A miserable Westie!

Re: A miserable Westie!

Bob Russell — Tue, 17 Aug 2010 15:26:15 GMT

Not had a report from the internal medicine specialists (had to talk to the owners for an update - not wonderful) but suspicion is apparently pancreatitis. All our bloods incl in house snap test were negative so still scratching my head. I assume a report will be forthcoming when he is discharged.

Strange how an owner gets twice daily updates but the referring vet gets none - can be rather embarrassing when owner comes in and we know nothing about what is happening.

Re: A miserable Westie!

Michael Woodhouse — Thu, 12 Aug 2010 22:29:52 GMT

[quote user="david hopper"]

sounds like one of these steroid responsive conditions? a small amount of soluble dexamethasone added to the antibiotic once can work wonders sometimes!

[/quote]

I thought that too!

Re: A miserable Westie!

sophia guymer — Thu, 12 Aug 2010 19:33:51 GMT

[quote user="Stephen Thompson"]Am I the only one who would be worried about a heart rate of only 50bpm[/quote]

Not at all!! Me too, have been following this waiting for someone to mention it and Addisons in correlation to it.

Was thinking I was being dim as it was first thing coming to mind, couldnt really of top of head think of anything else

Re: A miserable Westie!

Bob Russell — Thu, 12 Aug 2010 18:01:48 GMT

[quote user="Rob Reid"]

Is the heart rate regular? If not worth ECG to check for sick-sinus? Also might be worth checking thyroid...

[/quote]

Yes - regular. He is very chilled normally so heart rate does not ring immediate warning bells. I have just checked our first ever pacemaker dog so we are a bit trigger happy with ECG's at the moment!

I will look a bit of a pr*tt if it turns out to be thyroid - not checked it.

Re: A miserable Westie!

Bob Russell — Thu, 12 Aug 2010 17:59:16 GMT

[quote user="david hopper"]

sounds like one of these steroid responsive conditions? a small amount of soluble dexamethasone added to the antibiotic once can work wonders sometimes!

[/quote]

Fortunately well insured and very good owners so hopefully we will get some answers soon. Still have a feeling it will be steroid responsive though!!!

Re: A miserable Westie!

Bob Russell — Thu, 12 Aug 2010 17:56:36 GMT

He is being seen by one of the internal medicine specialists tomorrow! I think a fresh set of eyes are called for!

Re: A miserable Westie!

Rob Reid — Thu, 12 Aug 2010 17:22:54 GMT

Is the heart rate regular? If not worth ECG to check for sick-sinus? Also might be worth checking thyroid...

Re: A miserable Westie!

Stephen Thompson — Thu, 12 Aug 2010 17:14:57 GMT

Am I the only one who would be worried about a heart rate of only 50bpm?

Re: A miserable Westie!

Bob Russell — Thu, 12 Aug 2010 13:29:17 GMT

[quote user="Andrew Kent"]

It would also be worth an ACTH stim or at least basal cortisol (prior to steroids!!) to rule out Hypoadrenocorticism.

Andy

[/quote]

All our Addisons dogs seem to be Westies. Good idea!

Re: A miserable Westie!

Andrew Kent — Thu, 12 Aug 2010 12:28:56 GMT

It would also be worth an ACTH stim or at least basal cortisol (prior to steroids!!) to rule out Hypoadrenocorticism.

Andy

Re: A miserable Westie!

Andrew Kent — Thu, 12 Aug 2010 12:26:18 GMT

[quote user="Bob Russell"]I have quite a lot of confidence in our machine (VetScan) although I seem to be the only one!!![/quote]

It's not about machine confidence, it is likely your machine is reading total serum calcium correctly but this is different to an increase in biologically active ionized calcium (ie a genuine hypercalcemia).

The difficulty with measuring ionized calcium is that it needs to be done in house using electrolyte balanced heparin in order to get the most reliable answer. There is always a margin of error when sent away.

Andy

Re: A miserable Westie!

David Hopper — Thu, 12 Aug 2010 12:05:53 GMT

sounds like one of these steroid responsive conditions? a small amount of soluble dexamethasone added to the antibiotic once can work wonders sometimes!

Re: A miserable Westie!

Bob Russell — Thu, 12 Aug 2010 09:32:33 GMT

Ionised Calcium 1.24 so perhaps time for a rethink. Ln's possibly slightly smaller - only on nisamox - no brighter. Is there a smiley for scratching head and confused?

Re: A miserable Westie!

