Hi Everyone

With Ardy's permission, I want to share with everyone, the very promising 
results we have gotten with the use of Winstrol.

When Ardy first contacted me, she provided me with Tigger's lab results. As 
Ardy has mentioned, the results were pretty grim. The key findings for me were:

March 12/16     Red Cells:      1.07    (RR: 5-10)
                Haematocrit     6.3     (RR: 30.0 - 45.0%)
                Haemoglobin     4.6     (RR: 9.0 - 15.1)
                Reticulocyte    5.2%
                WBC             3.3     (RR: 5.5 - 19.5)
                %Neutrophils    16.4%
                %Lymphocytes    64.0%
                %Monocytes
                NRBC            None recorded

Even though there are no reference ranges listed for the percentage 
distribution of neutrophils and lymphocytes, I know this distribution pattern 
is abnormal. There should be more neutrophils and lymphocytes in cats, with the 
ratio being something like 1.8/1, so maybe 45% neutrophils and 25% to 35% 
lymphocytes would be the kind of range one would like to see. The very high 
lymphocyte count here (higher than the neutrophils) suggests these are leukemic 
cells - ie abnormal lymphocytes produced as a result of the viral infection.

Ardy frantically tried all kinds of places to get the Winstrol and she was 
finally able to get some and start Tigger on it, on March 15 - so three days 
after this blood work was drawn.

The next set of blood results showed an slight increase in red cells, a 
significant increase in the haematocrit, haemoglobin, reticulocytes, and a 
reversion of the neutrophil/lymphocyte distribution to what one would prefer to 
see.

March 25/16     Red Cells       1.70    (RR: 5-10)
                Haematocrit     14.1    (RR: 30.0 - 45%)
                Haemoglobin     4.6     (RR: 9.0 - 15.1)
                Reticulocyte    (Not done)
                WBC             3.1     (RR: 5.5 - 19.5)
                %Neutrophils    43%
                %Lymphocytes    20%
                %Monocytes      26%
                %Blasts 9%
                NRBC            9/100 WBC       (Normal is 0)


So we started to see a slight increase in the red cell count (which although it 
still is well out of reference range, is a 70% in increase from the previous 
awful result. The haematocrit more than doubled. The haemoglobin stayed about 
the same. The reticulocyte level wasn't done but we started to see nucleated 
red blood cells (NRBC) appearing, which are immature red cells which still have 
their nuclei - mature red cells do not have nuclei. This indicates they are 
being pushed out early by the bone marrow in response to the low red cell 
count. The neutrophil/lymphocyte ratio has normalized, but the monocytes are 
quite high (usually are low like 2% or so) and are indicative of an 
inflammatory process going on. The total white cell count was still lower than 
the reference range, suggesting a depression of this cell line as well.

Not surprisingly, the pathologist who reviewed this set of blood results said 
(in part) the following: "This anemia appears NON-REGENERATIVE, and although I 
can't confirm the exact cause based on this CBC alone, given this appearance, 
and especially the macrocytosis [elevated monocytes] and metarubricytosis 
[presence of lots of nucleated red blood cells] and in the face of minimal 
polychromasia, FeLV is my top differential. . . . The blasts noted do appear 
consistent with lymphoblasts. . . While they could be neoplastic, their overall 
concentration is small, and I could not confirm neoplasia as seen here."

In the meantime, Ardy was reporting that Tigger was not needing as much pain 
medication (or any at all), and began to eat on his own.


The last set of blood results showed:

April 26/16     Red Cells       1.67    (RR: 5-10)
                Haematocrit     12.2    (RR 30.0 - 45%)
                Haemoglobin     4.6     (RR: 9.0 - 15.1)
                Reticulocyte    10.31%          (Not usually seen)
                WBC             4.9     (RR: 5.5 - 19.5)
                %Neutrophils    45%
                %Lymphocytes    40%
                %Monocytes      3%
                %Blasts 12%
                NRBC            95/100 WBC      (Normal is 0)

So, looking at these results, I was initially concerned because of the slight 
slippage of the red cell count but then I realized that if you combine the red 
cells with the massive increase of nucleated red blood cells (95 per 100 WBC's) 
and also add the reticulocytes (an even more immature form of red cells), then 
we would actually be seeing a much much increased red cell count. (See the 
comments from the Pathologist, which follow, to see that he also has picked up 
on this.) I was also concerned about the drop in haematocrit but then I 
recognized that the red cells are becoming more normal in size (they were quite 
macrocytic in the last blood sample), so it would show a drop because it is 
machine calculation. I also initially could not understand why Ardy got a PCV 
result of 16 (with the previous one being 14), because PCV and haematocrit are 
considered the same. However, thinking it through further, I think the answer 
is that the PCV is the actual manual spinning down of the blood whereas the 
haematocrit is a machine calculation measuring the red cell density percentage. 
I think in this case, the machine has not added in the reticulocytes and the 
nucleated red blood cells in the calculation, whereas the manual spinning of 
the blood sample would have included these cells in the red cell density 
percentage. I therefore think that the true haematocrit is actually 16 not 12.2.

