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Author Topic: Auto-immune meningitis of borzoi  (Read 27889 times)

maxvv

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Auto-immune meningitis of borzoi
« on: December 09, 2012, 06:20:09 PM »

Hi,
I was very glad to find your site and need an advice
I have a young dog (around 2 years old borzoi). From his early
age (4months) he had some strange illness. Periodically (once in 3-4 months
approximately) he got a fever and pain in neck area. We treated him in some way with antibiotics, painkillers and prednisolone. Hear in Russia the situation with veterinary is not well.  Around a year ago he had a neck pain and his back legs refused. He was treated in some way (near a month) with prednisolone (low dose) antibiotics and vitamins and his legs restored. Unfortunately we stopped giving prednisolone very quickly.

Near half a year ago he had a fever again. We moved him in the only clinic in our city that can do CSF and C-reactive protein in blood
analyses. They have done it and give diagnoses autoimmune meningitis (C-reactive protein was near 40 or 60). Vets proscribed him metipred
(methylprednisolone) (4 X 4 mg 2 times a day, dogs weight 30 kg). They say we should come when clinical signs would be gone. In 2 weeks the
dog became much better. We came to the vets but they did not give us any treatment scheme, just recommended to reduce steroid dose gradually (without exact doses). We tried to reduce  methylprednisolone dose (in 2 weeks we reduced dose from 16 mg 2 times a day to 4 mg a day) but in a week after drug off fever returns. Vets said that the illness bad known and nobody better than we ourselves could say what dose we should give.

 I tried to find information in internet and found reports of Scotland and Croatic vets about steroid responsive meningitis. I was
very happy because it gave us a hope. I tried to use scheme that I found in the reports just replacing prednisolone with methylprednisolone (as we already used it and it helped) in 4/5 proportion (4 methylprednisolone instead of 5 prednisolone). We started with 4 X 4 mg twice a day, after 2 weeks made C-reactive protein analysis (was 3.0 only)  reduced to 2 X 4 mg twice a day.

 After 6 weeks from that time we reduce dose to 2 x 4 mg once a day but yesterday found that our dog had 39.5 temp. and he has pain (assumedly in neck). Besides he pull his back leg sometimes.  I want to do blood analysis now including C-reactive protein.

So, I am in a difficulty now. I can see that everywhere prednisolone is used (not methylprednisolone as in our case), perhaps we should try it instead.
Perhaps initial dose was too low. As I can see from scheme on this site ordinary dose is 1 mg/kg of prednisolone every 12 hours, we were prescribed with 0.5 mg/kg of methylprednisolone every 12 hours.
From other side we are afraid to increase dose to the maximum now as our dog is on non-low dose of steroid for definitely long period of time already. He has side effects. Not very strong, but he has 2 small red spot on his body that lost hair and he scratchs the spots often.

I will be glad to all advices as hear in Russia we do not have vets with big experience in auto-immune illness and have to make decision ourselves.
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Walcop

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Re: Auto-immune meningitis of borzoi
« Reply #1 on: December 09, 2012, 06:51:12 PM »

Hi Maxvv,

I am not knowledgeable enough to begin giving you advice, however there are others here who will provide you with advice very soon.

If it's any reassurance even a lot of vets here in the UK do jot have a lot of experience with auto immune conditions. It is very rare to find a vet who is familiar with a range of auto immun conditions? For that reason it is very often that you find people obtaining advice from the great people on this site.

Take care and I'm sure you will get some good advice very soon.

Steve
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maxvv

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Re: Auto-immune meningitis of borzoi
« Reply #2 on: December 09, 2012, 08:45:55 PM »

Hi Steve,

Thank you very much for your support. I hope we will be able to fight with our illness. Concerning veterinars, strange thing but nobody told us that we should not try to stop giving steroids in 2-3 weeks as it can lead to relapse with high probability.
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goldiepower

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Re: Auto-immune meningitis of borzoi
« Reply #3 on: December 10, 2012, 08:47:21 AM »

Hello Maxvv

You are asking all the right questions! It is SO important that your boy gets an immunosuppressive dose of pred which will stop the immune system attacking itself. I am not familiar with methylpred and its relative bioequivalence to pred, Jo or Penel will probably know but I will check with my vet contacts in the meantime.

