Mysterious dog injury/illness
September 27, 2015 3:40 PM   Subscribe

My dog's medical history has our vet stumped. Very low platelet count, lethargy, bad limping on one hind leg - two similar but not identical incidents 6 months apart. Maybe you can help?

My beagle Charlie has had a very strange and unpleasant year, and his symptoms have the vet stumped. I don't know what else to ask them, maybe you have seen something similar and have some suggestions?

Photo here

Charlie is nearly 7 years old, he's generally in good health - active and normal weight. In February he suddenly became lethargic and lame on his right hind leg. Occasionally he does limp on one leg (if he's overdone playing) but this seemed different so we had it checked out. The vet suspected a cruciate ligament injury but when they put him under anaesthetic for x-rays, they found bruising all over his belly and hips, did a blood test and found very low platelet and red blood cell count. The vet suspected either an autoimmune condition (IMT) or rat bat poising. Charlie received a plasma transfusion and they started him on Vitamin K in case it was the later - he then made an amazing recovery so it was assumed that it was the poisoning. The leg pain was assumed to be coincidental, i.e. that it was a minor injury hurting him much worse than in normally would due to the poison.

Fast forward to last week, and he's got almost exactly the same symptoms, except it's the opposite leg. Took him to the vet, again it looked like a cruciate or hip injury, but due to his history they did a blood test right away. This time the blood test came back with normal red blood cell count but extremely low platelets, so again they gave him the transfusion right away even though there were no signs of bleeding/clotting problems this time. Poisoning is not suspected and the symptoms/test results don't match either IMT or a congenital condition. Since the transfusion he has perked up and is almost himself again, but is still limping a little and is more tired than normal. They've found no evidence of back or leg injury, but haven't done x-rays.

Both presentations have been unusual and the vet can't figure things out. I suspect he'll get better over the next couple of days, and the vet will not follow-up anymore. I am worried about a repeat and it seems to me there must be something underlying both incidents that we're missing.
posted by cloverthistle to Pets & Animals (13 answers total)
Has he had a tick-borne illness panel done? Tick-borne diseases can cause these symptoms.
posted by biscotti at 3:42 PM on September 27, 2015 [6 favorites]

What about a bite from a venomous snake?
posted by WalkerWestridge at 4:09 PM on September 27, 2015 [1 favorite]

I'd get the x-ray done so you can rule out degenerative disc disease or visible hip problems. You may find the problem or not, at a cost of a couple hundred dollars. If you can afford it, do it.
posted by irisclara at 4:14 PM on September 27, 2015

Are you near a university with a teaching hospital, by chance? Ours is no more expensive than the regular vet, and I'm pretty sure they don't understand the concept of discontinuing follow-up unless the patient dies, especially for something intriguing or challenging.
posted by teremala at 4:18 PM on September 27, 2015 [1 favorite]

When my dog had Lyme disease, her main symptom was sudden lameness in one leg. It sounds like low platelets can also be a symptom.
posted by Redstart at 5:32 PM on September 27, 2015

I'm in love with Charlie!
That said, yes- full panel for tick borne infections- including Ehrlichia, Rocky Mountain Spotted Fever [RMSF] or Anaplasma. Also, sleuth around Google or Yahoo groups for "canine (illness you suspect)" for more clues and also for more treatment info after you get a diagnosis. Animal lovers who band together for mutual aide and support in those groups are an incredible resource.
posted by TenaciousB at 5:34 PM on September 27, 2015

You haven't stated your location, but where I live, limping is always reason to test for valley fever. I don't think valley fever affects platelet counts, but I'm no expert. It definitely causes limping and lethargy. It's a fungus and requires anti-fungals. It's endemic from California through Texas.
posted by Squeak Attack at 6:02 PM on September 27, 2015 [1 favorite]

I'm treating one of my dogs for a chronic tick-borne illness with a 3-week course of doxycycline for some of the same symptoms Charlie has, and she's already bouncing back. She hasn't had a tick in the year we've had her, so we're assuming she came with it from the shelter (with its outdoor cages in a wooded area).

Our vet found it with the specific type of heartworm test they use - it tests for tick-borne illnesses as well - but not all heartworm tests do so.
posted by bookdragoness at 6:23 PM on September 27, 2015

IMAV - I agree with Tenacious about the tick borne disease testing esp Ehrliachia. Why was autoimmune disease ruled out? There isn't really a good test for IMT. Tick borne disease testing can be tricky though as it takes a while for the body to make antibodies, and the new/ PCR tests aren't perfect either. Sometimes it comes down to a trial on Doxycyline, and then trial on prednisone if that doesn't work. (I'd definitely rec the tests though). Joint taps for cytology and culture might also be considered (this usually requires short sedation/anesthesia. Some parts of the country see a lot more tick borne disease than others.
posted by morchella at 11:59 PM on September 27, 2015

I'm also wondering-have they checked clotting times? The original supposition of rat poison could have been verified (or at least supported or ruled out) by coag testing. If they didn't recommend it (as opposed to you declining it due to cost) I might wonder if they are a bit out of there depth? Bruising is more indicative of low platelets that low clotting factors, so rat poison wouldn't be at the top of my list on a dog with bruising (though still very possible due to the consumption of platelets due to bleeding from the low clotting proteins).
posted by morchella at 12:19 AM on September 28, 2015

Response by poster: Thanks for all the thoughts so far. A few responses (I knew I'd forgotten some important details!)

Re ticks: I'm in Australia, in an area where tick and flea protection is *not* recommended for dogs as they are very rare here. I'm not sure what the situation is with tick-borne diseases here, whenever I've heard ticks mentioned people are always referring to paralysis ticks - which are obviously not at fault here.

Snake and spider bite were ruled out on the first occurrence (I think largely because, like paralysis ticks, he'd've been getting much sicker and died within days from anything around here). Liver function etc also all check out fine.

IMT hasn't been totally ruled out, they just say the blood test results don't really fit that diagnosis. Sorry, there's been a lot of complicated info coming my way and I haven't managed to keep on top of all of it. On the first occurrence clotting factors were extremely low (every time they took blood it was a drama). This time clotting factors are fine. This is probably what has them most confused because he seems so much like he did last time. The vet sent blood to a specialist pathologist in Sydney but that only confirmed the results from the clinic here.

Money is no concern. I'd rather get to the bottom of things now than potentially keep forking out big dollars for the plasma transfusions - despite them seeming like a miracle cure right now.

Today Charlie is barely limping and becoming a handful to keep quiet so he's obviously feeling better. We go back to the vet on Wednesday.
posted by cloverthistle at 12:57 AM on September 28, 2015

I had a foster fail to test positive for any tick-born diseases, and she was tested for erlichia, and tulerimia, both the stick test and the full-on bloodwork. Her platlets were so low that she had a bloody nose that didn't clot for a few days. She bruised really easily, which isn't always easy to see under the fur. She also manifested symptoms that looked like auto-immune, such as thick eye discharge/dry eye.

In the southwest where I am, flea/tick diseases have been far more common this year than they have been in the past, so we're not used to seeing them.

The first vet be brought her to wanted to do a CT scan, because none of the testing was negative. The second opinion vet put her doxicycline for quite awhile, and it resolved. The next step was a steroid burst, if the doxi didn't work.
posted by answergrape at 7:26 AM on September 28, 2015

You may want to try a doxicycline course, in part because it's cheaper to rule anything tick-related and move on, and then rule out auto-immune with steroids. These are much cheaper than other types of assessments, that will require expensive diagnostics.
posted by answergrape at 7:34 AM on September 28, 2015

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