The Results Are In For Beau

[greyhndz]

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!

[Guest KyGrey]

I'm glad you have a diagnosis even though it's not a good one. Sending more prayers and good thoughts that it will be managed and he will live a long less painful life.

[Neighsayer]

I'm sorry that it wasn't better news but glad that you at least know what you are dealing with. Hope he does well.

[Guest Alexandra_W]

I will follow this thread closley, as I have a dog with the same issue regarding the polyarthritis, we are awaiting the results of the synovial fluid tests to see if we can pinpoint WHAT kind of auto-immune devil, and HOPEFULLY rule out reumatiod arthritis that breaks down the joints.

 

But unfortnaltly they are sur by now the polyarthritis is auto-immune, just as they suspected from the start =/

 

So, I am truly sad that you (too) had to get that kind of diagnosis, but will follow this thread with interest.

 

My boy will be put on steriods whitin days, in HIGH doses initially that will be tapered off slowly down to 'lowest possible dose that still keeps it under control'. He will be given Medrol (dunno if it is the same brand name over there?) as it usually has less side effects than prednisone in dogs.

 

But, Im so sad that you have to go through this *hugs*

[Guest vahoundlover]

Be as pissy as you want

[greyhndz]

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.

 

I will follow this thread closley, as I have a dog with the same issue regarding the polyarthritis, we are awaiting the results of the synovial fluid tests to see if we can pinpoint WHAT kind of auto-immune devil, and HOPEFULLY rule out reumatiod arthritis that breaks down the joints.

 

But unfortnaltly they are sur by now the polyarthritis is auto-immune, just as they suspected from the start =/

 

So, I am truly sad that you (too) had to get that kind of diagnosis, but will follow this thread with interest.

 

My boy will be put on steriods whitin days, in HIGH doses initially that will be tapered off slowly down to 'lowest possible dose that still keeps it under control'. He will be given Medrol (dunno if it is the same brand name over there?) as it usually has less side effects than prednisone in dogs.

 

But, Im so sad that you have to go through this *hugs*

[Guest Spencers_Greyt]

It's always best to know what the problem is! A relief in that respect. And thank goodness it's not life threatening! Hugs to Beau!

 

[Guest Alexandra_W]

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.

 

There is no such plan, sadly. 'Best case scenario' its to:

 

a.) find a lowest minimun dose with medrol/equivalent that still works

b.) that it will go in cycles, were we can keep him off steroids for some periods of time

 

 

By some reason, imuran (called Imurel in sweden) and/or cyclosporin (brand name Sandimmun in Sweden) rarely/never (not 100% sure it is never, but very very rarley) is used in cases like my dog. Its used in dogs with IBD (think it is the correct name in english? TRanslated straight from swedish: Inflammatory bowel disease), but not in 'jointcases'. Dont have a clue why though, will try to remember to ask my vet later on, thanks for the tips. But my boy is taken care of at the Swedeish veterinary university hospital, ie when every single swedish vet is educated, so if they don't use it, literally no other does =/ But will try to remember to ask why, and perhaps if we can try it anyway later on =)

 

Good to her your girl is doing fine on the Medrol. I am a bit reluctant as it comes to steroids. I understand my boy needs them, but I have only had bad effects previous with steroids. But then it has been prednisone, and for other cases. SO I was a bit relieved to hear they would start right off with medrol, even though the price is terrible for medrol in sweden (and prednisone cost like nothing). Usually prednisone is the first hand choice, and a switch is made if the dog reacts bad to it. And i really hope it works, and without too many side-effects. I just want to think abouth the options if it doesn't.. =(

Edited March 26, 2009 by Alexandra_W

[Guest koolaidnconner]

This IBD thing causes a lot of havoc. At least you have a diagnosis now and can go from there. I know Conner from all the straining he did before we got a diagnosis they assume he has now damaged his sacral from it and now can not do zoomies anymore or he is hurting for days.

 

Take care Robin, it will all work out!

[Guest crazy4greys]

That is what Becky, the greyhound WAG has been taking care of has.

 

She is 56#'s now and is on Pred and something else I can't remember.

 

Good thoughts for Beau.

