Hey guys. I've got a very sick little cocker girl (saffy) who is 2 years old. Over the past month, Saff has been getting intermittent limps. She has been changing which leg she holds up and it has been bothering her neck area too. She found it really difficult to get up from lying down and then sitting. We were actually helping her to stand up! We took her along to our vet who was baffled but thought it could be menningitis so gave her 2 weeks of anti-biotics and metacam. We lasted a week before taking her back as the metacam wasn't touching the pain and the AB's were not working. The vet had another check and diagnosed Polyarthritis?.
She gave saff an injection of steroids which worked for 2 days and then we were to give her prednisolone 5mg twice per day. She weighs 12 kgs so she was to get one and half tabs x2 daily. This seemed to work. She went back to the vet the following week and although she still had a 'wobbly' walk/limp, she was a million times better. Vet said to keep her on the dose and just treat her as normal. That was Tuesday.
On wednesday morning, we went for our usual walk(off-lead grassy field). Saff had a great time playing with her doggy pals but when we got home, she was slower to rise. Eventually, by evening time, Saff couldn't get up and if helped, she had a really major limp, holding up her back leg. She also fell over and was really 'spaced'.
I took her back to the vet on Thursday as she was so bad and the vet gave her another injection of steroids and has doubled the dose of the prednisolone. None of this seems to be working. Saffy is lying, not moving, on the sofa(where I lifted her onto). She has a fantastic appetite but that is just the steriods and I can get her to walk into the kitchen if I promise her food but apart from that, she's not moving at all.
Does this sound like Immunity issues?
She has a temp(but not majorly high). Her joints are not swollen in the slightest and never have been hence the reason that we haven't taken joint fluid(that and I don't particularly want them to do this). Her skin has taken on a 'waxy' feel and is a bit smelly/fungal in her ears and feet.
She also vomitted after the injection on Thursday when we got her home but this is the first time she has done this.
I am seriously worried as my vet is saying if she doesn't respond to the meds, we are going to need to start thinking of her quality of life. And at this minute, she has none.
My normally exhuberant, crazy spaniel is like a stuffed toy and I'm so upset. She's only 2!
I would love some advice or knowledge or experienced opinions......anything
So sorry to hear about your poor wee baby. Hopefully Jo or Penel will come on soon and be able to advise you. They have a wealth of wonderful knowledge, more than many vets in my opinion. Sorry I can't give you any advice but you are in my thoughts. I know how awful it is to have a sick dog.
Regards
Dee
Sorry to hear about your Saffy. I only can comment on my own dog, whose illness was very much like your dog. The limping came and went. There were not swollen joints. The vet did not test her joint fluid. She was very painful at times and ran a fever. At those times when I took her to the vet they called her a lupus dog. Gave fluids and sent us home. Totally incompetent. I knew nothing of immune disease or "lupus." Eventually she had a major event, after we had changed vets. The new vet told me given her history (she had previously had IMHA as well as lesser immune diseases) that she appeared to have polyarthritis as well as polymyositis. She weighs 38 lbs and was taking 30 mg of pred. twice a day. They didn't bother to test her since she was so ill, with a fever of 106 degrees. She eventually got better, but it took months. If your dog isn't getting an immune suppressing dose of steroids, that may be the reason she isn't improving. Our vet insisted on giving the max at the time of the crisis. We did that for two weeks then tapered down to eventually 5 mg a day, then 5 eod for a total of about 4 months.
I hope you get some answers soon. Immune mediated polymyositis is very painful to the muscles. My dog got very thin and could not open her mouth to yawn. Had a clicking noise in her jaw. Hers was generalized and affected all her muscles.
gail
I'd recommend you get a referral to a specialist - if you are in the London area, you could go to the RVC they have a 24 hour intensive care and referral service.
Your Saffy sounds just like my SAffy was (12 yrs ago). The dosing they are doing hasn't been quite right, unfortunately they do need to be on a high dose straight away - for a 12kg dog you can go up to 50mg a day for the first week or so.
read this
http://cimda.co.uk/smf/index.php/topic,16.0.html
and this
http://cimda.co.uk/smf/index.php/topic,14.0.html
and this
http://cimda.co.uk/smf/index.php/topic,15.0.html
It could be IMPA (immune mediated polyarthritis) but it could be SLE which is what Saffy had - often dogs with SLE have IMPA as well as other types of autoimmune disease.
Don't give up hope please - get a second opinion, i don't think your vet is very familiar with autoimmune disease.
