Welcome, Guest. Please login or register.
Did you miss your activation email?
Show Posts
This section allows you to view all posts made by this member. Note that you can only see posts made in areas you currently have access to.
1
Auto immune disease in the dog - start here if you aren't sure. / Re: Steroid Responsive Meningitis ?
« on: July 09, 2020, 09:54:08 AM »
Hi Danielle
There are lots of different drugs on the MDR1 gene mutation list and not all will affect those who have the mutation. Sometimes the dose is relevant eg., high doses may affect the dog but not lower doses, so if Zora has coped well with the drug this far, it suggests that she will be fine.
You are so aware of the bigger picture, I am sure if you will know, just by looking at Zora, if she is not right and you need to change things.
Fingers crossed she will just go from strength to strength now.
Jo
P.S.
Just a note. When a dog is on a course of prednsiolone, it is important that the dose is tapered, and reduced over a period of time, and not suddenly stopped. Many other drugs, like antibiotics, can be stopped without weaning down, but not steroids.
There are lots of different drugs on the MDR1 gene mutation list and not all will affect those who have the mutation. Sometimes the dose is relevant eg., high doses may affect the dog but not lower doses, so if Zora has coped well with the drug this far, it suggests that she will be fine.
You are so aware of the bigger picture, I am sure if you will know, just by looking at Zora, if she is not right and you need to change things.
Fingers crossed she will just go from strength to strength now.
Jo
P.S.
Just a note. When a dog is on a course of prednsiolone, it is important that the dose is tapered, and reduced over a period of time, and not suddenly stopped. Many other drugs, like antibiotics, can be stopped without weaning down, but not steroids.
2
Auto immune disease in the dog - start here if you aren't sure. / Re: Steroid Responsive Meningitis ?
« on: July 08, 2020, 09:27:17 AM »
Hi
Twitching and muscle spasms are not unusual when a dog is sleeping, and it is quite normal, but I think it depends on what degree of twitching and muscle spasm occurs and if they disappear when the dog wakes up. Often it is just the dog dreaming and the movement can be quite robust and jerky at times.
Regardless of the cause, the combination of antibiotic and steroids have undoubtedly controlled/resolved the symptoms you were seeing, so this is good news. Until you have finished the course of medication I don't think you can make an assessment of what may or may not be long term, or something that has not yet been identified. I don't think the slight whistle sounds when sleeping is due to the medication but it might be a part of the inflammatory condition she is getting over. I wouldn't worry about it at this time. As for the breathing - preds can quicken breathing and cause a dog to pant more, so again see what Zora is like when she is off medication.
Doing the MDR1 test is a good thing for the future. I think you are really managing this very well and I am so glad that you have taken on board the advice of the WSAVA.
Jo
Twitching and muscle spasms are not unusual when a dog is sleeping, and it is quite normal, but I think it depends on what degree of twitching and muscle spasm occurs and if they disappear when the dog wakes up. Often it is just the dog dreaming and the movement can be quite robust and jerky at times.
Regardless of the cause, the combination of antibiotic and steroids have undoubtedly controlled/resolved the symptoms you were seeing, so this is good news. Until you have finished the course of medication I don't think you can make an assessment of what may or may not be long term, or something that has not yet been identified. I don't think the slight whistle sounds when sleeping is due to the medication but it might be a part of the inflammatory condition she is getting over. I wouldn't worry about it at this time. As for the breathing - preds can quicken breathing and cause a dog to pant more, so again see what Zora is like when she is off medication.
Doing the MDR1 test is a good thing for the future. I think you are really managing this very well and I am so glad that you have taken on board the advice of the WSAVA.
Jo
3
Auto immune disease in the dog - start here if you aren't sure. / Re: Steroid Responsive Meningitis ?
« on: July 07, 2020, 05:36:16 PM »
Hi
For a start, you didn't cause this. It happens. Not all dogs can cope with these preventative treatments and there are lots of documented adverse reactions. A lot depends on the genetic make-up/predisposition of the dog and of course this is not known to us before meds are given. Now you know that there is the potential for an adverse reaction you can manage Zora differently, and with awareness.
Did the episode of October 2019 follow any treatments, vaccines etc?
Not walking straight, stumbling and standing with the back legs apart to correct balance is called ataxia. It is likely caused by some neurological disturbance that has either been triggered by the meds or there is a predisposition that fails to stop certain drugs from entering the brain pathway. Look up MDR1 gene mutation. http://www.ashgi.org/home-page/genetics-info/faq/mdr1-faqs
If it is something of this nature then she should improve as the days pass. The preds are a fantastic anti-inflammatory drug, and this will help enormously to reduce inflammation and shorten the duration of symptoms, and when she is weaned off the steroids she will hopefully be normal again. This has been a warning, so in a way you are lucky that you know about this potential problem and you can avoid triggers or causes in the future.
