greyhndz
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Marcia, it really may be worth your while to contact the researcher from Cornell:
http://bakerinstitute.vet.cornell.edu/facu...page.php?id=206
She may be able to handle the karyotyping, and discount it for inclusion in her study, and she may be able to give you and your vet some direction.
According to her website, males can be carriers, but females are affected, and present as XXSR. They have "ovotestes" - both ovarian and testicular tissue.
Easy enough to e-mail or call her to see if she can give you some advice!
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PUPPY PHOTOS!!!! (warning: greyhound erotica ahead - includes pix of genitalia) 
(and Marcia also passed along the message that Perry did not have a UTI, as his culture was negative)
Perry comforting big sis Rita during a thunderstorm.
Bath!!!??!! This wasn't in my contract! Call my agent!!!
Photos below show Perry's "ambiguous genitalia".
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SEE POST #27 FOR PHOTOS!
Karyotype wouldn't really tell them what to expect during the procedure. If s/he has weird chromosomes, those could manifest themselves in all kinds of different ways.Exactly, which the researcher at the Baker Institute alludes to. Identifying karyotype or chromosomal mutations is academic (though fascinating!) - but this may be just the kind of thing Dr. Meyers-Wallen wants for her research, and may well do at a discounted (or no) cost.
thinking about it some more, I'll be interested to see what, if anything, the surgeon will order for pre-op imaging. Human infants are scanned up the kazoo and seen by every surgical specialty prior to reconstruction and gender assignment, but that's probably not realistic for dogs. I wonder if there are any surgeons in the southeast who are experienced in this type of reconstruction.
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Great resource! Do any of the photos seem to be comparable with Perry's genitalia? I wonder if you can send samples (don't know if she uses blood or sampling from cells in the mouth) to Dr. Meyers-Wallen - it may contribute to her database and she can also identify Perry's disorder for you.
OK, Scoop - cough it up. Time for photos!
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I tried expressing P's bladder and found nothing but muscle down there. Maybe I should try it before s/he pees. Or I may just be doing it all wrong.
They tried to catheretize "him" when they made the discovery but the cath never happened. I don't think I could do that anyway.
The vet and I really need to have a chat today about all this!If the bladder isn't filled, it can be hard to palpate. I've been going through this with Lexi (iggy) who needs periodic taps for urine protein creatinine studies. Hopefully the vet can demonstrate for you how to help Perry empty his bladder.
I was doing a pubmed search last night for info on ambiguous genitalia and gonadal anomalies, but either the full-text articles weren't available or I came across mind-boggling chromosomal-arm XX, XY, XXY factoids.
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The UTI isn't apparently too severe; I thing Perry/i's feeling better. We may need to switch abx; we'll see. Like Mandy, I figured the UTI is because of the anatomy.
Marcia
Scoop, until his plumbing has been straightened out and he can void normally, you might want to ask the vet if he should be on chronic antibiotics, because, not even taking into consideration what he's got for ureters and kidneys, if his bladder can't fully empty, he's a set up for recurrent infection. Or, you can straight cath him several times a day.
(or at least try to express his bladder) -
Wow, thanks so much for sharing Mazie's story! Could you also tell me more about her diagnostics, and also what was involved in her post-op recovery? What surgical procedure was done? Was it a laminectomy and diskectomy, or did the surgeon also have to do a fusion?
Only 3... you really didn't have much of a choice for this baby. I'm so glad to hear that she's recovered really well and is going to be able to live out a normal, pain-free life!
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Interesting! This is called "ambiguous genitalia" in humans. There may be associated anomalies of the urinary or GI tracts, so as you said, Perry will to have some imaging done before his/her "gender reassignment" surgery.
And they'll have to look carefully for any testicular remnants. Even though Perri may actually be male, it's probably far easier to reconstruct a female urethra and vulva than to try to construct a penis, though it'll be interesting to see what turns up when they actually explore in there. Would you ask the surgeon to film the procedure? (you know me... I'm serious
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Thanks for your input, guys!
