Strange rottie case

Re: Strange rottie case

Utlendigur — Mon, 03 Feb 2014 20:50:39 GMT

[quote user="mariette asselbergs"]

If money is an issue, then my approach would be to limit investigations to diagnoses which would have a treatment that the owner can afford. ...

So I would probably go for symptomatic treatment, making sure the dog is not in pain and comfortable and see how it goes, prepariong the owner for a sad outcome.

Mariette

[/quote]

Pretty much what I've done. I was hoping the initial results were excess consumption/bone marrow not yet responded, hence the wait and see/antibiotics approach - but the second bloods scuppered that idea. Wouldn't fancy ex lapping a dog with such low platelets anyway - plus I really don't think the abdo "mass" I thought I felt initially was a tumour as it didn't seem to be there on xray or palpation under sedation (not an easy dog to palpate conscious!)

He's booked in for pts on Weds having got worse over the weekend. I did toy with the idea of steroids (sorry, corticosteroids, in case Evelyn's around) but he looked as if verging on sepsis initially, then the owners seemed keen to go down the bone marrow biopsy route, and now he's got melaena - plus it probably wouldn't stave off the inevitable for long.

Re: Strange rottie case

Christopher Saul — Mon, 03 Feb 2014 20:34:40 GMT

Perfectly reasonable approach by Mariette. IF they really can't afford treatment then why go for diagnostics.

Maybe a halfway house option would be just to do the abdo ultrasound and FNA anything abnormal so you can try and prove a lymphoma

if you could prove it then, though IT'S NOT IDEAL, and it absolutely kills me to say this as a medic but........

Pred before dead / never let anything die before steroids <----- insert your own variation here

Re: Strange rottie case

mariette asselbergs — Mon, 03 Feb 2014 18:15:38 GMT

If money is an issue, then my approach would be to limit investigations to diagnoses which would have a treatment that the owner can afford. In this case, not much is there? Can the O afford an exlap?. Or is any following surgery then excluded for financial reasons anyway?

So I would probably go for symptomatic treatment, making sure the dog is not in pain and comfortable and see how it goes, prepariong the owner for a sad outcome.

Mariette

Re: Strange rottie case

Christopher Saul — Mon, 03 Feb 2014 12:14:05 GMT

You may well be right with the haemangiosarcoma theory but this dog is definitely myelosupressed, so whatever primary disease it has, there is bone marrow involvement. Simple chronic haemorrhage from an splenic HSA would not fully explain the haemogram IMO...

Re: Strange rottie case

Julian Earl — Mon, 03 Feb 2014 10:51:31 GMT

Top of my list would be a splenic haemangiosarcoma and ulrasound would have to be top of the list for investigation. Depending on size and shape it may or may not be clear on x ray; if it has just bled then it may be smaller for now following the "leak". Your blood results are consistent with a splenic HSA and they are common in larger dogs so with the great wisdom of not not seeing the dog but speculating, I would consider it an HSA until proved otherwise.

Also, they are almost invariably worthwhile removing as you can buy the dog time even if visible secondaries are present. The exception would be the presence of cardiac secondaries, ten or twenty per cent IIRC but otherwise, splenectomy is a risk but beneficial if they survie the initial op.

HTH.

Re: Strange rottie case

Utlendigur — Sun, 02 Feb 2014 23:45:32 GMT

Thank you for the comprehensive and helpful reply!

The abdominal "mass" I thought I felt initially didn't seem to be one when I palpated again with him sedated - would have made things easier if he did have a large tumour. The liver and spleen both looked normal size/shape on xray - just slightly odd position ? due to quite lax abdo muscles - and there wasn't any other obvious lump visible.

We got a urine sample initially but it looked normal visually so we left it at, that since there wasn't anything pointing to renal disease etc at the time and we were trying to shave every last £ off costs.

Thanks again!

Re: Strange rottie case

Christopher Saul — Sun, 02 Feb 2014 23:21:43 GMT

I think your suggestions for work up are absolutely on the mark; you've hit the nail on the head: this dog needs ultrasound, bone marrow and ECG.

The haemogram reveals a pancytopenia: you have a non-regenerative anaemia (and it is a non-regenerative rather than pre-regenerative given the time lag between the first and second samples) , a neutropenia and throbocytopenia. The pathologist also mentions:

Small number of large cells with excessive cytoplasm with apparent multiple vacoulation.

These are the 3 cell limes (RBCs, neuts and PLT) that we classically look at when evaluating bone marrow function; this dog is myelosupressed and definitely has bone marrow disease.

Given the myelosupression, in combination with the abdominal mass, and the age of the dog..... top of my list would be a diffuse infiltrative neoplasm such as lymphoma.

The way to go with this dog would be an abdominal ultrasound to look at the abdo mass (and FNA the mass if poss) and a bone marrow aspirate.

If cost is an issue maybe you could get the diagnosis by simply FNA ing the mass?? If you diagnosed, say, lymphoma then you wouldn't need to bone marrow.

The high urea noted on the first sample might be explained away by simple dehydration but GI haemorrhage and renal disease are on the list. Have you done a urine SpG?

Sorry I can't be more cheerful

Chris

Re: Strange rottie case

Utlendigur — Sun, 02 Feb 2014 22:55:10 GMT

That was one of my thoughts, but the D+ was only once. Owners says it has but can't remember when - we only have notes going back about 6mnths as the dog was somewhere else/different owner before.

Re: Strange rottie case

Robert Wilson — Sun, 02 Feb 2014 22:43:19 GMT

HAd it ever been vaccinated? Sub-clinical/clinical parvo?