Today I am looking at my bright-eyed beautiful boy who is right now pestering me to throw the ball as I try to write. With great relief I notice that most of the pigmentation around his eyelids, nose and lips has returned. The white of his eyes are still a bit red but his eyes are full of life and he can see perfectly. His eye exam last week showed improvement and the eye pressure had even increased to a more normal level. At the start of this disease the eye pressure was dangerously low and measured 4 & 5 but now it is at a more normal level measuring 13 & 15.
This is a crucial time in the course of events as we are slowly decreasing the prednisone after a long period at a high dosage. He was on 30mg of pred twice daily for 18 days. Before that he was getting by on 5mg pred every other day alternated with azathioprine 25mg until the relapse late March when we gradually doubled and then tripled the amount but didn't get enough response. We had continued the niacinamide twice daily and eyedrops twice then 3 x's daily. I also continued the Veterinary Immune Tabs daily as always since December '09. I have not changed his food since his stools are consistently good: Taste of the Wild salmon/sweet potato.
When the disease seemed to be coming out of remission by late March we noticed some depigmentation around the face although this time at a slower rate as my photos will show. At this point since he now has some tolerance toward the drugs we had to get much more aggressive. Below I've documented the dosages given along with the photos. Earlier documentation is shown if you scroll down to older posts.
Since early December 2009 when Corky was diagnosed with uveodermatologic disease I started him on a nutritional supplement that I've continued ever since. I believe it has helped with his success. It is called Verterinary Immune Tabs found at Ramaekers Nutrition online ramaekersnutrition.com. You must talk to one of the website's veterinarians in order to purchase the professional strength tabs. The basis is made from Transfer Factors derived from colostrum which carry molecules that help balance the immune system. It also utilizes powerful mushroom extracts potent in the healing process along with omega 3's, amino acids, trace minerals, msm, and everything else good for a balanced immune system.
As for the side effects from the high dosages of pred, we have seen the typical raveneous thirst and appetite, hyperactivity, panting, excessive peeing. The skin rash and dry cracked paws and nostrils may be caused by the drugs if not the disease, or perhaps the extra dry air and allergens this time of year here in Tucson. I worry about the long term affects of the drugs but we really have no choice. This disease won't go away and can only be managed by drugs. The past ten months has been an emotional rollercoaster struggling to keep our beloved dog alive. If we can sustain him at low doses as we did in January through March, then he could still live a long quality life. As loyal as he is to me I remain dedicated in fighting this disease with all the persistance it takes. Meantime, Corky reminds us how every moment counts, none of us will be here for long. He's waiting for me to throw more balls so off I go. Today is all there is.
And oh, yes, I believe dogs do feel love.
Wednesday, June 23, 2010
Eyes Summary January - June 2010
Did I tell you how much I love him? More than I can say...
June 23, 2010: prednisone 40mg once daily, azathioprine 50mg once daily, doxycycline 100mg and niacinamide 500mg twice daily. Immune tabs daily. Prednisolone acetate 1% eyedrops 3 x's daily, tropicamide drops 3 x's weekly.
June 21, 2010: prednisone had been reduced to 40mg once daily one week ago. All other meds remained same. Eyedrops 3 x's daily.
June 13, 2010: prednisone 30mg twice daily, azathioprine 50mg once daily, doxycycline and niacinamide twice daily, eyedrops 4 x's daily, immune tabs, tropicamide eyedrops 3 x's weekly.
May 29, 2010: started the aggressive approach May 27th with prednisone increased to 30mg twice daily, azathioprine 50mg, continued niacinamide 500mg twice daily, prednisolone actetate 1% eyedrops 4 x's daily, immune tabs daily.
May 23, 2010: prednisone increased to 30mg every day, azathioprine increased to 50mg every day instead of every other day. Eyedrops 3 x's daily. Other meds stay the same.
May 10, 2010:
April 30, 2010:
April 24, 2010: prednisone was increased from 5 mg to 7.5mg every other day along with the other meds since late March as the pigment started fading again.
June 23, 2010: prednisone 40mg once daily, azathioprine 50mg once daily, doxycycline 100mg and niacinamide 500mg twice daily. Immune tabs daily. Prednisolone acetate 1% eyedrops 3 x's daily, tropicamide drops 3 x's weekly.
June 21, 2010: prednisone had been reduced to 40mg once daily one week ago. All other meds remained same. Eyedrops 3 x's daily.
