Any ideas??

RE: Any ideas??

Andrew Kent — Tue, 22 Sep 2015 22:10:02 GMT

[quote user="Anthony Todd"]

[quote user="Andrew Kent"]classical portosystemic shunt[/quote]

Wouldn't the signs appear before 2yo?

[/quote]

Not always, some dogs are not diagnosed until late adulthood

RE: Any ideas??

Anthony Todd — Tue, 22 Sep 2015 21:36:57 GMT

[quote user="Andrew Kent"]classical portosystemic shunt[/quote]

Wouldn't the signs appear before 2yo?

RE: Any ideas??

David Mills — Tue, 22 Sep 2015 21:07:26 GMT

[quote user="Martin Atkinson"]Well they might as well be closed if they're not accepting new clients. Why have they gone into this mode what is the long term plan?[/quote]

Calm down dear. We're still providing routine care for the 80,000+ live patients still registered at both hospitals and various clinics. We're still on course to hit 15000 annual consults at each hospital.

As far as one-off treatments go, you can ask the 6 pyos, 2 fractures, 1 PRAA, 12 RTAs, 4 DKAs, 20 soft tissue surgeries and various GI, cardiac, lungworm, cat flu hospitalised animals that were registered for one-off treatments in the last 5 days whether we 'might as well be closed'. One-off treatment still covers surgeries and hospitalisations with a predictable endpoint, so you can untwist those knickers. Southall and Hillingdon clinics, closest to you, are still operating as normal.

The measure has been introduced whilst there is a review of London veterinary provision, for obvious reasons.

RE: Any ideas??

Andrew Kent — Tue, 22 Sep 2015 20:00:30 GMT

The presence of ascites makes it unlikely to be a classical portosystemic shunt as the presence of a shunt typically prevents the development of portal hypertension (and therefore ascites). So if the dog does have shunting then it is likely to be acquired (and therefore a sequel to severe liver disease) or a congenital shunt accompanied by another liver pathology.

In short it is unlikely that there is a quick (cheap) fix for this dog.

Andy

RE: Any ideas??

Hannah Wynne Richards — Tue, 22 Sep 2015 18:53:17 GMT

I have the most enormous admiration for individual RSPCA Inspectors. I know I couldn't possibly do their job - despite my absolute respect for the law, I'd be lucky to survive the 1st morning without landing up in the dock - and on a murder charge at that!

Despite that, I think that RSPCA headquarters staff have shown a lack of judgement in spending priorities - £17 million headquarters building, for example - which has alienated public opinion. Instead of selling that,and relocating somewhere smaller and in a cheaper area, they're reducing hospital services. I'm NOT impressed.

Individual branches - they range from excellent to useless - depending on local committeee members!

Wynne

RE: Any ideas??

Martin Atkinson — Tue, 22 Sep 2015 18:26:30 GMT

[quote user="David Mills"]Both RSPCA hospitals are open but not registering new clients for ongoing treatment at the moment (registering for one off treatments only).[/quote] Well they might as well be closed if they're not accepting new clients. Why have they gone into this mode what is the long term plan?

RE: Any ideas??

David Mills — Tue, 22 Sep 2015 17:36:00 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]When I did PDSA work, they would cover ga, sugery etc and client would be expacted to pay lab fees eg histo - seemed fair enough.[/quote]Our local RSPCA hospital (yes I know you said PDSA Robin), the Putney Hospital has closed as I think the Harmsworth has. Local branch never contributed to anything other than basic first opinion treatment any thing complicated went there. It has created a big black hole for the impecunious. I feel sorry for the genuinely hard up but not for the idiots who get animals when they know they can't afford them.

[/quote]

Both RSPCA hospitals are open but not registering new clients for ongoing treatment at the moment (registering for one off treatments only).

RE: Any ideas??

Martin Atkinson — Tue, 22 Sep 2015 17:22:34 GMT

RE: Any ideas??

Robin Grimmer — Tue, 22 Sep 2015 17:01:05 GMT

[quote user="Deborah Anwyl"]

I had that conversation this morning and have since contacted pdsa/rspca and the local 'not quite a charity but much cheaper than referral' practice. they all now say it isn't something they would deal with as they would want ad internal medicine specialist (which they don't have access to)

[/quote]

Seems a bit of a cop out on their part as obviously funds in this case aren't going to cater for an internal medicine specialist. Could they not do an ex lap? Would enable examination and biopsy of liver and other abdominal organs. I appreciate they probably aren't going to correct a shunt, but if looked bad eg cirrhotic liver they could PTS and if not biopsies should give answers. When I did PDSA work, they would cover ga, sugery etc and client would be expacted to pay lab fees eg histo - seemed fair enough.

RE: Any ideas??

Hannah Wynne Richards — Tue, 22 Sep 2015 16:27:25 GMT

Try to see if the owner will agree to a sob story in the local paper to raise money for a referral. Good luck

Wynne

RE: Any ideas??

Deborah Anwyl — Tue, 22 Sep 2015 16:16:31 GMT

RE: Any ideas??

Hannah Wynne Richards — Tue, 22 Sep 2015 16:10:56 GMT

I'd (tactfully) suggest that for the dog's sake she swallows her pride, and contacts one of the charities. Good luck - these cases are really heart-breaking for all concerned.

Wynne

RE: Any ideas??

Martin Atkinson — Tue, 22 Sep 2015 15:49:21 GMT

[quote user="Deborah Anwyl"]finances aren't going to stretch to same/hepatic diets. she had to borrow money to get the work up done that we have to this point. very frustrating.[/quote] If the owner can't/won't pay for further investigation or even basic treatment it doesn't sound as though you are going any further forward. You have already done as much as you can, its not your fault. Frustrating yes but you don't have a magic wand so don't be disappointed.

RE: Any ideas??

Deborah Anwyl — Tue, 22 Sep 2015 14:23:55 GMT

liver didn't look overly small but very rounded. I wouldn't say our scanner is the best and I have only previously scanned 2 with shunts so I could have missed something.

RE: Any ideas??

Robin Grimmer — Tue, 22 Sep 2015 14:19:50 GMT

I think a shunt as well. Was the liver size small? The question is, is this primary gi disease with secondary hepatopathy, or the other way round? I think the latter given the very high pre and post bile acids and hypoalbuminaemia. I would check a urine sample, just to rule out PLN. What was the urea? I'm guessing normal as you haven't listed it.

RE: Any ideas??

Deborah Anwyl — Tue, 22 Sep 2015 13:04:24 GMT

I had considered a shunt but to me (on our tiny scanner) I thought the vasculature looked pretty normal for the size of dog but the pyrexia threw me a bit too when I was thinking along those lines... reassuring that nobody has said I've missed something....

finances aren't going to stretch to same/hepatic diets. she had to borrow money to get the work up done that we have to this point. very frustrating.

RE: Any ideas??

Martin Atkinson — Tue, 22 Sep 2015 12:46:28 GMT

If you can't do a liver biopsy and/or investigate for a shunt then you realistically have little choice but to treat it empirically. I'd carry on with the antibiotics but add in some Destolit and SAMe with a hepatic diet.

RE: Any ideas??

Joyce Whitehead — Tue, 22 Sep 2015 12:16:11 GMT

Could it be a shunt? The last dog we has with an inoperable shunt developed ascites as part of his liver failure terminally.