Possible Lepto/auto-immune/?

[Guest SLH2]

Hi all

 

We're desperate for some advice. Some of the regulars here might remember us -- I used to post here several years ago under the username 'santaslittlehelper'. We have the best b&w tuxedo grey in the whole world, Scooby.

 

Scooby turned 9 in February. In late December, at his 'senior checkup' his bloodwork/physical results were fine -- in fact, the vet said he was in fantastic health. Late Feb, we noticed his appetite dropping off. His sister Daphne (also a littermate) had a drop in appetite, too. Scooby has always had periods where he 'goes off his food', and we assumed it was a food issue, and changed kibbles a couple of times. Nothing helped.

 

Fast forward to March 5: he went outside for a potty break and within a few seconds was screaming, with his front left leg raised off the ground. We rushed him to the local vet, who thought he was exhibiting neck pain, and gave him an analgesic injection and a 'script for Rimadyl.

 

He took Rimadyl for 3 days, but had an increased lack of appetite (he would still eat treats) and some vomiting. We took him off Rimadyl immediately.

 

On Sunday the 9th March, we took him for a gentle walk, and noticed his rear right leg slightly dragging on the ground. He spent Monday at the local vet, where blood test results showed elevated liver enzymes, pain at multiple points on his spine, and neurological issues. An x-ray revealed nothing. Our local vet recommended the 24 hr emergency vet hospital, where we took him, immediately.

 

Over the next week, he was seen by a neurologist, internal medicine specialist, and an orthopedic surgeon -- he had a tick panel run (all came back negative). He showed elevated titers for a particular strain of leptospirosis (not high enough for a definitive diagnosis), and highly elevated ANA levels (indicating possible immune mediated disease). He had another x-ray and ultrasound (which showed some abnormalities on his liver, but nothing definitive). They also noted an arrythmia. The ortho surgeon said that some of his issues appeared to be neurological. They didn't give us much hope, but said that multiple tumor sites were a possibility (ie, liver & spine).

 

Currently, he just finished a course of doxycycline (just in case he had a TBD, or lepto); has been on pred for 2 weeks (has not done anything, except increase his appetite a bit), and azathioprine (for 5 days) in case he has an immune mediated disorder, and Tramadol for pain. We re-checked his liver enzymes which had not improved.

 

He's lost a lot of weight and muscle, he appears to be declining fast (this morning, he had dark tarry stools, had some blood in his vomit, and is now bleeding from a sore/ ulcer on his lip). His mobility is declining. The internal specialist has recommended Prilosec and cutting his prednisone dosage in half (to 10 mg x 2 daily), thinking he may have developed a stomach ulcer. She wants to re-check his platelets.

 

Please, this might be a lot of info, but if you can provide any insight , it would be appreciated. I've enabled my email in case anyone wants to contact me directly. Thanks for any input.

 

- julie & scooby

Edited March 28, 2008 by SLH2

[Guest jurishound]

I have nothing helpful to offer - just wishes for the best possible outcome for Scooby.

[fritofeet]

I have no idea either, but I'm adding my prayers for answers and relief for you and your pup.

[Guest MomofSweetPotatoes]

if he's having dark tarry stools and blood in his vomit, then his stomach lining isn't good. It's probably from the pred. As suggested to me, I would ask for carafate (sulcrafate) get it in a slurry and down the hatch. It will help the stomach.

 

I am going through somewhat similar stuff with my old guy regarding stomach and appetite issues.

 

If he's not eating too much, we found, purely by accident, that ensure weight gain, frozen in cups made a good treat for our guy and got calories into him. However, where you've got stomach issues, I would say bland diet or even admit into the hospital for IV therapy.

 

I hope Scooby feels better soon. Poor guy. Please keep us posted. You will be in our thoughts here.

Edited March 28, 2008 by MomofSweetPotatoes

[Guest SLH2]

if he's having dark tarry stools and blood in his vomit, then his stomach lining isn't good. It's probably from the pred. As suggested to me, I would ask for carafate (sulcrafate) get it in a slurry and down the hatch. It will help the stomach.

 

Thanks MomofSweetPotatoes. Sorry to hear you are going through something similar. It's tough.

