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 1 
 on: Yesterday at 09:46:00 PM 
Started by dalebrook.bp@gmail.com - Last post by dalebrook.bp@gmail.com
Thanks for your help, Jo.  I feel much happier about the 7.5 mg a day, so I'll discuss it with the vet - Sophie goes for more bloods tomorrow and haematology and biochemistry are both going to be done.  She just had haematology a couple of weeks ago as her PCV had gone down the time before and he wanted to check that it had gone up to her usual level which seems to be around 38.  Apart from the ravenous appetite, which I guess might have become partly a learned behaviour, her other pred side effects are not too bad, so in view of her relapse, we have been taking things pretty slowly.

Thanks again - I really appreciate being able to discuss things with you and getting your advice.

Kind regards

Patricia

 2 
 on: July 20, 2018, 11:41:26 AM 
Started by Lucy - Last post by Jo CIMDA
Hi and welcome

I am sorry your collie has vestibular disease and hypothyroidism.  Vestibular disease will often spontaneously resolve within a few weeks but if he also has hypoT at the same time this will not help.  HypoT can be a primary disease or secondary to another condition that is affecting the thyroid.

  A reduced thyroid hormone affects all parts of the body and when replacement therapy is started you may see a good improvement within days and certainly after a couple of weeks he could be back to his old active self again with many of the clinical signs disappearing.  The skin and hair condition may take a while longer but it will all resolve in time.   

His TSH result isn't particularly that high but it indicates that the thyroid might be struggling.  A good diagnostic panel is Total T4, Free T4 and TSH.
When a young dog develops primary hypoT  it is usually caused by an autoimmune destruction of the thyroid glands but in an older dog this might not be the case and it might just be a wearing out of the gland because of advancing age.  The treatment is the same and that is with thyroid hormone replacement and if the dose is correct the dog will become fit and healthy once again.

I am so sorry you lost his son earlier this year,  and I understand that it makes dealing with this a lot harder, but the prognosis for a dog with HypoT is excellent so you should see improvement soon.

Below is an extract from my notes:

Jo



Hypothyroidism – An underactive thyroid gland

 ‘More than 95% of cases of canine hypothyroidism are believed to be due to acquired primary hypothyroidism. Destruction of the thyroid gland can result from lymphocytic thyroiditis, idiopathic thyroid atrophy or rarely neoplastic invasion.’  Canine Medicine and Therapeutics by Neil Gorman.

Hypothyroidism or under-active thyroid glands, is the most common autoimmune disease in the dog and is probably evident in most breeds, although the incidence appears to be higher in some breeds than others. This disease is usually a slow process resulting in the destruction of the thyroid glands by antibodies directed against the thyroid (lymphocytic thyroiditis).  As the body only needs less than 20% thyroid production to function, clinical signs of this disease often develop over a lengthy period of time and are so gradual that the owner is not always aware that the dog is slowing down.  The body will cope very well with diminishing thyroid glands, but when the glands have been more than 80% destroyed then clinical signs become more obvious. 
The thyroid is essential to life; it circulates thyroid hormones to all parts of the body. If replacement therapy is not given to a hypothyroid dog it will die.  Usually the clinical signs show well before this time and a thyroid blood test should confirm a diagnosis. Thyroid disease is not always simple to diagnose but usually a low TT4 (total thyroid hormone) confirmed by a low FreeT4 (thyroid hormone measurement without protein) and a high TSH (Thyroid Stimulating Hormone) is considered to be diagnostic of hypothyroidism.  (In addition, tests to assess thyroid dysfunction may include: TT3, FT3, autoantibody, TSH and TRH response tests).

Measuring TT4 alone is not enough to make a definitive diagnosis as the dog could be suffering from a non-thyroidal illness (NTI), that is an illness affecting the amount of thyroid hormone within the circulation, rather than a primary autoimmune destruction of the glands.  Non-thyroidal illness should be suspected if the dog has a low TT4 and a low TSH. Whippets and other sighthounds have a naturally lower TT4 than many other breeds but the FT4 is within normal limits.

Note: Several drugs, including prednisolone and diseases such as Cushing’s syndrome, will lower the circulating TT4 levels and this should be taken into account when evaluating the results.  Hypothyroidism is both over and under diagnosed.