She has had a booster vaccine after the age of 16 weeks, so it is likely that she will be immune to those core diseases and therefore no vaccinations will be necessary. Only worm her if you see worms and only use flea treatments if you see fleas - but avoid spot-on treatments and use the mildest available or natural remedies. Check out the WSAVA vaccination guidelines and feel happy about any future vaccination decision you make.
https://wsava.org/wp-content/uploads/2020/01/WSAVA-Vaccination-Guidelines-2015.pdf
Thuja is a homoeopathic remedy for reactions to vaccines. You can get it from Ainsworth's the homoeopathic pharmacy in London Tel: 0207 935 5330. They are very helpful. However, as Zora is improving on the current treatment, and unless you intend to give her any further vaccinations, you probably don't need to give it to her at this time. If, when she is off steroids, you still feel she might benefit from giving a homoeopathic remedy then perhaps a call to Ainsworth's might be worth doing.
When she is back to her usual self, if you see episodes that you are not happy about then she may have to be investigated again, but if it is a reaction to the meds then I really think she will be back to her old self again. I had a boy once with demodex - a skin mite. I had tried everything to get rid of this mite but nothing worked - everything except Ivermectin. He was a bearded collie and I was aware of the potential MDR1 gene mutation in collies and the risk of Ivermectin in MDR1 positive animals. In those days they didn't have a gene test for MDR1 mutation, but they do now. So I gave a 1/4 of a pipette - and he responded fine. Three days later I gave another 1/4 of the pipette and within one hour he started staggering and had dreadful neurological signs. I had to stop the Ivermectin. His symptoms were severe but over 3-4 days he started to improve and he fully recovered from the adverse reaction. Unfortunately, I didn't manage to get rid of the demodex, but that is another story!
I do hope Zora continues to improve. If it were SRMA, on this low dose of steroids she wouldn't get better and in time she would just get worse.
Jo
For a start, you didn't cause this. It happens. Not all dogs can cope with these preventative treatments and there are lots of documented adverse reactions. A lot depends on the genetic make-up/predisposition of the dog and of course this is not known to us before meds are given. Now you know that there is the potential for an adverse reaction you can manage Zora differently, and with awareness.
Did the episode of October 2019 follow any treatments, vaccines etc?
Not walking straight, stumbling and standing with the back legs apart to correct balance is called ataxia. It is likely caused by some neurological disturbance that has either been triggered by the meds or there is a predisposition that fails to stop certain drugs from entering the brain pathway. Look up MDR1 gene mutation. http://www.ashgi.org/home-page/genetics-info/faq/mdr1-faqs
If it is something of this nature then she should improve as the days pass. The preds are a fantastic anti-inflammatory drug, and this will help enormously to reduce inflammation and shorten the duration of symptoms, and when she is weaned off the steroids she will hopefully be normal again. This has been a warning, so in a way you are lucky that you know about this potential problem and you can avoid triggers or causes in the future.
She has had a booster vaccine after the age of 16 weeks, so it is likely that she will be immune to those core diseases and therefore no vaccinations will be necessary. Only worm her if you see worms and only use flea treatments if you see fleas - but avoid spot-on treatments and use the mildest available or natural remedies. Check out the WSAVA vaccination guidelines and feel happy about any future vaccination decision you make.
https://wsava.org/wp-content/uploads/2020/01/WSAVA-Vaccination-Guidelines-2015.pdf
Thuja is a homoeopathic remedy for reactions to vaccines. You can get it from Ainsworth's the homoeopathic pharmacy in London Tel: 0207 935 5330. They are very helpful. However, as Zora is improving on the current treatment, and unless you intend to give her any further vaccinations, you probably don't need to give it to her at this time. If, when she is off steroids, you still feel she might benefit from giving a homoeopathic remedy then perhaps a call to Ainsworth's might be worth doing.
When she is back to her usual self, if you see episodes that you are not happy about then she may have to be investigated again, but if it is a reaction to the meds then I really think she will be back to her old self again. I had a boy once with demodex - a skin mite. I had tried everything to get rid of this mite but nothing worked - everything except Ivermectin. He was a bearded collie and I was aware of the potential MDR1 gene mutation in collies and the risk of Ivermectin in MDR1 positive animals. In those days they didn't have a gene test for MDR1 mutation, but they do now. So I gave a 1/4 of a pipette - and he responded fine. Three days later I gave another 1/4 of the pipette and within one hour he started staggering and had dreadful neurological signs. I had to stop the Ivermectin. His symptoms were severe but over 3-4 days he started to improve and he fully recovered from the adverse reaction. Unfortunately, I didn't manage to get rid of the demodex, but that is another story!
I do hope Zora continues to improve. If it were SRMA, on this low dose of steroids she wouldn't get better and in time she would just get worse.
Jo
4
Auto immune disease in the dog - start here if you aren't sure. / Re: Steroid Responsive Meningitis ?
« on: July 06, 2020, 03:26:13 PM »
Hello and welcome
I am sorry that Zora is unwell.
From the history you have provided, I do wonder if the symptoms that you saw yesterday, and those that you are seeing now, are a result of an adverse reaction to the vaccines and spot-on treatments and not SRMA? Did you discuss with the vet that Zora could be having an adverse reaction to the vaccines and spot-on?
The clinical signs of SRMA are quite distinct and these include, extreme pain specially around the neck, and the neck is stiff and hung low, unwillingness to move with a stiff gait due to pain, and extremely high temperature, usually greater than 39.9. The pain that SRMA dogs are experiencing cannot be ignored.
