Pesky New User with lots of questions.

Started by andy1496, February 03, 2014, 09:20:51 PM

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andy1496

Hi.

My name is Andy and I am a Police dog handler with a 4 yr old GSD, general purpose dog and a 2 1/2 year old ESS drugs/cash/ firearms detection dog.

In November 2013 My GSD became generally unwell with shifting lameness and general lethargy, weight loss and stiffness.

After several frustrating visits to the vets I eventually made enough of a fuss (visit number five!) and had them give him a GA, in order to Xray him and carry out a joint tap.

The joint tap came back positive but somewhat to my dismay they didn't xray him.
I'd wanted an xray in order to determine whether the lameness/ joint swelling was erosive and whether it had caused any joint damage.

Anyway the diagnosis (which was not conclusive) was that they believed my GSD had immune mediated arthritis.

They prescribed prednisolone which to be fair did seem to improve his symptoms, considerably, very quickly.

I was quite surprised when I was getting to the end of his prescribed preds, that they didn't offer me a further prescription and told me he would be okay to come off them. I had tapered him down to 15mgs twice daily but went from that down to nothing.

This is contrary to my understanding of how steroids should be tapered. My colleagues dog had a similar issue and was tapered over many months down to half a tablet every other day.

I had read that sudden withdrawal from steroids can cause adrenal shock but unfortunately wasn't in possession of this info when I had the conversation with the vet.

Anyway he did seem to be more or less back to his old self although he was still underweight. Unfortunately he sustained a cut to his left hind leg which necessitated yet another visit to the vets.

He had a GA in order for the vet to stitch the pad and in order to take advantage of the GA, I had them xray him, to set my mind at rest that he hadn't suffered any lasting damaged.

I was taken aback when I collected him from the vets as I could see they had joint tapped him again, even though he wasn't lame.

The vet explained that my dogs condition was more serious than they'd originally thought and that they were awaiting the results of several tests in order to confirm/negate a diagnosis of SLE.

After several very worrying days waiting, the final test came back, this being a urine test, checking for the presence of ANA. This test came back negative and I can't tell you. how relieved I was. The vet told me that they would have him on a high dose of pred, to be tapered off over several months. He was also prescribed azathiaprine even though they'd more or less ruled out SLE.

Since then he did seem to get a bit better and I was even able to work him again briefly.

Last week he came down with really severe diarrhoea which contained blood and he also had quite a severe nosebleed. When I checked his nostrils they were ulcerated inside the top edge of both.

I took him straight back to the vets and he was given an examination that adduced a raised temperature. The vet thought he had caught a secondary infection and gave him an antibiotic injection and a course of antibiotics to take over the next five days.

This sorted the diarrhoea but he still wasn't well.

On Saturday (1/02) he was struggling to get up and couldn't weight bear on rear legs very well at all.
I took him straight to the emergency vets and they gave him an antibiotic shot and some pain relief. They also gave me some antibiotics to give him over this week and also five days supply of pain meds (tramadol)

He is no better and today he is even lame on his right foreleg with obvious swelling on his 'wrist' joint.

My supervision are of the opinion that the dog is suffering and due to monetary considerations are looking at two options:

Either retire the dog to me so he's my problem
Have him Euthanazed (sp?)

My only concern is my dogs welfare. He's my best buddy and I've had him since he was seven weeks old.
I will do what's necessary if this can't be sorted and he's in pain with no chance of getting better but I can't help thinking the vets don't really know definitively what's wrong.

Can anyone offer any suggestions or advice? I'm at my wits end and can't stand seeing him in any discomfort or even out of it on pain relief.

I've probably missed loads of info out. but will answer any questions as fully as I can.

Additionally, I've anonymised this posting somewhat to minimise the chances of being identified and therefore getting into any trouble- I hope you understand.

Thanks
Andy

Jo CIMDA

Hi Andy

Phew, you and your buddy GSD have been through it.  Most immune mediated (IM) diseases are treated the same and that is with immunosuppressive doses of steroids and/or a combination drug such as Azathioprine, but the dose and duration is crucial to the outcome.  Can you outline your boys last treatment regime please (drugs, dose and duration), especially what dose of steroids he was on when he had the bleeds?  Was he put on something to potect his stomach from the excess acid that the drugs cause?

