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Author Topic: New Member Farley  (Read 1390 times)

Corgilicious

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New Member Farley
« on: November 25, 2019, 11:14:54 PM »

Hi all, Iím thrilled to have found this group. It has been a discouraging battle so far.

Farley, who is a barely 2yr old corgi, began hesitating to get up using his back legs. He would sort of scoot forward to reach something. He could walk once he was up but he just never seemed keen on getting up. He didnít want to go for walks.

He had luxating patella surgery on his right knee about 7 months earlier so I suspected his other knee might be bad. He had also been diagnosed with hip displaysia at the time of his knee surgery so I also thought it might be a hip/back issue.

We tried rest and rimadyl, which didnít help. Xrays didnít show anything definitive and our local vet referred us to Orthopedics at the UC Davis Vet Medical School. After an extensive evaluation they determined it wasnít an ortho problem and referred us to Neurology.

We did an MRI, which didnít reveal anything that could be causing his problem. We moved onto electrical conduction studies and, finally, a spinal tap. The spinal fluid revealed inflammation and he did have pain when palpated in his lower spine. His reflexes were weak, too. Tests for Lyme disease etc. came back negative.

He began a high dose prednisone course for 6 weeks, which significantly improved his mobility but the side effects were terribleólethargy, thirst, insane hunger and, eventually, horribly disturbing muscle wasting.

At 6 weeks we began a 25% taper but the huge mobility improvement noticeably decreased. He was still better off than the beginning but not as good. And the side effects were just as terrible.

We were supposed to begin another 6 week taper but he became ill with an unknown infection. As you all may know the prednisone really knocks their bloodwork numbers out of whack.

After an antibiotic round we are scheduled to return to UC Davis in early December. Iíve lately noticed that Farley ďstumblesĒ at times, as if his front leg slipped out from under him. My heart wants to think ďoh, he just trippedĒ but my head knows something is up.

I need help trying to sort out how to proceed. I want him off the prednisone but to be replaced with what? Was he at least feeling better when he was scooting? What defines a good quality of life for a young dog? No ability to go on longer walks? Unable to play? Does eating and sleeping qualify? I am very discouraged.

Any thoughts/ advice would be gratefully appreciated. Thank you.

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Jo CIMDA

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Re: New Member Farley
« Reply #1 on: November 26, 2019, 02:29:45 PM »

Hi and welcome

I am so sorry your young Farley  is having these mobility problems.  UC DAvis is an excellent referral hospital, so I am surprised that they haven't come up with a definitive diagnosis - perhaps this illustrates the complexity of the disease Farley has - and a definitive diagnosis isn't always possible.

You mention that he had evidence of inflammation from the spinal tap.  Did anyone suggest it was Steroid responsive meningitis arteritis (SRMA)?  It is very likely, because they have been treating Farely with, I presume immunosuppressive doses of prednsiolone, that they consider this to be an immune mediated disease.   Usually, as the name implies, SRMA responds extremely well to immunosuppressive doses of steroids and most times, if the regimen is correct, remission is achieved.   

There are other similar diseases that come under the broad term  heading of  Meningoencephalomyelitis of unknown origin ( MUO )  See these links:

http://veterinarycalendar.dvm360.com/inflammatory-brain-disorders-dogs-gme-nme-ne-and-srma-proceedings

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

Dogs with suspected MUO are often treated with a combination of drugs including prednsiolone and some chemotherapy drugs.

Look up 'Keeper' on this forum, a lovely Cocker Spaniel.   MUO was diagnosed and the treatment has been very effective.

Other possible differentials might be:

Myasthenia gravis (MG)

Immune mediated polyarthritis (IMPA)

Immune mediated  polymyositis.


The problem with using high doses of prednsiolone when a dog has mobility problems is the side effects, and one of the most debilitating is muscle weakness.  This is why, when treating some immune mediated diseases, especially those that involve the muscles or muscle receptors,  prednsiolone alone can't be used and either a different drug/s are used or a combination of prednsiolone and other immunosuppressive drugs such as Leflunomide, or mycophenolate etc.,  are prescribed.  Fortunately, there are many more immunosuppressive drugs available these days and if one doesn't suit an individual dog then others can be tried. 

http://blog.vetbloom.com/internal-medicine/immunomodulating-therapy/

http://veterinarymedicine.dvm360.com/immunosuppressive-drugs-beyond-glucocorticoids


A vet friend once said to me "Believe your eyes" .  Go on your instinct, and what you see before you,  and make sure the vets listen to your concerns.

