Sam's Mystery

[calif_chaz]

My poor Sam already is hypothyroid (takes meds for it), the bad nails of SLO, and is a regular corn sufferer. But now something new and concerning has started. Early

November he quite suddenly develped a very painful, swollen jointon left front leg, the lower one (think ankle) on a front leg. Had no limping beforehand. This turned out to be a case

of septic arthritis. No sign of injury, skin break, bite. Treated and resolved with draining, saline flush and antibiotics. Now maybe 5 weeks later he again very suddenly

developed a hematoma on upper right front shoulder area. I noticed it when I petted him, about 3 inches across and very squishy. Vet did needle aspiration and drew out blood.

Did cbc and test for von willibrand which were ok. Put Sam on vit k for 2 weeks and a return on 12/30 for blood tests again. This is a dog who is very literally a couch

potato and neither of these things were caused by any sort of trauma. He does not run in the yard or do anything physical which could cause this. Lives a "quiet" life with

two retired people. I am wondering if a good idea to h ave a full tick panel run to check babesia, etc. I would really appreciate any thoughts and/or experiences you have had

with TBD.

[Guest Energy11]

Protatek Labs in Arizona has a FULL Greyhound TB panel. They are reasonable, too! Here is some more info., including the info for Protatek Labs. http://www.grassmere-animal-hospital.com/ticks.htm

 

You could have your vet draw and spin the blood and send yourself. That is what I did with all five of mine. Four came back low positive for Babesia, but, their PCRs were negative.

 

I hope you get to the bottom of this soon! Sending love your way! Dee and The Five.

[Remolacha]

Sounds like a tick panel would be a good idea. Also, has he been tested for Valley Fever? It can present in some odd ways, and depending on where your dog raced (AZ?, Caliente?) he could have been exposed.

[Batmom]

If you're going to do tick disease testing, I'd do an IDEXX 2828 Tick/Vector Comprehensive RealPCR with Lyme Quant C6 (some basic info down this page, look for 2828 IDEXX tick PCRs ). Covers pretty much *all* the vector borne diseases and gives you solid answers to work with. Antech, NCSU (North Carolina State University, the tick disease experts), and other universities probably have similar but I don't know the exact test names/numbers.

[Guest FawnFan]

I can't speak to the TBD or the other recent issues Sam is having. I did want to send along good vibes that you're able to figure out his issues soon.

 

I also wanted to say Sam sounds very much like my Dawson. Dawson's very lazy...likes to get his 16+ hours of sleep every day. He has corns on every foot now and he's had this problem since we got him (these make me ) He also is missing at least one toe on every foot (came like this except for one which we had removed because of a chronic infection which wouldn't heal.) Then this summer he developed SLO and has lost all of his toenails except one now.

 

Here's what I noticed just recently. Last year I started home cooking chicken thighs and sweet potatoes to add to my hound's meals. Last year Dawson's white socked feet turned bright red. Took him to the holistic vet and she told me it was chicken. Eliminate the chicken and his feet will heal. Sure enough, I stopped the chicken, used turkey instead and his feet healed.

 

This past summer, I switched back to chicken thighs because they were cheaper than the turkey ones. This is when the SLO started. I didn't think about it - just chalked it up to Dawson and his feet problems. By this time, turkey was abundant in the stores so I decided to get it again. Within a few weeks, his SLO symptoms stopped being an issue. I didn't refill the antibiotic and I haven't been doing the niamicide. It's been over a month now since I stopped the meds. Then last week, I ran out of turkey and had to use chicken in a pinch. Within 2 days of that chicken meal, he had another nail fall off. At this point, I'm not going back to chicken ever. I don't know if it's the chicken or if it's what the chicken ate or was given (it wasn't organic) yet I'm not going to chance it anymore. He's 9.5 now...he wants to just be happy and comfy. If I need a substitute, he'll get tuna or salmon instead.

 

I've been told many dogs are affected by chicken and corn. I had c-o-c-k-e-r spaniel mixes 15 years ago and both of them had chronic ear infections. My Vet suggested I give them vegetarian food (kibble + canned) or something with no chicken or corn in it. At the time there was only one food in Petsmart meeting that criteria (I think it was a Science Diet food.) Once I started them on it, within 2 weeks both of their ear infections cleared up. It was amazing actually.

