kingfisher7151 Posted January 31, 2015 Author Report Share Posted January 31, 2015 Hi everyone! Thank you so much for the help, I'm sorry I have so many questions! We got his test results back in today, and they are, for the most part, normal. His white blood cell count was very slightly low, but everything else was great. She conferred with the other doctor and they both believe it to be immune. She wants to start him on Clavamox and 10 mg. of Prednisone. Unfortunately, she says that she's not comfortable giving the B12. So, the question is, do we try to push for the B12 knowing that she will likely say no, or do we go with the Clavamox and Prednisone? The B12 is something we really, really want to try. We don't want to lose her trust by pushing against her suggestion or worse, finding an injection somewhere else. How far would you all go with this? We don't want to switch around vets constantly. It burns money, and we find strong relationships with our vets to be extremely important. Quote Link to comment Share on other sites More sharing options...
Maralynn Posted January 31, 2015 Report Share Posted January 31, 2015 So you want to try the B12 *instead* of the the clavimox/pred or along with it? Quote Link to comment Share on other sites More sharing options...
Maxi Posted January 31, 2015 Report Share Posted January 31, 2015 Personally I would go with your vet's advice and see how he progresses on the suggested treatment before pushing for B12 injections. Be aware that clavamox is a relatively broad spectrum antibiotic that should cover the bugs causing his tooth infection. But Prednisone as a steroid that will not only 'treat' any autoantibodies but may also surpress some of his normal immune function. By reducing the inflammatory response, it may also mask any signs of the infection spreading plus it is possible that it could allow a source of infection to get worse. So IMO just double check with your vet about the risk of sepsis from his tooth abscess when he is on the pred and whether it is better to get on top of that before starting the steroids. Jmo Ymmv Quote Link to comment Share on other sites More sharing options...
Maxi Posted January 31, 2015 Report Share Posted January 31, 2015 Should have added.. if he had b12 deficiency, there should be alteration in the red blood count (megaloblastic anaemia). From your earlier post, as this seems to be normal, I would think it unlikely that he has a significant B12 problem. Quote Link to comment Share on other sites More sharing options...
kingfisher7151 Posted January 31, 2015 Author Report Share Posted January 31, 2015 We wanted B12 instead of the Clavamox and Pred. Nothing that would create the "What's making him better" question. I worried about the effect of immunosuppressants while he has a confirmed abscess. But I'm not a vet! If she thinks it's the best course of action, then we will go ahead and do it. She doesn't want to remove the tooth yet until he's a little more stable. I'm quite happy with that, I don't want to put him under while he's still unhealthy. Surgery scares the dickens out of me. Quote Link to comment Share on other sites More sharing options...
Eileen Stein Posted January 31, 2015 Report Share Posted January 31, 2015 Maxi, from what I understand (and my limited direct experience) IGS in humans nearly always manifests as pernicious anemia leading to neurological problems, while cobalamin malabsorption syndrome (or IGS, if you prefer) in dogs more typically presents as GI issues. Is that your understanding too? I too tend to think B12 deficiency is looking less and less likely as the source of Trooper's problems. Quote Link to comment Share on other sites More sharing options...
Maralynn Posted January 31, 2015 Report Share Posted January 31, 2015 With a known tooth issue I would want to go the antibiotic route. I would ask about the possibility of infection being the root issue and if so if immune suppression with pred could possibly hurt more than help. Of course if they're pretty sure it is auto immune than that combination will suppress the immune system but also fight the infection with the tooth. Quote Link to comment Share on other sites More sharing options...
Maxi Posted January 31, 2015 Report Share Posted January 31, 2015 Kingfisher.. Personally, I would go with your vet's advice..thinking about it more, I have heard of dogs and sheep treated simultaneously with both steroids and antibiotics...I guess, it just depends on how significant the risk of sepsis from the tooth infection actually is and your (new) vet probably has already weighed this up. Eileen... human IGS is an autosomal recessive condition. The childern usually present before the age of 5. As you say, they usually present with chronic, relapsing pernicious (megaloblastic) anaemia. They also may develop a number of neurological conditions including confusion, dementia and a variety of peripheral effects (peripheral neuropathy, sensory impairment and parasthesia (pins and needles/burning sensations)). (...ETA.... In patients with the adult form of vitB12 deficiency, the neurological effects can occur independent of the anaemia rather than as a consequence of it) I don't know enough about the dog disease to really comment, but from what I have read, dogs with cobalamin deficiency also suffer from lethary, anorexia and failure to gain weight. The failure to absorb cobalamin may be secondary to other GI problems such as Exocrine Pancreatic Insufficiency..(the Pancreas secretes Intrinsic Factor that is needed by the body in order to absorb cobalamin). So I guess in these situations, it could be considered that the GI problems may be the cause rather than the consequence of the deficiency. (FWIW.. the original paper describing the condition in dogs - He et al. (2003) http://www.ncbi.nlm.nih.gov/pubmed/14722725 demonstrated that IGS in the dog maps to a region on dog ch'some 8 that is orthologous to human 14q that contains the AMN gene. (I can only access the abstract, so can't check this paper in detail). However, clicking through the links that you provided in your earlier post indicate that the different companies who do specifically state which gene they analyse (not all the firms state this) say they check for a mutation in CUBN.. I guess that subsequent research showed that this other gene was mutated in the BC form of the disease). Quote Link to comment Share on other sites More sharing options...
