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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Pet
Satisfied Customers: 27347
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My dog has High RBC, MCT, HGB...and low MONA..what does that

Customer Question

My dog has High RBC, MCT, HGB...and low MONA..what does that indicate?
JA: I'll do all I can to help. What is the matter with your dog?
Customer: she is a 8 year old Border Collie that had a seizure about 2 weeks ago.....in the last 2 years she has been treated for a week bladder and urinates while she sleeps....we rushed her to the vet for the seizure...RBC, MCT, and HGB was high..WBC and MONO was low....PHOG was low...ALT and TBIL was high
JA: Seizures always look scary. Let's get you talking to the Veterinarian. What is the dog's name?
Customer: Pretty
JA: Is there anything else important you think the Veterinarian should know about Pretty?
Customer: After the seizure the vet did a xray and said her bladder had a shadow and looked suspicious...recommended a ultra sound so we took her to another vet for a ultra sound of the bladder and it showed no cancer and no UTI infection...that vet said she saw where Pretty had a bad hip break that mended bad and was pushing into her uterus...and thought the pain was from the bad hip break that happen over 8 yrs ago..she is on Amoxacillian and Tremadol
Submitted: 9 months ago.
Category: Pet
Expert:  Dr. Michael Salkin replied 9 months ago.

I'm sorry to hear of this with Pretty. Did you mean MCV instead of MCT? The MCV is useful in clarifying which type of anemia is present. Pretty isn't anemic and so the MCV isn't useful. A high RBC and Hgb usually indicate dehydration although an egregious elevation of these values can indicate polycythemia vera - an inappropriate, absolute increase in red blood cell (RBC) mass, hemtocrit (Hct/PCV), and hemoglobin (Hb) concentration.

Decreased MONA - monocytes (monocytopenia) isn't significant. Can you upload a copy of all of Pretty's test results to our conversation? I understand that you might not have a copy at home but her vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/

Customer: replied 9 months ago.
I have her blood work with me. ..she is on Tremadol and Amoxicillin now which she is no better..she sleeps all day and her back end hurts her. .she can't sit down hardly
Customer: replied 9 months ago.
MONO is low...PHOS is low...ALT and TBIL is high......RBC,HCT,and HGB are high....
Expert:  Dr. Michael Salkin replied 9 months ago.

Yes, you posted that earlier. I need to see normal as well as abnormal test results including the numbers, please. A decreased phosphorus has too many possible causes to list in this venue. An elevated ALT indicates hepatocellular damage but not the cause. An increased total bilirubin (TBIL) can occur with both hepatic disorders and hemolysis (destruction) of red blood cells; hence, the need for me to review the entire diagnostic panel for you.

The new dosing recommendation for tramadol is 2-5 mg/lb up to thrice daily. It sounds as if Pretty would benefit from an increase in the tramadol dose. I don't know why amoxiicillin was prescribed. Seizures at her age are worrisome for brain tumor (most common) and adult onset epilepsy.

Customer: replied 9 months ago.
I can take a picture of the blood results in a few minutes...Her back end is hurting her..she can't sit and it hurting her to walk long....the first vet took a xray and thought she had bladder cancer...the second vet that did a ultra sound said no bladder cancer...and no UTI..the second vet seems to think its from the bad hip break and arthritis....and she is in extreme pain....but that don't explain the seizure
Expert:  Dr. Michael Salkin replied 9 months ago.

I'm hopeful that an increase in the tramadol dose will address her pain from her osteoarthritic hip. Adding a nonsteroidal antiinflammatory drug (NSAID) such as carprofen or meloxicam should synergize with the tramadol to provide the best analgesia for her. You're correct, so far I see nothing that explains a seizure but that's not unusual if it's due to brain tumor or adult onset epilepsy. I would need to perform an MRI on Pretty to check her brain. Blood and urine tests won't do the trick.

Customer: replied 9 months ago.
She was on Carprofen 100 mg and Amoxicillin and we saw no improvement...so the said try Tramadol 50 mg every 12 hours....and we still don't see no relief for her...she sleeps and gets startled a lot....so the only things she is on is Tramadol and Carprofen.....but I would like your input on the blood work results
Expert:  Dr. Michael Salkin replied 9 months ago.