 

Again just something I've experienced recently with my "foot problem" hound.

 

Good luck and hoping Sam is feeling better soon!

Jean

 

ETA: corrected typos.

Edited December 17, 2011 by FawnFan

[GreyTzu]

If you're going to do tick disease testing, I'd do an IDEXX 2828 Tick/Vector Comprehensive RealPCR with Lyme Quant C6 (some basic info down this page, look for 2828 IDEXX tick PCRs ). Covers pretty much *all* the vector borne diseases and gives you solid answers to work with. Antech, NCSU (North Carolina State University, the tick disease experts), and other universities probably have similar but I don't know the exact test names/numbers.

 

:nod

[tbhounds]

Sorry Sam is so ill- poor bugger sounds miserable. I do think running a vector borne panel (TBD) would be a greyt idea. Many labs offer good diagnostic panels- the above mentioned one from Idexx is good as well as the FastBack panel that Antech runs- sorry- really not a great fan of ProTec labs but, many will disagree with me.

Has your vet mentioned running other auto immune mediated tests such as a Coombs or an ANA? Why they aren't always definitive they may point you in the correct direction.

How was your hound diagnosed with hypothyroidism?

[calif_chaz]

As always, GTers have given me some good advice and things to think on. Maybe the weird septic joint and hematoma are totally unrelated but I just can't help feeling

there is some underlying connection for two such unusual things. I also never thought about a thing he has always gotten every so often, a small dark pink spot on his

belly or chest which eventually fades away. Usually only one spot, maybe two but separate, light or dark pink, size of maybe tip of my little finger or even size of a nickel. Never bothered him, but now I am rethinking that. Petechiael? Will definitely mention that to vet monday as well as a full tick panel being run. Other than the pain Sam had with the joint and his corns he is still his usual self and eating like the little piggie he always has been.

Again, many thanks for all your advice and suggestions!

 

Sorry Sam is so ill- poor bugger sounds miserable. I do think running a vector borne panel (TBD) would be a greyt idea. Many labs offer good diagnostic panels- the above mentioned one from Idexx is good as well as the FastBack panel that Antech runs- sorry- really not a great fan of ProTec labs but, many will disagree with me.

Has your vet mentioned running other auto immune mediated tests such as a Coombs or an ANA? Why they aren't always definitive they may point you in the correct direction.

How was your hound diagnosed with hypothyroidism?

 

About 2 years ago he had the full thyroid panel run. he had weight loss, hairless belly and chest, balding thighs, rather withdrawn and lethargic. he has definitely improved on his meds and gets blood recheck every 6 months.

[Batmom]

One or two largish spots would be insect bites or contact bruises rather than petechiae (generally a whole field o' little spots, I'll see if I can find a good pic).

[Burpdog]

Batmom & I have a difference of opinion on Protatek and NC. I'll take Protatek any day and this is from experience, not hearsay.

 

Protatek will get you answers quickly and they are knowledable. I believe every greyhound should have a tick panel done!

 

 

[JJNg]

I used to think that the PCR tick panels were the way to go for TBD screening. After attending a CE conference a couple months ago, I'm not so sure. PCR only detects TBD if there are organisms circulating in the bloodstream. Especially in chronic or latent cases, the organisms are often no longer in the bloodstream and are 'hiding' in other tissues. In these cases, antibody titer testing may be more sensitive, as PCR testing may give a high percentage of false negatives.

 

If a PCR test comes back positive, that's the gold standard for confirming infection. But if PCR is negative, it doesn't rule out the possibility of infection. Since many suspected cases of TBD in greys are chronic, often years after tick exposure in racing kennels, I'm beginning to think that screening with titer testing is the better way to go. Of course, you have to keep in mind that a positive titer only proves exposure and not active infection. But if the dog is showing clinical signs that fit with the positive titer, that is usually more than enough info to support starting treatment.

 

I've had good experiences with the NCSU tick-borne disease lab. That's my preferred lab, and I've also used Antech. No personal experience with Protatek.

