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Category: Dog illness

Regression to the Mean: Why Our Dogs’ Supplements Often Aren’t Working as Well as We Think

Regression to the Mean: Why Our Dogs’ Supplements Often Aren’t Working as Well as We Think

Last year I had a minor medical problem, more of a bother, really. It’s one for which a few supplements have been shown to help. My doctor said I could try “Supplement X, Y, or Z.” I didn’t do anything at the time I talked to him because the problem hadn’t been happening right then.

But then the problem started bugging me. I had it for about 10 days in a row. I thought, “Hey, this would be a great time to try Supplement Y.” I wrote down in my calendar that I had had the problem for those 10 days, and wrote down the day I started the supplement. And the problem improved massively for the next 14 days.

Yay, it worked, right?

No. I didn’t have enough evidence to conclude that. What I could have been seeing was regression to the mean.

When problems vary in intensity, people tend to try interventions during a “bad” spell. They call the doctor; ask their neighbor; or start a supplement, diet, or exercise regime.

That’s exactly what I did. I started a supplement when my problem was bad. But if a variable problem has been worse than average for a period of time, what usually happens next? It will likely get better. It’s variable. It is so easy to attribute the good spells to whatever intervention we might be trying. We want things to work, and we are wired to grab at such correlations.

Graph of severity of health problem. The first 46 days show a love level of severity, from 0–5. Then follows 10 days of values from 5–10. This is a classic setup for regression to the mean if those last 10 days were anomalous. The health condition in the next time period is likely to be improved.
From earlier data, what do you predict will be the severity of my health problem if I start a supplement on Day 56? What do you predict will be the severity of my health problem if I don’t start a supplement?

I had 10 days of data before I started the supplement, but it was 10 days of **extreme** data. And 10 days is pretty short in any case. (I made up the data on the graph for the first few weeks as a demonstration. It represents the low level of the problem that mostly passed under my radar.)

Regression to the mean is why people frequently will say of an intervention that it “worked for a while then stopped.” When we have that particular experience, the intervention likely didn’t help at all. We were only experiencing the effects of regression to the mean. Things got better because they were very unlikely to get worse. But we are humans, and we assign causation at the drop of a hat.

Health problems that are especially vulnerable to this false attribution include chronic conditions like pain from arthritis or headaches, allergies from unknown triggers, fatigue, and mild to moderate gastrointestinal problems. Any painful or bothersome condition that comes and goes but rarely reaches an acute level. (Because that’s when we go to the doctor for a more aggressive intervention.)

If I want to improve my chances of really knowing whether a supplement helps for a chronic, variable condition, I should take data for as long as possible before starting the supplement. (Almost none of us do this; more on taking data below.) I should start it at a random time. After I start the supplement, I should take it for a preassigned number of days. If there are studies supporting the use of the supplement, I should record data for at least as long as the studies did. I should decide the number of days beforehand and stick to it. (This removes the chance of stopping at a fortuitous time for the data.) I should record my data religiously. After the period is over, I should go off it again for the same amount of time and keep taking data. This is called a reversal design, and give you two chances to look for a difference due to the intervention: when you start it and when you stop it.

Obviously, I am not recommending you ever go off a doctor-recommended prescription medication as an experiment. The reversal design should only be implemented when it is safe to do so. In my situation, my doctor had encouraged me to experiment with the supplements.

Implementing a better structure would have given me a better chance of knowing whether the supplement had an effect. But even then, it would not tell me for sure. Besides regression to the mean, which still could be in play, there are a dozen other reasons and biases that could make it appear that the supplement was effective.

Regression to the mean is both a statistical event and a cognitive fallacy. The statistical event is as described above. When an entry in a time series is at an extreme value, the most likely thing to happen next is for it to fall back toward the mean, or average. This is not the same as the “law of averages,” which is itself a fallacy. Regression to the mean has to do with values over a span of time, and what happens after an extreme value.

If images are helpful to you, check out this article about regression to the mean that includes graphs and a couple of really clear scenarios. Also, it will let you know that some businesspeople and marketers know about regression to the mean and use it to sell products or services.

Regression to the Mean and Our Dogs

The above is not a made-up story. It did happen to me.  I’m sharing it because we do the same thing with our dogs. It’s a cautionary tale about how damn easy it is for us to assign causation when it’s not really there.

It happens all the time in life. How many times on a dog group have you seen someone write, “Yes, Acme Supplement is great, but after a while, it did stop working.” Or “I used Smoke’em Powder and it worked great at first. It was worth it for that period, even though it stopped working as my dog’s condition deteriorated.”

Our perception of skin allergies that come and go is subject to regression to the mean

Again, the way regression to the mean works is that we tend to consider interventions—diets, exercises, supplements—when the condition is at its worst. For example, we know our dog has some arthritis that is pretty well controlled most of the time with a prescription drug. But the arthritis is getting worse. Instead of going back to the vet, we may try a supplement that our neighbor told us about. And when do we tend to try it? When our dog is acting like she is in more pain than usual. When we are having extreme values in the time series.

So we start her on Acme Supplement. Lo and behold, over the next few days, her pain appears to lessen. We automatically attribute it to the supplement. That is how our brains work, noticing correlations and leaping to assigning causation. Between the regression to the mean fallacy and the owner placebo effect (since our dogs may not actually be feeling better—we just wish they were), we feel certain we have solved the issue. Our dog feels better and it’s because of Acme!

