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Topics - BrookeR

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Unfortunately we are having problems again.
We have had a number of things happen with Pepper since the start of this year, it would take me quite some time to document everything. But we are now at the point where she has lost a lot of muscle tone and is now frail looking. Even with increasing her food intake we have not been able to increase her weight.
My vet said maldigestion, malabsorption (intestinal wall), malassimilation (liver, kidney, cancers) ,and protein loss through gastro tract or kidney are all reasons for weight loss. She also has a low white cell count & my vet wants to investigate further if it persists to be low.

We did bloods, urine & stool sample 2 weeks ago and a weigh in and she had lost 400g since her prior weigh in.
There was a moderate  Alkp increase, mild increase in globulins, mild non regenerative anemia, moderate leukopenia (due to mild neutropenia and lymphopenia).
I have tried attaching her last blood results, but not sure if it will work. We took more blood and a urine sample today and are waiting on the results. Pep had gained 200g today. Which is not much, but its better than loosing more weight.

At this point I am not planning on going ahead with the ultrasound. I can't really afford the extra expense and anything we find on there is going to be something incurable (I will not put her through chemo at her age). I would also rather not know if she has cancer.
Due to her now being prone to pancreatitis if she has IBD we cannot really treat her by going up in preds. She also does not have consistent runny poos. Which has also led us to not feel that it is EPI. Multiple Myeloma is another thing that has been discussed. Just to list a few.

Does anyone have any thoughts or ideas based on her blood results?

We are back on the roller coaster again. We believe Pepper is relapsing again (impa)  and have had to go up in Pred. 😔
I have also just started giving her (very gradually) Si Miao San, Traditional Chinese Herbs. The list of things that it has claims that it helps with is extensive and would be absolutely amazing if it ends up doing even half the things they say it can help with.
With Peppers sensitivity I have always been scared with trying things like this. Although given her age, the chronic steroid use, the worsening of her joints and now this latest relapse I have decided itís worth the risk. So far we have had no problems but Iím still working up to her correct dose.

Has anyone else had any experience with using traditional Chinese medicine? In particular Si Miao San (four marvels powder).

General doggy chat / Very sad news - Pepper
« on: December 20, 2017, 05:48:58 PM »
It is with great sadness that I write on here now, but I wanted to give an update while I still can.
I have been absolutely heartbroken today to find out the news that my beautiful girl Pepper has a very rare and fast acting terminal cancer. Apologies for not being to write the name of it down at this point but my head has been a mess today.
She has a very swollen back toe where the cancer is and it is also in her lymph glands. We do not know the extent of exactly where else it is. But I am choosing not to run and further testing and instead just making her comfortable and spending every minute I can trying to give her as much love and happiness that I can in the little time they have advised me that we have left.
Pepper is my best mate and has been for the last 10.5years. I could never have asked for a more beautiful, placid, loving, loyal dog. We have been through so much together and barely spent a day apart only the little time when I was in hospital having my children. She follows me everywhere even at times when she has been in pain, she couldnít miss watching me go to the toilet or laying on the bathroom floor while Iím in the shower. Not to mention having to sit on my lap when we travel away to my parents farm 2+hrs away when there is a perfectly good seat free in the Back. Itís just too far away from me.
I have been lucky enough to work from home with pep ever since she was a pup. For the first 4 years it was only me and her. She has helped me build up our business until such point that my partner could also join us working from home. She was by my side every day keeping me sane through the early days of working on my own.
I am so so grateful for all the advice that I have received from on this forum from you jo especially and all the other great members. I believe you have given me the gift of having her with us for an extra few years.
Pepper was diagnosed impa the days before Christmas 2014. Each year we have had problems with relapses at Christmas time and I have been so worried about what was in store for this Christmas considering pepperís past traditions at Christmas. I did not expect this though. But have learnt over the years that Pepper always does the unexpected when it comes to anything health/medical related.
For anyone who knows myself and peppers story you will know how hard I have fought for her. She has basically been the dog that needed a bubble with all her allergies etc. After all the time at vets, specialists & researching everything that I could, giving her special diet and supplements. Finally we have had this last year living comfortably all but itch free with no colitis or gastro problems.

