New member - Khaleesi

Started by tkruger, September 09, 2017, 09:08:11 PM

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tkruger

Hi

We have a 2.5 year old female cavalier cross poodle. She has been undergoing tests for various things lately. She was presenting with exercise intolerance, silent open mouth panting with her tongue in - especially at night time, then started what looked like scooting but was going around in a circle with her head up in the air as if she was throwing her head back, then the paw licking all on her right side started and the scratching of her head, then rubbing her face. At first the vet thought it was her anal glands bit they were empty, then he said she must have allergies - but she has perfect skin, perfect ears and no redness or sores. At this point i decided to change vets as felt he was listening to my worries that i felt she was displaying signs of pain and felt that he was not singing from the same hymn sheet.  Im glad we did.  On the CT scan it showed she had chairi malformation and it was thought perhaps her other signs she were because she had syringomyelia. So we decided it was best to go ahead with firther investigation and she this week had MRI, Spinal fluid collected along with an array of bloods and tests for infectious diseases. She doesnt have syringomyelia but have been told that her immune system is attacking her central nervous system and she has lots of inflammation in her spine and neck.  They are awaiting two more tests to come back and then it is thought they will start steroids? I will discuss in more detail when she calls me monday. Im feeling very worried and wandering what the future holds and whether she will be ok.  Is there a name for this? so i can do some more research. Feeling a bit lost and worried. We have found a holistic vet who uses homeopathy as well as conventional medicine and accupuncture. Im sure she will guide us through.  We wont be seeing her until next week.  Is this something that will be life long or once treated it will stay away. Sorry for all the questions. Is the only treatment through steroids. Ive always heard bad things about steroids and wandered if they are suppressing her immune system to stop it attacking her nervous system does this not open her up to infections - all a minefield right now. thanks for taking the time to read

Jo CIMDA

Hi and welcome

I am sorry your young girl is so poorly, and you were right to change your vet.

As I read through your post, I too, suspected syringomyelia because of her Cavalier genes, but if it is a AI disease then I believe with the correct treatment the AI disease prognosis is much better.

From what you have written it sounds as if she may have Steroid Responsive Meningitis Arteritis (SRMA). If this is so then, as the name suggests, with the correct steroid treatment regimen she should respond well and in time reach remission.

Steroids are scary drugs when you don't know anything about them,but for dogs and humans with AI diseases they are a life saver and as long as the regimen is correct and side effects controlled then right now it is the best thing for your girl. If it is SRMA then you should see a remarkable improvement soon after steroid treatment has started, sometimes within hours. There is a lot of information on the site to familiarise yourself with what to expect but if you have any concerns just ask. 

Personally, I like homoeopathy and some alternative treatments and supplements, but it cannot bring AI disease into remission.  I think it can optimise good health, but at this time the only treatment for your girl is to suppress the immune system with immunosuppressant drugs which enable the body to start behaving normally again. What you can look into now is keeping her as naturally as possible eg., diet, no more vaccines or spot on treatments etc......  Autoimmune disease occurs when the dog has a genetic predisposition to autoimmunity and this is inherited from both parents.  For the dog to develop an AI disease they have to meet a 'trigger factor' and this can be anything within their environment that causes their immune system to become confused and start to destroy 'itself'. By limiting the known triggers you are minimising the risk of her relapsing.

SRMA often occurs in young dogs.  Relapses are reasonably common in the first couple of years but anecdotal evidence suggests that this settles in time and long term remission can reasonably be expected and she will be happy and pain free again.   

The best immunosuppressive drug protocol I have come across is by Prof. Michael J Day, and it can be confidently used as a guide. 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.

"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.


Below is an extract from my seminar notes and it will hopefully give you an idea of what to expect when treatment has started:

If a dog has a serious autoimmune disease, then the sooner treatment commences the better chance the dog has of survival.  The main delay to starting treatment is obtaining a diagnosis or at least your vet being sure that he hasn't missed anything that could be made worse by giving high doses of steroids.  Achieving a diagnosis can be a fight against time. 

If your vet has decided that in all probabilities your dog has an autoimmune disease, then to a certain extent, which autoimmune disease your dog has, as far as treatment is concerned, is irrelevant because with the exception of a few diseases, they are all treated the same, that is, with immunosuppressive drugs.  The main objective is to 'knock out' the immune system and virtually stop it from working (or near enough) so the destruction will cease and give the body a chance to recover.  As previously stated, this treatment regime works in most cases, that is, if it has been given early enough and the dosage is correct.  All dogs are different and some can tolerate the drugs better than others. In proportion to their size, small dogs seem more able to tolerate higher doses of steroids than large ones. Some diseases are more serious than others and carry a poorer prognosis. So the initial crisis is a crucial time, however anecdotal evidence shows that many more dogs survive than die if correct treatment is administered in good time.

