Red Blood Cell Breakdown - Vet Stumped

[Guest PiagetsMom]

I'd actually never heard of Rhabdo before your experience with Violet, Jen. Stress is the one thing that does seem to keep coming up consistantly in Maya's episodes of very bloody urine. I've emailed Dr. Miller with your questions, along with the other suggestions that have been mentioned and Dr. Couto's info, and I appreciate everyone's helpfulness. Hopefully we'll be able to come up with an answer for Maya!

[Burpdog]

Did they xray or ultrasound the kidneys? If not, I'd take her to Dr. Quick and get his opinion.

Edited January 6, 2014 by Burpdog

[Guest PiagetsMom]

Did they xray or ultrasound the kidneys? If not, I'd take her to Dr. Quick and get his opinion.

 

We've done both, Diane - an xray first, and then later an ultrasound.

[JJNg]

What I can tell you as it was explained to me is that with a UTI, the red blood cells normally settle and form a sediment in the bottom of a urine sample after spinning. In Maya's sample, they do not separate, but are broken down and remain throughout the sample. Her blood work also showed evidence of this happening in her bloodstream as well, and as I understand it, indicates that this is not just a UTI that we're dealing with but instead some sort of systemic issue that we've not been able to identify.

 

Has this been the consistent finding of "blood in her urine" every time she has had a urinalysis run, through this entire time, starting the with the very first episode while boarding? And what in her bloodwork showed that this was happening in her bloodstream as well?

 

Regarding the 'red blood cells' not settling and remaining throughout the urine sample, what you're describing is either hemoglobin or myoglobin in the urine (hemoglobinuria or myoglobinuria). This isn't red blood cells (RBCs) or 'blood in the urine' at all, but breakdown products of RBCs or muscle. The term hematuria, or blood in the urine, indicates finding whole RBCs in the urine, so your vet's use of this term for the initial episode while boarding is a little confusing. Unless she really did have whole RBCs in that first episode, which wouldn't be the same as what's going on now. Did they do a full urinalysis to assess this before starting Baytril?

 

You mentioned that more recent urine samples "still showed the red blood cell issue" even though there was no more visible blood. What exactly were they finding on the urinalysis/urine spin? Does she ever have whole RBCs, or is it always the hemoglobin/myoglobin? Also, when did she start having the bilirubin that you mentioned in the last couple urinalyses she's had done (mid-Dec and last Friday)? Bilirubin is a different issue than the blood/hemoglobin/myoglobin, and small amounts can be normal in dog urine.

 

Sorry this is more questions than answers, but hard to comment without knowing exactly what's been found on her multiple urinalyses. If it's been hemoglobin/myoglobin every time, then I would also be suspicious of some kind of chronic, mild rhabdomyolysis, as Jen (NeylasMom) mentioned. If it's been different findings, that makes things a bit more complicated. I definitely agree with all the recommendations for your vet to consult with Dr. Couto.

 

Here's a good (but pretty technical) article that explains the different things that cause red/brown discolored urine:

http://veterinarynews.dvm360.com/dvm/Diagnostic+Center/Discolored-urine-What-does-it-mean/ArticleStandard/Article/detail/15802

 

[Guest PiagetsMom]

JJng, you make me wish I were a vet, or at least had more knowledge and had been able to ask more intelligent questions of Dr. Miller when he was giving me info and test results. I confess that most of this is "greek" to me, and wish I'd been able to make these distinctions. I appreciate the link, and I will take a look at it. I'll add your thoughts to my notes from this thread and follow up on them when I next speak to Dr. Miller.

Edited January 7, 2014 by PiagetsMom

[NeylasMom]

Why not ask the office to fax or email you a full copy if all test results in addition to following up with your vet?

[Guest PiagetsMom]

Thanks, Jen - I've done that this morning.

[NeylasMom]

Any updates? How is Maya doing?

[Guest PiagetsMom]

I'd say about the same, Jen. I did hear from Dr. Miller's office and he did receive the info I emailed him. I assume he's waiting to contact me (as he said he would) until after he's been able to consult with the vet/behaviorist, and hopefully he will have made contact with Dr. Couto. He's been very good about checking on Maya, but if I haven't heard from him by Friday, I'll be calling him.

