Meningitis - Obi's story
Obiwan Kenobi (Obi for short) is my one year old, American cross Cockapoo. When Obi was six months old he suddenly became critically ill, literally overnight. After three awful days of not knowing what was happening to him he was referred to the Royal Veterinary College Hospital and he was diagnosed and treated for Steroid Responsive Meningitis Arteritis (SRMA). SRMA is thought to be an auto-immune condition that causes inflammation of the meninges (the covering layer of the central nervous system and brain) and peripheral nerve roots. It also affects arteries and tissues in many of the body’s systems. There is no known cause and it most commonly strikes between 4 month and 2 years old.
This is how events unfolded:
Sunday 11 Sep 2011 – Obi couldn’t get up to greet me in the morning. Eventually after a lot of effort he got up but wouldn’t eat or drink unless I held the bowls up to his mouth. Lots of unexplained, seemingly random yelping and very subdued. Normally a very social dog, he didn’t want any other dogs anywhere near him. Lots of shaking and panting and Obi didn’t really sleep.
Monday 12 Sep 2011 - First thing I took Obi straight to my local vet after a terrible night. The vet found he yelped when his head was manipulated and diagnosed his with a neck injury. He was given an anti-inflammatory and pain killer injections and I was told to take him home and rest him. When we got back I found Obi wasn’t comfortable lying down. He kept slowly pacing around with a hunched back and his head held low. Another terrible night followed.
Tuesday 13 Sep 2011- I took Obi back to the vet as I thought he was a lot worse and he was very hot. The vet confirmed he had a fever and took a blood sample and gave him another anti-inflammatory shot and more painkillers. Not long after returning home the vet called to say the blood results showed a high white cell count and this usually meant infection so Obi was taken back to the surgery for IV antibiotics. I started researching his symptoms at home and discovered dogs could get Meningitis. His symptoms seemed to fit. When I asked the vet he advised it was “highly unlikely as it was quite uncommon”. Later, back at home I watched Obi carefully and he was deteriorating with every hour. He was standing motionless and drooling and his eyes were all clogged up and closing up. I knew I had to do something and decided to go back to the vet immediately. The vet was puzzled and I raised the question of Meningitis again and insisted it be checked out properly or ruled out. It was at 8pm that night that my vet referred Obi to the Royal Veterinary College Hospital and he was admitted as an emergency case straight away. Obi was examined by a Neurologist and I was advised that a set of diagnostic tests would need to be done in the morning, including a spinal tap under general anesthetic. I agreed for Obi to be sedated and given morphine and then I had to leave. It had been a very distressing few days and I was really scared. I thought I was going to loose him.
Wednesday 14 Sep 2011 – Steroid Responsive Meningitis Arteritis was confirmed by the results of the spinal tap and scans. A course of steroids was started immediately and it was a case of waiting to see if Obi responded.
Thankfully Obi did start to respond and by Saturday morning he was deemed well enough to come home. He was sent home on a daily dose of 20mg of Prednisone (steroid) and every thirds day 25mg of Azathioprine (an immune system suppressant) and some pain killers. I was advised that medication side effects would be increased hunger and thirst and possibly depression and aggression. The first two were very noticeable immediately and he also slept a lot in the first few weeks home. After a week home we went out on a walk and he seemed well but perhaps not as energetic and bouncy as normal. On reflection now I realize he was suffering with a little depression as he was not as social with other dogs and appeared well enough but seemed to be in his ‘own little world’. There was no aggression at all though which was a huge relief as I have two young children at home.
I was advised of a 30% chance of a relapse and this would most likely occur as the medication is withdrawn. So the RVC Hospital set out a very careful plan to slowly reduce the medication over a long period of time. Every month Obi has to have a blood test to check his blood markers and if all is well we proceed with a small dosage drop of the steroids. We are now seven months on and Obi is on just 2.5mg of the Prednisone and as the dosage drops he gets more and more energy back and since we dropped below 5mg I’ve seen a marked difference. He’s getting more of his bounce back every day! He’s now back to wanting to play with other dogs and greeting everyone and you would never know he had been so poorly. The next step will be to drop to half tablet (2.5mg) every other day and then finally to stop. Only then will we see if his recovery is complete but I am very hopeful and optimistic with his progress so far.
