Thursday, August 27, 2009

The Horrors of SLO - Symmetrical Lupoid Onychodystrophy

Cole...

Symmetrical Lupoid Onychodystrophy (SLO) is a disease affecting the nails on a dog's paws, which causes complete loss of the nails (Onychomadesis). I had not heard of this condition before, which is why I was unaware of what was really going on with Cole when his first nail lifted off back in April of this year. It was a warm April afternoon, just before the easter weekend, when the nail on the most lateral toe on his right hind foot lifted off. This was the result of a traumatic injury; he was running around in the yard, ran too close to my husband, clipped his shoe with his left hind foot, screamed and when we investigated, we saw a nail that had been ripped off right to the nail bed, quick exposed underneath. The nail was not loose enough to pull off (we tried), so I took Cole with me to work the next morning, and with the help of some topical anesthetic cream, the nail was sucessfully pulled off without the need for a sedative. I really thought nothing of this at the time. Since I've been working in the veterinary field for 14 years, I have seen many nail trauma injuries where the nail must be pulled off. We bandaged his foot for a couple of days, and waited for it to heal.

Not long after this initial incident, perhaps a couple of weeks, another nail lifted off right to the nail bed. This time I could not confidently say that a trauma had taken place. Shortly thereafter, a third nail lifted. Just picture the hood of a car lifting up, intact, and then staying up in the lifted position; this is exactly what was happening to Cole's nails. The entire nail, intact, would detach from the quick, and lift up, staying attached at the nail bed. Upon closer inspection, nothing else out of the ordinary was apparent.... no swelling, no infection, no oozing, no abnormal appearance of the nail or surrounding tissue, just a nail that lifted up, leaving the quick exposed and the dog in significant discomfort. None of these nails that detached in this way were loose enough to be pulled off. The only option was heavy sedation or general anesthetic, or wait for them to fall off. After the 3rd nail lifted, I began asking questions to my veterinary friends and colleges... One DVM had heard of this, and had treated a few dogs, all them GSDs or GSD mixes. Others had heard of it, but were not familiar with it, and others simply had not heard of it. I decided to put a post on my favourite GSD online forum. I would never recommend this in place of veterinary advice. But I do like these forums, as there is so much traffic on there, you are almost certain to get a response from someone who has either had a dog with a similar condition, or from someone who knows someone who had a dog with the condition. This then sets the ball in motion for you to get more info, what you were after in the first place. Also, having dogs with rare medical conditions myself, I find it very comforting to communicate with others who are actually living with and managing these dogs as part of their daily lives. This is invaluable to me. In short order, I got a response from a couple of members who referred me to some links on SLO, including a yahoo group dedicated to the disease. I also had the added benefit of having a friend who was just finishing vet school, who did some research on VIN for me. Being an RVT, I don't really have access to the GOOD part of VIN. After some reading and some discussion, we are pretty certain that Cole has SLO. The only way to a definitive diagnosis is through ampuation of P3 of one of the afftected nails, something that is not actually recommended.

Cole had to suspend all activity, including his much loved agility career, which was just starting to take off. He could not run, play, go for walks, or even play fetch, his absolute favourite activity. I did try a few times to keep his agility lessons up, but even if he was having a good week with no nails that were lifted at the time, often just the activity alone would be enough to cause one or two more to become lifted off. The nails that were lifted but still attached were the most painful periods for him. Once the nails finally fell off (anywhere from 7 to 10 days typically), he was so much more comfortable. I also found that if he did little or no activity, thus significantly decreasing the chances of the nails lifting off due to trauma, that the nails took much longer to actually lift off away from the quick. This meant that by the time they actually did lift off, the quick was already blackened and somewhat hardened, and less painful for him. The nails that were lifted prematurely from trauma (such as from playing fetch), left a very tender, pink, raw, painful quick exposed. Also, because they were lifting off over a period of months (he has one nail left to come off as this is written - remember it started in April), putting him under sedation or GA everytime a nail lifted to have it pulled off was not practical or a good idea.

I am trying conservative treatment for him first, as there is some evidence that some people have had success with this. If this does not help, there is the option of him going on long term medications that have been reported to have some success.

