JASPER'S Bloodwork and Medication Record

The chart below summarizes the medications Jasper was on, shown as a timeline corresponding to the CBC values shown below.   Shaded areas on the CBC charts show the laboratory "normal" reference range for those parameters.   Below the chart is a table containing all the data.   This information is shared in the hope that others may be able to learn from it, and that it may help save another dog's life.

The medication schedule followed here is not to be taken as a recommendation.   In hindsight, I believe some mistakes were made in Jasper's treatment and if I had to do it over again, I would do things differently!

One lesson learned:   you can see on the chart below that Jasper's red cell count (as measured by the hematocrit) started to drop in October 1998, approximately 3 months after initial treatment was started, and again in February 1999, several months after being put back on high prednisone doses, and again a slight dip in June 1999, several months after the last rise in red cell count.   Each dip was less than the one before and proportionate to the rise in red cell count that preceded it.    

Red cells have a normal life span of 90-120 days, possibly less if they are stressed as Jasper's surely were.   At the time we did not make the connection ... if one has a time period of intense red cell production, where red cells are being produced at a far higher than normal rate, then one has a "bulge" in the age distribution of one's red blood cells, with a high portion of one's red cell population being very close in age.   This "bulge" of same-age red blood cells are going to all die at about the same time!  So it is may be quite natural that 90 to 120 days LATER one is going to see a drop in red cell count that is proportional to the rise in red cell count 3-4 months before!   I know suspect this is what was happening with Jasper.   Note that during the times his hematocrit drops substantially, his platelet and white cell counts were holding in normal; perhaps an indication that we should have simply been more patient and waited for Jasper's red cell count to stabilize on its own. 

ChartCopy

 

 

CBC values

Medications
Date WBC RBC Hematocrit Platelet Abs Retic count Retic count nRBC doxy (mg/day) Epogen pred (mg/day) Imuran Cytoxan

