Undiagnosed?

[cracar]

Hey guys.  I've got a very sick little cocker girl (saffy) who is 2 years old.  Over the past month, Saff has been getting intermittent limps.  She has been changing which leg she holds up and it has been bothering her neck area too. She found it really difficult to get up from lying down and then sitting.  We were actually helping her to stand up! We took her along to our vet who was baffled but thought it could be menningitis so gave her 2 weeks of anti-biotics and metacam.  We lasted a week before taking her back as the metacam wasn't touching the pain and the AB's were not working.  The vet had another check and diagnosed Polyarthritis?.
She gave saff an injection of steroids which worked for 2 days and then we were to give her prednisolone 5mg twice per day.  She weighs 12 kgs so she was to get one and half tabs x2 daily.  This seemed to work.  She went back to the vet the following week and although she still had a 'wobbly' walk/limp, she was a million times better.  Vet said to keep her on the dose and just treat her as normal.  That was Tuesday.
On wednesday morning, we went for our usual walk(off-lead grassy field).  Saff had a great time playing with her doggy pals but when we got home, she was slower to rise.  Eventually, by evening time, Saff couldn't get up and if helped, she had a really major limp, holding up her back leg.  She also fell over and was really 'spaced'.
I took her back to the vet on Thursday as she was so bad and the vet gave her another injection of steroids and has doubled the dose of the prednisolone.  None of this seems to be working.  Saffy is lying, not moving, on the sofa(where I lifted her onto).  She has a fantastic appetite but that is just the steriods and I can get her to walk into the kitchen if I promise her food but apart from that, she's not moving at all.
Does this sound like Immunity issues?
She has a temp(but not majorly high).  Her joints are not swollen in the slightest and never have been hence the reason that we haven't taken joint fluid(that and I don't particularly want them to do this).  Her skin has taken on a 'waxy' feel and is a bit smelly/fungal in her ears and feet.
She also vomitted after the injection on Thursday when we got her home but this is the first time she has done this.
I am seriously worried as my vet is saying if she doesn't respond to the meds, we are going to need to start thinking of her quality of life.  And at this minute, she has none.
My normally exhuberant, crazy spaniel is like a stuffed toy and I'm so upset.  She's only 2!
I would love some advice or knowledge or experienced opinions......anything

[Deeinnz]

So sorry to hear about your poor wee baby. Hopefully Jo or Penel will come on soon and be able to advise you. They have a wealth of wonderful knowledge, more than many vets in my opinion. Sorry I can't give you any advice but you are in my thoughts. I know how awful it is to have a sick dog.

Regards

Dee

[gschellinger]

Sorry to hear about your Saffy. I only can comment on my own dog, whose illness was very much like your dog. The limping came and went. There were not swollen joints. The vet did not test her joint fluid. She was very painful at times and ran a fever. At those times when I took her to the vet they called her a lupus dog. Gave fluids and sent us home. Totally incompetent. I knew nothing of immune disease or "lupus." Eventually she had a major event, after we had changed vets. The new vet told me given her history (she had previously had IMHA as well as lesser immune diseases) that she appeared to have polyarthritis as well as polymyositis. She weighs 38 lbs and was taking 30 mg of pred. twice a day. They didn't bother to test her since she was so ill, with a fever of 106 degrees. She eventually got better, but it took months. If your dog isn't getting an immune suppressing dose of steroids, that may be the reason she isn't improving. Our vet insisted on giving the max at the time of the crisis. We did that for two weeks then tapered down to eventually 5 mg a day, then 5 eod for a total of about 4 months.

I hope you get some answers soon. Immune mediated polymyositis is very painful to the muscles. My dog got very thin and could not open her mouth to yawn. Had a clicking noise in her jaw. Hers was generalized and affected all her muscles.
gail

[Penel CIMDA moderator]

I'd recommend you get a referral to a specialist - if you are in the London area, you could go to the RVC they have a 24 hour intensive care and referral service.
Your Saffy sounds just like my SAffy was (12 yrs ago).  The dosing they are doing hasn't been quite right, unfortunately they do need to be on a high dose straight away - for a 12kg dog you can go up to 50mg a day for the first week or so.
read this
http://cimda.co.uk/smf/index.php/topic,16.0.html
and this
http://cimda.co.uk/smf/index.php/topic,14.0.html
and this
http://cimda.co.uk/smf/index.php/topic,15.0.html
It could be IMPA (immune mediated polyarthritis) but it could be SLE which is what Saffy had - often dogs with SLE have IMPA as well as other types of autoimmune disease.
Don't give up hope please - get a second opinion, i don't think your vet is very familiar with autoimmune disease.

