New Member with SRMA - lots of questions

[Jo CIMDA]

Hi Annie

SRMA and IMPA are AI diseases that often occur in the young dog and it may take a few years to reach long term remission.  In other words relapses are very possible for a while following the initial diagnosis and treatment.  This isn't to say it always happens.  These  two AI diseases usually carry an excellent prognosis.  The idea is to treat in the usual way - using Michael J Day's protocol as a guide and wean off steroids.  If a relapse occurs then you have to start the treatment process all over again but often the second time around one would take the last stages slower and hope remission is achieved.  It is hoped that the steroids can be weaned off completely.  Like juvenile arthritis in young children, often, as they mature long term remission is achieved. 

As Finn has demodex - which can happen when a dog is on immunosuppressive doses of steroids, and clearly with all his achievements before Christmas and the Hooper's trial he is doing really well right now.  As it has been a while since his SRMA was a problem, I would be inclined to reduce the steroids with the aim of taking him off them altogether and treat the demodex.   

Bravecto is a relatively new product and many complaints about serious adverse reactions have been made.  There are other alternative treatments. You can try Amitraz baths if you don't want to use Ivermectin.  See this link:

https://www.1800petmeds.com/education/mange-treatment-dog-cat-9.htm

The low dose of steroids he is on will not stave off a reoccurrence of SRMA if he meets a trigger, so they are probably not contributing to his wellness and not really having much affect on suppressing his immune system either because his adrenal glands will be adjusting  to this low, artificial supply and  producing less corticosteroid.  It is very important you rid him of the demodex though.  Thank goodness he doesn't have the MDR1 gene mutation and you are able to treat with the drugs available.

I love homoeopathy and holistic therapies and in many circumstances they work but unfortunately, there is nothing holistic that I know of that can treat an AI disease, and if the homoeopathic vets are honest I doubt any of them have had success in treating AI disease.  Also, when my beardie had generalised demodex, and he had the MDR1 gene mutation, I tried every drug and holistic remedy rather than use Ivermectin to get ride of the mites but nothing was successful. I do believe when a dog has demodex the harsh antiparasitic chemicals have to be used to rid the dog of the parasites. Believe me you don't want to see a dog whose skin and flesh is being eaten away by advanced demodex infestation. 

I am not convinced that CRP blood tests have any particular role in indicating an inflammatory response when a dog is on steroids, because the steroids will reduce any inflammation. Certainly, I would expect a high temperature in a dog that is having a relapse of SRMA or IMPA.  A high temperature does indicate inflammation or an infection. Reducing the steroids is about  having an excellent protocol as a guide and then looking at the abatement of clinical signs of the disease and the adverse effects of the drugs and a lot of common sense, and not base these decisions solely on science. 

I don't know if I have answered all of your questions, let me know if you want something clarified.
Jo

[Annie Jackson]

