feemandvm

You definitely need to find out if she has any predisposing factors setting her up for a stroke. Blood pressure, general bloodwork and clotting times (see if she is hypercoagulable) would be a reasonable start. I would definitely discuss this with your neurologist! Here is some good information on strokes that should help you with your conversation. http://www.VeterinaryPartner.com/Content.plx?P=A&A=2354

60,000 is too low... not normal. What has been done to work her up? TBD titers? here is a link to some good information: http://www.VeterinaryPartner.com/Content.plx?P=A&A=1412

Perfectly safe for Greyhounds. It is convenient as it has both heartworm coverage and it also kills fleas. It only protects against 1 species of tick though and does not have GI parasites (hooks, rounds, whips) on the label. If your dog is on Revolution and gets those parasites, however, Pfizer will pay for the treatment (and maybe the fecal). It isn't the answer for every dog but is safe (it is actually even labeled to be safe in heartworm positive dogs) and is a great option for some dogs.

Greyhounds do run higher UPC ratios than other breeds... but we don't know the significance of that b/c Greyhounds have a higher incidence of glomerulonephritis (GN) than other breeds. OSU is doing a fair amount of work on Greyhounds with GN so in the future they may be able to answer that question. There is also a significant variation in the UPC ratio from day to day. The last value of 0.4 is somewhat surprising... but in a good way. I guess I'd recheck it in a month and see if that value was repeatable.

There was a lot of discussion on this at The North American Veterinary Conference. The question was why is a level of 30 considered a level high enough to treat? Severity of signs or liklihood to develop signs has NOT been associated with higher levels... it just seems to be random dogs (dogs may be sick with a level of 10 and healthy at 110). The level of 30 picked by IDEXX is arbitrary and not really based in science. The recommendation of the ACVIM is not to treat an asymptomatic dog no matter what the C6 is. Now if you treat, you should pursue a C6 titer as a response to treatment has been associated with a signficant drop in c6 levels so they do recommend a baseline c6 and retesting 6 months later to see if response was "adequate". Here is a link to the ACVIM position paper: http://www.acvim.org/uploadedFiles/Consens...20in%20Dogs.pdf

You need a urine protein creatinine ratio. If the level is >1 then you will need to discuss treatment... but not fluids (see below). If it is 0.5-1 then I would recheck it in 4 weeks... no treatment needed. If it is <0.5 then no follow-up needed... the 2+ protein was a false positive on teh stick due to urine concentration. http://www.VeterinaryPartner.com/Content.plx?P=A&A=1352

OK... clearly there are some very different opinions on TBDs here on GT... so just thought I'd list some common comments I've seen and give an opinion on them. 1. "If you suspect a TBD, put them on Doxycycline just in case". Not all TBDs respond to doxycycline so a trial of doxycycline does not rule out a TBD. If there is a strong suspicion of a TBD then Doxy can be started pending titer results... but it should not be used instead of titers. 2. "My dog has a TBD because the titer was positive" The only thing a titer can tell you is exposure. Certain titers are more suggestive of infection... but techincally they really only can tell you that your pet was exposed to a TBD and not that they are actively infected with one. As an aside... did you know that 95% of dog's with a positive Lyme titer will never have a single clinical sign or be ill a day in their life (compared to only about 10% of people)? Also... 40% of the dog's referred to the University of Pennsylvania for Lyme disease, actually had another diagnosis and were not actually sick with Lyme disease despite a positive titer. If I have a healthy dog and they have a positive titer to a TBD... I may look into general labwork but I am very rarely going to be convinced to treat a titer w/o bloodwork or clinical signs to support it. If nothing else is wrong... how will you ever know if the treatment worked? Titers can remain elevated for years even if the infection is gone. Also, be careful not just to assume the problem is a TBD with a positive titer, work up the dog and make sure the diagnosis "makes sense". 3. "I'm just going to PCR test for TBDs b/c that identifies the actual TBD and not just the body's response to exposure." Great idea in theory, bad in practice. PCRs can have false negative results so I would generally only pursue them if a dog had a positive titer and I wanted to confirm that the titer = infection. 4. "The RIGHT dose of Doxycycline is 5 mg/lbs twice a day." This dose is completely arbitrary and based on zero scientific fact. Just to show it wasn't only my opinion that this statement is incorrect, I contacted The Ohio State University, University of Florida, North Carolina State University and Texas A&M and none of those veterinary teaching hospitals believed that 5 mg/lbs was the "right dose". In fact, not one of them said they would use that dose. An argument for this protocol is that some strains of Ehrlichia COULD need a dose almost this high. While this is possible, it is like saying we should treat every urinary tract infection with 8 weeks of Baytril b/c some infections could require this. THe "right dose" of Doxycycline is 5-10 mg/kg orally once to twice daily. If your vet isn't using 5 mg/lbs of Doxycycline 2x/day it doesn't mean that they are "out of the loop"... it means they are actually doing what is recommended by every tick borne disease expert at the major teaching universities. 5. "It is safer just to treat my dog for Babesia or Ehrlichia based on a high titer than not." The treatment for babesia is far from a benign medication and can potentially have some serious side effects. I would feel terrible if my dog had a serious side effect from a drug that they never actually needed. If bloodwork was normal and the dog had no signs, I would definitely pursue a PCR test before commiting to treatment. While doxycycline may have fewer side effects, do I really want to put a dog on 8 weeks of an antibiotic that doesn't need it? How do you think we ended up with such nasty resistant bacteria in the environment? It has been due ot the use (or misuse) of antibiotics. Could we be setting these dogs up for resisitant infections in the future by giving them 8 weeks of antibiotcs that they don't need? Hard to say for certain but 8 weeks of doxy isn't risk free.

