Good Thoughts Appreciated For Aston -- Update Post 89

[Remolacha]

Poor boy! But, it sounds like is is doing better, do you think it is the meds?

[Guest PiagetsMom]

Definitely looking better in the last pic.....sending good thoughts for your boy!

[o_rooly]

Poor boy! But, it sounds like is is doing better, do you think it is the meds?

It seems like it. But then, prednisone perks him up anyway... and we've just quadrupled the dose.

The last time a joint randomly started to swell (with no cultured pathogens or oddball cytology present), it stayed at a low-grade, non-painful swelling for weeks, and then overnight ballooned and became incredibly painful. This was about a month ago. That's when fluid was extracted for testing, and then a compression wrap was applied, and the swelling reabsorbed within a day or two... it seems like it could have been another display of rheumatoid arthritis, but it resolved without having to up his prednisone at the time. So, Idunno

[Guest MnMDogs]

Jeez, you and Aston have been through the ringer... Again . I'm so glad to see that he's showing improvement; we know too well in our house just how valuable those front legs are. Sending you continued good thoughts for improvement, and some answers.

[JJNg]

Even though tick-borne disease testing has been negative, have you done or considered a course of doxycycline or other antibiotics just in case? TBDs can sometimes be difficult to diagnose, and false negatives aren't uncommon, especially with some of the less common organisms like Bartonella.

[silverfish]

It all sounds like a nightmare. Poor Aston. I'm glad you're finding something to work and have been able to improve him.

[Hawthorn]

Autoimmune diseases are horrible but I'm glad you are seeing improvement with Aston - very good news!

[FiveRoooooers]

That is a dramatic improvement from afternoon to evening. Hope that improvement continues. Clearly he is enjoying your cooking!

[4My2Greys]

Poor Aston , I hope the improvement continues. Beanie had something similar happen with her leg swelling and very extremely like his was.

[o_rooly]

Even though tick-borne disease testing has been negative, have you done or considered a course of doxycycline or other antibiotics just in case? TBDs can sometimes be difficult to diagnose, and false negatives aren't uncommon, especially with some of the less common organisms like Bartonella.

Thanks for the heads-up on this...

We're waiting on results from a rheumatoid-factor test, and I'm reading that false results are somewhat common in this case, too (false positives as well as negatives). Has this been your experience? I'm worried that the test may not actually tell us anything, and loading up on a new treatment always worries me given the med load that Aston's currently dealing with -- though of course, I wouldn't want to restrict it if it should still help him.

 

I can't thank everyone enough for the support.. .

[Guest IrskasMom]

Some more support, Prayers and good Thoughts for Aston :grouphug .

[o_rooly]

Poor Aston , I hope the improvement continues. Beanie had something similar happen with her leg swelling and very extremely like his was.

Was the cause of Beanie's swelling ever pinpointed?

 

 

I've sent an email to Dr. Couto to loop him in on the latest news.

In happy news, I found Natural Balance Limited Ingredient Bison & Sweet Potato kibble in a local shop; Amazon also has 15-lb bags for $37.99. Otherwise, I scouted around today, and the cost of fresh or frozen bison around here is $6.80/lb at the cheapest (Costco). I think that if I used the NB kibble, I would still just use it to bulk/supplement the ground bison to bring costs down. I'm afraid to risk using too much of (or any of) anything that could cause a flare.

Edited February 15, 2014 by o_rooly

[RaineysMom]

wow, what a nightmare. I"m so sorry you all are going through this. You are handling this much better than I could, that's for sure! Sending many hugs and prayers :hope

[o_rooly]

Dr. Couto just responded: "It is unlikely to be rheumatoid arthritis, since the cartilage is fine; in RA, the cartilage is eroded. Hence, if it is inflammatory, it is what we call non-erosive polyarthritis, most of which are immune-mediated. They should do a joint tap for cytology and culture (including Mycoplasma). Also, a SNAP 4DX PLUS would help with some of the odd tick borne disease. Did they do lab work to check his platelets?"
I've forwarded his response to my vet so that we can proceed.

So, it looks like we may be back to almost square 1 on diagnostics. I looked back at the cytology for his left-hind limb swelling, and IMPA was indicated then (my addled brain forgot). I suppose I should be very glad that it's not erosive, either way.. but Aston's still not able to walk well this morning. One improvement is that I can now manipulate/poke/squish his wrist without a blink from him. The joint, while still warm and swollen relative to other unaffected joints, does still seem to be tapering off very slowly.

He is scarfing his bison like a champ, and spending five extra minutes standing on three legs in order to lick his bowl SO SO CLEAN.
He seems to be in good spirits. Won't be swayed from his normal routine of going upstairs after his morning meal and morning (mini-)walk so that he can get up on his favorite couch in the office. We don't let him go downstairs on his own, though, since he'd be forcing a lot of weight downward -- my husband carries him downstairs whenever needed. Wish I'd kept up with my sandbag training so that I could actually be functional in this aspect.

