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Need Advice On Tick Titer Results And Neurological Symptoms


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Hi everyone,

 

I apologize in advance for the lengthy post, but I want to get all the details in here so I can get the helpful and insightful advice from the greytalk experts! :)

 

Two years ago my girl greyhound who, at the time, was undergoing a serious neurological emergency that was determined to be meningoencephalitis from an undetermined cause. She underwent MRI, CT scan and all kinds of testing at the time, including a "tick serology" test from her normal vet, which they said was "negative". At the time it was such a life-threatening emergency I didn't think anything more about the "negative" tick test and we started going to her neurologist instead of the regular vet immediately. She's had symptoms reoccur and then go into remission over the last two years since she had her emergency diagnosis. So with the advice of her neurologist, we go up on the prednisone dosage when she shows signs of relapse, as we have been doing over the last two years.

 

Fast forward to today, she recently relapsed and started having the neurological symptoms she had before; lethargy, weakness, ataxia, squinting eyes, third eyelids up when her eyes were open, just being "out of it" etc. I asked her neurologist if we should do a tick titer test now and he said we could, but that the one done 2 years ago by her normal vet was "negative" back when she first got sick. I said had him run the tick titer test again now anyways. So it came back with results that I don't know how to interpret. The neurologist tells me that the "slightly elevated levels" of tick borne disease just mean that she was exposed to the disease at some point in her life but doesn't necessarily indicate a current infection. He also said that since she is showing improvement currently with increased prednisone dosage that if she did have a tick borne disease, she would not be getting better with the prednisone.

 

Regardless, I want to be very proactive about this to protect her health, so I asked him if we should just go ahead and do a course of doxycycline (or whatever other medication to knock out any possible disease). He said we could do doxycycline, but that it causes GI trouble and that instead we could just check her titers levels again in a month.

 

Her Details:

Currently she is 7 years old and we have been managing her symptoms of neurological problems for the last two years with prednisone.

 

Here are the tick results from last week:

Ehrlichia= <1:80

Lyme= Negative

Rocky Mountain Spotted Fever= 1:128 (High)

 

I am picking up the detailed results from her tick test that was done 2 years ago when she first got sick and I will update the post with those results as soon as I get it.

 

So, the question is to you all: What should I do? Any recommendations or suggestions are very appreciated! Thank you all in advance for your help and advice!

 

Danielle

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I would treat with doxy, as in fact I am with my 7 y/o Shane. He had a variety of symptoms (e.g., heat sensitivity, lack of stamina for walking even a few blocks, limping) that came and went over three years. Bloodwork was always close to perfect. Finally thought to test him for TBDs, and he was low-positive (1:40) for Babesia and treated with Imizol, which took care of a lot of the symptoms but not all. My vet feels the symptoms remaining are consistent with Erlichia, so we're using doxy, and he continues to improve. (Dr. Holland at Prototek told my vet that there are many more varieties of these TBDs than they test for in a typical panel, and it could take a lot of testing to find the exact variety that he's positive to. So since doxy treats all of them, we decided to just go ahead and treat. And none of us are sorry, least of all Shane!)

 

He has had no stomach difficulty. But we are careful to wrap the pills in canned food and give them with his meals. On a few occasions we've given Pepcid when we weren't sure his tummy was 100%.

 

And I'm sure someone more expert than I will jump in and discuss how prednisone has a way of taking the breaks (oops) brakes off latent TBDs.

 

It has been very gratifying to watch Shane become stronger and more vivacious with this treatment. It had hurt to watch him living a sub-optimal life and not know why. Lots of people advised not to treat a low titer. A few other people said otherwise. We decided it was a disservice not to treat, and in our case I think we were right. I hope you find the best answer for you.

Edited by greyhead
Mary with Jumper Jack (2/17/11) and angels Shane (PA's Busta Rime, 12/10/02 - 10/14/16) and Spencer (Dutch Laser, 11/25/00 - 3/29/13).

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If it were me, I'd start treating with Doxy, it can't hurt and it certainly can help. Gee just went through 10 days with Doxy after having teeth pulled and had no problems with her stomach. I think if you give the meds with food the chances of it causing any problems are small.

