Abby

January was a rough month for Abby. She's doing better now, but here's what happened. Sorry for some of the gory details...and for the lengthy post!

Jan 1st & 2nd...we noticed some redish-brown stains on the couches...not completely uncommon in our house, as Elle's had a fistula repaired and then more recently had some scar tissue biopsied, so it wasn't out of the question to see little spots of blood in places. I just cleaned it up and went on with things.

Jan 3rd (Saturday morning -of course, a weekend!) Abby had pooped in her crate over night - a rarity for her, but again not out of the total ordinary as it was a weekend and Brendan let us sleep in until 7am or so instead of our normal 5:30am wake-up. However, what was more unusual was that there was some bright red blood mixed in, so I thought, hmmm...hemorrhoids?! Odd, but went on with our day. Later that day after returning from some errands, Abby was sitting on the couch and I noticed that she was leaving red bloody spots where she was sitting. Started to get worried. I took a look at her and she didn't seem to be outwardly bleeding anywhere. Then, she walked across the room and passed two large bloody clots. So, off to the Emergency Vet we go...because of course our dogs only get sick on weekends and evenings!

After an exam with one of the ER Vets (Dr. Andrea), we noticed bruising on Abby's belly and started to get very concerned. Dr. Andrea's first thought was that she had possibly gotten into some rat poison which is a blood thinner and that was causing her to bleed uncontrollably. She also noticed that she had some enlarged lymph nodes and an enlarged spleen - uncertain at the time if this was because of the bleeding or some other process such as cancer. We decided to check some blood work while the vet continued to monitor her. I ran an errand to try to distract myself with only a little success.

Returned to the vet within 30 minutes (lab results were supposed to take about 60 minutes). Apparently they had some emergencies to deal with and I waited at least an additional hour. In that time they took some x-rays of Abby's belly & chest to see what else was maybe going on. They also did a biopsy of her enlarged lymph nodes.

Finally, Dr. Andrea returned with Abby's blood work. Most tests came back normal - no evidence of rat poison as her clotting times were normal, however, her platelet count was very low (15,000). Low end of normal is around 150,000. This was why she was bleeding...as at this low of a platelet count the blood does not clot and spontaneous bleeding can occur - hence the bruising on her belly. The next question was WHY was her platelet count so low. On the x-rays, her spleen looked enlarged. There was also a question of a mass in her spleen. Was this an over-read on the x-ray or was there something there? Was her spleen enlarged because of the possible tumor in it or was it enlarged because it was "eating up" all of her platelets.

The other issue was the fact that she was still passing bloody clots which were quickly turning into bloody diarrhea.

Dr. Andrea wasn't certain if this was IMTP or ITP as it's called in humans or lymphoma. IMTP or ITP is immune mediated thrombocytopenia which essentially is abnormally low platelets. So of course, the concern was that this was cancer/lymphoma. The ER has a radiologist who does ultrasounds, but they weren't available since it was the weekend. The definite way to diagnose lymphoma was a bone marrow biopsy, which of course also couldn't be done nor was it safe to do with a platelet count of 15,000. Same with a biopsy of her spleen to see if there was a mass there. Dr. Andrea was a little hesitant to treat the ITP initially as it would prevent us from being able to fully evaluate for lymphoma as the treatment (steroids) would affect the tests. However, after some discussion, we decided that we had to treat her then as with her having bloody diarrhea, we were between a rock and a hard place.

So, around 8pm, I left the Emergency Vet, leaving Abby behind in their capable hands, but with my heart breaking. I could hear her barking in her crate as I left. They were giving her Prednisone (steroids), Imuran (an immune system suppresant), Pepcid and Carafate for her stomach, and two antibiotics - one for tick borne illnesses which can sometimes cause this and another to prevent her from getting a blood infection from the diarrhea.

Jan. 4th - Checked in with the vet first thing in the morning - they were absolutely wonderful about answering phone calls & questions at all hours of the day & night. Abby did well over night and continued to eat and drink and be quite energetic. Chris, Brendan & I went for a visit and my mom stopped by as well. It was both a positive and negative experience. She was so full of energy - we even took her for a short walk outside, but she was literally dripping blood from her behind as she walked at times. So, so scary to see. So at this point we knew had two problems - the low platelets plus bleeding into her stomach/intestines.

Got to talk to another vet today who was taking care of her. After having a decent night's sleep, I was able to ask some intelligent questions. What else can we do? What is the prognosis for either diagnosis. He was wonderful and gave us very frank answers, which is what I needed to hear, painful as it was. Depending on the type of cancer - forget the actual names now - as little as 4 weeks and at best 9 months with some chemotherapy. But IMTP can be manged with medications for the most part, so of course that is what we were hoping for. We talked about a somewhat experimental treatment of an infusion of Vincristine, which is a chemotherapy drug that has the side effect of causing the bone marrow to release platelets - they may be immature platelets, but platelets none the less. We decided to give this a shot - we really had nothing to lose at this point, as it typically takes about 3-4 days on the steroids and immune suppresants to see a rebound in the platelet count.

The plan was for an abdominal ultrasound on Monday by one of the Internal Medicine vets. The other issue that they had me start to think about was possibly doing a blood transfusion. They were monitoring Abby's Hgb/Hct every 8 hours and it was definitely dropping - not yet in a dangerous level, but getting there.

