greyhndz

Only problem is that 30mg of pred is very subtherapeutic. A true anti-inflammatory dose for Beau, using 66 lbs/30kg as his weight, would be 1-2mg/kg every 12 hrs, meaning 30-60mg twice daily to start with, and then a very, very gradual taper. A summary of info about this disease: WSAVA article on polyarthritis

They did, Jenny. That's how her vet determined that she has an inflammatory arthropathy. They also cultured and presumably checked for spirochetes and other organisms but didn't find anything. Joint taps are our friends.

Sorry that you, too, are in this "club" Alexandra. But the more info we can all share with each other, the more we can all learn. Medrol (aka methylprednisolone) is what Lexi has been on, too. She was initially on pred, but because of an Imuran-induced hepatitis, her liver enzymes were quite elevated, and she also has renal disease. The vet switched her onto medrol which is less toxic to the liver. She's done well on it, and her liver enzymes did normalize. Be sure, though, to ask your vet about a long-term plan for your boy, to keep him in remission OFF steroids (if possible). This is where meds like Imuran, cyclosporine, leflumonide, methotrexate, etc. come in.

My pack goes to PAH as well. I think we're sponsoring the addition of a fancy new wing of the hospital. My current pack is 4 galgos (from SOS Galgos in Barcelona), 1 retired broodie from GAF in Fla, and 3 iggies, all rescues. My original pack from the early to mid '90's came from GAS. Do you volunteer with GPS CNH? Jordan

Hmmm.. we identify strongly with pissy up here. I do pissy very well. i've been PM'ing with Robin about this, as my iggy was diagnosed with immune mediated polyarthritis last year, and I've spent the better part of that time researching my whoozits off. IMPA dogs aren't necessarily resigned to a lifetime of pain. Beau's case is more complex because of his IBD, and may require trials of different meds, different doses. I didn't recall his being on Imuran since january. I wouldn't be discouraged but I'd discuss seriously with the vet whether it might be appropriate to change him to a different immunomodulator. The fact that he had an acute flare of IMPA while on both Imuran and pred suggests to my fried little brain cells that his immune system continues to be in overdrive, and isn't adequately controlled. There are other meds to turn to besides Imuran - cyclosporine is commonly used, and there are several others. Lexi has been on leflumonide and is finally at the point where being entirely off steroids is at our fingertips. The ultimate goal should be to have Beau steroid-free. Steroids are nasty drugs with nasty side effects. Some dogs will always have to be on a steroid, but it's still important to try everything possible to get them off. The specific med protocols vary from vet to vet, but most of the articles I've read, and Lexi's prescribing vet, recommended a very gradual steroid taper over 6 months. Her initial dose was 2 mg/kg given twice daily, and she's about 10kg (21 lbs), so she was started at 20mg twice daily, then very gradually tapered down over 6 months. Approx 50% of dogs will go into remission after this 6-month course of steroids, so there's a fairly high rate of relapse, and indeed, Lexi relapsed within a week of stopping the pred. She was then put onto a 3-month steroid taper and started on Imuran, which made her very ill and set her back for several months. She was quickly started on another immunomodulator called leflumonide, which she has tolerated well. She has not (knock on wood) had another flare. Most immunomodulators take from weeks to months to become effective, so Beau will certainly need to be on steroids at least until then. You might want to ask your vet about bumping the pred up, given this new diagnosis, and then working on finding a different immunomodulator in place of Imuran. The important factor in all this is that you want to have a vet who is comfortable and competent in managing these medications. Many vets (and human health care providers) do not have experience prescribing this type of chemotherapy, and you want to have a vet who is well-versed in the use of these drugs, as well as management of autoimmune diseases. Usually, it's the internal medicine vets who have this type of experience. In human medicine, it's typically rheumatologists or immunologists. There *is* hope, there *is* reason to believe that Beau can have a very good quality of life. We with autoimmune dogs just learn that some days will be better than others, and that ups/downs are a fact of life. We get better at recognizing early signs of "flares", and being aggressive about treating them and looking for a cause, so our pups don't crash and burn. And to prove that these IMPA dogs really do bounce back (literally), the link below takes you to a video of my Lexi. She had been diagnosed with IMPA 3 days prior, and started on steroids 2 days before the video was taken. She had been barely getting around, having pain going up/down stairs, lethargic, acting like a sick dog. And then suddenly, she's ba-ack! (she's the seal/white missile on the right) Lexi on drugs!

Wow. Robin - check your PM!

It's all coming into place, Robin... the joint fluid is so valuable for diagnosis. They can even base a diagnosis upon the viscosity of the fluid itself. Autoimmune dogs form immune complex that circulate throughout the blood, and can settle into various organ systems, such as bone/joints, soft tissue, heart, kidneys, skin, etc. It's a fascinating process, unless you're living it. When iggy Lexi was diagnosed with IMPA, we also discovered chronic renal disease, likely a result of the above process. If you get to the point where you need more info on IMPA, let me know - I've got tons of studies and journal articles and websites that I'm happy to share. The initial treatment of choice is high-dose steroids, tapered slowly down over approx. 6 months. IN the meantime, an immodulating agent (such as azathioprine, cyclosporine, leflumonide, etc.) is introduced so it will be effective at the time the steroids are stopped. Answers are so close!

