CIMDA

Hi

All these alternative immunosuppressive drugs have the potential to control the immune system and bring the disease into remission but is is never without some side effects.  Some dogs will cope with the side effects more than others and there is no way of knowing how a dog will react before starting treatment.  Often two or even three drugs are used, sometimes in reduced doses,  in order to give adequate immunosuppression and limit the side effects of each drug.   I think it is worth trying the drug that most suits the condition because it may be that the side effects in Farley will not be as severe as feared.    What do you have to lose?

Some dogs cannot tolerate Atopica and others have no ill effects.  Some breeds, such as sighthounds cannot tolerate high doses of pred that well and yet other breeds can.  Smaller dogs usually tolerate the side effects of preds much better than larger dogs.  It is all about trying the best that is on offer and monitoring the side effects of the drugs and resolution of the disease, and adjusting the dose and duration. 

I do hope you can find a drug/s that best suits Farley.

Jo

Oh Brooke,  I have read through your posts and Catherine's very useful replies and I am so sorry you are having these problems with Pep.

I do wonder if she should be weaned off the preds, and if necessary this should be replaced with another drug (Avoid Previcox).  Preds can cause pancreatitis and it certainly won't be helping.  As you know it also causes muscle loss and in some breeds they lose weight when they are on preds, so an alternative might be a consideration.  I have also known older dogs not to tolerate the side effects of preds as well as they did in the past.

The good news is her kidney and liver values are good and this makes me think that whatever is the root cause of her current clinical signs, it could be resolved.  My concern was kidney failure but that is not the case. Pancreatitis is a tricky one to deal with sometimes - acute pancreatitis is urgent and very different in terms of how you respond, to chronic pancreatitis - and I don't see that enzymes would be a problem because she would likely just pass any excess through - and they might just help.

I have a book called:  The Pet Lovers Guide to Natural healing for cats and dogs by Barbara Fougere BVSc

'Pancreatitis - what you can do'
For chronic pancreatic problems,a highly digestible, low-fat, low fibre diet is recommended.  Protein should be of high quality and easy to digest.  Give small amount of food frequently rather than one big meal daily.  Each meal should be supplemented with digestive enzymes.  Low fat recipes should be fed under the supervision of your veterinarian.

Natural therapies:
Supplements:
Powered digestive enzymes
Cobalamin
Vitamins A, D, E, K, (these fat soluble vitamins may be low in a low-fat diet)
Vitamin B Complex or a multivitamin and mineral mix

Bach Flower remedy:
Rescue remedy is appropriate for pancreatitis: Olive and hornbeam for recovery.

Homoeopathy
Acute attacks Iris Versicolor 30c


My daughters dog had terrible problems with pancreatitis - usually acute - and Iris Versicolor  30C really worked, if she caught it early enough, but that might vary from dog to dog.

It sound like you have a vet who is will ing to work with you, so it might be worth discussing some of the above.

I do hope Pep can stabilise very soon and get back to he normal self again.

All the best
Jo

Hi Kay

GME is so often difficult to diagnose.  Reducing prednsiolone slowly is not a bad thing as long as the dog is coping with the numerous side effects.  One thing that pred causes is muscle weakness and this treatment can sometimes be contraindicated when treating immune mediated conditions that affect the muscles and co-ordination.  There are other drugs that can be used instead, or in combination with pred to enable the pred dose to be reduced a bit quicker.  Leflunomide is one that is often used.  Take a look at this article.  The DVM360 website is an excellent resource.

https://www.dvm360.com/view/emerging-treatments-granulomatous-meningoencephalomyelitis-proceedings

I do think Catherine's suggestion of hydrotherapy is good, so that may be worth discussing with the vet at UC Davis.   

I am so pleased you have taken Farley to a good referral school.  They will be aware of all the different drugs that could be used.