 

Scooby's vet thinks it is the pred causing the gastric upset, too. He was taking carafate when this all started, but only had a 5 day course. I can ask the vet if she thinks we should put him back on this again. We've only noticed the tarry stool/blood in vomit once at this point.

 

Fortunately, the prednisone did help increase his appetite: he's not eating regular dog food, but is eating a lot of calories (vanilla Ensure is one of the things he loves).

 

We've got a vet coming out to the house today to take some more blood work for Scooby (he gets extremely anxious at the vet), and we'll take it from there.

 

ps Thanks for the well-wishes fritofeet and jurishound.

 

 

[Guest Machbragal]

I don't have anything helpful, but I wanted to say that I am praying for Scooby. I hope you can pinpoint what is going on. Please keep us posted. Poor baby!

[Burpdog]

I think about you often! Poor Scooby

 

Did he improve after the doxy? What are his platelets?

 

If he is on the pred he needs the carafate as well as pepcid, tagamet or zantac.

 

Milk thistle is good for the liver.

 

Sending many prayers!

[Guest SLH2]

I think about you often! Poor Scooby

 

Did he improve after the doxy? What are his platelets?

 

If he is on the pred he needs the carafate as well as pepcid, tagamet or zantac.

 

Milk thistle is good for the liver.

 

Sending many prayers!

 

Hi Diane, it's good to 'see' you:

 

Scooby didn't improve at all after the doxy. He's been on a sort of steady decline. Ugh, it's hard to type that. I am not sure what his platelet levels are but I can get an answer on that. He is having those re-checked today (he's having a CBC and chem panel taken).

 

We had been giving him Pepcid twice a day, but the internal specialist thinks we should move on to Prilosec now (presumably because of the possible stomach ulcer issue).

 

Thanks for your great input. It's so hard to see Scooby go through this -- 9 does not seem 'old' to me for a greyhound!

 

ps Thanks for the well-wishes Machbragal.

[NancyB]

Julie I'm so sorry to hear about Scooby. I hope you figure out what is wrong, sending prayers.

[Guest MZH]

Wow, this is so vexing; our 9 year old fell apart too a couple months ago, so I know something about how you feel.

 

It sounds like you've done just about everything. A CT scan might be useful since they're very good at detecting tumors as well as other problems. Poor Scooby has so many different issues it must be terribly difficult deciding what to do next.

 

Has anybody mentioned inflammatory bowel disease in addition to the other possibilities? Maybe the ZD diet would be helpful for the digestive issues.

 

I'm sorry you're going through this.

 

Marcia

[Burpdog]

There are several TBDs that respond to different antibiotics. Has he been tested for RMSF? Have they treated him for lepto? Dr. Couto mentioned he has seen an increase in bartellenosis (sp) and that the treatment is zithromax. If nothing shows, it won't hurt to try it.

 

Even with prilosec (which is a good med), he needs carafate!

 

also: you or your vet can call or email Ohio State:

 

Medical Consult: greyosu@osu.edu

 

(614) 292-3551

Edited March 28, 2008 by Burpdog

[Guest trevdog]

no ideas but sending him lots of good thoughts. I agree I'd contact Dr Couto....

[Guest vahoundlover]

No ideas either, sending lots of prayers to you and Scooby.

[Guest SLH2]

Wow, this is so vexing; our 9 year old fell apart too a couple months ago, so I know something about how you feel.

 

It sounds like you've done just about everything. A CT scan might be useful since they're very good at detecting tumors as well as other problems. Poor Scooby has so many different issues it must be terribly difficult deciding what to do next.

 

Has anybody mentioned inflammatory bowel disease in addition to the other possibilities? Maybe the ZD diet would be helpful for the digestive issues.

 

I'm sorry you're going through this.

 

Marcia

 

I'm sorry to hear about your pup, too. All of the vet's we have seen seem to think nine is ancient for a dog of Scooby's size, but, somehow nine just does not seem old to me.

 

At this point, we have decided not to do the CT scan or liver biopsy, for a few reasons (the biggest one being if he does have liver/spine tumors, there is really nothing we can do). We were hoping he would respond to the doxy/pred treatment if he did have a TBD/auto-immune disease. He hasn't responded at all though, and is getting worse.

 

Nobody mentioned IBD -- at this point, I am not sure a special diet would work for him. His appetite has been so poor, and he has lost so much weight, we've been encouraged to feed him whatever he'll eat.

