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[ruxpin]

I have a five year  old greyhound bitch who out of the blue, about a month ago lost the outer nail on her front right paw.  (Incidentally this was approximately 10 day post her booster).   This was in the house and there had been no apparent trauma but we assumed she must have caught it on something.   It was hanging off and bleeding quite a bit so she had to go to the vet and with a light sedation they removed the nail and gave her some pain meds and antibiotics.  Over the last month the quick has gradually shrivelled and formed a hard coating (resembling a rice crispy).  She has been otherwise well in herself.  Then over the last week I have noticed her persistently licking the two nails adjacent to the one that she lost.  She did not appear to be in any pain from them and had been enjoying her walks as normal but when I tried to have a closer inspection she went for me as they were obviously annoying her and were painful.  These nails looked hollow and on looking on the web at SLO nails they are pretty much the same as the two affected ones. I also think she is probably developing a problem with her back right foot as a couple of the nails look as if they are splitting up the centre on the underside and she occasionally limps on that leg for a few steps when walking or if she has been laying down on the sofa all evening.   I was pointed in the direction of your website which is extremely helpful and intend getting Bobbie to our greyhound vets next week but I know they are not particularly up on this condition and wanted a better understanding of the condition myself before the consultation. 

I have a couple of questions which I hope you will be able to answer.

1.  Does the use of steroids only accelerate the treatment process or is it something I should consider if she loses multiple nails at once?
2.  On the information given it would be easier for me treat her with Doxycyline from an administration point of view.  Is there any evidence that one particular antibiotic is more effective than the other an also is one more expensive than the other?
3.  Am I better getting prescribed veterinary EPAs or are human ones bought from a health food shop just as good?  If so what sort of doseage should she have; she weighs 26kg.
4.  Does she only need the antibiotics if the nail beds are infected or are they important in addressing the autoimmune element of the disease. What should I be looking out for as signs of infection?  At present she is well in herself although a little more subdued than normal, there is no apparent discharge from the nails, the toes are not swollen or hot and she does not appear to be in any obvious pain on walking.
5.  How do you know when to stop the antibiotics and just carry on with the EPAs and what is the average length on time that most dogs are on the antibiotics for if they are not used in combination with steroids?

Sorry to ask so many questions but I want to be as clued up as possible when I visit the vets.

Many thanks in advance for your help.

[Jo CIMDA]

Hi and welcome

I have a five year  old greyhound bitch who out of the blue, about a month ago lost the outer nail on her front right paw.  (Incidentally this was approximately 10 day post her booster).   

Unfortunately some greyhounds are genetically predisposed to SLO so it doesn't surprise me.  The booster wouldn't have been the cause of your girls SLO because the damage to the nail is done at the nail bed and this will take a few months before this damage is seen emerging from the skin.  the trigger would have been a few months ago.

I have a couple of questions which I hope you will be able to answer.

1.  Does the use of steroids only accelerate the treatment process or is it something I should consider if she loses multiple nails at once?

Steroids have an almost immediate onset of action but it will not address the damage already done to the nails at the nail bed.   These nails will still grow through and break off.  The majority of dogs with SLO are treated with tetracycline antibiotics because these are very effective and it avoids the use of immunosuppressive doses of steroids.  If the disease can be brought into remission by other means then steroids really ought to be avoided. 

2.  On the information given it would be easier for me treat her with Doxycyline from an administration point of view.  Is there any evidence that one particular antibiotic is more effective than the other an also is one more expensive than the other?

Treatment for SLO (other than using high doses of steroids) is tetracycline or doxycyline with niacinamide and other supplements.  Doxycycline is only given once a day as opposed to tetracycline which is prescribed 2 or sometimes 3 times a day and has to be given with food  to avoid the dog feeling sick but food can inhibit absorption of the drug by 50% or more).  So Doxy' is a far more convenient drug to use and food doesn't significantly reduce it's absorption.  You will have to ask your vet about the cost.

3.  Am I better getting prescribed veterinary EPAs or are human ones bought from a health food shop just as good?  If so what sort of doseage should she have; she weighs 26kg.

You can use human supplements.

EFA Ratio
Quote: “Research is being performed to determine the optimal ratio of omega-6 to omega-3 fatty acids that should be consumed. Previously, it was thought that the ratio should be approximately 15:1. Current recommendations are for ratios of 10:1 to 5:1.” (Omega fatty Acids: sources, Effects, and Therapeutic uses in Dogs, Veterinary Services Department, Drs Foster & Smith, Inc.  Holly Nash, DVM, MS)
Example Therapeutic Dose: Essential Fatty Acids
Quote: “Effect appears to be dose related and optimum doses and the most effective combinations of these oils have not yet been determined. Daily doses of:
•   Evening Primrose oil 172mg/kg/day
•   Fish oil @ 44mg/kg/day
have been used in dogs over a one year period without ill effects.”
(Ref: The Veterinary Formulary by Yolande M Bishop)

