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Messages - Jo CIMDA

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1
General doggy chat / Re: Brittle nails
« on: March 19, 2020, 12:57:35 PM »
Hi Louise

Yes preds do have an affect on hair etc., and being on pred does inhibit healing, which won't help. 

The good news is it is isolated to one nail  so it is very likely to be, as you say, an injury which is taking longer than normal to heal.  You could try adding natural Vitamin E and essential fatty acids such as evening primrose oil and fish oil to his diet to nourish the skin and encourage new cell growth.

Jo

2
General doggy chat / Re: Brittle nails
« on: March 13, 2020, 02:23:28 PM »
Hi

Does Panda have a problem with all of his nails or just one?

Jo

3
Hi Louise

I hope now that Panda is back on a higher dose of prednisolone  it will bring the disease under control and eventually into remission.  If when you reduce the dose Panda still has clinical signs then perhaps your vet should consider introducing another immunosuppressive drug such as leflunomide or cyclosporine, or one of the other immunosuppressive drugs used commonly in a combination therapy.

Like you say, fingers crossed!

Jo

4
Hi Elaine

I am so pleased your dermatologist is willing to work with you.  This is so important and it will achieve the best outcome.

As Catherine says, it is only while Woody's immune system is being significantly suppressed that you have to worry about him being vulnerable to infections.  When the dose is much lower he will be fine to go outside where other dogs will be walking.  When he is off preds altogether, his immune system will return to normal strength.

I do hope this new drug regimen will bring remission.

Jo

 




5
The rapid increase in platelets is brilliant news Jane and it indicates that Archie's bone marrow is able to regenerate once the destructive immune cells were suppressed. 

Like you say, take this round of treatment slower, if side effects allow, and if necessary add another immunosuppressive drug to support the steroid treatment, which will enable the pred to be reduced quicker.  Taking the last stages slower is often the best way to go and when the dose is low, and the side effects of the preds is minimal, then there is no rush to wean off altogether. 

This is an excellent start to the treatment.

Jo

6
Hi Louise

The recommended drug  for improved outcome of GME alongside prednsiolone is Procarbizine (Ref:  Clinical Immunology of the Dog and Cat, 2nd edition, by Michael J Day)  so it might be worth discussing its use with your vet.

Reducing the dose of prednisolone slower usually achieves a better outcome.  See the protocol below. It is the best I have come across and it can confidently be used as a guide.  Always, the protocol has to be tailored to the individual.


Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
This example is base on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days


Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs..

The dose of azathioprine 2mg/kg/24 or 48 hrs, can be reduced initially by giving a lower dose tablet per day, or gradually reducing from daily dosing to every 2nd day, every 3rd day, every 4th day etc.....  Remember, azathioprine tablets should not be broken or handled without gloves.


I do hope Panda improves very soon.

Jo


7
Hi Jane

I hope Archie gets on well today.  Some dogs platelets can fluctuate but if it goes on for a long time then it is likely to be secondary or to be caused by destruction of platelets with the spleen etc.   I have know dogs with this problem and eventually the spleen has been removed and the problem is solved, but this would only be necessary if the low platelets were due to destruction other than a primary IMTP.

The best protocol I have come across is by Prof Michael J Day, and it can be confidently used as a guide.

Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
This example is base on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days

Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.

The last reductions can be taken much more slowly, even reducing by one or two mg at a time, and then going from every other day to every third day and so on........  There is no wrong way when the dose is this low.

Personally, I wouldn't give any chemicals like flea/worming treatments etc., unless of course you see fleas or worms.  Most dogs these days don't grub around when they are outside the house and it is therefore  unlikely that they would get worms, and if they do you would see them in the faeces when you pick up.  One can always have a stool test done to see if worms are present.    The spot-on treatments can cause an adverse reaction.  It is safer not to give anything that is a potential trigger and deal with pests as and when it happens.  If Archie has been vaccinated as an adult dog then it is most likely he will have immunity to those core diseases.    You have to feel comfortable about your decisions, so don't take my word for it. ook up the WSAVA Vaccination guidelines.  It is sound advice and based on facts.  At a seminar I once attended, I asked Prof Brian Catchpole (RVC)   should a dog who has had an AI disease ever be vaccinated again, and his immediate reply was, "No".

It is likely because Archie is very young that he has a primary IMTP and he should respond very well to good a treatment regimen.

Fingers crossed
Jo


8
Hi and welcome

I am sorry Archie has relapsed with IMTP.  Even after good and successful treatment,  this is not uncommon, but that doesn't mean that long term remission can't be reached - it can and does for most.   

Not showing other clinical signs of an IMTP relapse is usual.  It is only when the platelets fall below 40/50 that bruising starts to occur and even then there aren't usually  any other clinical signs, so it is good that you monitor Archie. 

Archie is on the right dose of steroids for his weight, so that is good news.  If the platelets are slow to regenerate there is a drug called Vincristine (given as a single shot) that has the ability of rapidly increasing the platelets, but this is usually only used if there is no sign of regeneration.   

It might be prudent, as Archie has relapsed, to add another drug to his regimen.  A combination therapy is often used when the dog has been on prednsiolone before.  Adding a second immunosuppressant drug allows the prednisolone to be reduced sooner, thereby limiting the side effects,  and still maintain a good level of immunosuppression.  Below is a good link to other immunosuppressive drugs.

https://www.dvm360.com/view/immunosuppressive-drugs-beyond-glucocorticoids

Archie responded well  last time and there is no reason why he shouldn't respond well this time.  There is no way of telling if a dog is in full remission. It is only by weaning down the drugs and then waiting and monitoring to see if the platelets stay within normal levels that you know if remission has been achieved.   Clearly, despite the gradual weaning down of the drugs, Archie wasn't in remission and as soon as the effect of the steroids had worn off the immune response against the platelets became active again.  The treatment protocol  and slow weaning down process that Archie received was good but you have to do the same all over again.  Maybe this time add another drug and also take the last stages even slower.  The protocol has to be tailored to the individual.

