Advice

[Penel CIMDA moderator]

Poor Piper, what a nightmare.  You get one thing sorted for her and then something else happens - this unfortunately is fairly typical for a dog with multi immune mediated disease 

I hope that increasing the Aza makes a difference as I know she can't have Pred.

[Jo CIMDA]

Hi Dom

It doesn't seem like IMPA as they usually have a high temperature and they are in lots of pain.  It is so difficult to differentiate between AI problems and other possible causes.  If her immune system is compromised very often infection is the cause.  I do hope piper improves very soon.

Jo

[dom]

Been to the vets today after lots of texting with my vets over the last few days. Piper now has a fever and is in a lot of pain with both front legs, neck and spine. Her breathing and heart rate are high, she is very chesty with gunky green coming out of her eyes and nose. Her Aza went up to maximum dose last Friday and she started back on the ronaxan 2 days ago. She has lost weight again and is down to 7.2kg.

Shes had some metacam to try and help manage the pain for today (I am aware that she isn't suppose to have it with being on steroid but there are limited pain relief options for her) and an additional steroid as well as an anti-nausea injection as that is getting worse at night. I am slightly at a loss as to where to go, I discuss PTS today and my vet said that he would understand if I wanted to go that route and would support me, but he seemed to be indicating that I should keep trying to see if there is any change over the next few days. So for the moment, its day by day and if she doesn't make any improvement then I will need to make the decision.

[Jo CIMDA]

Hi Dom

It seems as if you are desperate to find something to turn Pipers condition around.  You talk about possibly PTS, then perhaps you and your vet can try something as a last attempt before that option becomes the only one.  I have never known a dog to have such a reaction to preds and I do wonder if this might be a 'red herring' and perhaps this was not the reason for her to deteriorate at that time.

I wonder if Piper has an AI disease called SLE (systemic Lupus Erythematosus).  This is a multi-systemic AI disease that can affect any part of the body and usually several systems are affected at the same time, although in the early stages it can start with one problem and gradually over a period of time more and more systems become involved.   The only treatment is immunosuppressive drugs, and the best and the most quick acting is prednisolone, but the dose has to be immunosuppressive ie., at least  1mg/kg/12hrs.  Usually, an addition of other drugs such as Azathioprine or cyclosporin are added too.  If you do go down this route, as Piper is on Aza the only new drug to be added would be prednisolone.

Given the suspected adverse reaction to pred (and it is only suspect) this would be a last ditch attempt to avoid PTS - and it might just work.  What have you got to lose?  Perhaps Piper could go back to the Willows or even better, how about taking her to the Royal Vet College at North Mimms or Cambridge Vet School.  They are brilliant hospitals with the best clinicians in the country.

I can understand if you don't want to put Piper through any more but if you think she has a chance then it might pay off.

Thinking of you.

Jo