Judy, mom to Darth Vader, Bandita, And Angel

Forever in our hearts, DeeYoGee, Dani, Emmy, Andy, Heart, Saint, Valentino, Arrow, Gee, Bebe, Jilly Bean, Bullitt, Pistol, Junior, Sammie, Joey, Gizmo, Do Bee

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Oh, thank you so much for that information! Very interesting, as my girl shows the same symptoms as your boy; she is very sensitive to heat, has a lack of stamina and tends to stumble and limp when she feels bad!) It has been sad to not know what exactly is causing her symptoms (besides idiopathic meningoencephalitis, as her neurologist explained) and how to help her, but I feel like I'm getting some great insight with advice from greytalk people! :)

 

If you (or someone else) could explain more about "how prednisone has a way of taking the breaks off latent TBDs" that would be great. I assume you mean the prednisone helps to lessen the outward symptoms of TBD but doesn't actually "cure" anything, is that correct?

 

So, do you think there is any downside to me just going ahead and treating her with doxy? (besides tummy upset, which is no big deal compared to the scary neurological symptoms!) Maybe I should do tell the vet that I want to give her a course of doxy just to make sure she's ok, as long as the only potential side effects are GI related.

 

Are there other medications that are given for TBD besides doxy or does doxy cover all the possible TBD (i.e. ehrlicia, rocky mountain, lyme, etc.)?

 

 

Here are her titer results that were done two years ago:

Ehrlichia= <1:20

Lyme= Negative

Rocky Mountain Spotted Fever= Negative

 

 

My question is this: why is the "referenced range" on Ehrlicia different on her two different test results? Wouldn't the "reference range" stay the same and her values change?

The test from 2008 says "Ehrlicia reference range is <1:20 and that her results were <1:20. The test from last week says "Ehrlicia reference range is <1:80 and her results were <1:80"

 

I am not very familiar with tick titer levels and how to interpret them, as many of you on greytalk are, from your experiences. Any insight or information is VERY appreciated! I want my girl to get well ASAP! :colgate

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Just quickly, because I have to dash:

 

Prednisone suppresses the immune system, right? And the immune system keeps TBD's and all disease processes in check, to the extent that it can. When it is overwhelmed or inefficient, or lessened in effectiveness by an immuno-suppressing medicine, a disease is more likely to manifest or even take over.** So I was saying that your dog's immune system may have been keeping the TBD more or less in check, or keeping the brakes on it. But prednisone takes the brakes off and causes the TBD to become more evident.

 

If a dog is really known to have a TBD, prednisone is usually not given. The TBD should be cleared first. But in your case it sounds like the prednisone must be continued for neurological health! So I'd go ahead and give doxy for the suspected TBD. As Judy said, it can't hurt and it might help.

 

Just a note, though, to mention that I think the immune system's having to work hard to keep a TBD in check is what makes our dogs function less than optimally. I'm not convinced that the size of the titer necessarily reflects that. (The relationship between symptom severity and magnitude of test result is not always linear in medicine. Another example is TSH in hypothyroidism. The magnitude of the TSH is not strongly correlated with the severity of the symptoms.)

 

**Except, of course, when the disease is itself defined by overactivity of the immune system, and then pred and other drugs of that kind are needed to keep the brakes on the activity of the immune system. As with Inflammatory Bowel Disease, which our *other* dog has, where too much inflammation IS the problem! And I'm assuming that's also the deal with your dog's neurological problem.

 

Sorry I have to rush off. Glad I could help at all!

Edited by greyhead
Mary with Jumper Jack (2/17/11) and angels Shane (PA's Busta Rime, 12/10/02 - 10/14/16) and Spencer (Dutch Laser, 11/25/00 - 3/29/13).

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This is such a hot button topic in the greyhound world but, like the others have said, we have never experienced side effects with Doxy. Regardless of the titer, I'd treat the symptoms. I had a boy with similar titers and he never showed a symptom so we did not treat him. He was fine to the age of 14.

Edited by packmom
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Why is it such a hot button topic? Do you mean that people tend to disagree on whether or not to give antibiotics when titer levels are elevated?

 

Thanks!

 

People disagree about what numbers mean infection,when do you treat, labs disagree in the results, groups disagree about what kind of testing to use... you name it! :lol

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Why is it such a hot button topic? Do you mean that people tend to disagree on whether or not to give antibiotics when titer levels are elevated?

 

Thanks!

