This is a quick log of Bowdu’s dermal health, and to compare his summer allergies with almost the exact same time last year…
I’m happy to report that there’s not much to report.
24 July 2011
This year…
Raw and home-cooked meals make up at least 50% of his diet.
He’s on thyroid support (Soloxine).
He gets more daily nutritional supplements (in addition to the ones we were already using last year) like yucca, grass/pollen combatants, Vitamin E, etc.
He’s NOT on any prescription allergy drugs (though he’s been getting OTC antihistamines 1 – 2x a day).
He’s NOT in a cone.
He’s not licking his paw pads.
He’s still licking the same spots on his front “wrists” and the top of his back toes, though the spots are a lot smaller.
He still hates getting topical ointments rubbed on his parts, unless he’s in the car.
His paws are wiped down after every walk through grass and dirt.
He’s less smelly and his skin is less greasy.
He’s gotten 3 or 4 baths since the beginning of summer, purpose not being to drench him but to wash away allergens and loosen some undercoat.
He’s been brushed a lot less, though I will manually remove fur as I pet him, and I’m doing a lot more sweeping.
In summary, he’s doing really well, and is infinitely more manageable this year. The pictures show that he’s not in perfect condition, but again, compared to last year… wow.
However, August has typically been his worst month. He’s also due for another thyroid check, so I’m still holding my breath until we get through the dog days.
I’ll have another update on Bowpi’s skin breakout later. She does appear to be getting better, but progress on her has been a lot slower than anticipated.
I finished reading Dr. W. Jean Dodds and Diane Laverdure’s book, The Canine Thyroid Epidemic, and have some thoughts that may or may not appear later as a full review. One immediate reaction is that I was surprised by how the book offers just as much information specific to hypothyroid dogs as it does for general pet care. This is in accordance with the nature of the disease, given that thyroid problems impact a broad range of bodily systems. So the authors stress that one key to accurate diagnosis and management is to keep a detailed canine health journal.
Basically, they suggest that you spend about half an hour every week briefly documenting the condition of your dog so you get a baseline for what is normal and what changes according to seasons and according to age:
Hair/fur: overall feel, shedding cycles, thinning areas
Skin: including scabs, discoloration, oil production, smell
Teeth and gums: gums, loose teeth, brushing schedule
Weight
Urine: frequency, color, unusual accidents in home
Stool: frequency, color, consistency
Appetite: including notes on new food, if applicable
Water intake: increased thirst without temperature or activity changes could be indicative of internal problems
Energy levels
Reproductive health: heat cycles and related issues (for unaltered pets)
Maybe you can even add — Nose: respiration, moisture, color changes (i.e. snow nose). Finally, with the ubiquity of digital photo devices, a couple clear pictures offering a good shot of face, body, and any necessary close-ups (eyes, paws, etc.) should be easy to dump into the file.
More details about what is considered normal is offered in the book (46-48). I am not providing extensive quotes out of respect for their copyright. At any rate, you should already have a sense for what is “normal” for your dog and your breed.
Photo taken 10 May 2011: Bowpi’s teary eyes on a particularly windy day.
A health journal is not exactly a revolutionary concept, but it’s an important part of caring for any living creature that I hadn’t really considered as compulsory. Yet, as I mentioned in one of my very first posts, charting Bowdu’s health concerns was a motive for starting this blog, and for continuing to maintain it as consistently as I have. As redundant as my posts became during the summer months (“Yup, Bowdu’s feet still inflamed.” “Yup, he’s still in the cone.” “Bowpi’s slept 18 hours today, just as she did yesterday and the day before…”), I’m actually already looking forward to the month of July just to see if I can make any favorable comparisons between last year and this year, after all we’ve done.
Another motive was to contribute to and to organize some of this health and breed information, since it was hard for me to find reliable and accessible sources on the specific issues that mattered to me. Even though I don’t subscribe to the Google-knows-all approach to research, the internet has a strange way of bringing together like-minded people who are fixated on very specific issues.
