Von Wilebrandt's Disease?

[MrSnappy]

Here's the situation: we got a 4 year old unneutered male BC, so to my knowledge he has never had surgery before.

 

Less than a week after coming into rescue we had him neutered, and had his long nails clipped short while he was under.

 

Post neuter, his "sac" swelled up to the size of a small melon with blood, and also got infected - he was put on a course of antibiotics.

 

Four days after his neuter, three of his clipped toenails opened up and bled quite a bit on a dog walk.

 

Since being in foster care (2.5 weeks?) he has had several nosebleeds, ranging from moderate (a few drops of blood) to a pretty heavy one after exercise this past weekend.

 

Does this sound like a clotting disorder? Anyone have any experience with this? Obviously he will be off to the vet shortly, but I am diagnosing this myself at the moment as it's the only thing I can think of.

 

Suggestions? Experiences?

 

RDM

[ljrphoto]

I think that there are a lot of things that can cause the bleeding issue. I know from reading that some tick borne diseases can cause bleeding issues.

[MrSnappy]

We don't have tick borne diseases here to speak of, and this dog has never been out of his yard.

[Rebecca, Irena Farm]

If he were here, that's what I would think too. Do you have problems with TBD up your way?

 

There's a DNA test for VWD if you suspect it. But I think it's serious enough that he would not have survived even a neuter surgery. Not that sure, I'm unfamiliar with it.

[MrSnappy]

I think there are grades or types of it, and some are more severe than others. But I don't know a lot about it. I am off to do some research. I feel really bad for this dog. Took him out of a life in the laundry room only to find this

 

RDM

[BCjetta]

Some older male dogs can have issues with the sac swelling after a neuter. And also if the nails were trimmed short and cauterized and then he was out walking on a rough surface (like pavement) and scraped them its possible to get them bleeding. But the nose bleeds definitly aren't a normal thing and the 3 things combined certainly raises concern about a bleeding problem.

I know central lab for vets has a whole clotting type panel they can do. Is it possible the dog could have gotten into mouse or rat poison in the last month or so? That can cause prolonged bleeding time.

I hope he doesn't have a lifelong medical problem! Poor guy!

[MrSnappy]

The rat poison thing has been raised before; however, this dog has spent his life primarily in the laundry room and in his securely fenced back yard. I would imagine that given the woman had him and 4 other dogs, a problem would have been noted.

 

The sac swelling I have seen, but this was definitely larger than normal. The nosebleeds have been my biggest concern. He is full of pep and never stops, his appetite is good and all things being equal, he seems like a perfectly normal dog, except he bleeds!

 

Are there other clotting disorders??

 

RDM

[Kat's Dogs]

I don't know....

That would scare me to death though. Let me know what happens after a vet-visit. Hopefully it is something that he will get over quickly, poor guy.

[Alaska]

Well darn. I don't have anything to add, except tell the poor boy and his caregivers I'm sending best wishes. Even though I'm sure you've done plenty of searching already, I wanted to make sure you found this link: Canine Inherited Disorders Database (inherited blood disorders)

[DixiesDad]

Don't know if this will help but we had a young mule we raised that we lost after having vet cut him. Same symptons. What the UGA Vet school says happened he had a birth defect of the liver and a certain agent(can't remember name) that the blood needs wasn't produced in a large enough quanity for all the replacement blood he was producing. The agent was what kept the blood in the veins and arteries. He literally bleed to death on the inside.

[juliepoudrier]

RDM,

Okay, I know many of you are thinking that I sound like quite the broken record, but here goes. Please don't rule out TBDs. I've posted some links below that indicate ticks that carry the various TBDs and the TBDs themselves do occur in British Columbia. One of the common laments among the vets on tick-L is the propensity of vets in parts of North America to emphatically state that "tick disease doesn't occur here." Basic testing for the main TBDs is easy and relatively cheap (Snap 3 and Snap 4 are good screening tests). Treatment is also pretty inexpensive, though it's best to do it long-term (6-8 weeks). Ehrlichia causes bleeding--in fact, many dogs die from this disease by "bleeding out." Granted, your rescue doesn't appear to have any other symptoms, but the problem with many TBDs is that they don't present a consistent set of symptoms. Anyway, while researching other possible causes, I think I'd test and treat for TBDs, especially ehrlichiosis--it can't hurt. If he were mine, I would probably request treatment regardless of test results (that is, I'd treat even if the Snap test came back negative).

 

http://www.agf.gov.bc.ca/cropprot/ticksbc.htm

 

http://www.bchealthguide.org/healthfiles/hfile01.stm

“Other diseases passed on by ticks include relapsing fever, tularemia, Rocky Mountain Spotted Fever (RMSF), Q fever and anaplasmosis formerly known as Ehrlichiosis. All of these diseases are rare in British Columbia.”

