Random Issues With Zuri *****update #50: W/thyroid Results*****

[MandysMom]

Jen, I'm sorry Z isn't feeling great. I tend to go ahead and do all the tests, so I'd probably do the Thyroid panel along with CBC/chem to check glucose, kidney, and liver. I'd also get a scrape of the new wound. An acquaintance of mine posted this about covering the rear legs to prevent licking.

 

And, just because...here is a picture I took of him at GIG a few years ago. He came over to my aunt to get some pets (and probably a taste of her sandwich!):

[NeylasMom]

Thanks Bev. And yes, that looks like his focused on bread and/or cheese face.

[NeylasMom]

Okay, so these are the results from the more recent U/A, done on 6/26/14, about 2 weeks after Zuri started having the water consumption/peeing symptoms. We did this in house so I don't know if there are other results they're not including, they just forwarded the lab notes, but presumably everything else was normal if they looked at other things:

 

UA: via free catch

SG 1.036

pH 6

protein 1+

Glucose 1+

Bili large

 

And here are his lab results, which included a U/A. These are from 4/1/14 before any issues started, just part of our annual. We also did a snap test around this time that was negative.

 

4/1/2014

L

1

Chemistry results from IDEXX Reference Laboratory

Requisition ID: 9249 Posted Final

Test Result Reference Range

ALB 3.4 g/dL 2.7 - 3.9

ALKP 42 U/L 5 - 160

ALT 29 U/L 18 - 121

ANION GAP 18 mmol/L 11 - 26

AST 19 U/L 16 - 55

BICARB 23 mmol/L 13 - 27

BUN/UREA 26 mg/dL 9 - 31

Ca 10.3 mg/dL 8.8 - 11.2

Chloride 111 mmol/L 108 - 119

CHOL 182 mg/dL 131 - 345

CREA 1.3 mg/dL 0.5 - 1.5

DBIL 0.1 mg/dL 0.0 - 0.1

GGT 2 U/L 0 - 13

GLU 97 mg/dL 63 - 114

IBIL 0.1 mg/dL 0.0 - 0.2

PHOS 3.9 mg/dL 2.5 - 6.1

Potassium 4.6 mmol/L 4.0 - 5.4

TBIL 0.2 mg/dL 0.0 - 0.3

TP 6.2 g/dL 5.5 - 7.5

Sodium 147 mmol/L 142 - 152

A/G Ratio 1.2 0.7 - 1.5

B/C Ratio 20.0

Na/K Ratio 32 28 - 37

GLOB 2.8 g/dL 2.4 - 4.0

CK 67 U/L 10 - 200

Ascn: 2100014850

RE: 281 HEMOLYSIS INDEX 2+

Index of N, 1+, 2+ exhibits no significant effect on chemistry values.

RE: 282 LIPEMIA INDEX N

Index of N, 1+, 2+ exhibits no significant effect on chemistry values.

 

4/1/2014

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1

Endocrinology results from IDEXX Reference Laboratory

Requisition ID: 9249 Posted Final

Test Result Reference Range

T4 <0.4 ug/dL L 1.0 - 4.0

Ascn: 2100014850

Interpretive ranges:

<1.0 Low

1.0-4.0 Normal

>4.0 High

2.1-5.4 Therapeutic

Dogs with no clinical signs of hypothyroidism and results within the

normal reference range are likely euthyroid. Dogs with low T4

concentrations may be hypothyroid or euthyroid sick . Occasionally,

hypothyroid dogs can have T4 concentrations that are low normal. Dogs

with clinical signs of hypothyroidism and low or low normal T4

concentrations may be evaluated further by submission of free T4 and

canine TSH. A high T4 concentration in a clinically normal dog is

likely variation of normal; however elevations may occur secondary to

thyroid autoantibodies or rarely thyroid neoplasia. For dogs on

thyroid supplement, acceptable 4-6 hour post pill total T4

concentrations generally fall within the higher end or slightly above

the reference range.

