Not right since his op.

RE: Not right since his op.

Thomas Johnson — Mon, 04 Jun 2018 13:18:51 GMT

[quote user="Liz Barton"]

[quote user="Clive Ansell"]but he is now lethargic, listless, doesn't eat much, is exercise intolerant and generally depressed. [/quote]

I would do a 'pain trial' even though the limb is normal - a week of NSAIDs.

[/quote]

I think this would be a sensible idea as well. I recently amputated a digit from an 8yo collie because it had a melanoma. 2 weeks later the dog was a bit lethargic and very exercise intolerant. There was no apparent pain on palpation at the surgical site, which had healed very well. We had a good hunt for metastases but found none. Trial with pain relief and the dog was significantly improved.

RE: Not right since his op.

Noweia — Sat, 02 Jun 2018 22:52:19 GMT

Give them a 5kg bag of dog food and get them to lift it and tell them that is what their dog is carrying every day and regardless of what else is wrong with it, this isn't helping?

RE: Not right since his op.

Liz Barton — Sat, 02 Jun 2018 22:31:21 GMT

[quote user="Clive Ansell"]but he is now lethargic, listless, doesn't eat much, is exercise intolerant and generally depressed. [/quote]

I would do a 'pain trial' even though the limb is normal - a week of NSAIDs.

If no change in his demeanour you could go down the survey imaging route, but I'd be tempted to look more closely at behavioural issues first. This is not my forte, but Shiba Inu are an intelligent, sensitive breed. Maybe the cage rest post-op made the dog a bit depressed or he's bored by the home environment?

RE: Not right since his op.

Francisco Gomez — Sat, 02 Jun 2018 14:40:59 GMT

If Im allowed to clutch at straws:

Have you thought about imaging survey ie x-ray chest and ultrasound abdomen. I'm very against testing without indication buy in this case, might worth 'searching'.

Also, Is it gradually developing glaucoma?

I'd personally would have the dog in at a agreed price for all of above. If you have access to ultrasound, x-ray and tonometer and the dog allows it... With the caveat 'we might find nothing but you still have to pay'

RE: Not right since his op.

Julie Innes — Sat, 02 Jun 2018 13:17:38 GMT

These ones are difficult!! With the weight issue I tell people how few calories a day their dog actually needs and explain it to them in terms of "that's 2 slices of buttered toast!" Or similar. Watch the realisation dawning. When they tell you "but he only gets 200g" they just don't count the chicken/ ham/ custard creams!!

Of course there MAY be something else up with the dog, so you can offer to spend lots of their money making sure. I had one I referred for severe arthritis as the owners were determined there had to be something else they could do. CT scans and £2k later it came back....on a diet! I tell clients about this and gently suggest it might be worth losing the weight first and then referring if no difference!

RE: Not right since his op.

Edward Jones — Sat, 02 Jun 2018 12:56:17 GMT

[quote user="Clive Ansell"] Also, clients unwilling to pay as they feel it is all related to the surgery ??[/quote]

Just noticed this: It's an awkward position when clients don't understand that they still have to pay for treatment of complications (even though this almost certainly isn't).

edit: I wonder if it's sensible to have a small addition to the consent form, to the effect of: "I understand that treatment of complications may incur extra cost".

RE: Not right since his op.

Stephen Courtney — Fri, 01 Jun 2018 21:34:18 GMT

Increasing your body weight by 50% is going to slow anyone down, as well as increasing the risk of needing the other cruciate done as well.

The dog probably isn't unwell, but if the client is up for it, full bloods including pancreatic lipase and SDMA, full urinalysis including a prot:creat and culture, and if they still think he's ill, survey radiographs and abdominal ultrasound. if thats negative and they still think he's ill, a nose to tail CT is the next step.

I'm not joking. the last client I had with imaginitis of this scale said yes to all investigations because she knew there was something wrong. The CT showed a mass on the lesser curvature of the stomach, in a place where ultrasound wouldn't be able to see it. turned out to be a GIST ( gastro intestinal stromal tumour)

And all that taught me...it's good to have unlimited funds

RE: Not right since his op.

Jill Butterworth — Thu, 31 May 2018 18:41:44 GMT

[quote user="Clive Ansell"]other than being grossly obese, and in fact he has gained 5 Kg (12 to 17 Kg) since surgery[/quote]

That's a hell of a weight gain, about 40% of it's bodyweight....that would make me lethargic.

I would be looking for ways to articulate the significance of that to really bring it home, as they may be bored of talk of diets and feel dictated to. Post surgery, exercise will have been restricted making things worse etc. I would be telling them he probably only needs about half of what they are giving him, and watching their jaw drop. (Needs to be face to face not on the phone, so you can monitor the penny dropping...). Sometimes people don't realise a small dog (previously 12kg) doesn't need 'much'. I would be finding out specific quantities. A secret feeder, granny giving scraps? Other persuading tactics: compare costs of expensive blood test vs feeding half as much.

Great discussion, but common things are common...

RE: Not right since his op.

Clive Ansell — Thu, 31 May 2018 17:38:37 GMT

[quote user="Beats"]

what number was the T4?

was there a low-normal pcv or high normal pcv?

No elevation in fasting cholesterol?

just convincing myself defo not thyroid given description!

Basal cortisol to rule out hypocortisolemia?

Otherwise would query description of "normal function" and "exercise intolerant". Bilateral hindlimb lameness (eg cruciate) doesn't cause obviously assymetrical limping. I"d trot the dog up and diet it - 40% weight gain would cause lethargy and exercise intolerance. If not losing weight with dieting then I'd go back and reassess/reconsider thyroid.

[/quote]

I don't have the values to hand, but TT4 and TSH were both mid range, Chol was normal, and from memory pcv was mid range. Nothing really stood out on the bloods.

I did trot and walk the dog in a large waiting room, no obvious lameness.

I gut tells me it is a case of right dog wrong owner syndrome, just a fat dog that's needs diet and gentle exercise. 3 of us have examined and discussed the case, and have come to the same conclusion.

Had not though about cortisol, so maybe another avenue to explore to exclude Addison's

RE: Not right since his op.

Clive Ansell — Thu, 31 May 2018 17:33:26 GMT

[quote user="Richard Carter"]On a more serious note could xray the operated limb and just check nothing coming loose with no sign reaction to the implants/ osteomyelitis?[/quote]

I thought about that, but given the dog isn't lame, implant (TTA) feels intact and there is no obvious pain response to palpation and manipulation, it is on the back burner for now. Also, clients unwilling to pay as they feel it is all related to the surgery ??

He has had a trial with Metacam too, but no difference noted.

[quote user="Richard Carter"]try the RAW diet - seems to cure all other known diseases!! Join the swinging crystal brigade, try acupuncture (or is that for Chinese dogs?)[/quote]

maybe one for the homeopaths?

RE: Not right since his op.

Beats — Thu, 31 May 2018 16:51:35 GMT

what number was the T4?

was there a low-normal pcv or high normal pcv?

No elevation in fasting cholesterol?

just convincing myself defo not thyroid given description!

Basal cortisol to rule out hypocortisolemia?

RE: Not right since his op.

Richard Carter — Thu, 31 May 2018 16:23:19 GMT

try the RAW diet - seems to cure all other known diseases!! Join the swinging crystal brigade, try acupuncture (or is that for Chinese dogs?)

(or get a more entertaining program on TV/ friend to distract/ good psychiatrist/ anti-depressants for owner, patient, owner's friend ?)

On a more serious note could xray the operated limb and just check nothing coming loose with no sign reaction to the implants/ osteomyelitis?