It’s been a long time- Pep having trouble with swollen elbow

[Catherine]

I totally understand not wanting to contain her if it means upsetting her although she may be a quick learner and know that you will soon be back in the room after a few minutes. I do not know the layout of your home and how much she is getting up off the floor. It was just if it was something open plan and as you walk from a kitchen area say to a lounge area (but still in sight) it might be easier if she did not follow you. Of course, cantankerous dogs  would still get up inside the pen....

[Jo CIMDA]

Hi Brooke

If Pep was an ageing dog without all the AI problems that she has had, her back end weakness I would say is due to her getting older and her muscles not being as strong has they were.   All old dogs will have trouble gripping smooth floors. 

It is difficult, knowing her past medical history, not to think of it being an AI problem but the chances are it is just old age.  The floor matt's always had to come out when my dogs got older and sometimes I had to put a towel-sling under their middle to get them to their feet.  Once they were up and had their balance they were OK.  I think their mind is telling them that they can just jump up to their feet and rush off, but their body is telling them something different.   My 91 year old mum said to me, up here (pointing to her head) you feel the same - and she is right. You can't tell a dog that she is getting old and to slow down (my hubby can't tell me that either!)   Unless Pep is in pain and has a high temperature, that would usually accompany IMPA or an other inflammatory AI disease, then I doubt it is this.  The steroids she has been on will weaken her muscles, so add that to her getting older and this is a double whammy.

I also think slipping on the floor could cause some soft tissue/ligament damage.   Reducing the pred will lower the liver enzymes.  I hope with the Synovan injections she is having, and lowering the pred, that she will start to gain strength and feel more comfortable, and if she does have some degree of osteoarthritis then the Synovan should help.  If you can strip back any unnecessary supplements that might help her liver to cope, but don't panic about raised liver enzymes unless they are significantly raised.

  I do think the toe grips are a good idea.  I have known people to use them to good effect.   I don't know about the brace as I haven't come across it before.

I feel as if I personally know Pep and I can imagine this older lady carrying on as if she were a youngster.  I love the oldies. They get more precious with every passing year.

Jo

[BrookeR]

Thanks jo. I believe you are right about pep thinking she is young and thinking she should be able to just jump up and do all she used to. It sounds funny but I see it in her eyes, the way she looks at me sometimes. Like she wants to do something like jump up on the bed, but she needs help and is sad/annoyed or unsure why she can't .
She took off across the back yard a million miles an hour last night about 11pm, barking as she flew. There was a possum (or possibly a cat) on the far fence which ran down along the side fence and took off over the back fence. I tried so hard to catch her to stop her before she hurt herself, but there was no chance of that..... afterwards she seemed a bit frazzled. She can still move very fast if she wants to, but will feel it afterwards.

Pep has no temp and once she is up she is fine. She is a lot slower though than previously and you can hear her nails more on the ground. Like she doesn't lift her feet up as much as she used to. She does seem to struggle a bit getting down sometimes too. She stands there almost 'stuttering' (if there were such a word for movement). Like she is trying to safely get herself down and starts to go then changes her mind and moves her leg slightly and tries again or sometimes she just flops down. It's like she is trying to get her legs in the right place because once she is down she has trouble moving them if they are in an awkward position.
My vet did also say the same at one point. That Pep has no muscle now and no support so she will struggle getting up and down, as well as have slipping, due to that and her history. Regardless of if there is anything else going on.

Thanks for reassuring me and helping me understand the differences in an old dog.
Hopefully pep will tolerate the toe grips. Before impa when she was young she used to have to wear booties to stop her chewing her feet (allergies). She didn't like the front ones and always ripped them off straight away. But for most of the time she left the back ones on. Luckily they were also her worst feet and are now too. So hopefully she will leave them on and not pick at them.

