Immune-Mediated Thrombocytopenia (IMT) / Jackson

[PeterG]

1. Your pet's name / Jackson
2. Approximate age / 8 years, 11 months
3. Sex / Male
4. Neutering status / Not neutered
5. Breed / Rottweiler
6. Approximate weight / 90 lbs
7. What's their BEAM (behavior, energy, appetite, mood) / Behavior: gentle, affectionate, loyal - Energy: excellent - Appetite: very little Saturday - improving since then, - Mood: he can be a bit moody, cranky when tired, otherwise friendly and happy. Very very attached to his humans.
8. Diet: Ate Canine Cavier (kibble) for 8+ years. In the last month switched to Small Batch raw.
9. Vaccination history / exposure to toxins, other medication / Rabies, distemper (unsure of others). No kennel cough or flu vaccines, no medications at any time, no known exposures to toxins.
10. Primary problem, when it began and if there was anything else happening around that time / Began vomiting brown fluid on Saturday AM (8.5.23). Took him to a reputable emergency vet clinic on same day. Found he had a minor non-concering arrhythmia and very low platelet count (1,000). Also found 2 small nodules on his testicles and one on his spleen (have suggested monitoring them but taking no action for now. The vet believes the brown fluid vomit was due to possible bleeding in the stomach. Jackson had lost a companion dog 3 weeks prior. That dog had been with Jackson since birth. They were very close. He also switched to raw food in the last 3 weeks. When he left the hospital on 8.6.23 - his platelet count had improved to 15,000-20,000.
11. Is the condition better or worse from exercise, heat, cold, time of day, certain foods, emotional upset, being touched, excitement, etc? Too soon to know. The vet's instructions were to keep him quiet for the next few days. He generally loves to be outside, loves to walk, swim and play. Very athletic guy.
12. Has any diagnostic work been done? Diagnosis if available (you can attach your diagnostic tests to the post if you have them) / Attached.
13. Current and previous treatment - the vet put Jackson on a daily dose of prednisone (see report for more details)
14. Other health concerns - none. Before Saturday, Jackson appeared in great health. Excellent vitality.

@Dr. Jeff , @Dr. Christina , @Dr. Sara

 

[PeterG]

@Dr. Jeff , @Dr. Christina , @Dr. Sara

 

[PeterG]

Here is a bit more from my daughter on the drugs Jackson was given by the emergency vet:

"He's on a few for settling his stomach too. and an antibiotic for the tick born diseases. The only one that will continue is the Prednisone and that will likely only be 6 months or so.


Maropitant (Cerenia) ½ tablet once a day for 3 days for the vomiting

Doxycycline Hyclate for the tick born diseases

Sucralfate for 7 days I guess this one is like an antiacid for the regurgitation (he had been vomiting up a bit of mucus once or more times a day after switching to all raw food [**he was transitioned with a mix of kibble and raw for a week before switching to all raw.])

PredniSONE - the vet will lower the dose once they see his levels come up to normal.

Omeprazole - balance his stomach acid - GERD - for 7 days.


I think it'll be important to talk about the nodules on his spleen and testicle. And then is there anything that we can do to keep his levels up once he's off prednisone so he doesn't have to go back on it. Also, they are recommending neutering him in the next few months when he is strong again, etc."

@Dr. Jeff , @Dr. Christina , @Dr. Sara

 

[Dr. Jeff]

I'm super

Thanks for sharing this info Peter! I'll review it later today.

In the meantime, perhaps Kate can focus on getting Jackson outside as much as possible to just lie on the ground or have mild sniff walks.

Did you or she have any specific questions before we talk during your HMDM call on Thursday?

 

[PeterG]

Hi Jeff,
She wants a strategy to reduce his dependency on drugs - particularly prednisone - and wants your thoughts on the small nodules and whether Jackson should be neutered.

Also - the vet called to say his PCR test came back. He does not have an active tick infection of any kind right now. Kate was instructed to take him off the antibiotics immediately. BTW - she is working with Veterinary Specialists in West Hartford in case you know them.

Thanks again.
Peter

@Dr. Jeff @Dr. Christina , @Dr. Sara

 

[Dr. Jeff]

reduce his dependency on drugs - particularly prednisone -

OK! The very best way is to work 1:1 with a trained (and integrative) vet homeopath who can walk with her all the way through this challenge.

In lieu of that, having an open-minded vet who is willing to work with her to reduce the drug would be a great start. Then we can be there for as much support as she needs.