Thanks for replying. My vet actually went straight for the polyarthritis. Said she presented with everything but the swollen joints. I had a little read around last night(after posting) and seems she's not on enough of a dose? I will up her meds until the 28th(when she is back at the vet). Her muscles seem to be 'wasting' too so whoever had said that, that could be another sign of something else? She has always been such a fit, active little dog and had plently muscle.
Referal is a bit of a problem as we have no insurance and my vet has said that problems like these, she would expect the bill to run into the thousands. I can't afford that. My dog is priceless and I am trying my very best to help her but I have 4 kids too.
Can I ask? What are her life expectations with this disease? From what I read on here, it doesn't get a lot better and my vet seems to be thinking the same way. Or can it be managed with meds quite comfortably? Is life span shortened with the illness?
If it's IMPA then it is very manageable usually. Quality of life can be normal when you've dealt with the disease.
Personally I'd try upping the dose to 2 - 3 mg per kg split into two doses over 24 hrs to start with.
Don't forget the gastroprotectant - you can buy ranitidine in Asda for £1 a box (exactly the same thing as Zantac but half the price) Saffy should have half a 75mg tablet, twice a day to protect her tummy - you can give it at the same time as the pred.
So if she's 12 kgs, I'd consider 15mg pred, twice a day (total 30mg over 24 hrs). You need to have her on this dose for at least a week and see if the symptoms improve. If they don't improve then the vet must consider adding Imuran (Azathioprine) which is another immune suppressant and can allow you to lower the dose of the pred.
While she's on this kind of dose you must be aware that her immune system is suppressed so having her around other dogs is a bit of a risk in case they have kennel cough or some other illness.
She also should not be having anywhere near normal exercise, just a little trot up the road a couple of times a day - she should be kept nice and calm and quiet - it's very tiring having this kind of disease.
You could print off those protocols that I linked to - both written by specialists - and show your vet.
#thanks so much again.
Saffy is on 3x5mg of pred x2 daily so seems to be on the correct dose? She wasn't given anything to protect her tum so I will nip to tesco now and get something.
I haven't been walking her at all since the symptoms started again since Tuesday! But she was walked in a park with a pack of dogs(all friends) and unsurprisingly(after reading this forum!), came home with a tummy bug! She won't be going anywhere for a while.
She seems a bit better today(scared to say it though). He limp is not so bad and she is able to get up a bit better too but she is shaking all over and panting quite a bit. She has also been a bit aggressive today too. She had a go at one of our other dogs and bit the cat. She normally is the nicest dog ever.
Sometimes steroids can have an unpredictable effect on behaviour too. The only time our Saffy ever went for our other dog was when she was on quite high dose preds. I'd definitely take more care during feeding time as steroids make them ravenous.
The panting and shaking is unfortunately quite a normal side effect too. My lurcher who is on pred at the moment pants a lot.
The tummy bug might be the steroids having an effect on her tummy. The gastroprotectant will help with that. I hope you found the ranitidine, it's usualy with the anti acids.
There is also Antepsin and another one called Omeprazole - both from the vets though.
She seems a bit better today and even managed to sneak upstairs!lol It was definately a bug of some sort as our other dogs had it too. She's been OK at feeding times as she was never a great eater, the preds have just raised her appitite to 'normal'. I'm just feeding her little and often at the minute.
Fingers crossed we are on the road to recovery. This site has been invaluable for me to understand the nature of the disease and treatment methods. Thank you so much.
PS I don't vaccinate except puppy vacs so that won't be a consideration but what about switching to raw? Is that advisable?
PPS Does anyone know why dogs are now suffering for these types of conditions? I'd never heard about anthing like this in dogs.
Hi
I'm sorry Saffy is having such a bad time. From what you describe it sounds as if she has steroid responsive meningitis arteritis (SRMA). The neck pain and limp and the lack of swelling in her joints points more towards SRMA than IMPA. Having said that the treatment is the same so to a certain extent a precise diagnosis is irrelevant now.
This is not a bacterial meningitis (that is why the antibiotics didn't have any effect). SRMA is an immune mediated meningitis caused by a genetic predisposition that is then triggered by something. It typically occurs in young dogs.
Both SRMA and IMPA have a good prognosis and she should start to pick up very soon. YOu can't short cut the treatment though and she should be on this dose for 10-28 days depending on her progress and how she is coping with the drugs. Penel has given you good advice and I'm hoping you will see a difference in her very soon.
Jo
Hi Jo and thanks for your response.
