A Guide to Diagnostic Testing for Pet Parents of Senior Dogs
March 24, 2019 6:53 AM Subscribe
My senior's lab work revealed numerous abnormalities. I'm hoping to mitigate unnecessary spending whilst simultaneously doing right by her. What has your experience been with senior pet diagnostic testing?
You are not my veterinarian, and sharing your experiences or opinions will not be taken as medical advice for my dog.
Recently I decided to spay my senior dog to prevent pyometra from ever developing, as senior females are at an ever-increasing risk with each passing heat cycle. When she was young, her first veterinarian (not her current) told me that she would likely die on the table since she weighed only just over one pound, and that I should wait until adulthood. After hearing that and becoming upset and fearful, I read several publications that weighed the benefits against the risks of spay and neuter surgeries, and I opted not to spay her. I now regret that fear-based decision, because at two years old she was fully grown (3.5lbs), and could have handled a spay. If she'd of been spayed while still young, her risk for mammary cancer would have been greatly reduced and she might not have developed the lumps she just had removed along with her spay. That being said, beating myself up over this is not helpful at this point.
My hairy child is going on 14, and is as full of energy and wonderment as she always has been. She’s eating, drinking, and playing ferociously with her little toys, as she always has. She does have some arthritic joints, and to keep her comfortable I have her on flaxseed oil that I mix into oatmeal for good digestion. She does not like glucosamine, she refuses it no matter how I present it to her. She has always eaten a premium kibble and has maintained a healthy and consistent weight.
Recently she has developed what I believe to be a neurological tick. She will be resting, sleeping, or laying around and suddenly she will sit up slightly and begin to jerk her head, almost as if she’s being shocked or small droplets of water are hitting her in the face- it’s like she’s startled. This, along with 3 separate small, firm lumps near her right mammary tract (no ulcerations or redness) are her only symptoms.
Upon receiving her labs for her pre-surgery workup, her veterinarian called me immediately and said that she needed to see her. Her blood work was incredibly erratic, indicating that something was seriously wrong. A lung x-ray revealed no masses or fluid in the lungs; but two of her vertebrae have bright white areas between them and some moderate degeneration. The vet thinks that this is bad arthritis, but I’m wondering if it’s not encephalitis as well, because inflammation would be consistent with this, and it would explain her tick and her neutrophils being incredibly elevated.
A spinal tap to determine enchep will require an MRI to check for abnormalities before being performed, and these procedures along with more labs will cost in excess of $4,000+. I’ve spent close to $2,000 on her spay, biopsies and diagnostics so far, and I’m wondering if administering an antibiotic for bacterial encephalitis, checking her labs for improvement, and proceeding to treat for fungal enceph if that doesn’t work would be a more cost-effective option. Her veterinarian as agreed to try the bacterial hypothesis first. I have to do some research on whether or not it’s safe to treat with anti-fungals without a definitive diagnosis. There is an auto-immune enceph that is treated with anti-inflammatory meds as well, so that would be a third step.
If you are able to read labs, here are her numbers:
RBC: 4.13 M/uL 5.50 - 8.50
HCT: 24.8% 37.0 - 55.0
HGB 8.5 g/dL 12.0 - 18.0
MCV 60.0 fL 60.0 - 77.0
MCH 20.6 pg 18.5 - 30.0
MCHC 34.3 g/dL 30.0 - 37.5
RDW 18.3% 14.7 - 17.9
%RETIC 3.0%
RETIC 125.1 K/uL 10.0 - 110.0
WBC 106.10 K/uL 5.50 - 16.90 (white blood cells, very elevated, possible mammary cancer)
%NEU 26.2%
%LYM 61.6%
%MONO 11.0%
%EOS 1.1%
%BASO 0.0%
NEU 27.81 K/uL 2.00 - 12.00 (Neutrophils that are this elevated can indicate a bad infection)
LYM 65.35 K/uL 0.50 - 4.90
MONO 11.72 K/uL 0.30 - 2.00
EOS 1.21 K/uL 0.10 - 1.49
BASO 0.02 K/uL 0.00 - 0.10
PLT 187 K/uL 175 - 500
MPV 9.5 fL
PDW 22.3%
PCT 0.18%
Breed: Yorkshire Terrier
Weight: Consistent
Energy levels: High
Changes in behavior: None (which is perplexing with her labs being so bad)
Heartworm test: Negative
Lung x-ray: Clear
Blood parasite evidence: None thus far, it just said no evidence of parasites seen but maybe there is more specific testing that can be done for this
Meds: Ivermectin-Pyrantel, Activyl, and she was de-wormed for tapes after a positive test after a bad case of fleas. Maybe a tapeworm migrated to her brain and the meds only killed the one in her intestines? Educated guesses here are the only option. I'm trying to think of everything
Encephalitis is common in Yorkshire Terriers among a few other breeds. The neurological tick she has paired with the neutrophil count makes me think that’s potentially what I’m dealing with. Parasites are probably unlikely due to her being current on Ivermectin and having taken Revolution prior to that.