Will head out today to buy some Nature's Balance Bison + Sweet Potato, and will go half/half kibble/bison to see how it goes.
One thing I've noticed is that on straight bison, OMG his poops are so tiiiiiny. Makes me realize how much he couldn't get out of normal kibble -- if I tried to increase kibble amounts to put weight on him, it just sailed right through him.
Have to find something else for him to chew/clean teeth on, though -- turkey necks are now out. I was looking at ordering bison tails from ElkUSA, but I'm worried about feeding him raw bones when he's on a lot of immunosuppressive medication.

Anyone have any experience in feeding raw meat/RMBs to immunosuppressed dogs? Is it safe? I asked my vet about whether I'd need to change anything about Aston's care while he's on immunosuppressives, and she said no, and that it was fine for him to interact with other dogs as normal (well, medium/large dogs anyway ). This strikes me as odd, but she said that the immunosuppression here mostly affects bone marrow.

[Guest grey_dreams]

Wow, you and Aston have been through it. Glad that he seems better and there are options for the diagnosis and testing. Sending best wishes

 

Not sure if RMBs are ok for immunosuppressed dogs. Maybe another option could be something like dried trachea or dried ducks feet? It takes a long time for them to chew through dried trachea, and it does provide cleaning. The feet are gone quickly, but they provide a little bit of cleaning.

[o_rooly]

Thanks for the trachea idea!! Unfortunately, duck is out, since we're on a single, novel protein for now (bison). However, I just searched for bison chewies on Amazon and found a company (Great Dog Co) that sells a full line of trachea/tendon/"pizzle" chews from bison. YAY!

http://www.amazon.com/Great-Dog-Bison-Tubes-Sourced/dp/B00AEDY3HO/ref=sr_1_41?m=A35JA3B5HB628R&s=merchant-items&ie=UTF8&qid=1392570674&sr=1-41
I think I'd go for trachea first, since I'm sure the "pizzle" probably isn't the odor-free kind


Guh. I just looked over at Aston's leg, it looks waaaay vascular compared to the others.


I texted it to my vet (because I can't just leave the poor woman alone), and she thinks that it's just inflammation still, since I can manipulate his joint without complaint. Looks so weird, though. Want to fix.

Edited February 16, 2014 by o_rooly

[Charlies_Dad]

Continued good thoughts for Aston. It looks like based on the latest pics he is doing better, very strange though how his leg swelled so.

[EllenEveBaz]

to Aston and his family

[o_rooly]

My vet just responded to my text (which contained Dr. Couto's input) with: "We did all that."

I asked her last night about putting him on a round of doxycycline just in case the tick panel was a false negative. She doesn't think any treatment is warranted if the test is negative. I've read around on various dog forums, and it appears that the Antech lab panel that was run (along with other PCR tests) doesn't really tell you anything if it comes back negative. My head is spinning.
I'm considering pushing for another blood sample to be taken and sent to either Protatek (http://www.protatek.com/reflab/diag.html) or NCSU (http://www.cvm.ncsu.edu/vhc/csds/ticklab.html), but I also don't want to be at odds with my vet -- she's been great, answering my questions sometimes literally 24/7 via text. She is generally open to discussion and Dr. Couto's opinion, but in this case, I just want answers

[Batmom]

Which panel and PCR tests were run?

 

Some of the internet comments about those kinds of things aren't accurate.

[o_rooly]

The clinic had Antech run T961:FastPanel® PCR Canine Tick Borne Profile with Lyme Serology..

[Batmom]

What the negative PCR tells you is that no DNA of the organisms tested for (thus @ no organisms) was found. It can be useful to do antibody testing (titers) as well -- that tells you whether the dog has been exposed to the organism. A PCR can be negative when the dog DOES have a disease but the organisms aren't circulating in the bloodstream. A titer can be positive when the dog does NOT have the disease. Clear as mud, eh?

 

You might send NCSU an email or give them a call and ask them. Really bright people there vis-à-vis vector-borne diseases. They'll be able to think through the dog's symptoms and the tests you've done so far and help you (and/or your vet) figure out what's best to do next.

[JJNg]

I see that Dr. Couto already addressed this, but rheumatoid arthritis is extremely rare in dogs, mostly occurs in small breeds, and usually causes an erosive arthritis that causes visible changes on x-rays. There is an "erosive arthritis of greyhounds", but that usually affects young dogs and the cause is unknown.

You mentioned that they tapped the swelling of his left hind leg and did cytology and culture. Did they actually do *joint* taps, or just aspirate the soft tissue swelling?

