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Author Topic: Advice on immune problem underlying demodicosis (demodex mites)  (Read 5214 times)

briowizcar

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Advice on immune problem underlying demodicosis (demodex mites)
« on: January 21, 2013, 08:40:47 PM »

Hello,

I tried contacting Jo using an email address she gave in an article in the Bearded News back in 2007 but the message has bounced back so I suppose the address is out-of-date. I'm new to CIMDA but can already see some interesting posts.

Our three-year-old Beardie, Wizard, has just been diagnosed with demodicosis (demodex mites) and we have been told by our vet that this indicates an underlying immune problem which needs investigating and treating.

Several things over the last 18-24 months have made me wonder whether something was wrong, although nothing has been sufficiently specific or serious to go to the vet. Most things relate to aspects of Wizard’s behaviour which didn’t feel right in comparison to his character and demeanour as a puppy, including assorted fear reactions (shivering when someone uses the toaster, ‘freezing’ to stare behind him on night-time
walks, and ‘alerting’/barking at nothing); occasional muscle tremor in the hindquarters, often when showing ‘alerting’ reaction to other dogs; and intermittent periods when he was quieter/more passive than expected for his age. He also began to ‘stand off’ with head and tail erect when other dogs approached, and/or engage in a tense intrusive sniffs. He has never shown any signs of going for other dogs, but has occasionally been on the receiving end of aggression. Physically, he has a skinny physique bordering on thin, not helped by irregular bouts of not eating/diffidence towards food (typically 2-3 days duration) interspersed by normal appetite.

In July 2012 Wizard began bolting while out on walks. Initially it appeared he was running away from dogs he found threatening. After four instances in two weeks I took him to the vet and on their advice got a behavioural report from the head of the dog training school where I take our younger Beardie. The report noted that ‘many dogs found Wizard intimidating and chose to avoid him or try to use aggression to drive him away’, and concluded: ‘castration (or at least chemical castration) is the answer to other dogs behaviour towards Wizard, combined with training to reduce any learned behaviour or negative associations.’

I wasn’t comfortable with having Wizard castrated and had also noticed he occasionally tried to bolt from other things. After investigating the
options and talking to various people I decided the best option was a Suprelorin implant as the impact was not permanent. I asked whether there was any known impact on susceptibility to hyper- or hypo-thyroidism in Beardies and was told there were no contra-indications. The implant was done at the end of October 2012 and was not expected to be fully effective until a month later. I first noticed the signs of demodicosis at New Year, mistaking them for skin grazes until they did not heal. I now wonder whether Suprelorin was implicated or entirely incidental.

The breeder of our first Beardie still visits us on occasion and on hearing about Wizard’s diagnosis advised me to ask the vet to do a test for Addison’s disease, which one of their Beardies developed as a 5-year old after being castrated.

When I tried to email Jo, I was hoping that with her knowledge of immune-mediated diseases she could offer any comments to inform the discussion with our vet on Wizard’s immune problem and help focus the investigation on appropriate tests. I have just registered our Beardies on BeaCon and notice that one of Wizard’s half-siblings (same sire) has hypothyroidism.

If anyone else on the forum can advise, I would be very grateful.

Anne
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goldiepower

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #1 on: January 21, 2013, 08:56:08 PM »

Hello Anne

I would be getting his thyroid tested. I'm not an expert with Beardies, but I understand hypothyroidism is not uncommon in the breed and as you suspected does give skin and behavioural problems.

It is important to get a full thyroid panel done and not just a T4, and to get an expert interpretation as many labs will interpret values which are low but "within range" as acceptable when they are absolutely not!

I am sure Jo will respond to your post. Good luck!

Chris & the Golden Boys
^Chad^ (SRMA, Hypo-T), ^Thomas^ (Hypo-T), ^Jimmy^,
Sydney, Edward, William
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Catherine

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #2 on: January 22, 2013, 12:53:40 PM »

I echo what Chris says about having a full thyroid panel done. Plus I would also have the full haematology and biochemistry one (including electrolytes) done at the same time. This may throw up some pointers.

I have no experience with Suprelorin although I have heard of a few dogs who have it becoming ill but that may be co-incidence. Has it made any difference? If not then I would not have it - I never like giving dogs anything unless it is really necessary, thus giving their immune systems the best chance possible to keep healthy.
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Penel CIMDA moderator

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #3 on: January 22, 2013, 04:52:53 PM »

I've not heard of any problems like that related to Suprelorin and I have seen a lot of dogs who have been on it (for behavioural purposes).

I'm sure Jo will be on in the next day or so she will answer your post more fully - but the other advice is great.
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briowizcar

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #4 on: January 22, 2013, 10:28:13 PM »

Dear all,

Thanks for the advice – we are seeing the vet tomorrow evening (23 Jan) so it’s good to have an idea of the tests that might be useful, and any potential issues in interpreting them. I don’t know how far off ‘normal’ the results of any tests are likely to be, given that Wizard doesn’t appear particularly unwell - how do I make sure we get an expert interpretation? Our vet’s is an RCVS-accredited Veterinary Hospital and I’ve always felt I can trust them to take specialist advice if needed. Do they need to use a specialist lab? I found one (CSLS) on the internet which appears to specialise in endocrinology – are there others?   

