SRMA/IMPA in Greyhound

[Yvie48]

 Hi everyone, My greyhound Poppy has been ill with AI for almost 17months now  ,she presented with all the symptoms of SRMA at first, this was over the Christmas period so the labs were closed and my vet was limited to what tests he could do , luckily he thought it was an AI and the meninges were affected  she was given Loxicom to try to bring her temperature down ,antibiotics  and steroids ,she started to improve then suddenly  developed a stilted gait and was in a lot of pain . the symptoms of SRMA had gone but the vet was concerned as her inflammatory markers were high  and her white blood cell count was raised . He referred her to a veterinary specialist centre  where after multiple tests,scans and joint tapping she was diagnosed with IMPA . They recommended steroids as the main treatment  and my vet was seeing her on a regular basis to monitor her . she seemed to relapse when we got down to 15mg of prednisolone  with the return of the stilted gait , but what we have recently been told is that it was probably  an adverse effect of the steroids causing muscle weakness, after a long discussion with my vet it was decided 2 weeks ago to gradually reduce the steroids, she has had an xray of her legs and sp;ine  and nothing showed up she has been on a reduced dose of  one and a half prednisolone for 2 weeks and i am due to reduce it to one tablet a day for 2 weeks as from today. The problem she has now is that her back legs are still weak when she gets up from resting she either limps on one back leg or holds it up   but she is still keen to walk  so every hour i put her lead on and walk her around the garden a few times  and she is fine ,still a bit wobbly . My question is ,we are due to see the vet next Wednesday , do i carry on with what i am doing  or get an earlier appt . She is very well in all aspects apart from  her back legs ,she has a good appetite, is toileting normally and is bright and alert in herself. She has lost her muscle mass  and i'm thinking it  will take time to build this up slowly again . My vet does have a hydrotherapy treadmill  would she benefit from this So many questions, Sorry !!! Yvie

[Jo CIMDA]

Hi

Yes, I think Poppy will benefit from hydrotherapy.  It will take many months for the muscles to return to full strength, but it will come.  It is a slow process.  The good news is she is in remission.

Jo

[Yvie48]

 Hi Jo , I have communicated with you by e-mail prior to this post , you know me as Barbara, Yvie is my chat name.  I thought I would join the forum and might get more advice on here , sadly we have had to bring Poppy's vet appt forward from Wednesday to yesterday  as she really is struggling on her hind legs , our vet says the swellings  have got larger on her knee joints  and he is having her in tomorrow to x-ray and tap her knee joints , He thinks maybe there is more going on other than AI  arthritis or sepsis maybe ??  She is absolutely fine in all other aspects  this weakness started before  we reduced the steroid  and she is not in pain , just struggling to stand up and walk;. He could have done the xray and tap yesterday but that meant the sample would have to wait to be picked up by the courier on Monday so it would not be fresh and get a true reading. I will keep you updated.

[Jo CIMDA]

Good luck Barbara.  I hope all goes well.

Jo

[Yvie48]

Poppy had  x-rays and  both her rear knees tapped. the x-rays showed nothing abnormal,no arthritis, but he did draw a lot of fluid from both knees, no treatment given today until we get the first lot of results back from the lab. also  Vet said no damage to the cruciate ligaments. She is not in any obvious pain but really struggles to get up..

[Jo CIMDA]

That is very good news.  Did the vet not say that the muscle weakness is due to the long term use of preds? 

Now you know that there is nothing wrong you should lower the preds with the aim of to stopping them altogether, to enable her muscle strength to return.  High doses, or prolonged doses of Preds affect all parts of the body and she will benefit in so many ways once she is off the preds.

Good news!
Jo

[Yvie48]

 Hi Jo,  Yes the muscle weakness could be due to the preds it has been going on for a while and getting steadily worse  we reduced the steroids  down to 7.5 for 2 weeks then as of last Thursday she  was on one 5mg tablet every morning and the vet says it is a mystery ,both hind leg knee joints were slightly swollen 2 weeks ago but when we took her on Saturday he said they were visibly larger . She struggles to get up then once up is reluctant to move when she does it is pitiful to see her, we have to wait for the synovial fluid results to come back and hope we have a positive result as to knowing exactly what it is. It could be the AI  or a bacterial infection. We are getting her up every hour and walking her around the garden at least that way she is getting some form of exercise,and I am massaging her legs a couple of times a day and she seems to love it , certainly not showing any signs of pain. We are not expecting results for another couple of days, but I will post on here as soon as we know. the information you have given us has been invaluable. Thank you !
Kind regards
Barbara

[Yvie48]

Hi Jo, not the news we wanted to hear tonight, our vet rang to confirm the results of the cultures  taken from Poppy's knee joints ,the AI is still there inflammation markers are high so we have had to increase the  steroids immediately tonight to 20 mg  she was down to 5 mg , if no improvement in 3 days we are to take her back to see the vet  but if she shows signs of improvement he wants to see her next Thursday or Friday to palpate her knee joints  to see if the swelling has reduced. My vet also knows of my liasing with you and has asked me to ask you for a name of  a person or persons that were involved in the study/research of  AI in dogs if he could talk to someone  re: Poppy  as he feels that we may be missing out on something. She really is a mystery. We are due to go on holiday soon  and we need to get meds sorted before we go.

Kind Regards
Barbara

[Jo CIMDA]

Hi Barbara

If Poppy has inflammation that indicates she has relapsed then the dose of pred needs to be immunosuppressive
(1mg/kg/12hours prednsiolone not exceeding 80mg a day) Ref: Plumb's Veterinary Drug Handbook.   20mg pred a day will not bring the inflammation under control and lead to remission.  It will only temper the problem.

As Poppy has been on prednsiolone for a long period of time it might be prudent to introduce another drug, such as Leflunomide or mycophenolate.  There is only so much a dog can take of prednisolone and the use of a combination drug is common place, especially when a dog has relapsed before coming off preds altogether.  This is an excellent link:

https://veterinarymedicine.dvm360.com/immunosuppressive-drugs-beyond-glucocorticoids?id=&sk=&date=&pageID=5

If your vet calls the Royal Vet College or Cambridge Vet School or Glasgow Vet school, and speaks to an internal medicine specialists, they are usually only too pleased to give advice on how to treat AI disease.

I hope you can get Poppy sorted out very soon so you can all go  on a well deserved holiday.

Jo

[Yvie48]

Hi Jo ,  Thanks for your reply, We saw our vet on Thursday and Poppy  now has  swellings on all four knee joints and one shoulder, as we are going away  on Tuesday for 10 days he says to leave her on 20mg preds daily plus stomach protectant and he will contact Julian at Davies referrals  while we are away to see what will now be the best option for her  meds wise we have stopped the Atopica as he says  That obviously isn't working for her. She is still not showing any sign of pain, even when he manipulates her joints. He says that Julian may suggest Azathropline as an added immunosupressant. but I dont want to take the risk of giving her such a toxic drug while we are away and she has a reaction to it. I think i might phone him  for a return call later and see if he suggests putting the prednisolone dose up  for the two weeks that we are away and review her on 24th June (our next appt) Thank you so much for all your help and guidance  it really is appreciated.
Kind regards
Barbara.

[Jo CIMDA]

Hi Barbara

Azathioprine takes 6-8 weeks to have full effect.  I believe you need a quicker acting 'combination' drug she as those I mentioned in my previous reply. 

If this is a relapse of IMPA then 20mg of pred for a dog of Poppy's size will not address the fundamental problem, it will just reduce some inflammation and increase the side effects. 

I do hope you manage to have a good holiday.

Jo