What do you thiink?

[labblab]

Hello again and welcome back, although I'm very sorry about these additional problems.

In trying to offer help to you, we are at the point now where we absolutely need to know exactly which autoimmune disorder your girl has been diagnosed with. Otherwise, we will be endlessly chasing down rabbit holes in terms of both symptoms and treatment. So until we find out that diagnosis, I believe our hands are tied.

In terms of the seizures, however, I do have a couple of comments. First, was the phenobarbital prescribed solely for ten days alone? If so, this seems strange to be. It is a medication that takes time to build up to a therapeutic level in the bloodstream -- typically at least a couple of weeks. So I am not understanding why a short course such as ten days would even be of any value. Also, just as a sidebar, once a dog has been treated for a period of time with phenobarbital, it cannot be stopped cold turkey or else seizures can be triggered simply by stopping the drug. Ten days probably isn't long enough to cause this problem, but I just want to mention that weaning off is necessary if a longer course of the med is ever prescribed.

Also, I find it interesting that your girl had the seizures after the Apoquel was discontinued and not while she was taking it. In that case, I wouldn't think the seizures were a side effect of the medication, but perhaps instead a reaction to the discontinuation of the medication. Since Apoquel is an immunosuppressant, we're back to needing to know the name of your girl's autoimmune disorder. Perhaps it's the case that Apoquel's immunosuppressive properties were somehow inhibiting the seizures during the time period that she was taking the drug.

Marianne

[beaglesandbagels]

autoimmune thrombocytopenia

[labblab]

Thank you so much for this info! I will plan to go and read up on this disorder as soon as I can. In the meantime, I'm still wondering about the phenobarbital -- are you still giving it, or was it only for those ten days?

Marianne

[Squirt's Mom]

autoimmune thrombocytopenia

Primary?

Secondary?

If secondary, what was the cause and has it been resolved?

[beaglesandbagels]

Scarlet had never had a seizure, at least not to my knowledge. Her first one was extremely minor. In fact I didn't even consider it to be a seizure until her second seizure two days later which was roughly three minutes long and just horrible to say the least. The following day she was prescribed the ten days of phenobarbital, and another 30 days of apoquel. Four days after apoquel ran out she had another very bad seizure. More phenobarbital was prescribed and is still currently on that medication.

As far as the autoimmune thrombocytopenia, the type was never discussed. However I am going to assume idiopathic, or primary because all her life anytime blood work has been done her platelets are extremely low.

[molly muffin]

That does sound like it is a genetic disposition, so primary.

Hopefully the phenobarbital will control seisure issues once it's in her system for awhile.

[labblab]

OK, I've finally made my way back again and now I have a few more thoughts to offer out. First, from your description, I'd agree that it sounds as though Scarlet probably suffers from the primary form of autoimmune thrombocytopenia. For the benefit of our other readers, here's a link to an article that helped me better understand the disorder:

https://www.cliniciansbrief.com/site...ocytopenia.pdf

With this additional information in hand, I'd encourage you even more strongly to seek the advice of an IMS before launching into additional Cushing's testing or treatment. Given the nature of Scarlet's disorder, and especially now with the onset of the seizures, I think you'd both benefit from having a specialist's input re: coordinating her medication and her general treatment. Since the low platelet count is life-threatening, that really does take the top priority with the necessity of her periodically taking the immunosuppressants including the prednisone. As you already know, the prednisone may be exaggerating underlying Cushing's symptoms. But the low platelets trump everything else. And even if she does have naturally occurring Cushing's, I honestly don't know whether treatment would be recommended in conjunction with her other necessary meds. And that's even before the phenobarbital gets factored in!

My non-Cushing's Lab girl successfully took phenobarb for six years to control seizures of an unknown origin. But I have to tell you that, especially during the first weeks of treatment, phenobarb can elicit symptoms that are identical to Cushing's: excessive thirst, urination & weight gain, lethargy, and hind-end clumsiness. So if those symptoms re-emerge for Scarlet right now, are they caused by prednisone, naturally-occurring Cushing's, or instead the phenobarbital?

Also, I do want to mention that seizures can be triggered by low thyroid levels, and according to this latest labwork, Scarlet's thyroid level is below normal range. A complication to phenobarbital treatment is that the drug skews subsequent thyroid test results. So from this point onward, if she remains on the phenobarb, it will really be helpful to have somebody on her case who is knowledgeable about thyroid issues and test interpretation.

So for all these reasons, I really think you'd be well-served to seek a consultation with a specialist, if that's possible. If not, I believe I'd focus my attention on the thrombocytopenia and the seizures right now as opposed to more Cushing's testing. If you still want to test for Cushing's, I'd recommend the ACTH stimulation test as opposed to another LDDS. Both those tests can return false positives in the face of other nonadrenal illnesses, but the ACTH is less likely to do so.

Whatever you decide, please do keep us updated, OK?
Marianne

[beaglesandbagels]

Is thrombocytopenia something that is supposed to be treated?

[beaglesandbagels]

What is wrong with her? What is wrong with my vet?

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[molly muffin]

Oh poor baby. I looked up thrombocytopenia to see what I could find.
I don't know about treatment for immune type, it seems to be steroids, which would be in opposition to cushings, as it raises cortisol levels, but if that is the only option..... I don't know for sure what other types of options might be out there and is one reason that I would encourage you to try an Internal Medicine Specialist (small animal) As they might have more experience and know of various options for treatment.

https://www.vetinfo.com/thrombocytopenia-in-dogs.html