 

Thanks again for your thoughts and input.

 

ps Hi NancyB: thanks for the good thoughts for Scooby.

 

[Guest SLH2]

There are several TBDs that respond to different antibiotics. Has he been tested for RMSF? Have they treated him for lepto? Dr. Couto mentioned he has seen an increase in bartellenosis (sp) and that the treatment is zithromax. If nothing shows, it won't hurt to try it.

 

Even with prilosec (which is a good med), he needs carafate!

 

also: you or your vet can call or email Ohio State:

 

Medical Consult: greyosu@osu.edu

 

(614) 292-3551

 

I think the doxy course should have knocked out the lepto if that was causing his problems? I would have to ask about RMSF: I know that he did have a tick panel done, but I am not sure what that typically covers.

 

We did send an email to Ohio State but haven't heard anything back yet (this was a few days ago -- we assume they are extremely busy).

 

He is declining so fast at this point, we don't know how much time we've got left with him. His quality of life is so poor, we just don't know how much more we should put him through. It's very hard.

 

Thanks again for your advice, Diane.

 

ps And, thanks trevdog and vahoundlover for the good thoughts for Scooby.

[Guest mandm]

We went through something similar a few years back with a young greyhound. Vets initially suspected TBD, then Lepto -- tested for everything, or so they thought. Never tested for Babesia Canis, but tested for Babesia Gibsoni! Like your greyhound, mine did not respond to Doxy, because a different drug is used to treat b. Canis. Depending on where you live and where the tick panel was sent, b. Canis may have been omitted. Probably not, because it sounds like you & the vets are sharp, unlike my vets & me. But I thought I might offer my experence, just in case.

Edited March 28, 2008 by mandm

[Burpdog]

Good point.

 

Call Ohio State asap as it is Friday and they are on Eastern time.

[Guest SLH2]

That is interesting mandm. Do you recall which antibiotic your grey responded to?

 

Well, we've got an email through to Scooby's internal specialist asking whether he has been tested for Babesia Canis, and Rocky Mountain Spotted Fever. Also, whether it would hurt to try a different antibiotic (zithromax, like Diane mentioned) for him.

 

If we did try a different antibiotic, how quickly should we expect to see a positive improvement? With the doxy, I'd read that you should see a positive improvement within a matter of days.

 

Thanks again all for the advice -- it is scary how quickly health can decline, and it's hard for me to process everything (especially because Scooby has such a huge list of weird symptoms going on that are difficult to pin down to one thing). He has required constant monitoring the last 3 weeks (we are not able to leave him alone, because he's so ill), and it's tough to see him still declining and questioning whether you're doing the right things for him.

 

 

[Burpdog]

Results -- Doxy, at a strong dose, 5 or 6 days, or if you start with a shot of doxy and dexamethasone and follow up with oral, around 3 days.

 

If he has babesia canis doxy nor zithromax will help. It won't hurt to try the zithromax--I think you'd know in a few days.

[Guest SLH2]

Results -- Doxy, at a strong dose, 5 or 6 days, or if you start with a shot of doxy and dexamethasone and follow up with oral, around 3 days.

 

If he has babesia canis doxy nor zithromax will help. It won't hurt to try the zithromax--I think you'd know in a few days.

 

We heard back from the internal specialist this afternoon who said that he did test negative for babesia canis and rocky mountain spotted fever. She said she would not be opposed to writing a script for zithromax if we did want to try it, but said it is unlikely given his test results that it would give any additional benefit... The only positive result that came back on that series of tests was the ANA which was quite high.

 

Had a vet come around to the house this afternoon to take his blood work, and just give him another physical checkup. It was so nice to see Scooby having his checkup at home -- he was a lot more relaxed.

 

The bad news is that when she was feeling around his abdomen area, his liver felt thicker/hardened (I forget the term she used). He exhibited a lot of pain on his spine/neck again. The blood results should be in tomorrow afternoon, and we'll see what they say.

[Guest mandm]

That is interesting mandm. Do you recall which antibiotic your grey responded to?

