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"Not Doing Right"

A 10 lb, 9-month-old intact male Shih Tzu puppy with a heart murmur presented for vomiting and lethargy following dietary indiscretion.

A 9-month-old intact male Mastiff mixed breed with history of being underweight presented at a referral facility for echocardiogram due to heart murmur.

A 1-year-old, intact female Labrador Retriever/Great Dane mixed breed was presented for intermittent vomiting. Physical exam found the patient to be thin with pale mucous membranes, and missing left foreleg. The patient was treated with Cerenia after owner deferred diagnostics; while on Cerenia no vomiting was reported. Abdominal ultrasound was performed 12 days after initial visit.

Decreased appetite. Current meds: Metronidazole, Denamarin, Mirtazapine. ALT 393, T. bili 5.7, Mag 2.7, Chol 307, Amyl 1891, PSL 50, Lymphs 9, Mono 8, Neuts 11,680, Mono 1280,Eos. 1600, USG 1.048.

Weight loss, diarrhea, decreased appetite, occasional weakness. Glucose checks have been consistently in the low 60s. HCT over 60%, ALT 299, AST 141, BG 61. Recheck BG 64.

Patient was presented for ataxia, icterus, lethargy, and vomiting. History of atypical vaccine reaction after first DHLPP-ADR, enlarged peripheral LN. The patient has not been 100% since. Blood chemistry and CBC revealed BUN 3, TP 4.3, Alb 1.9, ALT 457, ALKP 869, GGT 20, Tbili 5.1, chol 84, amylase 216 and HCT 31%.

A 13-year-old MN Beagle mix with history of increased weakness and respiratory effort presented for a heart murmur, suspected pulmonary edema, enlarged liver, and possible cranial abdominal mass. The patient was abdominally retracting while breathing, but his mucous membranes remained consistently pink. The patient was started on furosemide 12.5 mg 3 tabs BID and Pimobendan 5 mg BID. CBC and blood chemistry found moderately high WBC count; poss. bands, Alk. Phos. 663. Urine specific gravity was 1.023.

The patient presented for ADR and hiding which was worsening over time. Blood chemistry, CBC, and urinalysis were both unremarkable. The caudal lumbar area of the patient was uncomfortable upon palpation. Radiographs revealed fused tail vertebrae, enlarged heart, and a mass effect in the chest. A double cavity ultrasound was performed and findings confirmed fused kidneys (which had previously been diagnosed) and a pericardial diaphragmatic hernia was noted. Falciform fat was in the pericardial space. The heart did not appear to be dysfunctional owing to this congenital defect. Due to splenic enlargement FNA of the spleen was recommended.
A few weeks later the patient's clinical signs worsened again. Despite treatment with pain medication, cortisone and antibiotics the patient presented again with dull mentation and not wanting to walk. Upon examination no ataxia or nystagmus was noted but the patient was squinting; there was concern for CNS disease. A CT study was performed at Blairstown Animal Hospital.

Patient presented for newly diagnosed grade 2/6 heart murmur, sudden weight loss, and newly diagnosed hypothyroidism. Previous history of random vocalization- unsure if from anxiety or discomfort.

The patient was presented for annual exam with a 1-2 month history of decreased appetite. Blood chemistry and CBC found a potassium low at 3.2, chloride low 113, AST high 70, monocytes high 684, and T4/fPL both normal. Repeat bloodwork a month later showed potassium even lower at 2.6. The patient was started on Renacare potassium supplement and abdominal ultrasound was scheduled.  The day of the ultrasound, potassium was rechecked and still low at 2.7; Renacare dose was increased and a month later the potassium level was normal. Post-ultrasound Aldosterone baseline level was high at 1194 (194-388). Prior to surgery she had a normal appetite and energy level, and CBC and chem were normal other than a mildly elevated ALT.

A 1-year-old, FS, Australian Shepherd mixed breed canine was presented for acute onset of collapse/dizziness. This was the first episode that the patient ever had; patient was BAR prior. Hepatomegaly was seen on radiographs. Blood chemistry showed an elevated ALT, CBC/UA were WNL. 4DX heartworm test was positive, Lepto test was negative.

A 3-year-old, MN, Catahoula Leopard Dog was presented for a 4 month history of ADR, diarrhea, and vomiting which had acutely worsened within the last 48 hours. Physical examination found the patient with a body score of 2/9 with a 14 lb weight loss, temperature of 102.9, QAR, and mildly dehydrated. CBC/Chem, cPLI, and fecal were all WNL with the exception of an increase in monocytes (11%) with a normal WBC of 14,650. A full abdominal ultrasound was performed.

The patient was presented for trouble seeing and staring into space. She appeared to respond well to steroids. Recent blood work was essentially normal.

Hx of TTA performed on both knees. The patient was presented for a mass seen on the right knee. Owner reported the patient seemed more tired and not motivated for walks; limping on right hind limb. Examination of the right leg found a 15 cm invasive mass at the knee. The patient was placed on NSAIDS and scheduled for further diagnostics. CBC/Chem was WNL. 