At least that's a reasonable combination of drugs. You can't increase the carprofen dose but you can increase the tramadol dose. I'll watch for the blood work.

Customer: replied 9 months ago.
she was on Diethystibestrol and Proin for her bladder within the last 3 months....the first vet said he thought she had bladder cancer because the x-ray showed a shadow and by the blood work....the ultra sound vet said no bladder cancer and no UTI infection.....can you tell by urine sample if a dog shows cancer cells?
Expert:  Dr. Michael Salkin replied 9 months ago.

Sometimes...the cancer has to be shedding cells that I can see in a urinalysis.

Customer: replied 9 months ago.
trying to send picture but keeps saying a error occured
Customer: replied 9 months ago.
don't know if you got it
Expert:  Dr. Michael Salkin replied 9 months ago.

I did. Give me a minute to review it, please.

Customer: replied 9 months ago.
I do have a copy of the X ray on a CD...I don't know if you would want to look at it or even if I could send....Pretty is not getting any relief on anything at the moment...and I meant to say she was on Amoxicillin and Tramadol....We still have a few Carprofen left....I wonder why she is on the Amoxicillin..does the blood work show a infection?
Expert:  Dr. Michael Salkin replied 9 months ago.

Her ALT of 247 is a significant increase but doesn't tell me why it was increased. If the blood were drawn directly after the seizure, that enzyme could have been expressed from her liver due to splanchnic congestion - blood being pushed into her liver during the seizure. I see that her white blood cell count (WBC) was low as well. This is a nonspecific change that could indicate significant inflammation somewhere in her body "using up" her white blood cells. Alternatively, there's a severe infection "using up" her white blood cells. I suspect that's why the amoxicillin was prescribed but as far as I can see, no focus of infection has been found. Her serum phosphorus is quite low as you mentioned but the cause of that is unclear to me at this time. I would repeat her tests in a week and see what these abnormal tests have done.

I'd like to see the X-ray if you could upload it. ***@******.*** can help you do that.

Customer: replied 9 months ago.
We had asked the 2 vet that did the ultra sound for a second opinion because we can't keep putting her in a car and getting her to a vet. She said to repeat blood work I about 2 months. Pretty is not doing good and I don't think she would last. The first vet we used is the one who upset our world for a weekend telling us she had bladder cancer! Its hard to get her up much less than get her in a car...but what she is on is showing no improvements at all. so..you suggest getting another blood count to see if it shows something different? Does a blood count point to cancer ?
Expert:  Dr. Michael Salkin replied 9 months ago.

I wouldn't wait for 2 months to recheck blood work. Yes, we need to see if the initial blood work improves, worsens, stay the same or perhaps represented lab error. No, unless there are cancerous cells circulating in her blood stream, a complete blood count doesn't reflect cancer.

Customer: replied 9 months ago.
Is Amoxcillin a good one to be on or infection? The 2nd vet said we should see a improvement when taking the Tremadol...but no improvement at all.....She was in such a deep fog this afternoon that I had to sit on the bed and lightly shake her to wake up...so how does one determine cancer?
Expert:  Dr. Michael Salkin replied 9 months ago.

It might be; it would depend upon which type of infection is present. Cancer is either visualized in X-rays or ultrasound or determined by biopsying tissue. Some cancers cause circulating cancer cells which can be seen in a complete blood count.

Customer: replied 9 months ago.
Pretty's x ray
Expert:  Dr. Michael Salkin replied 9 months ago.

Thank you but it arrived the size of a postage stamp...

Customer: replied 9 months ago.
o.k...so your final thoughts are???? another blood count soon.....but by looking at the blood work that was presented your final thoughts would be???? Does low white blood count show a sign of infection? Thanks
Expert:  Dr. Michael Salkin replied 9 months ago.

