Aladdin Has Spirometra! Also Low Thyroid. Update Post 56

[greytpups]

Here's hoping Aladdin is on his way to recovery...poor guy...lots of scritches coming from me.

[kudzu]

Before I go any further I want to point out that I am not a vet nor do I have any medical training. However, there are a few things that came to mind as I was reading your post that I would like to ask &/or mention.

- Was a complete thyroid panel run? Without it a diagnosis cannot be made. Even with it a vet must consider other factors before diagnosing & starting treatment for hypothyroidism.

- A T4 of 0.4 is not so low for a Greyhound compared to other non-sighthound breeds of dog. It's a bit low but not alarmingly so. With symptoms of hypothyroid a T4 of 0.4 merits further testing.

- Did the vet mention the possibility of this being euthyroid sick syndrome instead? Many things can contribute to a low T4 & illnesses rank high on that list. Again, a full thyroid panel would need to be done to help distinguish between sick euthyroid & a true hypothyroid condition.

- Unless the symptoms being seen are an actual result of hypythyroidism I think one would normally treat the illness causing the symptoms first because of the possibility of sick euthyroid.

- Drontal can be effective against spirometra but at a much higher, off label multi-dose. Maybe panacur can be used as well. I'm just not aware of it.

 

Am not saying the new vet is wrong. Its just that some of what you have relayed tends to throw up some red flags for me so I thought it best to mention this. Hope your boy is feeling well very soon & those nasty spirometra are given the boot permanently.

[SIGreyLady]

Glad to hear you have a very greyhound savvy vet. I hope and prayeer that Al;addin responds well to the meds. :grouphug

[tbhounds]

Glad to hear you have a very greyhound savvy vet. I hope and prayeer that Al;addin responds well to the meds. :grouphug

Greyhound savy? I'm finding myself questioning the hypothyroidism too.

[JJNg]

Ok, from what's been posted here, Aladdin's initial signs were explosive diarrhea and weight loss. The previous vet did a fecal, bloodwork, and prescribed a dewormer. To me, this sounds very appropropriate, certainly not "a waste of time and money".

 

Second, Panacur is not an effective treatment for Spirometra. The only species of tapeworm that Panacur is labeled to treat is Taenia, which is the one they get from eating rabbits and rodents. Spirometra is treated with praziquantel (the active ingredient in Droncit and Drontal) but at 5 times the dose usually used to treat other worms.

 

I also question the diagnosis of hypothyroidism, which kudzu responded in a lot more detail about. If they got results the same day, I'm pretty sure it was just a T4 and not a full panel. You can't diagnose hypothyroidism in a greyhound, or any sick dog, with just a T4.

[4greyhounds]

I hope you can read this, I have written at the bottom but it has the thyroid levels.

 

 

 

Also the full panel blood work was done on 1/12/12. there was no need to do another full panel today. He only wanted to check the levels.

 

At that time the levels were low.

[4greyhounds]

Second, Panacur is not an effective treatment for Spirometra. The only species of tapeworm that Panacur is labeled to treat is Taenia, which is the one they get from eating rabbits and rodents. Spirometra is treated with praziquantel (the active ingredient in Droncit and Drontal) but at 5 times the dose usually used to treat other worms.

 

 

Are you familiar with Spirometra this is only from eating raw fish or from a lizard that already has it. Aladdin was treated with Drontal and it did not work. The vet felt the other vet did not properly handle it should have been treated with Panacur.

 

I appreciate your advise but just wondering are you a vet? If so I would love to mention what you stated to my vet. I see you are in South Carolina are you familiar with this? I appreciate your advise but wondering where you are getting all your information. I am not a Vet but went one of the most popular well known vets here in Ft. Myers today and I would love to enlighten them if they are still wrong.

[MaryJane]

IMO, I'd be very hesitant to treat with thyroid medicine until I got a second opinion especially since the dog does not seem hypothyroid. My knowledge of thyroid conditions is that the weight loss and diarrhea could be associated with hyperthyroid, not with hypothyroid.

 

The lizard/fish parasite would be a definite possibility but, I would assume if it is a parasite it could be diagnosed by seeing the eggs in the feces (under microscope of course).