I can understand your vet's reluctance to use antibiotics without a definite indication, but personally, I would be even more concerned about immunosuppressive treatment without a clear diagnosis. IMO, unexplained pain and swelling in a greyhound is suspicious of tick-borne disease (TBD). Chronic TBD can have vague, non-specific signs, and can lead to secondary immune-mediated problems.

Doing a course of antibiotics that isn't needed is unlikely to cause any problems. Immunosuppressive meds in a dog with an undetected infection could make things much worse. Whether or not you push this depends on how he's responding. If he's continuing to improve with the current course, I might not worry too much about it. But if he gets worse, it's something else to consider trying.

It's not unusual for PCR testing for TBDs to have false negatives. I'd agree with Batmom that titer testing may be helpful. But when my own hound was very sick a few years ago with what we eventually decided was most likely Bartonella, all of her tests came back negative or normal, and we ran pretty much every relevant test there was. I consulted with our local internist, Dr. Couto, and Dr. Breitschwerdt (the TBD expert at NC State), and they all felt it was Bartonella even with negative results on titers, PCR, and culture.

My dog's case wasn't quite like Aston's as she also had a fever and enlarged lymph nodes, but if you're interested, you can read the details here: http://forum.greytalk.com/index.php/topic/268482-autoimmune-disease/?p=4844975

One thing to keep in mind is that if Aston was already on pred, that could be suppressing a fever.

[seeh2o]

Just seeing this thread about Aston. Sending good thoughts for your sweet boy.

[o_rooly]

I see that Dr. Couto already addressed this, but rheumatoid arthritis is extremely rare in dogs, mostly occurs in small breeds, and usually causes an erosive arthritis that causes visible changes on x-rays. There is an "erosive arthritis of greyhounds", but that usually affects young dogs and the cause is unknown.

 

You mentioned that they tapped the swelling of his left hind leg and did cytology and culture. Did they actually do *joint* taps, or just aspirate the soft tissue swelling?

 

I can understand your vet's reluctance to use antibiotics without a definite indication, but personally, I would be even more concerned about immunosuppressive treatment without a clear diagnosis. IMO, unexplained pain and swelling in a greyhound is suspicious of tick-borne disease (TBD). Chronic TBD can have vague, non-specific signs, and can lead to secondary immune-mediated problems.

 

Doing a course of antibiotics that isn't needed is unlikely to cause any problems. Immunosuppressive meds in a dog with an undetected infection could make things much worse. Whether or not you push this depends on how he's responding. If he's continuing to improve with the current course, I might not worry too much about it. But if he gets worse, it's something else to consider trying.

 

It's not unusual for PCR testing for TBDs to have false negatives. I'd agree with Batmom that titer testing may be helpful. But when my own hound was very sick a few years ago with what we eventually decided was most likely Bartonella, all of her tests came back negative or normal, and we ran pretty much every relevant test there was. I consulted with our local internist, Dr. Couto, and Dr. Breitschwerdt (the TBD expert at NC State), and they all felt it was Bartonella even with negative results on titers, PCR, and culture.

 

My dog's case wasn't quite like Aston's as she also had a fever and enlarged lymph nodes, but if you're interested, you can read the details here: http://forum.greytalk.com/index.php/topic/268482-autoimmune-disease/?p=4844975

 

One thing to keep in mind is that if Aston was already on pred, that could be suppressing a fever.

Joint fluid was extracted on the swollen left hock in January and sent for cytology (marked neutrophilic inflammation and suppurative arthropathy noted; no infectious agents), culture (negative) and the tick panel (negative).

 

I'm very paranoid about the immunosuppression in case there's an underlying infection. One note is that his lymph nodes have not been enlarged with either of these leg episodes (his popliteal node WAS huge when he was fighting the pseudomonas/staph infection in his left-hind in October, though, and he was on ~30mg of pred daily at the time).

 

In terms of improvement -- he seemed close to pain-free on Friday, after 24hours of increased pred + azathioprine, but since then, it has been up/down. At worst, he will still get up on his own if encouraged with treats, but will walk, very hobbly (not nearly as bad as it was at its worst), and will turn into a statue if I try to turn him around early on our (already short -- ~3/8 mile) walks. I can also manipulate the joint now without pain, whereas I literally couldn't look at it without Aston crying before.

 

I read over Willow's episode. That's incredibly frightening. I'm so glad to read that she was able to get back to normal, no small feat!!

 

 

Going to pick up the most recent CBC results tomorrow (from Thurs) to send along to Dr. Couto.

 

Batmom -- Will also contact NCSU once I get my act together with the backstory. Thank you for the heads-up!!

 

 

Edited February 17, 2014 by o_rooly