Orion not doing so great, fistulas, thyroid concerns, crysta

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Orion not doing so great, fistulas, thyroid concerns, crysta

Postby Riddick » Fri Jul 11, 2014 8:00 pm

Orion has been feeling pretty crummy lately.

2 weeks ago I lifted up his tail and found a butt riddled with perianal fistulas. We have 6-8 open holes and two different tunnels/tracks, and he was extremely inflamed and painful, on top of diarrhea. Rushed him straight to the emergency vet who put him on 14 days of Clavamox and a steroid topical ointment for his butt. So now Clavamox is done tomorrow, butt is very less inflamed and irritated, diarrhea is gone, and while the holes and tunnels/tracks are smaller and not oozing anymore, they are still there. His new vet (who just so happens to be my boss) recommended starting him on cyclosporine, so I am waiting on the pharmacy to ship that to me and we'll start a 6 week treatment of that for the fistulas.

So about a week ago I noticed that Orion had started drinking ridiculously excessive amounts of water and he was acting very sluggish and just off...Took him into the clinic I work for and my boss suggested we work him up, so we did. If you are familiar with Antech, we did a Pet Wellness Report. Full comprehensive bloodwork, thyroid, and urinalysis.

We drew blood and urine on him Monday afternoon (July 7th) I personally put his blood and urine, and his fecal sample out in the Antech pick up box Monday evening fully expecting the Antech driver to pick everything up, just like he usually does, and have results back Tuesday morning. Well I walk in to work Tuesday morning and discover that our stupid Antech driver picked up his fecal, but left his urine and blood in the box all night!

So of course I was obviously livid, Orion is very sick and I was counting on his blood and urine results to be back ASAP. So I called our Antech rep and expressed my extreme unhappiness with the driver, who at this point we can only figure he was just being careless, moving too fast and didn't check the box thoroughly, hence grabbing his poop but leaving the blood and urine. Our Antech rep assured me he would have a AM driver come pick his blood and urine up Tuesday morning...well surprise surprise, that never happened. SO I put his blood and urine out in the box AGAIN Tuesday night, and it finally did get picked up. So his blood and urine sat both outside and in the fridge in changing temperatures for over 48 hours.

Anyway, I got his entire work up done free of charge (bitching pays off sometimes!) but that's not my concern. My concern are 2 things:

First, his urinalysis. Showed he has a pH of 6.0 and 2-3 calcium dioxalate crystals in his urine. Problem is, I can't rely on those results being accurate, right? Cornell veterinary university's website clearly states that these particular crystals are more likely to form as artifacts in stored urine (which his was). My boss said none of this though...he immediately jumped to the doom and gloom. Said that it was a diet thing and Orion needed a diet change and the crystals forming are a result of the low pH which is a result of the food. I told him that we absolutely CAN NOT do a diet change on Orion. We fought for years and the ONLY thing he his stable, normal, and regular on is Acana Pacifica. Boss shrugged and said fine, we'll be doing surgery on him for stones then. (I know, great guy huh?) So that just exasperated me completely...Rest of urinalysis was fine, specific gravity low normal, negative for protein, glucose, ketones, etc.

Secondly, his thyroid. T4 came back extremely low, less then 0.5, when the normal canine range is 0.8-3.5 Antech recommended doing a Free-T4 test, boss said no that was useless and ordered a TSH instead. TSH came back and his TK9 (don't know what that is) came back as 0.121 with the canine range being 0.030-12.0 Boss said since it was in the normal range, even though it was low normal, that we don't need to treat his thyroid. But again, this is on blood that sat for over 48 hours. I don't know if that makes a difference...I've read many conflicting things. Some say TSH is useless and do Free T4 to determine accurate thyroid levels. Some say the exact opposite, Free T4 is useless. I'm so confused...

In the meantime, Orion still feels very icky and off and just not himself. Still drinking a ton, and peeing excessively (no infections btw forgot to mention). But he is eating completely normal, appetite has not changed at all, BUT he has lost 6 pounds in a significantly short period of time, and this is a dog who DOES NOT lose weight. He has been a steady solid 89 pounds for years. When I put him on the scale and it said 83 pounds I almost broke into tears...he's sick, and my boss is blowing him off...he's not concerned in the least bit about the accuracy of his blood and urine after sitting for so long. No concern about his T4 being so low.

SuperChem and CBC all came back completely normal. No abnormalities or extreme highs or lows.

So Monday we are going to his normal vet, the one who has seen him and treated him since he was 8 weeks old. I am getting all his blood, thyroid, and urinalysis redone and they can do everything in house while I'm sitting there so I can be assured that there will be no driver mishaps and blood and urine not sitting for hours and hours.

