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Old March 31st, 2012, 04:30 PM
LittleLucy LittleLucy is offline
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New Dog - possible immune condition?

Hi, This is our first post.
We adopted a new girl in the beginning of Feb. She is now approx 11mos, lab-x. She is the sweetest girl ever, however she is also a bet of a medical mess.

Here is a summary of what we have been going through (we have been to the vet almost daily and they are still not sure what is going on...)
- When we got her (frm a shelter) she had some flaking/discolouring to her left nostril and upper lip area, thought it was likely from rubbing up against the kennel. It went away within 1-2wks.
- Last monday, she seemed to have some irritation in her mouth, on inspection, found some bleeding at gumline, inflammation and smell.
- Went to vet, was prescribed antibiotics
- On friday, developed diahrrea, back to the vet, switched to a different antibiotic (metronidozole); the nostril/lip issue returned
- Sunday, diarrhea got worse, bloody, went back to vet Monday AM, she spent the day there on IV fluids and had a battery of tests (urine, stool, blood work); stopped antibiotics - none of the tests were conclusive of anthing
- Back to vet Tues/Wed for follow up/monitoring
- On wed. restarted the metronidozole as her mouth started to seem red again, plus she was still having diahrrea.
- Back to vet today, still diahrrea but little/no blood. Vet thinks it is just more time needed to let the antibiotics kick in; she has a sore bottom, likely from all the diahrrea but temp is normal.

So this seems like a lot of stuff going on - I don't know if they are all related or coincidence or seperate issues. One concern that I have is that it is an immune mediated issue. Particulalry due to this nostril/lip thing. I have attached a photo - does anyone have any ideas/seen something like this before?? My vet may end up referring us to a dermotologist.

Thanks for your thoughts.
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Old March 31st, 2012, 05:40 PM
MaxaLisa MaxaLisa is online now
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When I enlarge the pic on my phone, it almost looks slit, rather than raw? Is that just the wrong angle?

Let's start with some basic questions...

I'm guessing the dog was vaccinated just before it was adopted?

What are you feeding?

So, things went away on their own and then came back? Then the first antibiotic was started?

Do you have, or can you get a copy of the bloodwork?

I'm a little concerned that this isn't just the nose, but along the gumline too. Wondering if you have any ticks around?
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Old March 31st, 2012, 07:26 PM
LittleLucy LittleLucy is offline
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Hi

THe area of concern is actually the nostril (lower left), it was initially flakey and now it really just looks like it has lost pigmentation; it is not raw - I think what you are seeing in the photo is a result of the angle (it is the inner nose). The area on her lip does not seem tender or sore. The gums were bleeding and red/inflammed and seemed tender to the touch but this has resolved.

She has been vaccinated.

We were feeding Acana (kibble) but since the diahreea we have been feeding bland: yam/sweet potato; pumkin; rice; cottage cheese; chicken combos (not all at once). Also probiotics.

Things never really went away. The nose issue when we adopted her did go away and we were not treating it with anything. Then we essentially have had the mouth/gum sores; then diahrrea w/ and w/o blood.

She was initially on clinicin; then switched to metrozonidale plus another one. Now we are giving just the metro (flagyl) which is meant to be addressing the diarrhea issue.


Do you have, or can you get a copy of the bloodwork?
->Yes I have a copy.

I'm a little concerned that this isn't just the nose, but along the gumline too. Wondering if you have any ticks around?

->Not that I know of.
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Old March 31st, 2012, 09:35 PM
LittleLucy LittleLucy is offline
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Got a call from the vet. She is more suspicious that the skin issues are immune-related. She suggested a biopsy or even starting on prednisone to see if it has an effect. I am reluctant to do either but know I need to make a decision. The area to biopsy is tricky and quite invasive, however I would prefer not to treat with heavy duty meds until we know what we are dealing with. I also need to look further at long term implications. THanks.
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Old April 1st, 2012, 02:09 AM
MaxaLisa MaxaLisa is online now
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Can you scan, or post some, or take a good pic with your cell phone, of the blood result numbers and ? In particular, the blood count numbers? (white blood cells, red blood cells, platelets, absolute neutrophils, lymphocytes, monocytes, and eosinophils?)

I know that many German Shepherds have dealt with something similar, though on a smaller scale, called lip fold pyoderma. It reminds me of the sores on the side of your girl, though you don't usually see it on the front, at least we haven't. However, when I googled, I found that juvenile pyoderma can present all over the muzzle. I wonder if, in puppies, this is a presentation of an immature immune system. I would be very hesitant to treat with immune suppressants! And before doing so, I would seek the second opinion of a dermatologist since your vet really sounds like she is guessing here. Seems to me that someone that sees this a lot should be able to look right at it and tell you what it is.

