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Dr. Scarlett
Dr. Scarlett, Veterinarian
Category: Veterinary
Satisfied Customers: 3967
Experience:  I am a practicing small animal veterinarian with 16 years experience.
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My dog was recently diagnosed with "tick fever" (presumably

Customer Question

My dog was recently diagnosed with "tick fever" (presumably some sort of lyme disease) and has been on Docycycline for a week. Tonight he developed a very large swelling on the back of his neck, within hours. It feels "liquidy" but obviously I'm not an expert and can't tell. I have no access to veterinary services until tomorrow morning, I'm on an island several hours drive from the clinic.
Submitted: 1 year ago.
Category: Veterinary
Expert:  Dr. Scarlett replied 1 year ago.

Dr. Scarlett :

Hi,

Dr. Scarlett :

How is your dog feeling? Does that lump seem to bother him when you push on it? Are you able to check his temperature?

Customer:

Hi. It doesn't seem to bother him. It's hard to say how he's feeling because he's been so weak from the tick fever, but he's been more active and eating more last day or two.

Dr. Scarlett :

Do you feel any lumps anywhere else--like behind his knees or under his jaw?

Customer:

checking...

Customer:

he normally has quite a waddle, it "could" be a little swollen but I'm not 100% sure.

Customer:

I don't feel any lumps behind his knees. The swelling on the back of his neck is HUGE.

Customer:

like half a grapefruit.

Dr. Scarlett :

Huh. That is very odd. A few things come to mind: 1. an abscess/infection from a puncture wound on the back of his neck. Do you feel any small scabs in the swollen area? Does the area feel warm to the touch? I would expect some discomfort and "heat" with an abscess.

Customer:

no, I don't feel anything like that. He's been with me all day, just resting by my desk, pretty much no possibility of a puncture wound.

Dr. Scarlett :

2. I saw a thread on my veterinary site where a dog developed swollen eyelids soon after starting doxycycline. An odd reaction, but maybe that is the cause of the swelling?

Dr. Scarlett :

3. tick-borned diseases can cause a vasculitis--inflammation of small blood vessels, which can lead to swelling. But localized? Maybe.

Customer:

sorry: not warm to the touch either. and no apparent discomfort when I touch it or "squeeze" it (lightly of course) although he's always very stoic about such things.

Dr. Scarlett :

If it were an abscess, it would come on somewhat gradually, so the puncture could have happened days ago.

Customer:

well, the swelling happened very quickly, I was just petting him a couple hours ago... very thoroughly! :-) so for sure I would have been aware of it if it was present earlier.

Dr. Scarlett :

I think I would give the Rimadyl and monitor him. Ideally, a needle would be stuck in the lump and any fluid withdrawn to see what is going on.

Customer:

when I push on one side, it "shifts" to the other the way a water balloon would, so I'd say it's likely to be liquid.

Dr. Scarlett :

As long as he is otherwise feeling ok, eating, drinking, reasonably active, I would just watch it. If it continues to get bigger or doesn't seem to decrease, then I would definitely take him to your vet.

Dr. Scarlett :

Has he had even a small little lump in that area in the past?

Customer:

I thought of that (needle) but I don't have any available. should we go as far as using some other sharp sterilised item? I know that's a dangerous question to answer, but if it's blood in there I'd rather know now because he might not make it through the night if it's a hematoma.

Customer:

no, never noticed a lump in that area. he had a small 'whatever the fatty things are' on the side, but not in that area.

Dr. Scarlett :

Good thinking about the hematoma. Look at his gums, whites of his eyes, skin on his stomach (where there isn't much fur). Do you see anything that looks like little bruises or pinpoints of red?

Customer:

i'll check, just a second.

Customer:

I can't see his belly, I don't see anything in his eyes, and honestly I'm not sure about the gums... I never really paid attention to what they look like in their natural state.

Dr. Scarlett :

They should just be pink (or have some black pigment). Little red dots might indicate bleeding.

