Can CH Tollwest's Spice of Broadway, JH WC CD RE CGN, CARO RA-MCL, Am WC

I spoke to the vet yesterday, and Bella doesn't have lepto. Again. So, again, we still don't know what made her sick. ::sigh:: The vet spoke to another vet who specializes in pathology, and this vet didn't think the cause was likely to be a TBD. If she'd had Lyme either time, it would have been taken care of by the antibiotics, but in any case, her Lyme test has been negative three times. So has Erlichia. It could still be some untestable form of Rickettsia, but Bella's current doxy regime should take care of it. I had asked about doing titers for TBDs, but they're very expensive (about $100 for each one). The doxy should be taking care of them too, if they're there, so I think I'll pass on them for now.

The other possibilities are low-grade metritis and some kind of low-grade autoimmune disorder. Since whatever it is is only expressing itself in with fever and stiffness and then disappearing after a few days, there's no obvious way to test for whatever it is at the moment. The only thing to do at the moment is finish the course of doxy, wait for Bella to come into heat again, and see what happens.

Bella's nine-TBD panel came back last week--everything was negative. We're still waiting for confirmation on the lepto test, but I just can't imagine that she caught lepto two years in a row. Yes, it's endemic here, but it's not THAT common.

There are some TBDs that haven't been identified, so it's possible that she has some weird strain of Rickettsia that doesn't show up on the tests. I'm keeping her on doxy for at least another week in case that's what's going on.

So we're no further ahead in figuring out what's making her sick. The only link between the two illnesses at the moment is that she was having a false pregnancy both times.

Argh! I was hoping that something would come back positive so that it could be definitively treated and forgotten.

Bella's mystery illness has run its course. Thursday and Friday were pretty rough for her--she was stiff and sore, and once lying down, couldn't get up by herself. She couldn't walk up even one stair, and she tiptoed around like an old woman. The intial bloodwork at the vet's showed that she was slightly anaemic, her WBCs were normal, and her liver and kidney function were normal. Her fever peaked at 40.6C on Thursday by my thermometer and started slowly going down on Friday about 24 hours after she was started on amoxycillin.

After a discussion with other Toller folks on Facebook, I took Bella into the vet again on Friday for repeat bloodwork and to draw blood for the most comprehensive TBD panel the vet could find. Friday's bloodwork showed that the anaemia had corrected itself (just like last year) and that her WBC count was now slightly elevated (also just like last year). Her fever slowly decreased on Friday throughout the day, but she still had trouble moving. I had to hand-feed her both days because she couldn't reach down to the floor to eat, and she also had problems even bending her neck enough to take food from her bowl. She was briefly uninterested in food on Friday afternoon, but otherwise never lost her appetite. The vet gave me two weeks' worth of doxycillin in case she does have a TBD.

Bella managed a short walk down to the park on Friday evening and sat on the hill watching Nick chase tennis balls, and we headed up to the cottage with Jim and my parents early Saturday afternoon. She was still running a low fever, but she was moving much better and made it up and down the hill to the lake without much difficulty. She retrieved bumpers from the lake quite enthusiastically for a little while until she started to shiver. I put her lifejacket on to give her some insulation and then swaddled her in a blanket back up in the cottage. It took at least an hour for her to throw off the chill. She only went in the water once on Sunday--I expect she remembered that it made her feel worse the day before. She didn't get any more chills and was fine swimming on Monday when her temperature was back down to normal. By Monday evening, you'd never have known she'd been sick, although she did look rather tired.

This episode mimicked last year's almost exactly. Bella's fever went a little higher this time, and she took a little longer to recover, but everything else was the same. Her only symptoms were the sudden onset of a high fever, stiffness, and joint/muscle pain. She had no swelling, no vaginal discharge, and nothing in her bloodwork suggested anything more than that she was fighting some sort of infection and inflammation. She was happy to eat as long as I hand-fed her. The only link between the two episodes is that she was having and is having a false pregnancy. False pregnancies don't cause sudden high fevers, but if she's a TBD carrier, the hormone wackiness may have supressed her immune system enough to let the bug get a foothold.