June 13, 2010: prednisone 30mg twice daily, azathioprine 50mg once daily, doxycycline and niacinamide twice daily, eyedrops 4 x's daily, immune tabs, tropicamide eyedrops 3 x's weekly.
May 29, 2010: started the aggressive approach May 27th with prednisone increased to 30mg twice daily, azathioprine 50mg, continued niacinamide 500mg twice daily, prednisolone actetate 1% eyedrops 4 x's daily, immune tabs daily.
May 23, 2010: prednisone increased to 30mg every day, azathioprine increased to 50mg every day instead of every other day. Eyedrops 3 x's daily. Other meds stay the same.
May 10, 2010:
April 30, 2010:
April 24, 2010: prednisone was increased from 5 mg to 7.5mg every other day along with the other meds since late March as the pigment started fading again.
April 9, 2010: by late March we started to see some pigment fading again in the eye corner, lip margins and nose.
February 7, 2010:
February 7, 2010:
January 19, 2010:
Nostrils summary Jan - June 2010
June 22, 2010:
Though it doesn't show as much in photos the fur on his muzzle and between his eyes has thinned since the bery begining of the symptoms back in August 2009. His coat in general is somewhat dull but after his bath he still looks great. There's a patch of fur missing on his forearm where he'd formed a hot spot a couple weeks ago along with a big rash around his groin. The vet put him on doxycycline which works synergestically with the niacinamide he takes daily. He's been wearing a cone around his neck while we tackled the rash. I had applied hydrocortisone cream and ice packs to help speed the healing. It is finally cleared up. Is he gorgeous or what?:
June 23, 2010: it actually looks better today. We are continuing daily doses of prednisone 40mg in the morning and azathioprine 50 mg in the evening along with doxycycline 100mg twice daily, niacinamide 500mg twice daily, immune tabs. Prednisolone eyedrops will be decreased to twice daily and tropicanmide eyedrops 3 times weekly.
June 13, 2010: notice the smooth texture in contrast to the normal cobblestone texture in April photo. The cracks above his nostrils have been constant for weeks. Could be the disease or drug side effects or environmental. His paw pads have also been extra dry and cracked. I've been applying vit E to both.
May 23, 2010
Though it doesn't show as much in photos the fur on his muzzle and between his eyes has thinned since the bery begining of the symptoms back in August 2009. His coat in general is somewhat dull but after his bath he still looks great. There's a patch of fur missing on his forearm where he'd formed a hot spot a couple weeks ago along with a big rash around his groin. The vet put him on doxycycline which works synergestically with the niacinamide he takes daily. He's been wearing a cone around his neck while we tackled the rash. I had applied hydrocortisone cream and ice packs to help speed the healing. It is finally cleared up. Is he gorgeous or what?:
June 23, 2010: it actually looks better today. We are continuing daily doses of prednisone 40mg in the morning and azathioprine 50 mg in the evening along with doxycycline 100mg twice daily, niacinamide 500mg twice daily, immune tabs. Prednisolone eyedrops will be decreased to twice daily and tropicanmide eyedrops 3 times weekly.
June 13, 2010: notice the smooth texture in contrast to the normal cobblestone texture in April photo. The cracks above his nostrils have been constant for weeks. Could be the disease or drug side effects or environmental. His paw pads have also been extra dry and cracked. I've been applying vit E to both.
June 6, 2010:
May 23, 2010
April 20, 2010
March 30, 2010: coming out of remission...
February 7, 2010:
January 19, 2010: getting by nicely on 5mg prednisone every other day alternated with azathioprine 25mg along with niacinamide twice daily and immune tabs.
Nose bridge summary Jan - June 2010
June 22, 2010: One week after Prednisone dose was lowered to 40mg down from 60mg. All other drugs remained the same. Azathiprine 50mg given in pm / doxycyline 100mg twice daily / niacinamide 500mg twice daily / prednisolone acetate 1% eyedrops 3 x's daily / Veterinary Immune Tabs / Tropicamide eyedrops 3 x's weekly. There is more pigmentation returning however I am watching that tiny spot centered on nosebridge and the cracks above his nostrils that have been consistant for weeks. Also his paw pads have been extra cracked and bleed some. He wears his Ruff Wear Grip boots for walks. I keep vitamin E on his nose and paws. Think I'll also try calendua cream.