Dr. Scarlett :

Meat doesn't have any pain when you move his neck around, does he? He bends down to get a treat off the floor, looks up at you, etc?

Customer:

before starting this chat I looked up if doxycycline can cause hematoma, found several articles but it didn't look like it would from the few I read. I understand the limitations of what we can achieve on this chat. I guess what would be helpful would be knowing what I can do JUST IN CASE it's a hematoma or some other kind of reaction, sort of a shotgun approach "just in case" until I can get to a vet in the morning.

Customer:

answer to your question: it's really hard to say, he's very stoic and even when getting shots that are supposed to be painful he doesn't complain. really a trouper. I didn't even realise that he had tick fever until he couldn't get up, felt terrible about it.

Customer:

I checked his gums again, I really don't see any little red spots.

Dr. Scarlett :

If it is a bleeding disorder (like low platelets from a tick-borne disease or an autoimmune problem where the platelets are being attacked), there isn't anything you can do at home. Unless he had trauma in the area where the lump is, I would expect to see other signs of bleeding/bruising in other places before a huge hematoma occurred on the back of the neck. So I'm not convinced it is blood. If it is blood, then poking it wouldn't be the best thing to do.

Dr. Scarlett :

A fluid-filled cyst could occur in that area and cause no problems, but it would be unusual for it to get that huge, particularly so quickly.

Customer:

got it, no poking! I don't see any other areas of swelling though, I keep checking.

Dr. Scarlett :

Are you able to check his temperature? If it was a big abscess, then I would expect him to have a bit of a fever.

Dr. Scarlett :

Then I worry about things like lymphoma, a type of cancer. What were his original symptoms? Were any diagnostic tests done to diagnose the "tick fever?"

Customer:

I have a thermometer, I will check right now. but just so you know, he's a rescue and has had a myriad health problems including several urinary tract infections, and he pretty much always seems to have a low grade infection going on. I can tell because he tends to be a little incontinent when it happens, and that's been the case the last few days. but that could also be because he's been lethargic and not going outside to pee when he has to.

Customer:

yes, they did blood work and said he was positive for tick fever. I'm sorry I can't be more specific, that's the prevalent term here where I'm working (belize, central america).

Customer:

I'm going to take his temperature now, I apologise but I have to ask one very stupid question: I don't have any lubricant handy, is olive oil safe? Man, I never thought I'd have to ask that in my life, can't help but laugh! Also: how long does the thermometer have to stay in?

Dr. Scarlett :

Sure, olive oil, mineral oil, even spit will be fine. If it is a mercury thermometer, about 3 minutes is best. If digital, it should beep when it is done.

Customer:

mercury. so it'll be a bit. sorry.

Dr. Scarlett :

No worries. Only a little after 9p here.

Customer:

i'll be away from the computer until the reading is done.

Customer:

bad news, I think the thermometer is "broken"... the mercury didn't move out of the bulb at all, it's been sitting for a looong time. so I have no idea whether he has a temperature or not.

Dr. Scarlett :

Hmmm, don't guess you want to try it on yourself and see, huh? : ) Ok, do the insides of his ears feel very warm?

Customer:

A comedian, huh? Don't give up your day job! ;-) No, I don't think his ears feel particularly warm. Also, the swelling does not appear to have increased in the time we've been online, so if it's a hematoma it's not ongoing, at least.

Dr. Scarlett :

He's eating? Reasonably active?

Customer:

his appetite was very very low when he first got sick, but it's been improving steadily although I've had to add some broth to his dry food to make him eat more. and he's "normally" pretty lethargic, he has a broken femur, but his mobility has been improving quite a bit the last day or two. so overall he's getting better from the tick fever, at least.

Dr. Scarlett :

This broken femur is new or healed?? I guess if he seems to be improving a little and the swelling isn't apparently bothering him, I think he'll be ok until you can see your vet. Is the vet open tomorrow?