[but see below]

 

http://www.canlyme.com/bcconf.html

 

http://www.pubmedcentral.nih.gov/articlere...i?artid=1187793

 

http://jcm.asm.org/cgi/reprint/33/10/2710.pdf

“Ixodid ticks were collected from Connecticut, Massachusetts, Missouri, Pennsylvania, Rhode Island, and

British Columbia (Canada) during 1991 to 1994 to determine the prevalence of infection with hemocytic (blood

cell), rickettsia-like organisms. Hemolymph obtained from these ticks was analyzed by direct and indirect

fluorescent antibody (FA) staining methods with dog, horse, or human sera containing antibodies to Ehrlichia

canis, Ehrlichia equi, or Rickettsia rickettsii. Of the 693 nymphal and adult Amblyomma americanum, Dermacentor

variabilis, Ixodes scapularis, and Ixodes pacificus ticks tested with dog anti-E. canis antiserum, 209 (32.5%)

contained hemocytic bacteria. The prevalence of infected ticks varied greatly with species and locale. In parallel

tests of duplicate hemolymph preparations from adult I. scapularis ticks, the hemocytic organisms reacted

positively with E. canis and/or E. equi antisera, including sera from persons who had granulocytic ehrlichiosis.

In separate PCR analyses, DNA of the agent of human granulocytic ehrlichiosis was detected in 59 (50.0%) of

118 adult and in 1 of 2 nymphal I. scapularis ticks tested from Connecticut. There was no evidence of Ehrlichia

chaffeensis DNA in these ticks. In indirect FA tests of hemolymph for spotted fever group rickettsiae, the overall

prevalence of infection was less than 4%. Specificity tests of antigens and antisera used in these studies

revealed no cross-reactivity between E. canis and E. equi or between any of the ehrlichial reagents and those of

R. rickettsii. The geographic distribution of hemocytic microorganisms with shared antigens to Ehrlichia species

or spotted fever group rickettsiae is widespread. [emphasis added]”

 

ETA: The Marista Vet site has good information on a lot of veterinary issues. Here is the link to von Willebrand's disease:

http://www.marvistavet.com/html/von_willeb..._s_disease.html. There is a DNA test available for some breeds (there's a link to the company that offers the test, but I didn't check what breeds can be tested).

 

J.

[MrSnappy]

Julie,

 

the only incidents of tick borne disease (and they are rare) seen here are in the BC Interior. We just simply do NOT see it at all in the Lower Mainland. Unless the dog went on a trip to the Cariboo, and I doubt it, it seems really unlikely. I'll keep it in mind, but we have virtually no ticks in the Lower Mainland at all, much less disease carrying ticks.

 

RDM

[Kyrasmom]

Some odd autoimmune type reaction to the surgery/infection? My Samoyed had Pemphigus, which is an autoimmune condition triggered by stress, and once after a mammary surgery, she began to have clotting disorders and nosebleeds.

 

It passed on its own as she stabilized and healed, the pemphigus + diabetes made healing a lot more difficult but the vet chalked it up, at the time, to an autoimmune reaction.

 

Maria

[ljrphoto]

While I also would be very skeptical that the dog has a TBD based on the rarity your area experiences and the fact that the dog doesn't seem to be acting sick other than the bleeding issues, there is evidence that infected ticks are migrating to British Columbia "on the backs" of migratory song birds. Lyme disease used to be unheard of in Michigan too, but now is becoming much more commonplace. My son was treated for it a couple of summers ago.

 

I'm not trying to say that I think the dog has a TBD, just that I would consider screening for it in a case like this.

[stockdogranch]

I have that same broken record that Julie does--the one about TBDs. That's one test that's easy to do, not terribly expensive, and then it could be ruled out,

Anna

[MrSnappy]

I have that same broken record that Julie does--the one about TBDs. That's one test that's easy to do, not terribly expensive, and then it could be ruled out,

Anna

 

Actually, an Ehrlichia test at our Lab services here is $220.00 - this is NOT cheap, when you combine it with the blood draw, vet exam and Platelet count, plus clotting tests and general blood panel. I am looking at a $600.00 bill just for testing. While I am not adverse to spending what I need to spend on the dog, I AM adverse to spending it haphazardly, especially given the enormous vet bills we racked up with hairless KC (AKA the genetic mutant) and Hope's amputation.

 

I spoke to my vet, and my backup vet, extensively yesterday and neither one feels that Ehrlichia is the culprit. One of the vets has never seen it here, and one has seen what they suspected *might* be it, about 3 times in the last 20 years. In each instance, the test was negative - which I understand is not uncommon since it is designed to detect the disease in its infancy, not in an acute phase (which this phase would be, given the bleeding). And all of those dogs had visited outside the country in recent weeks. They feel it is not ehrlichia based mostly on the fact that there is no petichial hemorrahging and no swollen lymph nodes.

 

It's very frustrating, to pull this dog out of a substandard existance only to have him present like this. I also spoke to his previous owner yesterday and got a good grasp on his lineage - many of the local flyball dogs are directly related to him and none of them, to my knowledge, has VWD. My quandry is that if I sit around waiting for clotting tests for something that is not critical (ie VWD) we could be missing something that is (like Ehrlichia). OTOH, it's so unlikely that it is the latter. I did ask that a titre be done for it, this being approximately $120.00 cheaper than the test.

 

Argh.