Immune mediated polyarthritis (IMPA) is a primary AI disease or it can be a part of another AI disease such as IM myositis, SLE, meningitis.  It also can be secondary for example to tick borne disease but I don't think that is relevant here.  I have had a dog with SLE and he was very poorly, and still with the correct treatment and care he did reach remission and had a good quality of life for many years after diagnosis.  Dogs with IMPA usually do very well (and some seem to grow out of it, as humans do). Relapses are not uncommon but many can come off treatment altogether and also have a good quality of life.  I will have a look at my info and if there is anything I feel is useful I will post it on the forum for you.   

It could be that his extreme weakness is not an infection but a side effect of the high dose (I presume) of steroids.  Does he have a pot belly too, and is he panting a lot?  Don't give up on him.  Please check out this drug protocol that I think is the best guide to treating these diseases. Any info you can provide may give me a feel of what has gone wrong this time around.  I wouldn't have expected him to have achieved remission on the first drug protocol he was on, so a relapse was pretty predictable.


Jo


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.

Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 


This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

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



Jo CIMDA

This might be useful to you Andy.

WHAT TO EXPECT ONCE TREATMENT HAS STARTED
If a dog has a serious autoimmune disease, then the sooner treatment commences the better chance the dog has of survival.  The main delay to starting treatment is obtaining a diagnosis or at least your vet being sure that he hasn't missed anything that could be made worse by giving high doses of steroids.  Achieving a diagnosis can be a fight against time. 
If your vet has decided that in all probabilities your dog has an autoimmune disease, then to a certain extent, which autoimmune disease your dog has, as far as treatment is concerned, is irrelevant because with the exception of a few diseases, they are all treated the same, that is, with immunosuppressive drugs.  The main objective is to 'knock out' the immune system and virtually stop it from working (or near enough) so the destruction will cease and give the body a chance to recover.  As previously stated, this treatment regime works in most cases, that is, if it has been given early enough and the dosage is correct.  All dogs are different and some can tolerate the drugs better than others. In proportion to their size, small dogs seem more able to tolerate higher doses of steroids than large ones. Some diseases are more serious than others and carry a poorer prognosis. So the initial crisis is a crucial time, however anecdotal evidence shows that many more dogs survive than die if correct treatment is administered in good time.
It is hoped that a positive response can be seen within 4-6 hours of starting treatment (depending on the disease), but in a serious, life threatening situation, the first 2-7-14 days can be a very worrying time.  Assuming the dog has stabilised he will quickly feel much better, and if he is in hospital may be allowed home within a week.
When he comes home he will probably have a 'goody bag' full of drugs.  He will be on a high dose of steroid, usually prednisolone, and he may also be on another immunosuppressive drug, such as Azathioprine.  Your dog will be weaned off in a controlled manner according to his wellness and clinical observations. 
Note: High doses of steroids must not be stopped abruptly.  Your dog could go into an adrenal crisis if the medication is withdrawn too quickly. 
In addition to immunosuppressive drugs he should have something to protect his stomach from excess acid.  The last thing your dog needs when he is feeling poorly is a bleeding stomach ulcer caused by the drugs.  Sometimes, Antepsin is given to coat and protect the stomach (but this must not be given within two hours of other medication otherwise it will stop the drugs from being absorbed).  Zantac (Ranitidine) may also be prescribed to take away the excess acid. Zantac does not inhibit the absorption of the drugs. Another gastroprotectant used is Omeprazole. To minimise irritation to the stomach it is usual for the daily dose of steroid to be split into two doses and given with food, one dose in the morning with breakfast and the other dose with his evening meal. I have known several dogs, who did not receive a gastroprotectant as a part of their treatment regime, who went on to develop anaemia. This is not autoimmune haemolytic anaemia but iron deficiency anaemia caused by bleeding stomach ulcers. Using a gastroprotectant is a good preventative measure. When the steroids have been significantly reduced to a low dose, a gastroprotectant may not be necessary.
Excess acid produced because of the drugs may make a dog prone to developing pancreatitis. A dog with pancreatitis will appear in pain and his back may be arched as if he can't straighten up.  He may be lethargic, seem bloated and have a tender abdomen. Dogs usually go off food and water, may vomit and look depressed.  If you suspect that your dog has pancreatitis, don't try to feed him because it will make the condition worse. Take him to the vet as soon as possible as he may require treatment or need to go on an intravenous drip to stop him dehydrating.  Again, the risk of pancreatitis should be minimal once the dog is on a lower dose of steroids.   A low fat diet is best when your dog is on high dose steroids or prone to pancreatitis. 
As your dog's immune system is being significantly suppressed, he will be more likely to pick up infections, and will not have the ability to fight against them.  As a precaution a broad spectrum antibiotic is often prescribed. Also it is sensible not to exercise him in areas where he is more likely to encounter infections, for example, a park or a popular dog walking area. 
