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Author Topic: Uveo Dermatological Syndrome  (Read 2689 times)

Penel CIMDA moderator

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Uveo Dermatological Syndrome
« on: June 30, 2014, 10:14:06 PM »

Kindly written by one of our members Wolfenite, whose dog Skylar had Uveo Dermatological Syndrome.


Skylar’s story

March 28, 2012 she was blinking her eyes a lot and they were kind of greyish in color the next day March 29, 2012, we took her to the vet because overnight her eyes turned all red and swollen. Initially our local vet thought she had Lyme’s Disease, but the vet told us it could be other things as well either way treatment for  all would be to start Prednisone eye drops and Doxycycline tablets and get into an Veterinarian Eye Specialist and to do it right away or Skylar could lose her eyesight.   My first thoughts are; Oh no, here we go again, another issue with a super sweet girl.

At first she was given Pred. eye drops every two hours, and 2 Prednisone pills 2x day, while we waited to see the specialist (3 long days).  There the doctor said we would treat for Lyme’s and if it did not clear then test for other tick borne diseases.  We were to try a regime for 4 weeks if no improvement than go 6 more.

We changed her regime to add 1- Prednisone Tablet, dropped Doxycycline to 2 pills 1x day and Prednisone eye drops to 4x day for one week. Then changed regime to Doxycycline 2 pills in morning AND 2 pills at night, Prednisone eye drops every 6 hours, and full Pred. tablet in the morning, ½ tablet at noon and a full tablet at night we did this for four days then changed again changing the Oral Prednisone to ½ tablet every other day did this for 10 days.   Her eyes were slowly getting better  as they were not the angry red color but the blue was gone and the whites were still pinkish. The vet said she has run into stubborn Lyme’s disease but we needed to run a panel for other tick diseases. If those tests came back negative it could be a false negative just like there are false positives or it could be some type of auto immune disease.
So here we were 3 weeks from the initial issues and were running the tests. We changed the regime again to Doxycycline 4 pills a day, 2 in the morning and 2 at night; Prednisone eye drops 4xday, and ½ Prednisone tablet each day in the evening. 7 days later the eye specialist had us using Doxycycline 2 pills 2xday, Prednisone eye drops 4xday, 1 Prednisone tablet Every other day, AND added Atropine eye drops 1xday for right eye and 2x a week for left eye (her right eye later on required surgery).  Within 3 days the left eye flared doc wanted us to wait before added more drops day 7 on this regime right eye flared. We were at the mercy of the vet calling us back, we lived 2 hours away and she had no appointments open, three days later called her again, emailed pictures ( a great way for a vet to see what is happening)  we had to up the Pred. tablet to ¾  alt with ½ tablet  for 10 days then try to reduce(so one day ¾ next day ½ tablet), Prednisone eye drops 4x day, Atropine eye drops 1x day, ADDED Azathioprine tablets 1xday for 3 weeks (had to run a complete CBC before starting then at day 10 and again at day 21),  also added Clindamycin to be used when Doxycycline runs out.  Now we are on May 6 she has dropped five pounds, and we did x-rays to check lungs this was due to her having had Fibro Sarcoma diagnosed and removed on Aug. 23, 2011. Lungs clear and blood work good.

May 9, left eye grayish, right eye slight greyish in color.  By May 17th we still had greyish eyes, and were decreasing the oral prednisone and trying to decrease the Prednisone eye drops.  We added K-9 Immunity Plus (later on this proved to be a bad thing for Skylar as we were trying to suppress the immune system and the K-9 is used to make it stronger) ginger added for upset stomach due to the meds. Local vet okayed these, the Eye specialist nixed the K-9 immunity. By May 24 (two months) we are giving Prednisone eye drops 3xday, Azathioprine 3x week, no doxycycline, no Clindamycin, and oral Prednisone ½ tablet one day, skip a day then give ¼ tablet, then skip a day, then ½ tablet.  WHEW, we keep a daily journal and to make it easier for keeping track I write all directions for each day with blanks to fill in times and I do this for each day up to the next appointment day. 