 

We re-arranged our bedroom last night, hoping to put more space between the pups. It didn't seem to matter that Mirage was further away from Maya, and even out of her sight - any time he moved, she growled and barked. It's really strange to me that Maya has NO issues with Mirage at any other time that they are up and about - only seems to be when she is on a bed. I know it's been suggested that her snarkiness is coming from her not feeling well, or some discomfort, but it really seems more of a space issue that revolves around her lying down or around a bed, and that's not something that she's ever been protective of before. I don't know.......

 

I took her for a short walk this morning - she seemed to be walking normally, without any discomfort. We're still on the Rimadyl until I hear from Dr. Miller, as instructed.

 

Thanks for checking on us, Jen.

 

I did receive a copy of Maya's test results. For those who've asked about urine sample/testing, here's the results:

 

11/13

 

Urine Cytology results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 0 Posted Final

Test Result Reference Range

COLLECTION = void at vvc

COLOR = drk red

SPEC. GRAV = 1.048

CASTS = granular 4+

Manually entered.

Lots of other granular debris and fat droplets. No blood seen on cytology.

 

Chemistry results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 10007 Posted Final

Test Result Reference Range

ALB = 3.3 g/dL 2.3 - 4.0

ALKP = 40 U/L 23 - 212

ALT = 78 U/L 10 - 100

AMYL = 798 U/L 500 - 1500

BUN/UREA = 17 mg/dL 7 - 27

Ca = 8.4 mg/dL 7.9 - 12.0

Chloride = 119 mmol/L 109 - 122

CHOL = 120 mg/dL 110 - 320

CREA = 1.6 mg/dL 0.5 - 1.8

GGT < < 0 U/L 0 - 7

GLU = 128 mg/dL 74 - 143

LIPA = 844 U/L 200 - 1800

PHOS = 2.7 mg/dL 2.5 - 6.8

Potassium = 3.6 mmol/L 3.5 - 5.8

TBIL = 0.6 mg/dL 0.0 - 0.9

TP = 6.1 g/dL 5.2 - 8.2

Sodium = 156 mmol/L 144 - 160

GLOB = 2.8 g/dL 2.5 - 4.5

OSM calc = 310 mmol/kg

ALB/GLOB = 1.2

BUN/CREA = 11

Na/K = 43

 

 

11/14

 

Urinalysis results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 10017 Posted Final

Test Result Reference Range

pH = 6.0

LEU = Negative

PRO = Negative

GLU = Negative

KET = Negative

UBG = 4 mg/dL

BIL = 3 mg/dL

BLD = 250 Ery/uL

 

UA/Microscopy results from IDEXX Reference Laboratory

Requisition ID: 7247-2 Posted Final

Test Result Reference Range

BACTERIA NONE SEEN HPF

BILIRUBIN 1+ H

BLOOD 1+ H

CASTS NONE SEEN HPF

CLARITY TURBID

COLOR DK YELLOW

CRYSTALS NONE SEEN HPF

EPI CELL 1+ (1-2) HPF

GLUCOSE NEGATIVE

KETONES NEGATIVE

MUCUS NONE SEEN

PH 6.0

PROTEIN NEGATIVE

RBC 6-10 HPF H 0 - 5

SP GRAVITY 1.046

UROB NORMAL

WBC 2-5 HPF 0 - 5

Ascn: D2964070

RU FS CANINE

RE: 900 COLLECTION METHOD FREE-CATCH

11/18

Urine Cytology results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 0 Posted Final

Test Result Reference Range

COLLECTION = free catch

COLOR = yellow

SPEC. GRAV = < 1.050

RBC = occasional

WBC = 0-2

Manually entered.Urinalysis results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 10030 Posted Final

Test Result Reference Range

 

pH = 5.0

LEU = Negative

 

 

PRO = TR

GLU = Negative

KET = Negative

UBG = 4 mg/dL

BIL = 3 mg/dL

BLD = Negative

 

12/18

 

Urine Cytology results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 0 Posted Final

Test Result Reference Range

COLLECTION = void at home

COLOR = dk yellow

SPEC. GRAV = 1.046

CASTS = 1+ granular

FAT DROPS = 3+

Manually entered.

 

Granular casts/debris were yellow in color.

