Urgent question Polina is very sick - Page 6 - YorkieTalk.com Forums

dwerten · 05-25-2010, 08:11 PM

Prednisone alone or in combination therapy causes many adverse effects. When these adverse effects are severe they may require the prednisone dose to be reduced prematurely or even stopped entirely and another immune suppressive drug used in its place or combined with a reduced prednisone dose. The adverse effects that can occur are:

1. Severe polyuria, polydipsia, polyphagia and panting
2. Urinating in the house or urinary incontinence and weight gain
3. Colitis type diarrhea, vomiting and anorexia
4. Gastrointestinal (especially colonic) ulceration/perforation
5. Life threatening steroid hepatopathy
6. Urinary tract and skin infections and other infections
7. Severe mental depression and lethargy
8. Hyperexcitable, energetic, aggressive
9. Muscle atrophy and weakness
10. Endocrine alopecia
11. Hypertension
12. Calcinosis Cutis

Some of the more common side effects listed above can be prevented by some simple instructions to the owner. If the dog has normal renal function, the owner should limit the dog's water consumption to 20 ccs/pound of body weight divided three times a day. This will prevent the excess drinking that causes the dog to urinate in the house and be urinary incontinent. If the dog does start urinating in the house despite this, the dog's urine should be cultured using a cystocentesis urine sample to be sure a urinary tract infection has not developed. The dog should not be fed more than the amount of food he was fed before prednisone therapy. That should be no more than 20 calories of food per pound per day. Feeding a high fiber, low fat food, such as canine or feline RD or feline WD, prevents weight gain and prevents the steroid induced colitis diarrhea that is very common unless this diet is used. The dog should have a 12 hour fasted serum chemistry profile collected in all cases 10 to 14 days after this prednisone schedule is started. If the serum bilirubin is elevated above the normal range the prednisone dose should be immediately reduced to 0.5 mg/lb once a day and the steroid hepatopathy should gradually start to resolve. In those cases in which the dog becomes severely mentally depressed on prednisone or has severe muscle weakness or an intolerable personality change prednisone may have to be discontinued permanently or the dose drastically reduced and other immune suppressive drugs considered.

dwerten · 05-25-2010, 08:12 PM

High dose, long term, immunosuppression is the key to successful therapy for all autoimmune diseases of the CNS. For this reason it is imperative that infectious causes of CNS inflammation be ruled out by diagnostic testing since immunosuppressive therapy would obviously worsen these conditions. The following therapies have been found to have efficacy in treating CNS autoimmune disease:

1. Corticosteriods in immunosuppressive doses1,2,3
2. CCNU (Personal communication March, P, Ohio State University)4
3. Cyclosporine Modified by Microemulsion-Neoral®(Novartis
Pharmaceuticals Corporation, East Hanover, New Jersey 07936)5,6
4. Cytarabine7,18
5. Leflunomide15
6. Procarbazine7,19
7. Radiation Therapy8,3

Corticosteroids, primarily prednisone, is the drug of first choice and is often used as the sole therapy. It is important that immunosuppressive doses be used initially, and therapy be sustained at high doses, very gradually tapered over many months or relapses are likely to occur. A six-month tapering dosage schedule of prednisone that often works is as follows:

1 mg/lb Q 12 hours for 4 days
0.5 mg/lb Q 12 hours for 17 days
0.5 mg/lb Q 24 hours for 35 days
0.25 mg/lb Q 24 hours for 60 days
0.25 mg/lb Q 48 hours for 60 days

Dogs weighing less than 5 kgs are dosed as 5 kg dogs, and dogs weighing 5 to 10 kgs are dosed as 10 kg dogs. Dogs weighing over 35 kg are dosed as 35 kg dogs. Prednisone alone, used in the above dosage schedule, in about 75 percent of cases will cause permanent remission when neutrophilic or eosinophilic meningitis or focal GME of the posterior or rostral fossa of the brain are treated.

dwerten · 05-25-2010, 08:13 PM

These signs can progress at various rates, but surprisingly they are often acute (1-2 days) to peracute (8-12 hours) in duration on initial presentation. In the peracute form these autoimmune brain and spinal cord diseases can be one of the most serious neurological emergencies. It is possible for a dog with GME involving the brain stem to progress from mild vestibular ataxia to severe violent rolling to opisthotonos, coma and death within 12-24 hours from the first onset of clinical signs. A dog with GME involving the cervical spinal cord may progress from signs of mild ataxia to full tetraplegia in 1-2 days mimicking a cervical disc herniation. Pugs, Maltese terriers and Yorkshire terriers with necrotizing encephalitis commonly present with only 1-2 days or even a few hours of pacing, demented behavior followed by near constant seizure activity and death within 12 to 24 hours.

