Autoimmune disease. To treat based on numbers or leave alone?

[Ladyrosee]

I really need advice on what to do. Not medical help of course just a friend to a friend. Many of you know Morton the young kitty with ITP (a disease where the body accidentally destroys platelets). And his dka/sepsis/pancreatitis death bed story from August..you wouldn't have even think he spent half of it in the icu he is plump and in diabetic remission ever since!

He WAS also in ITP remission somehow since August when they abruptly stopped all of the immunosuppressive therapy in the icu. Now as of a little over a week ago his ITP is back. He walked up to me all happy and I noticed his ears (bleeding marks and bruising which in my experience with him means his platelets are 12,000 or under) platelets for animals and humans range from 150,000 to 450,000. Low platelets like his cause spontaneous bleeding usually petichiae and purpura (bleeding into the skin in big bruises or tiny red patches all over the body). I work for a vet and we have been on this rollercoaster for 2 years and most of that time he was severely overly immune suppressed, never feeling good or acting good and didnt need to be on the doses so high and it's actually what caused the August incident. Now with careful consideration his health is in my hands and the vet just wants me to be careful and look every day for any signs of low platelets and I get free blood work through my job for him usually every 3 weeks to check.

He is just doing so so well. Acting like a kitten, eating, PLAYING. He's making up for lost kittenhood he didn't get to experience. He is just so un disturbed when his platelets fall so low..they went up on their own a little bit all of his bruises went away within a few days and platelets are at 21,000. 65,000 is considered a safe zone for ITP. And usually based off symptoms for him 12k is getting critical.

I don't know what to do here. We have never given his body a chance to fight this and giving it a chance right now the platelets moved from active bleeding to not but they're still too low. If I put him on a high dose of steroids the platelets return to normal within a week or so but then I'd have to start the very careful weaning process.

Besides the platelets his blood work has NEVER looked so good. I want to frame it lol. I just need advice.. do I wait this out? Do I overload with steroids again to bring them up and try to wean off? What would you do? The vets all say steroids but I'm in an ITP group and almost all of those people just live with platelets like his because they feel fine and hate the drugs because they make them sick. They just are careful of tripping/being clumsy to prevent bruising. Hes just doing so well and of course ITP has to be thrown back in his face. He has an appt with the holistic vet tomorrow and she has some herbs that she is sure of that can help ITP and another that acts as a "natural immunosuppressive drug" I just don't know what to do

At home he is on a weekly b12 shot, multivitamin, iron (for when he is bruising), probiotic, 2 chinese herbs and he just acts so great..

 

[vince]

I responded to earlier threads about Morton. My own ITP got better on its own without having to resort to steroids, but I still have to watch my platelet count (seems to be holding almost asymptomatically about 45,000). If Mort is like me, he won't feel anything. ITP doesn't hurt, so that's why he seems to be doing so well. As long as the bleeding doesn't upset the red blood cell count too badly, he'll be okay. One warning though: It does take a while to build red blood cell count back up after a bad bout of ITP (took several months for me), so don't let it get too bad before changing treatment if so indicated.

Other acquaintances having autoimmune conditions told me that getting on steroids was a problem, since getting off them would be an ordeal. I haven't had to go that route, but It seems that what goes for humans holds true for cats, as far as autoimmune problems go.

If you feel comfortable with the holistic vet, go with that, but just keep checking to make sure the ITP doesn't get much worse, and use the steroids if the holistic approach isn't cutting it.

 

[Ladyrosee]

I responded to earlier threads about Morton. My own ITP got better on its own without having to resort to steroids, but I still have to watch my platelet count (seems to be holding almost asymptomatically about 45,000). If Mort is like me, he won't feel anything. ITP doesn't hurt, so that's why he seems to be doing so well. As long as the bleeding doesn't upset the red blood cell count too badly, he'll be okay. One warning though: It does take a while to build red blood cell count back up after a bad bout of ITP (took several months for me), so don't let it get too bad before changing treatment if so indicated.

Other acquaintances having autoimmune conditions told me that getting on steroids was a problem, since getting off them would be an ordeal. I haven't had to go that route, but It seems that what goes for humans holds true for cats, as far as autoimmune problems go.