 

Urinalysis results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 10207 Posted Final

Test Result Reference Range

pH = 5.0

LEU = Negative

PRO = Negative

GLU = Negative

KET = Negative

UBG = 1 mg/dL

BIL = 3 mg/dL

BLD = Negative

And, our last test on 1/2:

Urinalysis results from IDEXX VetLab In-clinic Laboratory

Requisition ID: 10302 Posted Final

Test Result Reference Range

pH = 7.0

LEU = Negative

PRO = 30 mg/dL

GLU = Negative

KET = Negative

UBG = 8 mg/dL

BIL = 6 mg/dL

 

BLD = 25 Ery/uL

UA/Microscopy results from IDEXX Reference Laboratory

Requisition ID: 7247-2 Posted Final

Test Result Reference Range

BACTERIA NONE SEEN HPF

BILIRUBIN 3+ H

BLOOD NEGATIVE

CASTS NONE SEEN HPF

CLARITY CLOUDY

COLOR DARK YELLOW

CRYSTALS NONE SEEN HPF

EPI CELL RARE (0-1) HPF

GLUCOSE NEGATIVE

KETONES TRACE H

MUCUS NONE SEEN

PH 7.0

PROTEIN NEGATIVE

RBC NONE SEEN HPF 0 - 5

SP GRAVITY 1.056

UROB NORMAL

WBC 0-2 HPF 0 - 5

Ascn: D3329232

2SS,RU,L,GNPED FS CANINE

RE: 900 COLLECTION METHOD FREE-CATCH

 

 

Gah! I'm sorry this is so long, but I was hoping this would provide answers to the questions that have been asked for anyone who's brave enough to look through all of this info!

 

Edited January 8, 2014 by PiagetsMom

[Guest PiagetsMom]

And, our latest blood work results:

 

Hematology results from IDEXX Reference Laboratory

Requisition ID: 7247-2 Posted Final

Test Result Reference Range

ANISO SLIGHT

BASO 0.0 %

EOS 3.7 %

HCT 59.5 % H 38.3 - 56.5

HGB 21.6 g/dL H 13.4 - 20.7

LYMPHS 41.0 %

MCH 22.2 pg 21.9 - 26.1

MCHC 36.3 g/dL 32.6 - 39.2

MCV 61 fL 59 - 76

MONOS 4.8 %

NEUT SEG 50.5 %

PLATELETS 146 K/uL 143 - 448

POIK SLIGHT

POLY SLIGHT

RBC 9.71 M/uL H 5.39 - 8.70

RETIC CNT 2.5 %

WBC 3.6 K/uL L 4.9 - 17.6

ABS BASO 0 /uL 0 - 100

ABS EOS 133 /uL 70 - 1490

ABS LYMPHS 1476 /uL 1060 - 4950

ABS MONOS 173 /uL 130 - 1150

ABS NEUTS 1818 /uL L 2940 - 12670

ABS RET 243 K/uL H 10 - 110

Ascn: D3329232

2SS,RU,L,GNPED FS CANINE

RE: 3180 RETICULOCYTE COMMENT

RETICULOCYTE COMMENT

In nonanemic dogs, a reticulocyte count of greater than 110 K/uL of

blood may be a transient physiologic response or evidence of bone

marrow response to an increased peripheral demand. A persistent

reticulocyte count >110 K/uL may indicate occult blood loss,

underlying hemolytic disease or disorder that causes an absolute

erythrocytosis. Serial monitoring of the erythrogram and reticulocyte

count may help determine the significance of this finding.

Edited January 8, 2014 by PiagetsMom

[NeylasMom]

Well I will leave the interpretation up to Jjng or other more experienced folk, but one thing I do note is the presence of casts in her first urine sample, which could support my theory that she suffered an episode of stress-induced rhabdo when boarded. I don't see CPK levels. Hopefully your vet will have an answer for you on that as I don't see any elevated enzyme levels at all in the results you've shared. Maybe he has other results that aren't included?

 

As far as the growling on the bed goes, who knows. Could be there was an incident when she was feeling her worst and you weren't there where Mirage stepped on her or accidentally caused discomfort some way so now she's hypersensitive. Could be it reminds her of the stress of being boarded somehow. Could be she's more uncomfortable when she's laying down although that seems unlikely. I really have no idea, but it seems it must somehow be related to what's going on since it started occurring at the same time. The only thing I can suggest is lots of positive reinforcement when she's on her bed and Mirage is nearby. Maybe spend some time during the day with both of them in there, but with her working on a stuffed kong so she can start to have some positive experiences related to Mirage moving around when she's on her bed?

[Batmom]

Has she had a chemistry panel done since that first one back in November?

[Guest PiagetsMom]

Has she had a chemistry panel done since that first one back in November?

