I have a 15 y.o. husky mix. For about a month or so she's been peeing
inside the house apparently unable to hold it till walking time and
has been having intense thirst. The vet did a urine test and a water
deprivation test that showed high microalbuminuria (38.5); the
bloodwork shows high ALT (SGPT) - 516, albumin - 3.2, bilirubin - 0.2.
Back in August microalbuminuria was 0.5; ALT (SGPT) - 424, albumin -
3.2, bilirubin - 0.4. The vet is not sure what's going on and wants to
do X-rays and CT. I'm not sure I like going on fishing expeditions.
Can anyone here help clear this up?

In article
,
boris wrote:

The vet is not sure what's going on and wants to
do X-rays and CT. I'm not sure I like going on fishing expeditions.
Can anyone here help clear this up?

The questions I always ask myself a what do these values indicate?
If more than one possibility, what is the prognosis and treatment/cure
for each of these conditions? What cost will there be in treatment of
this issue, both financially as well as time, duress to the dog, etc?
With treatment, will we be buying time, curing, or increasing quality of
life? What do you hope to find or not find with these tests? Will the
treatment options be different?

With a 15 yo dog, the answers may be significantly different from those
for a 2 yo dog. Assessing quality of life, longevity likelihood,
curative possibilities (including adequate management) are important.
And I won't pretend that financial considerations exist as well.

--
Janet Boss
www.bestfriendsdogobedience.com

On Apr 22, 11:38*am, Janet Boss
wrote:
In article
,

*boris wrote:
The vet is not sure what's going on and wants to
do X-rays and CT. I'm not sure I like going on fishing expeditions.
Can anyone here help clear this up?

The questions I always ask myself a *what do these values indicate? *
If more than one possibility, what is the prognosis and treatment/cure
for each of these conditions? *What cost will there be in treatment of
this issue, both financially as well as time, duress to the dog, etc? *
With treatment, will we be buying time, curing, or increasing quality of
life? *What do you hope to find or not find with these tests? *Will the
treatment options be different?

With a 15 yo dog, the answers may be significantly different from those
for a 2 yo dog. *Assessing quality of life, longevity likelihood,
curative possibilities (including adequate management) are important. *
And I won't pretend that financial considerations exist as well.

--
Janet Bosswww.bestfriendsdogobedience.com

These are really good questions but before asking and answering them
we need a firm diagnosis first, don't we?

In article
,
boris wrote:


These are really good questions but before asking and answering them
we need a firm diagnosis first, don't we?

Not for all of them. Read the first questions. Let's say there are 5
possible causes. Detail what each would entail to cure or manage it
effectively. Detail what would happen if you DON'T investigate and
treat. Then make the decisions.

--
Janet Boss
www.bestfriendsdogobedience.com

boris wrote:
On Apr 22, 11:38 am, Janet Boss
wrote:
In article
,

boris wrote:
The vet is not sure what's going on and wants to
do X-rays and CT. I'm not sure I like going on fishing expeditions.
Can anyone here help clear this up?
The questions I always ask myself a what do these values indicate?
If more than one possibility, what is the prognosis and treatment/cure
for each of these conditions? What cost will there be in treatment of
this issue, both financially as well as time, duress to the dog, etc?
With treatment, will we be buying time, curing, or increasing quality of
life? What do you hope to find or not find with these tests? Will the
treatment options be different?

With a 15 yo dog, the answers may be significantly different from those
for a 2 yo dog. Assessing quality of life, longevity likelihood,
curative possibilities (including adequate management) are important.
And I won't pretend that financial considerations exist as well.

--
Janet Bosswww.bestfriendsdogobedience.com

These are really good questions but before asking and answering them
we need a firm diagnosis first, don't we?

It's really hard to decide what to do when an elderly dog is ill.

In your first post, you indicated that your vet wants to take
x-rays and a CT, and you said you weren't sure if you wanted to
go on a fishing expedition. Well, sometimes a "fishing
expedition" is what it takes in order to get a firm diagnosis.
And you need to be clear with yourself what you are willing (and
financially able) to do to treat the dog, what makes sense given
age and general health, what is best for the dog, regardless of
what the fishing expedition turns up.

