Immune Mediated Thrombocytopenia

[Starkehre]

Hi pf. Well it is still all positive news. Yes, I am hoping to hear of an improvement soon also.

If the vets are considering any of the other drugs and thinks Esmay will benefit by taking them, then give them the go ahead asap, as they take longer to kick in, and that is why they always go for cortisone first, it is almost instant. It is a race against the clock. She needs her very options as early as possible to give her a fighting chance at life. By memory we started Dyzney on Imuran (Azothiaprine), Misoprostol and Cyclosporin on day 3 or 4, as well as the Cortisone (Prednisolone).

Keeping fighting Esmay. You can go it little girl.

[peacefrog]

Well, the vet phoned this afternoon and said they gave her her third transfusion. I have second hand information so I'm not quite sure of the finer details but I think she is off the cortisone treatment now and onto chemo tablets instead. The vet said she is looking the best she has seen her which is so good to hear! We went to visit her earlier tonight and we had to wear gloves to handle her from the treatment. She was so tired and sleepy but the blood in her eyes is starting to fade and she is getting some colour back into her gums.

I was so happy earlier to hear this news after such a long, emotional day at work but I'm on a bit of a downer again now as I really just want to see the numbers start creeping up now. So I yet again begin hoping for the positive news to come tomorrow, Day 6!!!

I would love to thank everyone again for the support, especially Dyzney, you are amazing and tireless in your continuous support of your fellow dol'ers through your own experiences of this disease, even though on each occasion it must dredge up some of those awful memories of your lost girl.

Anyway, here are some pics of Esmay at the hospital, these were taken on Tuesday night. She looks a bit groggy but was still quite aware of everything and was happy to walk over to each of us through the duration of our first visit, but has become more subdued each one since starting the treatment.

And my 2 girls, Pixie & Esmay in happier times

[SueM]

Go Esmay keep improving

[Starkehre]

Great news pf. Go Esmay.

The drugs you speak of that you should not handle are Imuran (Azathiaprine). Esmay will still be on cortisone. They cannot take her off that quickly. She will probably stay on cort for quite a long time, and then very slowly be weaned off it.

Oh, I just realised I read that incorrectly... they mad you handle Esmay with gloves?? OK, that is something I have not heard of. Perhaps it is not Imuran, but I think it would be. I thought you only needed to handle the tablets with gloves, not the dog??

anyway, good idea to do what they recommend.

This is great news pf, I am really excited for you. It is still early days though.

And look at Pixie and Esmay on the bed. they look like the terrible twosome uo to mischief. Such cuties. I bet Pixie is missing Esmay. Hipefully she will be home soon.

Hoping for some more good news on lifted platelets soon.

[peacefrog]

Thanks Vari :p

dyzney, they said it is very dangerous to come in contact with any remanence of faeces due to the chemo treatment she has had. It was a little confronting actually but all apart of the process I guess.

Hopefully an update this morning - and for some good news.

[Bokezu]

Hi peacefrog...sounds very positive for your girl Esmay, hoping things continue to improve, this is a bastard of a disease, but can be conquered, sending lots of hugs Esmays way xxx

I had my heart ripped out in November when I lost my young boy to this insidious disease, here is his story if you feel up to reading it Jordans fight with IMT

everyone here is fantastic and gave me so much support, really don't know what I would have done without them.

Lots of healing vibes to your dear little Esmay and lots of cuddles and strength to you

[peacefrog]

Thanks Bokezu, Dyzney gave me the link to Jordy's story and it was so heartbreaking to realise in the end that he didn't make it.

Well 4th blood transfusion needed today, still no change. She was vomiting abit overnight, maybe from the treatment? Feeling so freaking frustrated!!!! I I don't really ahve the words right now, I am at work and trying to keep it together!

[Bokezu]

Hoping she perks up after the blood transfusion, give her a hug from me when you see her next xx

[Starkehre]

Oh pf, I hate hearing you like this.

Boke and I, and many others know just what you are going through, and there is nothing any of us can do, but all pull together with loving thoughts of best wishes and wellness for Esmay.

