Autoimmune Disease

[Guest Giselle]

After years of misdiagnosed symptoms, the specialist has concluded that Giselle has an autoimmune disease. I'm glad it is not cancer or congestive heart failure, as those were the other possibilities that the regular vet proposed. But it's not terribly happy news.

 

Anyone have experience with autoimmune diseases in greys and/or other breeds?

 

Also: Giselle is severely underweight and has recently developed pressure sores on her hip bones. Any tips on how to get her back to normal? Without any further discoveries, the specialist has advised to go through a 1-month trial of Prednisone. Will this alone help her gain back weight or should I think of supplementation? Thanks for any info.

[JJNg]

"Autoimmune disease" is a very vague and general term. What symptoms has Giselle been showing, and what autoimmune disease did the specialist diagnose her with? Autoimmune, or immune-mediated, disorders can be triggered by underlying chronic infections, and with a grey, I might be suspicious of some kind of tick-borne disease.

 

Prednisone can actually cause weight loss in greys, so I would be very cautious with this. Is her appetite good? What organ system is affected, and what does the vet think caused the weight loss? I hope Giselle responds to treatment and that she makes a complete recovery.

[Hubcitypam]

"Autoimmune disease" is a very vague and general term.

I agree with that. My first grey went from fine to dead in 48 hours from immune mediated hemolytic anemia. It strikes cockers and other breeds far more than greys but middle aged bitches like Girl are most likely to die for some reason. My niece that is an RN said something similar happens to young Hispanic humans and Lupus. They just go down.

 

Indy, a grey that I adopted out was diagnosed with Lupus and lived a fairly good life for two or three years.

[Guest KennelMom]

I agree...what does "autoimmune disease" mean...there are many types and causes. As for prednisone...I use it very carefully in our greys. Some tolerate it OK, some will become walking skeletons in no time (BTDT). One of our old guys who's now at the Bridge had an auto-immune issue secondary to a tick disease (Ehrlichia)...he would have flare-ups where he'd get these horrible scabs around every orifice of his body....eyes, nose, mouth, etc. At any rate, the prednisone resolved the auto-immune symptoms but he dropped weight at a dangerous rate at even a very, very low dose. He ended up needing a dose of doxy every day to keep the tick disease at bay. The original Care of the Racing Greyhound makes reference to using prednisone very carefully in greyhounds...there are some drugs that I'm willing to throw at symptoms and see if it helps, but pred usually isn't one of them due to our personal bad experience with it.

 

So, in a nutshell, I wouldn't throw prednisone at some thing if my vet couldn't give me anything more specific than "autoimmunity"...I'd want to know why or what they suspect is causing it. You may have already had that discussion with the vet, but just wanted to throw that out there.

 

BTW, with auto-immunity, I'd move to a grain free food if you aren't already feeding one.

Edited February 9, 2011 by KennelMom

[Guest Swifthounds]

Was there an actual diagnosis? Autoimmune is a "catch-all" for a wide range of things.

[Guest SoulsMom]

I agree, need more information as to what kind of 'auto-immune' and the symptoms, etc . . . .there are many holistic ways to treat auto-immune disorders and the number one way to treat it with medication is the Pred. I don't know about in caninies, but in humans infection has to be MUST be ruled out before starting the steroids.

 

Soul has Discoid Lupus and possible Systemic Lupus, though I haven't done the tests to confirm because it's under control. Also my Father passed away from a mis-diagnosed auto-immune disorder.

[IndyandHollyluv]

I am sorry to hear about Giselle's woes - but I agree, sounds like you could use more specific info with respect to this vague diagnosis.

 

Just a few rambling thoughts:

 

I suppose Pred can be a lifesaver but a vet prescribed a brief course for one of my hounds who had LS and back / hind-end issues. He was miserable, drank a ton of water, peed up a storm (bloody at times) -- and didn't appear to feel any better. I voted "no" on any more Pred for him.

