dog would have to ingest about 20 ounces of propylene glycol before getting seriously ill. This is in contrast to the mere two ounces of ethylene glycol that can kill a pet." Sorbitol is a sugar and is not harmful to pets, though in large quantities might cause diarrhea. Xylitol, however, is a sugar substitute that is dangerous to dogs and can cause hypoglycemia and even liver damage. It is very easy, too easy, to become suspicious of everything. About a two months ago, one of the dog trainers in our Saturday class didn't show up for class. Her puppy, who is exactly Willie's age, had a vaccination during the earlier part of the week. Later during the week she bought groceries and they were in the back with the puppy on the way home. He got into a box of no-fragrance dryer sheets and was chewing them all up. That was enough to trigger a very serious, almost life threatening, symptom of anaphylactic shock. How could she have possibly anticipated that dryer sheets would be harmful? She is an expert in animal care and I don't know many people who take as good care of their dogs as she does. We just can't anticipate everything that will cause an animal to become sick. My husband once noted to me that dogs just seem more fragile than humans. I think genetically they have become that way over time. But their wild ancestors don't have it much better I think and dogs are not too far away genetically from them. But ask any vet what is the greatest threat to a dog's life and they will probably respond HBC. Hit by car. If we could just protect them from that danger..... I often reference folks to read Dr. Jean Dodds' paper The Canine Immune System and Disease Resistance. She does explain in great detail the kinds of things that do trigger a dog's immune system to overreact. Please take the time to read this. http://www.canine-epilepsy-guardian-angels.com/ImmuneSystem.htm my best patrice |
| Patrice NYS |
| Thank you Patrice for the information and the link...I'll read it now. I have not heard back from Dr. Kruger yet...are you familiar with the fluid in the belly...this doesn't sound good...Thanks Kathy |
| Kathy |
| ****Wow, I am really surprised that lady didnt know dryer sheets were so bad in her line of work. I was given a list back in the 90's of things to keep away from dogs, especially chewing puppies that like to put everything in their mouth and dryer sheets was one of many things on that list. They are loaded with bad chemicals, whether they are scented or unscented. How scary for her though. Unless you are using everything "natural" which is sometimes impossible there is a risk for a potentially serious reaction whether its human or canine. After my Jacob got sick I never even cleaned my carpets again. Kathy, I hope your sweet Clyde is stablizing now. Please keep us posted. Teresa |
| Teresa va |
| Hello All...it seems like I am living on this site...it has become my lifeline these days. UPDATE: I just got off the phone with Dr. Kruger. She said that Clyde's pack number is 22 and she is happy with that. She told me that she has changed Clyde's iv water because it seems that more is leaking into his belly. She did another ultrasound to make sure that his lungs arent' affected--they weren't. She told me that Clyde doens't have to be 40% to go home like other dogs. She said that we just need him to be stable and not have his number to be going lower. She also said that he did have some heavy breathing today. I have been reading the other posts here and I seem to remember that I read something but I can't find it now that can be given and they they don't breath heavy. I do have to admit that in most of the ones I read I was in tears before I reached the last post...Dr. Kruger also said that he is on everything he could be on...I don't know if I believe that after reading some of the posts here. Another blood test at midnight so will update then. Hugs and prayers to all, Kathy |
| Kathy |
| Kathy, I am glad to hear about the PCV of 22. Once Clyde gets into the 20's and stays relatively stable, then you can begin to relax a bit. Then there is time for the medications to really do their job correctly. He is experiencing ascites. This is fluid that leaks out of the blood vessels into the abdominal tissue. This happens because a protein, albumin, is low in the blood plasma. This protein helps keep the fluid inside the vessels. If this leaking happens too quickly and in large amounts it can cause problems because the blood volume becomes low. This can lead to symptoms of shock. If it happens gradually and is controlled, it will eventually lessen. If he is having trouble breathing they may want to remove some of this fluid to help that. No, he won't need to stay at an emergency clinic if he is stable. You and your family can provide the round the clock nursing care that he will need right now. Blood tests can be done at your local vet. At home provide a quiet, stable environment. Always have clean water and easily digestible food available. Be prepared to sleep near him if he needs to go out more often during the night. Prednisone will make him pee a lot. Don't be upset if he has accidents, he can't help himself. There are a number of side effects of prednisone that can sometimes seem worse than the disease. He may find lying uncomfortable as the liver enlarges. This may also cause him to pant a lot. He will be ravenous. His muscle tone will decrease and he will look "potty." There can be coat changes and skin problems. It is important now that your family all behave normally for him. If he senses you are distressed he will be upset. Dogs read our emotions. Promise yourself that when he gets better you can cry all you want, but that right now you need to focus your energy on him. I had a few days of tears but then I realized I was not doing Chance any good. So I started researching. Please begin keeping a notebook and make entries about all the meds, foods, potty breaks etc and continue that at home. It really helps. my best patrice |
