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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #1 ·
Bottom Line Up Front: Theo (6 months) went from a minor off week to serious lethargy, pain, bleeding profusely from the mouth, yellow eye discharge, and behavior changes (could be secondary to pain). Never stopped eating or drinking, no serious bathroom changes. Blood, x-rays, urinalysis normal. Coagulation panel normal. No indication of toxicity. Fibrinogen elevated. Vet suggests two weeks doxy for suspected tick borne illness and possible Von Willebrand test. If helpful a detailed explanation is below, questions at the bottom.

Since last week Theo's had a little less focus and taking more breaks in playtime. Minor and hard to interpret as he's been home for barely a month and just had 1.5 week modified for a limp and rest. Still training well with decent energy. Friday morning woke up vocal and did not do normal routine of belly rub, face punch, and run to a toy. At training he pulled towards me when normally he works with the trainer. Slept way more than usual, he is not a napper. Saturday woke up licking all his paws and frequently pawing at his nose. Short neighborhood walk seemed skittish. Inside still napping a lot and less attempts to play. Chewing his bone I noticed a little blood, so I removed it and checked his mouth. Saw nothing, figured maybe he gnawed too much but given everything called the emergency vet (since NYE) who was at full capacity. At dinner, I changed in my room and when the closet door opened he ran in charging (growling, hackles, tail) but saw it was me and went back to eating. Heard my belt buckle, same thing.

Next morning yellow discharge in one eye and blood on my sheets from him drooling at night. Still mopey. ER had a spot so off we went. Drooling mildly with a little blood, awake and alert in the car. Still loved on the new vet. Ruled out flu, chronic autoimmune (unless very rare), or liver/kidney. Doc said likely food allergy and to follow up with primary vet in a week. Allergy would not surprise me as his new food (75-25 this week in favor) has not seemed to agree with him, but this felt extreme. New food (Purina ProPlan SS) got good poops that night (a first since he's been home), but during a light quarter mile walk drool kept coming out so I took him inside and he immediately went to sleep. Eye kept gooping and he'd wake up to puddles of blood drool looking so out of it. By night needed to be coaxed to go outside, but went pee/poo quickly once out. Still eating and drinking. Slept glued to me the whole night.

Monday Theo was terrible. He really didn't want to move, would eat and go back to bed. Would not go outside willingly and was terrified once he was out there. Started growling on end at the door (even when no one was outside), especially after a meal. Though he stopped pawing at his nose, he was bleeding and drooling more. All he wanted to do was sleep, and not in his usual spots like by the door. Either his crate (which normally is the one place he refuses to sleep), my bed (which he only sleeps at night), or curled in a tight pained ball on the floor. He was looking so bad when he'd wake that I was worried he'd go back to sleep and not wake up. Called my primary vet explaining everything and we got him an appointment early the next morning. After dinner he went a little nuts, growling hackles at the door for minutes and following me around, not in affection but with a high tail and hackles and just staring. He would not go outside, so I set up pads. Slept as close to me as you can get.

Next morning had a little more energy. He picked up a toy upon waking like normal. Had to coax him out the door but walked to the car. Couple of tail wags to our vet but he was half there. Due to everything worsening, the vet and I chose to sedate Theo to get x-rays, bloodwork, and most importantly a good look into his mouth as he would not let anyone near it. His blood test was normal, aside from slightly elevated cholesterol (he ate not too long before the vet) and monocytes. X-rays of his throat, stomach, intestines all looked great, and since he was already sedated they took care of checking his shoulder area too (relating to the previous post regarding a limp). Nothing to explain the dramatic changes. Mouth was more odd as his teeth are great and more importantly, no inflammation on any of the gums. No petechial hemorrhaging. But every single tooth was traced around with a line in the gum that was producing blood. Because of this, the vet wanted to run a coagulation panel, results in a few days.

