by Anne O'Connor
Livia came from a perrera in Zaragoza, in the north of Spain. The photo here was of her there in February 2012. She looked like a small old little lady who had had a very hard life. She had what looked like a touch of mange and conjunctivitis, but nothing in the way of illness that I felt I couldn't handle. Her face was tired, she was the little lonely dog in the corner. Looking at her I knew that I could give her the life she deserved.
However Livia's blood tests revealed that she was in fact suffering from Leishmaniasis.
Receiving the news that your dog has a disease that is incurable is a bit like being punched in the stomach. It was certainly the feeling for me when this little podenca, who was about to get a second chance at life, was diagnosed with this disease. Leishmaniasis is caused by the parasite of the genus Leishmania. It can affect skin and organs and if left untreated can cause death.
The fear of this disease is not uncommon and usually a result of general ignorance about it. My way of dealing with this fear was to find out as much as I could. For a while the more I learned, the more questions I had. Would she recover? Would my other dogs catch it? Would I catch it? I discovered, that, yes, with treatment, she would recover; no, dogs cannot catch this disease directly from each other and no, I was not at risk either. But the most important thing I learned was that time was of the essence. The sooner my little dog started her treatment, the better.
Thankfully, thousands of vets had been treating and researching the disease for decades so there was enough knowledge and experience to get Livia back on the road to health. The following is a short account of Livia's journey through her treatment; a short guide about what to expect if you are facing this challenge.
STEP ONE: Testing and levels
Usually a dog from the Mediterranean parts of Europe is given a “snap” test for Leishmaniasis early on in their rescue and re-homing process. This just gives a straightforward positive or negative reading for the disease. Once the positive reading came back for Livia, she then had a further test to check the amount of parasites in her system. We needed to find out if they were reproducing and, if so, how rapidly. This test is also called a TITRE and the results are most commonly written as a fraction. So, Livia's first reading was 1/600. This reading is moderately high.
We also took a blood sample and ran tests for Liver and Kidney function. This is also an important step to establish whether the there is any damage to these vital organs. It may determine the treatment a vet will recommend.
STEP TWO: Stopping the parasite in its tracks
The first step in Livia's treatment was to be given a tablet called Allopurinol three times a day. Allopurinol is the brand name for a drug used to treat gout in humans. It is also used to reduce kidney stones in dogs prone to forming them, such as Dalmatians. Allopurinol is also known as Zyloprim, Allohexal, Allosig, Milurit, Alloril, Progout, Zyloprim, Zyloric, Zyrik and Aluron.
Studies in the 1970's discovered that Allopurinol is effective in stopping the Leishmania parasite make its own DNA. This makes it difficult for the parasite to replicate and damage the body of its host.
Livia had been deteriorating in the perrera since the first picture of her had been taken and circulated on social media. By the time she was rescued by the refuge, it had changed her appearance alarmingly. When I first met her she had lost all of the hair on her head and a lot from her body as well. Her claws were long thick and a deep brown colour. The pads on her feet were white and very flat. Her cheek bones stuck out like razorblades, so sunk was her face and her poor eyes were so swollen and watery with the conjunctivitis that she could hardly see properly.
These are all typical signs of a Leishmaniasis infection. It broke my heart to see her in this state but it made me all the more determined to help her. The Allopurinol that she had been taking since her rescue was not reversing these symptoms but it was buying her time and stopping the disease from progressing at a pace. Now Livia had regained a little strength, she was ready for a more aggressive form of therapy
STEP THREE: Getting out the big guns
In most cases where the Leishmania parasite is at low levels, the Allopurinol treatment can be enough. The dog's own immune system is able to deal with the parasite and they recover and keep the parasite at bay. However, if the levels are higher, or the dog's immune system is unable to deal with even the low levels of parasite, then a more aggressive treatment is called for.
It was important to kill as many of the parasites as possible and so Livia was prescribed the most successful and widely used drug in the war against Leishmaniasis. This medicine is Meglumine Antimoniate and only comes in the form of Glucantime, an injection only medicine that was first developed for treatment of Malaria.
Milteforan, also known as Miltefosine, comes from a compound that was originally developed for breast cancer and solid tumours. Its leishmanicidal properties were discovered later and the drug was developed for this treatment. Milteforan is the drug that I describe as a form of chemotherapy and not Glucantime.
I chose the Milteforan as it would be easier for me to administer. Livia sailed through the her treatment with no side effects whatsoever, which astonished me. In a matter of days I could see the results of the treatment. After a couple of days and with some eye cream as well, Livia's eyes were drying up and the swelling was diminishing rapidly. In the first week I could see her fur beginning to grow back on her face. Initially, she had been a very tired and lethargic girl, but she seemed to be growing a little stronger with every day that passed.