| Patrice NYS |
| Thanks Patrice...you are the best! Dr. Dobbs sent this email: We’ve completed the raw data on Clyde’s thyroid profile – he is hypothyroid [low T4 and freeT4] , although there is also non-thyroidal illness [low T3 and freeT3] – which we knew would be the case. So, thyroxine supplement IS in order to help his bone marrow replenish new blood cells. My recommended dose would be 0. 4 mg thyroxine twice daily, given at least an hour before or three hours after meals to ensure absorption. I am sending a copy of this over to Dr. Kruger tonight so she will have it in the morning. Talk to you all at midnight! Hugs and Prayers for your puppies as well...Kathy |
| Kathy |
| Dear Kathy, I am glad Dr Dodds recommended the thyroid supplement. Your Dr Kruegar sounds fantastic, but please do insist with her that Clyde takes thyroxine (as I know that you've said previously that she didn't want to test his thyroid). Secondly - as Patrice said, fluid retention is TOTALLY NORMAL with this disease. My Millie (who is a survivor), suffered badly from this initially. I remember getting Millie home from our vet after the initial diagnosis - PCV 27. Over the coming days her belly just got bigger and bigger, she found it harder to move around (how uncomfortable would that be!), and her breathing was laboured. Cutting a long story short, we were finally referred to a teaching hospital. They gave Millie an injection of frusemide (a diuretic, brand name Lasix), and put her on Flusaplex drops. I would get a frusemide injection every third day for Millie over about 2 weeks, as the drops themselves did not keep the ascites at bay. The ascites did resolve as Millie's PCV rose. Maybe talk to your vet about using a diuretic to help clear the fluid? A couple of point fluctuation in PCV is nothing to worry about. There can be multiple reasons why they are different by a couple of points. Keep an eye on it, but I think what you need to focus on is getting him to regenerate red blood cells. The thyroid supplement should help that. Hugs, Sam & Millie. |
| Samantha Geelong Australia |
| Good to hear Dr. Dodds is on board! Also remember to give the thyroid supplement WITHOUT food! Tessy had pretty bad ascites which lasted periodically. It came and went a couple times! They could always suck it out (think big needle) if it's making her uncomfy. Is Clyde home yet? Continued thoughts and prayers. Johnny & Tessy |
| Johnny |
| Glad to hear Clyde is stable, I hope it contiues to improve and he can come home soon:) Cheryl & Ginger (also on thyroid meds) |
| Cheryl & Ginger Pineville PA |
| Good Morning All and once again, thank you for all your support...the picture here would be very different without you... UPDATE: Clyde is not home yet...but I suspect that in the next couple days we will bring him home. Clyde's pack cell number was back up to 24 at midnight. I dont' have any other particulars until I talk with the doctor today. I do think it would help Clyde if she read our thread so I am printing it out for her. In the meantime we are going over everything and cleaning at my son's with just water and vinegar(if you can call that cleaning). I don't want to use any chemicals that would give us a do-over. Hugs and prayers to you all and I'll keep you posted, Kathy |
| Kathy |
| I use vinegar and water to clean just about everything here! Does just as good if not better than chemical cleaners!!! Good to hear the PCV is at 24%! Hopefully the addition of thyroid supplements will help! Johnny & Tessy |
| Johnny |
| Hello All, Great news!!! Clyde is home...Yahoo!! This afternoon his pack cell count was up another point to 25. He is more active and looking much more like himself...getting better every minute. He left the hospital with the following meds which we will continue at home: 1. Doxycycline 100mg 1 tablet every 12 hours 2. Pepcid AC 20mg 1 tablet every 12 hours 3. Cyclosporine Modified 100mg 1 capsule every 12 hours 4. Prendnisone 20mg 1 tablet every 12 hours 5. Aspirin 81mg 1/4 tablet every 12 hours 6. Ondansetron 8mg 1 tablet every 12 hours 1/2 hour before other medications His meals will consist of white rice and ground white turkey/chicken or low fat cottage cheese and ground white turkey/chicken--about 5 cups per day Ratio 1:1. He still has fluid and I did suggest lasix as someone recommended but Dr. Kruger said that his kidney's are working really hard right now and adding Lasix might put things over the top. She also felt the same about starting Clyde on Thyroid medication so that didn't happen. We kind of went round and round but as of now he is not on it. I sent an email to Dr. Dobbs to get her viewpoint and opinion. He has an office appointment Saturday for another pack cell count and exam...we hope some of the belly fluid will start to deminish by then. I can't tell you how happy we are...I can't stop smiling. I will keep you posted with an update tomorrow. Thank you all once again...Hugs and Prayers, Kathy |
| Kathy |
| Kathy, I have 3 poodles running around like crazy doing the poodle dance because I am clapping my hands and going yeah!!! You will see Clyde improving, now that he is home and in your special care. Too bad Dr. Kruger does not want to go along with the thyroid supplement, I think that would really help. Looking at his meds the other thing that stuck out to me was that the pepcid might not be enough to protect his stomach from the heavy duty medications. Something like sucralfate or carafate would be helping him not getting ulcers. Run that by Dr. Kruger on Saturday. The other thing you might want to add is Sam-E and milkthistle to help out his liver. I know there is so much already, but you will see his liver values going up and these two things could really help with that. Best wishes and give Clyde a hug from Brigitte & the poodle boys PS: it is Dr. Dodds with 2Ds:) |
