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Author Topic: New member, looking for some advice  (Read 26 times)

Mrs T

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New member, looking for some advice
« on: June 30, 2020, 05:19:42 PM »

Hi all. I wonder if anyone is able to give me some advice at all? Scooby is an 11 year old lurcher who has been unwell now for around 7 weeks. We noticed he was becoming lethargic on walks and a bit depressed and made an appointment at our usual vet. His temperature was found to be quite high and he was prescribed a painkiller and antibiotics. However when he didn't improve, we returned to the vet around five days later and she took some blood samples and a urine sample, but nothing showed up in terms of an infection etc. During the course of the following week, Scooby was becoming more lethargic, not eating properly and still having a high temperature. We also noticed that he was breathing faster than usual (not panting though). We returned to our vet who did a chest x-ray and an ultrasound of his heart and other organs, as well as a test for lungworm. She also took blood samples to measure his C-Reactive protein levels. Nothing showed on the chest x-ray or tests, and his ultrasound looked ok, other than slight inflammation of the spleen which she thought was incidental and not causing his current symptoms (but worth keeping an eye on). His C-Reactive protein level came back at 121, and the vet had said it should probably be around ten, so very elevated. She prescribed prednisolone, and after a few days the C-Reactive protein was retested and had come down to 21, although when tested for a third time after his symptoms again failed to improve it had climbed back to 82. He was put on a relatively low dose of prednisolone (7.5mg twice per day - he weighs around 22kg), and the vet began to suspected some kind of immune mediated response, however she didn't want to increase to an immune suppressing dose of prednisolone until we had ruled out all other causes. Scooby then went to the vet hospital where they carried out a CT scan and took a biopsy of the spleen and liver. The CT scans of his heart and lungs etc were all clear, however it because apparent that his liver, kidneys, spleen and pancreas were badly inflamed. They also did numerous blood tests to rule out rarer infections, which were all negative. The liver biopsy was fine, but the spleen biopsy showed some abnormal cells (they were not able to make a diagnosis based on the findings). The decision was made to remove his spleen for testing and we're still waiting on the results. There is a chance the spleen abnormality could be cancer (although nothing has showed in any other tests, and there is no sign of any cancer elsewhere at this stage).  The vet suspects that even if there is some form of cancer present in the spleen that it is an immune response that is causing his other symptoms (either triggered by cancer or unrelated). I have my fingers crossed that the spleen biopsy won't show anything too aggressive (although due to his age I am preparing for the worst), and I'm wondering about how we treat his symptoms should he be around for a wee while yet. I was wondering if anyone had a dog with similar sorts of symptoms, and how they reacted to treatment with high doses of steroids, and whether the symptoms cleared completely or just improved slightly? As well as the extreme lethargy and faster breathing, he has intermittent fever and high heart rate and had lost around 3kg (although his weight has been stable for around the last four weeks now thankfully). He also has occasional brownish discharge from his nose and sometimes a bit of a wheezing sound from his nose when breathing. He is eating fine (other than when his temperature spikes) and at some points seems to have slight neck/back pain (by the time he went to the vet hospital his neck pain had subsided, but slight arthritis was found in his back - however he had shown no signs of back pain until this recent illness). His heart and kidneys are showing signs of strain and he has been put on medication to support them until they can up the dose of prednisolone once he has healed from his splenectomy. He is recovering well from his surgery, which went well and with no complacations, and we should have results later this week, but if anyone can offer any advice in terms of things I can do alongside vet prescribed treatment for the inflammation then I'd really appreciate it. He's a great wee dog, and it's really sad seeing him so down in the dumps. Incidentally, he had a short illness around a year ago where he developed an extremely high temperature, loss of co-ordination and was flinching away from us when we tried to touch his face. He ended up in the emergency vet on fluids and drugs to reduce his temperature overnight, and was pretty much back to normal the next day. Again, nothing was found in blood or urine tests at the time. Not sure if this was something which has since flared up again in a more chronic form, but he was fine for the whole year in-between. :) Thanks in advance.
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Jo CIMDA

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Re: New member, looking for some advice
« Reply #1 on: June 30, 2020, 06:48:57 PM »

Hi and welcome

Gosh, poor Scooby.  He has been through a lot - and probably you have too!

With all the testing that has been done, and still no diagnosis, one would think the high temperature is due to inflammation (the C-Reactive test also shows this). 

It is said that cancer can be much easier to definitively diagnose than autoimmune disease.  So, after all these tests, and like the vets say, when Scooby has healed from the biopsies, I would think the only way forward is to try Scooby on immunosuppressive doses of steroids.  It might be that they give an injectable steroid called dexamethasone  to see if the response is favourable and then, if it is, start Scooby on an immunosuppressive regimen of prednsiolone. 

 It is not unusual if a definitive diagnosis is not reached and an immune mediated disease is suspected, speculative immunosuppressive treatment is given. What do you have to lose?

If Scooby has an inflammatory autoimmune disease, I would expect him to respond quickly to the steroids - but the dose has to be immunosuppressive.  Any lower, dose will not give the good response that is hoped for, and higher doses do not suppress the immune system any more, but they do produce unacceptable side effects, especially in a lurcher.   The best immunosuppressive drug protocol that I have come across is by Prof Michael J Day.  This can be confidently tailored to the individual.   See below:

Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based 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.
Prednisolone:  "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.



I do hope Scooby makes a speedy recovery from the 'surgery' so that he can start immunosuppressive treatment as soon as possible.

All the best
Jo

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Mrs T

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Re: New member, looking for some advice
« Reply #2 on: June 30, 2020, 07:44:59 PM »

Thank you so much Jo. Yes, he is a poor wee soul just now. Fingers crossed the spleen results show either no cancer or at least something not too aggressive and we can start on an immune suppressing regime to see if that helps. His first dose of steroids was an injection, and he definitely perked up after that initial dose, but then went downstairs again after going on the prednisolone tablets, but I'm not sure if that was just coincidence or whether the initial steroid dose was stronger than the tablets and that's why we had a bit of an improvement. I noticed when browsing posts on here that whippets seems to perhaps be more prone to immune conditions, and Scooby is part whippet. The vet thinks he should heal from his spleen removal in ten to 14 days, so hopefully won't be too long before we can give that a try. It's really sad as he was a really active wee dog right up until this all started. Hopefully we can get his weight back up and get him enjoying his walks again.
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Mrs T

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Re: New member, looking for some advice
« Reply #3 on: June 30, 2020, 07:46:23 PM »

Hehe. Downhill even. Not downstairs.  ;D
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Jo CIMDA

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Re: New member, looking for some advice
« Reply #4 on: July 01, 2020, 08:21:20 PM »

Hi

The initial improvement with the injectable steroid is good news but you must make sure that the prednsiolone tablets are at the correct dose 1mg/kg/12hours, otherwise it will not work and Scooby is very likely to relapse.  I hope your vet is following the protocol by Michael J Day.  The correct dose and duration is essential if remission is to be achieved.

Jo

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