If it is an adverse reaction to the vaccine and/or the spot-on treatments then hopefully the clinical signs will subside within a few days. You could try a homoeopathic remedy for adverse reactions called Thuja. This can be bought from a homoeopathic pharmacy such as Ainsworths.
As for a spinal tap to test for SRMA, unless Zora is showing the typical clinical signs of SRMA then personally, I wouldn't go down that route. The vet has given her prednisolone which is a steroid and this should reduce the inflammation, but if it is SRMA then the dose she is on will not be enough to control SRMA and bring it into remission. Immunosuppressive doses of prednsiolone are needed when treating SRMA. For a dog to have a spinal tap they should be off of steroids for a couple of weeks otherwise the prednsiolone will interfere with the results.
If Zora does get over this episode, on the current treatment, then I think you can assume it is an adverse reaction, and if this is the case then she shouldn't ever have any more vaccinations or spot on preventive treatments. If Zora's clinical signs worsen, it could still be an adverse reaction, but if she does get the typical signs of SRMA then your vet will need to treat speculatively and increase the dose of prednsiolone to 1mg/kg/12hours and follow a good reducing protocol such as Prof M J Day's. See below.
Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition, by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS
Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based 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.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
I do hope Zora will improve further without any further tests or medication.
All the best
Jo
I am sorry that Zora is unwell.
From the history you have provided, I do wonder if the symptoms that you saw yesterday, and those that you are seeing now, are a result of an adverse reaction to the vaccines and spot-on treatments and not SRMA? Did you discuss with the vet that Zora could be having an adverse reaction to the vaccines and spot-on?
The clinical signs of SRMA are quite distinct and these include, extreme pain specially around the neck, and the neck is stiff and hung low, unwillingness to move with a stiff gait due to pain, and extremely high temperature, usually greater than 39.9. The pain that SRMA dogs are experiencing cannot be ignored.
If it is an adverse reaction to the vaccine and/or the spot-on treatments then hopefully the clinical signs will subside within a few days. You could try a homoeopathic remedy for adverse reactions called Thuja. This can be bought from a homoeopathic pharmacy such as Ainsworths.
As for a spinal tap to test for SRMA, unless Zora is showing the typical clinical signs of SRMA then personally, I wouldn't go down that route. The vet has given her prednisolone which is a steroid and this should reduce the inflammation, but if it is SRMA then the dose she is on will not be enough to control SRMA and bring it into remission. Immunosuppressive doses of prednsiolone are needed when treating SRMA. For a dog to have a spinal tap they should be off of steroids for a couple of weeks otherwise the prednsiolone will interfere with the results.
If Zora does get over this episode, on the current treatment, then I think you can assume it is an adverse reaction, and if this is the case then she shouldn't ever have any more vaccinations or spot on preventive treatments. If Zora's clinical signs worsen, it could still be an adverse reaction, but if she does get the typical signs of SRMA then your vet will need to treat speculatively and increase the dose of prednsiolone to 1mg/kg/12hours and follow a good reducing protocol such as Prof M J Day's. See below.
Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition, by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS
Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based 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.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
I do hope Zora will improve further without any further tests or medication.
All the best
Jo
5
Systemic / Inflammatory (AIHA, IMTP, Evans, SLE, IMPA, SRMA) / Re: Foreign travel to France with IMT
« on: July 06, 2020, 02:34:32 PM »
Hi
I don't know enough about foreign travel but, nearer the time you want to go away, I would certainly have an antibody titre test to see what vaccinations are needed, if any. It could be that there are antibodies to all that you need and therefore Pippa will have protection.
Jo
I don't know enough about foreign travel but, nearer the time you want to go away, I would certainly have an antibody titre test to see what vaccinations are needed, if any. It could be that there are antibodies to all that you need and therefore Pippa will have protection.
Jo
6
Tell us a bit about yourself and your dog/s and learn more about the forum. / Re: Hello and introducing myself
« on: July 03, 2020, 10:15:59 AM »
This is the best reducing protocol that I have come across 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
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS
Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based 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.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition, by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS
Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based 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.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
7
Tell us a bit about yourself and your dog/s and learn more about the forum. / Re: Hello and introducing myself
« on: July 03, 2020, 10:14:31 AM »
Hi
"Do I need to worry about very fast breathing When she is resting or is this just another side effect of the steroids? "
Yes, you should be worried. Knowing that Pippa has been on exceptionally high doses of steroids for over a month and is still on a higher than needed immunosuppressive dose then, if Pippa were my dog, I would want the dose of prednsiolone reduced further now. Fast breathing isn't a good sign especially as Pippa's platelets are increasing fast.
If you keep her on this dose for another two weeks, that means she has been on very high doses (higher than need be) for 6 weeks and it is possible that the prolonged high doses of preds could cause serious problems, such a blood clots.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
40 mg/24hrs of prednsiolone for a 13kg dog is just over 3mg/kg/24hours. Pippa has had this dose for over one month.
30mg/24hrs is 2.3mg/kg/24hrs. Pippa is still having over the recommended maximum starting dose. See the guidelines above.
Side effects should be taken into account every day of treatment and if the clinical signs become intolerable or dangerous then the dose of pred should be reduced significantly enough to reduce the adverse effects.
Personally, and in response to the fast breathing, I would want the preds reduced to below an immunosuppressive dose. The steroids have done their job and there is no benefit to be gained by keeping her on very high doses - only harm.