If a dog is in remission for a period of time, and then relapses, then the dog has met a 'trigger' to cause this immune reaction.  A dog who has had an AI disease should be kept, as much as possible, clear of all potential triggers and these include vaccination, flea treatments and unnecessary regular worming etc., and as stress free as possible.  The latter is difficult to control when day to day life can be stressful.  Also hormones are a huge trigger factor.  It is impossible to guard against all the potential triggers but the least you can do is to avoid things like vaccinations and chemical treatments that aren't necessary but are considered by some vets, a part of responsible dog ownership.

I do hope you see a good response to the treatment and then you can start on the reducing drug protocol and achieve remission.

Jo



9
Hi Louise

If you do a search for   MUO or GME  on this site there should be a lot of postings about this subject.

Jo

10
Hi Louise

I am sorry Panda is unwell.   Has his symptoms improved since being on the treatment?

 GME comes under the heading of :  MUE (Meningoencephalitis of Unknown Etiology).  These neurological diseases are often treated slightly differently to other AI diseases.   Below is a link that gives treatment options and the dosages and duration of treatment for MUE diseases.   

https://vvma.org/resources/Documents/Rossmeisl-Where%20are%20we%20with%20MUE.pdf

There have been several dogs here with MUO/GME and with correct treatment the outcome can be very good.  Leflunomide has been a drug that is often used in these neurological diseases.

An immunosuppressive dose of prednsiolone is 1mg/kg/12 hours, so I wonder if the starting dose  was high enough?   If this dose has not reduced since October then it would be wrong to increase the dose of prednisolone because of the side effects but it is very possible to introduce another immunosuppressive drug, as indicated in the above link.

These links might be useful to you:

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4952320

https://www.fitzpatrickreferrals.co.uk/neurology/meningoencephalitis-of-unknown-aetiology-mua/


As Panda is still on prednisolone I question if spinal tap results will be accurate because prednsiolone can produce false negative/false positive results in various tests.   It is worth raising this with your vet before Wednesday's planned spinal tap and see what they say.

Jo


12
Hi Brooke

Your last paragraph is a treat to read and it bodes well.  I hope the urine result comes back good. 

Great news.

Jo

13
Hi Elaine

The fact that Woody responded really well to the initial dose of prednisolone is very good news, and in a way this indicates that, regardless of a definitive diagnosis, immunosuppressive treatment is the way to go.   Likewise, the slight decline since reducing the dose could likely  indicate that the dose may have been too low and not given for long enough. 

With inflammatory AI diseases, if the dose is not high enough or given for long enough, all that is happening is you are putting steroids into Woody's body without the possibility of significantly suppressing his immune system and therefore the underlying immune destruction is not being fully addressed and when you start to reduce the tablets all that happens is the immune response, and clinical signs, increase again - and all the time the side effects of the preds are building up in the body, and this makes it more difficult for the body to cope with if the dose is raised to immunosuppressive. 

Every mg of prednisolone should count for something, but this can only happen if the dosage and duration is right.    Try to chat with your specialist about using the Michael J Day protocol.

The aim is to treat the dog using a good protocol and start to wean down the steroids,  and ultimately go to every other day dosing and even every third day until there are no apparent clinical signs - then you can stop it altogether.  Some dogs will relapse and some won't - there is no way of knowing  but if a good protocol is followed, whilst keeping an eye on the side effects of the drugs, then this is the best chance you have of achieving long term remission.  If the dog relapses after you have weaned it off the drugs, then you have to put the dog back on an immunosuppressive dose again.

I hope you have a good meeting with the specialist.

Jo

14
Hi and welcome

I am sorry your Lowchen has IMTP.     There can be several reasons why a dog may have low platelets.  when a dog is older it may not be a primary autoimmune disease and caused by something else, perhaps  the destruction of platelets by the spleen for example. 

 I have known a single shot of Vincristine to be very successful in increasing platelet production and this might be worth discussing with the specialist.   

I do hope you start to see and improvement very soon.

Jo

15


Hi Brooke

Take a look at these links.  The increase in Pep's ALT might be due to muscle damage or at least contributing to the raised levels.

Jo


https://www.dvm360.com/view/canine-liver-enzymes-so-many-questions
ALT

ALT is found primarily in the cytosol of hepatocytes. It's released with increased cell membrane permeability or cell death. “Of all the liver enzymes, ALT is the most liver-specific,” says Dr. Lidbury. On rare occasions, ALT activity can be increased in patients with severe muscle injury. But, in general, ALT is considered a sensitive and specific marker of liver injury. “When hepatocytes die, then you get leakage,” Dr. Lidbury says. “ALT can also leak when you have just cell membrane damage. You don't have to have necrosis for ALT to go up. Also, severe ALT increases don't necessarily mean you have irreversible disease. Sometimes we misinterpret really high ALTs as irreversible disease and a poor prognosis. If you have a dog with acute liver injury, it might have a sky-high ALT, but if you can support the dog through that initial injury, then the disease could be reversible, and the liver can get back to normal. The liver has such great regenerative capacity.”



https://www.whole-dog-journal.com/health/liver-disease-in-dogs/
ALT is an enzyme that may be released with any source of damage to the liver. Blunt trauma, anaphylactic reaction, systemic illness such as thyroid disorders, and other problems that have nothing to do with the liver can cause an elevation of ALT in the blood. Just because ALT is elevated doesn’t mean the liver is failing, however. This result is interpreted in conjunction with clinical signs and other bloodwork and imaging changes.


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