If you feel comfortable with the holistic vet, go with that, but just keep checking to make sure the ITP doesn't get much worse, and use the steroids if the holistic approach isn't cutting it.

Thank you that made me feel better. I did get a chance to go over his blood work and in a week when they were at 18k he was borderline anemic and it didnt surprise me because he was covered in bruising but at 18k they were on their way to fading. He bruises like that 12k and under so it seems anything over I dont see any symptoms. And current blood work in a week went from nearly anemic at 18k to borderline anemic today and at 21k his percentage for the anemia is 1 below it should be so I am doubling the iron I'm giving him to the ideal dose for his weight.

I don't think you know how hard it is to decide to give his body a chance and do the natural stuff like the herb that is supposed to clot the blood from the inside his vet suggested or go with the steroid on a high dose that has shown to drastically improve him at his holistic appt tomorrow I will ask again.

And yes thank you for that red blood cell comment. I'm just worried why it has gone down a little when his platelets have improved a little but perhaps the body is doing it's best to try to heal and it needs more iron which I will start the doubled dose tonight.. that stuff works great for pets the pet tinic stuff. Sigh.

He can have 300k platelets one day and the next 10k. And on his own it seems like they just cant go up enough but the steroid brings them to a great level quick but I'd want to wean him off very soon after and that's stressful to do

 

[vince]

300k to 10k in a day seems an awful wide swing. I wouldn't think a mammal body could do that. Mine change only very slowly. I would question the accuracy of the tests.

Do you have any references that say the platelet count can swing that fast? Maybe it's just that cats are so small compared to humans?

I've gotten pretty good at gauging how the ITP is doing by how much my gums bleed when brushing my teeth, how long I bleed after I nick myself shaving (probably useless in the case of a cat with ITP) and the number of petechiae on my forearms. Maybe you could examine Mort and get a handle on how he's doing by examining him yourself.

 

[Ladyrosee]

300k to 10k in a day seems an awful wide swing. I wouldn't think a mammal body could do that. Mine change only very slowly. I would question the accuracy of the tests.

Do you have any references that say the platelet count can swing that fast? Maybe it's just that cats are so small compared to humans?

I've gotten pretty good at gauging how the ITP is doing by how much my gums bleed when brushing my teeth, how long I bleed after I nick myself shaving (probably useless in the case of a cat with ITP) and the number of petechiae on my forearms. Maybe you could examine Mort and get a handle on how he's doing by examining him yourself.

Its shocking yes. But when he was in the icu they saw it first hand. They checked his blood work every 12 hrs and it would go from 500k to 60k or so within those 12 hrs. So 300k to 10k doesnt seem like a stretch especially when I was getting him checked every couple of weeks for a year. He holds great in the high 300s then boom petichiae everywhere. However it could be within a week or so seeing as even at 18k he has no physical symptoms. Seems the low teens is when bleeding takes place.
Platelets for cats are notorious for clumping aka reading lower than they are but I know they're accurate with the petichiae ..

So maybe you can answer. Do you continue to be anemic or even trend downward if your platelets are going up a bit? My fear is hell maybe hes bleeding internally somewhere but he didnt even bleed internally at counts at 6k his lowest his paw usually bleeds though that low.

I see no petichiae since Nov 23 or so. Nov 20 is when I saw his ears covered in red spots and his belly had bruising then it started fading on it's own and was gone on the 23. I still got blood work and I know it went up in those few days since his bruises faded and no new ones popped up

The test tube the vet said his blood wasnt clotting in at all and it was 2 hrs after she took it.. the week before when they were a bit lower it clotted right away. Why does he have to be such a mystery

 

[Ladyrosee]

I think I just need mainly advice on why I find low platelets unacceptable even though hes not symptomatic. Of course treat when hes actively bleeding with iron etc but I'm not sure why I cant let go of him potentially living with low platelets vs using steroids to get them up to a perfect level only for them to fall again. Maybe his body just doesnt want all or them and if he sits low where he is low that they can maintain it on their own? Maybe when they're upped so high the body has a field day wanting to get rid of most

 

[vince]

The internal bleeding in the gut over a long time is what gave me the anemia. I had been diagnosed with anemia off and on for years before the doctors were able to put a finger on it. Anemia hasn't been a problem since they got on top of the ITP. Only had to take one med (don't remember what it was, but it wasn't a steroid) for a relatively short time. Did have a couple instances of hemorrhages in my legs and feet that were a problem for a time. No lasting troubles, though. The doctor doesn't worry about it much these days.