 Example:  Monday ____ am Prednisone eye    ____ noonish Prednisone eye   _____pm Prednisone eye,   ____ Atropine (left eye only),  _____ 1-Azathioprine Tablet  , _____ ¼ Pred Tablet ; 
  Tuesday ____ am Pred eye    ____ noonish Pred eye   _____pm Pred eye,   ____ Atropine (left eye only),  _____ 1-Azathioprine Tablet  , _NO  Pred Tablet;
 Wednesday ____ am Pred eye    ____ noonish Pred eye   _____pm Pred eye,   ____ Atropine (left eye only),  _____ 1-Azathioprine Tablet  , ___ 1/2  Pred Tablet.

This allowed me, my husband and our son to give Skylar her meds and know when exactly she was given them.  Skylar is so gentle she allows our  then 12 year old son to give her eye drops.    Now we’re in June… eyes are flaring… specialist wants us to see an internist, first appointment with internist not until August.   June 19, a mystery starts up… each morning I/we see blood on the carpet but cannot find where it is coming from… just a huge smeary spot. After a week I finally catch Skylar licking the carpet one night, she is licking blood spots and smearing them, I find the tiniest little pimple on her mouth that is bleeding. Just a small amount but enough when she licks it smears and looks worse than it really. Our   local vet says it’s allergies, change out her water bowl if we are using plastic and to use Neosporin on mouth.  We use metal bowls so I took to really washing them after each feeding and washing the water bowl every night.

June 21,2012  we have another appointment with the  eye specialist, she is suspecting an auto immune disease but said until it rears its ugly head we won’t know what kind and to keep on with the Prednisone trying to reduce, that she sometimes see dogs that really have a tough time with reducing the prednisone and Skylar seems to be one of those and in the heat of the summer she sees eye auto immune diseases flare and that by fall Skylar should be doing better.  We really trust this gal seeing as she treats the President’s dogs ( Bush and Obama), and military dogs. 

We now use Pred. eye drops 4x day, Azathioprine 2x week, ½ Prednisone tablet every day and ADDED Tropicimide eye drops 2xday  for 10 days then try to reduce Prednisone eye to 3x day, back to alternating Pred tablets to ½  & ¼  E.O.D. (every other day). For 2 weeks.  Now into July we are reducing the Azathioprine to ¾ tablet 3xweek, Pred. tablet to e ½ E.O.D., Atropine eye 1 x week (Left eye only), Tropicimide 2xday. Into August we see the internist…totally not helpful this doctor after waiting weeks to see, simply looked over all the blood work and x-rays we brought in with us (3 days old) wanted to run all the tests over including x-rays ($2000) and told us to get Skylar off  the Prednisone.  No kidding, we have been trying that all along. Two days later back to our eye vet specialist, we have Skylar down to Pred eye 3xday, Tropicimide 2xday, ¾ Azathioprine on M, W, F and ¾ Pred tablet on T, Th, Sat.  By end of August we changing oral Pred to ¾ on Th & Sat, and ½ tablet on Th.  We are making slow progress.  By end of September I am adding Milk thistle to her diet because liver numbers are up.

In October we are still working on reducing the oral pred.  By Nov. we have her down to ½ oral Pred 3 x week, Pred eye 3xday, Tropicimide 2x day.  Friday, Nov 16 we have eye vet appointment, Skylar started vomiting yesterday 1x last night, 2 x today before her appointment. Eye pressure is up… we now have to add Latanaprost, Dorzolomide, Timolol,  Methazolamide to her regime and drive back up on Monday for a pressure check.  She now gets  Tropicimide 1xday, Pred eye 4x day, Latanaprost 2x day, Dorzololmide 4x day, Methazolamide tablet 3x day, Timolol 4x day. The new eye drops to right eye only AND we have to space all drops a minimum of 10 minutes apart.  (so glad we keep a journal).   We can tell when eye pressures are up as she starts to vomit and blinks a lot. 

Thursday Nov. 29, 2012 Skylar has an iridectomy to help reduce eye pressure on her right eye.  Pressure increase is caused by all the Prednisone, she has developed secondary glaucoma.  Surgery successful and we were able to decrease most meds. By December she is down to Tropicimide 2x day, Pred eye 1xday in right eye, and 2x day in left, oral Pred. ½ tablet 3x week.   By February she hates eye drops we have to bribe her with a treat by bedtime.  She gets Tropicimide 1xday, Pred eye 1xday only 5 days of the week, Timolol 2xday in right eye, Dorzolamide eye 2xday right eye. ¼ Oral Pred 2x week.   