Welcome, Jen! I'm an almost-neighbor, in Pembroke. Jordan

If the cytology you're referring to is fluid from a joint aspirate, that should be your ticket to a diagnosis. They can culture this fluid directly to r/o infection (including spirochetes and any other TBD), as well as a bacterial infection causing a septic arthritis. I most definitely agree with starting the doxycycline empirically while waiting for the analysis to come back. Can't hurt, may well help, and you'll usually know within a couple of days whether it's helping. I'd also give thought to the fact that, with his IBD, Beau is already an "autoimmune" dog. Just as in humans, an autoimmune disease may present in other organ systems, and with what you've described as a migrating pattern of joint pain/swelling, this might be classic for an autoimmune (or immune mediated) polyarthritis. Type III: - IPA associated with gastrointestinal disease (enteropathic form). The diseased gut may show an increased permeability to potential antigens which could stimulate the production of immune complexes. Hepatopathic arthropathies have been described as well. The joint fluid analysis should show particular changes that go along with systemic inflammation. An immune mediated polyarthritis would also present with fever, lethargy, lack of appetite, and generalized owie-ness. BTDT with my iggie, who my vet and I were sure had disseminated Lyme. Months on antibiotics still resulted in relapse until it was pointed out by a specialist that it was the steroids giving her brief remissions, not the antibiotics. Her Lyme titre at Protatek was low positive (1:640, per their values) so we kept treating for Lyme, until repeat titres showed a decreased rather than an increase. A joint aspiration and careful re-evaluation of her symptoms confirmed the diagnosis of immune-mediated polyarthritis. Can't hurt to mention to your vet the possibility of Beau's current symptoms being a part of the overall constellation of symptoms asso. with an autoimmune syndrome. (see above) I apologize in advance for saying this and contradicting your vet, but I have to suggest that combining any NSAID with a steroid, especially in a dog with IBD and an already-compromised gut, is potentially disastrous. If Beau is having a great deal of pain, either the vet should bump up the steroids if she feels this is inflammatory, or add on narcotic pain meds for better pain control. OK, I'll shut my big yap now.

My greyhound "niece" (Miz Susie's sister Miz Mandy, almost 12) may have an insulinoma -- a pancreatic tumor which secretes insulin and causes profound hypoglycemia. Her glucose (taken about 2 hrs after a meal) was 39 and 37, respectively, over 3 days, and she has had the classic symptoms (PU/PD, collapse episodes after excitement or exertion, etc.) The complete workup still has to be done (insulin/glucose ratio, abdominal u/s) and her owner already has a call/e-mail in to Dr. Couto and is ready to drive to OSU if that's the best thing for Mandy. We've done a lot of research on treatment options once the diagnosis is confirmed, but in the interim, Miz Mandy's mum could use some advice on hypoglycemic diets. She does know that small meals every 2-3 hrs, complex carbs, high in protein, is the way to go, but can anyone give her specific suggestions for a diet she can start using right now? Also, Mandy needs to avoid excitement or overactivity (they cause a precipitous decline in blood sugar, and collapse) - if Mandy does need to travel to OSU, can anyone recommend a safe means of sedating her for travel? TIA, and I'm sure Miz Mandy's mum would like to hear from anyone who has had a dog diagnosed with insulinoma. Hopefully she'll be posting here soon. Thanks, from worried auntie.

Hoping for a fast and full recovery for your pup! My sweet Robyn had an acute vestibular episode at age 14. As you've found out, it's frightening to watch, but even more frightening for them to experience. Within a week, Robbie was back to normal without a residual head tilt. My 11 year old iggy, Lexi, had an episode last year, which I mistook for a seizure because of her flailing and inability to move. She'd improved dramatically within 1-2 days, and completely recovered a few days later. this was lexi the day after... her head tilt was gone before the end of the week.

Glad to hear this! Please keep us posted on your baby!

As Jenny said, VF testing should go to a lab very well-versed in VF, and it sounds as if the lab in AZ is the way to go. Usually, joint fluid goes to a regular lab for routine analysis (viscosity, cells, routine culturing, etc.) Not sure if Protatek or NC State do TBD cultures on joint fluid. When Lexi had her joint fluid analysis run at Angell Memorial in Boston, they did all of the culturing either in house or at their regular outside lab. Is the joint red from licking, or is it red and warm, which might indicate an inflammatory process?