[kudzu]

If a PCR test comes back positive, that's the gold standard for confirming infection. But if PCR is negative, it doesn't rule out the possibility of infection. Since many suspected cases of TBD in greys are chronic, often years after tick exposure in racing kennels, I'm beginning to think that screening with titer testing is the better way to go. Of course, you have to keep in mind that a positive titer only proves exposure and not active infection. But if the dog is showing clinical signs that fit with the positive titer, that is usually more than enough info to support starting treatment.

[Batmom]

The experts (such as NCSU) still recommend using both titer and PCR for diagnosis of many of the vector-born diseases. Neither is perfect. If the dog is having significant, specific symptoms, though, the disease isn't in hiding -- it's in an acute phase and the PCR is highly likely to be positive, whereas the dog may not have formed antibodies yet (in a newly acquired case of disease), may have reduced antibodies due to longterm infection, or may have an emerging organism that some of the older titer panels don't test for.

[Guest june]

I am so grateful that our adoption group does tick panels on all the dogs. Makes our lives so much easier in the long run.

[JJNg]

The experts (such as NCSU) still recommend using both titer and PCR for diagnosis of many of the vector-born diseases. Neither is perfect. If the dog is having significant, specific symptoms, though, the disease isn't in hiding -- it's in an acute phase and the PCR is highly likely to be positive, whereas the dog may not have formed antibodies yet (in a newly acquired case of disease), may have reduced antibodies due to longterm infection, or may have an emerging organism that some of the older titer panels don't test for.

I definitely agree that doing both titer and PCR testing is the best way to go. Practically speaking, many owners are unable to afford both. If I had to pick one or the other, I'm starting to lean more toward titers. Especially since most of the Antech FastPanel PCR TBD profiles I've submitted have come back negative. I believe PCR has a much higher chance of false negative results than titers. If the infection is chronic, even if the dog is experiencing symptoms, there may not be circulating organisms in the bloodstream since many of the chronic symptoms of TBD are secondary to immune-mediated responses.

[Batmom]

I guess my question would be, why then would you think TBD rather than a different illness?

 

The trouble I have with titers is, the organism's response is so varied -- you can have very low titer and disease, very high titer and no disease (including a very high titer remaining after treatment), medium titer and disease or not disease .... Unless you're talking paired acute and convalescent titers, they seem pretty nearly worthless to me.

 

Human medicine, including vector-borne disease diagnosis, is moving more and more to PCR.

[JJNg]

I'm mostly referring to situations where we're screening for the possibility of TBD, often when we're having difficulty making a diagnosis for vague, nonspecific, unusual signs (ie. swollen joints, enlarged lymph nodes, edema, recurrent fever/infections, lethargy, etc). These same signs can be seen with different TBDs, especially during the chronic stage.

 

Because of the difference in sensitivity/specificity, I think titers can provide more information for the purposes of screening because they are much less likely to give false negatives than PCR. Negative PCR results do not effectively rule out TBD infections.

 

If I get a significant titer and the clinical signs fit for TBD, I would find that convincing enough to treat. I certainly don't think titers are worthless when interpreted in conjunction with clinical signs. I would not treat based on a titer alone. I don't test for TBD unless I have some clinical suspicion for it. Testing and treatment of asymptomatic dogs is still pretty controversial.

 

When you say that human medicine is moving more to PCR, is that PCR alone, or in conjunction with serology? If they are going to PCR alone, do they not have problems with false negatives? Especially for particular diseases, like Lyme disease, PCR is still not considered to be very accurate. Titers are still the primary method of diagnosing Lyme, and while Antech initially had a Lyme PCR as part of their TBD FastPanel PCR, they removed it from the panel and now recommend antibody titers instead.

 

Also, when discussing TBD, I'm not sure human medicine is necessarily a good model as I hear of many cases that go misdiagnosed and unrecognized for years. I've even heard human physicians say that veterinarians are often more aware of TBD than MDs are.

[Batmom]

I'm mostly referring to situations where we're screening for the possibility of TBD, often when we're having difficulty making a diagnosis for vague, nonspecific, unusual signs (ie. swollen joints, enlarged lymph nodes, edema, recurrent fever/infections, lethargy, etc). These same signs can be seen with different TBDs, especially during the chronic stage.