These two biases together keep unproven supplement companies in business and whole product lines lucrative. All we have to do is try a certain product when the condition is at its worst. Then when the condition naturally improves, we are certain it is due to the product.

An interesting twist is that even after some time has passed and the product doesn’t seem to be working “anymore,” we don’t doubt its original efficacy. We rarely go back and say, hmmm, maybe it never worked after all! What we say, and tell others, is that it worked, but then stopped working. We often keep recommending it!

You will read versions of this over and over. You’ll see it in dog health, in suggestions for dealing with fearful dogs, in dog training of all sorts, in human health, and in other practices.

Owners of dogs with canine cognitive dysfunction are particularly vulnerable to regression to the mean with regard to interventions. Not only do the dog’s symptoms change from day to day, but the owners know it is a terminal condition and the worsening of the dog’s condition can’t be stopped. If the dog has a few good days in a row, it serves as a beacon of hope. That’s human nature.

Take Data and Be Skeptical of Assumptions

It’s normal to start to pay attention to a problem when it reaches a certain threshold. So it’s rare that we are going along, for instance, keeping a journal about how often we have headaches if we are not often troubled by them. But that’s exactly the type of data we need. We can’t go back in time when our dog develops a problem, but we can start keeping track immediately and also record anything we remember from the past.

Blanche Axton, a champion data recorder about her dogs’ health, wrote a super helpful article about this: “The Importance of Tracking Changes in Dog Behavior.” She is my inspiration.

There are lots of tracking tools available for those of us who like to use technology. When my dog Zani started exhibiting extremely fearful behaviors for which I couldn’t identify a trigger, I started taking data. I used a Mac journaling app called Day One. I created a template that included the behaviors I tracked. With the press of a button, I could pull up a blank template to fill out at the end of the day. This made it as easy as possible to write every day. I could add other notes and often included photos.

My system was primitive compared to what Blanche describes in her article. If you need to start tracking a health or behavioral problem with your dog, I suggest you take a look at hers, my simple lists below, and create something in between in a format that works for you.

Some of the things I tracked for Zani’s mysterious behavior change and included on the template were:

Bad Signs

  • trembling
  • slinking around 
  • unhappy facial expression, ear set 
  • staying at back door 
  • whining at front door 
  • avoiding bedroom 
  • avoiding kitchen when I am sitting at table 
  • coming to me repeatedly for help, then leaving 
  • clingy 
  • refusing food
  • getting in my lap trembling 

Good Signs

  • tail up 
  • playing 
  • enjoying training 
  • came in the bathroom while I showered 
  • did agility enthusiastically 
  • slept in bedroom 
  • hanging out with the rest of the dogs 
  • lying in dog bed on couch (instead of hiding in crate)
  • affectionate

These items were mostly hard to quantify. For most of them, I just answered yes/no for the day, then sometimes elaborated with notes. If you are tracking medical symptoms, you’ll probably need fewer categories than I needed for Zani’s mental breakdown, but you may need more detail about circumstances. Keep in mind Blanche’s system of noting things like times of day and other environmental factors and how much that helped. Perhaps if I had done that, I would have eventually found out what was freaking out my little dog.

Another thing to do is to be skeptical. I knew about regression to the mean, but I forgot and still thought the best time to start a supplement was during a symptom flareup! I think I’ve got the lesson a little better firmed in my mind now, but at the same time I need to remember that there is part of my brain that will grab at correlations whether I want it to or not.

Read the Kahneman book. It is full of examples about our cognitive biases and gives solid instructions about how to fight back against them.

And finally, regression to the mean can keep us messing around with things that aren’t really working. It’s a good reason to take data and be skeptical of our own “intuitive” responses that say something is working. We might be doing this while neglecting a proven intervention that can really help.

My Regression to the Mean Experience

In my case, it is unlikely that Supplement Y worked. After the first dramatic two weeks when my problem disappeared, it came back at about its normal levels (the mean). But then later when I finished the bottle and stopped the supplement, there was no uptick in the severity of the problem. It just continued in its on-again, off-again manner. I would need more carefully planned and gathered data to give me a better idea of whether Supplement Y helped me with my problem. But at this moment, despite those glorious few days when it was at a very low level, it probably didn’t help.

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Copyright 2020 Eileen Anderson

Placebos for Pets? A Book Review

Placebos for Pets? A Book Review

Dr. Brennen McKenzie released his blockbuster on alternative veterinary medicine on November 1, 2019. Placebos for Pets? The Truth About Alternative Medicine in Animals is out, and I recommend it highly. I am not a veterinarian, so keep that in mind as you read my review. But this is a great book for all pet owners, pet professionals, and others interested in animals who need help sifting through all the information on alternative veterinary medicine.

Book on alternative veterinary medicine: Placebos for Pets
Continue reading “Placebos for Pets? A Book Review”
A Dog With Spinal Cord Concussion: Zani’s Recovery on Video

A Dog With Spinal Cord Concussion: Zani’s Recovery on Video

Zani, a little black and tan dog, one day after her spinal cord concussion
Zani could use her front legs to balance a little while lying down on Day 1

This is a follow-up to Dog with Spinal Cord Concussion: Zani’s Story Part 1

In February I told the story of my dog Zani’s accident and traumatic spinal cord injury. Today, almost four months out from the accident, I’m publishing a video diary of the first days of her recovery.