RESULT VERIFIED BY REPEAT ANALYSIS

 

4/1/2014

L

1

Hematology results from IDEXX Reference Laboratory

Requisition ID: 9249 Posted Final

Test Result Reference Range

BASO 0.0 %

EOS 3.3 %

HCT 62.1 % 50.0 - 65.0

HGB 21.6 g/dL H 13.4 - 20.7

LYMPHS 27.4 %

MCH 23.7 pg 21.9 - 26.1

MCHC 34.8 g/dL 32.6 - 39.2

MCV 68 fL 59 - 76

MONOS 6.3 %

NEUT SEG 63.0 %

PLATELETS 116 K/uL 80 - 150

RBC 9.12 M/uL H 5.39 - 8.70

RETIC CNT 0.2 %

WBC 3.4 K/uL L 4.5 - 7.5

ABS BASO 0 /uL 0 - 100

ABS EOS 112 /uL 70 - 1490

ABS LYMPHS 932 /uL L 1060 - 4950

ABS MONOS 214 /uL 130 - 1150

ABS NEUTS 2142 /uL L 2940 - 12670

ABS RET 18 K/uL 10 - 110

Ascn: 2100014850

RE: 3034 REMARKS

REMARKS

SLIDE REVIEWED MICROSCOPICALLY.

 

4/1/2014

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1

UA/Microscopy results from IDEXX Reference Laboratory

Requisition ID: 9249 Posted Final

Test Result Reference Range

BACTERIA NONE SEEN HPF

BILIRUBIN 2+

BLOOD NEGATIVE

CASTS NONE SEEN HPF

CLARITY CLOUDY

COLOR DARK YELLOW

CRYSTALS NONE SEEN HPF

EPI CELL 1+ (1-2) HPF

GLUCOSE NEGATIVE

KETONES TRACE

MUCUS NONE SEEN

PH 7.0

PROTEIN NEGATIVE

RBC NONE SEEN HPF

SP GRAVITY 1.053

UROB NORMAL

WBC NONE SEEN HPF 0 - 5

Ascn: 2100014850

RE: 900 COLLECTION METHOD VOIDED

Confirmed by Ictotest

RAFTS OF EPITHELIAL CELLS PRESENT

Detection of trace ketones in patients who are normoglycemic or have

negative urine glucose is non-specific and of limited clinical

significance.

Protein test is performed and confirmed by the sulfosalicylic acid

test.

Edited August 1, 2014 by NeylasMom

[bradymom]

Jen,

I had 2 cats that were diabetics. Insulin shots twice a day. Cleo also was hypothroidism.

 

When her sugar levels were off, she drank tons of water. One day I found her sleeping with her front paws around the water dish. It was a sign that we need to have a bell curve done again.

 

She developed thyroid issues after the diabetes. For cats this can cause high blood pressure and if untreated blindness. (She lived to be 20.)

 

Good luck on Tuesday!

 

 

Debbie

[tbhounds]

I see the the urine was collected via free catch--sterile container???

[NeylasMom]

I see the the urine was collected via free catch--sterile container???

We did the free catch at the vet, so yes, sterile.

[tbhounds]

Double check--if the collection bowl wasnt completely clean and void of residue you can have false values returned.

[NeylasMom]

Double check--if the collection bowl wasnt completely clean and void of residue you can have false values returned.

It was into one of those little containers with the lid screwed on and taped close like you get in a doctor's office. I suppose I could have contaminated it in some way, but that seems pretty unlikely. I'm getting the feeling the glucose in the urine is a bad thing if it's not a false positive? I am planning to have her run another U/A when we go on Tuesday.

 

Do you know, does Idexx run everything that you need in the thyroid panel (free T4, T3, TSH, & thyroid antibodies, right?) reliably? Could we just request it all from Idexx and be done with it rather than going through MSU? If we're going to send out blood for another blood panel, then I'd rather just do it all through one place and the panel my vet has set up already (the Idexx results from April above) includes a U/A.

