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Dr. Karing
Dr. Karing, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 429
Experience:  General veterinarian with a special interest in internal medicine and emphasis on individualized care.
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I'm looking second opinion regarding my dogs x-rays. He

Customer Question

Hello, I'm looking for a second opinion regarding my dogs x-rays. He is a 10 yr. old male, 60 lb German shorthaired pointer, who has had a healthy. He began developing a cough which would occur once or twice a day, (mostly upon exercise) he'd gag and spit
out a small amount of foamy saliva, then he'd be better. I also noticed him panting more when excited or after running, however, that would end with a cough or he'd just relax and the panting would subside. Sometimes when laying on his side I would notice
the rear of his ribs expand and retracting the skin between them, then drop harshly when exhaling, that would go on until he fell asleep, then he'd breath normally. I took him to the vet and explained this, he could hear noises in his lungs so he x-rayed his
chest. He was prescribed 10 mg of prednisone twice daily for 4 days, then once daily for 3 days, then every other day until gone (20 pills). Also on 150 mg of antibiotics, 14 days. He had a great night last night (started prednisone yesterday at 5:30) and
having a great day today, breathing much better and almost no cough and no wheeze or stridor. I would appreciate your professional opinion of his x-rays and what you think he may have. thank you!
Submitted: 1 year ago.
Category: Dog Veterinary
Customer: replied 1 year ago.
here are the x-rays
thank you.
Expert:  Dr. Karing replied 1 year ago.

Hi there,

I'm Dr. Karing and I would be glad to help with yourquestion. The x-rays reveal nodules in the lungs as well as lymph nodeenlargement at the heart base (the area marked red on the attached image iswhere these lymph nodes are located) and enlarged sternal lymph nodes as well(green on the attached image). The mediastinum (blue on the attached image) iswidened and I suspect lymph node enlargement there too. Metastatic cancer (i.e.a cancer that originated elsewhere in the body and spread to the lungs) is themost likely cause of these findings. Some infections might cause this (i.e.fungal infection) but usually there is fever, depression and an elevated whiteblood cell count.

The next logical step would be to run blood work (i.e.chemistry profile, complete blood count and urinalysis) as well as to image theabdomen (x-rays and/or abdominal ultrasound). If the primary tumor can beidentified in the abdomen, then perhaps a small sample of cells can be takenwith a needle and sent to a pathologist in order to make a diagnosis. If therearen't any obvious masses in the abdomen, then it may be possible to perform aneedle aspirate from the chest lesions. The benefit of getting a specificdiagnosis from a cell sample is that chemotherapy can be helpful depending onthe type of cancer present. Steroids such as prednisone can help significantlyfor a short time. Usually, with steroids alone, survival is only about 2 monthsfor most dogs. You may consider taking Buster to an internal medicine specialistif you would like to pursue the additional diagnositcs I've suggested: time isof the essence if you want to be more aggressive with with treatment.

I'm very sorry that Buster is having this problem. In anycase, I hope that the information I provided has been helpful. Please rememberto select REPLY TO EXPERT if you have more questions or would likeadditionalinformation. It is my goal to provideyou with the most completeinformation possible prior to you leaving a feedbackrating. If you received alltheinformation you needed, then kindly submit a rating.


Dr. Karing

Expert:  Dr. Karing replied 1 year ago.

The image I wanted to attach will not upload but you can view it here

Customer: replied 1 year ago.
Thank you,
How hard is this treatment on him?
Expert:  Dr. Karing replied 1 year ago.

Chemotherapy is not a great option for all kinds of cancer but is very effective in others. In dogs, chemotherapy doses are such that the side effects are not too severe for most patients. The most common sides effects are nausea, vomiting and diarrhea but very infrequently other more serious side effects such as bone marrow suppression occur. Some drugs are known to very rarely be toxic to the heart, liver or kidneys. Most veterinarians prescribing chemotherapy will send home some medications to help alleviate nausea or diarrhea if those occur. It is also very common to reduce drug dosages or eliminate a drug altogether if it is poorly tolerated. The hardest part of chemotherapy for most dogs is that it requires frequent visits to the vet: often times placing an IV catheter in order to get the injections intravenously and returning for lab work frequently. All that being said, it is very important to know what kind of cancer you are dealing with and how likely it is to respond to chemotherapy so you can make an informed decision about the risks/benefits for Buster. Please let me know if you have other questions.

Customer: replied 1 year ago.
Not casting doubt on you're professional opinion, and I appreciate you're help, but you are the only vet that ruled out a lung infection in lieu of cancer.
Here's a link that was provided by another Dr.
quote, "For what it's worth, my subjective opinion based on these x-rays is they do NOT look overwhelmingly suspicious for cancer. That usually has more discreet spots that look like little balls in the lungs".7e8be149-2098-44c4-abea-67a9da6d7df7_cancer-lungs-mestastisize-xray.jpg86b5ab71-08b2-433d-84a1-a3650162fe63_Pneumocystis-x-ray.jpgCan you please clarify this for me?
Customer: replied 1 year ago.
Expert:  Dr. Karing replied 1 year ago.

Nodules can take on many different appearances and all ofthem aren't very obvious "little balls." I do appreciate many noduleson the films you provided and I circled a few of the most obvious ones. Suchnodules in the lungs are one of three things: neoplasia (i.e. cancer),abscesses or granulomas (scars, fungal lesions, etc.). I haven't ruled outinfection but as you'll see I stated that "some infections might causethis (i.e. fungal infection) but there is usually fever, depression and anelevated white blood cell count." Since your dog is elderly (i.e. higherlikeliehood of cancer), not exhibiting any signs of illness other than a mildcough and he is dramatically improved after one or two doses of steroids,cancer is the most likely cause of the nodules. Fungal disease is still on mylist but much lower. There is very little chance this is bacterial. I didadvise further work-up to learn more about the problems including lab work toevaluate the metabolic health of Buster, but I do believe he most likely hasmetastatic cancer. You can also see this link for an example of metastaticsquamous cell carcinoma and you will see the nodules aren't super obviouslittle balls.

images to follow

Customer: replied 1 year ago.
Feline? Can the two be compared?
Expert:  Dr. Karing replied 1 year ago.

Yes, you can compare. It's hard to find an image with the nodules marked. Here is a canine example without the nodules marked:

it came from this website

I am unable to attach the image of Buster's x-ray where I circled the nodules. I tried several times but it won't upload and says there is an error

Expert:  Dr. Karing replied 1 year ago.


I wanted to check in and see how Buster is doing. Is he breathing more comfortably? I also wondered if you have elected to pursue futher diagnostics or treatments for him.

Please let me know when you have a chance. I'm hoping the steroids are helping him with his problem.

Thanks so much,

Dr. Karing

Expert:  Dr. Karing replied 1 year ago.
I'm just following up on our conversation about Buster. How is everything going?
Dr. Karing