Please Help! Veterinary Advice Desperately Needed. - Page 9

I have been waiting to hear how the vet appointment went. Please update us Sabrina

Liz

Sorry everyone for the delayed update, we took Samantha to KL on Thursday and I'm afraid the results were not too good.

I have been just so upset over the last few days and feel so bad for poor Sam and I feel terrible that I cannot do more for her.

We are currently waiting for some results to come back and to see our vet tomorrow morning to discuss our options for Sam.

I have updated on the situation below, please read it and offer any advice to help us make a decision. 

Thank you.

SabrinaT, I am worried to see the word EDIT and nothing else. I fear there has been a setback? So sorry if that is the case.

UPDATE:

We got the bloodtest results from the vet on Tuesday and the results were:
(only listed results higher than or below notmal range)

                                           result (reference range)
HAEMATOLOGY
  ESR 40 (0 - 20)
  RBC 5.1 (5.5 - 8.5)
  HAEMOGLOBIN 12.3 (15 - 19)
  PCV 37 (44 - 52)
  WBC 18.1 (6 - 12)
  PLATELET COUNT 646 (>200)

KIDNEY FUNCTION
  UREA 16.8 (2.5 - 9.5)

LIVER FUNCTION
  SGOT (AST) 87 (15 - 80)
  SGPT (ALT) 51 (15 - 90)

Basically, our vet said there is nothing really conclusive he can see from the results and he still thinks it is a heart problem.

So we decided to take Sam to KL, and arranged to go on Thursday.
We were planning to do the tests to try and rule out a Heart Problem (Ultrasound, ECG) and an Ultrasound of the Abdomen (as we still hadn't seen a stool and a Blockage / Twisted Intestine had yet to be ruled out).

So, on Thursday we took Sam to KL (and she actually passed a stool on one of the stops on the way which was a little wet but not diarrhea)

We got to the vet and after him seeing the previous tests done and seeing Sam we did the Heart Ultrasound.

According to the vet, the ultrasound showed a large 'fluid filled mass' in the chest which has pushed the heart onto the right side of the chest and although the heart is actually working fine, it is unable to function properly due to the fact that it doesn't have adequate space.

He took a sample of the fluid which was very bloody and then we did some Chest X-Rays which confirmed there is a large amount of fluid in the chest which is constricting the heart.

He said the fluid could be a number of things (cancerous growth / tumour / lung node) but he said he thinks the most likely thing is a lung / lung node but we have sent the sample taken to be analysed so we can have a better idea of what exactly it is (results will take up to one week to come)

The vet in KL told us that the only way to remove this fluid is by surgery, which in her current condition Sam would be very unlikely to survive.

The vet in KL has spoken to our usual vet and we will go and speak to him as well tomorrrow to discuss Sam's options and to show him the test results.

The vet said Sam is not in pain, but she is in discomfort due to her breathing difficulty.

We are waiting for the results on the fluid sample to come back before we can make a decision for Sam.

So, please if anyone has any advice, it is welcome.
We have a very very difficult decision to make for Sam and any help is appreciated.

Thank you.

 Dear Sabrina,

The situation with Sam is very difficult. It seems that the vets there have some ideas about what are the signs of her distress, but don't have a clue about what is the actual cause. She is very young to have a cardiac problem that is congenital suddenly pop up, unless you missed something all along, thinking her energy levels were just normal for her etc.

I am not sure what else to tell you except that if she does have so much fluid in the chest, the question has to be asked exactly where is the fluid. Is it in the chest cavity itself or? There are many spaces it could be in, and that alone is a clue perhaps to what the primary problem is.

Based on the bloodwork, there are several things that show up, including a high white count that suggests infection, but it could be a leukemia as well. The dog does not appear to have sufficient oxygen carrying capacity, and her kidney function is off, but these could be primary or secondary indications from how she has been treated to date (medications etc).

Culturing/testing the fluid sample to see what is in it, is important for certain. But, if the dog is this ill, in the US, this dog would be hospitalized, and would likely have chest tubes to drain the fluid, IV antibiotics and other vigorous treatment and tests to find the primary cause and treat that, if possible.