[cracar]

Thanks for replying.  My vet actually went straight for the polyarthritis.  Said she presented with everything but the swollen joints.  I had a little read around last night(after posting) and seems she's not on enough of a dose?  I will up her meds until the 28th(when she is back at the vet).  Her muscles seem to be 'wasting' too so whoever had said that, that could be another sign of something else?  She has always been such a fit, active little dog and had plently muscle.
Referal is a bit of a problem as we have no insurance and my vet has said that problems like these, she would expect the bill to run into the thousands.  I can't afford that.  My dog is priceless and I am trying my very best to help her but I have 4 kids too.

Can I ask?  What are her life expectations with this disease?  From what I read on here, it doesn't get a lot better and my vet seems to be thinking the same way.  Or can it be managed with meds quite comfortably?  Is life span shortened with the illness?

[Penel CIMDA moderator]

If it's IMPA then it is very manageable usually.  Quality of life can be normal when you've dealt with the disease.
Personally I'd try upping the dose to 2 - 3 mg per kg split into two doses over 24 hrs to start with.
Don't forget the gastroprotectant - you can buy ranitidine in Asda for £1 a box (exactly the same thing as Zantac but half the price) Saffy should have half a 75mg tablet, twice a day to protect her tummy - you can give it at the same time as the pred.

So if she's 12 kgs, I'd consider 15mg pred, twice a day (total 30mg over 24 hrs).  You need to have her on this dose for at least a week and see if the symptoms improve.  If they don't improve then the vet must consider adding Imuran (Azathioprine) which is another immune suppressant and can allow you to lower the dose of the pred.

While she's on this kind of dose you must be aware that her immune system is suppressed so having her around other dogs is a bit of a risk in case they have kennel cough or some other illness.

She also should not be having anywhere near normal exercise, just a little trot up the road a couple of times a day - she should be kept nice and calm and quiet - it's very tiring having this kind of disease.

You could print off those protocols that I linked to - both written by specialists - and show your vet.

[cracar]

#thanks so much again.
Saffy is on 3x5mg of pred x2 daily so seems to be on the correct dose?  She wasn't given anything to protect her tum so I will nip to tesco now and get something.
I haven't been walking her at all since the symptoms started again since Tuesday!  But she was walked in a park with a pack of dogs(all friends) and unsurprisingly(after reading this forum!), came home with a tummy bug!  She won't be going anywhere for a while.
She seems a bit better today(scared to say it though).  He limp is not so bad and she is able to get up a bit better too but she is shaking all over and panting quite a bit.  She has also been a bit aggressive today too.  She had a go at one of our other dogs and bit the cat.  She normally is the nicest dog ever.

[Penel CIMDA moderator]

Sometimes steroids can have an unpredictable effect on behaviour too.  The only time our Saffy ever went for our other dog was when she was on quite high dose preds.  I'd definitely take more care during feeding time as steroids make them ravenous.
The panting and shaking is unfortunately quite a normal side effect too.  My lurcher who is on pred at the moment pants a lot.
The tummy bug might be the steroids having an effect on her tummy.  The gastroprotectant will help with that.  I hope you found the ranitidine, it's usualy with the anti acids.
There is also Antepsin and another one called Omeprazole - both from the vets though.

[cracar]

She seems a bit better today and even managed to sneak upstairs!lol  It was definately a bug of some sort as our other dogs had it too.  She's been OK at feeding times as she was never a great eater, the preds have just raised her appitite to 'normal'.  I'm just feeding her little and often at the minute.
Fingers crossed we are on the road to recovery.  This site has been invaluable for me to understand the nature of the disease and treatment methods.  Thank you so much.

PS  I don't vaccinate except puppy vacs so that won't be a consideration but what about switching to raw? Is that advisable?
PPS  Does anyone know why dogs are now suffering for these types of conditions? I'd never heard about anthing like this in dogs.

[Jo CIMDA]

Hi

I'm sorry Saffy is having such a bad time.  From what you describe it sounds as if she has steroid responsive meningitis arteritis (SRMA).  The neck pain and limp and the lack of swelling in her joints points more towards SRMA than IMPA.  Having said that the treatment is the same so to a certain extent a precise diagnosis is irrelevant now.

This is not a bacterial meningitis (that is why the antibiotics didn't have any effect).  SRMA is an immune mediated meningitis caused by a genetic predisposition that is then triggered by something. It typically occurs in young dogs.

Both SRMA and IMPA have a good prognosis and she should start to pick up very soon.  YOu can't short cut the treatment though and she should be on this dose for 10-28 days depending on her progress and how she is coping with the drugs.  Penel has given you good advice and I'm hoping you will see a difference in her very soon.

