Update on Puddy; she's gone*9/29* see post #421

[Catty1]

RIGHT! I forgot that your pooter was going to the vet also.

Puddy does defy the odds! I loved how Dr Lee was so sweet with her...and she KNOWS him, and just cried at him! With her not feeling well, it's so sweet that she would 'ask for help'.

Mary - don't drive yourself crazy with details, but I did find a couple of bits of information on Epogen. Just have a look and then check the link if you want to. Epogen is made from a human protein, which is why autoimmune can happen...but if her counts stay up, that is good. There's another drug mentioned here also.

http://www.marvistavet.com/html/erythropoietin.html

SIDE EFFECTS

The main adverse event to be concerned about is antibody production. Antibodies are generated in response to an alien protein in the body. The problem is that antibodies that are generated not just against the alien (human) erythropoietin but also against the patient’s natural erythorpoietin. This makes for a profound anemia which can only be treated with blood transfusions. Regular monitoring to check for a sudden drop in red cell count, is crucial as this is the sign that a problem is incipient and the product can be stopped while there is still time. It has been proposed that darbepoetin (Aranesp ®) is less likely to cause this reaction than other recombinant erythropoietins since it differs from the human product the most.

INTERACTIONS WITH OTHER DRUGS

It is very important to administer an iron supplement in conjunction with the erythropoietin injections so that the bone marrow will have all the necessary “supplies” with which to make red blood cells. A multivitamin with iron is typically used as this will also provide the B vitamins needed in red cell production as well.

In humans, carnitine administration improves the response to erythropoietin in some individuals. Carnitine is a nutritional supplement available at most vitamin stores.

Also...is she on any meds that Epogen might interfere with?

HUGS to you and Puddy. I hope you get some much-needed rest.

[Medusa]

RIGHT! I forgot that your pooter was going to the vet also.

Puddy does defy the odds! I loved how Dr Lee was so sweet with her...and she KNOWS him, and just cried at him! With her not feeling well, it's so sweet that she would 'ask for help'.

Mary - don't drive yourself crazy with details, but I did find a couple of bits of information on Epogen. Just have a look and then check the link if you want to. Epogen is made from a human protein, which is why autoimmune can happen...but if her counts stay up, that is good. There's another drug mentioned here also.

http://www.marvistavet.com/html/erythropoietin.html





Also...is she on any meds that Epogen might interfere with?

HUGS to you and Puddy. I hope you get some much-needed rest.

Thanx for the info, Candace. Dr. Lee did mention that possibly down the line if the Epogen isn't working as it should that I could consider a blood transfusion. He also mentioned a monthly iron injection but at the time, Puddy was so sick and frail that he didn't want to do it to her because he said it's painful and my little girl is only 5 lbs. To give her a painful injection right now just wouldn't sit well w/me and he said that it isn't essential at the moment, so I'll wait until he gives me the green light. She isn't on any meds other than aluminum hydroxide gel, which is a phosphorous binder and an antacid which helps w/nausea. Dr. Lee said that nausea is a big problem in kidney patients and he should know; he said he's had kidney stones, nausea, back pain, the works. He's been a kidney patient for quite some time, I guess, so he can really empathize w/Puddy.

[Catty1]

Could she take an oral (even liquid) form of the vitamins and iron?

Maybe just ask about darbepoetin (Aranesp ®). Carnitine is supposed to help the response to Epogen...it's made by the liver and kidneys, so Puddy might be low in it.

I an wondering what Dr Lee thinks of this stuff. HUGS!

[Medusa]

Could she take an oral (even liquid) form of the vitamins and iron?

Maybe just ask about darbepoetin (Aranesp ®). Carnitine is supposed to help the response to Epogen...it's made by the liver and kidneys, so Puddy might be low in it.

I an wondering what Dr Lee thinks of this stuff. HUGS!

I asked him about an oral iron supplement and he said "Oh, the Geritol effect. I'm of the opinion that it doesn't do a bit of good" and he proceeded w/a lengthy explanation that I've since forgotten. Long story short, he feels that studies have shown that iron supplements are fairly useless. Whether or not he's right is up for debate but seeing that he is of that opinion, I won't bother w/the oral supplements. I want to see how Puddy does after this Saturdays' Epogen shot, then I'll go from there and maybe take her in to my local vet for the iron shot unless she's not doing well, then of course, I want Dr. Lee to see her. I will ask him about Darbepoetin, though.

[Catty1]

and the carnitine? (I am SUCH a nag! )

[Medusa]

and the carnitine? (I am SUCH a nag! )

I'll ask him but he said that I'm jabbing her once a day, squirting meds down her throat twice a day, jabbing her again for another reason once a week, I have to brush her teeth every day, rinse her gums w/Chlorhexadine; he said that too much could stress her out and have a reverse effect on her. But I'll ask nonetheless; it couldn't hurt to ask.

[columbine]

Just a couple little things. An immune reaction can last longer than the presence of the thing that caused it - there's a feedback loop that takes time to wind down.

Also, have you tried offering her a bit of beef? I know that fresh, high-quality beef tastes heavenly to an anemic human!

Love, Columbine

[Emeraldgreen]

Dr. Lee sounds like a fantastic vet. I hope that it does turn out to be an autoimmune response to the Epogen and not something more serious. As you said, if she returns to the countertop after tomorrow's shot, it's likely you'll have your answer.
I'm glad she is still eating and hanging in there as best she can.

I'll ask him but he said that I'm jabbing her once a day, squirting meds down her throat twice a day, jabbing her again for another reason once a week, I have to brush her teeth every day, rinse her gums w/Chlorhexadine; he said that too much could stress her out and have a reverse effect on her. But I'll ask nonetheless; it couldn't hurt to ask.

Do you think that Dr. Lee would approve you cutting back on the brushing of her teeth and rinsing of her gums just for now until she gets through this part? I'm just imagining that feeling so lousy can only be harder with having objects and liquids in her mouth. But her dental condition may be serious enough to maintain this routine so only you and Dr. Lee will know what's best. Hopefully she will be back to her old self soon! Prayers going out for you both.