| Brigitte BC Canada |
| Welcome home Clyde!! Sending prayers for his continued improvement!!!! A VERY HAPPY:) Cheryl & Ginger |
| Cheryl & Ginger Pinevile PA |
| GREAT NEWS!!!! Having Clyde home is awesome!!! I bet he was probably stressed being at the vets. Hopefully you'll be able to talk the vet into adding the thyroid supplements. There's really no room for obstininity when treating this disease and Dr. Dodds really knows her stuff and wouldn't guide you wrong. Is he experiencing diarhea or loose stools? Just wondering why the bland diet. We can help you with suggestions if you'd like. I also agree that milk thistle would be a benificial addition!!! Keep us posted. Lots of prayers and healing vibes for Clyde. Johnny & Tessy |
| Johnny |
| Hello All, We are all still jumping around smiling! Thank you for all the kind words. I posted this response earlier but for some reason it isn't here...maybe I didn't hit the submit button. Anyway, Clyde is doing good...still has alot of belly fluid. He has an appointment at 10:30 in the morning so I hope to get more answers then. Clyde's Thyroid panel results from Dr. Dodds is posted below. I don't know why Clyde is on a bland diet...his poop was well formed and he has had no problem with his urine...I'll ask tomorrow. I know I am giving him Ondansetron so he doesn't throw up...so maybe its because of all his meds...?? I will ask. Tomorrow we are seeing Dr. Davidson...also an internist as Dr. Kruger won't be back in the office until Tuesday. Dr. Dodds sent an email espressing the need for Clyde to be on Thyroid medication so I will be talking to Dr. Davidson re that as well tomorrow. I'll update everyone after Clyde's appointment tomorrow. I posted his final panel below. (RR=Reference Range) T4: .60 RR: .80-3.80 Free T4: .72 RR: .55-2.32 T3: Less than 10 RR: 30-70 Free T3: 0.8 RR: 1.6-3.5 Thyroglobulin Antoantibodies: Less than 1 NEGATIVE Dear Diane/Autumn: Thyroid levels are too low here. The low T3s likely reflect a non-thyroidal issue. TgAA is normal. Giving Thyroxine can help stimulate hematopoiesis in these cases. Hugs and Prayers, Kathy |
| Kathy |
| Happy Saturday! Clyde's Update: Saw Dr. Davidson this morning and Clyde's pack cell is up to 27....YAHOO!! Dr. Davidson said that Clyde looks great...long way to go but he looks great. The whites of his eyes are back to white and he doesn't look yellow anymore. They sent his CBC out to the lab for a complete count so we should have the results back tomorrow. Clyde lost almost a pound which is good...the belly fluid is still a concern but his breathing is fine. We added 1/4 cup of bland canned dog food to his diet. We're looking good. Thank you again...Hugs and Prayers, Kathy |
| Kathy |
| What Jean is saying here is that organic disease (serious illness) will cause the body to manipulate or "adapt" the thyroid in order to lower the metabolism. The body may find this beneficial during serious illness. This is called Euthyroid sick syndrome. Once the underlying condition is resolved, the thyroid most likely will return to normal. Here is a good article that goes into depth about the thyroid and has a cool flow chart to show the feedback loops: http://www.mirage-samoyeds.com/thyroid3.htm I have found this next article to be of great help when trying to understand the gray areas of thyroid tests. Once you read it and do the math, you will understand why there is plenty of disagreement about thyroid testing and treatments among vets. It would also be helpful to read Dr. Dodds material on her website about the difference between each of the values. my best patrice Here is a snip from Alise Shatoff's article: "Most Vets will read the test, and as long as the dogs results fall anywhere in between the laboratory's "Normal Range" they will tell you (and believe) that the dog is not Hypothyroid. This is why it is VERY important that you understand how to analyze the test results for yourself to determine if your dog has "Borderline” (Sub- Clinical/Low-Normal) Hypothyroidism. Here is how you analyze your dogs test results..." http://www.diamondsintheruff.com/HowtoAnayzeYourDogsThyroidTestResults.pdf |
| Patrice NYS |
| Thank you Patrice...I'll read and study everything this afternoon. We appreciate it very much! Hugs and Prayers...Kathy and Clyde |
| Kathy |
| Hi Kathy How is Clyde doing, can you please give us an update when you get a chance. Give Clyde a hug from Ginger and I:) |
| Cheryl & Ginger Pinevile PA |
| Hello All, I have been wanting to update everyone but wanted the latest bloodwork to give you which I got today at Clyde's visit. His pack cell number today is 30. On Saturday it was 27...so it's going up! YAHOO!!! We are so happy... We also discontinued Doxycycline and Ondansetron today as well. Clyde's blood work...the latest...they also gave me blood work from 2/22 as well...is that needed since I have the most current? Let me know as I will post that as well. Total Protein 5.1 RR: 5.0-7-4 Albumin 2.9 RR: 2.7-4.4 Globulan 2.2 RR: 1.6-3.6 A/G Ratio 1.3 RR: 0.8-2.0 AST 21 RR: 15-66 ALT 23 RR: 12-118 ALK Phosphatase 170 RR: 5-131 (this was 126 on 2/22) GGT 6 RR: 1-12 Total Bilirubin 0.4 RR: 0.1-0.3 (this was 1.2 on 2/22) BUN 20 RR: 6-31 Creatinine 0.5 RR: 0.5-1.6 (this was 0.4 on 2/22) BUN/Creatine Ratio 40 RR: 4-27 (this was 28 on 2/22) Phosphorus 4.2 RR: 2.5-6.0 Glucose 110 RR: 70-138 Calcium 8.6 RR: 8.9-11.4 (this was 8.2 on 2/22) Corrected Calicum (I think) 9.2 (it's blurry) Magnesium 1.3 RR: 1.5-2.5 (this was 1.3 on 2/22) Sodium 148 RR: 139-154 Potassium 4.3 RR: 3.6-5.5 Na/K Ratio 34 RR: 27-38 Chloride 112 RR: 102-120 Cholesterol 145 RR: 