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Thyroids
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I just got back from a pretty nerve-wracking visit to the vet for my shiba. Basically, he's been battling some of the worst skin issues he's had in years running since March of this year. I wanted to get him in for some bloodwork, because I saw a lot of signs as described in hypothyroid dogs – I wanted to at least be able to rule it out.
Anyway, let's just say our shiba was not very compliant... After an hour and a half, some awkward conversation, some shiba screaming, an almost-bitten vet tech, a bitten boyfriend, doggy downers and doggy revivers, they got his blood, I have an extra vial for myself, and there's a nice $500 charge on my Visa.
So some of the awkward conversation revolved around Dr. Jean Dodds. I first heard her and Hemopet mentioned on this forum. People here seem to be happy with her help. My vet was not so enthusiastic. Some quotes... "Oh. Jean Dodds. […] She's controversial." "She calls herself an endocrinologist…" (Actually, I thought she called herself a hematologist.) "She's been known to overdiagnose greyhounds with hypothyroidism." (But that's what her non-profit does?) He was also telling me we don't really need the whole range of thyroid tests if we wanted to get a reading for hypothyroidism (which he never mentioned as even a remote possibility, either -- this is something I've asked him to do).
In the end, we're running the thyroid tests through their veterinary labs (it's a VCA), doing a full blood profile while we're at it (since it was so hard getting that blood from him in the first place), getting results on Saturday and going from there. I got the extra vial of blood sitting in the fridge just in case I do decide to pursue a second opinion.
I'm going to try and do some poking around and also try to call Hemopet later in the day, once I cool down from that stressful visit. Meanwhile, I'm wondering if folks on this forum could help me understand the background to this "controversy," or share any of their own experiences with Dr. Dodds. I'd like to try and formulate some kind of even-handed understanding of her practices, which admittedly does seem to be somewhat outside of the "regular" circuit of veterinary care. But I don't know that I am comfortable sticking only with "regular" health care practices anyway (for myself or my dogs), and am trying to keep an open mind as to all available options.
Thanks in advance.
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You will not get the full Thyroid panel using your Vet's lab, first of all, you are the client and should be able to tell them where you want tests done, you are paying for it. That said there are other approved labs, UC Davis is one, UC Mich is another that your Vet can send the sample to. I think that if you visit the OFA site you can find a list of approved labs for full thyroid testing.
And I know that my OJ would break out in hives all the time as he got older (11+) and once we tested his thyroid and put him on Meds, no more skin issues and he lived to 17+ years.
And just like other things with/between Vets, example is Fanconi and many Vets that tried to discredit Dr Gonto's finding and protocol…. everyone has an opinion.
While I have had thyroid done at different approved labs other then Dr. Dodds, I have sent her copies of the results, which she will review for free... and have even had her say she didn't think that a dog needed supplements even when recommend by the regular Vet
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The vet did namedrop UC Davis – I think he said they send it to the same place that UC Davis does thyroid work, but I'm not 100% certain that's what he said. Things were starting to get a little tense at that point, so I can't remember for sure. At any rate, it's not an on-site lab.
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As Pat said, the vet should be willing to draw the blood and send it without problem as my vet did 2 months ago. My vet did not question it or give an opinion they just said no problem. They drew the blood and shipped it for $18 and Dr Dodds was $70 for test and eval.
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This is not entriely true and somewhat misleading. The lab my clinic uses use is the exact same one Dr. Dodds uses so we have the ability to do anything and everything she does. Many labs have this capapbility. The tests might be called something else but they have the ability to test many, if not all, levels.
It is no secret Dr. Dodds is not as well respected in the veterinary field as she is with the laypeople. There is legitimate reasons on both sides for loving her and not loving her.
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This is not entriely true and somewhat misleading. The lab my clinic uses use is the exact same one Dr. Dodds uses so we have the ability to do anything and everything she does. Many labs have this capapbility. The tests might be called something else but they have the ability to test many, if not all, levels.
It is no secret Dr. Dodds is not as well respected in the veterinary field as she is with the laypeople. There is legitimate reasons on both sides for loving her and not loving her.However you have to make sure that you are not just getting the basic test.. and they run the full panel.... but if your Vet is sending to the same lab that does UC Davis and they request the full panel, you should be OK.
But again, it is your MONEY you are spending and you are the client... and no different then if they scrib medication, it is your right and they must do it, if you ask for the scrip for the prescription, it is the law in California that they give it to you and you can get it filled at a place of your choosing.... -
Pat, thanks for the tip about California pet scrip laws. I'll remember that as well… I wasn't having any luck finding where the text of such a law would be archived. You wouldn't happen to know what it's called or where I should check, do you?
