Australian Shepherd with Uveodermatological Syndrome

Definition repeat from older post:

2011-07-16T12:42:00.000-07:00

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

July 6, 2011 CORKY TURNS 8!!!

2011-07-08T12:21:00.000-07:00

HAPPY BIRTHDAY CORKY!!!!

Corky remains stable and happy and we have been enjoying a long remission of the disease... however the symptoms do try to sneak up at times and then I will increase the dosage of pred a bit following a gradual tapering until we are back to the EOD (every other day) routine. I watch for symptoms mainly of pigment recession around the eyerims, nose, and mouth and also for any squinting. When the black pigment starts to fade to pink, usually at the eye corners, I increase the dosage to 20mg prednisone for one day then decrease it to 15mg for the next two or three along with all the other meds until we get back to the EOD schedule.

Last eye exams were good and improved since we switched from regular prednisolone acetate drops to pred mild drops every other day. He only has to see the opthamologist every 4 months now. Cork's recent full body lab results showed normal ranges in all organs except now the liver is showing some steroids. This did not surprise the doctor but he had expected to see this kind of result many months ago as Corky has been under steroid therapy for 19 months. The doctor was simply amazed. I wondered if Cork's success can be credited to the long term use of the Veterinary Immune Tabs that have Transfer Factors and medicinal mushroom extracts. At any rate his thyroid is doing fine and overall Corky looks fantastic! His coat is thick and healthy, the black pigment around his face looks great, his musculature is great, paw pads have greatly improved, and even the limp is gone. As for the liver, we have added "SAMe" s-adenosyl 225mg/ milk thistle to his routine in order to protect the liver.

Here is Corky's current meds: Azathioprine 50mg once daily, niacinamide 500mg & doxycycline 100mg & SAMe 225mg & thyroxine .4mg twice daily. Prednisone 10mg or 12.5mg once every other day. Prednisolone mild acetate 12% eyedrops in both eyes once every other day. Genteal mild eyedrops twice daily. Veterinary Immune Tabs professional strength 2 tabs 4 times weekly. Taste of the Wild salmon/sweet potato kibble and spoonfuls of Naturals fish/sweet potato canned and/or fresh salmon, carrots, apple, treats. Also, to support his thyroid he gets 1 tsp organic kelp powder daily. Most important ingredient of all: unconditional endless LOVE!

During Corky's rehab for his front leg limp he swam many laps in the pool. The limp lasted about 6 months. Finally I restricted his daily walks to absolute minimum with no running but increased his swimming sessions. One day he suddenly stopped limping and hasn't limped since. Here he is going for a swim... fetching the ball in the long lap pool:

LUCKY BOY:

February 9, 2011 CORKY IS A SUCCESS CASE!

2011-02-09T15:01:00.000-08:00

It has been well over a year since Corky's official diagnosis of UVD and today he is looking and feeling great. His hair has mostly all grown back and it feels healthy and soft as it had drastically thinned back in September when his thyroid level dropped too low due to medication side effects. The pigment around his eyes, nose, and lips have stayed normal black for almost four months now.

We must be reminded of how serious and extreme Corky's symptoms were back in December 2009 (scroll down to earlier posts) and the long rollercoaster ride it took to finally get the disease into a sustained remission. Looking back we have endured two minor flareups and one major flareup in July 2010 which took a dreaded extended course of high dosage prednisone to bring the disease back under control. In addition to the numerous side effects from this episode, including hairloss and lowered thyroid, Corky had to undergo a major dental surgery in early October due to a deceptive cracked tooth which led to an abscessed carnasial molar that had be removed. This of course triggered his autoimmune UVD syndrome symptoms but after the surgery it calmed down and, to our great relief, has stayed in remmission ever since. His recent lab results came back healthy normal aside from his T-4 which seems to be oscillating between 1.7 and .5 so we have increased the thyroxine to .4mg twice daily. In addition to the thyroxine he is on a maintenance of prednisone every other day at 10mg alternated with 15mg EOD with a day of no pred inbetween. Niacinamide 500mg and Doxycycline 100mg twice daily. Azathioprine 50mg once daily. Prednisolone Acetate eyedrops twice daily. Other supplements include organic kelp powder and Veterinary Immune Tabs (professional strength) two tabs daily four times weekly. Taste of the Wild salmon/sweet potato grain free kibble and canned wet food for med adminstrating.