 

 

edited to add - got this from the veterinarypartner.com website

 

Measurement of T4

The T4 level (also called the total T4 level) is included in many routine screening blood panels. It would seem that a low T4 would indicate hypothyroidism and a normal T4 would indicate normal thyroid function. Unfortunately, it isn’t that simple. Dogs on certain drugs (most notably seizure medications phenobarbital and potassium bromide; prednisone or other corticosteroids; non-steroidal anti-inflammatory drugs or NSAIDs; a heart medication called propranolol; a behavior medication called clomipramine; or sulfa class antibiotics) or with illnesses other than thyroid disease often have depressed T4 secretion. These dogs will have low T4’s but are not hypothyroid. This means a normal T4 indicates normal thyroid function but a low T4 may or may not indicate hypothyroidism. There is also a grey zone where T4 results are considered not definitively normal and not definitively abnormal. In short, T4 alone is not adequate to make a diagnosis of hypothyroidism.

 

It should be noted that the sighthounds normally have much lower T4 levels than other breeds. In Greyhounds, for example, the T4 levels typically run about 50% of what other breeds do. Interestingly, their T3 levels have the same normal range as other breeds.

Edited February 11, 2012 by MaryJane

[4greyhounds]

Kudzu I really appreciate all your information!!!!!I have made a copy for you to see.

 

 

I really appreciate all the good thoughts and well wishes that mean a lot!

 

IMO, I'd be very hesitant to treat with thyroid medicine until I got a second opinion especially since the dog does not seem hypothyroid. My knowledge of thyroid conditions is that the weight loss and diarrhea could be associated with hyperthyroid, not with hypothyroid.

 

The lizard/fish parasite would be a definite possibility but, I would assume if it is a parasite it could be diagnosed by seeing the eggs in the feces (under microscope of course).

 

They did a fecal and it was sent to the lab and the parasite was seen under the microscope.

[tbhounds]

I hope you can read this, I have written at the bottom but it has the thyroid levels.

 

 

 

Also the full panel blood work was done on 1/12/12. there was no need to do another full panel today. He only wanted to check the levels.

 

At that time the levels were low.

Agh- can not see the pic too clearly-- but, I can tell you I true hypothyroid dog would have low t4 and a HIGH Tsh.

Edited February 11, 2012 by tbhounds

[4greyhounds]

IMO, I'd be very hesitant to treat with thyroid medicine until I got a second opinion especially since the dog does not seem hypothyroid. My knowledge of thyroid conditions is that the weight loss and diarrhea could be associated with hyperthyroid, not with hypothyroid.

 

The lizard/fish parasite would be a definite possibility but, I would assume if it is a parasite it could be diagnosed by seeing the eggs in the feces (under microscope of course).

 

 

edited to add - got this from the veterinarypartner.com website

 

Measurement of T4

The T4 level (also called the total T4 level) is included in many routine screening blood panels. It would seem that a low T4 would indicate hypothyroidism and a normal T4 would indicate normal thyroid function. Unfortunately, it isn’t that simple. Dogs on certain drugs (most notably seizure medications phenobarbital and potassium bromide; prednisone or other corticosteroids; non-steroidal anti-inflammatory drugs or NSAIDs; a heart medication called propranolol; a behavior medication called clomipramine; or sulfa class antibiotics) or with illnesses other than thyroid disease often have depressed T4 secretion. These dogs will have low T4’s but are not hypothyroid. This means a normal T4 indicates normal thyroid function but a low T4 may or may not indicate hypothyroidism. There is also a grey zone where T4 results are considered not definitively normal and not definitively abnormal. In short, T4 alone is not adequate to make a diagnosis of hypothyroidism.

 

It should be noted that the sighthounds normally have much lower T4 levels than other breeds. In Greyhounds, for example, the T4 levels typically run about 50% of what other breeds do. Interestingly, their T3 levels have the same normal range as other breeds.

 

Thanks so Much! His on the blood panel says < 0.4 Reference range 1.0- 4.0 ug/dl so it was even lower when they did the complete blood panel. Is this out of range for a greyhound? He is on the meds now to bring it up, the vet says to fight this his need to be brought up to have the imunity to fight it.

 

I do appreciate all the assistance and suggestions more than you will ever know...... I am at the wits end.... Trying my best but not sure where we should be now....

[PrairieProf]

It is totally not out of range for a greyhound.

[4greyhounds]

This is from the Blood Panel:

 

[Batmom]

That's just the T4. You have to do a special panel, not part of a regular blood test, to diagnose hypothyroidism.

 

I can't find any reference to treatment of Spirometra with anything except praziquantel (Droncit/Drontal).

[EllenEveBaz]

No suggestions, just sending our warmest best wishes and cyberhugs.

[4greyhounds]

That's just the T4. You have to do a special panel, not part of a regular blood test, to diagnose hypothyroidism.

 

I can't find any reference to treatment of Spirometra with anything except praziquantel (Droncit/Drontal).