I have dreaded this day and to say Iím am devastated is an understatement.
Pepper is my first baby, and my best friend who has been by my side through everything. I could never have imagined having so much love for one little staffy. There will never be another dog as placid, loving, kind nature and tolerant as pepper. She truly is one of a kind in all ways. She is so gentle and loving with kids and also other dogs. She will roll over and surrender to a chihuahua. Through all her problems she has always been the best patient you could ever ask for. I cannot even begin to imagine life without her. All I can keep telling myself is the only thing to do is try make every minute we have count and show her as much love and enjoyment that we can while we can. 😥😥😥

Pepper has been drug free since Monday. She had her last dose of cyclosporine on Sunday.  Even though she has been below therapeutic levels for skin conditions for some time, she has become more itchy since coming completely off. I cannot pinpoint anything else that may be causing her increased itch, for instance anything different flowering nearby etc. Yesterday she stopped itching so much but has been sad and now has swollen back leg joints. Her temp has gone up to 38.5 last night & then 39.2 this morning. I began worrying she was relapsing and so took her to my vet at lunch. She doesn't think that she is relapsing. She thinks her temp should be consistently higher if she was relapsing. (It was 38.9 & 39.1 while we were there.) She said her joints seem more painful, but only her back leg joints are swollen. Her ears are also looking a bit infected so we have began easotic with her. Normally Pep's temp this past year has been between 37.5 & 38. This is the hottest I have seen her since her IMPA. My vet seems to think perhaps her temp could vary now & she may have a new normal due to not being on the immune suppressent medications. As she has previously always been on them when I have tested her.

I have taken her to get accupuncture this afternoon and she was very tender (& hot) in a spot in her back as well as her back legs. (Her temp was back at 38.6). After the accupuncture her hot spot in her back loosened and felt cooler to touch. I also got them to do some allergy accupuncture points as well as for her joints/arthritis.

So we are hoping she is just sad and uncomfortable due to arthritis & her itch & ears.
We have exhausted all options when it comes to treatments for Pep's allergies. But my vet has
said that in the states they are starting to use gabapentin to treat itchy skin dogs and she is suggesting we trial it with pepper. With it also providing her some pain relief for her arthritis.

Does anyone have any knowledge about this? Is there any possible problems with it and her Impa?
I don't want to give her anti inflammatorys as we may still need to give her pred for her allergies (if they get too bad. However I am trying to hold out on that) or if she relapses.

Anyone's thoughts would be great.
Hopefully the accupuncture makes her feel better.

General doggy chat / Pimple size lumps in one ear
« on: November 12, 2015, 09:35:43 AM »
Not sure if this is anything to be concerned about. But I noticed a small pimple sized lump in peps ear a few days ago. It is just a little hard lump the size of a small pimple, almost like an ingrown hair. Tonight I noticed 4 more running diagonally down towards her ear canal. I'm not sure if they were all there originally and I didn't notice or if they have since came up. They don't look pussy or have heads on them and can only be seen if you look at her ear on an angle closely. Basically you can barely see them, but have to feel to know they are there.
I've never seen these on her before. I'm wondering if they could be some type of fungal thing or a side effect of cyclosporine or a sign of something else? Ordinarily I wouldn't do anything yet and would just keep an eye on them until I next saw my vet. But My vet is going to be away for a few weeks after next Wednesday, so I'm wondering if I should bother her by taking pep in to check these out? Whether I should put some fungal cream on? Does anyone have any ideas on what they may be?

So we have Pepper completely off pred now for a month plus. She is doing great. Since being off the pred her occasional front leg limping has gone & she even is getting up at night in her rear legs (I believe she has arthritis there now) better. I thought the front leg limping must have been an injury she had obtained, whilst her joints were unprotected when she had the impa. But the steroids must have also been weakening her & adding to it, as I haven't seen the limp again.