 

What heartbreaking story, poor baby.

 

Is there anyone interested in her? I wish we could. I really do.

 

No, no one interested in Becky.

[RobinM]

I just had a nice long chat with Jordan, houndzhigz.

 

This is where I am at. Being that Beau had a flare of the IMPA while on the pred and imuran, makes me wonder if he has been misdiagnosed. The meds for the flare ARE pred and imuran so how the heck could he have flared??

 

In addition, he repsonded to the doxy 24 hours after his first dose which was a shot. The snap TBDs are reading negative and the PCRs are still out. We will continue to treat for TBD regardless of what they say but oh boy, wouldn't it be nice to get a postitive TBD which responds to doxy? Can anything ever be that easy?

[BauersMom]

I just had a nice long chat with Jordan, houndzhigz.

 

This is where I am at. Being that Beau had a flare of the IMPA while on the pred and imuran, makes me wonder if he has been misdiagnosed. The meds for the flare ARE pred and imuran so how the heck could he have flared??

 

In addition, he repsonded to the doxy 24 hours after his first dose which was a shot. The snap TBDs are reading negative and the PCRs are still out. We will continue to treat for TBD regardless of what they say but oh boy, wouldn't it be nice to get a postitive TBD which responds to doxy? Can anything ever be that easy?

 

It's very possible. The SNAP 3dx is only Lyme and Ehrlichia canis - there are a lot of other TBDs out there, for sure.

 

The positive reaction with the doxy is certainly indicative of something, I'd say!

[Ullaluv]

Could you have gotten a false negative TBD because Beau is on Prednisone? Good idea to keep him on the Doxy.

[RobinM]

It's very possible. The SNAP 3dx is only Lyme and Ehrlichia canis - there are a lot of other TBDs out there, for sure.

 

The PCR was all the others, including valley fever, babesia, rocky mountain, bartonella (sp?) etc.

[BauersMom]

It's very possible. The SNAP 3dx is only Lyme and Ehrlichia canis - there are a lot of other TBDs out there, for sure.

 

The PCR was all the others, including valley fever, babesia, rocky mountain, bartonella (sp?) etc.

 

Right. So a negative SNAP doesn't really tell you anything much, except that he's negative for those two particular TBDs.

 

How much longer until the PCR is back?

[Batmom]

I have no idea whether Beau has tick disease or not. But. Doxycycline is not TBD-specific. It's a good ol' broad-spectrum antibiotic. It treats many types of infections.

[RobinM]

I have no idea whether Beau has tick disease or not. But. Doxycycline is not TBD-specific. It's a good ol' broad-spectrum antibiotic. It treats many types of infections.

 

Very true. This is what the specialist had to say. What do you think of this? I will be faxing over all the reports, labs etc tomorrow.

 

Certainly it sounds consistent with polyarthritis (assuming multiple joints were involved). Doxycycline has anti-inflammatory properties in addition to being an antibiotic so sometimes modulates immune mediated inflammation too. Certainly I too would be concerned about such an immune mediated disease occuring in the face of current pred and imuran therapy. To me this means either 1) the diagnosis is incorrect and there is an underlying condition as of yet unidentified or 2) the immune mediated disease required higher doses of medication (e.g. back up to higher, truly "immunusuppressive" doses of prednisone, which Beau is not currently on).

[BauersMom]

 

If anything I would guess the doxy is acting as an antiobiotic and not anti-inflammatory, given that pred is a good anti-inflammatory already.

 

 

[ahicks51]

I have no idea whether Beau has tick disease or not. But. Doxycycline is not TBD-specific. It's a good ol' broad-spectrum antibiotic. It treats many types of infections.

 

Not to mention how a related antibiotic- minocycline- has occasionally come up in studies as being strangely effective against rheumatoid arthritis (which in turn has strong links to Proteus mirabilis, a bacterium known to be responsible for urinary tract infections in humans).

[ShantisMom]

I have no idea whether Beau has tick disease or not. But. Doxycycline is not TBD-specific. It's a good ol' broad-spectrum antibiotic. It treats many types of infections.