There are several types of spinal cord injuries in dogs. Many of them are debilitating. My previous article describes how my small dog Zani got a traumatic spinal cord injury on February 8, 2018, after running full speed into a fence.  I didn’t know what we were dealing with, but I knew what to do. I called a friend, moved Zani carefully to the car, and we went straight to the vet.

Zani was semi-awake but as limp as a rag doll. But it turned out that considering the severity of the blow, her injury was probably the luckiest one she could have had.

After taking her to the vet immediately after the accident and getting her X-rays and a CT scan, Zani got the diagnosis of a spinal cord concussion. I then took her home again. I was shocked that they sent her home with me since she had no use of her legs. She couldn’t walk, crawl, or even use them to steady herself while lying down. But the vet was confident Zani would regain the use of her legs over time, possibly even making a full recovery. The X-rays and CT scan showed no fractures, nothing dislocated, no obvious bruising of the spinal cord. She told me that when the cord is bruised, damage can be permanent.

Zani’s ability to use her legs did come back, beginning the next day and increasing gradually.

The embedded video shows Zani’s daily progress at walking, starting the day after the accident. I created the video so people whose dogs get this rare injury can see the progress of a dog who recovered.

Small black dog standing in yard, recovering from spinal cord consussion
Zani looking pretty steady on Day 9

Starting the first day, I had to take Zani out to the yard so she could try to pee and poop. She is one of those dogs who won’t eliminate if she is not comfortable in a situation, including that she will “hold it” for 36 hours or more. No indoor solutions would work and she would hate a diaper. So I knew I needed to try to get her outside even though she could only flail and struggle.

The first few days as captured in the video are hard to watch. I had to let her stumble around because she wouldn’t even try to pee if I was close or trying to support her. She did work out how to pee on her own the very first day, and I was able to swoop in and help her stay steady when she got in position to poop. (I got lots of practice with that move with dear little Cricket.)

Link to the video for email subscribers.

Every dog’s situation will be different, as will be their abilities to heal and return to normal activities. I don’t know if Zani’s response was average, above, or below, but I do know that I feel very fortunate about her recovery. At almost four months out, she can run at about 75% of her former speed. She tends to list to one side or the other when she is moving fast, but she also corrects herself. She gets on and off things successfully; she has learned to be careful about it. She can go up and down flights of steps. The main clue that something is still wrong is the listing when moving fast and that she often nods her head or holds it a bit sideways when trotting. She also does some odd thrashing in her sleep that is new.

Beagle dog mix is lying on a mat, looking alert. She is recovering from a spinal cord concussionI will be consulting with a rehab vet soon about what exercises Zani can do and what might be contraindicated. I want to know how I can best help her. I also want to discuss the likelihood of problems as she ages resulting from her gait abnormalities.

At this point, I don’t think she will regain 100% of her pre-accident abilities, but as long as she is not in pain and can do things that make her happy I am good with that!

Related Post and Video

A Dog With Spinal Cord Concussion: Zani’s Story Part 1

YouTube video showing how dependent Zani was on care the first two days

 

 

 

 

Copyright 2017 Eileen Anderson

A Dog With Spinal Cord Concussion: Zani’s Story Part 1

A Dog With Spinal Cord Concussion: Zani’s Story Part 1

It started off as a normal winter afternoon. I had been home from work for a while. The weather was warm enough for the dogs to hang out in the yard. I sat wearing my warm coat and watching them from a chair in the sunshine.

Suddenly, a squirrel thumped down onto the fence and started running. I have a privacy fence all the way around the yard, and the squirrels run the length of two sides of it, using it as a highway from one tree to another. Clara enjoys running the fence after the squirrels, or even sometimes, by accident, ahead of them. This time Zani joined in. I watched because it is always entertaining. The dogs ran side by side.

Zani landed in the narrow space between that bush and the fence

Something happened so fast that even though I was watching, I didn’t exactly see it. But I heard a loud bump as a dog hit the fence, then I saw Zani lying very still on the ground on her side, right next to the fence. It had happened where there is a bush close to the fence, so my guess is that Clara ran Zani into the fence when the way got narrow. Zani landed facing the opposite direction she had been running, so she probably had two blows to her head and/or body: one when she hit the fence and another when she landed.

I don’t remember getting across the yard, but I got there fast. As I approached, Zani had a couple of spasms or seizures. Otherwise, she lay still on her side, too still, her eyes open.

I thought her neck was broken. Or her back. I thought she was going to die right there in my hands. But she didn’t. She kept breathing, her heart kept beating, and her eyes moved a little. But otherwise, she was completely still.

I texted my friend Ruth to come get us to take us to the vet and said I thought Zani’s neck was broken. I knelt there for a few minutes with my hands on her, murmuring to her. She was conscious but so still. Finally, I decided I should try to pick her up. I had to do something. I was still kneeling. I slid her away from between the fence and the bush and picked up her dead weight. I began to stand up, then I fell over backward. My yard is sloped. I managed to cushion her fall as I rolled onto my back.

I regrouped and strained to my feet. I carried her up the hill and up 12 steps into my house. The climb was exhausting. She is only 20 pounds, but she was a dead weight. I was trying to support her and not let her just hang there. I never knew how heavy 20 pounds of limp dog could be.

Ruth came and picked us up and drove to the vet, about 10 minutes away. I called them while we were en route.

When we got there, Ruth came around to the passenger’s side to take Zani from me because I had serious doubts about my ability to safely exit the car holding Zani’s dead weight.

Day 1: About three hours after the accident

At the Vet: Brain Concussion or Spinal Cord Injury?