I used the bill to track down the name of the lab -- Antech Diagnostics. They charged me for a "SR090 Senior Comprehensive", which the Antech website says includes "Superchem, CBC, T4, FT4 (ED)". So am I correct in understanding that the T4 and FT4 are the only thyroid-specific tests being conducted here? This was one of the points that we went back and forth about as well. I presented printouts of the information from Hemopet (the sheet that described specimen collection requirements broken down by test, a "letter to colleagues" with full contact information), and my vet said that much of the information collected by the Thyroid 5 is unnecessary (T4, free T4, T3, free T3, TGAA), that these kinds of extras were necessary in human diagnoses but you could get what you needed to know with just the T4s. So it doesn't sound like we're getting a "full" thyroid panel. We asked for the full blood profile when we saw how difficult it was getting any amount of blood out of our shiba in the first place, so we at least have that information on hand for future reference.
Anyway, I'm a little confused as to why they are using a "Senior Comprehensive package" since Bowdu is not a senior (he's 5.5 years old). Maybe it's just the name of the test package that included all the things we wanted. I am assuming I'll just get back a chart with all sorts of numbers, and they won't necessarily be skewed to account for the biological functions of a "senior" dog, which he's not.
I think maybe I'm overprocessing and should hold my breath until the info comes in on Saturday.
Linda, I would be curious to hear your take on some of these "legitimate reasons" for both loving and not loving Dr. Dodds, if you have the time to lay it out. As someone "on the inside" of the veterinary field as it were, your perspective would be much appreciated (not that I don't appreciate everyone else's!). If you don't feel comfortable going into specifics, maybe we can exchange private messages. Or not, that's fine too.
Dan, maybe I should get the name of your vet.
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UC Davis doesn't use a lab, they are a lab. I know because when I do thyroid panels on my dogs my vet does the blood draw and my husband drops them off in the lab on his way to work. He works in the adjacent building on campus.
Antech does OFA panels, they get sent to their New York lab when an OFA panel is requested. This is the same lab that runs samples for Dr Dodds.
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Thanks, lvoss. Just scratch what I said about UC Davis' relationship to my vet. I don't really understand what happened there, but I do know that UC Davis was name-dropped to help reassure me of the reliability of the lab used by my vet.
It's not that I think my vet or Antech is going to give me "wrong" results. I just wanted to make sure I was getting as complete a picture as possible from people who knew what to do with thyroids. And since my vet had never mentioned this as a concern in the first place, I had reason to think that someone who has a reputation across multiple breeds as a thyroid specialist (controversial or not) would be able to tell me more than my vet who had told me nothing at all.
There, I guess that's what I should've said to my vet.
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I asked my professor at the university about dr. Dodds and her full panel.. And he commented that doing all these test isn't nessecary as basic test and he thought that if someone did recommend it.. He or she was trying to earn some extra cash.. But that was just his opinion of course… A real specialist btw
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Janneke, I would usually adopt a similarly cynical view, except for a couple things in this instance –
1. Dr. Dodd's HemoPet/HemoLife is a registered non-profit agency. Of course, even at a registered non-profit, prices on some things may be above "market" price to help compensate for or fund other aspects of a non-profit, but I don't think this is the case here, because...
2. The most expensive test provided by their lab is the Thyroid Profile 5 PLUS, which includes a T4, Free T4, T3, Free T3, TgAA, CBC, Differential, Chemistries. That's $115 USD.
My vet charged me $230.85 USD for "Superchem, CBC, T4, FT4 (ED)."
Looking at the price chart at the Diagnostic Center for Population and Animal Health at Michigan State University (MSU in East Lansing, not UMich in Ann Arbor), I think -- am not sure -- I would need a Premium Canine Thyroid Profile (which I think includes a Free T4 by dialysis?) which is $59. The comparable Thyroid Profile offered by Hemolife is $71.
I'm learning that they do things a little differently at MSU as well as HemoLife, but both are considered thyroid experts. I have one extra vial of blood for one shot at a second opinion, which I now feel is necessary after having reflected on this whole procedure. So I'll have to make a choice.
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There are different types of tests. And everyone has their own opinion. Here is my experience with my boxer and the vets and Dr. Dodds. I had a specialized test because Zina was taking Dexamethasone and we had to discount that. After we got the test back, the lab and two vets here said her levels were 'fine'. That wasn't her problem. Now, mind you, she was BALD on both sides of her body, down her legs, her face, she was depressed, not eating properly, wasn't happy with the other dogs, sensitive to touch, the list went on. I contacted Dr. Dodds, told her Zina's history and syptoms, scanned and sent her the lab reports,(this is important, get the reports and send them to Dr. Dodds yourself with the history, it may take a few days, but she will get back with her opinion) and waited. It was a Jewish holiday, so I didn't hear back from her for about a week. Dr. Dodds told me what to do, I asked her the dosage, and within a month, Zina's hair started to grow back, she wasn't depressed, and there was a myriad of good things.