Which leads me to the idea that a canine health journal could potentially be a novel concept by bridging patient-client relationships through this portable, universally-accessible medium. The Internet-savvy vets that I know have more than a website — they have blogs, they’re on Facebook, and they’re sending e-mail as mass newsletters and as client-specific communication. They’re using new media to establish a different kind of rapport with their clients. But this only seems to cover the human side of business affairs.
Now, I imagine that for some dogs that are far too nervous to be properly examined by a vet (like my Shiba), or for some conditions where behavioral information would assist with diagnostics (or at least help suggest the kinds of treatment that would be most helpful), a canine health blog would be extremely helpful supplementary material. If they were at all interested in scanning a record of their patient in more “natural” settings, well, most pet blogs I know start from home. What could be more natural than that?
Bowdu and Bowpi lose what we call "Shiba/Basenji Pride" when they're nervous -- their upright curly tails droop and sag down.
I’ve never considered inviting my vet to be a potential member of my reading audience. If anything, half of the stuff I’ve filed under my blog’s vet tag has been my bitching about the practices at the Very Corporate Abomination of a clinic that treated Bowdu before our current vet, whom I’m maintaining a guarded optimism about. This blog has, at times, been a repository for my frustrated, antiveterinaryestablishmentarian shit talk. But if I had any intention of handing these public links over to my vet, I’d probably file them differently so that they’d be more useful. Maybe everything relevant would go under something like http://mywebsite.com/dog-name/health-journal (and with WordPress, you can even password-protect certain pages, though I’m not sure how this works with other blogging platforms). At any rate, if the vet is really curious about where I’m coming from, they’re free to page through the main blog itself.
Granted, there’s a lot of fluff in most pet blogs, much of it irrelevant to a vet’s concerns. I wouldn’t expect any vet to spend their professional time reading this crap. After all this time, I’m still too self-conscious about being a “Crazy dog lady with a blog for her widdle poochies” to invite most of my friends to read this, let alone my vet. But I know that if mine did, they would see a very different side of the Bows that is not always apparent in the clinic. I bet this is true for a lot of dogs. And I’m willing to hold out for the possibility that all this effort could sometimes aid in a more accurate, cooperative diagnosis.
Photo taken 29 January 2011. “Is he ever relaxed?” asked one of my vets while she was trying to befriend Bowdu who was backed into a corner. Why, yes, and he often shows us his belly of his own accord — but there is no way he will let a stranger get this kind of view, even if the missing fur on his belly is the reason for our concern!
Shortly after joining the Yahoo group for hypothyroid pets, another Shiba owner introduced herself to the list with the following anecdote (reposted with author’s permission with slight edits for clarity):
I have a five year old Shiba Inu who was just diagnosed as Hypothyroid. The reason we had her tested was due to “night terrors”. She has not slept through the night for 3 weeks. The first week she scratched at my face all night and panted so bad it was dripping all over my face. Nothing calmed her until dawn came. I used to crate her when she would get worked up over storms, but it wasn’t even storming. I tried to crate her but the anxiety increased. We tried to crate her in another room with a radio but she broke a tooth off at the gum line so crating is out. We do have a Kennel-aire now with the 1″ diameter wire so she can’t get her teeth on it. She goes in that during the day but I will still come home to a crate wet with drool. We tried Clomipramine at 25mg (she weighs 17lb) but that did nothing at night. While we were waiting for the thyroid results, which took 10 days, she has been on Reconcile [fluoxetine hydrochloride, aka Prozac] that helped a bit but seeing her on Prozac was SO SAD. She is now slowly being taken off that. It was horrible having her on it. She was on 8mg once a day which caused severe constipation.
NOW that we have her thyroid results she is on Pala-Tech 0.1mg twice a day. She still pants on and off through the night but she can’t make it through the night without going out to pee. I pull her water bowl up at 7pm and take her out at 9pm before bed. Is this due to the Pala-Tech? Will this go away? I need SLEEP. It’s been weeks. I also have to sleep downstairs with her because this night time fear all started when she heard bats in the attic and they were coming in the house. Bats are gone and we haven’t heard them for weeks now.
