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Dr., I finally decided to ask for that second radiologist

Dr. B, I finally decided to...
Dr. B,
I finally decided to ask for that second radiologist report since the first one was so vague.
I am including it. The common demoninator between the two is pneumonia. One says the infiltrates are atypical and the other just says pneumonia should be considered as the first consideration. The second one does refer to some possible soft tissue nodules which was not mentioned in the first one. These could be neoplasia or lymphoma. But if they are the cancer nodules, what are all the infiltrates? Dolly had so much fluid that it ran out of her mouth when they tried to revive her. Dolly's vet said that aspirated material usually moves by gravity to the ventral area by the sternum. Is that correct? The first rad report says the worst infiltrates are in the caudorsal lungs and the ventral aspect of the cranial to mid lungs. Is that compatible with or counter to aspiration? It looks like from these two reports that pneumonia is considered in both and possible nodules are mentioned in one. Drugs and the anal gland problem are not mentioned. So I have to think that she either inhaled some of the liquid and it caused pneumonia or she had a silent malignancy or both. What is your assessment now that we have this additional report? Much of it I don't understand. Findings: In the thorax, there are severe alveolar infiltrates in all lung fields. Air bronchograms are seen extending into the periphery of the lung and all directions. Evaluation of the heart is somewhat limited however there does appear to be mild enlargement of the right heart. The left atrium does not appear to be enlarged. There is narrowing of the mainstream bronchus seen on the lateral view. There is equivocal evidence of diffuse soft tissue nodules within the lung fields however evaluation is limited because of the overlying pulmonary alveolar infiltrate. There is mild narrowing of the cervical tracheal lumen. Conclusions: diffuse severe alveolar infiltrates. Pneumonia should be considered. I cannot rule out underlying neoplasia or possible pulmonary lymphoma. Cardiogenic edema is considered unlikely as there is no evidence of left atrial enlargement. The prominence of the right heart could be secondary to the breed however tricuspid insufficiency is also possible. I do not see abnormalities in the abdomen.
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Answered in 15 hours by:
10/8/2016
Dr. B.
Dr. B., Veterinarian
Category: Dog Veterinary
Satisfied Customers: 21,659
Experience: Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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Hello again,

I am currently away this weekend, but did want briefly answer your question.

Infiltrates and nodules often tend to refer to the same thing. As well, neoplasia is cancer and lymphoma is just one type of cancer.

In regards ***** ***** concerns, it does tend to start in the top part of the lungs and go ventral with gravity in the top region. Where the “infiltrates” in the xray/report were in the wrong part (top back, middle) for fluid. So, it reduces the aspiration suspicion again and rules our your suspicions of inhaling anything. And I’d note for them to say they cannot rule out neoplasia but have to consider pneumonia (which we all have to since infection in the lungs is so common) this makes your aspiration fears completely unfounded and should give you peace of mind that the Miralax had nothing to do wither signs.

Kind regards,

Dr. B.

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Customer reply replied 1 year ago

Please don't worry about responding until you return next week. But I wanted to go ahead and post my questions. I hope you found this new rad report to be much more informative than that first one. I wish I had asked for another report sooner. Even though it considers pneumonia, you don't think she had pneumonia, right? In the US, for some reason, infiltrates and tissue seem to be viewed as separate. Can you explain a little more when you have the time about what the report actually says as it says so much more than the other and I understand little of it. Would the fluid that drained from her mouth upon CPR have been compatible with the cancer and have developed from the cancer decompensation? The initial rad report said that the infiltrates were worst in the "ventral aspect of the cranial to mid lungs". Aspiration usually falls down due to gravity and typically has a heavier concentration in the ventral areas near the sternum. Would that be what the rad report said or am I totally confused? You said the infiltrates were in the top back, middle, but doesn't ventral means front like the chest? I know I must be confused. "Going ventral with gravity in the top region" is how you explained aspiration to me. Very confusing. With use of "ventral", it sounds like it would be in the same place, but apparently isn't. Where exactly would the aspirate go? I want to know what the x rays and reports mean, but I'm so confused. I know you said when you saw Dolly's x rays that they were wrong for aspiration, but I don't think you told me why. To me it sounds like the worst of the infiltrates were right where the aspirates would have ended up, but am I wrong? Is aspiration still definitely ruled out? With the two rad reports, is met. lung cancer still your top dx? I remember you said you once lost a dog to ARDS that had lymphoma. And just a thought, if her mouth was not held closed and remained level and she didn't swallow it, wouldn't the 1/2 cc liquid have just rolled out of her mouth when I opened her teeth to give her the next dose? Her chin was wet when I stopped. Thank you. Sorry to be so confused. This new report gives me another chance at closure and I want to be sure that I understand what you tell me.

