Enlarged tonsils in a Cavalier

RE: Enlarged tonsils in a Cavalier

Roland Bulkyn-Rackowe — Sun, 28 Mar 2021 23:01:40 GMT

Yes, this has been biopsied and is eosinophilic. There are also ulcerated plaques on the caudal hard palate. See the paper referenced by Rob earlier in the thread.

RE: Enlarged tonsils in a Cavalier

Julian Earl — Sun, 28 Mar 2021 22:04:21 GMT

Have I imagined this? But I thought that Cavaliers have a tendency to very large tonsils for a dog of their general size?? Or am I getting confused with soft palates somehow? Sorry if I dreamt this or something but it rings a bell for me. ??? Surely biopsy will tell you if they are abnormal in the first instance?

Good luck with this...!

RE: Enlarged tonsils in a Cavalier

Anthony Dennison — Thu, 25 Mar 2021 15:12:08 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229360#229360"]

Have a look below! Way beyond my knowledge and experience, but Preds seem to be the rcommended treatment, at least for a while.

So even if the diagnosis [even the name] would be beyond me ,most of the symptoms might not, and they use Pred in various forms and spellings....

https://www.dvm360.com/view/recognizing-and-treating-immune-mediated-polyarthritis-dogs

They might get better results with Depomed which, I don't think was around then.

[/quote]

Oh I know how to treat it, I treat it quite regularly. But you said a single large dose of prednisolone is enough.

From the webpage you've used:

'Corticosteroids are often the initial treatment of choice because of the low cost of treatment and rapid rate of action.1,2,4,6,18 About 80% of dogs with idiopathic type I IMPA respond to immunosuppressive doses of prednisone,9,15 but half of these dogs require long-term or combination drug therapy to maintain remission.15,18 Prednisone is initially administered at immunosuppressive doses of 2 to 4 mg/kg/day until remission is achieved (see Monitoring section below). Once remission is achieved, prednisone is then gradually reduced over an extended period, usually two to four months.1,4,6,18'

Most immune mediated conditions I know are on steroids for a minimum of three months, sometimes longer before tapering. One off doses or short courses aren't enough as the animal won't be in remission yet.

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Mon, 22 Mar 2021 15:56:38 GMT

Try searching "human tonsillitis"..... you won't get much science just a lot of general advice... nothing remotely analytical that I could find which i find odd??

Maybe humans react as Roland said and PMI with dogs is the same and best policy?

RE: Enlarged tonsils in a Cavalier

Roland Bulkyn-Rackowe — Mon, 22 Mar 2021 11:43:51 GMT

That paper was interesting. All of the dogs improved pretty much whatever was tried which doesn't inspire confidence in me giving high dose pred and expecting a miracle!

RE: Enlarged tonsils in a Cavalier

Lindsey Edwards — Mon, 22 Mar 2021 10:33:34 GMT

I think cyclosporin has been used but the patient I treated couldn't be tableted by owners on an empty stomach do discounted as an option at the time (atopica only option, oral solution not available at that time). I am not sure apoquel or cytopoint would help with the actual hypersensitivity (both aimed at reducing itch?) but may help with pain?

RE: Enlarged tonsils in a Cavalier

Sarah Keir — Mon, 22 Mar 2021 08:50:09 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229374#229374"]in many cases it seemed to me to have an effect for 4 days or so[/quote]

You need to go back to pharmacology - the drug (prednisolone) will not be measurable within the serum but it has already changed DNA reading and protein manufacture within cells and hence the drug has effects that last a lot longer than the time it is actually within the serum or even within the body.

RE: Enlarged tonsils in a Cavalier

Roland Bulkyn-Rackowe — Sun, 21 Mar 2021 23:30:21 GMT

Prednisone is metabolised to the active metabolite prednisolone, hence short half life.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604266/

Doesn't hang about.

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sun, 21 Mar 2021 22:53:09 GMT

Don't bother loads on google eg!

"For dogs and monkeys given in iv dose of prednisone, disappearance from the serum was biphasic with apparent half-lives of 15 and 82 minutes and 33 and 78 minutes respectively".

I assume prednisolone is around the same.......

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sun, 21 Mar 2021 22:48:30 GMT

Wow, didn't think it would be anywhere near that! I wonder why, in many cases it seemed to me to have an effect for 4 days or so??