 

RDM

[juliepoudrier]

RDM,

I certainly understand your frustration. I think Anna and I were both referring to the Snap test (the combo test that checks for HW, Lyme, and ehrlichia and costs maybe $40 here in the US). Another option is to simply treat for ehrlichia without testing for it. Many vets say that if treatment resolves the problem, then the dog likely had the disease, regardless of what the test indicated. I imagine a course of doxycycline would be the cheapest alternative available, and it would have the added bonus of covering other TBDs like Lyme as well.

 

Here's a quote from one of the links on the tick list: "The suggested treatment with doxycycline has been 5 to 10mg per day per Kg. (according to the Merck Manual.) Some dogs have been treated at a rate of 20 mg per kg body weight per day (or 200 mg for the typical 22 pound dog, divided into two daily doses given 12 hours apart) with excellent results. Most cases have shown that the higher dosage is more effective, but its use will be dictated by the animals tolerance. It should be administered for at least a 6 week period. "

 

Here's an intersting tidbit I found (from this site: ttp://www.cvm.okstate.edu/instruction/mm_curr/Ehrlichiosis/Ehrlichiosis.htm: "Ehrlichia platys, French and Harvey 1982

Ehrlichia platys which infects dog platelets is the only Ehrlichia spp that infect cells other than leukocytes. It causes infectious cyclic thrombocytopenia (ICT). The disease is characterized by severe thrombocytopenia(<15000/ul) occurring at regular intervals. The disease is often asymptomatic but thrombocytopenic animals may hemorrhage after accidents during surgery. [emphasis added]The vector for this agent is not known, though R. sanguineus is suspected."

 

If the culprit is ehrlichia or some other TBD, improvement is usually pretty dramatic within a few days of starting treatment. Anyway, I understand that your vets believe ehrlichiosis is unlikely, but lacking some better diagnosis (since vonWillebrand's seems unlikely), I think I'd try to the doxy (and maybe skip the titer) as an inexpensive option while your vets try to figure out what else to check for. And if the meds help, then you may be able to stop looking altogether!

 

J.

[MrSnappy]

The SNAP test is not available here because of the extreme rarity of TBD. It would have to be ordered - none of the vets I spoke to yesterday carry it, nor do they know anyone who does. I also spoke to two different friends who work in vet clinics and their clinics also don't carry it and can't suggest any who do. I am really not kidding when I say that Ehrlichia is so rare here that it is virtually non existant.

 

My vet said the same thing, that if he sees anything in the blood smear that suggests it would be a good idea to put him on Doxy we would (and again, Doxy is not cheap - I had to give it to to my dog when he got Lepto and it was $90.00 for the bottle, which was 10 days of treatment!). Regardless, I am reluctant to put him any high dose antibiotic with an undiagnosed bleeding disorder! Hence the frustration at not really knowing where to start. I trust my vets, but they are not the cheapest vets known to man and frankly, I have to be conservative in our spending.

 

It can't be something simple, because doG knows we do not get dogs with simple problems in our rescue; no, no way

 

RDM

[Lenajo]

Is Vancouver and Seattle that far apart - that is in terms of diseases? I know of several dogs that have had bad Erlichea in the Seattle area. Erlichia can also be transmitted in utero I believe, and a dog would be ok until he was under stress....say a neuter and a new home...

 

There are numerous types of clotting disorders, some genetic, some not.

 

What does his CBC look like?

[juliepoudrier]

RDM,

Can you get a prescription from your vet and order it? I just checked one source, KV Vet supply, and a bottle of 100-mg, 500 pills, was $40. I treated Twist with doxy last fall for 8 weeks and maybe used half a bottle. I don't know what rules are for shipping stuff to Canada, but if it can be done, doxy can be had for way cheaper than what you're getting from the vet. Just a thought (and here we are importing human drugs FROM Canada because they're such a bargain!).

 

If he didn't improve within a few days, you could stop treatment, so you wouldn't need to keep him on it long-term if it didn't appear to be working.

 

Anyway, I can't offer any other advice, but can send good thoughts your way in the hope that y'all will figure it out soon!

 

J.

[MrSnappy]

Well, we got back the results of all the tests today, and it appears that the dog is 100% normal. His renal function in excellent, his coagulant tests were perfectly well within range, his platelet counts were fine - apparently there is not one single thing wrong with this dog. My vet suggests he may have had a sinus infection, or inhaled a foreign body. She does not believe there are any tumours in his nose - she said she could send him for a nasal scope, but that she felt it would be a waste of money. He has not had a nose bleed now in a week, and she feels the antibiotics he was on for the neuter site infection probably played a hand in clearing up that as well.

 

So it remains a mystery, but apparently a good one.

 

RDM

[ShoresDog]

Good news! Glad to hear it, though I do hate mysteries. But better a mystery that remains while the dog does well than a mystery that refuses to yield when the dog is ill, eh?

[Kat's Dogs]

hmmmm. That is strange. At least he his test came back OK.

You seem to end up with great dogs with mysteries! And yet, you find every single one a home.

[PSmitty]

Good news! I hope he's fine from here on out.

[Eileen Stein]

Glad to hear he's okay.