Customer:

the femur is very old, he had it when we found him (on a deserted island, near death). The vet here says it can't be operated, which seems strange but seeing as she's the only one that could do it, I can't very well "make" her. Yes, the vet is open tomorrow. One question: is hematoma a possible side effect of the doxycycline, and if not any kind of swelling like what we're seeing? I'm asking to know if I should discontinue the treatment in lieu of something else, if he's having a bad reaction to it.

Dr. Scarlett :

Let me check--I've never seen that side effect before. Just a sec..

Customer:

ok

Dr. Scarlett :

No, I don't see anything about bleeding issues with doxycycline. This is what I find in the formulary: The most commonly reported side effects of oral doxycycline therapy in dogs and cats are vomiting, diarrhea and anorexia. Giving the drug with food may help alleviate these GI effects without significantly reducing drug absorption. Increased liver enzymes (ALT, ALP) have been reported in up to 40% of dogs treated. The clinical significance of increased liver enzymes has not been determined.

Dr. Scarlett :

In humans, doxycycline (or other tetracyclines) has also been associated with photosensitivity reactions and, rarely, hepatotoxicity or blood dyscrasias. Maybe a blood dyscrasia could cause low platelets, but I'm not convinced. That being said, ANY medication can cause problems. If you haven't given tonights doxy dose, it might be reasonable to skip it until you get to the vet in the morning.

Dr. Scarlett :

Anticipate your vet sticking a needle in there to find out what the fluid is comprised of. If it is blood, then she'll do a complete blood count to check platelets.

Customer:

I already have given him the dose, 100mg three times daily, always with food. Should I put an ice pack on it, to try to reduce the swelling?

Dr. Scarlett :

You can certainly try it. I can't see that it would hurt anything.

Dr. Scarlett :

How much does Meat weigh?

Customer:

ok, I'll give it a shot. he's a little overweight, about 85 pounds.

Dr. Scarlett :

Three times a day is an odd dosing for doxycycline. It is generally prescribed just once or twice a day. It isn't tetracycline, correct?

Customer:

I know, I just found out: there was a miscommunication and I understood it that way, when I talked to the vet tonight I found out it was meant the other way but she said it's ok anyway. should I go to once a day?

Dr. Scarlett :

I would have dosed him at 200 mg every 12 hours for a tick-borne disease. But I'm in Wisconsin, not Belize, so don't change anything without checking with your vet. So maybe he isn't getting enough?

Customer:

possibly. even though the vet said it's ok this way, I probably should switch to once a day since that was the original intended prescription and seems to be the norm, right? but the dose either way would be a total of 300mg per day, that I'm sure about because it says so on the bottle.

Customer:

look, without being a snob, vets here are not of the highest caliber... so if the standard dose is what you're saying, I'd place more value on your opinion than the local vet... as well meaning as they are. I won't tell you the horror stories...

Customer:

the prescription is actually for 300mg a day for 42 days. does that sound right?

Dr. Scarlett :

My low dose calculations come to 193 mg twice a day or 386 mg once a day. So I personally would have prescribed an extra 100mg per day for Meat. The formulary and the articles I've read on Lyme (and we have a fair amount up here) has the dose range at 5-10 mg/kg once or twice a day for 30 days for Lyme and ehrlichiosis. I don't see any diseases doxy is used for that treatment goes for 42 days. So I suspect you'd have enough if you gave 2 every 12 hours.

Customer:

thank you, XXXXX XXXXX do that. so that'll be 200mg every 12 hours, right? just to make sure. and just to be safe do it for 30 days from today, right?

Dr. Scarlett :

That is correct. 200 mg doxycyline orally every 12 hours for 30 days for a tick-borne disease. If Meat starts vomiting or not wanting to eat, you may need to try a different antibiotic.

Customer:

got it, thank you very much. I know it can't be easy diagnosing this way, but I appreciate the effort and insights.

Dr. Scarlett :

You're welcome. It is more of a challenge, to be sure, but makes me think harder and do more research. Let me know how Meat does and what you find out when the vet aspirates that lump!

Customer:

Thank you, XXXXX XXXXX Have a good night, I hope you're not working too late. over and out, with many thanks.

