Charlie - an update at 3 weeks

[Hua]

Hi, everyone.

It's been just over 3 weeks since I posted about Charlie possibly having IHMA here: http://www.doodlekisses.com/group/healthandmedicalissues/forum/topi...

I was really touched by all the support and encouragement I got.  thank you all.  This is an update of how Charlie is doing.

Since that last post, there have been more tests, including abdominal ultrasound and a bone marrow biopsy, and we have been seeing an internal medicine specialist for the last two weeks.  After all the tests, it was determined that rather than IMHA, Charlie seems to have something called Pure Red Cell Aplasia.  It is a bone marrow disorder where the body stops making red blood cell.  It is treated with immunosuppressant therapy (i.e. prednisone, etc).  But the tricky thing is that it takes a long time for the body to respond to treatment.  On average, it takes a month from the start of the treatment to see a response from the patient, and it can take between 6 months to a year for it to go into remission.  Our doctor has actually successfully treated 2 cases (and probably other unsuccessful ones that she didn't tell me in case I start bawling again), where 1 dog took 9 months and the other took almost a year to recover. 

The last three weeks have been really tough.  The first week, Charlie was not responding to prednisone but his RBC was around 18-20%.  The second week, the doctor added in mycophenolate (on top of amoxicillin, metronidazole and sulcrate), but his RBC dropped to 14-16%.  Last Thursday, Charlie's RBC dropped down to 9% and he couldn't even lift his head.  He had to have a blood transfusion.  Unfortunately, he had a bad reaction to the transfusion, which spiked a fever and made him nauseous.  He also develop pancreatitis and free fluid in his abdomen. That blood transfusion only managed to bring his RBC to 35%, which dropped down to 22% after 12 hours.  Over the weekend, his fever and pancreatitis were gone, and the free fluids in his abdomen have mostly cleared off, but his RBC continued to drop at about 2-3% a day.   

Today (Tuesday, May 9), he seems better (tongue/gum were looking a bit pinker), has a bit more energy, eating/drinking/pooping/peeing normally.  All other vitals also seems to be back to normal, except that his RBC is now down to 14%.  The doctor and I discussed.  1) It's possible that he will stabilize at around 14% which seems to be a level he is comfortable at, or 2) he's RBC will continue to drop at this rate and he'll be back to below 10% and critical in another day or so.   What we decided is that there is a high possibility that he'll require another blood transfusion this week, so we are going to do it today while his vitals are good and he's stronger (instead of when he's on the verge of dying).  The blood will be from another universal donor, and they are taking more precaution this time around since he's had a reaction last time.  We are hoping that his body will keep the red blood cells longer this time. He will also start taking dexamethasone, and his mycophenolate dosage will be increased from every 12 hours to every 8 hours.  It's been just over 2 weeks since he started his prednisone and we might not see a response for another 2 weeks, so we need to make sure he can last until then. 

He's at the hospital now getting the transfusion, and will probably remain in the hospital for at least the next few days.  I pray to god that I did the right thing.  I've been told that blood transfusion will stop working after a while (usually around the 3 to 5th time). 

[Karen, Jasper and Jackdoodle]

Thinking of you and Charlie, and hoping for the best possible results for him. 

[F, Calla & Luca]

Ditto.

[Hua]

Thank you. 

[Leslie, Yogi & Maci Bear]

Bless your heart. What a difficult time.

[Bonnie and Kona]

Thank you for the update. I hope and pray your sweet Charlie will quickly respond favorably to the treatments. Hoping you can find peace as you wait. How hard!

[Nancy, Ned, Clancy, and Charlie]

Hua, thank you so much for the update.  My heart breaks for you and Charlie to even have to go through this.  Just know that I am thinking of you both and sending hugs and wishes for the best possible outcome.

[Staci & Simon]

Oh Hua, I am so so sorry for you all. I know from personal experience that this journey is full of ups and downs. I do pray that you'll soon experience more ups than downs.
We had a hard time getting my Mona's Rbc stabilized initially too. Since it wasn't stabilizing with her on the cyclosporine, pred, & metronidazole our vet concluded that this was the wrong combination of meds. We actually took Mona off the metronidazole & pred & her Rbc did rise but not as much we wanted/needed it to. We then switched from cyclosporine to Mycophenolate. That's when we saw a significant rise & it did quickly stabilize at the 35-37 range and from there only got better.
Not to cause you any more additional stress or questions but I'm just wondering, are the doctors certain of their choices in meds? Just a thought.
We also had several bouts of pancreatitis but thy were only a couple days at a time. We switched foods so many time I lost count but boiled ground pork & boiled yams has worked for the longest stint.
If I think of anything else I'll certainly write again. In the meantime, I'm sending many prayers to you & Chalie & your family. Stay strong!
Staci