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Messages - buddy’s mum

#1
Thanks so much. One further question - buddy has been prescribed a single daily dose of prednisolone - should I be rather splitting the dose into two as per the protocol? Will that be safer?
Your advice is much appreciated!
#2
Thank you so much for your reply! It is a relief to hear that Buddy's symptoms make sense. I have been concerned by his bark and his swallowing but was told initially it was because he had a throat infection and even the specialist vets weren't over interested in these symptoms. On googling his symptoms I came across polymyositis. This wasn't even given to me as a differential but it makes more sense than a MUO or polyarthritis. As Buddy wasn't drooling or vomiting my concern regarding megaoesophagus was dismissed.  I was also told as his heart rate wasn't very high he wasn't in pain! He doesn't complain or whimper which was to his disadvantage and in the ten days he was in hospital he just wasted away. I got the impression they thought I was overreacting when I said Buddy was in pain.
Buddy is not on a gastroprotectant.
Ompeprazole only comes in 10mg tablets- can I halve the tablets as the dose is 1mg/kg for dogs? Which is better- ranitidine, famotidine or omeprazole? My initial vet gave me ranitidine with the antibiotics but it was a 150mg tablet and I was told to give Buddy a quarter- this equates to 37.5 mg and I believe his dose would be 12.5mg twice a day.  When I mentioned this I was told to give him a sliver of tablet with the antibiotics. Not sure how accurate a sliver would be! Do you think I should do this? I could get some famotidine  20 mg and divide that into 4- he would then get a dose of just under 1mg/kg. I started reducing  the dose from 12.5 to 10 today- at per the specialist vets instructions-  but I will go back to 12.5 tomorrow for a total of 21 days as I would rather err on the side of caution. He's only been in the dose for 11 days so far!
Your support and help is much appreciated!
#3
Hi
I'm new to the site and would appreciate any advice.
Buddy is 7 year old cavoodle- his mother was a cavoodle and his dad a poodle.
Last vaccinated April 17. Weighed 7.7kg at start.
Eats home cooked food and some shop bought dry food.
Has an underbite and has a dental clean once a year. Last done December 17.

Had reaction to worming drops late 2017 and they had to be wiped off.  This disrupted his schedule. Changed to heart worm tablets.
Was clipped on 13 April
He is an indoor dog.
Over a few week I noticed some subtle changes in behaviour- would hide away under desk after eating. Normally did this when he had done something naughty  like paw licking or when I want to bath him. Exercise  tolerance good- happy to do 4km walk. Did this the day before I took him to the vet.  Was sleeping in a bit and also not as social. I noticed a decreased water consumption for 3 days.  Stool normal and urinating ok.  Tended to rub face on carpet after eating . Had one episode of gagging/ retching in week before illness.

21 May 2018 Vet examined him and said it may be a viral infection and to observe him.  He had a slightly low lymphocyte count. Rest of bloods including liver and renal function normal.  Lymph glands not remarkable.

On evening if 22 May I noticed that he had a large submandibular lump on right side. I took him back to vet and she felt many of his lymph nodes were bigger. She took FNAs  of the lymph nodes. The right side submandibular area was very swollen compared to left. Not tender and not an abscess. I was told he may have lymphoma and to wait for the results.

Evening of 23 May dog was very lethargic and weak- only wanted to lie in basket and not on floor. I decided to take him to another vet. He was eating but not drinking. Vet concerned about right large submandibular node. Plan was to check pharynx and oesophagus for any lesions and X-rays. Also to take biopsies of lymph nodes

Vet  ultrasounded mass- oedematous swelling around slightly enlarged lymph node.When she spoke to me she told me it wasn't quite like normal cellulitis and not an abscess.  Chest and oral X-rays normal. Oesophagoscopy and gastroscope normal.

Slides  of biopsy which came back a few days later-no evidence of lymphoma. popliteal and submandibular nodes no obvious effacement of node
Plasma cells present
Moderately Increased macrophages and eosinophils In sinuses of both popliteal and submandibular node. 

Kept overnight hydrated and picked up next day. On amoxyclav 125mg twice a day. Three week course.

On 31 May returned -submandibular mass decreased. Localised dermatitis medial aspect left foreleg.- possible hot spot.

I made bone marrow broth and he drank this and eventually started drinking water again. Had diarrhoea from antibiotic and went on to develop anal gland abscess - never had problems before- which ruptured on grass outside vet while passing stool.  1  June

Revisit 8 June. Buddy's improvement generally was slow in that he wasn't himself and was more lethargic and sleepy than normal. Also didn't seem as steady as normal and not jumping up on high things. Eating and drinking ok.

Thought this may be due to antibiotics and loose stool causing him to feel a bit out of sorts

Took 3 week course. Stopped antibiotics and he slowly returned to his former self.


Probably lasted a few weeks before he was not quite as active as usual. Still active but not himself. Rubbed and scratched his right ear only occasionally - looked fine inside - really only after eating. I noticed he started  rubbing the top of his head on carpet occasionally after eating as well as both ears and mouth. he went off water again. His breath was really bad but it seemed to come deeper than from his teeth. He would yawn and then it would appear to catch as if it was sore. Yawned more than normal.  Bark not quite normal- higher pitched. Not vocalising as much. Buddy had exaggerated swallow when eating. No retching. No problem chewing chicken.

25 July returned to Vet. Buddy had temperature of 39.8
Had mild neutrophilia and increased globulins
Admitted for 2 nights then taken home on amoxyclav. Breath quickly smelled better.  Returned for blood test on 28 July - neutrophils from 13.36 to 13.29.  Temperature 38.4. Vet not happy and changed to Baytril.