Significant symptoms occur when my platelet count gets below about 28,000 for any extended time. The anemia does persist for some time after the platelet count comes back up.

 

[Ladyrosee]

The internal bleeding in the gut over a long time is what gave me the anemia. I had been diagnosed with anemia off and on for years before the doctors were able to put a finger on it. Anemia hasn't been a problem since they got on top of the ITP. Only had to take one med (don't remember what it was, but it wasn't a steroid) for a relatively short time. Did have a couple instances of hemorrhages in my legs and feet that were a problem for a time. No lasting troubles, though. The doctor doesn't worry about it much these days.

Significant symptoms occur when my platelet count gets below about 28,000 for any extended time. The anemia does persist for some time after the platelet count comes back up.

I think it just makes it worse because everyone panics when his numbers are low. It's very rare in cats so they dont know a lot about it but they severely stress about it when his numbers get low even it he's acting great they instantly want to overload him and then he gets very sick from basically having no immune system and constantly got infections and everything .

 

[MissClouseau]

You might have read this already but apparently false low PLT in cats is quite common.

Thrombocytopenia in Cats - WSAVA2006 - VIN

Platelet - an overview | ScienceDirect Topics

You can find more articles if you google "cat false platelets"

I wouldn't feel comfortable saying "I would do this" as I'm not with Morton nor have any experience with an ITP cat but, I can say that my own cat Hima's bloodwork has never been perfect. She got two done back in January when she was hospitalized with infection liver/gallbladder issues, and to check the situation again in June. In June she was acting perfectly normal (still is despite having dental problems) but her WBC was very low, bilirubin was on the edge of the normal range, and platelets were high (maximum is 514, Hima's was 547) The vet only gave a milk thistle supplement for her liver and said let's not vaccinate with low WBC. But he wasn't alarmed at all. I took the results to Hima's original vet and she believes the machine probably measured WBC incorrectly if she's acting well but she was also not alarmed by the other results. I went to online forums with vets and one said, "We treat a condition usually, not the numbers."

 

[Ladyrosee]

You might have read this already but apparently false low PLT in cats is quite common.

Thrombocytopenia in Cats - WSAVA2006 - VIN

Platelet - an overview | ScienceDirect Topics

You can find more articles if you google "cat false platelets"

I wouldn't feel comfortable saying "I would do this" as I'm not with Morton nor have any experience with an ITP cat but, I can say that my own cat Hima's bloodwork has never been perfect. She got two done back in January when she was hospitalized with infection liver/gallbladder issues, and to check the situation again in June. In June she was acting perfectly normal (still is despite having dental problems) but her WBC was very low, bilirubin was on the edge of the normal range, and platelets were high (maximum is 514, Hima's was 547) The vet only gave a milk thistle supplement for her liver and said let's not vaccinate with low WBC. But he wasn't alarmed at all. I took the results to Hima's original vet and she believes the machine probably measured WBC incorrectly if she's acting well but she was also not alarmed by the other results. I went to online forums with vets and one said, "We treat a condition usually, not the numbers."

I have read before that about cats..but he had visible bleeding and he is borderline anemic from the platelets dipping so low. From my experience the 2 years I've had him any time his ears are pooled with red blotches that means his platelets are low and he has purple bruises all over his stomach when they get about 12k or under. His current blood work showed 21k with some clumps making it appear lower than it is but it is still very low. No red marks or bruising currently since they are holding around 20k but at work the other day when we took his blood the tech informed me after a few hours his "blood still isn't clotting" which isnt good as blood should clot within 15 mins. I'm giving him pet tinic to get on top of the low iron. His iron runs high end naturally and it's right at the line of anemic probably from the low platelet incident with the bleeding.