By the end of her treatment, her little body was covered once more with fur, her claws and paw pads had returned to normal and she had more and more energy. I could take her on longer walks and she started to be more playful with her new pack mates. It felt like a miracle was happening before my eyes.
In some dogs the recovery process takes a lot longer, but it is always essential to finish the complete course of treatment.
STEP FOUR Interrupting the reproductive cycle
This final step is not widely known about, but it is a very cheap, very gentle and very effective drug that will disrupt the reproductive cycle of the parasite. What is more, it complements other treatments beautifully.
It is called Domperidone and is sold as the liquid or tablets known as Motilium for humans. It is also sold as a liquid called Leishguard for dogs. Leishguard is simply a repackaged version of Motilium, but there are no differences apart from flavour and colour. Motilium is an anti-vomiting medicine and affects the brain chemistry, which in turn affects the parasite's ability to replicate. Every three months I give Livia a daily dose of Motilium for a 30 day period. After her Milteforan treatment we started on this gentle and very effective medicine.
Livia had been through the initial treatment process and the next stage was to wait for a couple of months until it was time to retest her levels of infection.
Her results came back at 1/320, nearly half her previous levels. I was so relieved, the treatment had been effective. I could see she was so much better on the outside, now it was such a thrill to know it was working on the inside as well.
Although this was great progress, Livia was still giving positive readings, lower, but still positive. I needed to continue to keep her on the Allopurinol and decide whether to follow another course of Milteforan. Some vets like to repeat the treatment cycles until the reading is “negative” (1/80 or lower).
I decided to keep Livia on the Allopurinol and try some other more gentle alternative treatments that I had found in my research. After a few months, though, I was forced to stop the Allopurinol due to complications and continue simply with good diet and supplements etc. to keep her in top condition.
COST OF TREATMENT
If a dog has been diagnosed and treated for Leishmaniasis in a rescue association then the costs for maintenance with Allopurinol and Motilium are minimal. These are medications that can be found in most parts of the world and cost a few pounds at most. The good news is, a dog who has already been treated, with proper maintenance, will probably be fine for the rest of their life.
If treatment is needed then it is a good idea to contact the rescue association from which the dog was adopted. This is especially true for the Spanish adoptions. They should be able to help you source Milteforan or Glucantime for a good price. For example the Milteforan that I used cost me 113 Euros to buy. That was my largest expense. The only other outlay for me was the blood tests. In the UK it is important to shop around for blood tests and medicines if you intend source these through your vets as prices vary widely. One good place to get advice and support is from are groups on Facebook such as the group called “Living with Leish” or “Canine Leishmaniasis”
A year on, with no further Milteforan treatment and six months after we had stopped the Allopurinol, Livia's annual blood tests came back at 1/80! I was overjoyed. This is often seen as a negative reading in laboratories so she had made the most amazing progress. Whatever I was doing seemed to be working.
(Livia now, with Luke)
Apart from the information gathering, there were crucial lessons learned along the way. The support of others is really important, especially from your vet and the rescue association from which you adopted your dog. Don't ever accept what you do not feel comfortable with and remember you can always find a more understanding vet if that is what you need. The Facebook groups, “Living with Leish” and “Canine Leishmaniasis” have been great resources for me and others.
I also learned to trust that Leishmaniasis is not a death sentence and that Livia's immune system would, if supported, be her strongest ally in this battle. I focussed on good quality food (I feed human grade raw meat and veg) and supplements like Propolis to support immunity. Probably most important of all, I made sure she was happy and loved as much as possible. Loads of love and many cuddles and kisses are most crucial to maintaining a healthy immune system. This was definitely the easy part of the treatment!
Livia did get her second chance after all and she enjoys every minute of it. Strength means much more than physical power. Tiny as she is, Livia's strength of will to thrive has been an inspiration to me. She grasped life with both paws and has refused to let go or be quiet about it. I thought I was going take home a small quiet and frail little girl. What I actually discovered, even through the illness and treatment, was a dog with a great passion for life, great courage and so much love to give. Not for one moment have I regretted taking on the challenge of a dog with this disease. If Livia is not afraid of it then I have no need to be afraid either.'
Thank you so much, Anne, for sharing your experience of dealing with Leishmania in Livia. I hope that many people will now consider adopting a Spanish hound with a positive reading and refer to all the treatment used to help Livia and share it with their vets.