Catherine asked whether the Suprelorin has made a difference - the answer is that it hasn’t produced the outcome I hoped for, although Wizard hasn’t attracted any aggressive outbursts from other dogs, or bolted, since the drug took effect. However, on the negative side he seems less confident with a greater number of dogs than before. Apart from the behavioural impact, his appetite has improved and he is now carrying the amount of body that feels right for his build. Whether this is an effect of the Suprelorin or some change in his medical condition I don’t yet know.

Many thanks,
Anne
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Penel CIMDA moderator

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #5 on: January 23, 2013, 12:41:58 PM »

Quite possibly he needs help other than Suprelorin with the behaviour modification if you see what I mean.  If you're anywhere near Surrey it might be something I could help with as this is what I specialise in  www.dogcommunication.co.uk
Generally though if dogs feel unwell they are less likely to interact with other dogs and can appear either more nervous or the other extreme - can appear aggressive.
I've sent Jo a message to ask her to log in and have a look at your post too.
Your vets do sound good so I wouldn't worry that they aren't covering everything.
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Catherine

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #6 on: January 23, 2013, 12:49:32 PM »

 I would think most labs should be able to do the tests. Remember to have the thyroid done as well - a lot of vets do not routinely test the thyroid when there are problems and with some it is an uphill struggle to get them to even test when asked! So much better if you can point out some symptoms to back up the thyroid test although really I have never known a vet to refuse.......just some are reluctant.

Another thing that is helpful (and I personally have found is a must) and that is to ask for copies of all the blood test results. Try not to be put off with "within normal range", "a bit high/low". You really need to know the figures for each result (and the reference range) so if they really will not give you copies then the next best thing is to ask for each result etc. and write it down.

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briowizcar

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #7 on: January 23, 2013, 03:52:13 PM »

Hi Penel,

I’m in Sheffield which is a bit of a long round trip. Pity - I had a look at your website and the dog communication pictures are amazing. The APDT behaviourist I’ve been using does ‘life skills’ training walks in a nearby park but without stooge dogs, so the quality of the learning varies according to who else is on the walk, or in the park at the time. I’ve been also brushing up on canine communication to understand what’s going on with other dogs, and enrolled Wizard on the GCDS along with our younger Beardie to build on previous training. He has now got bronze, silver and gold awards. He’s never been easy to train and I’ve always assumed it was a dominant personality thing – if he wanted to focus on me, he did: otherwise, forget it. It now seems this may have been a bit simplistic. It would be lovely to see him romping around with other dogs, but I’d be happy to settle for a comfortable neutral reaction. Maybe when we address his health issues he’ll start feeling happier around other dogs.     
[...]
Just had to break off to answer a phone call from the vet’s. Apparently the lab has just sent back the results of Wizard’s skin scrapes, which show he also has ringworm. This is not good news, especially with two Beardies in the house.
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Jo CIMDA

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #8 on: January 23, 2013, 04:10:43 PM »

Hi Anne

Don't worry about the ringworm it is a fungus (not a worm) and easily treated with an antifungal cream such as Canesten, and it is not serious - but it is infectious so you must be careful not to get it.

Jo
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briowizcar

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #9 on: January 28, 2013, 05:19:06 PM »


Hello again,

Wizard's blood test results came in on Friday but I missed talking to the vet as it was the same day as mum's funeral.  Just getting back to normal routine today.

When I got through to the vet's they had two medical emergencies on so I've had chance to talk to them direct. However, one of the staff looked up the results and told me the lab report conclusion was that the result was consistent with normal thyroid function, so they were just proposing to repeat the blood test in 3 months.  I had the results sent to me – key points are below (bold results were highlighted by the lab as being outside the reference range):


Haematology
All well within normal reference range except for eosinophils:
Eosinophils (Absolute) 1.32 High nm/L 0.00 - 0.80
The morphological assessment was normal.

Biochemistry
All well within normal reference range except for cholesterol and urea, which were both high:
Cholesterol 7.10 High mmol/L (3.20 - 6.20)
Urea 7.8 High mmol/L (2.5 - 6.7)

Sodium, potassium, and the sodium/potassium ratio were all normal.

Endocrinology
The test was the standard monitoring test of T4/cTSH:
Canine Serum TSH 0.64 High ng/mL 0.00 - 0.50
Thyroxine 18.0 nmol/L (13.0 - 51.0)


I’m uneasy about the outcome as Wizard’s T4/cTSH levels seem to be in the same range as dogs who have been confirmed as having hypothyroidism. I found a useful canine hypothyroidism diagnostic flowchart on the website of one of the diagnostic labs which gives a diagnosis of ‘Hypothyroidism likely’ when the T4 result is low-normal and the cTSH is high. The flowchart also notes that hypercholesterolaemia may be seen with hypothyroidism. It doesn’t comment on urea or eosinophils – I gather that high eosinophils are associated with many conditions so have limited diagnostic usefulness, and urea is more likely with hypoadrenocorticism (Addisons disease).