A 3-year-old, 60 lb, MN, Labrador Retriever mixed breed canine was presented with a history of possible dietary indiscretion while on a hike with his owner 48 hrs prior. The patient was ADR and had been intermittently vomiting for 24 hrs. Upon physical examination the patient exhibited pain in the caudal abdomen and an abnormal structure could be felt on palpation. Radiographs showed an irregular, semi-circular area in the caudal abdomen. The patient was hospitalized on I.V. fluids and supportive care pending ultrasound.

A 7-year-old FS Bullmastiff was presented for acute diarrhea and decreased appetite.

Sonographic summary: The initial ultrasound findings were: Part of the small intestine presents a 1:1 muscularis/mucosa ratio with decreased motility, mildly obscured wall layering and mild accumulation of chyme. Focal circumferential wall thickening of up to 7 mm with transmural loss of layering is seen in the ileocecal region and is associated with an incomplete obstructive pattern with segmental dilation of the intestine with chyme. The central abdominal mesentery presents a generalized increase in echogenicity with loss of the regular echoarchitecture emphasizing the lymph node and intestinal wall changes. Severe mesenteric lymphadenomegaly of up to 8 cm is noted. The lymph nodes are rounded with a pathologic increase of their short-to-long-axis ratio beyond 0.5. A significant mass effect on the intestine resulting in an incomplete obstructive pattern is noted. The margin to the intestinal wall is obscured. Scant anechoic peritoneal effusion is noted. Ultrasound guided fine needle aspirations were performed for further definition and confirmed a large cell lymphoma. The patient underwent chemotherapy and presented two months later due to extreme ADR since finishing the 2nd round of chemo (Adriamycin), anorexia with the exception of treats, and PU/PD. Subcutaneous lymphoma of a single mass had been detected via FNA 1 week prior, therafter multiple SQ masses developed.

The progression of pre-chemo, post chemo, and escape from remission sonographic images are sequenced below.

A female Columbian red-tailed boa was presented for vomiting and 10 months of anorexia and weight loss.

A 2-year-old FS Beagle mixed breed. Clinical findings: 2 chest nodules. Fever of unknown origin. Vomiting/diarrhea. Altered CBC/Chem/UA values: WBC 20,000. TP 8.3. BUN subnormal at 5. Globulins sl. Elevated. Coag-wnl. HWT-neg.

An 8-year-old, F/S, 77 lb, Pitbull terrier was presented at RDVM for decreased activity level and behavioral changes. Blood work was performed and showed an increase in ALKP. The patient also had a dental cleaning recently where they extracted multiple teeth and put her on oral Tramadol. Owner says that she was “normal” on March 20th but has slowly been declining. Repeat blood work showed an increase in ALKP. Unable to perform physical exam due to hyper response. Owner reported the patient had become very head shy and aggressive with other dogs and had drastically changed in personality. RDVM recommended a brain CT scan and it was decided to include the liver due to increased ALKP.

The patient was presented for straining to defecate x 5 days, a poor appetite, recent vomiting, and possible hematuria. During physical exam a recal stricture was palpated. Blood was noted in the vulva. The patient was treated with Baytril, Cerenia, and IV fluids pending sonographic evaluation.

The patient was present for "ADR", back pain, pollakiuria and dysuria, and dark urine. Treatments included IVF, Ampicillin, and Baytril without clincial response. Urine specific gravity was 1.034, pH 7, 1+ protein. Bloodwork was unremarkable.

The patient was presented for evaluation due to severe vomiting. The vomiting stopped but the patient was now anorexic. The patient was quiet with a thin body condition. CBC found a low WBC of 3.7. Blood chemistry found albumin 3.7, total protein 7.0, ALKP 43, BUN 43, and cholesterol 79.

An 8-year-old MN Ragdoll cat was presented for examination due to ADR. Blood chemistry found hypokalemia, elevated liver enzymes, hyponatremia, and a CPK of 11981. Urinalysis showed a specifi gravity of 1.039, pH 7.5, 3+ protein, RBC 11-20, and WBC 2-3.

A 6-year FS Havanese with history of vomiting (mostly at night and in morning) for a few weeks; no diarrhea. Recent bloodwork found ALB 16, TP 40, GLOB 24 with other parmaters WNL. A fecal was negative. Urine SG 1.035, no protein on chemstrip and urine pro:crea ratio was pending.

An 11-year-old FS Greyhound was presented for recent left swelling at the humeral head, extending to radius/ulna/foot. This had happened once before in the past. No history of  fever, toxic insult, puncture wound, etc. However the dog loves to run through the owner's property. Radiograph showed a swelling at left humeral head. VDIC suggested ultrasound to view axillary vessels looking for thrombosis. No boney tumor was seen.