Canine Immune Mediated Disease Awareness

Auto-immune Disease

Anecdotal Evidence and Hindsight

 Do either have any value or should we wait for the evidence to be proven by science before reacting to unproven 'coincidences?'

 Cases of AI disease are still relatively uncommon within the general dog population.  However, during the past year, owners of dogs in over 80 different breeds (including a few cross breeds and mongrels) have contacted me at CIMDA, and information has been received from many owners whose dogs have suffered from an auto-immune disease of one kind or another. 

When information is received in this way, it is inevitable that 'common factors' will be highlighted.  Sadly, there are many 'coincidences' that are not instantly recognised as possible indicators to AI diseases.

 This article has been composed from the accounts of owners who have been unfortunate enough to have a dog diagnosed with an AI disease. 

Many of these anecdotal references cannot be regarded as having been confirmed by any scientific evidence, but they do illustrate some of the common recurring signs that seem to be associated with a dog suffering from an AI disease. (Dogs have shown one or more of the following "symptoms').

 General Observations Regularly Reported Prior to a Diagnosis

 1.      Diarrhoea - with or without traces of blood e.g. colitis.

 2.      Depression and lethargy, and the look of premature ageing.

 3.      Skin irritation, skin sores, nail bed problems, mouth ulcers, nose or anal lesions. 

4.      High temperature. 

5.      Weakness in the legs. 

6.      A tendency to lameness - limping. 

7.      Anaemia. 

8.      Collapse. 

9.      Intermittent symptoms that can disappear and reappear. 

10.    Young to middle aged dogs were the most commonly affected. 

11.    Ongoing symptoms that even after treatment remain constant and unresolved.

 

Haemolytic Anaemia (AIHA or IMRA) 

12.    Signs of AIHA that have been reported are: orange coloured faeces, orange coloured urine, craving to eat earth or gnaw concrete, weight loss, pale gums, high temperature, lethargy, fainting and little or nor appetite (but some dogs do not go off their food until they are desperately ill). 

To confirm AIHA, a Coombs blood test is usually carried out, to look for red cell-bound antibodies.  A negative result does not necessarily mean that the anaemic dog does not have AIHA, as the red cell destruction could be occurring in the bone marrow.

 To examine the bone marrow, a biopsy would have to be taken.

Thrombocytopenia (IMTP) 

Many owners, whose dogs were eventually diagnosed with RITP, have said that some of the common symptoms were:

 13.    Bleeding from the nose or gums, blood shot eyes, bruising on the body, blackened or dark coloured faeces (traces of dark coloured blood), high temperature. 

14.    That the dogs suffered from anaemia, haemorrhaging, lethargy and little or no appetite (some dogs will not go off their food until they are desperately ill). 

Another indicator was

1.       That the vet initially suspected poisoning and not an AI disease, as the symptoms were similar to 'Warfarin' poisoning.  Vitamin K was frequently prescribed. 

Signs for AIHA and IMTP can come on quickly, or show gradually over a period of a few weeks, and then the dog can deteriorate rapidly. 

Several owners have said that their vet didn't appear to attach too much importance to their dog's nosebleed, in fact one vet operated on a dog, and removed a small bone from her nose.  IMTP is a bleeding disorder, whereby the dog's blood loses ability to clot.  Performing an operation on this dog was probably the worst thing the vet could have done.  The dog haemorrhaged and was quickly referred to a specialist.  Fortunately, after a blood transfusion, intensive treatment and care, she is now well and fully recovered. 

With so many AI diseases, the owners have said that for sometime before their dog became acutely ill they had noticed the dog had an intermittent limp.  Very often the dog was thoroughly investigated, without a diagnosis being achieved. 

The Pemphigus Group and Lupus Group

These AI diseases can show in varying forms of skin problems.

 Owners have reported:

 15.    These diseases have been particularly difficult to diagnose and the poor dogs have suffered from very painful and uncomfortable skin lesions/ulcers, sometimes to the face only, and sometimes to the face or body or nails, or a combination of all three.

 The vet has usually taken biopsies and treated the dog with various antibiotics, antibacterial shampoos and new diets.

 The process of trying to reach a conclusive diagnosis of some AI diseases, especially skin conditions, can prove to be costly and often without any significant progress being obvious.  It can be extremely difficult to confirm a diagnosis as blood tests and biopsy results can be returned as 'inconclusive'.

Anecdotal reports appear to have shown than an AI disease, in an acute stage, has often caused the dog to have a high temperature.  Understandably, the vets have suspected an infection and usually prescribed antibiotics or put the dog on an intravenous drip, which has shown some improvement in the dog's condition. 

If the improvement is only temporary, and the vet cannot establish what is wrong with the dog, you may choose to ask for a referral to a vet college, or even seek a second opinion from another vet.  This might seem obvious, but when you are trying to cope with a desperate situation, the obvious is not always the first consideration, especially when your hopes and trust are placed with a vet who may appear to have the situation under control but is really struggling for a solution.

 Some owners have said that their vets continued to treat their dog in the same way, without successfully finding out the underlying cause of the illness.  The treatment, in many cases, continued for some considerable time, without any real improvement.

 There have been some reports that certain vets have failed to make an accurate diagnosis, even when the symptoms presented were 'classic' to a particular AI disease.  On the other hand, most owners praised their vets very highly and attributed the 'saving' of their dog to the prompt diagnosis, skill and attention they received. 

When the illness is prolonged, it is not uncommon for a dog to go into a 'crisis'. 

This is often the case with Addisons disease, vasculitis or one of the AI blood disorders.  The situation turns into 'a fight against time' and so often a diagnosis is reached at 'the eleventh hour'.  This can be too late, and the poor dog may not have any time left to respond to treatment.  A correct, early diagnosis can make the difference between life and death for your dog.

 This article attempts to share 'anecdotal evidence' and observations that many unfortunate owners of dogs with AI disease have noted.  There are reports where the owner (because they were aware of the health status of their breed) had made a suggestion to the vet, which subsequently led to a correct diagnosis and saved the dog's life. 

These anecdotal accounts indicate that more dogs seem to survive AI disease than die.  Many dogs that have survived their initial 'crisis' have continued to lead a normal life and have been 'weaned off' their medication.

 With Addison's disease and hypothyroidism, once a diagnosis has been reached, the appropriate hormone therapy started, and the dog stabilised, the prognosis is excellent.

 Care must he taken not to assume that your dog has an AI disease simply because one or more of the 'signs' are apparent.  If you are at all concerned, always contact your vet.

 It is hoped that reporting these facts may help to provoke a (quicker) diagnosis, thereby minimising suffering and possibly save the life of a dog in the future.

Jo Tucker

 An AI disease survey is being conducted by The Queen's Veterinary School Hospital, Cambridge  University, and will hopefully shed more light on the issue of AI disease in the dog.  The results of the survey will give the vets valuable information to further investigate the cause of these diseases. Anyone wanting to assist with this study or has a dog suffering from an immune mediated disease and would like further information please contact.' CIMDA, 73 Osidge Lane, Southgate, London N14 5JL. Tel. 020 8368 9148 email: jo@cimda.fsnet.net 

Your contribution is vitally important to this study.

 

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