Finn MUO

[KazMav]

Hi, Finn was diagnosed with MUO in Nov and has been on chem and preds since. He has responded well and is now on 5mg preds every other day and chemo for 2 days every 3 weeks. He still has a ravenous hunger which I hope will diminish as the preds reduce. In Apr he has his final chemo and the vet wants to do another spinal tap and blood tests before tapering his preds. I would prefer not to have the spinal tap and bloods but just to taper and be vigilant for a relapse. Just feel if the tap says he's not better ( which he appears to be)  I still don't want him having any more chemo. Any opinions would be appreciated. The vet has been so good I am worried about telling him.

[Jo CIMDA]

Hi

I am sorry Finn has MUO, and it is great that he has responded so well.  this is really positive news.

As with all autoimmune/immune-mediated diseases it isn't until the drugs are considerably reduced or withdrawn that anyone knows if a relapse will occur.  If a dog is not in true remission he may relapse when the drugs are at a low dose or within a month or so after the drugs have been withdrawn.  If this happens then the drugs have to be reintroduced or the dose has to be raised, usually up to an immunosuppressive dose.     If the dog doesn't relapse and time goes on and the dog is still well then he has reached remission.

To develop an AI disease a dog is born with a genetic predisposition to autoimmunity.  This potential cannot be detected until something within the environment such as drugs, vaccines,  preventative treatments (wormers/flea spot -ons etc) stress or hormones, triggers the immune system to wrongly attack a part of the dog's own body.   So long term remission - hopefully for life - is all that can be hoped for and all the owner can do is to limit, as best as possible, the trigger factors. 

When Finn finishes his treatment, it is hoped that he will be in remission - and his clinical signs and blood results will indicate this. Personally, I agree with you.   You know Finn's diagnosis, and you are aware of the clinical signs.  If Finn is well then I see no reason for you to consider a spinal tap, and if a spinal tap is performed whilst the dog is on preds it may not be a true analysis, because an elevated white cell count may not be seen in an immunosuppressed animal/person.

If you have a concern, because Finn is exhibiting certain clinical signs, then you can have a blood test done and nothing else is obvious (it could be something unrelated to AI) and the clinical signs are as before then you can assume a relapse and start treatment all over again.

Checking blood results every now and then might be comforting,  but to put his body though the stress, and the potential trigger,  of a General Anaesthetic for a spinal tap might not be a good idea, especially if he is well in himself.    This is a good link:

https://www.fitzpatrickreferrals.co.uk/neurology/meningoencephalitis-of-unknown-aetiology-mua/

Jo

P.S.  If you are worried about telling your vet of your decision not to have a spinal tap, just say you can't afford it.  It works every time!

[KazMav]

Thank you Jo for giving up your time to give such a helpful and comprehensive response. I touched on it with the vet today but he said because Finns case was originally so severe he thinks a spinal tap is requiered. He then explained that even if he was clear Finn would still need to be weaned off
chemo so instead of twice every 3 weeks , it might be every 6 then every 8 - I was hoping that following the tap ( if we had it) and 4 months of treatment he would just be weaned off the preds and the chemo would stop. He said it was normal to wean off - I don't think they do with humans? Just a little worried I'm being taken for a ride 🤔 His original report states -CSF RBC was 70 /ul, WBC 980/ul , total protein 148.1mg/ul
74% neutrophils,19% monocytes and 7% lymphocytes.which is marked neutrophilic predominant pleocytsis.

[Jo CIMDA]

Hi

My worry would be if Finn achieved remission the procedure and drugs used to perform a spinal tap might just be enough to trigger another episode.  I have not known another dog with MUO or SRMA etc to have a further spinal tap at that stage of treatment.

It is typical, and necessary,  to wean off prednisolone because it inhibits adrenal production, but the other drugs can usually be stopped as and when.  It might be that your vet thinks that weaning down will be less of a shock to the system, and often taking it slowly at the later end of the treatment can be beneficial because it maintains internal stability and homoeostasis.

If Finn is not exhibiting clinical signs of MUO then remission can be assumed - it is only ever assumed anyway.  You know the typical clinical signs of a relapse and if these occur then you just start treatment all over again. This is the typical approach to a dog that has an AI disease.

Ultimately the decision is yours, and I suggest you wait until that time comes and assess the situation then.  I would however, be very reluctant to do anything to Finn if he is well in himself.  It might be best to leave well enough alone.

Good luck

Jo

[KazMav]

Thank you 😀 nice to be able to consult with someone as knowledgeable as you but independent of vets. I will now wait until the time comes and then I will assess the situation again as you suggest. The threads are really interesting to read - it is such a horrible disease with such a long and worrying treatment duration- reassuring to share experiences.

[Jo CIMDA]

Hi

Yes it is a horrible disease and MUO is variable and less predictable both in treatment and recovery, and this makes the choice of drugs and the protocol less defined. 