 

Very true. This is what the specialist had to say. What do you think of this? I will be faxing over all the reports, labs etc tomorrow.

 

Certainly it sounds consistent with polyarthritis (assuming multiple joints were involved). Doxycycline has anti-inflammatory properties in addition to being an antibiotic so sometimes modulates immune mediated inflammation too. Certainly I too would be concerned about such an immune mediated disease occuring in the face of current pred and imuran therapy. To me this means either 1) the diagnosis is incorrect and there is an underlying condition as of yet unidentified or 2) the immune mediated disease required higher doses of medication (e.g. back up to higher, truly "immunusuppressive" doses of prednisone, which Beau is not currently on).

 

 

Robin did they do a joint tap and pull fluid? That fluid will give you a world of information. If they did pull it did they culture it? Sorry if I forgot, I just know he has been through tons!

[greyhndz]

Robin did they do a joint tap and pull fluid? That fluid will give you a world of information. If they did pull it did they culture it? Sorry if I forgot, I just know he has been through tons!

 

 

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.

[RobinM]

I have no idea whether Beau has tick disease or not. But. Doxycycline is not TBD-specific. It's a good ol' broad-spectrum antibiotic. It treats many types of infections.

 

Very true. This is what the specialist had to say. What do you think of this? I will be faxing over all the reports, labs etc tomorrow.

 

Certainly it sounds consistent with polyarthritis (assuming multiple joints were involved). Doxycycline has anti-inflammatory properties in addition to being an antibiotic so sometimes modulates immune mediated inflammation too. Certainly I too would be concerned about such an immune mediated disease occuring in the face of current pred and imuran therapy. To me this means either 1) the diagnosis is incorrect and there is an underlying condition as of yet unidentified or 2) the immune mediated disease required higher doses of medication (e.g. back up to higher, truly "immunusuppressive" doses of prednisone, which Beau is not currently on).

 

 

Robin did they do a joint tap and pull fluid? That fluid will give you a world of information. If they did pull it did they culture it? Sorry if I forgot, I just know he has been through tons!

 

Don't know. all I know is that it came back as negative showing "inflammation".

 

[greyhndz]

If anything I would guess the doxy is acting as an antiobiotic and not anti-inflammatory, given that pred is a good anti-inflammatory already.

 

 

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

[greyhndz]

This is what the specialist had to say. What do you think of this? I will be faxing over all the reports, labs etc tomorrow.

 

What I think is that Robin is going to be taking Beau for a ride to see the very bright specialist. She sounds like a good diagnostician, and also appears to be comfortable in managing autoimmune disease.

Certainly it sounds consistent with polyarthritis (assuming multiple joints were involved).

 

Which may well be the case.. often pain may be very transient, and hard to pick up on.

 

Certainly I too would be concerned about such an immune mediated disease occuring in the face of current pred and imuran therapy. To me this means either 1) the diagnosis is incorrect and there is an underlying condition as of yet unidentified or 2) the immune mediated disease required higher doses of medication (e.g. back up to higher, truly "immunusuppressive" doses of prednisone, which Beau is not currently on).

Exactly, which Robin and I spoke about earlier tonight. The PCR results will help, and the internal medicine vet can continue with a workup to rule-out any other underlying cause. Then, the vet and Robin need to discuss whether any med changes are indicated. What's great news is that Beau has improved dramatically, so the vet might decide to wait-and-see, i.e., not make changes unless he has another flare.

 

NCSU - Idexx Snap-3, 4

This article gets quite technical, but it's a very good overview by Ed Breidtschwert of NCSU's TBD lab, describing what the IDEXX snap-3 and snap-4 actually test for, and how to interpret the results, and also ways of identifying false positives. There are TBD's which are not covered by the IDEXX Snap-3 or 4. I've found it very helpful to talk personally with either Ed. Breidtschwert or Cindy Holland of Protatek, explain the dog's clinical symptoms, where the dog has lived, and let them guide me as to which TBD's to test for. They're also great resources for helping you understand what the test results mean, and advise of any repeat testing indicated in the coming weeks/months.

[Guest IrskasMom]

 

 

 

As always ,sending lots of for Beau and his Mama