Fingers crossed
Jo

Vaccination by Jo Tucker

Some of us (over a certain age) may be able to recall in the 1950’s 60’s and 70’s, the distressing signs of a young dog or puppy with a disease called distemper, sometimes known as `hard pad’.  I was about ten years old when I witnessed my friend’s puppy `climbing the walls’ (as I remember it) during a seizure caused by distemper.  It clearly had a lasting effect on me especially as there was no hope for the poor puppy and it had to be `put to sleep’.  In the late 1970’s many kennels were blighted with a new `killer’ disease called parvovirus and this proved to be devastating, especially to puppies. Both of these diseases are highly contagious and even today parvovirus could wipe out a whole litter and the virus remain active within the environment for a year or more.  Modified live vaccines were developed in an attempt to control these and other infectious diseases, including infectious canine hepatitis (canine adenovirus), and the good news is the vaccines have been very successful.  Distemper and infectious hepatitis are very rare in the UK these days, and parvovirus appears to be well under control in protected dogs. No one would want to see the return of those `dark days’, nor should we overlook the amazing achievement of immunisation – but can you have too much of a good thing?  Is annual vaccination a thing of the past and is it doing more harm than good?  Clearly some members of the veterinary profession, anti -vaccination groups and the pet owning public think so and in 2006 the World Small Animal Veterinary Association (WSAVA ) Vaccination Guidelines Group (VGG), Chaired by Prof. Michael J Day of Bristol University and author of ‘Clinical Immunology of the Dog and Cat’, convened to reassess the annual  “vaccinate against everything” protocol (practiced by vets for the best part of 50 years) and formulate  a new and more appropriate global vaccination guideline for cats and dogs based on modern science and decades of experience provided by internationally recognised experts in immunology, microbiology and vaccinology.
So why question the vaccine protocol that has been used for decades and have successfully brought these nasty diseases under control; and in doing so have saved so many dog’s lives?  Vaccines were genuinely considered harmless, but over the last 20 years or so, advancement in veterinary knowledge and experience, and reports of adverse reactions, such as the link to sarcomas developing at the vaccine injection site in cats; and a vaccine-linked trigger for immune mediated diseases in dogs, gave rise to question vaccine safety in companion animals.  This train of thought was further fuelled by all the adverse publicity surrounding the safety of the MMR vaccine in children.  Adverse reactions were, and still are, uncommon, but they do exist and vaccination guideline groups began to wonder if something could be done to reduce the small risk of adverse reaction without compromising the beneficial effect of vaccination.  The safety of vaccines was not the only reason for reassessing vaccine protocols.  It was the growing awareness that the duration of immunity for some vaccines was far longer than first thought and therefore likely that annual vaccination could be unnecessary.
The first WSAVA guidelines were produced in 2007 and updated in 2010. The guidelines are not compulsory but their recommendations could “assist the vet in practice to use vaccines more efficiently” (M.J.Day), and can be obtained from the WSAVA website.  In addition to the Vaccination Guidelines for vets there is an excellent, comprehensive step by step document written specifically for pet owners and breeders and this is a `must’ for any pet owner.  These guidelines take the reader through eleven sections giving sound, factual and scientific information, covering the major infectious diseases that we vaccinate against, through to how to report adverse reactions.  There is even a glossary of terms. This document is essential reading - and it’s free!  You just need to print it or read it on screen.
The chapter on immune response explains about the immune system and how the body responds to infections etc.  It also describes how the mother’s immunity (maternally derived antibodies- MDA) is passed to the pups via the placenta and mother’s milk (colostrum), and how the presence of these antibodies can negate the effect of vaccinations if they are given too early in the pup’s life. The maternal antibodies, present in the pup’s blood, will ‘fight’ and consequently cancel out the vaccine. So if your puppy has been vaccinated too early, unknown to you, it may not be protected.
