CIMDA

Can you not take Elsie with you on holiday or would she get worried away from home? Perhaps a weekend with family or a friend or someone with a dog Elsie gets on with who can share the responsibility and let you have some time to relax, even if just for a few hours?

Thanks Jo, and thanks for your help.
I am glad Elsie is currently okay. I do worm counts, check her for fleas etc. That is quite hard as we have cats which hunt..but I treat them.
You mentioned stress. I haven't had a holiday in 3 years because I have been afraid to leave her but I am worn out ( dad died, mum developed Alzheimer's) and I don't know how I can leave Elsie. We usually have a house sitter who looks after the animals. Elsie is good to leave whilst I am out but she expects me back. I am afraid to go away for fear of her getting stressed. 🙁

Hi Erica

It is such good news that Elsie has reached remission and has been well for 8 months.  What you have to limit now are the 'triggers' as she will remain in 'normal mode' unless she encounters something that will trigger the immune system into targeting its own body.  The triggers that you need to avoid are unnecessary drugs, regular flea treatment, wormers etc, vaccinations, stress, hormones (which is not easy when a dog is entire) etc.,etc.......

I asked the top Vet at the RVC if a dog that has had an AI disease should ever be vaccinated again, and his reply was No. He continued to say that the risk/benefits have to be considered, and the risks to a genetically predisposed dog is too great.  Do your own homework on the and a good website is WSAVA  vaccination guidelines.

Great news though.

Jo

My whippet, Elsie, had SRMA has as 7 month pup. She responded badly to the high dose steroids and I believe we reduced them too quickly and she relapsed whilst on a low dose. Elsie was put back on the immune suppressing dose and I held my nerve, took each day as it came, keeping her on this dose for 3 weeks. Elsie can't tolerate omeprazole as it gives her diarrhoea and makes her sick. This was difficult in the beginning as the vet thought it was the steroids making her sick.
Elsie has been off the steroids now for 8 months and has been fine. I still worry about her and watch her too intently. She eats well and is very active. I haven't vaccinated her again against the vet's advice. She isn't neutered which is a minor concern.
Good luck.

Fingers crossed for Oliver.  Great news.  Should he start to show signs again then please consider SRMA.  Thank you for the update.

Jo

Im happy to report that Oliver is recovering from whatever it was and he is able to raise his head and his temperature is now normal. He is slowly being allowed to go for walks and will be monitored closely.
He has taken ten days to recover from the gastrointestinal issue, which really made him poorly.
The neck/ head pain remains a bit of a mystery but we will just keep an eye on him to ensure that he remains ok.
Im happy to report that hes being naughty again, which is always reassuring!

I hope you can find the right way forward for Oliver very soon.   

If Oliver has to have a sedation for his neck x-ray, and this doesn't prove to be diagnostic, perhaps a spinal tap should follow immediately after. 

Wishing him much better. Fingers crossed.

Jo

Thank you so much for your reply. Our vet called this morning and I have discussed everything. They want him to finish his meds but if no better in 48hrs he will go in for imaging of his neck and after that if nothing shows up we are going with the Dexamethazone injection.
Vet said it would not be right to have the injection if we haven't ruled out a neck problem.
He's still quite sedated and quiet but he is eating better.
He is insured so am not worried about spinal tap in terms of cost but would rather not put him through an invasive procedure if the vets are willing to treat speculatively if that makes sense.
Oliver is a very small, dainty boy who is a bit of a baby so I don't want him to undergo too much stress in case it triggers other issues.

Hi

I am so sorry that you have then need to contact us again but, hopefully now, you will have enough information to have a productive chat with your vet and get Oliver treated and on the road to recovery.