Whilst your dog is on high dose steroids he will want to eat and drink excessively. However, this also means that he will want to urinate more and this can sometimes cause temporary incontinence.  You may have to get up to let him out during the night and if you leave the garden door open during the day, it may save some mopping up!  He cannot help it and won't like it either, so don't be too hard on him, it's only temporary. You will notice as he is weaned off the drugs the unwanted side effects will subside and he should return to normal habits and behaviour.  Urinary tract infections and/or bacterial skin pustules are not uncommon when a dog's immune system is suppressed, and this is often the reason for a dog to be off colour during this time.  Note: Always consider a urine infection if your dog seems under par.  A course of antibiotics will usually sort this out quickly.
Depending on what autoimmune disease your dog has, he will probably need to have regular blood tests.  Biochemical blood tests will also keep an eye on other body functions, such as those of the liver and kidneys, which is important at this stage.
Assuming good progress is being made, the clinical signs of his illness are diminishing and positive signs of improvement are apparent, your vet will want to start weaning him down from the high doses of steroid.  This process can take 3-6 months or more, and usually begins anytime after 10 - 28 days from the start of treatment, depending on the results of his blood tests and his clinical signs.
Relapses are not uncommon, especially in diseases that are difficult to control, for example SLE.  A relapse may mean that initially, your dog needed to be on a higher dose of immunosuppressive drugs for a longer period of time, or your dog may have been weaned off a little too quickly and then the dose withdrawn too soon.
If a relapse occurs he will probably show similar clinical signs to his initial crisis.  He will have to go back on an immunosuppressive dose of prednisolone, but it may not have to be quite as high as before. A combination drug may need to be added at this stage. The weaning process will then have to start all over again. Returning to an immunosuppressive dose will mean that he has to go back on a gastroprotectant.
Side effects of the drugs – Iatrogenic Cushings Syndrome
Iatrogenic Cushing's syndrome is a side effect of high dose steroids and is caused by too much corticosteroid in the body. To a lesser extent, the immediate side effects observed when the dog initially goes on steroids eg. drinking, eating and urinating excessively is a mild example of Cushing's syndrome.  Personally I like to see dogs responding to high doses of prednisolone in this way, as it means that they are responding to the drugs as they should.
Usually, Cushing's syndrome only becomes a real problem when exceptionally high doses, or prolonged high doses of steroids are administered, maybe due to a relapse, or in some cases where the vet is inexperienced in reducing steroid doses and keeps the dog on a high dose for longer than necessary; or when the dog is not responding to treatment and higher doses are necessary to control the disease.  This is where the cytotoxic drug Azathioprine is very useful. 
All drugs carry side effects and Azathioprine is no exception, but it does not carry the same side effects as prednisolone, therefore by using this drug in combination with prednisolone it reduces the risk of iatrogenic Cushing's syndrome.  As Azathioprine takes at least 10 days to take effect, starting the 'combination' therapy at the beginning of treatment may enable the prednisolone to be lowered within the 10-28 day band and still maintain a good level of immunosuppression. If your dog is not responding to treatment then your vet may consider changing his treatment to other immunosuppressive drugs.
HOW CAN I TELL IF MY DOG  DEVELOPS IATROGENIC CUSHINGS SYNDROME?
Iatrogenic means 'drug induced'.  Clinical signs of Iatrogenic Cushing's syndrome are the same as primary Cushing's syndrome but can present with acute clinical signs. It reflects the level of corticosteroid in the body.
The most notable side effects are, heavy panting, some hair loss, and an increase in drinking and urinating, excessive pigmentation.  This is something everyone seems to be aware of and accepts as normal when a dog is on high dose steroids. Very often the dog will be weaned down to a low dose before any major problems arise.  Acute Cushing's syndrome due to prolonged overdosing of corticoid steroids can be very serious.  Blood results will reflect this, especially the liver enzymes which may be extremely high. Blood platelets may also be high and blood clotting may be a risk.
So when should you alert your vet to suspected, unacceptable level of corticosteroid?  The owner should take note when other clinical signs occur, such as: Depression, anorexia, muscle wasting and extreme weakness, lethargy - unwillingness to exercise, skin lesions and thinning of the skin, excessive hair loss, pot-bellied appearance and sagging back, behavioural changes (aggression)
If your dog is showing these signs it will probably mean that the dose of steroids needs to be lowered. It is important that it is not confused with a relapse of the dog's condition or an infection. The dilemma is that steroids must not be withdrawn too quickly otherwise the dog may go into an adrenal insufficiency crisis.  If the clinical signs of iatrogenic Cushing syndrome is intolerable, it is hoped that the high dose of steroids that he has been on will have already done their job and that his autoimmune disease will be stable. As long as the steroids are lowered in a controlled manner and in time, all the symptoms of Cushing's will subside and your dog will return to normal, but extreme signs must not be ignored.


