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Cooper again

Started by Shannon, August 30, 2012, 04:23:06 PM

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Shannon

I think I need a little reassurance...

Cooper seems to have had a relapse of the IMPA. He's struggling to rise, slightly lame in the forelimbs but much worse in the hind, walking like a little tin soldier, didn't want to eat last night but is eating again today. He has a slight temp and although I know they're meant to have a high temp this is the way he presented when this whole thing started last year. He is also very depressed.

I took him to the vet today and was fobbed off about this being an auto immune problem, then got berated about the terrible side effects of pred... The vet who I dealt with before is away for another week and I can't leave him like this til then.

Should I just do what my gut tells me and put him back on a higher dose of pred without their support? I'd got to the one every third day stage with him and I think I know what triggered this whole thing... I took him to get clipped last friday as its really hot here (I held him the whole time so nothing bad happened ). He was over the top though and super duper excited and quite stressed towards the end. 5 days later this happens, makes me wonder...

I think I just need some reassurance that I'm doing the right thing. My biggest worry is that he's never had a definitive diagnosis only the rapid response to treatment and I'm afraid I'm going to make things worse for him. Sorry to ramble on so much, I'm just really worried about him.

Jo CIMDA

Quote from: Shannon on August 30, 2012, 04:23:06 PM
I think I need a little reassurance...

Cooper seems to have had a relapse of the IMPA. He's struggling to rise, slightly lame in the forelimbs but much worse in the hind, walking like a little tin soldier, didn't want to eat last night but is eating again today. He has a slight temp and although I know they're meant to have a high temp this is the way he presented when this whole thing started last year. He is also very depressed.

I took him to the vet today and was fobbed off about this being an auto immune problem, then got berated about the terrible side effects of pred... The vet who I dealt with before is away for another week and I can't leave him like this til then.

Should I just do what my gut tells me and put him back on a higher dose of pred without their support?

Hi Shannon

Only you can decide that, but if you say it started like this the first time then it is likely to be a relapse.  It is common for a dog with IMPA to relapse.  It is a disgrace and a lack of compassion and  understanding of AI disease for your vet to fob you off without any offer of treatment.   If this is a relapse you will see a remarkable difference if you put him back on an immunosuppressive dose. I presume your vet ruled out an infection of any sort etc. I don't understand why the vet didn't put Cooper back on immunosuppressive doses of steroids.  Sadly many of us have had to take control.  It shouldn't be this way.  You could always take Cooper to another vet.


You don't have a diganosis but it is common to treat dogs speculatively because sometimes a diagnosis can't be reached, and like you say you can't leave him like this. If the desired improvement is seen after the start of immunosuppressive treatment, then a diagnosis can be assumed and that's what happend in Cooper's case.   At times we have to trust our instinct.  Check out the Michael J Day protocol in the files.

I do hope you see an improvement very soon. 
Jo

Shannon

Thanks so much Jo,

I am going to take him to another vet tomorrow that I believe will be more receptive to his problem, but in the mean time I have given him 1mg/kg of pred tonight and I just pray there is an improvement soon.

His blood smear was normal with no sign of a neutrophilia so I don't believe there's an infection at play here. That was my initial concern, I didn't want to give him pred without antibiotic cover if he has a bacterial infection too. I am tired of being fobbed off and when I asked why he had responded so rapidly to treatment before, I was told that pred will make anything feel better for a while!

Is there anyway I can protect his ligaments while he's on the pred? He already has a partial tear of one cruciate. And should he follow the Michael Day protocol from the beginning again or will he be able to taper quicker? Sorry for all my questions and thanks so much for your support and advice. 

Jo CIMDA

Hi Shannon

I hope Cooper is feeling a little brighter today. If the vet is unsure this is relapse, and this is often the case, as long as the 'infection' aspect has been covered then a single immunosuppressive shot of dexamethasone can be a very good way to see if an immunosuppressive course of steroids is the right way to go.  Very often, and especially when dealing with IMPA, a single dose of Dex will show a remarkable improvement, if it does not then it is less likely to be an AI problem and your vet has to think again.  A single (or two shots) of dex can be given without having to wean down. The duration of action is up to 72 hrs. Of course if it has the desired effect then a complete course of treatment has to be started after 48 hours and the Michael J Day's protocol is an excellent guide.  You shouldn't taper any quicker.  As for the ligaments, there is nothing that I know about but you might have a word with your vet about calcium/vit D supplements - I have no experience of this, it's just a thought.  Good luck today.

