CIMDA

Yes, the pitch of mine did as well. It was like she was even more desperate for food (only time she barks is when she's hungry)!!

Rice isn't ideal, it will make her gain weight quickly. Raw green beans are a great snack, full of fiber and low in calories. As a dachshund you really do need to keep her trim due to her longer spine and the breed's predisposition to disc problems.
I wish there was an easy solution to the extreme hunger they feel while on pred.  Mine ate cat hair, leaf bits, cardboard bits... But I viewed it as a not-so-bad trade off for her feeling better, and made sure nothing was at ground level where she could reach (and vacuumed more so she wouldn't eat the cat litter). We also had to build elevated platforms for the litter boxes (3) so she couldn't get in them to go dumpster diving 

I've read on this board that giving the cyclosporine frozen cuts down on the gastric side effects, have you tried that?

Just an addendum to Jo's excellent post above: Don't give milk thistle when your dog is on cylcosporine- known interactions (seizures) can occur.

Happened to my girl when she was on it, was very frightening! The vets don't always know, but if you look up the interactions for humans it is clearly stated.

Stress can also raise the temperature, so a slight increase wouldn't worry me as much; like at the vet's, etc. usually it is slightly higher than when relaxed at home. Panting and any exercise also raises it a bit. You get a much clearer picture of the actual body temp at home. Best advice is to get a new 3-second thermometer from the pharmacy, jar of vaseline (you want it well lubed, just dip in the jar), disinfecting alcohol (for cleaning the thermometer after each use). Keep a daily chart of her temperature, and you will have an excellent baseline for now and further on down the road.

Full blown immune mediated disease/relapse will typically have a high fever. I imagine though that in the very beginnings, the fever may be less pronounced. Taking the temperature first thing in the morning when she wakes up and before she does anything is ideal, and again in the evening or anytime you see limping.

39 is a normal temp. What I did with Clover when I feared she was relapsing was take her temperature morning and night, that way I could chart any increase and know for sure.
Over 39.2 is a fever. Clover's was 41 when initially diagnosed, and 39.8 when she relapsed.

If she is relapsing she will have a temperature, even in the absence of limping. What was her temp when she saw the specialist?

I did still feed mine raw even while she was on meds. It's just the only food she can digest (IBD/ colitis). She didn't have any problems, even while on an immunosuppressant for a year.

Hi Tabitha,

Your specialist was absolutely correct, some antibiotics should not be given to dogs that have had immune mediated disease. They include: penicillins (including amoxicillin, ampicillin, Clavaseptin, and Clavamox), cephalosporins (including Cephalexin and Simplicef), and sulfa drugs (including trimethoprim-sulfa).

If there was a drug which may have precipitated her IMTP, it should also be avoided.

That said, my girl has had 2 dentals since her IMPA, both were done by the dental specialist at her referral hospital where internal medicine also is. Because the dentist is trained more extensively, no antibiotics were used or needed after her cleanings and extractions. Instead they were able to flush out the one pocket of infection that she did have, after extracting the (rather rotten) tooth.
If your specialist center isn't too far away from you, you may want to look into this and have a consult with the dental department there.

Kim

Hi Nicola,

Keeping Boog on the Zentonil should help his liver even more, usually it is recommended for a few to several months, depending on how long he needs it.

Hopefully he will do ok on the aza, slight upsets are completely normal in the first month.

Kim

There is still hope for him! The first relapse happened as the pred was reduced wayyyy too soon, and the second relapse perhaps it was also too soon- often the specialists recommend staying on the highest dose for 4 full weeks after already having a relapse. Exercise can also be a stressor on the body so be sure his walks are kept short.

I'm sure you've seen the recommended protocol here before, but here it is again. Any dog that has relapsed previously is recommended to keep to the longer duration before reducing the pred.

"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.

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!"

My girl relapsed on her meds but has now been IMPA-free and medication-free for almost a year and a half! I know it is so hard to get them through it.... But it is possible, there is hope.
Some cases will always require medication, but you don't know at this point yet how he will fare. Keep to the more conservative reducing of the pred and hopefully that in conjunction with the aza will do the trick.

Best of luck to you and Boog, I know how hard it is on both of you.

Kim

Thank you, Jo. Yeah my gut instinct is saying not to take the risk! 

Hi Jo,

Thank you, that is one of the articles that I found in my research. I had read about it being helpful for IM diseases, then was disappointed that it worsened RA. Since Clover had IMPA (non-erosive, but still similar to RA in that there is excessive inflammatory synovial fluid) it does worry me that it could cause a relapse. I couldn't find any mention of cytokines in regard to IMPA however, so am not certain... 

I've just come across this and am thinking it might not be wise to administer melatonin to her now:

"In spite of melatonin's antioxidant properties, it has demonstrated a tendency to stimulate inflammation in patients with certain autoimmune disorders. A study published in the October 2007 issue of "British Journal of Clinical Pharmacology" demonstrated that rheumatoid arthritis actually worsened in study subjects who took melatonin. This finding both surprised and disappointed the study's authors, whose original hypothesis centered on the potential benefit from using melatonin to treat autoimmune diseases. However, these results mirrored those of other studies, which showed that melatonin stimulated immune cells to release inflammatory cytokines.
Considerations

The interactions among immune cells, hormones and your nervous system -- the NEI -- are complex. Some previously observed properties of melatonin, such as its antioxidant activity, have not been borne out in all clinical studies. This has led some experts to recommend that you not use melatonin if you have an autoimmune disease, since it could aggravate your already overactive immune system and lead to a worsening of your symptoms."

Hi Jo,

Thank you  Yes, she is a tough little girl to have made it through everything! I bought the melatonin yesterday and am still researching and debating it. There are some conflicting articles on dosage- 1.5mg or 3mg for a small dog once a day (in the evening). I'm leaning towards starting out at the lower dose to help avoid any possible gastric upset.

Kim

Hi Jo,

She has had her thyroid levels monitored every 6 months for the past 3 years, and is thankfully TGAA-, we have been very careful and followed Dr. Dodds protocol for hypo-T testing since her IMPA. She just had a full panel again a month ago.

She is raw fed and has been on a vet prescribed multi vitamin/mineral supplement for over 2 years, as well as many years taking wild salmon oil every other day, and her other nutraceuticals (glucosamine, milk thistle, pre- and probiotics). She has colitis, so raw is the only food she can actually digest properly and has great stools on.

I am a professional groomer, so I know her hair has been looked after properly at least    She will be turning 15 this June, so her general practice vet thinks perhaps it is just little old lady alopecia. She has been tested for everything else except for the sex hormones and nothing pops out. The hair loss is her only physical symptom, so I am thankful for that!
I asked her about melatonin therapy for re-growth, she said she has seen some successes with it, and it wouldn't hurt to try. So I may go that route and do a trial for a few months (takes 4-6 weeks to start seeing any changes) as the few hairs she does have on her back are soft scraggly things, not like the rest of her coat at all. 

Kim