Thank you for posting all the lab work results. The lab results have been very helpful, and also very complex. I see why the veterinary internist may have been baffled.
Lethargy, anorexia, panting, hind leg weakness, gastrointestinal problems, vomiting, and hair thinning, were the symptoms that forced you to take your dog to the vet initially. These symptoms can be signs of endocrine disorders, specifically Hypoadrenocorticism (Addison's Disease), Hyperadrenocorticism (Cushing's Syndrome), and hypothyroid.
I think that your dog may have had undiagnosed Addison’s disease (Hypoadrenocorticism). The cause of Hypoadrenocorticism is unknown, although immune-mediated destruction of the adrenal gland is suspected in most cases. Addison’s disease is a deficiency of hormones normally produced by the adrenal glands. However, your dog’s the blood work was atypical for Addison‘s, so Addison’s disease would have to have been diagnosed with additional tests such as: ACTH stim test or Low dose dex. test., and unfortunately it is too late for such tests so we must just speculate.
The enlarged heart and poor eye sight may have been congenital or developmental and may not have been related to the endocrine disorder. Your dog had already been on heart medications for 3 years prior to this episode. However, electrolyte abnormalities secondary to Addison's disease can disrupt heart function and cause arrhythmia's, which could worsen an existing heart condition.
Addison’s disease can also cause seizure and coma due to hypoglycemia. Your dog’s last listed glucose level was 29. A glucose level of 29 is extremely low and is considered to be hypoglycemic. Hypoglycemia by itself can cause seizures and coma. Addison’s disease is not the only cause of sudden hypoglycemia, though. Other causes that could have occurred in your dog’s case include Insulinoma (a tumor of the pancreas that produces excess insulin) and overwhelming infection (possibly secondary to the surgery, in your dog‘s case). There was a sign of possible infection in your dog: “SQ emphysema” in the integument at the suture site, this can be indicative of infection.
No surgeon will perform surgery unless he/she takes a look at all diagnostics, such as the X-Rays and the ultrasound,. The surgeon will not rely only on another doctors recommendation., but will make his/her own decision. Your dog’s surgeon must have been convinced that there was an obstruction of some sort, or a very good reason for performing surgery, or the surgeon would not have performed the surgery, therefore, the blame cannot be given only to the internist on this one.
Though there is no way to be definitive about the cause of death for your dog the following rule outs are possible: Surgical complications secondary to Addison’s disease, Surgical complications secondary to heart disease, Infection following surgery, Adrenal carcinoma causing adrenal failure, or Pancreatic cancer (Insulinoma), among other possibilities.
No. These comments support kidney failure or kidney disease and hypoglycemia (low blood glucose). Azotemia means kidney disease, hepatopathy means abnormal liver, hyperphosphatemia means too much Phosphorus which is also due to kidney disease.
What a sad story. I'm so very sorry for your loss. As Dr. Cheng said, your dog's condition was very complex and it would have been very difficult to figure out. He obviously had a whole lot of things going wrong for a long time, and it finally became too much for his little body to overcome. Honestly, I don't think anyone could have saved him. While modern medicine can pull off some true miracles these days, there are still limits.
I've lost 2 dogs at nearly 14 years of age. One to pancreatitis and one to kidney failure. It's terrifically difficult to get past the idea that we should have seen the problems sooner or that the vets should have been able to save them. It was simply their time to leave us. No medicine and no treatment could have kept their worn out organs going. The only way I can deal with the loss is to remember that they had good long lives with me and my husband. The end was not nearly as important as all the years and all the love that came before. I hope and pray that you find peace from the traumatic loss of your friend.
Thank you for your kind words, and I hope that I have helped with closure, but please remember that my information is just objective advice since I was not able to be personally involved in an actual examination.
I think that it may be difficult to sort out who may be at fault, especially with out having had a necropsy or post-mortem performed. This is a very complex case.
Good luck with your complaint! And please remember that he is no longer suffering.
Dear Katrina,
You will have to just type in the results manually. Only post the ones that are abnormal. Biopsy results and all medications will also help. Was a post-mortum performed?
Thanks!
I am here to help!
Could you please get a copy of all the blood tests, urinalysis and any other test results and post them here so I will better able to help you. This is a serious and complicated question and I really require as much information as possible, so that I will be able to do the question, and your dog justice. Thank you! Dr. Cheng
thank u..i miss my boy and have to stop myself with runaway brain what if?i did the best for him..i have a new boy now..my galdog so lonely...me 2 and so many greyhounds need good homes...he is helping to mend our broken hearts!I do use the term guardians of my 4 leggeds..i watch over them and they give back sooo much as u very well know!