At this time, Cole seems confortable, and pain free. He has lost all 18 of his nails, except for one, which will be gone soon. Some of the nails appear to be growing back, albiet deformed. I will have to closely monitor the nails that are growing back, and keep them as short as possible. Soon he will be able to continue on in agility again, which will make him really happy.

I did not get any photos of the nails that were lifted off prematurely due to trauma, thus exposing the quick when it was red and raw.

Below is a lateral view of the left front paw. I am holding digit # 3, of which you can clearly see the entire intact nail has lifted away from the soft tissue underneath, yet still remains attached to the nail bed (Onycholysis). The quick has turned black, and has started to dry out.


Below is the same toe, from a head-on view. Digits 2 - 5 are all visible here. Digit #2 has already had the nail fall off, digits 4 & 5 still have the nails attached.


Below is a lateral view of the left hind paw. Digit #5 is clearly visible with the nail detached from the quick, completely lifted off, yet still attached at the nail bed. These nails are slightly movable, but cause considerable pain when touched.



Below is the same digit as the above photo, but looking at the toe from a head-on position.


Below is a medial view of digit #2 of the right hind paw. The nail has fallen off, and the underlying soft tissue has turned black and dried up. The nail is in the process of growing in, but it is deformed (Onychodystrophy).



Again, a medial view of the right hind paw. Here digits 2 -5 are visible. I am holding back some of the hair, and the new nails growing in that are deformed (Onychodystrophy) are seen here, especially on digits 2 & 3.

Below is a medial view of the left front paw with Cole in a sitting position. Here we see digits 2 & 3, with #2 missing the nail completely and a dried up quick, and another view of #3. Here it is easy to see what position the nail is in when the dog is weight bearing.



This is a lateral view of the right hind paw. I am holding digit #5. This was the very first nail to come off, as the result of the trauma described above in April. Here we can see a new nail growing in, but it is deformed (Onychodystrophy), and not really attached to the underlying tissues.

Dorsal view of the right front paw. Digits 2 - 5 are visible here. All the nails have come off. There is regrowth of nails, especially # 3 & 4, but they are deformed.



Lateral view of left hind paw with Cole standing. Digit 5 is seen here with the nail lifted up while Cole is weight bearing.

Lateral view of left front paw with Cole sitting. Digits 4 & 5 still have the nails in a normal position, yet they have become detached from the underlying tissue, and it is only a matter of time before they lift up. This is another view of digit 3's lifted nail, alongside the 2 that are still in normal position. It was much harder for Cole to walk without pain when nails on his front paws were in the lifted position, as opposed to the hind paws.


Palmar view of left front paw. Digit 3 is visible with its lifted nail. Digits 4 & 5 still have their nails in a normal position, but they have detached from the underlying tissue (Onycholysis). They appear as a loose sheath covering the quick.

Glossary of Terms:
Onychodystrophy - malformation of the nail
Onycholysis - loosening or separation of the nail from its bed

Onychomadesis - complete loss of the nails

Links:

Yahoo SLO Group -
http://groups.yahoo.com/group/SLOdogs/join.
Brief description of SLO, plus has a great link to a published study from the UK - http://www.bloodaxe.com/SLO.html

36 comments:

Kate said...

My name is Kate. I was a veterinary assistant for 9 years.
I have a German Shepherd whose nails just recently started coming off. I can't tell you how much I appreciate you putting this info with pics on-line. Now I know EXACTLY what is wrong with my dog Titan. I am treating with fish oil and fish and potato food. Here's hoping I see some improvement. So far he has lost 7 nails but I can see the signs more are going fall off. You truly are a Godsend to us. Thank you and God bless you. I hope Cole is back to himself very soon.

eh said...

An excellent post, with a lot of great detail and fotos, one that perhaps will be of great help to others.

We had a German Shepherd when I was growing up, but thankfully he never developed this problem. Poor Cole must have suffered greatly from this.

April said...

My greyhound, Runner has just been diagnosed with SLO. She has lost half of her nails, and is in a lot of discomfort. As am I since I had to carry all 70 lbs of her down the stairs this morning :). I am so glad I came across your post. We are beginning a regimen of fish oil supplements and Vitamin E, but are considering changing her diet as well to see if it helps.

schutzhundgirl said...

