Auto-immune meningitis of borzoi

[maxvv]

Hi, Jo

Thank you for answers!
Almost all clear except 2 things.
1. Dose of methylprednisolone. According to BSAVA  immunosupressive dose is 1-3 mg/kg, from other side 0.8 mg of methylprednisolone is equal 1 mg of prednisolone.  And immunosupressive dose of prednisolone is 1-2 mg/kg. Something strange here. We give now 7 tablettes (that is 0.8 mg/kg) twice a day. I thought that it is OK as it is the same as 1 mg/kg of prednisolone, but now I'm not sure.
2. Scheme of reducing dose of Aza. Should it be reduced together with methylprednisolone? At the same day?

One more question is about drug for liver. What about S-Adenosyl-methionine? It was recommended us once for other dog? Is it OK in this case?

Maxim

[Jo CIMDA]

Hi Maxim

The reason I quote from a source such as the BSAVA Formulary is to provide the most reliable information to owners and also to cover myself.  People must have confidence in the information from a support group such as this as our dogs are so important. Ultimately treatment decisions have to be the responsibility of the owner and their vet.  Having said that your are right 0.8mg methylprednisolone equals 1mg prednisolone and this is why for simplicity, it is easier to think that one 4mg tablet of methylpred is the same as one 5mg tablet of pred. They both have the same duration of biological effect. So tablet for tablet they are the same.  Why the BSAVA formulary states an immunosuppressive dose of methylpred is 1-3mg I can't answer. For me 7 tablets twice a day would be the right, minimum immunosuppressive dose. If you want to change to prednisolone, and you have no problems getting it from your pharmacy, then you can if it makes you feel more confident.   It is such a shame you don't have a vet to support you. Prof Day has given his permission for me to pass on his drug regime to be used as a guide for owners and vets.

The Aza shouldn't be reduced at the same time as the preds.  The idea is to maintain the same dose of Aza whilst the pred/methylpred is lowered and then, when the steroid dose gets to every other day, you can start to reduce the Aza to every other day, but given on alternate days; so one day you will give the steroid and the other the Aza etc......


S-Adenosyl-methionine (SAMe) is a very good liver support and I personally like it very much.  You can give it with or without the addition of Milk thistle.

I hope it is all a bit clearer now.

Jo

[shawkyelisabeth]

Hello Maxim, with this post I just want to support you to stay in this and not give up hope. I do not have enough experience to advise you on doses, but me too had to rely completely on Jos and other cimda friends advise since my vet here in Egypt did not know anything about autoimune diseases and I was completely on my own in taking decisions, I did not even have reliable blood tests and had to do a lot with my gut feelings. All I can contribute is that the lower doses should definitely be lowered slowlier if you dont see serious side effects, dont rush , be patient and happy with every good day you have with your furry friend.
Keeping fingers crossed
Elisabeth with Cecil and her late soul mate Stella

[maxvv]

Hi Jo,

Thank you very much for all your great explanation! My wife and I and Luch are grateful to you for all your words! Now always is clear and we will continue to treat Luch basing on your advices and considering his state.
Perhaps we need some blood test during the treatment?

Maxim

[maxvv]

Hi Elisabeth,

Thank you for your words of support! How is your dog now? I think that Jo is a great person and he is doing a very good thing supporting poor ill dogs and his owners. Unfortunately in your and my country there are impossible to find support from specialist in auto-immune illness. Without Jo and all other friends from this site we will have very little hope. I see that he has a lot of knowledge and trust in his advices a lot!

Maxim

[Jo CIMDA]

Hi Jo,

Thank you very much for all your great explanation! My wife and I and Luch are grateful to you for all your words! Now always is clear and we will continue to treat Luch basing on your advices and considering his state.
Perhaps we need some blood test during the treatment?

Maxim

Hi Maxim

I'm glad it is clearer to you now.  It can be very confusing, especially in the beginning.  The only reason to blood test a dog with SRMA is if you think the side effects are becoming too much and it might be useful to know the liver and platelet values etc., as these tend to rise when a dog is on steroids.  Larger dogs do tend to have more side effects than little dogs.

It seems as if we have both assumed each other is a different gender.  I thought you were a woman and you think I am a man, but the reality is you are a man and I am a woman!  Funny eh? 

Is English your first language?  If it is not then you write it very well.

Fingers crossed for Luch.

Jo

[maxvv]

Ha-ha,

It is really funny. I do not know why I thought that you are a man. Perhaps because from point of view of Russian person name Jo seems like a male name. But I can explain your mistake. I think it is because I translated a lot of words of my wife. Her name is Olga.

I do not know what first language is. I can assume that it is the language that person speak just after he/she was born. If so, of course my first language is Russian. Second language is Ukrainian because I was born in Ukraine in Russian-speaking region. These 2 languages are very similar. I know English because my job is software development and they should know English well.

By the way, I think that we made a mistake of male/female because in English no big difference if subject male or female. If we communicated in Russian we would not make this mistake because in Russian it is a big difference in form of verbs and adjectives depending male or female subject is.

