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Tuesday, May 25, 2010

A Tragic Double-Whammy

The two c-sections in the last week where all puppies lived were great experiences, and very happy. Unfortunately, not all cases can end on such a high note.

Today we saw a pair of puppies that had been adopted from a shelter last Thursday. As soon as the client took them home, they started coughing.  A few days later she took them to a vet who diagnosed kennel cough, and put them on antibiotics but was worried about the fact that one of them had a poor appetite.  Two days later she was at the emergency clinic with that puppy who was diagnosed with pneumonia and a consolidated lung lobe.  They switched antibiotics and hoped for the best.

When the two pups (black lab mixes about 3 months old) came in today there hadn't been any improvement.  The most severely affected one was also having diarrhea and her sister had just started having diarrhea and a loss in appetite.  Though not clinically very severe, both were lethargic and had coughs.  After talking to the owner and examining them, there was something nagging at the back of my mind.  These pups had been dewormed a few weeks previously, and had had two prior negative parvo tests.  But the symptoms other than the cough were consistent with parvo virus or some intestinal parasite.  Even though this was the third test for parvo, I convinced the owner to test for it.  And I'm glad we did.

The test rapidly became strongly positive for parvo.  So not only did both have kennel cough, but they also had a parvo infection and one had pneumonia.  Any one of these diagnoses was potentially severe enough and parvo by itself is life-threatening.  Having two diseases at the same time was a severe double blow to their chances of survival. 

Under ideal circumstances with unlimited money, these puppies probably would have had a 50/50 chance of survival at best, and realistically probably much less than that, especially with pneumonia.  They would have required intense hospitalization, easily totaling $1000 or more per puppy with no promise of survival.  Because of the money and the chances, the client elected to euthanize both puppies.  It was a very sad bookend to the successes of the two c-sections.

This case also reinforced a few lessons for me.  First, experienced doctors should follow their instincts.  Something abut this case made me suspicious of parvo, and though it wasn't my top likelihood I did consider it.  Second, there is a big benefit to diagnostic testing rather than guessing.  We could have assumed that the diarrhea was due to the liquid diet the owner was feeding and the inappetance was due to the respiratory disease and not ended up finding the real problem.  Third, a previous negative test doesn't mean that you can't be positive in the future, so it's often worth repeating diagnostics.

Oh, and make sure your pets are vaccinated!  In this case it wasn't the client's fault, but it's still important to remember.