The nine-disease tick panel and lepto test are pending. I expect the lepto test to be negative, just like last year, and I'm rather hoping that something comes back positive on the tick panel. Then at least I'd have a cause and a cure for this mystery ailment. Nothing else really fits: pyometra wouldn't have been cured by amoxycillin, her symptoms don't fit Addison's, and the lack of joint swelling or unusual bloodwork results don't suggest any autoimmune disorders. She seemed to respond to the antibiotics in about the time frame that you'd expect antibiotics to take effect. I had her on both amoxycillin and doxy on Friday and Saturday, but she lost her breakfast two days in a row, so now I'm just giving her the doxy. The vet said that the doxy might upset her stomach and that the amoxycillin wasn't really needed if she's also on doxy, so I thought that getting just one antibiotic might make her less nauseous. She kept all her meals down yesterday and on Sunday, so hopefully that'll continue.

[Truth be told, she's a teeny bit heavier than she ought to be, so missing a few meals won't hurt her. I'm cutting back her food until she loses two pounds and regains her girlish figure.]

A few people suggested that I spay her so that she won't have any more false pregnancies to trigger whatever this is. I'll wait until the results of the TBD panel comes back before I consider that. I'd like to find out what's actually making her sick--it'd suck if I spayed her and she got sick again anyway. Also, I'm a bit paranoid about anaesthetics after what happened to Lyza. I don't really care if she ever has puppies or not, but I'd kind of like to try to finish her championship. Of course, if I have to choose between a healthy Bella and champion sick Bella, it's a no-brainer. Ideally, a cause for the two episodes will present itself, be treated and cured, and then we can go on as usual.

At the moment, I'm just glad that my girl is back to her old self again. I hate seeing her sick.

The last topic of the day was hypothyroidism. About 70% of the thyroid gland has to be destroyed before classic hypothyroid symptoms present, so Dr. Dodds spent a lot of time going over the early signs of hypothyroid that aren't commonly recognized as such:

General symptoms: lethargy, mental dullness, exercise intolerance, neurologic signs, weight gain, cold intolerance, mood swings, hyperexcitability, stunted growth, and chronic infections.

Neuromuscular symptoms: weakness, stiffness, laryngeal paralysis (which results in a changed bark), facial paralysis, a "tragic" facial expression, knuckling or dragging feet, muscle wasting, megaesophagus, head tilt, and drooping eyelids.

Dermatological problems: dry scaly skin and dandruff (which can be treated by bathing the dog in Murphy's Oil Soap), coarse dull coat, bilaterally symmetrical hair loss, "rat tail", "puppy coat", hyperpigmentation, seborrhea or greasy skin, pyoderma or skin infections, myxedema (coarse, thickened skin), and chronic offensive skin odour (smells like rancid butter).

Reproductive disorders: (males) infertility, lack of libido, testicular atrophy, hypospermia/aspermia; (females) prolonged interestrus interval, no heat cycles, silent heats, false pregnacy beyond the maiden heat, and weak, dying, or stillborn pups.

Cardiac abnormalities: slow heart rate (check when the dog is at rest and look for changes over time), arrhythmia, and cardiomyopathy.

Gastrointestinal disorders (chronic, not occasional bouts): constipation, diarrhea, and vomiting.

Hematologic disorders: bleeding, bone marrow failure, and low red blood cell count, white blood cell count, and platelets.

Ocular symptoms: corneal lipid deposits, corneal ulceration, uveitis (inflammation of the middle layer of the eye), dry eye, and tear duct infections.

Other disorders: IgA deficiency, loss of smell, loss of taste, glycosuria (glucose in the urine), chronic active hepatitis, and other endocrinopathies (adrenal, pancreatic, and parathyroid).

I've seen various of these symptoms and disorders discussed on Toller-L and the Holistic Toller group. While just one isn't necessarily diagnostic of hypothyroidism, having an affected dog tested for hypothyroidism is probably a good idea.

Link to nutrition: there is too much iodine in many commerical foods, and iodine suppresses thyroid production. If you're supplementing your dog's diet with kelp, don't feed too much of it as kelp has lots of iodine.

The typical age of onset of hypothyroidism is 1.5 - 3 years, but it can happen any time after puberty. A complete thyroid panel should be done annually or every two years. Blood for testing should be drawn between heats and after false pregnancies, which means 12-16 weeks after the start of a heat.