By March of 2013 she is down to Prednisone eye 1xday, Timolol and Dorzolamide both 2x day, Atropine eye drop 1x week in left eye only, ½ Azathioprine tablet 3x weeks.  She continues on this until May of 2013 when she develops a sore on her foot and the local vet adds Cephalexin 2xday, says it is allergy related.  Mid May she is down to ¼ oral Pred 2x week, all others rx stay the same. June we decrease more and still looking good, foot healed.  Last day of June and Skylar’s mouth starts to look funny, liked it is chapped and has what looks like pimples/ blisters on it and she has started vomiting ½ hour after she gets cephalexin. Doctor says allergies and keep her on Cephalexin as it will cure it up and to give it to her ½ hour after meals.  She stops vomiting and it heals quickly. August 6 mouth sores reappears… I am insisting on biopsy,  the vet thinks I am crazy, they still believe it is allergy related.  My gut says otherwise.  She is down on meds, Dorzolamide Timolol Maleate combo eye drop 2xday, Pred eye drop 1x day 3x week, ½ Azathioprine 3x week, Atropine eye drop 1x week left eye only,  I am giving her Milk thistle and fish oil along with Turmeric, ground mustard, cottage cheese in her food.  Argh, August the eyes are now flaring…we started by upping only the Prednisone eye drops to 3x day and she is on Cephalexin 4x day. Biopsies and x-rays done Aug 15.   
August 2, 2013 we learned Skylar has Uveo Dermatoligic Syndrome treatment is what we are already doing for her. Because eyes flared we upped oral Pred and Pred eye drops.  Dec. 13 all looks good and meds are decreased again to Dorzolamide Timolol Maleate combo 2xday, Pred eye drop 1xday, ½ Azathioprine 3xweek, ¼ oral Pred 2xweek.

The next part is sad but helps explain what started her current flare up.  March 5, 2014, throws us for a loop, Timber (Skylar’s buddy) had to be euthanized for acute liver failure most likely due to Prednisone … he has been on a high dosage for  8 days, as his nose started peeling again, the local vet said allergy related but my heart sank I think it is more. Timber had never been sick.   December 29 Timber's nose (acutally more near the muzzle part) had a tiny bump on it, like a mosquito bite. December 30 it was gone. December 31 his nose looked like it was starting to peel wear the fur meets the muzzle. Vet says allergies and puts him on meds Doxycline. It starts to clear then on January 29, 2014 it looks worse.  On Jan. 31 since his nose is not better, and I had been researching possibilities on the internet. We insisted on biopsies, the,  results come in Feb. 4 2014 as Phemphigus Folliaceus,  The local vet put him on ½  of a 50mg Prednisone tablet 2xday (Skylar’s tablets are only 20mg) , Tramadol, fish oil 2 capsules (1000mg), 4-Doxycyline caps 2xday (8Doxy total) Feb. 9 they add Niacinamide 3xday,  Friday Feb 28 (last day of month) Timber has trouble walking… vet says it is arthritis, Sat and Sun he gets worse, Monday major snow storm everyone closed. Tuesday vet is book no appointments, Wednesday he is very wobbly on his legs… I get angry with vet and they fit him in on their lunch, he barely walks through the door and lays down, vet draws blood and he won’t stop bleeding.  I know it is bad, so does the vet he rushes him back shaves his belly and calls me back, Timber is bleeding on the inside and is oozing through his skin.  He has a 5% chance of making it if I chose to put him through transfusions etc, they cannot do it locally we have to drive 2hrs to a 24 hr vet.  We opt to say goodbye and bring Skylar and our son down to see him one last time.  They know… I believe it in my heart. Sadly since that happened Skylar is not her usual bouncy self.

