Ava's latest vet visit

[Stacy]

I still really like this new vet. He gives me so much information that I feel like I need to be taking notes. I have to come home and write everything down so I don’t forget anything important! He says the good news is that we know a lot of things that she doesn’t have. The bad news is that we still don’t know what she has, and we may never know.

The other bad news is that Ava’s down another 2.5 pounds since the beginning of December, and he feels (and I agree) that it’s muscle loss. Poor bony headed dog!

He feels that we are either dealing with some sort of immune-mediated disease that we haven’t been able to diagnose or cancer that we haven’t been able to diagnose. He said that the IMS that we saw is terrified of steroids and she is only on a physiologic dose of prednisone. And since we know she doesn’t have Addison’s that it would make sense to titrate her up to an anti-inflammatory dose and see what effect that has. Subjectively I feel like the steroids have been helping her. Maybe more will be better. So we’re going to go up to 12.5mg/day instead of 5 and do another exam and recheck labs at the beginning of February. The goal being that she doesn’t lose any more weight and hopefully has some other positive signs and that it doesn’t negatively impact her lab values.

He also mentioned IBD, even though she doesn’t have any of the typical symptoms. He said that often in cats the only symptom they have is weight loss. And apparently you can’t do an endoscopy on a cat because the scope is too big to pass. (And I’m wondering why we are talking about cats?) And I can’t believe he just randomly brought up IBD. But the point being that just because she doesn’t have all of the symptoms doesn’t mean that there isn’t that or something else lurking that perhaps the steroids will help with.

We already know that she has atopic dermatitis, and all of the auto-immune diseases do seem to run together. I once had a friend who had Crohn’s disease and her sister had Lupus. If there’s a genetic disposition towards immune-mediated disease the manifestation may be different, but it makes sense to me that they all seem to run together. I’ve never done any research, but it seems to make sense.

So that’s where we are. Still more questions than answers, but I feel like for all we don’t know, the treatment is the only thing that makes sense. And she does have a good quality of life. So we will just keep pushing forward and see what happens.

[Karen, Jasper and Jackdoodle]

Yes, dogs who have one immune-mediated disease often develop others; Jack's dermatologist told me that it's because their immune systems are hyperactive and react to things that they normally shouldn't. And I do know several dogs (besides JD) who have both Atopy and IBD- Jane's Murphy for one. Lots of members of my IBD Dogs group have dogs with more than one immune-mediated disease. And steroids do help with all of them.

However, I have never heard of any dog with IBD whose only system was weight loss. That may happen in cats, but there were several hundred dog owners in the IBD group, and I never heard of any dog there who didn't have symptoms of major digestive problems. So I hope your vet is wrong about that, because IBD is a really miserable disease to deal with. 

[Stacy]

I wonder if statistically the doodles have a higher incidence of health problems like this. It feels like they do, but maybe it's because I'm reading about doodles and not other breeds of dog. It just feels like all of these really sick dogs are outside the norm. 

I don't think he was really suggesting that Ava has IBD, but more that they often have to treat disease in animals without getting an official diagnosis. Since they can't do endoscopy with them they have to do surgery to biopsy them and most people don't want to do that. So after they've ruled out the other common causes of weight loss they treat them as if they've confirmed IBD. I don't know, it was a long conversation. Of course my first thought was, you want to do an endoscopy? We haven't done that. But he didn't make that suggestion at all. 

We came back around to the dilated esophagus again. But since the myasthenia gravis titer was negative and she doesn't seem to regurgitate they don't seem to have any suggestions for what or why. They've never said I should be feeding her upright either, which I would do if I thought it would help. 

I have my fingers crossed for the steroids. I hope this is something that we deal with long term as opposed to not having enough time. I can handle chronic illness. I just want to have her with me. 

[Nancy, Ned, Clancy, and Charlie]

I hope the increased dose on the steroids helps a lot.  Quality of life is so important and if you and your vet agree, treating symptoms is more important than finding an illusive and perhaps never-to-be-found disease.

[Stacy]

You're right. I just know that the steroids come with their own set of problems. But I guess if it increases her quality of life, even if it ultimately shortens her life, it's the right thing to do. I think what I have trouble articulating, even to myself, is the idea in the back of my head that if we just look harder we will find something we can cure. A pill, a shot. Something without side effects. And I understand that it's unrealistic, considering what we've already done. But I want it anyway. I guess on the bright side, she isn't at all itchy. I'm not sure if it's the time of year, the allergy shots, the steroids, or some combination of the three. But it's nice to see her so comfortable in that respect.

[Stacy]

I'm almost afraid to say this because I don't want to jinx it, or find out that it's just my imagination, but Ava seems better. I'm not sure if 3 days on an increased dose of steroids is even enough to do anything. But she really dug into her food. She was eager to run outside and she actually jogged all the way across the yard and checked things out instead of walking 10 feet out the door and lying down. She didn't work to stand, and she just seems more interested in attention. I hope that I can get my girl back. There have been times I've looked at her lately and I feel like she's almost given up. But I don't feel that way today. 

[Karen, Jasper and Jackdoodle]

It's not your imagination. Prednisone is a miracle drug. Yes, it comes with its own set of problems, and it should never be used casually, but it works miracles, and it works fast. 

[Stacy]

I can't even tell you how relieved I am just to think that this could be something that can be managed as a chronic disease. Steroids weren't my first choice for treatment, but anything is better than watching the life slowly drain out of her. I wish you could have seen her this morning, all snuggled, stealing the pillows, and demanding all of my attention. It was great.