Thanks for your comment. I thought that there would be a way to display the results as they appear on the paper the vets gave me. Besides, I wanted to post the biopsy results and the final report before my pet's death.
Katrina
I suspect that you will have to list tests results yourself, in a post...... Karla
Dr. Cheng:
Sorry to bother you again, but I left some very important information out from his last test:
The veteriranian's report had also the following comments:
"Pet recumbent and nonresponsive. Placed catheter via jugular (blood pressure too low to access peripheral veins). Started fluid therapy. Bloodwork revealed hypoglycemia, hyperphosphatemia, azotemia, hepatopathy, amylase did not read. Adm 18 cc 50% dextrose. Pet went into respiratory arrest unable to revive."
Are these comments helpful to support Addisonian crisis?
Thank you again.
I can't thank enough all of you guys for your kind words. It means so much to me! I'm so sorry for your loss too. I was thinking that we need to start a petition for naming all pet owners "GURDIANS." If we manage to do that, there would be serious legal ramifications, the vets will be better policed, and they will have to answer to pets' misdiagnoses and deaths!
My heart goes out to you!I recently lost my 10 year old greyhound to a autoimmune disorder that i believe was caused by a rabies shot when he was 8.You did beyond the best u could do for ur companion..never 4 get that!ur in my prayers !:)
Thank you for your kind words. The grief has been unbearable--it's not the fact that he is gone, but the way he went. And yes probably no one could have saved him, but I wanted the vets to tell me the truth and the possible outcome of such major surgery. Instead, the surgeon sounded so confident and never mentioned that my little bud could not survive the surgery. I should be the one to make the final decision about his fate. All I wanted was to have all the facts so I could have made an informed decision.
I am sorry that tough cases like my pet's cannot be diagnosed; one though has to wonder if the vets can only diagnose and treat easy cases.
It was a very traumatic experience for me and it's been very hard to cope with my loss. Tomorrow, I am going to seek professional counseling.
I can't describe in words my gratitude for giving me possible causes of my pet's death. Your expertise and professionalism are remarkable. I was so unfortunate not to have a knowledgeable and caring veterinarian such as you.
Besides the fact that it cost me almost $10,000 for all the treatments and surgery in a 2-month period, the grief is unbearable!
Some final comments: The surgeon told me that if it was not for the internist, I would never have met him. He said "The guy (the internist) doesn't work for me and I don't work for him." He was telling me that the only reason he operated on my pet was the internist's recommendation.
One final question: At the Emergency Clinic of N. Alabama, Huntsville, where I rushed my pet after the seizure (the day before he died), the vet there DID NOT PERFORM ANY DIAGNOSTIC TESTS AND DID NOT PUT HIM ON IV FLUIDS. If the vet at the emergency clinic did perform diagnostic tests and gave him IV fluids would that have saved my dog? Also, what did the internist see on the ultrasound and believed it to be an obstruction?
On March 18, I filed a complaint with the Alabama Board of Veterinary Medical Examiners. I have not heard anything yet. There was a a failure to diagnose, a misdiagnosis, and finally an unnecessary and killing surgery. Someone did something wrong--it sure wasn't me. I believe I have a strong case, and as a consumer and a tax payer, I felt that I had the right to ask the state's protection. Wether the state will protect me or not remains to be seen. . .
Here are some test result:
WBC 8.88 10^9/l RBC 7.08 10^12l
LYM 0.45 - 10^9/l HGB 17.7 g/dl
MON 0.34 10^9/l HCT 49.01 %
GRA 8.01 10^9/l MCV 69 fl
LY% 5.2 - % MCH 25.1 + pg
MO 3.9 % MCHC 36.2 + g/dl
GR 91.0 + % RDWc 15.6 %
---------------------------------------------------------------------------------------------------------------------
PLT 421 10^9/l
PCT 0.37 %
MPV 8.8 fl
PDWc 38.7 %
---------------------------------------------------------------
ALB 3.0
ALP 41
ALT 31
AMY 491
TBIL 0.3
BUN 10
CA 9.8
PHOS 4.0
CRE 1.0
GLU 106 (PREVIOUS WAS 126)
NA+ 154
K+ 4.4
TP 6.0
GLOB 3.0
----------------------------------------------------------------
Chemistry at Iternist's on 2/8/2009 6 DAYS BEFORE SURGERY
AMYL 398 - U/L LOW (500 - 1500)
LIPA 721 U/L (200 - 1800)
---------------------------------------------------------------------------------------------------------------------
BIOPSY 2/21/2009 (DAY HE DIED -- RECEIVED IT 0N 3/12 AFTER REPEATED PHONE CALLS TO GET MEDICAL RECORDS FROM SURGEON!
