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Dr. Gary
Dr. Gary, Dog Veterinarian
Category: Dog
Satisfied Customers: 19778
Experience:  DVM, Emergency Veterinarian; BS (Physiology) Michigan State Univ
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About a month ago, my 9 year old pug became lethargic, not

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About a month ago, my 9 year old pug became lethargic, not active, didn't want to eat and had a hard time breathing. This started out of the blue. I took her to the emergency vet and her platelets were 7,000, RBC was 25 and she tested positive for lymes. She was started on prednisone, minocycline and azathioprine. She has been on these medications since June 8, 2013. Initially her blood levels responded really well, her platelets came up to 112,000 the next day after the emergency vet. In the vet visits since, her RBC increased to 33%, went down to 32% at the last visit about a week ago and her platelets are normal. Her heart, lungs, and everything else has been good. The vet said that after 7/15 they couldn't give her anymore antibiotics and would start with xrays or ultrasound for other causes such as cancer. She still breathes hard. I am going to see a new vet on friday and not sure what really I should be looking for or asking. While she has been sick, I was moving to a new place so she has been staying with my parents. She is now home with me. She is active and starting to do some of her normal things, but tires easily of course. Any suggestions thoughts would be appreciated. I feel kind of lost and of course scared for her.
Hello, I'm Dr Gary. I've been practicing veterinary medicine since 2007. I look forward to helping with your questions/ concerns.

It sounds like we're most likely dealing with ITP/ IMT (Immune-Mediated Thrombocytopenia). This is an auto-immune disease where the body attacks it's own platelets. I know the Lyme test was positive, but we do have a lot of positive Lyme tests in dogs that don't really have Lyme.

I treat my ITP dogs with Prednisone alone in most cases. In the really bad ones, I'll add Imuran (Azathioprine). With the positive Lyme test, I would also add a Tetracycline like Mino or Doxy. Most of these dogs will end up doing well and they'll end up having a full recovery.

The long term management is important. With auto-immune diseases, we want to use immuno-suppressive meds for a good 3-6 months to help prevent a relapse.

I'll usually monitor these guys every few days until the PLT count is > 100,000 and the PCV (packed cell volume) is > 30%. Once stable like that, I'll monitor them every 2-4 weeks and decrease the meds slowly over the following months.

Your dog seems to be doing well. As the PCV normalizes and the immune system is back in check, she'll slowly get back to normal activity and energy.

Here is a nice link on the disease to read over:

I hope this helps, let me know if you have any other questions
Customer: replied 4 years ago.

So when the last vet said that she wouldn't be able to remain on the meds, that may not be accurate? Should I expect that she will remain on some form of the three meds she is currently on?

I would discontinue the Doxy now, but I would definitely stay on the Pred and Imuran. Those will be weaned slowly and one at a time over the next 2-4 months.
Customer: replied 4 years ago.

should I also be looking at doing the xrays and ultrasound for some other cause or stick with the treatment for ITP. Is her hard breathing related to her red blood count being low? I know that you haven't seen her in person, but its so hard to know what to do and with seeing now the third vet with her I want to do what's best for her, but don't want to subject her to needless treatments either.

I would do x-rays just to make sure you don't see any masses in the chest or abdomen. I don't think an ultrasound is necessary though.

The rapid breathing is probably due to the low red count. It can also be due to mild bleeding into the chest/ lungs and decreased oxygenation. The x-rays will rule out true disease in the chest cavity. With normal chest x-rays, the breathing is then likely due to the red cell count.

We can also see rapid breathing and panting secondary to Prednisone use. It will cause increased thirst/ urination, increased appetite and panting as expected side effects.
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Customer: replied 4 years ago.

Thank you for easing my concerns and helping me to do what is best for her.

You're very welcome.
Customer: replied 4 years ago.

Thank you for giving me hope. A week ago today, my Kayla passed away.