 

I was thinking maybe we'd just take a quick look at the urine in house first and if there was glucose again we'd have some direction, but I don't think that really helps us since I read you can have diabetes and hypothyroidism concurrently, and even if he has either of those things making him prone to infections, we'd still want to culture his wound and/or skin so we can treat the infection, no?

 

Thanks to you and everyone else for all of the input. My vet is great so I know ultimately we'll be able to figure out a good plan, but I like to have thought things through as much as possible before going in. Who me, overthink? No never.

Edited August 2, 2014 by NeylasMom

[tbhounds]

Looking at your hounds blood work nothing pops out. Definitely have your vet repeat a u/a--at least an house stick to recheck the glucose. Her blood glucose was fine--as was her cholestrol (sometimes a marker for hypo t). Certainly Idexx can run a full thyroid panel but, you may need to only run a Ft4/cTSH. If those numbers come back funky you may consider running further tests.

Your girl just might have allergies. Many dogs when not feeling well will drink excessively. Did you have a recent food change? Visit a new area? Introduced to different grasses etc..???

Edited to add --re-read the u/a--says glu was neg.

Edited August 2, 2014 by tbhounds

[NeylasMom]

Looking at your hounds blood work nothing pops out. Definitely have your vet repeat a u/a--at least an house stick to recheck the glucose. Her blood glucose was fine--as was her cholestrol (sometimes a marker for hypo t). Certainly Idexx can run a full thyroid panel but, you may need to only run a Ft4/cTSH. If those numbers come back funky you may consider running further tests.

Your girl just might have allergies. Many dogs when not feeling well will drink excessively. Did you have a recent food change? Visit a new area? Introduced to different grasses etc..???

Edited to add --re-read the u/a--says glu was neg.

Thanks! The big thing connected to all of this stuff was the dental, but the only change from what you mentioned was switching his diet temporarily because he couldn't eat bones (extractions). He got about 1 1/2 weeks of premade raw post-dental, but as I mentioned he's been back on regular food for many weeks so while it's still on my list, it seems like quite the whirlwind of stuff from a small diet change.

[MP_the4pack]

Free catch is never sterile. Not even in humans. The only way to get a sterile sample is needle into the bladder. It is a "clean catch", but not sterile.

 

So then, what would a 'dirty catch" be? It's when an animal is caged and you put a pan under to catch the urine. You have the pan there for several hours and it can contain food, poo, fur, whatever that animal can drop into the pan.

 

(I'm ASCP certified Medical Technologist. I do labwork)

[NeylasMom]

I just did a quick search to see what could cause false positives for glucose in urine and it turns out ABs is one of them. Zuri had finished the course he was on because of his extractions shortly before we went to the vet and did the U/A. So that's promising. Does beg the question - how long until they clear out of the system and no longer can cause a false test result because he did that second course for his skin infection. He'll have been off of them 1 week by the time we go in tomorrow. I'm assuming that would be enough time?

[greysandmollie]

Jen...Once you master this dog training stuff I think your next move it to try out Vet school.

 

Hope Z is feeling better everyday!

[NeylasMom]

Jen...Once you master this dog training stuff I think your next move it to try out Vet school.

 

Hope Z is feeling better everyday!

Ha. I was pre-vet when I started college actually. Somewhere along the lines I switched over to pre-med because that's the track all of the bio students at my school were on I guess and then come senior year, with secondary apps in hand, I realized I had no desire to go to medical school. And so I ended up in a job I really dislike for 15 years. I think I would have enjoyed being a vet. I had dreams of living in the country in England being a large animal vet. I read a lot of James Herriot.

[inugrey]

totally, Donna. I have no idea what has been said in this entire thread.

[a_daerr]

Do you know, does Idexx run everything that you need in the thyroid panel (free T4, T3, TSH, & thyroid antibodies, right?) reliably? Could we just request it all from Idexx and be done with it rather than going through MSU?