Although in most cases a neurological patient should be stabilized and diagnostic tests evaluated before treatment is started, a dog with rapidly progressive GME or necrotizing encephalitis may be dead, or permanently neurologically damaged, if treatment is withheld for 8-12 hours so a cerebrospinal fluid (CSF) analysis and advanced imaging can be evaluated before treatment is begun. It is therefore imperative that a high index of suspicion be maintained for autoimmune CNS disease when dogs are presented with unusually rapidly developing seizures, vestibular signs, tetraparesis, violent generalized tremors or blindness. Frequent, accurate neurological examinations will indicate if rapidly progressive or static to improving disease is present. For this reason do not admit a dog that appears to have acute onset geriatric vestibular disease with plans to re-evaluate the dog the next morning. If the dog has GME death may occur by then. If rapid neurologic deterioration is noted on repeat examination then immediate referral to a 24-hour emergency center or aggressive immune suppressive therapy should be started until a CSF analysis and advanced CNS imaging can be done to confirm the diagnosis. Increased cellularity of a CSF analysis is not likely to be altered by corticosteroid or other immunosuppressive therapy for 12 to perhaps 24 hours; so an accurate diagnosis can still be made after glucocorticoid therapy has begun. However, if CSF is collected after 12-24 hours of glucocorticoid therapy false negative results are often obtained. Therefore you must begin, or refer the dog for, diagnostic testing as soon as possible after initiating therapy in such an emergency situation.

dwerten · 05-25-2010, 08:14 PM

TREATMENT OF AUTOIMMUNE DISEASES OF THE CENTRAL NERVOUS SYSTEM OF DOGS
Allen Sisson DVM, MS, Diplomate ACVIM (Neurology)
Angell Animal Medical Center, Boston, Massachusetts

Several inflammatory, primary central nervous system (CNS) derangements of dogs have been described such as:

1. Granulomatous Meningoencephalomyelitis (GME)
2. Necrotizing Encephalitis of mostly Pug, Maltese and
Yorkshire terrier dogs
3. Corticosteroid-Responsive or Neutrophilic Meningitis
4. Eosinophilic Meningoencephalomyelitis
5. Idiopathic Tremor Syndrome or Cerebellitis
6. Pyogranulomatous Meningoencephalitis

The two things these conditions have in common are that they are considered to be idiopathic, since no causative agent or infectious organism has been found,10,17 and they all respond, to some degree, to immune suppressive therapy. Because of this, most people now believe that these diseases are either autoimmune or neoplastic in nature. However, an autoimmune etiology is most likely since in most cases with aggressive immunosuppressive therapy permanent remission can be achieved which would be unlikely if they really were of neoplastic origin.

Depending on where in the brain and spinal cord these diseases start, and how rapidly they progress, they can cause a wide variety of signs. The most common presenting clinical signs are:

1. Progressively worsening central vestibular signs
2. Progressively worsening seizures and behavior abnormalities
3. Progressively worsening neck and or back pain
4. Progressively worsening para or tetraparesis
5. Progressively worsening generalized severe intention tremor
6. Acute onset of blindness

dwerten · 05-25-2010, 08:16 PM

whew ok i think i got it all posted so you can read tonight and discuss with neurologist

I am so glad you took her in to neurologist and she is starting to be treated as the sooner the better with neurological conditions.

ladyjane · 05-25-2010, 09:20 PM

Quote:

Originally Posted by omichka

Our news are bad ....

suspected necrotizing leukoencephaloelitis (NLE) possible Necrotizing meningoencephalomyelitis (NME)

They did find extra fluids.

Neurologist said that this is worst case of GME (aka general GME) , and .... we do not know how long she will live - a few months or maximum a couple years.

I have not read about it yet, but doctor said that I should be still optimistic.

she was given new medication, including prednisolon, but they increased doses A LOT. Polina is 6.7 pounds only.

the list of medication:

1. prednisolon 3mg/ml, dose increse to 1ml for 5 days twice daily, then reduce to 0.5 91.5mgtwice daily for 3 weeks, then .5 once a day, then .5 ml every other day.

