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"Mystery Disease", Possibly Auto-Immune?


Camden's Mom
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My dog may or may not have an auto-immune disease which I’ve been treating with prednisone for over a year. I’ve been weening the dosage down for the past couple months and I’m prepared, against my vets advice, to take him off of it entirely.

 

My Questions: If the symptoms we were treating DO return what type of specialist would be best equipped to diagnose a mystery disease that’s presumed to be auto-immune? Secondly, are there better alternatives to treating an auto-immune disease? I’m especially interested in finding a treatment that would be compatible with the use of an NSAIDs like Rymadil, which prednisone most certainly is not.

 

OK, those are my core question but below I’ll list all of the details of Camden’s mystery disease. It’s long so feel free to skip it. However, if you DO read it all and anything jumps out at you or raises a red flag please let me know. I’m not anticipating anyone will be able to diagnose his “mystery disease” through the forums but I’ll take all the feedback, ideas, suggestions or personal experience you guys can offer. Thanks!

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More Details:


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Explanation and Original Symptoms: Boarded Camden (approx 7mo at the time) at our vet’s facility for five days over the 2012 Christmas Holiday. Within a week of our return he began to lose his appetite and over the course of the next week he lost all interest in food. During this time his water consumption increased dramatically. As a result he was urinating frequently, requiring potty breaks every 30 - 60 minutes. His urine was so diluted it had lost all coloration. He eventually became incontinent, walking around the house leaking urine (not squatting to pee, it was just dripping out of him).

Vet:

Original concern was infection, as blood work showed a high white blood cell count. We did antibiotic treatment for about three weeks and he was showing some improvement. Then suddenly he spiked a fever, lost interest in food, and was lethargic. We requested an ultrasound of his abdomen and everything appeared normal. The vet did more blood work and took a urine sample but all of the levels seemed fine.

During these four weeks Camden’s condition would fluctuate from seeming pretty normal to not being very well. Then in the first week of February he crashed. He received overnight emergency treatment of fluids, steroids and antibiotics to get his fever, which was over 105, down as quickly as possible. After this emergency treatment he was like a new dog! He bounced back completely. We still ran tests, but honestly he seemed fine. Then in the first week of March he crashed again: massive fever, overnight emergency treatment, although this time he was not administered antibiotics, just steroids and fluids. It was just like the last episode but it happened suddenly without the previous warning symptoms. While he didn’t bounce back as fully as the first time, he did show immediate improvement after the emergency treatment.

The vet’s best guess is that this is something auto-immune. We started him on 5mg of prednisone daily, just to see if the steroids would help him remain healthy and they did. A couple of months later we decided to try scaling the prednisone back, but eventually had return to the higher dosage because of a leg injury (we needed to use it as an anti-inflammatory… ugh). Finally in January of THIS year we’ve been in a position to scale the prednisone back. We are currently administering 2.5mg of prednisone every Mon., Wed., and Fri. Overall he seems to be doing OK on this dosage but I would like to get him off the drug to determine if there's still an issue and, if there is, try to diagnose it.

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I guess I should actually list what we've ruled out.

 

Ultrasound confirmed a healthy abdomen (kidneys, liver, etc.)

Leptospirosis

Pyelonephritis

Diabetes Insipidus

Addison's Desease

Urinalysis showed mildly elevated BUN and Crea, vet did not seem overly concerned

 

Given that it was January in Utah when this all started I don't know if a tick born disease is likely. Having said that I do not know for certain that it was ever tested for. If symptoms re-occure I will be sure to bring it up to the specialist.

 

 

Internal medicine specialist, preferably at a vet school.

 

Thank you, Liz! I want to make sure I had a someone lined up before taking him off the prednisone. I'll start looking around to see who's in my area. I think I remember hearing that the U of U had a good vet program... I'll start looking into that and other possible options.

 

I've thrown in the towel on my regular vet. He's just perplexed by the whole thing and wants to keep Camden on prednisone indefinitely since it's been working thus far.

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I'd suggest a vet school as well.

 

I'm sorry to hear this. It must have you very worried.

 

Thanks, Roxanne. Truth be told it's been "out of sight out of mind" (ok, not entirely out of mind, lol) for the past year or more at this point. I just don't want to keep covering up the issue. I figure if symptoms do come back maybe we have a shot at diagnosing it and forming a better game plan. Maybe it's something that can be managed with dietary changes or a different, less powerful, drug? I'd rather know and I always have the prednisone to fall back on if we're up against a wall.

