Mysterious Bull Mastiff

Re: Mysterious Bull Mastiff

Busybee — Thu, 23 Aug 2012 18:39:23 GMT

Update - suspected mediastinal, possible multicentric, lymphoma.

Breathing worse today, more laboured. Lump in groin almost certainly lymph node. Owner now reports when dog does eat, appears to have difficulty swallowing.

Mass in cranial chest seen on x-ray, elevating trachea dorsally and impinging on the cranial border of the cardiac silhouette. Abdo nad. Hips actually very good for a dog of this age and breed though marked spondylosis seen at lumbo-sacral spine.

FNA taken of mass. To my (not very expert) eye, I appear to have at least got lymphocytes. Wouldn't like to say whether they appear neoplastic but it would certainly fit the picture. Awaiting lab report tomorrow.

Owners very keen to do all they can so if lymphoma confirmed, we will likely be starting chemo though I wouldn't like to guarantee this dog will be alive in a year

Re: Mysterious Bull Mastiff

Rajat — Thu, 23 Aug 2012 16:54:27 GMT

[quote user="Bob Russell"] I am sure we miss a lot of cases here but have found the blood tests less than reliable![/quote]

I too think it is difficult to diagnose! Joint issues, with poss renal involvement with malaise or fever and lymphadenomegaly would make me suspicious. The prob with serology is it only tells us of exposure not infection. Like Malcolm says a strong suspicion for the disease along with supporting clinical signs seropositivity and response to treatment are prob the way to go. If it has a history of OA in the hips then lameness could be down to this. however if it developed a shifting lameness along with infective arthritis Lyme's disease is a possibility. I'm not in a heavy tick area so good to know that you aren't seeing many in your area either Malcolm.

There was an ACVIM consensus statement published on it which I found earlier and am posting the link for those who are interested https://docs.google.com/open?id=0Bx91qiJtLeKwV2gwTGJHczhqT1k

Best

Raj

Re: Mysterious Bull Mastiff

Utlendigur — Thu, 23 Aug 2012 15:29:06 GMT

[quote user="Rajat"]And call me nuts, but FWIW I wouldn't give an ill PUPD dog NSAIDs ..[/quote]

I wouldn't give an obviously sick/debilitated, definitely pupd dog nsaids but I maybe read the initial post with a different emphasis ie it sounded as if vague, non-specific signs (reduced appetite, lethargy, weight loss over which there seemed to be a query as to whether it was accurate and its timescale), nothing really obvious on CE, biochem/urine doesn't preclude nsaids, no mention of GI problems and query as to whether OA pain was a factor. I was also querying whether the dog was pupd given a SG of 1.032 having seen a case recently where the owner's initial estimate of intake would have had the dog drinking>200ml/kg/day but when they actually measured it over several days it was only 55ml/kg/day. I suppose that's the problem of reading a history summary without seeing the dog in front of you, you form different pictures of the case influenced by what you've seen recently - and if you've seen a pupd dog that wasn't and a couple of miserable arthritic dogs.....

Re: Mysterious Bull Mastiff

Rob Loxley — Thu, 23 Aug 2012 15:04:44 GMT

I'd guess the dog has orthopaedic problems (?hip OA) but unlikely the cause of such marked rapid weight loss and poor appetite/demeanour. I'd be thinking about survey imaging and some further urinalysis (given PUPD) next

Re: Mysterious Bull Mastiff

Malcolm Ness — Thu, 23 Aug 2012 11:40:04 GMT

[quote user="Bob Russell"] Lymes - how does anyone reliably diagnose it? I am sure we miss a lot of cases here but have found the blood tests less than reliable![/quote]

Excellent question! I am not so sure that you are missing many cases.

Although sero surveys have shown that exposure to the causal organism is not uncommon in UK, we do not recognise Lyme disease as s significant clinical problem in our practice - we have a substantial orthopaedic primary care and referral caseload and we are in the centre of a heavily ticked area. For me to be confident of the diagnosis I would want to see other differentials excluded; consistent clinical signs; joint fluid analysis; strongly supporting serology and a convincing response to treatment.

Discussing this disease with a colleague who works in ortho referral practice in Boston (Mass., not Lincs!) where Lyme disease is more common than elsewhere, he believes strongly that it is massively over-diagnosed with some clinicians happy to start treatment on the basis of lameness and a single positive serology. As my friend points out, in some parts of their area more than 25% dogs are seropositive and a lot of those dogs will have HD or cruciate failure.

Re: Mysterious Bull Mastiff

Bob Russell — Thu, 23 Aug 2012 10:49:19 GMT

Cushings dogs usually eat so unlikely to be 'uncomplicated' Cushings.

Interesting case - these are the real Sherlock Holmes cases!

Slight aside but linked to Rajat's comment about Lymes - how does anyone reliably diagnose it? I am sure we miss a lot of cases here but have found the blood tests less than reliable!

Re: Mysterious Bull Mastiff

Busybee — Thu, 23 Aug 2012 08:06:15 GMT

[quote user="Utlendigur"]Sounds annoyingly vague at the moment - any vomiting or diarrhoea? Signs of nausea?[/quote]

Tell me about it! No vomiting or diarrhoea, no signs of nausea.

[quote user="Utlendigur"]Could do a T4 with cTSH to give a bit more info on thyroid/non-thyroidal illness[/quote]

This was one line I was thinking of going down

[quote user="katie mountford"]lymphoma?! the lump in the groin could be inguinal lymph node-I'd be sticking a needle in that when you see her![/quote]

That'll be what I'll be doing today for definite! Already had 2 this week, bad things come in threes!

[quote user="Rajat"]sounds like the dog is going to need more working up (imaging, further bloods etc)[/quote]

I know, but just wished I could be a bit more focused on my work up. Plus dog is old (for breed) and not insured etc. Haven't got all bloods with me at present but can post later today. Will look into Lymes - never seen a case.

Thanks for all your help! Will keep you posted

Re: Mysterious Bull Mastiff

Rajat — Thu, 23 Aug 2012 00:01:29 GMT

I'll provide the zebras then - Lymes? It probably isn't based on what you describe..having the full blood work rather than just abnormals may give more food for thought but sounds like the dog is going to need more working up (imaging, further bloods etc)

And call me nuts, but FWIW I wouldn't give an ill PUPD dog NSAIDs ..

Re: Mysterious Bull Mastiff

katie mountford — Wed, 22 Aug 2012 23:27:33 GMT

lymphoma?! the lump in the groin could be inguinal lymph node-I'd be sticking a needle in that when you see her! I'd be surprised if pain from OA caused her to be polydipsic

Re: Mysterious Bull Mastiff

Utlendigur — Wed, 22 Aug 2012 23:26:48 GMT

Sounds annoyingly vague at the moment - any vomiting or diarrhoea? Signs of nausea?

Drinking twice normal but might be worth actual 24hr intake (would give a baseline if nothing else and owners can be fairly bad at guessing). Urine SG doesn't suggest lack of concentrating ability.

Could do a T4 with cTSH to give a bit more info on thyroid/non-thyroidal illness

Trial few days nsaids?

Urine culture in case UTI?

Sorry not many ideas