I have transitioned her to a new diet that I had formulated by pet diets specifically for her. We take the last step to increase the trace mineral supplement to its final amount this week. I want to wait for a couple of weeks or so once she is stable on all elements of her new diet & then begin reducing the cyclosporine. Pepper is very sensitive to change so we reduced the pred very slowly.

I am curious about what sort of reduction plan we should use for the cyclosporine. I read so much about pred reaction plans. Which I know is important to ensure the adrenal glands begin functioning again properly. This is not the case with cyclosporine but due to her sensitivity and being on it since just prior to Easter I would like to go slowly. I know not many people on here have used cyclosporine successfully. Although clover did, I'm wondering how she was reduced or anyone else who has done it? Pepper is currently on 1x 100mg tablet morning & 1x 100mg tablet nightly (human grade - neoral)

In terms of her allergies when we reduce the cyclosporine, I have spoken to my vet and discussed acupuncture (after I think penel you mentioned it seemed to help). So we have this organised.
I'm confident everything will go fine, but I'm sure Pep will throw me some curve balls along the way.
We will deal with the them as they come. I have everything as prepared as possible, in terms of management of certain problems (allergies etc) and that's all I can do.

Anyones thoughts on cyclosporine reduction would be great. Thanks.

Pepper is due for her vaccinations & yearly heartworm injection. Since Pepper was diagnosed with IMPA in December 2014 I have researched a lot and decided against getting her vaccinated anymore. However, she is now also due for her yearly heartworm injection.

My vet has voiced concern today about not giving her any heartworm prevention at all. She thinks that if we are going to risk giving her any medication, that heartworm prevention should be it. She is wanting to give Pepper a monthly tablet for heartworm.

I had read an article by Dr Jean Dodds a while back which came to mind, that I have mentioned and just emailed to my vet

The article discusses recommendations for heartworm prevention in dogs affected with autoimmune disease. Dr Dodds says that a daily dose of Dimmitrol is best to use if in an area where heartworm is prevalent and if not she recommends to use nothing.

What is everyone else's opinions & experience on the use of heartworm prevention? I mentioned to my vet that Dr Dodds had recommended a daily preventative rather than monthly. She seemed to think that the monthly should be okay, but is going to research further. She has given me a few days to think about it, but said that we need to make a decision soon. As otherwise Pepper will be outside of her current protection & will have to have testing done before we can continue with preventative treatment.

I have discussed on here before about looking for supplements and multivitamins for Pepper.
It has been an exhausting process trying to find one that I felt comfortable with all the ingredients in it (in terms of her not reacting to something) & to find one that was easily available in australia.
After getting Peppers nutriscan test done I have began looking again now that I have something more definate to go by in terms of what she can and can't have.

Finally I have found one that I feel happy with and am waiting on my vet to okay it.
It is Missing link - well blend skin and coat. They make a number of supplements but this is the only one available in australia. But it is also the one that I wanted in terms of feeling comfortable with the ingredients in it  Does anyone have any experience with using this ?

I also came across rose hip canine vital for her joints. I originally dismissed this as I thought rose hip was a flower, but it appears to be a fruit. She hasn't had any trouble with fruits before so I feel more comfortable with this.

Just wanted to see if anyone has used either of these before or heard much about them?

I asked my vet to contact our specialist and see what her thoughts were now on reducing the pred and cyclosporine as it has been 6 months. She has re-nigged on her initial comments of weaning after 6 months remission and is now saying she normally wants to wait two years! For dogs that have had a relapse. Peppers relapse was only because I was initially dealing with a vet that had no experience with IMPA. He had put her on too low of a dose and began weaning after 2 weeks and then again after another week and a half. At this point I went and saw a specialist and we restarted treatment at the correct dose.
I think the specialist may be chopping and changing what she says as we have only been to see her twice (due to the distance) and she is having trouble identifying properly with Peppers case. Because she has been so detached from it.

The specialist has now said with dogs that haven't had a relapse after six months she would begin weaning and put them on non steroidal anti inflammatories.

What is everyone's thoughts on this? I haven't heard of giving non steroidal anti inflammatories when weaning, is this needed? Is it to prevent the Impa returning or as some pain relief??