It is such a goddamned emotional rollercoaster. I really feel for you.

The vomitting could be the start of tummy ulcers or it could be just nausea from the drugs. The medication is so tough of their tummies, especially the littlies.

I hope the vomitting stops or was just a one off.

They put Dyz on Ondancetron for her tummy ulcers, but it made her nauseous. So, we had to take her straight back off it. And nasagastric for feeding is too risky with bleeding. As long as she keep eating, it will keep her strong and help lessen the risk of tummy ulcers. Get whatever you can into her.

Even take yummy stuff in with you if she is not eating what the vets are giving her.

I hope Esmay turns the corner soon pf. Poor little girl.

Sounds like the vets are doing a wonderful job.

Hang in there pf. Hugs to you.

[Lemonlime]

Peacefrog,

Still thinking of you here. I know exactly what you are going through. These immune diseases are bastards and unfortunately they are something you just have to wait out, thats the part that breaks you, not knowing what tomorrow will bring.

Your little Esmay looks like a real fighter, I really hope tomorrow brings some better news for you and your girl.

Hugs to you and Esmay!!!!! xo

ETA - My boy had vomiting and the runs from his gut protectants. He was on Cortisone and chemo drugs also.

Edited February 7, 2010 by groupfive

[Starkehre]

Groupfive, and others interested, Esmay is still with us.

She is riding the rollercoatster that IMT brings with treatment.

Groupfive I am so sorry you lost your lad to an IM disease. Yes they are hideous bastards of things, that there still is only limited information on.

Since peacefrog posted here last there have been several lows and bad news and much upset, to some much more promising news with lifted platelets and Esmay producing her own red blood cells again.

Currently she is doing reasonably well, all considered and things are looking as positive as they canwhilst this battle goes on.

pf is doing an amazing job of being strong and supporting her sweet little Esmay, and the vets are brilliant.

I know pf is tired and emotional, but absolutely to be expected. Her dad is being a pillar of strength along with others around her.

I hope she does not mind me updating here for her, we have been keeping in touch. I am sure she will post as soon as she feels up to it, and I know she appreciates everyone's support.

Come on Esmay, you keep fighting little girl.

[SueM]

I just read an update on facebook,so glad she is still with us, Esmay is a lovely wee girl, pf used to foster for saveapounddogqld and Esmay always welcomed the many foster dogs, she is a real wee character and a fighter

[moosepup]

Thanks for the update dyzney, I will be keeping my eye on this thread.

C'mon lil Esmay, get better for your mum.

[Lemonlime]

Groupfive, and others interested, Esmay is still with us.

She is riding the rollercoatster that IMT brings with treatment.

Groupfive I am so sorry you lost your lad to an IM disease. Yes they are hideous bastards of things, that there still is only limited information on.

Since peacefrog posted here last there have been several lows and bad news and much upset, to some much more promising news with lifted platelets and Esmay producing her own red blood cells again.

Currently she is doing reasonably well, all considered and things are looking as positive as they canwhilst this battle goes on.

pf is doing an amazing job of being strong and supporting her sweet little Esmay, and the vets are brilliant.

I know pf is tired and emotional, but absolutely to be expected. Her dad is being a pillar of strength along with others around her.

I hope she does not mind me updating here for her, we have been keeping in touch. I am sure she will post as soon as she feels up to it, and I know she appreciates everyone's support.

Come on Esmay, you keep fighting little girl.

Thankyou for the update. I only lost my boy 3 days ago so the pain is still raw and I really feel for Peacefrog, its so horrible to watch someone else go through the same thing. I do have a question for you Dyzney if Peacefrog doesnt mind me asking in his thread...it has been playing on my mind and I was too upset when I lost my boy to be bothered asking the vets at the time.

My boy had IMHA which came on immediately over night, we dont know what caused it. I want to know if he would have always had an underlying immune problem and this unknown cause has triggered the IMHA it or whether the disease picks dogs randomly. Hope this makes sense.

