Gabapentin- itchy dog & joint pain. Safe for impa? Anyone have experience using

Started by BrookeR, January 29, 2016, 05:19:46 AM

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BrookeR

Yes her other thyroid results were within normal range. (But low total t4). She was slightly low and jean said on close look at her results/ her symptoms & considering her history.,It may be worth a trial of thyroxine. But she didn't feel her symptoms were caused by a sluggish thyroid. She felt a non thyroidal illness was the cause.

Pepper is still on omega oils & has been on rose hip canine for her joints for months now. Due to her allergies we are quite limited in what we can give her. Also there is no trustworthy homeopathic vet anywhere remotely nearby & we are not able to travel at this point in time with her (with the baby being so close).

Jean suggested to try dlpa. I looked it up and it's an amino acid used to treat chronic pain & depression. It also is supposed to prolong the effects of acupuncture. I have mentioned it to my acupuncture vet & she is looking into it.
We have acupuncture tomorrow, hopefully that brings some relief. I am stopping the NSAIDs now as they don't appear to be helping. But my acupuncture vet can assess if she sees any improvement tomorrow after she has been on them.

The only other thing we have thought of is when Pep last saw the specialist & had an ultrasound done back in April 2015. She had an enlarged spleen. The specialist at the time didn't think think this was a problem for her. She said some dogs can just have larger than normal spleens for their breed. But she said to keep an eye on it down the track if problems arose. I have thought her tummy looked more bloated than usual lately. Tomorrow when we get acupuncture I am going to get the vet to have a feel around her tummy & see what she thinks. I have noticed when I help her up in the back end by placing hands around her tummy she appears uncomfortable. But whether that is from her tummy or her back/leg pain I'm not certain.
I may get her to check the X-rays we did the other day and see if anything is visible there. As much as I didn't want to sedate her for an ultrasound. If she finds anything when palpating her tummy or on the X-rays to make them believe that her spleen could be the problem. I think I may need to do it. It's kind of the last thing to be done, to rule other things out. I just don't feel this is all being caused by arthritis, considering how fast she has gone down & her unwillingness to eat. As well as the NSAIDs not working at all.
If nothing comes back on the ultrasound though I guess we just have to go with the arthritis being the problem. My vet is still wanting to trial the gabapentin, as she said she has had good results with it when treating pain. There isn't really any other options, she cannot be left how she is. It's not quality of life.
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

polly

So sorry to read about poor Pepper. A couple of thoughts - have you tried giving Pepper  fish oil and Glucosomine  for the joint pain/arthritis?  Both are used for humans and I know people who giver them to their dogs on vet's advice. Both are available over the counter from  from supermarkets/pharmacies.

You mentioned in a previous post hat  the blood results indicated slight anaemia. It is not a pleasant thought, but has your vet considered that Pepper may be developing IMHA as well as her current condition?   Before Jasper was diagnosed with IMHA he was lethargic, not eating, and had an enlarged spleen.   

BrookeR

Yes pepper takes salmon oil for her joints and rose hip supplement. Through nutriscan Tati g we found she has a problem with white fish but is fine with salmon. With the majority of glucosamine supplements coming from shellfish I don't feel confident with her white fish allergies that she wouldn't have a problem with it.

I did bring Imha up to my vet (as I read the about the enlarged spleen being a sign & looked into other symptoms that seemed to fit also) but she said to forget about it. That there were other factors that ruled it out. I don't know much about it but I thought she said something about peppers anaemia being non regenerative and that it should have been regenerative for it to be Imha? I could be wrong that that is what she said but I had mentioned it & she seemed certain that was not the case.
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

polly

 I hope it is not  IMHA - but  it occurred to me that while  Pepper was on immune suppressant medication for her other condition , if she did have it, the symptoms would not have been apparent because  the anaemia would have  been under control.   Has your vet done a PCV test recently?  Or examined Pepper's urine to see if there  is blood in it?  I don't understand the regenerative vs non-regenerative  thing either - or understand how your vet can be so sure which kind it is.


BrookeR

Yes that thought occurred to me to & was another reason I bought it up.
Peppers urine was tested a couple of weeks ago and there was no blood in it. That was one of the first tests we did. I'm not sure about the pcv test.
Perhaps Jo can shed some light on the blood results I listed about pepper & whether or not they are suggestive of Imha?
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Jo CIMDA

Hi

I don't know if this helps:

Immune mediated haemolytic anaemia (IMHA) can be subdivided into to categories. 

