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Author Topic: Addie spay complications  (Read 7786 times)
Princess L
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« Reply #25 on: September 21, 2007, 06:38:45 PM »

~flower~
I am so sorry you are going through this difficult time.   Cry

Please PM me if you need to talk and we'll exchange numbers.
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« Reply #26 on: September 21, 2007, 09:27:32 PM »

Flower, you need a couple shots of some cheap rum and some phone sex to cheer you up.
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« Reply #27 on: September 22, 2007, 06:15:47 AM »


I think you are right Jedi!!!
  Cheesy


 Ok, brief update:

 Results from the clot panel:  ACT(activated clotting time measures whole blood clotting time)  was  10.3 (normal 5-9secs)     PT (Prothrombin time measures how long it takes blood to clot) was 26.5  (normal is 10-12secs)

They are checking her crit now and depending on what it says she will be started on steroids.    The current thinking is idiopathic thrombocytopenia.   Her body basically is attacking it's red blood cells, so the steroids will "shut it down" from doing that. 

  The scrape on her knee he believes is a pressure sore, she didn't run into anything or get bumped, but it has gotten bigger.  It is like 4" around and constantly bleeding. Not dripping or gushing, but it is steadily wet. 


  She has none of these problems for her obstruction surgery.  She got over that like it never happened. The next day she was running and jumping around and no bleeding problems.   


They did get her to eat some more of what I brought for her last night.

 I call back in about an hour and see what the latest crit says and what that will tell us. 

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« Reply #28 on: September 22, 2007, 07:02:19 AM »

Platelets are down, she will be started on steriods and will possibly need a blood transfusion. 

  I told them I am not waiting until Monday to see her again, so they are going to get back to me to see if that can get arranged. There is the possibility that she won't make it, and I will be damned if I just leave her there and not visit her.
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Lord Humungous
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« Reply #29 on: September 22, 2007, 07:13:26 AM »

Hope every thing is ok Flower were all pullin for Addie over here
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« Reply #30 on: September 22, 2007, 08:06:23 AM »

. There is the possibility that she won't make it,

What!!  Please check your email and PMs
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« Reply #31 on: September 22, 2007, 08:52:03 AM »

 Huh

Whats weird is Addie used to bang into everything & it's now after 4 years...this comes out.

Do they have an explanation for this....or was it something she always had & you never knew about?

There wasn't somethig they could have given to her before surgery that gave her this blood problem?
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« Reply #32 on: September 22, 2007, 09:30:50 AM »

Huh

Whats weird is Addie used to bang into everything & it's now after 4 years...this comes out.

Do they have an explanation for this....or was it something she always had & you never knew about?

There wasn't somethig they could have given to her before surgery that gave her this blood problem?

The ruleout list for thrombocytopenia is a mile long..... literally, I can list 10-12 different causes off the top of my head ranging from use of platelets post surgery to bone marrow suppression to bone marrow dyscrai to drug reactions to genetic predispositions (Cavalier King Charles Spaniels) to autoimmune disease.   It makes thrombocytopenia a sometimes difficult disease to deal with---and unfortunately, considering Flowers opinions against vaccinations (I really don't want to start a fight here, but it needs to be said) there has been a correlation between recently administered modified live vaccinations and the development of immune mediated thrombocytopenia.  I'm only aware of cases where this was diagnosed 2-6 weeks post vaccination, not years as in Addies case, but there was a correlation.   

Unfortunately, unless a full CBC was done prior to surgery, there may have been no indication of what was going on within Addies body until her platelet count dropped so low as to cause a problem.  Even with preoperative blood work, if her platelet count was on the low side of "Normal" it might not have been an indication of a problem.     

The important thing now is to get her platelet count up.   
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« Reply #33 on: September 22, 2007, 09:47:59 AM »

The ruleout list for thrombocytopenia is a mile long..... literally, I can list 10-12 different causes off the top of my head ranging from use of platelets post surgery to bone marrow suppression to bone marrow dyscrai to drug reactions to genetic predispositions (Cavalier King Charles Spaniels) to autoimmune disease.   It makes thrombocytopenia a sometimes difficult disease to deal with---and unfortunately, considering Flowers opinions against vaccinations (I really don't want to start a fight here, but it needs to be said) there has been a correlation between recently administered modified live vaccinations and the development of immune mediated thrombocytopenia.  I'm only aware of cases where this was diagnosed 2-6 weeks post vaccination, not years as in Addies case, but there was a correlation.   