At this point it’s all just educated guessing, and testing. I do have money set aside for her veterinary care, but it is not in excess of what I’m potentially looking at here if I do every test imaginable, on top of MRI scans and spinal taps. Unfortunately I am not a wealthy individual. I need to be mindful of spending so that I don't encounter a hardship. I want to do everything that I can within my means to take care of her. I'd like to see her live to 16 or even 18 years old. From what I'm reading though, the smaller yorkies typically don't live as long as the larger ones.
What do you think, and have you any experience with senior pet diagnostics?
You are not my veterinarian, and sharing your experiences or opinions will not be taken as medical advice for my dog.
Recently I decided to spay my senior dog to prevent pyometra from ever developing, as senior females are at an ever-increasing risk with each passing heat cycle. When she was young, her first veterinarian (not her current) told me that she would likely die on the table since she weighed only just over one pound, and that I should wait until adulthood. After hearing that and becoming upset and fearful, I read several publications that weighed the benefits against the risks of spay and neuter surgeries, and I opted not to spay her. I now regret that fear-based decision, because at two years old she was fully grown (3.5lbs), and could have handled a spay. If she'd of been spayed while still young, her risk for mammary cancer would have been greatly reduced and she might not have developed the lumps she just had removed along with her spay. That being said, beating myself up over this is not helpful at this point.
My hairy child is going on 14, and is as full of energy and wonderment as she always has been. She’s eating, drinking, and playing ferociously with her little toys, as she always has. She does have some arthritic joints, and to keep her comfortable I have her on flaxseed oil that I mix into oatmeal for good digestion. She does not like glucosamine, she refuses it no matter how I present it to her. She has always eaten a premium kibble and has maintained a healthy and consistent weight.
Recently she has developed what I believe to be a neurological tick. She will be resting, sleeping, or laying around and suddenly she will sit up slightly and begin to jerk her head, almost as if she’s being shocked or small droplets of water are hitting her in the face- it’s like she’s startled. This, along with 3 separate small, firm lumps near her right mammary tract (no ulcerations or redness) are her only symptoms.
Upon receiving her labs for her pre-surgery workup, her veterinarian called me immediately and said that she needed to see her. Her blood work was incredibly erratic, indicating that something was seriously wrong. A lung x-ray revealed no masses or fluid in the lungs; but two of her vertebrae have bright white areas between them and some moderate degeneration. The vet thinks that this is bad arthritis, but I’m wondering if it’s not encephalitis as well, because inflammation would be consistent with this, and it would explain her tick and her neutrophils being incredibly elevated.
A spinal tap to determine enchep will require an MRI to check for abnormalities before being performed, and these procedures along with more labs will cost in excess of $4,000+. I’ve spent close to $2,000 on her spay, biopsies and diagnostics so far, and I’m wondering if administering an antibiotic for bacterial encephalitis, checking her labs for improvement, and proceeding to treat for fungal enceph if that doesn’t work would be a more cost-effective option. Her veterinarian as agreed to try the bacterial hypothesis first. I have to do some research on whether or not it’s safe to treat with anti-fungals without a definitive diagnosis. There is an auto-immune enceph that is treated with anti-inflammatory meds as well, so that would be a third step.