 

I thought I posted this panel done 1/2/14

 

Chemistry results from IDEXX Reference Laboratory

Requisition ID: 7247-2 Posted Final

Test Result Reference Range

ALB 4.1 g/dL H 2.7 - 3.9

ALKP 31 U/L 5 - 160

ALT 36 U/L 18 - 121

AMYL 1036 U/L 337 - 1469

ANION GAP 18 mmol/L 11 - 26

AST 57 U/L H 16 - 55

BICARB 26 mmol/L 13 - 27

BUN/UREA 21 mg/dL 9 - 31

Ca 10.1 mg/dL 8.8 - 11.2

Chloride 110 mmol/L 108 - 119

CHOL 150 mg/dL 131 - 345

CREA 1.4 mg/dL 0.5 - 1.5

DBIL 0.1 mg/dL 0.0 - 0.1

GGT 0 U/L 0 - 13

GLU 104 mg/dL 63 - 114

IBIL 0.3 mg/dL H 0.0 - 0.1

LIPA 540 U/L 138 - 755

PHOS 3.6 mg/dL 2.5 - 6.1

Potassium 3.9 mmol/L L 4.0 - 5.4

TBIL 0.4 mg/dL H 0.0 - 0.2

TP 6.9 g/dL 5.5 - 7.5

Sodium 150 mmol/L 142 - 152

A/G Ratio 1.5 0.7 - 1.5

B/C Ratio 15.0

Na/K Ratio 38 H 28 - 37

GLOB 2.8 g/dL 2.4 - 4.0

CK 553 U/L H 10 - 200

Ascn: D3329232

2SS,RU,L,GNPED FS CANINE

RE: 281 HEMOLYSIS INDEX +++

Index of +++ may decrease ALP by 25-50%, and increase AST by 25-50%.

RE: 282 LIPEMIA INDEX N

Index of N,+,++ exhibits no significant effect on chemistry values.

[NeylasMom]

 

I thought I posted this panel done 1/2/14

 

Chemistry results from IDEXX Reference Laboratory

CK 553 U/L H 10 - 200

And there's the elevated enzyme. Not alarmingly high, but this late in the game you wouldn't expect it to be. Unless there is some evidence to the contrary, maybe in the answers to Jjng's questions, this really looks like rhabdo to me.

[Batmom]

The CK isn't very elevated -- wouldn't consider that number significant. You can see a good bit higher than that just from going to the vet's office and having blood drawn.

[Guest PiagetsMom]

 

 

 

You mentioned that more recent urine samples "still showed the red blood cell issue" even though there was no more visible blood. What exactly were they finding on the urinalysis/urine spin? Does she ever have whole RBCs, or is it always the hemoglobin/myoglobin? Also, when did she start having the bilirubin that you mentioned in the last couple urinalyses she's had done (mid-Dec and last Friday)? Bilirubin is a different issue than the blood/hemoglobin/myoglobin, and small amounts can be normal in dog urine.

 

Sorry this is more questions than answers, but hard to comment without knowing exactly what's been found on her multiple urinalyses. If it's been hemoglobin/myoglobin every time, then I would also be suspicious of some kind of chronic, mild rhabdomyolysis, as Jen (NeylasMom) mentioned. If it's been different findings, that makes things a bit more complicated. I definitely agree with all the recommendations for your vet to consult with Dr. Couto.

 

 

 

I wish I could answer all of your questions, but looking at the results I posted, it appears that the Bilirubin (@1+) was present in the first test on 11/14. I also see it again in the last set of values from 1/2 at a slightly higher value (@3+).

 

I also see that the RBC count in the first test on 11/14 is high (@ 6-10 HPF), but it looks like there were none seen on 1/2.......if I'm reading those results correctly.

 

 

The CK isn't very elevated -- wouldn't consider that number significant. You can see a good bit higher than that just from going to the vet's office and having blood drawn.

 

 

Well, again, Dr. Miller described it as "slightly" elevated, and not something he would be concerned about in an otherwise healthy dog, however, something to take into consideraton knowing that Maya is having this unexplainable issue.

 

He actually was considering putting Maya on some Tramadol along with the Rimadyl, but decided to hold off on that until we talked next.

 

It's funny (well, not really) but, when this all started and we started running tests I was really just hoping that nothing turned up......after the last month and a half knowing that something is not right with Maya, with all of the vet visits and tests (and expense), I find myself really hoping that something does so that we at least know how to treat it.

Edited January 8, 2014 by PiagetsMom

[MaryJane]

Hmmm ... not seeing any urine culture done. Looks like they are relying on the microscopic analysis to determine whether there is bacteria - not sure a good idea in a case like this. I suggest that you get a sterile container and get a urine specimen which is a first morning mid-stream catch (clean her before you let her out.)