I am happy that my post has been a help to others. I was at a complete loss when this first started happening to Cole, and once I found others who knew about this condition, it was a great comfort to me. So far Cole has lost all of his nails, but appears to be comfortable. Keep my updated on your dogs' progress.

K9-CRAZY said...

This is a great post Dianne, I've posted this on my blog as SLO is something that is seen in Giant Schnauzers. The pictures are incredibly helpful as well!

sandra said...

giant service dog 7yrs problem for 5 years at what point do you consider toe removal-criteria? & success ?? he has been having nails removed on a 3 month basis pain controlled but problem not improving? suggestions? on all the supplements but no improvement except pain better/

schutzhundgirl said...

Sandra, unfortunately this is the only way I can respond, as your blogger profile is not public, I can't access it.
First thing I would recommend is to join the Yahoo SLO group if you haven't already, they are a wealth of info. Next I would find a veterinarian who has experience treating SLO. If you read all the recommended courses of treatment, they all seem to be the same from different sources. When you say he is on all the supplements, does that mean he is on the recommended medications as well? I know that there are a few different options for meds if the initial choices don't seem to work.
I am of the understanding that toe removal is never actually recommened...
Finally I would recommend a referral to a Board Certified Small Animal Dermatologist for an opinion, as these specialists are the ones mentioned for dogs with SLO.
Good Luck, 5 years is a long time to deal with that, and having his nails removed every 3 months does not sound nice either.

Anonymous said...

Thank you so much for this wonderful post, complete with pics. I have just gotten home from our vet with my dog, Josie, a Lab-Cur mix. Today she had an ANA blood profile run and a biopsy of one of her toes taken to confirm SLO. Within the last 3 weeks she has lost 6 nails. I've been so upset because I didn't understand what was going on. My vet of course has comforted me with this preliminary diagnosis and the treatment outlines, but seeing your pics and reading your blog has eased my mind even more. Thank you for all the great info, links and support. We are adding Vit E to Josie's daily dose of Omega-3,6 and starting her on a round of Doxy while we wait for results to confirm diagnosis. it's broken my heart--what a strange syndrome, and how uncomfortable it must be! Our poor pups! Thank you again, and my best wishes to you and your babies!

D said...

My 10 yr old dapple dachshund was just diagnosed by my Vet (no biopsy done) with SLO. He seems to think it was brought on my stress when my dog went under for teeth cleaning on 8/28 of this year. Since his claws are white and easy to trim, I trimmed them often myself. A few days after his teeth cleaning, I was inspecting his toenails and was surprised to see delamination of ALL his nails. What's this? I wondered! I kept an eye on this for a few weeks and it worsened. I made an appt to see my Vet and then contracted the Swine Flu and was unable to get him in as soon as I would have liked. While convalescing, I decided to start my little dog on WOBENZYM N; as I read that it has been successfully used in autoimmune disorders, as well as cancer (Whole Dog Journal Jan 05- I think). The licking of the toes was non-stop, but after only 24 hrs of having my dog on this digestive enzyme blend, he stopped licking! Three days my little dog was on the enzyme mix before finally seeing my Vet. It was clearly not getting worse and the licking has stopped altogether (til this day)as I give Bobbie 3 Wobenzym N pills per day (he weighs 10 lbs). The Vet also started Bobbie on Tetracycline & Niacinamide. He is much better but the condition is still definitely there and one I will monitor extremely close! furryfour@gmail.com

daren said...

I saw this on my dog about 2 years ago: I have 2 miniture schnauwzers - my oldest lost 3 toenails before I knew what was happening. I used to live out in the country and she is VERY active so all the running caused her to lose the nails very fast. I had talked to the local vet and they could not give me any help - wanted me to come in so they could amputate a toe - NO WAY! I researched it as much as I could online when I came upon an obscure document that suggested fush oils. I fed them more salmon as well as fish oils. She eventually lost them all but she was never in that much pain - only when I wanted to inspect them and then she would pull away and whine. They never did grow back and she just has fleshy stubs - it hasn't stopped her from being the fastest dog around though! Thanks for the great info. I have heard about a product called Bio-Preparation which is supposed to help.

