Stomatitis- any experience?

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Amanda
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Stomatitis- any experience?

Postby Amanda » Sun Jun 26, 2016 2:46 pm

Landis has some serious mouth lesions. I took him to a different vet that is open today and he was stumped. He prescribed clavamox and pain meds. But my awesome vet, who is on vacation in Hawaii, saw my Facebook post and took the time to look at pictures. He said it is stomatitis. A Google search tells me that is an allergic reaction to tooth plaque and steroids are needed to calm the inflammation and then a dental cleaning and extraction of all questionable teeth needed. Typically at home tooth care is insufficient to prevent plaque build up that triggers the allergic response. I feel terrible for the poor old man. The swelling came on suddenly. He ate breakfast easily this morning. I noticed the swelling afterward. When we finished at the vet he had trouble swallowing his medicine.

Any experience with this condition? Prognosis? We will see our regular vet next week.

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Re: Stomatitis- any experience?

Postby SherriA » Mon Jun 27, 2016 6:52 am

I thought there were a variety of different types of stomatitis with different causes (I seem to remember thyroid being on the list, and diabetes maybe, and kidney issues causing buildup of "bad" stuff in the body), some more serious than others. I think that's what my mom's ancient poodle had it, though that was a long time ago and I could be misremembering.
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Re: Stomatitis- any experience?

Postby Amanda » Mon Jun 27, 2016 7:01 pm

I have done a lot more googling since I posted and yes, Sherri, you are right. Auto-immune, kidney failure, cancer, etc are all in the differential diagnosis. My regular vet comes back Friday. I took him in this afternoon for a full senior panel with CBC, T4, Chem27, and urinalysis. Results should be back late Wednesday. He can review them Thursday. Then Friday at 9 I will take him in for an appt with the expectation that we will do a dental immediately.

He has had diarrhea a couple times in the last month. It was substantial both times and lasted about a week. Last time coincided with panacur treatment and I attributed it to that. Both times a bland diet for several days fixed it.This time I thought it was a new kibble I was trying. Every time I added kibble back he would get sick again so I stopped. He had solid stool (I think) on Saturday. I didn't see him do it but I thought it was his. Then he hasn't pooped at all since. And I've been vigilant to know if it was him or Zeke for the last 48 hrs. Then at the vet they told me his bladder was full so to make sure I let him pee when we left. That was 2 hrs ago. He still hasn't peed. He ate breakfast this morning and is asking for dinner now. I'm a little worried. Seems like this is more than just a sore mouth. He's so mellow and happy it is so hard to tell what he's feeling.

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Re: Stomatitis- any experience?

Postby MaisyPancakes » Mon Jun 27, 2016 8:06 pm

Oh Landis. :( I'm no help, but sending good vibes! Could something else making him reluctant to pee, like an owie in the hip area or another limb? I'm sure you've checked, but the kibble that made him sick hasn't been recalled or anything, right? If it's not too late, I'd ask for a full thyroid if you're doing everything anyway—only because T4 alone is supposedly pretty unreliable, so you may get more useful info for your investment if you do a full panel instead. Thursday feels like a long ways away—try to not worry too much, if you can.

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Re: Stomatitis- any experience?

Postby Amanda » Mon Jun 27, 2016 8:35 pm

He pooped! Normal poop too! We were out for an hour and he did it while we were gone so he may have peed as well. I would have locked him in but last week when we did that to control observations he had a blow out. So I was gunshy. So on we go and hopefully not worry too much.

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Re: Stomatitis- any experience?

Postby Amanda » Tue Jun 28, 2016 6:06 pm

He has elevated kidney values. Diet change required. Feels like Freddy deja vu. Still going to the dr Friday to see what we can do about his mouth.

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Re: Stomatitis- any experience?

Postby SherriA » Tue Jun 28, 2016 6:36 pm

Diet changes were a near miracle for both Jack and Oliver when their kidneys were bad. Here's hoping they work magic for Landis too!
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Re: Stomatitis- any experience?