So, the vets didn't want to do anything and I took a chance. I'm glad I did. Whatever you do, it's your decision. Like Pat states, it's your money, you should be able to get the tests that you want. If your vet doesn't like it, I would run, not walk to the next vet until you find one you are comfortable with. It's all your decision. If you have any questions on my experience, don't hesitate to ask.
ArleneBy the way, the symptoms were discussed somewhere on another thread in detail.
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Pat, thanks for the tip about California pet scrip laws. I'll remember that as well… I wasn't having any luck finding where the text of such a law would be archived. You wouldn't happen to know what it's called or where I should check, do you?
I believe it is required be posted in your Vet's office? It is in mine. That is where I have seen it, it is posted on the wall at my Vets office….. I can look the next time I stop by there for something.....
And as far as his age and calling it a senior panel, I have heard and seen some Vets call anything over 5 senior....
By the way, where are you in No. Calif? You can email me privately. My friend Parry Tallmadge used to live in the city and had a number of Vets that he used for his Basenjis that if I knew where you were I could get a list for your? I am guessing since you mentioned to Dan about getting the name of his Vet you are on that side of the Bay.
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Free T4 by equilibrium dialysis(e.d.) is the a minimum test you would want do for thyroid but it is an incomplete picture of what is going on so for some dogs you don't get to what is really going on.
My experience with Dr Dodds is that she was very helpful when I have sent results, my vet at the time wouldn't send them to her and wouldn't give me a blood sample, and gave a good explanation for why she made the recommendation she made. I had one of those cases where the full panel told a different story than the single result.
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We have labs, we have vet clinics, then we have clients.
The vet clinic in this instance is the middle man.
Cut out the middle man and you can get your testing cheaper - assuming the labs allow you to cut out the middle man, not all do (MSU would be one). When you have a middle man your cost helps offset their over head charges (staff, supplies, building, insurance, etc) and you are also paying for their interpretational skills which is not always created equal which is why I would prefer a board certified endocrinologist interpreting my results and my dog.
Caveat of cutting out the middle man means you now have to find someone to collect the blood for you($), put into the correct containers ($), properly pack (cold pack usually) for shipping ($$), then you have to ship ($$$) overnight and not on a weekend. You would be surprised how quickly it all adds up.
Make a mistake and you are back to square one ($$$$).
Our normal lab is Antech but we also use MSU, IDEXX and others. We have to ship just like a lay person does but due to bulk we are able to cut costs somewhat and pass them on to the client.
There are pros and cons to doing just the basic thyroid test (bare minimum would be FT4ed - skip the T4 as it is a waste, IMO but unfortunately standard) versus the more in depth testing that the OFA recommends. If you have a breeding animal - I rec'd doing more. If you are testing a non breeding animal who is showing signs of thyroid issues - I think starting with the FT4ed and basic blood profile is fine.
There is no need for the TgAA in a non breeding animal as it does not tell you anything about the function of the thyroid - which is what you are screening Bowdu for - function or lack thereof. I also feel the T3 tests are a waste in determining HYPOthyroid since the T4 is converted to T3 (the T4 is the first in line so if it is affected it stands to reason the T3 would also be so why spend money on testing it?).
Humans rarely if ever have T3's tested (in 30+ years living with thyroid disease I have never had anything but TSH and FT4ed) done. I imagine there are Dr.'s out there that feel we should be testing T3 as well but as of yet it is not an accepted method of testing for hypothyroidism. I am due for testing and looking at my test form - there is only one T3 test and its an uptake test which does not measure usable levels only circulating T3 proteins. Hardly useful in determining my function.
HSUS, PETA, ASPCA are all not for profit agencies - yet I would not lay down beside them on a National level. Just because someone or something is not for profit does not automatically mean or guarantee that they are without issues/concerns. Just something to think about.
Euthyroid sick dogs (sick from something not related to thyroid but which effects thyroid levels) will always respond to supplementation. Does not mean the dog necessarily needed it. You can also improve many things such as hair coat, fertility, etc (sheltie show people will attest to that) on dogs whose blood thyroid levels are normal. Does that mean they are hypothyroid or just responding normally to increased dosages of hormones??? Long term use though could have deleterious effects.
Having a reputation across multiple breeds as a thyroid specialist is not the same as having a similar reputation amongst your peers. I admit - I am still looking for peer reviewed and accepted articles and ideas of Dr. Dodds and am coming up short. That concerns me. As humans we naturally flock to those with similar ideas as ours, those who support our breeding practices and choices or those who validate what we are doing within a chosen field or who we are. This does not always equate to long term best interest of the dogs.