The "good" news is that meningitis (SRMA=Steroid Responsive Meningitis Arteritis) does exactly what it says, it responds to steroids and can be managed. My Golden Retriever, Chad, became ill when he was 9 months, after multiple bouts of illness, test and medication, he was diagnosed with SRMA and started treatment at 13 months. He was on steroids all his life to keep his immune system under control (he relapsed without them) and was the grand old age of 12 years and 5 months when he died just over a year ago.

Hang in there, we're here for you

Chris & the Golden Boys
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goldiepower

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Re: Auto-immune meningitis of borzoi
« Reply #4 on: December 10, 2012, 09:10:15 AM »

I have some information on relative dose of methylpred v pred - 5 mg of Prednisone approximates 4 mg of Methylprednisolone. On that basis your boy was given 16mg bid of methylpred which is equivalent to 20mg bid of pred. That does seem low for a 30kg dog... Jo/Penel?

Chris & the Golden Boys
Sydney (5), Edward (3), William (18 months),
^Chad^ (SRMA, Hypo-T), ^Thomas^ (Hypo-T, CHF), ^James^
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maxvv

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Re: Auto-immune meningitis of borzoi
« Reply #5 on: December 10, 2012, 05:40:52 PM »

Hello, Chris

Thank you for your words and your information about methylpred!
As Chad was on steroids all his life, what min dose of prednisilone that you gave him? Was he need some special care? I mean, is it OK to exercise such a dog when weather is cold? How long can he walk? Is it OK to drive him out of the city for an hour or 2 hours? Is it OK to let him run? Perhaps, he need some kind of clothes for cold weather?

Maxim
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goldiepower

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Re: Auto-immune meningitis of borzoi
« Reply #6 on: December 10, 2012, 06:23:57 PM »

Hi Maxim

Once we had the SRMA under control we gradually reduced the dosage over many months until he was on 5mg eod (every other day), that was his maintenance dose for 8-9 years. While he was unwell/recovering, I took my lead from him, obviously when he was in pain I did not take him out, just rested him, when he was recovering he had gentle walks, but once he was on the maintenance dose he did everything the other dogs did. He LOVED being in the car and went pretty much everywhere with me, even if he just went for the ride! If he had to have veterinary treatment (he had some teeth removed, he had a toe amputated...) he had that done always on a day when he did not have steroids. If ever he had to go to a vet we didn't know, the first thing I told them was "he is on steroids to control SRMA" and made sure they did not give him Metacam, Rimadyl or any other non-steroidal anti-inflamatory. If he needed pain relief he had Tramadol.

I have to say our idea of "cold" in the UK is very different from yours! I would not think your dog would need any different treatment in terms of clothes, but I'll let others comment on that!

Chris & the Golden Boys
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Penel CIMDA moderator

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Re: Auto-immune meningitis of borzoi
« Reply #7 on: December 10, 2012, 09:46:06 PM »

Hi Maxim,
did you see this
http://cimda.co.uk/smf/index.php/topic,25.0.html

I would think that your dog is accustomed to the cold weather but if the prolonged use of steroids has meant that his fur has thinned, then maybe a good dog coat will help.  In the UK we have www.equafleece.co.uk
http://www.equafleece.co.uk/store/dog_jumpers.html
this is the sort of thing I would probably get if I were you.
I have a lurcher (type of sighthound too) who has IBD and he has lost  a lot of weight - he wears this jumper on walks now.
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maxvv

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Re: Auto-immune meningitis of borzoi
« Reply #8 on: December 11, 2012, 08:43:55 AM »

Hi Penel,

Thank you for the reference, I read all information from your message about SRMA. Unforutunately we are already in the middle of treatment and it looks like initial dose of steroid was too low for our weight. We started from 16 mg (appr. 0.5 mg/kg) bid of methylprednisolone. As I understand it is equivalent of 20 mg of prednisolone (0.67 mg/kg). Dog weight is 30 kg.

