Brownie

Brownie is a dog that I had spayed for a family about 2 years ago.  Right now, she is in a hard way – outdoors and alone because she would otherwise be attacked by the other dogs in the house.  She is obviously very sick…
Good appetite today (she ate 1 can and 2 small bowls of dry food this morning), but a history of almost no appetite for a month.  Temperature is 102.4F.  Respiration is 47/min. post walk.
No apparent protein in urine.  The urine may have a greenish hue to it.  Did not urinate much when I took her for a walk.  Stool has a normal appearance.  No blood.
She presents severely emaciated, cavitated, no ketones on breath.
 
Unable to use her left hind leg well.  Partly this is due to an unclipped toenail.
 
Palpatations of left leg and abdomen reveal no pain or swelling.  Severe deterioration of muscle noted in rear left leg.  Front right leg has a nonunion fracture ? that dates to about 1 month ago.  No pain expressed on articulation.  Will post pictures when transferred from camera.
Muscle atrophy in left rear leg.
straightened right arm                                           bent right arm
left arm                                                                              right arm
front right arm sequence.  One notes the unusual angle of the arm movement.  The left rear leg has a similar angle of movement.  Family is trying to put together the money for 1 x-ray next week.  If there are any joints out of alignment that can be fixed without surgery, this is the one that should be x-rayed.  Or if there is a single x-ray that can capture what is wrong with both hip and knee joints, this one would be another option.  Walking has improved significantly (from 1 block initially to 16 blocks this morning).  Her heart has improved and she shows some ability to pull when she wants to chase.  Likely heartworm carrrier, although she has been treated without incident in the past with ivermectin. 
side view of front right leg.  Picture 5 demonstates the problem.
 
significant head bob as she walks (above).  Head comes up on picture 8 as weight is applied to right front leg.
back view of rear left leg.
This picture while not the most dignified shows a different leg position.  Unfortunately, the light was on the wrong side.  Solid poop. An analysis of the poop for worms shows a hookworm infestation, and also the presence of whipworm.  Because Brownie is stable after 6 days of food and walks, able to trot, I decided to draw blood and do an ESR as well as a CBC.  I took some pictures of the blood on a slide to look for heartworm.  I did not see a big problem with heartworm.  Because of the fecal worm load though, I will administer a very gentle wormer (Pyrantel pamoate (5-10 mg/kg)) under nonfasting conditions. This will get rid of some, but not all of the worms at once.  I need to work on getting her into an environment with less of a worm load, keep her area clean, and then eventually use the Fenbendazole wormer. 
To follow the link to the plotting software
 
The picture of blood to the right (400X) shows a larger cell shedding and breaking up at about 10 o clock.
 
 
Movies are in public folder.
 
Treated topically for fleas.
 
Tail wags sometimes.  Walks with difficulty.  I placed several masking tape markers on her leg to emphasize the joint movement.  I put together a sequence of photos for a complete joint movement on the leg for her (top 1-12), and an uninjured similar dog (bottom 1T-12T).
A comparison of Brownie’s knee and Tammy’s knee.  There is a big age difference, but I observe a damaged knee joint – possibly torn or absent cartiledge.
A comparison of Brownie and Tammy’s thighs.  I suspect possible damage of the hip cartilege, and a muscle that detatched? at the hip.  2 X-rays needed on this leg.
A canine anatomy book showing the muscles.
 
Movie in public folder.
 
 
ACTION TAKEN:
1) Toenails clipped, flea prevention, food until she did not want to eat more.
2) Personally walk 2X a day for 6 blocks.
3) Measurement of protein in urine (none).
4) Planning to quantify 24 hour food and water intake, as well as weight (estimate 47 pounds).
5) Advise family as to need to keep the dog indoors at this time.  Family is inquiring about euthanasia.
6) After food and water intake is assessed, investigate possible organ failure.  (Food and water intake look good – 4 cups dry and 26 oz wet/day, 650 mL water so far).
 
Brownie needs a temporary indoor home for Christmas where her will to live can be nurtured as a part of a family.  She hates going back out to her chain.  She needs to be an only dog (no other animals or small children – because of her health issues).  She is very loving with people.  Does not do well with other dogs.
 
Plan of action

Working hypothesis:

Right front leg injury  – no pain, impaired mobility, swelling on joint

Left rear leg injury – no pain, impaired mobility, possible twisting injury, muscle atrophy

Although she is an older dog, she was likely unvaccinated with attenuated virus, and carrying an active latent parvo infection that her immune system was fighting, but that broke out when her immunity was compromized by her injuries and lack of appetite.   Currently she is stable, her appetite and fluids are ok.  Possible/likely worms.

Angina

 

High end work-up

Low end work up

Immediate plan

3)CBC $25, chemistry $30

Test/treat for worms

Get weight

2)Site test to confirm parvo

Walks

Stool sample

1)3 X-rays evaluate for intervention.

$80/ x-ray.  Need to evaluate movies for best 1 shot.  Will post more movies when I transfer them.

Pain management

Heart rate, auscultation, respiration.

 

Monitor weight.

Very careful movie of leg and arm movement.  Trace out legs for best x-ray view..

 

 

 

 

What can be done to improve her situation? 

1)      Off chain.

2)      Integrated family situation.

3)      Monitor feeding/fluids/walking/toe-nail clipping/medicine.  Weekly weight.

4)      Warmth

12/10/10 :  Brownie weighed in at 47 lb.  Her daily consumption of food was 4 cups of dry and 26 oz cans wet.  She consumed about 750 mL of water.
12/17/10:  After an initial weight loss even with supervised feeding, followed by 2 days of a 3 day wormer and intensified feeding, Brownie weighed in at 48.6 lb. 
12/24/10: Brownie weighed in at 47.5 lb.  She is quite strong by now, in spite of a coccidiosis infection that I am waiting a little to see if she will clear now that her worm burden is lower.  Her hip is obviously subluxated and loose in the joint (tendon rupture).  In the absence of funds, I am tempted to wrap it for support.  She needs a bigger collar for Christmas.
 
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