Dyspnoeic Boxer

Re: Dyspnoeic Boxer

Martin Jones — Tue, 15 Sep 2009 18:24:36 GMT

Sorry to hear that, R. Antonio. Not surprised that the owners didn't want to do histopath - I think you already had a handle on things. There's always a chance that things will sort out, but you were up against it in this one, I think

Martin

Re: Dyspnoeic Boxer

R. Antonio La Greca — Tue, 15 Sep 2009 11:15:13 GMT

Just an up to date

I had to put him asleep for the deterioration of the condition.

Unfortunately the owner didn't agree to take a lung sample for hystophatology

All the best

R. Antonio

Re: Dyspnoeic Boxer

R. Antonio La Greca — Fri, 11 Sep 2009 15:28:06 GMT

Yes Martin,

maybe more than I do!

R. Antonio

Re: Dyspnoeic Boxer

Martin Jones — Fri, 11 Sep 2009 13:50:06 GMT

[quote user="Utlendigur"]

[quote user="Martin Jones"]hunting the primary down would be a moot point and would likely add to the bill without any helpful progress[/quote]

By "looking for a primary tumour" I was really just thinking of the basics - palpating abdomen, checking anal sacs and lymph nodes, possible haematology, rather than a host of tests - mainly to give the owners something to base a prognosis on. Typing in a hurry as usual

[/quote]

Absolutely - and no criticism in any way intended; just that as a profession, we can sometimes be blamed for going off down long avenues of investigation that might be seen as less than common sense. We should all be doing all the poking and prodding we can to look for answers

To R. Antonio

Re the use of preds, I think it largely depends on one's age and place in the pecking order. As someone who is technically a generation older than the new grads, I would be inclined towards steroids in this case, if only as a palliative measure; also, initally to reduce inflammation ASAP. With antibiotic and some fluid support (judicious, against the ongoing diuresis), there's no real reason not to. I do understand concerns about immunosuppression, toxaemia, shock etc - but when patients are this ill, it's about what will get one out of a hole now that counts.

You're obviously hanging in there, so let us know how things are panning out. Are the owners accepting that it's probably neoplastic?

Martin

Re: Dyspnoeic Boxer

R. Antonio La Greca — Fri, 11 Sep 2009 09:25:48 GMT

Of course the first step is a good physical examination and take a good remote and recent history. Unfortunately the owner dosen't know what type of prostate surgery his dog did.

Anal sacs, lymph nodes and palpation of abdomen was normal. I have to re-check the calcium that I'm trying to deal with furosemide I.V. 2 mg/kg every 8 h. I don't know if it is a good option the use of prednisolone.

R. Antonio

Re: Dyspnoeic Boxer

Utlendigur — Thu, 10 Sep 2009 21:33:07 GMT

[quote user="Martin Jones"]hunting the primary down would be a moot point and would likely add to the bill without any helpful progress[/quote]

Re: Dyspnoeic Boxer

Clive Ansell — Thu, 10 Sep 2009 19:42:24 GMT

Given the breed, age and the hypercalcaemia top of my list of differentials would have to be neoplasia, and the radiograpic appearence is typical of pulmonary metastasis. I think my next step would be looking for a primary tumour. what surgery was carried out on his prostate?

Re: Dyspnoeic Boxer

R. Antonio La Greca — Thu, 10 Sep 2009 17:16:37 GMT

Sorry Louisa

For SAS I meant sub aortic stenosis. Thank you for your advices

Martin, I agree with you very much!!

Re: Dyspnoeic Boxer

Martin Jones — Thu, 10 Sep 2009 15:54:42 GMT

[quote user="Louisa White"]

Angiostrongylus has been assoc with hypercalcaemia too

[/quote]

Would echo this. In real terms, this COULD be parasitic, granulomatous or neoplastic, but I'd be most worried about the latter; would also be looking at lameness re early osteosarcs, but looking at these rads, then hunting the primary down would be a moot point and would likely add to the bill without any helpful progress. Can you do the PTH vs non-PTH calcium thing?

My first impression would be that it's a guarded to grave prognosis. Would guess also that the plea for advice suggests you're isolated from referral help. In that case, if you're going to treat then obviously onto standard lung support, prob look for some diuresis for the calcium (which would clear any pulmonary oedema), go in with an appropriate anti-parasitic - and yes, I'd probably hit it with steroids also.

But I think I'd be keeping one eye on the horizon and helping to manage the owners to the likely neoplastic nature. We all have our cut-off points, and for me I think this patient is already there - but I do wish you the best of luck.

Martin

Re: Dyspnoeic Boxer

Louisa Huntington — Thu, 10 Sep 2009 14:44:57 GMT

Angiostrongylus has been assoc with hypercalcaemia too

Re: Dyspnoeic Boxer

Louisa Huntington — Thu, 10 Sep 2009 14:43:07 GMT

Sorry to be silly but what does SAS stand for?

The reason why I asked about the defecation is that one possibility is that the dog has anal sac adenocarcinoma. It can be a discrete or infiltrative peri anal mass that can be felt on rectal palpation. Apparently you can often get enlarged sub lumbar lymph nodes too which will have secondary effects on defecation. (I am saying apparently as I have not ever seen it.) Anal sac adenocarniomas can produce a parathyroid hormone related protein resulting in hypercalcaemia. (Other tumours can too tho!)

However other tumours can also cause hypercalcaemia, inc lymphosarcoma - this is just an idea to rule out.

What is the state of the lymph nodes? Any partiuclarly enlarged?

There are lots of other causes, renal failure, someendocrinopathies - some would be suspected / detected by the bloods but you say that they are normal.

it may be worth while getting urine sample and doing a spec gravity, look for crystals etc - always useful!

Palpate the cervical region as well as the perianal region too - in case there is enlargement of the parathyroid gland.

You may need to submit serum for PTH, PTHrp, ionized calcium, and 25 hydroxy vit d concentrations.

Am thinking and typing so i apologise for the brain storming effect!

Hope that helps a little - I will keep thinking

Re: Dyspnoeic Boxer

Utlendigur — Thu, 10 Sep 2009 14:42:03 GMT

Not an expert but lungs like that and hypercalcaemia (especially in an older boxer), I'd be thinking neoplasia with pulmonary metastases and looking for a primary tumour - anal glands, lymph nodes, myeloma etc and v poor prognosis. May be worth repeating calcium in few days to show persistence. If not neoplastic, could the lesions be pulmonary haemorrhage (is hametology/clotting ok), infection (pneumonia), inflammatory (lungworm) - but still doesn't explain hypercalcaemia

Re: Dyspnoeic Boxer

R. Antonio La Greca — Thu, 10 Sep 2009 13:30:51 GMT

Hi Louisa

The dog was castrated 1 years ago and did also a surgery for a "prostatitis".

Yes: he has some clinical signs such anorexia, vomiting and abnormal defecation.

He is on atenolol because his vet diagnosed an SAS.

I own a IDEXX Vet-test. The max for the calcium is 12 mg/dl

His history is unknown before 1 years ago because the owner found him in the middle of a street. (Very very sorry for my English!!).

Where do I start?

I'm very worried about the lungs situation.

R. Antonio

Re: Dyspnoeic Boxer

Louisa Huntington — Thu, 10 Sep 2009 13:03:14 GMT

Just to help the thinking...

Is this dog entire? Is he showing any clinical signs of hypercalcaemia i.e PU/PD, anorexia, weight loss, vomitting, constipation, muscle weakness, bradycardia etc?

Is this dog showing any signs of abnormal defecation ?

Why is it on atenolol?

Also what is the normal range for your lab/machine for calcium?

Thank you