Jo

Shannon

Hi Jo,

There is a definite improvement in Coop after the pred last night. He is not 100% better but he is vastly improved and is getting up and around much easier. He is still a little lethargic but definitely brighter than he was yesterday and the day before.

I have just got back from seeing the other vet and he agrees that this is a relapse and fully supports him going back onto the pred. He has seen Coop before and knows his whole history from the beginning of all the problems last year. He's very honest and frank and he definitely wouldn't agree with me just for the sake of it. I feel relieved that I have found someone who I can trust and who cares.
 
On top of this all Coop has an upset tummy. It started before the pred so I don't think it is related but he is on gastroprotectants now too.

Thanks for all your advice and help, it is very much appreciated.

Shannon

Oh, I forgot to say that I have him on a joint supplement with glucosamine/chondroitin and green lipped muscle extract so maybe that will help the ligaments. I did ask the vet if there was anything else I could do and he said not really, just to keep him as light as possible and carry on with the joint supplements.

Penel CIMDA moderator

Sorry to hear that poor Cooper is having a relapse.  The situation you describe would definitely have made Saffy relapse with her SLE.  Anything stressy / hot / cold / even getting very wet / once a friends dog nipped her - anything out of the ordinary can cause a relapse with these sensitive dogs.
At least you are recognising it for what it is, and finding a vet who is supportive too.  And obviously you have your own knowledge too.  I hope you have an ok weekend x
Penel
(SLE, Surrey - UK)
Forum Owner
CIMDA

Jo CIMDA

Hi Shannon

You must see this as good news.  You have a vet you can work with and that is worth so much, also you know that Cooper responded to the treatment the first time around and he can do it again.  Just make sure the protocol he is on is correct and I am very hopeful it will all go to plan.

This is not unusual but now you know what it is you can deal with it. You must feel more confident now.

He should improve quickly now.

Jo



Shannon

Thanks so much Jo and Penel,

His mobility is still improving, he is getting up so much easier and his gait is practically normal :) When he first started he had a very wide based stance and he walked like a tin soldier, not wanting to flex any joints and watching him rise was just awful. His tummy still seems to be a problem so I have been off to the vet and got him some metronidazole and amoxycillin/clavulanic acid to sort out any bugs that might be lurking. He's also got a probiotic now so I hope his tummy will settle down soon.

It truly does make a difference knowing there is someone in Coopers corner who is prepared to do what's best for him. I honestly don't know why some vets have such a problem accepting the possibility of AI disease in their patients.  It is so sad and so many animals will suffer because of it.

When I researched IMPA a while ago, I read that if they relapse then the IMPA can become more refractory to treatment, is this true? He has responded quickly to the pred again so I am hoping its an old wives tale.

Thanks Penel, I was wondering if I was just being silly but  I now have no doubt that the little trip to get him clipped and all his excitement set this off. I live quite far out of town and the parlour is in the middle of town so there was much excitement and barking, as he believes that all roads belong to him and people must just move out our way, so he tells them so! He was also very hyped up towards the end of the clipping and wanted to go home NOW!  From now on he is going to have to deal with my hair dressing skills.

Saffy and Coop sound similar in nature, it must be a cocker thing. Does it get easier to work out their triggers as time passes? I still feel a bit like I am fumbling in the dark with him and clutching at straws as to what sets him off.

Thank you both so much for your care and support, it really makes such a difference.

Shannon

Probably a silly question but would it be normal for him to still be a bit depressed and quiet if his joint pain has improved so significantly? I don't know if its his tummy, part of the impa or if I'm maybe missing something. I'm probably being a worry wart...

Penel CIMDA moderator

I think that they find relapses stressful.  I think they know "it's happened again" and also you will be more stressed than usual and Cooper will be picking up on that.  It's great that his movement has improved so quickly.

Cockers are quite busy stressy little beings (I have two at the moment, within my pack of 6), they can be v reactive to lots of things.  How does Cooper travel in the car - if he is crated then you could cover the crate to make the journeys more relaxing for you both.

I agree you should groom him yourself, who cares if he doesn't quite look perfect - it's far less stressful for you to do it at home, than to take him to a grooming parlour.

