CIMDA

Thanks Penel, I have lowered the dose today from 18mg down to 12.5mg so hopefully it will make  difference without too much going wrong.

Quote from: Catherine on April 01, 2015, 01:42:37 PM
Sometimes when a dog has something like a bad stomach upset or infection it can throw the blood result levels into disarray! Perhaps another blood test when she is better will give a better indication.

What is causing her liver to fail? How anaemic is she?

If the FT4 result is normal but just inside of the low normal range there can be "borderline Hypot".

My dog was okay on Azathioprine (Imuran), no pancreatitis.

We aren't sure of the reason for the liver issues. On ultra sound her liver looks okay (the pancreas and gall bladder look patchy though) and I considered a biopsy, but at the time when the liver results originally came back so high, it wasn't felt that she would survive an anesthetic so we started her on denamarin and ursodeoxycholic acid and her levels stablised at about 1500 (should be below 500 I think, but its been a while!) I'm not sure how anaemic she is, she is visually very pale, particularly her gums. She's been having trouble with constant eye ulcers since September, which I think has been making her feel down as well.

Was Saffy's dose reduced successfully Penel? I am nervous about reducing the dose as we don't know for definite that it is the cause. The vet said that the inflammation from the IBD could be a factor or the poorly liver. It's so hard to know what step to take next

Piper has IMPA (under control currently) and IBD (not really under control) and is in liver failure (currently stable on a load of meds). She hasn't been well for the last few weeks (more than normal) so had bloods last week which showed that she is anaemic, thyroid level is low and her pancreatic levels were high. The blood was re-sent off for more intensive testing and her free T4 is normal so her thyroid is low de to ill health. Her pancreatic levels are coming back at 600 (normal is 0-200). My vet is currently off, so one of the younger newly qualified vets rang to give me the results. She has suggested that there has been occasions where Imuran has caused pancreatitis in a dog and has recommended reducing the dose slightly. Has anyone experienced this? I know that we need to get the levels lower but she is already on a low fat diet, is fed small meals, etc.

Thanks for the recommendation Penel 

Just to add as well that when Piper (she has IMPA and IBD) was on the higher dose of preds, she was hugely urine incontinent overnight and was just leaky during the day. This has improved since the dose has gone down, but I have to get up once or twice a night to let her out.

Been to the vets today after lots of texting with my vets over the last few days. Piper now has a fever and is in a lot of pain with both front legs, neck and spine. Her breathing and heart rate are high, she is very chesty with gunky green coming out of her eyes and nose. Her Aza went up to maximum dose last Friday and she started back on the ronaxan 2 days ago. She has lost weight again and is down to 7.2kg.

Shes had some metacam to try and help manage the pain for today (I am aware that she isn't suppose to have it with being on steroid but there are limited pain relief options for her) and an additional steroid as well as an anti-nausea injection as that is getting worse at night. I am slightly at a loss as to where to go, I discuss PTS today and my vet said that he would understand if I wanted to go that route and would support me, but he seemed to be indicating that I should keep trying to see if there is any change over the next few days. So for the moment, its day by day and if she doesn't make any improvement then I will need to make the decision.

Bit of an update. The specialist asked me to take Piper to my local vets today for a general check up. This morning she was lame on the front left and stiff on the back left (so switched from last night). No temperature and heart/lungs sound fine. Her whole left side, from front leg, neck, along the spine and down the back leg seems to be weak but there is no swelling or pain. On examination her front right elbow was very painful and she has been unable to weight bear on it since this morning, but the vet does feel that she has an underlying issue in that leg. She was completely flat on getting home but has managed a 2.5 leg bounce around when wanting food! She has also lost weight, she was 7.45kg last week and is 7.3kg this week.