Dr. Scarlett, Veterinarian
Category: Veterinary
Satisfied Customers: 3967
Experience: I am a practicing small animal veterinarian with 16 years experience.
Dr. Scarlett and 2 other Veterinary Specialists are ready to help you
Customer: replied 1 year ago.

Hi Dr. Scarlett, the bump is still there. The local vet said it is likely a seroma, and suggested draining it. However, very little fluid was actually aspired and the dog seemed to be in pain after repeated attempts to we discontinued. I attach photos of the bump in its current state, pretty much unchanged since our first chat, and the aspired liquid. The dog does not seem to be in any discomfort from the swelling, but it's hard to say.


Thank you.

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Expert:  Dr. Scarlett replied 1 year ago.
Thanks for the pictures. The fluid does look like something you'd find in a seroma, but it is odd that one would just suddenly appear. Is there any chance Meat might have gotten bonked on that spot with something (a broken tree branch, a ball?) or tried to squeeze under something that would have caused some injury?

Did the vet add in another antibiotic at all?

No other swellings anywhere, right?
Customer: replied 1 year ago.

I'm pretty sure he didn't get bonked, but he does lay down in a spot leaning against a sharp counter edge. Since he developed the swelling I've been moving him away, but I did wonder if maybe it might have been caused by leaning against that for a prolonged time.


 


I should also mention that today it does not look bigger, but it "may" have shifted a bit to the side. I'm wondering if that might be because of how he was sleeping, he curls up in a hole in the sand and there may have been lateral pressure on it.


 


The doctor did not add any other antibiotic.


 


How important is it to drain this thing? If it will dissipate naturally I would prefer not to subject Meat to further discomfort.

Expert:  Dr. Scarlett replied 1 year ago.
If it is just a seroma it will disappear on its own. I wouldn't attempt any further drainage--a good way to introduce bacteria. I would try measuring it or take daily pictures so you can compare. If it isn"t improving then I would consider putting in a drain to help remove the fluid and give it a better chance to heal.
Customer: replied 1 year ago.

Thank you doctor. What kind of timeframe should I expect for it to go down naturally? I realise that there may not be a precise answer, but a guideline would be helpful in determining when I should consider having a drain put in, as in "if it's not down by half in ___ days then go do it".


 


Thanks again,


Peter

Expert:  Dr. Scarlett replied 1 year ago.
That is why I would measure it and re-measure every 2 days or so. As long as there is a slow decrease I think things are going fine. But I would guesstimate a couple of weeks to be completely gone. Or close to it. I would take Meat in sooner if the lump is getting bigger.
Customer: replied 1 year ago.

Thank you doctor, that's very helpful. I'll keep a close eye on it, if it gets any bigger I'll take him in. I'm stuck with him since the warranty has expired, anyway. :-)


 


Thanks again,


Peter

Expert:  Dr. Scarlett replied 1 year ago.
How is Meat doing today? Feeling any better?
Customer: replied 1 year ago.

Hi Dr. Scarlett, thanks for checking in. He seems about the same, to tell you the truth, or maybe a bit weaker... I wonder if that's due to the increase in antibiotics. But in any case he's always been a bit lethargic, so I'm keeping an eye on him constantly. I hope all's well on your end, and thank you sincerely XXX XXXX assistance.

Expert:  Dr. Scarlett replied 1 year ago.
I worry about ol' Meat--lethargy from the antibiotics just isn't that common. If he wasn't eating well or vomiting, then I'd blame the doxy, but lethargy and weakness--I'm just concerned there is something else going on.

How is the lump today? Any change?
Customer: replied 1 year ago.

Hello Doctor, thanks for following up. I'm sorry I wasn't clearer about the lethargy: he's always been pretty lethargic. He was a real mess when we rescued him (heart worm, et c.), plus his femur of course bothers him. This is not a new thing.


 


The lump is about the same, no noticeable change either way.

Expert:  Dr. Scarlett replied 1 year ago.
Ok, that makes me feel better! Give me an update in a week or so!

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