I can't help but wonder if all of this is linked to the Clavamox. He was having no symptoms until about a week into the Clavamox, but both emergency vet and boss assured me that Clavamox doesn't cause these kinds of side effects. But at this point I don't know who to trust...

I realize now that this has been just one giant long rant, but I am so drained, exasperated, frustrated, and concerned about my boy I just needed to vent. If anyone has any input, theories, experiences, as always I am greatly appreciative of your guys' wealth of knowledge and information. I know I don't post a lot on here, but I lurk everyday (to the point of I kind of feel like a stalker lol) I just want my Ori feeling better, and I hope that Monday's appointment with his normal vet is much more productive in finding answers then the complete uselessness I went through with my boss...thank you so much for listening...
~Lyssa~
Apollo, Orion & Remus...and the kitties, Flower and Jasper!!

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Calypso » Fri Jul 11, 2014 8:20 pm

Oh man! I'm so sorry that you and Orion are dealing with this. Unfortunately I have nothing to add about the blood and urine work up. All I can say is that I'm pulling for you guys and I hope your other vet has some good answers for you.

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Amanda » Fri Jul 11, 2014 10:48 pm

From all I know about thyroid in *dogs* it's the TSH test that is useless. It is a great indicator in humans but not dogs. I'd do a full thyroid panel perhaps through dr. Dodds. I think you'll get more answers on Monday and I hate that you and he have to wait so long.

I believe that even potassium bromide can mess with the thyroid too so make sure you take that into account.

Keep us posted.

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Sat Jul 12, 2014 4:48 am

Thanks Amanda :) Orion is not the seizure dog, that's Apollo on potassium bromide. The only thing Orion takes is metacam every other day for joint pain. I am planning to do a full thyroid panel through someone, gotta see how much Dr. Dodds costs and if my normal vet offers it.
~Lyssa~
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby MaisyPancakes » Sat Jul 12, 2014 6:31 am

Thinking of you guys. Too many mystery scary things going on on ODO. I hope you get some answers from the tests!

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby QBert » Sat Jul 12, 2014 6:50 am

What a cluster! I hope you're able to get him sorted soonest.

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby SherriA » Sat Jul 12, 2014 9:04 am

How frustrating that the lab screwed up so badly. Sending good thoughts for Orion.
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby emmas_mom » Sat Jul 12, 2014 9:05 am

I'm glad you are having the tests redone - I don't know about blood, but I know urine samples should be as fresh as possible and refrigerated if not being tested immediately. As for thyroid, all of my vets always say the Free T4 is the one that counts. And I highly recommend sending it to Hemopet (Dr Dodds) - I used her for one of my dogs where what I was seeing contradicted what the vet I used at that time was saying. She nailed the problem and the dosage and protocol for dosing, and she personally emailed me with the results, discussion of the findings, and answers to any questions I had. This was about four years ago and I think it cost me about $100, which was almost the same as what I would have paid to have it done at a lab here at that time.
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby JudyL » Sat Jul 12, 2014 9:21 am

Oh man, that must have been incredibly painful for Orion to have that many fistulas. I'd be frustrated over the handling of the samples too, and I wouldn't place great reliance on those results.

Was he on any oral steroids or just the topical? Those can increase thirst, but I don't think only a topical or the Clavamox would cause the increase. Do you measure out his food to know that he's been eating the same amount as before? Because he's feeling poorly, maybe he wasn't taking in quite as much as you thought. Also, if he's drinking more, that could have him feeling a little full when he does eat.

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Sat Jul 12, 2014 9:35 am

Just the topical steroid for his butt. And yes I always measure out his food. 1 cup for breakfast and 1 1/2 cups for dinner. He ate every meal with gusto and never left anything behind, and still lost 6 pounds! I actually bumped him up to 1 1/2 cups am and pm after I found out he lost so much weight :(

So how does sending stuff to Dr. Dodds work?
My vet draws the blood and then I mail her blood samples?
~Lyssa~
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby emmas_mom » Sat Jul 12, 2014 11:20 am

So how does sending stuff to Dr. Dodds work?
My vet draws the blood and then I mail her blood samples?
The vet draws the blood and then either the vet's office can send it (some will, some won't) or you can send it. The instructions are on the Hemopet website when you request a test, and the price list for various tests also. http://www.hemopet.org/veterinary-diagn ... atory.html
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby LisaT_II » Sat Jul 12, 2014 12:33 pm

Send it to Dodds yourself, priority mail (you'll have to overnight refrigerated if you add on the chem/cbc). If you send it in yourself won't have to pay the clinic markup. The TgAA is worth running once in non-senior dogs (thyroid panel 5), and after that I just use the $85 thyroid panel 4: https://labordatenbank.com/cake/hemopet ... mopet_form

I don't always follow her advice on treatment though. It has changed over the years, and I find that it's become more conservative. We went opposite her advice with Jazz here, and I'm glad that we did. Personally, i'd just run with the number you have and treat, since you are seeing symptoms and you are treating fistulas that are already very expensive. And I would ramp up the dose over time to not shock the body, and retest down the road. You know your boy well enough to note response.


