My dog has SRMA

[limvolution]

My dog has SRMA and has been on Prednisone. When she was first diagnosed, she started off with 40mg/24hr. She weighs 34kg. Every two months we tapered it off by 10mg so for example:

40mg/24hr For the month of January and Feb
30mg/24hr for the Month of March and April
20mg/24hr for the month of May and June

Now she has been on 10mg/24hr for the last two months and has been doing well.

I was wondering what the next step would be? I've just recently come across this forum and saw the Prednisone Taper Guide and so I was wondering if I should give her 5mg/24hr for the next two months or if I should give her 10mg every other day.

Thank you in advance
-Eric

[Jo CIMDA]

Hi Eric and welcome

I am sorry your dog has had SRMA.  It is good that she is doing well on the drug regimen she has been on.
the usual starting dose is 1mg/kg/every 12 hours so she has done remarkably well to have got this disease under control on such a low starting dose.  Perhaps the longer duration before each reduction has been beneficial.

The  Michael J Day immunosuppressive protocol is the best I have come across and it seems to optimise the control of the disease and also the side effects of the drugs, but it is only a guide and the regimen has to be tailored to the individual.

When you get down to such low doses, as your girl is now, as long as the dog is doing well and is not showing lots of side effects of the steroids then you have options and often the slower you reduce the dose at this stage the better the outcome, but it does depend on how she is coping with the drug side effects.  I am not a vet but my preference would be to reduce to 5mg a day before going over to every other day dosing, but there is no right or wrong answer. You can even take it slower and reduce the dose by say, 2.5mg a day for a few weeks before reducing it again. 

I believe if you can take it very slowly at the end stage, it helps to maintain homoeostasis.

Jo

[limvolution]

The only side effect I've noticed from Prednisones was her lack of muscle strength.

As I lower continue to lower it, am I likely to see her strength come back?

I guess the main question is: does Prednisone lower the strength of dogs?

Thank you once again Jo! I appreciate you and this forum.

-Eric

[Jo CIMDA]

Hi Eric

Yes prednisolone does weaken muscles, but when she is off them she will start to regain that strength and she can be as strong as before she got SRMA.

So that is the good news.  She has done well.

Jo

[RandyMan]

My dog has taken prednisone often this year for an unknown autoimmune disease, and it did make him very lethargic and depressed.  However, once he was finished with the regime, he began to have a lot of energy back and was very happy. 

Our vet suggested a taper like this:
1 pill for 7 days
1/2 pill for 7 days
1/4 pill for 7 days

That worked well for our dog! I wish you the best with your pup!

[limvolution]

Hi Jo! We are now at 2.5mg every third day. She is looking really good and having more energy. How long do you recommended I keep her on this schedule for? I was thinking for about four weeks but maybe it's better to go even slower at the last stages?

Thanks in advance
-Eric

[Jo CIMDA]

Hi Eric

That is really great news.  It is quite incredible how the last few months can fade into a distant memory when they are in remission and on a low dose of preds. 

Prednisolone is an incredible drug and I believe it is still the drug of choice for treating inflammatory AI diseases but it can take it's toll, especially if the protocol is not ideal and even more especially if the dog is large like you girl. So it is good to know that she is doing well.

I posted an answer to a similar question a few days ago.  I have altered it slightly to your specifications.

When you get down to very low doses of prednisolone there are many different ways of reducing the dose, and generally none are wrong.

2.5mg pred every third day is not a dose that will have much significance, especially in a dog of your girl's size,  but when a dog has been on pred for a long time it is always best to take the final reductions very slowly - so that it is hardly noticeable.

So some options could be:

2.5mg  every third day for a month and then you can go to every 4th day, if you wish, and then 5th etc.,

Some people would stop it altogether after a period of every third day dosing.  When you get the dose down to every third day, there is very little therapeutic effect because the duration of biological effect of prednisolone is 12-36 hours.

2.5mg pred every third day could be reduced to 2mg every third day, then after a month or so reduced to 1mg every third day etc...... until you feel it is time to leave it off altogether. The biological effect of this low dose is negligible.

And there could be many other permutations of an end stage prednisolone reducing protocol.   Throughout this time watch her closely for any changes.

  A dog that has been on steroid therapy has to be slowly weaned off prednisolone to allow the dog's adrenal glands to kick back in and function normally again.  Some dogs will have no problem in their adrenal glands resuming normal function again, but others can take a while and as there is no way of knowing if a dog's adrenal glands will start to function at a normal rate straight away.  I think it is better to take the last stages of the drug reduction slowly to maintain a good internal balance and stability.

This is a good stage to be at. 