I now know of other dogs that have also had SRMA. My own vet advised me he has since diagnosed another dog since Obi last year. The condition is not common but is well documented in Beagles (known as Beagle Pain Syndrome), Bernese Mountain Dogs and also Boxers. I also know of several Cockapoos too. Given it seems more prevalent in certain breeds further research needs to be conducted to determine if it possibly caused by genetics and is therefore hereditary. The key thing with SRMA is to spot it early and get it treated immediately to avoid any potential long term damage (or worse) from the swelling around the brain and nervous system. Be aware of the symptoms and if in any doubt go to your vet.
Typical symptoms include:
• Unexplained yelping
• Hyper reaction to touch, particularly neck/spine area
• Pain when head moved side to side, up and down
• Lethargic behavior
• Strange gait when walking
• Standing motionless with an arched back and lowered head
• Reluctance to go up/down steps
• Excessive drooling
• Shaking/panting (signs of severe pain)
19th April 2012
Great news! Today is a momentous day for us. After 8 months of careful management Obi is now finished with all medication! His withdrawal process has been so slow but worth it as no signs of a relapse. Infact he's bouncing around like a spring lamb! It must feel good to him and he's certainly a lot happier. He's lost nearly 1kg in weight and I'm so happy to have my boy healthy and well. Obviously I have to keep a very close eye on him but I know what signs to look for if anything is going to happen. Fingers crossed!
Thanks to everyone who has shown me great support going through this journey.
On the 17th May 2012, Obi relapsed and had another bout of Meningitis. I knew it was a possibility, but it was still a shock. I had been so optimistic because he had been so lively and active. It all happened really fast, just like the first time.
On that morning he seemed absolutely fine, running around like mad thing with a bunch of dogs in the park and having a great time. In the afternoon when I came back from the school run I noticed he was very subdued and not moving around much. By tea-time he wouldn't eat/drink unless I lifted the bowls up for him and I noticed he was struggling going down steps on to the lawn. I immediately started to suspect a relapse as these were the first signs he showed last time. I spoke to the Emergency vet and she advised me to give him 10mg of the steroids he had been on (luckily I had some left over). He perked up a little after 4-5 hours.
The following morning he had bloods done and the results confirmed his relapse. The plan was to go back on the steroids for the next three months. The only comfort I could take from it all was how quickly he responded to the steroids. Again, the cause was not known but he was neutered on the 1st May and the vet said it could have been the anesthetic that triggered an immune system response. Obi’s recovery was so much quicker this time and he stayed on the steroids until 11 Aug 2012, again gradually being weaned off them. I’m so pleased to say he has remained fit and well ever since.
Clare Harris ( Obi pictured above)
Meningitis - Beau's Story by owner Alison Maizey.
In April 2011 we purchased Beau from a small hobby breeder in Lincoln. She had her first injections a few days after purchase as we were conscious of the fact that everything was new to her and wanted her to settle into her new home before having anything done. She had her first vaccinations and two weeks later the second lot. She had no side effects whatsoever from these jabs and attended bronze and silver puppy classes.