If you are anxious about having this discussion with your vet (and I understand why) then you can ask him for a referral to a specialist veterinary practice or vet school.
At this stage, the side effects of the drugs are as important, if not more so, than controlling the disease.
Jo
"Do I need to worry about very fast breathing When she is resting or is this just another side effect of the steroids? "
Yes, you should be worried. Knowing that Pippa has been on exceptionally high doses of steroids for over a month and is still on a higher than needed immunosuppressive dose then, if Pippa were my dog, I would want the dose of prednsiolone reduced further now. Fast breathing isn't a good sign especially as Pippa's platelets are increasing fast.
If you keep her on this dose for another two weeks, that means she has been on very high doses (higher than need be) for 6 weeks and it is possible that the prolonged high doses of preds could cause serious problems, such a blood clots.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
40 mg/24hrs of prednsiolone for a 13kg dog is just over 3mg/kg/24hours. Pippa has had this dose for over one month.
30mg/24hrs is 2.3mg/kg/24hrs. Pippa is still having over the recommended maximum starting dose. See the guidelines above.
Side effects should be taken into account every day of treatment and if the clinical signs become intolerable or dangerous then the dose of pred should be reduced significantly enough to reduce the adverse effects.
Personally, and in response to the fast breathing, I would want the preds reduced to below an immunosuppressive dose. The steroids have done their job and there is no benefit to be gained by keeping her on very high doses - only harm.
If you are anxious about having this discussion with your vet (and I understand why) then you can ask him for a referral to a specialist veterinary practice or vet school.
At this stage, the side effects of the drugs are as important, if not more so, than controlling the disease.
Jo
8
Medication, supplements and alternative treatments / Re: Prednisolone
« on: July 01, 2020, 09:00:07 PM »
Hi
Usually the coat will grow back over a period of 6 months after the steroids are weaned off or at a very low every other day dose. So you have that to look forward to.
Jo
Usually the coat will grow back over a period of 6 months after the steroids are weaned off or at a very low every other day dose. So you have that to look forward to.
Jo
9
Tell us a bit about yourself and your dog/s and learn more about the forum. / Re: New member, looking for some advice
« on: July 01, 2020, 08:21:20 PM »
Hi
The initial improvement with the injectable steroid is good news but you must make sure that the prednsiolone tablets are at the correct dose 1mg/kg/12hours, otherwise it will not work and Scooby is very likely to relapse. I hope your vet is following the protocol by Michael J Day. The correct dose and duration is essential if remission is to be achieved.
Jo
The initial improvement with the injectable steroid is good news but you must make sure that the prednsiolone tablets are at the correct dose 1mg/kg/12hours, otherwise it will not work and Scooby is very likely to relapse. I hope your vet is following the protocol by Michael J Day. The correct dose and duration is essential if remission is to be achieved.
Jo
10
Tell us a bit about yourself and your dog/s and learn more about the forum. / Re: New member, looking for some advice
« on: June 30, 2020, 06:48:57 PM »
Hi and welcome
Gosh, poor Scooby. He has been through a lot - and probably you have too!
With all the testing that has been done, and still no diagnosis, one would think the high temperature is due to inflammation (the C-Reactive test also shows this).
It is said that cancer can be much easier to definitively diagnose than autoimmune disease. So, after all these tests, and like the vets say, when Scooby has healed from the biopsies, I would think the only way forward is to try Scooby on immunosuppressive doses of steroids. It might be that they give an injectable steroid called dexamethasone to see if the response is favourable and then, if it is, start Scooby on an immunosuppressive regimen of prednsiolone.
It is not unusual if a definitive diagnosis is not reached and an immune mediated disease is suspected, speculative immunosuppressive treatment is given. What do you have to lose?
If Scooby has an inflammatory autoimmune disease, I would expect him to respond quickly to the steroids - but the dose has to be immunosuppressive. Any lower, dose will not give the good response that is hoped for, and higher doses do not suppress the immune system any more, but they do produce unacceptable side effects, especially in a lurcher. The best immunosuppressive drug protocol that I have come across is by Prof Michael J Day. This can be confidently tailored to the individual. See below:
Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition, by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS
Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based 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.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
I do hope Scooby makes a speedy recovery from the 'surgery' so that he can start immunosuppressive treatment as soon as possible.
All the best
Jo
Gosh, poor Scooby. He has been through a lot - and probably you have too!
With all the testing that has been done, and still no diagnosis, one would think the high temperature is due to inflammation (the C-Reactive test also shows this).
It is said that cancer can be much easier to definitively diagnose than autoimmune disease. So, after all these tests, and like the vets say, when Scooby has healed from the biopsies, I would think the only way forward is to try Scooby on immunosuppressive doses of steroids. It might be that they give an injectable steroid called dexamethasone to see if the response is favourable and then, if it is, start Scooby on an immunosuppressive regimen of prednsiolone.
It is not unusual if a definitive diagnosis is not reached and an immune mediated disease is suspected, speculative immunosuppressive treatment is given. What do you have to lose?
