Thursday, December 1, 2016

Stella update and my thoughts yet again

I finally heard back from KSU via email.  The plan thus far is to up her pred dose while keeping it still every other day.  I hope this works, but have a sneaking suspicion that it won't.  From today until I see Dr. S at KSU on december 16th, we will keep the cyclopsporine at 100 mg x twice a day, 15mg of steroid every other day, and her enalapril 2 tablets twice a day.  I am going to start her on a joint supplement, so she will be on the loading dose for a month.

I picked the brain of our biology immunologist.   Here are his thoughts:

1. TNF inhibitor drugs like enbrel or Humira.  Are these drugs used in dogs at all?  Would these be an option to try?

2.  Cyclopsporine.  I know this is the macdaddy in dealing with T4 cells.  Can we conclude at this point that this is not T4 cell mediated since she is relapsing when we reduce pred?  Can we try another immunosuppresant?  Are there memory cells present that will never let this be forgotten in her body?

3. What about using dexamethosone?  

4.  Can we tell the cell types from the joint taps?  Macrophage versus lymphocyte, versus Neutrophil ETC?  Is that what is driving the decisions at this point or are we just trying to throw anything at this and hope something sticks?

I have emailed the vet at KSU with these questions, but have not received any thoughts back.  Our immunologist also asked his friend over in vet med who is an equine immunologist her thoughts, but she was reluctant to put her two cents in.  Her only comments were that she did not think that 1. was used in dogs or available yet to dogs and that my vet was the go to guy when dealing with immune mediated diseases.

I also now have in my possession records from a lady who contacted me via FB that had an aussie with IMPA.  It's 65 pages so I have a lot of reading to do.  An interesting stat I have already picked up on was that she was on pred for 2 YEARS!!!!!  I need to study how they tapered but TWO YEARS!  We are only at 7ish months at this point.  While i hate the side effects, I want the pain GONE.  I am willing to do whatever it takes.  Sigh.  The never ending saga of stella.  Hug your dogs.  Going to go hug mine. 

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