Even though I'm generally good with medical stuff, my head was swimming at AEC, so I asked the doctor if there was any way I could get a written report. He e-mailed me the following (after apologizing for his grammar, since I'm an English professor . . . I wish people wouldn't do that!):
Harley's delayed recovery from anesthesia, progressive weakness in the back legs and progression to severe pain is very concerning. Harley's history, physical exam findings and diagnostics lead to a diagnosis of a blood clot though we unfortunately cannot confirm this problem at this time. With aortic thromboembolism/blood clot formation we see that patients have a very guarded-poor prognosis and have a high risk of development of further blood clots in the future. In combination with the chronic blood in the urine, continued weight loss, chronic kidney failure and kidney stones we see an additional risk of terminal problems but with efforts, can be managed.I've never gotten such a long, thorough e-mail from a medical professional. (His e-mail included the same links I've used above.) Whatever the outcome, I'm very impressed with the care this doctor has given Harley, and me.
At this point we have elected to give Harley overnight on IV fluids, pain medications, antibiotics and low dose aspirin to see if we have a clinical improvement. Our hope is that with time Harley will have less pain, become more alert and improve with time and supportive care as we would expect with a non-progressive blood clot. If we have any worsening of clinical signs or Harley remains painful in the morning it is my professional opinion that Harley has a poor prognosis and euthanasia should be considered.
If we see a positive response to treatment we may elect to proceed with the abdominal ultrasound in the morning to further define the prognosis and continued care of Harley.
1. Aortic Thromboembolism – This is often times seen as a sequel of Hypertrophic Cardiomyopathy (HCM) which can often times be missed on physical exam and radiographs due to the nature of the disease. Blood clots can also form due to bacterial in the blood stream (increased risk with dental disease, possible kidney infection, etc.). Blood clots can lodge anywhere in the body though including the spine, back legs, kidneys, etc.
2. Hydronephrosis – Harley's kidney function is less than 75% of normal, resulting in elevation of the kidney values (currently BUN 41, Creat 1.9). Decreased kidney function can result in a number of complications including kidney stones of which Harley has and decreased breakdown of anesthetics/medications. Often times those urinary stones do not become problematic though they can harbor infection and become displaced. Displaced kidney stones can cause and obstruction leading to further injury to the kidney and severe pain. Considering the likely stable kidney values and lack of focal pain during kidney palpation this process is less likely for Harley's problems.
3. Pancreatitis – The pancreas produces digestive juices that are placed in the GI tract helping to break down the foods that we eat. When the pancreas becomes inflamed it can cause severe pain and result in increased risk of blood clots or other problems within the body. Pancreatitis can be seen as a complication from anesthesia and in combination with the radiographic changes it remains a differential, though again based on physical exam it is felt less likely.