What I do worry that she is much better after prednisolon, EVEN more active then used to be. IMO, dose already probably high for her, why MORE????

2. Clindamycin. 25 mg/ml. Twice 3ml. Antibiotic. 3 weeks only

3. Doxycycline. 10mg/ml. Twice 3ml. Antibiotic. 3 weeks only

4. Zonisamide. 25mg. Twice one pill.

I am so sorry about this diagnosis, but please know that this can be treated and hopefully you will have some quality time together.

We have a pup in YHR with GME. Her name is Roriee. Perhaps her story will encourage you:

Adoptable Pups

Whatever you do, do not change the dosage of pred that you are advised to give!

dwerten · 05-26-2010, 12:48 AM

Quote:

Originally Posted by ladyjane

I am so sorry about this diagnosis, but please know that this can be treated and hopefully you will have some quality time together.

We have a pup in YHR with GME. Her name is Roriee. Perhaps her story will encourage you:

Adoptable Pups

Whatever you do, do not change the dosage of pred that you are advised to give!

No never change anything without consulting with neurologist as i stated before but you definitely should discuss and send this info to your neurologist and ask them about dr sisson and if they are aware of his protocol and have them do a consult with dr sisson. They will explain everything on GME group as there are some very experienced people on this group who see neurologist all over the world and they will help you on how they work with their neurologist and dr sisson as a team. you will learn alot from them and they will explain things the neurologist may not have time to explain and be a tremendous support for you as they are going through the same thing you are going through

ladyjane · 05-26-2010, 05:05 AM

Here is a simple explanation of what you are dealing with. This does not cover all treatments but I feel this is an excellent description in lay people terms. Although it is good to know, sometimes all of the medical jargon can be overwhelming:

http://www.centerforvetspecialtycare.com/forms_handout/Meningitis%20Handout.pdf

omichka · 05-26-2010, 08:18 AM

I am very confused how this yahoo group works? I posted my question, but do not see it anywhere

dwerten · 05-26-2010, 08:40 AM

Quote:

Originally Posted by omichka

I am very confused how this yahoo group works? I posted my question, but do not see it anywhere

some do not post it immediately as they are screened - it gets emailed to you so are you checking your email? You can check messages on website or by your email. Let me check i will post a message about polina and check to see if yours came through

dwerten · 05-26-2010, 08:43 AM

Quote:

Originally Posted by dwerten

some do not post it immediately as they are screened - it gets emailed to you so are you checking your email? You can check messages on website or by your email. Let me check i will post a message about polina and check to see if yours came through

I just saw your post it is there so watch your email or sign on to yahoo and they will respond to you as soon as they read it - hang in there and i will get you dr sisson info and you can call him direct and fax him everything too

kjc · 05-29-2010, 10:47 AM

Glad to hear you were able to get her diagnosed quickly.... praying for her that the treatment is successful and she finds relief soon.... Kathy

dwerten · 05-31-2010, 10:47 PM

bumping this thread as there are some dogs showing neurological signs here recently

lillymae · 05-31-2010, 11:25 PM

How is this Baby doing ?

dwerten · 06-01-2010, 05:29 AM

Quote:

Originally Posted by lillymae

How is this Baby doing ?

she is doing ok as she is on the yahoogroup i am on and they are helping her - she is at least getting as much info as she can to get her to a good place so hopefully she will go into remission

05-26-2010, 05:05 AM	#83
ladyjane Resident Yorkie Nut Donating YT 20K Club Member Join Date: Sep 2006 Location: Texas Posts: 27,490	Here is a simple explanation of what you are dealing with. This does not cover all treatments but I feel this is an excellent description in lay people terms. Although it is good to know, sometimes all of the medical jargon can be overwhelming: http://www.centerforvetspecialtycare.com/forms_handout/Meningitis%20Handout.pdf __________________ CLOUD NINE BEDS--YORKIE HAVEN RESCUE MY ETSY SHOP

05-29-2010, 10:47 AM	#87
kjc I♥PeekTinkySaph&Finny Donating Member Join Date: May 2009 Location: Baltimore, Maryland Posts: 18,872	Glad to hear you were able to get her diagnosed quickly.... praying for her that the treatment is successful and she finds relief soon.... Kathy __________________ Kat Chloe Lizzy PeekABooTinkerbell SapphireInfinity

