Hello

[Lesleys]

Hello, I have a miniature poodle- called Charlie- who has been diagnosed with SRMA and IMPA. The illness came in quite quickly. The first I knew if anything wrong was at agility training, when ge just wasn't jumping or running as he usually does. A frightening few days of pain relief and antibiotics, followed by X-rays, scans and fluid samples taken. He is on 20mg Prednisolone a day and gas been fir a couple of weeks; however he hasn't made anywhere near as good an improvement as both the vet and I thought he would. He is now been prescribed 25mg of Azathioprine per day as well. My almost four year old Standard poodle, Ollie, was diagnosed with SRMA two years ago, which is really strange- he now has Addison's.. I'm so worried, I live in Cornwall, U.K.

[Lovemedogs]

Hi Lesley,
I am glad you have found CIMDA. Hopefully Jo or Penel or even someone else with knowledge of these two conditions will come along soon and offer their advice.

Hang in there,

Pam

[Jo CIMDA]

Hi and welcome

Gosh you have been unlucky. I hope Ollie is doing well on Zycortal.

A dog with an inflammatory AI disease such as SRMA or IMPA, or like your Charlie who has both, should be on prednisolone 1mg/kg/12hrs. 

How much does Charlie weigh?   Do you think he is on a higher dose than this?  The average weight of a Min Poodle is 7-8kg, I think so it could be that Charlie, although still on a dose within the recommended guidelines, is on higher dose than necessary and this is stopping any progress and making him feel unwell.  Little dogs cope better on higher doses of steroids than larger dogs, but if it is high then it still might be overwhelming for him. 

I will copy the Michael J Day protocol for you to compare the regimen that Charlie is presently on, and if it is higher than 1m/kg/12hrs then perhaps you can have a chat with your vet and consider lowering the dose. 

This protocol is the best I have come across and can be used confidently as a guide.  The dosages given are usually enough to bring the disease under control and yet limit the side effects of the preds. In most cases it works really well.  Prof Day is one of the world's top immunologists.

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 


This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!


I hope you see an improvement very soon.
Jo

[Lesleys]

Thanks for the info. Charlie was on quite a high steroid dosage which we reduced a few weeks ago. Unfortunately, he started chewing at his paws which meant he has continuously worn a cone. His pads became ulcerated. He has managed to get to the tops of his paws and has lost  one nail; another may have to be removed under ga. longer cone now and steroids are now back to 20mg a day. Charlie  weighs about 11kg now, he was a stocky, muscly boy of 13kg before becoming ill. He's on antibiotics as well.

[Jo CIMDA]

Hi

Did the ulceration of his pads occur after the steroids were reduced or whilst Charlie was still on a high dose?   

It would be unusual and unlikely for another autoimmune disease, such as SLO (an AI diseases that destroys the nails) SLE (a Multisystemic AI disease) or other AI diseases that affect the skin and foot pads, to show whilst a dog is on high doses of steroids, but it may develop as the steroids are significantly reduced if the dog has not achieved remission.  The treatment for these other possible AI diseases is significant suppression of the immune system.

Sometimes dog that has been on high doses of steroids for a fair time can develop ulcerated foot pads and I believe this might be due to vasculitis (damaged blood vessels)  and this usually heals when the treatment is at a very low dose.  Vasculitis can also be an AI disease.
AI skin diseases, and skin problems arising from treatment, should benefit from the introduction of essential fatty acids (Evening Primrose oil and fish oil) and natural Vitamin E. EFA's help to repair the skin barrier and Natural Vit E encourages new cell growth. The synthetic Vit  E is not effective.

There is a possibility that Charlie may have a mite (demodex)  that is causing him to chew his paws and this should be ruled out.  Demodicosis is kept under control by the immune system and when the dog's immune system is significantly suppressed the mite can become active and cause skin sores and lesions.  The feet is a classic area. This is not uncommon in a dog with an autoimmune disease and a suppressed immune system.  It can easily be diagnosed by a skin scraping or even a sellotape test.  If it is demodex then the lesions will only get worse and spread if immunosuppressive treatment is continued, and it is not treated appropriately, so it is worth consideration.

Is Charlie on something to protect his stomach?

I hope you see a improvement very soon.

Jo

[Lesleys]

Hi Jo,
Many thanks for the advice. To be honest, I think the paw problem started whilst he was on the high doseage. I have asked the vet for stomach protection; I'd forgotten about that! Interested re the demodex theory and will take all the information to my vet on Monday. The sores on the top of his paws are certainly looking better now he can't get to them. I need a bed at the vets....

[Jo CIMDA]

 "I need a bed at the vets...."

I know what you mean!

If the sores started whilst he was on the high dose of preds then it is likely to be either side effects of the preds that has caused the skin problems or demodex and not an AI skin disease.  Another common problem is high doses of steroids can cause the ligaments of the feet to stretch and therefore every time the dog takes a pace they can scrape their toes on the pavement causing sores on the knuckles of their toes.

Good luck next week.

Jo

[Jo CIMDA]

P.S.  Ranitidine can be bought from the supermarket in 75mg tablets.  It is the same as Zantac but the generic form is about a quarter of the price -  and it will be a lot cheaper than your vets.  The dose is 2mg/kg/every 8 hours (Plumb's Veterinary Drug Handbook).

Jo

[Lesleys]

Since Charlies foot problem started, he has only walked indoors and on the grass; not on any other surface, we carry him to and from the garden. I asked my vet re stomach protection. He said Charle doesn't need it as he has  not shown any sign of his tum being irritated by his meds; no sickness, diaorrhea or reflux. He said some dogs need it but others don't .

[Jo CIMDA]

Hi

Using a gastroprotectant is a preventative measure and it doesn't have to wait until a stomach ulcer has developed and started to bleed causing anaemia. 

It is especially important in Charlie's case because he has had to go back onto immunosuppressive doses of prednisolone and therefore he will be on a higher dose for longer than usual.

I have known dogs to become anaemic half way through treatment, and the vet automatically thinks it is a relapse of an AI disease but in fact the anaemia is caused by a bleeding stomach ulcer caused by the preds.  This is the worst case scenario and it doesn't happen to all dogs, and it probably won't to Charlie,  but it can and this is why the specialists always include a gastroprotectant when high doses of steroids are used for a prolonged period of time and in the use of other immunosuppressive drugs that can upset the tummy. 

Jo

[Lesleys]

Thanks Jo. I will push for it when he sees the vet tomorrow .

[DW]

Hi

Would just like to add my experience to what Jo has said.     Harley wasn't prescribed any protectors when he was started on Preds.
Nothing happened for a few weeks and then.........we had a gastric bleed which was quite scary.

I even continued with Rinitidine when the steroids were low dose.

[Lesleys]

Thank you. Armed with reasons why he should have this now!

[polly]

I bought the  generic brand sold for human use when my vet failed to prescribe them. However, they  are only available in large tablets here (Australia). Cutting tablets  accurately to the dose recommended  for a 10kg dog was tricky and when I fed  my dog chicken necks (his favourite treat)  there was insufficient acid in his stomach for them to be digested which led to constipation /  slight bleeding from the anus.  So no more chicken necks.