If Scooby has an inflammatory autoimmune disease, I would expect him to respond quickly to the steroids - but the dose has to be immunosuppressive. Any lower, dose will not give the good response that is hoped for, and higher doses do not suppress the immune system any more, but they do produce unacceptable side effects, especially in a lurcher. The best immunosuppressive drug protocol that I have come across is by Prof Michael J Day. This can be confidently tailored to the individual. See below:
Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition, by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS
Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based 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.
Prednisolone: "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight." Plumb's Veterinary Drug Handbook Eight Edition.
I do hope Scooby makes a speedy recovery from the 'surgery' so that he can start immunosuppressive treatment as soon as possible.
All the best
Jo
11
Tell us a bit about yourself and your dog/s and learn more about the forum. / Re: New member Woody, in need of advice!
« on: June 30, 2020, 11:04:34 AM »
Hi Elaine
You will have to check with your insurance company but when I decided not to vaccinate my dogs after their antibody tests proved that they had immunity, the insurance company were fine with this but said that they wouldn't be covered for those diseases that we vaccinate against. In all other respects the cover was the same.
Again, with lepto, you must weigh up the pros and cons -
only 4 strains of lepto are covered out of over 200,
and the very reduced duration of efficacy (they only give it annually but it doesn't last anywhere near that long)
and also the higher risk of an adverse reaction to the adjuvant that has to be used to make the vaccine effective
and how prevalent is lepto?
and how easy or difficult it is to contract?
Personally, I do think the core vaccinations are important, but if the dog has antibody titres then I wouldn't re vaccinate but you may want to do another titre test in a few years to check that the dog still has immunity.
Lepto is not considered core in the UK and neither are the other intranasal vaccines. Lepto should be tailored to the individual dog and their lifestyle and possible exposure to the virus. Vaccines and preventative treatments are the vets and drug companies 'bread and butter'. The guidelines do not take into account the individual dog's predisposition and I have to say that some vets will give an annual vaccination even to a poorly dog - out of ignorance - and this is the worse thing to do.
You have a choice whether to vaccinate or not, and you have to be content with your decision. This is the risk you take. Not giving a booster to an already protected dog might be a lesser risk than vaccinating and giving unnecessary preventative treatments. Whatever you decide it has to be a calculated risk.
This is a big decision, but if you do decide not to vaccinate any more, all I can say is the anxiety you feel now does subside overtime.
Jo
You will have to check with your insurance company but when I decided not to vaccinate my dogs after their antibody tests proved that they had immunity, the insurance company were fine with this but said that they wouldn't be covered for those diseases that we vaccinate against. In all other respects the cover was the same.
Again, with lepto, you must weigh up the pros and cons -
only 4 strains of lepto are covered out of over 200,
and the very reduced duration of efficacy (they only give it annually but it doesn't last anywhere near that long)
and also the higher risk of an adverse reaction to the adjuvant that has to be used to make the vaccine effective
and how prevalent is lepto?
and how easy or difficult it is to contract?
Personally, I do think the core vaccinations are important, but if the dog has antibody titres then I wouldn't re vaccinate but you may want to do another titre test in a few years to check that the dog still has immunity.
Lepto is not considered core in the UK and neither are the other intranasal vaccines. Lepto should be tailored to the individual dog and their lifestyle and possible exposure to the virus. Vaccines and preventative treatments are the vets and drug companies 'bread and butter'. The guidelines do not take into account the individual dog's predisposition and I have to say that some vets will give an annual vaccination even to a poorly dog - out of ignorance - and this is the worse thing to do.
You have a choice whether to vaccinate or not, and you have to be content with your decision. This is the risk you take. Not giving a booster to an already protected dog might be a lesser risk than vaccinating and giving unnecessary preventative treatments. Whatever you decide it has to be a calculated risk.
This is a big decision, but if you do decide not to vaccinate any more, all I can say is the anxiety you feel now does subside overtime.
Jo
12
Tell us a bit about yourself and your dog/s and learn more about the forum. / Re: New member Woody, in need of advice!
« on: June 29, 2020, 04:21:43 PM »
Hi Elaine
Good news that Woody is doing well.
You have done all the right things by testing. No one can tell you whether to booster or not, you have to do your homework and be happy that you are making the right decision. The best guide to read is the WSAVA vaccination guidelines
https://wsava.org/wp-content/uploads/2020/01/WSAVA-Vaccination-Guidelines-2015.pdf
A few years ago I attended a seminar at the Royal Veterinary College. Prof Brian Catchpole was speaking about autoimmune disease in the dog. At question time I took the opportunity of asking him, "Should a dog that has had an AI disease ever be vaccinated again?" and his reply was a resounding "NO"!!! He went on to say that the benefits of vaccination should outweigh the risks and in a dog that has a genetic predisposition to autoimmunity the risks of vaccination are too high - and this applies to spot on and any unnecessary preventative treatments. The dog should be kept as natural as possible and only treat with chemicals if you have to for fear of these things triggering another AI disease or relapse.
In the WSAVA vaccination guidelines you will see that it is recommended to vaccinate more dogs (to achieve herd immunity) but those that are vaccinated should be vaccinated less often. It also states that any measurement of antibodies to the core diseases, no matter how small, correlates to immunity. If you vaccinate a dog as an adult, or after the age of 16 weeks when the maternal antibodies have gone, then it may never need a vaccination (to the core diseases) again. This means that the dog will likely have protection for at least 9 years, if not the life of the dog (WSAVA).