Hi Jo,
Thank you for taking the time to answer my questions, it is a lonely place having two collies with SRMA and no one has ever heard of it except you and my vet.
Ages ago I had an email chat with an holistic vet at the Cambridge Clinic, Christopher Day, and it was he who told me that the gut and immune system are closely linked and one of the best places to start was to get Finn back onto a raw diet and to improve the natural balance of his stomach and gut.  Unfortunately a raw diet didn't agree with Finn hence Gentle a raw, freeze dried, cold pressed food.  If he eats something he's not supposed to he is very sick indeed and relapses, this happened in July last year when he had been on 2.5 mg every other day for quite some time.  Sadly we had to put him back onto a higher dose. 6 months seems a long long time to reduce it. I would have continued with his 2.5mg-5mg missing a day in between had it not been for the outbreak of Demodex.  I have reduced the 5mg dose to
3 1\2mg and will monitor very carefully.  If this low dose doesn't suppress his immune system very much at all one would expect the Demodex to be controlled naturally?? 
After reading what you had been through and the fact that both my boys MDR1 are n/n I may well have to give them Advocate.  As Bravecto is given orally and sickness can be a side effect, this drug is a no no.  What I would like to find out is what is the minimum number of months Advocate should be given to control the Demodex?  I will keep a close eye on them and if it looks as if it is else where on their bodies I will have to start the Advocate, hence finding out what the minimum is.
I looked up the Aludex you suggested and again because of how it can affect the stomach if it is ingested I don't want to take the risk.  It seems that both boys have very very sensitive stomachs so I have to watch them all the time we are out and keep them occupied with games and playing as well as chasing and fetching their frisbees.  On lead is a big problem as they like to sniff everything.  I know this is good for a dogs well being but I mustn't take my eyes off them.
They are both on the same dosage of steroid regime now which, as you suggest and Michael Day advises, I will keep them on for a month, maybe two, before lowering again.  Fingers crossed.
You showed me the research that proved this A I Disease is because of a complex genetic fault on the immune system which needs a 'trigger' to activate it  I wish I knew what that trigger was in case it is my fault.  They both became ill at exactly 6 months of age.  Both had puppy vaccines but at different ages and different regime, even the Lepto was different.  Both Finn's parents were owned by the breeder, Loki's mother is (and is the daughter of Finn's father) but Loki's father is owned by a Trials Champion sheep farmer and he, Rosewood Will, won the 2016 One Man and his Dog Championship.  I thought I would get a perfectly healthy puppy.
I still wonder if the undentified object that Loki swallowed, probably on the Saturday, could have been the trigger.  It showed up on an x-ray on the Sunday and the first sign of SRMA appeared on the Monday morning.  The nurses at the referral centre were supposed to examine his poos to make sure it had been expelled and to give it to the neurologist. They didn't do this so I will never know what it was.
Do you have any idea what could trigger SRMA?
I tell myself 'it is what it is' but I still can't help wondering why?  And my poor Finn is still on steroids and he will be 4 years old on February 8th.  And we both know how damaging steroids are to every cell in the dogs body, but what else can we do?  The side effects of Cyclosporine are horrendous too - rock and a hard place comes to mind.
Thank you again for all your help Jo, you are a sanity saver. 

[Jo CIMDA]

Hi Annie

Finn and Loki share the same inherited genes that make them predisposed to autoimmune disease. When dog develops an AI disease it is likely but not assured, that other siblings or other relatives will also be genetically predisposed.  Below is an extract from my notes:

The Importance of a Good Immune System

The immune system is very complex.  It is designed to protect the body by identifying, and then destroying, foreign invaders such as bacteria or viruses.  In order to do this the immune system develops a `memory', probably before birth, to distinguish between what is:
'itself' - the good cells - its own body 
and
'non-self'  - the bad cells - foreign to its body

The term `autoimmune' is used when the immune system begins destroying good cells for no apparent reason i.e. there are no underlying causes such as infectious or chronic inflammatory disease, or tumours.

A dog with an autoimmune disease does not have a weakened immune system, on the contrary it works extremely well - but what it does have, when triggered, is a confused one. The immune system of a genetically predisposed dog has the potential of being unable to distinguish between 'self' and 'foreign'.  These dogs may develop an autoimmune disease if they encounter a 'trigger' that confuses their immune system into thinking that a part, or parts, of their own body is a foreign invader. The immune system will respond by mounting an attack to remove the invader from the body, and in doing so destroys 'itself' thereby creating a situation that causes a primary autoimmune disease.  Unfortunately we cannot see our genes and a 'genetically predisposed' dog looks like any other dog until an autoimmune disease develops.

What You Should Know About Autoimmune Disease in the Dog

Genetics
It is known that autoimmune disease in the dog occurs in animals that are genetically predisposed. This means that they have an inherited risk of developing autoimmune disease.  It is thought to be a complicated mode of inheritance involving more than one gene; this is known as polygenic. Both parents carry the genes responsible and it does run in families, but this does not necessarily mean that if one dog in a litter gets an autoimmune disease the others will also follow.  This is possibly due to the different mix of inherited genes in individual pups in a litter, or environmental factors (potential triggers).  Unfortunately, at the moment, there are no DNA tests for these diseases.
It is not known why dogs with a genetic predisposition develop a specific autoimmune disease or indeed develop more than one autoimmune disease.  It may be due to the combination of inherited genes (or lack of them); different environmental influences; or a particular set of untimely circumstances that triggers specific diseases in a predisposed dog.
Age
It is more likely to occur in a young to middle aged dog, but occasionally dogs as old as 14, or more, have been known to develop an autoimmune disease.
Gender
Females seem to be more prone - and this probably due to hormonal influences. Also, it is known that hormones can be a major trigger factor for autoimmune disease in the dog, as in humans. 
So, for a dog to develop an autoimmune disease it needs to have a genetic predisposition, but that's not all, as it would have to encounter a `trigger' that causes the immune system to malfunction.