THE IMPORTANCE OF CORRECT TREATMENT AND DOSAGE
Iatrogenic Cushing's syndrome may also occur if the vet has initially prescribed a dose too high for the size of dog being treated.  For example:  I received an email from the owner of an Irish Setter, with AIHA.  The dog was prescribed 200mg of prednisolone each day. I called the owner, only to hear that the dog had to be put to sleep that day.  I was not surprised. The poor dog was on nearly twice the highest, recommended dose of prednisolone.  She was 9 years old and had never had a day's illness in her life.  What a terrible shock for the owners and what a lot of unnecessary suffering.  I know what it feels like because I too, have lost a dog due to prescribed overdosing of prednisolone.  The feelings of responsibility are enormous.
In contrast, some dogs are not treated with enough prednisolone.  Here's another story:
A greyhound diagnosed with immune mediated thrombocytopenia (IMTP).  Her vet gave her an initial shot of dexamethasone (a steroid which is 6 times stronger in terms of glucocorticoid activity than prednisolone).  Some vets choose to give a shot of 'Dex' as an initial therapy in autoimmune disease, especially if the patient is acutely ill.  Its effects can sometimes be seen within 6 hours and lasts for 36-72 hours.
The vet did really well and a marked improvement in her clinical signs was seen. It is usual, 24 to 48 hours after the shot of Dexamethasone for the treatment to change to an immunosuppressive dose of prednisolone tablets and for the owner to continue treatment in the usual way.  However, the vet only prescribed 5mg of prednisolone a day. The owner said they were very concerned that after a few days of improvement, she seemed to be very poorly again.  The vet couldn't understand why she was not continuing to improve.  He gave her another shot of Dexamethasone and the same improvement was seen.  I suggested to the owner that she either spoke to her vet about putting her dog on an immunosuppressive dose of prednisolone or change her vet.  They saw another vet in the practice, who was more experienced in treating autoimmune disease, and the dog was put on the correct, immunosuppressive dose of prednisolone and the treatment was successful.
These case histories demonstrate how important it is to treat promptly and correctly.
REDUCING THE TABLETS
When significant improvement in the dog's condition is seen, usually between 10-28 days, the initial steroid dose is usually reduced by up to half. The dose is generally given for another 10 - 28 days and depending on the dog's progress and clinical signs the dose is significantly reduced once more for a further 10-28 days; and again in another 10-28 days. Anecdotal evidence has shown that if at this stage the dose is lowered more slowly, or reduced to an every other day dose over a period of months rather than weeks, relapse are less likely to occur.  It is always tempting to get your dog off steroids as soon as possible, but when treating autoimmune disease, as long as the dog is on a low, every other day dose then taking the last stage slowly seems to work best, depending, of course, on the severity of the disease and allowing for the difference in individual response - no two dogs reactions are exactly the same.  With some autoimmune diseases such as SLE, the dog is likely to be on steroids for the rest of his life. Usually an every other day dose can be achieved, but you risk a relapse if you take the dose too low.