 

Yes, that was my experience. Henry had a low thyroid on routine bloodwork years ago, and we ran a full panel through Idexx.

[NeylasMom]

So we redid the urine in house, everything was normal, no glucose. Since that was normal, we decided not to redo the blood panel and just sent blood to MSU for the thyroid panel (over $150 btw, the price has gone up! ).

 

We also talked about his skin. Vet confirmed that she saw a lot of bacteria when she did the skin scraping last time so she's pretty confident he has/had a bacterial infection. She recommended an anti-bacterial/anti-fungal shampoo (Douxo chlorhexidine shampoo) that we're supposed to use every 3 days (going to be so fun with a dog who has issues with his backend - note to self, buy bathmats ) and see how that goes while we wait for thyroid results. If the thyroid is negative and his skin issues still don't clear up, she wants us to see a dermatologist.

 

Oh, his ear also looks cleared up so that's good. So perhaps now all that we're dealing with is the skin issue. I doubt the thyroid tests will come back positive, but we'll see. Here's hoping this shampoo does the trick. Zuri is not going to be happy about it and I hate the thought of doing them with no result.

[a_daerr]

Was it Staph?

[NeylasMom]

Was it Staph?

Don't know because she just looked under the microscope, we didn't culture it. Or at least she didn't say - maybe some people are skilled enough to eyeball what kind of bacteria.

[a_daerr]

I think something like 95% of skin infections are staph-related, so a vet can reasonably prescribe an antibiotic without doing a culture. That's pretty typical. But if a dog continues to develop Staph infections over time, the immune system may be compromised in some way. Since you're dealing with a bunch of other weird symptoms, I think I'd want the culture.

[NeylasMom]

I think something like 95% of skin infections are staph-related, so a vet can reasonably prescribe an antibiotic without doing a culture. That's pretty typical. But if a dog continues to develop Staph infections over time, the immune system may be compromised in some way. Since you're dealing with a bunch of other weird symptoms, I think I'd want the culture.

That's the plan if the shampoo doesn't work. My vet felt the dermatologist was better equipped to get a culture and send it to the right lab, plus investigate other issues that may be going on, which is why we didn't just do it today. She said it could take a long time to get into the derm so the shampoo is more of a let's try it while we wait sort of thing. Plus we'll get thyroid results in the interim.

[tbhounds]

Topical therapy-ie medicated shampoos are often the only thing you need to do it get the infection under control. The shampoo you have should do the trick. My Stan's derm Vet made the recc of bathing every 3-4 days during a flair then once weekly to every other week as needed.

[cleptogrey]

a big old towel in the tub works as well as the rubber bathmats. just pull it out and put it in a bucket when soapy and stick another towel under paws. the tub mats these days are pretty narrow. so you might want to triple them up to get the full length & width of the tub. i clearly remember the days of daily dipping one of my dogs when he had mange. look at the bright side- it's summer- just put him on the deck to dry!

[DofSweetPotatos]

With Yardman, we used a regular rubber backed bath rug. It was 24x30". I would put it on the bottom of the tub and yardman would stand on it.

I would face his head to the high end of the tub. Water still drained out of the mat, albeit a bit slower. He eventually learned that if he needed he could lay down while bathing. After the bath, I'd roll up the rug and squeeze as much water out as I could then would launder with his bath towels and hang to dry. It worked well for us.

[NeylasMom]

So just a quick update. We still haven't received the shampoo (freaking Entirely Pets!! ) so as you might imagine, the skin/hair loss issues have not resolved. The sore on his leg is finally close to being healed, but getting it there has been a real challenge (I still have to keep it bandaged to keep him from licking and reopening it). No sign of a return of the ear issue thankfully, but he certainly still continues to be irritable and grumpy with the other dogs at times.

 

Thyroid results from MSU are also in and my vet does feel he's hypothyroid. I started a new thread here to get feedback and would love input over there if anyone has any. Tx.