IMHA and AIHA (autoimmune haemolytic anaemia)

AIHA is idiopathic, meaning there is no underlying cause and it is primary AIHA.  This is usually non-regenerative and spontaneous and therefore it occurs as an autoimmune destruction of the immature red cells (reticulocytes) within the bone marrow.  This will be seen on the blood results as a low red cell count (HCT -  haematocrit, or PCV - packed cell volume) with no regeneration ie., no reticulocytes coming through from the bone marrow. These effects can be see with, for example, leukaemia as well as primary autoimmune haemolytic anaemia, and this is why some vets will want to do a bone marrow biopsy before treating AIHA with immunosuppressive doses of steroids.

In contrast, IMHA is secondary to an underlying cause (this is an immune response to something else going on in the body such as a parasitic disease, haemangiosarcoma etc., ) and this presents as regenerative anaemia, ie., the PVC or HCT is on the low side but the reticulocytes are high indicating that the bone marrow is responding to the lack of red blood cells in the circulation of the blood.  In these cases the primary cause or disease has provoked an immune response and the red cells are being destroying within the circulation of the blood. The primary cause has to be diagnosed and treated as well as the immune response for a good outcome.

In general if a dog has non-regenerative AIHA, I feel a lot more confident about it being treated with immunosuppressive doses of prednisolone etc.  I do worry when I hear that a dog has regenerative IMHA and is being treated with immunosuppressive drugs only without looking for an underlying disease. 

Jo

BrookeR

Is there usually a temp with either of these?

Pepper had acupuncture today and we only did thyroid points (which we have never done before) to try and see if stimulating her thyroid made any difference. She had it done at lunch time and as the afternoon went on she was more perky. She ate all her dinner on her own without me hand feeding her. Then she went outside and tried chasing the mower & playing with her ball. Barking & had a little run. This was a dramatic improvement on what she has been for the last few weeks. She has only really been going out briefly morning and night to go to the toilet and come back in. Only walking at a very slow stiff pace. She hasn't had any NSAIDs since yesterday morning at 10.30am.

I don't want to get too excited but I have never seen her have this sort of  improvement from acupuncture. Perhaps it is worth while giving her a trial of thyroxine. Jean had suggested a trial may be worthwhile even though she didn't have hyperthyroidism but considering her slightly low levels and her history.

On palpating peppers stomach my vet did not feel she was uncomfortable in terms of her spleen either.
i guess I just wait now & see how she is tomorrow & then decide whether to trial the thyroxine.
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Catherine

Anaemia can also be one of the symptoms of Hypothyroidism. Also Addison's. Increased ALT can also be seen in both.

Jo CIMDA

Hi

A brilliant response to acupuncture!  I have experienced similar.  Also perhaps the acupuncturist might consider treating her stomach (the whole gastrointestinal system) because this can be an area that if out of balance can cause all sorts of other problems.

Yes there is a temperature with both IMHA and AIHA.

Personally, I am not in favour of giving thyroid hormones if the dog is not hypothyroid.  I have seen too many complications in dogs that are inappropriately treated.  These are hormones and if the thyroid is working then don't throw it into confusion by supplementing with thyroid hormones it doesn't need.  The thyroid gland system is so clever and sophisticated and it knows exactly how much the body needs.  It self regulates production to optimise its function.   If you supplement when it is not needed the thyroid glands will shut down and you are then guessing how much replacement hormone is required.

I hope her improvement continues.

Jo

BrookeR

Unfortunately peppers improvement didn't continue. She was okay for another day and then continued to get worse. Yesterday she could not get up unaided & for most of the day could not walk either.

She had acupuncture again using the same thyroid points, but it had no affect this time.

She had a low dose methadone injection for pain relief which did not help to make her any less stiff. All her lymph nodes are enlarged & she has a very sore point in her lower back. Needle samples have been taken of her lymph nodes behind her knee & neck & sent away checking for lymphoma.

She now has dry eye :( as well and an infection in one eye.
It feels as if her immune system is just going into self destruct mode.

She has had two doses of gabapentin for pain relief & is having another first thing in the morning. So far that has shown no improvement. If that fails our last resort is to give her pred & see what happens.

She still does not have a temp (her biggest sign last time with impa). Last time she had impa all her lymph nodes were up. She does not have the same look she had when she had impa of having her head hung down etc. But I'm wondering if the absence of her temp is changing her symptoms. She was never weak in her back legs before. But we also now know she has bad arthritis in her back legs. So perhaps that has worsened her symptoms if it is impa?

I have dreaded impa returning, but at this point it is really our only hope :(
Assuming the gabapentin doesn't have a turn around in the morning, steroids is our last option. As nothing else has helped.
I hate filling her with drugs, but it feels like we have reached the end of the line & it's the only option.
I want to try whatever we can before giving up on her & there isn't really any where else to go once we try the steroids. We could do an ultrasound, but I cannot see that they will pick anything up that is going to be treatable. We have pretty much tried all drugs that should have helped any problems they may find with an ultrasound.
The baby has started moving its head down too and only 3 weeks to go. As much as I don't want to go through impa again (& don't know how we will). Im hoping the steroids work & that's what it is because I cannot handle having to lose her at this point :(
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Catherine

Were her freeT4 and TSH levels well into the normal range or were they borderline?