I heard it (Tramadol) might have been taken off the list... not 100% certain on that. You can call the pharmacy directly and ask though.

The dog's rarely complain about it... but if there is an exposed root... it is extremely painful. I'd get him to the vet ASAP to see what options you have.

A normal Greyhound can have platelets as low as 80,000 so 86,000 is not overly concerning. I tend to investigate things at <100,000 but again values as low as 80,000 can be normal. Unless the level is dropping below 80,000... I personally wouldn't pursue a bone marrow aspirate. I would definitely NOT pursue immunosuppressive medications such as Prednisone or Azathioprine or Cyclosporine to "help the platelets" unless they dropped significantly (they could make treatment of the TBD more difficult). A "transfusion" would not be necessary unless the platelet count dropped below 25,000... and even then platelet transfusions may only help for a few hours so are rarely warranted. Here is some information on low platelets (this is specifically when the immune system malfunctions and attacks the platelets... but it is still good information): http://www.VeterinaryPartner.com/Content.plx?P=A&A=1412 Also... RMSF is an acute disease... it is not something that slowly comes on. The dogs get sick and get treated and recover or they get sick and don't make it. Ehrlichia can lie dormant for years... not RMSF. Last thing... remember that the TBD titers only test for exposure and are not diagnostic for disease... so although she tested positive for 3 diseases... she may not actually have all 3.

No catches... the drugs are safe and effective... they are no different than what your vet would prescribe. The prescriptions are not all for a 30 day supply... it depends on teh drug and the animal's dose. Either way it is a nice savings! This is not at all like an on-line pharmacy where I think legitimate concerns can exist!!! No catches... the drugs are safe and effective... they are no different than what your vet would prescribe. The prescriptions are not all for a 30 day supply... it depends on teh drug and the animal's dose. Either way it is a nice savings! This is not at all like an on-line pharmacy where I think legitimate concerns can exist!!!

As someone else mentioned... the drug companies will not guarantee products purchased through many on-line pharmacies. We had a client purchase HW prevention from PetMedExpress and they turned up positive. When we called the drug company they said that many on-line pharmacies fail to store or ship the products safely and this may result in loss of efficacy of the product. Although this next example didn't occur at our clinic... it was written up in a veterinary journal. A dog in congestive heart failure was on medication and the owner decided to purchase them on-line to save money. The dog died of congestive heart failure and the owner worried about her decision and had her medications tested. Turns out the on-line pharmacy was purchasing the medications from India at a dramatic discount and the medications had almost no active ingredient. : ( While these examples may be the exception to the rule... they should still be pointed out. Best case scenario is your vet price matches on-line pharmacies so you get guaranteed product at discount prices. Vets cannot match Australia prices though b/c they can sell it for less then the vets can even buy it for.

