Steroid Responsive Meningitis ?

[Jo CIMDA]

Thank you so much Elaine and Catherine.  I am so sorry you are going through this yet again Elaine.

18 years ago, when my Bonnie died, as a result of bad treatment by a 'specialist' vet, I felt so alone.  At that time, the vets in general practice had very little experience of autoimmune disease in the dog, if any at all, and even the specialists were still struggling with knowledge, experience and documented evidence, and my poor Bonnie was a victim of this inadequacy.  Despite me telling the specialist that the dose of preds was too high, she told me if I lowered the dose I would kill her, so I listened to her, respecting her expert status, and Bonnie died of a blood clot as a result of the preds being too high.  After this time I was told that because of Bonnie it was accepted that larger dogs do not tolerate high doses of steroids, and from that time on the recommended starting dose of preds was established at 1mg/kg/12hrs.  Bonnie was my first dog and my soul mate. The grief of losing her was immense.

Breed clubs do not like anyone highlighting a genetic predisposition to a particular disease and when I brought this up at an AGM, I was told by the Chairman of the main club at the time, that I was making trouble. I replied by quoting a rule of the club that states something like this: If anyone knows anything that might be detrimental to the health of the breed then it is their duty to bring it to the attention of the club.  It didn't make me very popular, as you can imagine, and this is why CIMDA was formed. I was determined to broaden the awareness of AI disease, and I went it alone.  The rest is history, as they say.   I must point out that since then, my relationship with all the breed clubs, in my breed, has been a very good one and we work together on many issues and the genetic predisposition to AI disease is now accepted.

I am so glad this forum and website is able to provide information, by way of people's experiences, and also to give support to anyone who is unfortunate enough to have a dog with an AI disease, and as bad as that is, they know are not alone.  It wouldn't work without all of you sharing your experiences, so my thanks go to all of you.

Jo

[Elaineb1624]

Thank you for your response Jo.
This forum is unaware of the massive support you have given me privately in the last month when my third dog showed signs of SRMA plus panniculitis. The latter being something i had never heard of.

So CIMDA goes above and beyond this group.

For Information purposes i will brief my journey with Tara. Approx one month ago she presented with  what i will describe as nodules come up under her skin and they increased in number rapidly. A Fine needle asperation was taken  which proved inconclusive but suggested what Jo had already mentioned. Sterile nodular panniculitis. Inflammation of fatty tissue beneath the skin. It can be immune mediated. At this point we chose  a kinder route for treatment than steroids, she wasn unwell, however one week in Tara was rushed to the vet with a stiff neck. I couldnt quite comprehend my beautiful whippet was indeed showing signs of SRMA, her litter sister has had the same as all my other posts on this thread  tell her journey.  So there we are back here again and thank goodness for you wonderful people. Tara is on high doses of preds right now and coping well.

Although i have been here too many times already you have to take each day as it comes. Each dog being different. I know i couldnt do it without this fantastic group. Im only sorry so many dogs suffer. I hope you take some comfort in knowing through your terrible experience with Bonnie, Jo, you have saved so many many dogs over the years and For that we are all truly grateful.
Thank you for telling your story. You are one brave lady.

[Elaineb1624]

Thanks to Catherine for your response too! How rude of me to not mention you. Apologies.

[Catherine]

That's okay Elaine, I quite understand as you have enough to think about at the moment with Tara.

[Elaineb1624]

Hi
   I have concerns re Tara she has been being treated for SRMA for the last two weeks, i thought she looked thinner and its possible she has dropped almost 2 kg in this time. I am sure she has weight loss but without  weighing at the vets its only a rough guide on my home scales.
Is this something that can happen on immuno suppressant doses. She has no other signs of anything and eats well. I am worried. I will speak to my vet.
I am aware of poosible drug induced cushings but would this happen so soon in?
Thanks.
Elaine.

[Elaineb1624]

Hi All
Can I ask if products like raw milk and spirilina are ok to give to dogs with AI ?
Thanks in advance.

[Catherine]

I have no idea but personally I would not give a dog with autoimmune disease anything different whilst it is recovering.

[Elaineb1624]

Thanks Catherine, my two girls have been off meds for a long time now, it was a general enquiry that's all.

[Jo CIMDA]

Hi Elaine

I don't know if anyone can give you a definitive answer because raw milk undoubtedly contains bacteria, some of which can be harmful, but certain bacteria, such as listeria, campylobacter and salmonella may affect some people (or dogs) and not others, depending on their personal resistance or vulnerability.    I think you have to weigh up the risks vs benefits.   Personally, if a dog is in remission of an AI disease and is healthy and getting a good diet then I wouldn't introduce anything that might upset that balance, but this is only my personal opinion.

