Relapse questions...

[Koda bear]

Hi everyone   I have to ask about relapse , in an older dog, with probable SLE, when is it too late to reintroduce steroid therapy again? I am worried that now Koda may be spiraling down , judging by his symptoms. He has been on an extremely low dose of pred for many months, and we are still weaning him off, at 2.5 mg a day. He had many signs of cushings, and most have disappeared. Then he had an episode of pancreatitis, so he lost SO much weight and had diarrhea for months.
We connected with epi4dogs, and with support from my vet, we are treating him for EPI, with pancreatic enzymes added to every meal. He has had no GI issues, and is eating well. He is happy-
But the worst problems we see are his skin,and his lameness. He chews and licks and is developing sores on his belly and back legs, on his feet,. He is also looking a bit lame, and these are the signs I fear.
He is an older dog, almost 12 and about 36 kg. He was starting to go on walks and really doing so well, until this past Sunday.
I have a vet appt tomorrow, Sat with my vet. I want her to see how bad his skin is....I avoid taking him to the vet but it looks bad.
Would it be a good idea to try the doxy and Vit b3 , instead of back on high pred dose? OR-
Could he possibly improve with a modified pred dose, not quite so high?
Is he just too old to hope for remission ?
I saw this following post here on the board:

""If a relapse occurs he will probably show similar clinical signs to his initial crisis.  He will have to go back on an immunosuppressive dose of prednisolone, but it may not have to be quite as high as before. A combination drug may need to be added at this stage. The weaning process will then have to start all over again. Returning to an immunosuppressive dose will mean that he has to go back on a gastroprotectant.""

If anyone has any ideas or suggestions for me to take to my vet I would really appreciate it      I really love this guy    Thanks so much!!

Melissa

[Jo CIMDA]

Hi

I am sorry Koda is showing these signs.  If you are sure (or as sure as you can be) it is a relapse of the AI disease then his system has to be suppressed in order to control the immune system which is doing the damage.  However preds is just one immunosuppressive drug and these days you do have choices.  The Doxy won't address any symptoms of polyarthritis so you will probably have to go for a different sort of immunosuppressive drug such as cyclosporine, leflunomide, mycophenolate to mention a few.    Perhaps, especially as he is almost 12 years old,  a full blood test to see how his organs are at present might be good idea, and the results may help your vet to make a decision about which drug to try next. A good article about different immunosuppressive drugs:

https://www.dvm360.com/view/immunosuppressive-drugs-beyond-glucocorticoids

A lower dose of preds with a 'combination' drug might work for him and this will avoid severe Cushing's symptoms. If his skin is continuing to get worse then you do need something to halt the destruction. I would take Koda back to the vet and have a chat.  He is not too old for remission.  It just needs the right drug/s to control the 'out of control' immune system.

I hope you can start him on something very soon.

Jo

[Koda bear]

Hi Jo  thank you for your reply     I will see the vet in the morning and go over all of this. Koda had a full senior panel, with some extra thyroid tests, and ultrasound in September. Everything looked really good,  considering what he has been through. No kidney damage, nothing remarkable with his liver, only some damage to his pancreas, which we are addressing- successfully!
His blood work was practically normal, nothing significant at all.
I am just wondering if there is a time, with an old dog, where it may be cruel to put him back on the pred, if his body just won't withstand it. It's also cruel to leave him to chew on his skin, so that he has sores developing - it's very difficult!
    He does not seem that very lame, just a bit sore in his rear end. It may just be that he twisted something getting into the car on Sunday, I took him for a walk in the woods- and he jumped into the car quite enthusiastically, and came up sore on Monday...so I am not sure what I am seeing!
I know I am driving myself crazy with worry  I am going to read over the article you provided

THANKS for your time   I really appreciate it
Melissa

[Jo CIMDA]

Hi Melissa

If Koda's bloods were good in September then forget his age and treat him as you would any other dog.  Some old dogs are not as healthy as some old dogs, so armed with blood results treat what you see.  It would be unusual for an older dog not to have some stiffness or arthritis in the hind legs, so again I wouldn't worry about that either.

If it is mainly a skin problem then it isn't SLE.  SLE affects many different body symptoms and it does not isolate to just one. So this may not be an AI disease at all.  It may be an allergic reaction, or it may be a fungus, bacterial or parasitic problem.  Your vet may be able to assess and give speculative treatment without having to do extensive tests.  It is worth a try anyway.

So forget Koda's age and just look at what needs treating and go for it.

Jo

[Koda bear]

      Hi Jo  thank you so very much for your ideas     Koda saw our vet yesterday and she thinks that he is currently suffering with severe allergies and not an AI flareup.  She keeps saying, lets just get him off the pred, don't worry and we can put him back on if he really needs it. 
     She sent me home with apoquel, to give it a try for a few weeks.   I'm nervous about giving him this product, this drug is a little controversial here in the states. (BUT ... if it clears him up, then I know for sure he has allergies!) 

What do you think about it? Is it used often over by you?



Thanks   and wishing you a joyful and healthy holiday season!

Melissa

[Jo CIMDA]

Hi Melissa

That is good news. 

I have not used apoquel myself but I know it is a popular product for the treatment of allergies.    I would do some homework so that you are aware of the side effects and just watch out for any.  This article may be useful to you. 

https://www.petdermatologyclinic.com/apoquel-information

There are other drugs that can be tried, so if you have any problems get back to your vet and ask for an alternative.

Good luck -  fingers crossed.

Jo

[Koda bear]

Thank you Jo   This is a very informative article!
Melissa