Afraid of losing my dog

[.Poppy.]

That's a good idea. Honestly, I'm thinking about doing this test and calling it at that point unless more symptoms pop up. I'm inclined to do this one because 1) it's not incredibly expensive and 2) I already know he has joint problems, so his issues being joint-related would not surprise me.

My regular vet actually suspected that he had immune-mediated polyarthritis, which this test would confirm/deny. She wasn't sure if that was the case, though, since he isn't incredibly lame. However, I did look it up and it says that in a percentage of dogs lameness is really sporadic or not present and a fever is the main indicator. It's also something that is relatively easy to treat - just immunosuppressants until symptoms resolve and leave it until there is another flare, so if it truly is that easy to handle that would be a relief.

Either way I'm going to wait a week or two to give him a break from sedation.

[pulisa]

I think that this is a very sensible plan of action, Poppy. You don't want to stress him out with another procedure which isn't urgent. I hope this test proves to be the breakthrough re diagnosis. It's so frustrating to keep on getting nowhere and spending money to no therapeutic avail.

[.Poppy.]

I called the vet school and set up an appointment for a week from today to get his joints tapped - which is really the last test before we just sit back and wait. I feel a lot of guilt at setting it up - I hate bringing him in for things like that because I know he hates it, I am afraid of the results, and I also remember being so scared a couple of weeks ago when he was coming back from the sedation. But I know there will either be an answer or there won't, and either way we know the path forward (for now). That is absolutely not going to stop me from being in a total state, though, of getting bad news or of having something happen during sedation and him passing away. I would never forgive myself.

I was a little frustrated on the phone because the receptionist didn't really know what procedure he had been recommended, and there wasn't really a note in his file to that effect, either. So I do generally know what they wanted to do (joint tap to test synovial fluid) but I am really hoping that he can see the same student or intern and that they will know what was requested. I just really don't want to see totally new doctors who have a different lens or more tests to suggest because this was the plan of attack and I'd like to stick to it.

We were there last on a Tuesday, though, and this will also be a Tuesday so....maybe the same intern will be working and we can see her again. I didn't even think to ask if I could request that. I'm honestly kicking myself for either a) not just having them run that test when he was sedated last time or b) not just setting up the appointment when the intern called me back a couple of weeks ago.

[pulisa]

Why not just ring the vet school and say you want continuity of care with the same intern. Then fix the date to suit her availability?

You wanted to give Chisum a break from tests. You followed advice re the first series of tests and the joint tap is a follow up procedure as there is still no definitive diagnosis. You do need to know exactly what procedure he has been recommended though and it's strange that there are no notes to indicate that on his case history.

[.Poppy.]

Thanks, Pulisa. I think that would be a good course of action. I'm sure the intern we saw remembers what the planned course of action was, and I know for myself what she had recommended. It's just frustrating she didn't write it down, apparently, and we were at our regular vet last week and my regular vet said she had heard a few things, but that she hadn't heard the outcomes of some of his tests. She was pretty frustrated at that as I know she wanted to be kept in the loop.

As with everything (ha) I'm still stressing about the potential results of the tests, and am concerned that if they find he has what they think he has, that he will have to go on Prednisone, which can have some sketchy side effects. I would think maybe if they diagnosed him I could talk to my regular vet about medication options and concerns? I think she may be a bit more understanding as to my concerns since she knows me and Chisum well and the vet school staff does not.

[pulisa]

I don't think you should think too far ahead and try to predict what the tests will find. Remember that these are the second round of tests as the first lot weren't particularly helpful in terms of diagnosis so they are just casting the net around for anomalies. I'm sure you will be able to continue with your regular vet if you get any definitive diagnosis though. I would be concerned at the lack of communication from the vet school though and by the poor documentation of Chisum's history.

[.Poppy.]

I would be concerned at the lack of communication from the vet school though and by the poor documentation of Chisum's history.

Me too, that part is particularly frustrating, especially as they are, in theory, supposed to be the top place to go. In reality, I work at the university that houses the vet school and know that isn't the case - there is a lot of turnover, a lot of disorganization, and they have had issues with hiring/retaining good talent due to low pay and better alternatives elsewhere. So it's not really surprising, but being as I was working with an intern and a student I guess I really did expect better, since they should (in theory) be a bit more on the ball about stuff like that.

I'll just try to keep it together in the meantime. I honestly just have the worst dread. I hate taking him there and I hate leaving him behind, regardless of what they find. I just have this massive need to have him with me, or know right where he is at all times, I guess? I may be a bit overprotective. If they find something, or not, I can certainly talk to my vet about next steps and medication alternatives, but I have to get through that appointment first. I guess I just know that if something bad happens I won't be able to forgive myself and will blame myself for making those choices for him.

[pulisa]

Does he really need these tests, Poppy? Is he obviously in pain now and is his quality of life badly affected? What are the chances of them finding something "incidental" and then suggesting more tests?

[.Poppy.]

I think that's what makes it so hard, pulisa...I just don't know. There's no question he's unwell - he has a pretty significant fever nearly all of the time, his liver is enlarged (though I'm not sure if that's new or just the way it always has been), and his liver values are going up. As for external symptoms - he doesn't appear to be in pain most of the time. There are times when he is in pain, and this all started with a bout of really severe pain. But I also don't know if he's often in pain and just not showing it, and if the times he does show it if those are times when his pain is truly severe.

As far as I know, there are no more tests. This is the last one they can run, and then the vet at the vet school pretty much said if it was inconclusive it would be a matter of waiting if/until he became more ill, with more obvious symptoms that would point to a cause. So as hard as it is for me to take him there and part with him, I do know this is really the last time for a good long while.

IF they come back with some sort of diagnosis, I do plan to talk to my vet extensively about treatment plans, because I really am against putting him on something that could have a lot of bad side effects if he is outwardly fine now - I don't want to make him worse. But I guess I'll just have to cross that bridge if/when we come to it. If they don't come back with a diagnosis....we just wait.

It's a really hard place to be because I want to do what's right for him, but feel totally lost on what "right" is. He's had some health issues before that were really pretty intense and expensive - he broke a tooth that couldn't be pulled so had to be capped/sealed; he tore his CCL and needed surgery - but those instances it was very clear what had happened and what needed to be done. We did it, it got better. All of the ambiguity is just so frightening and hard. I just want him to be happy and healthy and here with me.

[pulisa]

Does your regular vet think he is unwell?