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DrRalston
DrRalston, Dog Veterinarian
Category: Dog Veterinary
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Experience:  Over twelve years of internal medicine, surgery, and preventive care.
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My 11 year old dog has edema in all four extremities. The

Customer Question

My 11 year old dog has edema in all four extremities. The rear legs started in 2009, the front ones about 3 months ago. They look like tree trunks legs. lasix 50 mg bid does not work, neighter is Rimadyl. legs are swollen especially in the hock areas with lumpy appearances. CBC and CHEM profile normal except elevated alk.phosph. CXR and abd. xrays normal. No surgeries or any traumatic injuries in the past. Negative hearworm test, lyme and rheumatoid test. I think it is lymphedema vs chf. lymphoma? How to decrease swellings in his legs ? tubigrips for the dog? should he get more tests? echo maybe and abdominal us?

Thank You,

Sylvie
Submitted: 3 years ago.
Category: Dog Veterinary
Expert:  DrRalston replied 3 years ago.
Hello, welcome to JustAnswer! I am a Veterinarian and will help you right away!

Lymphedema is a definite possibility. I would wonder though if there is any localized lymphnode inflammation.

Prednisone helps this type of inflammation greatly.

Cardiac ultrasound would show you abnormalities with heart flow. Remember that not all cardiac disease will have an audible murmur for the Veterinarian. So, I think ECHO is a good idea of the heart next but more simply a blood pressure check would be good as well.

Then the abdominal ultrasound paying specific attention to the lower abdomen, lumbar spinal region, and any area which might be causing edema in the rear limbs.

What type of dog is your dog? Some dogs have problems with edema like Sharpeis?

I definitely think steroids might be an option.

I doubt lasix will help if the edema is not cardiac derived. Tissue edema doesn't usually respond well to lasix, especially in the rear limbs. Just dehydrates the animal.
DrRalston, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 2098
Experience: Over twelve years of internal medicine, surgery, and preventive care.
DrRalston and 8 other Dog Veterinary Specialists are ready to help you
Expert:  DrRalston replied 3 years ago.
I have another question, has your pet travelled much? Especially mediterranean areas?
Expert:  DrRalston replied 3 years ago.
Was the total protein level in the blood at normal levels, specifically was the albumin?
Customer: replied 3 years ago.
No, he has not been traveling outside the state of Wisconsin. His total protein and albumin were normal.
Expert:  DrRalston replied 3 years ago.
Hopefully those tests have been repeated since 2007 to be sure right?

High ALP can be related to liver disease. If this was the case, I ask about the protein levels especially ALB because ALB is made in the liver. If the liver wasn't making it, protein in the blood drops, and liquid starts to leak out of the vessels due to osmotic pressure in the vessels. Essentially, protein is what keeps the concentration of the blood high enough to keep fluid in the blood and not leaking into the tissue.

But, that doesn't sound right. Protein losing enteropathy and nephropathy can be from diarrhea (bowel disease or inflammation) or kidney disease. The blood work and urine would have shown most of that though.

So, the other two major causes would be lymph or cardiovascular.

Ultrasound will show heart related disease and obstruction as we have discussed.

There are even more specialized tests of the lymph which involve injecting constast dyes and taking xrays of the lymph. Aspriates of the lymph might help too. This would likely be done by internal medical specialists instead of at your regular vet.

If blood work hasn't been repeated in a long time, I would definitely go ahead and repeat those tests and then head to the ultrasound. They might be able to do both the abdominal U/S and the ECHO at the same time.
Expert:  DrRalston replied 3 years ago.
What bothers me about cancer as an alternative is the 4 year history. I think that would be unlikely. Even for lymphoma.
Expert:  DrRalston replied 3 years ago.
MYXEDMA is that type of edema I was speaking of in certain breeds, especially sharpeis for some reason. Just has to be the type of protein they have in the tissue pulls fluid into the tissues out of the blood stream.

Fluid follows protein is a general rule that can be applied.

Another reason to repeat the blood work is this. Even if your pet's values fall within a normal range, it might not be normal for YOUR pet. Those values are based on 95% of all pets tested. Your pet may fall into the other 5%.

SO, if bloodwork and tests are old: repeat them.
Customer: replied 3 years ago.

The blood work was done 3 weeks ago. I will call my vet for prednisone. Would injection of Solumedrol be more helpful as a start?

 

Thanks a lot,

 

Sylvie

Expert:  DrRalston replied 3 years ago.
You bet Sylvie, good luck with this.

We usually use depomedrol, but yeah it might help. Problem is it can't be adjusted once it has been given. That's why sometimes I think oral pred is a better route. You can start higher and then if you have response bring it back.

Nothing wrong with massage either to reduce the edema, squeezing from the most distal portion of the leg at the toes up to the body to squeeze fluid back up. But, that might not actually work.

The long history of this one is really fascinating.

Unfortunately, if the blood work is normal, and the protein is normal, it still leaves strange protein in skin disease, lymph obstuction (or bad lymph valves), or cardiac disease.

Best of luck with this, please keep me up to date on further developments if you would.

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DrRalston
DrRalston
Associate Veterinarian, NBVME & CSBVM
1647 Satisfied Customers
Over twelve years of internal medicine, surgery, and preventive care.