The vet took the history quickly and examined Zani’s pupils for signs of a concussion. She dangled her above the floor and saw that she could not stand. Not even close. She rushed her for a steroid shot to limit swelling and took X-rays. At the time we didn’t know whether she had a concussion or a spinal injury or both. The X-rays looked good but could not show all the details we needed. It did look like nothing was fractured. The vet delineated the possibilities: all sorts of things that could be wrong with her head, spinal cord, or discs, including FCE, or fibrocartilaginous embolism. She recommended a CT scan to look for smaller fractures and damage to the spine. I agreed readily, even though it meant putting her under anesthesia. All this time Zani was dazed, but not completely out of it. She didn’t evidence any pain.

The CT results were very good. The vet said over and over how lucky we were. She and the internal medicine specialist at the clinic concurred that Zani probably had a spinal cord concussion. (If you do a web search on “spinal cord concussion,” most of your results will involve football players.) I asked what to expect, and she said she thought Zani could have a full recovery. Over time, she would regain the ability to walk. I should allow her to be ambulatory as she was able. If there were bruising of the spinal cord, then the prognosis was not quite as good.

I took my still-completely-limp dog home, wondering how hard it was going to be to take care of her.

Day 5: Hey! Steroids make me hungry!

More of the story to come. The injury happened on February 8th. So as not to leave you in suspense, Zani’s recovery is going very well. Her quadriplegia was transient. She has regained more leg function and balance every day.  Her appetite has been excellent throughout, her pain seems minimal, and she has been amazingly cooperative, especially considering the extent of her injury. (I think she could probably get an award as the only dog stricken with a spinal cord concussion and sudden quadriplegia who never eliminated in the house—even when I wanted her to.)

Here is a video of how limp she was for the first 24 hours or so.

I debated whether to post about this since it’s ongoing and personal, but finally decided to. I request that people don’t make medical or supplement recommendations. I have an excellent vet team, including access to a rehab specialist.

Thanks for caring about my little dog.

Day 8: Catching some rays

Copyright 2018 Eileen Anderson

Related Post

A Dog with Spinal Cord Concussion: Zani’s Recovery on Video

 

Canine Hemangiosarcoma: Summer’s Story

Canine Hemangiosarcoma: Summer’s Story

Most stories about dogs with the deadly cancer hemangiosarcoma end sadly and this one does too. Just so you know. But I want to tell the story because canine hemangiosarcoma is so sneaky and can be hard to diagnose. For Summer, it all started with a backache, though it turned out not to be the main problem. Continue reading “Canine Hemangiosarcoma: Summer’s Story”

Rocky Mountain Spotted Fever? But We Live in NJ!

Rocky Mountain Spotted Fever? But We Live in NJ!

Kate and BooBoo
Kate and BooBoo

Guest post by Kate LaSala, CTC

It’s the start of tick season here in the Northeast and I’ve been reflecting on last year’s tick season and how we almost lost our sweet BooBoo. So in the interest of raising awareness and saving lives, I share with you our story.

It was a beautiful Sunday in April 2015, one of the first nice days of the spring. My husband and I decided to take our two rescues, Mr. Barbo and BooBoo, for a hike and before we headed to bed that night, we did our standard post-hiking tick check and everyone checked out clean.

The next day we let the dogs out and as they chased the squirrels, BooBoo’s rear legs slipped and she fell. Did she trip on the pool cover? Maybe her hip dysplasia was acting up after our hike? I wasn’t really sure but she wiped out and then just kept going.

By dinnertime she was non-weight bearing on her right rear leg and I immediately worried she had an ACL injury from her earlier slip. I knew that non-weight bearing was a classic symptom so I put an afterhours call into our vet and immediately started her on some Rimadyl.

Over the next five days she improved and regressed. We brought her to the vet to rule out an ACL injury and our vet suggested we could re-run a Lyme test, even though she had just had one two months ago and even though we use Vectra 3D monthly.  We declined the test and suspected it was an injury from the slip that was causing her limp.

Our first red flag that we were dealing with something else came Saturday evening when she was curled up on the couch and whimpered as she adjusted herself.  We left a message for the vet saying we would need an appointment first thing after the weekend because the Rimadyl wasn’t working.

But, that plan changed Sunday morning when we woke up and she wasn’t in bed with us. We found her on the floor, lethargic and reluctant to move. She wouldn’t eat, not even her favorite treat and her temperature was well over 105. We rushed her to our local emergency facility, calling ahead so they were prepared to receive her. When temperatures are that high, the chance of a seizure is a real risk.

boohospital
BooBoo in the hospital

We arrived at the ER and they immediately started cooling her.   We explained the weeklong history since our hike and they suggested a Lyme test, as our vet originally did.  So we did the in office “snap test” but it came back negative. Despite the negative results, she was symptomatic of a tick disease and they suggested a full antibodies panel and PCR test for all the tick illnesses. We started Doxycycline right away and ran bloodwork and everything came back normal.  The tick panel would take several business days for results but if it were a tick disease, the Doxy should start to knock it out.  They admitted her for IV antibiotics and fluids to stabilize her and then said we could take her home.  After midnight, they called, said her temperature had been stable since 10PM and we could take her home with oral Doxy and Tramadol for pain.

We followed-up with our regular vet on Monday and she agreed with the ER’s diagnosis. BooBoo was on the meds, still lethargic and not eating well but her temperature seemed to be controlled.

