SLO in springer spaniel???

[Cassiewebster]

Hi

New to the forum as I am starting to think my 5 year old springer spaniel has SLO.

About 6-8 weeks ago I noticed his nails were poor and after we had done agility training he came up lame and finally noticed his nails was the cause of his issue. He has not done agility since this until we figure out what is happening and he is healthy.

4 weeks ago the vets decided to remove a nail to send it off for testing and it came back clear but 2 weeks after this he had to have a it cut back again as soft tissue started growing out of it. The vets then started questioning if it was a tumour and on Monday they xrayed him which look clear and removed the excess soft tissue again and sent this off to the lab (awaiting results) for the last 3 weeks he has now been in bandage on that foot. Last night we noticed his outer nail had just separated from the inner nail and with the permission of the vet on call I removed this as it was hanging on by a thread.

I have then started doing my research and I think he possibly has SLO for the following reasons:-
- Hes middle aged adult 5 (6 in Dec)
- Excessively licking all paws
- Occured on more then one nail
- Seems to be hiself otherwise

6 weeks ago I did put him on Biotin and Yuderm to try and help with the nail strength.

I have now asked my vets to start investigating SLO but would welcome peoples thoughts and how best to treat/diagnose if it is?

I will try and attach some pics from my phone

[Cassiewebster]

The pictures are to large to attached but here is a link to my facebook post with pictures

https://m.facebook.com/story.php?story_fbid=10164209061775300&id=530885299

[Catherine]

It could very well be SLO and if more than one nail is affected (and especially on different feet) then unlikely to be a tumour.

Have you seen all the information here?: http://cimda.co.uk/smf/index.php?topic=22.0 and if you use the search function on the main page for "SLO", "nails" etc. you will find several posts.

[Cassiewebster]

Yes I came across this article on the internet which led me to this forum.

Feels like the symptoms align to what we are saying but in a mild form

It could very well be SLO and if more than one nail is affected (and especially on different feet) then unlikely to be a tumour.

Have you seen all the information here?: http://cimda.co.uk/smf/index.php?topic=22.0 and if you use the search function on the main page for "SLO", "nails" etc. you will find several posts.

[Jo CIMDA]

Hi and welcome

I am sorry that your boy is having nail problems.  Generally if the nails on more than one foot are affected then it can be assumed that the problems is SLO. 

To get a definitive diagnosis the whole first digit of a toe (or an affected dew claw) has to be removed and sent to the lab for analysis.  Just removing the nail will not given enough evidence because the immune destruction occurs way  below the nail within the nail bed.

Biotin and essential fatty acids  is good and other supplements but if it is SLO then you have to stop the immune system from targeting the nail-bed and this is done with immunosuppressive doses of steroids or a more popular, and very effective treatment is with doxycycline and niacinamide and supplements.

If you would like my SLO seminar notes, pleased email me at cimda@aslog.co.uk and I will be able to send them to you.

Jo

[Cassiewebster]

Thank you I already have your lecture notes and forwarded them to my vets as they are very informative. My vets have never come across the condition so we are awaiting a dermatologist referral (trying to find one that isnt a 6 week wait).

I am a reluctant to get a amputation to get a diagnosis and would rather work on a presumptive diagnosis. Do people still get them removed?

[Catherine]

I would also hold back on the amputation.

My dog had SLO some years ago although we never had it confirmed. My vet prescribed a course of Clinacin and Malaseb shampoo. It was a long process of my dog losing her nails and they grew back fairly deformed and have kept short. We did not use any other medication and all dogs are different but it could give you some hope.

You could try putting some socks on the affected paws, at times, to stop him licking them if he is doing that. Dog boots would also help protect his nails being knocked when he goes outside. Just make sure that you keep his feet clean, dry and aired if you use the socks, boots.

[Cassiewebster]

Thank you, I think we are one of the lucky ones as his appears to be very mild if it is SLO. But we do have dog boots anyways so thats handy recommendation as didnt think about that

[Jo CIMDA]

Hi

Personally, I wouldn't agree to an amputation or bother going to see a specialist.  The only way to definitively diagnose is SLO is by amputation and if you are not going to do that then why don't you agree to treat speculatively with Doxy and niacinamide?  It is not like you are going to treat with immunosuppressive doses of steroids for many months. 

The sooner you start treatment the better because the immune destruction will continue if it is not treated and more nails will become affected.

