Young female collie with regurg/vomiting, lethargy and cardiac signs

Re: Young female collie with regurg/vomiting, lethargy and cardiac signs

Anthony Dennison — Wed, 14 Aug 2013 14:13:19 GMT

We have a collie on our books with that. Was coming in for regular B12 injections, owner now does them at home.

Re: Young female collie with regurg/vomiting, lethargy and cardiac signs

Utlendigur — Tue, 13 Aug 2013 22:02:17 GMT

Ditto re Addisons - first thing I thought of from the title

Have you done a cobalamin level? Some collies have an inherited inability to absorb cobalamin which can cause vague clinical signs like those described.

Clinical and Laboratory Findings in Border Collies with Presumed Hereditary Juvenile Cobalamin Deficiency

Juvenile cobalamin deficiency is a rare disease in border collies and its diagnosis requires a high level of clinical suspicion. The goal of this study was to increase awareness of this disease by describing the clinical and laboratory findings in four young border collies with inherited cobalamin deficiency. The median age of the dogs was 11.5 mo (range, 8–42 mo), and two of the four dogs were full siblings. Clinical signs included intermittent lethargy (n = 4), poor body condition (n = 4), odynophagia (n = 2), glossitis (n = 1), and bradyarrhythmia (n = 1). Pertinent laboratory abnormalities were mild to moderate normocytic nonregenerative anemia (n = 3), increased aspartate aminotransferase (AST) activity (n = 3), and mild proteinuria (n = 3). All of the dogs had serum cobalamin levels below the detection limit of the assay, marked methylmalonic aciduria, and hyperhomocysteinemia. Full clinical recovery was achieved in all dogs with regular parenteral cobalamin supplementation, and laboratory abnormalities resolved, except the proteinuria and elevated AST activity persisted. This case series demonstrates the diverse clinical picture of primary cobalamin deficiency in border collies. Young border collies presenting with ambiguous clinical signs should be screened for cobalamin deficiency.

JAAHA May/June 2013 Lutz, Sewell et al

Re: Young female collie with regurg/vomiting, lethargy and cardiac signs

Julie Innes — Tue, 13 Aug 2013 20:28:02 GMT

Have to say the first thing I thought of fron the history was Addisons, but then I saw that an ACTH stim had been normal. It does sound a lot like Addisons, so may be worth re-testing. No other great ideas, I'm afraid!!

Re: Young female collie with regurg/vomiting, lethargy and cardiac signs

Yvonne Black — Tue, 13 Aug 2013 18:49:25 GMT

Thanks for your reply, Sammy, and don't worry about overlooking the ACTH stim test - there's a fair bit of info to get through! And the blood test was taken before fluid administration. They might consider repeating the ACTH stim. It was done a while ago and would account for a lot of the symptoms. I'm also wondering if it's possible that it's myasthenia gravis despite the negative ACh antibody test, apparently a small percentage of dogs with MG do test negative for this.

Re: Young female collie with regurg/vomiting, lethargy and cardiac signs

Sammy82 — Tue, 13 Aug 2013 18:09:10 GMT

Despite normal electrolytes/ relativly high sodium:potassium ratio (was the blood taken before or after i.v. fluids?), has Addison's been ruled out? Not all dogs show the typical changes in the electrolytes, and it would explain gastrointestinal sign, weakness and bradicardia with low BP. I am not sure how her stiff joints would fit in with this though.

Edit: sorry overlooked the bit about ACTH stimulation test. But apparently the sensitivity is not so great for secondary adrenal hypocorticism, so might be worth repeating.

Re: Young female collie with regurg/vomiting, lethargy and cardiac signs

Shelley Wiltshire — Tue, 13 Aug 2013 11:50:20 GMT

Not sure if I'll be much help, but a few things that came to mind:

- consider a TLI test to rule out EPI. The vomiting could be put down to SIBO if there is EPI?

- not sure about the musculoskeletal signs and fitting these into the picture - are these consistent findings?

- chest radiographs? Megaoesophagus to explain the regurg? Might help complete the picture with the echo too

- I would've expected a tachycardia with DCM, not a bradycardia, so this seems a bit weird

- fenbendazole and tylosin trial?

- The hypercholesterolaemia - was this a post-prandial blood sample?

That's about all I've got. Good luck with this tricky case!

Re: Young female collie with regurg/vomiting, lethargy and cardiac signs

Yvonne Black — Tue, 13 Aug 2013 10:31:20 GMT

NB. I probably should have mentioned that recently some changes to Rosie's coat have been noticed. She is moulting more than normal, and in the areas which have been clipped for blood sampling, fluid administration etc. the hair is growing back very 'fluffy'. I suppose this may be due to steroid administration, but she;s been off these for a while (since June).