Unfortunately, unless a full CBC was done prior to surgery, there may have been no indication of what was going on within Addies body until her platelet count dropped so low as to cause a problem.  Even with preoperative blood work, if her platelet count was on the low side of "Normal" it might not have been an indication of a problem.     

The important thing now is to get her platelet count up.   

so in knny's terms (laymen)

There is a strong possibility something they gave her could have started this
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« Reply #34 on: September 22, 2007, 10:02:17 AM »

The ruleout list for thrombocytopenia is a mile long..... literally, I can list 10-12 different causes off the top of my head ranging from use of platelets post surgery to bone marrow suppression to bone marrow dyscrai to drug reactions to genetic predispositions (Cavalier King Charles Spaniels) to autoimmune disease.   It makes thrombocytopenia a sometimes difficult disease to deal with---and unfortunately, considering Flowers opinions against vaccinations (I really don't want to start a fight here, but it needs to be said) there has been a correlation between recently administered modified live vaccinations and the development of immune mediated thrombocytopenia.  I'm only aware of cases where this was diagnosed 2-6 weeks post vaccination, not years as in Addies case, but there was a correlation.     The Doctor said their could be many reasons for her platelet problem.

I haven't mentioned vaccines having anything to do with this because she hasn't been vaccinated since she has been with me, so I won't correlate this to them. She's had a major surgery in the past with no problems so that also makes me think a connection to any vacs she had years ago a thin one.  (See, I DON'T think every problem is vaccine related  Wink)    I would of thought she would of showed some signs when she had her obstruction surgery of a problem, or could something like this be "brewing" and just waiting for the body to be stressed enough to show up?


Quote
Unfortunately, unless a full CBC was done prior to surgery, there may have been no indication of what was going on within Addies body until her platelet count dropped so low as to cause a problem.  Even with preoperative blood work, if her platelet count was on the low side of "Normal" it might not have been an indication of a problem.     

The important thing now is to get her platelet count up.
 

I have her pre-op Hematology Report:

 WBC  7.2
 RBC   8.01
 HGB   18.5
 HCT   55.0
 MCV   69
 MCH   23.1
 MCHC  33.7
 Lymph  31
 Mono   4
 EOS     8
 Platelet Count  210

  then    ALKP  82 U/L     ALT  30 U/L    BUN  15 mg/dl   CREA  87 mg/dl
            TP  6.5 g/dl


Looking that the reference ranges for canine it says PLATELET COUNT is 200-900 thous/CMM so she was on the really low end for that?Huh


 The tech I spoke to didn't actually say she might not make it, but when they ask you how far to what extent they should do treatments, that doesn't sound good.  The transfusion will run around $200 and I told them if the felt it was a medical necessity then by all means do it. 


 
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« Reply #35 on: September 22, 2007, 10:40:08 AM »

I haven't mentioned vaccines having anything to do with this because she hasn't been vaccinated since she has been with me, so I won't correlate this to them. She's had a major surgery in the past with no problems so that also makes me think a connection to any vacs she had years ago a thin one.  (See, I DON'T think every problem is vaccine related  Wink)    I would of thought she would of showed some signs when she had her obstruction surgery of a problem, or could something like this be "brewing" and just waiting for the body to be stressed enough to show up?

Yeah, I know, I just didn't want to start somekind of a fight by bringing it up.  You've got enough on your plate right now. 

Yes, because of the many causes of thrombocytopenia, it could have developed/been brewing for some time.   I kind of look at it this way.  I was diagnosed with Type I insulin dependant diabetes when I was 12 years old (my father was diabetic).  The Halloween before I was diagnosed I gorged on candy with my friends.   Did that halloween cause me to be diabetic?  No.   Was I diabetic during that Halloween?  no.   The predisposition for the disease was there and it developed AFTER Halloween.     Does that make sense?