05-25-2010, 08:11 PM	#76
dwerten BANNED! Join Date: May 2007 Location: USA Posts: 11,073	Prednisone alone or in combination therapy causes many adverse effects. When these adverse effects are severe they may require the prednisone dose to be reduced prematurely or even stopped entirely and another immune suppressive drug used in its place or combined with a reduced prednisone dose. The adverse effects that can occur are: 1. Severe polyuria, polydipsia, polyphagia and panting 2. Urinating in the house or urinary incontinence and weight gain 3. Colitis type diarrhea, vomiting and anorexia 4. Gastrointestinal (especially colonic) ulceration/perforation 5. Life threatening steroid hepatopathy 6. Urinary tract and skin infections and other infections 7. Severe mental depression and lethargy 8. Hyperexcitable, energetic, aggressive 9. Muscle atrophy and weakness 10. Endocrine alopecia 11. Hypertension 12. Calcinosis Cutis Some of the more common side effects listed above can be prevented by some simple instructions to the owner. If the dog has normal renal function, the owner should limit the dog's water consumption to 20 ccs/pound of body weight divided three times a day. This will prevent the excess drinking that causes the dog to urinate in the house and be urinary incontinent. If the dog does start urinating in the house despite this, the dog's urine should be cultured using a cystocentesis urine sample to be sure a urinary tract infection has not developed. The dog should not be fed more than the amount of food he was fed before prednisone therapy. That should be no more than 20 calories of food per pound per day. Feeding a high fiber, low fat food, such as canine or feline RD or feline WD, prevents weight gain and prevents the steroid induced colitis diarrhea that is very common unless this diet is used. The dog should have a 12 hour fasted serum chemistry profile collected in all cases 10 to 14 days after this prednisone schedule is started. If the serum bilirubin is elevated above the normal range the prednisone dose should be immediately reduced to 0.5 mg/lb once a day and the steroid hepatopathy should gradually start to resolve. In those cases in which the dog becomes severely mentally depressed on prednisone or has severe muscle weakness or an intolerable personality change prednisone may have to be discontinued permanently or the dose drastically reduced and other immune suppressive drugs considered.

05-25-2010, 08:12 PM	#77
dwerten BANNED! Join Date: May 2007 Location: USA Posts: 11,073	High dose, long term, immunosuppression is the key to successful therapy for all autoimmune diseases of the CNS. For this reason it is imperative that infectious causes of CNS inflammation be ruled out by diagnostic testing since immunosuppressive therapy would obviously worsen these conditions. The following therapies have been found to have efficacy in treating CNS autoimmune disease: 1. Corticosteriods in immunosuppressive doses1,2,3 2. CCNU (Personal communication March, P, Ohio State University)4 3. Cyclosporine Modified by Microemulsion-Neoral®(Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936)5,6 4. Cytarabine7,18 5. Leflunomide15 6. Procarbazine7,19 7. Radiation Therapy8,3 Corticosteroids, primarily prednisone, is the drug of first choice and is often used as the sole therapy. It is important that immunosuppressive doses be used initially, and therapy be sustained at high doses, very gradually tapered over many months or relapses are likely to occur. A six-month tapering dosage schedule of prednisone that often works is as follows: 1 mg/lb Q 12 hours for 4 days 0.5 mg/lb Q 12 hours for 17 days 0.5 mg/lb Q 24 hours for 35 days 0.25 mg/lb Q 24 hours for 60 days 0.25 mg/lb Q 48 hours for 60 days Dogs weighing less than 5 kgs are dosed as 5 kg dogs, and dogs weighing 5 to 10 kgs are dosed as 10 kg dogs. Dogs weighing over 35 kg are dosed as 35 kg dogs. Prednisone alone, used in the above dosage schedule, in about 75 percent of cases will cause permanent remission when neutrophilic or eosinophilic meningitis or focal GME of the posterior or rostral fossa of the brain are treated.