The vet isn't entirely sure that it is a IMPA flare up but has agreed that her aza can go back up to the top dose for her weight. I am not sure to be honest. She doesn't seem to be in pain (apart from the right leg now) but can barely walk 

Piper is lame on her front left leg and is unable to weight bear on her back left leg. Her front wrists look swollen. I am just waiting for a call back from her specialist, I am hoping that we can increase the dose of aza back up and it works straight away

Quote from: Penel CIMDA moderator on June 03, 2014, 09:11:03 AM
I do think sometimes it can take a few days to get used to a new medicine.  Poor Piper she has been poorly for such a long time now. 

She was sick in the night and slept in until 6am (unheard of since she has been ill!) but seems to be okay again today. Hopefully I will see a difference in a few days.

It has been a long time  and I think that if everything was as bad I wouldn't continue but to compare photos from 2 months ago on the way to the vets again when she had lost the ability to weight bare her head but was unable to lay down due to the pain in her elbows 



to today's naughty post dinner face 

Piper started on Famotidine on Friday and I thought by Sunday that there was a slight improvement but this evening she is back to regurgitating and smacking her lips. She seems absolutely fine in herself and her usual IBD symptoms aren't there, so maybe I should just keep an eye on it and stay hopeful that its just an oddment for the moment 

Quote from: Clover on May 30, 2014, 03:08:27 AM
Just a long shot here, but did they rule out megaesophagus?

Its never been mentioned but she wasn't doing the gagging/choking/etc until about 12 months before the IBD diagnosis 

Thanks Penel 

Catherine - my local vet did query as to whether the cytotec might be doing more bad than good about 2 weeks ago when Piper suddenly bloated again and was rushed in. But we made the decision to lower her steroid dose again and my specialist prefers to only make one change at a time so the cytotec remained and Piper improved with the steroid reduction. It seems to be a bit of a balancing act with medication 

Thanks Jo  my local vet has rung today and Pipers blood is looking good. Her folate levels are back up so she can stop those from tomorrow. He has suggested a third gastroprotectant (I can't remember the name but I am collecting them tomorrow so will confirm) but also to consider starting her on dulcolax as her bowels are barely functioning so maybe what food she is having, is staying in her bowels for too long and making her feel sick (clutching straws here!) 

Piper is under a specialist (Jane Eastwood at Willows who is the head of internal medicine, she seems to know what she is talking about but has said that they haven't seen a dog react to steroids as badly as Piper before). She is on a homecooked food as directed by Willows (white fish, rice and sweet potato) and has been since Feb this year (she tried a few of the special tinned foods but none of them agreed with her). When Piper was last at Willows (a month or so ago) her pancreatic levels were higher than last year (she was tested for pancreatitis last year before the diagnosis of IBD was confirmed) but the levels weren't worrisome.

She is walking slightly oddly for the last two days but no sign of being lame so it might just be tiredness as she isn't sleeping at night very well. She is regurgitating food today and drinking a lot and doesn't seem as settled as she was yesterday. 

Piper is a 10/11 year old cocker spaniel who was diagnosed with IBD last year and IMPA a few months ago. She doesn't have any typical IBD symptoms, instead her abdomen bloats and hardens, stomach distends and she has episodes of gagging and retching. She was referred to Willows and was diagnosed with the IBD (severe in the stomach and moderate in the small intestine). This has been controlled with food and zantac (liquid 3 times a day) and no meds until the beginning of the year when Metronidazole was introduced.

A few months ago she became lame on 3 legs over night and had joint taps 2 days later which confirmed the IMPA. She was put on a low dose of pred to try and keep her water intake low (when she drinks water, this affects her IBD as it hits the stomach and starts the gagging). After an initial improvement, she went back down hill and the dose of the pred was increased. This lead to her bowels stopping completely, the start of heart failure and liquid on her lungs and around the heart. After scans and tests at the specialists again, they believe that the preds have had an adverse affect on her body and IBD. She was put on a quick reducing dose of the preds to get down to a low as dose as possible.

Medication wise, she is now on a reducing dose of Aza (was on 3/4 of a tab daily, now on 3/4 of a tab every other day) a four day pred dose cycle (5mg, 0mg, 2.5mg, 0mg and so on), cytotec, folate acid, Metronidazole and zantac. Pain relief, she can only tolerate paracetamol twice a day.

