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

Username: Password:
Pages: 1 [2]

Author Topic: Itís been a long time- Pep having trouble with swollen elbow  (Read 489 times)

BrookeR

  • Full Member
  • ***
  • Posts: 226
    • View Profile
Re: Itís been a long time- Pep having trouble with swollen elbow
« Reply #15 on: February 07, 2020, 08:39:51 PM »

Thanks jo. Lots of helpful things to think about and discuss with my vet.
Iíd desperately love to get pep back down lower on the pred, as I know itís not helping with the pancreatitis, recurring urine infection and muscle/weight loss. My vet has suggested trying Azathioprine, but I would rather not go down the path of another immune suppressing drug. She is so frail and old now I donít think she would handle it or that I want to do that to her. If Iím honest I donít think I could do it again with her at this point. When we did the cyclosporine with her she was only 7 and in much better condition to deal with it and itís nausea and other side effects.
 We tried to decrease her pred by 1.25mg when she had the pancreatitis attack and my vet believed this week when I saw her that pep was relapsing again so we had to go back up that drop again. If she really was relapsing it seems something keeps triggering her. Whether the immune system is active due to the urine infection which may be contributing however the infection could have been also a result of the dose increase due to the impa so it's hard to know which order. Either way it isn't helping her signs resolve.

On a Facebook forum I am on, another Aussie has had good success with her impa dog by giving synovan injections. I was always too scared to try as my vet couldnít find any info of their use in impa dogs and we were worried that they may trigger her and sheíd have a bad reaction . But we decided we were at the point where risks need to be taken. She had one zydex injection last week then we go back again this week for another at our weekly check up. We are also going to test her poo for worms. We have discussed possibly checking her vitamin b12 too.

I am still not completely sure that she was relapsing. Itís summer here and pep always has all her problems in summer. She does not like the heat and possibly there may be an environmental trigger around at this time of year. Whenever we had consecutive hot days in the past she would limp and then would do so for a few days after before coming good again. She just had troubles in the heat and for a few days after. Anyway the 4 days prior to see my vet we had over 43 degree Celsius temps. So that leaves still some doubt in my head that she was definitely relapsing. We donít want to do joint taps on her. But Another thought My vet had is measuring Peps C-Reactive Protein. She said it is typically elevated with poorly controlled IMPA and normal with osteoarthritis. She said there are other factors that can influence C-Reactive Protein so it may give us a false positive also for a separate inflammatory condition. But it could be a means for measuring response to prednisolone rather than joint aspirates. I questioned about the pancreas possibly still being inflamed and if that would cause it to be positive.  She said yes but  together with other tools (ie Spec CPL quantitative specific pancreas lipase measure-)-it may be useful.

My vet sent me a heap of studies to read on digestive enzyme use and how they saw no benefits and some cases where the dogs got bleeding from taking them. She said if we are going to try there is no point unless we use the prescription strength one, used for treating epi. I feel I still would like to try but donít want to use the prescription strength. The place I get peps msm from (Greenpet) and I have also ordered some cranberry powder from sells one called Ď Synbiotic 180-S Probiotic & Enzymesí . Itís not prescription strength and I discussed with their naturopath what ingredients was in it because pep is very sensitive. She said they have never had any dog get sick from it and didnít seem to think there was anything she should react to in it. Iím going to have to try discuss further with my vet next week.
Logged
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Jo CIMDA

  • Administrator
  • Hero Member
  • *****
  • Posts: 2892
    • View Profile
Re: Itís been a long time- Pep having trouble with swollen elbow
« Reply #16 on: February 11, 2020, 07:12:31 PM »

Hi Brooke

Well true to form, Pep is keeping you on your toes.  It must be difficult to assess when you live with such extreme hot weather conditions.  How you tolerate such temperatures, I don't know, and it must be awful for the animals too.

 If you use Azathioprine it won't have any real effect for several weeks. I think the question is, does Pep really need immunosuppressive treatment????     Synovan injections will not have any effect on IMPA.  I think they work well for some dogs with arthritis but not all dogs.    Have you considered weaning her off pred and giving a NSAID such as Metacam. This might be an alternative to giving Synovan but again it is just an anti-inflammatory and will not address an immune problem.   

I am not sure if C-Reactive Protein test will tell you anything.  It doesn't identify a specific inflammatory response, so it is not diagnostic.  A positive just suggests that there is inflammation somewhere in the body and this can be a multitude of things.

