Enlarged Heart in GSD - Page 2

Getting the dog to a specialist is definitely in store.  Also, if the specialist hospital has a cardiologist as well. 

I know that this might seem way out there, but has the dog been checked for Addisons disease? 

I'd like to see the blood tests repeated. Low serum potassium indicates congestive heart failure, which fits in with the enlarged heart and fluid in the lungs. Low sodium could be the result of haemodilution, due to the dog playing in the water, and drinking more than usual. That, of course, would now have gone back to normal, assuming the dog's kidneys were able to get rid of the extra fluid. (Congestive heart failure also affects kidney function, and the dog would tend to retain fluid, thus the excess fluid in the lungs.)

The white blood cells (WBC) and neutrophils (Neu) both being high would indicate an infection.

The glucose being high (VERY HIGH!!) would indicate acute stress, diabetes, Cushing's disease, hyperthyroidism or pancreatic insufficiency.

Was the hematocrit normal (HCT)?  What's normal for the WBC count in dogs? Does anyone know?

Okay, WBC count is only slightly elevated, normal is 6.0 - 17 x 1000/L.

Normal for lymphocytes (another type of white blood cell) is 1.0 - 4.8, so again, the value is not that far off normal, but is low rather than high.

I can't find a website that lists the norms for neutrophils (Neu) without breaking them down into the 3 different classes (banded, reticulocytes, segmented.)

The test value that is the most out of whack is the glucose. I have to think that, given how high the glucose is, your dog has DIABETES.

And guess what? Really high blood sugar causes diabetic ketoacidosis, which in turn causes LOW SODIUM VALUES!!

So, I think you may be dealing with two seperate but possibly inter-related problems here: diabetes and congestive heart failure, due to the enlarged heart. Diabetes does often cause cardiac complications. My best friend was diabetic, and died of a heart attack just after her 50th birthday.   However, cardiac problems can occur in dogs without being related to diabetes, as the above links will tell you.

Normal white Blood Count (WBC) : 6.0 - 17 x1000/ul - this value is really not high on the dog in question. 

Normal Glucose (GLU): 77.0 - 125.0 mg/dl  - depending on a lot of factors, again this value is high, but not astronomical. Stress, diabetes, high progesterone and other causes can lead to higher than normal values. This is not a value of concern unless it was known when the dog ate, and it could be duplicated. Time of drawing should always be minimally 12 hours of fasting which clearly cannot be the case in an emergency.

Don't forget that each type of equipment can give slightly different readings and will have slight differences in ranges of normal. also, each breed, and each dog may have values that differ from what is considered "normal".

Yes, stress can put blood glucose up. So can corticosteroids, or conditions that increase the cortisol level in the blood (Cushing's Disease).  But in human medicine, (which is not all that different from animal medicine),  I've only see it get completely out of control if the patient was ALSO DIABETIC.

The high glucose reading does not necessarily indicate diabetes. Ilness and stress can both cause high glucose readings plus with every everything else going on ( electrolyte imbalance etc) it's not surprising.  As Hodie noted repeat testing is in order .  Certainly is something that needs to be kept an eye on tho and short term also needs to be dealt with just so that healing is not affected.

Sunsilver, heart related problems in humans due to diabetes are usually the end result of long term diabetes not sudden onset. Sorry to hear about your friend. I have lost two family members to diabetes and so understand the loss .

Christine we're all hoping for a good outcome. Our thoughts are with you.

[quote=Tig]As Hodie noted repeat testing is in order .[/quote]

Er, [cough]

[quote=Sunsilver]I'd like to see the blood tests repeated.[/quote]

Certainly, I can understand why the vet is confused. Addison's Disease causes low sodium, Cushing's causes low potassium. Dehydration causes low potassium, while overhydration (for example, too much I.V. fluids) causes low sodium.

Hodie, they did take the dog's temperature, and it was normal.  I agree, we're not seeing the whole picture here, and more tests are needed.

Tig, yes, that's true, but diabetes would certainly stress an already enlarged heart. A heart attack might be a possibilty too. The highest glucose readings I ever saw in my diabetic friend came as a result of the stress of a very severe angina attack. (We had to rush her to the E.R. for help.)

Anyway, all this is just educated guesses and speculation. The who are there with the dog need to get busy and come up with the definitive answers.

THANK YOU ALL FOR YOUR SUPPORT AND SUGGESTIONS!!!!! 

I am happy to announce that Shive is now at home, and resting nicely.  I got a wonderful suggestion from a board member...  And she was right on the money!!!  I BOW DOWN TO YOU, OH GREAT ONE!!!!! :) 

WATER INTOXICATION.....causes both low sodium and Potasium levels together.  Here is what the vet and specialist both agree on...

"Intake of to much water, to fast, caused his body to go into "shock", causing the seziers.  Since we don't know if or how many he might have had between 3pm and 7pm (when we found him), this could have caused the fluid in the lungs, and making the heart work harder, causing it to show inlarged on the xrays."
 

Second blood test showed his Sodium and Potasium levels normal range, his protein was still at 5.4 (levels are from 5.4-8.2).  On the low side, but not dramatic.  However, his WBC and NEU are higher then what they were last night, but vet said that could be because of the fluid in the lungs and his body trying to fight it off.  Sunsilver....the workup i have says that normal NEU is 3-12.  His was at 14.7 last night, and over 16 today, and his WBC was 17.53 last night, and was over 18 today.  Again, vet didn't seem to concerned, but sent him home with antibiotics!  Normal GLU is 60-110...his was 235 last night, over twice the normal high.  It was still a little high today, but had come down...(sorry, don't remember what that one was, but know it did come down)...so they are thinking it was up due to stress.  Because of his temperment, they had to keep him sedated the entire time he was there (he is NOT a people person outside the family)  Also, the second set of xrays today, showed his heart just fine.  It's all greek to me....all I know is that he's home!!! :) :) :)

Don't get me wrong....he's not out of the woods yet, but good enough to come home.  Vet felt that he would be more comfortable here, and there was really nothing more they could do.  The vet wanted me to take him home this afternoon, and I flat out told him NO, until we talked to the radiologst and specialist.  When I finally heard from them, I was in his office in 20 minutes to pick him up! :)  And we still have our appt. with the specialist in Columbus, tomorrow! :)

Again....thank you all very much for your suggestion, thoughts and prayers! :)

Christine

Water intoxication? I'll be danged, learn something new every day. Never heard of it in dogs.  At any rate, I'm glad he is feeling better. If anything like that happened to Blitz, I think he'd need to be kept sedated too. Keep us posted.

 If the white count is rising, he does have an infection of some sort. I don't buy the water intoxication as it would just be really, really difficult to drink so much water that it would result in a problem as you describe unless he has a specific type of problem and this would likely have shown up before now.

An "enlarged heart" does not disappear overnight. Bloodwork should have immediately been done to rule out kidney and liver and other hematologic problems. In any case, water intoxication would more likely have produced hypoglycemia, not hyperglycemia. I am also not confident that both hyponatremia and hypokalemia would appear in such a condition for physiological reasons I have been taught.

Keep that appointment. Sometimes vets make explanations fit the story told by the owner, especially when they do not know what else to suggest. There is a lot more to investigate before accepting this diagnosis in my opinion.

In any case, I am glad the dog seems to be doing better. Good luck.