Have you considered that the metacam may be compromising his gut and flairing the fistula? It did for Max.

Not much else to add outside of the PMs, but I would be more interested in this Tk9 stuff your vet is talking about....
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Sat Jul 12, 2014 4:25 pm

Have you considered that the metacam may be compromising his gut and flairing the fistula? It did for Max.
Gosh I hope not. Metacam is the only thing that has worked so far for his arthritis/joint pain, and it's working fantastically. He's been on the metacam for a while now, since Christmas when his ear hematoma happened and we discovered it worked so good for the arthritis.

It never caused any diarrhea, excessive drinking or peeing, or any other digestive upset before. We actually stopped the metacam for a week to see if that was a cause of the drinking and peeing excessively because it was listed as a possible side effect. Stopping it didn't change anything though...just made his back end feel worse :(
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby LisaT_II » Sat Jul 12, 2014 6:37 pm

I hear you. I had the same problem with Max. I ended up using Adequan, hyaluronic acid, and DLPA for him.
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby LisaT_II » Sat Jul 12, 2014 7:07 pm

You haven't added or increased fish oil since they last closed?
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Sat Jul 12, 2014 7:31 pm

He can't do fish oil. I got him a bottle of that Sea Pet with Omega 3 and vitamin E when the first fistulas started years ago and OH MY god did it make him worse!!! Explosive diarrhea, super oily, itchy, hot skin. It was so bad...so bad...he can't really handle any supplements, glycoflex he did fine on digestive wise but it did nothing for his arthritis. Metacam has been a godsend for his pain, and we don't even do it everyday. Cyclosporine should be here Monday or Tuesday and we'll start that treatment. Clavamox was done this morning so we'll see how he does drinking/peeing wise tomorrow and Monday...I'm still not convinced it wasn't the Clavamox...appointment to redo everything is Monday at 5:15, and now Apollo is going with him too...he's having some incontinence issues :( these dogs are gonna be the death of me!
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby LisaT_II » Sat Jul 12, 2014 9:18 pm

Same with Max. I think that fish oil may alter the wrong part of the immune system when there is any type of infection.

Baytril made Max pee. He was fine on Cipro.

Some dogs are also sensitive to sulphur like msm, eggs, garlic, etc. and it can make them appear incontinent.

Dont' forget to rule out tick issues - can also complicate fistulas ;(
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Sun Jul 13, 2014 7:15 pm

Took him with me when I went to walk the boarding dogs at the clinic and threw him up on the scale...he's lost another pound and a half...since Monday :(
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby JudyL » Sun Jul 13, 2014 8:59 pm

Lyssa, do you know if the Acana product you are feeding has changed in the last couple of months? I googled and came up with some forum posts from this past March on the dogfoodadvisor that were discussing Acana changes that were made earlier this year. It didn't mention Pacifica specifically, but I'm wondering if there was a change of ingredients that might have caused the flare up of the fistulas, added to his diarrhea, and if there was a new formulation, if there was a slight reduction in the kcals of the food, or if there's some ingredient that Orion isn't able to utilize and causing him to lose weight. Certainly, the diarrhea could be part of the reason for his weight loss, but I'm wondering about the food too.

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby SherriA » Mon Jul 14, 2014 9:31 am

I know how worrisome it is when they lose weight. Sending good thoughts.

Have you considered digestive enzymes? I don't know if they'd help, but if he's not digesting his food well maybe that would help? It made a difference for Oliver when he started losing weight. He still lost weight because he wasn't eating well, but he lost at a slower rate.
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Mon Jul 14, 2014 9:32 am

Thank you so much Judy, I'm definitely going to call Champion pet foods and ask about that. Appointment to redo blood and urine is today, chest and abdominal X-rays are tomorrow...
~Lyssa~
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Mon Jul 14, 2014 9:36 am

Thank you Sherri, yes I plan to ask about digestive enzymes today at his normal vet.
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Amanda » Mon Jul 14, 2014 9:53 pm

Oops, sorry I got them confused. I'm hoping the test redos shed some more light on what is going on. Keep us posted. Oy. Too many puppies to worry about! We need a string of healthy ODO dog threads.

