We have a beautiful male Whippet named Alfie who will be three years old in February. Ever since he was about four months old he has suffered intermittent gastrointestinal problems with vomiting and diarrhoea. (He tested positive for giardia when he was seven months old and was treated with panacur.) As well as the gastro problems, Alfie suffers from a more serious health problem, that seems to follow a bout of vomitting and/or diarrhoea. It first occured when he was 10 months; he presented with a high temperature, general lethargy and discomfort with movement such as lying down or getting up. He did not respond to treatment with antibiotics. Eventually the vet prescribed steroids following Alfie's obvious discomfort when his neck was examined, and a noncommittal diagnosis of steroid-responsive meningitis was put forward. I did not want to go down the road of having a spinal tap carried out to confirm the diagnosis.
This condition has recurred another four times during the past two years, each time being treated with steroids - which bring about an almost miraculous recovery within 24 hours. He has been kept in overnight at the vet's on a drip on at least three occasions to ensure he does not dehydrate due to his high temperature.
He has just finished his most recent course of steroids and the vet is suggesting that we refer him to a neurologist if the condition recurs again, in order to get a definitive answer. This would mean a ferry ride and car drive (we live in the Channel Islands) when he is ill to the nearest specialist in the south of England. Alfie is insured so cost is not an issue, but the thought of the journey with the high temperature and obvious discomfort he shows really worries me. Would a definite diagnosis make a difference to his treatment? He responds to steroids so I wonder if a diagnosis, which could be inconclusive, would make any significant difference to his health management. I don't want him to be reliant on steroids forever, but if this works then is long-term treatment a realistic option?
I have to say when he is well you would never think he'd had an ill day in his life - he is energetic, loving and playful.
We would appreciate others' thoughts especially if you have been through something similar.
Jo Lamb, Guernsey
Steroid-responsive meningitis is often a condition diagnosed by excluding other causes for the clinical signs the patient is showing, and by response to treatment with corticosteroids. It is also a condition liable to flare up, such that long-term therapy with low-dose corticosteroids is not unusual.
It is because of this recurrent nature of steroid-responsive meningitis that your vet will have advised referral for a definitive diagnosis. If it was confirmed as the cause of your dog's bouts of illness, then all your questions and concerns about his treatment and long-term outlook could be addressed with a far greater degree of certainty. Long-term treatment with corticosteroids is not without its concerns but if needed for medical reasons then the benefits should outweigh any disadvantages.
It is however always your decision and I can quite appreciate your worries about referral, not least in your situation where travel involves a considerable journey including a ferry ride, and when Alfie is very unwell. On that basis, then a response to corticosteroid treatment when a flare-up occurs can be acceptable, provided there is full recovery with treatment. Compromise is not necessarily the wrong route to take.
I particularly remember a Border Collie who presented on an August Saturday with such acute neck pain that she had become stuck in the passenger footwell of her owner's car. I did refer her because I was worried about a slipped inter-vertebral disc in her neck, but she was diagnosed as having steroid-responsive meningitis and responded very well to methylprednisolone. When we began reducing the dose, she did have flare-ups, which settled once the dose went back up an increment. She has now been off treatment for three years.
Alison Logan, vet
