Difficult young Husky case

Re: Difficult young Husky case

james herriot lied — Sun, 03 Mar 2013 09:50:40 GMT

[quote user="Utlendigur"]

[quote user="james herriot lied"]Is there that one Husky thing that I'm not aware of?[/quote]

They are prone to eosinophilic bronchopneumonia

[/quote]

That's exactly the kind of thing I was worried about - the breed-specific oddity that I always feel I'm the only one to be unaware of.

It's possible that the severity of chest pathology has just massively increased vagal tone, but the bradycardia oughtn't to have been enough to precipitate signs of heart failure in an at-rest patient. Or would it? I also tend to look at lungworm the same way as mange - lack of positive diagnosis is no barrier to actually having the disease.

Eosinophilic bronchopneumonia - steroids, baytril and synulox, yes?

Re: Difficult young Husky case

Utlendigur — Sat, 02 Mar 2013 23:16:24 GMT

[quote user="james herriot lied"]Is there that one Husky thing that I'm not aware of?[/quote]

They are prone to eosinophilic bronchopneumonia (having just had one recently that was coughing - very productively! - haemorrhagic mucous, laboured breathing but negative lungworm on smears and no response to lungworm tx) but that wouldn't explain the other signs unless perhaps cor pulmonale, but seems to have come on very acutely for that.

Re: Difficult young Husky case

Kirsten Simpson — Fri, 01 Mar 2013 11:36:21 GMT

Haha! Sorry! Just left OOH and into normal practice and missing simple things like the Vetstat <3

Re: Difficult young Husky case

james herriot lied — Fri, 01 Mar 2013 11:28:48 GMT

[quote user="Kirsten Simpson"]

Have you done an arterial blood gas?

[/quote]

Oh, you...... . Don't I just wish.

Not sure that there's an eosinophilic complex going on - they were about 2.5 IIRC (currently hiding in the office). Steroids sounds right.

So far, better than it might all have been. Certainly a bit more comfortable today and the ascites is even reducing - I managed to get about a litre off in total overnight (by myself in the surgery), and there's more than that gone from the abdo now.

Cautious, but may be winning the battle, if not the war. Would just love to be able to positively diagnose angiostrongylus now, but guarding for sepsis, AI, allergy and rat bait in any case. Sooner or later we'll have to streamline treatment, but that will be on someone else's shift.

Greatly appreciate the input from all respondents; misery loves company, and it was nice to know I wasn't the only one awake at stupid o'clock.

Re: Difficult young Husky case

Kirsten Simpson — Fri, 01 Mar 2013 11:01:10 GMT

Have you done an arterial blood gas? Neurogenic pulmonary oedema or ARDS or a severe allergic reponse? The high eosinphils remind me of something similar in a Rottie that had Ascites +++ and loads of eospinohils, eosinophilic disease is a possibility? Can't remember the fancy name as it was areferral case we were looking after overnight, preds was his main treatment iirc... I agree that lungworm sounds most likely :\

It all sounds highly odd :s poor you!

Re: Difficult young Husky case

james herriot lied — Fri, 01 Mar 2013 06:01:28 GMT

Bradycardia wouldn't be out of place in a severe respiratory attack with lungworm; liver outline on rads was obscured by ascites, but with reduction overnight / diuresis, liver outline feels grossly normal.

Still here, and much reduced fluid pouring from front end. Resp rate 40, ventral lungs more clear and HR 70, no pulse deficits. No miracle cures just yet, but better parameters than six hours ago. Is tucking into a/d and drinking a little. Still no definitive diagnosis from lung fluid.

Re: Difficult young Husky case

Anthony Dennison — Fri, 01 Mar 2013 00:11:54 GMT

Did the liver look an abnormal size on abdo radiographs?

Re: Difficult young Husky case

David Mills — Fri, 01 Mar 2013 00:11:52 GMT

Hmmm thinking about it the bradycardia wouldn't fit with hf unless cardiogenic shock. It could be depressed due to severe respiratory issues I suppose with vagal overload. ECG? Don't suppose you have any dopamine / dobutamine? If the congestion isn't clearing amlodopine may be useful

Re: Difficult young Husky case

james herriot lied — Thu, 28 Feb 2013 23:55:05 GMT

Jugular pulses evident, and there are other signs of left and right side failure here, right more so. Pulse rate is steady-ish at about 50-60, which should be giving enough CO, and no pulse deficits. Frusemide is being pushed, with some effect. I briefly toyed with an (extremely) idiosyncratic leptospirosis, but keep coming back to lungworm as a primary differential.

