Welcome, Guest. Please login or register.
Did you miss your activation email?

Username: Password:

Author Topic: I'm new and need advice for my George with IMPA  (Read 74 times)

DebsH

  • Newbie
  • *
  • Posts: 2
    • View Profile
I'm new and need advice for my George with IMPA
« on: May 14, 2019, 11:35:46 PM »

Hi,
I have a lovely 8 year old Airedale called George and am so worried as he will shortly be starting on high dose Pred due to a recent IMPA diagnosis.

George has had food responsive IBD for the last 3 years and sadly cannot eat anything at all other than his kibble which he does do very well on.   Last July 18 he got up from sleeping and could hardly weight bear on his right leg due to pain in a toe joint.  He improved with rest, but didn't resolve so we got referred to Davies Vet Specialists, who did scans (normal), joint taps (inconclusive as normal apart from right elbow had a few abnormal cells) and a steriod jab into the toe joint.  4 days later he was sound.

Then this year in Feb after some waxing and waning IBD symptoms, he had a really bad vomiting session with terrible tummy pain.  He recovered but a week later got up one evening and could hardly weight bear on his right leg again. I found his elbow painful with two fluid lumps on it.  Our vet found no temperature and gave him a Tramadol jab which knocked him out for 7 hours solid (barely even opened his eyes!).  The following day he was miraculously sound and the swelling went after a few days.  He went back to normal exercise but didn't seem 100% as he was not running around quite as much as normal.

In April he got up after resting and couldn't weight bear on right leg again.  He was so lame and in pain we had to put his harness on and help him out to toilet.  After a couple of days like this (Easter & vet closed) he was a lot better but still limping slightly.  No temperature. Our vet referred us back to Davies, who found the following:

Heart murmur - scan showed low grade due to leaking heart valves
Spleen looked generally swollen, also two masses on spleen & biopsies showed hyperplasia
Pancreas showed sign of previous pancreatitis.
CT scan of forelimbs was normal
Joint taps of right elbow showed high levels of inflammatory cells
Joint taps of left elbow and both wrists showed low levels of inflammatory cells
All joint fluid was a watery consistency
Fluid cultures negative for bacteria

The vet called me with the results and recommended he starts on Pred at 50 mg per day (he weighs 25kg) which I was totally horrified at, but after reading online and the advice on here I now understand and realise this dose is correct.  However, I've got a few niggling doubts that I'm not sure quite fit with IMPA and wondered what your thoughts were:

-  He goes hopping lame all of a sudden but never has a temperature.  Is it normal for IMPA to come on so suddenly and acutely and does it always present with a temperature?
-  Shouldn't the inflammation levels be the same in all joints (his is massive in one elbow and much lower levels in other joints)?
-  Limp has always come on very suddenly and always Spring/Summer or when the ground is very hard (he has had bouts of limping in previous years which has also followed this pattern).
-  With his current right leg limp (and previous limps), if we rest him completely (no walk, on lead in garden, no jumping on furniture) we can get the limp to go, but as soon as he exercises again it comes back.  With IMPA is it normal for exercise to make it worse?
-  He always has a good appetite.

I've got a couple of questions re Pred:

-  George has been on Ranitidine twice a day for two years now, due to reflux, plant eating and vomiting bile.  The Ranitidine controls this, but it all comes back if stopped.  Should I keep him on Ranitidine or would Omeprazole work better for protecting his stomach whilst on Pred?
-  He has an ongoing lip fold yeast infection which is controlled but won't go (gets ulcerated) - I imagine this will get worse.  The vet says use Hibiscrub which doesn't help much - is there anything you recommend?
-  The vet has said two weeks on Pred, then more joint taps to check it is working.  Does this sound a good plan?  How can we tell that its working due to the immune system being suppressed rather than just because of the anti inflammatory effects of Pred?

To say I'm nervous about the Pred is an understatement, I feel completely sick about it, I can't sleep, I can't concentrate at work.  I so want to help my lovely boy, but feel overwhelmed at the prospect of him being really sick on the Pred esp as he has always been so sensitive to oral drugs and his tummy, let alone all its normal side effects.  I feel his limping is different/worse than on previous occasions, as he is much more lethargic and quiet in himself with it this time which makes me sad.  Gosh wouldn't it be easier if they could talk!

Sorry for the long post and thanks a million for any help, advice or encouragement you can give.

Deborah (and George)
« Last Edit: May 15, 2019, 12:01:04 AM by DebsH »
Logged

Jo CIMDA

  • Administrator
  • Hero Member
  • *****
  • Posts: 2845
    • View Profile
Re: I'm new and need advice for my George with IMPA
« Reply #1 on: May 15, 2019, 06:45:37 PM »

Hi Deborah and welcome to you and George.

