Update on Charlie (low PCV)

[Kim D]

Hi Traci and Wanda,

Traci, I know if you could reach through the computer to strangle me you would for waiting this long, but I finally took Charlie in today for a blood transfusion. I was so surprised at how easy the procedure was! Part of my reluctance to have it done was that I thought it would be so stressful for him that he wouldn't survive it. He was in and out of there in 3 hours and is home now doing better than ever.

It's so bizarre! I waited in the clinic for him because I was so afraid he wasn't going to make it and thought that if he did he would be completely out of it. But Traci I could tell instantly how much better he felt already. And when we got home he immediately started woofing out. He has more energy instead of less. Wow!

Brace yourself because now you're really going to be upset: his PCV level had dropped down to 10 (I'm hiding behind my hands as I write this). You don't need to chastise me for waiting because I'm already doing a fine job of that myself. You were right and I was wrong.

And can you believe that the pathology report that was sent in last Wed is still not in? Even the doctor got mad about that so hopefully he hustled them up.

I will keep you posted.

xoxoox
Kim

[Traci]

I'm releived to hear the news, Kim, thank you so much for the update.

Charlie and you were very fortunate. A PCV that drops that low is extremely difficult to recover. You did the right thing.

Please keep in constant contact with your vet at this point, and keep a log of Charlie's symptoms, improvement, and medication schedule where appropriate. If your vet has asked for a recheck in a day or two, please oblige him, he needs to know how Charlie is doing, if he's recovering, and of course, to treat as necessary once the pathology comes back indicating whatever disease process is going on. The treatment can vary depending on what the pathology says, so please be prepared for that. Ask your vet specifically what the path report says, if it is regenerative vs nonregenerative anemia, infectious disease, hemobart, etc...

In the meantime, please visit our feline vitals page to help you monitor Charlie's vitals, and pay special attention to his mucous membrane color (gums, whites of eyes, inside ears), temperature, and hydration status, these are most crucial of all at this point.

What medications does your vet have Charlie on right now? What is his plan of action in treatment at this point?

[Kim D]

Hi Traci,

Thanks for the advice. The vet told me to keep him on on prednisone pill a day (5 mg) and that's it. Hopefully the path report will be in today. The plan is to wait for that and see if the report says the cells are normal or abnormal. That's all I could glean from what he was saying.

The vet I took him to was the head of the clinic I usually go to. Most of the trouble I've had there was with the substituting vet, not the one I saw yesterday. I think he's a good vet, but they are so crowded now. The doctor was really rushed and impatient with me, but not rude and he did seem genuinely concerned. I guess I'm going to stick with him because he seems to have a real interest in my case.

I will check you vitals page now. Thanks for the help!

Kim

[Wanda]

Kim, that is really good news about Charlie! I was really scared for both of you, but appears like things are looking up now. Please do listen to Traci, she is not going to steer you wrong. All I can really offer is moral support, and that I freely give. Keep us posted. Wanda

[kk]

Oh Kim!

I'm so sorry that I have not read your story before today. I know very much what you are going through. Several years ago, I had my girl, Diva, in for a teeth cleaning and vaccines. We did no prelim blood work as she was only three (did you? I wish I had). She went downhill a few days later, becoming severely anemic and anorexic. She dropped to a PCV or around 8! Because she was young and strong (and treatment with high doses of pred and doxycycline), she pulled out of the worst of it within a few weeks. Very long weeks. She never was totally well after that, but she did live a few more good years with us. We had a biopsy of her bone marrow done, which really didn't help much, but did tell us she was regenerative. We also tested the bone marrow for FELV (neg)..the doc felt that it could be in her bone marrow even though she tested neg in her blood. The pred helped her appetite, which helped her keep her strength. It was a while later that I found Traci, and she was a great help to me with my girl's treatment. Eventually we lost her, but we had fought the good fight. Please do as Traci suggests (I know you are listening now!), and fight this as hard as you can! Oh, and as for the doxycycline, we did not find out until right before Diva passed to the bridge that she was actually positive for Hemobartonella. There were times that we didn't even treat her with doxy when we should have.

Anyway, I just want you to know that I TOTALLY understand what you are going through, and wish I had jumped in earlier to let you know that! Keep your chin up...I believe in Charlie, and I believe in you!

Hugs,

kk

[Kim D]

Hi Traci, Wanda and KK,

Wow, I really appreciate all this support! I have some good news. Charlie's path report finally came in and they saw nothing abnormal in it! I asked again if the tapazole (thryoid med) could have been the culprit as he had started taking it a couple weeks before he got so sick. She started muttering something about how it can do funny things to bone marrow but... anyway, then she asked me if it was possible that he could have gotten into some D-Con. What? Shouldn't that have been question #1? Because yes, anything like that is possible.

She also said that they are concerned about some kind of internal bleeding because of his tarry stools. Could that be the result of the anemia and not necessarily internal bleeding?

Well he's really rallying since his blood transfusion and I mean practically transformed back to normal. I am still watching his cat box but even though things looked quite normal in there this morning, my other cat had snuck in so who knows...

Traci, Charlie faked taking his prednisone yesterday (I found it under the coffee table). With this new information, should he still be taking it? And with what KK says, what do you think about the doxycillin? No one at my vet suggested it. Should I ask about it?

KK, I'm so sorry to hear about your kitty.

To answer your question though, Charlie had some basic blood work done before his teeth cleaning and that's when they found the hyperthyroid condition. But everything else looked normal at the time (last November). I didn't start giving him the tapazole for it until Dec 30 or so because I couldn't get anyone to talk to me about it. I had questions, like if there were any side effects I should look out for. No answers, but I started giving them to him anyway. I really wonder if there is a connection.