Trust your instincts though.

Jo

[Keeper]

My cocker spaniel has Focial GME and been in remission since May 18 and off alll his med since December 18, I ask my specialist if he should have a MRI to see if the changes have made they said no it's a waste off money which I was great for the simple answer, in your case it's a big thing and costs and everything should be considered especially if they are heading in the right direction and getting on top of MUO

[KazMav]

I have read all the Keepers posts they have been most useful thank you

[KazMav]

Hi all,

Thank you for your support. Yesterday Finn had bloods done ( no spinal tap ) and all was clear- I am delighted.  He is on 5mg pred every third day and we are now starting the chemotherapy wean down.
He was going every three weeks for two days treatment since November - the vet now wants two lots of 4 weeks for two days treatment, two lots of 5 weeks, then 6 and 7 . I think I will try to negotiate one two day treatment at 4 weeks, one at 5 ect . There doesn't seem to be many dogs on here going through such intensive chemo for MUO. Having said that, he doesn't mind going and has very little side effects- maybe tired for a morning. It is all very expensive though and Id rather not pay for something that isn't essential- I know we will need to watch him closely. He is absolutely fine in himself at the moment.

[Jo CIMDA]

Thank you so much for Finn's update.  MUO is less common than other AI diseases, so your input is very valuable to others.

I am so pleased Finn is doing well, and without having invasive testing too!  What a lovely character he is to not mind about having chemo treatment. 

It is very expensive, but I suppose if it is working then it is difficult to know what is essential treatment and what is not.  It is a tough time for you both financially and emotionally.  Finn is a lucky lad to have you.

Looking forward to the next instalment!
 
Jo

[KazMav]

Finn continues to make excellent progress. Chemo now every 6 weeks so heading in right direction. Still on 5 mg of predisolone every 3 days. Would like to reduce this carefully. Could we go to every 4 days for 3 weeks then 5 days ect ?

Would also appreciate your opinion on neuturing him whilst on predisolone and chemotherapy. Vet didn't seem dead against it but said it would be better not to because treatment may affect recovery even though the operation is not too invasive. He get so 'excited' at certain times around dogs and people and although really well behaved can sometimes not control his instincts. I would hope that neuturing might make him more settled- i know this may not be the case. Any advice appreciated.

[Catherine]

I am not sure what to advise about the medication reduction, but I am all for reducing slowly if the dog is coping well with the medication.

Personally I would hold off on having Finn neutered until he is off medication and seems stable.

[Jo CIMDA]

Hi

This is such good news about Finn. 

5mg of pred every three days is a very low dose and it is now likely not to be having any great effect so you can stop it, but also you may feel better if you give 5mg of pred every four days for a week or so and then 5 days for another week before stopping it altogether.  There is no hard and fast rules when the dose get very low and given every 3+ days.

Personally, I would avoid surgery whilst he is on chemo, and probably for 6 months after chemo has stopped.  Chemo is a tough drug regimen and it can affect so many parts of the body. Depending on what drugs are used Chemo can cause low platelets and any surgery should be avoided because of the possibility of bleeding.  Higher doses of preds can inhibit the healing process too.   

Often, if a dog is on prednisolone for any period of time, or chemo drugs, the dog will become impotent anyway, so you may agree to castration when in fact the drugs have done the job for you. 

Also, if Finn's MUO is immune mediated then surgery may trigger off another episode.  So there is a lot to think about and I wouldn't rush into decisions at this stage of his treatment.

All the best
Jo

[KazMav]

Thank you for such a positive reply. It is great to get second opinions and you
always Instill me with confidence moving forwards. My leg will resign itself to an
8pm daily humping - a small price to pay given what he's been through !

Really appreciate this site and the support given. I will keep you all updated with any changes -
hopefully good .

[Lorraine]

Hi KazMav,
My dog also has MUO, first initial diagnosis from our vet in March was mild stroke, put on steroids, doing great until tapered to 1mg then relapsed. That's when we had his MRI done end of May and got diagnosis, unfortunately by this time his was advanced. He started cytarabine and so far had 4 sessions every 3 weeks, next cytarabine will be every 4wks. He will then do every 6 weeks and hopefully reduce or stop. (No insurance, cost is killing us) He has been tapered from 10mg to now 5mg. On his last review 5th Aug they decided not to taper his pred, instead adding ciclosporin as they said his neurological symptoms had slightly decreased. He is very nervous when he attends and refuses to stand for full examination. I'm not convinced there was any decrease and just that he was extremely nervous but what do I know! It's a long process and slowly you see signs of their character coming back. Gigi has now started showing interest in his teddy and sleeping in his bed There is a blood test you can have to check for any inflammation still present, I think it's called CRP? It's a reactive protein test. Hope our dog's continue to improve.
Lorraine