Had a little read through the sticky about SRMA. Does sound like she has these symptoms although it says she should recover quickly after administering the steroids. She was given an injection on Thursday and I've continued that with oral Preds but although she is slightly better, she still isn't recovering the way she did the first time even though she is on double the dose of preds. She is majorly depressed, still in pain and limping on her front leg today. She is jumping on/off the sofa now though which is better.
I'm totally gutted today though as it seems to be genetic(all these AI illnesses). Saffy has had a litter of pups, one of which is here. I don't know what to do. Should I phone all the puppy owners and warn them? Or would this just worry unintentionally?
I'm bloody raging mad!! She had all the heath requirements for breeding as did daddy and we've passed this sh*t(excuse me!!)on through the lines! Why her? God, I'm gutted for the little 'uns....
>>>>
Quote from: cracar on Today at 03:24:47 PM
I don't know what to do. Should I phone all the puppy owners and warn them? Or would this just worry unintentionally?<<<<
I definitely think you should tell your puppy owners. It is not something people want to hear but it is much better to be forewarned just in case the dogs do become ill. I know I would rather be told especially as a lot of auto-immune diseases still go undiagnosed....or until it is too late to do anything I would, however, read up on the illnesses so you have as much information as possible and then after speaking to the owners you can send them the information.
The sire's owner should also be informed and the owners of any other relatives.
Quote from: cracar on December 24, 2012, 03:24:47 PM
Hi Jo and thanks for your response.
Had a little read through the sticky about SRMA. Does sound like she has these symptoms although it says she should recover quickly after administering the steroids. She was given an injection on Thursday and I've continued that with oral Preds but although she is slightly better, she still isn't recovering the way she did the first time even though she is on double the dose of preds. She is majorly depressed, still in pain and limping on her front leg today. She is jumping on/off the sofa now though which is better.
I'm totally gutted today though as it seems to be genetic(all these AI illnesses). Saffy has had a litter of pups, one of which is here. I don't know what to do. Should I phone all the puppy owners and warn them? Or would this just worry unintentionally?
I'm bloody raging mad!! She had all the heath requirements for breeding as did daddy and we've passed this sh*t(excuse me!!)on through the lines! Why her? God, I'm gutted for the little 'uns....
Hi
I know exactly how you feel because the same happened to me. I did what I thought was right and it all went wrong - but through no fault of my own, and it is no different for you. All you can do is to act on the information available and perform the relative health tests on your bitch and hope for honesty from the sire's owners. I presume you are in touch with your puppy people - as I was - and they appreciated my honesty and also the warning that if anything developed in their pup the they could call me and I would be able to give them the necessary information, and also the problem could be dealt with promptly and efficiently, saving lots of suffering, improving the prognosis and limiting the expense.
If she is on the correct dose of steroids then I am surprised that she is still in pain and showing symptoms. The symptoms usually respond pretty quickly. Do check that she doesn't have an infection because this can confuse things and make the vet and owner think it is the disease that's the problem when in fact it is a urine infection for example.
There is no point in beating yourself up. I think the more you ask around in your breed the more you will find out that you are not on your own. Of course many breeders will not tell the truth and that is a fact unfortunately. Some will also be untruthful about the cause of a young dog's death and you have to put two and two together but this gives you knowledge.
I do hope you see a significant improvement very soon.
Jo
Hello, and apologies for missing your earlier posts. As Jo said this could well be SRMA, so I just wanted to let you know about my precious Golden Retriever, Chad, who had SRMA. He was 9 months when he first got sick, he was 13 months by the time we got a definitive diagnosis and the right treatment, he was 12 years and 5 months when he died in November 2011. He lived a full and happy normal life, in spite of having to be on steroids all his life as he relapsed each time we tried to wean him off them.
SRMA can be managed, and as long as the dog receives the correct treatment, there should be no effect on quality of life or life expectancy. Chad had a degree of hearing loss which I put down to the meningitis, but it's difficult to tell for sure as Goldens have "selective deafness" lol!
The main reasons I would tell the pups owners are (1) so they don't breed from them and (2) if there are any symptoms in their pups they will spot it and be on the ball to get the right treatment for their pup. The chances must be low, but they are there. I know my boys breeder keeps in very close contact with all her pups owners and Chad was the only pup in the litter and in the line that has been diagnosed with such a problem. Chad's litter was the only one from that sire x dam, the mating was not repeated because of his illness, in fact neither was used again, it wasn't worth the risk.
All paws crossed for Saffy, I hope she picks up very soon.