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I hate to say it but he probably was not concerned over the elevated BUN and creatinine because being on the prednisone can cause this. We had a Yorkie with an auto immune disease, Found it when she was 6 months old. Hers started attacking her ears and turned them a blackish color on the inside. They wanted us to keep her on the prednisone indefinitely too but I refused to do it as it can damage the kidneys to be on it indefinitely (this was 20 years ago before there were natural cures like now, all kinds of natural remedies out there, just search the web). They also wanted me to bring her in biweekly for expensive blood tests so they could document the disease and send it off to a special laboratory but they wanted me to foot the 500 bill every 2 weeks, which I could not afford. We kept her on the prednisone for a bit but she was doing worse on the medicine than before, drinking all the time, peeing all the time, having accidents, being lethargic, so we just stopped it. We decided her time would be how it would be and we were not going to dope her up, her life was miserable on the meds.

 

The vet told us she could live 2 weeks or 20 years, no one knew much about it back then. It was fairly new evidently being found in dogs. She had a few times when she got pretty sick but we did the antibiotics and a special food for a bit and she recovered.

 

Cuddles was 15-1/2 when she passed 4 years ago and many people including the last vet's office thought she was still a pup from the way she acted. She passed from mammary gland cancer, that we were informed we could or should not have operated on at her 13 years of age because of the auto immune disease.

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  • 3 weeks later...

Update: I talked to my regular vet and asked for a recommendation for an internal medicine specialist, possibly at a veterinary school. His response was the only internal medicine specialists that would be better equipped then his facility to handle diagnosing whatever is gong on would be in Colorado. That's very far away from SLC...

 

My current vet also suggested that we'd probably have to take a bone marrow sample in order to diagnose the auto-immune disease. Does that sound accurate? On a better note, he also explained that there are other immune suppressing drugs that we could put Camden on that would be compatible with NSAID's.

 

I don't want to bash my current vet, I think he's a great guy with the best of intentions... and no dummy either. However we were not able to figure out a diagnosis before and his game plan was to stay on prednisone indefinitely... not an idea that I like. I'm wondering if I should push forward with him, at the very least to get Camden off pred and onto another immune suppressing drug but ideally I'd like to get a diagnosis. Just wanted to share what he told me and run it past those of you who have dealt with auto-immune and see if what he said sounds legit.

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I was also going to suggest a phone consult. And if a bone marrow aspirate is really needed, the specimen could be shipped somewhere for analysis.

 

I agree that it is not a good idea to treat with steroids in the long term without a diagnosis. All immunosupressants have undesirable side effects. I would press for a diagnosis before going down that road.

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Based on the legwork I did on my own, the best vet school in the area is Utah State University's two year program. I guess the fact that it's only two year made me wary. My vet didn't think there would be anyone there better qualified to handle Camden's case. He did specifically mention a place in Colorado that would be ideal. I will follow up with him and get their info. I like the idea of doing a phone consult and it seems to me that having my current vet involved and able to give opinions/feedback to the specialist regarding Camden's case would be a plus.

 

Thanks everyone!

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  • 2 weeks later...

We've actually got a consult in at Colorado State. My vet is also involved in the consultation with the specialists on staff there so he can answer any complicated questions or discuss details that I would be unable to address. Given that the dog is in good health and holding steady on the prednisone it's not a rush, so we're in "wait and see" mode right now. I'm hoping, at the very least, Colorado State will be able to set us up with a good game plan to get a diagnosis if all of these symptoms resurface when we pull him off the prednisone entirely. I'll be sure to post an update when I know more!

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I was told my BC likely had an auto-immune disorder when she was 6 months old because she was anemic. After testing her for a bunch of different problems they (every vet in the practice saw her) decided she had an auto-immune disorder and started her on medicine for it. However, when I overheard my vet describing her as "the puppy with the poor prognosis" I posted here. Someone told me to get her to a board certified vetinary internal medicine specialist. I found one here: http://www.acvim.org/ It turned out she just had anemia (possibly from swallowing a bit of cactus). The specialist put her on iron supplements for several months and she made a full recovery. That was nine years ago.

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