I am sorry George is having these problems.  I will try to answer your questions in the hope it may clarify things for you.

This is an excellent website for all things veterinary, and it is very reliable.

http://veterinarymedicine.dvm360.com/recognizing-and-treating-immune-mediated-polyarthritis-dogs


 He goes hopping lame all of a sudden but never has a temperature.  Is it normal for IMPA to come on so suddenly and acutely and does it always present with a temperature?

IMPA is one of the autoimmune diseases that is often categorised as the primary cause of  'Fevers of unknown origin'.  So, yes, it is usual for a dog with IMPA to have a high fever, sometimes in excess of 106.  IMPA often starts with intermittent lameness but if it is not diagnosed and treated  it progresses to lameness on all four legs with multiple joint involvement.  If a diagnosis is made early in the disease process the lameness may only be in a two or three joints.  IMPA can occur in combination with other AI diseases and this may include inflammatory bowel disease.

-  Shouldn't the inflammation levels be the same in all joints (his is massive in one elbow and much lower levels in other joints)?

I think this has been answered above.

-  Limp has always come on very suddenly and always Spring/Summer or when the ground is very hard (he has had bouts of limping in previous years which has also followed this pattern).

Autoimmune disease has to be triggered by something and this may be of a seasonal nature.  Vaccination can trigger IMPA.

-  With his current right leg limp (and previous limps), if we rest him completely (no walk, on lead in garden, no jumping on furniture) we can get the limp to go, but as soon as he exercises again it comes back.  With IMPA is it normal for exercise to make it worse?

Yes exercise will make the pain much worse.  IMPA is a very painful AI disease and it is progressive, so it may wax and wane but it will get worse if it is not treated with immunosuppressive therapy.   


I've got a couple of questions re Pred:

-  George has been on Ranitidine twice a day for two years now, due to reflux, plant eating and vomiting bile.  The Ranitidine controls this, but it all comes back if stopped.  Should I keep him on Ranitidine or would Omeprazole work better for protecting his stomach whilst on Pred?

Ranitidine and Omeprazole are both used for prevention of gastric ulceration when high doses of preds are used.  Either can do the job but Omeprazole is , I think, more commonly used. 

-  He has an ongoing lip fold yeast infection which is controlled but won't go (gets ulcerated) - I imagine this will get worse.  The vet says use Hibiscrub which doesn't help much - is there anything you recommend?   

It is very likely to get worse if his immune system is significantly suppressed.  I think all you can do is to use the recommended yeast controlling preparations and antibiotics if there is infection present.



-  The vet has said two weeks on Pred, then more joint taps to check it is working.  Does this sound a good plan?  How can we tell that its working due to the immune system being suppressed rather than just because of the anti inflammatory effects of Pred?[/b][/i]

Personally, I see no point in doing joint taps when a dog is on high doses of pred.  The steroids will mask the results and  he will have to be put out under a general anaesthetic to prove nothing.  Resolution of the disease by following a recommended immunosuppressive drug protocol, such as the Michael J Day protocol is the usual way to bring IMPA into remission.

I suggest you have a chat with the internal medicine specialist again and voice your concerns and ask if the test proved positive  for IMPA. Steroids are wonderful anti-inflammatory drugs, so I would expect Geroge's limp to improve somewhat but if you don't have to use them then there are other treatments for joint problems.

Good luck

Jo

Logged

DebsH

  • Newbie
  • *
  • Posts: 2
    • View Profile
Re: I'm new and need advice for my George with IMPA
« Reply #2 on: May 19, 2019, 10:54:48 PM »

Thanks for all the info Jo, its very interesting and a great help.

The long day at the specialist vets seemed to have knocked George for six so much - not sure if due to the stress (he is very noise sensitive and can be nervous) or all the tests.  I was a bit worried as he was so quiet and lethargic for a week afterwards, but has perked up the last 2-3 days and is getting back to his playful self. 

He has been having small on lead walks on grass and his limp seems to have pretty much gone for now and the fluid has reduced.  I find it confusing that his elbow/limp is so very exercise dependant and also the lack of temperature, no heat in the joint and good appetite makes me feel that I just can't do it to him and put all that Pred down his throat  :-\

My regular vet said she is very concerned about George having such a high dose due to his age and also because she knows him well and knows how intolerant and sensitive he has been in the past with medication and things like GAs.  I'll be having a chat with the specialist vet in the next day or two to discuss a few things and also want to see their report and get the full joint tap results which I haven't yet received, so will go from there.

Thanks again, much appreciated.

Deborah Handley


Logged

Jo CIMDA

  • Administrator
  • Hero Member
  • *****
  • Posts: 2845
    • View Profile
Re: I'm new and need advice for my George with IMPA
« Reply #3 on: May 20, 2019, 05:40:26 PM »

I hope it all goes well.

Jo
Logged