Hello again,

Since your paragraph is a jumble of quite a lot of questions, I will separate them and touch on each briefly.

Even though it considers pneumonia, you don't think she had pneumonia, right?

Her sudden onset signs make pneumonia less likely here so that wouldn't have been on top of my differential list.

In the US, for some reason, infiltrates and tissue seem to be viewed as separate. Can you explain a little more when you have the time about what the report actually says as it says so much more than the other and I understand little of it.

Tissue and infiltrates are different. Its nodules and infiltrates that often are the same. If you meant those were different contextually, then I suppose they are trying to differentiate between abnormalities on and inside the lung tissue. Though as x-ray is two dimensional that would be difficult and not really change anything diagnostically. As for interpreting the

Would the fluid that drained from her mouth upon CPR have been compatible with the cancer and have developed from the cancer decompensation?

Yes, it would.

The initial rad report said that the infiltrates were worst in the "ventral aspect of the cranial to mid lungs". Aspiration usually falls down due to gravity and typically has a heavier concentration in the ventral areas near the sternum. Would that be what the rad report said or am I totally confused?

Dorsal is towards the back, ventral is down or towards the belly. Cranial is towards the head and caudal is towards the tail. Ventral aspect of the cranial to mid lung just means the bottom of the lung tissues closer to the head and middle of the chest. I think my spell check on my phone (all I had on me and why it was difficult to answer this weekend) may have been playing up there. Aspiration though tends to be cranial lobes but dorsal and ventral, where this goes further back and doesn't have that pattern.

If her mouth was not held closed and remained level and she didn't swallow it, wouldn't the 1/2 cc liquid have just rolled out of her mouth when I opened her teeth to give her the next dose?

It would have rolled out.

The first rad report says the worst infiltrates are in the caudorsal lungs and the ventral aspect of the cranial to mid lungs. Is that compatible with or counter to aspiration?

No, because again we expect aspiration to lead to cranial dorsal and ventral signs not caudodorsal ones.

It looks like from these two reports that pneumonia is considered in both and possible nodules are mentioned in one. What is your assessment now that we have this additional report?

My assessment hasn't changed. As I noted, pneumonia is always an x-ray differential when we are looking at lungs. But the pattern looks more like neoplasia to me.

Dr. B.

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Customer reply replied 1 year ago

Can you tell me something about what things like the bronchograms and narrowing of the mainstream bronchus and cervical tracheal lumen, etc. were caused by and actually mean? What could tricuspid insufficiency have caused? The first rad report didn't give any of that detail. You are the only one that I trust to explain where I can maybe understand. You did not finish "as for interpreting". Did she have signs of aspiration in the cranial and mid lungs and then more secondary infiltrates (caudodorsal) or no signs of aspiration at all? I guess the key to it all is if she aspirated because maybe that could have caused the secondary infection/infiltrates from bacteria in the liquid or if the miralax was toxic to her lungs, which you believe it would not have been. It seems that the nodules would not have been caused by any of the interventions prior to her death. The terminology is difficult. I want to understand what happened to her as much as I can ascertain with x rays and not pathology. I thought the new report might help clarify. Dolly's vet had a 10 month old who vomited and died the next day of pneumonia with no signs until inability to breathe. So that was confusing to me wondering did he vomit because he was developing pneumonia or did the vomit cause the rapid pneumonia without symptoms. And there is a dx called acute onset ARDS that is confusing too. The nodules in the new report could indicate that something had been going on with her for a while. Do they get fatty tumors in the lungs or was it likely a cancer of some type?