I've seen pep make a mockery of test results before when they were certain she had plasmacytoma that had metasized. So I am always skeptical about her test results. The best way to judge pep has always been just by watching her and her demeanour. So I think I will just continue doing that and try not panic so much about bloods. Even if she has liver cancer or something Pep is going to be the one who shows me how she handles that. She likely won't follow the normal rules anyway.

[Jo CIMDA]

Hi Brooke

It is hard to accept the signs of ageing but it is preferable to her having an AI disease and having to put her back on a cocktail of drugs that have nasty side effects.

If she can take off after a possum or a cat then she is still in charge.   I love her 'never give in' character.

Jo

[BrookeR]

Yes, she really is one special character and so determined to not give in. That helps me stay determined too.

Unfortunately she slipped bad again yesterday and was limping bad last night and today. I really hope that is all it is and not another relapse. She had her last synovan injection yesterday and each time she has had those she has been a bit off for the following couple of days. So that's another thing to consider and it has been hot again the last couple of days. I need to give her some more time before panicking about a relapse. However, this is around the same amount of days passed that it has been the last few times we have dropped back by 1/4 pred and then limping or swelling came. Each time we have gone back up again 1/4 pred.

Some good news, her toe grips arrived this afternoon and make a big difference for her walking on the tiles. She isn't slipping out like she was, so hopefully with some rest her limping may also improve. Fingers crossed. No more slipping out is a positive, so I am going to take that as a small win.

Another small win we had is that at Pep's check up yesterday (Tuesday) she had gained 400g (since last Wednesday).

Also her urine showed no blood (which is a first for her in some time) but the ph was still up and my vet looked under the microscope and said it wasn't completely clear, but lots better than it was. She sent it off to culture anyway. She said if it only showed minimal growth she was okay with that.

The vet nurse rang me today and said her ALT level was back (we only tested ALT this time). My vet was away today and is going to ring me tomorrow once the urine culture is back to discuss further. Last Wednesday her ALT was 318. On Friday we dropped her back by 1.25mg pred per day. Yesterday (Tuesday) it was 304. I think around 80 is normal? So it dropped back, but not by very much.

If she does have cancer. Have you had any experience with impa dogs getting cancer and this causes them to continue to relapse?

The other thing I am wondering about is something I read in dogs naturally magazine. An article called 'MSM: Does your dog need it?' Its the article that actually put me onto msm. However one paragraph concerned me and I discussed it with my vet and she wasn't sure about it either. We decided to go ahead, but its been in the back of mind all along especially now that her ALT levels are much higher than they have ever been at this same pred dose.

'Chronic Pain
MSM is a natural analgesic and blocks the transfer of pain impulses through the nerve fibers. MSM also blocks the inflammation process by enhancing the activity of cortisol, a natural anti-inflammatory hormone produced by the body.'

I am unsure if this means that msm used with pred could increase ALT levels? I cannot find any other reference to this in other literature. I have found a few people also questioning this, but in human use and they have no answers listed. I contacted the animal naturopath I got the msm from and brought this up with them and asked their thoughts. They said they hadn't came across any similar cases, but would suggest stopping the msm and checking if her ALT levels drop.  I discussed this with my vet last week when we first found out her ALT had gone up. I had said if it was still high this week my thoughts were to drop the msm and also try risking trying milk thistle with her. I got some milk thistle without any alcohol in it from my human naturopath on Monday and have it on standby.

I will wait until tomorrow to discuss further with my vet. Hopefully the limping improves so we are not forced to go back up the 1/4 pred.

If she does have cancer. Have you had any experience with impa dogs getting cancer and this causing them to continue to relapse?

[Catherine]

I am glad the toe grips are helping Peps. Also good news about a little weight gain and her urine improving.

What are the normal levels for ALT? They may be different to the UK ones so it is difficult to make a comment on the figures you give. My AIHA dog's ALT (and ALKP) went high when she was on high doses of Preds. but did return to normal.

I do not know about MSM but had a quick look at some information. Not all natural things are good and some dogs (and humans) can be affected by natural things. Personally I would not worry about giving too many supplements at the moment and see how things go.