Postby Amanda » Tue Jul 12, 2016 11:45 am

Went back to the vet yesterday after his nose started to bleed over the weekend. It happens usually when he eats and occasionally when he gets excited (i.e. When we come home after work.) Going in Thursday for a dental. (Was Wednesday but had to change schedule.) The differential diagnosis right now includes abscessed tooth or teeth, autoimmune disease attacking mucous membranes, and nasal polyps. A foxtail is possible but he isn't having sneezing episodes like crazy. Coagulation issues ruled out because I have seen blood clots come out. The tooth is likely because the bleeding gets far worse when he chews suggesting the tooth punctured the sinus cavity and chewing pumps blood out of it. However, he still has mouth lesions (better but not gone like we would expect) and he also has a weird hotspot type thing around one of his nipples and autoimmune would attack the lining of mouth and nose, genitals, and teats. His bits all look fine but the nipple thing in conjunction with everything else is suspicious.

So dental with X-rays and possible extractions. If nothing of consequence is found there, nasal scope to look and see what is going on inside his nose. If nothing there, punch biopsy of the lesions in mouth (and possibly nose) to find out what the heck is happening. A tooth extraction would be our ideal case because it's the cheapest and easiest to fix. Although none of this is cheap and with all of Zeke's issues this year we are really running on empty. Just want the old guy to be comfortable and happy which he seems to be for the most part. But I wonder if he has a massively abscessed tooth just how happy he really is. Labs are so stoic sometimes. It's incredible. Wish us luck!

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Re: Stomatitis- any experience?

Postby MaisyPancakes » Tue Jul 12, 2016 11:56 am

I hope it's the tooth or whatever is the least big deal! Poor Landis and poor you guys!

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Re: Stomatitis- any experience?

Postby UpwardDog » Tue Jul 12, 2016 6:15 pm

I'll be thinking about you both, hoping for something cheap and easy. Enough with the vet bills already!!

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Re: Stomatitis- any experience?

Postby SherriA » Wed Jul 13, 2016 6:03 am

Fingers crossed for the easiest solution.
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Re: Stomatitis- any experience?

Postby Amanda » Wed Jul 13, 2016 11:00 am

We are going to run an immune panel on Landis now. His globulin is off the charts high and his albumin is low. We are starting to lean toward autoimmune disease more heavily. I was hoping for a tooth, but Dr. B is really concerned about he immune thing. If the profile shows immune issues then we will skip the procedure for the dental and all that. Start treating with steroids, etc. Sigh. My poor boy. I vaccinated him last fall so he could come to work with me. I hope I didn't trigger this with the vaccinations.

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Re: Stomatitis- any experience?

Postby Sabine » Wed Jul 13, 2016 6:36 pm

Oh poor Landis :( I hope you can get to the bottom of things quickly. :(
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Re: Stomatitis- any experience?

Postby Amanda » Wed Jul 13, 2016 9:19 pm

I was hoping for results this afternoon but they didn't come before closing time. So I wait until tomorrow morning...

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Re: Stomatitis- any experience?

Postby Amanda » Sat Jul 16, 2016 12:38 am

It's autoimmune. Biopsy tomorrow morning to send out for pathology. Steroids to start and then fine tune after biopsy results are back. His front right paw pad is now peeling off. This has been the strangest thing.

When we saw the vet Monday he said he was thinking teeth because that was the most obvious, common, and logical item in the differential. Autoimmune isn't all that common and it would be unusual to have me hit the odds of bad luck on this dog too. He did come back a few minutes later and say he was still suspicious of autoimmune but he was thinking a tooth was more likely. So here I am with my bad dog luck again. Boo. After the biopsy comes in we will know what he has and what the prognosis is. From what I've googled, most of the options say UV light makes things worse and I am so sad because one his very most favorite things is to sunbathe in the yard. :( I hope I don't have to take that away from him.