If your vet sends the sample to IDEXX and they use IDEXX for their regular lab... they are not charged shipping. The cost of the test is more than if it was run directly by the other lab... but the cost is rarely as much as the shipping + the cost of the lab. For example, Protatek charges $60 for TBD panel Shipping for Protatek: $50 IDEXX charges #=$90 for TBD panel Shipping= no charge b/c a courier already comes ot the clinic and the lab absorbs the cost of shipping as part of their mark-up. The vet will then mark-up appropriately on either test to make up for their fees and to generate a profit.

No tick control with Comfortis... fleas only so keep that in mind!

You do need to be very careful in which supplement you buy as not all contain what they say they do. On the human side I like Culturelle (www.culturelle.com). On the dog side... I like fortiflora (http://www.purinaveterinarydiets.com/CanineProductDetail.aspx?prod=244).

Asked to comment: My last Greyhound had a natural arthrodesis (fusion) of his joint secondary to a central tarsal fracture that was put in a cast instead of surgically repaired. His 'ankle' was a mess on x-ray but functionally he did well on the leg. He limped a bit in really cold weather but overall was just fine. I think a surgical arthrodesis is a good procedure when warranted. I have no experience wiht stem cell therapy.... here is a link to some more information: www.vet-stem.com/smallanimal/ It is definitely experimental... might help... might not. Don't really see how it can hurt. I wonder how much it costs?

Asked to comment... 1. I would recheck the coagulation panel to see if the elevated partial thoromboplastin time is repeatable. 2. If the value comes back low, I would next send blood to Cornell University to test for hemophilia. At 13 I could certainly understand not wanting to sedate for x-rays, etc... but a bloodtest would be fairly non=invassive IMHO and would be what I would do next.

You can read my issues with NGAP in the thread quoted above. In the end it is up to you if you are comfortable with the procedures that they perform or not.

I'd personally only use NC State for tick testing. They really are the top TBD speicalists in the US IMHO and have PCR testing when indicated and have really been the researchers that discovered hte significance of Bartonella! Other labs may be less expensive but I would be less likely to believe the results so not sure that I would be any further ahead. : ( 163 isn't bad for a GH blood pressure. That is where my GH's is currently and I am trying to decide if I should put her on an additional medication to lower it a little further. I'd love to see it around 140 if possible. It isn't uncommon to see elevating kidney values without a rise of the phosphorous level beyond the normal range. At the vet conference I was just at... the specialists stated that the labs used normal ranges for phosphorous that were "way" too high and it is lulling owners and many vets into a false sense of security.

With protein being lost into the urine (glomerulonephritis) you definitely want a lower protein diet! http://www.VeterinaryPartner.com/Content.plx?P=A&A=1352

#1 Clindamycin A distant #2 would be Clavamox (similar to human Augmentin)

The anemia seen in dogs with kidney disease is NOT due to excessively low protein. The underlying cause is a deficiency of erythorpoetin in most cases. You can also see na anemia of "chronic disease" but this also has nothing to do with the lower protein levels found in most kidney diets. We know that lowering protein is beneficial in moderate/severe kidney failure or when the they have excessive amounts of protein in their urine. I would NOT supplement extra protein... that is something that they have studied and when the kidneys are leaking protein giving the dog more protein simply results in a more rapid progression of the disease. With more routine kidney disease... early on I don't think the protein restriction is beneficial but it is one of the ways they lower the phosphorous b/c it is heavily protein bound. There is no evidence that switching a dog with routine kidney disease (not the urine protein leaking kind) is beneficial... although it would be easy to postulate how it could be. The reasoning for switching earlier in disease is b/c the dogs feel better and might be more apt to accept a diet change. Also, there is hope that although it hasn't been studied the same benefits noted in later disease could exist earlier in disease as well. Home cooking is another option but is expensive and is hard to do well. You would want to contact a nutritionist to make sure you are balancing the diet. There is no evidence to show it is "better" but if it is balanced I can't see how it could be worse. A dropping urine specific gravity could mean anything form early kidney disease to a dog having a big drink of water. Don't take a randomly low specific gravity and over interpret it. Urine that persistently won't concentrate (especially that first one in the AM) would be worrisome for kidney disease. The drop in protein is made up in carbohydrates and fat. There is concern for pancreatitis in "at risk" breeds but in the last 5 years I've had 0 patients develop pancreatitis on the kidney diets. Not saying it cannot happen... just that it isn't common. I would change to a kidney diet if there was excessive protein loss in teh urine documented by an elevated urine protein creatinine ratio (even if the bloodwork was normal). That inherently implies kidney disease no matter if the BUN or creatinine are elevated or not. Did I get to everything?