June 18, 2010: after an intensive course of high dosage of meds the pigment gradually returned and his two eye exams showed positive results. So far there has not been any retinal detachment and the eye pressure is now more normal. Back at the acute stage in December '09 his eye pressure was dangerously low measuring 4 & 5. Today it is around 13 & 15. He has been on prednisone 60mg (two dosages) for 18 days and was tapered to 40mg June 14. He has the normal side effects, excessive thirst with urination, hunger, hyperactive. We had to give doxycycline to help clear up a skin rash as a result of low immunity. In spite of all the drugs, Corky is full of life and enjoying life.
May 15, 2010: by May 21st we increased the prednisone to 30mg in the am and azathiprine 50mg in the pm every day, continuing the naicinamide, immune tabs, and eyedrops daily. By May 27 we still weren't seeing enough results so we got more aggressive and increased the pred to 30mg TWICE daily along with azathiprine 50mg and increased eyedrops to 4 x's daily.
April 30, 2010: Corky was doing so well we tried skipping one day of meds per week but two consecutive weeks but by late March the pigment around his nose, eyes, and lips started to receed again. The depigmentation was very slow and we thought taking the pred dosage up to 7.5mg every other day would be enough to turn it around. By the end of April we went to 10mg two days in a row then skipping every other day continuing the azathioprine alternate days.
March 30, 2010
February 7, 2010
January 19, 2010: here we were seeing the disease in remission. The pigmentation continued to return. The bare spot above his nostril was orginally like that when he was a pup, it was the last spot to fill in as he grew. At this point he was getting only 5mg prednisone every other day alternated with azathioprine 25mg and the niacinamide 500mg twice daily.
June 18, 2010: after an intensive course of high dosage of meds the pigment gradually returned and his two eye exams showed positive results. So far there has not been any retinal detachment and the eye pressure is now more normal. Back at the acute stage in December '09 his eye pressure was dangerously low measuring 4 & 5. Today it is around 13 & 15. He has been on prednisone 60mg (two dosages) for 18 days and was tapered to 40mg June 14. He has the normal side effects, excessive thirst with urination, hunger, hyperactive. We had to give doxycycline to help clear up a skin rash as a result of low immunity. In spite of all the drugs, Corky is full of life and enjoying life.
May 15, 2010: by May 21st we increased the prednisone to 30mg in the am and azathiprine 50mg in the pm every day, continuing the naicinamide, immune tabs, and eyedrops daily. By May 27 we still weren't seeing enough results so we got more aggressive and increased the pred to 30mg TWICE daily along with azathiprine 50mg and increased eyedrops to 4 x's daily.
April 30, 2010: Corky was doing so well we tried skipping one day of meds per week but two consecutive weeks but by late March the pigment around his nose, eyes, and lips started to receed again. The depigmentation was very slow and we thought taking the pred dosage up to 7.5mg every other day would be enough to turn it around. By the end of April we went to 10mg two days in a row then skipping every other day continuing the azathioprine alternate days.
March 30, 2010
February 7, 2010
January 19, 2010: here we were seeing the disease in remission. The pigmentation continued to return. The bare spot above his nostril was orginally like that when he was a pup, it was the last spot to fill in as he grew. At this point he was getting only 5mg prednisone every other day alternated with azathioprine 25mg and the niacinamide 500mg twice daily.
Wednesday, June 16, 2010
Uveodermatological Syndrome:
Uveodermatological Syndrome (UDS) is an immune-mediated canine disease characterized by inflammation of the eye, depigmentation of skin and whitening of hair. Morbidity is related primarily to the eye inflammation, which can result in secondary ophthalmological disorders that lead to blindness. Treatment involves both topical and systemic immunosuppression. It is believed that UDS results from a genetic flaw, and as yet there is no cure.
Uveodermatological Syndrome is similar to the human Vogt-Koyanagi-Haradi Syndrome (VKH), was first described in 1977. Human VKH is characterized by uveitis (inflammation of the eye), poliosis (whitening of hair), vitiligo (depigmentation of skin) and a variety of neurological symptoms. Unlike VKH, however, UDS does not usually present with neurological symptoms. Because of the similarity of the two entities, UDS is sometimes referred to as VKH-like Syndrome or simply VKH. Although generally considered to be more common in Northern breeds, such as Akitas, Siberians and Samoyeds, there have been reports of the disease in a wide range of breeds, including the Australian Shepherd, Dachshund, Brazilian Fila dog.