 It also explains how the MDA levels in individual pups can differ, and why some pups in the litter may, depending on how much or how little maternal antibodies are present, respond to a vaccination at the age of 8 weeks and why others will not respond until 12 weeks or more.  The waning of mother’s immunity will vary from pup to pup but it is unlikely there will be any significant antibodies present after the age of 14-16 weeks.
The document explains the principle of vaccination, and how infectious disease can be brought under control, but in order for this to be possible `herd immunity’ is essential, meaning that the greater number of the population has to be immunised (>65%) for full effect.  BUT THIS DOES NOT MEAN THAT AN INDIVIDUAL DOG OR CAT HAS TO BE VACCINATED EVERY YEAR! 
“We should aim to vaccinate every animal with core vaccines, and to vaccinate each individual less frequently by only giving non-core vaccines that are necessary for that animal”  WSAVA, Vaccination Guidelines Group.
The VGG recognises that vaccination requirements may differ greatly between developed and undeveloped countries.  The global vaccination guidelines, devised by the VGG, have been welcomed by countries as a basis to further develop their existing national vaccination guidelines, and adopted by some countries where guidelines did not previously exist. 
Different types of vaccines, and the duration of immunity (DOI) are discussed.  The two major types of vaccines are defined as infectious (core) and non-infectious (non-core).  Infectious vaccines are also known as modified live vaccines (MLV) or live attenuated vaccines, and to be effective these have to infect the animal in order to cause an immune response which consequently produces protective antibodies.   
Core vaccines: `Contains antigens of infectious agents every dog and cat should be protected against as those infectious agents cause lethal disease.’
The VGG’s recommended core vaccination programme for dogs in the UK is canine parvovirus (CPV-2), canine distemper (CDV) and canine adenovirus (CAV), more commonly known as infectious hepatitis.   Fortunately, modern science has taken the guesswork out of knowing if your dog is protected against these diseases as the level of immunity can now be established by a simple blood test which measures antibodies to the core diseases that we vaccinate against. Antibody titre testing has shown that the duration of immunity provided by modified live vaccines is far greater than we are lead to believe by many vets in general practice and also the vaccine manufacturers.  Certainly the duration of protection provided by modified live vaccines is considerably longer than the non-infectious vaccine.  It is known that immunity provided by MLV’s can last many years;  in fact, it has been proven that only one dose of a MLV given after the maternal antibodies have left (greater than 16 weeks or as an adult) can provide a lifetime of immunity for a dog.  However, if the vaccination programme is started at 16 weeks of age it is recommended that two doses are given, two weeks apart, as some pups may not respond to one dose.  The manufacturer’s guidelines recommending MLV revaccination, or boosters, after 3 years is attributed to the duration of the product’s license and not the duration of proven immunity.
Non-core vaccines:  `Are to protect against infectious agents that not every dog or cat risks being exposed to. Their use should be carefully considered and they should only be given to animals with a defined exposure risk.’
Non-infectious vaccines are referred to as `inactive’. These are used to vaccinate against diseases such as leptospirosis, bordetella, parainfluenza etc.  The duration of immunity created by inactive vaccines is known to be much shorter than the immunity produced by a live vaccine. Unlike MLV’s, non-infectious vaccines cannot infect the animal, so in order to be successful a substance called an adjuvant is added to enhance its effect. This allows the vaccine a clear passage to the immune system. Inactive vaccines, especially if they contain an adjuvant or whole killed bacteria, are more likely to cause adverse reactions.
The need to give non–core vaccinations should be assessed by the owner and vet based on lifestyle and the possibility of exposure to the non-core diseases.  For example, it may be prudent give a dog a leptospirosis vaccination if it regularly plays in water where rats may live, whereas a dog with a different lifestyle that’s unlikely to come in contact with rat infested water is at far less risk of contracting leptospirosis.  The owner and vet should adopt a `risk-benefit analysis’ for each individual animal and not just blindly vaccinate because `it is that time of the year again’! The VGG recommend that vets should aim to reduce the `vaccine load’ on individual animals. The manufacturer’s guidelines are for non-core vaccines to be given annually but it is known, for example, that immunity for leptospirosis may not last for twelve months, and can be a little as three, so you may think your dogs have immunity when for most of the time they haven’t!  So do your dogs really need the non-core vaccinations? Perhaps if the risk of exposure is so great they may need this vaccination more often than once a year.