92-324 Triglyceride 65 RR: 29-291 Amylase 1384 RR: 290-1125 (this was 248 on 2/22) Lipase 255 RR: 77-695 CPK 107 RR: 59-895 WBC 26.1 RR: 4.0-15.5 (this was 25.9 on 2/22) RBC 3.1 RR: 4.8-9.3 (this was 1.5 on 2/22) HGB 8.0 RR: 12.1-20.3 (this was 3.8 on 2/22) HCT 28 RR: 36-60 (This was 11 on 2/22) MCV 90 RR: 58-79 (this was 74 on 2/22) MCH 25.8 RR: 19-28 MCHC 29 RR: 30-38 (this was 34 on 2/22) Hypochromasia: Moderate (this was slight on 2/22) Anisocytosis: Marked (this was marked on 2/22 Polychromasia: slight (this was slight on 2/22) NRBC: 4 RR: 0-1 (this was 2 on 2/22) Platelet Count: 149 RR: 170-400 (this was 84 on 2/22) Giant platelets present may indicate active thrombopoiesls. Platelet count reflects the minium number due to clumping Platelet Est: Adequate Neutrophils: 21663 (High) RR: 2060-10600 Dohle Bodies Slight Bands: 522 (high) RR: 0-300 Lymphocytes 1568 RR: 690-4500 Monocytes 1566 (high) RR: 0-840 Eosinophils: 261 RR: 0-1200 Basophils: 0 RR: 0-150 Metamyolocytes 522 (high) RR: 0-0 Path Review: Frequent platelet clumping is observed along the feathered edge and margins of the smear. Platelet numbers are likely adwquate. A moderate, regenerative anemia is present. Erythrocyte morphology is difficult to assess on this slide. Anisocyosis is seen. A small population of small dense cells resembling spherocytes is also noted. In low numbers this finding is nonspecific. The regenerative status of the anemia may suggest a hemorrhage or hemolytic etiology. Hemic parasites are not seen. A coombs test may be helpful to further investigate IMHA in this patient, if appropriate. Hemic parasites are not appreciated. A mild inflammatory leukogram is present. i am not appreciating metamyelocytes, although low numbers of bands are noted. Rare dohle bodies are seen. I will request a recheck on the reported differential. Clyde is back being followed by Dr. Davidson who really seems to know here stuff. She also teaches at Davis so that's a good sign. Clyde has an appointment for one week. We also started him on bland dry and bland canned dog food as well today. He also was given an iron shot today as well. We are feeding him 4 smaller meals a day...It's so good to have him home. His sister Bonnie missed him so much...she's so happy too. Again, thank you all for everything...They will be repeating the chem panel and cbc next week as well. Hugs and prayers, Kathy |
| kathy |
| ALK Phosphatase 170 RR: 5-131 (this was 126 on 2/22) This is an enzyme that probably indicates the liver complaining about the high dose of prednisone. Cells are being damaged as they process this drug and the liver is attempting to make more cells to recover. This number, while high, is not very high and will return to normal when the pred is removed. Total Bilirubin 0.4 RR: 0.1-0.3 (this was 1.2 on 2/22) This is an indication that red blood cell destruction has slowed down. Amylase 1384 RR: 290-1125 (this was 248 on 2/22) This enzyme is generally thought of as a pancreatic enzyme but the liver can also release this. It is something to watch as it might indicate a tendency to pancreatitis (inflammation). This is a common side effect of being on prednisone. If you see Clyde arching his back, or drooling, licking and other general discomfort, tell your vet what you have seen. Note: Reticulocytes have been left off this panel. An unusual thing from my viewpoint and something I wanted to see. But it is easy to reverse engineer that there must be many present by the other results. WBC 26.1 RR: 4.0-15.5 (this was 25.9 on 2/22) Neutrophils: 21663 (High) RR: 2060-10600 The WBC is a measure of all types of white blood cells, the elements of the immune system. Each type is also reflected separately and we see here that the most numerous type of white blood cell, the neutrophil, is quite high. This can reflect inflammation, severe infection, or in rare cases a type of bone cancer. It could mean the immune system is stressed and fighting something. It could also just indicate that the dog is under high levels of stress. It can also occur in a response to corticosteroid (prednisone) treatments. So the vet is determining what is the cause of this elevation and should it be treated. RBC 3.1 RR: 4.8-9.3 (this was 1.5 on 2/22) HGB 8.0 RR: 12.1-20.3 (this was 3.8 on 2/22) HCT 28 RR: 36-60 (This was 11 on 2/22) All these are red blood cell indices. They are not in the normal range, but they have risen significantly since the last test you posted. This indicates great cell regeneration and increased carrying of oxygen to the body cells. MCV 90 RR: 58-79 (this was 74 on 2/22) Mean corpuscle volume. It just means that a lot of the red blood cells are larger than mature red blood cells (have more volume). This is perfectly normal as it is reflecting the large number of reticulocytes in circulation, they are larger when they are released from the bone marrow. Hypochromasia: Moderate (this was slight on 2/22 Indicates low hemoglobin content within the cells, the cells are not as brightly colored as normal red blood cells. This indicates anemia. Anisocytosis: Marked (this was marked on 2/22 This indicates quick regeneration of new red blood cells by the body and is normal under this circumstance. Giant platelets present may indicate active thrombopoiesls. Regeneration of platelets are happening in the marrow also. Good thing The lab is noting that some of the results may indicate continued hemolysis. They say this because of the great regeneration of red blood cells happening. So they are concerned that there may still be red blood cell destruction. But this can also be viewed as an appropriate response to severe anemia. The next test will hopefully indicate that the destructive period is over. my best patrice |
| Patrice NYS |
