Lupus? - Addie

[~flower~]

Addie had her staples and sutures out this morning.  That incision is healing fine and overall she is doing good.  Her vet did mention the possibility that she might have lupus.  Along with her knee she also has a quarter sized sore on her side, and some smaller ones on her belly and her elbows.  At the time of her spay a skin tag was also removed from her neck and she has had an inflammatory reaction to the sutures there also, nothing major, just a lump that he believes will go down. Lupus would explain her complications after her spay, her bodies immune system just went haywire and started attacking the sutures and her blood and skin.   The vet does believe that she does have some immune problem, lupus or not, and in the future we may do some tests to see if we can find out what it is but for now we are just concentrating on her body getting back to normal. 

  Vet, any experience with Lupus and your thoughts?  Or anyone else?

  Never a dull moment with Addie.   

[Lord Humungous]

That sucks Flower! 

[~flower~]

That sucks Flower! 

  Well, we are not sure if she has Lupus or what is going on, but even if it is Lupus it may only be a problem if she has a surgery or some event sets it off.  So, she could go along just fine.  Any future surgeries (hopefully will never be another one!!) she will be red flagged as to potential complications.

[Princess L]

That f'g sucks 

I have a friend who had an Akita with it.  The ultimate outcome was not positive.  I could connect you with her and she could fill you in on what she knows now that she didn't know then and what she may have done differently 

[Vet]

I've never diagnosed lupus in a dog.  I have assisted in managing two cases (both in shetland sheep dogs) that other veterinarians I worked with had diagnosed.   As a matter of fact, I almost have more experience with humans in dealing with lupus than animals--I have two aunts and a cousin with it. 

Immune mediated hemolytic anemias are associated with systemic Lupus.   if there is a thought of Addie having it, an ANA test should be run.  It'll be relatively certian in ruling it in or out.   


Below is some FYI information I pulled from VeterinaryPartner.   In general terms, Addie doesn't sound like one of these cases. 

Systemic Lupus Erythematosus (SLE)

Authored by: Becky Lundgren, DVM

Systemic lupus erythematosus (SLE) is a fairly rare chronic and potentially-fatal autoimmune disease. The dog’s immune system fights itself by forming antibodies that “protect” it against its own cells and tissues. This results in inflammation and tissue damage in the skin, heart, lungs, kidneys, joints, nervous system, or blood. Usually several organs are affected. SLE can be managed, but not cured. While the disease itself is chronic, signs can be acute, chronic, or both. Lifelong treatment is necessary. It is different from discoid lupus erythematosus (DLE), which is a skin disease.

The word lupus is Latin for “wolf.” (Some humans get a facial rash that has a slight similarity with a wolf’s face.)

Breeds that most typically are affected by SLE include Afghan Hounds, Beagles, German Shepherd Dogs, Irish Setters, Old English Sheepdogs, Poodles, Rough Collies, and Shetland Sheepdogs. Dogs are usually middle-aged when they get SLE. Females are not more likely than males to get SLE.

The most common significant signs of SLE are a non-erosive polyarthritis (an arthritis that affects several joints), painful muscles; shifting lameness; skin sores and blisters; proteinuria (protein in the urine); decreased platelet and white blood cell count; fluctuating fevers, and immune mediated hemolytic anemia (IMHA). Some less-significant signs are mouth ulcers, inflamed lining of the chest cavity or heart, dementia, swollen lymph nodes, and seizures. Usually, dogs with SLE are first taken to the veterinarian because of the skin problems or lameness.

Blood tests are needed for diagnosis. While all dogs won’t have the same signs, dogs with SLE typically test positive for anti-nuclear antibodies (ANA). There are so many effects of this multi-systemic disease that it’s hard to rule any one disease in or out. Diagnosis is typically made using a combination of a positive ANA test with at least two of the most common signs. Even then, it can be difficult to make a positive diagnosis, since other problems, such as drug reactions and cancer, can have many of the same signs.

Treatment is aimed at decreasing the inflammation and autoimmune activity, so treatment centers around anti-inflammatory and immunosuppressive medications such as corticosteroids (e.g. prednisone). Sometimes a second immunosuppressant, such as azathioprine, cyclophosphamide, or cyclosporine will be necessary. Specific problems, such as kidney or spleen damage, will also have to be treated. Treatment plans depend on what organs are affected.

