CASE OVERVIEW #1
Leonard Kreger, DVM
Sparky, a 5-year old beagle mix was brought to me for a “second opinion” on April 14, 2009. He had been under the care of another veterinarian for 4 weeks, but had not improved. When he came to me he had recently lost 10% of his previous body weight and was not eating or drinking. He was extremely reluctant to move and yelped with pain when coaxed. Besides the reluctance to move, when he did walk he often favored one or the other hind leg. He carried it rather than put weight on it.
Sparky’s first vet treated for Lyme’s disease as Sparky had a known history of tick bites. A systemic bacterial infection was also previously suspected although antibiotics had proved unsuccessful.
When he came to me his temperature was 103.2. Blood test results showed high WBC, high neutrophils and bands. I, too, suspected some type of systemic bacterial infection because of the high WBC, bands, high neutrophils and high fever. I also considered diskospondylitis. X-rays of the spine were taken but no lesions were present in the films. Another possibility that might explain the high WBC count and the fever was an internal abdominal abscess. To confirm we did an ultrasound of Sparky’s abdomen in our office. All appeared normal.
Previously Sparky had been on a course of several antibiotics as well as anti-inflammatory drugs, one of which was Prednisone. The only drug that made any change in Sparky's condition was the low dose of Prednisone. (The owner reported that the relief was only temporary.) It was a puzzle.
Later that evening I discussed this case with a
colleague
and a former lab partner from Vet school at Cornell, Mitch Kornet of
the
Hicksville Veterinary Clinic in
By the next morning, Sparky was almost a different dog than the night before. His fever was back to normal and he was walking, eating and drinking on his own. He was sent home later that day with a prescription for Prednisone 20 mg. Tablets, twice a day for a week, with lower doses to follow.
The plan was to gradually taper the dose of Prednisone over the next few weeks until, eventually, we could see if Sparky could do without it. But when Sparky got to the 20mg every other day rate he started to backslide. I suggested going back to the original dose of 20mg twice per day until he appeared completely well and then start lowering the dose much more gradually. Ten weeks after the initial diagnosis of BPS and Sparky was receiving alternating doses of 20mg one day, 10mg on the next. The owner reports that he appears to be completely back to normal.
Since Sparky's diagnosis I have seen 3 more cases of BPS and in retrospect I am sure I have seen at least 2 more cases but didn't know it was BPS at the time.
July 22, 2009 -The owner reports that Sparky's Prednisone dose has now been lowered to 10 mg/day and Sparky is still doing well.
August 20, 2009- Sparky has been receiving 10mg of Prednisone every three days for one week. He has now concluded his treatment and will be totally of steroid treatment for the first time since April.
Additional Note from Owner:
Three years ago when Sparky was about 2 years old he jumped off the couch, squealed in pain and could hardly move. I took him to a vet who suspected that he had hurt his back. He was put on Prednisone for about a week. He improved dramatically with no further problems. This could have been the first episode of BPS in retrospect. Prior to the diagnosis of SRM, I was considering euthanasia due to the fact he was not improving and in severe pain.