New member - Buddy

[stevenday]

Hi everyone,

Our family have a 7 month old Cavachon puppy called Buddy, who started limping 3 weeks ago. At first we thought he had sprained his leg or something but after 3 days, he could hardly walk and was in pain.

He has been X-Rayed which did not show anything sinister, he has had blood tests which have all come back clear of Lime Disease and other diseases. His temperature has been normal and his breathing has been normal and his heart beat only slightly fast. Our Vet has been great and diagnosed Idiopathic Immune-Mediated Polyarthritis after about a week, although he has never treated the condition before. He sent off tests of his join fluid and confirmed that there was no bacteria in there, but the liquid pointed to Immune-Mediated Polyarthritis.

Buddy is on 2x5mg Prednicare tablets, twice per day, 1/2 tablet of Zitac twice per day and 25mg Atopica tablets, twice per day.

Buddy just lies still all day long, with his eyes open. He is in some discomfort. He is eating, drinking and going to the toilet as normal, but he made no real progress within the past week. We were wondering how long it may take before he shows some kind of recovery. I am obviously aware that he may not recover fully.

Should was also get a second opinion, although I can't fault our Vet.

Thanks

Steve

[Jo CIMDA]

Hi Steve and welcome

I am sorry Buddy has IMPA.  It is a very painful condition and it is so upsetting especially when they are so young.

I don't know how much Buddy weighs but generally, the starting dose of Prednisolone is 1mg/kg/12hours.  IMPA usually responds quickly to prednisolone  and the  pain should reduce within 48 hours of starting immunosuppressive therapy. Sometimes puppies and smaller dogs  may need to have a slightly higher dose because their metabolism is quicker.  The good news is smaller dogs cope much better with higher doses of prednisolone than larger dogs. Also, you should expect Buddy to be very hungry and drinking a lot, as a result of the steroids.  His joints might be dry at the moment and it will take a short while after treatment has started for the synovial fluid to be replenished, so during this time don't walk him far and allow him to rest.  You say at the moment he is just lying down and this might be the reason why.   

If the dose is correct then I would have hoped for more improvement than you describe.  This could be because the dose of steroids is not enough, or it is too high.  Or the Atopica is not agreeing with him - it doesn't suit every dog and if it is making Buddy feel sick then it is best to lower the dose and let his body become accustomed to the drug before increasing it to the full dose.  Very often IMPA doesn't need another immunosuppressive drug as it can be brought under control by the correct dose of steroids.  Also, your vet has put Buddy on a gastroprotectant, which is good as not all vets think it is necessary, but if this is not sufficient then the vet can change the gastroprotectant to Omeprazole. 

You have a confirmed diagnosis by examination of the synovial fluid within the joints but it is usual with IMPA to have a very high temperature, which you say Buddy hasn't had, so that is puzzling and might or might not be significant

You are very lucky to have a vet that is honest enough to say that he hasn't treated this before, and he sounds as if he is a vet you can work with, which is great.  If you don't see an improvement in a few days then perhaps (as the Christmas holidays are coming up) you should see if you can get a referral to a specialist this week or ask your vet to make a call to a vet college for advice.

The treatment for IMPA is quite straight forward - that is with immunosuppressive doses of prednisolone - so there is no reason why your vet can't treat this successfully but you must bear in mind that dogs are individuals and they can react differently to the drugs, some respond better than others and like I have said puppies may need a higher dose, so the drug protocol has to be tailored to the individual.  The  protocol below is the best I have come across and it is by one of the world's leading immunologist Prof Michael J Day.

Primary IMPA often occurs in young dogs and it does have a good prognosis but relapses are not uncommon for the first year or so (that doesn't mean Buddy will relapse though)  but so often long term remission can be achieved and the dog can lead a normal life but so much depends on the correct drug treatment and management of the side effects of the drugs.

I do hope you see improvement in Buddy very soon.

Jo

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 up to half. 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 adjusted to the individual.

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.

[stevenday]

Hi Jo,

Thank you so much for taking the time to respond.

We are seeing a second Vet tomorrow evening, so I will let you know what they say.