After much research we decided to have Beau spayed pre-season at 6 months old. We will never know if this was the correct decision as so much information out there but with hindsight I feel she may have been a little too young. We took her to our vet on Wednesday 24th August at 9am. She had the conventional spay as we didn't know about keyhole as would have had this done as we have a local vet who would have done this. We collected her at 3pm and she was a bit quiet but that was to be expected. The following couple of days she seemed fine although not quite as bouncy as usual. Friday evening she slept a lot and we were a bit concerned but we had pain relief for her and she was eating and drinking normally. On Saturday morning I woke up to find Beau very lifeless (she sleeps on the end of my bed) and when I went to move her she had wet herself, was very hot and cried out in pain. I rang the vets and was told to take her across and hour later (we can see the vet's surgery from our window). Our usual vet wasn't working that day so we saw the nurse who took Beau's temperature and said that it was extremely high and she wanted the locum vet to check on her. He manipulated Beau's neck and again she cried in pain but he said that he thought she had an infection so the nurse was told to give Beau an antibiotic injection and prescribe more for us to take home and return on Monday morning unless she got worse. When the nurse injected Beau she screamed out in pain and was shaking. We took her home and she slept a lot with us having to carry her to the garden to go to the toilet. By Sunday afternoon Beau had begun to improve slightly but I found that she had a lump where the nurse had administered the antibiotic injection. We took her to see Gerhard our usual vet on the Monday morning and he was pleased with her and said that some injections can cause a lump although it did feel to me as if it had fluid in it he said not to worry. We took Beau to see him daily until she had her sutures removed and he was satisfied that she had made a good recovery but with hindsight I wish Gerhard had been the vet to see her when she first became ill as I am sure he would have diagnosed her with meningitis there and then. We attended the All About Dogs Day the following weekend and people were surprised she had been so ill.
On the 11 March 2012 we took Beau on a long walk and when we returned home she was a bit quieter than usual but we put this down to it being quite a warm day and she hadn't stopped for a minute. Again Beau slept on my bed but when I woke in the morning she was again very lifeless which immediately rang alarm bells. I rang the vets and was told that Gerhard wasn't in until 3pm and as it was him I wanted to see I said that I would wait unless she got worse. Beau slept most of the morning but when she evetually woke up she was walking with her head hanging very low, could see the whites of her eyes, she was panting and had a very bad twitch in her leg. She wasn't eating, drinking or going to the toilet and she was also very hot. We took her to see Gerhard and he took her temperature which again was very high. He tried to manipulate her neck and she was screaming in pain. He then asked if we could get her to Dick White Referrals which is a Specialist Clinic in Newmarket (we live in Norwich so about an hour and a half away) as he was positive Beau had meningitis and needed specialist treatment. We arrived at 5.30pm and she was examined by one of the vets who said that she felt it was meningitis but as Beau had the twitch in her left it could also me distemper which is fatal. We were told Beau would have to stay there as they needed to do an MRI etc. When we left her she looked far worse than during the day and we honestly believed it would be the last time we would see her. Later on that night the vet rang to say that Beau had been put on a drip for pain relief, fluids etc and they had put her on steroids immediately. We were then told she would be having the MRI in the morning plus she would need a spinal tap. The vet then rang Tuesday morning to say Beau had a good night probably due to the pain relief and that she would ring again that evening which she did to explain that Beau had the spinal tap which we were worried about as has to be done under a general anaestheric and also the MRI but that the MRI was good as not showing any damage. We were advised that Beau would not be home before Friday as they had to wait for the blood tests and spinal tap results and that they would prefer us not to visit as it would be upsetting for Beau if we kept leaving her. On the Wednesday morning the vet rang again and said that Beau was looking brighter and she would ring again on Thursday morning. On Thursday evening the results for some of Beau's tests were back and there was nothing conclusive but we were told that as she was eating, drinking, exercising etc we could collect her after lunch the next day (Friday). When we arrived at the clinic the vet took us to see the MRI and said she had been very happy with it. She said that they were still waiting for some of her blood tests etc to come back but that we could still take her home and that they wanted to see her again the following Friday. When they brought Beau out to see us we were shocked at how terrible she looked. Her head and front legs had been shaved, she had lost a lot of weight which she couldn't really afford to do and her coat was one big matt but we knew as soon as we saw her she was on the mend and as did her usual bouncing around Madeleine and squealing! We were advised to walk her once a day to start with but that as she was on steroids it was important that she got exercise to improve muscle tone as this can be damaged by steroids. We had to give her three quarters of a tablet of steroid for the first two days and the drop to half a tablet in the morning and then three times a day a tablet to prevent acid build up and also another one to coat her stomach to prevent damage from the steroids.