Of course, I jumped right on that one. I felt a particular sense of urgency to respond because Bowdu was going through a simultaneous bout of consecutive nights of “night terrors,” as she so aptly described it.
From April 21st to April 27th, Bowdu did not sleep through an entire night.
April 21, 7 AM (about half an hour before my alarm clock): Bowdu jumped up onto my side of the bed to hover over my head, back legs quaking.
April 22, 6 AM: Same thing. I groggily let him out in the backyard to relieve himself, thinking this might help. When he came back, he was still shaking so I held him and tried vainly to doze until my alarm went off.
April 23: An especially rough night. I was looking at a 14-hour day across the Bay, and already went to bed far too late. Bowdu jumped up into bed at 2:30 AM, shaking for no discernible reason. This time I desperately did not want to deal with it, so I flounced off to the front room with earplugs stuffed into my ears and closed the door, hoping the Doggy Daddy could be awakened from his winterbear-slumber. Instead, Bowdu pushed open my door and climbed onto the futon, trembling so hard that I could not fall asleep.
This lasted for three hours.
Finally at 5:30 AM, I reached over and dragged him from the edge of the futon over to the wall next to me, where I pressed my body against him and the pillow propped up against the wall. I basically sandwiched him between a bunch of soft things. And then miraculously, maybe because he was finally exhausted or because I had inadvertently unlocked the secret of the “squeeze machine”, he stopped shaking. Bodies aligned, we got about an hour’s worth of sleep.
That was the worst of it. Bowdu continued to jump up onto the bed trembling at 7 AM, 4 AM, and 7 AM again for the next few days, but the terrors eventually subsided. Unlike the other Shiba above, he did not drool, but the other behaviors sounded all too familiar — all that panting, pacing, trembling, which I’ve documented just recently.
I am not familiar with any of the drugs that the other Shiba owner gave her pet (except for Prozac, which is more extreme than what I think is necessary for Bowdu). We both got one “new” suggestion from the Hypothyroid pet list to check out our pets’ cortisol levels and to supplement with T3 drugs (Triiodothyronine) instead of just T4 (Levothyroxine), which is what we’ve been doing.
I am not ready to go this route, and need to look into it a little more, especially as I recall the peer-reviewed literature recommending against T3 therapy for a variety of reasons related mainly to sourcing (i.e., bovine vs. porcine hormones) that I have to fact check before I report back here. At any rate, I know there is some preference for this kind of dessicated thyroid therapy since it’s available from animal sources. Could the trade-off be standardization of production and quality control (including published research that does not make a distinction between bovine or porcine sources for natural thyroid extracts)? Though Soloxine is synthetic, honestly, it has worked very well for Bowdu for a good run so far, and I’m not willing to risk upsetting the balance until I know exactly what I’m doing or until I have veterinary approval.
At any rate, it’s a reminder to take online veterinary health advice with caution, and follow up with your own diligent research. Even if I don’t understand everything that I’m told/given, I will at least evaluate my sources. (The academic in me revolts against the very idea of citing Wikipedia as a source, but if you read between the lines of the entry on dessicated thyroid extracts, you get a hint of the contested nature of this terrain in both human and animal health.)
In other news, last week I ran into another Shiba owner whom I had never met before. She was with a handsome red male named Fuji. After brief introductions, one of her first questions was, “Does your Shiba have allergies?“
So I referred her to this blog…
I can’t remember how old Fuji is, but I seem to recall that he was quite young for a Shiba who’s already undergone the rigmarole of steroid pills, Atopica, allergy testing, and now allergy shots. I didn’t get a good look at his fur or his skin. It was rather hot that day, and Fuji was hanging out under the shade while the Two Bows were pushing ahead in the opposite direction. Fuji’s person commented that Bowdu appeared in good shape for a Shiba who was supposedly prone to allergies. All I can say to that is knock on wood. In the past couple of weeks, both Bows have been licking themselves and scratching their muzzles more often, though there is no visible change to their skin. We’re trying to get a jump on preventative therapy this year, so I’ve already been dosing Bowdu with OTC allergy pills about every other day or when plant activity seems especially profuse. I’m also busting out the baby wipes after every dog park run. I also need to pick up some more local honey from the community garden down the street (great for homemade facial masks, too!).
