Running out of ideas please help!

Re: Running out of ideas please help!

Ian Battersby — Fri, 23 Dec 2011 16:00:47 GMT

I agree with Cris's explaination for the bradycardia in this case - i have seen a number of dogs present with bradycardia and exercise intollerance due to increased vagal tone due to the GI disease. some of them are IBD.

Had a really nice case a while ago which is a good example - an agility dog that was collapsing during competitions had a bradycardia that was atropine responsive . Only GIT sign was borgymgyi no D+ or V+ - endoscopy biopsies changes consistent with IBD type disease and a change in diet improved everything and it is back to winning rossettes.

WRT hypovoleamia - a lack of intravascular volume would cause reduction in BP etc so generally this causes a tachycardia however if other factors exist such as hyperkalaemia this may result in a bradycardia despite a hypovoleamic state ( e.g addisions crisis)

Merry Christmas and hope everyone has a great new year

Ian

Re: Running out of ideas please help!

Anthony Todd — Fri, 23 Dec 2011 12:13:36 GMT

With respect, and grandmothers should not be told how to suck eggs but, yet again, a "weird" diarrhoea ends up as a plain old dietary sensitivity.

Colin Burrows in Florida told me that 90% of his referred diarrhoea cases were just diet sensitivities!!

First line for me was water only for 24hours, then water and boiled chicken or fish; and my results would be better than CB's 90% on a first opinion case ie nearly 100%.

Give a token metoclopramide or a token antibiotic 'cos if you've not given "an injection" you've done nothing.....

And "nothing else" means just that, and definitely NO MILK or milk products, and keep them on a lead so they don't eat hamburgers, etc. etc.

These are basically well, bright animals though, not talking about obviously ill animals or parvo etc.

No black blood, no bile vomiting, no distress [except from the owner....] etc.

Not normal in max 48 hours then start all the tests and umming and ahhing.

Why this isn't taught as the first line treatment is beyond me!

As one of my mentors told me "My horses only get ordinary things wrong with them".

Or better "Common causes are common"

Re: Running out of ideas please help!

chrisdj — Fri, 23 Dec 2011 11:46:37 GMT

Had a similar case with a lhasa apso with severe bradycardia. Turned out to be IBD resulting in vagal overstimulus thus resulting in bradycardia. The specialist did an atropine challenge test, did ECG and bradycardia dissapeared, and dog is now succesfully controlled with intestinal diet. Also had to do B12 for a while. Maybe another option?

Re: Running out of ideas please help!

Charlotte Marshall — Sat, 19 Nov 2011 18:40:49 GMT

Via the external Idexx lab. I didn't even know there was a snap cortisol test!

Re: Running out of ideas please help!

Christopher Saul — Thu, 17 Nov 2011 23:44:58 GMT

[quote user="Charlotte Marshall"]The acth stim came back normal.[/quote]

Was this run on an in-house SNAP test or via an external lab? Just a word of caution - a few months back I had a dog with a suspected addisonian crisis. In house SNAP cortisol was something like 250 basal - which would exclude addison's, but I was so sceptical that I ran a stim at the external lab - unreadably low!!

Re: Running out of ideas please help!

Charlotte Marshall — Thu, 17 Nov 2011 22:46:53 GMT

Typically the day after I posted this the owner rang me to say that over the weekend the dog suddenly seemd to get better. solid faeces bright as a button again. It came in yesterday just to check heart rate and it was 120 although the dog had had dia that morning after being given fresh chicken the day before. so may be it was dietary after all. I've told her to stick to the diet and water only now and we shall keep our fingers crossed.

thanks for the input I'll bear it in mind if it relapses!

Re: Running out of ideas please help!

Mark Hedberg — Tue, 15 Nov 2011 01:21:07 GMT

I'd definitely agree with the panacur (7 days instead of 3, suspicious of giardia), and a bland diet. hypoallergenic diets are more expensive than regular food, but cheaper than repeat consults! :)

Re: Running out of ideas please help!

Busybee — Mon, 14 Nov 2011 21:28:25 GMT

I know it's not presenting classically, but have you checked T4? Just throwing it out there! But more likely a primary GI problem.

Re: Running out of ideas please help!

Robin Grimmer — Mon, 14 Nov 2011 21:02:52 GMT

[quote user="David Mills"]

Bradycardia can come about due to hypovolaemia (distinct from dehydration) if blood is lost chronically from GI tract - loss of hypertonic fluid from the ECF (IV) promotes solution movement into interstitial space and ICF - giving a hypovolaemic, viscous ECF (IV) with very hydrated cells (and therefore no skin tent/tackiness of membranes). Increased blood viscosity can slow heart rate significantly. What's the pulse quality like?

Sounds like there's still ongoing losses with crap appetite so I'd be tempted to perfuse this dog for 48-72hr with crystalloids and see if there's a change in demeanour, and monitor HR over this time. An ECG would be far more useful than ultrasound or xrays if you're worried about rate after this time.

[/quote]

I don't agree with this. If you have chronic blood loss from the GI tract then you will have a normovolaemic anaemia and therefore reduced blood viscosity.

You get increased blood viscosity and marked haemoconcentration with HGE - but this is an acute disease, and also you get tachycardia because the animal is in shock. A quick PCV will confirm the diagnosis.

Re: Running out of ideas please help!

Stephen Courtney — Mon, 14 Nov 2011 18:15:44 GMT

If you have no money to spend on this, start metronidazole and put it on a good white meat/ enteric diet. futher supportive treatment like fluids etc if indicated, and a shot of B12 wouldn't be a bad idea , thinking about the age of the animal, giardia and crytposporidia are high on the list. do a fecal smear and look for ypourself, the blob of feces on the end of the thermometer is often enough, just swish it into a drop of saline on a slide.

these days i would never give a diarrhoea case potentiated amoxycillin unless there was a fever/ passing blood/ obvious systemic illness. And then i'd probably start with augmentin IV. if I think they need antibiotics i usually start with metronidazole.

Re: Running out of ideas please help!

David Mills — Mon, 14 Nov 2011 16:55:03 GMT

Re: Running out of ideas please help!

Dagmar Steele — Mon, 14 Nov 2011 16:42:17 GMT

I'd definitely do a fecal exam, as Giardia and Coccidia come to mind. Not sure about the heart rate, but I've seen the young and very old ones affected more by it than middle aged dogs and they can become really depressed. Shouldn't be too expensive before you move on to more elaborate examinations like ultrasound and biopsies.