I honestly believe Pepper is not going to relapse especially seeming she was only on a low dose of pred for 2-3months while we tried to get her cyclosporine dose up to immune suppressant levels. I feel her body needs some time of the drugs for us to really asses what's going on with her.
If I go against the specialist and we have any problems I will most likely need to find a new specialist. But I truely feel the medication she is on is not necessary and may be causing more problems rather than solving any.

At a loss :(

Medication, supplements and alternative treatments / Cracking jaw
« on: May 26, 2015, 10:36:45 PM »
I have noticed in the last week that when I give pepper her medication her jaw loudly cracks. I have been giving her medication daily since Christmas and there has never been this jaw cracking sound before.

Could this be some side effect of the cyclosporine or a sign of something else that I should be worried about?

We were always giving pepper cyclosporine with a meal and for the last two weeks have started giving it with only a tablespoon of food. We are still waiting on cyclosporine blood level results to come back. She had a urine test and complete bloods done also. Her urine test showed nothing, her alt and cholesterol levels had returned back into normal ranges for the first time in a long while. Yay!! Her alp s were still above normal, but lower than they have been (she is also still on 10mg pred EOD). But for the first time since Christmas (after monthly or sometimes even more frequent) bloods her protein and globulin levels were increased outside of normal ranges.
We have waited a week and just run bloods again and are waiting on results. I have also documented Peppers water intake over the last few days prior to taking bloods. Her drinking had gone back to the same consumption prior to going on the preds at Christmas. But for the last couple of weeks she hasn't been drinking hardly at all. I have only been seeing her have one small drink a day in the afternoon.  (She cannot drink without me knowing, I have her bowl beside me all day as my 2 year old gets in it otherwise). Normally she wasn't a big drinker, but would drink after having a meal (she has 3 smaller meals a day). She would also normally drink after having a dried sheeps ear treat. But she isn't anymore.

I had read that a toxicity reaction to cyclosporine was increased thirst and urination. I was worried the dose may be too high now we have removed the food. But she is drinking less so that doesn't fit?
My vet got me to measure her water intake as dehydration can cause the increased levels to rise. Hopefully it's not something more sinister. But if it is dehydration I don't know why she isn't drinking. She is still eating well. Her gums and tongue appear more pale in colour than usual, but there is no ulcers or bleeding.

Ps I also told my vet that I am taking her off the cyclosporine when we reach 6months remission (end June). She was not too impressed at all and is trying to advise against it. But will not change my mind, I want her off it. I would prefer to give Pepper a go in terms of her allergies and see what she is like. Rather than medicate her with such a harsh drug, 'just in case'. We don't know what's she is like now that she cannot have her desensitising injections anymore. She has been on them for 4years and has only been off them since Christmas. But has been on the immune suppressant doses of pred and cyclosporine in his time so we have no way of knowing what she will be like on no medication. My vet seems to think she is going to fall in a heap, but I don't agree. The vet may be right, but I would prefer to at least try her and see rather than medicate her with something so harsh when we possibly don't need too. The side effects of cyclosporine use long term scare me too much.
I have been getting her diet and all environmental allergens sorted to get her as healthy as possible and give her the best chance when it comes to 6 months.

She is looking better than she has in a long time. Her hair has grown back, her coat is soft and shiny. She is maintaining a good weight and is looking better in herself. Also her strength seems to have built up again as she hasn't been hurting her self chasing birds and limping like she had been. Her loose stools had been sorted for a while until yesterday when she had some troubles again. But I think she may have got some potato chips and possibly fish from my son. (Fish and potatoes are on her list to avoid).

I know there are many things that can trigger impa or immune mediated conditions. But certain antibiotics and vaccinations are known possible triggers. I'm wondering if allerderm spot on may be of any concern?