Hugs from
Chris & the Golden Boys
^Chad^ (SRMA, Hypo-T), ^Thomas^ (Hypo-T), ^James^,
Sydney, Edward and William
Thanks for the replies. I was thinking not to let the pups owners know as they might think every little thing was this horrible thing starting but I suppose forewarned is forearmed. I will contact them all this week. I do keep in touch will all my pups owners so I can contact them no probs. Also, the breeding won;t be an issue as the pups all have exemptions on the registration, which won't be lifted. None of the pups were bought for breeding anyway so it's a non-issue(thankfully). It's awful because it's a cumlination of many generations breeding, gone. Just like that. As it can't be tested for and I wouldn't take the chance, ever. It's such an awful thing.
Saff has now been on the max dose for 13 days and her limp is back this morning again. My vet doesn't want to reduce the dose till she stops limping as she thinks she will go into a total relapse?
She was given a 2 week strong antibiotic course before the steroids as my vet thought the joints/temp was an infection. Obviously, when the AB's didn't work, they went down the steroid route and 'accidently' found a diagnosis that way.
My main worry is, I won't be able to reduce the steroids without her relapsing. Can this happen?
Quote from: cracar on January 02, 2013, 02:05:54 PM
Saff has now been on the max dose for 13 days and her limp is back this morning again. My vet doesn't want to reduce the dose till she stops limping as she thinks she will go into a total relapse?
She was given a 2 week strong antibiotic course before the steroids as my vet thought the joints/temp was an infection. Obviously, when the AB's didn't work, they went down the steroid route and 'accidently' found a diagnosis that way.
My main worry is, I won't be able to reduce the steroids without her relapsing. Can this happen?
If this is SRMA or IMPA I am surprised her limp is back. BUT maybe she will respond better to Aza and pred together... I don't have experience of using Aza, so have to leave it to Penel and Jo to make recommendations.
Once she has the treatment that stops the immune system attacking itself you should be able very gradually to wean her off the steroids. Having said that, there is a chance of relapse and some dogs need to stay on preds for life at a low "maintenance" dose.
Chris & the Golden Boys
Ah, OK, I kind of get it now. I was thinking she would need to stay on the max dose. Thing is, I don;t think my vet has much experience in this type of thing as she is quite off-putting. She keeps telling me that I need to make sure saffy has a decent quality of life!! Jeez, she's only 2! I'm not giving in on her quite yet! I think it's because Saff is quite sore and depressed when she is really suffering but she is only limping at the min, not sore. And....it's not a total relapse(but I think it's the preds that's stopping it). I will take her back for her check up and we can talk about mixing up the steroids to get her in total remission before talking about cutting the steroids back.
PS What do all you guys do about boosters? And kenneling? Reason I ask is, we have a holiday booked in May and although my lot will be going to kennels, Saff's not getting her booster at the min so can't go. (And I'm worried about sending her anyway TBH).
Quote from: cracar on January 02, 2013, 02:56:57 PM
Jeez, she's only 2! I'm not giving in on her quite yet!
PS What do all you guys do about boosters? And kenneling? Reason I ask is, we have a holiday booked in May and although my lot will be going to kennels, Saff's not getting her booster at the min so can't go. (And I'm worried about sending her anyway TBH).
No, definitely not! SRMA and IMPA are very controllable, my boy Chad did competition obedience and went everywhere with me just like any other dog, he lived almost 12 years after he first got sick, he was a happy happy boy!
Boosters are a NO for AI dogs I'm afraid. Anything that is an assault on the immune system could cause a relapse. Do you have a friend who would take care of her while you're away? Or maybe the kennels would accept titre test results to show she has antibodies? If you're in the UK she could always come up to Bradford if she could cope with the naughty Golden Boys!
Quote from: cracar on January 02, 2013, 02:56:57 PM
Thing is, I don;t think my vet has much experience in this type of thing as she is quite off-putting.
Another thought... do you think your vet would talk to another vet who does have experience?
Hehe!!!Thanks Goldiepower! But I don't think your goldie boys could handle the little madam! I have a family member that would take her but my preference would be to keep all the pack together but I will let her go to my cousin instead. I was allready worrying about the kennels.
As for my vet, it's a rather large practise and we have been seeing the same vet since Saffy started getting not well. She is not my usual vet as we normally see one of the partners(what with us having loads of pets and keeping the practise in the manner it has become accustomed!). I thnk when we go back, I will ask for the older, experienced vet. During the holidays, any vet was sufficing but now, we need the experience.
