What am I missing?

Re: What am I missing?

Glenn Hodgson — Sun, 09 Nov 2014 18:15:07 GMT

Give 2 months synulox and cross your fingers. ? I also think care disk infection or ta hidden abcess. any previous surgery? Infected cat gut pedicle.... ?

Re: What am I missing?

Busybee — Sun, 09 Nov 2014 15:32:54 GMT

Consider complex partial seizures (psychomotor seizures). Though I appreciate it may not tick every box, I had one very similar that was referred and this is what came back as a diagnosis.

Re: What am I missing?

james herriot lied — Sun, 09 Nov 2014 14:56:06 GMT

[quote user="Anthony Dennison"]

Any neck pain or pain on spinal palpation?

[/quote]

No discernible pain response anywhere, although as CRP, Acth-stim and proBNP were all negative, we're doing a trial on response to pain relief anyway. Having pored over the xrays again, there's an eye-of-faith tiny, tiny narrowing of one disc space (costs preclude more advanced imaging): probably straw-grasping, but when isn't pain relief a sensible option? Don't answer that.

One of those where I'm sure a referral guy would spot the issue on walking through the door, but I'm stumped.

Re: What am I missing?

Miriam Lodewyks — Sat, 08 Nov 2014 23:26:54 GMT

Yes, my thought too: neck or spinal pain? Saw a similar case a few days ago, resolved after a few days on NSAID + Tramadol.

Re: What am I missing?

Anthony Dennison — Thu, 06 Nov 2014 09:32:15 GMT

Any neck pain or pain on spinal palpation?

Re: What am I missing?

Nicola Lawlor — Wed, 05 Nov 2014 21:53:21 GMT

Had one like this a few years ago that eventually developed a lumbar pain with these episodes, was referred and had a migrating grass seed up around the lumbar vertebrae.

Had another similar case last year that we suspect had lyme disease.

Consider endocarditis, autoimmune issues too?

Re: What am I missing?

james herriot lied — Wed, 05 Nov 2014 18:22:03 GMT

[quote user="ksg"]

Could you please clarify what were the initial presenting symptoms/ owner's concerns on the 1st & 2nd consultation? Tense abdomen?

[/quote]

Certainly - was just mindful that these posts go on a bit. Symptoms are a bit vague, which is much of the problem. Presentation is that dog appears excitable - no changes in mentation, but some terrier tremor and panting a bit. Temperature around 39.5. No V/D, eating and drinking normally. Two occasions of slimy stools in the last month. No Neuro deficits. Heart rate between 120 and 140. Tense on initial palpation of abdomen, but softens with continued exam and no focal pain apparent.

Basically, she looks like any number of nervous little terriers. I'd venture white coat syndrome, but she's doing it at home, apparently in response to stressors, and this is out of character. Long experience teaches us that underestimating or dismissing these cases leads to disaster and until we've been through a few investigations, I don't know whether it's likely to be progressive.

Many thanks

Re: What am I missing?

ksg — Wed, 05 Nov 2014 16:37:00 GMT

Could you please clarify what were the initial presenting symptoms/ owner's concerns on the 1st & 2nd consultation? Tense abdomen?

Re: What am I missing?

Rob Loxley — Wed, 05 Nov 2014 16:34:03 GMT

[quote user="Martin Atkinson"]I don't trust SNAP cPL entirely and if this is a chronic pancreatitis or taken too long after an acute episode it may show up normal. I would check this with a lab test if in doubt. [/quote]

An aside but I've found the Snap test performs well at what it says it does and correlates well with lab test. For me the issue is that neither the snap nor lab test will pick up all cases.

Re: What am I missing?

james herriot lied — Wed, 05 Nov 2014 14:59:08 GMT

No relation to feeding, and no other symptoms (funnily enough, we also had a bile acid stim in yesterday and we were pondering on whether one could incorporate a bile acid into the ACTH stim).

Pancreas was ok on scan and I'm inclined away from it - which is a big wrench for me, as it's my default diagnosis.

Thanks for the suggestions.

Re: What am I missing?

Martin Atkinson — Wed, 05 Nov 2014 14:30:13 GMT

Acquired PSS?, how do the symptoms relate to feeding? Maybe therefore BA stim test pity we can't do (reliable) ammonia in house.

I don't trust SNAP cPL entirely and if this is a chronic pancreatitis or taken too long after an acute episode it may show up normal. I would check this with a lab test if in doubt.