Saturday, December 27, 2014

Nicky's Story. Hemothorax and Hemangiosarcoma: When The Diagnosis is Incurable.

I wrote about Palmer a few days ago. She was brought to me for lethargy, panting, and anorexia. A week after her case Nickle arrived at the clinic with the same clinical signs.

Nickle is a five year old, mixed breed Huskie, who is under close supervision, and current on all recommended medical care, vaccines, and has no history of trauma, toxins, or illness.

Here are Nickle's presenting complaints;
  • Not acting right. 
  • Labored breathing.
  • Not eating for 3 days,
  • Weak in the back legs.
  • Appears to be painful.

The list above could be many things. For all of those Pawbly questions that list these as clinical signs I always have to refer the pet to a veterinarian or emergency clinic immediately. Here's why..

His physical exam revealed the following;
  • Quiet and depressed. In the hospital I expect dogs to be curious, anxious, greeting, hiding, something. Some expression of being in a foreign place. He was just there. He was too.. something? sick, tired, weak..something to act normally. LISTEN to your patient. He knew something was wrong, I needed to find it.
  • Poor body condition score. He was a young dog, who was active, but now he appeared to have poor muscle mass. This is a sign that whatever is going on has been a slow and gradual process.
  • He had muddy pink and tacky mucous membranes. This gives an indication of blood loss, and ability for them to circulate and dehydration. 
  • Elevated heart rate. Can be stress?, can be pain?, can be fever?, but it indicates a pet in need of immediate care.
  • Elevated respiratory rate. Same list as heart rate above.
  • Quiet lungs.. Something is making it hard for me to hear his normal lung sounds.
  • Abdomen seems normal.
He needs a chest x-ray immediately. (Just like Palmer did).

Here are his chest radiographs.
The lungs should be black and fill the whole area within the ribs.
Nicky's are being compressed and pushed to the far right,
which is the dorsal (top or towards his spine) and caudal (towards the tail).
This doesn't allow the lungs to expand or draw in air with each breath.

Compare Nickle's x-ray to Palmers here.

The radiographs show fluid, specifically blood, (although this can be hard to distinguish in some cases) in the lung space. This is making it very hard for his lungs to expand, or pull oxygen into the body and feed his muscles with the fuel they need to function. As soon as I saw his x-rays Nickle was immediately referred to an emergency clinic and specialist to further work-up his case.

Here is where Nickles case and Palmer's case has similarities;

  • They are both young, active, very closely watched pets. 
Here is where they differ;

  • Nickles x-rays and case were reviewed by a boarded radiologist, a neurologist, and a surgeon. He was sent for BOTH a CT and an MRI. From these he was found to have both a mass on his heart that extended up and around his spine. These were causing his neurologic (weakness in the back legs) signs, and the blood in his chest. He had an extensive, and expensive, work-up. I have to admit that in 10 years of practice I have never seen a case worked up this extensively, nor this completely, nor this complicated. Nickle had a surgery on the mass around his spine to provide a diagnosis of the mass in his chest. To provide a treatment to a condition it must be diagnosed. The best way to do this is with tissue. Nickle's surgery was performed to try to remove the mass on his spine, to help reduce the paralysis in his back legs, and tailor a treatment plan for his specific tumor. His mass came back as a hemangiosarcoma. These are aggressive, invasive and very difficult, if not impossible, to remove. Nickle's tumor was also in his chest surrounding his heart. The tumor was invading his spine and this caused his rear limb paralysis. His parents carried him or used a sling to help him walk. Although his family had provided him every diagnostic, and collected every piece of information needed to provide a prognosis, Nickle's condition was grave. His family spent the last few days with him spoiling him, doting on him, and telling him how much he was loved. 

I asked his mom if she wanted to add her thoughts to his story. This is her eulogy to her pup, Nicky.

Our Nicky –

It was August of 2012, and we were looking for the last member of our pack.  We choose our kids based on their lot in life; and that’s what connected us with “Mr. Barkley”, our Nicky.  He had been adopted out as a pup, but boomeranged   back due to some behavioral issues.  When we met, he was a long-time resident of The Jarrettsville Vet Kennel.

The intro went as well as expected, although he did take a nip at me – I explained that I would be back the following week to take him to his forever home.  Not sure the Tech believed me or not, but return I did and “Mr. Barkley”, now our Nicky and me headed home to Carroll County to meet his new family. 

Introductions were made slowly and successfully, and although he mostly kept to the edges of the pack, he seemed to be settling in.  And then it happened, every parent’s nightmare, a fully fledged dog fight in the dark.   When the blood settled, Nicky had minor injuries but our husky was seriously injured. 

We carted the husky to the vet and am embarrassed to admit - returned Nicky to Jarrettsville, he was just too dangerous.  Well it only took us one night to come to our senses, if not us, then who?  The answer was obvious, we had to go get our boy back, and that’s just what we did.  The staff was understanding and suggested a kennel to help him feel secure. 

So on the ride home, with Nicky taking what we would learn to be his customary position on Mommy’s lap in the front passenger seat; we had some shopping to do.  The kennel proved to be the difference.  We placed it in our bedroom and while the rest of the pack slept across the hall in their room, our Nicky had his own cubby. 

The pack sorted itself out in short order and Nicky assumed fence perimeter duties.  During his two years with us he grew to be more self-confident and out-going.  He was always very obedient and smarter than most.  Our boy loved his soccer and footballs.  And while not food motivated, he tended to save his nightly biscuits, he would occasionally pop out of his cubby in the morning grinning with one tucked into his cheek. 

He quickly became Mommy’s little helper in feeding the pond fish and remained ever vigilant for anything approaching our property; he was always first to sound the alarm.   He loved to talk back to the freight trains that rumbled by in the distance, not always in perfect pitch.

I could say in many ways he was just your typical boy.  But that would not be accurate, because he matured more these past two years than many folks do in a lifetime.  

I wanted to tell both stories because they both were young healthy dogs with the same presenting complaints and the same condition. Two happy, apparently healthy, pampered pups. Who both had bleeding into their chest. Two emergencies, two totally different diagnoses, and endings.

If your pet ends up at the ER with hemothorax, please look for the cause. It might be treatable!

Related blogs;

Hemoabdomen, Palmer's Story. The case of a happy ending.

Making Vet Care More Accessible

There Has To Be Mercy Before Money.

Making Vet Care More Accessible

Any pet questions? Meet me on and I will answer them for free. You can also help other pet parents with their pet questions. Behavior, nutrition, homeopathy, disease, you name it we can help.

I am also available at my clinic, Jarrettsville Vet, in Jarrettsville Maryland. Or, find me on Twitter @FreePetAdvice.

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