UC Davis has all the up to date resources, so I do hope that perhaps using  a different drug regimen will see an improvement in Farley very soon.

Jo



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Corgilicious

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Re: New Member Farley
« Reply #2 on: November 27, 2019, 12:06:51 AM »

Thanks so much for the speedy and helpful reply. I have spent a lot of time looking up the information you provided.

UC Davis, with whom I have a high level of confidence, could not name a specific diagnosis such as SRMA. I read Keeperís story and looked at GME. Iím still not sure it fits because the original issue was hind leg weakness and a sore back.

Why is this so difficult to pin down? The variability is frustrating and I canít get a handle on a prognosis. Are there any other posts you could refer me to.

This website is a blessing...
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Catherine

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Re: New Member Farley
« Reply #3 on: November 27, 2019, 08:23:55 AM »

Have you tried using the search facility on the website to see if there are other relevant posts? Search here: http://cimda.co.uk/smf/index.php?action=search
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BrookeR

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Re: New Member Farley
« Reply #4 on: November 27, 2019, 09:52:17 AM »

I am sorry to hear about Farleys problems. When my staffy first got impa she started with hind leg weakness.  One of the times she relapsed she had a sore back. Another her wrist and now her elbow. Each time she has relapsed there has been a different focus point, which has always off put me, to think that it wasnt impa. But each time after exhausting other options, when we finally decided to try up her pred she has responded and we have decided it must have been impa. Iím not saying that Farley has Impa, but just saying that in my (5year) impa experience, these immune mediated diseases donít always seem to follow the same pattern/rules and can be really tricky to try and pin down. I keep expecting it to be the same but it never is. Sorry this doesnít really help you. But you have came to the best place you can be on this forum. Finding this forum and in particular Jo has been the most beneficial thing to us on our immune mediated disease journey.
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Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Corgilicious

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Re: New Member Farley
« Reply #5 on: November 27, 2019, 04:12:32 PM »

This was super helpful and gives me an idea of the road we are on. A 5 year journey for you must have been so hard. As you increase the prednisone how does your staffy do with muscle wasting?

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Jo CIMDA

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Re: New Member Farley
« Reply #6 on: November 27, 2019, 06:38:34 PM »

Hi

Many, but not all,  inflammatory immune mediated diseases carry a high temperature.  Has this been a feature on Farley's case?

Hind leg weakness can be a symptom of so many diseases, and it is not always due to a muscular problem.  It could be due to a structural  problem in the spine or the messages from the nerves are not getting through to the muscles, or an inflammatory immune mediated problem. This particular website, DVM 360,  is a very good resource and is definitely worth checking out.

http://veterinarycalendar.dvm360.com/diagnosis-and-management-generalized-weakness-dog-proceedings

Has UC Davis tested for the SOD 1 gene mutation that is seen with Canine degenerative myleopathy?   The Pembroke Welsh Corgi can be genetically predisposed to this condition, so it might be worth having a DNA test done.

https://en.wikipedia.org/wiki/Canine_degenerative_myelopathy

It is so frustrating when a definitive diagnosis can't be reached and speculative treatment doesn't seem to resolve the clinical signs. Prednisolone is an incredible drug but it can only be given for a limited duration because of the side effects.  I hope you can do more research so that when you go back to  UC Davis you will be able to have an informed and productive discussion with the vets there and go forward with a new drug protocol for Farley.

Please let us know how things go, and if you need to 'chat', even if it is not an immune mediated disease,  then we are here.

Jo


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BrookeR

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Re: New Member Farley
« Reply #7 on: November 27, 2019, 08:31:32 PM »