Quote
I have her pre-op Hematology Report:

 WBC  7.2
 RBC   8.01
 HGB   18.5
 HCT   55.0
 MCV   69
 MCH   23.1
 MCHC  33.7
 Lymph  31
 Mono   4
 EOS     8
 Platelet Count  210

  then    ALKP  82 U/L     ALT  30 U/L    BUN  15 mg/dl   CREA  87 mg/dl
            TP  6.5 g/dl


Looking that the reference ranges for canine it says PLATELET COUNT is 200-900 thous/CMM so she was on the really low end for that?Huh

Its impossible to say without knowing the cytologists notes for platelet clumping and morphology.  If the platelets were clumped than everything could have been normal.  Its also impossible to say without knowing platelet morphology.  Idenitfying things like "Giant" platelets in the face of a normal platelet count can be an indicator of a brewing problem.    Depending on how the blood work was run---manual count vs automated cytometer vs laboratory its possible that the count was given and these notes weren't done.   

In all honesty, in a dog her age, with no other outward signs of clinical problems and a normal physical exam, I would have spayed her.   There isn't enough of an indication of a predisposing problem. 


Quote
The tech I spoke to didn't actually say she might not make it, but when they ask you how far to what extent they should do treatments, that doesn't sound good.  The transfusion will run around $200 and I told them if the felt it was a medical necessity then by all means do it. 

Its impossible for me to give you any indication of prognosis without seeing her.   I'm sorry.    I will say that this is something very serious.   I will also say I've seen several dogs survive thrombocytopenic events and go on to lead normal lives.    She's been through alot, but she's still not out for the fight.   There are some "ifs" involved....   the biggest being why she's thrombocytopenic in the first place.   Idiopathic means the exact cause isn't known.  So treatment is general, based on clinical signs AND based on evaluation of physical parameters including what her platelet count is doing.   


I'm going to be on and off the computer all afternoon today and tomorrow (damned phenobarb paper I'm trying to write.   Angry  Angry )  Feel free to PM or e-mail me if her status changes.   I'll do what I can to answer your questions.   
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« Reply #36 on: September 22, 2007, 10:41:46 AM »

so in knny's terms (laymen)

There is a strong possibility something they gave her could have started this

No.  There are many causes of thrombocytopenia.   
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« Reply #37 on: September 22, 2007, 11:41:59 AM »

Yeah, I know, I just didn't want to start somekind of a fight by bringing it up.  You've got enough on your plate right now. 

Yes, because of the many causes of thrombocytopenia, it could have developed/been brewing for some time.   I kind of look at it this way.  I was diagnosed with Type I insulin dependant diabetes when I was 12 years old (my father was diabetic).  The Halloween before I was diagnosed I gorged on candy with my friends.   Did that halloween cause me to be diabetic?  No.   Was I diabetic during that Halloween?  no.   The predisposition for the disease was there and it developed AFTER Halloween.     Does that make sense?

  Yup, that makes sense.  

Quote

Its impossible to say without knowing the cytologists notes for platelet clumping and morphology.  If the platelets were clumped than everything could have been normal.  Its also impossible to say without knowing platelet morphology.  Idenitfying things like "Giant" platelets in the face of a normal platelet count can be an indicator of a brewing problem.    Depending on how the blood work was run---manual count vs automated cytometer vs laboratory its possible that the count was given and these notes weren't done.   

In all honesty, in a dog her age, with no other outward signs of clinical problems and a normal physical exam, I would have spayed her.   There isn't enough of an indication of a predisposing problem. 


Its impossible for me to give you any indication of prognosis without seeing her.   I'm sorry.    I will say that this is something very serious.   I will also say I've seen several dogs survive thrombocytopenic events and go on to lead normal lives.    She's been through alot, but she's still not out for the fight.   There are some "ifs" involved....   the biggest being why she's thrombocytopenic in the first place.   Idiopathic means the exact cause isn't known.  So treatment is general, based on clinical signs AND based on evaluation of physical parameters including what her platelet count is doing.   


I'm going to be on and off the computer all afternoon today and tomorrow (damned phenobarb paper I'm trying to write.   Angry  Angry )  Feel free to PM or e-mail me if her status changes.   I'll do what I can to answer your questions.
   


 The Doctor just called back, her platelets are being destroyed.  She is down to 33,000 (per whatever??).    He has started her on Dexamethasone (sp) and has contacted the Emergency Vet (also the Ortho, Cancer and Eye specialist Center) to make sure they have the packed cells on hand if she does need them.  He wants to see what the Dexamethasone does before going that route. 

 I believe he said her crit is at 32, so she is okay in that area, it's the platelets.

