Mikey, canine, with Autoimmune disease

[mikeysmom]

Mikey was not diagnosed right away.  He is a 6 yr old hound mix, 38 lbs.  Last fall he started blowing snot from his nose.  Then his ears were inflamed. He drooled a lot.  He was eating well and loosing weight, lost 5 lbs.  His gums were red.  Vet didn't know, but thought Mikey had gotten into something as his blood work was in normal range.  He was put on Doxycycline and Prednisone.  Mikey started to get better until he finished all the meds.  The antibiotic was renewed for another round.  Again, after the antibiotic was finished.  He got worse.  Took him back to the vet and requested that he be sedated so that we could get a good look into Mikey's mouth.  Ultrasound was done and lymph nodes checked.  Mikey's mouth was covered with lesions, gums and lips were bleeding.  Vet said a couple of lesions were visible on his penis and anus.  He was prescribed Azathioprine, Sucralfate,  and a different antibiotic.  He could not tolerate the Azathioprine.  He stopped eating and threw up.  The dose was cut in half with the same results.  By then the antibiotics has cured the infection in his mouth.  Vet wanted to put him on Prednisone.  Told him that I wanted to try Beta-Thym first.  He is still on Sucralfate.   I wanted Prednisone to be the last option.  Mikey has been on the Beta-Thym for 2 weeks now.  He no longer wants his breakfast when he first wakes up.  He'll wait a couple of hours.  Some days, he will eat all his dinner and some days only half.  I wonder is the weather is a factor in this.  Seems that when raining or snowing, he eats less.  Looking for advice.  Wondering is I should put Mikey on Prednisone at least for a while.
Thanks in advance

[Catherine]

Has your vet given you a diagnosis? Does he think it is an allergy and was the Prednisolone dose an allergy one rather than an autoimmune dose? Could it be Aspergillosis?

[mikeysmom]

Definitely a systemic  auto immune disease, not an allergy
When he prescribed the Prednisone, the vet at first thought last fall that Mikey was having an allergic reaction to something that he got into as all symptoms were in his head.  The dose was 20mg giving 1/2 tablet twice daily for 10 days.  It wasn't until the next time I took him in, and we had him sedated, that the lesions were seen. 

[Catherine]

Do you mean the total was only 20mg a day? If he weighs about 18kg he should have been started on an immunosuppressive dose of 36mg total a day and then reduced gradually. Here is a good medication protocol:

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – 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/q12hrs (every 12 hours).

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

[mikeysmom]

Do you mean the total was only 20mg a day? If he weighs about 18kg he should have been started on an immunosuppressive dose of 36mg total a day and then reduced gradually. Here is a good medication protocol:

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – 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/q12hrs (every 12 hours).

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

Do you mean the total was only 20mg a day? If he weighs about 18kg he should have been started on an immunosuppressive dose of 36mg total a day and then reduced gradually. Here is a good medication protocol:

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – 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/q12hrs (every 12 hours).

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

[mikeysmom]

At first the vet thought he was dealing with an allergic reaction so the dose was 20mg per day.  After we ran out of the Prednisone, he got worse.  I took him back to the vet.  He was sedated and we got a good look at his mouth.  There were lesions everywhere.  His lips were bleeding.   His nose was crusted and bloodied when he bumped it.  And yet though this, he was eating well.  Don't know how he did it.  He was put on Azathioprine.  It caused him to stop eating and he through up a lot.
He is now on an otc called Beta-Thym, a natural Prednisone 3 times a day.  He's been taking it for 2 weeks.  He is ever so slowly seeming to get a little better.  I can see some small parts of his tongue that are a normal color. I'm wondering if I should let him be on Prednisone until at least he is a lot better.  He is eating fairly well except when rain or snow is coming.  I'm also giving him some goat milk.  I melt down a Sucralfate pill and use a syringe to put it in his mouth 3 times a day.

Do you mean the total was only 20mg a day? If he weighs about 18kg he should have been started on an immunosuppressive dose of 36mg total a day and then reduced gradually. Here is a good medication protocol:

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – 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/q12hrs (every 12 hours).

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

Do you mean the total was only 20mg a day? If he weighs about 18kg he should have been started on an immunosuppressive dose of 36mg total a day and then reduced gradually. Here is a good medication protocol:

Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – 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/q12hrs (every 12 hours).

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h            10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day      at least 21 days
0.25-0.5 mg/kg/ Every third day       at least 21 days

Azathioprine (a cytotoxic drug) can be used in combination with prednisolone at 2mg/kg/24 or 48 hrs and dose gradually reduced, when remission is achieved, over a period of months.
Clinical response to Azathioprine may take up to 6 weeks. (Plumb's Veterinary Drug Handbook)

Don't forget the gastroprotectant!

[/quote]

[Jo CIMDA]

Hi and welcome Mickey's mom.

I am sorry that your Mickey is having these problems.  I am a big fan of supplements, and some alternatives to conventional veterinary medicine but I have to acknowledge that a dog with an autoimmune disease  often needs conventional drugs to significantly suppress the immune system in order to bring the disease under control and into remission.   

It is not always necessary to give immunosuppressive doses of prednisolone for some autoimmune skin diseases such as discoid lupus  (DLE) and symmetrical lupoid onychodystrophy (SLE,) but if the AI disease is life threatening or it  needs to be brought under control quickly such as pemphigus, then immunosuppressive doses of prednsiolone is extremely effective.  It does, however, have to be given in the correct dose and for the correct duration to have any lasting effects and to achieve remission.  The immunosuppressive protocol that has already been posted by Catherine is the best protocol that I have come across and it can be confidently used as a guide.

It is much better for the poorly dog to put them onto  a good drug protocol than to go on for many weeks without achieving remission in an attempt to avoid using immunosuppressive drugs.   If Mickey does have an autoimmune disease then it would be better for him to go onto a good protocol with prednsiolone and taper off over a period of a few months than to give something that will not fully address the problem, and the immune destruction of the skin, that is causing ulceration, will just continue and get worse. 

If you wanted to avoid the use of steroids then you might try a treatment of doxycycline and niacinamide with the addition of Natural Vitamin E and essential fatty acids.  This treatment could take 9 months or more but it may work, depending on the sort of autoimmune skin problem that he has. Even if you go down the steroid route you might consider adding EFA's, because this does have an anti-inflammatory effect after a while, and is known to be 'steroid sparing',  and Natural Vitamin E as this encourages new cell growth, but it has to be the natural form because the synthetic form is not effective.

Have a chat with your vet and don't be put off by using conventional drugs, but be sure that it is the correct dosage and the protocol is a good one.

Jo

[mikeysmom]

Thank you.   Called my vet.  Picked up antibiotic and prednisone for Mikey.  Will be starting this today.  I so hate having to give him prednisone, but must do what is best for him.

[Jo CIMDA]

Good luck. Hoping you will see an improvement very soon

Jo