| Oh my gosh!!! Thank you so much Patrice for everything. Yesterday when I was trying to ask questions...no one whated to take the time...basically whenever I ask something these days (I am known for being a question asker) everyone just tells me that "the important thing is that Clyde is doing better and going in the right direction" I totally agree...but I want to understand as well. I am a firm believer in more eyes are better than two. Thank you again. Kathy |
| kathy |
| Kathy, if it were me I'd take a urine sample in and ask for a FULL urinalysis. The high amylase and immature neutrophils might signal a problem starting in the urinary track or bladder. Might be best to check it out just to make sure! Those numbers are looking great thus far! Avoid fatty food for now also just in case it might be the beginning stages of pancreatitis. Hugs and continued prayers. Johnny & Tessy |
| Johnny |
| Thanks Johnny (and Tessy)...I'll call the vet right now and ask how they would like the urine :) You know...Clyde was eating really well the last few days with ground turkey and rice...now since we changed his food to the "EN" brand...he isn't eating as well. I went back this morning and added some turkey to the mix and he ate a little more but didn't dig in like he had been doing... Thank you all so much! Hugs and prayers...kathy |
| Kathy |
| Hello All...Question regarding Cyclosporine please... I am reading online that while Clyde is on Cyclosporine he needs to have his blood checked and that it is important that his diet not be changed...well the words are below... ...Because cyclosporine interacts with a variety of other drugs it should be used with caution with other medications. To get the full benefit from cyclosporine the dog must be on a very strict feeding and dosing schedule. The diet must be consistent without any deviations in amount, type of food or feeding time. Because cyclosporine has a half life of only 19 hours it must be given every 12 hours. I just checked with the vet as no one ever said anything about an added blood test and I guess the vet sends the blood to the human hospital for results. The nurse told me that we don't need to be strict as far as Clyde's feeding schedule. I told them that I would not have changed his diet from the rice and ground turkey if this was the case--especially now that he doesn't like the new food. Does anyone have any thoughts on this? I will call Dr. Davidson tomorrow as well. When does one of these tests usually get done...Clyde has been on Cyclosporine since 2/19. Thank you to all...hugs and prayers, Kathy |
| Kathy |
| Kathy, I don't have a lot of experience with cyclosporine, I am sure somebody else can explain things better. Here is what I know. They can do a blood test to determine if the cyclosporine dose is adequate. This test is probably pretty expensive and your vet wants you to save money? This test would probably be worth doing, because then you know if there is enough cyclosporin in his system or not. I don't think the dosing is as easy as with prednisone, where it just goes by weight. As for food, I think it is important to always feed at the same time, so Clyde has the optimum absorption of all the meds. If it were me, I would switch to the home made diet again. This way you know exactly what he is getting. There is so much junk in even the better commercial foods. Here is a link to Dr. Dodds liver cleansing diet: http://www.canine-epilepsy-guardian-angels.com/liver_cleansing_diet.htm It is on a website for epilepsy but many people here have used it for their IMHA dogs with success. Ideally Clyde should get as little fat as possible and no grains or soy. Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| Thank you...I am taking in a urine sample in the morning for a full urinalysis. They said we should have it back in 48 hours or so... I have cooked up some turkey and rice for Clyde's dinner tonight. He was eating really well until we added the "EN" dog food. Back to the turk/rice bland. I bought lean turkey but I think it's light and dark mixed up...it's ground meat and he did ok on it before...at least he was eating. I've left a message for Dr. Davidson to call me tomorrow re the blood test... Thank you all...I will keep you posted- Thank you so much again. You are all in my prayers everynight -I am so, so glad I found you! Hugs, Kathy |
| Kathy |
| Kathy, For a "clean" urine analysis it would be good if they take the urine directly from his bladder. If you take him in with a very full bladder, that would make things easier. They will take it through his belly with a needle. It sounds awful, but it is really no big deal if the bladder is full. my dog found it less invasive than the blood draws. I usually got the vet to do it and she was VERY good at it. Remember that rice is a grain and white rice does not have much nutritional value. Good luck and keep us posted! |
| Brigitte BC Canada |
| Thanks Brigitte...they did give me the option of low fat cottage cheese...but I thought dogs had issues with dairy products so I opted for the rice...those are the only two options they gave me with a ratio of 1:1. I hope to get something in his stomach tonight. When I called earlier the nurse said I could go get baby food and give that to him as well. I'll see how it goes and then if he is still not interested then I'll go get some turkey baby food. Hugs, K |
| kathy |