Our dog Dylan had cancer (successfully treated), and later she
developed seizures. We did some of the basic tests, which didn't
show much of anything, so the next one was a cranial MRI, and we
opted not to do it, since Phenobarb was controlling the seizures.
If an MRI had shown that she had a brain tumor, we would not
have opted for surgery or more radiation or chemo, so there
really wasn't any point in doing it. [Phenobarb controlled her
seizures for another 2 years; she had a massive seizure when she
died at 11 (almost instantly, after stealing half a package of
crackers and scarfing them down), leading us and our vet to
suspect that the problem was probably an aneurysm. But we'll
never know. And we can live with that.]

Were you asking for someone on this forum to form a diagnosis
based on the results of the urine test? (That wouldn't be me.)

If the diagnosis isn't clear cut, it can be a short or long
fishing expedition to figure out the problem. IME, vets usually
start looking at the most likely causes, but sometimes "likely"
isn't the answer, and then it's a longer process of test,
eliminate possibilities, test, eliminate possibilities ... IOW,
fishing.

FurPaw

--
Don't believe everything that you think.

To reply, unleash the dog.

On Apr 22, 12:22*pm, FurPaw wrote:
boris wrote:
On Apr 22, 11:38 am, Janet Boss
wrote:
In article
,

*boris wrote:
The vet is not sure what's going on and wants to
do X-rays and CT. I'm not sure I like going on fishing expeditions.
Can anyone here help clear this up?
The questions I always ask myself a *what do these values indicate? *
If more than one possibility, what is the prognosis and treatment/cure
for each of these conditions? *What cost will there be in treatment of
this issue, both financially as well as time, duress to the dog, etc? *
With treatment, will we be buying time, curing, or increasing quality of
life? *What do you hope to find or not find with these tests? *Will the
treatment options be different?

With a 15 yo dog, the answers may be significantly different from those
for a 2 yo dog. *Assessing quality of life, longevity likelihood,
curative possibilities (including adequate management) are important. *
And I won't pretend that financial considerations exist as well.

--
Janet Bosswww.bestfriendsdogobedience.com

These are really good questions but before asking and answering them
we need a firm diagnosis first, don't we?

It's really hard to decide what to do when an elderly dog is ill.

In your first post, you indicated that your vet wants to take
x-rays and a CT, and you said you weren't sure if you wanted to
go on a fishing expedition. *Well, sometimes a "fishing
expedition" is what it takes in order to get a firm diagnosis.
And you need to be clear with yourself what you are willing (and
financially able) to do to treat the dog, what makes sense given
age and general health, what is best for the dog, regardless of
what the fishing expedition turns up.

Our dog Dylan had cancer (successfully treated), and later she
developed seizures. *We did some of the basic tests, which didn't
show much of anything, so the next one was a cranial MRI, and we
opted not to do it, since Phenobarb was controlling the seizures.
* If an MRI had shown that she had a brain tumor, we would not
have opted for surgery or more radiation or chemo, so there
really wasn't any point in doing it. *[Phenobarb controlled her
seizures for another 2 years; she had a massive seizure when she
died at 11 (almost instantly, after stealing half a package of
crackers and scarfing them down), leading us and our vet to
suspect that the problem was probably an aneurysm. *But we'll
never know. *And we can live with that.]

Were you asking for someone on this forum to form a diagnosis
based on the results of the urine test? *(That wouldn't be me.)

If the diagnosis isn't clear cut, it can be a short or long
fishing expedition to figure out the problem. *IME, vets usually
start looking at the most likely causes, but sometimes "likely"
isn't the answer, and then it's a longer process of test,
eliminate possibilities, test, eliminate possibilities ... IOW,
fishing.

FurPaw

--
Don't believe everything that you think.

To reply, unleash the dog.- Hide quoted text -

- Show quoted text -

Well, I'll tell you a different experience. My mom has just gone
through her doctors' fishing expedition who decided to treat her with
chemo just in case she had cancer only based on the markers in her
blood. Three weeks into the chemo the doc rescinded his "diagnosis",
basically saying "never mind" but the damage from chemo had already
been done while her actual problem with the lungs kept being
untreated. I consider this elimination approach they use here in the
US as fundamentally flawed and bordering on negligent. Clearly, it
shows that diagnostics is not their strongest suit. IOW, when it comes
to the family's health I don't trust the first opinion I get and if
they need someone to drag through endless tests and try endless drugs
that do more harm than good on let them do it to someone else.