Hi again,

Air bronchograms just mean that there is air trapped in the bronchi. This can be secondary to inflammation or infiltrates compressing or within the airway. As well, if there are narrowing in the trachea or bronchus that isn't necessarily significant and could just again fit with inflammation or be related to when they took the x-ray (if she was breathing in or out). And just disregards the "as for interpreting," as I had started that answer with it, went back, and then forgot to remove it. Sometimes I think too fast and my fingers cannot keep up :P

In regards ***** ***** growths, we don't see those nor really benign masses in the lungs. Only growths caused by cells of the lung tissue or from other metastatic cancers spreading to the lungs via the blood. So, growths in the lungs is more often than not cancerous. As for tricuspid insufficiency, heart issues like valve based disease tend to cause fluid build up or dilation of the vessels around the lungs if anything in the lungs. Finally, it doesn't appear that she did have any signs (and we'd not see secondary infectious issues that quick in adult dogs, who are quite different then pups in their immune strength and their ability to guard their airway) since neither report nor the x-ray showed the pattern we'd expect as we have noted before.

Kind regards,

Dr. B.

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Customer reply replied 1 year ago

That information helps. So with the new rad report information, it sounds like you are even more convinced of the cancer dx with no aspiration, secondary infection or drug reaction/allergic reaction occurring at all, but inflammation, edema and fluid - essentially ARDS w/o warning from the cancer decompensation. I do remember the patient you had who had lymphoma and you saw him in the morning and his lungs were fine and in the afternoon, he returned in extreme respiratory distress from the cancer spread.

Good, I am glad it does.

Yes, the second report even more so brings us away from those other differentials and does support my suspicions here.

Kind regards,

Dr. B.

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Customer reply replied 1 year ago

That is good. I know you once talked about studying the x rays for signs of inflammation possibly from allergy to meds. Does the new report give you further information about that possibility as well? I know Dolly's vet said you always have to consider med reactions, I guess like you always have to consider pneumonia.

Good morning

The new radiograph report excludes that for us.

Best wishes,

Dr. B

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Customer reply replied 1 year ago

I have one more question and then I will try to quit bothering you.

What are the chances that Dolly, with the nodules, still died of pneumonia?

Customer reply replied 1 year ago

Sorry I hit save instead of the enter button.

What are the chances that Dolly, with the nodules, still died of pneumonia?

I have one more question and then I will try to quit bothering you. I know you said that you thought that most of Dolly's health problems were related to her thyroid and alopecia issues and that Dolly's age when she began to develop those problems was about the age that problems began in a dog's life. Is Alopecia X a common problem? I seem to hear about it more. Dolly loved to give the kids at school kisses on the hands and I worry if she might have picked up something that could have caused those problems. Gabby loves to kiss too and no matter how much I watch her and tell her no lick, she still manages to get the kisses in. I worry about everything since losing Dolly and can't really enjoy Gabby..

.

Good evening,

It is possible but given how rapidly her signs progressed without warning, its doubtful. And it is rare a dog picks up pathogens from interacting as she did. Its dogs that eat feces and nasty things like that that we’d be worried about. Otherwise, in regards ***** ***** X, its not common but I think its being seen more due to being a genetic issue (where some breeders are careless, allowing health issues into breed lines) and being recognized more. So, its not common but we may be seeing an increase and an increased recognition.

Kind regards,

Dr. B.

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Customer reply replied 1 year ago

So even if it were pneumonia, you still don't think it was caused by aspiration or that it caused the nodules in her lungs. Dolly's vet doesn't believe it was pneumonia either because of lack of symptoms. I think that like you said the cancer just brought her down. Do you think it was more likely met.lung cancer or lymphoma? She didn't have symptoms like weight loss, no appetite, excessive thirst, etc. Just suddenly crashed. Kids, nursing home and hospital patients pet and hold the dogs and the dogs lick their own fur, feet, etc. as well as the people and walk on the floors, so I am sure they come into mouth contact with some feces, urine, pathogens, etc. The pathogens in those nasty things that you mentioned - what problems/diseases/parasites would they cause - they would not cause problems like hypothyroidism and alopecia? Maybe like you told me, the time she developed them was the time in her life when she would have anyway. And there are genes. If her blood work and organ function always tested good, would that be a good indicator that she had not picked up anything in the way of infection? And I don't think contact with such would cause lung cancer or pulmonary lymphoma?

I believe they are more environmentally caused - carcinogens, medications, vaccines, chemicals, water, air, food - the same that are killing us. If I keep Gabby, I want to be able to enjoy her without worrying about her constantly.

