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Author Topic: Introduction  (Read 253 times)

Louise

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Introduction
« on: March 01, 2020, 05:55:02 PM »

Hi I'm Louise and Panda is suffering from inflammation of his central nervous system possibly gme or autoimmune disease still trying to get a diagnosis he is on prednisone and azathioprine he has back pain which causes him to skip and grade 1 bilateral luxating patella he is 3yrs old and been on prednisone since 18th October 2019 due to have a spinal tap on Wednesday to see if anything has changed inflammation wise.
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Catherine

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Re: Introduction
« Reply #1 on: March 01, 2020, 06:33:27 PM »

How much does Panda weigh and what dosage of medication is he on?

If you do a search on the main page there will be a few posts about GME that may be helpful. Here is a good one  about Keeper the dog : http://cimda.co.uk/smf/index.php?topic=1149.msg9968#msg9968
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Louise

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Re: Introduction
« Reply #2 on: March 01, 2020, 09:45:19 PM »

Panda weighs 12.5kg he is on prednisone 20 mg daily and azathioprine 12.5mg every 2nd day
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Jo CIMDA

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Re: Introduction
« Reply #3 on: March 02, 2020, 10:56:23 AM »

Hi Louise

I am sorry Panda is unwell.   Has his symptoms improved since being on the treatment?

 GME comes under the heading of :  MUE (Meningoencephalitis of Unknown Etiology).  These neurological diseases are often treated slightly differently to other AI diseases.   Below is a link that gives treatment options and the dosages and duration of treatment for MUE diseases.   

https://vvma.org/resources/Documents/Rossmeisl-Where%20are%20we%20with%20MUE.pdf

There have been several dogs here with MUO/GME and with correct treatment the outcome can be very good.  Leflunomide has been a drug that is often used in these neurological diseases.

An immunosuppressive dose of prednsiolone is 1mg/kg/12 hours, so I wonder if the starting dose  was high enough?   If this dose has not reduced since October then it would be wrong to increase the dose of prednisolone because of the side effects but it is very possible to introduce another immunosuppressive drug, as indicated in the above link.

These links might be useful to you:

https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4952320

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


As Panda is still on prednisolone I question if spinal tap results will be accurate because prednsiolone can produce false negative/false positive results in various tests.   It is worth raising this with your vet before Wednesday's planned spinal tap and see what they say.

Jo

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Jo CIMDA

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Re: Introduction
« Reply #4 on: March 02, 2020, 11:00:10 AM »

Hi Louise

If you do a search for   MUO or GME  on this site there should be a lot of postings about this subject.

Jo
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Louise

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Re: Introduction
« Reply #5 on: March 03, 2020, 12:30:05 AM »

He was initially on 40mg daily then after 3 weeks was reduced to 20mg after 3 weeks reduced to 10mg daily until 7th January when it was upped to 20mg for 9 days then upped to 40mg for 7 days because he became very sore and didn't want to do any walks after that we reduced it to 20mg daily which he is on now they are looking at changing his meds to cyclosporine if he still has inflammation the 2nd tap showed improvement in the levels of inflammation however he was meant to have a spinal tap after 3 weeks of 40mg but the lab didn't do the cytology requested so specialist said reduce to once daily so possibly it was reduced to quickly and he did improve in pain level as well but is sore now even though he is on 20mg prednisone.
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Jo CIMDA

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Re: Introduction
« Reply #6 on: March 04, 2020, 12:41:34 PM »

Hi Louise

The recommended drug  for improved outcome of GME alongside prednsiolone is Procarbizine (Ref:  Clinical Immunology of the Dog and Cat, 2nd edition, by Michael J Day)  so it might be worth discussing its use with your vet.

Reducing the dose of prednisolone slower usually achieves a better outcome.  See the protocol below. It is the best I have come across and it can confidently be used as a guide.  Always, the protocol has to be tailored to the individual.


Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
This example is base on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days


Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs..

The dose of azathioprine 2mg/kg/24 or 48 hrs, can be reduced initially by giving a lower dose tablet per day, or gradually reducing from daily dosing to every 2nd day, every 3rd day, every 4th day etc.....  Remember, azathioprine tablets should not be broken or handled without gloves.


I do hope Panda improves very soon.

Jo

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Louise

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Re: Introduction
« Reply #7 on: March 11, 2020, 01:06:24 AM »

Update on panda spinal tap results showed improvement so my vet has said that the cns disease is being affected by the immunosuppressive regime but possibly not controlled so we are doing 10mg prednisone twice daily for 2 weeks then reassess him he is due a blood test on the 20th just before he has been on the dose for 2weeks he is still sore and skipping also he had clipper rash and his hair is getting very thin fingers crossed that he will be ok now thoughts were initially the prednisone was reduced to quickly and we didn't have control of his inflammation before it was reduced.
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Jo CIMDA

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Re: Introduction
« Reply #8 on: March 13, 2020, 02:22:05 PM »

Hi Louise

I hope now that Panda is back on a higher dose of prednisolone  it will bring the disease under control and eventually into remission.  If when you reduce the dose Panda still has clinical signs then perhaps your vet should consider introducing another immunosuppressive drug such as leflunomide or cyclosporine, or one of the other immunosuppressive drugs used commonly in a combination therapy.

Like you say, fingers crossed!

Jo
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Louise

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Re: Introduction
« Reply #9 on: March 16, 2020, 06:34:37 AM »

Yes the plan is based on his clinical signs and the blood test results we will either continue to slowly reduce the prednisone or change or add different drugs in to hopefully get him more comfortable and happy after 5 long months of this and possibly another 4 months before we will hopefully have reduced his prednisone but day by day and fingers toes and paws crossed that he will be ok.
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