When a dog has been vaccinated with the core vaccines, and there are positive antibodies to those diseases in the blood, in times when the dog doesn't encounter the virus in the field, it is natural for those antibodies to reduce to small numbers (because they are not needing to be active). When the dog encounters the virus on his walks, those antibodies will respond and multiply to give immunity. This is how vaccination works. So it is fine if the Distemper antibodies are 40. They could go even lower than that, and when needed they will multiply - as long as there are antibodies they will provide protection. Also, as Catherine says, because vaccination has been so successful the core diseases are very rare in the UK anyway. You have to weigh up the pros and cons. Vaccination has its place for sure, but you can have too much of a good thing.
With regard to lepto vaccine, it is a killed virus vaccine and this is why antibodies are unlikely to be detected on a test. It is given once a year but the truth is, it is likely to give protection for only 3-6 months, so for at least half of the time you think the dog has immunity, it doesn't. Also, there are over 250 strains of leptospirosis and you can only vaccinate against 4 of them. The killed virus vaccine has to have an adjuvant to open up the immune system in order for it to take effect and this can trigger an adverse immune response in genetically predisposed dogs. Lepto is also rare, and should only be given if the dog frequents places like rat infested waters etc. The urine of a rat that has leptospirosis has to enter the dog's body either by it drinking the water, or through broken skin, for it to be a risk. Another seminar, on vaccinations, that I attended at the RVC and presented by Prof Michael J Day, when he was asked about leptospirosis vaccine, he said - "Where is leptospirosis? I would like to do a survey of the incidence throughout the UK." This is why is not considered a core vaccine.
Over a period of 4 years, I antibody titre tested 4 of my dogs and this taught me a lot - and also my vet admitted that he learned a lot too. It was a good exercise to do and it proved that from one year to another the antibody titres naturally fluctuate, and yet there was still immunity.
After all that, the choice is still yours. Happy reading!
Jo
Good news that Woody is doing well.
You have done all the right things by testing. No one can tell you whether to booster or not, you have to do your homework and be happy that you are making the right decision. The best guide to read is the WSAVA vaccination guidelines
https://wsava.org/wp-content/uploads/2020/01/WSAVA-Vaccination-Guidelines-2015.pdf
A few years ago I attended a seminar at the Royal Veterinary College. Prof Brian Catchpole was speaking about autoimmune disease in the dog. At question time I took the opportunity of asking him, "Should a dog that has had an AI disease ever be vaccinated again?" and his reply was a resounding "NO"!!! He went on to say that the benefits of vaccination should outweigh the risks and in a dog that has a genetic predisposition to autoimmunity the risks of vaccination are too high - and this applies to spot on and any unnecessary preventative treatments. The dog should be kept as natural as possible and only treat with chemicals if you have to for fear of these things triggering another AI disease or relapse.
In the WSAVA vaccination guidelines you will see that it is recommended to vaccinate more dogs (to achieve herd immunity) but those that are vaccinated should be vaccinated less often. It also states that any measurement of antibodies to the core diseases, no matter how small, correlates to immunity. If you vaccinate a dog as an adult, or after the age of 16 weeks when the maternal antibodies have gone, then it may never need a vaccination (to the core diseases) again. This means that the dog will likely have protection for at least 9 years, if not the life of the dog (WSAVA).
When a dog has been vaccinated with the core vaccines, and there are positive antibodies to those diseases in the blood, in times when the dog doesn't encounter the virus in the field, it is natural for those antibodies to reduce to small numbers (because they are not needing to be active). When the dog encounters the virus on his walks, those antibodies will respond and multiply to give immunity. This is how vaccination works. So it is fine if the Distemper antibodies are 40. They could go even lower than that, and when needed they will multiply - as long as there are antibodies they will provide protection. Also, as Catherine says, because vaccination has been so successful the core diseases are very rare in the UK anyway. You have to weigh up the pros and cons. Vaccination has its place for sure, but you can have too much of a good thing.
With regard to lepto vaccine, it is a killed virus vaccine and this is why antibodies are unlikely to be detected on a test. It is given once a year but the truth is, it is likely to give protection for only 3-6 months, so for at least half of the time you think the dog has immunity, it doesn't. Also, there are over 250 strains of leptospirosis and you can only vaccinate against 4 of them. The killed virus vaccine has to have an adjuvant to open up the immune system in order for it to take effect and this can trigger an adverse immune response in genetically predisposed dogs. Lepto is also rare, and should only be given if the dog frequents places like rat infested waters etc. The urine of a rat that has leptospirosis has to enter the dog's body either by it drinking the water, or through broken skin, for it to be a risk. Another seminar, on vaccinations, that I attended at the RVC and presented by Prof Michael J Day, when he was asked about leptospirosis vaccine, he said - "Where is leptospirosis? I would like to do a survey of the incidence throughout the UK." This is why is not considered a core vaccine.
Over a period of 4 years, I antibody titre tested 4 of my dogs and this taught me a lot - and also my vet admitted that he learned a lot too. It was a good exercise to do and it proved that from one year to another the antibody titres naturally fluctuate, and yet there was still immunity.