Ha ha! Well I'm glad you have somewhere she can go other than the kennels :)
Good idea about asking for a different vet, I hope you get someone more helpful and knowledgable!
Chris & the Golden Boys
And if that vet doesn't have experience in AI disease you ask him to speak to a vet at a vet college (RVC or similar) who does. I think Saffy needs to be on the combination therapy of Aza and pred - she should not be limping on the max dose of pred. Limping means it's not under control.
Definitely no boosters ever again. No kennels either - too stressful.
My Saffy was 3 when she got SLE - triggered by her booster jab. None of my dogs are vaccinated nowadays.
Been back to see the vet today and decided to up the preds. She really doesn't want to use the Aza as she feels it's quite an invasive drug. She wants to blast with the preds(she put her on20mg/twice daily for a 12kg dog) and see how she goes with that. I've to phone her on the 18th and let her know how she responded and we will revise again after that if she isn't showing any symptoms.
PS I asked the vet about letting saff go for walks and stuff and she said to take her for little toddles on-lead. Is this advisable? She's got loads of energy but I'm not too concerned about walking her or anything. In fact, I would prefer to just let her potter about the house.
Hi
Watch the side affects of this high dose and if she starts to go off her food and gets depressed and perhaps huffs and puffs too much then you may need to reduce it.
She may be limping because she does not have adequate synoval fluid in her joints. Personally I think they need a change of scenery and a little gently walk does them good but I wouldn't over do it until she is much better.
Jo
God! Why does my bloody vet not tell me these things?!!! I had a go at her yesterday because I have learned more about her illness from this forum than from the vet, who I pay to know these things!! ~And now she has omited to inform me about side effects!!Pah!!
After having a read about (AGAIN) on here, I decided to up Saffy's dose to 5x5mgs pred twice daily. She is still not symptom free. She still limps when just starting to walk and struggles to get up and down after resting.
Don't get me wrong, she is loads better than she was but I can't see the point of keeping up the high dose of preds if they are not working? Am I correct in thinking that if she is still limping, they can't reduce the preds?
This is the only symptoms that she is still showing. Her joints have never been swollen and her temp is normal. She isn't depressed or sick. It's just the blasted restricted movements. And it's only when she's been resting. Could this just be the way she is now? Or do we still not have control?
I'm so confused ???
Also, she is turned into a land shark. No food is safe!!!!! She literally took food out of my mouth yesterday! Think I may kill her before she is better ;) Where has my Saffy of old went? :'(
Hi
The problem with these autoimmune diseases is it can be difficult to differentiate between symptoms of the disease and side affects of the drugs, and also perhaps a totally unrelated reason for limping such as a ligament weakness/injury.
Does the limp go away when you increase the steroids? It is very difficult to know if the disease process has ceased. Usually the history of dose and, duration of drugs, and the lack of clinical signs are all that can indicate if the disease is in remission and the only way to find out is to start a reducing drug regime. The treatment has to be balanced against the clinical signs of the disease and the side effects of the drugs. A dog can't stay on very high doses for a long time. Relapses are not uncommon in SRMA and IMPA but eventually the disease can be brought under control.
Clearly her increased appetite is the steroids. It is very early days yet, but it does get better, and she will return to her normal self.
Jo
No, the limp is there regardless of how many steroids she has had. Funny thing is, it is different legs/front and back. Some days, I will hardly notice a limp at all(some days she doesn't have any limp) then all of a sudden, the limp is back so bad that she is holding her leg aloft. Same with getting up and down. It has improved but then, last night, she couldn't get up after sleeping on the sofa and needed a lift! But then, 2 days earlier, she was able to climb onto my knee herself.
She was started on a low dose of preds which improved it straight away but it hasn't seemed to improve since that even though she is on almost treble the dose.
I don't think you can go any higher than 50mgs a day in a 12kg dog. And she can only be on this dose for 10 days - 2 weeks max or you will start to see some serious side effects.
I really think she needs a combination of meds - either Azathioprine or another immune suppressant.
Could your vet talk to a specialist - I know she's not insured (at least I think you said that?) so you can't take her to one but a lot of vets will consult with specialists for free.
the shifting lameness you describe is exactly what my SAffy was like - but she responded to high dose preds within about 48 hrs each time.
Quote from: cracar on January 07, 2013, 03:23:04 PM
No, the limp is there regardless of how many steroids she has had. Funny thing is, it is different legs/front and back. Some days, I will hardly notice a limp at all(some days she doesn't have any limp) then all of a sudden, the limp is back so bad that she is holding her leg aloft. Same with getting up and down. It has improved but then, last night, she couldn't get up after sleeping on the sofa and needed a lift! But then, 2 days earlier, she was able to climb onto my knee herself.