HOW DO I KNOW IF MY DOG WILL RELAPSE?
Until you have attempted to wean your dog off of the tablets for the first time you will not know if he is likely to relapse or not.  Sometimes during the weaning off process, before you even get down to an every other day dose, he may relapse.  If this happens then the drug dosage has to be raised, probably up to the last dose before the relapse (maybe a little higher, depending on the severity of the relapse) and then start the weaning process again.  If this happens again, then you and your vet may have to settle for keeping him on a low maintenance dose to achieve a good quality of life. A low, every other day maintenance dose of prednisolone is preferred to enable the dog's liver to rest in between doses. There are many autoimmune diseases that carry a good, drug free prognosis.  The more common, serious autoimmune diseases that may not need long term steroid therapy are: primary immune-mediated polyarthritis, autoimmune haemolytic anaemia and thrombocytopenia. However, as previously stated, all dogs are different and the very much depends on the individual dog, the severity of the disease and the vigilance and compliance of its owner.
If a relapse occurs whilst the dog is still being treated then true remission has not been achieved.  If the dog has achieved remission and has enjoyed a long period without drugs or on EOD maintenance drugs, then a relapse occurs or he develops another autoimmune disease, he has encountered a 'trigger factor' which has induced this change.

Jo CIMDA

A bit more info.

IMPA - Immune Mediated Polyarthritis
Primary Immune mediated polyarthritis is the most common non-erosive polyarthritis in the dog. IMPA can be primary, or secondary to other diseases such as SLE, myositis or meningitis. Symptoms of IMPA can closely resemble Lyme disease or a multiple joint infection and this has to be considered in the differential diagnoses.
For a confirmed diagnosis of IMPA, joint taps need to be performed to obtain evidence of infiltrating immune cells within the synoval fluid in the joints.   Clinical signs such as shifting lameness, soft tissue swelling around the joints, difficulty in rising to a stand, stiffness in the neck and back, and very high temperatures etc., can be vague and evident for several months prior to diagnosis. Clinical signs therefore can be intermittent and initially antibiotic and non steroidal anti-inflammatory drugs are usually given, but little improvement is seen. The disease continues to progress until the dog becomes quite overcome by the inflammatory process. Also it is not unusual for the dog to become depressed and anorexic and stand with its head held low, unwilling to move. This is a very painful condition.

SLE - Systemic Lupus Erythematosus
SLE is a multisystemic disease that can affect many parts and systems of the body.  It is categorised into major and minor signs.
Major signs can be:
Shifting lameness (polyarthritis), anaemia and thrombocytopenia(blood abnormalities), skin lesions, kidney nephritis (inflammation).
Minor signs can be: 
Inflammation of the heart, lungs & muscles, mouth ulcers, enlarged lymph nodes, gastrointestinal signs (vomiting and diarrhoea), central nervous system may be affected causing: Behavioural changes, seizures, and staggering (ataxia).
Clinical signs can be extremely varied and not all dogs with SLE will show the same symptoms. An antinuclear antibody blood test (ANA) can be useful in diagnosis but a negative result still does not rule out SLE.
The dog will normally demonstrate signs of pain and stiffness in the joints and this may be accompanied with anaemia, skin lesions and one or more of the minor signs.  One would expect the dog to show other clinical signs such as high temperature, enlarged lymph nodes, thrombocytopenia, lethargy, depression, lack of appetite, muscle weakness (myosytis) sometimes causing weakness of the throat muscles (megaoesophagus).   Megaoesophagus is a serious complication and if this is present then the quicker correct treatment is started the more chance you have of limiting the effects.  A dog will have difficulty in drinking and eating and this can cause recurring aspirate pneumonia.  The primary autoimmune disease may have been brought under control but the effects of megaoesophagus may not resolve completely.
SLE can affect any body system/s. A definitive diagnosis may not be achieved, but it may be presumed, based on clinical evidence and response to treatment.  Again knowledge of breed predisposition and family history will be beneficial in obtaining a diagnosis.   Dogs can have periods of remission and relapse.  The prognosis for SLE is guarded.

Multisystemic Autoimmune Disease
In addition to Evans syndrome and SLE there are a number of multiple autoimmune disease syndromes such as: Polyarthritis/meningitis, polyarthritis/myositis and polyglandular disease such as hypothyroidism/Addison's disease/diabetes mellitus.  It is not that uncommon for a dog with Addison's disease or another autoimmune disease to develop hypothyroidism at a later date.