So what are trigger factors?
Anything within your dog's environment that may challenge the immune system can be a potential `trigger'.  A dog that develops an autoimmune disease may have encountered the same trigger factor before, with no detrimental effect, but for some reason `on this occasion' it has caused the immune system to malfunction resulting in the dog developing an autoimmune disease.

Possible trigger factors are:
1.   Stress eg., fireworks, thunderstorms, separation anxiety, whelping, hormones etc.
2.   Viral or bacterial infection.
3.   Reaction to chemicals, drugs or vaccines.

To sum up:
A primary autoimmune disease may occur if a genetically predisposed dog encounters a trigger factor that causes the immune system to become confused and mounts an attack on its own body parts or systems.

Although this low dose of preds Finn is having is not suppressing the immune system, the demodex is still active and this has to be dealt with in a conventional way - with chemicals.  It is likely that the very low dose of preds is not necessary any more as clearly the SRMA is in remission. 

I fully appreciate your apprehension about using harsh chemicals but I don't think you have much choice - like you say, in between a rock and a hard place!  I know a dog with a very complicated medical history, even the usual thyroid medication for an under active thyroid wasn't effective.  He got demodex and because of his complicated medical history he was referred to a skin specialist.  He was successfully treated for demodex with Sarolaner (Simparica—Zoetis).  Simparica is licenced for tick and flea treatment but it did work for Louis and I believe the reason why this was chosen above Advocate etc., is because of his complicated medical history.  I am not saying that this is a better option for Finn but it is worth looking into.

http://veterinarymedicine.dvm360.com/new-hope-defeating-demodicosis

The triggers for autoimmune disease are not necessarily specific to individual diseases.  Various triggers might even be specific to an individual dog.   There is data for vaccinations causing IMTP, IMPA and AIHA but to be honest I believe a trigger is probably a set of circumstances that unfortunately come together at a particular time. Dogs have vaccinations/flea treatments year after year and then one year they will have a bad reaction to it.  That might be because there are other unidentifiable factors going on in the body at that time and the vaccine or drug just tips the immune response over the edge.  Little facts are known about this subject.

Cyclosporin and many of the other immunosuppressive drugs are cytotoxic and these can cause cells to change resulting in cancers so, I personally feel, if one can deal with an AI disease with steroids alone then at least the long term side effects are not potentially as catastrophic - but sometimes you have no choice and you have to do the best to save the dog's life.

Good luck with your choices Annie.

Jo

[Jo CIMDA]

Hi again Annie

I forgot to say that the link between the immune system and the gut is not new and there is a lot to read about on the internet.  The gut is said to be the 'second brain' and it has it's own immune defences. I do not pretend to know about it but it is very interesting and I do believe that one can optimise good health by the correct diet - that isn't necessarily raw for every individual. 

I have looked at a few 'human' webinars by Tom O'Bryan and a lot of it makes sense but I haven't had the time to study it properly. If you are interested then you can start with these links:

https://healthunlocked.com/nras/posts/134638719/for-all-autoimmuners-free-7-part-documentary-with-tom-obryan


http://www.dogsnaturallymagazine.com/leaky-gut-syndrome-in-dogs/

Jo

[Annie Jackson]