Have you got a reference or link?

RE: Enlarged tonsils in a Cavalier

Roland Bulkyn-Rackowe — Sun, 21 Mar 2021 20:00:22 GMT

The reason I thought pred was the preferred corticosteroid was the short half life (compared to other synthetic steroids). It's in the region of 90 minutes so plasma levels are almost back to zero by 12-15 hours. So less HPA suppression.

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sun, 21 Mar 2021 13:55:44 GMT

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229362#229362"]With oral pred you've got more control over the dose/ frequency so you can hopefully slowly wean off/ down over several weeks.[/quote]

Only if it is realised that daily dosing is actually a rising dose rate [because of the residual levels for, what 3-5 days??] so tapered dosing is probably better just stopped, or lengthening the dosing regime.

RE: Enlarged tonsils in a Cavalier

Lucy Fleming — Sun, 21 Mar 2021 10:10:50 GMT

I think depo-medrone can have its place, but I would tend to agree with others that I wouldn't usually use it for this type of case, where you generally want a slower taper in levels (hopefully down to nothing eventually, though some cases seem to need an ongoing homeopathic dose) - I tend to find that the drop in drug levels with depo-med is too quick for a lot of these immune mediated type cases, leading to relapse of signs. Of course you can repeat the injection at that point, but then you're pretty much back to square one with dosing...

With oral pred you've got more control over the dose/ frequency so you can hopefully slowly wean off/ down over several weeks.

I've also generally found that the majority of owners are pretty terrible at noticing the return of clinical signs at an early stage. This seems to especially apply to things like pruritus (makes sense, I guess, as who really thinks twice about the dog scratching, or the cat having a wash, until you slowly realise they are doing it all the time?!) and oral lesions. I have a few feline gingivostomatitis cases that are managed on regular depo-medrone injections and, even though their owners bring them in as soon as they notice anything, their mouths are usually incredibly inflamed and painful by then.

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sat, 20 Mar 2021 22:30:18 GMT

[quote userid="11308" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229353#229353"]I'm curious Tony. For cases of immune mediated disease such as IMHA, IMTP, IMPA or SRMA, how did you treat them?[/quote]

Have a look below! Way beyond my knowledge and experience, but Preds seem to be the rcommended treatment, at least for a while.

So even if the diagnosis [even the name] would be beyond me ,most of the symptoms might not, and they use Pred in various forms and spellings....

https://www.dvm360.com/view/recognizing-and-treating-immune-mediated-polyarthritis-dogs

They might get better results with Depomed which, I don't think was around then.

RE: Enlarged tonsils in a Cavalier

Roland Bulkyn-Rackowe — Sat, 20 Mar 2021 20:15:47 GMT

I'd guess these (IL31 acting agents) would maybe help with discomfort but maybe not the inflammation? Thanks for the input. I like the idea of desensitising injections, I don't know where we are with treatment at the moment and may well be stymied by recent glucocorticoid administration. Not sure I can sell the idea of being off treatment for long enough to try this.

RE: Enlarged tonsils in a Cavalier

Anthony Dennison — Sat, 20 Mar 2021 19:43:08 GMT

I'm curious Tony. For cases of immune mediated disease such as IMHA, IMTP, IMPA or SRMA, how did you treat them?

Back to the thread, with the idea that the desensitisation injections (presume this is repeated low dose hyposensitisation therapy used with allergic skin disease - we use artuvetrin). Is it then mainly an allergy issue? Would anything like cytopoint or apoquel have any effect (used off license obv) have an affect on the eosinophilic accumulation?

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sat, 20 Mar 2021 15:39:14 GMT

I made one recommendation or suggestion which worked usually for me and hasn't been challenged,at all, apart from "bollocks", having been asked for just that.

And got an unsubstantiated totally unhelpful "bollocks" .

And an unexplained "disagree" which doesn't add to anyone's knowledge without some sort of explanation, let alone someone who has used it??

RE: Enlarged tonsils in a Cavalier

Rob Davis — Sat, 20 Mar 2021 15:28:23 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229344#229344"]which might be condemned by Cambridge graduates so logically, helpfully and scientifically as "bollocks!"[/quote]

Anthony, if you make broad statements which go against the generally accepted wisdom then you need to provide some evidence over and above "it worked like this for me so it must be right"....