Jo CIMDA

Hmmm... it is very confusing.  Enlarged lymph nodes but no temperature??? Sore point in her back???  I wonder if the two are related or are you looking at two different problems?

Sore point in back and enlarged lymph nodes could be an immune mediated problem and, like you say, you may not have any other option but to give her steroids.  If you are going to go down that route then I wonder if your vet will consider giving Pepper an injection of Dexamethasone?  If she improves, and this could be rapid, then you can probably assume it is an immune mediated problem and then a course of steroids might be the way to go.  If she doesn't improve then nothing is lost because the duration of action of one Dex' injection is 48-72 hours and you don't have to wean down.  It is safe to give a one off injection.

Are you treating her dry eye? Does she have any muscle wastage - especially around the eyes/head? 

I do hope she improves soon.

Jo

BrookeR

Yes my vet is under the impression it is likely there may be more than one problem going on with her.
It is Saturday morning here and my vet is not open again until Monday. She has given me steroids to have with me & I have to email her this morning with how pepper has gone with the gabapentin. She is going to email back and advise what to do. Which the plan was if it hadn't worked, give her the steroids. Unless she has since thought of another option.
Otherwise perhaps the injection of Dex may have been an option if it were a week day & she was open. But she didn't want to leave me all weekend with her if she didn't improve from the gabapentin. I can have & give the steroids myself, but not an injection.

I have antibiotic ointment for her dry eye and tear lubricant. Which I only started using yesterday. We are going to treat the infection first & then retest her tear sample. It was very low originally so I'm assuming it still will be & then we will start the cyclosporine eye ointment.

I had wondered if her face perhaps looked a bit drawn & muscle wasted. Also her limbs/legs i had thought looked kind of drawn, & had mentioned it to my acupuncture vet. But she is not my ordinary vet who has been dealing with peppers impa all along. As she is a staffy & therefore quite muscly, it is hard to notice. Sometime back now (before all this recent drama) she had one of her eyes go funny & that side of her face appeared to droop. There was concern at the time she was developing another immune disorder. But we left her and she improved. That eye has since become one that she squints in on and off. But her face hasn't  appeared to be droopy in that side anymore. They had told me if she had the immune disorder that droop should have remained permanent.
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

BrookeR

Hi Catherine,
I have tried attaching a copy of her thyroid report, but couldn't get it to work. So I have just entered it below.


Test Requested                Result                           Case Specific                                   General Range Units

T4                                     1.01                              1.30 - 3.20                                      0.80 - 3.80 ug/dL
Free T4                             0.83                              0.75 - 2.00                                      0.55 - 2.32 ng/dL
T4/FT4 Ratio                     1.22 See below                                                                    1.25 - 1.75
T3                                     40.6                              30 - 70                                            30.0 - 70.0 ng/dL
Free T3                             1.70                              1.6 - 3.5                                          1.60 - 3.50 pg/mL
Thyroglobulin
Autoantibody(TgAA)         3 Negative                    < 10                                                < 10 %

FINAL REPORT TgAA is normal (negative), so her sluggish thyroid function is not due to heritable thyroiditis.
Suggest following the recommendations below. Best wishes, Jean

MORE COMMENTS On further reviewing these results and her long case history and other recent labs
provided, the T4 and free T4 were on the low side of the Case Specific range for her breed type and age.
Final interpretation depends upon the TgAA result. Given the detailed history and these results, I think
that boosting her basal thyroid levels would be appropriate.

Suggest a 6-8 week conservative dose trial of thyroxine at 0. 2 mg twice daily, given at least an hour
before or three hours after any food or treat containing calcium or soy to ensure absorption.
Brooke with
Pepper, the English Staffy (IMPA since Dec 2014)
NSW Australia

Catherine

Was there no TSH result? Is Pepper spayed? (The results can be affected if she is near to having a season).

On the one hand it is not good to start her on thyroid medication if the thyroid is not causing the problems. On the other hand, if it is borderline, it is not good to wait until all the numbers "add up" as she could end up having unnecessary treatment for the problems she has now.

It is a difficult one, and you have to try and look at it with an open mind. Do not try and fit the symptoms to HypoT but at the same time if there ARE physical symptoms then it may be worth considering.

I have experienced borderline results with some of my dogs. One, in particularly was having increasing ALT and GGT levels over some months (as well as some physical symptoms that were not the common HypoT symptoms.) My vet was pushing for my dog to have liver tests but I was not convinced there was a problem with her liver. So we started her on thyroid medication and she improved and.....her ALT and GGT went back to normal levels!