As now it looks like a relapse (high temperature and neck pain) perhaps we should start again from the high dose but increase it to 1 mg/kg? One more question is about  steroid. Vet prescribed methylprednisilone. He said that it is the same as prednisolone but more new and has less side effect. But if it was so I think that everybody would use it instead of pred. May be it is something wrong with it and we should use prednisolone instead?

Maxim
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Jo CIMDA

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Re: Auto-immune meningitis of borzoi
« Reply #9 on: December 11, 2012, 10:26:53 AM »

Hi Maxim

I'm sorry you are having so many problems with your boy.  As with all inflammatory autoimmune diseases the dose of steroid and the duration is crucial if remission is to be achieved, and the good news about SRMA is remission can be achieved and very often the dog will 'grow out' of SRMA recurring. Relapses are not unusual though and the only way to deal with a relapse is to start treatment again with immunosuppressive doses of steroid and wean down in the usual way (please see Michael J Day's drug protocol in the files.  This is an excellent guide and you may want your vet to have a copy).  It is such a shame that you have no support from the vets in Russia.  I suppose we take that for granted in the UK and other parts of the world.  I know Elisabeth, in Egypt has had similar problems in the past.

Prednisolone or methylprednisolone doesn't really matter.  What does matter is the dose and the weaning down protocol.  Unless the dose is immunosuppressive (prednisolone 1-2mg/kg/12hours, starting at the lowest dose) then the dog will always relapse. If you are still giving him methylprednisolone then a 4mg tablet is equivalent to one 5mg tablet of prednisolone, so an easy calculation would be 30kg bodyweight would need 6 tablets of either methlyprednisolone or prednisolone twice a day.

You have rightly said that he has been on steroids for a while now and you have to consider the side effects but at this stage you don't have much choice but to raise the dose to immunosuppressive but if you can get a drug called azathioprine in Russia then you can give this as well (2mg/kg 24 or 48 hrs) and this is called a 'combination therapy'.  The reason for this is the Aza will give added immunosuppression and therefore you should be able to wean down the steroids more effectively thereby reducing the time you dog will be on steroids.  More information is available if you start this regime but I don't want to overload you at this time.

As your boy has been on steroids  for a while now it is important to give him something to protect his stomach from the excess acid that steroids produce.  You can ask your vet about this or if you can get ranitidine in Russia the this is a good gastroprotectant (2mg/kg/3 times a day).

I have know lots of dogs with SRMA and the outcome has been good, even if like Chris you have to keep your dog on a very low every other day dose of steroids.

If your vet is willing he/she could email a vet college in the UK for advice.  I'm sure they would be very happy to help.  Prof.  Michael J Day is at Bristol University in the UK and I have know people to email him and he always replies.  He is a very caring man.


Best wishes

jo

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maxvv

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Re: Auto-immune meningitis of borzoi
« Reply #10 on: December 11, 2012, 07:27:04 PM »

Hi Jo,

First of all I want to thank you for all you words and such a lot of portion of information that you give.
We started give 6 tablets of methylprednisolone to Luch from yesterday evening and he is better already. He has normal temperature and it looks like pain does not disturb him. At least not like it was yesterday. I think we will increase dose even to 7 tablettes as his real weight is near 35 kg. He is more active now.

I bought azathioprine in a drug store. Did I understand you right that we can give it together with prednisolone and dose of prednisolone should not be lower in this case? What should be changed in scheme of treatment then. I bought ranitidine also.
Should we give him something to support his liver?

We will try to interest our vets with treatment scheme but we are not sure in result as we have in our city only 1 clinic (for 5 million of population) which specialization is neurological illness and it looks like they are not very attuned to clients opinion. But we will try.