After all that, the choice is still yours. Happy reading!
Jo
13
Tell us a bit about yourself and your dog/s and learn more about the forum. / Re: Hello and introducing myself
« on: June 29, 2020, 03:15:43 PM »
That's all good news. Fingers crossed.
Jo
Jo
14
Systemic / Inflammatory (AIHA, IMTP, Evans, SLE, IMPA, SRMA) / Re: Cushings- advice please
« on: June 27, 2020, 09:50:09 AM »
How Can I Tell if My Dog Develops Iatrogenic Cushing’s Syndrome?
Iatrogenic means ‘drug induced’. Clinical signs of Iatrogenic Cushing’s syndrome are the same as primary Cushing’s syndrome but can present with acute clinical signs. It reflects the level of corticosteroid in the body.
The most notable side effects are, heavy panting, some hair loss, and an increase in drinking and urinating, excessive pigmentation. This is something everyone seems to be aware of and accepts as normal when a dog is on high dose steroids. Very often the dog will be weaned down to a low dose before any major problems arise.
Acute Cushing’s syndrome due to overdosing of corticosteroids can be very serious. Blood results will reflect this, especially the liver enzymes which may be extremely high. Red blood cells and blood platelets may also be high and blood clotting may be a risk.
So when should you alert your vet to suspected, unacceptable level of corticosteroid? The owner should take note when other clinical signs occur, such as: Depression, anorexia, muscle wasting and extreme weakness, continuous panting, lethargy - unwillingness to exercise, skin lesions and thinning of the skin, excessive hair loss, pot-bellied appearance and sagging back, behavioural changes (aggression).
If your dog is showing these signs it will probably mean that the dose of steroids needs to be lowered. It is important that it is not confused with a relapse of the dog’s condition or an infection. The dilemma is that steroids must not be withdrawn too quickly otherwise the dog may go into an adrenal insufficiency crisis. If the clinical signs of iatrogenic Cushing’s syndrome is intolerable, it is hoped that the high dose of steroids that he has been on will have already done their job and that his autoimmune disease will be stable. As long as the steroids are lowered in a controlled manner and in time, all the symptoms of Cushing’s will subside and your dog will return to normal, but extreme signs must not be ignored.
Reducing the Tablets
When significant improvement in the dog’s condition is seen, usually between 10-28 days, the initial steroid dose is usually reduced by 25%. The dose is generally given for another 10 - 28 days and depending on the dog’s progress and clinical signs the dose is significantly reduced once more for a further 10-28 days; and again in another 10-28 days. Anecdotal evidence has shown that if at this stage the dose is lowered more slowly, or reduced to an every other day dose over a period of months rather than weeks, relapse are less likely to occur. It is always tempting to get your dog off steroids as soon as possible, but when treating autoimmune disease, as long as the dog is on a low, every other day dose then taking the last stage slowly seems to work best, depending, of course, on the severity of the disease and allowing for the difference in individual response - no two dogs reactions are exactly the same. With some autoimmune diseases such as SLE, the dog is likely to be on steroids for the rest of his life. Usually an every other day dose can be achieved, but you risk a relapse if you take the dose too low.
Iatrogenic means ‘drug induced’. Clinical signs of Iatrogenic Cushing’s syndrome are the same as primary Cushing’s syndrome but can present with acute clinical signs. It reflects the level of corticosteroid in the body.
The most notable side effects are, heavy panting, some hair loss, and an increase in drinking and urinating, excessive pigmentation. This is something everyone seems to be aware of and accepts as normal when a dog is on high dose steroids. Very often the dog will be weaned down to a low dose before any major problems arise.
Acute Cushing’s syndrome due to overdosing of corticosteroids can be very serious. Blood results will reflect this, especially the liver enzymes which may be extremely high. Red blood cells and blood platelets may also be high and blood clotting may be a risk.
So when should you alert your vet to suspected, unacceptable level of corticosteroid? The owner should take note when other clinical signs occur, such as: Depression, anorexia, muscle wasting and extreme weakness, continuous panting, lethargy - unwillingness to exercise, skin lesions and thinning of the skin, excessive hair loss, pot-bellied appearance and sagging back, behavioural changes (aggression).
If your dog is showing these signs it will probably mean that the dose of steroids needs to be lowered. It is important that it is not confused with a relapse of the dog’s condition or an infection. The dilemma is that steroids must not be withdrawn too quickly otherwise the dog may go into an adrenal insufficiency crisis. If the clinical signs of iatrogenic Cushing’s syndrome is intolerable, it is hoped that the high dose of steroids that he has been on will have already done their job and that his autoimmune disease will be stable. As long as the steroids are lowered in a controlled manner and in time, all the symptoms of Cushing’s will subside and your dog will return to normal, but extreme signs must not be ignored.
Reducing the Tablets
When significant improvement in the dog’s condition is seen, usually between 10-28 days, the initial steroid dose is usually reduced by 25%. The dose is generally given for another 10 - 28 days and depending on the dog’s progress and clinical signs the dose is significantly reduced once more for a further 10-28 days; and again in another 10-28 days. Anecdotal evidence has shown that if at this stage the dose is lowered more slowly, or reduced to an every other day dose over a period of months rather than weeks, relapse are less likely to occur. It is always tempting to get your dog off steroids as soon as possible, but when treating autoimmune disease, as long as the dog is on a low, every other day dose then taking the last stage slowly seems to work best, depending, of course, on the severity of the disease and allowing for the difference in individual response - no two dogs reactions are exactly the same. With some autoimmune diseases such as SLE, the dog is likely to be on steroids for the rest of his life. Usually an every other day dose can be achieved, but you risk a relapse if you take the dose too low.