As the Antech liaison at my work I can answer your question re: why the senior panel. Antech realized many vets were ordering the same type of testing on dogs and cats of a certain age. The clinics and clients however were complaining that the tests were cost prohibitive. Antech decided to make bundles of tests that can be ordered as a unit at a far cheaper price then if ordered individually. They call them senior and or junior profiles (junior would have less tests in the bundle) amongst other things but they are the same tests that would be run on an animal of any age at any time individually. Yes - they could have just run the thyroid bundle of tests to see what Bowdu's function is but there are other things that can show up on normal blood work that can help form the big picture - increased triglycerides and cholesterol to name a few. Let's say Bowdu's thyroid levels are baseline - without symptoms or without other correlating blood work - the vets might think baseline is normal for him and do nothing. But with symptoms and with correlating blood work they might decide he is baseline now, headed for low, so lets treat for a trial of 3 months and see how he does.
Your vet was wrong when he told you "…that these kinds of extras were necessary in human diagnoses...." Human field rarely tests any of these things sans FT4ed and TSH. I think he would have been better to say those other tests are good for determining breeding animals potential for future hypothyroidism. He is correct that most of those tests tell you nothing regarding the function of the thyroid only the condition the thyroid is in at that moment in time. The FT4ed will tell you function, as will the chemistries/CBC. It is a good place to start but might not be the only place.
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Linda, just wanted to pop in and say that all that information was very helpful and I appreciate the time you took into typing all that out. I concur on your point on non-profits, for sure.
Nothing else to add at the moment as I'm still waiting on test results.
Pat, I'll be sending you a PM.
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Linda that was really informative, thanks ! … and I hope Bowdu results are good. Its so hard when you know they are not at their best.
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There is no need for the TgAA in a non breeding animal as it does not tell you anything about the function of the thyroid - which is what you are screening Bowdu for - function or lack thereof. I also feel the T3 tests are a waste in determining HYPOthyroid since the T4 is converted to T3 (the T4 is the first in line so if it is affected it stands to reason the T3 would also be so why spend money on testing it?).
I disagree. I had a dog that at 18 months old tested low T4 on a blood panel and the vet wanted to supplement. I asked they run a full panel since I wanted the FT4ed since there were no symptoms of HT. T4 was still low but he also had high T3. I sent the results to Dr Dodds for interpretation and she said wait 6 months and retest to see if anything changed. The T4 came back up into the normal range and has been normal since.
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My Eddie had some low values and some high, vet did not recommend treatment but Dr. Dodds started him on a low dose. Disposition improved (was not really bad) and oddly, his body temp seemed to lower…he had been the hottest basenji I had ever slept with, just petting him and another basenji you could feel the difference. He now seems normal, is perkier, plays more. My vet was fine with me referring to her, he is not a basenji expert, but I really think Eddie has benefitted from his daily pills.
Many people with new or controversial ideas are ridiculed or even demonized by peers at first, some are proven right later on, some not. After being published in a Vet. journal by Jennifer Yearly, more Vets at least listened to Dr. Gonto's theory. It does pay to be cautious, do your own research. Anecdotal stories off the internet do not impress most scientific people....but it does not mean there is no truth there.
Good luck with your boy. Sorry about your experience, I'm sure that affected your feelings about your vet overall.
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I disagree. I had a dog that at 18 months old tested low T4 on a blood panel and the vet wanted to supplement. I asked they run a full panel since I wanted the FT4ed since there were no symptoms of HT. T4 was still low but he also had high T3. I sent the results to Dr Dodds for interpretation and she said wait 6 months and retest to see if anything changed. The T4 came back up into the normal range and has been normal since.
What do you not agree with? What did the T3 tell you? The T3 did not dx your dog with HT, nor did it unequivocally tell you the thyroid was ok. In the end you still needed to know what the T4 was to determine/validate thyroid function.
The vets I work with, if the only problem is a low blood value - without symptoms - they reccomend recheck in 4-6 months to make sure there is not some other underlying reason for the low T4 (such as normal flucuations in values throughout the day, immune responses to something, et al).
This is where it is important for the humans to be moderately knowledgeable in disease and to be their pets advocate. If your dog does not have symptoms correlating with blood results - it will not hurt to wait. Same as if the blood results do not always correlate with the symptoms, it does not hurt to do a 3 months trial - then wean off - if symptoms do not return then there is no true disease.
The only caveat to the trial is this: 1) all mammals will respond positively to increased hormones as we all deplete our stores throughout the day. Is the positive result truly indicative of long term need or just a normal response of the body. The only way to know is to slowly wean off (to give the thyroid time to wake up after its vacation) and see if symptoms return 2) if the thyroid is not really needing supplements but supplement is used long term it can create a non functioning thyroid to the point of atrophy and "death" - so if used when not necessary you could be creating hypothyroidism.
