[Felvtalk] Anemia and Aranesp

Sat May 12 16:32:35 CDT 2018

Hi Maribel,

I totally agree about Zander’s Protocol being your best option, and that it needs to be started as soon as possible. One thing I might add, if it was not mentioned in the comments by Amani and Sandy is that if your vet will order it for you, they might not know of a source for it. Your vet can prescribe and order it online at www.diamondbackdrugs.com <http://www.diamondbackdrugs.com>   -- this is a large compounding pharmacy in Arizona, and they will ship it anywhere. Their phone number is 866-578-4420 if you want to call them. The Winstrol comes in several flavors, and forms. I believe it was around $40 when I used it for my Tigger. Best wishes to you and Flaqui.

Ardy

From: Felvtalk [mailto:felvtalk-bounces at felineleukemia.org] On Behalf Of Maribel Piloto
Sent: Thursday, May 10, 2018 10:38 PM
To: felvtalk at felineleukemia.org
Subject: Re: [Felvtalk] Anemia and Aranesp

Thank you guys.    Very encouraging.  Now let’s see if I can get my vet to prescribe the Winstrol.   I’m sending him all the things you have written.

Maribel

"The greatness of a nation can be judged by the way its animals are treated."
-Mohandas Ghandi

On May 10, 2018, at 11:02 PM, Amani Oakley <aoakley at oakleylegal.com <mailto:aoakley at oakleylegal.com> > wrote:

Thank you Sandy. You saved me from repeating what I have posted so very often now.

Mirabel, regarding the Aranesp, it is a product which mimics the effects of erythropoietin. I do not believe it will assist because erythropoietin tells the bone marrow to produce more red cells. With FeLV, it infects the cells in the bone marrow which produce all three cell lines (red cells, white cells, platelets). The cells are taken over and destroyed by the virus, which means that the bone marrow can no longer produce red cells, white cells and/or platelets. The erythropoietin or Aranesp is speaking to these cells and telling them to churn out more red cells, but the bone marrow cells can no longer do that. My experience with the Winstrol is that after my cat had the very worst results (HAEMATOCRIT OF FIVE!!!, ZERO % RETICULOCYTES, etc.) and AFTER I had given him several bouts of blood transfusions, the Winstrol turned back on the bone marrow and he began producing red cells, white cells and platelets again.

Amani

From: Felvtalk [mailto:felvtalk-bounces at felineleukemia.org] On Behalf Of Sandy
Sent: May-10-18 8:48 PM
To: Maribel Piloto; felvtalk at felineleukemia.org <mailto:felvtalk at felineleukemia.org> 
Subject: Re: [Felvtalk] Anemia and Aranesp

This is long because I just copied this whole conversation - but your answer lies in this combination of drugs - make no mistake this will work if your vet will give it a try - there is nothing to lose - BUT you and the vet need to act immediately. - good luck. You will probably get more responses - Sandy W

Winstrol – 1 mg twice a day

Doxycycline – 1/5 to ¼ tablet (100 mg) twice a day

Prednisolone – ½ 5 mg tablet, twice a day

If there are problems with the intestines (vomiting, constipation, slow moving stools, stools of large diameters, all of which might be indicative of the effect of the virus on the intestines) you can try adding ¼ tablet of apometocloprimide.

If the haematocrit level is REALLY REALLY low – like below 5-8, you might consider starting the Winstrol at 2 mg twice a day for a week, to try and kickstart things quickly, but given that there is going to be a likely increase in liver enzymes with the use of Winstrol, recognize that this might also increase the liver enzymes faster.

 Hope this helps! Amani

 From: Felvtalk [mailto:felvtalk-bounces at felineleukemia.org] On Behalf Of gary
Sent: January-27-17 4:04 PM
To: felvtalk at felineleukemia.org <mailto:felvtalk at felineleukemia.org> 
Subject: Re: [Felvtalk] My baby recently diagnosed with FeLV

 Amani,

Could you please give the dosages used for Zander's Protocol? I know they must have been previously given, but I cannot seem to find them.