For the GSDs, penaten creme has been the go-to treatment:
http://germanshepherdhome.net/forum/.../topics/157831

This article lists some of the antibiotics used for pyoderma:
http://veterinarynews.dvm360.com/dvm...l.jsp?id=94402

I didn't find "clinicin" when I googled, but I'm guessing that this is clindamycin? If so, I'm guessing that it created the diarrhea, since it's notorious for causing this problem in humans. (In some dogs, cephalexin can do the same thing, so I would be hesitant to use that in your girl right now.) In fact, in humans, clindamycin can create a serious infection with clostridium difficile. I would strongly recommend getting some probiotics for your dog. In humans, probiotics containing Saccharomyces boulardii are very helpful in combating C. Diff in humans. In dogs, they tend to get clostridium perfringens and I don't know if you want the same thing, but yes, do go to the refrigerated section of the health food store and get some probiotics that contain acidophilous, bifidous, and bulgaricus, and if they have one with sacchromyces, that's even better.

I think with the bleeding gums, I would be more concerned with an overall infection and choosing the right antibiotic is important here. Your dog was in a shelter, and then received her shots (stressful and can cause immune suppression and side effects in a stressed dog), and now probably has suffered a reaction from the antibiotic/clindamycin.

I like that you are taking a cautious approach and following your instincts!
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Old April 1st, 2012, 12:24 PM
LittleLucy LittleLucy is offline
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THANK YOU!! I will try and upload the blood results soon - they are in my car and my bf is out with the car right now. However, here were some of the "out of range" results:
- Globulin - slightly high at 32 (normal is 12-30)
- Tetraidothyronine - low at 14.7 (normal is 20-52)
- In her urine there was some Bilirubin staining; amorphous debris and a small
amount of oil droplets present

The vet felt all of these were to be expected in a dog experiencing GI issues. Stool and culture came back with no abnormalities but I don't have a copy of it.

I will look up pyoderma, thank you so much. One thing is that there in no pus or open areas that I can see. More flaking and discolouration.

Yes, I think the original a/b clinacin (clindamycin hydrochloride) caused the diarrhea since she was fine until starting it. . Once the diarrhea started she was switched over to metronidazole plus clavaseptin - the later of which I believe can also cause GI upset - the diarrhea got worse. SHe is now ony on metro, plus sucralfate and pepcid. I am also giving probiotics and once her tummy settles will resart the omega 3 fats.

Thanks for you help.
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Old April 1st, 2012, 02:09 PM
MaxaLisa MaxaLisa is online now
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**Tetraidothyronine - low at 14.7 (normal is 20-52)**

Okay, had to look that up and it's thyroid T4, here they use a different name.

Anyway, while the thyroid can be low in a diseased state, that is for chronic disease. In a young dog, that value should be safely above the midpoint of that range, which means that it sbould be above 36. So it isn't just a little low, it's A LOT low for a year old dog.

Before I did anything else, I would want a thyroid panel, because just about nothing works right when the thyroid isn't working right. Therapies will fail if the thyroid is not functioning.

I don't know if you can easily send blood to california to run the Thyroid 5 panel here: http://www.hemopet.org/services.html

With a young dog with thyroid disease, that your vet didn't catch,, you will need a vet like Dodds to help interpret. Many vets run the wrong panel (you need the free T4, free T3 and TgAA to start with), and then many vets run the TSH, which can be wrong 30% of the time. If you can't send to Dodds, you can insist that your vet run the thyroid panel that includes those things (be sure to insist on the TGAA), and pay for a consult with Dodds after if that's needed.

Your dog is hypothyroid! It might be from the thyroid itself, or maybe someother disease process, but further testing is probably needed, unless something else jumps out with the rest of the bloodwork.

You do need to wait 2 months I think after a rabies shot to run the TgAA - I don't know if she got a rabies vax.
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Old April 1st, 2012, 02:23 PM
MaxaLisa MaxaLisa is online now
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Forgot to mention, be sure not to give any supplements with kelp or other seaweeds until the thyroid gets tested. The stuff in the dog food is fine.
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Old April 1st, 2012, 03:18 PM
LittleLucy LittleLucy is offline
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THis is why I think I need a second opinion. I was told by my vet (and the notes from the lab said the same) that while her T4 is low, it is in the "normal" range for an adult dog, which they suggested she was close to at 11mos age?
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Old April 1st, 2012, 03:52 PM
MaxaLisa MaxaLisa is online now
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Quote:
Originally Posted by LittleLucy View Post
THis is why I think I need a second opinion. I was told by my vet (and the notes from the lab said the same) that while her T4 is low, it is in the "normal" range for an adult dog, which they suggested she was close to at 11mos age?
I guess my first question is which range did they give you on the sheet??

