Home Run, Lost Game, etc. Part 2

So where was I?  I sent off the mother of all tick panels to try to diagnose Lucky’s leukocytosis (fancy word for high white blood cell count).  I tested for:  Lyme, Rocky Mountain Spotted Fever, Babesia, Anaplasma, Ehrlichia, Hepatozoon, Leishmania, Neorickettsia, Bartonella, Mycoplasma (2 kinds) and Cand. M Haematoparvum.  

While these tests were running, I placed a call to my local internal medicine specialist Dr. Kelly Nitsche to discuss the case.  I told him I was running the “big” tick panel looking for odd diseases and he said “Ha! Like you’re gonna find Hepatozoon or something! Those are so rare, don’t get your hopes up!”.  Ha ha I joked back…secretly thinking “Just you wait Mr. Specialist guy…I AM gonna find some rare disease and be a hero”. 

Granted, half of those organisms I was testing for, I hadn’t heard of or knew as some other name (microbiologists seem to like changing the names of organisms alot, not sure what that’s about other than to confuse me). But that wouldn’t hamper the rush of discovery I’d get from diagnosing one of them.

Oh and did I mention that on fecal exam, Lucky tested positive for nose worms?  Eucoleus boehmi.  I 100% forgot that one even existed! She was treated with two injections of Ivermectin for that.  Can you even imagine having WORMS in your NOSE!  Super gross, but apparently they are fairly benign in dogs.   

Anyhow, the test I ran for the tick borne diseases was a PCR test which essentially looks for tiny pieces of DNA from the organisms in the blood.  As with any test, there is fine print: a positive means they’ve got the bug and it may or may not be making the pet sick and a negative just means there wasn’t enough DNA to pick up but the pet could still have said organism.   

Everything on Lucky’s test was negative. 

Boy was I bummed. 

I called the client to tell her the test results, and she said it was a miracle:  Lucky was a new dog.  She was playing, crazy and wild.  She was eating like a pig. 

I felt like a hero.

I wanted to rest on my laurels.  My novel antibiotic had cured this dog.

However, there was a little treasonous scratchy voice in the back of my mind that said: really?  What if you’re masking something with the pain pills? 

I wanted to ignore it, but couldn’t. 

I did what I always do when I’m stumped, I pick up the phone and call people who I think are smarter than me.

First I called Dr. Monica Bungee, she works for our outside lab.  She practiced most of her career in the deep South. Louisiana, Mississippi, etc.  She’s my go-to person for weird infectious or parasitic diseases.  (Somehow I had this gut feeling that whatever was going on with Lucky was of that nature, since she was young, maybe 2 or 3 years old so cancer and organ failure, etc are less likely to blame here).

She said what I was thinking: maybe the pain pills are masking our symptoms. 

I hoped she (and that stupid voice) were wrong, but when I rechecked the white blood cell count, it was still high.  Granted it was less high, down from 25K at last count to 21.  Maybe it was a step in the right direction.  Lucky was still wild and happy.

The plan was to continue my miracle drugs and recheck the white count in two weeks.  With one caveat:  (reluctantly, because I part of me didn’t want to know…) I had the client wean the dog off of the pain pills.

Like clockwork, two days after stopping the Rimadyl, Lucky was back to being miserable.  She stopped eating, playing, moving.  She just curled up into a ball. 

Her white count was up to 30K.  Her urine was pretty normal (we were wondering kidney infection). Now she has a fever though. 

We referred her to the specialists for an ultrasound to definitively rule out pyometra (infected uterus) or some other internal organ issue. 

Her ultrasound was normal, and the only new information we got was that the specialist felt like she was painful in her lumbar area.  He wondered if maybe she has some variant of “Beagle Pain Syndrome”, meningitis, or discospondylitis (infection between the vertebrae.)  She needed an MRI to be sure, but the client wasn’t going for that financially. So they put her back on the Rimadyl, changed her antibiotic again, and hospitalized her for the night. 

Beagle pain syndrome AKA Steroid responsive arteritis: another disease I’ve never heard of.  Thus, I hit the books and the internet….  Basically it’s an immune mediated disease that causes neck pain, a high white count, and is steroid responsive. 

It sounded good, but a) Rimadyl shouldn’t be enough to totally mask the symptoms, these dogs scream in pain. b) this dog has back pain not neck pain c) the white cell was higher than typical for this syndrome.  Still I figured it was certainly possible, but the voice in my head didn’t think that was it. 

The voice made me refrain from “trying” her on steroids.  Steroids could maybe repair that beagle pain thing but it would supress her immune system and be a disaster if Lucky had an infectious disease. Plus she was back to feeling stupendous on the Rimadyl.

She came in for a recheck.  I rechecked her blood, her urine and a fecal.  The urine was normal.  White count still high at 28K.  The fecal recheck was still positive for those blasted nose worms.

I’m literally scratching my head, now what?

To be continued…

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