A lot of the time his platelets will be in the low 100ks and 150k is the cut off low range and it will say "adequate numbers due to platelet clumping". When it's very low my boss has the pathologist look himself to confirm

If cats have an infection their platelets usually rise like that. When Morton was very sick in august they got to almost 600k. any time he has an infection they get higher because the body is ridding the infection in his case and not focusing on killing platelets. Milk thistle is also awesome. I use 0.45 mls per day for Morton and finally after 2 months his liver enzymes are normal. They were almost 1 thousand from a few days on doxycycline he wont ever be having that again

I think definitely for him treat the symptoms not the numbers. So the anemia I'm getting on top of before he goes full blown anemic. and somehow raise the platelets or let them do their thing for a while longer. I'll let you guys know what the holistic vet says as this will be his 3rd visit

 

[Ladyrosee]

The internal bleeding in the gut over a long time is what gave me the anemia. I had been diagnosed with anemia off and on for years before the doctors were able to put a finger on it. Anemia hasn't been a problem since they got on top of the ITP. Only had to take one med (don't remember what it was, but it wasn't a steroid) for a relatively short time. Did have a couple instances of hemorrhages in my legs and feet that were a problem for a time. No lasting troubles, though. The doctor doesn't worry about it much these days.

Significant symptoms occur when my platelet count gets below about 28,000 for any extended time. The anemia does persist for some time after the platelet count comes back up.

His petichiae went away completely for like 8 days and now they're back. I wish I knew why and what was happening in him. I might have to double the steroid. Still to a low dose of 5mg but it's so upsetting. He was even off of all meds for months and great platelets. Will he ever be fine again? I just want to cry. Hes acting so well other than the marks I just dont know what's best to do

 

[cat nap]

His petichiae went away completely for like 8 days and now they're back. I wish I knew why and what was happening in him. I might have to double the steroid. Still to a low dose of 5mg but it's so upsetting. He was even off of all meds for months and great platelets. Will he ever be fine again? I just want to cry. Hes acting so well other than the marks I just dont know what's best to do

@Catxmama ....I'm so sorry your Morton, and you, have to go through this terrible illness.
I've never even heard of ITP, ...before reading this thread.

Did your holistic Vet, offer any insights, as to why the ITP seems to 'flare-up' like this?
Does the petechiae happen from cats running around, and using their muscles, or does it come on suddenly?
(I definitely have to read more about ITP in cats,...so as not to bother you with too many questions.)

Sending you Mega Health Vibes for Morton, and vibes for you,...because I think you are doing an amazing job.

 

[Ladyrosee]

@Catxmama ....I'm so sorry your Morton, and you, have to go through this terrible illness.
I've never even heard of ITP, ...before reading this thread.

Did your holistic Vet, offer any insights, as to why the ITP seems to 'flare-up' like this?
Does the petechiae happen from cats running around, and using their muscles, or does it come on suddenly?
(I definitely have to read more about ITP in cats,...so as not to bother you with too many questions.)

Sending you Mega Health Vibes for Morton, and vibes for you,...because I think you are doing an amazing job.

Its VERY rare in cats but common in people. some have chronic or acute. A lot is caused by vaccines especially in young children. He got it at 4 months probably from the shelter vaccines. He has a big bald spot from one of the vaccine sites.

If we knew the cause of the petichiae (low platelet symptom). I guess you can say hes very fortunate because immunosuppressive drugs keep his numbers perfect and steroids instantly bring his numbers normal. Most people who have it nothing works for them and they're constantly in the hospital or dying. I've talked to some people who are on a very low dose of steroids to keep their mi numbers up but they tapered the dose over years and are down to 1mg which is basically nothing.

If I knew the trigger of low platelets we could prevent it.. it seems when he is sick his counts are high because his immune system is busy attacking the CORRECT thing instead of platelets. But hes the healthiest hes been and I tapered his steroid a tiny bit and boom. This problem

 

[cat nap]

(I was on prednisone, at age 10, and again 15...but it was for an 'inflammatory muscle condition'....they called it 'inflammatory myositis'...but really did not know what caused it either. They guessed it was caused by a viral infection.)

(I do remember that the tapering off of prednisone....if done too quickly....caused another flare-up.)