Thanks again

Steve

[stevenday]

We have been to another vets today, who have seen the condition before and have treated it.

They have advised us to reduce his steroids and have recommended the following drugs from today onwards:

0.5 x 250mg tablet Ceporex twice per day
1 x 25mg tablet Atopica once per day
1 x 10mg tablet Omeprazole once per day
2 x 5mg tablets Prednicare once per day

We will let you know how he gets on.

[Jo CIMDA]

Hi

I hope you seen an improvement very soon.

Jo

[stevenday]

Hi Jo,

I thought I would give you and anyone else on the forum, an update on the condition of Buddy.

Two days after the dose of steroids was reduced and the antibiotics introduced, Buddy started to improve and become interested in his surroundings again. He had a couple of bad days, when he was in pain and struggled to walk, but each day he has improved. It is now nearly two weeks after the doses were changed and he is going out for small walks and is nearly back to the active puppy that he was.

I am sure there is still a long way to go, but after fearing the worst, initially, Buddy is now wanting to go out, play and is pulling the ornaments off the Christmas tree!

It is a horrible and frightening condition, but reading forum and reading other people's experiences, gave us hope. We also passed on some of the information on here to our Vets.

Thanks

Steve

[Jo CIMDA]

That's great news Steve.  What a Christmas present for you.

Don't be tempted to reduce the preds too quickly and look at Michael J Day's protocol and use it as a guide.

Thanks for the update.

Great Stuff!

Jo

[stevenday]

Hi Jo - I thought I would post a further update for you and anyone having similar issues.

Buddy's tablets have now been reduced as follows:

1 x 25mg tablet Atopica every other day
1.5 x 5mg tablets Prednicare once per day

He's doing great and is 95% back to normal. He seems to know his own limits. He can go for long walks, runs up and down the stairs, runs around, but stops when he gets tired.

The plan is to see the Vet once a month and further reduce the tablets down over a period of weeks/months, but the treatment seems to have worked for now.

He may have to be on tablets of some sort for the rest of his life, but we're just so pleased that we have our puppy back.

The treatment for this condition does seem to be about finding the right level of tablets for each individual dog.

Steve

[Jo CIMDA]

Hi Steve

This is Fantastic news!  It is so good for others to hear of successful stories. 

Thank you for the update.

Here's to a better year for Buddy.

Jo

[stevenday]

Hi Jo,

I thought I would give you a further update so people can see the timescales involved with this disease from the date of my first post and so they don't lose hope or fear the worst.

Buddy's tablets have been reduced from last Wednesday (21st February) down to just 1 x 5mg tablet of Prednicare per day.

He had already been taken off the Atopica tablets the week before (14th February). For a day or so, the effects of being on the steroids were highlighted (being up late, eating loads, walking at 100 miles per hour) but that settled down quickly.

He will be on the single tablet for 2/3 more weeks and I think the intention is to take him down to half a tablet or a tablet every couple of days.

He's doing great though. His appetite is huge, due to the tablets and he has found a way of breaking open the fridge, so we have to watch that, but apart from that he's great with no side effects. He's a happy, loving and energetic little dog.

Steve

[Jo CIMDA]

Hi Steve

Thank you so much for the update on your Buddy. Progress reports are so useful for others going though similar.

I am so pleased that he is doing well. Things seem to be going as one would hope.  As he is well in himself then you can afford to take this last stage of reducing the meds even slower if you wish, in the hope that he stays in remission.

Looking forward to the next update.

All the best

Jo

[stevenday]

Hi Jo,

A further update for you and anyone else reading this.

Buddy is now down to half a tablet of Prednicare, every two days and is doing great. Out Vet thinks that he will be on that dose for a further 4 weeks and will then come off the tablets completely.

We are aware that the condition may re-appear, but there are no signs of it at all at the moment and the current dose is very low.

He's lost the wight he put on when he was on a higher dose of steroids and is a happy, active dog.

Cheers

Steve

[Jo CIMDA]

Really great news Steve.  I am so pleased for you all and this is a lovely story for others to read.

Many thanks for the update.

Jo