I thank you for your photos emailed on Sep 24, 2011. We met at the Surgery on Sunday Sep 25, 2011. I have had discussed with you further the management of pemphigus in your dog.
An auto-immune disease has no cure and control is by medication that has to be given according to response. There is no fixed formula for medication in auto-immune diseases as dosage depends on response and this can only be known through weekly or regular assessment. Too high a dosage results in kidney damage. Too low a dosage and it does not work.
On Sun, Sep 25, 2011 at 9:24 AM, ...@yahoo.com> wrote:
Dear Dr Sing,
here is an update since the review on last sunday.
the lumps on the paws are getting bigger and started to be smelly for the past few weeks; even the small lump at the mouth is also getting visible and seems growing.
i have attached some photos taken for the mouth, ears & paws.
E-MAIL REPLY FROM DR SING AFTER DISCUSSION WITH THE OWNER
From your feedback of the paws and the right gum swelling, the disease needs a higher dosage of medication for the next 7 days. This dosage depends on response for the next 7 days and frequent monitoring and discussion with the vet.
Washing of the ear flaps and each paws in a bowl of warm water + anti-fungal solution, keeping them very clean and dry, wearing of pad stockings, applying anti-fungal cream to blisters, wearing an e-collar at all times and taking medication of the two immuno-suppressive drugs and antibioics are part of the management of this disease for the next 7 days and beyond.