Luch have a diarrhea today. Do you know if it can be side effect of drugs? 

Maxim

[Jo CIMDA]

Hi Maxim

How is Luch today?  Diarrhoea shouldn't be a problem but Aza can sometimes cause a stomach upset. Also when the dog's immune system is low they can pick up so many different bugs and it is not unusual to get infections. The most common one is a urine infection. Antibiotics usually sort it out though. Give it a while and see how it goes. He should be drinking a lot anyway but do be sure if he has watery stools that he doesn't dehydrate.  Slippery elm is a natural remedy for diarrhoea, or a light kaolin might help.  Metronidazole is a good antibiotic for diarrhoea (15-25mg/kg/12hr - BSAVA Small Animal Formulary).  Can you buy this from your pharmacist?  It is a prescription drug in the UK.

Yes mixing up the gender is funny and I understand what you mean by it not being a big difference in English. My full name is Josephine (shortened to Jo) in the UK the masculine spelling for Jo is Joe.  Your English is excellent Maxim.  You must have a talent for languages.

I do hope Luch's tummy settles down very soon. Hallo to Olga!

Jo

[maxvv]

Hi Jo,

Luch is OK but he still have diarrhoea or stomach upset (I do not know the difference). Ordinary we limit his food but now we afraid to do this because of steroids. We gave him rice food (it helped earlier, but now it has not helped). Looks like he does not like dry food (he eats it less than earlier), but ordinary meal he eats like it was earlier. Now weather is cold (-10 C), so I think that it is not a big possibility to get infection. I will try to get metronidosole this evening. He drinks a lot, so I hope that dehydration does not threaten him.

Now I got where my error was. I should note the absence of -e in the end of your name. You have a wonderful name. Is it typical for England?

Hallo from Olga to you too!

Maxim

[Jo CIMDA]

Hi Maxim

It might be the Aza causing diarrhoea but there is no way of knowing for sure at this stage.  There is a good product called Prokolin.  It is a probiotic and also kaolin to firm up his stools.  You may be able to get this from the internet.  If the diarrhoea continues then perhaps you should stop the aza to see if by withdrawing this drug the diarrhoea stops.  He should want to eat when he is on steroids, if he goes off his food then again the Aza may be making him feel sick.

Jo

PS. The name Joesphine is typically Irish (my father was Irish but lived in the UK)

[maxvv]

Hi Jo,

Thank you! He is OK today, so we continue giving him Aza and Metipred.

Maxim

[maxvv]

Hi Jo,

Now is 10th day of methylprednizolone and 8th day of Aza. Yesterday he was OK, just urinated a lot (2-3 times a day at home, at night or while waiting for me from office). But it looks like he scratched his leg somewhere, and today the leg became thick and it looks like pus there.
We put some salve there and made him injection of Ceftriaxone (antibiotic). We are going to start decreasing pred dose tomorrow. On Saturday we are going to vet with his leg.

Jo, is his immune system will be restoring when we decrease dose of steroids?

Maxim

[Jo CIMDA]

Hi Maxim

If an infection occurs when the immune system is compromised then it is very likely antibiotics will be needed. This isn't usually a problem as the antibiotics usually sort out the infection. You are right to give the antibiotics early.

How is Luch in himself?  Is he coping with the steroids?  If he is, and he is not showing too many side affects, then if you can manage to keep him on this dose of steroids for a few more days you may stand a better chance of achieving remission, but only you and your vet can assess if he can stay on this dose for longer.  I have some drug protocols for SRMA that keep the dog on the highest dose for a month or more - not that I agree with this - but if you can stretch it out for a bit longer it might be better in the long term. Perhaps you could discuss this with your vet tomorrow. Aza takes at least 10 days to have any effect but it takes as long as four/six weeks to reach full potential.

Yes, as you lower the steroids his immune system will start to restore but it is relative to the dose, and he won't be at anything like full immune function until he is at least on a low, every other day dose.

Good luck tomorrow.

Jo

[goldiepower]

Hello Maxim, just sending our good wishes and let you know we're thing about Luch!

Chris & the Golden Boys
Sydney, Edward, William,
^Chad^ (SRMA, HypoT), ^Thomas^ (HypoT, CHF), ^Sweet Baby James^

[maxvv]

Hi Chris and Jo,

Thank you for your kind wishes!

Indeed, as Luch leg was in a bad state in the morning (he can stand up very hard), we decided not to wait until tomorrow and went to the vet today.
As we scared for his leg we decreased steroid dose to 5 tabblets. Perhaps it was emotional decision.
Our vets are good people but they know not much about auto-immune illnessess and SRMA protocols. First that they said when heared about high dose of prednisolone is that this would kill our dog. Later when we explained the situation they calmed down and even very interested in our treatment scheme (we will send them info by e-mail) but could not advice anything about dose.

As for wound they made injection of metronidasole intravenously through drop counter (we will do this at home also) and prescribed the antibiotic that we already start giving (Ceftriaxone). It looks like leg is better already but not normal yet.

Maxim