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Re: Stomatitis- any experience?

Postby emmas_mom » Sat Jul 16, 2016 10:07 am

I'm so sorry, Amanda. Poor Landis! I hope the biopsy enables them to identify something specific that will respond well to treatment.
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Re: Stomatitis- any experience?

Postby SherriA » Sun Jul 17, 2016 7:55 am

Not what anyone wanted to hear, but I hope you get some good options after the biopsy results come in.
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Re: Stomatitis- any experience?

Postby UpwardDog » Sun Jul 17, 2016 7:05 pm

Oh, I'm sorry. I hope whatever it is , it goes into remission after some steroids and stays gone. I didn't know autoimmune issues could start so late in life.

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Re: Stomatitis- any experience?

Postby Amanda » Sun Jul 17, 2016 8:25 pm

I don't know what it is or why it happened at this time. But I kind of wonder if he didn't always have it but just not as bad. When he was at CCI for training his lips had lesions break out on them. And he had recurring ear infections after that. Then he started with the facial hot spots. And now this. Maybe old age is making it worse? Kidney deterioration contributing?

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Re: Stomatitis- any experience?

Postby JudyL » Mon Jul 18, 2016 10:14 am

I'm sorry, Amanda, but am glad you have a proper diagnosis and am hopefully that you'll be able to manage this and keep him stable for a long time to come.

Fwiw because obviously commenting on my dog's condition is purely anecdotal, ChiChi's autoimmune issue started in early 2009 at a few months after her 10th birthday. Up until then, she was an active and healthy dog with no issues whatsoever, and other than part of that year discovering and figuring out the treatment and handling of an inflammed joint and the ongoing dry eye issues, she lived very comfortably for an additional 6 years.

I think with Chi, a dysfunction of the immune system may have been a contributing factor since sister Dixie developed cancer later in life, and with that in mind, was also likely caused by overstimulation or overtaxing of the immune system with all of the vaccines they received over their lives, because 10 years isn't a very advanced age for small dogs like them.

ETA- sorry if that sounded like I was making this about my dogs because that wasn't my intention. I was trying to answer Heather's statement about development of autoimmune issues in older dogs. :(

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Re: Stomatitis- any experience?

Postby Amanda » Mon Jul 18, 2016 4:45 pm

I called CCI and none of his litter mates have reported any issues. One is a breeding male and one is a working grad dog. So those two for sure have accurate records. My vet is faxing our records to them because they are a concerned with what his diagnosis ends up being considering his brother has produced progeny.

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Re: Stomatitis- any experience?

Postby Amanda » Mon Jul 18, 2016 4:48 pm

Judy- late onset autoimmune with Chi is interesting to me because a number of people have asked me why we are seeing this now. I am going to ask the vet on Wednesday.

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Re: Stomatitis- any experience?

Postby MaisyPancakes » Mon Jul 18, 2016 4:54 pm

Hugs your way, Amanda! Hoping it is easily managed and Landis will be feeling all better, soon!

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Re: Stomatitis- any experience?

Postby Amanda » Tue Jul 19, 2016 10:24 pm

The head vet from CCI's breeding department called me today. She wants me to ask the vet about multiple myeloma. Blood plasma cancer. His bloodwork, to her, indicates this is something to test for. Not sure what I will do yet (looks like bone marrow biopsy is the way to test thoug maybe by blood work too). I am going to bring it up to the vet in the morning. I hope our biopsy results come in before our appointment. I would like to go over those in person instead of on the phone.

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Re: Stomatitis- any experience?

Postby UpwardDog » Tue Jul 19, 2016 11:49 pm

Oh my goodness, I sure hope its not multiple myeloma.I am so sorry, you must be so stressed and worried. It is so hard not knowing too.Hang in there, Amanda.XO

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Re: Stomatitis- any experience?