What an ordeal this has been! He sure did take to that transfusion though. I'm going to buy their donor cat a nice present. He has a follow up appt next Thurs, so keep your fingers crossed that he is on the mend!

Thanks everyone!

xoxoxo
Kim

[Traci]

Kim, I'm getting confused about your vet's comments, especially since upon a negative pathology, he didn't tell you whether or not to continue the prednisone or to start doxycycline.

I am assuming the 'pathology' was an actual feline serology? This is what I referred to before, a serology tests for immunological problems, such as Coombs, hemobart, FELV/FIV, regenerative anemia causes---sent to an outside lab. If the pathology was in fact, a full feline immunological profile serology, and if it was in fact negative for all of the above mentioned, then continuing the prednisone may not be necessary. If this pathology was anything other than the above mentioned, I would sure be interested in knowing what it was testing for in particular.

My confusion starts here. On the 21st, I am ssuming the PCV, hematocrit and CBC were done in the clinic, thereby indicating the low PCV at 12 and the recommendation for a blood transfusion. I also assume the blood taken was divided to send off for the pathology (immunological serology), and I am assuming an FELV snap test there in the clinic might have been done to rule out FELV. Then on the 26th, the day of the transfusion, is it correct to assume that only the PCV was tested, or was there another blood test done, such as CBC and chemical analysis?

If your vet suspected toxicity at all, he could and should have included a chemical profile to monitor liver and kidney function. The kidney enzymes would probably have been elevated if toxicity were a concern. Again, retesting the thyroid levels at the same time might have given your vet any indication of a potential Tapazole toxicity. If a rodenticide toxicity (d-con) was a concern to your vet, the chemical analysis should have given him a clue (combined with the hematocrit, RBC destruction, etc)

Since anemia was (and still could be ) a grave concern here, the cause still needs to be investigated, confirmed. Whether this is due to a toxicity or viral or immunological disease, it STILL needs to be determined, diagnosed effectively. Since tarry stools or any indication of blood loss is still a concern, this could indicate internal hemmorhage somewhere, could indicate hemobart, or any other regenerative anemia. The problem is finding out WHAT is causing the blood loss, why the tarry stools, why the PCV dropped so critically. To find these out, one must perform the appropriate blood testing and immunological profiling.

So, I would suggest asking your vet exactly WHAT parameters were tested with the pathology: Coombs, hemobart, FELV/FIV, toxo, etc. and if all of these were in fact negative. I would then ask (or demand) that the thyroid levels be checked immediately. Lastly, you have to call him and find out if he wants Charlie to continue the prednisone, usually this is extended and then reduced/tapered at some point, but it depends on what the PCV and hematocrit reveal at this point, be prepared to get another PCV done before next Thursday if Charlie suddenly declines again or if his vitals are abnormal.

I know this is all very confusing to you, and it's difficult for me to advise simply because I don't know what was lost in translation between you and your vet. I don't know the parameters tested to advise much further, but I am compelled to caution you to watch Charlie extremely carefully and do not hesitate in the least to get a new hematocrit done in the event that Charlie develops similar symptoms again, or any indication whatsoever, no matter how slight, that he is not feeling well (again, monitor his vitals at least twice a day, report to your vet at once should anything be off)

Even though the transfusion was successful, without knowing what is causing the blood loss/anemia, Charlie is still at risk....for this reason, I strongly suggest you ask your vet the above questions ASAP.

[Kim D]

Thanks Traci -- these are all excellent questions. I'm going to print this out and take it in to them today if I can get in. I just called to ask about the pred and they are out to lunch so I'll try later. Yes, I should be demanding. Actually I have been pretty demanding and they don't take too kindly to it.

As far as the path report goes, I really don't know what they were testing for or if they did serology or not. I know that last Wed the blood work they did in their own lab showed feline leukemia negative, but he said there could be another kind of leukemia. I wish I would have had your list of questions that day. I do think they were looking for cancer cells though. He said something about the nuclei of his blood looking funny when he did a smear that day.

Also the blood taken on the 15th showed that his thyroid level had dropped to a little below normal. So that's from too high to a little low in about 17 days. Is that normal? I have a hypothyroid condition and thought that it took a month of medication for the results to be show in the blood test.

These guys at that clinic.... I tried to find another vet to take my case but with no luck. They all just said that the best oncologists were at the clinic I'm going to. I don't want to think too hard about that!

I'll let you know what they say to all these questions. I wonder how they will react? I won't mention your name or site if you don't want.

Kim

[Kim D]

Hi Tracy,

The vets haven't gotten back to me yet today so that I could ask your questions about the serology, but I did find some information about Tapazole. One of the major adverse reactions is aplastic anemia. It can also cause agranulocytosis, granulopenia and thrombocytopenia. From what I can gather these last three are blood disorders and the aplastic anemia has to do with red blood cells and bone marrow. Bone marrow has been a constant byword in Charlie's case. Hmmmm.... more questions to ask when and if they ever get back to me. I do have an appt Thursday though.

I took him off the Tapazole on my own initiative the day before I saw the vet who told me to take him off of it -- he said that after I asked him if I should. It was the day after that that Charlie rallied and had 2 good days before he declined again and had the blood transfusion.

By the way, there are 2 vets at that clinic that I'm dealing with in case you are confused by me referring to the vet alternately as him and her.

The cat box action seems to be improving. He is still soaking it but the smell is getting a little stronger (it's been practically odorless for several days). And there's a 99% chance that the healthy-looking poop this morning Charlie's and not my other cat's. But I am still watching.

Kim

[Traci]

Which coinsides with why I suggest getting the thyroid checked. Even if the anemia were unrelated to the thyroid meds, you still need to monitor his thyroid function, because untreated hyperthyroidism can lead to other complcations.