4 year old vizsla no diagnosis yet

[Lucyb73]

Hi,
I'm new to the group, very pleased I've found you as there's an immense amount of knowledge here clearly.

My 4 year old Vizsla became ill suddenly last Wednesday, woke up not wanting his breakfast abs slightly more subdued on his walk. Took him to the vet the following days as he was slowly becoming more depressed and still hasn't eaten anything, he now also had a temperature. Vet confirmed high temp, took bloods, and have loxicom and antibiotics.  Bloods indicated raised liver enzymes and low white blood cell count. Next couple of days absolutely no improvement, just a steady decline in health and still no appetite. Sunday morning I woke early with him, his breathing was laboured and he was bleeding from his nose. He looked very unwell. We took him to the emergency vet where he stayed for 4 days. He only came back to us yesterday. Vets identified ulcers inside his mouth, his penis abs likely up his nose hence the bleeding. His clotting function wasn't quite right abs his white blood cells remained very low. It took a couple of days to reduce his temperature, he was on IV antibiotics and buprenorphine for the pain, plus paracetamol. X-rays showed nothing, further bloods also showed nothing really to give them any idea as to what was wrong. Tuesday the vet starts him on 25mg prednisone, a few hours later he eats for the first time in a week. He's now home. He's eating, and starting to perk up but I'm very concerned as we do not have a diagnosis. He's not insured and so vets were worried about cost of knocking him out for biopsy so they started steroids with no biopsy. Obviously can't do one now.
Does anyone have any idea what this could be? We're due back at the vets tomorrow for his first follow up and I want to go armed with some information about what this might be.
Any advise would be appreciated.

[Jo CIMDA]

Hi and welcome

I am sorry that your Vizsla is unwell.  The Vizsla breed can be genetically predisposed to immune mediated/autoimmune disease.  See this website:   https://www.vizslahealth.net/

A definitive diagnosis is not always possible, or necessary, especially is speculative treatment has started and an improvement is seen.   The main concern now is, assuming that this is an autoimmune disease the dose of steroids is crucial to the outcome and I I don't know how much your boy weighs but 25mg of prednsiolone doesn't seem like an immunosuppressive dose which should be 1mg/kg/12hours.  Any less than this dose will not achieve long term remission, and much more than this dose will produce unnecessary side effects.  This is the best immunosuppressive drug protocol that I have come across and it can be confidently used as a guide.

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 that you vet will work with you, and if needed, increase the pred dose to an immunosuppressive dose.

Best wishes
Jo

[Lucyb73]

Thanks Jo. He's 25kg and was put on 25mg twice daily. He's now being reduced as per regimen but I am concerned it may be too soon. The vet is wanting to taper so that we can see if his symptoms return. Bit of a worrying process really.
Thanks for the link to the vizsla health page, he doesn't appear to fit with VIP, do you know if vizslas can develop other autoimmune diseases? The only ones that "fit" with his symptoms really are pemphigus and SLE.

[Jo CIMDA]

Hi

It is good that your vet has given the correct immunosuppressive dose. If the dose is reduced too soon then it is most likely that a relapse will occur.  The idea is to give the starting dose enough time for it to bring the immune system under control so that when you reduce the dose, and continue to reduce over a period of time, remission will be reached.  If the dose is reduced too soon and a relapse occurs then the dose will have to be put back to an immunosuppressive dose and you will have to start all over again, but this time there will already be a build up of glucocorticoid in the system and the side effects may become too much.

Yes other AI diseases can occur and some breeds are more prone to particular AI diseases, but that doesn't mean that a different AI disease can't be triggered in a genetically predisposed dog.

I do hope he is improving.  The protocol below is the best guide.  The longer you can leave it before reducing, say to 18-21 days the more likely the immune system will be sufficiently suppressed to return to normal function once it is released again when reducing the  preds. 

Jo