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Messy Diagnosis & Treatment


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I recently posted about Patty's distended belly (ascites, in jargon).  Blood tests have ruled out liver and kidney malfunction, which seems to indicate heart, ie. dilated cardio-myelopathy (sp?). or DCM. No grain free diet. 

I'd love to hear from others who have been down this path.

The vet wants to refer me to a specialist.  It's a long drive and she says $500 would be a conservative guess.  I asked her what, beyond a clear diagnosis, it would gain, and she got vague, but I think it boils down to a better treatment plan and maybe a few months of life. 

There are no vet cardiologists nearby, and I'm not sure how much value there is in getting a second opinion from a non - specialist. 

 

I'm unsure of the diagnosis.  There's no question that she's retaining fluid, but that's the only symptom of DCM (various vet school websites give lists of symptoms...retaining fluid in never at the top of the list).  Her resting breathing rate is 21/minute.  The vet sites says to worry at 40/minute. She is less energetic than the two 15 mo puppies with me ATM, but she's 6 1/2, but not lethargic. 

Any thoughts or suggestions? 

 

NOTE: After posting this I checked around and found that there is a veterinary cardio about 25 km from me.  GRRRRR.  Very disappointed in my vet for not referring me locally.  So I've scheduled a local consult. 

 

P. S. She also had some sort of tummy bug.  This has cleared up with antibiotics. 

Edited by sandgrubber
Title was misleading
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It's so hard when there are so many possibilities to investigate.   But the vet cardiologist consult would probably be useful . if only to narrow the possibilities down.   I'm assuming that specialist will be able to do an echocardiograph on site.  I guess also, will have had a wider range of practical experience in tricky diagnostic problems.  Fingers crossed.

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49 minutes ago, Snook said:

I'm glad you've been able to find a local specialist to get Patty checked out. It can be really hard to know what the best course of action is, especially when your vet can't give you any clear guidance. How long do you have to wait to see the specialist? 

Until next Wednesday. Yes, decisions are hard. Patty has improved so much since the first vet put her on antibiotics, I keep hoping it will all blow away.  Nothing I've read suggests that's likely. 

 

3 hours ago, Tassie said:

It's so hard when there are so many possibilities to investigate.   But the vet cardiologist consult would probably be useful . if only to narrow the possibilities down.   I'm assuming that specialist will be able to do an echocardiograph on site.  I guess also, will have had a wider range of practical experience in tricky diagnostic problems.  Fingers crossed.

Yes, the specialist has an echocardiograph. I hope he will have a clearer idea of what's wrong. I don't think the first vet even did a careful listen to her heart or looked for enlargement on the ultrasound. Maybe my expectations are too high.  (My father was a cardiologist who worked as a GP).

 

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19 hours ago, sandgrubber said:

...

Yes, the specialist has an echocardiograph. I hope he will have a clearer idea of what's wrong. I don't think the first vet even did a careful listen to her heart or looked for enlargement on the ultrasound. Maybe my expectations are too high.  (My father was a cardiologist who worked as a GP).

 

That family background is good .. so you'll probably "speak the language" and know the sorts of things to ask.   

Yep .. in house ultrasounds are usually limited ..at both my vets ('normal' and holistic) they will get the specialist vet ultrasonographer down if they need more detail than they can get in house .. problem is he's 200km away .. but worth the 3 hour wait usually.  Fingers still crossed for you and Patty.

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5 hours ago, Snook said:

How is Patty doing today? 

Very well.  Her belly has shrunk as well.  I begin to hope this was all a scare, though nothing I found on the internet gave me reason to hope the distended belly was anything other than a symptom of a terminal illness.  Holding my breath until the cardiologist visit on Wednesday 

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20 hours ago, Snook said:

How's Patty doing ahead of her appointment tomorrow? 

She's fine.  I wouldn't know she'd been sick.  Though of canceling the appointment but decided it was worth looking for advice on what happened and whether it might reoccur.  

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Went to the supermarket just before my appointment.  Dropped my keys somewhere.  It took 45 minutes before someone returned them to customer service.  Missed the appointment.  Bugger! (it's only 16C today... no problem leaving a dog in the car). 

Edited by sandgrubber
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I rebooked, but did some reading and saw another vet, who says her energy level and condition are not indicative of a heart problem.  The aspirated sample of abdominal fluid was inconclusive. Possibly a sarcoma.  Possibly an infection.  All in all a difficult diagnosis.  The bloods ruled out liver disease.

Patty responded so well to antibiotics that I decided to put her back on and watch and wait.  If a longer course of antibiotics takes care of it, good news.  If not, waiting awhile may result in a clearer reading on the aspirated fluid. If it's a sarcoma, there's not much hope of a cure...just prednisone and measures to reduce fluid buildup. When I has the kennel I watched a few clients go through expensive and difficult testing only to have their dog die soon after. Unless there's likely to be something curable, I think I'll settle for paleative care.  Who knows, the antibiotics may do the trick. 

Edited by sandgrubber
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Poor Patty.  The antibiotics didn't do the trick.  She looks like she's about to whelp a big litter, except no boobs, and she's spayed, so it's not pups. She's now having trouble eating. We just got back from seeing a third vet, who was inclined to different recommendations (basically he said he couldn't diagnose, but prescribed a diuretic to get the fluid down) than the first two, but agreed that it's messy.  He recommended seeing a top rate ultrasound-ographer.  Unfortunately a few hours drive.  My arthritis makes it hard to drive that far... so it comes down to trying to find someone who can help.  Sigh.  I sure hope the diuretic helps relieve the pressure on her gut. 

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44 minutes ago, Snook said:

Oh, the poor darling. I'm so sorry that she's relapsed. You must be so worried. :( Do you have someone who can drive you both for the ultrasound? 

I cried help on our village Facebook group and got two offers.  It's hard to ask for help from strangers, but it's something us oldies gotta learn. 

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Up and down.  She's not eating much... Boiled chicken in small amounts, not the rice I cooked with it.  She puked a big feed on chicken... so now she gets several little ones. The vet gave her diuretics, which have reduced the fluid in her belly, but it's clearly still there.  We talk to the vet tomorrow and maybe schedule the specialist visit.  The more I think about it and read, the more I conclude it's better to just go paleative and forget the specialist.  None of the possible diagnoses lead to cures... mostly it's supportive measures, some of them pretty gruesome, like draining the fluid buildup. 

On the positive side, Patty remains cheerful and despite her bad digestive system, acts pretty healthy. 

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5 hours ago, Snook said:

 

Do you have any idea what palliative care might look like at this stage? Is there anything other than diuretics that can be done to address the fluid, beyond having it drained manually? 

Prednisone + diuretics is what one vet said. I don't know if prednisone will help with the fluid accumulation. If it comes to being so bloated that breathing is difficult and she seems miserable, I favor the green dream.  Of course death makes for heavy sadness, but there are worse options. 

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Prednisone gives a boost, if nothing else, by increasing appetite.  A Labrador refusing food is a worry, and not eating for a few days must bring a dog down.  Patty is now gobbling down chicken necks (just learned that a local meat distributor sells them in 10 kg lots at a reasonable price) and her poos have firmed up.  At least I'm sleeping better. So hard to say whether she's improving or I'm deluding myself, and all indicators are that the prednisone improvement will be short lived.

To ward off false hope I've been digging a hole...hopefully not a grave... but useful for poo disposal if no miracle happens. 

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