Jo

[cracar]

Hi Jo and thanks for your response.
Had a little read through the sticky about SRMA.  Does sound like she has these symptoms although it says she should recover quickly after administering the steroids.  She was given an injection on Thursday and I've continued that with oral Preds but although she is slightly better, she still isn't recovering the way she did the first time even though she is on double the dose of preds.  She is majorly depressed, still in pain and limping on her front leg today.  She is jumping on/off the sofa now though which is better.

I'm totally gutted today though as it seems to be genetic(all these AI illnesses).  Saffy has had a litter of pups, one of which is here.  I don't know what to do.  Should I phone all the puppy owners and warn them? Or would this just worry unintentionally?
I'm bloody raging mad!! She had all the heath requirements for breeding as did daddy and we've passed this sh*t(excuse me!!)on through the lines!  Why her? God, I'm gutted for the little 'uns....

[Catherine]

>>>>
Quote from: cracar on Today at 03:24:47 PM
  I don't know what to do.  Should I phone all the puppy owners and warn them? Or would this just worry unintentionally?<<<<


I definitely think you should tell your puppy owners. It is not something people want to hear but it is much better to be forewarned just in case the dogs do become ill. I know I would rather be told especially as a lot of auto-immune diseases still go undiagnosed....or until it is too late to do anything   I would, however, read up on the illnesses so you have as much information as possible and then after speaking to the owners you can send them the information.

[Catherine]

The sire's owner should also be informed and the owners of any other relatives.

[Jo CIMDA]

Hi Jo and thanks for your response.
Had a little read through the sticky about SRMA.  Does sound like she has these symptoms although it says she should recover quickly after administering the steroids.  She was given an injection on Thursday and I've continued that with oral Preds but although she is slightly better, she still isn't recovering the way she did the first time even though she is on double the dose of preds.  She is majorly depressed, still in pain and limping on her front leg today.  She is jumping on/off the sofa now though which is better.

I'm totally gutted today though as it seems to be genetic(all these AI illnesses).  Saffy has had a litter of pups, one of which is here.  I don't know what to do.  Should I phone all the puppy owners and warn them? Or would this just worry unintentionally?
I'm bloody raging mad!! She had all the heath requirements for breeding as did daddy and we've passed this sh*t(excuse me!!)on through the lines!  Why her? God, I'm gutted for the little 'uns....

Hi

I know exactly how you feel because the same happened to me.  I did what I thought was right and it all went wrong - but through no fault of my own, and it is no different for you.  All you can do is to act on the information available and perform the relative health tests on your bitch and hope for honesty from the sire's owners.  I presume you are in touch with your puppy people - as I was - and they appreciated my honesty and also the warning that if anything developed in their pup the they could call me and I would be able to give them the necessary information, and also the problem could be dealt with promptly and efficiently, saving lots of suffering, improving the prognosis and limiting the expense.

If she is on the correct dose of steroids then I am surprised that she is still in pain and showing symptoms.  The symptoms usually respond pretty quickly.  Do check that she doesn't have an infection because this can confuse things and make the vet and owner think it is the disease that's the problem when in fact it is a urine infection for example.

There is no point in beating yourself up.  I think the more you ask around in your breed the more you will find out that you are not on your own.  Of course many breeders will not tell the truth and that is a fact unfortunately.  Some will also be untruthful about the cause of a young dog's death and you have to put two and two together but this gives you knowledge.

I do hope you see a significant improvement very soon.

Jo

[goldiepower]

Hello, and apologies for missing your earlier posts. As Jo said this could well be SRMA, so I just wanted to let you know about my precious Golden Retriever, Chad, who had SRMA. He was 9 months when he first got sick, he was 13 months by the time we got a definitive diagnosis and the right treatment, he was 12 years and 5 months when he died in November 2011. He lived a full and happy normal life, in spite of having to be on steroids all his life as he relapsed each time we tried to wean him off them.

SRMA can be managed, and as long as the dog receives the correct treatment, there should be no effect on quality of life or life expectancy. Chad had a degree of hearing loss which I put down to the meningitis, but it's difficult to tell for sure as Goldens have "selective deafness" lol!

The main reasons I would tell the pups owners are (1) so they don't breed from them and (2) if there are any symptoms in their pups they will spot it and be on the ball to get the right treatment for their pup. The chances must be low, but they are there. I know my boys breeder keeps in very close contact with all her pups owners and Chad was the only pup in the litter and in the line that has been diagnosed with such a problem. Chad's litter was the only one from that sire x dam, the mating was not repeated because of his illness, in fact neither was used again, it wasn't worth the risk.

All paws crossed for Saffy, I hope she picks up very soon.

Hugs from
Chris & the Golden Boys
^Chad^ (SRMA, Hypo-T), ^Thomas^ (Hypo-T), ^James^,
Sydney, Edward and William