The ultraviolet rays in sunlight can cause flare-ups of SLE, so exposure to sunlight should be limited.

Prognosis depends entirely on how each dog is affected, but owners can expect that their pets will require life-long treatment. Unfortunately, sometimes the damage caused by this disease can result in death.

Date Published: 1/21/2007 1:05:00 PM

[~flower~]

I came across that too, but I also found this:

"However, dogs with SLE may not show clinical signs until there is an initiating factor, such as a bacterial or viral infection, a drug reaction, cancer or some event that has a big impact on the immune system.

SLE has a variable prognosis. If there is an initiating factor and it can
be controlled there is a good chance of regaining a state in which the
disease is still present but it isn't causing much problem -- which was the
situation prior to the recent problems, probably. There may be future
relapses but they can often be controlled, too. If there isn't an obvious
underlying cause the prognosis is not as good. In general, it is usually
possible to control the disease for at least some time using
immunosuppressive medications but eventually these usually lead to
complications of their own and so dogs with SLE that must be constantly
medicated tend to have shorter lifespans than dogs without this problem. It
seems possible to keep dogs pretty comfortable during their lifetime in
many cases, however."

Another reference said having had many operations may be a contributor. 

 What little I do know about Lupus is that (I think) it can flare up and then "disappear" and it can affect many different parts of the body, no two cases are alike. 

I may do a test somewhere down the line to see what, if any, immune problem she may have. 

  I just fear that she does and it was dormant and the spay has now awakened it.  

That f'g sucks 

I have a friend who had an Akita with it.  The ultimate outcome was not positive.  I could connect you with her and she could fill you in on what she knows now that she didn't know then and what she may have done differently 

Thanks Princess, I think I will hold on that since nothing is sure and I will try and think positive that this was just a fluke and she will be fine.  But I will ask you if it necessary.   

[~flower~]

the latest Addie boo boo pics don't scroll down if squeamish

[~flower~]

her elbow (not really a big deal but just to get the whole scope of it) that's her head down in the bottom right, the vet described them as her skin sloughing off 

[knny187]

looks ugly...but looks good too

[~flower~]

looks ugly...but looks good too

 He said the big one on her leg will take a few weeks to completely heal.  We go back on the 20th for a recheck unless it gets infected before then.

 I think the possible reason for all those "sores" and skin destruction is what he is concerned about. 

[~flower~]

  I should clarify, those dark centers on both her knee and her side are NOT scabs, that is her skin (with fur), that "skin" is actually, like he said, sloughing off. Her immune system attacked her skin and killed it in those areas and it's slowing falling off revealing the new skin underneath as the edges curl up. 

     

[Vet]

  I should clarify, those dark centers on both her knee and her side are NOT scabs, that is her skin (with fur), that "skin" is actually, like he said, sloughing off. Her immune system attacked her skin and killed it in those areas and it's slowing falling off revealing the new skin underneath as the edges curl up. 

     

I don't think you can say with any certianty that the immune system "attacked the skin" there.  What kept the immune system from attacking the rest of the skin all over the body?  Why at just those localized areas?   That doesn't make sense. 


Those areas look to me like what I described in your PM---areas of vasculitis.  There was loss of blood flow to that particular area of skin and the skin died as a result.  Thats why there is dark/dried out skin with hair covering those areas.   Now, I'm not going to say its impossible for there to have been some sort of immune complex disease that caused clogging of microvessels in the skin, but why isn't it all over her body.   There is a form of lupus that affects the skin--discoid lupus.   This absolutely DOES NOT look like that disease to me.  DLE causes "collie nose" typically. 


I'd still consider just having an ANA test done on Addie.  It'll help solve any lupus questions and its not that expensive of a test. 

[~flower~]

I don't think you can say with any certianty that the immune system "attacked the skin" there.  What kept the immune system from attacking the rest of the skin all over the body?  Why at just those localized areas?   That doesn't make sense.

I think at this point the vet is kind of stumped.  He doesn't think they are from pressure or anything, so he believes they are immune related.  Psoriasis is an immune mediated skin problem and it doesn't affect every where on the body, it can just be localized. So who knows why?

