Simon's IMPA

[Susannejones67]

Hi Everyone,
I'm so glad I found the site! IMPA has been knocking me (and my 7-year-old Dobbie mutt, Simon) to my knees. It seems to just present ever so differently...I guess that's the nature of auto-immune diseases.

In Simon's case, the IMPA ball got rolling with a pneumonia. He became more and more lethargic until Sept. 28, 2014, when I finally took him to ER because he was just so weak. He has spondylosis (since 2; it's asymptomatic, really) and so I thought, he is just in pain..for some reason. Well, turns out, it was pneumonia.

Three days later, in the morning, I wake up and his frontleg is sticking out straight and he is just whincing in pain! I freaked. Took him in right away. Rads showed mild mineralization and the vet suggested, it might be osteosarcoma, I was crushed! That cancer is badnewsbears!

Well, I did not take that and called the Vet Center here at the University of Minnesota. They are top-of-the-line and Simon had an orthopedic surgeon there, who checked him out, and just pointed to his joints. I cannot believe I missed it: they were ballons--the synovial fluid was all over and joint tabs confirmed IMPA.

Prednisolone was our treatment..you all have been through it. But here's what happened to Simon. He was on 30 megs of Pred for 4 days only and that night at 4am, he woke up shaking, heart racing, panting, super nauseous (lip licking). We were back in ER at 4:30am. Finally, 4pm, 12 hours later...ultrasounds, aspirates, blood/urincultures, rads--later. The shock: Simon's reaction to Pred was just vile, and every one at the was just shocked at the tremendous muscle wasting. He went from 74 to 66! Yes; the fluid subsided. BUT Simon completely stopped eating and drank like a sailor (easily a GALLON a day! Filtered water, folks). He';s normally on a raw diet--which ended. No salmon, steak, or goat cheese in the world could coax him to eat.

We tapered him off Pred (added Omaprezole) and integrated Leflunomide (which was the plan all along). Leflunomide works differently than Pred.; it "harnesses" the white blood cells, so to speak. It's not a steroid, and thus does not have the liver side effects. Simon's been on it now for 10 days and the plan is to leave him on it for 6 weeks

But Leflunomide can cause GI issues, stomach upset, and nausea. Indeed, as I resumed his raw diet two days ago, Simon became nauseous. My hunch is that the raw diet (I resumed solid vegs and ground bone-in-duck to get his calories up), I did not realize that it's WAY TOO HIGH in fat and protein. Plus his ALT and ALK phos levels are still high from the Pred. suggesting liver damage, still. So, his liver cannot handle super high fat and protein. So last night, he pooped mucus and clear blood--ulcers.

We will see the surgeon again tomorrow and an alternative vet then.

So long story short...the challenge I find with IMPA for Simon is a mixture of handling his nutrition while sustaining his internal and hoping the Leflunomide works.

I'd love to know from others here who also had their companion on Leflunomide..what are y'alls experiences? Plus what kind of diet/supplements are y'all adding (beyond Thistle, Turmeric, and Vit C/B/E)? Just today I added Slippery Elm to his diet...I feel so darn helpless!

Susanne

[Jo CIMDA]

Hi Susanne

What a dreadful experience you have had with Simon and his IMPA.  It is very unusual to have this sort of reaction to preds especially as he wasn't on a large dose for what I imagine to be a reasonably weighty dog. Does the vet think that the pneumonia was a trigger for his IMPA?  Primary IMPA only affects the joints. 

I have only known one other dog to be treated with Leflunomide.  Unfortunately I lost contact with the owner so I don't know the outcome.  It is certainly an alternative to prednisolone for joint problems, but it is not widely used.  Cyclosporin is more widely used as an alternative to steroids but that could have something to do with the broad marketing of cyclosporin (Atopica).  There maybe others on the forum that have treated their dog with Leflunomide.

Leflunomide can take up to 4 weeks to achieve full effect so I would expect the treatment would continue beyond the 6 weeks if it is successful. This suggests that you won't see a remarkable improvement in Simon's condition for a few weeks. You can give pain killing/anti inflammatory drugs during this time.   It is so unfortunate he can't tolerate prednisolone because the improvement can be see within a few hours.   Leflunomide does have an effect on the liver and I think this is to be expected when these drugs are used.  The good news is when the drugs are reduced and eventually stopped, the liver should return to normal.   I think all the supplements you are giving are very good and will help his liver during this time. SAMe is another very good liver support but you should ask your vet about that, and the alternative vet will have some suggestions, I'm sure.

Omeprazole should sort out any existing gastric ulcers but do check with the vet if you have to allow time in between giving the Omeprazole and Leflunomide because some gastroprotectants inhibit the absorption of other drugs if administered within an hour or two of each other.   

Good luck tomorrow.

Jo

[Penel CIMDA moderator]

I have nothing to add to Jo's post but just wanted to say I really hope things settle down for Dobbie now x