The good news is that Corky is happy and enjoying life as we are thoroughly enjoying him. Although his drama will always continue... he had developed a slight limp in his left front leg a couple months ago which he is still struggling with. The vet thinks he might have injured a shoulder ligament and since we are very cautious about using anesthesia for diagnosis we are not doing xrays at this time. Instead we have restricted his activities and giving it time to heal, expecting the healing to be slowed because of the pred usage. In fact, it may have been the pred that weakened his muscles making him more prone to injuries. It is a fine line any way you see it. Now since he is banned from chasing balls and frisbees which help with muscle tone, he is confined to walking only. He has gained a couple pounds putting more weight on the injured leg even though I've cut down on his calories. Then just when I think we're making a little progress he manages to gobble up a WHOLE LOAF of banana bread behind my back... aaaagggghhhh... so you get the picture...

One more new issue we are dealing with... he now has a ulcer in his left eye. Stopped pred acetate in that eye and are administrating two new serums and antibiotics... to be continued...

Meantime, a few recent photos of our beautiful Corkster:

a good looking eye:

a good looking nose:

Corky and Lulu... best buddies:

UPDATE Sept 10, 2010

2010-09-13T13:03:00.000-07:00

Here's Corky today, feeling and looking great. He is on a maintenance of low doses of prednisone every other day along with the other supplements: Prednisone 10mg EOD alternated with 15mg EOD, azathioprine 50mg, doxycycline 100mg twice daily, niacinamide 500mg twice daily, Veterinary Immune Tabs 2 pro tabs daily 4x weekly, plus organic kelp powder daily.

Now that he is stabilized the next step is to slowly reduce the azathioprine and doxycyline. He will see the opthamologist this week and then his main vet for a check up and another thyroid test. Last lab results early August showed everything normal including all organs except the thyroid was very low at .4 (normal is 1 - 4). Although since he wasn't displaying typical hypo-thyroid symptoms we did not treat it. The vet said his low reading was extremely common for dogs undergoing intense prednisone treatment. If you review Corky's blog from March through July you will see the events of his relapse and the aggressive treatment we were forced to use.

As a result of the high dosages of prednisone during July, Corky suffered major side effects including shocking hair loss which is documented in the photos below. However, we were surprised at the speed of recovery as we expected extra slow hair regrowth due to the pred. This I lean toward crediting to the Vet Immune Tabs that he has been taking since the onset of symptoms back in December. At any rate, by early August it seemed the disease was back in remission, just prior our vacation to the High Sierra where we're originally from. We knew it would be a risk exposing Corky to the more intense ultra violet rays at high altitudes but I had made him a wardrobe of hats with visors and cooling coats to shade the bald spots all over his back and top of head. Well, right after our first fun hike with our long time friends and Cork's doggie buddies did he start to relapse with the same exact pattern of pigment fading across the nosebridge as what happened back in May (see earlier blog posts), along with a little blood from him rubbing his irritated nose against the grass. Okay, then... it didn't take long for me to discover that it is THE SUN! that triggers the symptoms. So, once I realized that I immediately modified his hat visors to extend beyond his nose and also decided to be vigilant about keeping that nose out of the sun for good. Which meant, sticking to shaded hikes, keeping those visors on him when in the sun, and continuing early morning and dusk walks. Once I realized that Corky is extremely sun sensitive I became adamant about his routines. And it worked.
Now, when he did begin to relapse second week of August I did what the eye doc suggested and backed up a step on the meds, meaning instead of every other day of pred I did every day at 20mg for a week. However, I was so nervous about a relapse like before that I decided to really stay on top of the process and hit him hard for one day at 30mg in the morning then 10mg in evening and tapper it down next day to 30mg, etc until we were back to 20mg daily. This course took 10 days. After that his nose pigment returned and we got back on the schedule of every other day 10mg alternated with 20mg. Today he is at 10mg EOD then 15mg EOD along with the other supplements and avoiding the sun. Whew! See below for photos of his hats. Double click photos to enlarge.