What Jenny said <g> Analyzing joint fluid will give your vet a lot of info - as Jenny mentioned, not only can it be cultured for multiple bacterial, fungal, rickettsial diseases, but looking at the viscosity of the fluid itself, as well as the presence of various types of cells, can quickly determine an inflammatory arthritis. Has your vet gone ahead and treated empirically for TBD with a course of doxycycline? Can't hurt, might very well help, especially diagnostically, as usually there will be some improvement in the first 2-3 days if it is TBD. If this turns out to be an immune mediated arthritis, the first line treatment initially is a long steroid taper, and the addition of one of the immunomodulating meds, such as azathioprine or leflumonide. Hopefully this won't be the case, though. You didn't mention if there are any systemic symptoms - such as fever, lethargy, loss of appetite, weight loss, etc.?!?!?

Coming from a human medical perspective (and also as the mom of an iggy with immune mediated polyarthritis), I'd be concerned about a 2 year old showing signs of degenerative arthritis, unless there were a known history of fracture or other joint trauma. There are several canine autoimmune diseases which can present this way, such erosive polyarthritis, rheumatoid arthritis or systemic lupus. The arthritis may also be due to an underlying infection (such as tickborne disease or, as Shanti's Mom is now all too aware, valley fever) so hopefully your orthopaedist has ruled all of these out. Drawing a sample of joint fluid out and sending it for an analysis can be very helpful in making a diagnosis. They do test for sedimentation rate, canine rheumatoid factor and ANA, and but negative results don't rule out an autoimmune or inflammatory disease. And these diseases are treated very differently than a degenerative arthritis caused by past trauma. This is a technical but excellent article about various causes of arthritis: http://www.vin.com/proceedings/Proceedings...5&O=Generic Best wishes and skritches to your baby!

I hope you get a definitive answer, Diane, and that Mizzy will be much more comfortable. Will she tolerate a therapaw or other bootie? I just got a set of booties for Susie from Voyagers, and if you think Mizzy will wear them, I'm happy to ship them out to you. I'm very anxious to hear how this turns out. If I can do any research for you, please let me know! Jordan

Not to worry. I routinely give iggy Bailey 3-4 drops. He'd probably have to ingest a bottle of RR to get a buzz on. The other thing I use for my iggies and Biggies when I want them to sleep or relax is melatonin. The tabs are 3mg, and I'd probably give an iggy 1/4 of a tab. Hope your sweetie gets better soon!

There are several liver support supplements out there. "Liver Support Factors" is an excellent one. I've been using sam-E for iggy Lexi with great results. I originally used Denosyl, but just switched to Vitality's sam-E with other supplements, as it's less expensive. I order these from Entirelypets.com as their prices are the best, and they ship very quickly. The sam-E brought Lexi's liver enzymes down from astronomically high to normal, and she's now on it permanently. Hope this helps!

Imuran is most definitely a possibility - not sure why your vet dismissed it. Lexi was on Imuran for 1 week when she developed drug-induced hepatitis; she stopped eating and was very ill, requiring IV hydration and a major change in strategy. It took her about 2 months to recover. Labwork (liver function tests) would indicate whether this is the case with Beau. Some dogs just cannot tolerate Imuran, but one of the other immunomodulators might work well for him. IMHO, I wouldn't stop Prilosec and carafate.

Sarcoidosis, according to the literature I just searched, only presents as skin lesions in dogs. We humans with sarcoidosis aren't so lucky - I've had pulmonary and ocular involvement. So it seems pretty safe to say that Jen's pup doesn't have sarcoidosis. Jen, a Fentanyl patch is a very potent narcotic which, once applied, remains on for 3 days. If your pup has bad reactions to narcotics, I'd be very hesitant to even consider Fentanyl. If he doesn't do well on it, you have to deal with removing the patch (difficult on its own) and waiting for the effects to wear off, which can take hours. My osteo dogs seemed to do well on tylenol w/codeine when tramadol was no longer working - you might ask your vet about this. I'm so sorry - I know that this is equally painful for you, though spiritually more than physically. Jordan

Light as a feather! What the heck are you feeding that boy?

I'm so terribly sorry, but what a beautiful tribute you've shared with all of us, of your Angel Boy. Run free on 4 strong legs, Stepper. You were deeply loved.

I initially saw some improvement in big boy Dandi, who has intervertebral disc disease. But it didn't last. When I brought him to his veterinary acupuncturist, she told me that in her experience, DGP has not been effective, and when she reviewed the list of ingredients, she wasn't impressed, and actually said that the herbs used in DGP wouldn't be her choice for relieving pain. She's got Dandi doing really well with acupuncture and Chinese herbs, so I think highly of her opinion.

But, Winslow, I'd MUCH rather do a little private-duty nursing for you.. <wink wink> Mafi

Dear Winslow, I'm on a sabbatical at the moment (that means sequential napping) and would be happy to lend you my uniform, so you can be all decked out when Auntie Burpdog arrives. You might have to let it out a little, and maybe the cap is a little 1940's, but whatever you do, DON'T let anyone call you "Pope"! Mafi