Between all of this and the sedation, Theo was terrified out of his mind. He was such an empty shell he walked right by the neighbors in our entranceway (the only place he still doesn't like to see people) with not so much as a look. Slept the moment he got home, bleeding onto whatever his jaw was on. Then magically four hours later he woke up and brought me a sock. Wanted to play so we did "chase" around the couch at a baby pace. Went outside without coaxing, though still didn't want to go far. By night grabbing toys again, and at dinner blood wasn't appearing in water bowl until four trips or so. No more drooling, still some blood when drinking or using mouth. Yesterday morning woke up to a giant yawn and getting boxed in the face, knew it was going to be a better day. He went out confidently, kept wanting to play, and on the toy (we are NOT playing tug anytime soon) minimal blood that was gummy. Back to sleeping in his favorite spots, barking at the neighbors door instead of growling, and he started doing zoomies on the leash (I never thought I'd be so happy to see him be a menace on a walk). You'd think he was never so sick. But I see the bloodstains all over my sheets and floor and the worried feeling has not left.

Vet called and all of his clotting was normal (still waiting on one more test), except fibrinogen was elevated. She interpreted this as inflammation, and believes he may have a tick-borne illness from his days as a stray in the country and shelter (now 38 days ago) since I started him on tick prevention within a day of being home. Though he is feeling better, she wants to start him on doxy for at least two weeks. She mentioned if that doesn't help we can test for Von Willebrand. Overjoyed Theo does not have FVIII, and the tick-borne illness does not sound too crazy given how his level of endurance has been on and off since adopting him. I plan to pick up the doxy today, but I want to go ahead and test his blood for Von Willebrand's since to me it seems safe to check due to his unknown breeding and the fact he's already had a major sudden issue involving blood. He's still got energy today (still less than normal), no blood, a little eye goop (both eyes). Since adoption he has always been a very fast breather in sleep and panter, and now he sleeps quietly and softly. I cannot tell if that is good, or bad.

Here are my questions:
  • Given that Theo has almost never had good poop yet, and the doxy can cause extra diarrhea due to affects on stomach flora, is there anything to do beyond yogurt/probiotics? I've read a few threads mentioning coconut oil etc.
  • Has anyone ever experienced something like this with the blood and sudden serious lethargy?
  • He seems in good enough spirits, but I worry about the impact this can all have on Theo's behavior. This is a lot for a puppy to go through at 5-6 months (abandonment, shelter, adoption, injury/rest, so many vet visits, and this episode). I was surprised as all **** today on his walk when he showed no reactivity to cars or people/dogs in the near distance given his behavior just a day prior. I don't want to deprive him of freedom, but I feel some level of caution is warranted.
-We cancelled his training this week. Instead of 8 straight weeks its been 1,2, (2 week gap), 3 (and now a gap again). Should we pause training for a while after, to make sure nothing new arises and then resume?
-Theo was on a week of Rimadyl (100 mg morning) from Dec 20-27. Could this be a latant reaction to that?
-Any other advice thoughts are very welcome. I am so proud and impressed by Theo's ability to handle all this, and I want to do everything I can to support him.
 

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I have no experience with this sort of issue - but my heart was in my throat reading this so I can only imagine how you felt!!! I am so glad he’s improving!!!

I personally would keep him home from training until he’s better and recovered, but that’s just me.

Give him a scritch for me.
 

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That sounds very worrying.

FWIW, there is a good tick titer test that tests for a big list of possible infections -- it has to be sent off and takes a good week or so to come back. You might ask your vet about it -- I don't remember if that one goes to IDEXX or to a vet school lab, but your vet should know.

I'm not worried about Doxy. It causes far less diarrhea than other abx in my experience, and I've used tons of it at a pretty high dose for treating heartworms in foster dogs. Even my IBD dog tolerated it when he was on it for a bit for his cancer. I wouldn't hesitate to give it if your vet thinks this is tick-borne.

Rimadyl/Carprofen though can definitely jack with tummies. You need to call your vet right away if it triggers a GI reaction, as it can be an early sign of a serious side effect.

I'd be tempted to ask the vet if we should drive for a consultation with an internal medicine specialist (or do a teleconsult where they provide the vet, but not you, with guidance). Those specialists are usually housed in the state's vet school or in regional "specialty clinics," that have teams of only vet specialists. Most great vets are very open to having a specialist on-board the team for hard cases, and they often know someone they like working with and trust (possibly at the vet school they attended, if they're less than 10 years out). It can add significant cost, so talk with your primary vet about pros and cons of this approach for this case.
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #5 ·
I have no experience with this sort of issue - but my heart was in my throat reading this so I can only imagine how you felt!!! I am so glad he’s improving!!!

