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Dr. Gary
Dr. Gary, Dog Veterinarian
Category: Dog
Satisfied Customers: 17228
Experience:  DVM, Emergency Veterinarian; BS (Physiology) Michigan State Univ
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My male great dane is 3 years old & right now his bloodwork

Customer Question

My male great dane is 3 years old & right now his bloodwork shows his red cell count is dangerously low!
My vet put him on 150mg of predisone/day which is VERY high. His nose is bleeding and did so when I was at the vets. Sadly, his weight is only 92 pounds. The vet told me his nose should stop bleeding sometime tonight. I hope so! My question is this:

1. He took 75 mg of predisone about 7PM tonight. Can I have him his second dose at 2AM or would it be better to wait until morning?

He was on an antibiotic that had sulfa in it. My vet thinks he had a reaction to this since he has not injected any rat poison.

2. How long can a dog go without eating before something serious happens to him?

3. What are the side effects to predisone for dogs?
Submitted: 3 years ago.
Category: Dog
Expert:  Dr. Gary replied 3 years ago.
Hello.

It sounds like he has IMHA (immune mediated hemolytic anemia). This is an auto-immune disease where there is a low red cell count (anemia) secondary to an over active immune system. They can also often have a low platelet count (ITP- immune mediated thrombocytopenia). The treatment is immuno-suppression with Prednisone and also Imuran (Azathioprine). We will also often need to give blood transfusions as needed to keep the red cell count up. Typically I'll have these dogs in the hospital for 2-3 days to closely monitor their counts and then once stable they go home. If you can, I would get him to an ER vet for 24 hour monitoring/ care.

As for the Pred, I use a dose of 1-2 mg per kg per day. The high end of the dose for this dog would be 40 mg twice daily. I think that 150 mg dose is too high and not needed. It'll cause GI side effects- ulcers- as well as make him more likely to develop diarrhea and pancreatitis. I would instead go with 40 mg twice daily and then add 100 mg of Imuran once daily. I would also have him on Pepcid to protect the GI tract and potentially Doxycycline (antibiotic) in case of tick born disease.

I hope this helps, let me know if you have any other questions.
Customer: replied 3 years ago.

Thank you so much for your prompt response. The vet prescribed the high doseage of prednisone in an attempt to stabilize him quickly. He goes in tomorrow morning to have his blood tested again to see if this is starting to happen. He has also been prescribed famotidine, 20mg twice daily in order to protect internal ulceration from the prednisone.

 

I hope you do not mind if I show your response to our vet where you addressed your concern about the high doseage of predisone. Both my husband and myself are worried sick about our great dane. The vet also told us amongst other things that there was a possibility this could be a reaction to a sulfa antibiotic that he had been taking for 10 days. She also told us this could be bone marrow related and/or genetic weakness.

 

Do you feel the prescription for famotidine is adequate for the amount of prednisone she prescribed? HELP!

Expert:  Dr. Gary replied 3 years ago.
I don't mind if you share this information. Vets will do things differently, but my typical IMHA's I don't put on that high of a dose of Pred. You can get immuno-suppression at the 1-2 mg/kg/day dose. As for Pepcid, I would go 20 mg 1-2 times daily.

I would also inquire about starting Imuran or Cyclosporine (Atopica) as a second immuno-suppressive drug. I find it helpful to go with both right from day one.

As for the drug induced- this is very well possible. I have seen it secondary to Cephalexin use, but not Sulfa drugs. It is possible though and we basically treat the same way along with stopping the Sulfa drug.
Dr. Gary, Dog Veterinarian
Category: Dog
Satisfied Customers: 17228
Experience: DVM, Emergency Veterinarian; BS (Physiology) Michigan State Univ
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Customer: replied 3 years ago.

Dr. Gary:

Both yesterday and today I believe is platelet count is 18. For several days my great dane had a bloody nose and then it stopped but today it is back! My vet thought his labored breathing was from his nose. He has blood at the back of his throat but other than that the vet there wasn't anything wrong with his throat but that it could be down in his esophogas (sp).

 

Any idea why he has a bloody nose and if there is anything I can do to help him! He looks so uncomfortable. He is still on the high doseage of prednisone because the vet told me that while his immune system is making red blood cells, they do not know where they are going. His white cell count is still really high so they put him on another antibiotic. We are so afraid that we are going to lose him. He isn't even 4 years old!

Expert:  Dr. Gary replied 3 years ago.
Ok thanks.

A normal platelet count is 200-500. Anything < 25 can cause spontaneous bleeding and typically mucosal bleeding- aka bleeding from gums, nose bleed. We can also see red dots in the ears, on the abdomen and on the gums. The nosebleed is from this low platelet count. If enough bleeding, then it will make the IMHA worse by dropping that count.

My advice- he needs to be on a second immunosuppressant. Imuran or Cyclosporine (Atopica). Imuran (Azathioprine) is much less expensive and in a dog this size that is what I'd go with.

As for the bloody nose, we can't cauterize like what is done in people- there are too many crevices and turbinate bones that it would make it worse trying to get cautery up there. Instead, we use Epinephrine drops- this causes constriction of vessels and will help stop the bleeding.
Customer: replied 3 years ago.