Some clinical signs of hypothyroidism are:
Lethargy, mental dullness, unwillingness to exercise,  stiffness in gait – limping, weight gain (obesity), dry scaly skin or greasy skin, excessive pigmentation (hyperpigmentation),  skin lesions, on-going ear problems, coat texture and colour changes, loss of hair particularly on the tail and bilateral, symmetrical  hair loss, signs of premature ageing, irregular seasons - poor infertility and libido, depression (tragic expression), irritability or aggression, intolerance to cold, seizures, voice change (pitch of bark),  muscle weakness, megaoesophagus (weakness of muscles in the throat causing difficulty in swallowing).
On examination your vet may also find that a hypothyroid dog has a slow heart beat (bradycardia), eye abnormalities such as corneal lipid deposits or ulceration: dysfunction of the central nervous system (CNS), such as tilting of head, circling, unsteady gait (ataxia):  Blood analysis may also reveal anaemia and high cholesterol.
The prognosis for dogs with hypothyroidism is excellent, although life-long daily treatment with hormone replacement, Levothyroxine, is required. Giving half the daily hormone replacement dose every twelve hours provides a more balanced level of thyroid hormone throughout a 24 hour period and avoids peaks and troughs. (BSAVA Small Animal Endocrinology)  “Levothyroxine is better absorbed on an empty stomach”.  Canine Medicine & Therapeutics by Neil Gorman

 3 
 on: July 19, 2018, 10:12:51 PM 
Started by Lucy - Last post by Lucy
My 13 year old collie had a vestibular attack 6 weeks ago and on undertaking a full range of blood tests it was noted that his thyroid function was greatly reduced from 12 months ago.  It was 16, a repeat test of the thyroid function was done Tuesday 6 weeks after the last blood test and it has dropped to 15.  The sample was sent off for full TSH function etc and has come back today as TSH at  1.78,  I hope that's right I haven't got the full results only the TSH levels.  My vet is starting him on Thyforon 200mg. 

Up until last September he was competing at flyball and I retired him in September as he was 13 in March.  He was a fit, healthy dog who exercised regularly.  Since the New Year he has become letheragic, had the vestibular attack, head tilt, eye rolling, falling over, his gaining a lot of weight and has had some senile type moments.  He is raw fed and because he has been on reduced exercise, I had reduced his food by 100g and he is still gaining weight.  His coat is dull and lacks its normal sheen, but I wouldn't say its thinning just lacking its normal sheen.

He is also on vitafyllin for his vestibular disease but having done a limited amount of research I'm unsure whether his episode was vestibular or thyroid induced.  He has damaged lungs due to getting kennel cough when he was younger that turned to pneumonia so has an inhaler once a day which I'm told the vitafyllin may help.

I was posted towards this site to get some help and advice on how to go forward with Oz and I'd really appreciate any help and advice on this illness and how best to treat him and feed him etc.   

I lost his son at Easter who was being treated for pancreatitis but it was a tumour and we had to put him to sleep at 11 years old.  His dad seems to have aged quickly and all this has happened or come to the surface in that time. 

Any help would be greatly appreciated.

Thanks

Lucy

 4 
 on: July 19, 2018, 08:29:25 PM 
Started by tamarmot - Last post by tamarmot
Went to neurologist vet again this morning, she is pleased with his progress.  She sees more response on his right side now, and he is avoiding obstacles better.  His right hind leg is still laggy.

I asked her about the pred dose and she confirmed that she wants him on 15mg every 12 hours; 20 mg every 12 hours is the most she will give any dog of any size, based on her experience and the studies she has researched.  She says the mycophenolate will not have kicked in yet, so any improvements we see are from the pred.  His fever is also gone.

She is upping his mycophenolate dose to 250mg, as the 166mg he was on was too small.  I am considering a Cytosar (chemo) treatment, which I really don't want to do, mostly because I have to leave town on 8/4 for 10 days, and my husband works, so the sooner we can get Tucker's brain working the better/safer he will be.

I will continue to post with his treatment protocol and progress in the hopes that it will help others.
Thanks for your support!
Tamar

 5 
 on: July 19, 2018, 01:32:45 PM 
Started by dalebrook.bp@gmail.com - Last post by Jo CIMDA
Hello Patricia

It is good news that Sophie is doing well. 

   I agree with Catherine, and I would use the reducing protocol by Michael J Day as a guide - but you can go slower at this stage if the side effects of the preds allow.  Anecdotally, if the last stages of immunosuppressive protocol is taken slowly, on a daily basis,  it usually reaps better results and a greater chance of reaching long term remission.  As long as she is coping with the side effects then there is no rush, but no two dogs are the same and the protocol has to be tailored to the individual. 

I am not a vet so I can only give a personal opinion on what I would like to do if Sophie were mine. In an ideal situation 10mg a day can be reduced to 7.5mg a day and if all is well it is best to eek out the duration to 14 days and if clinical signs allow I would stretch that to 16 or 18 days and then reduce to 5mg per day.  Then, one option would be to reduce from 5mg every day to 2.5mg every day -  or you could go 5mg and 2.5mg on alternate days. Again I would eek out the duration of this small dose for up to 21 days. Then you can go 2.5mg every other day etc., etc..... and eventually wean off altogether.   

There is no hard and fast rule at this stage of treatment but what you want to achieve is stability and homoeostasis and when dogs are on steroids for many months, taking the last stages slower seems to give a better chance of achieving this. These low doses are having no real therapeutic effect but anecdotally the evidence shows by giving a very low every other day dose, that is very gradually weaned down,  is less of a shock to the body and as the dose is lowered the body's own cortisol will naturally start to produce the correct level of cortisol needed to function normally.