I personally would keep him home from training until he’s better and recovered, but that’s just me.

Give him a scritch for me.
Scra(i)tches given. Thank you, all I can say is if you anyone's in need of a diet this was a highly effective weight loss plan.
Definitely not bringing him anywhere near the trainers until he's recovered, but I was wondering if even past that we should wait. My thought is if he finishes the doxy and everything seems okay, I feel like it might be better to be cautious and see if he really is in the clear.

That sounds very worrying.

FWIW, there is a good tick titer test that tests for a big list of possible infections -- it has to be sent off and takes a good week or so to come back. You might ask your vet about it -- I don't remember if that one goes to IDEXX or to a vet school lab, but your vet should know.

I'm not worried about Doxy. It causes far less diarrhea than other abx in my experience, and I've used tons of it at a pretty high dose for treating heartworms in foster dogs. Even my IBD dog tolerated it when he was on it for a bit for his cancer. I wouldn't hesitate to give it if your vet thinks this is tick-borne.

Rimadyl/Carprofen though can definitely jack with tummies. You need to call your vet right away if it triggers a GI reaction, as it can be an early sign of a serious side effect.

I'd be tempted to ask the vet if we should drive for a consultation with an internal medicine specialist (or do a teleconsult where they provide the vet, but not you, with guidance). Those specialists are usually housed in the state's vet school or in regional "specialty clinics," that have teams of only vet specialists. Most great vets are very open to having a specialist on-board the team for hard cases, and they often know someone they like working with and trust (possibly at the vet school they attended, if they're less than 10 years out). It can add significant cost, so talk with your primary vet about pros and cons of this approach for this case.
Thank you for all of that. I was thinking about going back and asking for some type of tick test, since this is more on a hunch right now, does it matter to do that before starting the doxy?
Awesome, I picked it up today and we just started with dinner. As for the Rimadyl, Theo had no issues when he was on it that week, and as soon as these issues popped up I let every vet who saw him known about it. The vet taking his case now considered it at first, but upon seeing him she didn't think it was the likely cause.
I can certainly ask her, she's pretty open to whatever we need. We were at a vet school for his ER (not in state but nearby that all the vets here recommend during off hours) and they said he was looked at by a derm, criticalist, and other specialists; but I'd go back again in a non-ER to discuss everything. If she recommends a specialist pet insurance will possibly help lessen the dent. Would you suggest waiting to see if the doxy does anything or pressing forward now?
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #6 ·
Physically today he is still better with the energy and very minimal blood. His behavior has me concerned. He's licking his junk a good deal (and from my eyes I see no irritation). He'll go outside enthusiastically but he gets a whiff of something with the wind and gets skittish. In the house there are behaviors I'm worried will grow into OCD. Light chasing, tail chasing, and licking the carpet especially if he sees a blade of grass/leaf etc.(this has been going on the past week). At this point none of these are to the point that if I so much as say his name or grab a toy he won't stop, but I'm having trouble discerning if it is from him wanting attention/frustrated we're not playing/walking as much, aftermath of the recent stress, or a true shift in behavior.
 

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I'm curious when his last vaccines were? When did he get his rabies vaccine in relation to onset of illness?
@Magwart thoughts about possible delayed vaccinosis given the appearance of neurological type behavioral changes?
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #8 ·
I'm curious when his last vaccines were? When did he get his rabies vaccine in relation to onset of illness?
@Magwart thoughts about possible delayed vaccinosis given the appearance of neurological type behavioral changes?
Vaccines:
11-10-22: Parvo/Distemper and Bordatella (Shelter)
11-22-22: Rabies and Neuter (Shelter)
12-1-22 and 12-21-22: Lepto and booster

The light chasing is likely that my garmin was reflecting light while I was working yesterday and I didn't catch until after 30 seconds. I know the danger of laser pointers, so now all the curtains are closed for the time being.
Tail wagging and carpet licking/stuffing nose and jumping on the couch and shove his face between cushions has been this past week before the blood. Tail wagging was innocent enough, it has since increased the past two days. I would chalk all of this up to the fact his routine has been blown up for three weeks now and Mom won't play with him like she used to, but with the blood episode now so many things makes me on edge (though trying hard to not let him sense that).