| That's an awefull long time to wait just for a urinalysis! They're usually done in house. When I get Tessy's done I usually get the results within an hour. As far as diet and cyclo goes I wouldn't be too concerned about it. Cyclo is supposed to be given on an empty stomach but I gave Tessy hers *with* food that way it was easier on the stomach. Not a lot...just a handfull. It's important though to avoid dairy products when using cyclo cause it inhibits the absorption. Given the lymph counts above I don't think you have to worry about absorption issues. Seems to be doing its job fairly well. Turkey and rice isn't the greatest diet to be using. Use the link Brigitte provided and add some other foods to the mix as per the liver cleansing diet. I used a modified version of this with success for Tessy....she LOVED it! I added scrambled eggs, brocolli, green beens, beef heart/liver, spinach/beetgreens, boiled hamburger, squash, zuccinni, etc. Packed full of nutrients (b vits and iron)!!! Get creative...remember that diet is super important! Hugs, Johnny & Tessy |
| Johnny |
| Kathy, Much of the drug information for cyclosporine comes from its use in humans. It was developed to be used in patients who have had a transplant. For them it is a lifesaving drug. It suppresses the elements of the immune system that cause the rejection of the organ and leaves the rest of the immune system intact. The history of its use in canine medicine is much shorter. Recently it was shown to excel in treating dogs that have very severe allergies and is marketed as Atopica. Studies were done for this use only. So the evaluations of dosage, side effects etc. take this into account. The off label use of cyclosporine for canine autoimmune diseases is, relatively speaking, pretty new. Recently it has become more accepted and is being used more frequently. However, Atopica, is still only marketed by Novartis for Canine Atopic Dermatitis. Thus there are no guidelines for dosage etc for this use. However, clinical experience by veterinary clinics gives them a good idea of how to administer this drug. Dr. Dodds advised me to use cyclosporine in 2007 for Chance. She had been using it for canine bone marrow failure and was finding great success with it. In fact, we were one of the first to use Atopica, the weight dosed formula marketed for dogs. So, again, Dr. Dodds clinical experience has led her to certain protocols that specify how she doses dogs. This may differ from other vet's protocols. But I wanted to put it out here for you to read. Chance was dosed very high for about a week or two, almost at the max for his weight. Then we tapered down to a slightly lower dose. In addition, we were instructed to dose only Monday through Friday and have weekends drug free. This type of pulse dosing is known to herbalists. Dr. Dodds has found this to be very successful in treating intractable non-regenerative anemia. I discussed the trough blood tests with her and she felt it was unnecessary and expensive. In fact, of course, if he was not getting any doses over the weekend, his blood saturations would be very low. So I did not do trough level testing. It was apparent in just about 3 weeks that the drug was successful for him. The main goal of using cyclosporine in these dogs is to move the job of suppression of the immune system over to a drug that has less side effects and slowly decrease the dosage of prednisone which has severe side effects when used in the long term. But working in tandem with prednisone it provides a powerful immunomodulation. It is your choice ultimately to perform trough testing. But it is expensive. If you are still in contact with Dr. Dodds you might feel more comfortable asking her if she advises it. As for special food, hmm, not what she ever said to me. Just a well digestible diet, with plenty of appropriate proteins, moderate fat and low carbohydrates (no grains!). Dogs that are having severe liver issues (as evidenced by a out of range value for ALK and ALT) should not be getting a lot of red meat. Thus her liver cleansing diet contains fish and vegetables. Dogs can digest small amounts of dairy that have been cultured. Yogurt and cottage cheese are a regular treat at our house. In addition I make my own dog food using ground meats like turkey and beef. I add eggs because they provide excellent nutrition. I also use veggies that I process. My dogs get a raw diet and thus get a raw meaty bone with each meal for the calcium benefit. I use chicken wings and pork necks, with an occasional lamb neck. A diet of meat only is not healthful, there must be a balance between phosphorous and calcium. However, egg shells can be used to balance the diet. One of my favorite websites for canine diet is http://www.dogaware.com/diet/index.html Mary Straus has many varieties of homemade diets and explains how to balance out the diet. my best patrice |
| Patrice NYS |
| Thank you Patrice...your information is always so very helpful. UPDATE: Clyde threw up three times last night and doen't want anything to do with food. I called to talk to Dr. Davidson this morning as I was told she would be there today and this morning they said that she was only there on Tuesday's....(grumble, grumble) I asked to talk with Dr. Kruger who was there. A few minutes later Dr. Davidson's nurse called me back and said that she was at Davis but she could get ahold of her. I again explained Clyde not eating and that I had called twice yesterday and that finally when he did he kept throwing up. We went over his medications and it appears that I was giving him 1/4 aspirin TWICE a day instead of ONCE a day...(Brother!) So we have stopped that all together for now. I went over to the vet and icked up carafate which I will give once every 12 hours. We also started back on Ondansetron as well. This is the picture: 11:30AM: Ondansetron 8mg 1 tablet 1:30PM: Carafate 1gm 1 tablet 3:30PM: Ground Turkey/white rice 1:1 1 cup Pecid AC 1 tablet Prednisone 20mg 1 tablet Cyclosporine Modified 1 capsule 6:30PM: Ground Turkey/White rice 1:1 1 cup 8:30PM: Ground Turkey/White rice 1:1 1 cup 11:30PM: Ondansetron 8mg 1 tablet 1:30AM: Carafate 1gm 1 tablet 3:30AM: Ground Turkey/white rice 1:1 1 cup Pecid AC 1 tablet Prednisone 20mg 1 tablet Cyclosporine Modified 1 capsule So this will be our schedule for the next week or so until we can get Clyde back on eating regular. What an idiot I am for not reading the instructions more careful re the aspirin... This is where we stand. I did do some looking up on Dr. Davidson...who appears to be a reproductive specialist...she came highly recommended and I am trying really, really hard not to have second thoughts about this...Hugs and Prayers to you all, Kathy |