Yup, they (we) sure do! Some of the difference is due to different experiences. Some is due to philosophy of treatment in general and meds in particular. We all mean well. smile.gif

 

Sometimes I feel as if maybe I discuss my own dogs too much in replying to people; but they are the basis for most of my experience with veterinary medicine. The rest of my experience/philosophy comes from a bit of experience as a patient myself and from studying enough statistics in school to make me skeptical of decisions based solely on statistics. Our professor insisted that we learn to be skeptical about the use of statistical procedures! And he taught us why. (And the short course there is that it's a double-edged sword that can do a lot of good but also a lot of bad in the wrong hands and wielded in the wrong way. And the "wrong way" would be without critical thought, among other things.) But you sound entirely up to the job of critical thought, so I'm not worried for you. Which is really good because, unfortunately, people studying to be MDs and DVMs don't study anywhere near the statistics and research methods that people studying to be PhDs even in social sciences do. Our vet also has a PhD in neurology, lucky us.

 

As to your earlier question on the reference ranges, that confuses me too. There's more than one kind of Erlichia, and maybe they have different threhholds, or maybe the standard has changed, or...I don't know! Hope somebody who does know will jump in.

Mary with Jumper Jack (2/17/11) and angels Shane (PA's Busta Rime, 12/10/02 - 10/14/16) and Spencer (Dutch Laser, 11/25/00 - 3/29/13).

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Guest ChasesMum

if you look for posts I have starts (click on my name, click on posts I have started) you can find my tick disussions and a link to a tick email list that might be helpful to you as well to join.

 

For Chase we specifically had an ehrlichia positive SNAP test (as your vet said, it tells us that she has been exposed in the past) so we ran the PCR (Polymerase chain reaction) to look for ehrlicha dna in her blood. it too was positive so we treated with Doxy. I don't know if that test helps you at all, but the SNAP tests for ehrlicha Canis and not the multiple other ehrlicha strains that dogs can have, so its only so diagnostic (as was said before)

 

Chase was on both Doxy and pred which isnt ideal. - the way i understood is pred is an immune suppressant which keeps a reaction under control but her immune system NEEDS to react a lot to get the ehrlichia under control. suppressing the immune system can allow a tbd to bloom since the immune system can't ramp up. so its a balancing act...

 

our vet said that while on doxy for ehrlichia they monitor platlets to come up and ... umm ... another level to come down. the protein/creatinine ratio maybe? I can't remember now. I had so much info overload and emotional overload that month between diagnosis and loss. SO maybe there is monitoring you can do to see if doxy is helping? There is also a range of dosage, Chase could have been on anywhere from 150 to 300mg twice a day. maybe there is a lower dose that you could try out, see if it helps? Many say to clobber it with the largest dose possible (this causes most stomach upset) and others like to play the safety. Talk to your vet and see what they say.

 

you can also see if Dr Suzanne Stack has info on www.greythealth.com that may be of help. I know there was ehrlichia info on there.

 

chase had neurological symptoms too, nothing quite clicked with her - always something was off. in the end we didnt even get a solid cancer diagnosis and yet, she still died. I feel like we missed somehting somewhere, but I don't know what. She was swelling, no one could seem to offer any ideas on getting that under control. if I can be of any more help please feel free to pm me.

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  • 1 month later...

Update on my girl:

 

I convinced the doctor to put her on a course of doxycycline since she was tested twice positive for RMSF from two different labs. Her bottle of Doxy says 100 mg and to administer 2 pills in morning and 2 at night, so does that mean it's 100 mg Doxy per tablet or per dose (a dose being 2 pills at once = 100 mg?)

 

 

If they are indeed 100 mg. Doxy each tablet, he's got her on Doxy 100 mg pills, two pills in am and two in night, so that's 400 mg daily, correct? Along with Prednisone 20 mg in am and 20 mg pm, so daily total of 40 mg. Prednisone.

 

She started the Doxy 9-9-10 and he said she'll be on it about a month at least.

 

Question: Is this dosage of Doxy high enough to treat a TBD like this?

 

Some veterinary doctors I've read about said "The dosage we recommend on Tick List is an aggressive one: 5 mg. of doxy per pound of body weight given every 12 hours for 8 weeks."

 

So, my girl is about 65 lbs, so if she's getting 400 mg. Doxy daily does that seem like the right amount?

 

Sorry I get SO confused with numbers, math, dosages, etc. :P

 

Any help from fellow Greytalk experts would be GREATLY appreciated and thanks in advance! :)

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Some veterinary doctors I've read about said "The dosage we recommend on Tick List is an aggressive one: 5 mg. of doxy per pound of body weight given every 12 hours for 8 weeks."

 

I believe this dose is for erlichia. Not sure the treatment for RSMF is the same. Why not ask on the tick list?