Jo

[Cassiewebster]

Thank you where do I get Doxy and niacinamide from please? Any brands particularly safe for dogs?

[Jo CIMDA]

HI

You have to get doxycycline from your vet as it is a prescription only drug.  The vet may want to give you Oxytetracycline as it is from the same group of antibiotics but it does not have the immunomodulatory effects of doxycycline.  Tetracycline does, but this has to be given more often and its effect is badly inhibited by food.  Doxycycline is the most convenient.

Jo


Treatment Options for Autoimmune Skin Disease
Fortunately, there are different treatment options for autoimmune skin diseases and as primary SLO is not life threatening, the most popular treatment seems to be with either,  Doxycycline, Tetracycline or Minocycline,  with Niacinamide (Vitamin B3).
Doxycycline, Tetracycline and minocycline are from a group of antimicrobial drugs that come under the heading of Tetracyclines.  There are over 6 different antimicrobials in this group but only tetracycline, doxycycline and minocycline are indicated in the treatment of SLO and other autoimmune skin disease. 
Doxycycline, Tetracycline and minocycline are antibiotics which also have anti-inflammatory properties and suppress antibody production. They are immunomodulating drugs, meaning that they have the ability to adjust the immune response to a desired level. They are known as 'steroid sparing' meaning that the molecular effect is similar to using steroids.
An antibiotic in this class of Tetracyclines, commonly used in veterinary medicine, is Oxytetracycline but it does not have the same properties as those listed above, and is not indicated for the treatment of autoimmune skin disease.
Niacinamide works with Doxycycline, Tetracycline or Minocycline to further suppress antibody production and provide additional anti-inflammatory and immunomodulatory effects.
Important Notes:
1.   Tetracycline should be used with caution in dogs with renal impairment as it is eliminated from the body via the glomerula filtration and a build-up of the drug can occur if used for prolonged periods. If it is necessary to give a dog with renal impairment Tetracycline the dose should be lower than recommended, but a lower dose may not address the problem of SLO, and also the treatment is likely to be for many months at least.  However, Doxycycline is excreted in the faeces and does not affect renal function and can be used for animals with renal insufficiency. (Plumb's Veterinary Drug Handbook)
2.   Niacinamide is also known as nicotinamide but it must not be confused with, Nicotinic Acid, (Niacin). Although Niacin acts identically as a vitamin, it increases the blood flow and blood pressure, and should not be used for the treatment of SLO. See this link:
   https://niacinreviews.com/difference-niacin-niacinamide-non-flushing-vs-flushing/
If you are in doubt as to which product to buy, look for niacinamide or nicotinamide 'Non-flush' label. 
Recovery:
Unfortunately, it will take 1-3 months before any positive results are seen (although duration of treatment is much longer, probably 6-12 months on a reducing dose regimen) but, in spite of this, it does seem to be the treatment of choice for SLO as it is effective and usually well tolerated - and it avoids the use of steroids and other stronger drugs.  Most dogs do very well on this treatment regimen. When good clinical improvement is seen the drugs can be gradually reduced and the dog weaned off medication over a period of many months, or remain on a low maintenance dose. 
Dose:  Tetracycline with Niacinamide
*Ref: Plumb's Veterinary Drug Handbook Eighth Edition.
*Dogs weighing less than 5kg : 100mg niacinamide, 3 times a day.
*Dogs less than 10kg : 250mg each Tetracycline and niacinamide three times a day.
*Dogs more than 10kg : 500mg each Tetracycline and niacinamide three times a day.
Give three times a day until improvement is seen, 3-6 months.  Then give twice a day for 2 months, then once a day for maintenance. (Manual of skin Diseases of the Cat and Dog 2nd Edition, By Sue Paterson).
Note:  Food or dairy products can significantly reduce (up to 50% or more) the amount of Tetracycline absorbed.   Avoid giving oral tetracycline within 1-2 hours of feeding or giving milk or dairy products.
Doxycycline with Niacinamide
Historically the use of doxycycline, instead of Tetracycline, for autoimmune skin disease was much more convenient because unlike tetracycline, dairy products do not affect its absorption and the recommended dose was 5mg/kg/once a day (Plumb's Veterinary Drug Handbook, Fifth Edition). 
The new *Plumb's Veterinary Drug Handbook, Eighth Edition, recommends the dosage as:
*Doxycycline: Consider 5-10mg/kg/twice daily
or
*Minocycline - Consider 7.5mg/kg twice daily
The dose of Niacinamide (see above) is the same regardless of which combination drug is used.
Note:  I have known numerous SLO dogs to achieve remission on Doxycycline: 5mg/kg/once a day but referencing both of these recommendations gives the vet licence to adjust the dosage if necessary.
Tetracycline or Doxycycline is usually well tolerated however, some dogs exhibit signs of nausea, vomiting or diarrhoea at the start of treatment, if this happens reduce the dose for a week or so and gradually increase to full dose.