| Kathy |
| Kathy: Cyclosporine is a wonder drug in our opinion. We feel it made the difference in Sheba's recovery process. We never had a trough test done and no one ever suggested we should. As for diet - we fed her a low fat diet but otherwise we didn't make any other changes. We were very careful about the timing of her medications though. We did make sure she got it either one hour before food or two hours after. Because she is picky about taking meds we did have to use food to get her to take it. We found that canned food worked well. We were not familiar with Dr. Dodds' protocol for cyclosporine so Sheba took it seven days a week. It was the last medication we weaned her off of and we've been fortunate that she has never suffered a relapse. She will be a three year survivor on April 3rd. Hope this helps! Rita, Mike and Sheba |
| Rita IA |
| Kathy, sounds like quite the day Clyde had! Are they sure it's an ulcer and not pancreatitis? What did the vomit look like? Any blood? How's the stools look? Keep us posted. Continued thoughts and prayers for Clyde! Johnny & Tessy |
| Johnny |
| Again, thank you all for your help. UPDATE: Since we d/c aspirin and started the 12 hour regiment with carafate and back oin ondansetron things are looking up. Clyde has now eaten his dinner (3:30AM)-yahoo he's hungary again. Thank you for the tips on the pills that need to be taken without food...I was putting everything in ground turkey and feeding that to him. We think he's doing much better. His throw up was just the food and water he ate. His stools are for the most part formed but appears to be more of a shell if you know what I mean because it's mushey inside as well as the first part of the stool being a bit on the loose side. We are now giving him the Ondansetron and the Carafate alone without anything...just stuffing it down...it doesn't work for me, Clyde won't open his mouth so Brian my son has that down pretty well. I must say that this 12 hour schedule would have worked better if we had it like 9 and 9 or 10 and 10 or even 8 and 8...this 3:30 and 3:30 is a bit rough but I think Dr. Davidson will evaluate on Tuesday when we go in. She only gave us enough Carafate for 7 days. Many hugs and prayers coming from Clyde and I...Kathy |
| Kathy |
| Kathy, I must say the 3:30 & 3:30 looks brutal to me. I don't see why you could not change that. I would just move everything up by 1/2 hour every day until you are at a more humane time. As for giving pills without food. I think it is better to give a little bit of food with those pills, some canned fish or pill pockets work very well. I think the shoving down of pills can be stressful for everybody involved and that is not good. Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| Thanks...I thought so too but when I asked the nurse how I was supposed to get Clyde to swallow them without being wrapped in food she said to put it in the side of his mouth and rub his throat...which is what we did and then when we stopped, Clyde promptly spit it out...He is such a smart dog. I think we will keep the 3:30 and 3:30 until Tuesday when we see Dr. Davidson again. I'm nervous to change anything since he's now eating again. The vet said that Clyde couldn't have any fish, only ground chicken or turkey. I've read lots of great stuff on fish and really liked the receipe for Dr. Dodds liver diet. I think it will be easier on Tuesday when we're in the office. I have to write my questions down otherwise I always forget something and then have to call. Clyde ate his first meal today...not everything but half. Will keep you posted tomorrow. Hugs and prayers, kathy |
| Kathy |
| Hello All...I have another question please... Since Clyde has been taken off aspirin yesterday--do we now stand the risk of his platlets clumping more?? In every blood test it says they were clumped...I don't want Clyde to be off this very long if that is the case. He is still doing well today with his eating...I think he has eaten 3.5 maybe 4 cups of food. Can I have your thoughts? Should I wait to see the vet on Tuesday or should I call them tomorrow and let them know that Clyde is doing much better and maybe they want to start the 1/4 low dose up again. Seems like such a trade off... Thanks so much...Hugs and Prayers, Kathy and Clyde |
| Kathy |
| This clumping has more to do with the blood sample and how it is handled than it does with how the platelets behave inside the body. It is somewhat normal for them to clump on the slide when it is prepared. If you leave blood samples standing for too long they eventually do coagulate. His blood test seemed to indicate that hemolysis was minimizing. Have they released him home to you? If so, then they must believe that he is stable. p |
| Patrice NYS |
| picture of clumping http://ahdc.vet.cornell.edu/clinpath/modules/heme1/2thin.htm how platelets are measured http://ahdc.vet.cornell.edu/sects/clinpath/modules/coags/platno.htm p |
| Patrice NYS |
| Thank you Patrice...I always appreciate you and your suggestions and help. Yes Clyde came home on...I think the 25th. I didn't know if the aspirin is what stops the blood clots and if since Clyde is now eating if we should put him back on 1/4 low dose once a day. Thank you again...Hugs and Prayers, Kathy and Clyde |
| kathy |