 

There was a regular blood test that was done a complete blood panel and the numbers were lower than the T4. The vet told me the Drontal did not kill the parasites because it was not strong enough..... I am very confused now..... I am calling the vets in the morning, this is driving me to my wits end, I just want Aladdin better. I ask the vet today I knew the levels were lower on a greyhound and he said yes by 1/2 a lot of times but not this low.

[kudzu]

Frustrating wouldn't even begin to describe it if I were in your position. When referring to a "full thyroid panel" I was referring to additional thyroid specific tests besides just T4. While running a CBC & blood chemistry is important as well that was not what I was asking about. (Though I probably should have so good that you mentioned it.) My oldest Greyhound is on thyroid hormone therapy. While we use T4 to help monitor her therapy that is not how it was diagnosed. When we run the thyroid panels used to help diagnosis I believe they include T4, fT4(ed), T3, TSH, TGAA. (I think IDEXX has introduced a new fT4 that might replace the fT4(ed) on their panels.)

 

Please believe us when we say that hypothyroidism cannot be diagnosed by T4 alone. That is especially true in Greyhounds. If it were my Greyhound I would not put the dog on supplementation without further investigation. If the dog wasn't displaying symptoms of hypothyroidism then I'm not sure we'd even consider more diagnostics let alone start treatment. There are just too many other things besides thyroid disease that can cause the T4 to be low. I know you are in a bit of a quandry since the vet says the thyroid level is effecting the immune system thus preventing erradicating the tape worm. Yet that is in part contrary to all I have read in that the primary disease is treated first then the thyroid panel is rerun to see if it still indicates possible hypothyroid.

 

Here are some links on hypothyroidism including diagnosis. The first two are the easiest to read, at least for non medical me. However, the last one is very interesting & well worth a read.

 

Greyhound oriented

http://www.greythealth.com/hypothyroid.html

 

Greyhounds/sighthounds are notably mentioned

http://www.marvistavet.com/html/hypothyroidism.html

 

Dogs in general

http://www.vet.uga.edu/vpp/clerk/bell/index.php

http://www.newmanveterinary.com/Hypothyroid.html

 

Roundtable discussion on thyroid disease from IDEXX Labs

http://www.idexx.com.au/pdf/en_au/smallanimal/snap/t4/sah-thyroid-roundtable.pdf

 

Let me ask you something else. What possible hypothyroid symptoms does Alladin have?

[4greyhounds]

The blod panel was done at Indexx labs...... www.vetconnect.com this is where the complete Senior Profile w/Reflux UPC CHEM 27 and the CBC blood panel was done. Aladdin was not having any problems until this came off except he has always been a bit more hyper than my other Greys. He is the one that was the trouble maker. You know if there was something to get into he was there getting into it..... Very Active. Since he has lost the weight he does not have the same energy levels he is laying around more, sleeps through the night and does not have the activity level he had before...... Everyhing else is the same he is eating like he always has, he is just losing massive weight.

 

Now they started him on 1/2 a pill today and every day for the next 29 days and then he was suppose to go back and have the blood re checked. After he finished the Pancus the day after I was to get a stool sample and take it in. Are you saying don't give him the Thyroid Meds. The Vet was saying if he did not get it, we would have a problem resolving the Spirometra.

 

Thanks so much for the articles and I will be reading them now, I am reading and getting everythig I can get my hands on...... I just want him better and these medical bills are pilling up as I feel like my baby is wasting away and I am spinning wheels..... Very Frustrating! I really do appreciate the help and please anything I need it!

Edited February 11, 2012 by 4greyhounds

[kudzu]

I am not trying to say what you should do. Most sincerely, I am not. What I meant is that if it were my dog I would not have started the thyroid meds without doing the thyroid panel. The T4 is the only thing you have shown that is part of what we meant by thyroid panel. Everything else is part of the CBC & blood chemistry.

 

What I am about to say next may feel like a catch 22 but adding Soloxine can actually contribute to weight loss.

[4greyhounds]

No, I am not disagreeing with you and the last thing I want to happen is for Aladdin to lose more weight. I am calling the vet back tomorrow and I think I am requesting more test. He told me if we did not get Aladdin on this his immune system would not be able to handle the treatment to get better to heal from the Spirometra. I do appreciate you bringing this to my attention, I am not about to do something to make him lose more weight.

[JJNg]

Darlene, yes, I'm a vet. We don't see a lot of Spirometra in SC, but I researched it a few years ago when my technician's cat had it. I reviewed my sources today, and I can find no information about treating Spirometra with Panacur. Everything I read says that you need to use a high dose of praziquantel (which is in Droncit/Drontal Plus). It sounds like the dose of Drontal that Aladdin received was a normal dose, not the high dose. You're welcome to share my information with your vet. If your vet believes that Panacur works for Spirometra, I'd love to see his source for that information.

