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 1 
 on: June 01, 2020, 11:12:31 AM 
Started by KassieandArchie - Last post by Jo CIMDA
Hi Kassie

If Archie is not taking another immunosuppressive drug alongside prednisolone then I would ask your vet to seriously consider introducing one asap.  The 'combination' drug needs to be one that doesn't have a long lead-in time and can take effect within a few days.  Mycophenolate Mofetil and Leflunomide might be a consideration, another one which may take a few more days to kick in is cyclosporine.  I believe this is essential if remission is to be achieved.    Take a look at this link:

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

I believe  you can get Archie back to where he was before and by using a combination drug you will achieve greater immunosuppression and you will be able to lower the preds quicker.  He responded to the drugs first time, so there is a good chance that he will respond this time.

You have to tailor the pred drug protocol  to the individual, and you have to respond to the clinical signs of the adverse effects however, 50% reduction, unless it is absolutely necessary, is not the best way to go.  A much slower reduction of 25% or even less, if you can, seems to lessen the side effects but continues to control the disease process.  Relapses are not uncommon, and in many ways can be expected, but you just raise the dose of drug to where it was before (or higher)  and control of the disease continues.  In Archie's case you probably had no choice but to lower the preds by 50% but because he hasn't got a back-up drug, he started to relapse.   This makes sense.

I do hope your vet will listen to you and introduce another immunosuppressive drug now.  What do you have to lose?

Jo

 2 
 on: June 01, 2020, 08:02:18 AM 
Started by KassieandArchie - Last post by KassieandArchie
Hi Jo

Another update. We dropped his second dose of prednisolone (15mg 2X daily) a week early as he was really suffering with side effects. He went down to 15mg 1X daily. This was great because he is nearly side effects free and back to his old energetic self, however we have relapsed with the progress in his face. I have been told that if a relapse occurs we are unlikely to get any improvement again. We will continue to wean off the steroids but Iím not sure what our next move will be.

Swings and roundabouts. Always.

Thanks, Kassie

 3 
 on: May 29, 2020, 11:52:00 AM 
Started by BrookeR - Last post by Jo CIMDA
I totally agree Brooke.  Quality of life is the most important thing.  Having said that, if her vitals are good then this is a big plus and it is about controlling any pain that she has.   I hope the Zydax will do the trick and you will see and improvement in Pep very soon.

I have a feeling, as she has caught us out so many times before, it will be Pep who decides when she has had enough!  She is not one to give up easily.

Jo



 4 
 on: May 28, 2020, 10:06:32 PM 
Started by BrookeR - Last post by BrookeR
Thanks jo, I really appreciate you always being there when I have needed to go over my thoughts about pep and for your advice/ knowledge to help me feel that I am making the right decisions for her.

Yes I do believe pred is fast acting, even though my vet is skeptical. Iíve seen it change Pep very quickly. When she first was diagnosed with impa finally after a drawn out period of no one being able to diagnose her. She went weeks before I came across and insisted they test her for impa. Anyway I gave her the pred at lunchtime, she hadnít been able to walk prior and then she was running around the yard that afternoon. There have been a number of times Iíve seen fast improvement in pep from pred.

We saw our vet yesterday and she hadnít seen pep in a few weeks. She said she wasnít looking good and that time is coming soon. In saying that she also said she has seen pep look terrible before and then she rallyís and pulls her strength together and fights back. All her vitals are good itís just her terrible joints. She has more hair loss down her back and more black head and dark skin patches but nothing is infected or nasty looking. Ideally we would like to be able to drop the pred to stop what itís doing to her skin, muscle wastage and try prevent her from doing her other cruciate. Also my vet believed pep had more muscle wastage and said if she keeps going she eventually wonít be able to walk. We have started her next 4 week round of zydax injections. So will be visiting the vet weekly for the next few weeks. Now thinking of it, it was at the time we initially had zydax (3months ago) that pep was looking terrible and my vet said we didnít have long then. She said she was going to be monitoring her closer each week while we had the zydax. Pep ended up picking up then after the injections, until now. So Iím hoping the zydax is going to give her a little more time.
As for other pain killers and supplements my vet wants to leave everything as is for now with pep and just monitor her over the next few weeks to see what the zydax does to help. I also think this is the best thing to do at this point .

I agree with you, for now I feel we need to keep her at this pred dose. It is slowly eating her away but at least she is mobile and still able to walk and wanting to be here. It seems each time we reduce she begins having more trouble and can barely walk. She likes to be able to follow me around and if she canít do that thatís not a happy life for her. So I think leaving her on this dose is the best option we have at having a little more time together. Rather than drop the pred and have her not be able to walk and need to be carried everywhere. That wouldnít be fair to her.

 5 
 on: May 27, 2020, 04:56:49 PM 
Started by BrookeR - Last post by Jo CIMDA
Hi Brooke

If it is just one elbow then it is not IMPA, and if it were IMPA it would need a lot more pred to make a difference.

 Having said that pred can have an amazing affect within 45 minutes of having a tablet (I have seen this myself)  and this is purely the anti-inflammatory response of a low dose of pred.  Personally, unless you have to take Pep off of pred for good reason then I would keep her on the low dose because it gives her a much better quality of life than without it.  I would imagine pep's elbow problem is age related and not immune mediated, which is good news.

I am honestly not sure if the other alternative therapies work.  They might to to an individual, but not for everyone/dog who has them.  I did use Cortaflex on one of my old girls once and I believe that did make a difference but it will take a while to kick in.  It is very popular for arthritis in horses too.   

I hope she improves very soon.