Jan 5th - Internal Medicine Vet did the ultrasound finally late afternoon on Monday - she did not see a mass in her spleen, which was very good news. She did notice an enlarged lymph node, but wasn't sure what to make of it and was going to have the radiologist repeat it later on. Radiologist repeated the ultrasound and didn't see anything abnormal other than fluid in her stomach and what appeared to be something "pumping" into her stomach - blood? The vet had never heard anything described this way. Abby had started to vomit, so they had to put an IV in her to give her her medicines and some fluids. I stopped by the vet after work to visit with Abby. She was still pretty active. We got a towel laid out on the floor and I sat down next to her...she eventually laid down next to me and I swear she was asleep almost instantly. (I doubt that she slept much of the weekend while at the vet - the lights are always on in the back and there's always barking and talking.) This was the day that I got to meet Dr. Johnson - wonderful, wonderful vet! Her platelet count dropped to 2,000 today.

So, with a "normal" ultrasound - minus the bleeding into her stomach of course - we pressed on. Her counts were definitely getting lower. I spoke with the night vet and decided that if she needed a blood transfusion we would go ahead and do it hoping that it would buy us some time until her platelet counts rebounded. (They do blood transfusions for dogs & I'm assuming cats, but they do not have the ability to do give platelets as they do in humans.) The night vet called me at 2am on Tuesday morning to let me know that they were going to do the blood transfusion, as she had become lethargic and her blood counts confirmed that her hemoglobin had dropped to a dangerous level.

Jan 6th - Abby did very well with the blood transfusion. She did not have any vomiting today and very little bloody diarrhea, so things were a little more encouraging. I again stopped by after work to visit. She was definitely perkier after having had the blood transfusion, which made me feel very good about the decision to do it. We got back more encouraging results as well...her tick titers were negative, so no tick borne illnesses as the cause. Also, her lymph node biopsy that they had done on Saturday came back negative for cancer as well. So, her diagnosis officially became IMTP. I was so excited and relieved! Things really started to look up. After a long visit with Abby, I got her to eat a little bit of food as well, before I went home.

Jan 7th - (My day off - much needed as my weekend was not very productive.) I stopped by the vet during the early afternoon. Apparently Dr. Johnson had just talked to Chris while I was driving down to see Abby. Her platelet count had just come back...39,000!!!!! I was elated! (Anything about 30,000 greatly decreases the risk of spontaneous bleeding) They were still watching her hemoglobin closely and wanted to see that her counts had at least stablized if not gone up since that morning before we could talk about taking her home. Unfortunately, her counts dipped a little bit on the 4pm check. We talked it over though and Dr. Johnson agreed that we could take her home as long as we kept her very quiet and brought her back the next morning for a recheck of her hemoglobin.

It was so wonderful to bring Abby home! Without her there, there was such a hole in my life. I'd drop a crumb of food on the floor while cooking and there was no one to come and lick it up. We could load the dishwasher without a doggy nose supervising. There was no one to greet me at the door with a bark and a wagging tail. We were of course very anxious about having her home and watched her like a hawk! We had to keep an eye out for more bruising as well as bloody diarrhea. She was on a "bland diet" of canned food as well as Prednisone, Pepcid, Carafate and Imuran.

Jan 8th - Chris took Abby back to the vet for a quick blood draw. Her hemoglobin was back on the rise, so things were good for now. Dr. Johnson released us back to our normal vet (Dr. Havens) at Parkside for a CBC on Monday if everything continued to seem OK.

Jan 12th - Dr. Havens saw us when we came in for her bloodwork. Her bruising on her belly was fading which was very encouraging. Her platelet count came back as 1.2 million -- which was great because it wasn't abnormally low, but was well above the upper limits of normal at 550,000 or so. Dr. Johnson warned us that they often see this dramatic rebound with the steroids, vincristine infusion, and Imuran. Dr. Havens decided to cut the dose of Prednisone in half from 10mg BID to 5mg BID. I was a little nervous about this as I thought we wouldn't try to taper the meds for awhile, but he seemed confident.

Jan 21st - Repeat CBC - platelets 655,000. Still slightly high, but closer to normal. We kept her steroid dose the same.

Jan 28th - Snow storm - unable to get to the vet for our CBC. Rescheduled for 29th.

Jan 29th - Repeat CBC - platelets 9,000. Sample was somewhat clotted - so may not have been that low. Dr. Havens called us with the results over dinner. I of course was very upset and anxious about Abby. Dr. Havens wanted us to watch her and plan to repeat the blood work next Wednesday. He also wanted us to go back up on her steroid dose to 10mg BID.

Jan 30th - I noticed some small bruising on Abby's belly this morning before going to work. I called the vet when they opened at 7am (not worth calling the on-call doc or taking her to the ER as there's not much to do.). Dr. Havens was definitely more concerned with some signs of bleeding, so we agreed to repeat her counts on Saturday morning.

Jan 31st - Repeat CBC - platelet back up to 171,000! Very, very relieved. We're still watching her like a hawk, but at least she's back up in a "normal" range again. We go back on Wednesday for another repeat. Hopefully we'll taper her dose a lot slower next time.

Overall, Abby is no worse for the wear of all of this...not sure that I can say that for myself! :) The most annoying part of all of this is that one of the side effects of the steroids is increased thirst, which isn't a problem, but what goes in of course, must come out! Abby is constantly drinking and wanting to go outside. Which is a problem, but it's becoming an even bigger problem in that Brendan is absolutely enthralled with the dog's room/laundry room and is constantly trying to crawl in there. It just makes me nervous for him to be in the dog's "territory" and plus, sometimes Abby doesn't let us know in time to get outside and she pees on the laundry room rug...really don't want Brendan crawling in dog pee!!

So the chaos of my life continues!