Hurry up and wait...

Today was a pretty big step forward. In other words, G-dawg does not have to go to the hospital tomorrow!

This morning I was in clinical pathology spinning blood for the research I am helping with and I had to resist the urge the harass the clinical pathologist about Guimauve's cytology of his lymph nodes. I was almost done when who wanders in but Dr. Costa. The good news was no obvious neoplastic changes! On to the biopsy!

I was fortunate enough to meet Dr. Costa and Marcie for the biopsy. I have to say it is a little weird seeing your own dog hooked up to anesthesia and then watching them put an endoscope down his esophagus. It was pretty cool from the veterinary student standpoint!

They took several biopsies of his duodenum (the part of the small intestine right after the stomach) and several in the stomach. I even got to help take the biopsies. It is kind of interesting. The biopsy tool is a small cable that goes through a port in the endoscope. It has "pincers" at the end to take the biopsy. Dr. Costa directed the endoscope and the end of the biopsy tool and then would ask Marcie or I to pinch it and then pull the tool back out and put the biopsy in a jar for toe lab. Pretty crazy procedure to watch!

Afterwards I walked the samples to the diagnostic lab where I work and now it is just waiting until tomorrow when the pathologist can look at the biopsies under a microscope and later in the week for the blood test results...

But G-dawg is playing and is very glad to be home and eating again!

Karo Syrup Cure?

Ah another day in frustration paradise! Guimauve got his blood drawn today for the previous mentioned tests. Then it was time for the barium study. Just as a preliminary, radiology took lateral radiographs (on his side) to see if he had any food in his stomach. Guess what?! Even though he had not eaten since 6 pm and it was about 11 am, he still had food in his stomach. So much for the barium study!

The decision was made in the afternoon to do a fine needle aspirate of his mesenteric lymph nodes to rule out lymphoma before we do any more diagnostics. I will know the results in the morning.

However, in anticipation of a possible endoscopic biopsy of his intestine. Dr. Costa gave me Karo Syrup for his dinner today (6/27). She said it was mostly so I felt better because he has not eaten anything in over 24 hours. I think she feels guilty. Funny part was, tonight he was acting like his normal self for the first time in awhile. He was stealing my socks and was just a ball of energy. Maybe I should invest in this sweet elixir...

Crossing fingers biopsy tomorrow, answers by Thursday!

Your Dog is Weird

The words you definitely want to hear coming out of your vet's mouth right?

Last night Guimauve had diarrhea every two hours. This sort of started Friday with some diarrhea, but Saturday his stools were mostly normal until the evening. I had a suspicion it was the metoclopramide we started him on to increase his gastric motility.

This morning I had to go into the hospital early to run blood from the research project I am working on, so I figured I would stick my head in and see if Marcie was in. Voila! I was in luck she was in. I told her what was going on and she said she would call Dr. Costa in a bit when it was not quite so early. I spun the blood down and returned to find Marcie.

Today was my lucky day, Dr. Costa happened to be working at the hospital today and was learning about the cases received overnight and then I could talk with her. Not long after Marcie tells me this Dr. Costa walks through the doors and stops dead in her tracks and looks at me then Marcie and back to me with a look of "Oh no, now what?!" on her face. I felt kind of bad, but at the same time it was a pretty priceless look.

I explained to her the diarrhea and we decided to take him off the metoclopramide which seems to have worked so far.

As I was walking away Dr. Costa told me I had a weird dog and I just smiled and shook my head saying I know.

The Saga: Part Deux

I forgot to provide the results of the fecal received yesterday!!! So working in WADDL I had the inside, unofficial results. 10 oocysts (a cyst containing a zygote of the parasite) per gram of coccidiosis. So of course I tell Dr. Costa and the problem is it is not enough to be pathogenic. However, never hurts to treat! So he got Drontal Plus (anti-parasitic) as well as Albon an antibiotic.

And now for today. I bring him in early and Marcie (the awesome and stupendous 4th year student on his case!) tells me they have two options for his endoscopic biopsy. At 11am or 3pm. So of course at 11 I call and find out he is going in. Not even 30 minutes later I get another call, Guimauve's stomach was full of food! So I get the (nice) Spanish Inquisition as to how he might have grown opposable thumbs and opened a refrigerator door to get to the canned food. For everyone's knowledge he is on z/d at the moment. z/d is a food for dogs with allergies so it is pretty much hydrolyzed chicken (easily absorbed) corn starch and water with vitamins and minerals. Guimauve practically inhales it though!

+1 on the problems list. Delayed gastric emptying. (I can't help but picture House and his white board and thinking "One of these problems is not like the others"). The food in his stomach prevented them from getting a biopsy. I talked with Dr. Costa and Marcie about our weekend strategy when I picked Guimauve up. The top of the differential list is still a protein losing enteropathy.

So we have several directions to go now. First choice was to put him on metoclopramide to treat the vomiting that occurred from a full stomach and going under anesthesia as well as increase gastric motility for the weekend. Continuation of the plan is to have him off food and medication on Sunday night/Monday morn. Then he goes through a Barium study. Barium is a mineral that will show up on x-ray or in his case fluoroscope. Fluroscope is like an x-ray type machine that gives "real time" x-rays. This way they can determine strength of gastric contractions, motility and measure the amount of time it takes for food to pass through his digestive tract.