[Guest PiagetsMom]

I will certainly ask Dr. Miller about a culture, but the focus doesn't appear to be on whether or not she has a UTI. As a precaution we treated with a second round of Baytril, and she's exhibited no symptoms of a UTI afterwards. Evidently Dr. Miller hasn't felt that a UTI would be the cause of the reoccurance of bloody urine when she had to stay for her ultrasounds, or the red blood cell breakdown that he still sees in her urine on spinning, or the tenderness in her back and leg. But, I will add it to my list of things to check with him.

Edited January 9, 2014 by PiagetsMom

[MaryJane]

One of the symptoms of a bad UTI in a person is that they get back pain. Bad UTIs that have been untreated for awhile can cause irritation and inflammation and that could explain some of the blood in the urine - but, not as much as you are talking about though. Check with the vet to see if the area in the back where it is sensitive corresponds with the location of the kidneys. UTIs can also cause some mood swings and memory loss in people, wouldn't be surprised if the same thing happens in dogs.

 

Hope you get to the bottom of this ..

[MilliesMom]

Max, our Maltipoo, developed babesia last year. It took quite awhile to figure out what was going on and was terrible. We're grateful he was able to pull out.

 

Can't say what's going on with your dog, but I can give you the name of a vet who might have some idea. We use him as a specialist to consult with Max (who's now developed diabetes) and our FIV+ cat, Oscar. He works online and by phone with you and your local vet: Dr. Bob Goldstein, The Healing Center for Animals, 914-533-5162. Good luck.

[Guest PiagetsMom]

Max, our Maltipoo, developed babesia last year. It took quite awhile to figure out what was going on and was terrible. We're grateful he was able to pull out.

 

Can't say what's going on with your dog, but I can give you the name of a vet who might have some idea. We use him as a specialist to consult with Max (who's now developed diabetes) and our FIV+ cat, Oscar. He works online and by phone with you and your local vet: Dr. Bob Goldstein, The Healing Center for Animals, 914-533-5162. Good luck.

 

Thank you. Maya's tests were negative for babesia, so we know that's not the issue.

 

I had jury duty today and missed a call from Dr. Miller. Hopefully I'll get in touch with him tomorrow.

 

We had another escalation of Maya's reactivity tonight. I was sitting on the floor, Maya on one side of me and Mirage on the other - Mirage moved ever so slightly, and Maya growled and barked, and then left the room. I feel badly for her.....she wants to be close, but her reactivity to Mirage makes it difficult for her.

 

It's becoming increasingly challenging. I've resorted to muzzling them when I leave, something I haven't done in a very long time, but better safe than sorry. Because of her uneasiness with Mirage, Maya is isolating herself to another room more often. I know there's a medical issue that's unresolved with Maya, but her behavioral issues are just as concerning to me. As MaryJane said, I hope we can get to the bottom of this.

Edited January 10, 2014 by PiagetsMom

[NeylasMom]

Focus on getting answers on the medical issue. If you resolve that and still have the behavioral issues, then worry about those. I know how unsettling that kind of stuff is, but if the medical issue is the culprit, there's really not much you can do outside of doing what to can to not let Maya feel isolated (split up where you hang out, put crates, X-pens or other safe spots up, maybe put up some temporary physical barriers (you could use an X-pen spread out with sheets or blankets over it) to block their sight of wach other).

 

And please get in touch with your vet tomorrow. This wait is killing me! Seriously though, i check this thread constantly for updates.

[JJNg]

I've been trying to look through the labwork and figure out where it fits into the earlier history provided. I don't see urinalysis results from the boarding visit when she was first started on Baytril?

I'm assuming the 11/13 and 11/14 bloodwork and urinalysis (UA) results were from the vet visit where her lower back was found to be sore and her urine was red when she peed at the clinic? Were there UAs done on 2 different samples? Or did they do part of it in house, and send out part of it? The results were a little confusing as part of the UA was on 11/13, and part on 11/14, but the in-house sample was dark red in color, and the sample apparently sent out was noted to be dark yellow. Looks like the UA from 1/2 was also partially run in-house and part sent out. Was a CBC (hematology) done at that visit, or just the chemistry?

I also didn't see urinalysis results from the sample that was red ('bloody') during her ultrasound appointment?