Customer reply replied 1 year ago

Copied because they closed the questions. So even if it were pneumonia, you still don't think it was caused by aspiration. I read there is an acute onset type. But that wouldn't have caused the nodules in her lungs. I think that like you said the cancer just brought her down. Do you think it was more likely met.lung cancer or lymphoma? She didn't have symptoms like weight loss, no appetite, excessive thirst, cough, etc. Just suddenly crashed. Kids, nursing home and hospital patients pet and hold the dogs and the dogs lick their own fur, feet, etc. as well as the people and walk on the floors, so I am sure they come into contact with some feces, urine, etc. The pathogens in those nasty things that you mentioned - what problems/diseases/parasites would they cause - they would not cause problems like hypothyroidism and alopecia? . If her blood work and organ function tested good, would that be a good indicator that she had not picked up anything in the way of a serious nature? Wouldn't an infection have shown up on blood work? And if she had any kind of chronic infection, wouldn't it have shown some symptoms like cough, etc.? And I don't think it would cause lung cancer or pulmonary lymphoma? From what I have read, pulmonary lymphoma is fatal rather quickly with no treatment. I really believe from reading vet articles that Dolly's problems were triggered by her vaccinations. She was perfectly healthy until a few months after her dental and her booster shots and that is when she developed hair loss and we found the thyroid problem, which did not help the hair loss and so eventually alopecia x was dx. I think it progressed from there. I know they are more environmentally caused - carcinogens, medications, vaccines, chemicals, water, air, food - the same that are killing us. I want to be able to enjoy Gabby without worrying about her constantly.

Pneumonia doesn't require aspiration and neither would cause nodules. So, I do feel a cancer in the lungs potentially spreading from another organ was the cause of death. And I was saying dogs that eat large volumes of these may be at risk, not causal exposure as you noted. So, I don't think that played a role at all nor caused her other signs. And yes if she wasn't unwell and has bloods were normal that would make that even less of a concern. Furthermore, while cancer won't be detected in bloods and often is silent, no exposure in her life would have caused that. And I completely and utterly disagree with your thoughts on this having been related to vaccination not even her genetic issues with Alopecia X. Yes, our lifestyles can be filled with carcinogens but rarely do we see that cause issue for our short lived companions …partly because they don't partake of the vices we do and partly because they don't often even life long enough for those things to cause them issue.

Dr. B.

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Customer reply replied 1 year ago

Thanks for the information about vaccinations. I am so sorry. I did not mean to annoy you. I was told by a vet that on rare occasions a vaccine can disrupt the immune system and it results in autoimmune problems like Dolly had., What do you think could have caused the endocrine system breakdown and then cancer? None of her parents, sisters or brothers from the same bloodline have had alopecia, hypothyroid or cancer. I am friends with the breeder who keeps in touch with many of the owners and actually showed Dolly's sister who is now 10. I use no chemicals on the yard and only vinegar and steam in the house and no chemicals on the dogs. I have never had a dog with cancer before. What else can I do to make it safer? What you say makes sense and I have to keep Gabby's vaccinations current if I want her to be a therapy dog. And your assessment makes me think I can do that safely, especially if she does not receive multiple ones at the same time.. And I don't need to be concerned if Gabby kisses people either. Thank you. I think I will be ok now. The radiologist validating all the vet's suspicions was what I needed to accept what happened because I know you all have respect for radiologists and you are all on the same page with this case. The other rad report was superficial and really worthless in terms of validating anything with Dolly's situation.

Customer reply replied 1 year ago

Thanks for the information about vaccinations. I am so sorry. I did not mean to annoy you. I was told by a vet that on rare occasions a vaccine can disrupt the immune system and it results in autoimmune problems like Dolly had., What do you think could have caused the endocrine system breakdown and then cancer? None of her parents, sisters or brothers from the same bloodline have had alopecia, hypothyroid or cancer. I am friends with the breeder who keeps in touch with many of the owners and actually showed Dolly's sister who is now 10. I use no chemicals on the yard and only vinegar and steam in the house and no chemicals on the dogs. I have never had a dog with cancer before. What else can I do to make it safer? What you say makes sense and I have to keep Gabby's vaccinations current if I want her to be a therapy dog. And your assessment makes me think I can do that safely, especially if she does not receive multiple ones at the same time.. And I don't need to be concerned if Gabby kisses people either. Thank you. I think I will be ok now. The radiologist validating all the vet's suspicions was what I needed to accept what happened because I know you all have respect for radiologists and you are all on the same page with this case. The other rad report was superficial and really worthless in terms of validating anything with Dolly's situation.