kingfisher7151 Posted January 31, 2015 Author Report Share Posted January 31, 2015 I asked yesterday if the tooth could be the cause of many of his symptoms, and she didn't seem to think so. She said she's never seen a tooth abscess that also caused such a fluctuation fever. But if there's any chance there's a systemic infection it could definitely play part. I imagine the vet has already weighed all of the factors though. I should also mention that when the vet called, she told my mom that Trooper is also slightly anemic. Very slightly, but it's still there. I wasn't on the other end of the phone, so I didn't hear that until I specifically asked for it. We're picking up the antibiotics and Prednisone in the next half an hour, so we'll see how this all goes! She said if he does ANYTHING that looks remotely like he's going backwards we are to stop the drugs immediately and call her. Quote Link to comment Share on other sites More sharing options...
Maxi Posted January 31, 2015 Report Share Posted January 31, 2015 I should also mention that when the vet called, she told my mom that Trooper is also slightly anemic. Very slightly, but it's still there. I wasn't on the other end of the phone, so I didn't hear that until I specifically asked for it. Any animal/person who has been ill for a length of time may be slightly anaemic - especially if he has not been eating for a while. However, VitB12 deficiency causes a specific form of anaemia where the red blood cells (RBC) look 'megaloblastic'. These altered cells can be detected by looking down a microscope at a blood film (or these days, RBC counting machines (haemocytometers) give information about the cells that indicate whether the aneamia is 'megaloblastic' in type). We're picking up the antibiotics and Prednisone in the next half an hour, so we'll see how this all goes! She said if he does ANYTHING that looks remotely like he's going backwards we are to stop the drugs immediately and call her. This Sounds good. Hope it all goes well. Keep us informed. Good luck to you, your mom and of course to Trooper Quote Link to comment Share on other sites More sharing options...
GentleLake Posted January 31, 2015 Report Share Posted January 31, 2015 I don't know enough about the dog disease to really comment, but from what I have read, dogs with cobalamin deficiency also suffer from lethary, anorexia and failure to gain weight. The failure to absorb cobalamin may be secondary to other GI problems such as Exocrine Pancreatic Insufficiency..(the Pancreas secretes Intrinsic Factor that is needed by the body in order to absorb cobalamin). So I guess in these situations, it could be considered that the GI problems may be the cause rather than the consequence of the deficiency. Take this with a grain of salt because, as I said before, I don't know a whole lot about this. Tilly had the lethargy, anorexia and weight loss. The biggest issue for her though was severe diarrhea and even more severe vomiting which, combined with inability to eat or drink without it coming right back up, also led to rapid weight loss. With regular B 12 injections, she has none of these symptoms. This lead me to think that the malapsorption is the cause of the GI issues rather than consequence. But this is only one dog, so it may not mean anything beyond her individual case. Quote Link to comment Share on other sites More sharing options...
Maxi Posted January 31, 2015 Report Share Posted January 31, 2015 Take this with a grain of salt because, as I said before, I don't know a whole lot about this. Tilly had the lethargy, anorexia and weight loss. The biggest issue for her though was severe diarrhea and even m,ore sever vomiting, which, combined with inability to eat or drink without it coming right back up, also led to rapid weight loss. With regular B 12 injections, she has none of these symptoms. This lead me to think that the malapsorption is the cause of the GI issuesrather than consequence. But this is only one dog, so it may not mean anything beyond her individual case. Well, I'm not even basing my comments on an actual dog, just on what I've read ..though in the example I gave ( EPI), it would seem likely that for dogs with this condition that any cobalamin deficiency is secondary to the pancreatic problem. But this scenario may an exception rather than the rule.. and I will be the first to admit that it is not always easy to separate cause from consequence or even just from 'mere' correlation. Quote Link to comment Share on other sites More sharing options...
kingfisher7151 Posted January 31, 2015 Author Report Share Posted January 31, 2015 Just in case anyone was curious, here are his CBC results. There isn't really anything abnormal, but it's interesting nonetheless. They pretty much just indicate generally poor health. Possibly for quite some time. Quote Link to comment Share on other sites More sharing options...