We’re also trying the above combination of Azmira Holistic herbal extracts. I dropped about $40 on two vials of Yucca Intensive and Aller’G Grass and Pollen mix (which contains a pungent mixture of eyebright herb, bayberry root bark, goldenseal root, calamus root, stinging nettle leaf, and grain alcohol). A couple other different kinds of Aller’G extracts are available through this company, and they recommend using them in combination with several other products, but given how expensive these remedies are, I’d rather try a bit at a time and see if I can notice any improvement over time.
The last 2 fl. oz vial of Yucca Intensive lasted nearly a year (only Bowdu was getting this natural anti-inflammatory supplement). So presumably the 1 oz. vial of Aller’G Grass and Pollen will last long enough for me to assess its efficacy. Both Bows are getting a few drops several times a day, mixed with a little bit of all natural apple juice. It’s a new treat they’re quite happy to lap up.
I’m aware that this is not a peer-reviewed veterinary publisher, and I’m not sure how I feel about the alarmist word “epidemic” in the title… Nevertheless, I’m sure I’ll make good use of this resource. As will the average pet owner trying to figure out what’s going on with their hypothyroid dog.
This is fairly new behavior, as of this year (since the end of last summer, around when Bowdu started his thyroid meds).
Video taken 9 April 2011 (Apologies for the angle)
You might say this is just a scared dog, and dogs just get scared every now and then. But this has happened more than occasionally (at least once a month, sometimes two or three times), and Bowdu’s reactions often seem disproportionate to the magnitude of the apparent cause.
This was about 4 or 5 PM on a Saturday. That day was a bit windy, and the trees in the backyard had been rustling all afternoon. In addition, a low-flying plane had been circling for about an hour. I’m pretty sure it was the latter that pushed him overboard. Or under the table, as it were.
Buzzing objects in the sky must seem unusual and inexplicable to him. I can understand why Bowdu would find it unsettling.
It’s not the first time planes or helicopters have been abuzz in our neighborhood, though. And in his youth, Bowdu has never reacted so intensely to mere wind. Hell, he’s been through typhoons in Taiwan without so much as a whimper. We’ve been to Bay Area dog parks where we’ve just sat around watching airplanes take off and land. So I’m not sure why he’s now become so sensitive to atmospheric disturbances, over three years after we’ve moved into this house.
Bowpi, meanwhile, was snoring on the futon, dead to the world and to Bowdu’s anxiety.
I previously wondered if these episodes might have something to do with his fluctuating thyroxine levels, since these episodes typically occurred at night. They stopped for a while, then resumed sporadically. More recently, there have been a few shaking episodes during the daytime, as well.
Photo taken 13 March 2011
The Doggy Daddy’s approach is to let him have free run of the house. Let him pace as he pleases (he has no crate), let him hide under desks if that makes him feel more comfortable, let him go to the backyard to check out whatever is upsetting him if he wants to, but just leave him be, and don’t coddle him. Resume activity around the house as if nothing is out of the ordinary, and interact with him as normal.
Since most of my activity in the house is situated within the study den, and Bowdu comes to me for attention — assurance — I’m not sure what — I find it hard to proceed as normal during his nervous fits. I try to put him up on the futon or hold him like a human thunder shirt, because otherwise it’s really distracting having him walking under and out from the end table while I’m trying to work! I talk normally and occasionally to him. It doesn’t seem to make any difference in easing his shaking.
That particular episode lasted over an hour. After the plane stopped buzzing overhead, he eventually returned to normal.
Perhaps his threshold for the unfamiliar has just changed over the years, and has little to do with hormones, synthetic or otherwise. People’s personalities change; why shouldn’t dog personalities be volatile and susceptible to new triggers, as well?