He mentioned Lupus because if Addie was a person and had all those complications after surgery Lupus would be considered as a possibility.

[Princess L]

I think at this point the vet is kind of stumped. 

Are there any vet universities near you ~flower?

[~flower~]

Are there any vet universities near you ~flower?

Yes, Cornell is close.   I shouldn't of used the word "stumped" because we haven't done any tests that have left us "stumped" yet.  There are a few that would rule out or confirm some possibilities.  When she goes back on the 20th I am sure we will discuss them again and decide if any should be done.

[temper35]

The "head vet" of the Vet I go to went to Cornell.  Great school.

[Al-Gebra]

The "head vet" of the Vet I go to went to Cornell.  Great school.

They're thinking of renaming it New York A&M.

[~flower~]

They're thinking of renaming it New York A&M.

Seriously? If that is a joke I don't get it?   




  Boo-boo update!!     This is her side boo-boo, it is "sloughing off"  

[~flower~]

okay, update time again.  The skin on her side fell off, it looks like a car lighter was held to her side.  But it looks okay considering.  Her back leg has me concerned.  About half of the skin fell or shriveled off and I can't believe the number of layers deep this thing is!!  I think I might call her vet tomorrow and see if I can get her in to have it checked, I don't think I want to wait till the 20th.  I wonder if she is in pain because it looks like it would hurt, but she doesn't really act like it. 

 Again, don't look if you are squeamish......

[SinCitysmallGUY]

What in the hell causes that shit.. That is some serious nastyness.

[Vet]

What in the hell causes that shit.. That is some serious nastyness.

The pictures Flower posted up make me more positive of what I said this was in the first place.  There was damage/clotting/rupture/whatever to the deeper blood vessels (capillaries) supplying that particular area of skin with blood.  The skin died.  What you see is the healing process.  Skin, with any injury, will heal from the edges in towards the center of the injury---thats why the outside appears less deep than the center and why there is that ringed/pink appearance to the skin.   The deepest part--the center, which occurs because the vessels come up towards the surface then "branch out" has not got that degree of healing done yet.   I wouldn't push pulling off the scab in the center.  Let it fall off on its own. 

Overall, that doesn't look that bad.  Addie will heal.  Nothing looks infected.  There are going to be some scaring, but as that scar shrinks with time and contraction occurs, it shouldn't look so bad.  I wouldn't recommend surgery to remove the scars (some vets would encourage this---its unnecessary unless you have personal issues with them)

[~flower~]

We just got back from the vet's, Addie is going to have debridement and closure surgery tomorrow.  In some spots it has gone down to the muscle but he believes the muscle is fine.   We had hoped that it was just going to be a superficial layer of skin like the one on her side and not this.   

 He said it could heal on it's own in about 6-8 weeks, I really don't want her walking around with it for that long like that and hoping it heals fine and no infection sets in.   He feels there is more than enough skin to close it and will put a drain in for a few days and thinks the surgery is a good decision. 

A CBC is being done just to make sure that her blood is fine again.

[SinCitysmallGUY]

Vet what do you think about Flower applying Vitamin E capsule liquid on the wound after the drain tube is out. That is what we did with Chaos and his scar is healing up very well. We just cut the Vitamin E capsules and put the liquid on his scar and massaged it in??

[~flower~]

That sounds like a good idea Sin.   Would help keep it pliable while healing.

She'll get some pain meds too, something not a NSAID because of her recent bleeding problem.   That will be good for her, you can't tell me missing a chunk of your skin down to the muscle doesn't hurt.  And every time she sits down it stretches across the knee which has to make it worse. 

Better to close it up to help it heal faster.  I just hope I don't end up regretting this decision like I have her spay!!

[Vet]

Vet what do you think about Flower applying Vitamin E capsule liquid on the wound after the drain tube is out. That is what we did with Chaos and his scar is healing up very well. We just cut the Vitamin E capsules and put the liquid on his scar and massaged it in??

It won't hurt anything.


Those don't look like full thickness skin lesions to me, but I'd really have to see her in person to make certian.  Even if it was full thickness, I'm not sure I'd do anything with them until they are fully healed considering the size of the lesions.