Need Some Help With This Dx

[BauersMom]

If anyone has any suggestions on what to look at next, I'm all ears. Here's the story of the last two weeks -

 

Tex was hauled up from Florida a few weeks ago, so I don't have a ton of history on him. By all accounts, he came up looking and acting fine.

 

He has a recurring fever, between 103-104 usually. But it's not a constant fever - it's periodically came out at a normal temp. But when he heats up, he's HOT - I can feel how hot he is.

 

He had a bad bout of diarrhea for a week or so. It's better now, but not perfect. Fecal was negative.

 

He's lost a lot of weight, like 8-10lbs. I am feeding him a ton of food (raw and kibble) and he hasn't gained a thing.

 

He acts like an old dog (he's four this year). Getting up and getting down are clearly painful for him. He will limp on various legs, and shifts his weight frequently when standing. The vet called it a 'polyarthritis' type presentation.

 

He had pyoderma.

 

For meds, he was put on cephalexin for the pyoderma and flagyl for the diarrhea. Those helped. When the fever came back (while still on the ATBs) and the limping got more pronounced, they assumed it might be tick related, so we started him on doxy. His full tick panel has since come back totally clean. We're keeping him on the doxy still.

 

Because he's clearly in pain of some sort, last night the vet gave him a shot of an anti-inflammatory. Definitely saw improvement in his desire to get up and walk around - he was still gimpy and stiff, but more spunky. We're putting him on deramaxx now to help with that.

 

With the fever, the vet is narrowing it down to some sort of infection. Because of that we've sent out for a full fungal panel as the next step. Bloodwork is unremarkable except for an elevated ALT (220 u/L, I think, I don't have it in front of me).

 

Annnd on top of all that, the poor dog has a bad case of happy tail.

 

Any thoughts? Ideas??

Edited February 23, 2012 by BauersMom

[MaryJane]

It might be a good idea to check to see how all the other dogs that were on the same road trip are doing. Also, were other dogs picked up along the way and were any non-greyhounds.

 

On second thought, have they checked for meningitis or septicemia - that would cause the fevers and stiffness and would not be readily apparent in generic tests. Although, the symptoms you describe really do seem to present more as a tick borne disease especially something like Lyme ...

 

Another possibility might be a spider/snake/insect bite - it would be more common in the south then in the New England area and could be missed on an initial exam.

[BauersMom]

Good question about the other dogs - one other also came down with diarrhea/weight loss, but he rebounded pretty quickly. No other symptoms with that dog like fever, etc. And no other non-greys on this haul.

 

I don't think they've tested for meningitis or septicemia, but I will check. Thanks

[Batmom]

What type of tick panel was run? Any films (e.g., abdominal / lung / heart x-ray)?

 

I'm sorry he isn't better .

[MP_the4pack]

Even though the tick panel is coming back clean, did it test for the rarer tick problems? We've seen a few pop up here.

[Guest JustGreyt05]

Normal cardiac auscultation? Undulating FUO definitely puts vegetative endocarditis on the list, however unlikely in dogs. Also an ALT at 220 is not significant.

[Tallgreydogmom]

What is Tex's racing name and where was he hauled from in Florida? If it's one of the usual groups that does the hauls they would probably like to know he is sick. Sometimes they know where the greyhound has been before the haul. If he came out of a racing kennel they might have some idea about him.

Edited February 23, 2012 by Tallgreydogmom

[krissn333]

Maybe run a CPL on him too (test for pancreatitis).

 

Angel Sutra's symptoms came on really slowly with just the little abnormality here and there, and then before we knew it, he was so sick he nearly died. Worth running the CPL just to rule it out, if nothing else. If it is, Zeniquin + Clavamox is what helped Sutra the most.

[BauersMom]

What type of tick panel was run? Any films (e.g., abdominal / lung / heart x-ray)?

 

I'm sorry he isn't better .

 

No films (yet).

 

I believe it was an Idexx panel (PCR), not 100% sure, covering Anaplasma, Babesia, Bartonella, Ehrlichia, Hepatozoon, Leishmania, Neorickettsia risticii, Rocky Mountain spotted fever and Canine Hemotropic Mycoplasma and Lyme QuantC6 (from their website, and this matches up with what he read me today).

 

 

He came right out of a racing kennel, and wasn't showing any issues at the time of the haul. In fact, I saw him right after he got here and he was a bouncy, happy dog. He's very subdued now.

 

Everything was normal (well, except for everything wrong with him!) on physical exam (heart/lung sounds, etc).

 

One other thing I've noticed is that he has two white spots on his nose...like he's losing pigment there? They are small, but definitely unusual and something I didn't notice on him two weeks ago...??

[tbhounds]

Polyarthritis flair brought on by the stress of the haul?? How old is this boy???

ETA- I see that's he's 4-- I would be very suspicious of PA.

Edited February 24, 2012 by tbhounds

[BauersMom]

Polyarthritis flair brought on by the stress of the haul?? How old is this boy???

 

He turns 4 this year.

 

I feel like the stress of the haul "triggered" something, however that's just a guess and the timing could also be coincidental. I don't know!

 

Edit to add - is there a test for polyarthritis? Does it present with a fever, or is that something else, you think?

Edited February 24, 2012 by BauersMom

[tbhounds]

Yes, they can present with a fever.

http://www.acvim.org/websites/acvim/index.php?p=217

Hope this link helps (or actually works- I'm on my phone)!

