Thursday, 15 January 2009

A.T.E (Aortic Thromboembolism)

Well you learn something new every day. I am very used, thanks to the emergency work, to dealing with cats that have had an ATE (Aortic Thromboembolism) In other words the clot of blood that breaks free and lodges, generally speaking at the branch of the where the Aorta separates down the cats back legs.
It is intensely painful and a very high percentage of cats die. If they do recover it is a very guarded prognosis.
Sometimes the clot travels round and lodges in the lungs. Usually this is less painful as blood is still circulating past it but it still causes a lot of problems. And again a guarded prognosis.

When we did the pacemaker on the cat Mike explained that one of the risks is that cats blood clots very easily, like a humans does. A dog’s blood is different so they were able to do a lot more heart operations on dogs.
I never though to ask about thrombus in dog's. I did not think l had seen (as far as l knew) any in dogs and we were discussing a cat and a very big operation on it.

Today was one of those rude awakening days. Wibble has been a bit puffy for about 3 weeks but l thought with central heating being up, l did not want to be a paranoid owner, would just keep an eye and if l was still not 100% happy l would speak to the 2 Mikes today.
The problem is working, especially like l do, with a major part of my work emergencys you get paranoid that every little thing is a major 'thing'. The animal suffers endless needles and exams to go to the other extreme of dismissing everything as paranoia. So l tend to end up on a bit of a tightrope and often the vets check my dogs and find nothing, but l try and withold endless tests and needles etc.
Mike J beat me to it. Last night he stayed behind to chat about Wibs and that they had been worried about her breathing, he did not remember her being like that before. I agreed and asked if he could check her. He was happy to, so today we put her through the heart and respiratory ‘book’.

First was auscultation (listening with a stethoscope) not a quick listen but very involved, different areas for several minutes per area. There was just a slight grade 2 murmur lots have that and l was not worried.

Then onto fluoroscopy, live moving x-ray of how her breathing was, anything obvious like collapsing airway, or nasty looking areas.
She was settled for a few minutes then went into freak panic mode just because Mike not me was holding her head, l was holding her legs but oh no not good enough. After she settled Mike and l swapped places and he finished the flouro, nothing showed up.

Then a heart scan. Now we were headed towards the problem. She had a minor bit of valve disease and a bit of ‘regurg’ (swirly blood going back and forwards instead of just one way through the valve) but considering she is 15 nothing to worry about.

The pulmonary artery was the problem it was greatly enlarged and had a high pressure. Normally the dog and cat pressures are up to 3 meters Wibble is 4 so why and what caused this?
Well she had had heart worm years ago so possibly a hangover of damage but unlikely as it was an acute cause. She did not appear to have lung worm, so more working out.

The thought is that she has had an ATE. And it has lodged in her lungs. Apparently in dogs although rare they get 2 sorts. An acute ATE that causes extreme pain and the animal dies within about 2 hours (very rare) The dog gets a lesser clot, it shows no signs other than the breathlessness on exercise and if active possibly intermittent collapse. Wibs is not active so that didn’t show but the breathlessness does.

After lunch we took x-rays. Mike J asked if l thought we should sedate her perfect timing as at the same time l was saying we need to sedate her. It was to much hassle to do conscious she would have been kicking and getting annoyed at being positioned. So a break while the dozey juice kicked in and several x-rays later. Again nothing showed. Heart size was fine, no lung worm patterns, no nasty shadows.

Mike J then did an abdominal scan to check spleen and liver and kidneys for anything that looked wrong to see if the clot was as a result of that, all was clear. This scan was great she was nicely sedated and did not care who held what or did what to her.

Final test was blood, and yes, Mike J held her while l shoved a needle into her jugular and pulled out 5ml.
Blood smears and various tubes have gone to the labs to measure the levels of a by-product of clotting material called D-dimer, a tube of blood for a general haematology and a couple of blood smears.

Treatment for pulmonary arterial hypertension is on hold until results are back next week probably Tuesday. If it is an ATE she will go onto aspirin and a heparin drug to help thin her blood down and Mike says that it is a pretty good diagnosis and should more or less clear her up. So we will see how she does. (on the link scroll down to Pathogenesis it explains things well)

She is so lucky that we are at the top Cardio Respiratory Referral Centre, in Europe and one of the best in the world. We (Wibble and l) owe a big thank you to every one here.
Sitting in the fridge is 2 very very chocolate cakes and l have planned a couple of other personal gifts but as l can not get to the shops till Saturday l am not saying in case one of the Mikes reads this.

l have the fluoroscopy on DVD l may try and upload some when l get home and work out how. I have clips of the heart scan again may try an upload. Finally l have her x-rays.

Wibs - "WTF hit me" recovering post sedation. I threw my jersey over her so she could snuggle.


joker the lurcher said...

hell what a worry for you! i am so glad it is all looking positive. once they are this old your heart is in your mouth about this sort of thing. hugs.

Pickyknitter said...

What bad *and* good fortune! I hope Wibble is feeling better soon.

Dave the Dog said...

Fingers crossed !


Fi from Four Paws and Whiskers said...

All the best with Wibble. So glad you both have such a competent team and technology there to increase the chances of diagnosis and treatment :)

Auntie Jane said...

Wibble has reached a good age... I do hope everything turns out ok. It is such a worry when they aren't too well.

Like you, I know my dogs and tend to take them straight to the vet if there is any change in them. I'd rather be safe than sorry.

Lesley said...

Give Wibs a special love from me Caro. xxx

Roses said...

Oh no...many hugs to you and to Wibble. Poor love.

It's really strange, getting to know her through your anecdotes and seeing her picture, she now feels like any other virtual friend, just that she's a canine. I'm thinking of you both.

Please let us know how she gets on. xxx

Vetnurse said...

Mnay thanks to everyone. Will keep you updated on how she goes. At the moment sleeping (not unusual) got used to being carried up and down stairs (avoids the puffing) and otherwise treating her as usuall.

Which means threatening her for trying to nick the biscuits out of my handbag and getting the injured.
"I was just sniffing! no need to be so arsey" look from her.