I'll ponder the results you attached and see what I think.

and wants your thoughts on the small nodules and whether Jackson should be neutered.

I bet those are incidental findings. I would not introduce any stressor at this time.

Has he had a full evaluation by an internist?

 

[Dr. Jeff]

Wow! 80mg of pred/day?

It would be great see his full CBC result and to know if the 1,000 platelets result was run in house (or sent out).

BTW-At the 2022 ACVIM conference the use of pred for ITP was controversial to at least one of the experts:

https://www.eventscribe.net/2022/ACVIM/agenda.asp?pfp=FullSchedule

 

[PeterG]

Hi Jeff,
Thank you for your thoughts. Any chance she could work with you directly on Jackson's case going forward?
Also - Jackson was carefully examined by two vets at Veterinary Specialists (he was there for one night and a full day). Would that qualify as a full evaluation? Also - he is going back for blood work Thursday to check his levels. Anything special she should ask for?
Peter

@Dr. Jeff @Dr. Christina @Dr. Sara

 

[Dr. Jeff]

Any chance she could work with you directly on Jackson's case going forward?

We can discuss this on Thursday. In the meantime she can certainly submit this new client info. in case we do decide to work together 1:1:

New Client Questionaire

www.homevet.com

Also - Jackson was carefully examined by two vets at Veterinary Specialists (he was there for one night and a full day). Would that qualify as a full evaluation?

The general (maybe in the ER?) vet on the report I read was not an internist. If he had a full consultation with an internist or hematologist then yes, it would.

The intent is just to have the most complete picture.

 

[PeterG]

Working to get you the full CBC result. It was an in-house test. They ran two tests Saturday night and one on Sunday (8/5 & 6).
@Dr. Jeff , @Dr. Christina , @Dr. Sara

 

[Dr. Jeff]

You and Kate may want to have the next one sent out to the lab...

 

[PeterG]

Hi Jeff,
Here is the full report for Jackson for your review. I will let Kate know to suggest a test by an outside lab. You are referring to a platelet test only or a full blood panel?
Peter

@Dr. Jeff, @Dr. Christina , @Dr. Sara

 

[Dr. Jeff]

Thanks!

I was referring to a full CBC.

 

[PeterG]

Hi Jeff,
This report did not have that information I take it?
Peter

@Dr. Jeff

 

[Dr. Jeff]

Yes!

These CBC results are exactly what is needed!!

I'm suggesting that the next CBC is sent to the lab (for the best possible accuracy).

 

[PeterG]

Hi Jeff,
I have attached Jackson's most recent blood work. They also drew more blood today to check him again. His platelet levels are back to normal so they are rapidly weaning Jackson off prednisone. The vet is worried their testing equipment gave faulty results the weekend they first saw him. Please let me know if you have any thoughts on how quickly he can be weaned off the drug. It is the only med he is taking now.
Thanks
Pete

@Dr. Jeff

 

[Dr. Jeff]

Great question, and wonderful news about Jackson's platelet count Pete!

The exact speed of weaning will need to be determined by Kate's local vet who is seeing Jackson.

It sounds like they'll try to do it as quickly as they deem safe.

In general, the weaning is related to the current dose and how long he has been on it.

The 80mg/day that he had been on could have shut down his adrenal production of natural steroids if he was on that dose for more than a few days.

If he was, it may take a few weeks.

 

[PeterG]

Thank you Jeff! Appreciate all of your excellent help and advice!! You have been terrific as always!!

@Dr. Jeff

 

[Dr. Jeff]

You're welcome Pete! And thanks for the kind words. They're much appreciated.

 

[PeterG]

Jackson had a new ultrasound done on his spleen yesterday. They found a growth 2-3 inches in size on the tail of the spleen. When looking back at the ultrasound from 4 weeks ago - the vet said this growth is not visible. In that original ultrasound, there was a 2 mm spot on a different part of the spleen. That no longer concerns the vet. The vet says there is a 70% chance that the growth is cancer (given Jackson's age and size) and that if it is, Jackson would have 2-3 months to live. He also admitted that cancers don't typically appear and grow at that rate of speed - so it could be something else - a large blood clot or something - possibly a consequence of the original problem. The big question is how could they have missed something that large just a few weeks ago. And if it is unlikely they could have missed it at that size - what is it? We would love your thoughts Jeff. Happy to pay you for your time.

Here is a link to the ultrasound results (I will also email you the link):
click here

Another ultrasound is scheduled in two weeks. If the growth is still there they want to remove and biopsy the spleen.

@Dr. Jeff