You are very welcome,

Please know that I wasn’t annoyed, its just something I see owners focus on but the reality is that it is very, very rarely involved and an adult dog with a lifetime of vaccination won’t be a dog where that is an issue. So, its really not something we’d even consider here.

And in Dolly’s case, her endocrine issues sound genetic (so it goes back to her breeding line even if not in her immediate family, which isn’t unexpected since it is one of the more rare genetic issues that we are just recognizing more these days as medicine advances) and cancer can be caused by a range of things even for us. So, its not really something you can modify your life or their lives to avoid. You just need to go forward from this and be vigilant with Gabby. And I am glad that you do plan to keep Gabby up to date on her vaccines since I see a lot more Parvo and Distemper (and adenovirus too these days) from people not vaccinating then I see complications from them. And it breaks my heart since those threats are so much more common and a risk for them.

Kind regards,

Dr. B.

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Customer reply replied 1 year ago
Let me close with a summary. See if I am on target. Nodules and tissue are different. So would the nodules the radiologist saw have been tumors in the tissue? The rad report said he could not rule out cancer. What else could it have been if not cancer nodules/tumors since they don't get fatty/benign tumors in the lungs? And you think this was more likely met. lung cancer than pulmonary lymphoma? Dolly's endocrine problems were likely genetic, although perhaps reccessive and not apparent in her close family. Could years of her endocrine problems and/or the many meds like fungal txs she received have lead to the development of cancer? Neither Dolly's endocrine problems nor cancer would have been caused by Dolly licking residents/patients/kids hands and I do not need to be concerned if Gabby gives kisses. Just keep her vaccinations up to date and feed her as healthy a diet as I can find. Being a rescue I have no info about her genetics, so I will just have to deal with whatever the future holds. Did I get it right?

Yes, I think you have it.

Nodules are abnormal tissue growths that should not be there. Cancer is the most common type of nodule present. Fungal infection would be the other concern but was ruled out by your vet given your region. In regards ***** ***** type, both are possible but metastasis is more common. Otherwise, you are right that she may have had some recessive gene causing those other issues but the treatments themselves nor human contact predisposed her to cancer. So,its fine for Gabby to give kisses, kept up on vaccines, and kept healthy to ensure she lives to her full potential with you.

Best wishes.

Dr. B.

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Customer reply replied 1 year ago
Thanks so much. I have read that cancer in small breeds is less common than large breeds. But in your years of experience do you find cancer to be very unusual in small breeds like Chihuahuas or do you find that the cancer that happened to Dolly is not that out of the ordinary? Can you give me just a guess as to how long it might have taken Dolly's cancer to develop? I don't know if it takes weeks, months or years. I think you mentioned months one time, so I suspect it is probably a few months, but would just like to have a perspective on it. Thanks.

You are very welcome,

I see nearly as much cancer in small breeds than larger ones, so it is not unusual at all and her situation isn't out of the ordinary. There is no way to know how rapid a cancer grew without analysis of its cells to see how quick it was dividing. So, it coul dhave been weeks to months to years. We cannot know without that extra analysis but months would be a mid-range/average to work from without that information.

Take care,

Dr. B.

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Customer reply replied 1 year ago

Thank you. You are so kind and patient. I am really trying to accept the cancer diagnosis, but still have a question and I know you can tell me. You know what things look like. I had never seen anything until Dolly's x rays. You said that most nodules in the lungs are a malignancy. What are pulmonary calcification and ossification nodules? I know they happen sometimes in older dogs and have read also perhaps in dogs with hyperadrenocortical situations - the Alopecia X?. The radiologist did not mention calcification, but said he could not rule out cancer, so would they look similar? Do mineralization nodules look differently than the cancer ones? If they are diffuse in the lungs as these were, do they look different and are not like the cancer nodules? Just trying to tie up loose ends in my mind.

You are very welcome,

Both of those types of nodules look very different then cancerous ones. Both will look white like bone (which is also made of calcium), so they are very obvious when present and something we didn’t at all see on her xray.

Take care,

Dr. B.

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Customer reply replied 1 year ago
OK, Dr, B, I am going to try to accept that in spite of the several coincidences that occurred around Dolly's death, that she actually died from lung cancer. The nodules are strong evidence. I am also trying very hard to overcome the reoccurring fear that still haunts me that I gave her aspiration pneumonia, although you have told me that is not the case. That was the biggest coincidence and has been the most difficult for me. And thanks so much for always helping me.