 

Last year I adopted an older male hound who has skin growths, gut issues (e.g., absorption?), bloody stool, burps. Low thyroid function. So trying to figure what is causing what (and have made some progress by changing his food and supporting his thyroid). He is also rather slim and I am trying to keep him from losing any more weight.

 

So depending on what Giselle likes, might I suggest adding some canned food (one of the chunky stew versions - Merrick, Wellness, Avoderm, others) - to her food. There are low-glycemic and grain-free canned products available. For dinner, I warm up some canned food and cooked vegetables and mix it in with the kibble. Makes a nice warm stew-like meal. My hounds get very excited at dinner time! May not be super high-calorie but the aroma and combination of yummy foods is very enticing.

 

Obviously, there are other high-calorie options but I haven't had to go down that path yet.

 

Also I don't know if anyone offers this service in your corner of the world but I also took my boy to a vet who does nutritional analysis testing (I'm in Michigan). The objective is to identify what food is or isn't working for your pooch and then consider possible dietary or organ supportive supplements. (I had a holistic doctor who tested me years ago.)

 

So there may be some alternative holistic options you could explore. Traditional veterinary medicine is what it is.

 

Not quite sure what Giselle's primary issues are and I don't know if you feed raw or commercial - but if commercial I certainly would be sure to eliminate wheat, corn, soy, and dairy from her diet.

 

Hope your girl feels better soon. Let us know how she does.

Edited February 9, 2011 by IndyandHollyluv

[Trihounds]

Bumper has an "autoimmune" disease which is being successfully treated with Dexamethasone. He had a flare up last week, we increased the dose (under vet guidance) and it seems to be working well. His issue is swelling in his spine with cause unknown.

 

I'll check the thread back when you have more details posted.

[DesiRayMom]

Please be careful with Prednisone. Sometimes it makes the appetite greater, but with my bridge boy Gringo & now with DesiRay,

a course of Pred just made weight fall off.

 

edited because of spelling.

Edited February 9, 2011 by DesiRayMom

[Guest Giselle]

No specificity as to what type of autoimmune disease it may be, partially because so much is unknown anyways. Also partially because we haven't done tests to determine whether it is related to a tick-borne illness. I know there's always a risk, but we do live in a very low-risk area and Giselle has been on flea/tick preventives. In my entire experience, I've seen only one tick on my dogs, and that was one time several years ago (5 years?) on my Pekingese. Not to say the risk isn't there, but the internist said it might be in our best and most economic interest to treat her rather than do a full panel that may prove fruitless. So.. all I know is "autoimmune disease". FYI, her symptoms have been recurring for years, but it's basically:

- pitted edema in both front legs

- severe skin/coat problems/frequent inflammation

- recurring weight issues

- wounds that won't heal (this one really bugged me; her regular vet just didn't care about this but I knew something was always wrong)

- fairly severe pressure sores (again, extreme difficulty in healing)

- lack of energy

- heavy panting with minimal physical exertion

- she also has a heart murmur and was found to be anemic in her most recent blood panel. And regular vet #2 found her to be hypothyroid, but we're questioning that now...

 

So, the biggest issue that we're dealing with now is the pitted edema, which they initially thought was due to a joint infection. They did a joint tap but the synovial fluid looked fine, so they sent out a sample of the fluid in the actual swollen area of her leg (which had a red-tint and looked suspicious), instead. The internist talked to the nearby dermatologist and said it was indicative of a skin infection, which they hinted towards being a secondary symptom of whatever autoimmune dysfunction she has. We get lab results back in 3-5 days. Maybe then we'll have a better idea of what autoimmune disorder it is? 'Til then, it's a brief trial of antibiotics and perhaps Prednisone (I still have to talk to him about it; will ask about other types of immunosuppresant drugs). She's in bad shape. I honestly don't care what meds she has to take right now to get her to normal, but she needs some type of immunosuppresant. She is less than 80% of her normal weight. Three medical professionals glanced at her and said, "Wow. She just looks cachexic." sigh

[JJNg]

Is Giselle a retired racer? If so, tick-borne disease (TBD) is very high on the list of possibilities even if you are in a low-risk area. They can be exposed while at the track, and many of the TBD can remain inactive for years before causing problems. With my grey who was suspected to have a TBD, I'd had her for 3 years when she got sick, and I'd never seen a tick the entire time I had her. I understand that testing for TBD can be frustrating and often low-yield, but if she were to test positive, you might have a definite diagnosis. There are full panels available these days that aren't all that expensive (probably around $200). The lab at NC State is very good, and Antech also has a fairly new PCR panel.

