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Does your team ever review highly complicated cases that…

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Hi Pearl - Does...

Hi Pearl - Does your team ever review highly complicated cases that will probably require an hour or so of review? We are considering transferring care from Sage (san jose, ca) to UC Davis and seeing that Dr. Andy is from UC Davis I would be interested in his opinion on what makes the most sense for our girl. Her history is here: http://instadan.postach.io/post/oshii-labs

Veterinarian's Assistant: I'll do all I can to help. What sort of animal are we talking about?

I completely understand if you don't take on cases such as this one in this online setting, but I would feel much more comfortable with a second opinion on current course of action.

Veterinarian's Assistant: Maybe I'm confused. I thought you had a problem with a pet. Is that correct?

We use words like "girl" to refer to our female dog.

Veterinarian's Assistant: What seems to be the problem with the dog?

Symptoms:* Lymphadenopathy - Right mandibular lymph node enlarged to 4 times normal size
* Fever/Temp -
*
* 9/13-9/16 - Persistent fever prior to antibiotics - Range of 104-105
* 9/16 (4PM) - 9/17 (4PM) - Normal 102 range (unisyn antibiotic started at 8am, 9/16. Fluoroquinolone started at 4Pm 9/16)
* 9/17 (8PM) - Fever - 104.2
* 9/18 (midnight - 4am) - 103.5* Lack of Appetite - Highly food motivated dog showed no interest in food beginning 9/12
*
* Would eat mushed up banana and other soft food unenthusiastically
* 9/14-Present - Only eating baby food* Lethargy/Weakness - Beginning 9/14 and increased in severity until antibiotics were administered
*
* 9/14-9/15 Very slow to respond to stimuli, difficulty walking, needs help to stand
* 9/16-9/17 - Slowly increasing energy from but still highly lethargic and weak

Veterinarian's Assistant: It could be an infection. The Expert will know what to do. What is the dog's name?

Oshii.

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Oshii?

If the vet is willing to review this page, http://instadan.postach.io/post/oshii-labs. A complete history is there, including the internal specialists summary of history written yesterday.

Submitted: 8 months ago.Category: Veterinary
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Answered in 10 minutes by:
9/18/2017
Veterinarian: Dr. Andy, Medical Director replied 8 months ago
Dr. Andy
Dr. Andy, Medical Director
Category: Veterinary
Satisfied Customers: 30,409
Experience: UC Davis graduate, Interests: Dermatology, Internal Medicine, Pain Management
Verified

Welcome! My name is***** am a 2003 UC Davis graduate and practice owner.

I have reviewed your notes.
I understand they have nearly ruled out lymphoma as a cause for the lymphadenopathy, so the tests currently pending will be very important.

I do agree that x-rays will likely not offer much additional information about what is going on with the lymph node although, x-rays are very important as a diagnostic step for checking for metastasis (spread of cancer, especially to the lungs).

There is no question, that based on Sage's current symptoms and declining condition, a second opinion with another specialist is worthwhile. Why?

Well, internist are all excellent generally. But with a complicated case, it may be best to utilize a facility that can draw on multi-disciplines and "brains" to ensure no particular therapies are being missed. In addition, if a MRI or CT were to be pursued, everything is located at Davis.

I am very sorry to hear about this complication for Sage.
The additional infectious disease panels that are pending were appropriate in consideration of a lack of answers so far.

I do think considering a migrating foxtail or other foreign body could be a cause as well, and therefore, a test like a MRI is going to be necessary to try and help find it.

As a general practice veterinarian giving a second opinion, the treatment plan, diagnostics performed so far, and the current antibiotic therapy all seems good.

Dr. Andy

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Veterinarian: Dr. Andy, Medical Director replied 8 months ago

I do have to add that I cannot establish a patient-client-doctor relationship without performing my own examination, and that my interpretation is based only on the notes provided.
I will pray for a speedy recovery for Sage.
Dr. Andy

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Veterinarian: Dr. Andy, Medical Director replied 8 months ago

One other thing:

It appears from the notes that a fine needle aspirate was done of the lymph node and not a biopsy.

I could be wrong about that, but that is the only other question I would ask the doctor.

The difference being a biopsy is performed under sedation and they are taking a "chunk of lymph node" for histopathology, not just relying on some sample that is collected by needle, which can often NOT be diagnostic.

There was a mild increase in the ALT liver enzyme, but I think that is more reactive to everything else going on and not something actually present in the liver. Nonetheless, appropriate diagnostics were already done to ensure liver is okay and no evidence of cancer in the liver.

I am surprised that the WBC (white blood cell count) was not higher on the most recent blood testing. Not a bad sign.

Fungal disease would be less likely unless it is prevalent in your area or if you have been traveling with Sage. Can't really comment on how prevalent fungal conditions may be in San Jose.

Good Luck!

Dr. Andy

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Veterinarian: Dr. Andy, Medical Director replied 8 months ago

Hello,

I wanted to ensure my messages were getting through due to the severity of your concern?

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Veterinarian: Dr. Andy, Medical Director replied 8 months ago
Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Andy
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Dr. Andy
Dr. Andy, Medical Director
Category: Veterinary
Satisfied Customers: 30,409
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Experience: UC Davis graduate, Interests: Dermatology, Internal Medicine, Pain Management

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