I just got back from a veterinary conference and one of the topics that I attended dealt with treating kidney disease. Anyway... there is a good paper and research published showing that feeding a "kidney diet" will help slow the progression of kidney disease in patients with mild to moderate kidney disease (see below). IMHO it is not the protein restriction in teh foods that are the most beneficial (at least not in early disease unless there is protein loss in the urine) but the restricted phosphorous and the alkalinizing effect of the diet. The specialists actually recommended starting the dogs pretty early b/c we know it helps them as the disease progresses and it is easier to switch them earlier in the disease b/c they have less GI upset and are more open to diet changes. We need more research to show if the kidney diet is truly beneficial in very early stages or if it just makes the transition easier. Anyway... I've not always been a big fan of kidney diets early in kidney disease unless there is protein loss in the urine but now I'd rethink things a bit: Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs J Am Vet Med Assoc. April 2002;220(8):1163-70. Frederic Jacob1, David J Polzin, Carl A Osborne, Timothy A Allen, Claudia A Kirk, James D Neaton, Chalermpol Lekcharoensuk, Laurie L Swanson 1 Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul 55108, USA. Abstract OBJECTIVE: To determine whether a diet used for dogs with renal failure (renal food [RF]) was superior to an adult maintenance food (MF) in minimizing uremic crises and mortality rate in dogs with spontaneous chronic renal failure. DESIGN: Double-masked, randomized, controlled clinical trial. ANIMALS: 38 dogs with spontaneous chronic renal failure. PROCEDURE: Dogs were randomly assigned to a group fed adult MF or a group fed RF and evaluated for up to 24 months. The 2 groups were of similar clinical, biochemical, and hematologic status. The effects of diets on uremic crises and mortality rate were compared. Changes in renal function were evaluated by use of serial evaluation of serum creatinine concentrations and reciprocal of serum creatinine concentrations. RESULTS: Compared with the MF, the RF had a beneficial effect regarding uremic crises and mortality rate in dogs with mild and moderate renal failure. Dogs fed the RF had a slower decline in renal function, compared with dogs fed the MF. CONCLUSIONS AND CLINICAL RELEVANCE: Dietary modifications are beneficial in minimizing extrarenal manifestations of uremia and mortality rate in dogs with mild and moderate spontaneous chronic renal failure. Results are consistent with the hypothesis that delay in development of uremic crises and associated mortality rate in dogs fed RF was associated, at least in part, with reduction in rate of progression of renal failure.

Asked to comment... I don't find those platelet counts alarming at all. I really don't glance at platelet counts in Greyhounds unless they are <100,000. Batmom is exactly right... there can be a lot of fluctuation in platelet counts in a standard purple top associated with platelet clumping. TBD is a rule out for low platelets and for kidney disease so you can test... but I'd be hard pressed to think that is the cause even with a positive result based on teh history you provided. Still if you have the money, it couldn't hurt to test... just consider a PCR test if you get a positive titer. What is her BP currently? Do you have her on fatty acid supplementation?

Annual heartworm tests are now recommended by the national heartworm society regardless of whether or not a pet is on year round prevention. No heartworm prevention is 100% effective and so the risk of not testing every year is that if your dog has a break through, they may go untreated with heartworm disease for over a year or close to 2 years if they are not tested annually. There is some controversy as to why some dogs on prevention "get heartworm". Is it owner error and a missed dose or did the dog vomit up the heartgard tablet and the owner didn't know? No-one really knows but the current recommendation is to test every year. It used to be every other year if on year round but they changed that a year or two ago.