Hi Jo
The way you explain everything makes perfect sense and has taken quite a weight off my shoulders as I really took it to heart when the breeder insisted it was my fault that both my boys had SRMA.  Because of the timing of Loki's becoming ill it could well be that whatever he swallowed (we know it wasn't lead) May have caused a crisis in his stomach and gut and hence be the 'trigger' we will never know but.......
I have been reading up on diets for Demodex and raw is generally seen as the best with no yeast forming foods I.e grains and cereals, most vegetable and fruits with the exception of blue berries and goji berries.
Neither of my boys like chicken maybe that's because although they were weaned with good turkey mince and yogurt after this they were fed puppy kibble and thrown a chicken carcass! 
I will have another close look at their present freeze dried/cold pressed diet whilst I have enough left to change over to something else if there is anything that could promote yeast growth.  It is a grain free, fish product but does contain rice so will need to check if they way it is prepared will prevent this.
I shouldn't have mentioned the name of Loki's sire as he is a phenomenal dog who I watched in action before deciding to have one of his off spring.  His owner said that he sends him out on his own, he has a massive sheep farm, and he brings back many many hundreds of sheep.  Loki has inherited his single mindedness and work ethic!  We had an hour's agility lesson (puppy class) this morning, I am shattered but he was pulling me to go back for more!
I am using 50/50 neem oil with either coconut or wheatgerm oil as the Demodex is still localised but will only do this for a very short time and watch closely.  Both boys are on 2 1/2mg miss a day the 3 1/2mg
And so on and will be on this for a couple of months.  This as you say is a very low dose and if their immune systems are kicking in then hopefully the Demodex will not get any worse and maybe start to improve.  If it doesn't then I still have some Advocate that is within the useby date and I will talk to my vet and start their treatment.
I have read the links you sent regarding other products for Demodex but the tablet ones that have a side effect of sickness and diarrhoea I am sure will not be a good choice for my boys as whenever they have eaten something horrid they have sickness and/or diarrhoea followed by a relapse.  So your first suggestion of Advocate is probably the best given that athey are MDR1 n/n.  I will also ask my vet about Ivermectin liquid to put directly on the affected areas to kill the mites, I read about this, but never heard this before so will need advice before venturing there.
Although I tell myself - it is what it is - it hasn't been easy really believing it.  The more I speak with you the easier this becomes and for this I am eternally grateful.
Thank you so very much.
Annie x

[Jo CIMDA]

HI Annie

As Finn's demodex is localised I would be inclined to use a topical solution such as Aludex and just make up a small amount of solution and dab it on the affected areas.  You have to be very careful about the eyes though.

  Here is the lowdown on Ivermectin. 

http://dogskintreatments.com/articles/demodectic-mange/ivermectin-for-demodectic-mange-explained/


The dog that I know who was treated successfully for demodex with Sarolaner (Simparica—Zoetis) also has a complicated medical history, and has many other health problems to take into consideration, and this is why the skin specialist and the internal medicine specialist decided that Simparica  was the best option for him.  He is also hypothyroid which is an autoimmune destruction of the thyroid gland.  Simparica is not a one off treatment, because  the unhatched eggs have to be erradicated, but when the mites have gone it should be given every month, but I think that is one for you to decide when you are at that stage.

Dr. Tom O'Bryan says apple sauce is the best thing for the gut. See this link:

https://www.organicolivia.com/2017/02/why-applesauce-is-the-most-underrated-food-for-healing-leaky-gut/

Jo

[Annie Jackson]

Hi Jo
Thank you for the latest links.
I have read the one about Ivermectin and with regard to Finn it makes sense.  He was given Advocate from 9 weeks old until he was nearly 3 yrs old and was beginning to look and act very 'down' and out of sorts. No wonder his general health and vitality started to improve after I stopped using it. That was in March last year. Since this outbreak of Demodex has only recently appeared on him it just shows how long the drug stayed active in his body!  Particularly since he is now on a low level of pred.  Although since he had a relapse last July due to ingesting something and being very sick (literally) and had to have the steroids increased again this just could have kick started a whole chain of events. 
I am reading more on the leaky gut topic, from what I have read a raw food diet is the best way to go and since Gentle can be fed with raw food I can do this in very tiny amounts without any sudden drastic changes.  Nutrition by Nature look to be very good.  It seems that too much of the wrong type of fungus could also be contributing.  Fungus feeds on sugar, carbohydrates turn to sugar so vegetables especially the grains and root vegetable are out.  gentle contains potato, parsnips and rice so am asking about these.
I will definitely explore the other ways before considering Ivermectin and am now going to look at getting some Aludex to help with Finn's localised outbreak on his legs whilst I work on getting his system healthy.
Thank you again,
Annie

[Jo CIMDA]

Good luck Annie

Jo

[Annie Jackson]