Can't post the rads as can't get them into small enough files off the digital storage - usually have to email them to myself and cut down on my home lap top - but I'll not be going home tonight, I think. Not the best xrays in any case, as conscious, laterals only and with a very rapid respiratory rate - but no blindingly obvious diagnostic changes seen.

Ultrasound is a bit of a bust - could tell that there was no effusion, but that was about the only certainty. I'm continuing to manually drain the dog and sift through the fluid for any signs of larvae.

Right now, a little more settled. Colour better, but with a CRT of almost zero, it's a bit misleading in any case. I've got an air bed next to the kennel room, so will just wing it from here.

Many thanks to all.

Re: Difficult young Husky case

Luciano Nebiante PGCertSAS — Thu, 28 Feb 2013 23:16:58 GMT

[quote user="james herriot lied"]

sg was 1.016 on refractometer, and protein - dipstick only so far - 3+. We'll be running it through the vet test shortly. But it was very thin fluid, and on tapping approximately half a litre, was foamy but very watery.

[/quote]

From the specific gravity it seems a transudate. You can measure the total protein on the refractometer too. That would provide other informations.

Anyway causes of transudate from my book are: Hypoproteinemia (your values seems towards lower end), Neoplasia (in a very young dog?), Lymphatic obstruction, Pre-hepatic and Hepatic portal hypertension.

I agree on what David has suggested. Hopefully you will see some improvement.

Re: Difficult young Husky case

David Mills — Thu, 28 Feb 2013 22:56:37 GMT

What are his jugular pulses doing?

From what you describe biventricular CHF has to be high on the list. Any chance of posting xrays (I'm up all night too)?

Otherwise, RHS HF 2y to a severe resp issue tipping over into pulmonary hypertension - obviously lungworm would be a worry. Pulmonic stenosis is a possibility, could be something weird and wonderful such as cor traitratum dexter. A right to left shunting abnormality is possible.

Obviously the prirotity for now is breathing. To this end, I'd max out frusemide to 6-8mg/kg IV and observe response. This can be repeated every hour in extremis. You may even need to go higher with the dex on board.

Ah, for a decent echo machine...any chance at all of measuring LA:Ao? Can usually manage with a curvilinear if that's all you've got. Bit of butorphanol can calm the dog and improve breathing/reduce panic enough to get a quick echo so may be worthwhile so you can rule in/out LS CHF?

Re: Difficult young Husky case

james herriot lied — Thu, 28 Feb 2013 22:17:44 GMT

Addison's would certainly fit with the bradycardia, pupd, vague history of GI disease and bleeding - but potassium was normal, so no hyperkalaemic bradycardia mechanism; Na:K was 36 and there was a fairly high wbc.

Globulin is only 25, which makes me think more that it might be sinking into something rather than that there isn't an inflammatory response, particularly with a neutrophilia. Albumin 24 so low in normal range, but still normal.

Thanks for the input, Elisabeth. All suggestions gratefully received, particularly as this one will (hopefully) be an all-nighter (the alternative being that he doesn't get all the way through the night).

Re: Difficult young Husky case

Elisabeth Knappett — Thu, 28 Feb 2013 22:00:42 GMT

Addison's? But wouldn't explain everything, what were the protein levels in the blood?

Re: Difficult young Husky case

james herriot lied — Thu, 28 Feb 2013 21:49:23 GMT

Now progressing to haemorrhagic fluid in the airways - gentle and transient lifting to vertical, with head down, has produced quite a copious amount. Some relief from symptoms for a short period and he's able to doze a little now. Konakion added in as a precautionary measure, but no exposure to rat bait. Still no larvae found in secretions.

Lovely young dog, but not looking too good right now.

Re: Difficult young Husky case

james herriot lied — Thu, 28 Feb 2013 20:11:01 GMT

Hi Luciano

Re: Difficult young Husky case

Luciano Nebiante PGCertSAS — Thu, 28 Feb 2013 19:58:13 GMT

Hi James,

what is the specific gravity and total protein of the fluid from the abdomen? This will help to rule out exudate.

Re: Difficult young Husky case

james herriot lied — Thu, 28 Feb 2013 19:23:22 GMT

Sorry, should have mentioned - also on supplementary oxygen (natch), but with the attendant difficulties of being too big for any kind of tent and too alert for a continuous masking. May try nasal insufflation later, although his colour's improving at the mo. Also took some fluid off his abdomen, but he did become a little stressed and breathless. Currently coughing up some slightly pink phlegm, which is going under the microscope at regular intervals to look for larvae, so far without success.

Is there that one Husky thing that I'm not aware of?