If it helps, there are a few behaviors he has had since the shelter that I found odd:
-Struggled hard to play tug. And for chase with a toy, 70% chance it falls out. Only time he played tug well was the three cold days (I live in GA) over the holidays, true Christmas miracle
-Often drop a toy mid play in search of a new one (and whines). When we play with the buffalo horn (which he grips) he doesn't trade that one.
-He is a plopper in public. At the vet or trainers, after he has said hello to everyone he will get tired and plop. It's like pancaking, but he'll get up whenever you ask no hesitation. For example, trainer teaches place command, Theo does it, trainer talks to me and plop as if he is so done. Could be boredom, but it's a similar behavior he does mid-play this week when he seems to get tired. Which would be plop, dig the ground, and shove nose in it.

He woke up with energy again today. He is still breathing more quietly at night (which could be good, his poops are also better still), but would wake up to lick junk (which he's also doing now). The vet said to let him do what he wants (ie. sleep or exercise), but I do not want to push him too hard. I plan today to do some light beighborhood walks and little off leash play in our fenced run. Instead of bones/horns which he loves, I filled a kong with frozen pumpkin.
 

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@Springbrz - I don't know enough about vaccinosis. I've never experienced it with any of the rescue's dogs, and I know that there's a lot of controversy as to what it is and isn't, and I just don't have an opinion.

It sounds like there's a really good primary care vet on the case who's working to figure this case out and not blowing the owner off -- I would ask her about the Doxy affecting a tick-titer test. I think the panel can show up positive even after treatment because it tests for antibodies, but I'm not positive. Your vet will definitely be able to answer this.

FWIW, it seems like it's VERY common in clinical practice to start doxy immediately upon suspicion of tick-borne disease because those diseases are sometimes hard to diagnose definitively -- responsiveness to treatment is part of definitive diagnosis with a few of them. And there is a widely held suspicion that there might be more tick diseases than we know about and can test for: multiple tests come back negative but the dog responds to doxy treatment and the sysmptoms are "tick-borne illness-like" -- that's a pretty common practice experience I've heard of from vets. So I think you can be very comfortable that what your vet is doing here makes a lot of sense.
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #10 ·
@Springbrz - I don't know enough about vaccinosis. I've never experienced it with any of the rescue's dogs, and I know that there's a lot of controversy as to what it is and isn't, and I just don't have an opinion.

It sounds like there's a really good primary care vet on the case who's working to figure this case out and not blowing the owner off -- I would ask her about the Doxy affecting a tick-titer test. I think the panel can show up positive even after treatment because it tests for antibodies, but I'm not positive. Your vet will definitely be able to answer this.

FWIW, it seems like it's VERY common in clinical practice to start doxy immediately upon suspicion of tick-borne disease because those diseases are sometimes hard to diagnose definitively -- responsiveness to treatment is part of definitive diagnosis with a few of them. And there is a widely held suspicion that there might be more tick diseases than we know about and can test for: multiple tests come back negative but the dog responds to doxy treatment and the sysmptoms are "tick-borne illness-like" -- that's a pretty common practice experience I've heard of from vets. So I think you can be very comfortable that what your vet is doing here makes a lot of sense.
Thank you, I planned already on giving my vet a call Monday to let her know how everything was going, and I’ll ask about the titer test. You are correct, this primary vet I value immensely how prompt and thorough she tested him. Considering Theo was a stray in Alabama country which is deep woods and tall grass (the shelter was in the woods itself) tick borne illness is not unlikely and I’ve read anaplasmosis can cause cyclic and random thrombocytopenia.