Final Report
PATAHOLOGY RESULTS
SURGICAL PATHOLOGY
REF CASE MP
ANIMAL ID Asproolee
SPECIES Canine
BREED Poodle, Toy
SEX Male, Castrated
AGE 14 y (they had the wrong age--was 13y)
HISTOPATHOLOGY Liver. There is overall moderate expansion of the hepetocytes
fine cytoplasmic vacuolization consistent with glycogen as well
as multiple well-demarcated areas in which vacuolization is
significantly more pronounced.
Jejunum: No histologic lesions are noted.
Ileocecocolic junction: The muscular tunics appear
subjectively mildly thickned, with mild goblet cell hyperplasia.
DIAGNOSIS 1. Ileocecocolic junction: Smooth muscle hypertrophy, mild
focal, chronic.
2. Liver: Glycogenosis, diffuse, moderate to marked,
chronic, consistent with steroid-induced hepatopathy.
COMMENTS The diagnosis of thickening in this area is subjective, and may
need to be interpreted in light of the animal's advanced age.
No neoplastic cells or significant inflammatory infiltrates are
seen within the intestinal tissue submitted.
PATHOLOGIST JENNIFER W. KOEHLER, D.V.M. //S//
PATHOLOGIST KELLYE S. JOINER, D.V.M. PH.D. //S//
_____________________________________________________________________
TEST RESULTS A FEW MINUTES BEFORE HE DIED
2/21/2008 Chemistry results from IDEXX VetLab In-clinic Laboratory
Chloride 105 mmol/L L
Potassium 5.4 mmol/L
Sodium 153 mmol/L
Hematology results
HCT 31.1 % L
HGB 10.8 g/dL L
MCHC 34.9 g/dL
WBC 8.34 K/m(Greek m)L
NEUT * 6.86 K/m " L
%NEUT *
EOS 0.53 K/GreekmL
%EOS 6.3 %
PLT 130 K/GreekmL L
Retics 28.6 K/GreekmL
%Retics 0.6 %
RBC 4.44 M/GreekmL L
MCV 69.9 fL
MHC 24.36 pg
RDW 16.1 %
MPV 14.98 fL
PDW 21.2 %
PCT 0.2 %
LYMPHS 0.35 K/GreekmL L
%LYMPHS 4.2%
MONO * 0.53 K/GreekmL
%MONOS * 6.3 %
BASO 0.07 K/GreekmL
%BASO 0.8 %
______________________________________________________________________
Chemistry results
ALB 2. g/dL
ALKP 664 U/L H
ALT 119 U/L H
AMYL - --- --- U/L
BUN/UREA 84 mg/dL H
Ca 9.4 mg/dL
CHOL 173 mg/dL
CREA 2.5 mg/dL H
GLU 29 mg/dL L
PHOS > 16.1 mg/dL H
TBIL 2.0 mg/dL H
TP 5.5 g/dL
GLOB 3.3 g/dL
Attitude/Appearance: recumbent non responsive
Oral Cavity/Teeth: n
Mucous Membranes: pale crt > 2 sec
Eyes: cloudy pupils dilated non responsive
Ears: n
Cardiovascular: bradycardia
Respiratory: agonal
Gastrointestinal: n
Musculoskeletal: n
Lymph Nodes: n
Urogenital: n
Integumentary: Bruising midline from incision from surgery, SQ emphysema
Nervous System: recumbent
Pain: n
I am sorry for the length of this post; however, I would appreciate any insight as to the cause of my pet. I've gone thru a lot of pain and agony for the unjust and unexpected loss of my canine pet.
Thank you
I will be more than happy to post all tests that I have on my pet. Just how do I do that?
Thank you
Dear Dr. Cheng:
A few more comments that might be helpful.
A couple of days before surgery, my dog's voice had changed, and I did mention it to the surgeon.
His referring vets had my pet on METACAM for about 30 days because they believed he had minor arthritis (hind legs) pain. His symptoms then gotten worse. . .They asked me to stop the medication when they realized that the med was hurting him. Then they asked me to let them have him 3 days for observation and testing (X-rays, barium, meds, etc.) Still not conclusive diagnosis. They suggested pancreatitis or GI track problems. Since they could not give me a confirmed diagnosis, they then suggested ultrasound.
My pet was also on Enalapril (3 years) then the cardiologist in Birmingham changed it to Benazopril (Nov 07). We spent 9 years in Europe working for the U.S. Government and came back to Madison, Alabama, in Sept 07. The European doctors had prescribed Enalapril.
The referring veterans never called after the surgery to provide assistance and follow-up care. I didn't know then that the referring vets had to follow up--I found out that later. . .
Thank you again
The surgeon gave me two kinds of antibiotics, Clavamox and Baytril plus more METACAM. When I called the surgeon after the seizure, he told me "Stop all the medications!"