I just saw a beautiful little 4 month old lab puppy who was limping.  I thought it would be fun to walk you through how we approach a case like this in a real life situation.  

For those of you who are reading this now, I originally posted this with no diagnosis.  But now, the diagnosis is written at the end of the story.

Signalment:

This is a 4 month old Labrador Retriever.  She is not spayed.

History:

She was playing roughly with her “older sister” who is a much larger lab when suddenly the owner heard her scream very loudly.  This happened early on Saturday morning.  (It is now Monday morning.)  Since then, she has been bright and happy and eating well, but she is barely putting any weight on her left hind leg.  It hasn’t gotten any better or worse since it happened.

Physical Exam:

The dog was crazy excited and just wanted to lick me instead of being examined.  :)  The first thing I noticed is that she was not putting any weight at all on her left hind leg.  Her heart rate was 130bpm.  Her temperature was 38.6 C (101.5 F).  Here is what I noticed when I palpated her leg:

• I didn’t see anything unusual on her toes, toenails, or skin anywhere on the leg.
• She let me flex and extend her toes and her stifle (knee) without concern.
• At first I thought she was sore when I extended her hock.  But, when I repeated this, she didn’t seem sore.
• None of the joints were obviously swollen.
• There was no drawer sign in her stifle.  (This is a test that we do to determine if there is a tear in the cruciate ligament.)
• She was reluctant to extend her hip.  She could do it, but she pulled back against me when I tried, and she cried if I tried to do it repeatedly.  She could abduct her hip.  (“Abducting” is the movement a dog would make when they lift their leg to pee.)

When I finished the exam she was even more sore on the leg.  (Yeah, I know, I’m kind of mean, but hey…you have to do stuff like this when you are a vet.)

Tests:

We decided that we needed to take some hip xrays.  She shouldn’t be this sore.  She was a little difficult to keep still on the xray table, so we ended up using a cool padded trough that we have which helps dogs to be more comfortable when they lie on their back.  Here’s the xray we got (click to enlarge):

On the xray above, she is on her back, so the bones on the left of the picture are actually her right side.

Diagnosis and Treatment:

So perhaps I have been a little tricky in giving this case as a “Guess the Diagnosis” case.  I say this because the xrays really don’t tell me anything at all!  The hips look fine.  A few of you mentioned the possibility of hip dysplasia.  Dogs with hip dysplasia will have a number of changes that we can see on xrays.  You will see that much of the “ball” portion of the ball and socket joint is not sitting in the “socket”.  In medical terms, the head of the femur is not well seated in the acetabulum.  You will also see that the neck of the femur is wider than it should be.  And, the head of the femur tends to get flatter than normal when a dog has hip dysplasia.  I’ve created a graphic to show the difference.  The hip on the left is the one from our patient.  The hip on the right is a dysplastic hip (click to enlarge):

So, the final verdict was that there was likely nothing serious going on.  I suspect that she had a deep muscle bruise.  I put her on a pain reliever called Previcox.  (This is an NSAID drug very similar to Metacam, Rimadyl or Deramaxx).  She was also instructed to rest, which is a very difficult thing to ask of a lab.

How is she now?

Today (24 hours later) I gave the owner a call to see how our patient was doing.  It turns out that she is 90% better already!

One of my technicians found these on a fecal exam today.  Do you know what they are?

40x:

100x:

I thought I’d share a case with you guys today.

The case:

The appointment was booked early this morning.  It was an older cat and the appointment book simply said, “Eye Infection”.  Those are usually pretty easy appointments.  Sometimes the problem will be because of a scratch on the eye and sometimes it can be because of an upper respiratory virus.  While there are other things that can cause eye problems in cats, these are the most common.

But, I knew there was something seriously wrong when I saw this girl.  She was an elderly cat…I think around 15 years old.  She had a strange fleshy growth on the inside of her lower left eyelid.  It wasn’t a cherry eye, but it looked like it was probably a tumor of the conjunctiva which is basically the inside of the lower lid.  The tumor didn’t seem that bothersome to the kitty.  However, she had some other issues that made me worried.