OTHER
7/20/98 7.3 1.77 11.5 63 5310 0.3% 4 600 40
7/23/98 10.1 1.77 11.5 81 0 0.0%    
7/24/98 14.3 1.58 10.6 86 0 0.0%   3x weekly transfuse to hematocrit of 15%
7/27/98 22.9 1.7 11.9 73 1700 0.1%     150
7/28/00 20 1.74 12.2 109 3000 0.2% 3    
7/29/00 15.7 1.47 10.3 80 1470 0.1% 1     begin Imuran begin Cytoxan, 4 days on, 4 days off transfuse
7/31/98 27.8 2.16 15.1 97 8640 0.4%    
8/3/98 27.5 1.84 13.1 98 1840 0.1%    
8/5/98 22.9 1.98 14.1 131 1980 0.1%    
8/7/98 23 1.82 13.1 156 14560 0.8% 2    
8/10/00 22.8 1.9 13.9 249 15200 0.8%    
8/12/98 22.4 2.13 15.8 260 51120 2.4%     Interceptor
8/14/98 26.8 2.23 16.7 242 40140 1.8%    
8/19/98 13.3 2.52 19.4 452 60480 2.4% 3     last Cytoxan
8/24/98 11.4 2.82 22 548 73320 2.6% 4    
8/31/98 7.9 3.4 27.2 581 44200 1.3%   2x weekly 120
9/8/98 9.8 3.99 32.3 485 55860 1.4%    
9/14/98 15.3 3.69 29.9 386 3690 0.1%     Interceptor
9/17/98 17.4 4.67 36.9 419 stop doxy  
9/21/98 14.5 5.22 41.2 462   100
9/28/98 15.7 5.49 42.8 418  
10/5/98 13.6 5.99 46.1 331  
10/12/98 11.7 6.44 48.3 361 stop Epogen 50
10/19/98 15.3 6.46 47.8 357
10/26/98 12.6 6.46 47.2 440
11/2/98 9.6 5.68 41.9 229 20 Interceptor
11/9/98 6.1 5.3 38.2 259
11/12/98 7 5.31 38.4 281 5310 0.1%
11/16/98 7.8 4.98 35.8 282 80
11/23/98 9 4.67 33.4 313 4670 0.1%
11/30/98 10.2 3.87 27.3 239 7740 0.2%
12/1/98 3x weekly 150 Interceptor
12/3/98 10 3.68 25.9 262 3680 0.1%  
12/7/98 11.1 3.81 27 231 15240 0.4%  
12/14/98 11.7 4.13 30.9 287 82600 2.0% 2x weekly
12/21/98 10.6 4.03 30.6 240 72540 1.8%  
12/29/98 12.7 4.27 32.7 230 64050 1.5%   Interceptor
1/4/99 12.3 4.35 33.8 304 26100 0.6%  
1/11/99 11.4 4.89 38.5 363 44010 0.9%  
1/18/99 14.7 4.9 38 271 44100 0.9%  
1/25/99 10.8 5.72 44.5 103 85800 1.5% stop
2/1/99 11.3 5.24 39.8 293 5240 0.1% diarrhea
2/4/99 12.2 4.64 35.2 293 0 0.0% Epogen 3000 units 2x week 120 Interceptor
2/8/99 10.9 4.13 31.1 131 16520 0.4%   Flagyl 500 mg bid for Imeria, 5 days
2/11/99 1500 units 2x week 100 begin 1 baby aspirin daily
2/15/99 13.8 3.92 28.8 318 15680 0.4%  
2/18/99   80
2/20/99 600   SNAKE BITE
2/22/99 18.3 3.58 27.3 211 7160 0.2%    
2/25/99     60
3/1/99 17.4 4.1 31.2 451 127100 3.1%     Interceptor
3/4/99     40
3/8/99 15.6 3.91 30.2 421 140760 3.6% end doxy  
3/11/99   30
3/15/99 18.9 4.39 34.1 439 122920 2.8%  
3/22/99 13.7 4.75 36.4 371 38000 0.8%  
3/25/99   20
3/29/99 13.5 4.75 36.3 431 142500 3.0%   Interceptor
4/5/99 17.4 4.96 37.4 484 4960 0.1%   every 3rd day
4/8/99   10
4/12/99 11.4 5.07 38 348 10140 0.2%  
4/22/99   5
4/26/99 9.8 5.32 38.3 347 10640 0.2%  
5/3/99 10.9 5.63 39.5 324 0 0.0% 1000 IU once per week
5/6/99   5 every other day
5/10/99 10.7 5.83 40.2 364 last Epogen 1/2 every 3rd day Albon for 7 days
5/17/99 11.1 5.66 38.3 349 11320 0.2%
5/20/99 5 every 3rd day last Imuran
5/24/99 9.3 5.8 38.7 354 last pred! last daily aspirin
6/8/99 10.9 6.6 38.5 225 46200 0.7% in Colorado June 1 to 18
6/14/99 11.4 6.35 40.3 279 31750 0.5% in Colorado
6/21/99 12.2 5.82 37.3 371 11640 0.2%
7/6/99 10 5.59 34.4 359 5690 0.1%
7/12/99 10.5 5.74 35.4 309 22960 0.4%
7/19/99 10 6 36.4 329 24000 0.4%
7/26/99 9.6 6.09 36.9 267 48720 0.8%
8/2/99 EPO analysis = 18.6 (Normal)
8/9/99 9.4 6.49 39.1 317 19470 0.3%
9/13/99 8.4 7.18 43 310 0 0.0%
10/11/99 8.4 7.56 45.4 366 22680 0.3%
11/15/99 8.2 6.52 40.6 270 13420 0.2%
12/13/99 7.2 6.87 44.6 356 13840 0.2%
1/25/00 6.53 39.7 256 0 0.0% 1/20/00 Full thyroid panel NORMAL
2/28/00 8.3 6.99 41.3 269 14200 0.2%
6/5/00 6.3 6.32 38.8 299 6320 0.1%
8/7/00 7.8 6.4 39.2 184 0.0%
6/18/01 10.8 44 399
6/13/02 7 41.5 345
6/16/03 6.51 6.17 39.1 174 19300 0.3%

600 mg
7/15/03 7.96 5.5 35.5 257 9700 0.2%

20 mg/day for 4 weeks
8/7/03 6.93 5.84 37.9 224 7100 0.1%

stop doxy

 8/18/03 ultrasound finds 4cm splenic mass
8/25/03 5.16 4.92 31.4 237 12300 0.3% 8/25/03 splenectomy; splenic hematoma
10/31/03 8.83 5.36 35.1 437 16600 0.3%

600
11/12/03 8.72 5.55 36.9 312 10400 0.2%

 

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