Hemolife is the diagnostic arm of Hemopet and will be doing its own thyroid tests within the next month. A complete basic thyroid profile includes T4, T3, FT4, FT3, T4AA, and T3AA. FT4 and FT3 measure the amount of free, bioavailable T4 and T3, while T4AA and T3AA measure autoantibodies. Additional tests are available for TSH (thyroid stimulating hormone) and TgAA (thyroglobulin autoantibody). The OFA thyroid registry performs limited thyroid panels and will miss about 8% of positives. If you want to send blood in to Hemolife, you can find the instructions for how to do this under "Services" on their website: www.hemopet.org. Hemolife will provide you with a breed-specific, age-specific interpretation of the results.

When interpreting the results of thyroid tests, you have to know your dog. Puppies have higher thyroid levels than adults, while geriatric dogs have lower levels. Large and giant breeds have lower thryoid levels, and sighthounds have higher levels. Rabies vaccines can raise TgAA levels, so wait at least 60 days post-vaccination before testing.

Dogs with autoimmune thyroiditis should NOT be bred, regardless of their clinical status, because autoimmune thyroiditis is a heritable trait. Relatives of potential breeders should be screened annually from puberty. Dr. Dodds recommends that dogs not be bred until at least the age of three (later is better) to allow time for the condition, if it exists, to show up.

Hypothyroid dogs can be treated with thyroxine. The half-life of thyroxine in the body is 12-16 hours, so it's better to give the dog two doses per day instead of one. Two doses per day will provide more constant levels of thyroxine. Thyroxine binds to calcium and soy, so it's better to dose directly by mouth rather than putting the pill in food. Give doses one hour before or three hours after meals. "Pill pockets" (e.g., a bit of bread, a dunk of peanut butter) to encourage the dog to eat the pill are fine.

When testing dogs on thyroxine, draw blood 4 to 6 hours post-pill, and have the full profile done to make sure everything's as it should be. Readings should be high if the blood is taken 4 to 6 hours post-pill. Dogs should be dosed based on their optimum weight, not their overweight weight.

Dr. Dodds recommended the Whole Dog Journal as a valuable source of information on all kinds of things.

And finally, proof that I'm not just making all this up:

It's going to be a bit of a challenge to write up my notes--the seminar tended to jump from topic to topic, especially when people were asking a lot of questions--but I'll give it my best shot.

According to Dr. Dodds, yearly vaccinations were originally recommended for dogs and cats not because there was evidence that they needed them that often, but because it was a mechanism to get pets into the vet's office for an annual check-up. When you compare the number of vaccinations that a dog typically gets in its relatively short lifetime to the number of vaccinations that a person gets in their much longer lifetime--well, it's a bit ridiculous, really. The core vaccinations for dogs (the ones every dog should have) are distemper, adenovirus 2, parvovirus, and rabies. The core vaccinations for cats are feline parvovirus, herpes virus, calicvirus, and rabies. As I mentioned in my last post, I'm not sure what adenovirus is, never mind the what the difference is between adenovirus 1 and 2. I know that Lucy was vaccinated for feline leukemia when she went from being an indoor to an outdoor cat, but I don't know why that's not one of the core vaccinations.

For dogs, parvovirus is the most serious and common disease right now. There have been a number of parvo outbreaks in the U.S. in recent years. There's not much distemper around in the pet population anymore, because of vaccination programs, but it still exists in wildlife and feral dogs and can enter the pet population through contact with those animals. As I mentioned yesterday, there's very little rabies in Ontario. There's no difference between the one-year and three-year rabies vaccine except for the label on the bottle, so dogs don't need to be vaccinated for rabies annually. The goal of Dr. Dodds' rabies challenge study is to evaulate the duration of rabies immunity conferred by the vaccine. She thinks it lasts for seven years or more, perhaps even the lifetime of the dog. When vaccinating your dog for rabies, ask for a vaccine that doesn't have mercury or thimerosal in it (Imrab makes this kind of vaccine).

Another serious illness that dogs can contract is canine influenza, and there is no vaccine for it. Its symptoms look a lot like kennel cough, which isn't life threatening. The difference is that canine influenza comes with a fever, while kennel cough doesn't. If your dog starts to cough and is running a fever, it should be taken to the vet and started on a course of antibiotics immediately as the risk of pneumonia is very high.