You are very welcome my dear and I faith you will find peace with this,

Best wishes,

Dr. B.

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Customer reply replied 1 year ago
the dx is 1) ARDS due to metastatic lung cancer 2) (would you list pneumonia or drug allergy?) and 3) NO aspiration - I so want to believe no aspiration. And she could have actually gone to bed symptomless and developed the ARDS in a couple of hours. Am I right? If so, I will concentrate on this and try to move more forward with Gabby. Thanks so much.

Yes to 1 & 3, where 2 I'd not put drug allergy on my differential list but would leave pneumonia since we cannot rule that out without an autopsy. And she could have developed this acutely with no warning before.

Best wishes and a peaceful evening,

Dr. B.

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Customer reply replied 1 year ago
But if she had pneumonia, didn't you tell me she would have had some kind of symptoms and that is why you didn't think she had it? I didn't know that adult dogs suddenly died of pneumonia without any warning symptoms. And if she did, then that makes me worry about aspiration and the meds 24 hours before again? And if pneumonia, what would that mean for the significance of the nodules?

Most of the time, they will hacv signs. But as we are discussing xrays and you were listing differentials, I left it on since we cannot fully exclude it. It is unlikely with the nodules but would be a differential without a post mortem examination. In regards ***** ***** situation and signs specifically, it is not likely.

Dr. B.

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Customer reply replied 1 year ago
If she had pneumonia without warning, then that would make me worry again about the meds and aspiration 24 hours before. You still are very comfortable that she didn't aspirate and get aspiration pneumonia right? And if she did have pneumonia what would then be the significance of the nodules? I think I hear you saying that pneumonia would always be listed because it was a lung issue. I think you are comfortable that she indeed had cancer.
that is what I am saying as we have said before. :) And as I have said from the day I saw her x-rays, these nodules look like cancer. Pneumonia wouldn't have had nodules and this has never look liked aspiration. So cancer would be my primary differential for wee Dolly.
Have a peaceful evening,Dr. B
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Customer reply replied 1 year ago
Thank you. Have a wonderful weekend. And I promise not to bother you!

You are very welcome & you have a lovely weekend too. :)

Dr. B.

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Customer reply replied 1 year ago
I will share this with you because it illustrates so beautifully what we have experienced in our search for what happened to Dolly. I happened across a Just Answer on the Internet and pulled it up. It was from one of Just Answer vets - a critical care emergency care vet. The question that was asked about was from a lady whose vet had told her her dog had lung cancer. She wanted to know if there was a way to find out if it was cancer or fungal before she decided what to do. The JA vet suggested that she get a radiology consult. The lady replied that had already happened and it suggested lung cancer as well. So she asked if she was grasping at straws. The JA vet responded he thought so and that many vets can tell the difference and a radiologist specializes in such distinctions and while she could have a biopsy done, he thought that she had the right answer already. Well, in our case, the vets thought cancer, the radiologist leaned toward cancer and did not even mention fungal. It was good to get the radiology report that supported the vets. So I guess we have the right answer as well.

He was quite right there and I think we have found our answer too.

Kind regards,

Dr. B.

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Customer reply replied 1 year ago
Thanks to lol who helped me find the answer, I am comfortable that I know what happened to Dolly. I still have one thing that I still regret. After Dolly fainted and I first handed her to the vet, I never saw her again while they were treating her and until some time later when she stopped breathing and they could not revive her and we stopped her heart. I was in a little room by the treatment area. I wonder if after she regained consciousness and during her remaining time if she thought I had abandoned her. At one point the vet said something about hypoxia. She said if she could have revived her, it probably wouldn't have been "my dog". Would she have been aware enough during that treatment time to be afraid because I wasn't there or was she just struggling to breathe and somewhat in a fog? Or was our bond so strong that she didn't think I had left her? I feel so bad that I didn't just insist upon seeing her, but I think I was just in shock by then.

Good afternoon,

Shock was undertandable in such a situation. And I know it was hard letting her go then, but it was the right thing to do and you could not have know she was deteriorating as quickly as she was. If she was hypoxic (meaning her brain hadn't enough oxygen), she likely would not have been mentally aware of anything and would not have known if you weren't there and that she herself was passing away. So, she likely hadn't any stress and would have basically been faint until she just slipped away from consciousness. Finally, just in regards ***** ***** they said about not being your dog if they revived her, they meant brain damage from oxygen deprivation could have caused mental changes but also left her unable to walk or a vegetable. So, if the brain had been starved of oyxgen at the end, it was right to let her go.