Once the time is determined we will then know how long to fast him before the endoscope and potentially solve why he has reduced gastric motility.

Plus Guimauve is becoming a blood donor, he gets to donate again Monday for cobalamin/folate levels. These tests measure the amount of cobalamin/folate absorbed. Folate is absorbed in the proximal intestine while folate is absorbed in the distal small intestine. This may help pinpoint where the problem is in the intestine. Another test is the trypsin-like immunoreactivity (TLI) which is an indicator of pancreatic function.

So that is where we stand now!

Thanks to everyone for your good wishes and for stopping by and visiting me and Guimauve!

The Saga Continues

Yesterday Guimauve went in for some more tests. Dr. Costa (the intern working on his case, she's awesome!) told me his second bile acid test was slightly elevated but not to the point of providing any direction. His cortisol baseline was also tested to rule out Addison's Disease. It was not abnormal so they put that aside for the moment. Normal baseline cortisol levels do not completely rule out Addison's, but it is a good indication.

Addison's is a disease where the body does not produce enough cortisol which is important in helping the body respond to stress, maintain blood pressure and cardiovascular function, slow the immune system's inflammatory response, maintain levels of glucose in the blood, regulate the metabolism of proteins, carbs and fats; etc.

There was still no specific indication whether or not his problems were GI or liver related. The next decision was made to do a focal ultrasound of his abdomen (focal is cheaper and they look at only specific areas). They checked his liver, bowel loops and mesenteric lymph nodes. The liver looked normal, putting shunt at the bottom of the differential list. The bowels looked normal. His mesenteric lymph nodes were slightly enlarged. Add another problem to the list.

This gave some more options for diagnostics. Aspiration of the lymph nodes which would determine whether they are normal or not. I declined because it would not lead to a specific diagnosis. The only way to specifically diagnose what is wrong with his lymph nodes is surgical biopsy, which is not an option. Plus, they could just be enlarged due to GI issues. The other option for enlarged lymph nodes is lymphoma which is at the bottom of the differential list.

After the ultrasound Dr. Costa and I discussed the next options. Surgical biopsy of liver, lymph nodes and intestine OR endoscopic biopsy of his intestines. The pros of surgery: we get to see more and get good biopsies of everything. Cons: His low protein means lower ability to heal and he would have to be under anesthesia longer. Pros to endoscope: Get to see the stomach and intestines from the inside. Cons: Biopsies are not the best and usually not full thickness of the intestine. Cannot get biopsies of liver and lymph nodes.

Based on pocket book I picked endoscopic biopsy. I fed him about 9:30 last night and then took him in this morning. And now for part deux....

The Inevitable of Being a Vet Student

Not that many people really follow this since I am a major slacker! But for the benefit of my fellow vet students and other curious folks, I present a case. The Case of Guimauve (Pronounced Ga-move or Gi-move depending on your French accent).

Guimauve is my 18 month old papillon. When I got him the end of March he was fairly thin. The breeder stated that he was at a show facility and came back to her that thin. Got him back to Pullman and he was eating like a pig and doing great. Took him in to the vet hospital at the beginning of April for a severe cough. They put him on drugs and he got better. Beginning of May got the little bugger neutered and his teeth cleaned. Before his surgery he had gained almost half a pound! Yay! (For a dog about 4 lbs that is quite a bit)

I took him to Spokane and left him for a bit so he could adjust to farm life and socialize with some other dogs. Mum began to worry because he had a gastrocolic reflex of a puppy which he did not have when I got him. Gastrocolic reflex is the reason why puppies have to poop 20-45 minutes after they eat.

Mum took him to a vet in Spokane on June 8th. They ran a fecal and it came up negative for parasites. Vet advised her to continue as she was.

I talked with the breeder on 6/21 to see if she had any knowledge of something similar in any papillons. I was informed that coccidiosis was found in Guimauve's littermate and one of her other dogs.

On 6/22 mum took him to the holistic/acupuncture vet in Spokane. He had been depressed for a couple of days and she was still concerned by his lack of weight gain. The holistic vet determined he had abdominal pain and bradycardia (low heart rate) and he needed to get some blood work done and possibly an abdominal ultrasound to determine liver or GI disease.

Mum brought him to Pullman and we took him to the hospital. The doctor looked him over and determined a basic chemistry profile and CBC were warranted. Some of their differentials included a Protein Losing Enteropathy which is a condition of the GI tract that causes a net loss in proteins, liver shunt, fat malabsorption (pancreas) and parasites. Also, she took blood for a fasting bile acid level test. The acid bile test came back as not too high but enough to get the second bile test that evening.

When I took him in that evening I was informed that his albumin was very low. Normal is 2.5-4.3 and his was 1.6. Albumin is a protein that is produced by the liver. It is the main protein in blood plasma and is very important in transport of things through the blood as well as platelet function. Needless to say hypoalbuminemia is bad.

Today (6/23) I am waiting on bile acid test #2 results and fecal results. Next step is possible intestinal biopsy via endoscope. Funny part of all this is the fecal samples and, if the biopsy is performed, those samples will all go to the lab I work in, WADDL. Not my specific division, but just the lab next door.

Well ladies and gents, there is a case study for you! I will keep you updated as things progress.