The optimal age for vaccinating is 12+ weeks for puppies and 10 weeks for kittens. The earliest safe age to vaccinate puppies and kittens is six weeks, but Dr. Dodds said that vaccinations really shouldn't be given before eight weeks. The age at which vaccinations are effective depends on when the maternal antibodies wear off--if maternal antibodies are still present when a puppy is vaccinated, the antibodies will neutralize the vaccine. This is why puppies get a series of vaccinations: because it's difficult to predict when the maternal antibodies will wear off, and there may be differences between individual dogs and between breeds. Dr. Dodds prefers single vaccinations to combinations, and she recommends giving them 3-4 weeks apart. Again, the most important one is parvo, so it should be given first. Females shouldn't be vaccinated just before becoming pregnant in order to increase antibodies in the pups, because their hormones are out of whack when they're in season, and this raises the risk of adverse reactions. Dogs shouldn't be vaccinated at all after 10 years of age.

It's considered safe to take puppies out into the world three days after their second vaccination. The problem, of course, is how to socialize a puppy while not exposing it to life-threatening viruses when it's still vulnerable, particularly if you're spacing individual vaccines 3-4 weeks apart. Dr. Dodds suggested taking puppies to public places where dogs aren't common, such as parking lots outside of stores and malls, or inviting healthy dogs to your home. Carrying the puppy and having people play with it in your (or their) arms instead of letting it touch the ground in public places will also reduce the risk of exposure. Puppies can attend puppy obedience classes after their first round of shots because owners who take their puppies to classes are generally a clean and responsible lot, so the risk of infection is relatively low. However, there is still a risk, because nothing is risk free, so puppy owners should have this explained to them.

The only vaccination required by law in Ontario is rabies--everything else is a recommendation and is optional. Vets incur no legal liability by not recommending vaccinations, except for rabies, because everything on the label is a recommendation. Ontario law doesn't clearly specify a minimum age at which puppies should be vaccinated for rabies--it says something like "three months or older," which may be interpreted by individual public health officers either as "it must be given at three months of age" or "it must be given sometime after three months of age."

A titre measures the immunity conferred by vaccinations and by natural exposure. Because of the lower limits of lab tests, any measurable titre is considered protective--a measurable level = committed immune memory cells. The number provided on a titre test (e.g., 1:256) refers to the number of dilutions it took before antibodies could no longer be detected. A higher second number in the ratio (1:1024) is better than a lower number (1:16), but any measurable titre is a good titre. However, in Ontario, public health officers will not accept titres as evidence of vaccination.

After vaccination, a dog's titre will rise for about three months, after which time it will stabilize and return to the dog's basal level. Once the animal has stabilized, its titre should stay at its basal level and not decrease with time. This is only true for virus vaccinations, not bacteria vaccinations (such as lepto), but I don't know why. This is why Dr. Dodds doesn't think that dogs need to be repeatedly vaccinated against viral diseases. You can't boost an immune system that is already on guard for a specific disease, and over-vaccination can backfire and weaken a dog's immune system. [On a human note, annual flu shots are recommended for susceptible individuals because cold and flu viruses mutate quickly--this year's flu is not the same as last year's flu, and immunity to one doesn't provide immunity to another. That's why you can catch colds and the flu throughout your life. I don't know why these viruses mutate quickly while other don't.] Titres should be done several months after vaccinating (so that you're not measuring the temporary spike) and then again in several years.

Inoculated dogs will shed virus, so dogs that come into contact with them may show a measurable titre even if they haven't been vaccinated themselves. Dogs can also be exposed to a virus in the environment without necessarily becoming sick, so they can produce positive titres that way too. Rabies is always fatal, however, so a dog can only produce a measurable rabies titre through vaccination. I'm a little fuzzy on why rabies virus can't be shed by vaccinated dogs--I'm guessing it's because the the rabies vaccine is a killed virus rather than a modified live virus. A modified live virus will reproduce in the dog's body, but a killed one won't. In any event, Dr. Dodds was quite clear on this point: positive rabies titres can only be gained by vaccination. She has had the occasional positive titre from an unvaccinated dog come up, but it's always been a false positive as a result of a clerical error.