Lara said...

Hello, I am a veterinary assistant and my dog has suspected SLO, not confirmed as we do not want to amputate a toe at this time. So far she has only lost 1 nail. I think we may have caught it in the early stages. She started licking her feet obsessively so I brought her in and while waiting to see the doctor, she jumped up to catch a cookie and when she landed, it pulled the nail away. We removed it after a local. All her other nails on all her feet are loose, but no more have come off yet. She is on EPAs, Niacinamide, Tetracycline and Vitamin E. She is also living in a cone because everytime it is off, she licks her toes. I was wondering what you treated your dog with, it didn't say that I could see. Also, did your dog lick at his feet too? I haven't heard of that being a symptom, but someone else posted a message that their dog was licking alot too. It may just be that she is a licker to begin with. Thank you for your story and the great pictures!

Anonymous said...

Stumbled on your post not even looking for info on this topic. My guide dog was diagnosed with this condition in July. She is now on the reccomended meds and a pain med and seems to be doing well. Just wondering how your dog is doing now? email me at mlturtle@wavecable.com if you would like.

Anonymous said...

Thanks so much for the informative SLO post. I have been going crazy trying to treat my purebred Doberman...with no luck. I treated as fungal infection, dietary issue etc...and have suffered the pain, splitting and loss of his nails right along with him. When they start splitting--I know that very soon the nail will break off at the base and it usually starts a bleeding issue. Our vet gives us vials of coagulant as unfortuanetely our Dobe is a bleeder. This started 8 months ago and he has 4 toes with just nubs. Can someone please recommend a food that they find helpful? I had him on Innova--but it is actually worse. I can be reached at noreen@hvc.rr.com
Thanks for any help.

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Amy said...

Thanks for the informative post and photos. I highly suspect this is what's causing my LabX to lose his nails. He lost one in September, then one at Halloween and another at Thanksgiving (I guess it was nice he didn't lose one at Christmastime too. I noticed yesterday that another has lifted. His are only on his hind feet so far and he's lost nails on both outer toes and both inner toes. He used to be so good about his feet, I could cut his nails and he didn't care. Not anymore :-(

Patrice said...

Thank you so much for posting the pictures. Your dog must be very patient.

I'm just now getting the courage to write about this, and I'll be linking to your blog so people can see pictures.

Deanna said...

I very much appreciate you sharing your story of Cole and his SLO. Just started happening to my doberman about two weeks ago; now 3nails are affected. I had no idea what this was. She is in considerable pain. Thank you especially for the photos.

Anonymous said...

Thank you all for your information. My rottie started loosing her nails back in august. She lost them all very rapidly. We have had her on omega fish oil supplements, plus extra vit. E, tetracyline and niacin. She has not gotten any better but has not gotten worse. I really dont want to start her on predisone so I think I am going to try a different food. Any recommendations of what others feed? thanks-Lindsay

Michi + Aisha said...

Hi, I'm looking for information bout it for 5 weeks now. My GSD has definitly SLO and I'm really searching for people whose dogs have also SLO. Unfortunately there is no general forum for this desease in Germany. We got the horror from one to the other moment. But the stories are nearly all the same. Can this horror be stopped in any way? Really need talking bout it with others! Aisha lost 9 of 16 now.

Anonymous said...

Hi
Very nice and intrestingss story.

Anonymous said...

My westie has just been diognosed with slo after having a biopsy on all her nails. She has had all her nails cut very short to the nail bed (while under sadation) as they wer very painful and broken, now on antibiotics, hypoallegenic food and food supplements such as fatty acids im hoping these will help her and make her comfortable. Its such a horrible thing to happen i feel so bad for her :( . Will post again if i find any thing to help ! Thanks for the info/storys. X Vikki X

rottngrl said...

How is your dog doing? My dog started to show symptoms of SLO over a year ago. Panicked I switched him to a natural diet. I was convinced the cause was a nutrient deficiency from his kibble. It seemed to have helped. Nails went from going soft, separating, cracking and splitting to just flaking. Finally lost a nail a few months ago, and another just recently. They were already down to the nubs. For the most part it seemed like his nails are getting better. I'd like to email you to see what you've done, and share with you what I've done. (BTW, I'm in Ontario too.)