Maxi Posted January 31, 2015 Report Share Posted January 31, 2015 He has a mild "normocytic, hypochromic" aneamia without any evidence of abnormal red cell breakdown or abnormal reticulocyte (immature red blood cell) production. These results are often associated with the 'anaemia of chronic disease'. They are NOT the results usually associated with vitamin B12/folate deficiency. Quote Link to comment Share on other sites More sharing options...
emilyfalk Posted January 31, 2015 Report Share Posted January 31, 2015 For those concerned about the prednisone: there is an anti-inflammatory dose and a higher immunosuppressive dose. As I mentioned earlier, a short course of low dose steroids should not crash the immune system. Steroids get a bad rap, and it's good that people are aware of the side effects, but when used appropriately they can be very helpful! For an average sized border collie, 10mg a day is not a high dose that would act as an immunosuppressive. Quote Link to comment Share on other sites More sharing options...
Maralynn Posted January 31, 2015 Report Share Posted January 31, 2015 This might sound like a stupid question, but for a autoimmune issues I always thought the pred/steroids were supposed to supress the immune system a bit to solve the issue? Or how exactly does it work? Quote Link to comment Share on other sites More sharing options...
kingfisher7151 Posted February 1, 2015 Author Report Share Posted February 1, 2015 Alright, new disconcerting symptom. He had a pretty sudden, very noticeable nosebleed during dinner. We're stopping the medication right now. Ready, set, go. Quote Link to comment Share on other sites More sharing options...
kingfisher7151 Posted February 1, 2015 Author Report Share Posted February 1, 2015 I should mention it happened while eating a chicken bone. It's also on the same side as his tooth abscess. Maybe it ruptured into his nasal cavity? Quote Link to comment Share on other sites More sharing options...
Maralynn Posted February 1, 2015 Report Share Posted February 1, 2015 I'd be trying to contact a vet - the latest one if at all possible. And I really leary of feeding raw to him with the current plethora of issues. Quote Link to comment Share on other sites More sharing options...
Sue R Posted February 1, 2015 Report Share Posted February 1, 2015 Some of the dental roots extend to the nasal cavity. Is it possible that the infected tooth abscess could have ruptured into the nasal cavity? Quote Link to comment Share on other sites More sharing options...
kingfisher7151 Posted February 1, 2015 Author Report Share Posted February 1, 2015 I wish we could get him to eat regular food (even though we love raw) for the time being, but raw is essentially the only thing he will eat. We've tried essentially every other thing we can think of. Quote Link to comment Share on other sites More sharing options...
GentleLake Posted February 1, 2015 Report Share Posted February 1, 2015 For dogs, raw is regular food. There are many raw advocates who question the logic of feeding sick food (aka kibble) to a sick dog. It would be the human equivalent of giving someone who's sick a diet of Kraft macaroni and cheese, Kentucky Fried Chicken, and French fries to someone who's sick. Just like humans are advised to eat a healthy diet of wholesome, fresh foods, especially when they're ill, shouldn't we consider a diet of fresh, whole, species appropriate foods to be a better choice for our dogs than processed kibble? I know this isn't going to go over well for the anti-raw crowd, but for those of us who are open to it, I do think it's a logical conclusion. Quote Link to comment Share on other sites More sharing options...
Maralynn Posted February 1, 2015 Report Share Posted February 1, 2015 But there are more options than just raw or kibble I've fed raw before and would again if that was what my dog needed (and if that's all a dog will eat then it's what is needed). But raw meat can be pretty bateria laden (as can kibble) and I balk at the idea of introducing more bacteria to a dog that is already sick and has open mouth sores if something like home cooked is an option. I did feed raw to my dog with hemangiosarcoma because that was all she would eat. When Kipp was sick I fed him THK and some added scrambled eggs or cooked chicken - easy to digest and I wasn't introducing more bacteria to his compromised system. Quote Link to comment Share on other sites More sharing options...
Shetlander Posted February 1, 2015 Report Share Posted February 1, 2015 Quinn's holistic,pro raw vet didn't want him eating raw when she first took over care of his IBD. She said his system couldn't handle it at that point. Quote Link to comment Share on other sites More sharing options...
B Point Posted February 2, 2015 Report Share Posted February 2, 2015 You're kind of damned if you damned if you don't. Regular BM's are my litmus test for how stressed or not his system is. If you ever need any help on dealing with incontinence from the high dose Pred... let me know. Quote Link to comment Share on other sites More sharing options...
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