Imizol is what is used to treat babesia Canis. But unlike antibiotics, it is a hard treatment, and would not be given w/o proof or strong suspicion of b. Canis. While TBD titers are not fool proof, he likely doesn't have it if he was negative. The titers were done prior to Pred, it that correct? Because if they were done after he started on Pred, then the titers would probably not be accurate.

 

[Guest SLH2]

That is interesting mandm. Do you recall which antibiotic your grey responded to?

Imizol is what is used to treat babesia Canis. But unlike antibiotics, it is a hard treatment, and would not be given w/o proof or strong suspicion of b. Canis. While TBD titers are not fool proof, he likely doesn't have it if he was negative. The titers were done prior to Pred, it that correct? Because if they were done after he started on Pred, then the titers would probably not be accurate.

 

He had the titers done before he started on the pred. I've just heard back from the vet again and got more detail: he tested negative for babesia Canis, but was not tested for the other strain, babesia Gibsonii (in which case, I think the treatment is doxy which he's already had with no success).

 

 

 

 

[Trudy]

Julie -

was the ultrasound strong enough to get good images of the liver?

If there are issues with his neck/spine - what are they thinking? Ryan's neuro was adamant he had cancer in his neck. Turns out his neck problems were due to a HUGE clot that went almost the entire length of his neck in a weird area which they saw with an MRI. Nobody saw any cancer. May be worth doing an MRI if it can rule out/in tumors in/on his spine.

 

Also, if he's got a bleeding ulcer, I'd STOP the pred, put him back on carafate again and start dosing 2x a day with prilosec. The pred isn't going to allow that ulcer to heal up as long as he's still taking it.

 

Good luck with you and Scooby.

Is Daphne start to go down the same path or does she seem better now?

[Guest mandm]

he tested negative for babesia Canis, but was not tested for the other strain, babesia Gibsonii (in which case, I think the treatment is doxy which he's already had with no success).

 

The other type, b. Gibsonii is really, really rare in greyhounds. It is a pitbull disease. And it's very hard to treat, it's not treated with Doxy. As I understand it, the best treatment is not available in the U.S., but American vets can get their hands on it if necessary. The e-vet handling my greyhound procured some, but b. Gibsonii was not the problem.

 

It's so hard trying to figure out what to do. Maybe try the Zithromax. If I remember correctly, it's been a few years, Bartonella was one of the diseases they tested my greyhound for. They said the symptoms fit, very low platelets & GI distress. My greyhound had also gone lame, but I don't remember if that was one of the Bartonella symptoms. Mainly, I think, it was the low platelet/GI distress combo.

 

[Guest SLH2]

Julie -

was the ultrasound strong enough to get good images of the liver?

If there are issues with his neck/spine - what are they thinking? Ryan's neuro was adamant he had cancer in his neck. Turns out his neck problems were due to a HUGE clot that went almost the entire length of his neck in a weird area which they saw with an MRI. Nobody saw any cancer. May be worth doing an MRI if it can rule out/in tumors in/on his spine.

 

Also, if he's got a bleeding ulcer, I'd STOP the pred, put him back on carafate again and start dosing 2x a day with prilosec. The pred isn't going to allow that ulcer to heal up as long as he's still taking it.

 

Good luck with you and Scooby.

Is Daphne start to go down the same path or does she seem better now?

 

Hey Trudy

 

I think the ultrasound got good images of the liver where they saw multiple lesions. But, w/out doing a liver biopsy they can't say for sure what the lesions are. With his mobility issues steadily worsening (neck, front left leg, and both rear legs), the neuro said that it was possible that he also has multiple tumors on his spine (without an MRI we can't know for sure on that either. The x-rays he had didn't show anything, but that's not really surprising).

 

At that point, he was already so sick (and heavily stressed w/ medical stuff) we decided to start with the treatment for possible TBD/auto-immune disease, because we felt it was the only condition that we really could treat, anyway.

 

Btw, is it safe to stop prednisone suddenly if they have been on it for a while? I thought they had to step down the dosage. At this point, we're scared to stop this treatment because it is the only thing that seems to be remotely doing anything (ie, he is eating a bit again). He hasn't vomited again, and his poops (while not healthy looking aren't the dark, tarry color they were)...

 

ps Daphne's appetite is completely back to normal. I am not sure what triggered her appetite loss (it was never as bad as Scooby's to begin with), but it was an odd coincidence for a while.