[Starkehre]

Hi groupfive, once again, I am so sorry to hear about your boy. It will probably still be raw forever. I lost Ruby to IMT 4 years ago next month, and it hurts like crazy. Each Immune Mediated thread that comes up makes me feel sick to the stomach when I see them

Regarding your question, I am not a vet and have no real expertise in the field, and would never claim to, but I will have a go at answering your question as best as I can from all the information I have learned over the past 4 years....

Before I start, please understand that there is relatively little known about Immune Mediated disorders, and quite often even the vets are adding a fair bit of guess work when trying to answer questions. They do their best, but the cases manifest and respond to treatment in so many different ways.

So, as you understand, IM diseases are idiopathic, which means they cannot say for sure what has caused it, unless it is secondary. I would say your first selected answer is closer to the correct one.

Quite often these things show outward symptoms over night, but what has typically been happening is for the past 2-3 months the immune system has decided to red flag something in the body of the dog and things are already happening, but just slowly. When you see the dog crash, that is when it has reached rock bottom. Both my dogs exhibited different signs. One appeared with more warning and the other overnight, like your boy.

What is tricky is that being idiopathic, quite often the owners have a fairly good idea of what may have caused the on set of the disease. I strongly believe that I know what brought on both of mine - Rimadyl and Stibestrol, but of course I will never actually know that for sure. What I do know is that these are both drugs that are included in the list of possible causes of IM disorders, and both my dogs received these in the correct time frame before becoming ill and had not been administered these previously.

Now, let's say that you had a sudden epiphany, and felt strongly about what your boy's cause was, let's say it just dawned upon you. Let's say you got a new deck out in the backyard that had been treated with chemicals and he spent much part of the day laying on it and this 2-3 months prior to him becoming ill, and not one other single thing had changed in his life. Then let's say you did some research into the chemicals contained in this decking timber. So, then what?? You see, you have no proof, so the vets will not take that on board and include it into any study or information that becomes readily available to vets treating the disease with others later on. So, you may feel you know what caused it in your boy, but no one else will ever know the dangers of this decking timber with these chemicals. See what I mean.

And here is the other thing... sadly your boy passed away, so as it turned out, it really didn't matter too much that you did not find out what brought the disease on, because you did not need to remove whatever it was from his life. Of course you are curious, and we all would be, but the answer is mute really.

So, all these drugs and chemicals that could all be possible factors into causing IM illnesses (along with other things like stress, hormones, excessive exercise, vaccinations and others) are used everyday successfully on hundreds and thousands of other dogs, and nothing goes wrong.

So, why your dog, why my dogs, why peacefrogs dog and others??? From what I have learned talking to many many vets and specialists over the past 4 years... the general concensus is that it is genetic. The predisposition is hereditary. Having said this it still does not seem to pop up in certain lines commonly. It is still relatively rare, but does appear. So, a predisposition and then a trigger seems to be what most of the more highly regarded specialists believe.

Now, having said all of this some people can never come up with their dog's trigger. I have a friend on here that has absolutely no idea what brought it on in her girl. We are all wondering if there is a heat component to the triggers, as many of these dogs are getting it in the hot months of the year. But then could that be air-conditioning or excessive water with fluoride, who knows?? I know of 2 people that believe it was brought on by swimming in dams, and that may have been blue green algae??

When the dogs diagnosed with an IM disease have an obvious underlying problem that is also found, the IM is secondary, and these ones are less brain challenging as more questions are answered. But primary IM diseases are and will probably always be a bit of a puzzle.

I have received some other interesting information from vets too. We do know that it is more common in middle aged bitches, and more prolific in some breeds also. But an interesting one I found out was that some specialists in USA believe it is more prevalent in black and tan dogs. Interesting. I know Cocker Spaniels and Rottis are high on the list of more common breeds, and Dobermanns are on there also. So, there is definitely a genetic component.

At this point, it is not something I would blame a breeder for, as often they are not aware of it.

I don't know if I have answered your question well, but I hope it helps a bit.

Edited February 8, 2010 by dyzney

[Bokezu]

Excellent post dyzney, it should be stuck so everyone can read it, very helpful for owners of newly diagnosed dogs.....

hope little Esmay is doing well

[Starkehre]

Hi Boke, how are you going?

