August 8th, 2008

Devcolor

Devon

I haven't posted much about Devon because I haven't had any good news to report. We've had his blood drawn  several times but the results are equivicol at best. I also haven't been thrilled with the way my vet has been communicating with me. She basically doesn't say much and I really haven't understood her take on his case.
Devon's last platelet count said he had 10,000 platelets with clumping present. That's lower than when we started giving him Prednisone and we've already increased the dose by 5 mg/day. When I heard that today I felt my heart drop and just felt so discouraged. My vet suggested that she refer me to the vet school and that the next step would probably include a bone marrow aspirate.

As  I usually do I immediately called my husband with the news and he suggested that I speak with a friend of ours who is a vet tech for a well-respected orthopedic vet who works at a specialty hospital. I didn't really see any point but I called her and I'm so glad I did.
Her response, after I filled her in on Devon's case, was to tell me that if they got a CBC with a comment like "clumping present" and every other value was normal, they would disregard the number of platelets and assume the patient was fine. She also said that since platelets are supposed to clump, having them clump in a blood sample could be thought of as a good thing and not something to worry about. When I asked her about the fact that the lab had given an estimate of "low" she suggested that there really wasn't any way to get any kind of an accurate estimate when there was clumping present. In other words, in her opinion Devon's platelets could be completely normal and that in the absence of any signs or symptoms of anything else being wrong, we could be treating him for no reason at all. She went on to say that if it was her dog, she wouldn't do anything more unless some other problem developed. Her advice was made so much sense to me and it jibed so well with the lack of any symptoms that Devon has that I felt like it had to be the most reasonable explanation.

So my plan is to wean him off the prednisone as quickly as is safe but to continue giving him the Doxy. It won't hurt him and I've already paid for it. It may take several weeks to wean him off the Prednisone. At this point he has to stay in the back hallway when we're not home and at night because he sometimes can't wait to be let out before he pees. And he's gotten really chunky. And I haven't been able to do any agility with him because of the way Prednisone affects muscle tissue.

I have to say that I feel an equal amount of relief and anger. Anger at myself and at my vet. Even though my specialty isn't hematology, I should have trusted my own knowledge of laboratory medicine enough to investigate the liklihood that the low platelets was a spurious finding on his CBC. instead I assumed that my vet was on the right track by treating with Prednisone instead of looking further into the possibility of getting a more accurate platelet count. Why didn't I, as a laboratory professional, call someone in hematology and find out if there was some other anticoagulant that could be used? Why didn't I at least ask my vet what the consequences of not treating Devon would be? I just can't get past the idea that I could allow my dog to be treated for nothing.

And I'm really disappointed in my vet. I think if she had spent any time really thinking about Devon's case or maybe consulted someone, she might have realized that we could be rushing into treatment without any real reason.