There are just so many possibilities for why fluid is there, including something as simple as the dog inhaling some sort of plant material, like a foxtail, that later ends up being implanted somewhere it should not be, to heart failure, to an infection of the lining of the heart, or some other infection, cancer (a hemangiosarcoma or other tumor) and on and on.

I think if you are to save this dog, you must return to the best clinic in the country and find the best vets and see what they would suggest you do. When you say they recommended surgery but said she would not survive that, what was the surgery for? Just exploratory? Did they mention insertion of chest tubes? The prognosis does not seem very good without competent and continuous vet care. Only you can decide what is best at this point for Sam. Breathing difficulties are not painful per se, but it certainly is not comfortable for the dog. It is good that she had a bowel movement, but if she will not eat well, that too does not suggest a good outcome. She probably does not want to eat, for a variety of reasons.

I wish we could help more, but I am out of ideas. This is a very serious situation and you will have to weigh the options you have and make the best decision you can for Sam and for you. It does not seem like your local vet can give her the aggressive care she needs so that too must weigh in on the decision you make.

You may also have to begin to consider the cost. I am certain this has cost a small fortune already. But without someone stepping up and saying we think we need to do this because.......I don't know what else to say. Everything we say here is only a guess. The fluid sample, if it is pus, may give some clue, but it may not give a clue either. But in any case, I think without much more aggressive treatment, including IV broad spectrum antibiotics, there may not be much you can do. 

Please do keep us posted. We are all thinking of you and hoping for the best.

Sabina, I can't offer much in the way of medical advice but I've been through a dire diagnosis and subsequent death of a very young dog.  I know how difficult it can be and my heart goes out to you.  Don't give up on her but make sure you know if and when she's had enough.  I hope the picture improves and am sending good wished your way, hang in there.  This girl is lucky to have you and I'm sure she knows that!

Hodie or Sunsilver please jump in here and explain this better than I can.
I'm speculating but maybe?
A friend of mine showed a lot of the same problems as this dog for months.
Yes human but the anatomy is the pretty much the same.
Fluid buildup in the legs, infection somewhere, Lasix, anitbiotics, breathing problems, heart problems, nothing working.
Finally, ultrasound, chest xrays showed a lot of fluid in the chest cavity too. No fluid in the sac around the heart, but they drained a lot of fluid from the sac around one lung, cultured it and that was the source of the infection. More antibiotics and he was much better almost right away. A few weeks later, the fluid and infection was back and they ended up re-draining it and injecting some kind of glue? full of antibiotics into where the fluid had been building up to kill the infection, eliminate the pocket and keep the fluid from coming back. He's been fine ever since. The original source of the infection was never figured out.

Sabina, good luck. I hope they find something and can help her.

Mobjack,

There are many reasons for fluid buildup. One certainly is an infection. As I said, aggressive treatment for such an infection would be IV antibiotics. Oral antibiotics are never enough in these type infections. And, depending on just how compromised the heart and lungs are from the fluid, draining the fluid would be a consideration. The problem is that Sabrina is not in a situation where sophisticated vet care seems available. But yes, your situation seems very similar and the treatment seems appropriate from what you say and most of all, how the dog did in the end.

Has she been tested and found negative for heartworm?

Yes, hexe, that was one of the first tests the vet did.

Mobojack, that 'glue' they used is the same as what they use on human cancer patients. It causes the lining (pleura) of the lung to stick to the lining of the chest cavity, so fluid can't build up between the two.

If it is fluid in the lung, though, I' m wondering why the vet didn't deal with it right away. It's fairly simple to do, and I've even heard of this being done in wilderness emergency situations, where the patient had a collapsed lung, or blood/fluid in the chest cavity. (As a nurse and outdoors person, I've read a fair bit about wilderness emegency first aid.)

If the fluid is in the space around the heart (mediastinum) that's a different story, and is much trickier to deal with. It bothers me that the fluid is bloody. That could mean hemangiosarcoma.