I'm seriously considering acupuncture, but the veterinary acupuncturist I know in this area has about a 2 month wait for an apppointment... I'll look around to see if anyone else is in practice.
I would be far more inclined to just treat this conservatively if Dandi didn't already have a neurologic deficit in his R hind.
Pam, this is definitely not LSS. If it were, I'd actively push for a depo-medrol injection. I did discuss with his neurologist non-surgical options that we often use for humans with disc herniations, such as epidural steroids, but apparently there have not been any good, long-term studies on this method and so the neurologist does not perform them.
Deramaxx - won't use it. My 13 yo Arielle had scapular osteo (this was in 2003). The oncologist she saw gave us Deramaxx to try. Within 24 hrs, Ari was vomiting intractably, having severe abdominal pain, and had to be euthanized. She'd had a massive GI bleed. I'll never allow any of my dogs to be given Deramaxx again.
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The first article from human literature refers to "azoles" in general - fluconazole, itraconazole, etc. The second article mentions intraconazole, with the dog eventually doing well on fluconazole.
But interesting that this occurred after she came off the pred, Jenny - that could certainly be a factor.
I surrender, Shanti!
You are what we call a "diagnostic dilemma"! -
I may be facing this decision with my galgo, Dandi, who is approx. 7-8 years old. He was evaluated by a neurologist/neurosurgeon whom I trust implicitly (Dr. Sisson at Angell in Boston). Basically, I've suspected back issues for over a year, as he's shown signs of sciatica in his R hind. I first had him evaluated by a chiropractor who agreed that there were signs of some type of lumbar dysfunction, and tried VOM (veterinary orthopaedic manipulation) with him - I thought with some improvement, but he would not tolerate it after the first 2-3 treatments, so we had to discontinue after he wouldn't even allow massage or gentle manual manipulation.
Today, the neurologist confirmed that he has marked tenderness at L5-6 and is knuckling on his R hind. He suspects some type of nerve root compression at that level, though Dandi will need further diagnostics for confirmation, and to determine not only the exact location and type of lesion, but also whether it is correctable with surgery. So, I'm mulling the possibilities:
Neuro (who is NOT an aggressive, every-expensive-diagnostic-test-in-the-book kind of vet) suggested an EMG (nerve conduction test done under anesthesia) followed by MRI to see if surgery is even an option. If so, Dandi is young and healthy enough that I would consider surgical decompression if it will likely be curative. (So, I won't eat for the next 6 months....
)We can also try to find another anti-inflammatory/analgesic that will be more effective than Rimadyl or meloxicam, which have only helped minimally. Neuro does not believe this will help significantly, and it certainly won't address the neurologic deficit he already has. But Dandi also has recurrent colitis, so we run the risk of any new meds exacerbating that.
And of course we can simply opt for alternative therapy, with acupuncture, physical therapy, etc., though I don't know how much handling Dandi will tolerate, given his, um, "difficult" temperament.
I'd like to hear the experiences of others who have faced this decision, including what type of treatment you opted for, and if you went ahead with surgery, how your hound did post-operatively.
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Jenny, you always manage to get me thinking... and researching.. and learning something new.
The short answer to your question is, YES, this might possibly be a reaction to the itraconazole. I pulled up some studies -- some of them apply more to cutaneous (skin) reactions, but they also describe an acute inflammatory response in animals (and people) put onto oral antifungals:
human dermatology - inflammatory flare-ups
In this report, we describe five patients, observed over a 10-year period, who presented with inflammatory exacerbations following oral antifungal therapy for dermatomycoses. We also review the literature on inflammatory reactions exacerbated by oral antifungal agents.
Another report (in a dog) of a reaction to itraconazole:
Plotnick AN, Boshoven EW, Rosychuk RA.Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins 80523-1620, USA.
Three weeks after traveling to Arizona, a 13-month-old, female Labrador retriever developed draining tracts in the right hind limb. Primary cutaneous coccidioidomycosis was diagnosed. Initial treatment with itraconazole resulted in exacerbation of clinical signs. Histopathology was suggestive of a cutaneous drug eruption. Discontinuation of the itraconazole caused resolution of the drug eruption. Successful treatment of the fungal infection was achieved using ketoconazole.