Thanks,   Gary

 On 9/16/2016 8:52 AM, Amani Oakley wrote:

Hi Sherri

I hope you got some good news today. However, as you know, my experience is that the Winstrol needs to be used long term before the red cells are back into the normal range. I continue to recommend use of the Doxycyline to interfere with viral RNA synthesis. The Winstrol does not attack the virus, though I believe it makes the cat stronger overall and able to fight back. But at the outset of the treatment regime, I believe you must have the Doxycycline on board to try and reduce the viral load, or at least, keep it from rising.

Amani

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Hi Liz

The only thing that works to turn back on red cell production is Winstrol (Stanazolol). It is an ANABOLIC steroid (as opposed to most steroids we are used to getting, like prednisone, which is a corticosteroid.

Anabolic steroids are ones which build muscle, tissue, etc.

Adding Winstrol to the combination of medication you have your cat on right now, would be the best thing to do. The Doxycycline acts to slow down or inhibit the reproduction of the FeLV virus by interfering the RNA duplication. The prednisone is helpful in keeping inflammation at bay, but neither of these helps to increase the red cells. The Winstrol acts directly and very quickly on the bone marrow and seems to get red cells generated again, quite promptly. At least it did for my Zander, and I have been contacted directly by several people from this group, who have reported to me that they also saw almost immediate (within 3 days) evidence of their cats’ gums/ears/pads pinkening up.

The problem is that Winstrol is a controversial drug because it is also what professional athletes use to get bigger, stronger and faster. Quite unfortunately (since none of our cats are entering the Olympics) that association with doping scandals has cast a shadow on its use in both animal and people medicine. In human medicine, it is the only drug found to be effective in treating hereditary angioedema and anemia.

Here is a blurb I found about it:

Winstrol was first invented in 1959. Soon after that, the UK based Winthrop Laboratories created a prescription medicine from it. Later, in 1961, Winthrop’s patent was bought by the US based Sterling that started manufacturing and selling the drug in the American markets.

In the beginning, Winstrol was used for a variety of medical reasons. But later, by the 1970s, the FDA had restricted its use to only promoting growth and treating osteoporosis. In the 1980s, there was a termination of the manufacture of anabolic steroids in the American market. But Winstrol was among those steroids which not only survived, but thrived in the 1980s and 1990s. During this period, its use was reinforced as a cure for anemia – as it had the power to boost red blood cell count, and was used as a treatment for facial swelling or angioedema.

When the manufacture of Winstrol was finally discontinued, Ovation Pharmaceuticals bought the rights to manufacture it, in 2003. However, Ovation Pharmaceuticals have ceased their operations now, so the Winstrol products available today in the American markets are only generic and not pharmaceutical grade. Outside the USA, however, several large brands still manufacture and sell Winstrol.

Genuine Stanozolol can be distinguished in water suspensions because it separates from the liquid into micrometer particles. These particles will fall to the bottom if the container is not disturbed for a few hours. The crystals have a milky white color.

Winstrol can not only be used for humans, but it has veterinary uses as well. Weakened or injured animals can be treated with Winstrol in order to promote red blood cell count, strengthen bones, stimulate appetite, and enhance muscle growth. It has also reportedly been used to dope horses in US horse races.

If your vet is willing to try this, he/she will need to order it from a compounding pharmacy.

The dose should be 1 mg 2 times a day for a cat. If your cat is in poor shape and needs an immediate boost, start him on 2 mg x 2 times a day for a week or so, and then drop down to the lower dose.

Your vet will undoubtedly say that Winstrol is known to cause liver damage.

The first answer to this is, so what? FeLV will almost invariably result in the premature death of cats. The vets have nothing which is directly effective to fight FeLV. Things like Interferon may or may not assist but such a treatment is again a side treatment where you are hoping to boost your cat’s immune system, rather than a direct attack on the virus. It is also quite indirect in that IF the interferon helps, it will be more long term, and only if it manages to boost the immune system enough to permit your cat’s system to try and fight the virus, and when/if the virus is inhibited enough, then MAYBE (if the virus hasn’t already destroyed all the progenitor cells in the bone marrow) will red cell production begin to climb again. Winstrol is the only medication that I know of, (and believe me, I have looked!) that seems to work by turning back on those progenitor cells or possibly promoting the growth of new ones since it also works to enhance the production of bone cells (effective against osteoporosis).