If you are able to read labs, here are her numbers:
RBC: 4.13 M/uL 5.50 - 8.50
HCT: 24.8% 37.0 - 55.0
HGB 8.5 g/dL 12.0 - 18.0
MCV 60.0 fL 60.0 - 77.0
MCH 20.6 pg 18.5 - 30.0
MCHC 34.3 g/dL 30.0 - 37.5
RDW 18.3% 14.7 - 17.9
%RETIC 3.0%
RETIC 125.1 K/uL 10.0 - 110.0
WBC 106.10 K/uL 5.50 - 16.90 (white blood cells, very elevated, possible mammary cancer)
%NEU 26.2%
%LYM 61.6%
%MONO 11.0%
%EOS 1.1%
%BASO 0.0%
NEU 27.81 K/uL 2.00 - 12.00 (Neutrophils that are this elevated can indicate a bad infection)
LYM 65.35 K/uL 0.50 - 4.90
MONO 11.72 K/uL 0.30 - 2.00
EOS 1.21 K/uL 0.10 - 1.49
BASO 0.02 K/uL 0.00 - 0.10
PLT 187 K/uL 175 - 500
MPV 9.5 fL
PDW 22.3%
PCT 0.18%
Breed: Yorkshire Terrier
Weight: Consistent
Energy levels: High
Changes in behavior: None (which is perplexing with her labs being so bad)
Heartworm test: Negative
Lung x-ray: Clear
Blood parasite evidence: None thus far, it just said no evidence of parasites seen but maybe there is more specific testing that can be done for this
Meds: Ivermectin-Pyrantel, Activyl, and she was de-wormed for tapes after a positive test after a bad case of fleas. Maybe a tapeworm migrated to her brain and the meds only killed the one in her intestines? Educated guesses here are the only option. I'm trying to think of everything
Encephalitis is common in Yorkshire Terriers among a few other breeds. The neurological tick she has paired with the neutrophil count makes me think that’s potentially what I’m dealing with. Parasites are probably unlikely due to her being current on Ivermectin and having taken Revolution prior to that.
At this point it’s all just educated guessing, and testing. I do have money set aside for her veterinary care, but it is not in excess of what I’m potentially looking at here if I do every test imaginable, on top of MRI scans and spinal taps. Unfortunately I am not a wealthy individual. I need to be mindful of spending so that I don't encounter a hardship. I want to do everything that I can within my means to take care of her. I'd like to see her live to 16 or even 18 years old. From what I'm reading though, the smaller yorkies typically don't live as long as the larger ones.
What do you think, and have you any experience with senior pet diagnostics?
I am not a vet and can't speak to the specifics of the diagnoses you are describing. More generally, though, when our beloved dog became elderly we made the decision that we would provide limitless pain control and anything else to improve quality of life, but that extensive diagnostic testing and major surgery were off the table. For us (and for our dog), that was the right decision at that time, and we were fortunate to have a vet who was supportive of taking a less-invasive approach.
Money was a definitely a factor -- not in the sense of not loving him enough to pay for treatment, but rather recognizing that he was close to the end of his life and money spent on testing and surgery would mean stress and discomfort for him without adding much to either his quality or quantity of life remaining.
posted by Dip Flash at 7:48 AM on March 24, 2019 [6 favorites]
Money was a definitely a factor -- not in the sense of not loving him enough to pay for treatment, but rather recognizing that he was close to the end of his life and money spent on testing and surgery would mean stress and discomfort for him without adding much to either his quality or quantity of life remaining.
posted by Dip Flash at 7:48 AM on March 24, 2019 [6 favorites]
We are taking the non-invasive tack with our frail senior dog: medicate to our best guesses without intrusive diagnostics, knowing we might have done some other thing that might buy a bit more time but then again might not and could reduce his stability. He's on daily gapiprant for a touch of arthritis and probably some other pain (we know he has at least two kinds of cancer, both slow-moving), and one of his tumors periodically necrotizes and we've learned to recognize it coming on and call in for antibiotics, and we've just recently gone to pretty much daily gabapentin for additional pain. Our vet agrees with us that palliative care is all that is appropriate at this point; just getting the x-rays we needed for our final decision-making was really hard on him, and we won't do it again.