Penel CIMDA moderator

Hi Andy, Jo has covered it all but I just wanted to say hi, and reiterate don't give up - I had a dog with SLE, she lived a good quality of life for two years with the disease, so even if it is that, it's not necessarily the worst news.
Penel
(SLE, Surrey - UK)
Forum Owner
CIMDA

andy1496

Hi Jo and thank you for the very comprehensive reply.

Until Sat 1st Feb, my dog was on 50mg prednisolone twice daily.

He is now on:
40mg Omeprazole  daily  (at my suggestion )
600mg penicillin twice daily for a secondary infection
75mg azathioprine daily
40mg Prednisolone twice daily
100mg Tramadol 3 x daily prescribed recently due to him being in obvious discomfort from swollen joints.

He pants a lot, has a raging thirst and is now urine incontinent. No pot belly though although I have noticed he seems to tremble quite a lot now, both when standing and whilst laid down.

He is very weak in his rear end and has started falling if he tries to turn quickly. His appetite is reasonable but he eats really slowly and seems to struggle swallowing at times.

One of my supervisors was at the vets yesterday to try and pin them down with a firm diagnosis and prognosis.

They couldn't be absolutely definite about either and suggested we try him for another fortnight on the medication to give it time to work (or determine that it's definitely not working :( )

I have the final say though and if he gets worse and I believe he is suffering, I will take him  and have him put to sleep.

I really, really hope that it doesn't come to this but considering that until recently he was a high drive, agile, fit and brave Police dog, I can't bear to see how depressed he seems when he looks at me.

Thanks for all your advice.

Andy

Catherine

I have not had a dog with IMPA, only one with AIHA so I can not advise about the lameness etc. But here are a few thoughts:

Your GSD was put on quite a high dose of Preds. for quite a long time and although the Preds. have been reduced a bit they could still be causing your dog to feel worse.

I have not had experience with Penicillin and Tramadol either but wonder if they can be adding to rather than helping his problems. What is the secondary infection - is it still there?

Has your GSD had full blood tests recently - haematology, biochemistry AND thyroid (although the thyroid ones will be a problem now he is on Preds.)? You really need to have his kidneys, liver checked out to see how he is doing with the medication.

Can you get him to a specialist?

Also, whilst your GSD is ill and even whilst he is recuperating (and on the steroids) he needs to rest and not be walked far. I realize you need him for work but he needs time to get better.

Plenty of dogs with the correct diagnosis and the correct treatment do eventually go on to lead normal lives again. It can be very disheartening seeing them so poorly but there can be light at the end of the tunnel and in a lot of cases a dog  can go from death's door to running about normally again, given time.

andy1496

Hi Catherine.

The vet was asked about medication but insists that he needs to be kept on it.

I can knock off the tramadol (as long as it isn't obvious the pain/discomfort gets worse) but I would be concerned about knocking off the penicillin part way through the course?

He's had full bloods done recently (2 weeks ago) and although his liver enzymes were high, I was told this is because of the pred.

The earlier anaemia he'd presented with was better and his white cells were back to normal.

I'm not working him at he moment and haven't done since he became unwell most recently. I also don't walk him far and exercise my other two dogs separately.

He spends most of his time in the living room and only goes for one walk a day currently and goes to the toilet in the garden at the moment.

I'll knock the tramadol off from now and report back whether it makes any difference.


Thanks

Andy

Jo CIMDA

Hi Andy

I don't know how long 'Buddy' was on the initial dose of steroids,  and when he started on the second steroid treatment, but if he has been on 80mg-100mg a day for most of the time since November then in my opinion it is most likely to be the prednisolone that is causing the current problems.

A dog cannot  withstand very high doses of prednisolone for that length of time and  significantly, especially a larger dog.  His current symptoms, and probably his blood results, such as raised liver enzymes and posibly his platelets (which will be high)  indicate that he is likely to be acutely Cushingoid. If his platelets are high then it might be prudent to put him on an antithrombotic dose of Asprin.  Perhaps you could check this with your vet.

Sometimes, whether the disease has reached remission or not, the steroids must be lowered because this can become a bigger and more urgent problem than the disease itself,  and although Buddy's steroids have been lowered by 20mg a day perhaps this is not enough given his clinical signs.   