Your vet seems so good at discussing things with you.  I hope you are able to come up with a plan for Pepper this week.

Jo
Logged

BrookeR

  • Full Member
  • ***
  • Posts: 226
    • View Profile
Re: Itís been a long time- Pep having trouble with swollen elbow
« Reply #17 on: Yesterday at 08:37:30 PM »

Hi Jo,
Yes pep is definitely following her usually form of keeping me on my toes.
The hot weather has been terrible. I normally like summer but itís been so humid and hard to do anything even in air conditioning. So I canít imagine how it had been for Pep. Luckily it has cooled down a since those 43 + degree days and we have had constant storms now on and off. Which have still been causing it to be muggy but no where near like it was.

In the past, the two times we have tried nsaids with pep she has ended up even worse & quickly and had to go back on and up with pred. So I donít want to try that as I donít feel she will do wel. I know the Synovan wont help with the impa, but we believe she has normal arthritis at play as well. Especially after seeing the state of her elbow on the X-ray we have been wanting to try the Synovan with her. Hopefully it may help with her normal arthritis and the poor state of her joints. I just was worried it may cause a relapse or trigger a bad reaction from her, thatís why I hadnít Tried sooner. She has had 2 injections so far and is okay, with no bad reaction.

I ended up deciding not to do the c-reactive protein test. Instead we did a poo sample and tested her b12 levels. We also tested her urine again which looked fairly good, but my vet said she still wanted to run another course of antibiotics just to make sure. As she didnít believe it was 100% perfect looking at under the microscope. Pep had maintained her same weight from the previous week and her joints looked a bit better. My vet admitted she thought the week prior pep had looked so bad that we would be discussing putting her to sleep very soon :( But she was greatly impressed by how pep looked this week in comparison to the previous week. The week before she had her head down and didnít want to move anywhere. This week her head was up and she was pacing around. She did however get very anxious on the way there. Normally she is fine going to the vets, but in the car she was panting like crazy, shaking and so anxious looking. Even after we got there she continued to pace around looking anxious. My vet seemed to think maybe itís because our visits were only a week apart and she is getting less tolerant to being poked and prodded. I donít know what was going on. We go back tomorrow so Iíll see if she does the same then.

Since I last wrote on her I have started giving pep cranberry powder. She has been fine with it so far. I have also upped her food back to almost normal level and she isnít appearing sick or showing signs of pancreatitis.
The poo sample came back negative to all types of worms including negative to Guardia. I had expected the b12 sample to come back low, but it came back elevated! My vet said this can be caused by liver disease :(
We didnít do bloods as we had only done those the week prior (her liver levels had looked fine then). I am going back tomorrow and we will be running bloods to check her liver levels again.

 I checked the trace vitamins and minerals supplement that I give pep and realised that since she has lost weight and I had also dropped her food back (a while back when she had trouble with her elbow) I hadnít readjusted her dose. So I have been giving her too much for almost 2 months! Iíve been trying so hard to make sure I get everything right as she is on so much different medication/supplements at different times and being fed 4 times a day. Getting up every night every 2 hrs or so with her has me so exhausted and makes it so hard for my brain to concentrate. I feel terrible that I may have been poisoning her. My vet said that over supplementing could cause her b12 to be up hence why I thought to check the trace vitamins and minerals supplement and therefore saw my terrible mistake. But I have been reading since and read somewhere  that b vitamins are water soluble and will just get weeíd out if you take too many. Iím not sure if this is true or not? It is hard to find info on over supplementing. There is lots of other vitamins and minerals in the supplement, too not just bís....which is concerning. I have stopped giving her the supplement since I realised my horrible mistake.

 I have now sadly started to think more that she is in liver failure or has cancer. The night before last she got up in the early hours of the night and was panting and appeared anxious. I didnít feel it was hot. I calmed her quickly and she settled and stopped panting. She did this on one other occasion over the weekend. Her poos had been normal (I have been watching every poo and wee she does)  but last night she did a very runny poo. I have been writing down everything. I.e when she eats, wees, poos, what meds she has and when etc. Just so I can keep an eye on everything. I noticed she is still weeing more frequently than I thought she should be. I emailed my vet with my concerns and said I wanted to drop the pred back again. She wasnít happy about it, I agreed to wait until our appointment tomorrow when we check her bloods. I have, however, stopped the losec as she hasnít been looking sick anymore and out of all the drugs/supplements she is taking this seems the least necessary. That is one less thing her liver has to process. I did also read some sources that said antacids were bad for dogs with liver disease, but my vet said she still uses all the time in dogs with liver disease.