Prednisolone is far more commonly used for ongoing continuous conditions than for single, one-off administration. I am well aware of the the bee which resides in your bonnet over glucocorticoid usage and we have been here before. Yet again you are in danger of monopolising somebody else's thread with your somewhat dogmatic views.

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sat, 20 Mar 2021 14:39:24 GMT

[quote userid="13683" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229343#229343"]n=1 but I had spectacular results[/quote]

Thanks, for another sensible suggestion in cases like this which often respond to suggestions which might be condemned by Cambridge graduates so logically, helpfully and scientifically as "bollocks!"

RE: Enlarged tonsils in a Cavalier

Lindsey Edwards — Sat, 20 Mar 2021 14:32:57 GMT

n=1 but I had spectacular results following desenitisation injections (artu laboratories at the time) plus hydrolysed diet - dog returned to full appetite, destructive chewing behaviour (normal for him) and no oral lesions visible (responded much better than most 'skin' patients I have used it for!). From what I remember he tested 'sensitive' to storage mites and multiple pollens (plus foods which I wouldn't rely on being accurate)

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sat, 20 Mar 2021 13:20:55 GMT

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229339#229339"]So that you have control over the dose and retain the ability to taper the dose at whatever rate you choose. [/quote]

If you think about it, the residual amount of Pred, assuming you say it has action for say ,3-5 days makes daily doseage an obviously rising dose rate......

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229339#229339"]IMHO this is bollocks [/quote]

[sigh] only saying what I have seen a lot more than once....

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229339#229339"]Biopsy has already been done and has confirmed the suspicion that this is eosinophilic stomatitis. It has ruled out other more sinister pathologie[/quote]

Seems like we're back on the 'roids then, hope it works, 'cos it probably will ,and then won't be "bollocks".

RE: Enlarged tonsils in a Cavalier

Rob Davis — Sat, 20 Mar 2021 13:08:26 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229330#229330"]Why use Pred?[/quote]

So that you have control over the dose and retain the ability to taper the dose at whatever rate you choose. Depomedrone has its place, but IMHO this is not it, unless the dog was impossible to tablet.

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229330#229330"]Pred does work best as a single dose , only as necessary, for recurrent intermittent allergies but,IMHO, not for this sort of "continuous" condition.[/quote]

IMHO this is bollocks

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229330#229330"]Depomed worked so much better for me although , of course, in humans they [used to?] remove the tonsils [or used to] almost as a rite of passage to adulthood, and there never seemed to be any bad results??[/quote]

This has, I believe, largely gone out of fashion in humans, and is totally irrelevant in this case anyway.

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/f/misc-case-discussions/29274/enlarged-tonsils-in-a-cavalier/229330#229330"]I can't see that a biopsy will help, or change, anything.[/quote]

Biopsy has already been done and has confirmed the suspicion that this is eosinophilic stomatitis. It has ruled out other more sinister pathologies such as squamous cell carcinoma.

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sat, 20 Mar 2021 13:07:00 GMT

Yes sorry, Depomedrone, and I gave up on I/M after the only injection reaction I ever remember when I gave it I/M, so S/C which never seemed to give any problem and seemed to work fine.

What did the biopsy show or say??

RE: Enlarged tonsils in a Cavalier

Roland Bulkyn-Rackowe — Sat, 20 Mar 2021 12:44:56 GMT

I have biopsied the palate already, I'm not going to do it again. The problem unfortunately isn't confined to the tonsils but is also the gingiva and palate. I don't think a tonsillectomy will do a great deal here.

Are you suggesting depo medrone instead of prednisolone?

Thanks for the suggestions, I'll see the dog back on Thursday and see how things are looking.

RE: Enlarged tonsils in a Cavalier

Anthony Todd — Sat, 20 Mar 2021 12:05:41 GMT

Why use Pred?

IMHO it never worked as well in these sort of cases as well as skewing the adrenal axis 'cos of rising blood levels on continual use which mightn't be good.

Pred does work best as a single dose , only as necessary, for recurrent intermittent allergies but,IMHO, not for this sort of "continuous" condition.

Depomed worked so much better for me although , of course, in humans they [used to?] remove the tonsils [or used to] almost as a rite of passage to adulthood, and there never seemed to be any bad results??

I can't see that a biopsy will help, or change, anything.