Reducing the Azathioprine

So my vet suggested reducing Aza to 1/4 tablet eod (every other day.) I started doing that on Tuesday and am a little uneasy about it, watching Janine for a relapse. Poor Janine- I'm always looking at her gums and examining her eyes and belly for bruising or bleeds. But she seems to feel fine. She looks good, has good energy, and isn't too bitchy.

October update

I had Janine's bloodwork done earlier than planned as I expect to be out of town next weekend and was worried about leaving her if she wasn't 100%. Well, she IS 100%! Everything looked good. She's doing very well on the lower dose of pred and her coat feels better, she isn't so thirsty, and her numbers are still staying in the normal range. Even her RBC is normal now.

Good news for Janine

Janine is still doing well so its time to reduce her pred to 5 mg eod. All her numbers except RBC/HCT were good (and her red blood count has never been normal.) She feels good and her teeth looked much better than in the spring and no longer look like they need cleaning. (Lots of marrow bones this summer or maybe it was those rabbit bones!)

Vet visit 5/14/2009

There's good news, then there is bad news.

The good news is that after a week on 10 mg per day of Pred, Janine's ALT is lower, platelets are still normal, and RBC and HCT are coming up, closer to normal than before.

The bad news is that Dr. K. checked out her back, and thinks she has a slow response (proprioceptive defect) in her left rear leg and pain around L2-3. Likely a disk. We did not do any X-rays as she is a very poor surgical candidate right now, anyway. She's already on Pred and can't take any NSAIDS because of her liver, already on SAM-e. So he gave me Tramadol and Robaxin to make her feel better.

He said that although steroids are used to reduce swelling, they also have negative effects on all the other tissues, and even something as simple as her muscle loss could have precipitated the back issue. Hopefully if that's the case she could improve once her muscle builds back up.

My gut feeling is not to try to restrict her activities. She already isn't jumping (her choice) and since her life expectancy is already probably limited, I can't see making her spend it in a crate. I'd rather let her run and be a corgi and if her back goes, it goes, we'll deal with paralysis if we have to. (Probably a better bet than risking her life on surgery but I suppose if her ALT is normal and RBC is back to normal at some point, I might reconsider that.)

Vet visit 4/30/09

Janine had blood drawn again- poor baby, she is getting to hate going to the vet! Most of her numbers were pretty good- a little low on PCV and RBC but platelets normal and ALT only slightly elevated. I told Dr. Kahn she doesn't feel very good, though. We are reducing the Pred to 10 mg BID for a week and then 10 every 24 hrs for another week, then the last check before I leave. (Assuming she doesn't tank again before that- I can usually tell by her lack of color.) If she does then it might be time to try another drug or go back up a bit on the Azathioprine.

She will be happy to be lower on Pred if she can maintain her platelet level. I'll watch her carefully.

Some good news

Janine needed some good news, and recently her DM (degenerative myelopathy) test came in. For Janine this may not be relevant, as she may not survive to the age (8-15) when Pembroke Welsh corgis start showing symptoms of DM, but it is good news all the same.

FORPAWS JANINE JUST IN TIME
JANINE
F WCP
DM Received: 03/25/2009
Processed: 03/27/2009
Test: Degenerative Myelopathy
Results: CARRIER (Heterozygous A/N, Carrier)

Being a carrier may not sound so good, but the genes ( a recessive gene) for DM are very prevalent in Pembroke Welsh corgis, so Carrier status, which means Janine cannot get DM, is wonderful news. A pet dog which is a carrier is no problem whatsoever. A breeding corgi that is a carrier means the breeder needs to be careful selecting a mate. The only breedings that cannot produce a puppy At Risk for DM are breedings to Clear (one parent must be Clear.) However, breeding of Carrier to Carrier would still potentially reduce the number of At Risk dogs in the Pembroke population.

A dog that is At Risk may not get DM. But if you are buying a corgi you should get full disclosure from the breeder about testing and the status of the pup, and if you opt to buy one that has tested "At Risk" (or has not been tested) you should be aware of the possibility that your puppy could develop this disease in late middle age. (As early as 8 if he is a corgi.) Until July 2008 breeders could not test, but they can now, so if they tell you they don't, or they don't need to, run as fast as you can away from that breeder! (Or at the very least insist on having the puppy tested- and the results OFA published- before buying it.) If you need help finding a breeder who does test for DM let me know and I can steer you in the right direction.