Postby Amanda » Thu Jul 21, 2016 10:47 pm

My vet is very sure we aren't seeing multiple myeloma. His blood calcium is very normal and that's against classic symptoms. Biopsy was inconclusive. He called the lab to have them recheck on new slices of tissue just to be sure and also to run a special stain test he knows about. Pathologist is out until Wednesday so no results til late next week. He said we probably should have biopsied the lesions the very first day, but hindsight is 20:20.

Symptoms seem to waning? No nose bleeds, mouth lesions are gone, hot spot near teats isn't gone but looks a bit better, paw pad skin no longer peeling off. Plan is to cut steroid by 50% every 10 days and watch for symptom return. Recheck in 20 days. So first cut is Tuesday.

Concerns I have currently: weight loss. He's down 5ish lbs despite eating a diet that was originally designed for Freddy who was 15-18 pounds heavier than him. I started giving him bigger portions last week and most recently I made a 14 days supply and cut it into 11 days so he's getting ~ 1/4 portion more each day. But tonight he is looking even thinner than yesterday morning so I threw in some kibble just to give him added calories. Not ideal, but just had to do it. I didn't have any extra of the homemade thawed for tonight. Maybe I will feed him another 1/4 portion extra each day. That would make each days' calorie count 1.5 what he should be getting- in theory.

My other concern is his tongue looks darker to me today. Like deep red with a hint of purple. Capillary refill on his guns looks fine. It's just the tongue.

Continuing to leave both dogs home from work. Leaving my shoes in the garage and changing clothes before I even come inside. Thorough hand washing before touching or feeding him. Vet says after we reduce his dose next week his immune system should start back up again and we won't need to be as careful. Which will be nice to let Zeke get back to playing and exercising there. He's a little stir crazy.

That's where we are now. Trying not to borrow trouble or worry too much. My son said, "Is Landis going to die? He can't die because he's our last good dog!" Lol. Poor Zeke has big paws to fill.

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Re: Stomatitis- any experience?

Postby UpwardDog » Fri Jul 22, 2016 5:49 pm

Hmm, well I'm very glad his symptoms are subsiding. I hope he's enjoying the extra food.Often steroids make them ravenous and gain weight.
I had to increase Sam's food by a lot when he had kidney failure. Weight was falling off him and he got boney. I think that's typical of kidney failure from what I know. I felt like a real jerk feeding Sam heaping bowls of real food 3-4 times a day whilst Rosie got two small bowls of kibble with a wee bit of real food on top.

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Re: Stomatitis- any experience?

Postby Amanda » Fri Jul 29, 2016 10:30 am

Latest on Landis: had to cut his steroids a few days early because his symptoms are too severe. Bloody diarrhea and weight loss. Muscle wasting away dramatically. So we went to 50% dose Sunday and will cut by half every week until he's down to 1/4 tab daily.

Biopsy was worthless. Pathologist said only 2/10 autoimmune dogs can be diagnosed by mouth biopsy so clinical presentation is diagnostic more than biopsies.

He has aged unbelievably in the last few weeks. He looks decrepit and sickly. I am anxious to reduce the steroids asap. His attitude is subdued even for him although he perks up when I talk to him or pet him. I don't know what the future holds but we are just taking it a day at a time and he is enjoying his meals and slow short walks. We will go in for a recheck next week sometime.

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Re: Stomatitis- any experience?

Postby MaisyPancakes » Fri Jul 29, 2016 10:38 am

Oh Amanda, I'm so sorry. And how disappointing to hear you sent in the biopsy that it's not all that helpful!! I mean, all this time (and $) spent waiting and worrying about the results! :(((( I hope he springs back up quickly after steroids are reduced—poor you guys. Heart aching; sending you hugs and sanity.

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Re: Stomatitis- any experience?

Postby SherriA » Fri Jul 29, 2016 10:02 pm

Oh Amanda, I'm sorry to hear this. I hope he bounces back as the steroids are reduced.
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