[HopeForHounds]

FWIW Jake had an PCR Tick test for the usual ones when he first became a blood donor. A year or so later he began to have rotating lameness with swelling and fever. We spent a fortune trying to figure this out with no luck, many, many tests and antibiotics for the suspected infections. After the episodes became more frequent and he suddenly was lame in two back legs our vet was in a panic. We opted to treat him as if he had tick disease, and lo and behold within 10 days of doxycyclin we had a new dog. Since TBD's are almost unheard of here in our area our vet didn't give a very high dose so Jake did have one relapse a few months later. One more 8 week course of doxy and he hasn't had another. Our vet firmly believes he had one of the rarer forms of ehrlichia. What I'm getting at is that a negative tick test in a sick dog doesn't always mean they don't have a TBD, they just don't have the TBD they tested for.

[BauersMom]

Yes, they can present with a fever.

http://www.acvim.org/websites/acvim/index.php?p=217

Hope this link helps (or actually works- I'm on my phone)!

 

The link works, and it sounds really possible. The only piece then is the GI/weight loss, which could be something unrelated. The vet mentioned doing a joint tap - he must have had something like this in mind.

 

And yes, we're keeping him on the doxy for exactly that reason, foxysmom!

Edited February 24, 2012 by BauersMom

[Batmom]

If he's an easy dog to vet, I'd be inclined to do a quick x-ray or two just to make sure everything is OK with those essential parts.

[JJNg]

I agree that it sounds like polyarthritis, which can be diagnosed with joint taps. What was the anti-inflammatory injection that your vet gave - not a steroid, I hope? A steroid might interfere with results from a joint tap, not to mention the risk when followed with oral NSAIDs, which is why I'm hoping it was an NSAID injection.

 

However, if it's immune-mediated polyarthritis, that usually responds best to steroids. And if he's had NSAIDs now, it would be safest to do a washout period before switching to steroids. The other big question with polyarthritis is whether it is primary immune-mediated, or is it secondary to a systemic infection.

 

Many of the tick-borne disease can cause a secondary immune-mediated polyarthritis. This is what we suspected was the case when my girl Willow developed polyarthritis and fever (along with other signs) a couple years ago. After consulting with my local internist, and also getting input from Dr. Couto and Dr. Breitschwerdt (tick disease expert at NCSU), the most likely diagnosis was Bartonella, but we were never able to confirm it despite running multiple tests. Apparently it is not unusual to get false negative results with Bartonella.

 

If the tick panel you did was a PCR panel, I'd consider also doing an antibody titer panel to go along with that. PCR can be very sensitive, but may have a higher rate of false negatives than titers. With the suspicion of immune-mediated polyarthritis, as well as the possibility of infectious disease, the dilemma is that most immune-mediated disease are treated with immunosuppressive doses of steroids and other drugs. But suppressing the immune system of a dog that is fighting an infection can make that infection go out of control. With Bartonella, it increases the risk of the infection going into the heart valves (infectious endocarditis), which is very difficult to treat and leads to a much worse prognosis.

 

When Willow had polyarthritis, we treated with a combination of doxy plus Baytril for a total of 8 weeks. Her joint inflammation still hadn't improved after more than a week on the antibiotics, and the internist wanted to start her on immunosuppressive doses of pred. I was reluctant to do this due to the risk of making infection worse, and after discussing it with both the internist and Dr. Breitschwerdt, we decided to start with a lower, anti-inflammatory dose of pred. She was feeling better, and the joint inflammation improved, within a couple days of starting the pred. In addition to treatment with antibiotics and steroids, we also treated Willow with acupuncture, Chinese herbs, Adequan and oral joint supplements.

 

Btw, have you submitted a consult to Dr. Couto's team at OSU?

[BauersMom]

No steroids at this point, for sure. It's all been NSAIDs for pain relief.

 

I'll check about the antibody panel, thanks for the suggestion. The vet we have been seeing is out until early next week - do you think it's worth doing a joint tap sooner rather than later? I could see about getting in with another one at the practice today or saturday.

[joejoesmom]

 

Btw, have you submitted a consult to Dr. Couto's team at OSU?

 

I second this, however... The greyhound health and wellness program is incredibly short staffed right now. Dr. Marin is on a leave of absence until sometime in April -- I believe she is home in Columbia taking care of a sick parent. Dr. Couto just left today with some students for Scooby in Spain and won't be back until March 13. Obviously this was scheduled before Dr. Marin had to leave or it would have been postponed (students had already purchased their tickets I'm sure). So the program is down to just Dr. Sara Zaldivar, who normally focuses on just the research side of things. I'm not sure what they are doing for the next 3 weeks.

 

Jane

[BauersMom]

I know about the backlog from the osteo thread. I haven't yet submitted anything though.

[JJNg]

The vet we have been seeing is out until early next week - do you think it's worth doing a joint tap sooner rather than later? I could see about getting in with another one at the practice today or saturday.

At this point, I don't think it would make a huge difference if you could get in for the joint taps Mon or Tues. Especially if he's stable and not progressively getting worse. The sooner the diagnosis is made, though, the sooner you can start treatment. So if you feel comfortable with another vet doing it, and they have availability tomorrow, you might consider going ahead and just having it done.

[robinw]

His symptoms sound like Phene's just before he was diagnosed with babesia, especially the difficulty getting up.

[BauersMom]

So we're seeing some improvement. He shows moments of having no pain, like last night at 2am he was ready to walk around the house and investigate! This hadn't happened at all for the two weeks he's been here, so even though it was at an ungodly hour, I took it to be a good sign.

 

He's subdued again tonight, but a few times today he seemed more perky. I'm encouraged. He's on doxy and deramaxx only at this point - not sure which is having the positive effect, but I'll take it!

[BauersMom]

I noticed some spots on him this morning - balding, crusty and looking a little red. One toe is nearly completely hairless now, and he has probably another 4-6 spots on him. Left over from the pyoderma? Related to some sort of immune issue?

[tbhounds]

The can have hair loss with pyoderma. You may notice flaking too. Once the lesions are healed the hair will grow back in time.

[mychip1]

Good thougths for this hound.......