SRMA?

[Chli1859]

Hello,

We are hoping you might be able to help us. A vet has said she definitely thinks Bodi has SRMA, however the symptoms do not seem to line up and we are concerned we are missing something. Bodi is our 10 month old Great Pyrenees/Bernese Mountain Dog. No one can figure him out. He has had 3 episodes spaced about 1-2 months apart. Each episodes starts with lethargy, refusal to eat, crackly breathing/coughing, then fever spikes extremely high after a day or two of initial symptoms. Get him to the ER, start IV antibiotics and fluids, he comes home after 8-12 hrs in ICU and bounces back completely after 1-3 days.

First two episodes ER care found he had fluid in his lungs and diagnosed him with sudden onset pneumonia. He responds quickly to IV fluids and antibiotics (almost completely back to normal 1-3 days after bringing him home), have him on oral antibiotics for several weeks, take him off antibiotics and a few weeks later we are going through the same thing.

The third, and most recent episode happened about two weeks ago, same symptoms (with strange crackly breathing, but clear X-ray this time, but got him in right away as we saw the warning signs), only this time he did not respond as quickly to IV fluids/antibiotics the first time and had to go back to the ER, then they transferred us to CSU. CSU reported they found he had severe neck pain and are suspecting SRMA. They have performed so many blood tests, which have been negative so far. Most blood samples were taken after starting antibiotics, which concerns me for false negative results. Elevated white blood cell count is the only thing they have found with this most recent episode. We have not noticed obvious neck/back pain with any of the episodes, but very lethargic and not wanting to get up (also weren't looking for it until now).

The vet's best idea for the fluid in the lungs the previous 2 times was aspiration pneumonia due to a sore neck causing him to eat abnormally. Again, we have never noticed neck pain and he has always developed the raspy breathing/coughing at the same time when symptoms start to show. And the abnormal breathing was present this last episode without X-ray evidence of fluid. She said he bounced back this time because of the gabapentin, but how could his neck be completely back to normal only a few days after the episode even off of gabapentin if he really does have SRMA?

He has tricuspid valve dysplasia of the heart, so endocarditis was a concern and still is to us since he *seems* to respond to antibiotics, even though they reported they did not find anything on the echocardiogram.

He is completely back to his normal, rambunctious self and has been since 2 days after taking him home from ER care (on gabapentin for 3 days, but took him off after 4 days being home as he has been normal and continues to be normal off of it). Still on antibiotics. Scared to start steroids if it is something infectious.

Could these symptoms and spacing of episodes line up with SRMA?

Any thoughts would be SO appreciated. Thank you!

[Catherine]

It does sound complicated! Just a suggestion, could several different things be the cause but the vet is linking them up? There could be the ongoing heart problem (sorry I have not read up on that); Bodi could be allergic to something; he could be getting infections. I did think of the wax and wane of Addisons but I am not sure they are the right symptoms his has.

Have you seen this?: http://cimda.co.uk/smf/index.php?topic=25.0  Did the vet do a spinal fluid analysis?

Just a thought do you feed, give Bodi water in an elevated bowl? Do you feed him twice (or three) times a day rather than one big meal and do you use a special bowl etc. to try and slow down his eating to avoid bloat etc.? Also do you feed him some time before or after exercising and make sure he does not drink too much water at once? Probably nothing to do with what is happening to him but.........

[Jo CIMDA]

Hi and welcome

I am sorry Bodi is having these intermittent problems.  Has anyone suggested that Bodi may have megaosoephagus (MO)?  This is the inability of the muscles in the oesophagus to carry food efficiently into the stomach and this often leads to aspirate pneumonia.   This can be a primary disease or it can be linked to other autoimmune diseases such as polymyositis and myasthenia gravis.

It is not usual for MO  to occur with primary SRMA, although I suppose Bodi could have two primary diseases at the same time.  I presume they have done a spinal tap to rule out SRMA? Also, the clinical signs of SRMA are very characteristic of the disease eg., extreme pain in the neck, unwillingness to move and head held low to avoid neck movement and if you know what you are looking for it can be obvious. 

A spike in temperature will occur with any inflammatory AI disease, as will the high white blood cell count.  The high temperatures seen in an inflammatory AI disease are often way higher than those usually seen as a result of an infection and because they are so high, these are considered not true temperatures. It is an inflammatory response. 

SRMA, as the name suggests responds very well, and quickly,  to immunosuppressive doses of steroids. The same positive improvement would not be seen with gabapentin.

Lethargy and not wanting to get up might be due to pain.  Dogs are very stoical and they often hide their pain.  You may consider mentioning  Myasthenia gravis and polymyositis to your vet just so that they can put these on their list of differential diagnoses.   Inflammatory autoimmune diseases, especially those involving the muscles,  are very often progressive and they can wax and wane,  and to start with it can be difficult to get a definitive diagnosis.

I hope you manage to sort this very soon.

Jo

[Chli1859]

Thank you both very much for taking the time to respond. No spinal fluid analysis at this point. They were talking about starting him on steroids without CSF tap/mri as they thought it was definitely SRMA, however by the time we got him home and we were supposed to start steroids he was back to 100% without anything but antibiotics. The more we are researching SRMA the more we do not feel that his symptoms align, however like it was mentioned, he could have multiple things going on.

We do feed him in an elevated bowl 2-3 times a day. He has always been a picky eater and takes breaks while he is eating, so we do not have to slow his eating down. We read this is normal for the Great Pyrenees breed.

Some vets have brought up megaosoephagus (or just problems with his esophagus/larynx), but thought we would have had episodes early than 5 months of age is this was the case. They mentioned wanting to do a scope to rule out esophagus/larynx issues if we decide to move forward with a CSF tap when/if he has a 4th episode.

I wish we could go back and have known to look at neck pain, but from what we can recall with each episode we never remember him showing any signs of extreme neck pain, more so just lethargy. But then again he could have been hiding it and we could have been missing it.

That is good to now about the high fever, Jo. His first episode he went from 104 to 106.5 deg/Fahrenheit over the course of being in the ER for 2 hours. His breathing symptoms were also the worst at his first episode though.

Thank you for those other thoughts and we will bring that up to our vet.

We are getting a second opinion with a cardiologist today and will follow up with questions to our neurologist after that. I think our plan will be to do a spinal tap as soon as he becomes symptomatic again and also rule out esophagus/larynx issues while he is sedated for the spinal tap.

Thank you so much for your comments and reply!

[Jo CIMDA]

Good luck today

Diseases that affect the muscles can also affect the heart muscles, so bear that in mind.

I have known megaoesophagus to occur much later than 5 months of age. If it is combined with an AI muscle/nerve receptor disease it has to be triggered and this can be at any age, although it often occurs when the dog is young.

Jo