Any of my uneasiness and questions is not in how the vet is handling this, it’s just hoping we are on the right track so Theo (hopefully) never has to go through that again.
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #11 ·
Not to reopen thread, but an update in the case a decade from now someone's reading through threads of "bleeding gums" (like I was). The rest of Theo's coagulation panel was normal. Speaking with the vet, she advised that a tick test would not be a great use of money/resources for largely the reasons @Magwart mentioned (not 100% conclusive and the possibility of unknown diseases). She agreed that it would be a good idea to make sure he doesn't have Von Willebrand's, so we will take his blood at next week's follow up. If that's positive I'll note it. Theo has had no more bleeding since last Wednesday, he needs some time off bones to not reopen anything. No lethargy, energy and focus good. Skittishness went away after a few days, as did most of the anxious behavior changes. Still bites at paws mainly upon waking, but that may be the allergies.
 

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After my people losing their pup Maverick to being poisoned, I think I see poisoning in everything.
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #14 ·
After my people losing their pup Maverick to being poisoned, I think I see poisoning in everything.
I’m very sorry for that loss.
When I googled bleeding gums, poison (especially rat) came up constantly. I showed up to the vet with a bag of everything I could recall him touching with his mouth in case it was.
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #15 ·
Theo is negative for Von Willebrand's, and vet prescribed two more weeks of doxy. At the follow up I listed every little thing I've noticed sine the bleeding. Testing revealed he also has an ear infection (yeast) and we are likely testing poop soon since it is pudding for days, and vet and I are not certain it's just the antibiotics.
Theo had been doing really well until a few days ago. Some of the fearful behaviors came back, really culminating last night (won't go outside, growling/hiding, biting at paws). A little less energy than normal. Puppy fear stage is naturally now, but I can sense he is in some pain. I am hoping it's only the antibiotics, since I've yet to see any blood (vet is tracking all).
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #17 · (Edited)
Thanks for keeping your thread updated. These "medical mystery" threads often have someone pop in and disappear, and so we never learn the outcome. I really hope you get answers!
Of course, that's exactly why I updated it since I saw a lot of "so what happened?"

As far as a final answer for a future reader, the vet is pretty certain at this point it is a tick-borne illness, and I don't disagree. None of his clotting factors were off, which is amazing considering the amount of blood produced. The revival of refusing outside disappeared after he had explosive poops, so I think those behaviors are pain related. He bounces back to friendly and energetic pretty quick.

Everything else (ears, poop, etc) we just hit month two of having Theo. Less than a week before I got him he was wild stray for who knows how long + his previous owner clearly treated him poorly. These issues may have been ongoing just not as apparent. My vet is great with illness-related issues and checking everything I point out, which I'm grateful for.
We have a suspicion poop could be Giardia, negative at his initial check up but we walk in the woods a lot and he laps at any water we see (trainer thinks it's learned behavior from being a wild stray). Pumpkin has helped, and an order of Feed Sentials and Sunday Sundae is on the way, excited to try.

Edit: Sorry, big disclaimer: If anyone has bought a food scoop from Chewy's (Petmate Two Cup), PLEASE check it. I checked it since overfeeding is a cause of diarrhea, it overstimates by 1/2-3/4 cup. Making a serving of 4 1/2 more like 7.5 cups.

I'll update future posts only if there's a new medical discovery related to the title. Thank you all!
 

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Wouldn't pain be pano in a 6 month old (growing pains)
And did bleeding start after rimadyl?
 

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Theo GSD 06/17/22 Adopted 11/23/22
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Discussion Starter · #19 ·
Wouldn't pain be pano in a 6 month old (growing pains)
And did bleeding start after rimadyl?
I’m not sure which pain you’re referring to in Theo’s story. The pain and limp that resulted in rimadyl was not described as pano by the two vets that evaluated him (I asked bout it by name). Their reason was how the limp presented and that it resolved and did not come back after a week of rest. The pain now/when he was bleeding, that caused the sudden behavior switch, always followed dinner so I believe it related to stomach/pain from eating.
Yes, the bleeding started after rimadyl. The vet currently treating him considered it at first, but did not after evaluating him in person and that he was on it a week and was a little more than week done. It will be something though I’ll watch in the future if he is ever prescribed it again, which I hope he won’t.
 
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