JASPER'S Blood work 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. 

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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