Would anyone like a challenge and a Springer Spaniel

RE: Would anyone like a challenge and a Springer Spaniel

Martin Atkinson — Thu, 27 Oct 2016 10:58:34 GMT

[quote user="Hannah Wynne Richards"]

[/quote]Everyone else seems to have been tactful enough not to reply to this post and as the dog is now pushing up daisies its a bit irrelevant. But I suspect that Christina knows the client well enough to make this assumption. You need to climb off your high horse occasionally Wynne.

RE: Would anyone like a challenge and a Springer Spaniel

Christina Smith — Wed, 26 Oct 2016 23:28:31 GMT

Sorry I don't know. Her owners let us know when they got a booster reminder. She had some very profound neurological episodes so it may have been during a seizure so perhaps a combination

RE: Would anyone like a challenge and a Springer Spaniel

Andrew Kent — Wed, 26 Oct 2016 22:52:32 GMT

Hi Christina,

thanks for the update, what a sad outcome - did the dog just die acutely? Was the heart disease ever investigated?

if this was a sudden death would guess it related to heart disease rather than a shunt as sudden death would be very unusual with the latter.

Andy

RE: Would anyone like a challenge and a Springer Spaniel

Christina Smith — Wed, 26 Oct 2016 21:28:19 GMT

Update. Eventually this dog was referred. PSS confirmed. She was due to be spayed but died a couple of weeks prior to aged 8 months.

Re: Would anyone like a challenge and a Springer Spaniel

Stephen Courtney — Mon, 27 Oct 2014 22:18:55 GMT

Finding a tactful way to 'recommend' at least thinking about euthanasia is sometimes a kindness to both owner and animal - knowing how far to go is hard, and sometimes giving people all the options gets confusing and adds layers of unhelpful guilt to a decision process.

Still don't have answers for the OP but personally I'd be inclined to let this pup go.

Re: Would anyone like a challenge and a Springer Spaniel

Christopher Saul — Mon, 27 Oct 2014 14:19:57 GMT

[quote user="Andrew Kent"]

Many dogs can then live a pretty normal life with appropriate medical management. It would seem a shame to euthanase without even giving this a go. You might even be able to manage it just with diet.

Clearly this doesn't do anything towards investigation of a murmur, but again the dog could be asymptomatic of heart disease for years.

There probably is a middle ground...

[/quote]

Andy and I are not arguing against PTS if the seizures cannot be medically controlled; rather we were just offering advice on how the seizures could be controlled medically first

Re: Would anyone like a challenge and a Springer Spaniel

Bob Russell — Mon, 27 Oct 2014 14:00:07 GMT

If you feel the quality of life is unacceptable then the advice should be to PTS.

If it is happy and coping most of the time it depends on owners motivation. Six meals a day and expensive medication is an owners decision, not ours,if the dog is happy and pain free.

Life is not sacred but should not be taken without a bit of thought!

Well worth posting to get other vets views IMO!

Re: Would anyone like a challenge and a Springer Spaniel

Richard Carter — Mon, 27 Oct 2014 13:02:03 GMT

Sorry but I am in the PTS camp on humane grounds if this pup is going to need constant attention and expense for rest of its life and especially if the seizures are not controlled. We seem to be falling into the 'life is sacred' over 'life must be worth living' argument - both for the dog and its owners.

Re: Would anyone like a challenge and a Springer Spaniel

Christina Smith — Sun, 26 Oct 2014 18:32:59 GMT

Thank you very much Christopher and Andrew for the helpful and positive advice. Frequent feeding and hydrolysed diet make absolute sense and I will phone the owners tomorrow. I am not sure which day they are due in but I will let you know of their decision. Bile acid stim tests have been advised and they hopefully will opt to have those done before any final decision.

Re: Would anyone like a challenge and a Springer Spaniel

Christopher Saul — Sun, 26 Oct 2014 13:10:30 GMT

Hi Christiana

The ideal diet for PSS patients is the matter of some debate and is actually not that simple.

[quote user="Christina Smith"]s there a better more protein restricted diet ? [/quote]

I would worry that the best diet for this puppy might not be a more protein restricted diet but a LESS protein restricted diet. Ultra low protein diets are no longer recommended in humans with HE (though admittedly that is in patients with cirrhotic rather than congenital disease, so we should be careful not to draw too many conclusions).

A young growing puppy will have quite high protein requirements, and if we do not meet these by diet then the pup will get its protein from accelerated muscle breakdown which can only be detrimental.

The logic behind ultra low protein diets was that the rise in postprandial ammonia was thought due to bacterial fermentation of protein in the colon. It's now thought that the postprandial rise in portal ammonia is possibly more due to glutamine metabolism in the small intestinal enteroctytes (the only way of avoiding this would be to not feed the dog at all, which is of course out of the question).