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Riddick » Tue Jul 15, 2014 8:50 am

You ever feel like you want to pull your hair out while simultaneously banging your head against a brick wall? That's about how I feel right now...

Good news first. Apollo, my 14 1/2 year old seizure boy is doing fantastic. His urinalysis came back completely normal, no UTI which we were worried about because he's been having some incontinence issues. So basically with him it's just a old dog thing and we (meaning my lazy useless brother) have to be more diligent about getting him outside to empty his bladder more often. We opted not to do Proin right now because he's doing so so good on just the potassium bromide that I don't want to throw a wrench into anything. His bloodwork came back awesome, that one liver value, ALKP (alkaline phosphatase?) is down way low! From 1020, to 302! With normal range being 23-212. This was the one the Phenobarb was messing up so bad. Sodium and Chloride are a little elevated, but that's from the potassium bromide, but this drug is so much easier on his body. Thyroid is normal, kidney values are great, so Apollo is in the clear!!

Now Orion....problem child Orion. First off, I don't know if my scale at work just sucks, or it's broken, but Sunday night on my scale at work he was 83.1 pounds, down from his usual 89. Yesterday at his normal vet the scale read 87.9...so I immediately said whoa whoa whoa no way that's right, especially when just last night the scale read 83.1 so the tech grabbed a bag of food to make sure it was right, it was, and she also weighed herself. She said all good. So according to his normal vet's scale he's barely lost a pound. But I checked my scale at work too with a bag of food and it read fine. So (insert banging head on brick wall) I don't know what to believe now. To me, he doesn't look like he's lost 6-7 pounds, but I see him everyday, so I can't be a good judge of that.

Urinalysis, no crystals in fresh urine!!! Which is what I suspected, so happy dance for that. pH is low normal, but not doom and gloom low that boss gave me. His urine is very very dilute, so there is something going on. CBC is normal, so no infection. His ALT and ALKP are elevated though, not super high, but elevated enough that his normal vet is concerned. Those two values were not elevated on last Monday's Antech screwed up bloodwork, so basically we are just gonna throw that report out and forget we ever did it. She doesn't know yet why these two values are elevated, but she said she was gonna research and call me back today. He's still drinking and peeing like crazy, and just not acting himself.

Thyroid, T4 was still low, but normal vet said the TSH that boss ran, because that serum was safe in the fridge and sent to our good lab that we can count on those results being accurate. She said since the TSH is low that the thyroid is not malfunctioning, it's just sick because there is something else going on in his body. She said if there was a actual thyroid problem that the TSH would have been way high. So yes T4 is low, but only because of euthyroid sick syndrome?

So with his liver values the way they are right now, she said no to starting the cyclosporine for his fistulas until we figure out the cause of the liver problems. His butt is looking really good though, so cross our fingers that it just continues to improve with my cleaning and topical ointment until we can start cyclosporine.

Somebody just come snap their fingers and fix him...
~Lyssa~
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby Calypso » Tue Jul 15, 2014 11:13 am

I'm snapping for all I'm worth. Hope it helps.

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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby LisaT_II » Tue Jul 15, 2014 1:34 pm

Did you show the vet the information from Antech about the problem with TSH and determining hypothryoidism in dogs? Any vet that bases that decision about hypo on the TSH clearly is not fully informed about the thryoid in dogs. Same info on the TSH is mentioned here:
http://www.veterinarypracticenews.com/v ... ction.aspx

Hypothyroidism can also cause elevated liver enzymes, and incontinence.

Treat the thryoid, and see what happens. Liver support would be helpful. Rule out tick disease. If the fistulas get worse, consider doxy, but you would need that liver support.
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby LisaT_II » Tue Jul 15, 2014 1:59 pm

From Cornell, stating that low TSH does not rule out hypothyroidism.
https://ahdc.vet.cornell.edu/docs/Canin ... esting.pdf

In order to diagnose NTI, you actually need a full panel, including the free and total T3, which was not done here. In the area of thyroid, this vet is pretty clueless, which, unfortunately, is pretty common.
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Re: Orion not doing so great, fistulas, thyroid concerns, cr

Postby MaisyPancakes » Tue Jul 15, 2014 3:17 pm

Man, what would we do without insanely knowledgeable ODO Aunties looking out for our dogs! I hope his liver improves and that the vet gets more current on the thyroid info. Yay for healthy Apollo and Orion's crystal-free pee!


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