**Tetraidothyronine - low at 14.7 (normal is 20-52)**

My next observation is that, no, she isn't an adult dog, and even a young adult should be above the midpoint of the range.

Now, I've found just as many "specialists" and even university vets Fail on this one, which concerns me about 2nd opinions on this stuff. Nicholas Dodman, a beahviourist, has also done a lot of work in this area.

Your girl's thyroid function is Not Normal for a dog her age (and I would argue probably any age depending on what the adult range is). Now, whether it's primary thyroid disease or some other chronic condition could be a basis for debate, but that it's not functioning the way it should for a dog her age should be absolutely clear to anyone that understands the thyroid and thyroid disease. Aargh, definitely a pet peeve of mine!
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Old April 1st, 2012, 03:54 PM
MaxaLisa MaxaLisa is online now
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I don't know if it's possible for elevated thyroglobulins (positive TgAA, found in autoimmune thyroiditis) to increase the globulin count in the body as you have. The globulin count includes lots of different types of globulins, and I'm not well-versed in that area.

I would send an email to Dr. Dodds and ask about your girl and give her the numbers and see what she advises.
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Old April 1st, 2012, 05:15 PM
LittleLucy LittleLucy is offline
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Thanks, I will try and email Dr Dobbs, thanks for the suggestion. We don't have any vet schools in BC. I have attached some pics of the blood and urine results. Sorry they are poor. See the comment at the bottom of the page states "...the low T4 likely reflects the euthyroid sick syndrome, i.e., thyroid suppression due to non-thyroidal illness. Note that the T4 level would be normal for an adult...."
I have not yet been able to find a reference to what "normal" is for an "adult" dog (ie, range#s, and age that classifies dog as adult). Any chance you can private message me the contact for Dr Dobbs?
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Old April 1st, 2012, 06:31 PM
MaxaLisa MaxaLisa is online now
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At the link here is the email address: http://www.hemopet.org/contact.html .... it's hemopet@hotmail.com and it's Dr. Dodds (careful of the spelling!).

This could be euthyroid sick syndrome, but it looks to me like you don't have enough information to determine that. The thyroid levels are different than what I'm used to seeing, different labs have different ranges. However, Dodd's adult range for her lab starts at 1.40, so it might be a unit measurement thing. If your girl is at the bottom of the adult range that is still not sufficient, and certainly with only a T4 and no other diagnosis, without eliminating autoimmune thyroiditis, there is absolutely no way for them to say whether this is secondary or not.

From what I know, there shouldn't be more than trace protein in the urinalysis, and bilirubin should be negative. Also concerned about the observation on the blood smear: http://www.vet.uga.edu/vpp/clerk/Stello/index.php I wonder if there is any chance that she was given the rattlesnake vaccine or a snake bite? (longshot, I know!)


I think it's important to contact Dr. Dodds. I think that the lip stuff, etc. is probably a symptom and not a cause.

So, other than the things already marked as abnormal, it looks like just about everything is right in the normal range and with my regular non-vet eyes, I can't find a red flag, well, maybe....

Lymphocytes and eosinophils are at the low end of their ranges, while abs nuetrophils are above the midpoint. Now, divide the monocyte range into sixths. Lucy's monocyte value is in the top 1/6th range. This may or may not be significant....it could be a one time thing, but you don't have much to go one here.

If I look at everything, a non-functioning thyroid, and problems with red blood cells, and problems with monocytes, if it's not thyroid disease, it's something, well, I'm not sure, I think it's REALLY important to have a thyroid panel that includes free T3, free T4, and TgAA as a first step.
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Old April 1st, 2012, 07:39 PM
LittleLucy LittleLucy is offline
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Sorry about the errant spelling, I will be more mindful when I send the email. Feeling a bit of a buzz and overwhelmed so missing the details, but important details. I will look again at the result more carefully, thank you for your suggestions/highlights of concern. I had a dog that we had to PTS last year and she also had a handful of health issues but more ortho issues and then cancer, so they were more cut and dry and I new what I was dealing with so could do my own research and find the answers I needed to make the best decision for her. Like you said, I feel like I have very little direction right now. I went to the spca (where I adopted her in early Feb) to ask if they would consider giving us a free second opinion just to see how another vet would proceed with all the symptoms. I hope to hear back from them tomorrow. The good news is that she does seem to be feeling better - more perky today, eating well, had soft stool but not diarrhea. Thanks so much for your thoughts, they are very apprecaited and valuable to us right now.
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Old April 1st, 2012, 08:21 PM
MaxaLisa MaxaLisa is online now
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The longer away from the clindamycin and on the probiotics and metro, the better the stools should get! In fact, metro is one of the abx used for clostridium. I'm really glad that it's working!