That's not to say that the ammonia due to colonic fermentation plays no part at all in HE; it probably does - we just don't think it's the whole story. Therefore HIGH protein diets ( such as puppy life stage diets) should be avoided. Current thinking is that we should feed a moderate protein but most importantly HIGHLY DIGESTIBLE protein diet fed in small meals but frequently. in this way (in theory) most of the dietary protein will be absorbed in the SI and relatively minimal amounts will make it though to the colon for fermentation.

Soy based diets have a better branched chain to aromatic amino acid ratio than do meat based diets, and this MIGHT be helpful. I would add though that as far as I am aware there is no evidence to suggest that this actually makes a clinical difference in practice. But it might help so I like the idea. Also soy I think has less urates than meat so a soy based diet is less likely to support urate urolith development.

So - we need a moderate, highly digestible protein diet (perhaps based on soy). For my PSS patients I use Purina HA as it ticks these boxes, but to be honest any intestinal or hydrolysed diet might be fine.

On the other hand, we don't really know an awful lot about the biochemistry behind HE and have a lot to learn. It's been a little while since I went into this particular subject so maybe I'll be corrected by someone!

I hope this helps

Re: Would anyone like a challenge and a Springer Spaniel

Andrew Kent — Sun, 26 Oct 2014 12:42:46 GMT

The frequency of feeding is probably more important than the diet so I would feed 6 or so smaller meals a day if you're not already doing that. In a puppy this young you don't really want to protein restrict any more and might want to think about additional protein in the future. Soy based diets are also generally less ammonogenic as an alternative if needed (eg Purina HA). Are the owners being compliant avoiding other foods?

did you do some bile acids?

Andy

Re: Would anyone like a challenge and a Springer Spaniel

Christina Smith — Sun, 26 Oct 2014 10:04:57 GMT

She is now being maintained on antibiotic,[amoxicillin],lactulose and hills LD. She has had a second severe neurological episode on this regime. It sounds as if she has had lesser episodes relating to feeding. Is there a better more protein restricted diet ? She is very small and looks like a 12 week puppy and weighs 7.5 kg. I wondered about feeding a hydrolyzed protein diet . Any other ideas on diet ?

Re: Would anyone like a challenge and a Springer Spaniel

Andrew Kent — Sat, 25 Oct 2014 21:45:53 GMT

Is the dog well between episodes? Because if this is a PSS then the alternative option would be to start medical management of a shunt and see how the dog gets on within the constraints of its current owner. A post-prandial bile acids is pretty cheap and if in the hundreds is convincing for a shunt. Many dogs can then live a pretty normal life with appropriate medical management. It would seem a shame to euthanase without even giving this a go. You might even be able to manage it just with diet.

Clearly this doesn't do anything towards investigation of a murmur, but again the dog could be asymptomatic of heart disease for years.

There probably is a middle ground...

Andy

Re: Would anyone like a challenge and a Springer Spaniel

Christina Smith — Sat, 25 Oct 2014 18:56:10 GMT

Sorry for the confusion. Referral and tests have been discussed. Portosystemic Shunt is presumed on biochemistry results. The owners have declined referral on cost grounds. I meant that the posting on here had not been discussed. Rehoming is the only alternative to euthanasia that is why I put the posting up.

Re: Would anyone like a challenge and a Springer Spaniel

Virginia Campbell — Sat, 25 Oct 2014 16:52:44 GMT

[quote user="Sammy82"]How can the pup be up for PTS if it hasn't been discussed?[/quote]

I took it that it was rehoming that hadn't been discussed (for fear of getting the owners' hopes up) rather than PTS.

Re: Would anyone like a challenge and a Springer Spaniel

Sammy82 — Sat, 25 Oct 2014 16:43:04 GMT

How can the pup be up for PTS if it hasn't been discussed? And is it even nescessary yet when it only had 2 episodes? Obviously something is going on with it. If the owners decline referral they might still want to do some investigations? Hepatic shunt should certainly be on the list, but could these episodes also be temporary cerebral ischaemia/hypoxic events? In any case I would prepare the owner that the pup could just drop dead at any point, so they don't blame you for it. I would also advise them to take it easy and not encourage the pup to excercise anymore than it does by itself.

Re: Would anyone like a challenge and a Springer Spaniel

Emily Rainbow — Sat, 25 Oct 2014 15:02:02 GMT

Has any work up been done? Hepatic shunt?

Re: Would anyone like a challenge and a Springer Spaniel

Hannah Wynne Richards — Sat, 25 Oct 2014 14:20:48 GMT

How do you know referral costs are out of the question, if you haven't asked? You have absolutely no right to make this assumption!

Wynne