05-25-2010, 08:13 PM	#78
dwerten BANNED! Join Date: May 2007 Location: USA Posts: 11,073	These signs can progress at various rates, but surprisingly they are often acute (1-2 days) to peracute (8-12 hours) in duration on initial presentation. In the peracute form these autoimmune brain and spinal cord diseases can be one of the most serious neurological emergencies. It is possible for a dog with GME involving the brain stem to progress from mild vestibular ataxia to severe violent rolling to opisthotonos, coma and death within 12-24 hours from the first onset of clinical signs. A dog with GME involving the cervical spinal cord may progress from signs of mild ataxia to full tetraplegia in 1-2 days mimicking a cervical disc herniation. Pugs, Maltese terriers and Yorkshire terriers with necrotizing encephalitis commonly present with only 1-2 days or even a few hours of pacing, demented behavior followed by near constant seizure activity and death within 12 to 24 hours. Although in most cases a neurological patient should be stabilized and diagnostic tests evaluated before treatment is started, a dog with rapidly progressive GME or necrotizing encephalitis may be dead, or permanently neurologically damaged, if treatment is withheld for 8-12 hours so a cerebrospinal fluid (CSF) analysis and advanced imaging can be evaluated before treatment is begun. It is therefore imperative that a high index of suspicion be maintained for autoimmune CNS disease when dogs are presented with unusually rapidly developing seizures, vestibular signs, tetraparesis, violent generalized tremors or blindness. Frequent, accurate neurological examinations will indicate if rapidly progressive or static to improving disease is present. For this reason do not admit a dog that appears to have acute onset geriatric vestibular disease with plans to re-evaluate the dog the next morning. If the dog has GME death may occur by then. If rapid neurologic deterioration is noted on repeat examination then immediate referral to a 24-hour emergency center or aggressive immune suppressive therapy should be started until a CSF analysis and advanced CNS imaging can be done to confirm the diagnosis. Increased cellularity of a CSF analysis is not likely to be altered by corticosteroid or other immunosuppressive therapy for 12 to perhaps 24 hours; so an accurate diagnosis can still be made after glucocorticoid therapy has begun. However, if CSF is collected after 12-24 hours of glucocorticoid therapy false negative results are often obtained. Therefore you must begin, or refer the dog for, diagnostic testing as soon as possible after initiating therapy in such an emergency situation.

05-25-2010, 08:14 PM	#79
dwerten BANNED! Join Date: May 2007 Location: USA Posts: 11,073	TREATMENT OF AUTOIMMUNE DISEASES OF THE CENTRAL NERVOUS SYSTEM OF DOGS Allen Sisson DVM, MS, Diplomate ACVIM (Neurology) Angell Animal Medical Center, Boston, Massachusetts Several inflammatory, primary central nervous system (CNS) derangements of dogs have been described such as: 1. Granulomatous Meningoencephalomyelitis (GME) 2. Necrotizing Encephalitis of mostly Pug, Maltese and Yorkshire terrier dogs 3. Corticosteroid-Responsive or Neutrophilic Meningitis 4. Eosinophilic Meningoencephalomyelitis 5. Idiopathic Tremor Syndrome or Cerebellitis 6. Pyogranulomatous Meningoencephalitis The two things these conditions have in common are that they are considered to be idiopathic, since no causative agent or infectious organism has been found,10,17 and they all respond, to some degree, to immune suppressive therapy. Because of this, most people now believe that these diseases are either autoimmune or neoplastic in nature. However, an autoimmune etiology is most likely since in most cases with aggressive immunosuppressive therapy permanent remission can be achieved which would be unlikely if they really were of neoplastic origin. Depending on where in the brain and spinal cord these diseases start, and how rapidly they progress, they can cause a wide variety of signs. The most common presenting clinical signs are: 1. Progressively worsening central vestibular signs 2. Progressively worsening seizures and behavior abnormalities 3. Progressively worsening neck and or back pain 4. Progressively worsening para or tetraparesis 5. Progressively worsening generalized severe intention tremor 6. Acute onset of blindness

05-25-2010, 08:16 PM	#80
dwerten BANNED! Join Date: May 2007 Location: USA Posts: 11,073	whew ok i think i got it all posted so you can read tonight and discuss with neurologist I am so glad you took her in to neurologist and she is starting to be treated as the sooner the better with neurological conditions.

05-26-2010, 08:18 AM	#84
omichka YT 500 Club Member Join Date: Sep 2004 Location: *** Posts: 647	I am very confused how this yahoo group works? I posted my question, but do not see it anywhere

05-31-2010, 10:47 PM	#88
dwerten BANNED! Join Date: May 2007 Location: USA Posts: 11,073	bumping this thread as there are some dogs showing neurological signs here recently

05-31-2010, 11:25 PM	#89
lillymae YT 3000 Club Member Join Date: Apr 2009 Location: Idaho Posts: 4,544	How is this Baby doing ?