Diane & The Senior Gang

Burpdog Biscuits

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Guest cruzNhounds

Web searching I found this about prednisone, not sure if it would be the same in your dogs case but it makes sense to me. Poppie has been on both, doxy 4 months and pred 3 months.

"If immune-mediated secondary reactions to the Ehrlichia are a problem (such as immune-mediated arthritis, or immune-mediated platelet loss) corticosteroids such as prednisone can be used to palliate the situation while the antibiotics are starting to work." http://www.marvistavet.com/html/body_ehrlichia_infection_in_dogs.html

 

 

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Danielle, sorry to read she is having more trouble. Poor baby, she's really gotten a bad deal with this.

 

From info on the UGA site it appears that dosage is within range for RMSF of 10-20 mg /kg body weight given twice a day. For a Grey Bina's size that would mean approx 300-600 mg every 12 hours. She is getting 400 mg twice a day so that is smack in the middle. Note that is also says, "Anti-inflammatory doses of prednisolone have been shown to have no negative effects on the treatment of RMSF, although antibody titers may be decreased."

 

Hoping Bina is better soon.

 

Laura with Venus & missing Sir Luke

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The bottle says Doxyclycline 100 mg, give two tablets twice per day so does that mean EACH tablet is 100 mg or that the dosage of 100 mg. was for TWO Doxy pills, therefore she'd be taking only 200 mg. daily instead of 400 mg? I get so confused with conversions and all that stuff. Thanks for helping me sort it out.

 

She's been on the prednisone non-stop for the last two years since she first fell ill. We've titrated back up and down over time to adjust, but currently she's doing 40 mg. daily. It does seem to keep the outward symptoms of her illness away, especially the higher the dosage of prednisone.

 

However, with her confirmed RMSF tests, I insisted we do a course of Doxycycline so I wanted to check with the experts here at Greytalk to make SURE that dosage was high enough to knock out any infection or tick-based evils.

 

With this current medicine regimen, she seems to feel pretty well, with hardly any outward symptoms of relapsing Meningoencephalitis. However, one concern of mine is the weakness and atrophy of her rear leg muscles and alongside the spine area. That was something that seemed to get better about a year after her treatment began, but now her poor little back legs seem SO weak, she struggles to hold herself up to pee but I let her do it herself to hopefully strengthen those muscles. The muscle area alongside her spine is disturbing, as it seems to get atrophied so quickly when she has a relapse. I'm thinking I could take her back to swim therapy to strengthen those muscles back up, but I don't know if it would be too stressful on her system.

 

I just want Bina to be able to live a long, happy, fully mobile life. I read a post on Greytalk where someone was talking about their grey and once they gave them the course of antibiotics for suspected TBD that her dog was like a puppy again, all healthy, happy and well. I was hoping for a rapid and radical transformation in Bina once we started the Doxy, but I'm not sure what to think now.

 

Thanks for the support, everyone! I truly appreciate it with all my heart! :)

 

 

 

"Danielle, sorry to read she is having more trouble. Poor baby, she's really gotten a bad deal with this."

Thanks for your concern, Laura.

Her neurologist told me he lost his own, personal dog to GME and that he treated it aggressively as possible and he still lost her within two months. So he says we're doing pretty good, given all the circumstances (which still sounds scary to me, nonetheless!)

Did you get those pics of Sir Luke I sent you in the mail and did you find any ones that you didn't already have that you loved, he was SO photogenic! I think you'd love to meet my Teddy, he is a total goofy boy and reminds me of a much less distinguished version of The Great Sir Luke. Hopefully in time Teddy will grow to embody the type of wisdom and gentlemanly style that Luke had.

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Guest greytlady93

You've received good info here and I wish you the best of luck in dealing with your pup's health issues.

 

Since these issues have been a part of my life for years, I'll offer my two cents as well.

 

These are my feelings and opinions and others may disagree, but I always like to hear all sides so that when I make a decision I feel as though I have as much info and input as possible.

 

In my area, pups and people suffer from tick bourne diseases even when precautions are used consistently. The illnesses are often not diagnosed or not diagnosed until significant damage has been done.

 

A tick bite is an arachnid bite (spider) and the specific illnesses we usually test for (lyme, ehrlichia, babesia, rmsf) are only a few of the diseases that are carried by these critters. The truth is they don't have any way of knowing what illness or combination of illnesses may be carried by ticks. The tests that have been developed are not always conclusive, levels of disease vary and then there are false negatives which complicate an already complicated situation. It is my experience that many (human) doctors and vets believe that the "new" lyme tests are completely accurate. They couldn't be more wrong.