Hi Jo
Both Finn and Loki's Demodex don't appear to be getting worse, so am holding off chemicals but taking things day by day and have the Advocate ready in case I see even a little change.
On a different note i.e. worms including lungworm.  As I said some posts ago that I had used the link you suggested to Fenland Forager and started both boys on their Scram Powder (diatomaceous earth with wormwood and clove). Three months ago their test showed negative in all worms.  This time I wasn't going to do the lungworm as they were clear last time.  Thank goodness I spoke to wormcount.com because they advised having the lungworm test again as there had been a marked increase, countywide, in fox lungworm. I didn't know about this particular lungworm, so glad I phoned them as we take our boys out of our garden gate onto fields and woods where there are foxes, badgers, deer and rabbits - as well as lots of dog walkers some of whom do not pick up their own dog or dogs poo!
Both boy's wormcounts are clear and I should get the lungworm results today.  Thank you for that link.
I have been reading more about the not so common side effects of steroids i.e. other behaviour changes, the list includes excessive barking which I am working on.  At least his aggression to other dogs has now stopped since lowering his steroid dose.  Knowing why these things are happening is a great help to putting them right.
Thank you for all your help and direction.
Annie

[Jo CIMDA]

Hi Annie

It would be great if their own immune system can keep the demodex in check.

I am getting from you the feeling that the more information we have to hand the more empowered we are, and this is so important for our sanity when dealing with dogs with AI disease and the consequential steroid spin-offs. This knowledge is something we don't have when first faced with having to deal with an AI disease. It is a huge learning curve.  It is such a shame that we all have to go through this, and the stress that goes with it.  It is something that none of us expect to deal with. 

I am so pleased the aggression has eased.  Steroids can affect every single part of our body and the incredible thing is individuals react differently.  If you speak to humans who have been on high doses of steroids they say they do not feel like the same person and they sometimes feel out of control, so his aggression can be forgiven.

Thank you for the update on your boys. 

Jo

[Annie Jackson]

Hi Jo,
I am beginning to think that Finn's immune system is damaged beyond repair.  For no obvious reason that we can think of i.e ingesting something horrid Finn had a relapse last night and it took 25mg of pred to bring his temperature down to 38c, that was 12.30 last night. At six am his temp was still 38c and he's been bouncing around.  This time though there was no sickness, diarrhoea or refusal to eat or drink!  In the past i've had to physically hold him up and push the tabs down his throat, this time his head was up, ears pricked and he gobbled up the sausage with the pred in it. Quite confusing.  All of this doesn't help the recovery of his immune system and hence the Demodex.  Because he didn't appear to be totally recovered from his bout of sickness he had last July I got in touch with Canine Vitality and she sent me her Gut Buster tonic - the difference in his wellbeing is a joy to see - maybe it is helping in lots of ways.
Which brings me to the Demodex. If his immune system has been over surpressed maybe by being on steroids for so very long then he has no hope of controlling these mites himself, and since his immune system is attacking the good cells as well as the bad and needs to be dampened down is it wrong to try and strengthen it to handle the Demodex mites?  I've not had any luck so far in finding studies or reports on this particular question.
I've been reading up on Sarolaner, which you mentioned earlier, it seems a good fit for Finn if chemical intervention is needed, rather than the Advocate.  Thank you for telling me about this as I'd not heard of it and will talk to my vet during my boy's appointment this week.
It seems as if we are going round in circles with this SRMA, hence me seeking holistic advice to help the body as a whole to cope with this disease which cannot be cured.
One thing is certain though and that's the more I learn the less I know! 
This SRMA is certainly a very complex condition.
Best wishes
Annie

[Jo CIMDA]

Hi Annie

I am sorry Finn has relapsed.  How do you propose to deal with this?  Now he has had 25mg of pred, are you going to start an immunosuppressive protocol again, or just for a few days and wean off?

I feel you have no option but to conventionally treat his demodex, especially as the 25mg pred will have suppressed his immune system (this is why you have seen a remarkable overnight response).  I would start demodex treatment as soon as possible.  If demodex gets a hold the effects can be catastrophic.

AI disease cannot be cured because of the genetic predisposition,  but long term remission can be achieved, and I would expect that with SRMA.

I agree about the knowledge - I learn something new every day. Experience is the best learning tool - even if you don't want it.