The rabies vaccination is the strongest vaccination given to dogs, and it's one of the ones most likely to cause adverse effects. Rabies vaccinations should be given separately (i.e., 3-4 weeks before or after) from other vaccinations when the dog is healthy, not in heat, etc. Dogs with chronic conditions (e.g., hypothyroidism) shouldn't be vaccinated at all. A letter of exemption from a vet is acceptable in lieu of a rabies vaccination in Ontario, so owners of geriatric dogs (> 10 years old) or dogs with chronic health problems should get one of these from their vet. Adverse reactions from the rabies vaccination can include changes in temperament.

To be continued...

~*~
Bella's right eye was kind of runny yesterday evening, and the white part of her eye was an interesting shade of pink. I made an appointment with the vet for this afternoon. The vet examined Bella's eye, said her cornea appeared to be clear and unscratched, noted that the accumulated goop (which I hadn't wiped off because I wanted her to see it) was slightly green and the tissues around her eye were a little swollen, and concluded that it was conjunctivitis. I have cream to put in both eyes to clear it up/prevent the other one from becoming infected. Bella's eye looks a little more gooey than usual, but it doesn't seem to be causing her any discomfort and she's not squinting or blinking any more than normal. She sure doesn't like having the cream put in, though. But, then, neither would I. And she can't go to doggy daycare tomorrow because she might be contagious. :-(

While I was at the vet's, I also had a Lyme test done to see if that's what made her sick in July. It came back negative (she was also negative for heartworm--they do both at once). I talked to the vet about whether her illness could have been a reaction to the vaccination, but she was inclined to say no until I mentioned that Bella had been having a false pregnancy at the time of the vaccination (it was a different vet than the one who told me about the false pregnancy). Then she conceded that it might have been. Since parvo is an immunosuppressive virus, it might also have been the start of an opportunistic infection that moved in while her immune system was below par after the parvo vaccination. There's no way to know. I think I'll bring Bella in for titres--including a rabies titre--after her next heat. If the rabies titre comes back positive, then I'll ask if they'll sign a waiver for rabies shots on the condition that I have rabies titres done every three years. I'm also going to email Jean Dodds and ask her opinion. Mairon has emailed her a few times, and she said that she's always gotten an answer.

Here on a quick trip back from the cottage for MiddleJim's soccer game. Bella's doing great and she loves the cottage. She and Katie have been playing tag with each other and jumping off the dock to retrieve sticks. Bella hasn't quite figured out that she's supposed to bring the stick back to me and drops them all in a particularly inaccessible place on shore as soon as she stops to shake.

Bella also got to go on her first motor boat ride yesterday. She was a little alarmed at first, but settled in as soon as she saw that Katie didn't mind the noisy engine. The boys like to go across the lake to the "jumping rocks," where they can jump anywhere from a couple of feet to about 30 feet into a deep part of the lake. There's not much of a shoreline there, so people have to climb back into the boat using the prop of the motor as a step. Everyone laughed at the bright orange lifejacket that Bella was wearing, but its usefulness became apparent when it was time to haul the dogs back into the boat: it has two handles on the back (which was partly why I bought it). Getting Bella in the boat was easy; getting Katie, who weighs more, especially when she's wet (she's an unusually furry border collie), was a lot harder. Score one for the funny-looking lifejacket!

There was a message waiting for me from the vet: the urine culture came back negative, and the lepto DNA test was also negative. So, it wasn't a kidney or bladder infection, and it wasn't lepto. I'll bring her back in a couple of weeks for a repeat Lyme test. If that's negative, well, we may never know what kind of infection she had. The important thing is that she's back to her normal, bouncy, happy self.

Bella just keeps doing better and better as the day goes on. I took her out for a second walk this afternoon, and she trotted along beside me almost the entire time. Towards the end, she even broke out into a run.

We left her in the backyard with the boys to go grocery shopping, and when we got home she greeted us with a big smile. She ran in circles around us and jumped off and back on to the front porch a couple of times. Considering that she was having trouble even walking up a single step yesterday, that's pretty good. She still has a little residual stiffness, but she looks like Bella again. Thank GOD. I will sleep better tonight, I can tell you.