I have sent the flowchart and one of the BeaCon articles to the vet and asked if they can explain the difference in interpretation. I’ve also asked whether putting Wizard on a low dose of thyroxine would have any therapeutic use in helping his immune system deal with the demodecosis and/or the behavioural issues. I’m currently waiting for a response.

Does anyone have any further comments or advice?

Anne
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Catherine

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #10 on: January 29, 2013, 01:29:06 PM »

It is good that you are asking questions and finding out information from other places - this will be help you more to find out what is wrong with Wizard. How is he doing with the demodicosis and ringworm?

If Wizard is Hypothyroid then certainly giving medication to help his thyroid will also probably help with his immune system. BUT, personally, I think there could be a question mark over whether he is HypoT. On the one hand some dogs are "within normal range" and are indeed Hypot but I think perhaps I would have him checked/tested for other things first. Elevated cholesterol can also be associated with liver problems and Cushing's. Also I am not sure how much having the demodicosis etc. and the medication for it would affect the thyroid results.

I would let things settle down, discuss more testing with your vet, monitor his symptoms (keeping a "dog" diary helps) and test his thyroid again (including the Free T4 this time) in a month.
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Jo CIMDA

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Re: Advice on immune problem underlying demodicosis (demodex mites)
« Reply #11 on: January 30, 2013, 08:44:53 PM »


Hello again,

Wizard's blood test results came in on Friday but I missed talking to the vet as it was the same day as mum's funeral.  Just getting back to normal routine today.

When I got through to the vet's they had two medical emergencies on so I've had chance to talk to them direct. However, one of the staff looked up the results and told me the lab report conclusion was that the result was consistent with normal thyroid function, so they were just proposing to repeat the blood test in 3 months.  I had the results sent to me – key points are below (bold results were highlighted by the lab as being outside the reference range):


Haematology
All well within normal reference range except for eosinophils:
Eosinophils (Absolute) 1.32 High nm/L 0.00 - 0.80
The morphological assessment was normal.

Biochemistry
All well within normal reference range except for cholesterol and urea, which were both high:
Cholesterol 7.10 High mmol/L (3.20 - 6.20)
Urea 7.8 High mmol/L (2.5 - 6.7)

Sodium, potassium, and the sodium/potassium ratio were all normal.

Endocrinology
The test was the standard monitoring test of T4/cTSH:
Canine Serum TSH 0.64 High ng/mL 0.00 - 0.50
Thyroxine 18.0 nmol/L (13.0 - 51.0)


I’m uneasy about the outcome as Wizard’s T4/cTSH levels seem to be in the same range as dogs who have been confirmed as having hypothyroidism. I found a useful canine hypothyroidism diagnostic flowchart on the website of one of the diagnostic labs which gives a diagnosis of ‘Hypothyroidism likely’ when the T4 result is low-normal and the cTSH is high. The flowchart also notes that hypercholesterolaemia may be seen with hypothyroidism. It doesn’t comment on urea or eosinophils – I gather that high eosinophils are associated with many conditions so have limited diagnostic usefulness, and urea is more likely with hypoadrenocorticism (Addisons disease).

I have sent the flowchart and one of the BeaCon articles to the vet and asked if they can explain the difference in interpretation. I’ve also asked whether putting Wizard on a low dose of thyroxine would have any therapeutic use in helping his immune system deal with the demodecosis and/or the behavioural issues. I’m currently waiting for a response.

Does anyone have any further comments or advice?

Anne

Hi Anne

I'm sorry for your loss. 

Catherine is right when she says you should get a FT4 result next time. The thyroid results look ok to me.  The TT4 (total thyroxine) is within normal range and the TSH slightly over but nothing like you would normally see in a dog with HypoT.  The cholesterol is only just over too so I wouldn't worry about that at this time. 

TT4 levels can go up and down in a dog depending on it health status.  If a dog is poorly the level of  TT4 sometimes reduces but the TSH and FreeT4 (that is TT4 measured without bound protein) remains within range, and this is known as a non-thyroidal illness, meaning that it is not a primary thyroid problem but the TT4 levels are being lowered by something else going on in the body, such as Cushing's.  In a dog with primary HypoT, the TT4 and FT4 will be lower than the normal range and the TSH higher.

FT4 is the most important measurement because FT4 is the portion of hormone that filters through to every part of the body.  Measuring TT4, FT4 and TSH should give you a picture of the thyroid status. 

Please don't be in a rush to medicate with thyroid hormone if Wizard doesn't need it.  I have known so many dogs develop complications due to people giving their dog thryoid meds when the dog is not truly hypoT.

Jo
 



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