Martin Atkinson — Wed, 11 Aug 2010 09:54:38 GMT

[quote user="Bob Russell"]

I have quite a lot of confidence in our machine (VetScan) although I seem to be the only one!!!

[/quote]

Make that +1.

Re: A miserable Westie!

Bob Russell — Tue, 10 Aug 2010 18:03:29 GMT

[quote user="Mike Nikolaou"]

I agree with the previous poster, every pet bar one that showed up as hypercalcaemic with our in-house machine , when I checked ionised calcium, it came back normal...

[/quote]

Last one we did came back normal from lab but did have lymphoma. Almost every one we have had come up as positive that was positive when a second sample was taken a week later has come to a sticky end - either lymphoma or anal gland (not anal sac!!!) carcinoma. I have quite a lot of confidence in our machine (VetScan) although I seem to be the only one!!!

Re: A miserable Westie!

Mike Nikolaou — Tue, 10 Aug 2010 17:53:53 GMT

I agree with the previous poster, every pet bar one that showed up as hypercalcaemic with our in-house machine , when I checked ionised calcium, it came back normal...

Re: A miserable Westie!

chrisdj — Tue, 10 Aug 2010 16:42:08 GMT

Why not check ionised calcium first??? We have found that not all hypercalcaemias are explained by increased physiological calcium.... or maybe we do not trust our machines that much!

Re: A miserable Westie!

Andrew Kent — Tue, 10 Aug 2010 16:19:37 GMT

[quote user="Martin Atkinson"]Supposedly something like 80% sensitivity and specifivity but I've had lymphomas diagnosed by lymph node biopsy that came back -ve on Petscreen, however its something to do to show the client you're trying.[/quote]

The only people that seem that convinced by the screen are petscreen themselves. I think it is less to do with sampling and more to do with pot luck. I'm certainly yet to find an oncologist that puts any weight in the test.

Andy

Re: A miserable Westie!

bob lehner — Tue, 10 Aug 2010 15:40:02 GMT

Strange co-incidence...... I have seen a 10 yo nm boxer his morning - v miserable, anorexic, febrile, stiff in h legs, heart murmur, poss difficulty in urinating. Bloods all OK except Ca++ hi at 3.5 No enl LNs; no anal tumour.

X-rayed chest/abdomen/pneumocystogram - expecting prostate neoplasia or something - but found v large and obvious mediastinal mass ! NAD otherwise.

Re: A miserable Westie!

Martin Atkinson — Tue, 10 Aug 2010 15:28:11 GMT

[quote user="Andrew Kent"]

I don't find the petscreen test worth the money, it's just not reliable enough.

[/quote]

Supposedly something like 80% sensitivity and specifivity but I've had lymphomas diagnosed by lymph node biopsy that came back -ve on Petscreen, however its something to do to show the client you're trying. I think its possibly more to do with sample preparation and transportation as the last one I performed was on a Retriever with very vague signs that came back positive after I was scrupulous over this. One lymphoma case just had a sub-lumbar mass and mets in the kidneys but all the lymph nodes were normal. Still it had a specatcular response to chemo though on modified Madison protocol and is in remission 51 months post diagnosis - is that a record? And while we're on the subject of reliability FNA's are also IME a waste of time nothing beats whipping out a popliteal node for histopathology!

Re: A miserable Westie!

Rob Reid — Tue, 10 Aug 2010 14:19:01 GMT

[quote user="Bob Russell"]It is a very nice dog and owner[/quote]

Yep, it's definitely something nasty in that case!!

Re: A miserable Westie!

Andrew Kent — Tue, 10 Aug 2010 14:13:58 GMT

If the lymph nodes are not pathologically enlarged then still neoplasia elswewhere until proven otherwise. Have you had a good feel of the anal region?

I don't find the petscreen test worth the money, it's just not reliable enough.

Andy

Re: A miserable Westie!

Bob Russell — Tue, 10 Aug 2010 13:42:27 GMT

[quote user="Martin Atkinson"]

Enlarged lymph nodes, hypercalcaemia, 10yr old Westie = lymphoma until proven otherwise! May be worth doing a lymphoma test from Petscreen and a FNA from the popliteal or pre-scap LN but not the sub. mand. If you're still suspicious do a full lymph node biopsy from the politeal.

[/quote]

Thanks - I know this is the logical answer but the enlargement is very slight and debatable but yes FNA tomorrow once the lab have double checked the Ca++. It is a very nice dog and owner and sods law says that nasty things only happen to nice dogs - anyone else found this?

Re: A miserable Westie!

Martin Atkinson — Tue, 10 Aug 2010 12:22:29 GMT