Anybody seen a PSS in a 5 year old dog?

Re: Anybody seen a PSS in a 5 year old dog?

Moira Hamilton — Sat, 03 Nov 2012 23:55:18 GMT

No signs of hypovolaemia, albumin levels normal, picky eater, but owner feeds her chicken, so unsurprising that wouldn't eat in surgery! Is much brighter, but not back to her normal self.

Re: Anybody seen a PSS in a 5 year old dog?

Moira Hamilton — Sat, 03 Nov 2012 23:51:21 GMT

Sorry for not updating anybody on this, been a very busy week and surgery isn't computerized! Bile stim test showed no increase after fasting(for 18 hrs), tried to do ECG but sadly it hasn't been used for some time and wasn't working. At present she isn't doing too badly, would love to do a chest x-ray, but owner is a pensioner, and though is insured, we don't do direct claims, but am trying to speak to the refferral people, sadly by the time I had the chance to call the person I needed to call had gone home. In my defense was only 5:10pm. Plan is to refer asap and I think they do direct claims, so will prob do x-rays/ultrasounds, etc of heart at the same time so we can find out what the other condition that is going on. Disappointing that I can't get any further with her, as would love to solve the heart condition, though hasn't been wheezy since starting the benazepril and pimobendan, but still has the dysrhythmia. will update when know more, did do ProBNP test but haven't got the results yet, but not waiting on these before referring.

Re: Anybody seen a PSS in a 5 year old dog?

Sarah Keir — Fri, 02 Nov 2012 20:29:18 GMT

Moira, what happened to the dog?

Re: Anybody seen a PSS in a 5 year old dog?

Sarah Keir — Tue, 30 Oct 2012 16:19:11 GMT

I've diagnosed a PSS in a dog over 10 years old before but this case has too many questions about it to jump to that kind of diagnosis.

Problem list

- lethargy/depression - non specific

- cranial abdomenal pain - suggests abdomenal pathology such as liver/pancreas/stomach/spleen

- lymphadenopathy - confined to one lymph node

- urea mildly raised - likely pre-renal as presumably creatinine was normal plus urine SG very high (dehydration, hypovolaemia). ALso makes PSS less likely as liver is making adequate urea. What about albumin levels?

- ALT - mildly raised, very non specific at this level

- bile acids mildly raised - at <50 secondary reactive changes are more likely than primary liver problem, though doesn't rule out diffuse hepatic changes or normal liver with the gall bladder contraction before sampling.

- unspecified dysrhythmia

- wheezing.

I think as a minimum you need a chest xray (is the wheezing due to CHF or primary lung pathology), sampling of the lymph node, imaging of the abdomen to investigate the cranial abdomenal pain (plain xray to assess liver size and for renal/urinary stones that can be associated with PSS plus an ultrasound scan). I would also do a specCPL at this stage as several of the problems could be attributed to pancreatitis!

My tuppence worth!

Sarah

Re: Anybody seen a PSS in a 5 year old dog?

Martin Atkinson — Tue, 30 Oct 2012 09:00:03 GMT

[quote user="Andrew Kent"]I cannot see even 1 way that BNP will help you in this case. It has a role in some populations but in a sick dog doesn't really help you confirm or deny cardiac disease!

[/quote] Depends on how used you are to interpreting them.

Re: Anybody seen a PSS in a 5 year old dog?

David Mills — Tue, 30 Oct 2012 00:34:00 GMT

Disagree about the BAs not being high enough. I think these more chronic ones seem to have raised - but not in the 100s - levels; don't see how you can start to rule out a PSS with these levels

Re: Anybody seen a PSS in a 5 year old dog?

Andrew Kent — Mon, 29 Oct 2012 19:00:07 GMT

I cannot see even 1 way that BNP will help you in this case. It has a role in some populations but in a sick dog doesn't really help you confirm or deny cardiac disease!

Re: Anybody seen a PSS in a 5 year old dog?

Martin Atkinson — Mon, 29 Oct 2012 09:27:28 GMT

Older dogs can get acquired PSSs but the raised urea and not very high bile acids don't really support this. I disagree about proBNP is think it is one of the most useful and economical things you can do to assess the extent of cardiac disease, but you certainly need ECG and chest radiographs before ultrasound if it has CHF it is going to die of that quicker than a PSS. But arrythmias can be associated with abdominal pain and splenic masses so abdominal ultrasound will be helpful.

Re: Anybody seen a PSS in a 5 year old dog?

Rajat — Sun, 28 Oct 2012 23:13:53 GMT

I agree with Andrew- referral for further workup is indicated- preferably with a specialist in imaging as shunts can be quite tricky to image sonographically. Looks like he'll need at least an ECG if not an echo as well. I'm not sure fortekor and pimobendan are going to achieve anything here unless he is in CHF. Pro BNP is not going to help you determine the cause of the arrhythmia so I'd save the owners money and not run this personally.Urea although usually low with PSS can be high if there is concurrent GI bleeding (which can be present in shunts though I cannot remember the aetiopathology of this)

Just my 2c.

Re: Anybody seen a PSS in a 5 year old dog?

Andrew Kent — Sun, 28 Oct 2012 21:29:39 GMT

Did you radiograph her chest or perform an ECG? Shunts can occur in older animals but this doesn't sound classic and bile acids are not that high (was that fasted or post-prandial). BNP would be a waste of money in this dog as there is likely concurrent disease which makes interpretation impossible. The dog needs imaging, both thoracic and abdominal so it sounds like referral sooner rather than later would be a good idea.

Re: Anybody seen a PSS in a 5 year old dog?

CatherineThomas — Sun, 28 Oct 2012 20:10:00 GMT

I saw a 7year old dog with PSS. It had always had mild neurological signs which had been put down to possible cerebellar hypoplasia/brain damage as a puppy. Then he had a couple of episodes of lethargy and vomiting so we took bloods which showed raised bile acids. I referred him and he had surgery after the shunt was confirmed a few months ago. The owner says he is a differnt dog since the surgery.

Re: Anybody seen a PSS in a 5 year old dog?

Moira Hamilton — Sun, 28 Oct 2012 19:58:40 GMT

Thanks for that, and yes this is a Shih Tzu too!

Re: Anybody seen a PSS in a 5 year old dog?

Rachael Winder — Sun, 28 Oct 2012 19:32:39 GMT

I've just found my 3rd PSS in a 5y.o. dog, but none presented poorly. 2 were Shih Tzus and 1 was a WHWT, each was a bit on the lean side and a lifelong hx of picky appetite. All got diagnosed as they turned up with whacking great urate uroliths which resulted in bloods, BAST etc etc. SO not much help wrt your case I'm afraid! However all the referral people I spoke to said they are quite often diagnosed in older dogs.