Saffy had SLE which is way different to IMPA as I'm sure you know, so I don't have personal experience with IMPA relapses.  I do know though from people on CIMDA support, that IMPA is one of the ones that tends to respond really well.  It may be that Cooper needs to stay on a maintenance dose of pred ever so slightly higher than what you had him on.
Penel
(SLE, Surrey - UK)
Forum Owner
CIMDA

Shannon

Thanks Penel,

He will NEVER ever go near another grooming parlour after this. I'm afraid he'll have to put up with me hacking away at him with a pair of scissors. He's only been twice and just to get clipped because of the heat here. The last time he was on a significantly higher dose of pred so I think that may have kept things on a more even keel.

He loves travelling but he is terrified of crates and as he's from the SPCA, I figure something awful has happened in his life. He can't be in a cage at the vets either, it sends him into an absolute frenzy. He travels on the seat with a harness but is like hawk eye, constantly on the look out for pedestrians, bicycles and other cars. I think it is quite stressful for him as he's always on high alert and perhaps I need to look into ways of teaching him to relax a little and show him that he doesn't have to keep an eye on everything. I haven't a clue how to go about it though...

He seemed a little stiffer this evening than he was this morning but I did notice it was worse just before he was due his second dose of pred for the day. I wonder if that had something to do with it? He is still quite subdued and depressed and I'm not sure if it is the impa, upset tum or possibly both.

I totally agree with you that they know that "IT" has happened again as well as the fact that they pick up on our stress. I need to learn to hide mine better from him (I'm sure my problem is a case of a little knowledge being dangerous) :)

I do think cockers have very active minds and that makes them quite prone to stress, they're always involved in everything and hence everything that goes on affects them in some way. Thanks so much for listening to all my worries about him and I hope you're having a good weekend with your pack of furry people. 

gschellinger

In the early years when I had first adopted my staffy Lola, she had many IMPA events. Our vet at the time was unaware or incompetent. Lola would be fine,then lay down to take a nap. Wake up and not be able to get herself outside. I would have to carry her. I was clueless. She was only one year old. She also is considered to have SLE because of the variety of immue diseases she has had. But back then we only knew of AIHA, and her vet didn't make the connection. So, by day two of an event like this, she would stay in her crate, not want to eat, have a raging fever and I would haul her off to the "vet" where they would say things like "oh, it's Lola our lupus dog." Never did they explain to me what they were talking about, I was dumb. And they did not treat her with steroids either.

She had these kinds of episodes for about a year and a half. They would give subQfluids and she would sleep it off and be better in a couple of days. But sometimes I would see a slight limp again, and then another episode. When finally she had a critical episode we had switched to another practice. Because of her history this new vet put her on high dose pred. even w/o a diagnosis. I joined CIMDA about that time. It took a long, long time, months, before we could get her totally off pred. I think she becames sick in March and it was August before we were successful in weaning her entirely. Lola is nine now. Her IMPA has never returned. She has many other problems now, hereditary in nature. But the IMPA never returned, nor have the other immune issues she had back then. It takes a while sometimes to get a good solid remmission, but it can happen and for Lola it is a success story, as far as IMPA goes. I hope your Cooper will be like Lola in that respect. Lots of rest and quiet. Lots of good, real, food. Lots of love :)

I hope you can get some strength and support from my Lola's experience with IMPA.
gail.
gail and Lola (SLE, hereditary cerebellar ataxia, chronic undiagnosed nasal congestion) usa

shawkyelisabeth

Reading this post gail it gives me hope that things can be achieved even with relapses and setbacks. You have really been an inspiration for me with your long struggle with lola never giving up and so i wish well to cooper and hope tomorrow will be a better day for our furry kids and stella will be better on her legs and responding to the medication and starting to eat...elisabeth

Shannon

Thank you for sharing Lola's story, Gail. You and Lola have had a long hard road but it makes you love them all the more. She is a lucky girl to have such a dedicated mum and you and her are an inspiration. I hope her congestion has improved?

Coop's saga started in August last year and he and I were fobbed off for months with Rimadyl, then his symptoms were put down to a prolapsed L7S1 disc which was  removed and he just got worse and worse. He had months of being put on Rimadyl and then tramadol was added to it. It never made an iota of difference to his pain. By December, at which point we were at home for Christmas, things reached a crisis point,his quality of life was very poor and the end was in sight. He was having fevers,swollen lymph nodes and had a bit of swelling of some joints which prompted the pred and the change was astounding. I have been trying to wean him off since then but he has been on a very low dose for a couple of months. 5mg eod seems to be the last dose that kept him stable.  I wish I'd found this site a long time ago.

He still seems quite depressed this morning although his appetite is good(thanks to the pred, but he likes his food anyway). I just miss his twinkly eyes...