  He is going home now to eat and relax a bit but will be back there to check on her at 5:15 so I will be meeting him there and get to see her for a few minutes.  He said that sore bloody spot on her knee doesn't actively bleed unless she moves around.   What could cause that?  He said a pressure sore?  But it is on the inside of her knee?  I guess depending on how she is sitting it could rub.  Is her skin that fragile because of the platelets low count? 

  I will update later after I see her.   


 Thanks for your replies vet, I appreciate your knowledge.
   Smiley


 
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« Reply #38 on: September 22, 2007, 11:57:51 AM »

  Yup, that makes sense.  
   


 The Doctor just called back, her platelets are being destroyed.  She is down to 33,000 (per whatever??).    He has started her on Dexamethasone (sp) and has contacted the Emergency Vet (also the Ortho, Cancer and Eye specialist Center) to make sure they have the packed cells on hand if she does need them.  He wants to see what the Dexamethasone does before going that route. 

 I believe he said her crit is at 32, so she is okay in that area, it's the platelets.

  He is going home now to eat and relax a bit but will be back there to check on her at 5:15 so I will be meeting him there and get to see her for a few minutes.  He said that sore bloody spot on her knee doesn't actively bleed unless she moves around.   What could cause that?  He said a pressure sore?  But it is on the inside of her knee?  I guess depending on how she is sitting it could rub.  Is her skin that fragile because of the platelets low count? 

  I will update later after I see her.   


 Thanks for your replies vet, I appreciate your knowledge.
   Smiley


 
Dang Flowey.

Could she be licking/biting that area to cause the spot?  Or would the sore be different than what it is?   Does she ever lick/bite her legs when she is stressed?
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« Reply #39 on: September 22, 2007, 11:58:00 AM »

since I am the google copy and paste queen  Roll Eyes:


http://www.veterinarypartner.com/Content.plx?P=A&A=1412


Immune-Mediated Platelet Destruction

For reasons unknown, platelets can be mistaken by the immune system as invaders. When this happens, antibodies coat the platelets and the spleen's phagocytes remove them in numbers up to 10 times greater than the normal platelet removal rate. The megakaryocytes in the bone marrow respond by getting larger and growing in numbers so that they may increase their production of platelets. The platelets produced under these circumstances tend to be larger and more effective than normal platelets and are called stress platelets. The bone marrow attempts to overcome the accelerated platelet destruction rate; unfortunately, with immune-mediated destruction occurring, a human platelet can expect to survive only one day in the circulation instead of its normal 6 to 8 days. If antibody levels are very high, a platelet may survive only minutes or hours after its release from the bone marrow and, making matters worse, antibody coated platelets still circulating do not function normally. This is balanced by the especially effective stress platelets entering the scene so that overall it is hard to predict how the balance will work out in a given patient.

What Would Cause the Immune System to Get so Confused?

In many cases, a cause is never found; however, in some cases a primary reaction in the immune system precedes the platelet destruction. For example, immune destruction of some other stimulus could be occurring. A blood parasite, tumor, drug, or other cell type (as in lupus or immune-mediated red cell destruction) might all generate an antibody response. As antibodies are produced in response to the surface shapes of the enemy cell, some of the surface shapes may unfortunately resemble "self" shapes, such as shapes on the surface of platelets.

What Happens to the Patient?

The usual patient is a middle-aged dog. Poodles appear to be predisposed, though Cocker Spaniels and Old English Sheepdogs also seem to have a higher than average incidence of this condition. Cats are rarely affected and it is usually associated with feline leukemia.

Spontaneous bruising is the major clinical sign. The gums and oral surfaces or the whites of the eyes are obvious areas to check, as is the hairless area of the belly. Small spots of bruising in large conglomerations called petechiae (pet-TEEK-ee-a) are the hallmark signs. A large, purple expansive bruise might also be seen. This is called ecchymosis. Large internal bleeds are not typical of platelet dysfunction, though bleeding small amounts in urine, from the nose, or rectally may also indicate a platelet problem.

When these sorts of signs are seen, a platelet count is drawn, along with usually an array of clotting parameters; red blood cell counts to assess blood loss, and other general metabolic blood tests. Since testing to detect actual anti-platelet antibodies is not available, the veterinarian must determine if any other possible causes of low platelet count make sense.