Paula said...

Our dog has just been diagnosed with SLO and he's lost 7 nails so far and there are a few more that are just hanging on. He's a Sheppard/Lab mix and 7 years old. Our vet gave us 1 month's supply of antibotics and Omega3's and I hope that helps him. He's been on Nutram dog food his whole life...any suggestions out there on hypoallergenic dog food we can switch to?
Thanks,

Anonymous said...

My 5 yr. old German Shepherd has lost 11 nails in the last week from this disease. My Vet has never seen it, so treating with medication for now. She is very uncomfortable. Lose of appetite and activity. Hoping she feels better soon. Thank you for all the info.

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Elizabeth said...

I have a GSD 8 year old girl called Kyra. Just diagnosed with SLO,she has painfully lost all but 6 of her nails. It took a specialist to diagnose her and although he put my mind at rest by saying its not life threatning, it does impact the quality of life so depending on how frequently the chronic phase occurs and how painfull this is for her will depend on the treatment. All the medicines have side effects and some of them are worse than the disease itself! for now it's wait and see over the next 2/3 months but this condition i am told is not curable and relies on life time medication. right now my lovely girl is in good form and has her mojo back!

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Erin said...

I have a 12 year old rotti/lab/shepherd mix named Brando and he has suffered terribly with SLO. He was diagnosed about 7 years ago and we have had him on large doses of fish oil ever since. He goes through bad flare-ups and he is in the middle of one right now. He currently has 2 nails lifted up from the nail bed but has not had success getting them off, nor have we. We have literally spent thousands of dollars over the years on diagnosing the problem and then the many trips to the vet for infected toes where the nail has ripped off exposing the quick. We recently changed his food to a low fat bland diet due to some stomach troubles but I am wondering if the lack of fat is also causing the flare up. Can anyone suggest a good diet or dog food for dogs with SLO? I am so glad to come across this page!

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Anonymous said...

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djungelkattenskeaton said...

Hello!
My name is Linda and I have a Rhodesian Ridgeback, Caesar, who started loosing his claws for 6 months ago. In september (2010) he got diagnosed with SLO. Today we are waiting for the new claws to come.

Although Caesar is still without claws on every toe, he is happy and lively! And me too!

I know you will have a hard time reading in Swedish, but you can look at the pictures if you want on my blog.
Just klick "SLO" at the top on my blog.

http://djungelkattenskeaton.wordpress.com

Anonymous said...

Hi, I have a Parson Russell who is having an awful time with SLO at the moment. He's on supplements, but I was wondering whether anyone else had tried Wobenzym N, like furryfour, and if so, with what success. I'm desperate to find something that might help. Many thanks, Katie

Anonymous said...

Hi my name is Donna, I recently rescued a female Dogo Argentino who was very malnourished. Her nails were all lopsided and within days we had to have one removed. Dogo;s tend to have pink and white nails but hers were dark at the tops. The vet gave antibiotics and advice soaking feet in epsom salts. We both assumed the issue was nutritional. Last night I was clipping her nails which I had not yet done due to this problem. I clipped only a small amount off the very tip and two nails began to bleed...from the top.
I did some research and found this site and a few others, even found pictures of nails that look exactly like hers.
Looks like I have joined the SLO group. I have an appointment with the vet and will be taking in information found at this site and others. Thanks so much for sharing this.

Katie said...

I have 2 bearded collies (litter mates) who both have slo. I am having trouble getting the males under control. My female has been alright with it, the nails are deformed but tolerable. I have tried meds, food change and everything else you could think of. If there are any recommendations that would be great!

gale said...

I know this is an old post but I'm hoping you'll see this comment. I was wondering if you would allow me to use your SLO pictures on my blog. I want to post about our dog but I didn't take pictures when her nails were lifting and now she has none left on her front and the back are impossible to hold still to take a picture. If you don't mind me doing so please send me a message (there's a link on my profile and on my blog) and let me know. thank you.