I'm absolutely comfortable with this plan, and finances are an aspect of that but at this point even transporting him to the vet (which we won't do any longer, we work with our vet by phone and Facetime, and there are several home euthanasia services here we can choose from) is too hard and stressful for him and for us.
posted by Lyn Never at 8:17 AM on March 24, 2019
I'm absolutely comfortable with this plan, and finances are an aspect of that but at this point even transporting him to the vet (which we won't do any longer, we work with our vet by phone and Facetime, and there are several home euthanasia services here we can choose from) is too hard and stressful for him and for us.
posted by Lyn Never at 8:17 AM on March 24, 2019
My dog was only 9 (would have been considered senior at 10 due to her breed) when she was hospitalized a few weeks ago, but here is what I learned:
1) blood work can change very quickly with medication--my girl's numbers changed about every 8 hours during treatment for an autoimmune disorder
2) for MRIs and anything else where they need to hold still more than a few seconds, they will sedate the dog. How do you feel about her being sedated again for a diagnostic process? How likely is having a diagnosis to change the outcome of the disease course?
Ultimately, my dog had an initial Xray and MRI to rule out cancer causing her disease, but when she later developed neurological symptoms, the vet and I determined that it would be too taxing on her body to be sedated again, and that while ruling out cancer as a trigger of the autoimmune disorder had been treatment-altering, knowing what exactly was the cause of her new neuro symptoms was not worth it.
Sorry you and your babe are going through this--it's so hard to make decisions for them, and I think sometimes vets err on the side of more intervention (much like human doctors). I asked my vet to be really frank about the risk/benefit of each procedure, and she gave me percentages that really helped me make decisions.
posted by assenav at 10:22 AM on March 24, 2019
1) blood work can change very quickly with medication--my girl's numbers changed about every 8 hours during treatment for an autoimmune disorder
2) for MRIs and anything else where they need to hold still more than a few seconds, they will sedate the dog. How do you feel about her being sedated again for a diagnostic process? How likely is having a diagnosis to change the outcome of the disease course?
Ultimately, my dog had an initial Xray and MRI to rule out cancer causing her disease, but when she later developed neurological symptoms, the vet and I determined that it would be too taxing on her body to be sedated again, and that while ruling out cancer as a trigger of the autoimmune disorder had been treatment-altering, knowing what exactly was the cause of her new neuro symptoms was not worth it.
Sorry you and your babe are going through this--it's so hard to make decisions for them, and I think sometimes vets err on the side of more intervention (much like human doctors). I asked my vet to be really frank about the risk/benefit of each procedure, and she gave me percentages that really helped me make decisions.
posted by assenav at 10:22 AM on March 24, 2019
IAAV. IANYV.
Ask them to draw blood for the CBC again and send it out to Antech or Idexx, and ask for a pathologist review of the blood smear.
When numbers are off like this, it's worth repeating the test to make sure it's not a machine error. Especially since dog is overall doing well at home.
Also, get a needle sample of those new lumps ("fine needle aspirate") and send those out for cytology (microscope review of the slide) if not done already.
Then come back with an update on what you find.
posted by dum spiro spero at 7:04 PM on March 24, 2019
Ask them to draw blood for the CBC again and send it out to Antech or Idexx, and ask for a pathologist review of the blood smear.
When numbers are off like this, it's worth repeating the test to make sure it's not a machine error. Especially since dog is overall doing well at home.
Also, get a needle sample of those new lumps ("fine needle aspirate") and send those out for cytology (microscope review of the slide) if not done already.
Then come back with an update on what you find.
posted by dum spiro spero at 7:04 PM on March 24, 2019
As to new neurological tick - switch to something other than Activyl (e.g. Revolution/selamectin) to rule that out as the cause, especially if newly on it.
posted by dum spiro spero at 7:30 PM on March 24, 2019
posted by dum spiro spero at 7:30 PM on March 24, 2019
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You have a small dog who is already 14 years old. Even if you did everything and paid for everything and it was all wildly successful your dog will still pass from something relatively soon.
I'm very much of the let your dog be comfortable and it's OK not to know and not to explore philosophy . I have my own animals and this is incredibly hard to hear, it's not fun or fair but it is OK not to pay for everything in the world for your animal.
Take gentle care of you and your pup
posted by AlexiaSky at 7:07 AM on March 24, 2019 [16 favorites]