But then Tuesday evening her temperature spiked back over 104 again and we rushed back to the ER where they admitted her again, this time for several days. We consulted with the internal medicine specialist to discuss the all possibilities from cancer to autoimmune issues to tumors and other super scary things since the Doxy didn’t seem to be working. We ran additional diagnostics including ultrasound and x-rays and she got the all clear. No cancer. No tumors.  All of her organs were the right size and everything looked perfect. A glimmer of good news in a sea of uncertainty. But her fever was still fluctuating and they were struggling to keep her stable.  The 5 doctors now on her team were all brainstorming to figure out what was causing our sweet Boo to be so sick.

Later in the week, the antibodies results returned a “high positive” for Rocky Mountain Spotted Fever. I was thrilled to know what we were dealing with but I was baffled. We hadn’t been in that area of the country, so how did she get it? But then I learned that despite its name, only 5% of the cases were actually from that region1. As I researched, she fit much of the epidemiology. RMSF is called “the great imitator” because clinical signs are often vague and symptoms are often confused with other infections but high fever, joint and muscle pains are usually observed within 3 days of exposure. And with delayed diagnosis and treatment, within days the effect on the central nervous and vascular systems can be devastating including death within a very short period of time. I was beginning to realize how close we were to losing her.

So with the RMSF on the radar, the vets changed the drug regimen within 24 hours she stabilized and we were able to bring her home Friday.  The bad news was the PCR test came back negative, which meant either she had been a carrier of RMSF for a long time and it was a red herring that was throwing off what we should actually be treating or that the DNA wasn’t in her bloodstream because it had attached to things like cell or artery walls. Since RMSF typically attacks the vascular system the latter option was a possibility, but we had no way to be sure.

We stayed the course and remained vigilant for any additional symptoms and completed the prescribed 3 weeks of medication. She progressed little by little but never got to 100% by the time the drugs ran out. She was still reluctant to jump up and was still very tentative on the stairs.

So what now? Retesting the tick panel at this point wouldn’t give us any new information. We could do additional diagnostics like joint taps to rule out things like autoimmune polyarthropathy but doing invasive procedures like that brings its own risks. Would she now be lame forever?

We opted to started her on Prednisone to see if her mobility improved. After 2 days of Prednisone, she had mobility improvement but also was experiencing the known side-effects of steroids – increase appetite (not really bad for her at this point) and increased thirst/urination. We continued the Prednisone for months, dropping the dose as advised but noticed that even though we were dropping her dosage, her need to urinate very frequently wasn’t subsiding. This caused our vet to begin to worry about liver, kidney and diabetes risks. We ran additional bloodwork and now her liver values were dangerously high. We continued to step down the Prednisone as quickly as we safely could and added in Denamarin, to help support her liver.

It would take over six months after her diagnosis to completely step her down off the medications before her liver values returned to normal and she got a clean bill of health.

Black dog BooBoo, survivor of Rocky Mountain Spotted Fever, joyfully running on a bridge
BooBoo feeling good again

So here we are, a year later at the beginning of a new tick season. She’s healthy and happy but is a changed dog and we’ve made changes as a result of this experience. We still hike – our dogs love it and even through almost life ending experience, I wouldn’t want to keep them from that joy. After all my research on RMSF and the recent Powassan virus, I discovered that some of these tick-borne diseases only take a few hours to be transmitted and that is truly frightening to me. Unlike Lyme, where the tick needs to be attached for 24-48 hours to transmit the disease, RMSF can be transmitted in as little as 5 hours.  This means hiking a full day and not checking for ticks until before bed will no longer do.  We now do a mid-hike tick check every 2 hours if we’re out for a long day in the woods.

As I reflect back on this ordeal, I’ve got several important takeaways that I’d like to share.

  1. Know your dog inside and out.  Know how to take your dog’s temperature and pulse. Just like people, dog temperatures vary and knowing what is normal for your dog could help you spot an early warning sign.  Know your dog’s normal vitals (body temperature, average resting pulse), appetite pattern, coat texture and sleeping   habits.
  2. Be your dog’s advocate. Don’t just wait it out to see if it gets better on its own, as tempting as it might be.  Time is of the essence.  Seek out care right away and be your dog’s advocate.  Don’t wait for organ failure or hemorrhaging – it very well might be too late to treat at that point. Be proactive in the care your dog gets.
  3. Pet insurance.  We purchased insurance soon after adoption so there would be no excluded pre-existing conditions. Having the peace of mind knowing that everything would be covered allowed us to focus on BooBoo and do whatever the doctors recommended and not have the financial strain as a deciding factor in her medical care.  Yes, the monthly premium is a lot but insurance is exactly for cases like this. We received 100% reimbursement of over $6500 in vet bills (minus our $100 deductible.)
  4. Topical treatments.  Although we are generally holistic, we do apply a monthly topical tick preventative.  When I approached the manufacturer about how she could be infected with being on preventative every month, even through the winter, they stated it’s only 97% effective in repelling.  So some ticks will get through.  I suspect we never found the tick that infected Boo because it bit her and then the Vectra killed it, and the tick fell off before we did our evening check.  We still use the topical but now also supplement with an essential oil spray. Also, having proof of purchase of tick preventative was necessary for our insurance claims to be paid 100%.
  5. Have a regular vet.  As tempting as it is to bounce around to low cost clinics for vaccines, this reinforced how it’s far more important to have a solid relationship with a regular vet, who sees your pet at least once annually, whether they are sick or not. We have an amazing vet and we trust her implicitly. When ER vets were throwing out all sorts of tests and things they could do, we relied on our regular vet’s advice and knowledge of the history of our dog to help us decide a course of treatment. Our regular vet worked in tandem with the ER staff and the specialists, reviewing all the lab reports and treatment plans.  They sent her daily updates and reports. It’s easy to be overwhelmed when your pet is in medical crisis and having a regular vet as an ally helps you make decisions and not feel like the ER vets might be taking advantage of your compromised state.
  6. Have an ER vet. You never want to need to use it, but in an emergency you don’t want to lose precious minutes looking up who your closest ER facility is.       Know where they are, know how to get there and have the phone number programmed in your phone so you can call them on your way so they’re ready to take you in for a real emergency. In our case, getting Boo’s temperature down was critical to saving her life and preventing a seizure. The hospital knowing we were on our way gave them advance warning to prepare a room for her so there was no delay when we arrived.