Back on Pred, platelets back up

Back on 40 mg a day of Pred (from 5!) Janine's platelets did respond to pred this time and are back to low normal. Blood count is a bit low so she may have had some bleeding while her numbers were low. ALT only slightly elevated. She will stay home this weekend instead of boarding at the vet, but I'll take Teddy so she can't fight with him (Pred makes her grouchy) and can have the run of the house (Teddy can't have the run of the living room.) Linda will take care of Janine and she is a loner anyway- likes to sit outside and in the living room when she can.

and bad news...

Janine's platelets are back to 45,000. Dr. L. wants to increase the pred again and not the Imuran so we're doing that but I'm taking her in Friday morning to make sure it is working before I leave for the weekend. Janine may spend the weekend there at the vet's where she is safe from fights (dangerous with low platelets.) Her RBC was okay. I'm skeptical of the Pred getting her back up to normal but will try it. So she's back up from 5 mg a day to 40! (Since it didn't work before I don't see it working now.)

Good news!

Not about her blood, but I sent Janine's DNA in to OFA to do the DM test and she came back Carrier- so she will NOT get DM. It's so good to know that none of them (except Merlin) will have to go through this horrible disease.

Now we just have to fix whatever is wrong with Janine so she can live a long, healthy life!

Still anemic

I took Janine in for bloodwork this morning because she was looking pale (gums, top of nose) and she was down just a little bit in RBC and HCT. Platelets were normal, though, hooray! So going on with the lower dose of Azathioprine and she has an appointment for Tuesday the 31st (when I'm off.)

Giardia negative

Janine's giardia test was negative. Dr. Kahn, in consultation with Dr. Sarah Lien, decided to have her go to 10 mg Pred every other day (instead of 5 every day) and reduce the Azathioprine to every other day as well. So I started that yesterday by giving another 5 of Pred at night and then skipping the Imuran, then giving that this morning. (I had to write it down to keep straight which day is which.) Fingers and paws crossed that her platelets don't drop with the reduced Imuran.

And time to try another food as she is still loose on Kirkland. I think we will try Canidae again now that the giardia is gone and see how she does.

Vet visit 3/12/09

Janine's bloodwork is better than last time- ALT a bit elevated but near normal (Says liver is better) and blood count (red) back nearer normal and platelets back into normal. We did another fecal to send off to recheck giardia. It's a good sign things went back closer to normal but no idea why they were lower last time. My vet wonders about a systemic reaction to the giardia but I had googled that already and not found much indicating platelets could go as low as hers did, and the other vet there didn't think so, either.

So she is still on the same meds pending results of the giardia test. She has a bad pocket on one tooth that needs treating but he didn't want to do anything until we see where she is going with giardia and bloodwork. If she ends up needing a bone marrow biopsy she can get the dental work at the same time.

Janine already hates the car and now she isn't too fond of the vet, either.

Vet visit 2-12-09

I moved this one up a bit as Janine was acting grouchy. Sure enough her platelets are down a bit (not terribly low) and WBC is down and RBC still isn't up. And ALT is about the same.

So now she is getting more SAM-e, another round of Panacur, and got a shot of ProCrit. I hope it helps.. I hate to see her getting sick again.

Daily checks and a scare

Last night Janine managed to snag a Zonisamide capsule. Zonisamide is for Merlin's seizures and is a sulfa drug, and could potentially cause her to have problems. So I tried to get her to vomit (Hydrogen peroxide) with no luck. So today I come home from work to check and her gums looked white and I freaked. But ten minutes later they are fairly pink so I think we can wait until the vet appointment on Thursday afternoon. If she shows any signs of being ill before then I'll call the vet and ask about upping her Pred again or drop her off there tomorrow morning.

She's been good but as she is now on only 5 mg a day of Pred I'm nervous that she'll relapse, and we never had had her RBC up to normal. Plus she has been a bit bitchy lately which can be a sign that she's not feeling well. Or it can mean she is a normal corgi female. Hard to tell sometimes!

Bunnies and Prednisone

Janine got her wish and chased bunnies up in Washington over Christmas vacation. She had fun in the snow and on the beach and especially chasing the rabbits on the dike, lawn, and beach.

On January 6 or so I cut her Prednisone down to 5 mg and around the end of the month will take her back to the vet to be rechecked. Decreasing Pred has not bothered her, but I don't know when we will be able to decrease the azathioprine.