I don't feel like I have a complete picture, but just some thoughts I had after going through the lab results. From what I can see, these are the pertinent lab results:

1) Red urine on several occasions. The one with UA results posted had no RBCs (or very low: 6-10 RBC/HPF isn't very significant), so this indicates either hemoglobin or myoglobin in the sample. Unfortunately, there is no easy way to differentiate between hemoglobin and myoglobin. Myoglobin would indicate rhabdomyolysis. Hemoglobin would point toward a hemolytic condition (breakdown of RBCs).

2) More recent UAs with bilirubin. Trace to 1+ bilirubin can be normal in dogs. 3+ is definitely high, and can be due to liver issues or hemolysis. Given the earlier 'red urine' I would lean more toward hemolysis.

3) Bloodwork on 1/2 showed mildly elevated bilirubin levels, and an increased reticulocyte (immature RBC) count. These can both be an indication of hemolysis, although since the hematocrit (RBC count) was normal, it would be very mild.

Given her history of Babesia, I have to wonder if a chronic, low-grade infection might still be a consideration. Was she ever diagnosed with a specific type of Babesia (ie. B. canis vs B. gibsoni)? And which tests were done recently to retest - titers or PCR? Tick-borne disease testing isn't always definitive, and past treatment and antibiotics could interfere with results.

I sure hope your vet is consulting with Dr. Couto, as that's what I'd be doing if she was my patient.

One final note regarding your earlier comment about it being strange that Maya only showed space issues when she was lying down or on a bed. I find that dogs tend to be more defensive, perhaps because they feel more vulnerable, when they are lying down. This seems to be true whether it's purely behavioral and they are insecure and fear aggressive, or if there's an underlying medical issue and they just don't feel good. It seems when they are lying down, they just want to be left alone.

[Guest PiagetsMom]

Given her history of Babesia, I have to wonder if a chronic, low-grade infection might still be a consideration. Was she ever diagnosed with a specific type of Babesia (ie. B. canis vs B. gibsoni)? And which tests were done recently to retest - titers or PCR? Tick-borne disease testing isn't always definitive, and past treatment and antibiotics could interfere with results.

 

I sure hope your vet is consulting with Dr. Couto, as that's what I'd be doing if she was my patient.

 

One final note regarding your earlier comment about it being strange that Maya only showed space issues when she was lying down or on a bed. I find that dogs tend to be more defensive, perhaps because they feel more vulnerable, when they are lying down. This seems to be true whether it's purely behavioral and they are insecure and fear aggressive, or if there's an underlying medical issue and they just don't feel good. It seems when they are lying down, they just want to be left alone.

 

Looking back on her lab results from her original adoption vetting through GPAH done on 9/8/11, her Serology shows a positive testing for Babesia canis at 1:640/Baseline dilution = 1.40

 

She was given two Babesia shots, one on 9/28, and the second on 10/12/11

 

We did discuss Maya's history of Babesia, and Dr. Miller is of the mind that there may be some pups who are treated for it, but it may still be dormant in their body, becoming an issue in times of stress. He likened it to the chickenpox/shingles virus in humans. In the initial bloodwork, after a week of Baytril, Dr. Miller did test her on 11/13/13 with these results. She was treated with 2 rounds of Doxy after the blood draw, I assume as a precaution:

 

Requisition ID: 7247-2 Posted Final

Ascn: D2957217

SS,L FS CANINE

RE: 2633 BABESIA SPP by RealPCR NEGATIVE

RE: 2824 ANAPLASMA SPP by RealPCR NEGATIVE

RE: 2854 EHRLICHIA SPP by RealPCR NEGATIVE

RE: 2825 RICKETTSIA SPP by RealPCR NEGATIVE

RE: 2833 HEPATOZOON SPP by RealPCR NEGATIVE

RE: 2834 LEISHMANIA SPP by RealPCR NEGATIVE

RE: 2829 NEORICKETTSIA RIST by RealPCR NEGATIVE

RE: 2867 CANINE BARTONELLA RealPCR NEGATIVE

 

Jjing, thanks for your input. I'm hoping to talk to Dr. Miller today.

Edited January 10, 2014 by PiagetsMom

[kudzu]

Maya's tests were negative for babesia, so we know that's not the issue.

While having tested negative for Babesia does make it far less likely that is the current problem, I believe it does not make it impossible. It may be possible for circulating parasites to be low enough that it wouldn't be picked up, even by PCR. Though I'd think if it was that low it would greatly reduce the chances the dog would be symptomatic of Babesia. Just something to think about.