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The panting, and increased water intake are most likely side effects of the prednisone. The decreased activity could be a side effect of the pred, anemia or the underlying cause of the low platelet levels. These signs should resolve as the pred dose is decreased. Has your girl been worked up for the primary cause (blood count, blood chemistry, coagulation panel, etc.)?
Usual dosage for doxycycline ranges from 2.5-10 mg/lb once a day and is sometimes divided in half for twice daily dosing. The usual dosage for prednisone for immunosuppression is 1-3 mg/lb once a day tapering to 1-2 mg/lb every other day. The tapering schedule varies widely (Reference The Pill Book Guide to Medication for your Dog and Cat - 1998).
Side effects of corticosteroids (prednisone) are dose dependent. They include increased appetite, thirst and urination, panting, diarrhea, vomiting, pancreatitis gastrointestinal ulcers, diabetes, muscle wasting and behavioral changes.
Bruising as you saw on the belly is a sign of decreased clotting ability. Immune mediated thrombocytopenia (IMT) is the most common cause in dogs. Sometimes the cause is unknown (idiopathic or primary IMT). Secondary IMT has a number of causes including autoimmune disorders, drug therapy, rodent poison (anticoagulants), vaccines, cancer, infections and transfusions.
Let me know if you have follow up questions.
The immune system and its components are phenomenally complex. Regulatory or suppressor T cells are a subset of immune system T cells that suppress activation of the immune system and help maintain tolerance of "self." Borrelia burgdorferi infection by itself causes inflammation, but specific T cells are required to produce immune mediated (autoimmune) disease. That means that Lyme disease can result in autoimmune disease in individuals who are genetically and immunologically predisposed, but does not cause immune mediated diseases in all individuals who are infected.
It is difficult to prove a relationship between Borrelia burgdorferi infection based on antibody titers and immune mediated disease. Positive Lyme titers indicate infection at some point in time, but not current infection. It takes a long time (years) for positive titers to decrease. This distinction is important for treatment and prognosis.
Most (not all) dogs with immune mediated thrombocytopenia whether or not it is related to infections, drugs, etc. recover and resume normal activities. Many require immunosuppressive drugs in addition to corticosteroids (prednisone). Some relapse and need continued treatment often long term. Sometimes removal of the spleen is indicated.
The prognosis of thrombocytopenia secondary to infection is good if the underlying disease can be cured. The survival rates reported depend on the study. Some indicate up to a 30% death/euthanasia rate during the initial or subsequent episodes. Recurrent thrombocytopenia Other studies report a death rate below 10%. A 40% recurrence of thrombocytopenia has been reported. Relapses are controlled by the same treatment with a more gradual tapering regime with dogs staying on alternate day prednisone for months to years.
You have not mentioned signs of lameness in Lucy. Lameness is the most common sign of Lyme disease in dogs. Most Lyme associated lameness resolves in dogs, but some animals have intermittent bouts. Assuming no lameness and response to treatment, Lucy should be able to resume normal activities.
I apologize for the detailed answer, but do not think there are simple answers to immune mediated disease nor to Lyme separately or together.
Dear Dr. Lenny,
Please do not apologize for the detailed answer. I am desperately trying to educate myself about Lyme disease and autoimmune disease and very much appreciate your taking the time to talk with me.
Lucy was always very active and in the beginning of her treatment, I really had to work at restricting her running and playing due to the bruising that was occuring. Since she has been on the doxycycline and prednisone, I have noticed her activity waning. I can see she wants to play, but doesn't appear to have the energy to exert herself. However, yesterday she was more active and alert and this morning she ran a bit in the yard. Hopefully, this is a good sign!
You asked me earlier if Lucy had other blood work done and I apologize for not answering that question. Yes, she did and the results were all in the normal range.
I should also tell you, I had another golden retriever who contracted Lyme disease and died 2 weeks after her diagnosis. The disease was so advanced in her. I didn't even know anything was wrong, until she stumbled one day at home and I took her to the vet. She tested postive for lyme and exhibited restlessness and heavy panting and was put on doxycycline and a diuretic. Xrays showed excessive fluid in her body, that we couldn't even see her heart.
