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sandgrubber

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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Tassie   

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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Snook   

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? 

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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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Snook   

Wednesday isn't too far away and hopefully the antibiotics will keep Patty doing well until the specialist can assess her. It sounds like you'll be in good hands and should have a much better idea of what's going on once you've had the appointment. 

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Tassie   
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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Snook   

It's wonderful that she's doing so well and her belly is going down. I have no idea what the cause could be but we'll keep fingers and paws crossed that it is all just a scare and that Patty will bounce back from it. :heart:

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Snook   

How's Patty doing ahead of her appointment tomorrow? 

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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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Snook   
3 hours ago, sandgrubber said:

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.  

Oh wow.. It's awesome that she seems to be back to normal. I hope the specialist can shed some light on what happened and help prevent it from happening again. I'm really interested to know what they think. 

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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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Snook   

Thank goodness the appointment wasn't critical any more and it wasn't a hot day! Do you think you'll rebook the appt? 

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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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Snook   

I'm so glad Patty has responded as well as she has to the antibiotics. I completely understand your decision. I feel much the same way about Justice. I'm not willing to put him through extensive testing or treatment for anything that's either not curable or is going to significantly reduce the quality of however much life he's got left. We'll keep fingers and paws crossed that the antibiotics are the cure for your dear girl. :heart:

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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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OH, not good :( 
Sorry it's come back with a vengeance- it must be so uncomfortable for Patty, and such a worry for you :(
 

Sending thoughts. 

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Snook   

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? 

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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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