The second answer, regarding the liver damage, is that the only information about this is quite suspect, coming out of a very poorly designed research study where the cats in the study were given doses found effective on HUSKY SLED DOGS for lord’s sake! The cats were given a LOADING DOSE via intravenous injection, of 25 mg – more than 10 times the recommended daily dose for cats. That’s the only study which has found this supposed link between Winstrol and liver damage. And even in that study, with those remarkably ridiculous doses, the cats in that study only had elevated liver enzymes (no tumours, etc.) and the liver enzymes dropped back to normal levels when the Winstrol was discontinued. This is consistent with my experience as well. I refused to stop the Winstrol for my cat, when the enzymes went up, because he was going to die with the low red cell count he had. I kept him on Winstrol for around 10 months, before the red cells were in a normal range. During that ten month period, I would wean him down a few times, but ALWAYS the red cells would immediately drop again, so it was more than clear that it was the Winstrol making the numbers rise. So, in the end, he had Winstrol pretty much for the duration of 10 months and his liver enzymes went right back to normal again, once I discontinued the Winstrol – NO lasting damage. This was also my experience with a second cat with a nasal sarcoma, and where I used the Winstrol to keep her appetite up and reduce the swelling (she was 16). The enzymes went quite high at the outset of my use of Winstrol, but went back to normal when I weaned her off for a bit and then again when I ultimately took her off the Winstrol.

Get the Winstrol if you can, and use it in combination with the prednisone (which I am told also helps to protect the liver when the Winstrol is used) and Doxycycline.

Amani

From: Felvtalk [mailto:felvtalk-bounces at felineleukemia.org] On Behalf Of Liz McCarty
Sent: September-15-16 1:40 PM
To: felvtalk at felineleukemia.org <mailto:felvtalk at felineleukemia.org> 
Subject: [Felvtalk] My baby recently diagnosed with FeLV

 Hi everyone,

Looking for support, suggestions, and information. I've never had a cat with FeLV. We took our 1 year old, Hodor, to the vet because he seemed lethargic and in his stool there was a piece of floss that was red. At the vet things escalated and they told us he was severely anemic and would need a transfusion that day. I took off work and rushed him to a specialist. The vet there told us she would run an FeLV test before doing anything in case we wanted to avoid the extra tests and procedures. She told us he was FeLV positive and persistently talked to me and my fiance about euthanizing him which was out of the question for us. I took him to the vet thinking it was going to be minor and then she's talking to me about killing him! We went forward with the blood transfusion. It's been almost 3 weeks now. They had him on doxycycline  in case there was a bacterial cause, and prednisone. Last week he started interferon... Does anyone have experience with that and know if it was effective? I also started him on Pet Tinic.   Any other suggestions? Any insight into whether you think he will be able to pull through? He doesn't have cancer, they ran the tests but don't know if it's in the bone marrow.  I'm scared. We have another one year old, unrelated, and they are best friends. It breaks my heart to think they might be separated. She's not FeLV positive.

Additionally I have set up a go fund me to help with the costs we incurred, and I want to donate half to FeLV research if anyone is interested.  
http://www.gofundme.com/2mzdpgk

Mainly looking for support and advice. Thank you in advance.

Elizabeth McCarty, ASW #36438

On May 10, 2018 at 4:09 PM Maribel Piloto <pilotom at bellsouth.net <mailto:pilotom at bellsouth.net> > wrote:

Hi all,

I have a Leuk+ girl who is getting very anemic.  Her name is Flaqui.  She showed up at one of the colonies I feed a couple of months ago (already spayed) and was so thin I thought she was an elderly cat with not much time left so I took her home to give her some comfort in her final days.  When I took her to the vet it turned out that she isn't that old (vet things 4-5) but she's Leuk+.   I decided to keep her in my room where I have another Leuk+ guy.  I'm building a little catio for them outside one of the bedroom windows so they can enjoy the outside.