From the information that you have given, and also having been in contact with many Whippet owners over the years,   on top of the list of differentials I would, as you suspected, put SRMA.  I have known many Whippets to have SRMA, and so they can have a genetic predisposition, and for Oliver at his age to be displaying extreme pain, especially when his neck is moved, I would suggest that this is the most likely cause of his current problems.  SRMA is definitely diagnosed by examination of fluid via a spinal tap.  If you are not able to agree to this procedure, for whatever reasons, then if you have vet who will work with you then he or she may be willing to treat speculatively by giving an immunosuppressive shot of dexamethasone, and if there is remarkable improvement then a presumptive diagnosis can be made and a complete course of immunosuppressive treatment can be started within 2-3 days. 

Steroid Responsive Meningitis Arteritis
Not to be confused with bacterial meningitis.
SRMA is inflammation of the meninges (membrane covering the brain) and peripheral nerve roots, caused by immune mediated infiltration via the spinal cord.  The disease may acute or chronic and is cyclic in nature.   Relapse is not uncommon.
Clinical signs:
High temperature (up to 42C – 107.6F)
Neck and joint pain with stiffness.  Neck is often held in a low, stiff position and the dog shows a reluctance to move head.
Depression.
Diagnosis:  Evidence of immune cells via spinal tap and clinical signs.
Treatment:  Immunosuppressive doses of Steroids/cytotoxic drugs

The good news is, SRMA is not life threatening and if treated correctly, long term remission can be reached.  A relapse may occur, but that is often because the dosage has been reduced too quickly and immunosuppressive therapy has to be started again.  I have known numerous dogs with SRMA and although it is extremely painful, it can be brought under control very soon after starting immunosuppressive treatment.  The inflammation in SRMA is reduced very quickly, and the dog starts to feel better within 48 hours, and some feel much better, and without pain, much sooner. 

The best reducing immunosuppressive protocol that I have come across is by Prof. Michael J Day.  See below:

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. Below is the best example of a reducing immunosuppressive protocol I have come across. It is an excellent guide and can be tailored to the individual.


Example: Reduction Protocol for prednisolone:


Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael Day BSc, 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.


Merlin had IMTP which is a life threatening AI disease.  The treatment protocol is the same, although SRMA should be easier to treat, and you will hopefully see a much happier Oliver soon after starting treatment.

If you have any queries, please get back to us.

All the best

Jo

Hi
I've been here previously with my previous dog/s but I have a young whippet,20 months,who has been ill the last few days and I could use some help if you can suggest anything.

Oliver started with upset tummy ie mucus, loose poo followed by small amounts of fresh blood. His tummy has been noisy and he kept going outside every hour etc.
He went off his food the next day and seemed quite flat. Took him to the vets after 36hrs of onset of symptoms. I gave him a day to see if he would shake it off himself.

The vets gave him an anti nausea injection , Metronidazole and gut function paste. His temp was 39.4.
That was Friday. Yesterday morning he screamed when he moved his head, wouldn't lift his head above shoulder height and seemed stiff in his movement of his front legs so we went back for a follow up in the morning. Temp 39.3.  The vet gave him a thorough check over applying pressure to his gut etc and moved his neck in each direction but could find nothing specific.
He got worse through the day and kept screaming from time to time when moving his head.

Last night we were so worried we took him to Vet Hospital. He had very thorough exam, all the blood tests they could do. He was tender in his tummy and although at first didn't scream when the vet moved his head, he eventually did scream. His temp 39.5
The vet could get him to move his neck ok of his own accord but she said he did seem very very sad and hunched.
She said nothing remarkable on his bloods just potassium a touch low. She also said something was a touch high but it often is in sight hounds but I think it was CBC or something like that.
He's been given paracetamol and Gabapentin. He seems no worse but equally no better this morning but his temp is 39.1
I have some misgivings still as he is still very sad and flat, reluctant to move about, he knuckled over on his front paw earlier and still very reluctant to move his head. He's eating cooked chicken but won't take anything else.
He doesn't do being poorly and is a baby BUT I am feeling like either he has two separate issues or are these all related symptoms.
My first thought is SRMA but I really don't know what to think.
You guys were amazing help when I had Merlin who had IMTP so I'm just hoping you will read about Oliver and offer some advice. Thank you.