boris wrote:
On Apr 22, 12:22 pm, FurPaw wrote:
boris wrote:
On Apr 22, 11:38 am, Janet Boss
wrote:
In article
,
boris wrote:
The vet is not sure what's going on and wants to
do X-rays and CT. I'm not sure I like going on fishing expeditions.
Can anyone here help clear this up?
The questions I always ask myself a what do these values indicate?
If more than one possibility, what is the prognosis and treatment/cure
for each of these conditions? What cost will there be in treatment of
this issue, both financially as well as time, duress to the dog, etc?
With treatment, will we be buying time, curing, or increasing quality of
life? What do you hope to find or not find with these tests? Will the
treatment options be different?
With a 15 yo dog, the answers may be significantly different from those
for a 2 yo dog. Assessing quality of life, longevity likelihood,
curative possibilities (including adequate management) are important.
And I won't pretend that financial considerations exist as well.
--
Janet Bosswww.bestfriendsdogobedience.com
These are really good questions but before asking and answering them
we need a firm diagnosis first, don't we?
It's really hard to decide what to do when an elderly dog is ill.

In your first post, you indicated that your vet wants to take
x-rays and a CT, and you said you weren't sure if you wanted to
go on a fishing expedition. Well, sometimes a "fishing
expedition" is what it takes in order to get a firm diagnosis.
And you need to be clear with yourself what you are willing (and
financially able) to do to treat the dog, what makes sense given
age and general health, what is best for the dog, regardless of
what the fishing expedition turns up.

Our dog Dylan had cancer (successfully treated), and later she
developed seizures. We did some of the basic tests, which didn't
show much of anything, so the next one was a cranial MRI, and we
opted not to do it, since Phenobarb was controlling the seizures.
If an MRI had shown that she had a brain tumor, we would not
have opted for surgery or more radiation or chemo, so there
really wasn't any point in doing it. [Phenobarb controlled her
seizures for another 2 years; she had a massive seizure when she
died at 11 (almost instantly, after stealing half a package of
crackers and scarfing them down), leading us and our vet to
suspect that the problem was probably an aneurysm. But we'll
never know. And we can live with that.]

Were you asking for someone on this forum to form a diagnosis
based on the results of the urine test? (That wouldn't be me.)

If the diagnosis isn't clear cut, it can be a short or long
fishing expedition to figure out the problem. IME, vets usually
start looking at the most likely causes, but sometimes "likely"
isn't the answer, and then it's a longer process of test,
eliminate possibilities, test, eliminate possibilities ... IOW,
fishing.

FurPaw

--
Don't believe everything that you think.

To reply, unleash the dog.- Hide quoted text -

- Show quoted text -

Well, I'll tell you a different experience. My mom has just gone
through her doctors' fishing expedition who decided to treat her with
chemo just in case she had cancer only based on the markers in her
blood. Three weeks into the chemo the doc rescinded his "diagnosis",
basically saying "never mind" but the damage from chemo had already
been done while her actual problem with the lungs kept being
untreated. I consider this elimination approach they use here in the
US as fundamentally flawed and bordering on negligent. Clearly, it
shows that diagnostics is not their strongest suit. IOW, when it comes
to the family's health I don't trust the first opinion I get and if
they need someone to drag through endless tests and try endless drugs
that do more harm than good on let them do it to someone else.

I think you may have a misconception. There
aren't definitive diagnostic tests for
everything a person or an animal can have. In
the absence of a definitive diagnostic test,
the only way to approach a doagnosis is
through eliminating what it *isn't*. That's
not an "American" style, that's simply the
deal until we've solved the lystery of every
single disease humans and animals can get.

No one said to come up with a list of 5
things and then *go ahead and treat them even
though you have no idea*. Wow. I never once
read that suggestion.

I did see people give you the very wise
suggestion of coming up with the likliest
diseases and then *writing down on paper*
what the treatments would be, what the sucess
rates would be, and what impact those
treatments would have on a 15 year old dog.
None of that implies giving a dog who needs
ascriptin (for example) a round of chemo. I'm
not sure where you got the idea anyone was
coming close to saying such a thing.