This is an extract from a spirulina information website that is very interesting: 

People with certain autoimmune conditions should avoid Spirulina supplements, according to the NIH. Since Spirulina enhances the immune system, Spirulina supplements may worsen symptoms of multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis and other conditions linked to overactive immune systems. For the same reason, Spirulina may weaken the effect of immunosuppressants, which are often prescribed to treat autoimmune conditions and prevent the body from rejecting organ transplants. Spirulina may also interfere with drugs that slow blood clotting, including blood thinners such as warfarin as well as nonsteroidal anti-inflammatory (NSAIDS) pain medications. Combining Spirulina with herbal supplements that slow blood clotting may increase a person's risk of bleeding. Such herbs include cloves, danshen, garlic, ginger, ginkgo, ginseng and turmeric, according to the NIH. 

https://www.livescience.com/48853-spirulina-supplement-facts.html

Ultimately it is your decision, but go into it thoroughly (which I know you will) before changing anything that might upset homoeostasis.

Jo

[dmdee]

Hello,

I am new to this forum.

History: I have a 1 year old (estimate) whippet/german shepard mix. 4 weeks ago she started having awful muscle spasms, I was worried it was seizures and took her to the vet for a blood panel and fecal sample. Fecal sample came back normal. Blood panel came back with elevated levels of "Eosinophils". The vet said it is probably not seizures and not to worry as she is just sleeping. I was still sure the dog was not quite right. Yesterday we came back from an outing and went to get the dog out of her kennel, her tongue was sticking out with her mouth closed, she was falling over, shaking uncontrollably and swaying from side to side. We rushed her to they vet and found of she had a fever of 39.9 C. The vet (different than the first vet) said it is most likely meningitis and gave her a shot of dexamethasone and enrofloxacin. Zora got some rest overnight but was found with her eyes open and a blank stare. Today we gave her 10mg of Prednisone and 125mg of Ciprofoxacin. She is now on this dosage twice a day.

Current: She has been sleeping most the day and has been able to eat and drink. Starting giving some wet food because she seems to like it better. She has had one muscle spams episode today where her snout was twitching badly. Her temperature is down to 38.7 C. I am a university student and do not have much money to get the spinal tap to diagnose the dog.

I do not know how to proceed and live in a rural community with poor vet access. Any tips are greatly appreciated.

Thank you.

PS: it is important to note I applied spot on flea and tick treatment 4 days ago and she got parvo/distemper booster and rabies 7 days ago.

[Jo CIMDA]

Hello and welcome

I am sorry that  Zora is unwell. 

From the history you have provided, I do wonder if the symptoms that you saw yesterday, and those that you are seeing now, are a result of an adverse reaction to the vaccines and spot-on treatments and not SRMA?    Did you discuss with the vet that Zora could be having an adverse reaction to the vaccines and spot-on?

The clinical signs of SRMA are quite distinct and these include, extreme pain specially around the neck, and the neck is stiff and hung low, unwillingness to move with a stiff gait due to pain, and extremely high temperature, usually greater than  39.9.  The pain that SRMA dogs are experiencing cannot be ignored. 

If it is an adverse reaction to the vaccine and/or the spot-on treatments then hopefully the clinical signs will subside within a few days.  You could try a homoeopathic remedy for adverse reactions called Thuja.  This can be bought from a homoeopathic pharmacy such as Ainsworths.

As for a spinal tap to test for SRMA, unless Zora is showing the typical clinical signs of SRMA then personally,  I wouldn't go down that route.   The vet has given her prednisolone  which is a steroid and this should reduce the inflammation, but if it is SRMA then the dose she is on will not be enough to control SRMA and bring it into remission.  Immunosuppressive doses of prednsiolone are needed when treating SRMA. For a dog to have a spinal tap they should be off of steroids for a couple of weeks otherwise the prednsiolone will interfere with the results.

If Zora does get over this episode, on the current treatment, then I think you can assume it is an adverse reaction, and if this is the case then she shouldn't ever have any more vaccinations or spot on preventive treatments.   If Zora's clinical signs worsen, it could still be an adverse reaction,  but if she does get the typical signs of SRMA then your vet will need to treat speculatively and increase the dose of prednsiolone to 1mg/kg/12hours and follow a good reducing protocol such as Prof M J Day's.  See below.

Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days

Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.
Prednisolone:  "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.

I do hope Zora will improve further without any further tests or medication.

All the best
Jo

[dmdee]

Hello Jo,

Thank you so much for the fast reply. I do agree with you that I think it is an adverse reaction. I spoke with the vet about this and they disregarded my thoughts. I have been giving her flea and tick treatment for 9 months now. I am so scared and feel so guilty that I have caused this. Should I keep her on the current medication of antibiotics and steroids? Could you elaborate a bit more on the Thuja? What form and how much? Could this condition be called ataxia? Is the curable or will she have a life long dose of steroids. This is the second episode of this nature, the first episode was in October 2019.

During her episode a few days ago she could not walk straight and was standing with her back legs very far apart. She was stumbling all over the place with

The symptoms have already gotten better but I am afraid that when we take her off the meds she will worsen again. I also have some videos of some twitching or spasms while sleeping and I am wondering if those are also connected.

Thank you so much for your help. I am scared and guilty.

[Jo CIMDA]

Hi

For a start, you didn't cause this.  It happens.  Not all dogs can cope with these preventative treatments and there are lots of documented adverse reactions.   A lot depends on the genetic make-up/predisposition  of the dog and of course this is not known to us before meds are given.   Now you know that there is the potential for an adverse reaction you can manage Zora differently, and with awareness.   