 

Here are a couple of articles about Spirometra:

http://www.capcvet.org/recommendations/tapeworm2.html

http://www.scribd.com/doc/23745522/C-F-Spirometra-%C4%B0nfection-in-cats-and-dogs

 

I think others have already mentioned this, but to accurately diagnose a thyroid problem, you need to do a full thyroid panel. This is not the same as a full blood panel. A full thyroid panel includes other thyroid-specific tests - at a minimum, it should include a free T4 (FT4) and thyroid stimulating hormone (TSH). These give a more reliable assessment of thyroid function than just doing a T4 which is just an initial screening test for thyroid problems.

 

Here's an article about the common misdiagnosis of hypothyroid problems in greyhounds. You might want to print this out for your new vet.

http://www.vet.ohio-state.edu/assets/pdf/hospital/bloodBank/wellness/newsletters/2010/ghwpNewsletterWinter2010.pdf

 

I hope Aladdin feels better soon. It sounds like the Spirometra infection may be the cause of all his signs. I'd treat that appropriately first, and not continue on the thyroid medication until you can get that diagnosis verified. Clearing a parasitic infection relies more on the appropriate type and dose of deworming medication and less on a healthy immune system. And at this point, I'm not sure Aladdin has any signs to indicate a weak immune system.

 

The additional bloodwork you posted (the CBC - complete blood count) is normal for a greyhound. The paperwork even has a special comment noting the normal reference range for greyhounds, and if you use those numbers, instead of the numbers in the column next to the test, his results are completely normal.

 

If you do request additional thyroid testing, see if they have enough blood left to run it on the sample that was drawn before he ever started on Soloxine. One or two doses might not make a difference, but it's best to run the additional tests without interference from medication.

[4greyhounds]

Yes, It was the Drontal Plus:

 

 

The vet today told me that was a waste and he was not sure why the vet would have ever put Aladdin on this! It is very expensive as you can see, after he took these 3 pills, the weight just kept pouring off of him.

 

I called the vet back and she said that the 3 pills should have gotten rid of it and if it did not that Aladdin needed to get a X-Ray. She was not able to see him again until Monday. He was getting worse as far as no energy this other vet was highly recommended to me and he was in shock that the vet would recommend this to Aladdin and that is when we started this other treatment plan. Now, I find out we are going down a wrong turn and I still don't really know what is going on with my Aladdin. I thought I had got a better vet today but I don't know.......

 

I will call back in the morning and ask about this, also I have gotten lab information from someone else to get a full thyroid test done.

 

I just want my boy better, seeing him waste away like this is Awful! I really appreciate your assistance.

[JJNg]

You mentioned in a previous post that the instructions for the Drontal Plus was 1.5 tablets on the first day, then 1.5 tablet the next day. This is the regular, label dose for deworming a 60-90 lb dog. Spirometra requires a minimum of 2-3 times this dose to be effective, and many vets recommend up to 5 times. Yes, it does get very expensive using the commercial veterinary products. A couple options that may be more affordable is to go with the human product, Biltricide which contains a larger amount of praziquantel than the veterinary product, or use a compounding pharmacy.

[MaryJane]

I just wanted to add .. don't lose sight that you have a diagnosis of what is wrong and while the treatment was right, it just may not have been enough and that's why it didn't resolve the first time. It does look like there is light at the end of the tunnel.

 

Good luck today.

[4greyhounds]

Thank You very much! The vet feels he is very determined that the pancus for the 7 day treatment is the only thing that has been able to get rid of the Spirometra and that the Drontal Plus at any dosage has not worked on any of the cases he has treated here in Florida but the problem is there has been very few for this vet or the other vet and they are both talking now.... That is the reason the other vet wanted to do the X-rays she felt their is more going on than just this.... One vet feels just like as many of you do that the thyroid is a little low but not so low that treatment is needed the other vet feels that it is too low and that treatment is needed. At this point I have stopped the pills and Aladdin only ever got one. There is a lab that a GT person has recommended me to that I am going to send blood work out and have a complete thyroid level done. In the mean time I am still treating Aladdin with the Pancus I am not sure what the harm can be done if the Spirometra is not gone in 7 days as the vet has stated it should be then we are going to have to look at other alternatives. Either way he can not continue to lose weight and I do hope that it is not something else which leads me to do I follow the other vets advise and have the X-Ray done or wait? Thanks so Much for all the suggestions and I really do appreciate all the help!!!!!!!!!!