The vet put our great dane on Imuran and a further gastric lining medication. I got him to eat a little bit of melted ice cream but that is all. His nose bleeding seems to be much lighter than 2 days ago. We just cannot believe this much can go wrong with our dog in such a short amount of time! Do you have ANY idea when he might start feeling better! (how long is a piece of string???).

 

Our vet mentioned the possibility that he could have lupus because of his high white cell count! He hacks sometimes and it is like he is trying to get something out from his throat! Shoudn't we suggest an x-ray?! I know the vets main concern is his internal bleeding and low platelet count.

Expert:  Dr. Gary replied 3 years ago.
Usually the dogs that survive the first 3 days will survive the disease. I wouldn't get too pessimistic. I know it's scary, but this is a tough disease in dogs.

I'm glad he was started on Imuran as well- that's good.

I don't think this is Lupus- the high white count is pretty typical for IMHA/ ITP (aka "Evan's Syndrome"). The coughing is likely due to bleeding in the lungs. The other thing I forgot to mention- I would give an injection of Vincristine. This is a chemotherapy drug. The reason I would give it is because it causes a boost in the Platelet count. It's something I give once to my ITP (low platelet) dogs if there is evidence of actual bleeding. It's kind of expensive, but it does seem to help and there are studies showing that it improves outcome. As for x-rays, yes I would get chest x-rays to make sure there are no masses that could be underlying this disease. It's likely to only show some fluid in the lungs (blood) and not much else. It's still worth checking to make sure- I do this on most of my IMHA/ ITP dogs. I also shoot an abdominal x-ray as ingestion of zinc containing metals (pennies more commonly) can cause IMHA.
Customer: replied 3 years ago.

Thank you so much for your assurance and hope. We will definitely have Winston get the vincristine injection. Anything that can help!

 

Again, thank you Dr. Gary. I am so glad that you do the kind of work that you do.

 

Sue & Ted

Expert:  Dr. Gary replied 3 years ago.
You're very welcome.... keep me posted how he does.
Customer: replied 3 years ago.
We certainly will. Thank you again Dr. GarySmile
Expert:  Dr. Gary replied 3 years ago.
Sure thing.
Customer: replied 3 years ago.

Dr. Gary:

 

Winston's red cell count dropped from 18 to 14! Not good. He is now staying overnight at our vets. Ideally, could we have afforded the treatment at WSU where he would have been hospitalized and given blood transfusions this would have been good. Sadly, the cost is too high - several thousand dollars which must be prepaid.

 

Our vet has him on a drip and they did give him the injection you had told us about yesterday to help bring up his red cell count. He now weighs 88 pounds. Once again, he was alert tonight when we visited him and we did get him to eat a little bitEmbarassed

 

The vet keeps telling us that hopefully the medication (high doseage of prednisone) will hopefully begin working soon! We know he is running out of time. He has been battling this hard for 5 days.

 

He is very weak and hardly got up all day while at the vets. They will do more blood work tomorrow morning. His nose bleed was bad for most of the day but by latter afternoon he had stopped dripping blood from his nose and it was clotting! Does this mean anything at all or am I just grabbing at straws?

Customer: replied 3 years ago.

Our great dane is being examined about our vet daily together with daily blood work. Right now he is spending the night since his red blood count dropped even further - from 18 to 14!! This is the 5th day that he has been battling this and slowly we are going to lose him if the prednisone does not work soon!

 

He was given the shot you recommended Dr. Gary. All we can do is wait until tomorrow and see what is red cell count is at that time. How long can a dog go without food? Winston's weight is down to 88 pounds!

 

So many tears today Dr. Gary. He isn't even 4 years old! His nose bled a lot today (continual dripping) but by 5PM it had stopped! Is this a sign that something may be starting to work?

Expert:  Dr. Gary replied 3 years ago.
I'm sorry to hear it's dropping again. It does sound like he really needs a transfusion. If there is any way your vet can do one, I would get it done.

The clotting of blood in the nose is good, this means the platelets are coming back. That means the Vincristine injection is working.

Keep me posted.
Customer: replied 3 years ago.

I will keep you posted. We will see him tomorrow morning and find out how is red cell count is doing. Even his eyes are bloodshot. I am glad though that the shot is helping! Does the vet just do this one time or can he have more than one injection?

 

Our vet HOPES the medication he is on will finally start working where his red cell count will start going up! They told us that sometimes this can take anywhere from 5-8 days. Tomorrow is Day 6.

 

Very hard on him as well as his owners. Especially when he isn't even 4 years old.

 

Thank you for getting back to me. Your responses have helped so much Dr. Gary.

 

 

Expert:  Dr. Gary replied 3 years ago.
Vincristine is a one time thing- no more injections needed and it wouldn't help anyways to give it again.

If it helps, typically the dogs that are not going to survive will die in the first 2-3 days. We usually think of the survivors as the ones that make it out at least 3 days. I know it's hard to see this, but I would stay optimistic. A transfusion would probably turn him into a new dog right now, but I know it's expensive, especially a dog this size that would require 2 units of blood.

Hang in there...

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Dr. Gary
Dr. Gary
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DVM, Emergency Veterinarian; BS (Physiology) Michigan State Univ