My specialist wants pepper on cyclosporine for at least 6 months remission. My vet is concerned about Peppers atopy and I have a feeling she is going to want to leave pepper on the cyclosporine after 6 months. 6 months remission is coming up in June.
I do not want her on the cyclosporine for the long term and I would prefer to manage her allergies as best I can by trying to eliminate what she comes in contact with. Regular maintenance and baths, possibly pred on an as needed basis. We used to give her antihistamines. I'm assuming these are still fine in regards to not having possibility of triggering impa. I would prefer to try manage her allergies instead of worrying about the side effects of  long term cyclosporine use. She has been having trouble with allergy type symptoms now whilst being on the cyclosporine anyway and it's supposed to help allergies.

I have been trying to prepare for when we reach the 6 months and the discussion with my vet about not wanting to continue with the cyclosporine. I found (while doing some reading on cyclosporine being used to treat allergies), a product called allerderm spot on by virbac. It is a topical therapy that helps to repair and restore the epidermal barrier in dogs suffering from skin disease. It comes in little pipettes, I'm assuming like frontine & advantix etc come in. In all the consults we have had with allergy specialists here none of them have ever mentioned this product to me. So I am unsure if we can even get it in australia. But before I try and see if I can get it here I wanted to post on the forum and see if anyone knew of any known problems or suspects that it could cause any problems in triggering impa.
Thanks in advance

I wasn't sure what section to post this in, but have ended up here.

Peppers Nutriscan Results are in. Penel you had asked for me to let you know how they went.
I have attached copies of the results to this post.
Peppers thyroid results are also attached above the Nutriscan results. I was wrong, she does not have hypothyroidism. Which is a good thing. If she did though it would have answered a lot of questions, but at least we have ruled something else out.

I have read Dr Dodds thyroid book and she talks about selenium deficiency causing symptoms of hypothyroidism without showing up as hypothyroid in blood thyroid tests. Also mentioned is when the liver is not functioning properly that this can cause hypothyroid symptoms without showing as a thyroid problem in the bloods. Peppers liver has been doing it hard due to the high doses of immune suppressant drugs which she has been on and this is evident in her blood results.

I am still reading Dr Dodds Canine Nutrigenomics book and believe that hopefully if I can get Peppers diet better suited to her needs/conditions, that may help some of her issues.

Pepper is due to have a cbc, urinalysis, titer testing (she is due for vaccination in June) and cyclosporine bloods levels done on Monday. We stopped giving her the cyclosporine with food at the start of this week and are testing to see what her trough level is at now. Yesterday she began drinking and urinating lots, and was quiet hungry. I was a bit concerned about toxicity and that the dose we are giving her may be too high since we have removed the food? Today she hasn't been drinking or urinating like crazy as she was yesterday, but she is quiet lethargic.
Yesterday was her eod of (10mg) pred. Wondering also whether the removal of food with the cyclosporine may have increased the interaction between the pred & cyclosporine in terms of both taking the CYP450 pathway through the body?

I am probably just being too picky and need to wait and see how things go. The cyclosporine blood levels normally take about a week to come back. I guess I will just have to keep an eye on her until then and see what they say.

Pepper has some sores that have developed on the inside point of her ear flap. She has never had sores like this before. My vet thought they may have just been a bacterial infection which they told me to treat with malaseb twice a day leaving on for 10mins. The sore has now been there for 3 weeks. I have been treating it for the last 2 and it has spread and looks worse.
I wasn't sure if someone mentioned sores in the ears as a side effect of cyclosporine to me on the forum previously? I remember the bleeding gums being one (which luckily at this point she doesn't have) but remember reading some where about ear sores. Maybe it was mentioned as a symtom of hypothyroidism? Which we are testing her for next week.
Does anyone have any idea about the sores? It may just be a bacteria infection but it isn't getting better and even with her allergie problems pepper has never had something like this before. So I wanted to make sure it wasn't a side effect of the cyclosporine.
Any thoughts would be great?

