Three Strikes and You're Out by Bev Lewis, Akita Alumni Canada as printed in Akita Dog the official publication of the Akita Club of America
The first time I heard anything about VKH was in Barbara Bouyet's book, Akita Treasure of Japan. My second experience was at a seminar by Dr. Bob Kenn for Akita Alumni. It sounded like a dreadful condition. Little did I know just how bad it could really be and how it would shatter my hopes.
Since I had no first hand experience with the disease and knew of no one else who had either, I dismissed the subject until ... My third strike of information about VKH came many years later, when one morning our 18 month old Akita puppy "Taiyo" awoke blind, in pain and terrified. From there began a 2 month trial of agonizing pain for Taiyo and learning, suffering and crying for us, ending with sorrow.
Uveodermatological Syndrome or VKH (Vogt-Koyanagi-Harada) is a disease of humans, reported commonly in Italians and Japanese peoples, and nordic breeds of dogs. In an article by Beverley Cottrell and K.C. Barnett (Harada' s Disease in the Japanese Akita 1987) it is also referred to as uveitis-vitiligo-alopecia-poliosis syndrome. "It is a condition principally affecting the young adult. It has three recognized phases: a meningoencephalitic phase, an ophthalmic phase and a dermatological phase". In dogs it was often referred to as VKH-like syndrome, but now is readily known as VKH. According to Cottrell and Barnett, the first case reported in Japan was in 1977, followed by a report in Canada in 1982. Cotrell and Barnett argued that since only 388 Akitas were registered in the United Kingdom, inbreeding would be likely, leading to an increase of frequency of the disease. VKH is an autoimmune related disease with heritable implications and is being reported at an alarming rate world-wide in our Akitas. It is not certain whether the incidence of the disease is on the increase or if vets are now being trained to recognize it better.
Whatever the reason for what appears to be a sudden increase in diagnosed cases, my experience is that there are a great number of Akita owners who are fighting a daily battle to hold on to their dogs. And many more lose that war.
First Signs:
The onset of VKH can be slow or sudden; dramatic or hardly noticeable. Meningoencephalitic Phase Interestingly, I have never found any reports of this phase, and some experts deny that it even occurs in dogs. But I'm certain that our Taiyo did experience this. About 10 days previous to his sudden attack, he had a strange malady. In humans this stage is characterized by fever, malaise, headache, nausea and vomiting. We thought it might be kennel cough but it passed as quickly as it came.
Dermatological Phase:
Some dogs have a few blisters on their nose - a sort of crusty bit that just won't heal. Vets will often prescribe steroids and the symptom may disappear for a while. These sores can be seen in other areas of the body, such as the eyelids, lips, pads of the feet, scrotum and anus. The sores may increase in size and numbers, or they may never be anything more than a nuisance. After a period of time, the area will begin to depigment and there is often hair loss and/or the hair will also lose its color. There have been reports of some Akitas whose toenails begin to fall off about a year prior to diagnosis, but this is not common.
Ophthalmic Phase:
In some cases, the dog will become blind as the pressure in the eye builds up and causes the retina (in the back of the eye) to detach. Even these retinal detachments vary in severity and frequency.
And then there are remissions for some dogs: all symptoms will inexplicably disappear for a period of time, even without treatment. If treatment is being used, it is often reduced, and length of remission can be unpredictable before another attack. Treatment Some dogs never stabilize after the first attack, as in our case. Any treatment sets up yet another challenge to the already unbalanced state of health. Yes, this is a life-threatening disease because the treatment is so invasive. VKH and its treatment is a jarring and nasty experience for dog and owner. And it can be agonizing for the dog. Living with a VKH afflicted dog requires a great deal of energy, a bottomless bank account and emotional fortitude that few of us possess.
There is only one way to fight an acute attack of VKH: Aggressively! Sizable doses of steroids both topical and oral are augmented by immune-suppressants. Some success has been reported with cyclosporin and there might be hope with the use of anti-rejection drugs used for organ transplant patients. But this is not available for use on dogs and is profoundly expensive even for humans. The steroids come with their own special brand of side effects: insatiable thirst and hunger, frequent and smelly urine, depression, aggression and eventual damage to vital organs. The dog can exhibit shocking personality changes.
If the dog's condition is severe, the steroid treatment will never end and the constant barrage of these drugs will eventually kill the animal it is supposed to save. Another set of drugs will be needed to try to offset the steroid damage. Immune suppressants on the other hand will also be a constant companion to the VKH dog. These drugs set up the animal for any opportunistic invasion of bacteria or viruses. Antibiotics become a frequent prescription to deal with infections. The best case scenarios are for those dogs who have long periods of remission or who are moderately afflicted. For them, smaller doses of meds or natural treatments will hold the disease at bay. These are the lucky ones, as they can live a long and relatively healthy life. Their unfortunate brethren do not fair so well as seen by some of the stories below.
A Cure?