 

What antibiotic are you treating with, and how long of a course? Has an echo (heart ultrasound) been done to assess the heart murmur? What other testing has been done over the years? What treatments have you tried, and what was her response?

 

Have you consulted with Dr. Couto at OSU? With the suspicion of TBD, you might also consider consulting with Dr. Ed Breitschwerdt at NC State (or have your vet or specialist contact him). When my girl Willow was sick last year, both of them were very helpful. With Willow, we were never able to get a definite diagnosis despite doing multiple tests (PCR, titers, as well as cultures) for TBD but we were very suspicious of Bartonella, which is a fairly newly recognized problem. Previously thought to just cause 'cat scratch fever' Bartonella has now been shown to cause a number of other systemic problems in dogs, as well as humans, and a number of other species.

 

While Willow's symptoms were much more acute and not quite the same as Giselle's, there are some similarities, so you may want to ask your specialists about Bartonella. In some human cases, it has caused a number of non-specific chronic problems that were often misdiagnosed for years - this has been a hot topic in vet journals recently as vets appear to be at higher risk of contracting Bartonella due to contact with animals that may be carrying it.

 

With Willow's illness last year, she started off with a right front lameness and by the end of the day, the lymph node in her right arm pit and right side of her neck had become swollen with associated edema. Over the next few days, the rest of her lymph nodes also became mildly enlarged, and pitting edema progressed to both front legs, her jaw/face, and also very mild edema in her back legs as well. She was very painful in the area of her right arm pit extending to the side of her chest behind her elbow, and the skin over that area became red and ulcerated.

 

Biopsies of the lymph node and abnormal skin only showed granulomatous inflammation of the lymph nodes and panniculitis/dermatitis (ie. inflammation) in the skin. She was on Clavamox after the biopsies, but she continued to get worse and the biopsy sites dehisced and opened up. The internist I was working with became suspicious of Bartonella and recommended we switch antibiotics. We put her on a 6-wk course of doxycycline and azithromycin, and within days of starting the new antibiotics, the skin and biopsy sites started to improve.

 

Willow continued to recover on the antibiotics, but a couple weeks after finishing the 6-wk course, she had a relapse but with different signs. She developed a generalized muscle soreness, fever, and then generalized joint swelling. Joint taps showed an inflammatory response, and the internist suspected immune-mediated polyarthritis secondary to the suspected Bartonella infection. (Repeated the Bartonella testing at this time, but it was still negative, but apparently false negatives are quite common.) Dr. Breitschwerdt, the TBD expert at NC State recommended using Baytril and doxy the 2nd time around because research showed Bartonella often became resistant to azithromycin quickly.

 

We treated with an 8-wk course of Baytril and doxy. Internist also wanted to start immunosuppressive doses of pred, but I was not comfortable doing that with the possibility of ongoing infection. After over week on the antibiotics, the fever and joint swelling still weren't improving (in fact, getting worse), I finally did start her on pred, but at a low anti-inflammatory dose, NOT immunosuppressive. The joint swelling and fever went down within a couple days of starting the pred. To help support her immune system and hopefully prevent another relapse, we also did acupunture and Chinese herbs. Even with the low pred dose, we did a VERY slow taper and weaned her off over a period of about 4 months. She's been off of all meds since last Sept and is completely back to normal and doing great now.

 

Anyway, I hope you're able to find some answers for Giselle. And maybe someone can benefit from my experience with Willow - it sure was a learning experience for me as well!