Repeat blood work 1-2 weeks after the intial blood work. There's nothing in the current blood work that points a finger at anything specifically. A low white blood cell count can indicate infection, yes, but in general it indicates that she either can't produce enough white blood cells or there's increased tissue consumption of them secondary to inflammation.

I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

Customer: replied 9 months ago.
your thoughts on the drugs Diethystibestrol and Proin ? the second vet said we should wait a week and try the Prion again...
Expert:  Dr. Michael Salkin replied 9 months ago.

Either can be prescribed to address urethral incompetence - "leaky" dogs. Both are generally quite safe.

Customer: replied 9 months ago.
Should I ask my vet about prescribing something for inflammation..even though I don't know if something is inflamed?
Expert:  Dr. Michael Salkin replied 9 months ago.

No, for the very reason we don't know if something is inflamed...

Customer: replied 9 months ago.
I got a updated blood work if you would like to see it. ..The 3rd vet seemed to think it was her back end hurting her. .the x ray showed where she had a caved in hip from 8 yrs ago. But she had another seizure last night. ..that's 2 seizure in 3 weeks....so. there is something else going on with our dog....she is on tramadol and Gabapentin...we tried metacam liquid also. ..but we see nothing. ..that's why I think it's more than her hip...she pants and pace alot
Expert:  Dr. Michael Salkin replied 9 months ago.

I would like to see the new blood work, please. Can you upload a copy of the test results to our conversation? I understand that you might not have a copy at home but her vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/

That's too many seizures within a month's time and so an anticonvulsive drug such as phenobarbital, levetiracetam, or zonisamide needs to be prescribed.

Customer: replied 9 months ago.
He said he would give us some diazepam
Expert:  Dr. Michael Salkin replied 9 months ago.

I can't read a few of the values but it appears that her ALT and bilirubin continue to be increased. To see if significant liver function has been lost and is contributing to her seizure activity, serum bile acid testing is necessary. Diazepam isn't likely to suffice. I would consider a more potent anticonvulsive predicated upon the findings in bile acid testing.

Customer: replied 9 months ago.
The vet wants to refer her to Auburn University in Alabama...that would be a 2.5 hour drive for us...he was treating her for the crushed hip that happen 8 yrs ago...which she limps and acts like her back end is in major pain....do you think we should keep her on Gabapentin? In the last few days she has been on gabapentin and Tramadol. We have been thinking in the last week she has been trying to have a seizure. She pants and paces for awhile before she settles down and then a few days she kinda acts like she going to fall over....it's more than hip pain. ..
Expert:  Dr. Michael Salkin replied 9 months ago.

Tramadol should be used cautiously in seizure patients because it can induce seizures in them. It doesn't do that in patients not experiencing seizures, however. Gabapentin may be of value when used in combination with a nonsteroidal antiinflammatory drug (NSAID) such as carprofen or meloxicam or a narcotic such as tramadol. Efficacy of gabapentin is questionable in that regard, however, and so if you believe there to be a connection between its use and her seizures, stopping its administration is reasonable. It should be tapered off if you've been giving it for more than a couple of weeks and you should let her vet know that you're doing so.

Customer: replied 9 months ago.
Well all the medicine she has been given in the 3 weeks for the most part has been for her bad hip...which I know the pain is not causing the seizures. ...the medacam... Tramadol and Gabapentin was for her hip....my question would be should I even still give her any of that? I did read Gabapentin did help with seizures
Expert:  Dr. Michael Salkin replied 9 months ago.

If you believe that these drugs are helping her hip, yes, continue giving them. Yes, gabapentin in combination with other anticonvulsives can help control seizures. It's not considered to be reliably effective when given alone for that purpose.

Customer: replied 9 months ago.
Do you think gabapentin and Medicam would be okay? We think she has been fixing to have a seizure all week....we will stop the Tremadol. ...the only thing she got today was the diazepam about 6 clock this morning and 1 Gabapentin....didn't know if Medicam would help or hurt seizure
Expert:  Dr. Michael Salkin replied 9 months ago.

Yes, I like that combination. Meloxicam (Metacam) shouldn't affect seizure activity unless it could reduce inflammation in the brain causing those seizures. It's not commonly prescribed for that purpose.