Not likely in my lifetime. The best we can expect is that in the near future a genetic marker will be found that will enable breeders to test breeding stock for the existence of the disease. Like the many other tools available to reputable breeders, this could become a normal part of the testing procedure before breeding an Akita, as with hip and eye certification and thyroid testing. Recently a DNA genetic marker study was undertaken by UC Davis with seed funding provided by staunch Akita lover, Linda Wroth. It has been ongoing for a few years now and the study is slated to wind down by June of 1999. But with the help of the Akita fancy, UC Davis was able to gather the 1000 samples needed. Thanks also goes to Akita Alumni who mailed out more than 600 free confidential swab kits for Akita owners to supply that precious Akita DNA tissue from a simple cheek rubbing. More information about banking DNA samples for VKH and other diseases of our Akitas will be announced in the near future. And there is a hope that studies will begin in other countries such as England, New Zealand and Australia. Again we will depend on the Akita community to continue to be cooperative and helpful with these attempts to save our beloved breed.
What are the Causes?
There is no vaccine or preventative elixir. There are many theories as to what triggers VKH. Certainly, stress and other disease will weaken a dog's resistance. I felt that our Akita's VKH was triggered by his yearly vaccines. Many others have noticed a similar connection. Any dog who does suffer with the disease should not be vaccinated, as VKH is an immune related disease. The last thing needed is to set up yet another immune response to some other disease. Stress takes a terrible toll on all living creatures, so a stress-free life is always ideal. Good nutrition and some natural supplements can help too. A complete thyroid panel is also in order before beginning treatment.
Chief:
Chief was diagnosed with VKH in 1992 at 2 1/2. At seven he now copes with VKH and Sebaceous Adenitis. His quality of life is excellent. Chief's owner reports that he was stricken 10 days after his yearly vaccine. He now receives "nosodes for Rabies, heartworm and DHLPP, and is titer tested annually." He is aging more rapidly than might be expected, but Chief is living proof that his original vet's recommendation to "put him down" was absolutely wrong. Chief used to have bleeding sores on his gums and lips but with homeopathic meds, he shows no serious effects from the ravages of either VKH or SA. Chief's owner states, "VKH is a very dark and gloomy disease that has many facets to it, and depending on the severity, many like my Chief are able to live a strong happy fulfilling life - "with" many adaptations by the owner."
Kisaki:
It has been many years since Kisaki passed away from a severe case of VKH. She was an exceptional guardian and yet still liked other dogs. Her owner reports that as the disease progressed, Kisaki's once jovial attitude to other animals changed. Yet through all her treatments, she remained trusting of her doctors as though she understood how they wanted to help her. Kisaki's owner shared his heartbreak this way, "The disease, for those that haven't encountered it, can be described as up and down. You can have initial failures with the steroid treatment and still have hope for success. Hope is given and then taken away and then given back again. You are on an emotional roller coaster. Our roller coaster crashed and burned. Kisaki had to be put down."
Nikki:
This is a 7 year old survivor of VKH. She has been diagnosed only this past year but is doing very well. Her owner has taken an active approach to dealing with the side effects of meds. She uses milk thistle and Eye Bright with some success. As Nikki and her owner are relatively new to VKH, they are trying many natural remedies in hopes of keeping Nikki comfortable. Nikki is one of the few VKH dogs who has a normal thyroid. Nikki's owner comments, "It hasn't been easy dealing with it all, but I'm just thankful she's still with me. I can say that things have greatly improved since it all started, though."
Taiyo:
Our boy was stricken suddenly at 18 months of age. One morning he awoke with bulging eyes that showed a distinct milky blue surface. He lost 20 pounds the first month of the disease and was put out of his misery after 8 weeks of invasive, expensive treatment. He suffered terribly and is an example of the extreme side of the disease. Taiyo is my personal poster Akita for VKH and has come to represent the war we wage to save others from the suffering he endured.
Sweetie:
This 5 year old Akita (pg 16) was blind with VKH at 1 year. Her eyes still caused her great pain and the owners made a bold decision. They had her eyes removed, and Sweetie began to play and yodel to herself for the first time since she was a puppy - just days after her surgery. She is a survivor as are so many brave Akitas. Nikea She was first diagnosed with VKH at 2 and is now a nearly 8.
Nikea:
Nikea (pg 17) is a miracle of sorts as she has never been medicated. Her depigmentation is quite severe but she exhibits no other symptoms. Her owner maintains the healthiest and most natural life possible - no chemicals, home prepared meals and sun block on her pink nose.
Tai Tai is being treated with kinesiology to adjust the medication used and is receiving special supplements. She is doing very well and being monitored carefully.
The British Boy:
This young fellow fought VKH for 18 months but eventually his owner had to make that final decision. He could no longer cope with the disease or the treatment. In his memory a "diary" of those 18 months has been prepared with proceeds going to further research into VKH.
Our hearts go out to those who did not make it. My deepest appreciation to the countless Akita people who have shared their experiences with VKH - both the sad and the hopeful, and especially to those whose stories are told here (Stephanie Fournier, Christina Ashley Scott, Clark Schaak, Michele Guzik, Bea Pitts and Shelly Chase Simon). We all owe a debt of gratitude to those who still inspire us to forge ahead and who have supported us through our time of fear and sadness (Linda Wroth, Barbara Bouyet, the researchers at UC Davis and the many vets who help us to cope with the day-to-day ordeal of VKH).