Beau's has always been a very fussy eater and can like something one day and hate it the next so we were shocked with the amount of food she started to eat once on steroids although we had been warned by Clare (Obi's owner) that this would happen (in some ways this was a good thing as we got to use up all the half eaten bags of food we had in the cupboard). Beau had never been a scrounger but she changed overnight and started to try and steal food of us, the cat etc. She would normally lay on the kitchen floor watching what I was doing (velcro dog) and wasn't bothered about food but she started to jump up at the work tops in the hope of getting extra food. She also drank far more which meant more toilet breaks (again we were warned about this) but she did only have one accident in the house. The downside of being on steroids was that Beau became even more clingy than normal and got extremely stressed when left. She started to scratch doors and "eat" the door frame. We eventually got a dog crate as we were worried she would hurt herself and only stopped using it recently when she came off the steroids. She was quite playful with smaller dogs but if a bigger dog came near her she would snap at them and cry a lot though I think that it was due to the fact she was frightened of them hurting her as she was very sensitive to pain. Luckily we have good neighbours as they likened her to one of the Hounds of the Baskervilles when left on her own which fortunately wasn't very often. She also Beau also lost her "bounce" and looked very depressed which Giunio did explain was a side effect of the steroids and once the dose started to decrease we would have our bouncy Poo back.
A week after collecting Beau we went back to DWR (Dick White Referrals) and Beau had her neck manipulated, temperature taken etc and was told to once again bring her back the following Friday but that we could stop the acid tablet and stomach lining one at lunch time as Beau didn't eat at lunch time and this had to be given an hour before food. I was also advised to make Beau look up, down and from side to side to ensure there was stiffness in her neck.
I asked about the test results and was advised that they were inconclusive which can happen but that Giunio was adamant Beau had SRM (steroid responsive meningitis). He explained that meningitis was often very difficult to diagnose but that all the signs were there. He also explained that as Beau had been diagnosed and treated with steroids within hours of becoming ill meant that she was less likely to have a relapse or be on steroids as long as some other dogs may have to be. He did however explain that a relapse was quite rare and so not to worry. I have since found 3 or 4 Cocker Spaniels in our local area who have or are being treated for meningitis so maybe this is the link as not heard of any Poodles (so far).
The following week we spoke to Gerhard who said it thought it was unnecessary for us to take Beau to Newmarket every week as he was treating a Cocker Spaniel with the same problem and that he took instructions from Giunio Bruno Cherubini who is the Consultant Neurology Specialist at the DWR and that as long as Giunio agreed with this it would save us the long journey. I contacted Giunio who agreed that unless Beau took a turn for the worse which he doubted as she was making such a good progress that he would speak to me every few weeks and instruct me on the dosage without having to go to Gerhard. He also advised that it was extremely important that the dosage drop was done gradually as Beau would be less likely to have a relapse. I rang Giunio on the 27 April and he asked lots of questions about Beau's overall health, whether she was exercising enough and also about her food and water consumption. He said he was satisfied with her recovery and that we should stop steroids at weekends and just give them to her Monday to Friday for the next month and to ring again at the end of May which we did and Giunio told us to give steroids Mondays, Wednesdays and Fridays only. This continued until the end of June when we were advised to give them to her on Mondays and Thursday only and to ring back on the 1 August. With each drop in steroids we saw the great improvement in Beau's "bounce"
On Wednesday 1 August I rang Giunio and he once again asked lots of questions about Beau's overall health and said that he was extremely satisfied with how she was doing and that we could stop steroids etc completely. He also advised us not to have Beau vaccinated until Easter 2014 unless there is an outbreak of something in our area as this can cause a relapse. Giunio told me to not keep looking out for any signs of a relapse and to enjoy our Poo which is easier said than done as Beau was laying on the end of my bed recently and didn't move when I got up to have a shower which she would normally do and I panicked as thought she was having a relapse but then she stretched and did a big yawn and I realised she just wanted a lie in!
I hope that our story may help someone else in the future as the best treatment for meningitis is early diagnosis and aggressive treatment as this can dramatically reduce the chances of a relapse. I have also given the Cockerpoo Owners Club permission to give out my email to anyone whose Poo has been diagnosed with meningitis or if they feel that they could have it but are not getting any help as I was very grateful for Clare's (Obi's owner) help and advice during Beau's illness.
Love Ali X
Thanks to Clare and Ali for sharing their stories.
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