I first heard about canine hypothyroidism from Basenji people. With a current rank of #29 on the the list of breeds at risk for thyroid disease according to statistics compiled by the Orthopedic Foundation for Animals, and #35 according to Michigan State University, Basenji breeders had reason to be concerned. No, they don’t top the list, nor is that an enviable position to be in (that honor goes to the English Setter). But if even one out of every 10 dogs was showing abnormalities in a condition that could be screened, seems like it’s worth the test to me.
So it looks like responsible breeders were and have long been testing thyroids. And breeder websites have been where I have found some of the most informative, publicly-accessible information on hypothyroidism and canine thyroid health. Here are some of the links that I have found to be helpful.
Apu’s Basenjis: Basenji Health
- Karen Christensen, who provided the article on Apu’s page, also wrote up an article for the New York-based Rip Van Wrinkle Basenji club magazine, The Wrinkler. A .pdf is available here.
sinbajé basenjis: Thyroid Problems of the Basenji Dog.
- As far as breeder sites go, this is one of the most well done that I’ve seen, hitting a perfect mix of personal and professional, providing a ton of great information without cluttered design.
Moonstruck Meadows: Canine Health Testing: OFA Thyroid Tests
- via a breeder of Shetland Sheepdogs, what to look for in proof that a breeder has done proper testing on a dog.
I’m sure there are more out there, but this is enough for now.
One of the tests that we ordered from Hemopet/Hemolife labs as part of their Thyroid 5 panel was TgAA, or thyroglobulin autoantibodies. Yeah, say that one three times fast.
Well, we ordered it, but I didn’t really understand what the measure was for, nor how to match it against the reference range; I just wanted to be thorough. To rehash, Bowdu’s test numbers from Hemopet looked like this:
T4: 0.87 (reference range 0.80 ~ 3.80 μg/dL) Free T4: 0.53 (reference range 0.55 ~ 2.32 ng/dL) T3: < 10, verified by repeat analysis (reference range 30 ~ 70 ng/dL) Free T3: 1.9 (reference range 1.6 ~ 3.5 pg/mL) Thyroglobulin Antibodies: <1% (reference range: negative [?])
TGAA CONFIRMATORY TEST INTERPRETATION
less than 10% = NEGATIVE 10 ~ 25% EQUIVOCAL greater than 25% = POSITIVE
I didn’t understand why the reference range was supposed to be “negative,” since a number that’s less than 1% is still a “positive” number. At any rate, Bowdu’s TgAA results fell within the reference range, while the others were low enough to diagnose him with hypothyroidism. How did his TgAA relate to the diagnosis?
Well, I’ve done some reading and poking around, and so I’m going to take a stab at rendering my understanding of what TgAA is and what those test results meant. If any experts are reading this and found that I’ve misunderstood what I’ve researched, please let me know. This is NOT my field by a long shot!
Photo taken 4 February 2011
Thyrogloblin AutoAntibodies (TgAA) are present in the system when the dog’s thyroid basically starts attacking itself, when something starts to go wrong with the thyroid glands. If a dog tests positive for TgAA, and other values are low, a dog is said to have autoimmune thyroiditis — the body is basically obstructing its own normal thyroid function. If other values are low, and TgAA is negative, it is labeled idiopathic thyroiditis — there’s some other reason that the thyroid production has atrophied. OR it could be that the condition has already progressed for some time such that you’re actually looking at the end stage of autoimmune thyroiditis, which is what I think is happening with Bowdu given his age and history of symptoms.
Some people called TgAA the “best” test in pinpointing thyroid dysfunction. As I understand it, it’s certainly not enough on its own. TgAA is the best advance indicator of possible thyroid disease further down the road, because if a dog is going to develop thyroid problems, he may test positive for TgAA as early as 1 year old, even without exhibiting other clinical symptoms or low T4 or T3 levels (subclinical thyroiditis). If TgAA comes back positive, it is “highly suggestive of later development of clinical hypothyroidism” (Ferguson, 658), though visible symptoms may not appear until years later. So it’s best to keep monitoring such a dog, and take into consideration all the other values from other thyroid tests.