Pepper is still down and I'm really hoping it's just the cyclosporine. But I have a bad feeling that she may be relapsing. As she looks like she did in the couple of weeks prior to getting really sick and being diagnosed with impa. She is down & has her sad face with head hung low (it's not hung low all of the time though). She has a sunken looking back and is more hesitant to move than normal and is a bit off in her back legs when she gets up. She still has periods where she will bark and chase a bird though.
The big difference is that she doesn't have a temp. Her temp was the most prominent thing when she was diagnosed. She is having 10mg of pred every second day & cyclosporine (which isn't in immune suppressant levels in her body). Could that be enough for her to not have a temp? Or is there not always a temp?

Hello, Sorry to post on here yet again. Everyone must be getting sick of the sight of all my questions.

Pepper's cyclosporine (neoral) blood test results are in and they aren't very good. Her trough concentrations (12hrs after her last dose) were only around 34 (ng/ml). Our vet said the minimum to achieve immune suppression was around 300.
I also have since read online from a university therapeutic drug monitoring study that they suggest clinical benefits have not been observed when trough concentrations fall below 50ng/ml & they were referring in terms of dermatitis treatment.

So it would seem that the cyclosporine is in too low levels in her body to have any effect on her. I thought this was going to be the case, as I had noticed her chewing at her feet and thought they looked a bit yeast looking inside. I mentioned it to the vet and she checked & confirmed it when we were there today. Lots of yeast was evident in her feet.

She started the cyclosporine on the 4th of this Month and was having 1x50mg tablet per day. We were worried she would get sick and decided to start low for a week to see how she went and then increase the dose. She was on 50mg a day until the 13th, when we put her up to 2x 50mg per day. She has been on 2x 50mg tablets a day until now. After seeing her blood level results our vet wants to increase tomorrow (Friday) to 3x 50mg tablets a day and then on Monday (when the vets are open again) go up to 4x50mg tablets.

We have been giving it to her with food and I know this affects the absorption. But our vet thinks it best to continue giving with food until we get the dose stabilised and then try her without food.

Does anyone have any experience with cyclosporine and have knowledge on what may be causing her poor absorption?
I know every dog is different in their level of absorption, but I am wondering about any other medical conditions that may be affecting it.
Not sure if I have mentioned it before, but we believe that Pepper has IBD, but this has not been conclusively diagnosed.

I also have the horrible thought in the back of my mind about a IMPA relapse.
We reduced her pred from one (20mg) tablet every second day to 1/2 (10mg) a tablet every second day on Tuesday (today is Thursday here). As some of you may have noticed I mentioned in another post I made that she was now limping in her front.
But this has also happened after a crazy amount of running and playing on Monday afternoon and a small amount again on Tuesday afternoon. She is limping always in the same leg, there is no shifting of lameness. This is also the same leg she was limping on a few times for brief periods prior to reducing the pred. This was when we didn't know whether to reduce the pred because of the limp and so did another joint tap. The joint tap showed her front legs had normal levels. Her back legs had increased abnormal cells, but less than initially (when diagnosed) and at a level our specialist said could just be arthritis.

She does not have a temperature, which I have been monitoring closely. She also does not have her head hung down low and the 'walking on egg shells' look that she did when diagnosed. My feelings are that the problems are joint, muscular and ligament related due to the pred use and deteriation of her body during this hard time. I feel (or hope?) that she has just over exerted herself playing on Monday and Tuesday and is feeling the repercussions. Not the IMPA. But with hearing the cyclosporine levels are too low, I am terrified and doubts are creeping in.

How long does it normally take for a relapse to progress?

She had some acupuncture today and chiro/muscle work done. The vet said she was tight throughout her body and her neck was the only muscle in her body that didn't seem weak/stressed. Her muscles loosened up after a bit of work.

She showed pain when the vet checked out all her joints, which is the first time she has shown real pain when her joints have been manipulated. When she was initially diagnosed with IMPA, she never showed any signs of pain when her joints were manipulated. Hence why it too so long for the diagnosis.
Hopefully that means this is different, not the IMPA? Am I clutching at straws? What is everyone elses thoughts?

We have increased her pred back up to the 20mg every second day until we can get her cyclosporine level up higher. I am not willing to go up any further on the steroids, as she has suffered too much from them at this point and I don't think her body could handle it.

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