8:15 pm: 38.4C Even lower!

Bella looks a little bit perkier this morning. I got her up and took her out for a pee around 4 am--I've been mixing quite a bit of water into her food, so I figured she might need to go. Also, she's stiff, so once she lies down, she tends not to move much. After four hours lying on one side, I thought it would be good to rotate her.

When we went out this morning, she perked up when she saw the cat and a bird. Then Belle next door came out (Bella could see her through the fence), and Bella started moving towards her like she wanted to go and play. There's life in the old girl yet.

She still grunts when going up stairs, but she's walking faster. She even managed a trot a couple of times. And she snarfed back a watered-down patty for breakfast--there's definitely nothing wrong with her appetite.

9:30 am: 39.3C

1:30 pm: 38.9C Yay! That puts her in the range of "normal."

The vet clinic called this morning to see how she was, and I asked about metacam. The vet I spoke to was a different one (I think she's an older woman who owns the business), and she seems to think that the underlying cause of all this is pyometra, a uterine infection. She didn't want Bella to have metacam because it might mask some symptoms. Oddly, she simultaneously implied that keeping Bella intact was a bad thing to do because it increased the risk of pyometra and that the most important thing to protect was not Bella but the viability of her uterus so that she could be bred in the future. O_o

Ooookay.

The vet that actually saw Bella was of the opinion that pyometra was unlikely in a such young dog and that it was more or less ruled out by the x-ray and lack of discharge.

The vet I talked to today was going through her chart and told me that Bella had been tested for Lyme disease when she went in last week for her vaccination. It came back negative, but she'd put a note in saying that she should have a snap test in three weeks' time to make sure. I don't think Lyme is particularly common around here--I've only seen a tick once or twice in my life--but it would be good to make sure.

So one vet thinks it's pyometra, the other vet thinks it's lepto, Liz thinks it's a passing virus like Bounty seemed to have, and Carolee--who is PADOC's equivalent of Toller-L's Deena Mottola--thinks it's all the fault of the vaccination. That's a lot of opinions, and any one of them could be right. I'm just glad that, whatever it is, Bella seems to be getting better.

Bella's home. She had a shot of amoxicillin around 1 pm, and I have a three-week supply of pills to give her. Her temperature is about the same, but the vet said that she looked perkier at the end of the day than in the morning. She was "vocalizing" at the cat in the kennel above her. :-) Hopefully, the amoxicillin will do what needs to be done.

She's still very lethargic, and she needed help getting into the car. I think her joints are sore because when I bumped against her elbow, she gave a little yelp. When we got home, she made a beeline for the back door--she really had to pee. Now she's lying on her pillow by the couch and moving as little as possible. In a little while, I'll mix her dinner with some water (to keep her fluids up).

I'll be taking her temperature several times a day for the next few days and keeping track of pees and poops. The vet is going to send a urine sample off for culture and DNA analysis to test for lepto. If it comes back positive, it means that there's lepto in her system, but it won't prove that that's what made her sick. For that, you need to do two blood titres two weeks apart. The vet saved some serum from today for the first sample and will collect a second one if we need to. Analysis of the blood titres is really expensive, but if the urine analysis indicates lepto, I want to know for sure. It'll be useful information for me and for other people in the area who struggle with the question of whether to vaccinate for lepto or not.

Poor Boo. She was happy to see me, and I think she's glad to be home, but between feeling sick and losing a lot of her coat lately, she looks rather woebegone.

I just talked to the vet again, and I'm going to bring Bella in for some more tests. She's going to repeat the bloodwork, see if she can get a urine sample, and maybe take an x-ray to see if her uterus is swollen. Bella's not drinking, so she may put her on an IV to keep her hydrated. She may also put her on a broad-spectrum antibiotic and see if that helps.

Bella's not vomiting, she doesn't have diarrhea, and there's no discharge from her vulva. I offered her a liver treat this morning, and she ate it. I was going to lift her up on the bed, and she whimpered a little, so I left her on her pillow. She might be sore from the fever (my joints always hurt when I have a fever), or something inside might hurt. She's quite reluctant to move.

I called doggy daycare, and no other owners have reported sick dogs. So at the moment, Bella has a "fever of unknown origin."

::frets::