Other drug options, if your initial choice doesn't work, can include:
(Chlorambocyl, Gold salts, Pentoxifylline, Retinoids, Azathioprine, Atopica)
•   Pain Relief especially in the early stages or after surgery may be necessary, eg. Tramadol.
•   Essential Fatty Acids (EFA's) are given in therapeutic doses, regardless of which primary treatment regime is used.  High doses of EFA's play an `active' role in the treatment of skin diseases and should be included in the treatment regimen and in low maintenance doses after remission.  EFA's are known to be `steroid sparing' in high doses. This means that they have anti-inflammatory properties which may ultimately, lead to a lower dose of steroids being used and this is especially useful in dogs that remain dependant on steroids. However it is not easy to find a specified dose that is consistently used.  Examples below:
EFA Ratio/Supplements
The 'therapeutic' dose of recommended supplements, in the treatment of autoimmune skin disease, often varies from one clinician to another.  Below are some examples with their references.
Quote: "Research is being performed to determine the optimal ratio of omega-6 to omega-3 fatty acids that should be consumed. Previously, it was thought that the ratio should be approximately 15:1. Current recommendations are for ratios of 10:1 to 5:1." (Omega fatty Acids: sources, Effects, and Therapeutic uses in Dogs, Veterinary Services Department, Drs Foster & Smith, Inc.  Holly Nash, DVM, MS)
Example Therapeutic Dose: Essential Fatty Acids
Quote: "Effect appears to be dose related and optimum doses and the most effective combinations of these oils have not yet been determined. Daily doses of Evening Primrose oil 172mg/kg/day, and Fish oil @ 44mg/kg/day, have been used in dogs over a one year period without ill effects". (Ref: The Veterinary Formulary by Yolande M Bishop)
•   EFA dose should start at a high level until a response is seen.  This can take up to 12 weeks. EFA's can cause loose stools. If this occurs, start on a lower dose and build up to the highest dose over a couple of weeks. Avoid using Evening Primrose Oil in dogs with epilepsy.  Always follow manufacturer's dosing recommendations.
Manual of Skin Diseases of the Dog and Cat by Sue Paterson – Drug therapies for onychodystrophy
Essential Fatty Acid    Dosage differs with individuals   
EPA 400mg/10kg
GLA 100mg/10mg
Biotin         2.5mg/dog once a day

•   Natural Vitamin E (400-800iu/12hrs) encourages new cell growth.  (Ref: Clinical Immunology of the Dog and Cat by Michael J Day). 
•   Chinese herbs are also noted as being effective but the owner should consult a vet who practices in natural treatments.
Biotin (5mg/kg/day: Ref: Muller, Kirks Small Animal Dermatology)
•   Improves the quality of the nails but it can be difficult to obtain. Some dogs with SLO have shown to be deficient in biotin. This may be due to their diet.  Foods with a relatively high biotin content include cooked eggs, liver, chicken livers, kidneys, some vegetables eg., boiled broad beans, raw or canned tomatoes, raw cauliflower, dried skimmed or whole milk, fresh milk, bran, yeast and raw egg yolk.

Note: Do not give raw egg white as it contains a substance called avidin which binds to biotin and prevents its absorption. This does not apply to cooked egg whites as the cooking process deactivates avidin.
•   Gelatine – 10 grains (one capsule) every 12 hours. Ref: Muller, Kirks Small Animal Dermatology.  Some owners give 1-2 cubes of jelly every day.
•   Good quality high protein diet in case of nutritional deficiencies.
•   Antibiotics if secondary infection is present
•   Topical acrylic nail cement applied externally to permanent nail deformities, which suffer from re infection.  Nails could be strengthened and protected by this application.
I haven't known a dog to have external acrylic nail cement treatment but reference to this can be found in Muller, Kirks Small Animal Dermatology.