Sept 10, 2010:

July 23, 2010:

August 10, 2010

Sept 10, 2010:

May 27, 2010:

June 28, 2010:

Sept 10, 2010:

July 23, 2010:

Sept 10, 2010:

July 5, 2010:

July 29, 2010:

Sept 10, 2010:

July 29, 2010:

August 10, 2010:

Sept 10, 2010:

August 10, 2010: this hat covered his bald spot on his head and protected his eyes but the visor was too short to cover the nose so the sun aggravated it and triggered a relapse. Afterward I made extra long visors to shade his nose. Corky is also wearing a cooling coat to shade his bald spots. Needless to say he had a blast in the high country with his old pals.

These boots are made for walking and he loves them. They are by Ruffwear and have great traction and stay on. Best boots on market. His pads tend to get dry and cracked so I apply an organic foot balm then put his socks on before the boots. What a good sport!

SUMMARY August 1, 2010

2010-08-01T17:30:00.001-07:00

Below are photos showing a brief course of events since the onset back in 2009. Corky relapsed in March while on a low maintenance dosage of prednisone 5mg every other day alternated with azathioprine along with niacinamide and prednisolone eyedrops twice daily. We continued the Veterinary Immue Tabs daily.

As the disease became more aggressive we gradually increased the pred but as the disease continued to be aggressive we had to get aggressive with the medication. During the whole month of June he was given up to 60mg pred for 18 days then gradually tappered to 30mg daily until his eye exams improved. He had seen the opthomologist three times that month. By July the pigment continued to return and the pred was reduced to 20mg daily. By mid July we were able to skip a day and go every other day at 20mg. We are now down to 20mg of pred EOD alternated with 10mg EOD. All other medications remain the same: azathioprine 50mg daily, niacinamide and doxycycline twice daily, prednisolone acetate 1% eyedrops twice daily, tropicamide eyedrops three times weekly. Vetinerinary Immune Tabs daily.

Corky's complete blood analysis came back with good results showing very normal organ levels except the thyroid read .4 (normal is between 1 - 4). The vet said this is typical of an animal on high medication. However, Corky does not have any clinical signs of hypo-thyroid symptoms so we will not treat it at this time. Instead we are gradually lowering the prednisone and will recheck the thyroid in 6 weeks. Meantime, Corky is full of energy and enjoying life.

As for the side effects of prednisone at high doses for the extended period Corky had the typical excessive thirst and urination, ravenous appetite, and hyper energy. He developed moist dermatitus and a rash on his belly which we treated with hydrocortisone cream and a cone around his neck to prevent him from licking. He had to wear the cone for weeks even after the rash cleared up. His paws became so dry and cracked sometimes he limped. I applied a natural organic foot balm to his paw pads and wrapped them in socks at night. During the day on our hikes he wore boots and socks made by Ruff Wear, the best on the market. He could run and chase balls without the boots coming off and he actually seemed to like wearing them. Now he doesn't need to wear them anymore. It took continuous effort to soften his paws and at the same time exercise him enough in order to keep his muscles toned since the pred weakens muscles. In the long run we did notice muscle loss with a slight swayback. It would've been much worse if he didn't get adequate exercise but he hikes every day with us, chases balls and frisbees and swims in the lap pool.

The cracks at his nostrils bled occasionally during the drug therapy but once blood poured from his left nostril on a hot day. Luckily it didn't last long and didn't happen again. Because the pred thinned his skin he bleeds more easily. One day on our morning hike he rubbed himself hard against a nasty thorn bush which left deep scratches on top his head and along his back. Although these scratches bled more than normal we didn't notice them until the next day after they scabbed. The scabs dried up, he kept rolling on his back to relieve the itch, the scabs came off along with the hairs. To our horror, he ended up a patchwork of big bald spots all over his body. At this time I cannot bring myself to post the photos but when the hairs all grow back I'll show before and afters. To our relief the hairs are growing back nicely though we expected a very slow process due to the pred. Perhaps the Vet Immune Tabs made the difference. Corky now has a whole wardrobe of hats and cooling coats he must wear everyday when outside. Luckily he is a good sport and wears anything I put on him.

All in all we are on an uphill of the rollercoaster. The disease seems to be back in remission. Slowly we are decreasing the pred but will not go as low as before the second episode. Meantime, Corky is having a good life full of fun and lots of love.