In the microscopic, it is also noted that Howell-Jolly bodies are also present. 
These are remnants of nuclei in mature red cells and again supports the 
conclusion that there are a lot of new red cells coming out of the bone marrow 
(which frankly, is amazing given that the blood work from the end of March 
suggested that (a) the bone marrow was no longer producing red cells and (b) 
the red cell population in the circulating blood was dangerously depleted).

The total white cell count has also increased to the point that it is just 
below the normal reference range, so that is more good news. The lymphocyte 
percentage is up a bit higher than we like to see, but the dramatic monocyte 
count seen in the last sample has dropped significantly (12% to 3%), so again, 
more normal. The blasts are still there.

My opinion to Ardy was that she actually needed to double the Winstrol at this 
point and put Tigger on Doxycycline. Ardy had discussed Doxycycline with her 
vets but they talked her into Convenia instead. The great thing about Convenia 
is that Tigger can get one shot which lasts several weeks, and so it is one 
less thing Ardy has to stress him about in terms of giving him more medicine. 
So we agreed to just keep going with the Convenia and play it by ear. However, 
seeing the blasts and the slightly increased lymphocyte percentage, I think 
that Doxycycline is needed here. I confirmed that while Doxycycline (being an 
antibiotic) doesn't kill the FeLV virus, but it interferes with RNA replication 
which is how the virus reproduces and pretty much every source I checked 
recommended the use of Doxycycline when treating for FeLV. Ardy has spoken to 
her vet about it.

With respect to the Winstrol, I actually had my Zander on 2mg twice daily for a 
long time - until his haematocrit went above 20 or 25 I think, and then I 
dropped him down to 1 mg twice a day. However, any appreciable dip in the 
haematocrit, I would go back to the 2 mg twice daily dose until I was satisfied 
his results were stable again. My view is that while Tigger's red cells and 
anemia have responded to the Winstrol, it is a sluggish response to date 
(although the immature red cells are really appearing in significant numbers), 
so I suggested we try 2 mg twice daily until his red cell counts begin to 
recover more satisfactorily.

Here is what the Pathologist is now saying, when looking at the CBC results: 
"This anemia is MARKEDLY REGENERATIVE. While I would want to rule out 
hemorrhage, given this presentation, I suspect this is secondary to hemolysis. 
IMHA secondary to FIV infection is a differential to consider. . . . I do 
recommend repeat CBCs with reticulocyte counts to monitor HCT levels and 
regenerative status. Blasts are seen. Upon close review, they appear consistent 
with large immature lymphocytes. While I couldn't rule out an early leukemic 
population, they are still present in small numbers, and a definitive diagnosis 
of neoplasia cannot be made here. Given their concentration, it is also 
possible that they could also represent stimulated inflammatory blasts instead. 
. . " Unfortunately, I think we have utterly confused the pathologist at this 
point, because he has no idea what could account for the change he has seen 
between the earlier blood results and this one, so you can see he is now making 
other suggested diagnoses, and he doesn't even mention FeLV (though Tigger has 
tested positive several times now for FeLV).

As Ardy has said, she knows that Tigger is not out of the woods yet, but we are 
certainly seeing signs of moving in the right direction, though it will be a 
bumpy ride for sure. We have had to adjust medications in response to his 
symptoms, and Ardy has been unwavering in her commitment to her little boy. She 
has had to deal with less-than-committed vets, who, as is often the case, are 
ready to write off Tigger. Thankfully for Tigger, he has a tireless defender on 
his side!

I am also happy to see that the Winstrol appears to be making a big difference 
here. As I have posted previously, when the bone marrow shuts downs, I know of 
no other product that is able to turn it back on again to produce red cells, 
white cells and platelets. Moreover, it is pretty darned inexpensive compared 
to all the other products offered which sometimes work but often don't. 
Ideally, in my view, if a cat is confirmed to be FeLV positive, he/she should 
be started on Winstrol to AVOID the almost inevitable crash in red cells, white 
cells and platelets.

Amani


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