 

Because of the difference in sensitivity/specificity, I think titers can provide more information for the purposes of screening because they are much less likely to give false negatives than PCR. Negative PCR results do not effectively rule out TBD infections.

 

But a negative titer doesn't rule TBD out either, particularly early in the disease and when the dog has been infected and ill for a long time.

 

If I get a significant titer and the clinical signs fit for TBD, I would find that convincing enough to treat. I certainly don't think titers are worthless when interpreted in conjunction with clinical signs. I would not treat based on a titer alone. I don't test for TBD unless I have some clinical suspicion for it. Testing and treatment of asymptomatic dogs is still pretty controversial.

 

That makes sense . The cases that worry me are those where there are nonspecific symptoms and there's no particular reason to suspect TBD over anything else. In a retired racing greyhound, you're highly likely to find antibodies to various TBDs. But some possibly significant number of those dogs merely have antibodies and not current TBD.

 

When you say that human medicine is moving more to PCR, is that PCR alone, or in conjunction with serology?

 

Some of each. Certainly several PCRs (or other nucleic acid tests) are used for screening and diagnosis -- West Nile Virus and gonorrhea would be good examples. Many times (C. diff is a good example) antigen or antibody testing is used first because it's cheaper; I believe that is starting to change. If a lab can afford the equipment and an approved PCR (or other nucleic acid) test is available, the PCR/nucleic acid test is used.

 

Also, when discussing TBD, I'm not sure human medicine is necessarily a good model as I hear of many cases that go misdiagnosed and unrecognized for years. I've even heard human physicians say that veterinarians are often more aware of TBD than MDs are.

 

 

Can't disagree with you there. For TBDs in humans, I think part of the problem is lack of awareness. If you don't think to test for it, you're not likely to find it unless you get lucky and see it on a blood smear. And in current human medicine, you'd probably only see it on a blood smear if the automated CBC/Chemistry equipment found a serious enough anomaly to flag the sample.

 

Four things concern me: (1) The phenomenon of finding what you look for and not finding what you don't, especially when symptoms are nonspecific or equivocal, or when there are no symptoms at all. If I had itchy spots and someone did a measles titer, I'd be positive. But I wouldn't have measles ..... (2) The newer findings that suggest that the Ehrlichias may not be cleared by doxycycline treatment in some non-negligible number of cases. There, we really want to know what the dog has/had because we want to know if we need to keep looking or testing, if we need to be more aware of seemingly minor health status changes in the future, etc. (3) The emergence/existence of diseases other than those commonly tested for, such as Bartonellosis and Leptospirosis ....... (4) The notion that PCR/nucleic acid test results are highly lab dependent while IFA/ELISAs are not. The possibilities for false negatives, false positives, and oddments are slightly different among those techniques, but you can screw up an IFA, ELISA, or even a cell culture at least as easily as you can screw up a PCR -- oftentimes more easily, because many labs use older, less automated equipment for IFAs/ELISAs/cultures.

 

PCR/nucleic acid testing isn't going to be the answer for everything, but at least from what I have seen in the human lab, where validated PCRs are available they are becoming the tests of choice due to sensitivity, specificity, and reliability.

[Batmom]

P.S. After this maybe jjng and I should take our discussion elsewhere. How is Sam doing??

[kudzu]

If you take it elsewhere I hope it is to a new thread on this board. I am enjoying reading the discussion.

 

Hope Sam is better.

[JJNg]

Any updates on Sam?

 

Hope no one minds us continuing the testing discussion here.

 

But a negative titer doesn't rule TBD out either, particularly early in the disease and when the dog has been infected and ill for a long time.

Agreed. However, I would put more stock in a negative titer than a negative PCR. It somewhat depends on the particular test and lab, but generally speaking, PCR tends to be a higher percentage of false negatives than antibody titers.

 

The cases that worry me are those where there are nonspecific symptoms and there's no particular reason to suspect TBD over anything else.

There are particular clinical signs that make us more suspicious of TBD. These signs include swollen joints, enlarged lymph nodes, edema, recurrent fever/infections, lethargy, among others. Especially when these signs are seen in combination, there aren't a whole lot of other recognized illnesses that can explain them. Other rule-outs usually include other types of infections, immune-mediated disease, or cancer. Of these possibilities, TBDs and infections are the most easily treatable, and the treatment often overlaps (ie. antibiotics). Additionally, there is much speculation that TBD may trigger immune-mediated reactions.