Eyes summary

2010-08-01T16:54:00.000-07:00

August 1, 2010:

June 28, 2010:

May 31, 2010:

March 20, 2010:

February 9, 2010:

January 19, 2010:

December 8, 2009:

Nosebridge summary

2010-08-01T16:39:00.000-07:00

August 1, 2010:

June 28, 2010:

May 31, 2010:

February 9, 2010:

January 19, 2010:

December 8, 2009:

Lips & nostrils summary

2010-07-29T17:02:00.000-07:00

August 1, 2010: smoother with cobblestone texture. Full pigmentation.

June 28, 2010: loss of cobblestone texture, cracks around nostrils that often bled.

May 31, 2010:

February 9, 2010:

January 19, 2010:

December 8, 2009:

August 1, 2010: Complete return of pigmentation. Continued lowering of prednisone dosage. Every other day pred 20mg / skip a day / pred 10mg / skip / pred 20mg/ skip / pred 10 mg... Next step will be pred 15mg EOD then gradually 10mg EOD. All other meds and eyedrops remain the same.

June 28, 2010: After intense period of aggressive medication to put the disease back into remission. See earlier posts for medication routine.

May 31, 2010: at the start of the aggressive medication approach as the disease became more aggressive:

March 20, 2010: Relapse mid March. Increased pred from 5mg to 10mg for several weeks at no avail.

February 9, 2010: Continued improvement and stabilization with low doses of prednisone 5mg every other day alternated with azathioprine. Con't with niacinamide and Veterinary Immune Tabs daily. See earliest posts for complete medication program.

January 19, 2010: After several weeks of initial treatment and maintenance of 5mg pred every other day alternated with azathioprine. See earliest posts for complete med program.

December 8, 2009: Just biopsied and diagnosed as UVD. On the surface the disease attacks the margins at mucous membranes where pigment meets hairline; the lips, nose bridge, eyerims, paws, anus. Internally it also attacks the eye retina and nostrils and other mucous membranes. Here, prior correct treatment, Corky lost all black pigment on his lips:

JULY 6TH, 2010 HAPPY BIRTHDAY CORKY!

2010-07-06T20:01:00.000-07:00

Today he turned 7! Isn't he gorgeous! Today is a good day!

Luckily you can't see the bald spots except for the one on his front leg. More on the pred side effects later. For now we are celebrating his happy day. Today he is full of life and loves his new birthday ball. Simple things...

July 5, 2010

2010-07-05T19:09:00.000-07:00

Here is a quick update for now... photos before we started the intense therapy course and after. Scroll down to earlier posts for details of medication adjustments and more photos. We have tappered the prednisone down from 60mg for 18 days then 40mg 10 days, 30mg 10 days, and are now down to 20mg per day. All other meds remained the same. We are aiming to get him on an every other day maintenence schedule again. I will update after the next eye exam in a few days and also comment on the side effects of the high dosages. He is still full of energy and still has a great attitude. He is just the best sport ever. I hate to see him as the poster dog for this disease but if this blog could help someone else, here it is. We are thrilled to be able to celebrate his 7th birthday tomorrow. Today he had a fun hike along his favorite trail up Mt Lemmon with the family and tomorrow he'll get to party more... Every day is precious. Did I say how much I love him?...

More later, for now here's a comparison of the pigment changes since May 23:

July 5, 2010:

May 23, 2010:

July 5, 2010:

May 23, 2010:

July 5, 2010:

May 23, 2010:

July 5, 2010: Notice the hyperpigmentation in a place he never had pigment before. It is not consistent this time around:

May 23, 2010:

June 23, 2010 UPDATE

2010-06-23T15:54:00.000-07:00

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.

Eyes Summary January - June 2010

2010-06-23T15:19:00.000-07:00

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.

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:

January 19, 2010:

Nostrils summary Jan - June 2010

2010-06-23T14:44:00.000-07:00

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.

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

2010-06-23T13:39:00.000-07:00

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.

Uveodermatological Syndrome:

2010-06-16T07:13:00.001-07:00

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.

DEC 2009 / JAN 2010 SUMMARY: EYES

2010-06-11T10:07:00.000-07:00

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.