In reality, the average pet owner is not going to ask for a TgAA test as part of annual bloodwork. But dogs intended to be used in breeding programs should have this measure on the record; it is one of the values that the Orthopedic Foundation for Animals (OFA) asks for when registering a dog in their database.
The diagnosis of “hypothyroidism” isn’t about a positive or a negative TgAA. But a positive or negative TgAA associated with hypothyroidism varies by breed. Hypothyroid English Setters and Golden Retrievers, for example, tend to test positive for TgAA more often than not, whereas hypothyroid Collies and Doberman Pinschers do not test positive for TgAA as often (Graham et. al, 624). Age at diagnosis was figured into those statistics somehow, which led researchers to suggest that the disease progresses differently, perhaps at a slower rate, in some breeds than in others. Overall, it’s about a 50/50 split across breeds whether you’re looking at autoimmune or idiopathic thyroiditis. You’ll have to consult the article or experts from your own breed club to see where your breed falls (there was no specific information for Shiba Inu, though Ferguson makes mentions the Basenji as one of the breeds with the highest prevalence of hypothyroidism based on some research done by Nachreiner at Michigan State University and others [649]).
This bit was interesting to me:
In a preliminary investigation of the influence of geography on the prevalence of thyroiditis in samples submitted to Michigan State University, some significant differences were observed. The prevalence of TgAA was significantly higher in samples submitted from North Dakota, Vermont, Wyoming, Minnesota, and Colorado compared with Michigan (range of odds ratios: 1.19 – 1.41; P < .05). The prevalence was significantly lower in samples from Massachusetts, Maryland, Virginia, North Carolina, Florida, South Carolina, Kentucky, Texas, West Virginia, Tennessee, and Alabama (range of odds ratios: 0.39 – 0.79; P < .05). There was no interaction with breed prevalence, but the underlying reasons (if any) for these observations have yet to be discovered. (Graham et. al, 623)
Tantalizing, isn’t it? Is it something in the water? Or the presence of puppy mills? Hunters? Urban sprawl? Mountain air? Who knows?!
At any rate, TgAA by itself is not an adequate test for diagnosing hypothyroidism. A dog can test positive for TgAA but still have T4 and fT4 levels within the normal range, which means the body is still producing enough hormone levels on its own, though the rumblings of worse to come are on the horizon. Likewise, a dog may not test positive for TgAA but the T4 and fT4 levels are low because the thyroids are already pooped; there’s nothing left worth attacking, so there’s no need to pump out more antibodies.
So I guess for the average pet owner like me, the TgAA was useful to suggest how far along Bowdu may have been in the disease. I’ll probably skip it next time, along with the T3 and fT3, and just order baseline readings of T4 and free T4 levels for the purposes of general monitoring.
Annotated list of References:
All articles come from The Thyroid special issue of Veterinary Clinics of North America: Small Animal Practice 37.4 (July 2007), edited by Cynthia R. Ward. I am disappointed to report that the veterinary college that delivered this title to my university library passed along a virtually pristine, unread copy. I sincerely hope that these articles are being accessed in electronic form by our future veterinary specialists in training!
Graham, Peter A., Kent R. Refsal, Raymond F. Nachreiner. “Etiopathologic Findings of Canine Hypothyroidism.” Vet Clin Small Anim 37.4 (2007): 617-631.
[too technical for me in some parts, and doesn't really venture to offer any causes for the occurrence of thyroid disease though the authors tease their readers with intriguing statistics and suggestive avenues for further research; some illuminating charts which show some breed-specific information]
Ferguson, Duncan C. “Testing for Hypothyroidism in Dogs.” Vet Clin Small Anim 37.4 (2007): 647-669.