Did the episode of October 2019  follow any treatments, vaccines etc? 

Not walking straight, stumbling and standing with the back legs apart to correct balance is called ataxia.  It is likely caused by some neurological disturbance that has either been triggered by the meds or there is a predisposition that fails to stop certain drugs from entering the brain pathway.  Look up MDR1 gene mutation.  http://www.ashgi.org/home-page/genetics-info/faq/mdr1-faqs

If it is something of this nature then she should improve as the days pass.  The preds are a fantastic anti-inflammatory drug, and this will help enormously to reduce inflammation and shorten the duration of symptoms,  and when she is weaned off the steroids she will hopefully be normal again.  This has been a warning, so in a way you are lucky that you know about this potential problem and you can avoid triggers or causes in the future. 

She has had a booster vaccine after the age of 16 weeks,  so it is likely that she will be immune to those core diseases and therefore no vaccinations will be necessary.  Only worm her if you see worms and only use flea treatments if you see fleas - but avoid spot-on treatments and use the mildest available or natural remedies.  Check out the WSAVA vaccination guidelines and feel happy about any future  vaccination decision you make.
https://wsava.org/wp-content/uploads/2020/01/WSAVA-Vaccination-Guidelines-2015.pdf

Thuja is a homoeopathic remedy for reactions to vaccines.  You can get it from Ainsworth's the homoeopathic pharmacy in London Tel: 0207 935 5330.  They are very helpful.  However, as Zora is improving on the current treatment, and unless you intend to give her any further vaccinations, you probably don't need to give it to her at this time. If, when she is off steroids, you still feel she might benefit from giving a homoeopathic remedy then perhaps a call to Ainsworth's might be worth doing.   

When she is back to her usual self, if you see episodes that you are not happy about then she may have to be investigated again, but if it is a reaction to the meds then I really think she will be back to her old self again.     I had a boy once with demodex - a skin mite.   I had tried everything to get rid of this mite but nothing worked - everything except Ivermectin.  He was a bearded collie and I was aware of the potential MDR1 gene mutation in collies and the risk of Ivermectin in MDR1 positive animals.  In those days they didn't have a gene test for MDR1 mutation, but they do now.  So I gave a 1/4 of a pipette  - and he responded fine.  Three days later I gave another 1/4 of the pipette and within one hour he started staggering and had dreadful neurological signs.  I had to stop the Ivermectin.  His symptoms were severe but over 3-4 days he started to improve and he fully recovered from the adverse reaction.  Unfortunately, I didn't manage to get rid of the demodex, but that is another story!

I do hope Zora continues to improve.  If it were SRMA, on this low dose of steroids she wouldn't get better and in time she would just get worse.

Jo

[dmdee]

Hello Jo,

Thank you so very much, you are truly providing piece of mind at this time. You are so very helpful.

During the October episode she was giving flea and tick spot treatment but that was 20 days prior.

I have ordered the MDR1 test you wrote about and will keep you posted on the results. When I was on the ASHGI website, I noticed one of the drugs on the problem drug list erythromycin and I am currently giving her a 14 day dose of ciprofloxacin.

I have also read the document on vaccinations that you provided, it has been extremely helpful. I saw that the only two core vaccines are distemper and rabies. She just got her 3 year rabies and has now had 2 distemper shots, I do not think we will be giving her anymore vaccines. I gave her a Heartguard monthly pill as well but do not think I will continue with that medicine either.

Thank you for the information regarding Anisworth.

She continues to have twitching or spasm events when sleeping but no more stumbling and high temperatures. It does seem that she has a hard time catching her breath but only at certain times of the day. She is taking short, hard and fast breaths when awake and sleeping. The breathes also sometimes cause a faint whistle sound coming from her snout, would this be a result of the medication? She has never done this before. She also seems to be very twitchy when I reach to touch her front two legs when laying down, any thoughts on this?

Thank you so much for your encouraging story regarding your bearded collie! I sure do hope we will have the same positive results and I am hoping that we do.

Thank you again and again.

[Jo CIMDA]

Hi

Twitching and muscle spasms are not unusual when a dog is sleeping, and it is quite normal,  but I think it depends on what degree of twitching and muscle spasm occurs and if they disappear when the dog wakes up.  Often it is just the dog dreaming and the movement can be quite robust and jerky at times.

Regardless of the cause, the combination of antibiotic and steroids have undoubtedly controlled/resolved the symptoms you were seeing, so this is good news.  Until you have finished the course of medication I don't think you can make an assessment of what may or may not be long term, or something that has not yet been identified.  I don't think the slight whistle sounds when sleeping is due to the medication but it might be a part of the inflammatory condition she is getting over.   I wouldn't worry about it at this time.   As for the breathing  - preds can quicken breathing and cause a dog to pant more, so again see what Zora is like when she is off medication.

Doing the MDR1 test is a good thing for the future.  I think you are really managing this very well and I am so glad that you have taken on board the advice of the WSAVA.

Jo