Clinical Relevance: Some breeds in which uveodermatologic syndrome has been reported (eg, Siberian Huskies, Old English Sheepdogs, Australian Shepherds, and Shetland Sheepdogs) often have heterochromia irides. This case highlights the fact that dogs with asymmetric uveal pigmentation may have unilateral ocular changes; therefore, uveodermatologic syndrome should not be excluded as a differential diagnosis on the basis of unilateral clinical signs.
Here are links to good documentations of dogs with the disease:
http://www.dogbreedinfo.com/articles/vkhsyndrome.htm
http://www.samoyedhealthfoundation.org/diseases/uveodermatologic-syndrome-uds/living-with-uds-vkh
Below is my documentation of my dog who got the disease around age six which is the typical age for this disease to manifest although sometimes it strikes sooner. My earlier posts will fill you in on the sequence of events. Feel free to contact me via email or post comments. I will keep updating this blog as best as possible.
Uveodermatological Syndrome is similar to the human Vogt-Koyanagi-Haradi Syndrome (VKH), was first described in 1977. Human VKH is characterized by uveitis (inflammation of the eye), poliosis (whitening of hair), vitiligo (depigmentation of skin) and a variety of neurological symptoms. Unlike VKH, however, UDS does not usually present with neurological symptoms. Because of the similarity of the two entities, UDS is sometimes referred to as VKH-like Syndrome or simply VKH. Although generally considered to be more common in Northern breeds, such as Akitas, Siberians and Samoyeds, there have been reports of the disease in a wide range of breeds, including the Australian Shepherd, Dachshund, Brazilian Fila dog.
Clinical Relevance: Some breeds in which uveodermatologic syndrome has been reported (eg, Siberian Huskies, Old English Sheepdogs, Australian Shepherds, and Shetland Sheepdogs) often have heterochromia irides. This case highlights the fact that dogs with asymmetric uveal pigmentation may have unilateral ocular changes; therefore, uveodermatologic syndrome should not be excluded as a differential diagnosis on the basis of unilateral clinical signs.
Here are links to good documentations of dogs with the disease:
http://www.dogbreedinfo.com/articles/vkhsyndrome.htm
http://www.samoyedhealthfoundation.org/diseases/uveodermatologic-syndrome-uds/living-with-uds-vkh
Below is my documentation of my dog who got the disease around age six which is the typical age for this disease to manifest although sometimes it strikes sooner. My earlier posts will fill you in on the sequence of events. Feel free to contact me via email or post comments. I will keep updating this blog as best as possible.
Friday, June 11, 2010
DEC 2009 / JAN 2010 SUMMARY: EYES
Prednisone 5mg every other day four times weekly. Azathioprine 50mg every alternate day. Niacinamide 500mg twice daily. Prednisolone Acetate 1% twice daily. Veterinary Immune Tabs daily. No other supplements. Had switched food from Royal Canin duck/potato (made stools too soft and Corky lost weight because he didn't like it) to Taste of the Wild salmon/sweet potato (stools became firm and he regained his normal weight).
January 9, 2009:
December 28, 2009:
December 28, 2009:
December 2o, 2009: Prednisone 10mg once daily 4 days weekly. Azathioprine 50mg once daily. Niacinamide 500mg twice daily. Doxycycline 200mg twice daily. Prednisolone Acetate 1% eydrops 3 x's daily. Veterinary Immune Tabs daily.
December 20, 2009:
December 13, 2009: Prednisone 20mg once daily. Azathioprine 50mg once daily. Doxycycline 200mg twice daily. Niacinamide 500mg twice daily. Veterinary Immune Tabs daily. Prednisolone Acetate 1% 4 x's daily.
December 8, 2009: Day of correct diagnosis. Prednisone injected under eyelids. Then Prednisolone Acetate 1% eyedrops 4 x's daily. Prednisone 30mg twice dialy. Niacinamide 500mg once daily. Doxycycline 250mg twice daily. Discontinue Cephalexin. Veterinary Immune Tabs daily.
January 9, 2009:
December 28, 2009:
December 28, 2009:
December 2o, 2009: Prednisone 10mg once daily 4 days weekly. Azathioprine 50mg once daily. Niacinamide 500mg twice daily. Doxycycline 200mg twice daily. Prednisolone Acetate 1% eydrops 3 x's daily. Veterinary Immune Tabs daily.