DEC 2009 / JAN 2010 SUMMARY: NOSE BRIDGE

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(Scroll down to older posts for detailed info and medications)
January 19, 2009

January 19, 2009

January 9, 2009

December 30, 2009

December 20, 2009

December 8, 2009

DEC 2009 / JAN 2010 SUMMARY: NOSTRILS

2010-06-11T09:32:00.000-07:00

(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:

DEC 2009 / JAN 2010 SUMMARY: LIPS

2010-06-10T12:13:00.000-07:00

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 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.

UPDATE

2010-06-09T13:00:00.000-07:00

The postings below document the course of events from the start of symptoms in late September 2009 through the turning point after the correct diagnosis December 8, 2009.
I am preparing to document the results and events after that date up until today.

SUMMARY: EYES

2010-06-09T11:26:00.000-07:00

December 8, 2009: Day of correct diagnoses. Uveitus detected but with retina in tact (right photo). Corky's eyes were on the edge of going blind. He was treated with Prednisone injected under the eyelids then started a course of oral Pred 30mg twice daily along with Niacinamide 500mg twice daily as an antiiflammatory. Prednisolone Acetate 1% was applied 4 x's daily. Also Doxycycline twice daily. (see "lip
summary" below for details.

November 26, 2009: Continued

Cephalexin. Preparing for biopsy which was December 1st

November 15, 2009: Continued

Cephalexin and treating like

allergy. Debating about when to

schedule biopsy with his massive

histamine condition still active.

October 17, 2009: The right

eye corner is starting to fade

as the nose pigment returns.

October 11, 2009: Eye pigment looks

normal while nose pigment is faded.

August 2009: This is how he

normally looked (bottom right).

SUMMARY: NOSE BRIDGE

2010-06-09T10:30:00.000-07:00

December 8, 2009: Biopsy was taken Dec 1st from the nose bridge (right) and lip margin (see "lip summary). Corky had remained in a state of massive histamine release making him unstable for the biopsy sedation. The sneezing continued and pigment fading waivered during November but by the last week it became more aggressive. Waiting for the correct diagnoses from three different pathologists posed great risks but the disease was confirmed December 8th as uveodermatological syndrome (see "nostril summary" for further report and treatment).

Lower bottom photo taken October 7, 2009: The pigment fading as a band across his nose bridge began late September and continued along with some flaking of the pigmented skin. The symptoms matched those of discoid lupus in which case their is no real cure. However I started him on a homeopathic for discoid lupus utilizing sulphur 30x and A. Triphyllum. We did suspect allergies and discontinued all nutritional supplements including fish oil, vit E, ester C, and Cosequin. We continued his holistic diet of Orijen Adult formula.

October 26, 2009: The vet wanted us to keep things very simple in case the problem was allergy related so we stopped the homeopathic remedy along with the supplements mid October. Corky's entire body was in a state of a massive histamine release and wasn't fit to undergo sedation for a biopsy. To our relief, the nose pigment returned by late October but only to decieve us.
November 2, 2009: The pigment began to wane again. By this point he had only been fed his usual diet with no supplementation. His stools were always a too soft and we suspected possibly a chicken protein allergy. On November 5th I switched his diet to Taste of the Wild salmon and sweet potato. His stools were perfect from then on.

UPDATES COMMING SOON!

2010-06-08T15:20:00.001-07:00

June 8, 2010

I am organizing a summary of Corky's progress along with detailed photos. As of today we've been trying to put Corky's disease back into remission after a recent relapse, probably because we had cut down his dosage of meds too low. We are now making progress but not as fast as before. Meantime, he is still enjoying life with high energy and his eyes checked out fine. If you need information faster please leave a comment. I am now checking this blog regularly.

SUMMARY: NOSTRILS

2010-06-08T14:48:00.000-07:00

Top left photo November 15, 2009: pigment loss and sneezing caused by disease attacking mucuos membranes inside nostrils although we assumed the cause was allergies or possible discoid lupus.

Top right photo December 8, 2009: Biopsy taken Dec 1st from nose bridge (see blue stitches)Diagnosis not confirmed until Dec 8th after awaiting results from 3 different pathologists.

Lower bottom photo taken October 2, 2009: guessing allergies or discoid lupus. Began homeopathic remedy as stated under "lip summary."