Flaqui's numbers in January 2018 were...

RBC - 4.15 M/ul (5.00-10.00) LOW

HCT - 20.2% (30.0-45.0) LOW

HGB 6.8 g/dl (9.0-15.1) LOW

MCV 48.7 fL (41.0-58.0)

MCH - 16.5 pg (12.0-20.0)

MCHC - 33.8 g/dL (29.0-37.5)

RDW - 20.5% (17.3-22.0)

%RETIC - 1.3%

RETIC - 53.2 K/uL (3.0-50.0) HIGH

WBC - 15.30 K/uL (5.50-19.50)

EOS - 1.8 K/uL (0.10-0.79) HIGH

PLT - 663 K/uL (175-600)

Everything else was normal

I started her on Liqui-Tinic which is a supplement containing iron and B-12 among other things.  Also giving her Vetri-DMG.   She initially had very bad diarrhea but I managed to clear this with Metronidazole.  She's also been dewormed and got Revolution.   Despite eating and showing an interest in food, she has been losing weight (down to 5 lbs) so last week I had bloodwork done again.  Here are the results...

RBC - 3.79 M/ul (5.00-10.00) LOW

HCT - 14.8% (30.0-45.0) LOW

HGB 8.1 g/dl (9.0-15.1) LOW

MCV 39.2 fL (41.0-58.0) LOW

MCH - 21.4 pg (12.0-20.0) HIGH

MCHC - --- g/dL (29.0-37.5)

RDW - 21.7% (17.3-22.0)

%RETIC - 1.1%

RETIC - 40.7 K/uL (3.0-50.0)

WBC - 22.73. K/uL (5.50-19.50) HIGH

NEU - 18.48 K/uL (2.50-12.50) HIGH

PLT 698 K/uL (175-600) HIGH

Everything else was normal

My vet told me to start her on Clavamox since the white blood cell count was high which is indicative on an infection somewhere.  I was really alarmed by the HCT number because I had a cat with chronic renal failure and anemia some years back and I know that once the HCT numbers get below 20% it can be very dangerous.   With that cat, Grayson, I used Aranesp very successfully to treat his anemia.  He eventually succumbed to the kidney failure but the Aranesp kept his anemia at bay.

I've been reading that blood transfusions are one of the things to do with Leuk+ cats once the HCT numbers get low but blood transfusions in my area (South FL) are in the $1000 range and I manage 6 colonies and have other cats at home with medical needs including one that needs a full mouth extraction for stomatitis and I just can't spend that type of money on Flaqui.

Do you guys think that Aranesp is something that would work on her?  She does not have kidney problems.  However, based on the reticulocyte levels, she does seem to have  non-regenerative anaemia.   I read this document at Tanya's Comprehensive Guide to Feline Chronic Kidney Disease that explains that the reticulocyte level needs to be adjusted based on PCV...

In particular, since reticulocytes are commonly expressed in percentage terms, they need to be adjusted to allow for the degree of anaemia, i.e. 1% reticulocytes in a cat with a PCV of 20% is twice as many as 1% reticulocytes in a cat with a PCV of 10%. 

Let's assume your cat's PCV is 18% and the measured reticulocyte count is 0.75%. You multiply the PCV by the measured count, then divide the result by the normal PCV level (35% for many laboratories). In this instance, you would get an adjusted result of 0.39%, which indicates non-regeneration.

In contrast, if your cat's PCV was 13% and the measured reticulocyte count was 0.75%, your adjusted result would be 0.28. This also indicates non-regeneration, but it is more severe (i.e. the lower the corrected value, the lower the regenerative response).

Flaqui's adjusted reticulocyte level is 14.8HCT X 1.1 RET = 16.28/35 = .46 which indicates non-regeneration.

Any help would be appreciated.  Flaqui has been doing better the last couple of days.  I think the Clavamox helped - but I really wish I could improve those HCT numbers.

Maribel & Flaqui.

"The greatness of a nation can be judged by the way its animals are treated."
-Mohandas Ghandi

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