I am forever grateful to the medical team that saved our girl but I know our quick action also played a part. Many dogs do not get diagnosed with RMSF until it is too late to save them – until they are hemorrhaging or some other equally awful symptom appears. It wasn’t her time but it easily could have been if I hadn’t taken her temperature or if the ER vets hadn’t started her on drugs at that moment. There are so many things that could have altered our outcome. Our sweet Boo came to us as a feral dog from Kentucky and is now a certified therapy dog and I like to think the world needed her around for a while longer. I hope that others hearing our RMSF story will bring awareness to tick-borne illnesses and help people notice the symptoms early on to help save lives.

For now, we will keep hiking but checking for nasty ticks often and cuddling as much as possible to enjoy every moment that we have left together.

For more information, please check these RMSF resources

JAVMA, Vol 221, No. 10, November 15, 2002
Companion Animal Parasite Council
Merck Veterinary Manual
Medscape
US CDC

Kate LaSala, CTC is an honors graduate of The Academy for Dog Trainers and owns  Rescued By Training in Central NJ. She is also a certified AKC Canine Good Citizen (CGC) Evaluator and trainer for the NJ Chapter of Pets for Vets.  She shares her home with her husband John and their two rescue dogs, Mr. Barbo and BooBoo. Kate and BooBoo are a certified therapy dog team, visiting nursing and rehabilitation homes locally. Follow her on Facebook for training tips and helpful information.

Copyright 2016 Kate LaSala

Related Post from Eileen

My dog Clara also had Rocky Mountain Spotted Fever. Here is her story and a video showing her symptoms:

The Dangers of Rocky Mountain Spotted Fever for Dogs

The Dangers of Rocky Mountain Spotted Fever for Dogs

Many thanks to jarah’s mom for researching RMSF and answering my questions and generally getting me out of a confused state. Thanks also to Lori S. and Judith B. for their support and info, and to the many other helpful friends and well-wishers.  

On November 6, 2014 my dear dog Clara got a blood work result that very strongly indicated that she had Rocky Mountain Spotted Fever, a serious, potentially fatal tick-borne disease that affects people, dogs and some other animals in North, Central, and South America. Clara had been showing symptoms for quite some time.

Clara is probably not in danger for her life at this point, and most people wouldn’t even be able to tell that she is sick. Although she is on a strong course of antibiotics, some effects of the infection remain. Time will tell whether she will recover completely. I’m sharing the story of her diagnosis in case it will help others. This disease can be difficult to diagnose, and a timely diagnosis can save a life in some cases.

A tan dog with a black muzzle and tail is on a chaise longue. It's sunny and she is looking straight into the camera
Clara catching some rays. She looks serious but is wagging her tail.

Diagnosis

In September 2014, I started to notice that Clara was getting increasingly stiff and weak in her hind end. This worsened, and by early November when she was finally diagnosed, she had also gotten prone to trembling, not only when she was cold or excited, but sometimes for no apparent reason, even while asleep.

Thinking back, for as long as several months before this, she had run and jumped less when playing with Zani and had less stamina for playing ball. I didn’t mention it in the post, but you can see in the video in “How My Dogs Play” that Clara typically waits in the corner while Zani runs around the yard (previously, she would have run after her every time). Clara also lies down a lot in the play session, which is very polite and self-handicapping of her, but also could have been because she was tired.

She also had a rash on her chest, abdomen and legs in October 2014, which may or may not have been connected.

I made the movie below to chronicle her symptoms, but held back for some time on publishing it. I wanted to be as sure as possible that her diagnosis was correct and that there wasn’t an additional problem or other reason for her symptoms.

The symptoms of tick-borne diseases vary greatly and also can be confused with many other diseases and conditions. (There are quite a few of these diseases, the most well known of which is probably Lyme disease. I included some links in the Resources section at the bottom of this post that list all the types, for humans and dogs.)

So before the blood work to test for tick-borne and parasitic diseases was done, the following tests were performed:

  • extensive range of motion testing on hips and back legs (excellent!)
  • hip, pelvis, and back leg X-rays (clear!)
  • complete blood count including to test for muscle enzymes related to soft tissue damage. The muscle enzymes were fine, but the CBC showed a lowered platelet count, which is a typical symptom of tick-borne diseases.

The lack of other diagnoses plus the low platelet count made tick-borne diseases the next most likely candidate for Clara’s symptoms. She was put on antibiotics and more blood was drawn so she could be tested for tick-borne and parasitic diseases.