Unlike infectious vaccines, non-infectious vaccines do not have the ability to produce a strong antibody presence; therefore an antibody titre test for this type of vaccine is of no value. Core vaccines are often 99% effective as opposed to only 70% or less efficacy of non-core vaccines.  A simple blood test can show the immunity your dog has to these core diseases and is a far better, scientific way of knowing if your dog is protected than simply giving yet another jab.
`The presence of serum antibody, regardless of titre, in an actively immunised dog over the age of 16 weeks is correlated with protection’.
Try not to be put-off by the cost of titre testing.  Your dog may only need one testing to indicate life-long protection, and at least you will know if previous vaccination has been successful or not.  Titre testing performed at Glasgow Veterinary School has always been very reasonably priced, and there is now a new product available in the UK, an in-house titre test called VacciCheck. This can be done quickly and simply at your vet’s surgery.
Genetics play a part in how an animal responds to vaccination.  Some dogs, due to their genetic make-up, will be a `non-responder’ and no matter how many times they are vaccinated they will never be able to produce protective antibodies to the core diseases.  Conversely, there are a percentage of dogs who respond to vaccination by producing a very high antibody titre.  Most adverse reactions are genetically driven, and some breeds or families will be more likely to develop adverse reactions than others.  The sire and dam of these affected dogs should not be mated together again.
It is proven that the duration of protection given by the core vaccines may last in excess of 9 years and possibly for the life of the dog and yet many vets in general practice still insist their `clients’ should be vaccinated annually, even though this could be doing the animal more harm than good.  A survey showed only 53% of UK vet practices had adopted the VGG recommended vaccine protocols for dogs. 
A change is also needed in local bylaws that govern kennels and catteries as, unbelievably, they still insist on annual vaccination for boarders.  Annual, or repeated, modified live vaccination does not necessarily increase protective immunity, as existing antibodies can fight against the vaccine, blocking it at the injection site and rendering it useless, therefore no benefit is gained. How many times do you hear if a dog has missed the revaccination date it has to have a full course of vaccinations again?  Dogs that have not been regularly vaccinated but have previously received puppy shots and a yearly booster, only require a single dose of core vaccine and not a full course of vaccinations again. The VGG state that `this practice is unjustified and simply contrary to the fundamental principle of immunological memory’. 
So why has the uptake of the WSAVA vaccination guidelines been so slow in general veterinary practice in the UK?  I’ll leave you to think about that.
This short article is intended to be an `appetiser’.  It is impossible to condense such a comprehensive document into a few paragraphs.  Please don’t take my word for it – go into the WSAVA website and print off the information you need.  It is so refreshing to have experts in the veterinary field writing a  paper, specifically for pet owners and breeders, and one that doesn’t try to `pull the wool over our eyes’. It has been written for good reason, in an attempt to transform the old fashioned, traditional vaccine protocol that has been in place for almost half a century, and this can only benefit our pets. Change can be made through the power of reliably informed dog owners and breeders. Yes, it is saying that vaccinating the individual is important (it must not be forgotten that vaccination was successful in eradicating smallpox virus from the world) but it is also suggesting that the decision whether to revaccinate or not lies with the owner and should be tailored to the individual dog.  Annual vaccination is outdated and a thing of the past so don’t let your vet convince you that you are being irresponsible by not continuing to annually vaccinate your dog – in fact you are being responsible!  Your vet should be aware of these guidelines, and if he or she chooses to ignore the VGG recommendations and continue to encourage annual vaccination then it is the vet who is being irresponsible and perhaps contravening the veterinary surgeons code:
 “...........to ensure the welfare of animals committed to my care and that I will pursue the work of my profession with integrity and accept my responsibilities.................”