[Batmom]

How far north in CA are you, and where did Giselle come from?

 

What antibiotic are they giving?

 

The group of symptoms you describe could be autoimmune, but really read more like an infective process. I would get a tick panel -- one of the comprehensive fastpanels from Idexx or Antech; these cover more organisms than others -- and possibly a Valley Fever test as well. If she's taking thyroid meds I would stop those.

 

Hugs and best luck with your girl.

[Trihounds]

IF you continue down the autoimmune route, the other immunosuppressants I am aware of are Dexamethasone and Imuran, the latter apparently being very good but very expensive. As mentioned above, Bumper has been on Dex successfully and without significant impact to his body for 20 months - but his maintenance dose is a low one. Good luck - hope the results you are soon to receive help some.

[Guest KennelMom]

With the suspicion of TBD, you might also consider consulting with Dr. Ed Breitschwerdt at NC State (or have your vet or specialist contact him).

 

he's awesome. our vet in NC consulted with him with Grandpa's autoimmune issues related to his tick disease. NC State is where we run all of our tick panels through...$200 sounds about right.

 

I wouldn't rule out a tick disease...they can lay dormant for many years. Even after successful treatment, they can flair up later in life. When we were going through all that stuff with Grandpa, it was explained to me by our vet after consulting w/NCSU that it's believed the organism may "hide out" deep in various tissues.

Edited February 10, 2011 by KennelMom

[fsugrad]

Last year. our Robin started getting red, scaly spots on his ears. Then his ears started going bald. Then the red bumps spread onto his torso and front legs and face, and he started losing hair there too. He also started losing weight/stopped eating (approx 13 pound weight loss). He was miserable and was a total mess.

Everyone thought it was mange or a TBD related problem. Tests kept coming back negative for everything our vet checked him for. Until we took him to the Univ of FL Vet School and they biopsied some of the red bumps and we learned that he had an autoimmune disease....pemphigus foliaceus. Long story short, he took an unbelievable crapload of prednisone and antibiotics for a couple of months. The pred completely shut down his immune system. The good news with that was that it stopped his body from attacking healthy skin cells and allowed him to heal. The bad news is that, with no immune system, he developed a horrible staph infection in his front right leg, to the point where the joint swelled up painfully and he couldn't even walk on it, and ended up in ICU at the vet school for 4 days.

At first they thought we'd have to keep him on a maintenance/preventative daily dose of prednisone for the rest of his life, but they decided that since he went into remission, and is doing beautifully, to keep him off meds and only treat him if/when he flares up again. We are hoping and praying he stays in remission.

 

Here are links and pictures from our ordeal with Robin last year.

http://forum.greytalk.com/index.php/topic/260532-robin-is-a-total-mess-our-poor-baby/page__hl__pemphigus

 

http://forum.greytalk.com/index.php/topic/262504-the-robin-update-pemphigus-treatment-new-pics/page__p__4714878__hl__pemphigus__fromsearch__1#entry4714878

 

http://forum.greytalk.com/index.php/topic/262833-robin-is-home-from-the-hospital/page__p__4721721__hl__pemphigus__fromsearch__1#entry4721721

 

He gained all his weight back and as another GT'er told me recently, you'd never even believe he'd been sick. Thank God!

Edited February 10, 2011 by fsugrad

[Guest Giselle]

Wow, Jennifer, your story doesn't sound that far off from Giselle's. I don't have much time to respond because I have to leave in about 5 minutes, but just wanted to update that the vet called with half of our lab results back and they do indeed think it is immune-mediate polyarthritis. We've yet to get results back regarding the actual fluid in the swollen area. I asked him again about the possibility of it being a tick borne disease, and he said that, given this situation, it's probably best to treat first rather than do tick titers. I'm going to wait until the last half of our lab results are back, see what they have to say, and then consider tick titers again if they think it'll produce a good clue. You know, I totally forgot about being exposed to ticks at the track... I think the vets did, too. They know she's a retired racer, but that totally slipped my mind.