Her eyes flared within days of Timber passing and have only gotten worse.  The vet initially wanted to wait before upping her meds because of her mourning Timber but on Friday June 13, when we went for an appointment we had no choice, the summer heat in upon us.  The vet still did not up them to the amount she originally wanted because Skylar is still mourning Timber and stress makes it worse, and her eye pressure was up in the Right eye (her surgery eye) not too high 22/20/22 readings and anything over 20 is considered high.  So currently she is on Dorzolamide Timolol Maleate combo 2xday, Prednisone eye 1xday every day, ½ Azathioprine 3x week, Atropine 1xweek left eye only, ½ oral Prednisone 3x week. We will try this for two weeks and see how she is doing.  The eye specialist is great in that I can email pictures and she will respond although sometimes it takes her 2 days to do so. It saves us a 2 hour trip one way and time off from work to do this.  We have been told repeatedly how lucky we are regarding Skylar, because of her light blue eyes I am able to catch any changes were easily.   In about a week we will take her off the Dorzolamide Timolol Maleate combo eye drop and put her on those drops as separate drops as they are stronger seperately.

Photos to be added.
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Penel
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Re: Uveo Dermatological Syndrome
« Reply #2 on: January 03, 2015, 08:05:12 PM »


July 18, 2014- Album is now updated with Timber pictures as well.  Skyalr is still having issues with depigmentation and not responding as well as we had hoped to the increase in the Predinisone. The specialist does not want to go as high as we did last year becuase Skylar's eye pressures are going up when we increase the prednisone and she has gained a bit of weight.  Vet is worried about Cushings and diabetes so far she does not have these but can develope them.


December 30, 2014 her recheck:  Left eye is doing better, right has some improvement but not as much as we had hoped. Contacts were removed and meds changed again. Added Flurbiprofen to be used before ointment in right eye only (unless it stings then we stop it, so far so good), Pred eye drops added back in for left eye, Ofloxacin sol. 4x day for right eye only, everything else stayed the same.  We go back on Januray 9, 2015 for another recheck. So far she is doing okay. Her spirits are still good and the weather is much cooler which she is loving.  Hopefully her eyes will heal as they are supposed to. I want to post a picture but for whatever reason I am currently not able to upload any pictures to my Facebook where I have been keeping track of her progress.


January 1, 2015.  First Happy New Year to each of you.
Now for an update on Skylar and her on going battle Uveo Dermatoligic Syndrome.
She has really struggled this entire year.  By September she had lost all the black pigment on her nose, her lips and around her eyes. :(    We upped her meds again even though we really did not want to. However, by the end of November her pigment was coming back and we were decreasing her meds. :)  Eye pressures were reading 10 & 11 and  she was down to 1/2 Azathiprine 3x wk, 1/2 Pred tablet 3x week, Pred eye drops 2x day, Atropine eye drops 2x wk in left eye, 1x wk in the right eye, Timolol and Dorzolamide 2x day everyday. She had some small crystals developing in her eyes but the vet said this was normal and not an issue at this time, but we would be watching them.  This was to be short lived.  On December 15 She was blinking her eyes and I noticed the whites were turning red again we upped the Pred eye drops to 3x a day, 3x week and raised her Azathoprine to 3/4 tablet on Mondays and 1/2 tablet on Wednesdays and Fridays. We also raised her predninisone tablet to 3/4 on Tuesday and 1/2 tablet on Thursdays and Saturdays. On December 18 her right eye (surgery eye) looked really red and kind of funky near the crystals. I sent a picture to the doctor's cell and she told me bring Skylar up the next morning. Good thing we did as her right eye had developed and ulcer and it was 80% deep in just a few short days. She also had more crystals in her left eye.  The doctor debrided both eyes and placed a contact lens in both eyes and Skylar was sent home wearing the dreaded Elizabethan Collar she hates. She was then placed on a new routine of meds.  Eliminate the Prednisone eye deops as her condition which is caused by both steroid use and inherited. We added Ofloxacin sol. 1 drop both eyes 4x day, Triple Antibiotic Ointment 1/4" strip both eyes 3x day, Atropine eye drops 1 drop both eyes 3x week, and Tramadol 50mg for pain 1-2 pills 2 to 3 times a day, the  Prednisone 20 mg, Azathiprine 50 mg, and Timolol and Dorzolamide stayed the same, recheck on the 30 of December.
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Penel
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Jo CIMDA

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Re: Uveo Dermatological Syndrome
« Reply #3 on: January 04, 2015, 01:38:53 PM »

Thank you so much for this update on Skylar.  It will be invaluable to others who are trying to deal with this disease.

What a long slog you and Skylar have had.  I do hope things get easier in the New Year. 

Well done to you and your vet.

Jo
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