Jo



 6 
 on: May 27, 2020, 03:15:44 AM 
Started by BrookeR - Last post by BrookeR
Thanks jo. We ended up dropping the pred By 1/4 of a 5mg tablet and then tried Adding gabapentin. She was good for the first week almost two weeks of the reduced pred and then when I added the gabapentin she began limping and continued to get worse. I stopped the gabapentin and she was still worse. So we upped that 1/4 pred again. She began to walk again. When I gave her the increased pred dose at night she was back walking in the morning. My vet said pred couldnít be that quick of a reaction. I canít see it was the gabapentin and feel itís the pred. Every time we drop the pred any amount the swelling comes back in that same front elbow she began having trouble with October last year. The one we xrayed which was missing bone. Itís always this elbow that she limps on too. If it were true poly arthritis why is it always this elbow? Could it show the poly arthritis more due to it already being damaged? Or is there any other things that could cause the elbow to swell every time we drop the pred and cause limping? No pain killers seem to help only the pred because it takes the swelling down. Could it just be really bad arthritis and damage to that joint. So many questions I have no answers to.
Iím trying to think of other anti inflammatory things we could try. We canít do NSAIDs. I am wondering about trying natural ones we have been previously too scared to try eg cbd oil, turmeric, etc

I had also read trials of doxycycline being used to treat arthritis but they seemed to say it only was worth while when it was used initially when pain had not long begun, not for chronic pain that had already existed for some time.

 7 
 on: May 25, 2020, 09:23:00 AM 
Started by Jo CIMDA - Last post by Jo CIMDA
Hello Everyone

I have just heard the very sad news that Prof Michael J Day has recently passed away. 

Some of you may not know of this amazing gentleman's achievements, but the links below will give you some idea of the impact that he made on the veterinary world.


https://wsava.org/wp-content/uploads/2020/05/WSAVA-Pays-Tribute-to-Emeritus-Professor-Michael-Day.pdf

https://www.vettimes.co.uk/news/tributes-paid-following-death-of-michael-day/

Personally, I am truly saddened because Prof Day's immunosuppressive drug protocol has helped so many dogs with autoimmune disease, when their own vet had no previous knowledge of such treatments, and there is no doubt that his protocol has saved many, many lives that would have been lost.  It is the best immunosuppressive protocol that I have come across.  Many years ago, I emailed Prof Day to ask if I could pass on his protocol to those who may need it, and he replied straight away giving his permission but stressing that the protocol has to be tailored to the individual.  Now, I have no veterinary qualifications and yet this amazing man acknowledged that there was a need to get this specific treatment regimen out 'there' and he gave his permission with no hesitation.  I, and many, many others, will always  be truly grateful to him.

Prof Day, along with his colleagues at the WSAVA, is also the person who brought to the attention of the veterinary world that annual vaccination was not necessary and although it was important to vaccinate, to over vaccinate is potentially doing more harm than good.   

He has achieved so much more in his short life and you can read about him in the links, but I would like to say, Thank you Professor Day for all that you have done during your career and for going over and beyond to help individuals with your knowledge,  and the veterinary profession to understand more about immunology and these terrible diseases, and most importantly how to treat theses dreadful diseases and achieve remission, so that these dogs may have the chance of a happy and healthy life. 

Rest in Peace Michael J Day, and thank you from us all.  Your loss, to us in this world, is huge.

Jo


 

 8 
 on: May 25, 2020, 08:53:08 AM 
Started by Alison68 - Last post by Jo CIMDA
Best wishes for Bella.

 Fingers crossed!

Jo

 9 
 on: May 23, 2020, 02:48:26 PM 
Started by Alison68 - Last post by Alison68
Yes I'll be keeping a close eye on her regarding the pred's because five years ago while she was being treated for the first time she had thrombocytopenia she ended up with bad calcium deposits on the inside of her back legs due to being on steroids for 18 months and we had to quickly get her off them and her legs healed up nicely once the steroids had been dropped to a very low dose and she finally came off them.Bella's eight and a half years old now and still proving that she's determined to keep on living no matter what life throws at her. I want be doing anything drastic with the little lump on her toe. Her platelet count will more than likely be higher next month because last time she was on the steroids her platelets would drop a bit when she was on lower doses, it's just the way she is. Hopefully next month she'll be able to drop to 10mg a day. I'll keep you posted with how things are going.







 10 
 on: May 23, 2020, 11:45:27 AM 
Started by Alison68 - Last post by Jo CIMDA
Hi Alison

It is always very disappointing when these AI problems return.  At least you know that Bella responds pretty well to treatment but it is still exhausting - yet again!

If her platelet count was 70 but with clumps,  then you know the true count is much higher.  Perhaps next time they can use a bigger needle, to avoid any sample damage and,  if they don't already, then take the sample from the neck as opposed to the leg.

As Bella is a whippet, and they are much more sensitive to steroids than most other breeds, just keep an eye on her  adverse effects of the preds and if her clinical signs suggest then perhaps have another blood test before the month is out and if necessary reduce the preds a bit sooner.   The adverse effects of the preds can be a problem after a while. 

As for the thing on her toe, it could be several things including  an interdigital cyst or just  an infection.  Personally, if Bella wee mine,  I wouldn't want her put under a general anaesthetic for investigations, for fear of it triggering another episode of AI.

Many years ago I knew a bulldog who had interdigital cysts and this was successfully treated with Dorwest herbs, Garlic and Fenugreek and I think they also gave mixed vegetable tablets too.  It might be worth checking with your vet if Bella can take this or having a chat with Dorwest. It might be something to consider after the treatment for IMTP is finished.  See this link:

https://www.dorwest.com/common-problems/interdigital-cysts-in-dogs-cats/

Fingers crossed that the next blood test will show a rise in platelets, and at least a sample without clumping, so that you can have an accurate result.

Jo



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