She was started on a low dose of preds which improved it straight away but it hasn't seemed to improve since that even though she is on almost treble the dose.
Hi
Penel is right about the amount of steroids a dog can cope with. The smaller the dog the easier they cope, but that doesn't mean that a dog should be on these high doses of any longer than necessary.
From what you describe I have a hunch that it might be the steroids that are causing her problems. Muscle weakness, in the way you describe above, is typical in a dog who has been on heavy doses of steroids for weeks. Also steroids stretch ligaments causing weakness within that limb so this may also be a factor. It is not easy to determine what is causing the limp but if it is the AI disease then you should see a rapid and marked improvement when the steroids are raised and as you haven't then I doubt there is any benefit in keeping her on a high dose. Sometimes less is more. Also she doesn't have a high temperature and this can be a clue to a relapse.
If she were mine I think I would start to reduce the dose and see what happens. If she doesn't get worse then you can continue to reduce as per the protocol and hopefully, as you get down to lower doses, you should see an improvement in her whole demeanor. Often, it is only when the dose is down to every other day that you will see the sparkle come back - in both the owner and the dog. This is a long haul but it is worth it when you see your 'old' dog back with you again. If she gets worse then you probably do need another immunosuppressant drug such as azathioprine.
This whole business is a steep learning curve, and it can be very confusing at times even for the most experienced vets. There are a lot of people on the forum who can totally sympathise with your situation, but take it steady, and it will get better.
Jo
Thanks again so very much. I know you have all been there so it really helps. Saff only limps for a second when she gets up and then it's gone. Obviously worse in the morning when she toddles out for a piddle, her leg is aloft but when she comes back down the garden, she's walking normally again.
I will try to get the steroids down again. I think my main fear was putting her through all this medication and then it all flaring up again when I reduce it!! I hate giving meds!!And I'm the same with me and the kids.
She seems to have lost the sensation for peeing too? I've noticed her bed is wet quite often now. She's not drinking loads more as I've been watching as it seems to be a side effect?
I did suggest the Aza/pred combination to my vet last visit but she was very wary. She seems to think that Saffy will need much more monitoring with that drug and needs weekly blood test to watch her bone marrow production?
Such a strange, befuddling illness......
Also, my vet had put Saffy on the huge dose of preds last friday and didn't want me to reduce nor see her again till a phone consultation on the 18th Jan. This is far too long on such a high dose so I think I will start trying to reduce her slightly and then resort to the timescale on here. Vet has no probs writing me up for the steroids and I don;t need to take Saff everytime which is a bonus!
Hi
I think it is reasonable to believe that Saffy's immune system is significantly suppressed and given the length of time she has been on an immunosuppressive dose perhaps you can assume she is in remission. The bed wetting is probably due to the steroids but if she starts to wee very often then it could be a urine infection which is very common when a dog is on steroids.
There is no guarantee when you lower the steroids that she won't relapse, and by keeping her on the high doses much longer than necessary doesn't improve her chances it just increases the side affects. You won't know until you lower the steroids if she really is in remission, but that is a chance we all have to take. I always say you have to be brave to give immunosuppressive doses of steroids but you also have to be brave when the time comes to lower them. The best anyone can do is to follow the tried and tested protocols and hope for the best. It usually works but if the dog is unfortunate and it relapses, then you have no choice but to start over again and the second time around often does the trick, and that is often because the second time around the drug protocol is correct. It is annoying and upsetting but the outcome for Saffy is favourable. AI diseases such as SRMA and IMPA are not life threatening and if a relapse occurs it responds very well to the steroids. Other AI diseases such as haemolytic anaemia carry a life threatening risk with every relapse and the prognosis is often guarded. So as much as you don't want Saffy to relapse you won't know until you wean down the steroids.
Yes Azathioprine can suppress bone marrow production but it is rarely a problem. Aza and steroids have been used very successfully for many years and sometimes it is absolutely necessary to use a 'combination' drug with the steroids. I have never known anyone bother with weekly monitoring to check blood production. Also, I doubt any suppression would be significant but if it did happen to suppress bone marrow production all you do is to stop the drug and the bone marrow will be released again. The only reason I can see for introducing Aza would be if Saffy did relapse and then, over a period of time, Aza will help to minimise the amount of steroids needed to bring her back into remission.
Saffy seems to be doing reasonably well.
Jo