[clear, easy-to-understand survey of current available testing methods, their usefulness, limits, and attendant problems in diagnosis]
Scott-Moncrieff, J. Catherine. “Clinical Signs and Concurrent Diseases of Hypothyroidism in Dogs and Cats.” Vet Clin Small Anim 37.4 (2007): 709-722.
[also very technical, but covers a broad range and good for anyone who might be searching for answers on the relationship between thyroid disorders and other specific issues like cardiovascular and opthalmologic abnormalities, anemia, diabetes, bleeding disorders, etc.; good for mining additional sources]
Photo taken 3 February 2011
To bring this all back home, here are some pictures of Bowdu’s recent dermatological issues. He’s lost chunks of fur on his neck, one armpit, and a little bit on his belly, though he hasn’t been itching excessively nor does he seem to be in discomfort though he’s bald to the skin in some places, and there are patches of hyperpigmentation which come and go. We’re still monitoring him and treating him with medicated shampoo on affected areas, as well as Sulfodene on the hot spots, which seems to be keeping things from getting worse.
If this is just “allergies,” as I’m afraid the vet is going to say, then allergy season is really starting earlier and earlier each year… I’m still unwilling to admit that allergy season is year round, though this may be our punishment for living in the land of perpetual sunshine and no snow.
This post is about our experiences thus far with Soloxine, an inexpensive synthetic hormone currently manufactured and distributed by Virbac. Soloxine is one of the most popular name brands for Levothyroxine Sodium, designated specifically for veterinary (animal) use. Another brand for animals is Thyro-Tabs, which we have no experience with. Brand name L-thyroxine is apparently more effective than generics, and these two were the brands specifically recommended by Dr. Jean Dodds.
When Bowdu had his first thyroid panel done in August 2010, the results came back with his T4 levels below minimum, and his FT4 levels at 1 pmol/L within normal, at the bottom end of the reference range. My vet called it “borderline low,” but based on his concurrent clinical symptoms, I was ready to start him on thyroid supplementation immediately.
Once thyroid supplementation begins, it is usually expected that the dog is to remain on thyroid supplements for the rest of his life. Clinical signs of hypothyroidism, which clearly matched Bowdu’s physical condition, usually indicate that the thyroid has already been mostly destroyed by its own immune system. Long-term hormone replacement would result in the shutdown of any natural hormone production as well, which is why it is important to get an accurate diagnosis with both T4 and Free T4 panels, at the very least.
We began with one pill twice a day, at a dose of 0.2 mg based on his weight (at the time) of 33 pounds. Soloxine’s site recommends an initial dose of 0.1 mg per 10 pounds. Hemopet suggests 0.1 mg per 12 – 15 pounds, then adjusting the dosage as necessary according to follow-up bloodwork.
I had no hesitation about starting Bowdu on thyroid supplements, as I’d heard anecdotal accounts that they made a huge and immediate difference. I was also less concerned about this medication, given that thyroxine is supposed to be in his system anyway. However, as with all drugs, this one is not completely without side effects, though I think they were of minimal concern and far outweighed by benefits.
One of the more undesirable side effects that I would ascribe to the thyroid medication (though I don’t know for sure if this is the cause) is exhibited in this video:
Video taken 23 September 2010
About a week after Bowdu started thyroid supplementation and continuing for a couple months, he would exhibit bouts of confusion or just plain weird behavior. In this video, he’s still battling his raging allergies, as he had been all summer, which is why he’s in the cone. These episodes only happened at night, either right before or a few hours after his evening pill. He would get strangely clingy or antsy, and his tail would droop. He’d pant. He’d crawl into corners as if he was looking for something, or try to squeeze himself underneath endtables, or in this case, he’d poke at objects in corners of rooms, like this paper shredder that has always been there. Another time, he jumped up into bed, stepping all over my head in the process (he’s usually more conscious of personal space than that), moved from there to the nightstand, and pawed at the bedside lamp. When I pulled him towards me and held him, I could feel his body trembling.
The trembling was very similar to this video:
Video taken 29 August 2010
The above was taken when Bowdu appeared to be asleep. However, he was awake and very conscious in other episodes of shaking.