Other Causes of Platelet Dysfunction

Dramatic reduction in platelet numbers is almost always caused by immune-mediated destruction, though certain tick-borne blood parasites could also be responsible:

    * Ehrlichiosis (especially infection with Ehrlichia platys)
    * Rickettsia rickettsii (Rocky Mountain spotted fever)

Very low platelet counts can also occur in response to the suppression of megakaryocytes within the bone marrow. This might be caused by:

    * Artificial estrogens
    * Sulfonamide antibiotics
    * Chloramphenicol(an antibiotic)
    * Chemotherapy drugs
    * Bone marrow cancers

Disseminated intravascular coagulation is a life-threatening disastrous uncoupling of normal blood clotting and clot dissolving functions in the body. One of its hallmark signs is a drop in platelet count (along with a constellation of other signs).

If platelet numbers are normal but it is obvious that platelet function is not, some other causes to look into might include:

    * Von Willebrand's disease (a hereditary clotting disorder)
    * Metabolic toxins (liver or kidney failure)
    * Overuse of aspirinor similar NSAID
    * Pancreatitis
    * methimazole(for the treatment of hyperthyroid cats)
    * Bone marrow cancers

Therapy for Immune Mediated Platelet Destruction

Once a tentative diagnosis of immune-mediated platelet destruction has been made, the goal in therapy is to stop the phagocytes of the spleen from removing the antibody-coated platelets and cutting off antibody production. This, of course, means suppressing the immune system using whatever combination of medication seems to work best for the individual patient.

Prednisone or Dexamethasone
These steroid hormones are the first line of defense and often are all that is necessary to bring platelet counts back up. Unfortunately, long-term use should be expected and this means steroid side effects are eventually inevitable*: excessive thirst, possible urinary tract infection, panting, poor hair coat etc. The good news is that these effects should resolve once medication is discontinued; further, if side effects are especially problematic, other medications can be brought in to reduce the dose of steroid needed.

  ** THIS COULD NOW BE A LIFE LONG CONDITION FOR HER??


Vincristine
This injectable medication is mildly immune suppressive but also seems to stimulate a sudden burst of platelet release from the marrow megakaryocytes. The platelets released in response to vincristine contain a phagocyte toxin so that when spleen phagocytes ultimately eat them, the phagocytes will die. While repeated injections of vincristine ultimately do not yield the same effect, at least a one-time dose may be extremely helpful. One should note that vincristine is extremely irritating if delivered outside of the vein. It must be given IV cleanly or the overlying tissue will slough.

Androgens
Male hormones may have some masculinizing side effects but they do seem to cut production of anti-platelet antibodies. It also seems to synergize with the corticosteroid hormones like prednisone and dexamethasone. Danazol has been the androgen typically recommended in the treatment of immune-mediated platelet destruction with weight gain being the most common side effect.

Azathioprineor Cyclophosphamide
These are stronger immune suppressive agents typically used in cancer chemotherapy. If steroid side effects are unacceptable or if the patient does not respond to steroids alone, one of these medications may be indicated. Cyclosporine, a newer medication made popular in organ transplantation, also may be used, but expense has been problematic.

Transfusion

One might think that a transfusion of blood or at least platelet-rich plasma might be helpful in the treatment of a platelet dysfunction. The problem is that platelets do not survive well after removal from a blood donor. One has about 12 hours to deliver the freshly withdrawn blood to the recipient before the platelets become inactive. After the platelets are delivered they are likely to live only hours. In general, most efforts are spent on establishing immune suppression.

Gamma Globulin Transfusion

Gamma globulins are blood proteins including antibodies. Human gamma globulin appears to occupy the phagocyte antibody-binding site so that coated platelets cannot be grabbed out of the circulation. This has been a promising therapy for both humans and dogs, but is generally prohibitively expensive.

Splenectomy

If medication simply does not work or the condition keeps recurring once medications are discontinued, the solution may be to simply remove the spleen. After all, this is where the phagocytes removing the platelets are primarily located. In humans, immune-mediated platelet destruction is generally treated with splenectomy first. Response in dogs has not been as predictably good, thus in veterinary medicine it is generally one of the last therapies invoked.



Could the anesthesia or some drug used to sedate cause this? 
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« Reply #40 on: September 22, 2007, 12:03:54 PM »

Dang Flowey.

Could she be licking/biting that area to cause the spot?  Or would the sore be different than what it is?   Does she ever lick/bite her legs when she is stressed?

"Spontaneous bruising is the major clinical sign."