| I have to give Ginger her pills in a very small amount of peanut butter or she will NOT TAKE them and she has been getting them that way for the last 3 1/2 years and is doing just fine. Have you tried peanut butter with Clyde, if so just use a very small amount to coat or hide the pill, she probably gets less then 1/2 a teaspoon a day. I do think someone mentioned on this forum not to give our dogs peanut butter but it is THE ONLY way Ginger will take the pills so that is how she gets them. Of course always check with your vet first. Ginger is also on Cyclosporine she was started at 200mg a day and she is now getting 25mg a day and .5mgs of pred 3x a week. She can't go med free as we have tried with no success, but so far so good. Hope Clyde is continuing to do well. Cheryl & Ginger |
| Cheryl & Ginger Pinevile PA |
| Cheryl, When I took the workshop with Jean Dodds, this was exactly what she said to use to dose the soloxine, a little bit of pb. I see no problem with small amounts of pb. I use a natural, no salt, sugar or fat pb for the dogs. I put a bit inside their kongs and let them work it out. However, dog food or treats that are made with pb can come from questionable sources (does not have to comply with human food standards) and I have read that pb can contain mold in some rare cases. Perhaps this is where this idea started? When Chance's heart condition was the worst, I had to be very creative about foods to get his many pills down. The specialist said "whatever it takes." His appetite was very poor. My vet has always advised me that the smelliest fish is the best stuff. So sometimes I have made stinky sardine "sandwiches." p |
| Patrice NYS |
| Thanks you two...I went to the health food store and bought the best peanut butter I could find...actually they grind it up right there...pretty neat and Clyde took his pills this afternoon like a champ...no problem at all. Thank you all once again...I love this site! Hugs and prayers for all, Kathy and Clyde |
| Kathy |
| Kathy, I definitely like the idea of pb or sardines better than just shoving pills down a dogs throat! I think this tiny bit of food will not hurt and make Clyde much happier. I hope things will improve for him soon. Best wishes, Brigitte & the poodle boys |
| Brigitte BC Canada |
| Thanks Brigitte and the poodle boys! I totally agree...I guess sometimes I have to push back just an ittie bitty bit when I'm talking to the hospital nurses. An added note is that Clyde no longer has any belly fluid either. He goes back in for lab work on Tuesday so we are all keeping our fingers, paws and toes crossed! Hugs and everyone in our prayers, Kathy and Clyde |
| Kathy |
| Kathy, You drive the bus. Be nice, but firm, when it comes to being the advocate for your dog (or your family). I have learned to always be polite to everyone because I never know what important person I might be polite to. And I have found that pretty much everyone is important. p |
| Patrice NYS |
| Kathy I was very glad to read that Clyde likes PB and hopefully that makes life easier for both of you. Ginger somehow knows when I open the jar of PB and comes running into the kitchen even if she is on another floor of the house, I think she can smell it a mile away. Sometimes Ginger is hesitant to get up and go outside for potty break and we just say want your pill and she comes running because she knows she might get some PB:) We have tried pretty much everything to get her to take her pills and this is what worked for her and now pill time is a happy time:) Glad to read Clyde is doing well. Cheryl & Ginger |
| Cheryl & Ginger Pinevile PA |
| Clyde's Update: Clyde went to see Dr. Davidson today. His pack blood is 37!! We are so happy, his mouth is pink, pink and more pink! She also did a chem panel but we wont have that back until tomorrow. She d/c his Carafate and Ondansetron and added back in the aspirin 1/4 low dose tablet twice a week on Thurs/Mon. She also is letting him back on his regular kibble which has made him very happy. I hope that he gains some of the weight he has lost. He was down to 49 lbs today...he's lost almost 10 lbs. Everything is looking up. We are so grateful to everyone! Thank you for all your help. I'll post his blood work tomorrow as soon as I get it. Hugs and prayers, Kathy and Clyde |
| Kathy |
| Kathy, I am so glad things are improving for Clyde! I am a bit concerned why the carafate is being discontinued. He is still on Cyclosporin and prednisone is he not? This could give him ulcers, a complication you don't want. If it were my dog I would continue with the carafate. Kibble is ok, as long as it is high quality and contains no grains, corn or soy. I still like the idea of home cooking better. You feed better quality and in the long run it will be cheaper too. But of course it is quite a bit more work. Keep it up Kathy. It looks like you are doing things right! Best wishes, Brigitte & the poodle boys PS: This thread is starting to get very long, maybe you could start a new one tomorrow? |
| Brigitte BC Canada |
| Hi Brigitte and the Poodle Boys! Yes he is still on these two..Prednisone 20mg and Cyclosporine 100 mg. As I was going over the appt in my head on the way home...I thought that was a bit odd as well...especially since we are giving him aspirin again. I'll call tomorrow and leave a message that I'd feel more confortable with him staying on it. I'm going to read the label on the kibble...but I don't think it's the very best...it's Purina One-Lamb and rice. She said that he needs to be on something other than turkey and rice because he isn't getting a balance meal. The last thing we need is to go backwards because we are trying to go too fast forward.. Sure I can start a new thread...I didn't know that's what we do. I'll call it Clyde's Update Thank you again...everyone...hugs and prayers, Kathy and Clyde |
| Kathy |
This thread was discussed between 19/02/2011 and 09/03/2011
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