 

My friend's afghan is dying from lyme related kidney disease and she tested negative for the disease over and over. By the time she tested positive, the damage had been done. Two of her other hounds also originally tested negative and when she insisted the tests be rerun (at the same office visit), they came back positive.

 

My rules of judgement on decisions for my pups begin with these: I know my hounds better than anyone; I know when something is wrong; I seek out as much info and advice as I can; I insist the vet explain in depth their decision and then I determine if I agree.

 

Sad to say, there isn't always a "clear" answer. That's when I follow my gut. If numbers are low, but we are seeing symptoms, honestly, my feeling is better safe than sorry especially if the damage from the untreated disease can be disabling or fatal.

 

Best wishes.

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Guest ChasesMum

Update on my girl:

 

I convinced the doctor to put her on a course of doxycycline since she was tested twice positive for RMSF from two different labs. Her bottle of Doxy says 100 mg and to administer 2 pills in morning and 2 at night, so does that mean it's 100 mg Doxy per tablet or per dose (a dose being 2 pills at once = 100 mg?)

 

 

If they are indeed 100 mg. Doxy each tablet, he's got her on Doxy 100 mg pills, two pills in am and two in night, so that's 400 mg daily, correct? Along with Prednisone 20 mg in am and 20 mg pm, so daily total of 40 mg. Prednisone.

 

She started the Doxy 9-9-10 and he said she'll be on it about a month at least.

 

Question: Is this dosage of Doxy high enough to treat a TBD like this?

 

Some veterinary doctors I've read about said "The dosage we recommend on Tick List is an aggressive one: 5 mg. of doxy per pound of body weight given every 12 hours for 8 weeks."

 

So, my girl is about 65 lbs, so if she's getting 400 mg. Doxy daily does that seem like the right amount?

 

Sorry I get SO confused with numbers, math, dosages, etc. :P

 

Any help from fellow Greytalk experts would be GREATLY appreciated and thanks in advance! :)

 

Yes, if it says Doxy 100mg then each pill is 100mg and she is on 200mg every 12 hrs. We went round and round on dosage with the vets. from my experience FOR EHRLICHIA 10mg/kg (or 5mg/lb some say) q12hrs is agressive, 5mg/kg q12 hrs is a less agressive dose, so if Kudzu's 10-20mg/kg q 12hrs and approimation of a required 300-600mg q 12 hrs is correct, then she is NOT on a high enough dose.

 

Its 'just' an antibiotic (compared to say a narcotic), so if you feel it should be increased then increase it. IMHO Its your call to take a more agressive approach within the accepted range and accept that your dog may have more side effects from the higher dose.

 

We were on a low dose for Chase's ehrlichia (150mg q12hrs), and I increased it to 200mg then it was increased in her last week to 300mg. aargh. I don't think it would have made any differece to her outcome to have it higher at the start but I will never know (she had a diffuse infiltrative cancer of some form that came at the same time).

Edited by ChasesMum
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Ok, so thanks for clarifying that each tablet IS actually 100 mg each, so he has her taking 2 Doxy in the am and 2 in the evening...so that's 400 mg. total per day.

 

So that is a fairly adequate dose, I suppose, given the UGA info and other sources I've heard from. I was afraid he would put her on too low of a dose, but if it is 400 mg. daily Doxy I guess I feel better about it comparing her dosage levels to other similar cases. Her doctor was saying that the Rocky Mountain Spotted Fever was only SLIGHTLY elevated in her lab tests, but I told him that even a slightly elevated level concerned the heck out of me, so that's when I convinced him to put her on Doxy. His theory was that it would not improve her condition or help her and my hypothesis was (obviously) the exact opposite and hopeful. I think right now she seems somewhere in the middle....better than before Doxy, but not 100% spunky and happy like normal.

 

Perhaps there is some residual effects in her system from having this condition that cannot easily or quickly be reversed just by a course of Doxycycline. I guess I expected some kind of amazing, immediate miracle. :blush

 

 

You all are such help and support, thank you SO much! :colgate

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Guest spider9174

I was at a seminar recently given by Dr. Cuoto. He stated that OSU does not treat asymtomatic dogs. That they test again and wait. So, the question is...is her relapse from her neurological or from a tick borne disease?

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