Perhaps you can discuss this option with your vet.

Jo 

 6 
 on: July 19, 2018, 12:50:53 PM 
Started by tamarmot - Last post by Jo CIMDA
That is brilliant!!!! Long may Keeper continue to improve and enjoy life, and long may your cat continue to excite and challenge him.

Jo

 7 
 on: July 19, 2018, 12:48:16 PM 
Started by MonasWeim - Last post by Jo CIMDA
Oh Simone, I am so sorry and so very sad. 

Dear Riley, despite all his problems, he made your life whole.  He gave unlimited and unconditional love that fed your heart.  I can't express how sad and teary I feel at this news - but you did everything possible to make his life wonderful and the fact that he was your constant companion was so much more than he could ever have wished for.  The dark days are bound to be there but they will eventually be replaced by the extra special memories of your extraordinary special boy and these memories will eventually heal you.

He is free of his physical burden and at peace - dear Riley.

Thank you Simone for sharing with us just a little part of your life together.

Jo


 8 
 on: July 19, 2018, 09:09:37 AM 
Started by MonasWeim - Last post by MonasWeim
To Jo and all those who have helped us through the bad times over the last ten and a half years I just wanted to let you know that sadly we had to have Riley put to sleep this week. He was just too sick and although everything in my body screamed at me not to let him go I could see he was suffering and with each day over the last few days came a new problem and on the last day he couldn't stand at all so we made the awful decision to let him go. He went peacefully at home with my partner and I stroking him and whispering that he was such a good boy into his ear as I had so many millions of times before. I brought Riley home at 12 weeks and he has only spent one night away from me in nearly 11 years (in a vet hospital) so to say the loss is devastating doesn't quite cut it.  He was by my side at work and at home every day over that time and I don't quite know what I'm going to do without him. He was ill all his life, with SRMA from a year old we battled every ailment over the years, he was a constant worry every day and just when you thought you were having a nice healthy week he would throw a spanner in the works and become ill. He was so patient with everything I had to do to him, from going to sleep while I plucked his eyelashes out to offering a paw to allow me cut his claws. He was the kindest, gentlest soul and everyone who met him fell in love with him. He taught me so much over the years and at times that knowledge has helped me to help others in similar situations.  In my mind, in my own silly way I always thought "if I can just get him to ten years old then we will have won the battle and he would have had a good go at life" and I did, so in a way that was an achievement in itself.  He was my best friend, my own little soul mate and my comfort on all those bad days - a cuddle with Riley made everything not so scary. He was my clown and my protector, my exercise partner and my Sunday afternoon black and white movie watching companion and has always been right by my side through thick and thin.  In all those years I never went on holiday or away for the night as one of his triggers was stress in the car and separation anxiety so we stayed close to home and lived in our little bubble, always making sure that if I went out I was back by 5pm to feed and medicate the boy. The big wide world beckons now, Riley was the love of my life but I think it's time to do some living myself and just for once not wake up 5 times a night with the dog to clear his nose of mucus, put the fan on, cover him up or get up with him if he was sick. I've been sleeping on a mattress on the floor downstairs with him for 6 weeks as he couldn't get up the stairs so being in a normal bed will be heaven.  You know me, I have fought for this dog every day of his life and always believed where there is life there is hope so I do not want anyone to think I took the easy way out but I could not sit there and watch my best friend in so much pain unable to play, walk or enjoy life when we had tried so many different meds, new things arose on a daily basis in the last two weeks and nothing had worked. I feel gut wrenching sense of guilt but even if we had managed to fix one major issue we still had two more issues and a handful of small ones so deep down I knew it was impossible to get him back to any type of normal life.
I would like to thank everyone who has helped us over the years, you do not know how much we have appreciated it, you all got us through some very dark times and for that I shall be forever grateful. From the bottom of my heart - thank you.
Simona. x       

 9 
 on: July 19, 2018, 02:27:08 AM 
Started by dalebrook.bp@gmail.com - Last post by dalebrook.bp@gmail.com
Sorry Jo - yes she is still on the Leflunomide - 30 mg per day.  I assume you would still keep doses even of two days - ie 7.5mg per day?

Patricia

 10 
 on: July 18, 2018, 09:18:12 PM 
Started by dalebrook.bp@gmail.com - Last post by Catherine
Has she stopped the 30 mg of Leflunomide once a day then? I have no experience of Leflunomide but if it does a similar job to Azathioprine I would have reduced the Preds and then stopped the Preds completely before reducing and stopping the other drug.

If she is only having the Preds now I agree with you that it would be better to keep to the same amount daily if Sophie is coping well with the medication. So 7.5mg daily and then eventually to 5mg daily rather than every other day or different amounts each day.

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