My only guess is that these were episodes of short-term thyrotoxicosis, or thyroid drug overdose. According to Soloxine’s drug information insert, the symptoms of thyrotoxicosis include: “polydipsia [increased thirst], polyuria [increased urination], polyphagia [increased appetite], reduced heat tolerance and hyperactivity or personality change.” The last bit seems overly generalized to me, and doesn’t adequately compare to even Wikipedia‘s description: “In excess, [thyroid hormone] both overstimulates metabolism and exacerbates the effect of the sympathetic nervous system, causing ‘speeding up’ of various body systems and symptoms resembling an overdose of epinephrine (adrenaline). These include fast heart beat and symptoms of palpitations, nervous system tremor such as of the hands and anxiety symptoms…”
As I understand it, thyroid hormones are normally secreted as necessary to keep overall levels stable. With synthetic supplementation, artificial “peaks and valleys” are created. While dosing twice a day (BID) as opposed to once every 24 hours (SID) creates more “stable” levels, no doubt the body still responds to the changing level of hormones. If Bowdu’s levels had been low for some time, it would stand to reason that these elevated thyroid levels would feel disorienting, even if they were being maintained at “normal” levels.
So for the sake of minimizing these shocks to his system, I thought it was important to keep Bowdu’s doses as close to 12 hours apart as possible. We’ve developed a pretty good system where he gets his medication first thing in the morning, about an hour before breakfast. Knowing that I have a hard time functioning before coffee, I’ve made things as easy as possible by preparing his marshmallow-wrapped morning dose in advance. A weekly round of morning pills rests conveniently on the nightstand; I don’t even have to be fully awake to pop one out of the case, lean over the edge of the bed to slip it to Bowdu, then hit the snooze bar.
The other half of the daily dose awaits in the kitchen, where it is offered in the evening, about 2-3 hours after dinner.
9 January 2011
Getting Bowdu used to his pills wasn’t hard, though it took a few tricks to turn it into routine. He has a bit of a sweet tooth, so we wrap his pill in a fat-free, but oh-so-sugary mini marshmallow. He also gets more interested if he sees me consuming something first, so at first I made a big show out of eating some marshmallows before offering him one. It also helped to lick the surface of the marshmallow I was offering him, so that it would become a little gooier, thus sticking more to his palate.
Marshmallows are also a great treat for catching in mid-air. Sometimes to liven up the routine of pilling, I’ll grab maybe three or four, one of them stuffed with Soloxine, and gently toss the treats for Bowdu to snap out of the air. When pilling becomes a game, the task is just easier.
About six weeks after he started taking Soloxine, we had a follow-up thyroid panel. Results were within normal range, as expected, so he remained on the same dosage. This will probably change over the years, but for now, we’ll maintain this regimen.
Also, the episodes of oddness depicted in these videos seem to have stopped for now. Something new may arise in the future. As for what came before, I can definitely say we’ve made progress when I compare the archives to his current state.
Old habits are hard to break. Bowdu still licks his feet occasionally, and I swear he’s learned to do it extra surreptitiously because he knows I don’t like it. But despite it all, his feet are looking really good now. Normal, I’d even say.
Photo taken 19 December 2010
And a front paw…
Compare this to just three months ago, when the briefest bout of licking would cause his pads to swell immediately:
Photo taken 25 September 2010. Back foot (don’t remember which one).
And just before he began his summer of imprisonment in the cone:
Photo taken 12 July 2010. After a longer bout of unapproved, furtive foot-licking.
Tonight, we are the furthest from summer that we can possibly be, and I’m actually grateful. The changing seasons have brought us reprieve, and we can finally sleep peacefully during these long, dark nights.
I hope this recovery is due to more than just changes in weather. I hope that everything we’ve done for his diet and dermal health and stabilizing his thyroid levels is contributing to a stronger overall immune system, because I’m afraid that eight months from now, this blog is going to turn once again into the chronicles of daily frustration that it was this preceding summer.