 

Re: heart murmur. Yes, she went to a cardiologist who agreed that she has a mild heart murmur. It's very slight, so there's nothing we can do about it. Chest x-rays show typical but mild signs (slight enlargement, thinning of the walls). It hasn't gotten much worse in the ~2 years that she was diagnosed, so it's not a major concern here. Will answer other questions later and read responses more in depth later. Thanks everyone

[sweetdogs]

Here are some links about bartonella, a case study & Dr. Breitschwerdt.

 

FWIW based on personal (human) experience, I don't believe in "autoimmune". I think everything is infectious & needs an inquisitive vet/doctor to beat it back with antibiotics. If Giselle does have some tickborne disease or co-infections, immune suppressants are contra-indicated (except at low doses) so just give it some thought before going down that path.

 

I hope you find a good treatment option soon for beautiful Giselle.

[turbotaina]

It's probably too late now, but I'd do the tick panel, regardless. It just takes a few seconds to draw the blood for it and if you put it off, then it's that much more time wasted if the other options don't work. I just don't get the vet's reasoning behind not doing the panel.

[greypuppyluv]

It's probably too late now, but I'd do the tick panel, regardless. It just takes a few seconds to draw the blood for it and if you put it off, then it's that much more time wasted if the other options don't work. I just don't get the vet's reasoning behind not doing the panel.

 

I agree. Plus, the different TBD are treated with different meds. No one med covers all the TBD. Giselle could have Babesia, but if you treat her with say, doxy, you won't be helping her.

[greypuppyluv]

I forgot to mention that Protatek Labs used to offer a reduced rate on TBD testing for greyhounds, so that may be something you or your vet may want to look into. I'm not sure if Dr. Cynthia Holland is still the contact there, but she used to be a wealth of information on the TBD and Valley Fever.

[Guest Giselle]

Thank you for the resources. Will discuss options with specialist and am studying autoimmune diseases in the meantime. It pays to have a well-resourced relative I just got two autoimmune textbooks on .pdf. Wahoo! Granted, I won't understand EVERYTHING, but I'd much rather have the cut and dry definitions to go off of than a variable interpretation from Mr. Random. They are also (un)fortunately based off human autoimmune diseases, so there isn't much on tick-borne illnesses. It only talks briefly about how tick bites break the dermal barrier and introduce pathogens into the mammalian body.

 

As for our location, we are in the SF Bay Area, and I plan on consulting with my mentors about it, too. One is also connected with UC Davis school of vet med and, if I ever need a second opinion or researcher's opinion, that would be my preference. I'm actually out of town and family picked up Giselle from the vet and is taking care of the dogs now, so I don't know the exact dosage or type of antibiotics she was given but I should be back tomorrow evening. From what I've read from those with autoimmune disorders, it does sound like an appropriate dose of immunosuppresants is the most effective avenue of action. I will discuss tick titers with the specialist again (he should call in 24-48 hours). He had slight qualms with prescribing prednisone because of the risk of further infection, so she's not on anything now. But we've got to come up with a plan within the next few days; just waiting for the next half of lab results...

[greyhndz]

Autoimmune disease - I have more knowledge than I'd care to admit.

 

But first, I'm so excited to see jjng on GT! I first met Jennifer early in January, 1998, when she brought a very special delivery all the way from home in SC, to Boston. She'd been a freshman at MIT at that time. On one of the coldest nights of the year, I went to Cambridge to meet Jennifer, because she'd brought home my new iggy Lexi.

 

 

 

 

Lex is also servng as the face of a dog who lived with autoimmume disease. Even though I lost Lexi to immune-mediated polyarthritis and renal failure in 2009, and even though I lost touch with Jennifer for many years, she's always been Lexi's godmother. Now, she's been a vet for a number of years and has also been converted to Greyhoundism.

 

Jen, you're a very welcome member of GT, and I know will be a greyt resource!