 

While it's nice to to be able to get some sort of confirmation/diagnosis with a positive test (whether titer or PCR), given that none of these tests are 100% accurate, we are often treating based on our best interpretation of all the information available. And in the case of veterinary medicine, clients often can only afford limited testing (sometimes none at all), and we end up having to just treat based mostly on the clinical signs.

 

Four things concern me: (1) The phenomenon of finding what you look for and not finding what you don't, especially when symptoms are nonspecific or equivocal, or when there are no symptoms at all.

Unfortunately this phenomenon applies to any disease, and also applies to both PCR or titer testing. Hence the lack of awareness of MD's resulting in missed diagnoses of TBD. With nonspecific signs, diagnosis becomes very difficult as you can't test for every disease that exists. And this is also why I don't believe in TBD testing when there are no symptoms.

 

(2) The newer findings that suggest that the Ehrlichias may not be cleared by doxycycline treatment in some non-negligible number of cases. There, we really want to know what the dog has/had because we want to know if we need to keep looking or testing, if we need to be more aware of seemingly minor health status changes in the future, etc.

In this type of case, I definitely agree that PCR testing would be better. Not unusual for titers to remain high even after infection is cleared, and PCR would give you a better idea of whether there is still active infection. However, if the dog continues to show clinical signs consistent with ehrlichiosis, but comes up negative on a PCR, would you then rule it out and look for another diagnosis, or would you consider that it might be a false negative? Don't think it would be wrong to continue to test for other possibilities, but I'd certainly continue treatment for Ehrlichia in the meantime.

 

(3) The emergence/existence of diseases other than those commonly tested for, such as Bartonellosis and Leptospirosis .......

Are you saying that Bartonella and Lepto are not commonly tested for? This may have been true a few years ago, at least for Bartonella, but it's been a very hot topic in both vet and human med lately. In vet med at least, Bartonella is increasingly being included in many tick panels - both PCR and titers. I got a crash course on this disease when my own grey was sick for most of 2010, and the suspected diagnosis (never confirmed) was bartonellosis. And at least in my part of the country, Lepto testing is pretty common when the clinical signs fit.

 

(4) The notion that PCR/nucleic acid test results are highly lab dependent while IFA/ELISAs are not.

I wasn't aware this was a common notion? I think accuracy of results is dependent on lab and quality control for any test. This certainly didn't factor into my speculation on the usefulness of PCR vs. titer testing.

 

PCR/nucleic acid testing isn't going to be the answer for everything, but at least from what I have seen in the human lab, where validated PCRs are available they are becoming the tests of choice due to sensitivity, specificity, and reliability.

I agree that PCR is rapidly becoming the gold standard for many diseases. However, I feel there is still a place for titer testing. PCR relies on the presence of viral or bacterial DNA in the sample being testing. With infectious organisms that do not consistently circulate in easily accessible areas (like bloodstream or urine), PCR may not be so reliable.

 

There is also the effect of prevalence on sensitivity and specificity of tests. With diseases that are have a fairly high prevalence within a population (such as TBD in greys), any test will have a lower rate of false positives, but a higher percentage of false negatives. Something else to keep in mind when interpreting results.

[calif_chaz]

Sam was back at the vet the 30th for more blood work which came back fine. ( clotting panel after several days of vit K). No swollen joins, no limited range of movement, no fever. Hematoma area completely resolved. spine examined and ok. Only things were a tenderness in right rear leg when extended in range of movement examination and sadly even more corns. This poor dog is a "corn farm", no pun intended. Vet suspects arthritis in right rear hip and has put Sam on rimadyl for several days and we will check back with him at that time. Sam is definitely more comfortable, from less corns or rimadyl who knows. But does seem more active now. Next step would be x-ray of that right hip. He is such a good boy and I hope doesn't have to go back to the vet for awhile. he just shakes head to tail there. Thanks for all your input~~I am amazed at the amount of knowledge and expertise so many of you have!