I live near Reading, Pennsylvania in the United States. I discovered I live in a high Lyme area. My home is surrounded by farm fields and woods. After the death of my other golden, I was very proactive in Lucy's health. I had her vaccinated against Lyme when she was a puppy in addition to all the regular required shots. I do understand that the Lyme vaccination is only 80% effective. She is also treated with Frontline Plus however, the vet switched her to ProMeris when we discovered she had Lyme disease. I honestly don't know what else to do as far as protecting Lucy from this disease. Since this is the second dog to have contracted Lyme disease from our backyard, I am equally concerned for myself and my family.
If there is anything else I can be doing for Lucy, please let me know. I so appreciate your time.
I am a bit south of you (Chester County) and in Penn Vet country, which may bias my view of the Lyme vaccine. Penn and most of the vet schools do not recommend the vaccine although most will give it if asked. I do not recommend it nor vaccinate my own dogs. I discuss pros and cons with clients let them decide.
If you have not yet run across the consensus report on Lyme vaccination by the College of Veterinary Internal Medicine, you can follow the link below. It is only a paragraph so a quick read.
One of the concerns about the vaccine is that it can cause some of the immune mediated syndromes (polyarthritis and glomerulonephritis) similar to actual Lyme disease. Goldens and Labs are reported to have an increased risk of immune mediated Lyme related disease. I have not seen reports of increased risk related to the vaccine. I have seen several cases of kidney failure that may have been Lyme related, but have not seen adverse reactions to the vaccine in the few Labs/Goldens I've vaccinated... all for what it is worth since numbers are too small to have significance.
I've never seen IMT mentioned, but it is not generally considered a common Lyme related disease in dogs. Getting good disease statistics in dogs is difficult because there is no mandatory reporting for the vast majority of diseases or vaccine reactions in pets.
Is Lucy related to your other Golden?
It sounds like you are on track with treating Lucy and I hope/expect the platelet count will return to normal. I hope her activity level continues to increase and that she feels better. It is very hard to have sick critterkids. Take care of yourself also. Let me know how she does if you get a chance.
Dear Dr. Lenny,
Just wanted to let you know that I took Lucy to the vet on Tuesday for another blood test and her platelet count was over 300,000. This is good news! The vet feels we are on the right track for her treatment. Lucy's activity level has risen, but I am being very careful (maybe too cautious) about her activity. I don't want a set-back. We are continuing the doxycycline and the prednisone and she will go back for blood work again on December 12th.
Thank you so much for your thoughts and time. I will continue to update you on Lucy's progress.
Wonderful! That is well within the normal range and she should be clotting normally again. I would take it easy with her, but you can again go for short walks. I would have no problem with an easy 1/2 mile off pavement or 1/4 on pavement.
You'll need to watch her carefully and continue platelet counts as you back off the pred dose.
Hello Dr. Lenny,
I just wanted to give you an update on Lucy. She has been off the prednisone for 4 weeks. On Dec. 19th we had her blood drawn for another platelet count and her results came back at 215,000. The vet was pleased with the results and felt she was "cured" of the lyme disease and said I could resume walking with her, but taking it slowly and building up her strength.
Two days ago I noticed that her breath was foul smelling. My concern is this, Lucy had foul smelling breath for approximately 1-2 months prior to my noticing the bruising on her belly. I assumed she was digging in our compost pile, eating chicken poop or digging in the meadow and I would brush her teeth or give her bisquits to try and combat the smell. With all the research I did on her lyme disease and the autoimmune disease, I recall one of the symptoms of lyme is foul smelling breath. Is it possible for the lyme disease to come back again and if so, can it come back this quickly? I am also treating her with ProMeris once a month.
I look forward to hearing from you.
The assumption was that you were dealing with an immune mediated disease. Lyme may be what initiated it, but the immune mediated reaction is not just an infection. I know you read a lot about this. The immune mediated reaction can recur without a new infection.
Lucy will test positive to Lyme. The tests detect antibody to the organism and the titer can take years to decrease. You may have a recurrence of the immune mediated disease without active infection.
Does your vet plan on monitoring the platelet count for a while? It might be a good idea to recheck platelet levels once a month for several (6??) to make sure that they are staying in normal range. A repeat chemistry screen for kidney and liver enzymes, etc. would also be reasonable.
Is she eating and drinking? Urinating normally (frequency and volume)?
Other causes of stinky breath exist, but follow up monitoring is not a bad idea.