It is hoped that a positive response can be seen within 4-6 hours of starting treatment (depending on the disease), but in a serious, life threatening situation, the first 2-7-14 days can be a very worrying time.  Assuming the dog has stabilised he will quickly feel much better, and if he is in hospital may be allowed home within a week.

When he comes home he will probably have a 'goody bag' full of drugs.  He will be on a high dose of steroid, usually prednisolone, and he may also be on another immunosuppressive drug, such as Azathioprine.  Your dog will be weaned off in a controlled manner according to his wellness and clinical observations. 

Note: High doses of steroids must not be stopped abruptly.  Your dog could go into an adrenal crisis if the medication is withdrawn too quickly.
 
In addition to immunosuppressive drugs he should have something to protect his stomach from excess acid.  The last thing your dog needs when he is feeling poorly is a bleeding stomach ulcer caused by the drugs.  Sometimes, Antepsin is given to coat and protect the stomach (but this must not be given within two hours of other medication otherwise it will stop the drugs from being absorbed).  Zantac (Ranitidine) may also be prescribed to take away the excess acid. Another gastroprotectant used is Omeprazole. To minimise irritation to the stomach it is usual for the daily dose of steroid to be split into two doses and given with food, one dose in the morning with breakfast and the other dose with his evening meal. I have known several dogs, who did not receive a gastroprotectant as a part of their treatment regime, and went on to develop anaemia. This is not autoimmune haemolytic anaemia but iron deficiency anaemia caused by bleeding stomach ulcers. Using a gastroprotectant is a good preventative measure. When the steroids have been significantly reduced to a low dose, a gastroprotectant may not be necessary.

Excess acid, produced because of the drugs, may make a dog prone to developing pancreatitis. A dog with pancreatitis will appear in pain and his back may be arched as if he can't straighten up.  He may be lethargic, seem bloated and have a tender abdomen. Dogs usually go off food and water, may vomit and look depressed.  If you suspect that your dog has pancreatitis, don't try to feed him because it will make the condition worse. Take him to the vet as soon as possible as he may require treatment or need to go on an intravenous drip to stop him dehydrating.  Again, the risk of pancreatitis should be minimal once the dog is on a lower dose of steroids.   A low fat diet is best when your dog is on high dose steroids or prone to pancreatitis. 
As your dog's immune system is being significantly suppressed, he will be more likely to pick up infections, and will not have the ability to fight against them.  As a precaution a broad spectrum antibiotic is often prescribed. Also it is sensible not to exercise him in areas where he is more likely to encounter infections, for example, a park or a popular dog walking area.

Whilst your dog is on high dose steroids he will want to eat and drink excessively. However, this also means that he will want to urinate more and this can sometimes cause temporary incontinence.  You may have to get up to let him out during the night and if you leave the garden door open during the day, it may save some mopping up!  He cannot help it and won't like it either, so don't be too hard on him, it's only temporary. You will notice as he is weaned off the drugs the unwanted side effects will subside and he should return to normal habits and behaviour.  Urinary tract infections and/or bacterial skin pustules are not uncommon when a dog's immune system is suppressed, and this is often the reason for a dog to be off colour during this time.  Note: Always consider a urine infection if your dog seems under par.  A course of antibiotics will usually sort this out quickly.

Depending on what autoimmune disease your dog has, he will probably need to have regular blood tests.  Biochemical blood tests will also keep an eye on other body functions, such as those of the liver and kidneys, which is important at this stage.

Assuming good progress is being made, the clinical signs of his illness are diminishing and positive signs of improvement are apparent, your vet will want to start weaning him down from the high doses of steroid.  This process can take 3-6 months or more, and usually begins anytime after 10 - 28 days from the start of treatment, depending on the results of his blood tests and his clinical signs.

Relapses are not uncommon, especially in diseases that are difficult to control, for example SLE.  A relapse may mean that initially, your dog needed to be on a higher dose of immunosuppressive drugs for a longer period of time, or your dog may have been weaned off a little too quickly and then the dose withdrawn too soon.

If a relapse occurs he will probably show similar clinical signs to his initial crisis.  He will have to go back on an immunosuppressive dose of prednisolone, but it may not have to be quite as high as before. A combination drug may need to be added at this stage. The weaning process will then have to start all over again. Returning to an immunosuppressive dose will mean that he has to go back on a gastroprotectant.

 


The sooner treatment has started the better and I hope you will see her so much better very soon.

Jo