New member Woody, in need of advice!

[Jo CIMDA]

Hi Elaine

I am so pleased your dermatologist is willing to work with you.  This is so important and it will achieve the best outcome.

As Catherine says, it is only while Woody's immune system is being significantly suppressed that you have to worry about him being vulnerable to infections.  When the dose is much lower he will be fine to go outside where other dogs will be walking.  When he is off preds altogether, his immune system will return to normal strength.

I do hope this new drug regimen will bring remission.

Jo

[Elaine Graham]

Hello again Jo

Obviously I've posted about our Woody on here before. I'll try and keep this brief as I don't want to repeat what I have already said in other posts.

Obviously Woody was diagnosed with autoimmune disease earlier this year and has just got to the end of his course of steroids to tackle the autoimmune disease. The steroid course was a substantial one, tapering back down very slowly to nothing, and we are now hoping to achieve remission (fingers crossed!)
I now try to avoid the use of unnecessary chemicals on him. Thanks to all your advice I felt informed enough to have conversations with my main vet and Woody's dermatologist about this issue and on the whole my main vet agrees and is supporting us in this.

Therefore just recently I had both our whippet's (Woody and Sansa's) poo tested for worm eggs at my main vets and happily all was OK so no wormer needed for now (woo hoo!! Happy days!!)
We also had both Woody and Sansa Titer tested at my main vets instead of doing the routine annual boosters: Sansa is fine so no booster needed for her apart from she will need the Lepto jab (which cannot be Titer tested for from my understanding).
However Woodys test has come back as a low(ish) score of just 40 on the Distemper antibodies.
So now my dilemma is whether to do the booster or not now, I had a chat with my main vet about is and we more or less decided NOT to do it for this year at least, the reason being I'm scared all his auto immune symptoms will return. We are not doing the Lepto either and discussed being careful about where we take him etc., and just being very vigilant on the whole with him.

However Woody's dermatologist (Sharon the dermatologist is the one that gave us the autoimmune diagnosis in the first place, and it was very fast, but she is definitely not against chemicals!!) said we should go ahead with the booster injection in about 1 months time 'to boost his immunity' I'm confused!!!! Also I hate the fact that we can't just inject for the Distemper, the injection covers Parvo and Hepatitis also, so that would be 3 things he is having.

My instinct is NOT to have the injection but I'd love to know what you think.

All the best Elaine

[Catherine]

I am sure Jo will be along soon. Meanwhile I am with you (and your main vet) with NOT giving Woody his booster.

Who is to say that if you give Woody the distemper booster the score of the antibodies will increase? Some dogs, you could keep on boostering and it does not take.

Some years ago my vet (in the UK) said he had hardly ever seen a dog with hepatitis and parvo and distemper tended to be only in some areas in the big cities. Leptospirosis he had only seen a few cases of.

I think if you google distemper in the UK you will find it is quite rare and if you google Lepto you will find lots of reasons not to vaccinate for that especially with Lepto4!

Just be vigilant – stay away from large dog gatherings and with regard to the leptospirosis keep him away from streams etc. I am sure you have done your homework on all that and know what to look out for.

[Elaine Graham]

Thank you so much Catherine! 

[Jo CIMDA]

Hi Elaine

Good news that Woody is doing well.

You have done all the right things by testing.    No one can tell you whether to booster or not, you have to do your homework and be happy that you are making the right decision.   The best guide to read is the WSAVA vaccination guidelines

https://wsava.org/wp-content/uploads/2020/01/WSAVA-Vaccination-Guidelines-2015.pdf

A few years ago I attended a seminar at the Royal Veterinary College.  Prof Brian Catchpole was speaking about autoimmune disease in the dog.  At question time I took the opportunity of asking him,  "Should a dog that has had an AI disease ever be vaccinated again?" and his reply was a resounding "NO"!!!  He went on to say that the benefits of vaccination should outweigh the risks and in a dog that has a genetic predisposition to autoimmunity the risks of vaccination are too high - and this applies to spot on and any unnecessary preventative treatments. The dog should be kept as natural as possible and only treat with chemicals if you have to for fear of these things triggering another AI disease or relapse.

In the WSAVA vaccination guidelines you will see that it is recommended to vaccinate more dogs (to achieve herd immunity) but those that are vaccinated should be vaccinated less often.   It also states that any measurement of antibodies to the core diseases, no matter how small, correlates to immunity. If you vaccinate a dog as an adult, or after the age of 16 weeks when the maternal antibodies have gone,  then it may never need a vaccination (to the core diseases) again.  This means that the dog will likely have protection for at least 9 years, if not the life of the dog (WSAVA).

