Home from the Vet - The next step

I mentioned at the vet that Skelly has not had much of an appetite. The vet techs gave him some fancy canned food which he gobbled up.

Skelly urinated on the way out to the car. It was far from healthy looking. During the car ride home, he was unable to keep down all that yummy food. :(

Last week the doc was under the impression that Skelly was having an auto-immune reaction similar to the one that he had when they gave him the initial preventative. It appears that is not the case.

The x-ray revealed that portions of Skeletors lungs are not functional. This is further evidenced by his abnormal heart murmur, and labored breathing.  They gave me 2 possible explanations for this. 1) The adult heartworms have shifted, causing a blockage and cutting off the blood supply to portions of his lungs. 2) Pneumonia.

It's not likely that pneumonia is to blame for the anomalies found in the x-ray. The reason for this is that he has not been running a temperature at all.

I was given no other possibilities to account for Skeletor's rapidly deteriorating state.

The next step is to perform an echocardiogram. This is a sonogram, which will give the doctors a clearer picture of the state of Skeletor's heart and the parasites contained therein. 

The first thing we need to do if we're going to save this pup is figure out for sure what is wrong. It seems apparent that we're indeed dealing with a blockage. Nothing else accounts for all of his symptoms and their very sudden onset.

Unfortunately diagnosis is only the beginning. I asked Dr. Fish what our options would be in the event that he's right about the blockage. There are only two. (three if you count euthanasia)

One (which Dr. Fish would not even begin to recommend for a dog in Skeletor's weakened state) is to kill the adult heartworms through the use of Immiticide injections.

Two is to remove the obstruction surgically.

I just found a very informative page on the subject.
http://www.veterinarypartner.com/Content.plx?A=610

Here's an excerpt... 

• Class I: Lowest Risk. Young healthy dogs with minimal disease evident on radiographs, normal blood work, and no symptoms of illness. They may cough only occasionally if ever, they only fatigue with exercise, and their chest radiographs are normal. 
• Class II: Moderately Affected. Healthy dogs with minimal signs as above, occasional coughing, fatigue only with exercise but with radiographs that show definite evidence of heart disease. Lab testing shows mild anemia, urine dipsticks show some protein, but not severe urinary protein loss.
  

  Chest radiograph from a severely affected dog

• Class III: Severely Affected. Dog is suffering from weight loss, cough, difficulty breathing, blatant damage to the vasculature is apparent on radiographs, laboratory work reveals a more severe anemia and marked urinary protein loss.
• Class IV: Caval Syndrome. Dog is collapsing in shock and dark brown urine is evident.
  Heartworms visible by ultrasound in the AV valve of the right side of the heart, and blood work is very abnormal. These dogs are dying and can only be saved by the physical removal of adult heartworms via an incision through the jugular vein. If such a dog can be saved from this crisis, further heartworm infection treatment cannot be contemplated until the dog is stable enough to fit into one of the other categories above.

Skeletor seems to have jumped from somewhere around Class II clear into Class III in literally 2 weeks. 

I'm awaiting a phone call to let me know when I can bring Skelly in for the echocardiogram. This procedure is supposed to be around $200. The summer slump in business has left me with no kind of budget for this. Much less the surgery that will undoubtedly be astronomical. :(

Dr. Fish mentioned that they could keep him hospitalized in the meantime, but saw no reason to.  It would just cost extra money and they feel like he's being well taken care of here.

Poor Skelly. I hate to wrap up this post without a single positive thing to say...

While we were in the back, Skeletor saw another sick pup and was trying to go say hi. He was acting just like his normal chipper self but to a much lesser degree. He really tries to be happy no matter how bad he's feeling.

When we got home and I finished cleaning up the back seat, I noticed Skelly laying down in the living room. Sophie walked up to him with her tail wagging. She then licked and nibbled at his face almost as if she could tell that he was sick. I wish I had been video taping.

 Hang in there buddy!!