I am thinking that this is actually a "bruise", and maybe because of her size and the area it is (the knee where the skin is stretched as she sits) maybe it opened?    Maybe Vet will have a thought?  I will be asking my vet when I see her later, he did say that it wasn't done in transport or when she was up and moving.  That was my first thought.  Moving big dogs can be dangerous to the dog and to the staff.  When they are knocked out they aren't as easy to move as a person.  Some vets won't do some surgeries on giant dogs because of the strength needed and the chance of harm to everyone.  At least I have had one vet tell me that.  The woman who did Emmett's neuter wouldn't do Addie's spay even though Addie is 40pounds lighter. She said it was just too much to move them and dangerous.  She did also have some arthritis in her wrists which also made working on a giant dog harder on her. 
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« Reply #41 on: September 22, 2007, 12:08:35 PM »

Can she have a toy in her cage?  Or can you take her a shirt of yours or blanket you haven't laundered yet?  It may be of some comfort?






Damn  Cry
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« Reply #42 on: September 22, 2007, 12:16:52 PM »

probably no toys because it is best for her just to lie their calmly.  Not that I think she would play anyways. Sad

   
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« Reply #43 on: September 22, 2007, 12:20:27 PM »

probably no toys because it is best for her just to lie their calmly.  Not that I think she would play anyways. Sad

   

After I posted that I thought she could end up eating your shirt or something....so forget that  Sad

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« Reply #44 on: September 22, 2007, 12:36:40 PM »


Yes, that would be great, another obstruction.   Tongue


 I noticed on the Hematology report that Anisocytosis is checked (looks like a tv or tr ?)

 Would unequal red blood cells have any input on what is going on with her or point to a possible cause?
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« Reply #45 on: September 22, 2007, 12:42:48 PM »

 Cry


Ok.....

explain this to someone that can't comprend this stuff....

Is Addie in trouble?  What's the seriousness?

I know it's not great....but just to what degree.








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« Reply #46 on: September 22, 2007, 01:16:11 PM »


 I don't know if I can answer that right now.  After we see what the dexamethasone does and a transfusion if she does end up having that, a better prognosis could be given.  I am going to ask the vet just that question later, is she in danger and how real is that.  He has called her condition "fair" this whole time. I guess that means she hasn't entered into an actual crisis yet, but the results on her platelets show that she is heading that way. 

 I don't know what this means long term for her either? Will she be on meds? Is this a "crisis" of a disease and maybe she will never have another "crisis" present itself?

 She was healthy before she went in, so that is on her side.


I don't think DIC has been ruled out conclusively at this point:




DIAGNOSIS OF DIC

DIC can be difficult to diagnose because it can be triggered by many unrelated diseases, the clinical manifestations are variable, and there is quasi-consensus about what constitutes a definitive diagnosis. Diagnosis is based on the following criteria:

Presence of an underlying disease known to be associated with DIC.

Multiple abnormalities of the coagulation profile. Not all variables will be abnormal in every case. Some clinicians consider abnormalities in 3 of the following commonly available tests to be sufficient for a diagnosis: Platelet count; ACT, PT and APTT; fibrinogen concentration; AT-III concentration; FDP concentration; presence of schistocytes on a peripheral blood smear.



 Undecided        http://www.vetcentric.com/magazine/magazineArticle.cfm?ARTICLE=Thrombocytopenia%3A%20When%20Your%20Dog%20Suddenly%20Starts%20Bleeding

Severe thrombocytopenia is much more common in canine patients than in feline patients. The disease has diverse causes, ranging from active bleeding during surgery to cancers to Rocky Mountain spotted fever. However, in dogs, the most common cause is the disease immune-mediated thrombocytopenia, or IMT. Unfortunately, mortality rates of patients with IMT approach 50 percent: death is caused by severe blood loss, especially bleeding into the gastrointestinal tract, or bleeding into the brain.
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knny187
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« Reply #47 on: September 22, 2007, 01:56:11 PM »

I always have Dr's or Vets tell me on a scale value (scale 1-10 - 10 being bad)

It's the only way I can understand things
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JediKnight
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« Reply #48 on: September 22, 2007, 02:10:03 PM »

Flower, if you need any donations to help with the doctor's bill,,let me know. Wink
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drkaje
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Quiet, Err. I'm transmitting rage.


WWW
« Reply #49 on: September 22, 2007, 02:18:50 PM »

Good luck.
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