PMID: 9111724 [PubMed - indexed for MEDLINE]
There's not much in the literature about this subject but it's definitely worth discussing with your vet ASAP before continuing with the itraconazole. I'll see if I can find anything else in the human literature.
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Cuffy
in Remembrance
I'm so sorry, Joslin. Cuffy couldn't have had a more loving and determined mom. He's running free again, with no pain, doing zoomies with all of our angels who were at the Bridge to greet him.
Warmest hugs, my friend.
Jordan
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Hi Joslin
Sounds like IMHA - hemolytic anemia, which would cause splenic enlargement, and also jaundice (and dark urine - both are due to elevated serum bilirubin). The elevated bilirubin occurs due to the breakdown of red blood cells. I hate to say it but this is an emergency, requiring steroids and immunosuppression ASAP. Definitely contact Dr. Couto immediately, and he can guide you further.
I'll also e-mail you...
You've had more than your share, Joslin.... it really bites.
What's happening with all of our Massachusetts hounds?? ETA: some links on IMHA.
http://www.veterinarypartner.com/Content.plx?P=A&A=1390
http://www.vetinfo.com/dencyclopedia/deimha.html
http://www.canine-epilepsy-guardian-angels...ytic_Anemia.htm
http://www.vin.com/proceedings/Proceedings...ID=15727&O=Generic
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Oh, poor Flex! I hope once his UTI has cleared, that he'll give his little weenie a break.
I also hope that your surgery goes well!
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IMPA = immune mediated (autoimmune) polyarthritis.
Did the ortho indicate what he found when he tapped the joints? Can you find out if he sent the fluid for lab analysis and culture? So much information can be garnered from that fluid!
A lumbar puncture (spinal tap) could provide information about why he is having the relapsing neurologic symptoms. Spinal fluid is analyzed for signs of inflammation or granulomatous/autoimmune disease such as GME. It can also be cultured for infection and tickborne disease, just as joint fluid can.
One set of tick titres may be normal, but it's important to do serial (repeat) titres, because it can take a few weeks for a dog to mount antibody response to a tickborne disease. When I was going through this with Lexi last fall, I was in close contact with Cynthia Holland at Protatek -- she recommended repeating the titre in about 3 weeks, expecting it to have risen if she had active Lyme disease. And it never hurts to put a dog on Doxy while awaiting PCR results, even if the tick panel is negative. They just need to use an adequate dose: 10mg/kg or 5mg/lb given twice daily (doxy).
And I know that $$$$ is becoming tight but it's never too late to connect with Dr. Sisson. You can also e-mail him to see if he has any suggestions. (I'm going down there 7/26 - back-to-back cardiology and neuro appointments. My wallet is bleeding!!)
Let me see if I can answer all your questions. First, what's IMPA?They ran a full ANA series. They did the full TBD panel with IDEXX but sent all babesia info to NCSU. The ortho surgeon who saw him on Sunday morning in the e-room did tap his joints and noticed pain which lead to the IM appointment on Monday. As far as I know, he has never had fever. A lumbar puncture has not been done. Why would we do that? He did have an ultra sound on Monday which I assume was renal based on his blood work. Protein creatinine ratio is off so he's on Enacard and currently on ID food until the GI resolve. Still kicking myself for not going to Sisson. The IM doc did admit that they don't have a lot of experience with Babesia. Because all the other titers are negative, she's not recommending Doxy. Great questions!
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I'm going to stalk Shanti's Mom again, because we've had very similar experiences with our autoimmune (immune mediated) polyarthritis hounds.
One of the features of IMPA is migratory lameness - the dog may be lame transiently in one extremity, and then minutes or hours later, appear fine, only to be lame in another extremity at another time.