Good luck, keep us posted!
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Old April 16th, 2012, 08:57 PM
LittleLucy LittleLucy is offline
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A quick update is that Lucy is feeling much better. Her stools are back to normal, she has been off the antibiotics for 5days. The areas on her lips and nose have nearly resolved so there is not anything to biopsy at present, and to be honest I hope they don't return and we never have to do a biopsy. I have been doing oral care every day and there have been no further sores in her mouth/gums. We went to a homeopathic vet and she recommneded DMG to boost the immune system. She has been on it for just over a week and certainly seems perkier. We did send her blood work to Hemopet/Jean Dodds and are waiting for the results. SHe still has hair loss/slow hair regrowth and seems a little lower energy than most 1yr old dogs I know. But generally she seems good right now so I am trying to go day by day rather than worrrying what the future holds. I hope I am not being too niaive but again, we are looking into the thyroid issue and we can't really further assess the possible immune-mediated issue unless there is a "flare up" of sorts that we could biopsy. Thanks for all your input!!
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Old April 16th, 2012, 09:34 PM
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Yay for feeling better, LittleLucy!
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Old April 18th, 2012, 01:46 AM
MaxaLisa MaxaLisa is online now
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It sounds very positive!
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Old April 18th, 2012, 11:59 PM
LittleLucy LittleLucy is offline
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Yes, thanks it is positive. I just am holding my breath that the positive health continues. Got the thyroid results today (from HemoPet) and her thyroid function is normal. So I guess that is more good news right?? Now just monitoring for sores/skin issues and will do a biopsy if anything else pops up. I do have to say I think DMG has been a great supplement in boosting her immune system and just generally making her feel good.
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Old April 30th, 2012, 01:13 AM
MaxaLisa MaxaLisa is online now
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Originally Posted by LittleLucy View Post
Yes, thanks it is positive. I just am holding my breath that the positive health continues. Got the thyroid results today (from HemoPet) and her thyroid function is normal. So I guess that is more good news right?? Now just monitoring for sores/skin issues and will do a biopsy if anything else pops up. I do have to say I think DMG has been a great supplement in boosting her immune system and just generally making her feel good.
I have a friend whose senior dog had those sore and skin issues, and the DMG actually made it worse? I do think that it's a good immune booster, but sometimes, if it's an immune mediated thing, it might be boosting the wrong thing? Just maybe something to fiddle with?

I might consider a supplement like Canine Complete, to support the thyroid?
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Old April 30th, 2012, 01:35 PM
LittleLucy LittleLucy is offline
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Thanks. In terms of her energy the DMG seems to have improved things. She has had no issues with the skin issues around her nose/lip. She has had some redness around her gums so we are brushing daily, using an oral clense and giving manuka honey.
Her coat is still poor and she has pretty significant hair loss under her "armpits" where her harness rubs. She only wears the harness on walks and I am going to try and put some sheepskin material on the straps to reduce the friction. We have started her on FlaxForward which is another supplement. She eats Acana dog food. I think once we finish this bottle of DMG we will give it a rest and see if we see any change (good or bad).
Interesting what your friend experienced, I guess that is the challenge with a possible/undiagnosed immune issue - don't know whether the system is over vs under responsive and to what....
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Old May 2nd, 2012, 03:33 PM
Kasianni Kasianni is offline
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Hi! May I just add to all the great info..antibiotics are very hard on a puppies tummy, and that can cause bleeding and diarrhea etc. I am very surprised that your vet did not prescribe something for the puppy to take before you give him the antibiotics..like pepcid, half hour before you give him the antibiotics. Also, always give the meds with a meal so its not so harsh on the tummy. Pepcid coats the tummy and protects it from the meds. Good luck with everything, hope the puppy is okay.

Opps just read that she has been off antibiotics for a few days now. However, if ever she needs them again, make sure the vet gives you some pepcid to take before the antibiotics. They can use pepcid from the pharmacy. I give 1/4 of the pill to mine (mine weighs 12 pounds).
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Old May 4th, 2012, 01:41 AM
MaxaLisa MaxaLisa is online now
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Pepcid protects against excess acid. I'm not sure that all dogs will experience this when on antibiotics. As a general rule, I don't add pepcid when giving abx, unless it's long term and the dog is showing some signs of intolerance. I think some of the leaking gut supplements are actually better, one of my favorites being DGL licorice. I know others that will use slippery elm bark. And of course ample probiotics...
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