The subsequent blood work returned a Rocky Mountain Spotted Fever titer of greater than or equal to 1:1024, the highest result possible at that lab.  This high reading indicated that Clara had a large number of antibodies to the Rickettsia rickettsii bacteria and had been fighting the Rocky Mountain Spotted Fever infection for a while, probably weeks or months.

This movie is a bit hard to watch.

Link to the video for email subscribers.

Mechanism of the Disease

The Rickettsia rickettsii bacteria are introduced into the dog or other animal from the bite of a tick that has been attached for 5-20 hours.1)Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44. (This is a very good reason to perform daily tick checks if your dog has been in areas where ticks are present.) The bacteria have been found to be transmitted by at least four tick species, but the most common are the American dog tick (what probably bit Clara) and the Rocky Mountain wood tick.

Tick hemolymph cells infected with Rickettsia rickettsii
Tick hemolymph cells infected with Rickettsia rickettsii. Public domain image from the US Centers for Disease Control.

The bacteria are nasty. They immediately spread throughout the body via the blood and lymphatic systems and invade the cells of the endothelium, the cells in the lining of the blood and lymphatic vessels. They multiply there and move into the smooth muscle tissue. 2)Harrus, S., et al. “Rickettsiales.” Pathogenesis of Bacterial Infections in Animals, Third Edition (2004): 425-444. Since this is happening all over the body, the presenting symptoms can vary. Many different organs can be damaged or fail. The dog often bleeds from the nose or other locations.  There are joint and muscle problems. There can be gangrene in the extremities as the tissue dies. Dogs can have inflammation of the eyes, shortness of breath if the lungs are affected, have seizures or other nervous system symptoms, or can die suddenly of a heart attack. The kidneys can fail.

It most often affects dogs under four years old (Clara is 3 1/2). The response can range from no apparent problems at all, where the dog is infected but remains asymptomatic and lives a normal life, to death in a matter of days.

One dog study reported a mortality rate of 4%3)Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44., but there doesn’t seem to be much information in general on that topic. The rate is probably higher. In studies where dogs were injected with large quantity of the bacteria (sorry to even mention this), mortality was 100% when the disease was untreated.4)Keenan, K. P., et al. “Studies on the pathogenesis of Rickettsia rickettsii in the dog: clinical and clinicopathologic changes of experimental infection.” American journal of veterinary research 38.6 (1977): 851-856.  In humans, RMSF is fatal in 20-25% of untreated cases and for 5-10% of treated ones.5)Bakken, Johan S., et al. “Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States.” MMWR Morb Mortal Wkly Rep 55 (2006): 1.

Treatment

Clara is now on her second three-week round of Doxycycline, which luckily does not appear to upset her stomach. She obviously felt better in a metabolic sense after two days on the antibiotic; she was perkier and had more energy, and has stayed that way. But the stiffness has been much slower to change. I’ve been keeping a video record and I think she is finally improving, though. I have to remind myself that progress won’t necessarily be linear.

The Future

I feel a little weird for publishing this movie and blog, like I’m exaggerating the seriousness of Clara’s illness. But I’m not. Although the trembling has lessened, she still has periods of weakness and/or stiffness and is clearly fatigued after she exerts herself. I’m still trying to get my head around it all. I go from thinking she will be tragically affected for the rest of her life, to thinking there isn’t much to it and I’m overreacting. There’s still a flavor of “this can’t be happening…” But I’m also counting our blessings.

I’m almost afraid to ask for others’ experiences, because I’m sure there are some sad ones out there. But I think education about RMSF and the other tick-borne diseases is valuable and important. So please share if you are willing.

Kate and BooBoo’s Story: Rocky Mountain Spotted Fever? But We Live in NJ!

Resources

Lists of tick-borne diseases.

Rocky Mountain Spotted Fever in Humans

Rocky Mountain Spotted Fever in Dogs

Tick Safety

  • Do whatever you can to prevent tick exposure in the first place.
  • Check your dog thoroughly after possible exposures.
  • Remove any attached ticks quickly. Some tick-borne diseases are transferred quickly.
  • Get your dog to the vet if she has a fever or any of the symptoms listed here: Symptoms of Tick-Borne Diseases.
  • Oh yes, and be careful for yourself and human loved ones as well. There are cases of dog and humans simultaneously getting the disease because of concentrations of infected ticks in the same area.6)Paddock, Christopher D., et al. “Short report: concurrent Rocky Mountain spotted fever in a dog and its owner.” The American journal of tropical medicine and hygiene 66.2 (2002): 197-199. 7)Elchos, Brigid N., and Jerome Goddard. “Implications of presumptive fatal Rocky Mountain spotted fever in two dogs and their owner.” Journal of the American Veterinary Medical Association 223.10 (2003): 1450-1452. If you are in the U.S., check the incidence map in this article to see how prevalent it is in your state. RMSF is not found outside the Americas, but there are other related spotted fevers found in most parts of the globe.