Because we saw nice improvement by October 18 (lower right photo) we were deceptively convinced this was discoid lupus and/or allergies. You can see the cobblestone texture returning along with black pigment. We had held off on the biopsy since his entire body was in a state of a massive histamine release we assumed was an allergic response to either an external or food allergen. I thought the residual from the homeopathics were kicking in.

By November 2nd he started to take a turn.

SUMMARY: LIPS

2010-06-08T13:29:00.000-07:00

The photos below are listed latest to earliest, the bottom one dated October 2, 2009:

December 4, 2009: Biopsy was
taken Dec 1st but we had to wait for correct diagnoses from three separate pathologists. Since the disease attacks the margins where mucuos membranes meet hairlines such as the nose bridge, lips, eyerims, anus, and toe edges, samples were taken from the lip corner (see blue stitches at right photo) and nose bridge. Diagnoses was confirmed Dec 8th after the opthamology exam and we began treatment. Waiting so long for the biopsy results posed great risk and at this point Corky almost went blind. Prednisone was injected under eyelids then Prednisolone acetate 1%eyedrops was continued 4 x's daily along with oral Pred 30mg twice daily for 2 days tapered to 20mg 2 x's daily while starting Azathioprine 50mg daily. He was also given 500mg Niacinamide twice daily as an antiinflammatory. On December 5th I had also started him on Veterinary Immune Tabs Professional strength as found on Dr. Ramaekers website of Ramaekers Nutrition which I've continued ever since (rotating with the maintenance formula). We were able to taper the Pred a week later down to 10mg daily along with 50mg Azathioprine and gradually alternate days with 4 days weekly of Prednisone and 3 days of Azathioprine. The Niacinamide was continued every day. Corky's response was remarkable as the next series of photos will show.
Nov 15, 2009: Unable to perform a biopsy as Corky was still having a massive histamine release
Nov 2, 2009: The unknown disease was attacking the lip margins as well as the nose and eyerim pigment.

Oct 18, 2009: Per doctors advice we had stopped all supplements including fish oil, vit E, vit C, Cosequin and the homeopathics. Deceiving to us the pigment was returning so we thought he was improving
Oct 2, 2009: We assumed this was an allergy or discoid lupus. Continued the holistic Orijen Adult Formula kibble and started a homeopathic remedy for discoid lupus utilizing Sulphur 30x and A. Triphyllum.

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Corky's success

2010-02-27T09:45:00.000-08:00

Corky continues to improve. Stay tuned for further updates. I will document all the steps we took to heal him including the correct nutritional supplements. His team of doctors are amazed and we are all pleased with the results.

Please contact me if you'd like the information before I get around to posting it.

Australian Shepherd with Uveodermatological Syndrome

2009-12-26T09:41:00.000-08:00

Corky is a georgeous 6 1/2 year old blue merle Australian Shepherd, full of life and love, one of the happiest dogs on earth as well as one of the most loved. You would never know he has an autoimmune disease called uveodermatological syndrome with uveitus or VKH syndrome unless you've seen his before and after photos which I shall post here along with a journal. As of now we are on an uphill path making dramatic progress but only two and a half weeks ago the opthomologist told us that Corky almost went blind. Luckily though, his condition was instantly turned around in the nick of time and the eye specialist is confident he can make a 100% recovery. These photos will speak for themselves but I will continue to log Corky's history along with his healing process. I will share the steps we are taking including all medications, supplements, diet, exercise, etc., with hopes that this information may become useful to anyone else seeking help. The photo at the right was taken long before this disease struck, it is one of my favorites.

I will back up to the start of Corky's symptoms beginning September 2009 when the disease mimicked other conditions which were treated as allergy mediated. Corky was losing the black pigment on his nose and lips and then later the inner corners of his eyerims. As the symptoms seemed to improve and then wane he was not biopsied until late November. It took three pathologists to finally find the correct diagnoses. Meanwhile, the symptoms worsened, he lost all black pigment on his lips and eyerims and half of his nose. Again, I will log details from the beginning but for now here are photos taken December 8th, 2009, just prior treatment and then December 20th, twelve days later.

Hmmm, please bear with me. I'm new to this blog and can't figure how to set photos here where I want them...