Jo

[limvolution]

Hi Jo,

My dog has been off prednisone for about two weeks but now has been getting redness on your foot(currently both her back legs) and one of her legs looks swollen. Could this be one of her permutations?

I took her to the vet and they recommend that I put her back on prednisone but I would hate for her to be back on prednisone again. Currently I'm soaking her foot in Chlorhexidine everyday.

Could this be her autoimmune disease attacking her body again?

Thanks in adavnce,
Eric

[Jo CIMDA]

Hi Eric

Clinical signs of inflammatory autoimmune disease will mostly be symmetrical so what you are describing is unlikely to be a flare up or a relapse especially is she has a normal temperature.   Sometimes high doses of prednisolone can cause ligament problems and at worst, ligament rupture.  Has your vet considered this?

If the redness on her feet continues then it might be worth having a sellotape test or a skin scrape to see if there are parasites present such as demodex.  Demodex can become active when a dog has been on immunosuppressive therapy because the immune system isn't able to keep it in check.  If she has demodex then the worst thing you can do is to give her prednisolone again.    I would certainly treat her with Chlorhexadine and other speculative topical treatments.  If it is not demodex then,  if appropriate, ask your vet for some Fuciderm ointment.  That might solve her red skin. https://www.viovet.co.uk/Isaderm_formerly_Fuciderm_Gel_for_Dogs/c174/

I do hope you see an improvement very soon.

Jo

[limvolution]

Hi Jo,

She does have a high temperature and is a bit more lethargic.

I will go check to see if she has demodex.

If she has to be prednisone again, what kind of schedule would you recommend?
Would she have to go back to the Michael J Day reduction protocol?

Thank you,
Eric

[Jo CIMDA]

Hi Eric

It is sometimes hard to differentiate between an infection and an inflammatory immune response.  The symptoms can be very similar. An AI response is likely to carry a very high temperature, higher than one might expect if the clinical signs are due to an infection.

If a relapse is suspected, but you are unsure, then I would ask the vet to give an immunosuppressive shot of a steroid called dexamethasone, and a perhaps a general antibiotic.  The antibiotic should address infection, and protect from bacteria taking hold, whilst the immune system is suppressed by the steroid.

Dexamethasone is a long acting steroid that lasts up to 48-72 hours and the benefit is, if there is an inflammatory immune response going on, such as SRMA or IMPA, then you should see an improvement in clinical signs, possibly within hours.  If this happens then a relapse can be assumed and a full course of immunosuppressive treatment can be started, such as the Michael J Day immunosuppressive drug protocol.  If there is no significant response then you do not have to wean the dog off steroids.

Good luck

Jo

[Jo CIMDA]

PS.  High temperature and lethargy are significant symptoms of an inflammatory immune response.  Does she also have stiffness in her neck/limbs and appear to be in pain?

Jo

[limvolution]

Hi Jo,

I believe it is demodox mange because it's now affecting all her feet.

What are some treatments you recommend? or do you recommend she be back on a prednisone schedule?

Eric

[Jo CIMDA]

Hi Eric

If your girl has demodex then it has to be treated, and the worst thing is to put her back on to prednisolone because this
will most definitely exacerbate the problem and allow the mites to take hold even more.  Demodicosis is an unfortunate spin off of being treated with immunosuppressive drugs. A good immune system keeps these mites dormant so when a dog is treated with prednisolone it allows the demodex to take hold whilst the immune system is being suppressed.  You resolve one thing and end up with another problem.  It is not uncommon.

Ivermectin is the most widely used drug to kill demodex (there are others on the market) but, I don't know what breed of dog your girl is, you must make sure she does not have the MDR1 gene mutation.  This can be tested by a simple cheek swab. I have recently discussed this subject on the forum.   If you are in the UK you can get  the test done at the AHT:

https://www.ahtdnatesting.co.uk/tests/mdr1-ivermectin/

If the  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 bathe her feet or dab it on the affected areas.  You have to be very careful about the eyes though. As far as I know,  Aludex can be used on all dogs.   If the demodex is generalised and Ivermectin or another chemical has to be used, and your girl is a breed that is known to be have this gene mutation, then please have a cheek swab done beforehand.

http://www.vetstreet.com/dr-marty-becker/multidrug-sensitivity-what-you-need-to-know

http://www.ashgi.org/home-page/genetics-info/faq/mdr1-faqs

  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 eradicated, but when the mites have gone it should be given every month.  This and other treatments for demodex have to be discussed with your vet, but I suggest you do your own research too. 

One thing for sure, you must treat this infestation asap because it can get out of hand.  I have first hand experience of demodex infestation that I couldn't treat properly because my boy had the MDR1 gene mutation and it became impossible to control.

Jo