© Eileen Anderson 2014                                                                                                             eileenanddogs.com

Notes   [ + ]

1. Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44.
2. Harrus, S., et al. “Rickettsiales.” Pathogenesis of Bacterial Infections in Animals, Third Edition (2004): 425-444.
3. Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44.
4. Keenan, K. P., et al. “Studies on the pathogenesis of Rickettsia rickettsii in the dog: clinical and clinicopathologic changes of experimental infection.” American journal of veterinary research 38.6 (1977): 851-856.
5. Bakken, Johan S., et al. “Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States.” MMWR Morb Mortal Wkly Rep 55 (2006): 1.
6. Paddock, Christopher D., et al. “Short report: concurrent Rocky Mountain spotted fever in a dog and its owner.” The American journal of tropical medicine and hygiene 66.2 (2002): 197-199.
7. Elchos, Brigid N., and Jerome Goddard. “Implications of presumptive fatal Rocky Mountain spotted fever in two dogs and their owner.” Journal of the American Veterinary Medical Association 223.10 (2003): 1450-1452.
Canine Cognitive Dysfunction

Canine Cognitive Dysfunction

Cricket standing with her head in a corner

This is a hard post to write, but perhaps not for the reason you would think. My old dog Cricket has Canine Cognitive Dysfunction. This condition is like Alzheimer’s or dementia for dogs. It’s hard to write about not because I am permeated with sadness about it. It’s hard to write because I’m not. I live with Cricket and attend to her, and I don’t see that she suffers much from CCD. Of course I regret the loss of her capabilities, and the decline can be hard to witness, but for her day to day comfort, I am more concerned about possible pain from arthritis and weakness in her rear legs.

It’s mostly hard to write about this because I’m concerned about being judged. There are a handful of videos on the Internet showing dogs purported to have dementia, and the videos to me are very sad. My visceral reaction is sometimes that the people are not doing the dog a kindness by letting its existence continue. Or perhaps that they are callous to suffering on their dogs’ part. So I wonder whether you’ll have that reaction to my pictures and video of Cricket.

I hope not. I remind myself when I see the other videos, and I hope you all will keep in mind as well, that we are seeing but a small part of the dog’s life. Not only that, but in my observation of Cricket, her own condition is not distressing to her. It can, however, be distressing to witness. It also requires careful management of her environment and a watchful eye on my part to keep her safe. I have written some about Cricket’s care in a previous post: Poop in my Pocket.

Am I being selfish keeping her with me on this earth? I truly don’t think so.

As long as she has enjoyment in life, minimal stress and pain, and still knows me (she has always been very attached to me and I am her anchor), I think her quality of life is just fine. Her appetite is good. She continues to go to work with me several half days a week, and she looks forward to those outings. At the office she is free of bother from other dogs, and has a completely carpeted surface to walk on. She toddles around after me or sometimes sleeps close by. She still sleeps pretty well at night (knock on wood). When she wanders or stands with her head in a corner, she does not display stress that I can see. In fact I see fewer signs of stress or anxiety from her now than I did before she got dementia.

My main purpose in posting these photos is so that others might see what doggie dementia can look like. Cricket started exhibiting symptoms in early 2011, but it was 2012 before I realized what might be going on. The first thing I noticed was a loss of comfort with people she used to be very close to. I don’t have pictures of that, obviously, but it was very disconcerting. Why would she suddenly give the cold shoulder to someone she had formerly known and loved?

By now she has close to a classic set of symptoms. But it took quite a bit of time to tease them out of problems she had because of sensory impairments and body stiffness.  She was diagnosed by a vet early this year. There is medication for this condition, and it has helped Cricket.

Among her symptoms are:

  • standing in corners or with her face next to the wall
  • getting stuck behind furniture
  • confusion about doors (trying to go out the hinge side)
  • forgetting what she is doing
  • circling
  • staring into space
  • occasional tremors
  • pacing or wandering
  • lack of interest in people (other than me)

Another thing I notice that is not on the standard lists is that she can’t get onto mats or pillows in a way that all of her body is on there. I’m pretty sure this is not a physical problem, in the sense of limited mobility or range of motion. She can’t figure out how to arrange herself. She will circle and lie down carefully but end up with her body sliding off the pillow or only a small part of her back on the mat. This is notable in view of her lifelong avoidance of bare floors.

She has lost the general ability to back up, and again, I suspect it is a cognitive problem. She can physically do it. She just can’t figure out that that is what she needs to do.

Here is a the abstract of a scholarly article that links dementia behaviors in dogs with specific brain changes detected by necropsy. In other words, it establishes that the behavior changes are linked to detectable brain changes.

Cognitive disturbances in old dogs suffering from the canine counterpart of Alzheimer’s disease.

Here is an article that lists many of the symptom behaviors of CCD.

Cognitive Dysfunction Syndrome in Dogs.

So here are what some of the behaviors look like.

Cricket standing with her head very close to the wall

Cricket standing with her head under an office chair

Cricket with most of her body on the linoleum instead of the mat

Cricket still missing the mat, and now with her back braced against a chair base

Cricket sitting on the edge of a crate facing into the dark, with her butt hanging out

Cricket sitting on the base of a rolling office chair

Here also, is a video of several of her dementia related behaviors. They are: getting “stuck” behind an office typewriter table; forgetting what she is doing; losing the door;  and circling.

DISCLAIMER: I am not a vet and have no medical training for animals or humans. The information on Canine Cognitive Dysfunction included in this post comes from my vet, from articles, and my own observations of Cricket as her behavior has changed. If you are concerned that your dog might have CCD, please contact your vet.

I hope this was helpful to you, and not too saddening to view. Cricket has a good life, and seems to be unaware of her limitations.

Thanks for reading.

Note: Cricket passed away on May 31, 2013 at the age of almost 17. She lived a good life to her very last day. I miss her greatly.

Resources

Remember Me 3dMy book on Canine Cognitive Dysfunction: Remember Me? Loving and Caring for a Dog with Canine Cognitive Dysfunction

Web:

Eileenanddogs on YouTube

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