When a dog has been vaccinated with the core vaccines, and there are positive antibodies to those diseases in the blood, in times when the dog doesn't encounter the virus in the field, it is natural for those antibodies to reduce to small numbers (because they are not needing to be active).  When the dog encounters the virus on his walks, those antibodies will respond and multiply to give immunity.  This is how vaccination works.  So it is fine if the Distemper antibodies are 40.  They could go even lower than that, and when needed they will multiply  - as long as there are antibodies they will provide protection.   Also, as Catherine says, because vaccination has been so successful the core diseases are very rare in the UK anyway. You have to weigh up the pros and cons.   Vaccination has its place for sure, but you can have too much of a good thing.

With regard to lepto vaccine, it is a killed virus vaccine and this is why antibodies are unlikely to be detected on a test.  It is given once a year but the truth is,  it is likely to give protection for only 3-6 months, so for at least half of the time you think the dog has immunity, it doesn't.  Also, there are over 250 strains of leptospirosis and you can only vaccinate against 4 of them.    The killed virus vaccine has to have an adjuvant to open up the immune system in order for it to take effect and this can trigger an adverse immune response  in genetically predisposed dogs. Lepto is also rare, and should only be given if the dog frequents places like rat infested waters etc.  The urine of a rat that has leptospirosis has to enter the dog's body either by it drinking the water, or through broken skin, for it to be a risk.   Another seminar, on vaccinations, that I attended at the RVC and presented by Prof Michael J Day, when he was asked about leptospirosis vaccine, he said - "Where is leptospirosis?  I would like to do a survey of the incidence throughout the UK."  This is why is not considered a core vaccine.

Over a period of 4 years, I antibody titre tested 4 of my dogs and this taught me a lot - and also my vet admitted that he learned a lot too.  It was a good exercise to do and it proved that from one year to another the antibody titres naturally fluctuate, and yet there was still immunity. 

After all that, the choice is still yours.  Happy reading!

Jo

[Elaine Graham]

Dear Jo

I cant thank you enough for this, it'll take a few readings for it to fully sink in but it makes total sense on first reading. Also I now understand that the benefit does not outweigh the risk, I was thinking that but hadnt fully processed the thought if you get what I mean!
Another thing I have been wondering about is insurance? Have you any experience of dealing with this? Whenever I make a claim for Woody I have to put on the form what date his last boosters were. I know all firms are different but I'm just wondering if it will affect his cover. Not that it matters, also I know I need to tell Woody's insurers all about the non boosters, and I guess we wont be covered if he gets anything that the boosters would have stopped but I just wondered what you did in this regard?

Also I'm left in a situation where Woody is probably going to have no vaccines and I am comfortable with that option. However Sansa is supposed to be having the Lepto booster (her titer showed that she is OK for the other 3 but the vet said the titer does not test for Lepto). After all I have read on here and elsewhere I am inclined not to risk the Lepto jab for Sansa either. She is a fit and well dog and I think I would rather swot up on how to avoid the places that she may pick it up. I know I need to decide for myself but what would you do in this situation?

Thank you so much again!
Elaine

[Jo CIMDA]

Hi Elaine

You will have to check with your insurance company but when I decided not to vaccinate my dogs after their antibody tests proved that they had immunity, the insurance company were fine with this but said that they wouldn't be covered for those diseases that we vaccinate against.  In all other respects the cover was the same.

Again, with lepto,  you must weigh up the pros and cons -

only 4 strains of lepto are covered out of over 200, 
and the very reduced duration of efficacy (they only give it annually but it doesn't last anywhere near that long)
and also the higher risk of an adverse reaction to the adjuvant that has to be used to make the vaccine effective
and how prevalent is lepto?
and how easy or difficult it is to contract?

Personally, I do think the core vaccinations are important, but if the dog has antibody titres then I wouldn't re vaccinate but you may want to do another  titre test in a few years to check that the dog still has immunity.   

Lepto is not considered core in the UK and neither are the other intranasal vaccines.  Lepto should be tailored to the individual dog and their lifestyle and possible exposure to the virus.  Vaccines and preventative treatments are the vets and drug companies 'bread and butter'.  The guidelines do not take into account the individual dog's predisposition and I have to say that some vets will give an annual vaccination even to a poorly dog - out of ignorance - and this is the worse thing to do.

You have a choice whether to vaccinate or not, and you have to be content with your decision. This is the risk you take. Not giving a booster to an already protected dog might be a lesser risk than vaccinating and giving unnecessary preventative treatments.  Whatever you decide it has to be a calculated risk.

This is a big decision, but if you do decide not to vaccinate any more, all I can say is the anxiety you feel now does subside overtime.