Good luck

Jo

[Annie Jackson]

Hi Jo,
Yes to the steroid reduction protocol, even though he has bounced right back and is his normal self again. I looked back on my 2017 calendar to what my vet said to do last July when Finn was ill and am following that regime.  I have booked an appointment for them both for tomorrow arvo and will suggest the Sarolaner, since Finn doesn't need a wormer such as Advocate I am sure it will be better for him. 
Loki's Demodex is just eyes and ears and not very much at all, nowhere near as bad as it was a few months ago. So might hold off anything for him but will have to be guided by my vet.
I do hope that he doesn't insist on a CRP blood test as the skin on Finn's neck looks inflamed.  From what I read the dark pink is from the Demodex.  It doesn't seem to bother him as the steroids are controlling that.  Unless, of course, he uses the blood sample to check for any other things.
Both Finn and Loki are negative for all Lungworms, didn't know there were so many different types!  Pleased I had it done anyway.
I have just seen a post by my boys breeder in the ISDS health Forum - she is now titre testing all her puppies before they are sold and has changed her advice regarding vaccinations.  Pity that wasn't done for my boys, all their suffering might well have been avoided as it could have been the vaccinations that triggered their SRMA - who knows?  I have read Dr Jean Dodds research into vaccinations and it seems that they are responsible for a lot of things not just AI diseases.
Thank goodness for the internet and all the information that can be found which has enabled me to understand more and be able to discuss things properly with my vet.
Best wishes
Annie

[Jo CIMDA]

HI Annie

Hope all goes well at your vet's.

Without doing research, I don't know how accurate titre testing on puppies under 12 weeks will be because many of them will still have their mother's antibodies to those core diseases and they will diminish quickly as the weeks go by.

I am pleased the breeder has changed her advice about vaccinations.  Vaccinating under 12 weeks is not much use.

Jo

[Annie Jackson]

Hi Jo
Good point about the titre testing on puppies, I had forgotten about them still having immunity from their mother.  Good that the breeder is taking note though. 
I don't know if this still applies or even if it applies to all vacccine manufacturers but I did read that it was the liquid that the vaccines were mixed with i.e a mercury preservative that was the main cause of the problems, that and the fact that like babies vaccinations so many were in the same shot.  Can't remember where I read this but it popped up when I was reading about vaccines.
All good at the vet.  He had a good look at Finn's Demodex and said that he recommends holding off from giving Finn anything for the moment and to carry on with the neem baths and applications, as he is healthy and bouncy despite his relapse on Sunday. The brightness of his skin that appeared was probably due to his temperature going up and not the Demodex taking a greater hold which doesn't usually happen in such a short space of time but to contact him if any change. Good news.
Another Demodex product you mentioned Milbemycin Oxime (Interceptor) might well be better for my boys if needed, than the Sarolaner, as it is said to be better tolerated by Collies even those with the MDR1 Mutation. 
You are such a good source of information Jo - it is so good to be armed with alternatives to suggest to my vet.
As mentioned earlier Finn's Sunday relapse was so very different to his others.  Vet said this last one was a more 'normal' relapse and could well be that he is on his way to complete remission. Whoopee.  Great news and a long time coming.  Vet said that he had never seen a dog so ill with this as Finn has been.  The neurologist said the same. 
Vet explained that the CRP blood test shows much more that just inflammation as dogs can have a normal temperature but the C-Reactive Protein levels could still be raised.  So both boys were tested.  Glad I asked as that was puzzling me.
So pleased that you raise the questions for me to look into as it helps so much to have a greater understanding of what is going on. 
Fingers crossed for low CRP results so we can attempt lowering preds again.  Finn is staying on a slightly higher dose for the moment because of his relapse, Loki too as he relapse two weeks ago, but as you said this does happen but the future looks bright.  I have learned how to handle Loki's, not so good, behaviour and relax.  Now I know that it's not my fault I can do this and best of all it's working.  He, Loki, had a Hoopers lesson a couple of weeks ago we were split into two groups.  He was so well behaved with the other dogs even though a couple of times he ran off to join the more advanced class there was no aggressiveness just Natural exuberance and he came back to me immediately.  Big sigh of relief and happy smile.
Annie