Although I had never seen her before, it was obvious that she had lost weight as I could easily feel her backbone and hips.  The other thing that concerned me was the way that she was breathing.  Instead of taking normal breaths, each time she breathed her abdomen would expand and contract.  This is what is called “abdominal breathing” and it almost always means that there is a serious problem.

The xrays:

The first step for us was to take some radiographs.  It can sometimes be a tricky thing to get xrays of a cat who is having breathing troubles.  Too much stress can cause a cat to go in to respiratory distress.  But, she did well.  Here is the lateral (i.e. side) view of her chest.  (You can click on the image to see a larger version):

What’s the diagnosis?

OK guys…first of all, thanks for the comments!  For those who are just reading this post now, I originally asked for comments before I revealed the diagnosis.

The first thing I thought, when I saw this xray is, “This is bad….really bad,” and then, as some of you pointed out, I saw the trachea.  A normal trachea should follow a fairly straight line.  In this photo, I’ve drawn a yellow line to show the path of the trachea:

The other thing that I noticed is that there was a lot of fluid in the chest.  On a chest xray we should be seeing a lot of black.  Black means gas or air, and as most of the chest is taken up by air-filled lungs, this is what we should be seeing.  However, check out the line I’ve drawn in this diagram.  The grey area below the line is a whole bunch of fluid in the chest:

So, what would cause the deviation of the trachea and an accumulation of fluid?  There really is only one answer and that is cancer.  In fact, if you look closely, you can see what is likely a mass just in front of the heart.  This mass is pushing the trachea up and is likely also producing fluid that is spilling into the chest:

What happened to the cat?

Unfortunately, there was not much we could do for this kitty.  The owner knew it was time for euthanasia.  However, he asked if he could have a few hours to take her home and have the family say goodbye.  So, we gave her an injection of a diuretic called furosemide with the hopes of relieving some of the fluid in the chest so that she could breathe a little better.

She came back in later in the day and was euthanized peacefully.  The owner did allow us to do a post mortem exam.  It turns out that the fluid in the chest was something called chyle.  Chyle fluid, also called, chylous effusion, is usually produced by a type of cancer called lymphoma.  The tumor was a large mass in the part of the chest called the mediastinum which is the space in front of the heart where the trachea and esophagus sit.  We didn’t send samples away to get a for-sure diagnosis, but most likely what she had was mediastinal lymphoma.

OK folks…let’s see how smart you are!  What do you think the bump is on this dog’s ear?

Here’s some background information.  The dog is a 4 year old Boxer cross.  The bump just appeared and doesn’t seem to bother her at all.

What do you think it is?  Leave a comment below!

Welcome to another installment of Guess the Diagnosis! Here is case #3:

This is Barley, a female 10 year old Bernese Mountain Dog:

Barley’s owner brought her to see Dr. Marie because she has been panting a lot lately, especially after exercise. At times her bark seems to be a little hoarse as well.

There will be more information posted in the days to come. (If you would like to be notified by email when a post is made, click here.)

If you think you know the answer, leave a comment. Or, if you would like to ask more information about the case, leave a comment with your question. The first correct guess wins a free question on www.askavetquestion.com!!!

Have fun!

Welcome to another installment of Guess the diagnosis! This one is a little different.

Can you guess what this cat ate?

Here is the radiograph:

The red arrows are pointing to the cat’s stomach. Can you tell what is in there?

The first correct guess wins a free question on www.askavetquestion.com! Leave your guess as a comment below. You can have one guess per day.

Want to be notified by email when a new post is made to Guess the Diagnosis? Click here for email notification.

Want to ask Dr. Marie a vet question? Want to see questions that other people have asked? Check out www.askavetquestion.com.

Have you been following the case of Leila the lethargic Golden Retriever? If you missed the original posts, click here:

Guess the diagnosis – Case #1

Congratulations to our winner, Jen!  Jen correctly guessed that Leila had leptospirosis.