 

I am living with autoimmune disease myself, and shared Lexi's journey with her own IMPA, by working with a vet from Angell to stabilize her polyarthritis. I can tell you that it's a challenge reaching the correct diagnosis, ruling out any underlying infection, and then playing the steroid game. As in humans, the goal in autoimmune dogs should be remission with a steroid-sparing treatment plan. Steroids often have to be used during the acute stage, and for disease flares, but given he many potential side effects of steroids, getting the dog off steroids,and onto a different type of immunosuppressant/immunomodulator/ These meds include azathiaprine (Imuran), cyclosporine, leflunomide, cytoxan and"biologic"agents,such as Remicade and Enbrel. It's not that these meds don't carry the potential for serious side effects of their own, but they're still superior over steroids.

 

Autoimmune diseases can be challenging to manage. They require frequent bloodwork and follow-up, It can take a while before the right regimen is found. But if you can achieve remission off steroids, that's the optimal goal.

[JJNg]

Give the possibility of some kind of infection/TBD, I'd consider asking your specialist about starting with a lower (anti-inflammatory) dose of pred instead of jumping straight to immunosuppressive therapy. This was what we did with Willow, and she responded immediately to the low dose of pred. Despite the fact that she had immune-mediate polyarthritis confirmed by joint taps, she never needed immunosuppression because I still believe that the primary underlying problem was infectious.

 

Giselle's case may be different, and she may still eventually need immunosuppressive drugs, but starting with anti-inflammatory doses of pred may be a safer way to go. If there is an underlying infection, suppressing her immune system may allow it to spread out of control. Especially with the strong suspicion of Bartonella in my girl, I was strongly against going straight to immunosuppressive therapy because Bartonella is known to cause endocarditis (infection in the heart valves), which is difficult to treat and often fatal.

 

When deciding between immunosuppressive vs. anti-inflammatory doses of pred, I asked our internist what the disadvantages would be to trying the lower anti-inflammatory dose first. He said that the only drawback would be possible resistance so that if we did have to immunosuppress later, she might not respond as well to a higher dose of pred. However, with a number of other immunosuppressive drugs available, he said this didn't bother him and he was fully supportive of going with the lower dose first.

 

Also, I do understand your preference to work with local specialists and researchers, but I would really encourage you to contact Dr. Couto and/or Dr. Breitschwerdt. Given greyhound medical idiosyncrasies, and differences in regional experience with TBD, consulting with specialists who are very familiar with the breed and with TBD can make a huge difference. Dr. Couto's team at OSU is really easy to contact through their online submission form:

https://greyhound.osu.edu/article.cfm?id=6238

 

When I emailed Dr. Couto with Willow's signs, Bartonella was one of the things he mentioned as a possibility right from the start. While we weren't able to confirm it, she responded so well to treatment that we are all convinced that's what she had. My contact with Dr. Breitschwerdt was mostly via our local internist, but he also helped out a lot with antibiotic choice, as well as the question of whether or not to use pred and at what dose.

 

Here's another article on Bartonella:

http://www.cvbd.org/3952.0.html

 

(ETA: Another reason I did not feel Willow had a primary immune-mediated/autoimmune disorder was because of the multi-system involvement. While there are autoimmune diseases that can affect multiple systems (like systemic lupus), most specifically target one type of cell (ie. RBC in immune-mediated hemolytic anemia, skin in pemphigus foliaceous, joints in primary immune-mediated polyarthritis). With involvement of lymph nodes, skin, and joints, I believed that a primary infectious cause was much more likely. And while you haven't mentioned any lymph node involvement with Giselle, the recurrent edema does suggest some affect on the lymphatic system.)

 

Good to see you on here, Jordan! That photo sure brings back memories as it was taken in my brother's apartment the night we arrived back in Boston from SC.

Edited February 12, 2011 by jjng

[robinw]

I would also do a tick panel. different tick diseases are treated with different meds. Phoenix had babesia, which is treated very differently than other tick diseases.