Prior to the last month (we are going through problems at the moment) my staffy Pep had been really well and stable for over a year or more and had only been taking a pred dose of 2.5mg once a day. For roughly the year prior to that she was on 5mg once a day. She weighs around 14kg.
I didnít so much notice the muscle wastage when she initially was on immune suppressing doses of pred. She had more of a bad cushings (induced) appearance then. Where she had a really sway back and big pot belly. But after this long term use and even only on a really small amount of pred she is now showing really bad muscle wastage, for the last maybe 2-3 years.?
New people see her and say she looks really skinny and needs to eat more. But it doesnít matter what she eats, as itís her muscle thatís gone and we canít put that back on. Keeping her weight down too is the best I can do to try help her joints now they have no muscle support.
She is now 12.5years old. Her spine sticks out in her back, her eyes/eyebrows look really sunken as she has lost her big staffy head. But the most obvious is her chest. Being a staffy they normally have a very muscular chest, but hers is all gone. She doesnít have any support now for her joints and is currently having a problem with her elbow. I have also noticed her wrists are starting to drop and not hold up like they should and even her elbows (front stance) seem to turn out now. Itís not nice what the pred has done to her body, but the pred has saved her a number of times. Without it she definitely wouldnít be here now, so you need to take the bad with the good. I know Pep is greatful to still be here, even with the bad muscle wastage she has. She is a fighter and will continue to do so.

I really hope you can pinpoint what is going on with Farley and get the help needed to get him well again.
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Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Corgilicious

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Re: New Member Farley
« Reply #8 on: November 27, 2019, 09:09:48 PM »

Farley has never had a fever. UC Davis he was way too young to consider DM so I will take all the information provided in this brilliant site and ask more questions.

Thank you. His appt is mid-December so I will post a follow up.

Best,

Kay
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Jo CIMDA

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Re: New Member Farley
« Reply #9 on: November 28, 2019, 01:54:48 PM »


Whilst I am writing, it is so amazing to know that Pepper is 12 an a half years old, and it just goes to show that diligence and persistence can pay of and Pepper is evidence of that.

Good luck Kay.  I hope it goes well for Farley and you.

Jo
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Corgilicious

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Re: New Member Farley
« Reply #10 on: December 14, 2019, 11:40:29 PM »

Hi everyone,

In my last post I mentioned taking Farley back to UC Davis in mid-December.

Iím happy to report that he was so much improved from his infection that it wasnít necessary.

We were able to start another taper, going from 7.5mg/am and 10mg/pm, to a new dose of 7.5mg/am BUT only 5mg/pm, and our fingers are crossed.

Our next appt is early January so I will update again. Hopefully we can do another small taper.

Thanks to you all and Happy Holidays.

Best

Kay
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Catherine

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Re: New Member Farley
« Reply #11 on: December 20, 2019, 03:29:11 PM »

Thanks for updating us, Kay, with the good news and we hope that Farley continues to improve so well.
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Corgilicious

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Re: New Member Farley
« Reply #12 on: January 07, 2020, 11:26:11 PM »

UPDATE


We took Farley back to UC Davis. They said he still has ďdecreased awareness of where his pelvic limbs are in space, more notable in his right pelvic limb. His left patellar reflexes are also still slightly decreased, but are present in both limbs.Ē

I finally got a diagnosis of what they were working fromógranulomatous meningoencephalitis (GME) that is affecting his spinal cord.

They want to remain cautious in tapering off the prednisone 7.5mg/am and 5mg/pm so he will stay at this dose for another 6 weeks. They encouraged me to work on building up his muscles, which have atrophied quite a lot.

We go back in late February. Any thoughts or comments are welcome. Thanks again for your support.
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Catherine

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Re: New Member Farley
« Reply #13 on: January 11, 2020, 08:43:59 AM »

I can not suggest anything. Did UC Davis come up with anything? I do not know about this disease but would hydrotherapy be any good?
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Jo CIMDA

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Re: New Member Farley
« Reply #14 on: January 13, 2020, 02:10:36 PM »

Hi Kay

GME is so often difficult to diagnose.  Reducing prednsiolone slowly is not a bad thing as long as the dog is coping with the numerous side effects.  One thing that pred causes is muscle weakness and this treatment can sometimes be contraindicated when treating immune mediated conditions that affect the muscles and co-ordination.  There are other drugs that can be used instead, or in combination with pred to enable the pred dose to be reduced a bit quicker.  Leflunomide is one that is often used.  Take a look at this article.  The DVM360 website is an excellent resource.

https://www.dvm360.com/view/emerging-treatments-granulomatous-meningoencephalomyelitis-proceedings

I do think Catherine's suggestion of hydrotherapy is good, so that may be worth discussing with the vet at UC Davis.   

I am so pleased you have taken Farley to a good referral school.  They will be aware of all the different drugs that could be used.

Fingers crossed
Jo
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