On Monday 30 July returned as not drinking. Buddy admitted. Plan to check mouth and perform dental clean.
Neutrophils up even further 17.47. Globulins raised - no evidence of renal or liver issues.
Teeth cleaned but gums fine- no gingivitis. Tonsils ok - possible mild inflammation of larynx. I believe there was some mucus present as well. Swabs taken
Put back on noroclav
He was discharged on Noroclav 125mg
Xrays of chest normal and compared to previous X-ray.

Actinomyces was cultured in throat - found normally in dogs? Vet asked buddy to be admitted on 3 August
Given penicillin high doses iv for actinomyces on 3 August 4 August 5 August
No improvement- actually got worse. Another vet working on Sunday noted he was stiff and had pain in right rear leg. Couldn't repeat the pain reaction though.
Changed to triple therapy amoxyclav, baytril and metronidazole

Clinically and bloods worse so on Wednesday 8 August metronidazole changed to clindamycin. He looked a little brighter on 10 August and temperature down. Vocalised and managed to make a decent barking sound- not done that for a while! Took him to park near vets and after eating he tried to rub his ears - especially right and also top of head on ground. 11 August bright in morning not quite as bright in evening.
12 August morning quite bright but temperature down. On walk near vets managed to climb 3 stairs. Discharged 12 August but temp of 39.4. Measured later at home 39.6. During 10 days in hospital on iv fluids continuously Buddy not keen to drink but would eat.
Given amoxyclav clindamycin and baytril at home
13 August  temp 39.6. He started walking like an old dog and appeared stiff. Right hind leg appeared tender when I first touched it. Couldn't repeat that though. Occasional fast breathing and panting. Vet felt it may be fluid but this panting continued on and off till 15 August.
14 August temperature still up, went to see Vet. Buddy not drinking still and very lethargic. I was giving him water by syringe. He was eating though. Bloods showed that his neutrophils up even further - 25.96 on 11 August to 29.09 on 14 August.
Vet mentioned mri and csf tap. Buddy unable to get up from lying position and unable to lie down from upright position. Muscles very wasted- down to 6.2kg. I was having to move him in his basket and change his position as he couldn't do it. I carried him out to wee and poo. Didn't walk more than 2 steps. Refused food on 14 August and morning of 15. Decided not to go ahead with more tests as he was suffering- tests would involve a 6 hour round trip in car.

On 15 August vet put him on steroid 2mg/ kg twice a day- total of 4mg/kg. after 8 hours remarkable as could actually get up out of bed to drink. Was walking  around less stiffly. Still very tired but more alert. Stopped antibiotics

Drank lots on 15 and morning of 16 August  then stopped.
Exaggerated swallow never totally went away. Seemed difficult to swallow. Ate some wet royal canin to which I was advised to add water and appeared to choke. Stopped royal canin and back on chicken. Bad side effects from steroids - appeared restless and uncomfortable- panting and awake a lot.  Breathing very fast.

Went to specialist vet on 20 August given remarkable recovery. Nothing obvious on hour long  examination. Told to stop steroids and return when he's worse. Retuned 4 days later. Another full hour examination but no localising symptoms. Still refusing to drink. Eating well.  Specialist Vet couldn't offer any more general tests- asked about Creatinine kinase but vet felt not worth while. Offered an abdominal ultrasound but told it was unlikely to find anything as his blood results normal and no abdominal symptoms. No lymphadenopathy peripherally. With nothing to go on not worth subjecting him to joint and csf taps and muscle biopsies. Most likely auto immune but may be underlying infection or cancer.

Given 2mg/kg per day of prednisolone and told to taper to 1.75mg/kg after 10 days.
Buddy has improved remarkably. I spoke to Specialist vet on Friday and his dose has been adjusted from 2 mg/kg - 12.5 mg daily down to 10 mg daily for at least 2 weeks. Then will be dropped stepwise by about 25% every 3-4 weeks.

He's still reluctant to drink and I'm giving him chicken stock and water jelly. He is eating mainly chicken with a few veggies- I've added natural health booster to his food to add some vitamins.  He is walking every day and is more confident going up and down stairs. He  struggles to jump up high - he has been more successful in the last 2 days compared to a week ago. He's gone from 6kg to 6.5 kg but his muscles are very wasted. I've raised his bowl to ensure that it's easier to swallow.  No evidence on X-ray of megaoesophagus but I'm thinking his exaggerated swallow and his reluctance to drink water may be a functional issue. Eating very well and very hungry all the time! His bark has improved but is higher pitched than before. He still seems to catch when he yawns. He's stopped the panting and licking of his lips which in retrospect I think were signs of pain.  He is still occasionally scratching at his right ear and occasionally rubs his ears and top of head on floor after eating. After which he sometimes lies on his back and gives that a rub. 

I'm enjoying his company on a day to day basis as I'm aware that without a diagnosis his prognosis is uncertain. However the steroids are working for now and Buddy is happy and sleeping well at night.

Has anyone seen anything similar? Not sure if the significance of the right ear scratching and the rubbing of top of his head. No external ear infection according to vet. Seems to mainly happen after eating but not every time. Remarkable response to steroids with 6-8 hours. Is this normal response- does it help point to a diagnosis? I'm thinking polymyositis but I've got nothing to go on. Possible polyarthritis - His joints were examined by two specialist vets and an orthopaedic vet and there was no evidence of pain or fluid. No obvious central nervous system signs on examination! Any ideas would be appreciated
Thanks