5month old Bernese Mountain Dog pup with suspect SRMA?

Re: 5month old Bernese Mountain Dog pup with suspect SRMA?

Alex Gough — Mon, 05 Sep 2011 15:18:32 GMT

[quote user="Michael Woodhouse"]

It comes back down to offering clients what they want and not gold standard for everything. I have found dogs with PUO often do much better with steroids than NSAIDS and some of them can be ataxic. Many respond very quickly and I would doubt the SRM diagnosis, a single shot of Voren at top dose range seems to be often enough.

[/quote]

I think the steroid approach to PUO is acceptable at the point the owners decline further investigations/therapeutic trials, especially if antibiotics have already been trialled, and imaging performed. The difficulty is when you have reached for the steroid early on, without informing the owners of the downsides. If the dog then goes for a second opinion or referral, will the owner be aware that the steroids which might have helped some cases, in this case has masked a lymphoma/made lymphoma more resistant to chemotherapy/masked an immune mediated disease/worsened an infectious disease?

Last week's PUO here had IMPA - would have been impossible to diagnose early if it had had previous steroids, although it would probably have got better temporarily, before relapsing, leaving diagnostic confusion...

Alex

Re: 5month old Bernese Mountain Dog pup with suspect SRMA?

Richard Fox — Mon, 05 Sep 2011 11:44:20 GMT

Damn - keep hitting the answer button!

You may think I am not in the "real world" but I think it is our obligation to at least suggest the most appropriate tests - this is limited mostly by money but we should strive for "good" medicine? Of course the owner decides but should we really only suggest test / treatment that the only the owner wants?

I find myself in diagnostics suggesting option that I am sure only a limited number of clients will go for but I feel an obligation to suggest them at the very least?

Anyway I digress - CSF analysis would be my next step if SRMA/SRM is still suspected - I would also have to consider a septic/suppuration inflammatory focus leading to systemic inflammation/clinical signs? Granted this also maybe hard to ID?

Is this Ab responsive?

Re: 5month old Bernese Mountain Dog pup with suspect SRMA?

Michael Woodhouse — Mon, 05 Sep 2011 11:34:13 GMT

Re: 5month old Bernese Mountain Dog pup with suspect SRMA?

Andrew Kent — Sun, 04 Sep 2011 17:14:20 GMT

Hi Carolyn,

SRM is possible I suppose but not entirely convinced - in general I would say they are more pyrexic than this and usually will have some neck pain (but not always). How high exactly were the white cells? The problem is that you have started a treatment without a diagnosis which will make it a little tricky especially if response to therapy is not great. If you think it is SRM then you really need a CSF sample, these are fairly simple and cheap to obtain/analyse but would tell you if on the right track. However the fact that dexamethasone has been administered may mask any changes now.

In terms of long term management of SRM yes you would switch to oral prednisolone at immunosuppressive doses and then gradually try to taper off over a period of months.

Andy

Re: 5month old Bernese Mountain Dog pup with suspect SRMA?

mariette asselbergs — Sun, 04 Sep 2011 16:56:22 GMT

Hip dysplasia? Temp just because is hot, very hairy dog, distressed, has been in car?.