Esmay is doing OK. Her platelets had lifted a little, but are remaining and not rising to where they should be for the moment. Vets are conducting more tests to rule out secondary cause. She appears as though she is starting to manufacture her own red blood cells, though they will not be sure until they have these results back from the bone marrow test.

Although it is still all good news so far, some better news would be better very soon.

she is still having fairly regular blood transfusions, so these are keeping her in good stead whilst pf plays the waiting game for the drugs to do their thing and knock her bloody immune system on the head.

[Bokezu]

Hi Boke, how are you going?

Esmay is doing OK. Her platelets had lifted a little, but are remaining and not rising to where they should be for the moment. Vets are conducting more tests to rule out secondary cause. She appears as though she is starting to manufacture her own red blood cells, though they will not be sure until they have these results back from the bone marrow test.

Although it is still all good news so far, some better news would be better very soon.

she is still having fairly regular blood transfusions, so these are keeping her in good stead whilst pf plays the waiting game for the drugs to do their thing and knock her bloody immune system on the head.

I'm doing ok Dyz, have my moments everyday, it hurts like hell, but you know what thats like...

Reading the way they are treating Esmay makes me wonder why they didn't give Jordy more transfusions, all mute questions now but they are getting in and giving her lots more, would that be because she is smaller? or maybe they are more experienced with the disease and know the best shot is to keep transfusing...........hope it works, things are looking up a little for Esmay, hugs to her xxxx

[peacefrog]

Thank you so much Dyzney for keeping the topic updated. I have been coping okay but am feeling completely drained!!! This disease is a marathon, there is so much going on , the progress is so up and down eacy and every day and there is so much information to get my head around. I feel I'm not doing so great understanding the complete in's and out's but people like Dyzney and other sources online are breaking it down for me.

The vet suspects Esmay has Evan's Syndrome, which is where ITP & AIHA both occur. Where we are at today is Esmay has had her 7th blood transfusion; She still has very little platelets and her red cells aren't holding between transfusions. They are going to do a bone marrow biopsy today to see if the cells are being produced and are still just being killed off, or if nothing is happening at all. (In which case, I don't know what happens then - is that it? does that mean red cells will never be produced?.)

The vet isn't very happy with her decline across the weekend and thinks she should have progressed more by now. She is being started on a new drug this afternoon - which I will supply the name of when I find out.

I have forwarded my vet an email I received from Dr Jean Dodd's who suggested they start her on a thyroid hormone treatment as well as an indepth article she wrote on this disease. I'm not sure if this will provide any new information but I figure nothing ventured nothing gained.

I am also thinking of suggesting they put her on a Milk Thistle supplement to aid in protecting her liver from all the treatments she is receiving, alot of owner's start their pets on it after the intial treatment but I'm wondering if it can be started whilst she is in the midst of this serious treatment??

I am really willing to try anything, no matter how silly it may seem at this point in time.

Edited February 8, 2010 by peacefrog

[Starkehre]

Hi Boke, how are you going?

Esmay is doing OK. Her platelets had lifted a little, but are remaining and not rising to where they should be for the moment. Vets are conducting more tests to rule out secondary cause. She appears as though she is starting to manufacture her own red blood cells, though they will not be sure until they have these results back from the bone marrow test.

Although it is still all good news so far, some better news would be better very soon.

she is still having fairly regular blood transfusions, so these are keeping her in good stead whilst pf plays the waiting game for the drugs to do their thing and knock her bloody immune system on the head.

I'm doing ok Dyz, have my moments everyday, it hurts like hell, but you know what thats like...

Reading the way they are treating Esmay makes me wonder why they didn't give Jordy more transfusions, all mute questions now but they are getting in and giving her lots more, would that be because she is smaller? or maybe they are more experienced with the disease and know the best shot is to keep transfusing...........hope it works, things are looking up a little for Esmay, hugs to her xxxx

I know Boke, still so raw for you. :D

I have no idea of more transfusions would have helped Jordy, and I don't think size has anything to do with it, but I am not really sure.