Jo

[Elaine Graham]

Thank you once again Jo, I am so grateful for the advice, I'll now find out more about Lepto in this area   .......  Our main vet is very supportative about not vaccinating Woody, and she did the fecal tests for worms whilst saying that was a good idea also.

However I spoke to her this morning about not giving Sansa the Lepto jab and she put her foot down a bit and said that there is Lepto in this area (we live in the countryside) and she said she sees it in unprotected dogs specifically and they die from it. The only thing I think is that our Sansa never really gets off the lead, (we go to the seaside so she can go crazy or she zooms about in the garden) and she never drinks from puddles or swims in rivers so like you say I will do my own research now and decide from there.

Thank you again!
Elaine

[Catherine]

I am afraid if that was me I would be asking the vet to be a bit more precise about exactly how many cases of Lepto out of how many and fuller details. It is so difficult to make informed decisions (about anything) nowadays without the full information and correct figures. I am guessing (and I may be wrong) that the ones she sees are perhaps farm dogs (more at risk with all the rats usually found around farms) or dogs that are left to wander and maybe by the time the owners realize something is wrong it is too late. Apologies to farmers who do look after their dogs but I have seen too many left to their own devices.

As Jo says, there are many strains of Lepto. I think it is possible to reduce the risks and be vigilant for any signs but I do think we have to beware of being scared there is an infected puddle, river etc. everywhere!

[Elaine Graham]

Thank you very much Jo 

[Elaine Graham]

Dear Jo
I apologise, I'm not really sure how to use this forum so I'm not sure if I have put this in the right place. All I wanted to say was that Woody has been off steroids completely for 3 months now. Obviously thanks to your advice Woody's vet put him on the reccommended dose of steroids. So far Woody is fine, his symptoms seem to have stayed away (fingers crossed). Although I do not want to tempt fate by going on about it too much!
However there isn't a day that goes by that I dont think of all the advice you gave me, for which I am so grateful. I know there is a chance his symptoms may return but I just thought I would let you know the outcome so far.
All the best and thanks again!
Elaine

[Jo CIMDA]

Dear Elaine

That is such good news for Woody, and for you, and it is so lovely of you to let us know how he is getting on.  I am so pleased that we could help.  You have made my day!

Long may Woody continue to be well.

All the best

Jo

[Elaine Graham]

Aaah thank you once again! I am so grateful for everything.
I am now super vigilant to see if his symptoms are returning (and also quite paranoid about it!). Since he has been off the steroids I THINK!! I may have noticed a couple of his original symptoms creeping back, but then they have gone again, for instance a couple of tiny bumps on his legs that have come and gone again, and a bit of stiffness in his limbs that again has come and gone.
So I am fully expecting it to return (as I know life isnt that simple!) I have been back a couple of times to see the vet that diagnosed the disease in the first place, just to monitor him really and more blood tests have been done. Nothing bad has been found and she is satisfied with progress so I plan to wait and just enjoy life with him.
IF I do think his symptoms are returning is your advice to put him on another course of steroids exactly like the one he has just been on? I had this conversation with his vet and she says this is what she thinks we should do. Do you agree? Also at what stage should I take the decision to put him back on steroids if his symptoms do come back? Is it better to jump on it quickly while symptoms are mild or is it better to wait it out and see if the symptoms get bad before starting with the steroids again?
Once again thank you!
All the best Elaine xxx

[Jo CIMDA]

Dear Elaine

Yes, if Woody starts to show significant clinical signs of his AI disease returning then he should be put back on an immunosuppressive dose of steroids, and if your vet agrees, to follow a protocol like Prof Day's.  There is no point in giving less than an immunosuppressive dose, or a shorter duration, because it won't work.

I would say a significant symptom is if the stiffness and pain, and high temperature returns then don't hesitate to put him back on the preds. The odd skin bump here and there might not be a good enough symptom to put him back on to an immunosuppressive dose. 

If you do have to start treatment again then I feel if it is caught in the bud, so to speak, he will respond well.

I hope  you don't have to go down that route again, but if you do then you have the experience now to deal with it.

Best wishes
Jo

[Elaine Graham]

Thank you very much Jo.

I hardly dare hope that it has actually worked and just want to be ready for if it hasn't.

I was talking to someone about Woody the other day and he said he used to own a Golden Retreiver that had autoimmune disease, I cannot remember what it was, it wasnt the same as Woody's. Anyway he said that she needed 3 of the big steroid courses before she finally entered remission. When she eventually died it was of old age and not the disease, so I am trying to prepare myself for the possibility of another course. Thanks again, I will keep in touch (good or bad)

Elaine xxx