So to my question! She is only able to eat 1 spoonful of food five times a day to avoid flaring up her IBD, and she is dropping weight. Before being diagnosed she was 10.2kg and she is now 7.4kg. She was sick on Sunday and since then she has been gagging, drinking a lot and smacking her lips constantly. She has been sick again today but it was just water that she brought up. She was at the vets yesterday to check her folate levels (results back tomorrow) and he also ran a general blood level check due to her sickness. But he said that the zantac and cytotec should be stopping any nausea. Does anyone have any thoughts on it? I have left a message with the specialists for a call back but on our last visit they said that we have no further treatment options for Piper so there isn't much point going back!

Thank you both for replying 

Vixen had her x-rays and she has arthritis in her left hip but nothing else was spotted. Her neurological problems have increased and she is loosing coordination. She is spinning (to the left only) much more than normal, struggling to work out how to climb the stairs (it was never a problem previously), experiencing more spasms and her general behaviour is odder than normal. Forgot to add, the vet was also concerned about her gait when she went in for the xrays as she over steps and she has now started to splay her back legs and over step with her front.

But, she doesn't seem overly bothered by any of this. She is enjoying her walks but has gone off her food (I have put her on some very smelly wet dog food instead which she seems to want!) I am still waiting to see if Axa are going to treat this as a different condition and if so I can arrange for a MRI to see if there are any changes in her brain.

Hello!

I am Dominique and I live in Derbyshire with my 4 dogs. I have a little cross breed girl called Vixen who has been being treated for an immune mediated disease for the last 5 years 

Hello

I originally joined the Yahoo groups but had difficultly working it all out 

Vixen is a 6 year old cross breed (probably collie x brittany) and came to me directly from the pound aged somewhere between 6-9 months of age. On arrivial she had the following:

- severe ulceration of the mouth (hard and soft tissue, roof of the mouth, tongue, back of her throat - she constantly pants and drinks)
- broken nails on all feet
- skin lesions (lower ears, neck, inner thighs, tail and belly button)
- unable to eat any dry food and wet food has to have liquid added to also added lactolose as she was unable to do a poo without screaming in agony
- urine leakage

Auto-immune was mentioned by the vets quite early on but we discovered that Vixen was pregnant so no treatment was started. Once pups were weaned Vixen was spayed and all skin lesions removed for testing (apart from ears and her tail was removed before we realised she was pregnant as it was constantly bleeding).

We started pred (looks like a maintenance dose after reading through on here) for about a 18 months and she started to suffer from depression so moved her onto medrone. She managed about 15 months on that before the depression returned. Switched her back onto pred. She had 2 incidents with a spider biting her and both times her face/neck swelled extensive, she lost her fur and recovery was about 6 months on continually antibiotics (she has permanent scarring from both incidents). She has had 2 incidents of reduced oxygen and her tongue went blue, she saw a heart specialist and her heart is fine.

Two years ago I managed to get some money together to take her to Willows in Solihull, where we withdrew her from the pred to make her mouth ulceration as bad as possible to take biopsies. She was also tested for cushings as she was displaying a lot of the symptoms at this stage (negative result) and a anti-necular test (also negative result). Kirsty the vet was very certain that Vixen has SLE and was surprised at the negative result. However, with all of the symptoms her vet is continuing to treat her as though she has SLE.

Vixen was put on atopica but the side effects were a nightmare. So she is now on a mix of atopica and pred (both maintenance doses).

Current additional issues (the ones mentioned above from when she arrived are still an issue)
- spinal discomfort (going in for x-rays in 2 weeks)
- abdominal pain after meals (she is now having 4 smaller meals rather than 2 normal sized ones)
- Facial and right front leg spasms
- increased isolation from the rest of us (I see her for maybe an hour a day, the rest of the time she is under the computer desk or in the garden)

Unfortunately, Vixen's insurance doesn't cover anything as she came with this condition. I am maxed out on credit cards on her vets bill (7k) so I am pretty much stuck now.