Primary Cushing's syndrome is pretty common in dogs and it is a chronic, progressive problem that many vets are used to seeing especially in older dogs. Acute, drug induced Cushing's isn't recognised that often and the vet just concentrates on the AI disease and assumes the symptoms that are showing are due to the disease and not the drugs and therefore they insist the drugs are kept at that high level when infact the opposite is needed.  This is not an uncommon scenario. I have had a dog with acute, drug induced Cushing's syndrome and I have known many others who have been over medicated  but if the dose is lowered in time  this can resolve. The good news is, as the steroids are lowered the body slowly returns to normal and the strength returns.  There are plenty of people on the forum who have experienced this.  Even if, as you lower the steroids, and signs of his AI disease return, then other drugs can be used to suppress his immune system thereby reducing the side effects of the preds.

Certainly, on the dose Buddy is on, his immune system is being significantly suppressed, and for the length of time he has been on the high dose of steroids it is predictable that his body will now be responding in this way.  Do you know what his red cell count is? 

Would you be able to take him to a vet college or get a second opinion? I really think it is worth it.  He is a wonderful Service dog. If you can and let me know the area you are in, I or someone else here may be able to tell you of a very good referral centre.

Jo

Penel CIMDA moderator

Just re read the first post and Buddy came off the pred - and has just gone back on it so I don't think this can be Iatrogenic Cushings.  I'd imagine he's a good 35kgs so the dose he is on should be ok.
Personally I would not knock off the TRamadol its good pain relief to give at the same time as the other drugs.

I"d agree with Jo if you can get a second opinion that would be good.  The other possibility is to give your vet Kit Sturgess' details and Kit can give them a second opinion of the case.  I know he does this service for vets.  I would highly recommend Kit I know him well.

Dr Kit Sturgess
MA, VetMB, PhD, CertVR, DSAM, CertVC, MRCVS
RCVS Recognised Specialist in Small Animal Medicine
Penel
(SLE, Surrey - UK)
Forum Owner
CIMDA

Clover

If I understood your post correctly it sounds like he relapsed after coming off the pred so abruptly. Bloody diarrhea is often one of the first signs of relapse in IMPA. :( Your vet certainly did not taper off correctly, which would make me question their protocol.
Tramadol is the safest painkiller out there, with the least side effects. It is actually the only one my girl can tolerate. I doubt it is causing any of the troubles.

A relapse can be more difficult to treat, and can take a bit longer if he was off pred completely when it occurred. Azathioprine has some unpleasant side effects, it could be causing nausea and he should be on a gastro-protectant 1 hr before aza dose to help alleviate that. Also, did they say to give with or without food? Giving with a meal (if allowed) will help prevent any vomiting/nausea/stomach cramping from the drug.

They prescribed the aza because he had a relapse. Any IMPA relapse is typically given a secondary immuno-suppressant drug (azathioprine, cyclosporine, etc.).
An IMPA dog should not be worked. Mild to moderate exercise is good once they are in recovery, but overdoing it can also bring about a future relapse. He should also not be vaccinated ever again.

andy1496

Thanks for the responses.

I'm in Yorkshire but I will Google the vet you suggest and see if a trip/consultation is viable.

The vaccination comment is very interesting because he had his booster vaccinations at the same visit  the vet brought him off prednisolone (after his first bout of illness before Christmas.)

Could this be why he relapsed so quickly?

Thanks

Andy

gschellinger

Vaccinations affect the immune system and are known triggers for AI disease. Most of us never vaccinate our dogs again, after an immune disease. I don't even vaccinate my well dog, although I am considering rabies since she is illegal here in the states.

gail
gail and Lola (SLE, hereditary cerebellar ataxia, chronic undiagnosed nasal congestion) usa

andy1496

Thank you all for your kind words of advice and support.

Unfortunately my dog took a turn for the worse this afternoon.

His condition had deteriorated and he could no longer sit up, let alone stand.

I have just returned from the vets where they made the decision that they had done everything they could and could see that he was very unhappy. The kindest thing to do was to put him to sleep.

PD Neo
24/10/2009 - 6/02/2014
RIP buddy.


Thanks.

Andy

clare28

Hi Andy,

I have been reading your posts as my dog currently has IMPA. I am so sorry to hear of the sad news your chap had to be put down. Thinking of you at this time you did everything you possibly could. Clare