I haven't read your other thread ...about him having dka/sepsis/pancreatitis...so I'll go and find it...and read it this weekend.
I do so hope that Morton gets back to feeling much better.
He is a gorgeous cat.

 

[Ladyrosee]

(I was on prednisone, at age 10, and again 15...but it was for an 'inflammatory muscle condition'....they called it 'inflammatory myositis'...but really did not know what caused it either. They guessed it was caused by a viral infection.)

(I do remember that the tapering off of prednisone....if done too quickly....caused another flare-up.)

I haven't read your other thread ...about him having dka/sepsis/pancreatitis...so I'll go and find it...and read it this weekend.
I do so hope that Morton gets back to feeling much better.
He is a gorgeous cat.

Yes some people believe high dose for 4 days and completely stopping can work but others recommend high dose for a couple weeks then taper off taking like 6 months.

Thank you he is an angel. The people at the icu he stayed at for like 11 days said his will to live and come home to me is what they think had him live through it all because they said they've never seen an animal so sick and resistant to treatment. But slowly improved every day. Especially when I'd visit. Nearly fell out of the cage and got so exhausted from being excited he would collapse

 

[Ladyrosee]

And the thing is he feels great and better than he ever has. But it's the platelets kicking his butt and stressing me out. He most likely feels nothing

 

[cat nap]

But you said that your Vet is concerned?
And his symptoms of petechiae are what alerted you to his platelet counts?

 

[cat nap]

...Thank you he is an angel. The people at the icu he stayed at for like 11 days said his will to live and come home to me is what they think had him live through it all because they said they've never seen an animal so sick and resistant to treatment. But slowly improved every day. Especially when I'd visit. Nearly fell out of the cage and got so exhausted from being excited he would collapse

The power of the 'love bond'. Morton is amazing. But your love for him, is also special....and his for you.

 

[Ladyrosee]

But you said that your Vet is concerned?
And his symptoms of petechiae are what alerted you to his platelet counts?

I think at this point (vet has known Morton from day 1 and hes actually my boss) he said well how is he acting? I said great. And he said well theres several options if you want me to tell them but I'm sure you know: 10mg of steroids which gets platelets up quick. Dont treat and watch/get checked whenever. Do a little more steroid and wait and see. He used to absolutely freak because in his 25 years of only working with cats hes only had 3 cases total of ITP. One went into remission and the other had steroids off and on. But hes terrified of it because he has like no experience with it. his internal medicine doctor isnt very involved but he basically said just a professional and not personal opinion: steroids. His holistic vet said to try herbs which he is on they just can take a few weeks to build up and if hes acting great and doesnt get worse with anemia then do what I feel is best because how he looks to her she isnt too worried about him since hes acting so well

But physically being able to actually see this disease stresses me. His little ears are blotchy bright blood red spots and in his mouth a few specks here and there. That means they're very low and of course when they're really low he wants to run around and rough house with the other cat and if he does that then bruises galore

 

[cat nap]

I think at this point (vet has known Morton from day 1 and hes actually my boss) he said well how is he acting? I said great. And he said well theres several options if you want me to tell them but I'm sure you know: 10mg of steroids which gets platelets up quick. Dont treat and watch/get checked whenever. Do a little more steroid and wait and see. He used to absolutely freak because in his 25 years of only working with cats hes only had 3 cases total of ITP. One went into remission and the other had steroids off and on. But hes terrified of it because he has like no experience with it. his internal medicine doctor isnt very involved but he basically said just a professional and not personal opinion: steroids. His holistic vet said to try herbs which he is on they just can take a few weeks to build up and if hes acting great and doesnt get worse with anemia then do what I feel is best because how he looks to her she isnt too worried about him since hes acting so well

So you basically have four options:
1) 10 mg steroid....platelets rise
2) don't treat and watch....check platelets again
3) small increase in steroid....wait and see
4) try herbs....can take 2 weeks....make sure anemia does not get worse

How much experience does the holistic Vet have with ITP?

I wish you had an online cat-ITP-related group to join....not just for people....or dogs.
(I know you said ITP is rare in cats....which is a good thing....but not in this case.)