On Wed, 22 Apr 2009 11:24:05 -0700 (PDT), boris
wrote:

On Apr 22, 12:22*pm, FurPaw wrote:
boris wrote:
On Apr 22, 11:38 am, Janet Boss
wrote:
In article
,

Well, I'll tell you a different experience. My mom has just gone
through her doctors' fishing expedition who decided to treat her with
chemo just in case she had cancer only based on the markers in her
blood. Three weeks into the chemo the doc rescinded his "diagnosis",
basically saying "never mind" but the damage from chemo had already
been done while her actual problem with the lungs kept being
untreated. I consider this elimination approach they use here in the
US as fundamentally flawed and bordering on negligent.

It is not the standard of care in the US to treat someone with chemo
just in case they have cancer, or based on tumor markers. Any
physician who does that is probably committing malpractice (I say
probably in case there aren't other issues you didn't mention, such as
scan results). But people do bear some responsibility in their health
care. I can't imagine why someone would consent to chemotherapy
treatment solely on the basis you described.

Your original post disappeared from my program. Is it possible to
manage your dog's condition symptomatically? 15 is old even for a
husky.

On Apr 22, 11:30*am, boris wrote:
I have a 15 y.o. husky mix. For about a month or so she's been peeing
inside the house apparently unable to hold it till walking time and
has been having intense thirst. The vet did a urine test and a water
deprivation test that showed high microalbuminuria (38.5); the
bloodwork shows high ALT (SGPT) - 516, albumin - 3.2, bilirubin - 0.2.
Back in August microalbuminuria was 0.5; ALT (SGPT) - 424, albumin -
3.2, bilirubin - 0.4. The vet is not sure what's going on and wants to
do X-rays and CT. I'm not sure I like going on fishing expeditions.
Can anyone here help clear this up?

For kidney and urination issues, you might want to try joining this
group:
http://pets.groups.yahoo.com/group/K9KIDNEYS/
it's a moderated group (no spam or obnoxious side discussions) with a
lot of knowledgeable people who are much more likely to give you
specific meaningful advice based on those lab numbers.

If cost is part of the question here, an x-ray is a lot cheaper than a
CT, so you could see what shows up on the x-ray first, then re-asses
and go from there. It can also be less time and hassle, both for you
and the dog. For us, the x-ray was something our vet could do in-
house, a CT would have required admission to the teaching hospital up
the road, a much more stressful environment for our dog (and us). For
my Akita, just an x-ray was enough to make a decision, even though our
vet initially wanted to do a CT (hers was not a kidney issue--your
problem may not be so simple to see).

I like Janet's idea--find out what the possible diagnoses are. Are
any of the most likely ones reasonably treatable? Are the treatments
quick and simple, or complicated/involved/uncertain or risky? How long
will it take for her to recover from them, can you do something else
instead that would simply keep her comfortable in the time she has
left? What might her quaility of life be expected to be if that
diagnosis were left untreated, or treated minimally? How many of
these possible diagnoses could be treated by the same approach without
doing the more expensive tests to isolate the cause to just one? At
15, pills and prescription diets are one thing, surgeries another.

I've heard of some people who simply put down plastic and old throw
rugs and deal with the mess for the time that their old dog had left
rather than put them through a long ordeal--there may be some other
ways you and your vet could find that can help make her and yourself
more comfortable that do not require a completely medical solution.

Good luck,
--Glenn Lyford

boris wrote:

Well, I'll tell you a different experience. My mom has just gone
through her doctors' fishing expedition who decided to treat her with
chemo just in case she had cancer only based on the markers in her
blood. Three weeks into the chemo the doc rescinded his "diagnosis",
basically saying "never mind" but the damage from chemo had already
been done while her actual problem with the lungs kept being
untreated. I consider this elimination approach they use here in the
US as fundamentally flawed and bordering on negligent. Clearly, it
shows that diagnostics is not their strongest suit. IOW, when it comes
to the family's health I don't trust the first opinion I get and if
they need someone to drag through endless tests and try endless drugs
that do more harm than good on let them do it to someone else.

I can understand why you're spittin' mad about your doctor's
treatment of your mom, but I'm kind of surprised that she'd
consent to undergo chemo "just in case." Did she get another
opinion?

I'm not sure what you're looking for from this group.

FurPaw

--
Don't believe everything that you think.

To reply, unleash the dog.