Lastly, I think it may help to take a step back and relax. When my AIHA dog was very ill I became very stressed and well meaning people told me to relax. Of course it is easier said than done, but I have to tell you, Brooke, that a lot of dogs do pick up on our stress. I know it is so difficult to do, especially if, like I had, a dog that picks up on your every emotion.

[BrookeR]

Peps ALT has been high before at high doses of pred and came down as we dropped back . But we are at a much lower dose of pred now and getting the high ALT. We were on the same pred dose around only a month ago when I wrote on here and her ALT wasn't this high. My vet is concerned that it's not normal for Pep and it's an unusual worrying spike. I thought the vet nurse said 80 was normal and pep is 304. I'll have to find out more today when my vet calls. It's hard to get accurate info from the vet nurse. I used to keep copies of all her blood results but started looking too much into them and decided it best to leave to my vet. Previously I kept copes when I was going to a different vet that I didn't trust and liked to check everything myself and compare. My vet now always cross checks all peps new tests with her past ones over the years and tells me when we discuss.
I want to start by dropping the msm, as I agree with you and I have read too that some people (dogs would be included) don't agree with msm.

Will try my best to relax. I know you are right Catherine. Pep is absolutely a dog that picks up on my emotions. She senses everything and feeds off it. I always try to remind myself that, but it is so hard. I must try harder.

[Jo CIMDA]

Hi Brooke

Take a look at these links.  The increase in Pep's ALT might be due to muscle damage or at least contributing to the raised levels.

Jo


https://www.dvm360.com/view/canine-liver-enzymes-so-many-questions
ALT

ALT is found primarily in the cytosol of hepatocytes. It's released with increased cell membrane permeability or cell death. "Of all the liver enzymes, ALT is the most liver-specific," says Dr. Lidbury. On rare occasions, ALT activity can be increased in patients with severe muscle injury. But, in general, ALT is considered a sensitive and specific marker of liver injury. "When hepatocytes die, then you get leakage," Dr. Lidbury says. "ALT can also leak when you have just cell membrane damage. You don't have to have necrosis for ALT to go up. Also, severe ALT increases don't necessarily mean you have irreversible disease. Sometimes we misinterpret really high ALTs as irreversible disease and a poor prognosis. If you have a dog with acute liver injury, it might have a sky-high ALT, but if you can support the dog through that initial injury, then the disease could be reversible, and the liver can get back to normal. The liver has such great regenerative capacity."



https://www.whole-dog-journal.com/health/liver-disease-in-dogs/
ALT is an enzyme that may be released with any source of damage to the liver. Blunt trauma, anaphylactic reaction, systemic illness such as thyroid disorders, and other problems that have nothing to do with the liver can cause an elevation of ALT in the blood. Just because ALT is elevated doesn't mean the liver is failing, however. This result is interpreted in conjunction with clinical signs and other bloodwork and imaging changes.

[BrookeR]

Thanks Jo,  I'll have a read through these. Sounds interesting.

We went back to the vet today as Peps urine culture grew a moderate growth again. So my vet wanted to take a needle sample directly from her bladder to eliminate any exterior contaminants. We have sent this away for culture.

I also got her to check peps ears as I noticed they were a bit waxy. She also has a mild infection in both ears, one worse than the other.

I have stopped giving the msm. We are going to wait until Wednesday the week after next to recheck her ears and ALT levels (unless she becomes unwell in the meantime).

She is still a bit limpy, but is much more herself personality wise and has been more perky. I had to wake her during the night to get her to do a wee to make sure she could hold long enough to have a full bladder for our appointment this morning. She was sleeping soundly and has been a lot more settled  at night and not getting up so much. Also no signs of sickness.

[Jo CIMDA]

Hi Brooke

Your last paragraph is a treat to read and it bodes well.  I hope the urine result comes back good. 

Great news.

Jo