Leptospirosis is a bacteria that is shed in the urine of some skunks, foxes, badgers or racoons.  It does not cause disease in those species, but if a dog ingests the urine (i.e. from drinking from a contaminated puddle) it can cause serious illness.

There are different types (serovars) of leptospirosis.  Some types can cause kidney disease, some liver disease and there are others as well.  In any case it is a very deadly disease.

There is a vaccine for leptospirosis that covers 4 of the possible serovars.  It is not 100% effective but is fairly good protection.

Our first case of Guess the Diagnosis generated a great amount of interest, so we will do it again!  If you want to be alerted of the next case click on the orange RSS feed button to subscribe to the Online Veterinary Advice blog.  The next case will be posted soon!

Jen, you will be contacted shortly to be informed of how you can ask your free veterinary question on www.askavetquestion.com.  Thank you to everyone who contributed!!!

Dr. Marie.

Want to ask Dr. Marie a vet question? Want to see questions that other people have asked? Check out www.askavetquestion.com.

Want to be notified by email when a new post is made to Guess the Diagnosis? Click here for email notification.

Are you still following Leila’s case?  This installment should give some major clues as to what her problem is.  If you missed the first two installments, click here:

Guess the Diagnosis – Case #1

So, Leila is improving.  Some more lab results came back.  A PCR (DNA) test for a particular condition came up positive in her urine.  We are now waiting for blood titers for this condition to come back.

Because Dr. Marie is quite certain that Leila has this condition she has started her on IV Ampicillin and oral Doxycycline.

Leila was not vaccinated for this condition – had she been vaccinated she likely would not have gotten sick!

Do you know the diagnosis now?  If so, leave a comment after this blog.  The first correct guess wins a free question on www.askavetquestion.com!

Want to ask Dr. Marie a vet question? Want to see questions that other people have asked? Check out www.askavetquestion.com.

What a great response!  Some of you are very close, but we need to be more specific.

If you missed part one, you can read it here:

Guess the diagnosis: Case #1

Because of Leila’s dehydration she was placed on IV fluids and kept in the hospital.  A urine sample showed that her specific gravity (her ability to concentrate urine) was 1.009 which is very low.  Also her bloodwork showed a very high increase in BUN and CREA enzymes.

Think you know the diagnosis?  Leave a comment below.  The first correct answer wins a free question on www.askavetquestion.com.

Part 3 is now up on the blog!  You can read it here:

Guess the diagnosis: Case #1, part 3.

Want to ask Dr. Marie a vet question? Want to see questions that other people have asked? Check out www.askavetquestion.com.

Welcome to the first edition of Guess the Diagnosis!  This is your chance to show off your veterinary knowledge.  New information will be added regularly to the case.  If you think you know what condition the animal has, leave it as a comment.  You are only allowed one guess per day.

THE FIRST PERSON TO GUESS THE CORRECT DIAGNOSIS WINS A FREE QUESTION ON WWW.ASKAVETQUESTION.COM!!!

Case #1: Leila, the Golden Retriever

Name: Leila

Age: 8 months

Sex: Female (spayed)

Breed: Golden Retriever

Leila came in to see Dr. Marie because the owners noticed that she was just “not herself”.  She had been lethargic for a few days and her appetite was decreased.  She was still drinking.  In fact, she was possibly drinking a little more water than usual.  She also had had a few urinary accidents in the house too.

Dr. Marie did a thorough physical exam.  Lola was very quiet and had a mild skin tent meaning that she was possibly a little dehydrated.  Her temperature was elevated at 103.3 F (39.6 C).  Everything else seemed normal.

What’s your diagnosis?

Guess the diagnosis by leaving a comment.  It is a good idea to subscribe to this feed so you are updated when new info is added. You can do so by clicking on the orange RSS button in the right column.

…Part 2 is now up! You can read it here:

Guess the diagnosis: Part 2 – Case #1
Want to ask Dr. Marie a vet question? Want to see questions that other people have asked? Check out www.askavetquestion.com.