15
Systemic / Inflammatory (AIHA, IMTP, Evans, SLE, IMPA, SRMA) / Re: Cushings- advice please
« on: June 27, 2020, 09:48:09 AM »
Hi and welcome
I am sorry you have had this yo-yo ride with Ezzy and IMTP - unfortunately this is not unusual especially with the first episode. A slow weaning down at the end of treatment, if the patient doesn't have many Cushing's symptoms is often a very good thing.
If a relapse happens, then you have to go back to an immunosuppressive dose and follow a good reducing protocol such as Prof Michael J Day's. If the dose isn't immunosuppressive then the relapse won't be brought under control, and when you lower the preds it is very likely that the disease process will become active again. This means more steroids, and an increase in Cushing's symptoms is inevitable.
Depending on what Ezzy's bloods are showing now, determines the path to take. If Ezzy's platelets are still not within normal range and she is therefore not in remission, then further immunosuppression is needed. As she is showing signs of Cushing's both in the bloodwork and in her clinical signs, then it would be prudent to introduce a 'combination' immunosuppressive drug such as Cyclosporine, mycophenolate mofetil, or leflunomide etc..... Once the combination drug is active (lead-in time varies from drug to drug) this would allow the preds to be reduced quicker, and significantly reduce the clinical signs of Cushing's. It is often a balancing act between giving enough immunosuppressive drugs and the side effects. The good news is, as soon as you start to reduce the preds, the body will start to recover from the effects of Cushing's and her liver enzymes will reduce. Eventually all these adverse effects will disappear and Ezzy can be a normal dog again.
As you are 38 weeks pregnant, please ask your vet to double check which 'combination' drugs are appropriate, and always use rubber gloves when handling cytotoxic drugs and don't split the tablets.
Long term steroids without giving a gastroprotectant will often cause gastric problems, and sometimes gastric ulcers can develop which may cause regenerative anaemia, so it is worth talking to your vet about giving a short course of omeprazole.
I understand that you need to get this under control before your baby arrives so find out what stage the IMTP is at (via blood results) and then assess how serious the Cushing's symptoms are, then you can make a decision whether to just lower the preds (if the IMTP is under control and she is in remission) to reduce the Cushing's symptoms, or if another drug is needed to control the IMTP. By introducing another drug you can reduce the preds quicker and still control the IMTP, and reduce the Cushing's.
I do hope your vet will help you to sort this out and get Ezzy's symptoms under control and stable so that you can have your baby with peace of mind, and be confident that everything is in order.
Jo
I am sorry you have had this yo-yo ride with Ezzy and IMTP - unfortunately this is not unusual especially with the first episode. A slow weaning down at the end of treatment, if the patient doesn't have many Cushing's symptoms is often a very good thing.
If a relapse happens, then you have to go back to an immunosuppressive dose and follow a good reducing protocol such as Prof Michael J Day's. If the dose isn't immunosuppressive then the relapse won't be brought under control, and when you lower the preds it is very likely that the disease process will become active again. This means more steroids, and an increase in Cushing's symptoms is inevitable.
Depending on what Ezzy's bloods are showing now, determines the path to take. If Ezzy's platelets are still not within normal range and she is therefore not in remission, then further immunosuppression is needed. As she is showing signs of Cushing's both in the bloodwork and in her clinical signs, then it would be prudent to introduce a 'combination' immunosuppressive drug such as Cyclosporine, mycophenolate mofetil, or leflunomide etc..... Once the combination drug is active (lead-in time varies from drug to drug) this would allow the preds to be reduced quicker, and significantly reduce the clinical signs of Cushing's. It is often a balancing act between giving enough immunosuppressive drugs and the side effects. The good news is, as soon as you start to reduce the preds, the body will start to recover from the effects of Cushing's and her liver enzymes will reduce. Eventually all these adverse effects will disappear and Ezzy can be a normal dog again.
As you are 38 weeks pregnant, please ask your vet to double check which 'combination' drugs are appropriate, and always use rubber gloves when handling cytotoxic drugs and don't split the tablets.
Long term steroids without giving a gastroprotectant will often cause gastric problems, and sometimes gastric ulcers can develop which may cause regenerative anaemia, so it is worth talking to your vet about giving a short course of omeprazole.
I understand that you need to get this under control before your baby arrives so find out what stage the IMTP is at (via blood results) and then assess how serious the Cushing's symptoms are, then you can make a decision whether to just lower the preds (if the IMTP is under control and she is in remission) to reduce the Cushing's symptoms, or if another drug is needed to control the IMTP. By introducing another drug you can reduce the preds quicker and still control the IMTP, and reduce the Cushing's.
I do hope your vet will help you to sort this out and get Ezzy's symptoms under control and stable so that you can have your baby with peace of mind, and be confident that everything is in order.
Jo