My vet feels Peps joints are of more concern than her liver in terms of her quality of life. She always seems to get annoyed with me when I panic about her liver and want to drop the pred back. I feel bad because I must be the most annoying patient (owner). I throw so much information at her and question everything because I want to understand and make sure I am doing the right thing. I have had bad experience from past vets and that has caused me to question everything and make sure I am comfortable with what we do with pep. I completely trust my vet now. She has been with us since not long after peps impa diagnosis. But I know pep better than anyone else and she doesnít usually follow the Ďtextbook rulesí or the Ďnormalí when it comes to symptoms and conditions. So even though I trust my vet, sometimes I feel I need to trust my gut and follow what I feel is best for pep because no one knows her better than me. I donít mean to offend my vet and seem like I donít trust her. But it must come off that way sometimes, which I feel terrible for.
Also because I work from home, I am with pep 24/7 and have been since she was 8 weeks old. So I pick up on the tiniest little changes and signs that most people wouldnít notice. Then panic about them and question my vet as to what they could be a sign of or what I think they are.
So I have decided to have email silence with my vet until our appointment and maintain the pred dose as she wanted. I donít want to annoy her anymore. I suppose another day or so to get the bloods results isnít really going to make a difference. If she does have liver disease it is likely too late to change from what I have read. The signs donít really show until the disease is progressed.
Logged
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Catherine

  • Hero Member
  • *****
  • Posts: 523
    • View Profile
Re: Itís been a long time- Pep having trouble with swollen elbow
« Reply #18 on: Yesterday at 09:00:33 PM »

Thank you for updating us - it must have taken you ages to type it all out - but it is good to have detailed information.

Well....there seems to be some good news there and I am glad to hear that Pep, on the whole has improved since the previous week. As she is getting older and maybe some of the medication is taking its toll then that may be why she has a runny poo now and again or an anxious moment. Sometimes older dogs start to wake in the night and wander about or whine.

Some of your post sounds just like me! I have felt awful if I have made a mistake with regard to the medication or treatment of my dog, even though it was minor. But we are only human and coupled with lack of sleep and worry it can happen. Also, the bit about bad experiences in the past with vets, questioning everything your vet says etc. - that's me! I tend to "apologize" to my vet for questioning him at times, but seeing as I have been right and he has been wrong at times, he accepts my questioning him. So hopefully your vet understands too.
Logged

BrookeR

  • Full Member
  • ***
  • Posts: 226
    • View Profile
Re: Itís been a long time- Pep having trouble with swollen elbow
« Reply #19 on: Yesterday at 11:07:52 PM »

Thanks so much Catherine for your kinds words. I have been quite down in the dumps the last couple of days, but you have really uplifted my spirits. Much appreciated.
You are right too. I need to keep reminding myself of how old Pep is in the equivalent human years and realise there is going to be up and down days and things that don't make sense. That happens a lot with old people, so it must be the same in dogs. It's hard thinking of her as being so old when we have been together so long and I just feel like she is my mate who has grown with me and hence should age like me. Ive never had an old dog before and didn't realise they could have night restlessness. I had moved away to uni by the time my childhood dog got really old and only then saw her briefly on visits. Actually a lady I was talking to while in my vets waiting room the other day said her old dog was restless at night and had dementia and would get up in the night pacing and wanting food as if it had forgot that it had eaten. So perhaps pep's night restlessness is just old age.

Yes at times I have been right too and my vet has been wrong. She even admits that the times I have been right that she kicks herself a little that I am so in tuned with Pep and perceiving things that are wrong with her. She has commented many times that when I have pushed about something being wrong with her that I am often right, so she always takes my concerns seriously.
I know she understands, but I still feel bad for being 'that' patient/client.

Thanks again Catherine, you have perked me back up ready to take on whatever comes next.
Logged
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Catherine

  • Hero Member
  • *****
  • Posts: 523
    • View Profile

Thanks for taking the time to say that Brooke and I am glad it helped.

Although some vets think they know it all, good vets appreciate owners who are vigilant. I am sure it makes their lives a bit easier to have an owner rattle off their dog's symptoms, history etc. It also helps the dog for an owner to keep their own records of blood tests, illnesses etc.

But we do need to take a step back now and again and not worry so much - it is just knowing when we can do that. :-\
Logged
Pages: 1 [2]