References:
World Small Animal Veterinary Association Vaccination Guidelines (WSAVA) for the Owners and Breeders of Dogs and Cats (2011) http://www.wsava.org/VGG1.htm
WSAVA Guidelines for the Vaccination of Dogs and Cats (Revised 2010)
Veterinary Record – BSAVA Congress: Different Perspectives on Vaccination Advice (April 2011) Report by Catherine Jacob
Veterinary Record – Research: Vaccination of Dogs and Cats: No Longer so Controversial? M.J.Day (May 2011)
Draft Code of Professional Conduct for Veterinary Surgeons (2011)
Antibody titre testing can be performed at University of Glasgow, School of Veterinary Medicine and other UK laboratories.
VacciCheck is now available in the UK from:  Complete Veterinary Care –http://www.cvcgroup.co.uk/, telephone 01923 470 0101. The parent company’s website is www.biogal.co.il/.

Hi

I am so sorry to hear your sad story.

There is no easy path we can take when our dogs are so unwell that a decision needs to be made - not for us - but for them.  It is the most unselfish thing you can do, and getting the time  right, I feel,  is the most difficult.  The love we have for our dogs is pure and it comes from the same place whether it be an animal or a beloved human.  It is a huge loss. 

Writing down your concerns, and expressing your pain helps sometimes, as it purges your heart and mind of those negative thoughts and the total frustration of not being in control, and having to make a decision that we just don't want to make.   You did all you could for your boy.  You didn't just accept one vet's opinion, you took him to see a specialist and from what you say, you had no choice.   Letting him go was the ultimate kindness.  He is no longer in pain.   He was a lucky boy to have you care for him throughout his life, so hold on to the lovely memories because in time they will come to the fore and warm your heart, but it does take time.

Our thoughts are with you.

Jo

 

Hi

Many, but not all,  inflammatory immune mediated diseases carry a high temperature.  Has this been a feature on Farley's case?

Hind leg weakness can be a symptom of so many diseases, and it is not always due to a muscular problem.  It could be due to a structural  problem in the spine or the messages from the nerves are not getting through to the muscles, or an inflammatory immune mediated problem. This particular website, DVM 360,  is a very good resource and is definitely worth checking out.

http://veterinarycalendar.dvm360.com/diagnosis-and-management-generalized-weakness-dog-proceedings

Has UC Davis tested for the SOD 1 gene mutation that is seen with Canine degenerative myleopathy?   The Pembroke Welsh Corgi can be genetically predisposed to this condition, so it might be worth having a DNA test done.

https://en.wikipedia.org/wiki/Canine_degenerative_myelopathy

It is so frustrating when a definitive diagnosis can't be reached and speculative treatment doesn't seem to resolve the clinical signs. Prednisolone is an incredible drug but it can only be given for a limited duration because of the side effects.  I hope you can do more research so that when you go back to  UC Davis you will be able to have an informed and productive discussion with the vets there and go forward with a new drug protocol for Farley.

Please let us know how things go, and if you need to 'chat', even if it is not an immune mediated disease,  then we are here.

Jo

Hi and welcome

I am sorry your Yorkie has AIHA.   Imuran (Azathioprine) often doesn't agree with some dogs, so this is no surprise.

There are two types of AIHA.  One is when the immature red blood cells are being destroyed in the bone marrow, this is called non-regenerative anaemia, and the other is when the anaemia is secondary to something else going on in the body such as, the red blood cells are being destroyed within the circulation of the blood or destroyed by the spleen, cancer etc. This is known as regenerative anaemia.  If it is the latter then the primary cause of the anaemia needs to be identified and resolved, for example if the red blood cells are being destroyed by the spleen, then it will be necessary to remove the spleen.  After surgery the red blood cells will return to normal level.
   
 The mainstay of treatment for non-regenerative AIHA is immunosuppressive doses of preds, and following a good protocol, such as the one that Catherine has copied for you.   If the dose is not high enough then the immune system will not be significantly suppressed in order to stop the destruction of the red blood cells, and the treatment will not work.  Also, it is worth mentioning that smaller dogs, or puppies, because they have a quicker metabolism, will often need a slightly higher dose of prednsiolone than 1mg/kg/12 hours and they also tolerate the higher dose of preds much better than larger dogs.   So from the information you have given 7.5mg per day of prednsiolone is not sufficient and it is only an anti-inflammatory dose and not an immunosuppressive dose of pred. 

As Catherine has mentioned, there are other immunosuppressive drugs that can be used as 'combination' therapy if necessary.   There are many dogs on this forum who have been treated correctly and have survived, so don't give up on your girl.  Do you live near a specialist vet or a vet college where you can get specialist help? If you do then your vet will be able to give you a referral letter.  If this is not possible, please ask your vet to telephone a vet college, such as Glasgow, or the Royal Vet College in Hertfordshire and ask him/her to talk to an internal medicine specialist, who will be able to direct your vet as to what dose of pred to give your girl and a good protocol to follow, and advise if another immunosuppressive drug is needed.   This is key to a good outcome.  The protocol that Catherine has posted is the best I have come across and it can be confidently used as a guide.

I do hope you can get your vet to work with you and your Yorkie reaches remission.

Jo