Best regards,
Maxim
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Penel CIMDA moderator

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Re: Auto-immune meningitis of borzoi
« Reply #11 on: December 12, 2012, 07:32:04 PM »

Hi Maxim,
there is more info on this link too
http://cimda.co.uk/smf/index.php/topic,16.0.html

I will let Jo answer your other questions I think.
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maxvv

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Re: Auto-immune meningitis of borzoi
« Reply #12 on: December 13, 2012, 08:05:06 PM »

Hi Penel,

Thank you for the reference! Just want to be sure. So, additionally to dose of prednisolone I can give Aza to Luch and it allows reduce dose of prednisolone more quickly? How can I decide that it is time to reduce dose of steroid? In scheme there are 10-28 days, but it is a big difference between 10 and 28.


Maxim
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goldiepower

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Re: Auto-immune meningitis of borzoi
« Reply #13 on: December 13, 2012, 09:21:38 PM »

Hi Maxim

I need to let Jo give you advice on this, I will just say that from my experience, which is limited to one dog, the shorter period is used for reduction of the higher dose levels and the longer for the lower doses. Chad (25kg) was on 50mg bid for 5 days then 25mg bid for 14 days then subsequent reductions were then 28 days or longer. HOWEVER this was 12 years ago and he was only on pred with no aza.

I hope that makes sense, I know Jo will have better advice for you!

Chris & the Golden Boys
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Jo CIMDA

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Re: Auto-immune meningitis of borzoi
« Reply #14 on: December 14, 2012, 08:57:47 AM »

Hi Jo,

First of all I want to thank you for all you words and such a lot of portion of information that you give.
We started give 6 tablets of methylprednisolone to Luch from yesterday evening and he is better already. He has normal temperature and it looks like pain does not disturb him. At least not like it was yesterday. I think we will increase dose even to 7 tablettes as his real weight is near 35 kg. He is more active now.

I bought azathioprine in a drug store. Did I understand you right that we can give it together with prednisolone and dose of prednisolone should not be lower in this case? What should be changed in scheme of treatment then. I bought ranitidine also.
Should we give him something to support his liver?

We will try to interest our vets with treatment scheme but we are not sure in result as we have in our city only 1 clinic (for 5 million of population) which specialization is neurological illness and it looks like they are not very attuned to clients opinion. But we will try.

Best regards,
Maxim

Hi Maxim

I'm so pleased Luch has responded so quickly. 

For the record, the immunosuppressive dose for methylprednisolone (BSAVA Small Animal Formulary) is 1-3mg/kg/12hrs.  So you are right,  the minimum dose you should give to Luch is 7 tablets in the morning and 7 tablets in the evening with food.  It is amazing how quickly they respond to treatment, usually within 4-6 hours. 

10-28 days duration is a wide margin and the reason for this is individual dogs will show different side effects to the drug and it always has to be a balance between treating the disease and limiting the side effects. Also some diseases respond quicker than others.  Luch is a large dog and they tend to show more side effects, so you have to watch him and if he starts to go off his food and becomes weak on his legs then it is probably time to reduce the steroids.  10 days is about the minimum you should aim for but even then the whole picture must be assessed and the drugs reduced if necessary. 

I am amazed you can buy Azathioprine over the counter. It is a prescription drug in the UK.  It is made in 25 and 50mg tablets and a dog the size of luch will probably be put on one 50mg tablet a day.  These tablets are what they call cytotoxic and they shouldn't be handled without gloves and should not be broken or split.  You can give the steroids and the Aza with food at the same time. T he ranitidine can also be given at the same time.

If Luch responds well and the SRMA symptoms have gone you should be able to start weaning him off the steroids after 10 days using the  Michael J Day protocol.  You could try to lower the dose after a week but if the side effects are not too much of a problem then it is better to leave him on this dose for at least ten days and hopefully this time he will stay in remission.

If you can get some milk thistle you could give that to him to support his liver.  Also try to keep him on a low fat died and feed him smaller meals and more often.

I'm sorry you don't have the support of your vet.

Good luck

Jo

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