Please take care,

Dr. B.

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Customer reply replied 1 year ago

.

Customer reply replied 1 year ago

Thanks. At one point, they told me she was stable, but critical. But she just kept getting worse. She fainted just as I entered the ER parking lot after going from distressed breathing to open mouth panting. But even right after they revived her from fainting and I guess put her in the oxygen cage, they said she was struggling to breathe. So do you think that the entire time she was trying to breathe she was just faint and hazy and not really feeling or knowing much of anything?

I had no choice but to let her go because she stopped breathing and they could not revive her and I knew she was brain dead.I looked at her and she was gone, but her heart was still beating. So I asked them to stop it. I just don't want to think that she felt like I deserted her. I loved her so much and I tried.

I do feel she was hazy and unaware of anything further then her breathing. And with her being in that state, I don't feel that she thought you left her but instead gave her mercy when you left her go.

Please take care,

Dr. B.

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Customer reply replied 1 year ago

Thank you. That makes sense. She became worse and worse during the car ride and then fainted. So I guess she was already hypoxic and the oxygen didn't help much, just prolonged the inevitable. Even if she had stabilized, I would never have prolonged her life if she were suffering and couldn't get better. I loved her too much for that.

Bless you. Have a great week.

You are very welcome, my dear.

You have a peaceful weekend too and please know you did all you could for her,

Dr. B.

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Customer reply replied 1 year ago

Quick question - do you see hypothyroidism in as many small breeds as large ones? Do they have any idea what causes it? It seems more prevalent than it used to.

Hi again,

I have seen it in all breeds, large and small. Unfortunately, we don't have any strong correlations to what may predispose them. It is thought diet or genetics may play a role but no one knows for sure. and to what degree it does.

Best wishes,

Dr. B.

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Customer reply replied 1 year ago
Question: Didn't you tell me that there is no way that Dolly could have gotten her cancer or her endocrine problems from a person? I would like to let Gabby work at a kids cancer camp. Dolly's cancer really caught me off guard. She had worked with some cancer patients but I had never worried about it.
Thank you.

Hi again,

I did since neither cancer nor endocrine diseases are infectious or something any individual can spread. So, it is fine for Gabby to be involved in a kid's cancer camp and that would not have caused Dolly any harm either.

Best wishes,

Dr. B.

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Customer reply replied 1 year ago

So there are no viruses that can transmit either problem from man to dog?

Thank you very much.

No, thankfully none at all. :)

Best wishes,

Dr. B.

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Customer reply replied 1 year ago

That is good to hear. I know dogs can get MRSA infections from people, but I don't know if they can effect a dog's internal organs like they can with people or which ones? And viruses can cause thyroid problems in people, but from what you say they would not transmit to dogs.

Hi again,

That is a bacteria and usually for animals it will be a skin infection cause when present. But again that nor viruses are recognized to cause either health issues we discussed for dogs.

Best wishes,

Dr. B.

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Customer reply replied 1 year ago

.

Customer reply replied 1 year ago

.

Customer reply replied 1 year ago

Please allow me to pick your brain once more with some additional questions I have since doing some reading. I just need to validate or discard them.

Can you please help me one more time? Then I will go away and leave you alone and either accept it was cancer or just try to live with wondering. I trust what you tell me because you seem so knowledgeable. But the coincidence is a struggle