•   EFA dose should start at a high level until a response is seen.  This can take up to 12 weeks. EFA’s can cause loose stools. If this occurs, start on a lower dose and build up to highest dose over a couple of weeks. Avoid Evening Primrose Oil in dogs with epilepsy.  Branded veterinary products are available. Follow manufacturer’s dosing recommendations.
•   Natural Vitamin E (400-800iu/12hrs) encourages new cell growth.
(Ref: Clinical Immunology of the Dog and Cat by Michael J Day). 
•   Chinese herbs are also noted as being effective but the owner would have to go to a vet who practices in natural treatments.
•   Biotin (*5mg/kg/day) improves the quality of the nails but it can be difficult to obtain. Some dogs with SLO have shown to be deficient in biotin. This may be due to their diet.  Foods with a relatively, high biotin content include cooked eggs, liver, chicken livers, kidneys, some vegetables eg., boiled broad beans, raw or canned tomatoes, raw cauliflower, dried skimmed or whole milk, fresh milk, bran, yeast and raw egg yolk.  Do not give raw egg white as it contains a substance called avidin which binds to biotin and prevents its absorption. This does not apply to cooked egg whites as the cooking process deactivates avidin.
•   Gelatine – *10 grains (one capsule) every 12 hours.   (*Ref: Muller, Kirks Small Animal Dermatology).  Some owners give 1-2 cubes of jelly every day.
•   Good quality high protein diet in case of deficiencies.
•   Antibiotics if secondary infection is present
•   Topical acrylic nail cement applied externally to permanent nail deformities, which suffer from re infection, could be strengthened and protected by this application.
I haven’t known a dog to have external acrylic nail cement treatment but reference to this can be found in Muller, Kirks Small Animal Dermatology.
•   Removal of loose nails Loose nails may have to be removed, usually under anaesthesia. As you can imagine, recovery from this procedure is likely to be very painful.  Clipping, cleansing, removal of the fractured portion of claws may be necessary even after treatment is well under way.
•   Topical shampoos, Antiseptic soaks (Salt or Epsom Salt foot baths, Hibiscrub etc). Initially it may be necessary to bathe your dog’s feet to keep them clean and to wash off the blood etc., but once they are dry and healing it seems better practice to try to keep their feet dry.  Antiseptic soaks or salt soaks will help to soothe and clean.  Epsom salt soaks are supposed to be very soothing when the dog has pain. When the feet are sore and weeping, you can use socks and boots (or strong plastic bags tied with string) when out walking.  This will keep the feet clean, but do remove the boots when indoors otherwise the feet may become warm and sweaty which could set up more secondary infection and prolong the healing time. New nails should be kept short.
 

4.  Does she only need the antibiotics if the nail beds are infected or are they important in addressing the autoimmune element of the disease. What should I be looking out for as signs of infection?  At present she is well in herself although a little more subdued than normal, there is no apparent discharge from the nails, the toes are not swollen or hot and she does not appear to be in any obvious pain on walking.

The specific antibiotics used to bring SLO into remission have effect on the immune system  and halt the destruction of the nail and surrounding skin within the nail bed. In addition to the damaged nails, secondary infection can occur when the broken nail and surrounding skin is broken and the dogs picks up infection purely by walking or licking the nail and skin.  Dogs are vey stoical and they often become quiet when they are in pain. I cannot imagine the pain they must be in when they have to walk on broken nails.

5.  How do you know when to stop the antibiotics and just carry on with the EPAs and what is the average length on time that most dogs are on the antibiotics for if they are not used in combination with steroids?

The treatment for SLO is either steroids or a tetracycline antibiotic (there are about 6 different tretracyclines) , commonly, Doxycycline or tetracycline are used for SLO. Both treatments are not used together.  The length of treatment time is at least 6 months, probably for both treatments.  You should see an improvement in 2-3 months (probably a bit quicker with steroids - but at a price!) but it is not until the new nails start to grow through that you will see if the disease is in remission.  The new nails might be normal or they may be deformed.  Even if they are deformed they may be functional and the dog will not be in pain.  This is when you know the disease is in remission and the main stay of treatment can be reduced over a period of months.

I'm not sure if my seminar notes about SLO are in the files but if they are not then please email me at cimda@aslog.co.uk and I can attach them to an email for you. Hope the above helps.

Jo

 

Sorry to ask so many questions but I want to be as clued up as possible when I visit the vets.

Many thanks in advance for your help.

[ruxpin]

Thanks for your answers.  One further question if I may - if my dog is on Doxycycline at the recommended dose how much Niacinamide a day should she be on.  I  can see how much she should be on if taking Tetracycline which is three times a day - should she be on the same amount but given just once a day or is the doseage different.  She weighs 26kg and the vet has put her on doxycycline, biotin, fish oils, evening primrose.  Do you have any links on line where you can buy it for dogs as I have looked with no success.

Many thanks again.

Carol

[Jo CIMDA]

Hi Carol

I presume you know the dose of Doxycycline for treatment of SLO and other immune mediated skin disease is: 5mg/kg/24hrs  (Tapp 2002).  Niacinamide is given at the same dose whether you are treating with Tetracycline or Doxycycline.

Extract from:  Manual of Skin Diseases of the Dog and Cat By Sue Paterson

Dogs<10kg, 250mg three times a day
Dogs >10kg 500mg three times a day

Give three times a day until noticeable nail growth is seen 3-6 months.  Then give twice a day for two months, then once a day for maintenance.

Plumb's Veterinary Drug Handbook gives exactly the same dose for niacinamide, however in the book Clinical Immunology of the dog and Cat by Michael J Day it is stated the same dose but only given twice a day.

If adverse effects become a problem then reduce the niacinamide dose first  (Plumb's Veterinary Drug Handbook)

Do make sure you are giving niacinamide or nicotinamide,  and not nicotinic acid (niacin).  Although Niacin acts identically as a vitamin, it increases the blood flow and blood pressure and should not be used.

Doxycycline is the only drug that you need a prescription for and this can be obtained from your vet.  You could try  Meedicines4pets, Vet medic or Hyperdrug and there are many other online pharmacies, but you could also get a quote from your local pharmacy or from Boots the Chemists if you are in the UK.  The other supplements (and niacinamide) can be bought from a health food shop and the oils may be bought cheaper from the supermarket.  Natural Vit E is another excellent supplement but it is used in therapeutic doses 400iu twice a day (Clinical Immunology of the Dog and Cat by Michael J Day)

You have to be patient with this treatment but it will pay off in a couple of months.

Jo