Lethargy, fever, GI symptoms -- may also be part of the IMPA syndrome. Per Dr. Sisson, labwork may appear deceptively normal, and the tests for autoimmune disease that they run (usually sedimentation rate, ANA, canine rheumatoid factor) are very often normal. I don't remember if any of the vets at MVRH had tapped his joints -- this would be a definitive way of finding out if there is an inflammatory arthritis. The joint fluid can also be cultured for infection, including tickborne disease.
I totally agree with pursuing the PCR and serial titres, and treating him in the interim if he hasn't been already. You also had him titred for anaplasma, didn't you?
I don't recall all of the diagnostics Dr. Silver et al have done up until now. Has a lumbar puncture been done? Renal ultrasound? Urine studies (protein creatinine ratio)? Is he on a kidney diet?
(I'm really nosey tonight, aren't I?
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Are you home yet? How did everything go? How is Merlin doing?
Have you taken your xanax yet?
In all seriousness, I think that if you have a trained eye and experience assessing wounds, you can decide whether or not a wound needs immediate treatment. If you don't feel comfortable making that assessment, I'd err on the side of caution and go.
You can also ask your vet if she/he would be willing to give you some amoxicillin or clavamox to keep at home for situations like this; with antibiotics on board and a thorough wound cleansing, I'd feel more secure about waiting to see my own vet.
Hoping to hear that the patient is comfy and snoozing!
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Have you tried a simple deterrent like a weenie-wrapper? (belly band
). It velcro's right on and will keep him from licking at himself. Often it's a matter of breaking the lick cycle - same as with dogs that create lick granulomas. -
Ducky, instead of plain milk thistle, I use Liver Support Factors, which includes milk thistle in addition to other supplements which help with liver disease. They're soft caplets that break and crumble easily, and Lexi has never balked when I've added them to her food.
Sam-E is recommended for liver disease as well. I buy the Denosyl brand from Entirelypets.com.
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Joslin, that's an interesting point you made about Cuffy's tremors stopping when he's fed a treat.
In humans, there are different types of tremors. There are "resting" tremors which, as the name suggests, occur when the person's muscles are at rest - i.e., they're not attempting to move the affected body part, such as the hands. When the patient does go to move (points a finger, grasps an object, etc.) the tremor stops or diminishes. Then there are "intention" tremors, which occur primarily with movement.
The fact that when Cuffy moves in order to get the ice cream, and the tremor subsides, makes it sound like an intention tremor.
What good that factoid does I don't know, but I thought I'd throw it out there, because that also seems to be the case with Gigi's tremors.
J
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Gigi has never used Frontline, so I know that's not a factor. Chloe's tremor is much more noticeable. I don't believe Gigi had them when she was awake - and certainly Chloe looks wide awake in your videos. When you were taking the films, was she originally sleeping, then suddenly awakened? Does she have the tremor when she's standing or walking around?
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Joslin, I just e-mailed you at home, but in case you check here first, tomorrow is the Int'l GH Symposium in Hopkinton, and Dr. Couto is going to be speaking!!! If you can get there, this would be a golden opportunity for you to talk with him, show him whatever records you might have for Cuffy, and get some guidance!!
Can you possibly come? (then I can give you a hug in person, as can Mafi)
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Actually, yes! I first noticed it the night Gigi was found after being lost for a week. Because she was very dehydrated and malnourished, the vet and I attributed it to her condition at the time. I saw the tremor several times in the months thereafter, always when sleeping. I very rarely notice it nowadays (1.5 years later). Quite similar to Chloe, but Gigi's are more subtle.
PUPPY PHOTOS!!!! (warning: greyhound erotica ahead - includes pix of genitalia) 
The vet and I really need to have a chat today about all this!
(or at least try to express his bladder)
)
You are what we call a "diagnostic dilemma"! 
What's happening with all of our Massachusetts hounds??
Need Help Locating A Document
in Health and Medical discussion
Posted · Edited by houndznigz
Here are a few, plus a link to the Epi-angels webpage, which is an invaluable resource. Best of luck, and I hope you can get Booker's episodes under control!
interactive seizure diary For logging seizures)
CCD tests (criteria for diagnosing CCD)
Epi-angels
Epi-angel website