  1. I know you are totally convinced that Dolly did not aspirate and that the X rays bear that out. I also understand that you said that she would have reacted if she aspirated. I am unclear about if she could have inhaled a small amount and not have had a reaction or if she would have reacted to any amount that went down the wrong way? She did not react at any time. Wouldn't she have been uncomfortable? She ate some chicken after I quit trying to give her the med.
  2. The first rad report said that it could be aspiration or bacterial pneumonia but the infiltrates would be atypical. Does that mean it still could be pneumonia, but that it would be unusual placement. You told me that aspiration pneumonia depends upon the amount inhaled, what is inhaled and the distribution of the contents. What does that distribution of the contents mean in respect to Dolly's case and the placement of the infiltrates? I read a study that the middle lobe is classically the most affected by aspiration pneumonia with average 1.7 lobes affected. Dolly's was worst in the ventral aspect of the cranial to mid lungs. Isn't that compatible with aspiration? I am confused I guess. The rad report said he couldn't rule out cancer. I guess without a biopsy. Her endocrine problems wouldn't have caused nodules in her lungs would they? Could pneumonia have caused blobs of congestion that look like nodules?
  3. I read about something called acute-onset aspiration pneumonia. Is there such and would that be like Dolly? Do dogs develop pneumonia without any progression of symptoms?
  4. I know you are also totally convinced that Dolly had cancer. I also desperately want to accept that she had a malignancy. I still struggle to believe that there is no chance that giving her the med caused aspiration. It is just such a hard coincidence to accept that I gave her water and meds with a springe and she died 24 hours later of pulmonary edema. But with her mouth not held closed, maybe it was more like rinsing out her mouth instead of giving her meds.

God bless you. You're the best. You know so much and I so little.

She would not have aspirated nor inhaled without you being aware or without it showing on the xray (the distribution is characteristic and wasn’t present in her xray). So, if she showed no signs, no distress, and ate afterwards; that undermines and discounts the first reports suggestion of atypical issues. I do hope you can find peace with that since the treatment you gave clearly played no role here and you are causing yourself unnecessary guilt and stress.

As for atypical pneumonia, we’d leave it as a differential but only because its in the lungs, not because its likely here. And I did put pneumonia on the bottom of my differential list for the same reason because again the pattern isn’t consistent for that since it would not cause nodules. And her endocrine issues would not have caused nodules unless she had a thyroid tumor that spread. And unfortunately, as we have said all along we’d only know if that was the spreading source with a biopsy or autopsy.

.

Kind regards,

Dr. B.

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Customer reply replied 1 year ago

.

Customer reply replied 1 year ago

I don't think I ever told you, but the reason that I have been so hesitant to accept cancer and let go of other causes is because I talked to the ER owner vet not long after this happened and I asked about a spot that the ER vet who treated her had told me might be a tumor. And the ER owner vet looked at the x rays and said that it could just be a blob of congestion. That is what I think we are now calling nodules. Is that true? Is that why the radiologist couldn't rule out cancer?

I am sorry. Just clarify something for me please. So she would have

shown me the signs you said with any amount inhaled not just a significant amount even with a liquid? And she would have been somewhat distressed/uncomfortable. By the "distribution is characteristic" do mean the distribution on an x ray has a classic pattern in aspiration? I don't understand exactly what you mean by discounting the rad report of atypical issues? Could the atypical pattern have still been aspiration? I thought you ruled that out when you first looked at the x rays. Just a little confused.

If it had been aspiration of any amount, I’d have expected signs (especially with a liquid). And again the xrays do not support that as even

What I said before was that aspiration has a characteristic appearance and that wasn’t seen on her xray. So, it isn’t likely here at all. As for the radiologists mention of “atypical,” that just means a rare/odd case that doesn’t look usual. It is them leaving it as a differential but an unlikely one. And given all we know of her and her history, all of us vets that have assessed this case would rule that out since we have the history of events before/during when that xray was taken. So, it isn’t likely and to be fair congestion doesn’t tend to look like that xray (its more diffuse), so again I can only keep saying to you that those nodules look cancerous in my opinion and the 2nd specialist has supported that by keeping it on their differential list.

Dr. B.

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Customer reply replied 1 year ago

Thank you again. I have worried about the congestion ever since the ER vet made that comment. So even though the rad report said the nodules were diffuse, congestion would have been even more spread out? The spot I had asked her about was somewhat large and blobby and over to itself near the bottom of the lung.

They weren't as diffuse as congestion would be, since congestion cannot usually cause nodule like appearances.

Take care,

Dr. B.

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Customer reply replied 1 year ago

One last question - if wee Dolly had been your dog, would you be totally convinced that she succumbed to cancer?

Gabby passed her eval to be complex, so we are going to participate in some Christmas activities. I will try very hard to accept cancer and stop thinking that I caused her death.

God bless you.

Yes, I would be just as convinced if she had been my own.

Dr. B.

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Customer reply replied 1 year ago

OK. I will keep telling myself that if I encounter a wave of doubt. I am going to close the thread and leave you $100. tip. You have been so very kind.

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