Customer: replied 9 months ago.
This is some of the testing they did
Customer: replied 9 months ago.
Maybe you can see the blood work better in this pic
Expert:  Dr. Michael Salkin replied 9 months ago.

Thank you. Testing is nicely inclusive. The increased red blood cell indices suggest dehydration.

Customer: replied 9 months ago.
More pic
Expert:  Dr. Michael Salkin replied 9 months ago.

Yes, I've seen those results. Notice the increased albumin - another indicator of dehydration when the red blood cell indices are increased.

Customer: replied 9 months ago.
The vet just called and said they would give us some more diazepam and a anti seizure medicine ...wanted us to stop the Medicam and tramadol...and wanted us to see a neurological vet....the dog keeps pacing today. .and panting....do you think it's ok to give her the diazepam again tonight? It's 10 mg.... phenobarbital for dogs is what he is giving us today also...I think that is spelled right
Expert:  Dr. Michael Salkin replied 9 months ago.

I wouldn't administer diazepam on top of phenobarbital unless you have rectal diazepam and need to give something quickly in addition to the phenobarbital that would already be on board. Pacing and panting are signs of encephalopathy (brain disorder) involving the forebrain - cerebrum and thalamus. This doesn't bode well...

Customer: replied 9 months ago.
Ok. .so diazepam and Phenobarbital are different? So. .if we start her on the phenobarbital tonight. ..we shouldn't give her diazepam anymore? Kinda confused on why he is prescribing both?
Expert:  Dr. Michael Salkin replied 9 months ago.

Yes, diazepam is a benzodiazepine most useful as an anxiolytic (anti-anxiety) drug. It also has anticonvulsive activity. The phenobarbital is a barbiturate used primarily as an anticonvulsive. There's no reason to give both unless it's necessary to do so. Let's see how the phenobarbital affects Pretty first.

Customer: replied 9 months ago.
will phenobarbital calm her down from the panting and pacing? We are trying to get her into a specialist next week if we can....but she won't settle down....we just want to make sure we did all we could to help her and know what it is that is causing the seizures. ...if it is something we don't want to really hear..we will know we did all we could....
Expert:  Dr. Michael Salkin replied 9 months ago.

That's certainly the hope. Keep me posted, please.

Customer: replied 9 months ago.
Pretty had a bad night last night. Would never calm down..constantly pacing and walking into things...last night was the first night on phenobarbital. ...she still pacing this morning. I read that it will take over a week to get into her system. ...any advice to calm her down?
Expert:  Dr. Michael Salkin replied 9 months ago.

Sorry for the delay. I was off hiking. To reach a therapeutic level sooner some suggest an intilal loading dose of 5.5 - 11 mg/lb intravenously once. If that can't be done, diazepam can be given at doses up to 1 mg/lb.

Customer: replied 8 months ago.
Pretty didn't react well to phenobarbital. ..she don't react well to any kind of medice...it knocked her out and she act like she was barely breathing. My mother don't want to give it to her....Pretty acts like her back end gives out on her. ..weak in her hind legs.. the only thing she is taking is gabapentin. ..which I thought I read that something like weakness is a side affect of gavapentin. ...we don't know if all this medicine is messing her up or its neurological....2 seizures within a month and she sleeps alot....we are trying to get her into a vet neurological place Monday if she makes it. ...what is your opinion on gavapentin?
Expert:  Dr. Michael Salkin replied 8 months ago.

I don't think it's much of an anticonvulsive when used alone. In conjunction with phenobarbital it should synergize to provide better anticonvulsive activity. In conjunction with a nonsteroidal antiinflammatory drug (NSAID) or narcotic it should synergize to provide better pain relief.

Customer: replied 8 months ago.
We found out through a MRI that pretty has brain cancer. . Haven't talked to my mother yet but they texted me saying cancer...thanks for all your advice and help
Expert:  Dr. Michael Salkin replied 8 months ago.

Oh my. I'm sorry to hear this. I appreciate your taking the time to let me know. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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