December 20, 2009:
December 13, 2009: Prednisone 20mg once daily. Azathioprine 50mg once daily. Doxycycline 200mg twice daily. Niacinamide 500mg twice daily. Veterinary Immune Tabs daily. Prednisolone Acetate 1% 4 x's daily.
December 8, 2009: Day of correct diagnosis. Prednisone injected under eyelids. Then Prednisolone Acetate 1% eyedrops 4 x's daily. Prednisone 30mg twice dialy. Niacinamide 500mg once daily. Doxycycline 250mg twice daily. Discontinue Cephalexin. Veterinary Immune Tabs daily.
DEC 2009 / JAN 2010 SUMMARY: NOSE BRIDGE
(Scroll down to older posts for detailed info and medications)
January 19, 2009
January 19, 2009
January 9, 2009
December 30, 2009
December 30, 2009
December 20, 2009
December 8, 2009
January 19, 2009
January 19, 2009
January 9, 2009
December 30, 2009
December 30, 2009
December 20, 2009
December 8, 2009
DEC 2009 / JAN 2010 SUMMARY: NOSTRILS
(Scroll down to earlier posts showing Oct - Nov 2009 for detailed info and medications: see much older post "Lip Summary")
January 9, 2009:
December 30, 2009:
December 30, 2009:
December 20, 2009:
December 8, 2009:
January 9, 2009:
December 30, 2009:
December 30, 2009:
December 20, 2009:
December 8, 2009:
Thursday, June 10, 2010
DEC 2009 / JAN 2010 SUMMARY: LIPS
January 19, 2010: Prednisone 5mg every other day four times weekly. Azathioprine 50mg every alternate day. Niacinamide 500mg twice daily. Prednisolone Acetate 1% twice daily. Veterinary Immune Tabs daily. No other supplements. Had switched food from Royal Canin duck/potato (made stools too soft and Corky lost weight because he didn't like it) to Taste of the Wild salmon/sweet potato (stools became firm and he regained his normal weight).
January 19, 2010
January 19, 2010
Janaury 9, 2010
December 28, 2009: Prednisone 10mg four days weekly alternated with Azathioprine 50mg three days weekly, niacinamide 500mg twice daily, Doxycycline 200mg twice daily, Prednisolone Acetate 1% eyedrops three times daily until Jan 4th then applied twice daily. Veterinary Immune Tabs daily. Fed Royal Canin duck/potato limited ingredients.
December 28, 2009
December 28, 2009
December 13, 2009
December 8, 2009: Prednisone 30mg twice daily for two days. Doxycycline 250mg twice daily. Niacinamide 500mg twice daily. Prednisolone Acetate 1% FOUR times daily. After two days Dec 10th oral Prednisone was reduced to 20mg twice daily. Azathioprine 50mg was added once daily. Oral Pred was reduced to 20mg once daily Dec 12th. Fed Royal Canin duck/potato limited ingredients. Veterinary Immune Tabs daily.
January 19, 2010
January 19, 2010
Janaury 9, 2010
December 28, 2009: Prednisone 10mg four days weekly alternated with Azathioprine 50mg three days weekly, niacinamide 500mg twice daily, Doxycycline 200mg twice daily, Prednisolone Acetate 1% eyedrops three times daily until Jan 4th then applied twice daily. Veterinary Immune Tabs daily. Fed Royal Canin duck/potato limited ingredients.
December 28, 2009
December 28, 2009
December 20, 2009: Prednisone 10mg once daily four days weekly. Azathioprine 50mg once daily. Niacinamide 500mg twice daily. Doxycycline 200mg twice daily. Prednisolone Acetate 1% eyedrops three times daily. Vet Immune Tabs daily.
December 20, 2009
December 13, 2009
December 8, 2009: Prednisone 30mg twice daily for two days. Doxycycline 250mg twice daily. Niacinamide 500mg twice daily. Prednisolone Acetate 1% FOUR times daily. After two days Dec 10th oral Prednisone was reduced to 20mg twice daily. Azathioprine 50mg was added once daily. Oral Pred was reduced to 20mg once daily Dec 12th. Fed Royal Canin duck/potato limited ingredients. Veterinary Immune Tabs daily.
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