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My Maltese cavalier mix..9 years old male was not himself..I…

My Maltese cavalier mix..9...

My Maltese cavalier mix..9 years old male was not himself..I thought he was just not feeling great, but he seemed to get worse. In April of 2017 I took him to the Vet for an itchy ear...the vet said it was infected..he needed an antibiotic, and a steroid for swelling, he also thought he should have a parvo vaccine plus heart worm meds and tick prevention meds. I felt this was a lot for him at one time.. roughly 3 weeks after is when the trouble started. He was also bit on his head and the bleeding would not stop. He was diagnosed with IMT..they ran a tick or parasite check..started him on an antipbiotic but discontinued because they said there was no sign of infection from parasite. He was given a blood transfusion because he had no platelets or rbc..

Veterinarian's Assistant: I'll do all I can to help. There are all sorts of infections your dog can pick up. I'll have you talk to the Veterinarian who'll sort out what is wrong and help you decide what to do about it. What is the dog's name?

He is being treated with prednisone and cyclosporine...his blood work looks good .BUT his platelets are not coming up to a high enough level...I have added milk thistle to help his liver counter all the meds...I have also recently started him on immune boosters or modulator to balance his immune system. I give him chicken and sweet potatoes ...he exercises daily 1-2 miles... I'm wondering if a parasite test could have missed something...he's been on meds way to long..please help...

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about your dog?

No..I think I've covered the most important things...he has CBC every two weeks roughly to see if he's over the hump..his platelets go up..they are very clumping so they typically do a hand count in addition to the machine...

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Customer reply replied 1 month ago
He has had all the tests..MRI, X-rays..to eliminate an underlying problem..he was a healthy dog prior ..walked 3-5 miles daily... he was also treated with azathiaprine to help stop destruction of platelets...I've read and asked so many questions about IMT..I really need some hope..for my dog.. I've also spent thousands of dollars..so please ...
Answered in 2 hours by:
3/22/2018
Jillian Costello
Category: Dog Veterinary
Satisfied Customers: 21
Experience: Imaging Fellow at Virginia Equine Imaging
Verified

Hello, my name is ***** ***** I am a veterinarian. I'm sorry to hear your dog is struggling with IMT. You've probably read that Cavaliers and cavalier mixes may have large platelets, called congenital macrothrombocytopenia. This usually does not cause clinical signs, like the bleeding your dog experienced, but does tend to show up as chronic low platelet counts. Auburn University has developed a genetic test for it (http://www.vetmed.auburn.edu/wp-content/uploads/2018/02/CONGENITAL-MACROTHROMBOCYTOPENIA-BETA1-TUBULIN.pdf). I'm not sure if that is something that has been talked about with your dog, but if not may be something to think about. Some dogs may never have their platelet levels reach the normal range, but that is OK as long as they are not showing clinical signs and their platelet counts stay above roughly 50,000. Some dogs may need to live on immunosuppressive medications for the rest of their lives. A little trial and error is often needed to get them on the correct medications for them (for example prednisone or prednisolone) and the lowest drug dosage that keeps them healthy and minimizes side effects. It is unlikely that he would still have a tick-borne disease without showing worsening illness, but is possible. You could ask your veterinarian to run a couple more blood tests to rule them out, including PCR testing which looks for the DNA of the organism, and serology which looks for the antibodies that respond to the organism. You could also contact a veterinary nutritionist to set up a diet for your dog to ensure that he is getting all the nutrients he needs to build strong platelets. It sounds like you have done everything you can for your dog, which is wonderful. IMT can be very frustrating when it doesn't go away like it is supposed to, but it is a manageable disease and you are doing everything right so far.

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Customer reply replied 1 month ago
Hello Jill,Thanks for your response. I did bring up the platelet issue (breed-related) with the Vet. He felt even if he did have the platelet issue because he is a Cavalier his platelets should have come up higher because of the amount of meds he is on.. His platelets did rise up to 176,000 at one point..machine count too. I guess ideally a baseline prior to the onset of IMT would have been helpful. I think he's been on too much prednisone without a lot of benefit..I'm not sure why he's on the cyclosporine..I know it's a nonsteroidal immunosuppressive with less side effects. I guess I don't understand why Prednisone, azathiaprine and cyclosporine are being used but his body is still destroying the platelets.. I recently read that mycophenolate is shown to help dogs with IMT..minimal side effects and cost is not prohibitive. Also any Chinese herbs such as yunnan baiyao..I'm open to any ideas...thanks..again

What are his platelets at now? Unfortunately the immune system is something we don't totally understand, and we don't have have very many ways of manipulating it or controlling it. Your dog's immune system has decided it doesn't like its own platelets, and that signal may be stronger than any drug we can give to stop it.
Mycophenolate is a relatively new drug for IMT in veterinary medicine. Have you talked with your veterinarian about trying it? If they are not comfortable with it, you may be able to speak with an internal medicine specialist who has used it and can help you and your veterinarian start down that path. You can find one close to you at this website if you aren't already working with a specialist: http://find.vetspecialists.com/ . Another treatment that is quite good is a short round of vincristine. Have you tried that? It is a chemotherapeutic so has to be administered at a specialty hospital.
Unfortunately I'm not well versed in traditional chinese medicine or holistic care, so I'm no help on that front. The association for holistic veterinary care has a lot of resources and a way to find a holistic veterinarian that can come up with herbal supplements you can try.
I wish I had better answers for you. Sometimes the best we can do is try, and you're doing all of that very well.

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Customer reply replied 1 month ago
His last platelet count was 75,000 machine..with a higher manuel count. That CBC was two weeks ago. Two weeks prior they were at 115 ...okay thank you for your input, I appreciate it.

You're very welcome. I forgot to add the holistic association website: https://www.ahvma.org/ . If I can do anything else for you please let me know.

If I've done a good job helping you today, please give me a 5-star rating. If not, let me know what I can do to improve!

Jillian Costello
Category: Dog Veterinary
Satisfied Customers: 21
Experience: Imaging Fellow at Virginia Equine Imaging
Verified
Jillian Costello and 87 other Dog Veterinary Specialists are ready to help you
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Customer reply replied 1 month ago
If you had the magic bullet , I’d give you a 10 star rating. I was just hoping and grasping for anything. Thanks
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Category: Dog Veterinary
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