Saying 'No' to x-ray in (nearly) 13 year old.

[MattB]

I will write this as objectively as I can as I'm feeling quite tearful.

Daisy, who I've posted about before, has been doing well in spite of her kidney disease but her back and in particular one of her rear legs seems to have been getting weaker which has been discussed with the vet a few times. Her rear right is a leg we think she has pulled a muscle in previously and recovered from, but today she is limping more on it. She has painkillers and she seems her happy self but I have a sense of dread.

I would like to give Daisy a day or so to see if her leg is going to improve - she has had a couple of slips on the ice recently, although that was a few days ago so I don't think it's that. She is only taking paracetamol as she hasn't got on with Previcox (suspected ulcers) but I would imagine that we could use for something acute if necessary or look at other meds. 

My fear is that the vet will suggest an x-ray and, if there is bad news, not bringing her round. 

However, as I've probably mentioned a few times in other posts, Daisy is such a nervous dog, I know that leaving her at the vets while she waited for an x-ray would be unbelievable stressful for her and I can't bear for her to spend potentially her last day so unhappy. But what is the other option? Take her to the vet and see if she could have some stronger painkillers for a couple of days and then say goodbye if it doesn't help? I'm feel like with an elderly dog there are likely to be limited options even if not osteo.

I would really value other perspectives on this and happy to be told that I'm wrong.  

[macoduck]

I've had a similar problem with a few of my greyhounds who stress severely at the vet office.

Ask for Trazodone for you to give her 30-45 minutes prior to your appointment. (For Georgie's nail trims we started at 100mg and over the following months we were finally able to cut the dose down to nothing.) If your vet is willing, ask if you can have some to try before the day of the appointment so you can see how she does on it. You need that balance of enough to cut the edge of panic off and get her relaxed. The full dose may make her really wonky, so perhaps try a half pill first. It generally only lasts 4-6 hours.

See if your vet will allow you to wait in the car with Daisy until they are absolutely ready to have you walk her in and go directly to xray even if it means doing her physical exam there and then immediately putting her on the xray table. Then rather than wait for the results while in the building, ask if you can place her in the car if she'll be calmer there.

[MP_the4pack]

You do want an xray. Because if it is the dreaded osteo you don't want her to break her leg.

[MattB]

5 minutes ago, MP_the4pack said:

You do want an xray. Because if it is the dreaded osteo you don't want her to break her leg.

Thanks - No I absolutely agree, I wasn't suggesting that I didn't do anything and I'm just waiting for a call back from the vet now.

More questioning whether it is likely to be helpful at all. I.e. is there a situation where there is something treatable or will it always end in having to say goodbye, in which case would it be better to do so together without putting her through an x-ray given her age and other health problems. This may be an entirely unjustified positive and of course I don't want Daisy to go a day earlier than she needs to, it just comes from my experiences with the last 3 greyhounds we've had. 

2 hours ago, macoduck said:

I've had a similar problem with a few of my greyhounds who stress severely at the vet office.

Ask for Trazodone for you to give her 30-45 minutes prior to your appointment. (For Georgie's nail trims we started at 100mg and over the following months we were finally able to cut the dose down to nothing.) If your vet is willing, ask if you can have some to try before the day of the appointment so you can see how she does on it. You need that balance of enough to cut the edge of panic off and get her relaxed. The full dose may make her really wonky, so perhaps try a half pill first. It generally only lasts 4-6 hours.

See if your vet will allow you to wait in the car with Daisy until they are absolutely ready to have you walk her in and go directly to xray even if it means doing her physical exam there and then immediately putting her on the xray table. Then rather than wait for the results while in the building, ask if you can place her in the car if she'll be calmer there.

Unfortunately I don't think there is any flexibility with this process (there wasn't last time with this vet anyway) - I think because they're such a busy practice - but of course I will try to go through all possible options with the vet.

 Thanks both. 

 

[cleptogrey]

42 minutes ago, MP_the4pack said:

You do want an xray. Because if it is the dreaded osteo you don't want her to break her leg.

Annie showed no signs of osteo until she jumped off the bed onto carpeting and her leg broke in half. You don't want to experience that! X -ray with orders to euthanize while under. Let your sweet old gal not suffer one minute more. I hate to sound so blunt but both of my girls had osteo. 10+years later I still have a bitter taste in my mouth since the first vet would not follow my request and insisted that we should consider amputation and chemo. It was 6 weeks of drugged misery for poor Emily and our family.

[Remolacha]

I understand your hesitation, I am always a bit reluctant to do diagnostics on an older dog if it isn’t going to change the treatment, even though I really like to know what’s going on. However, you really, really, really do not want a broken leg. The screaming is the worst thing I have ever heard. Even if you can’t go in with her, giving her something to calm her is a good idea. 

[ramonaghan]

I'm so sorry you're going through this. In your shoes, I'd want to know for sure. It's of course possible Daisy's just sore from slipping, in which case that is totally treatable and she'll be fine in a few more days. She might do better with Galliprant, an NSAID that's gentler on the kidneys, than Previcox. If it's the dreaded osteo, you can let her go if that's what you think is best for her. You know your dog better than anyone and will make the right choice for her. I don't say that lightly, having been through a leg break surgery and an amputation with a 12-year-old this year, and now facing a likely third surgery to remove a soft tissue sarcoma on Sweep's front leg. (I'm sure some people think I'm nuts!) Sweep is also quite nervous at the vet, which limits our treatment options somewhat. Ducky's suggestion of Trazadone is a good one. Proceed with a very low dose and see how Daisy reacts; the one time Sweep got a full dose of 100mg, she was very unsteady (not good for a broken leg dog). But I gave her a quarter-dose during bad storms last night and it took the edge off enough for us both to get some sleep. Best thoughts to you and your girl.

[greysmom]

IMO, any vet that won't make *any* accommodation for a nervous senior hound deserves to be left in the rear view mirror.  I know it's difficult right now in the veterinary field with staffing issues and with COVID procedures, but helping you help your dog - and them! - is something they should be on board with 100%.

As far as the xray itself - meh.  I would probably wait a couple days anyway, and administer whatever meds she's had in the past that helped, as a soft tissue injury is probably more likely than cancer, particularly if she has presented like this before.  But I would probably only proceed if the results will change your dog's treatment in an appreciable way.  Meds aren't going to help forever, though, and you need to have a serious conversation with your vet about what your options are going forward considering her age, her anxiety, and her overall health.

An nsaid is fine, as far as it goes, but at some point you're likely to need an actual pain reliever.  Stay very far away from Tramadol and Fentanyl, and most other opioids, as greyhounds don't process them very well.  The one exception is a drug called codeine sulfate - which is an opioid, but much better tolerated and useful.

And, finally, you have a 13 year old dog with multiple health concerns.  You need to really be considering end-of-life issues *now* so you don't feel forced to make a decision at the spur of the moment in the middle of a crisis.  No one wants to think about losing their dog, but she's been your faithful companion and deserves not to suffer a day when you can give her the last gift of release from any suffering.

[KF_in_Georgia]

It could be something treatable. It could be a pulled muscle that she keeps tweaking, and restricted activity might be helpful. (Especially since she's injured it before.)

It might at least be something that won't get worse.

I would try to push for the trazadone unless the vet can give you a good reason not to do it. You may have to insist--asking why they're in so much of a hurry they can't make Daisy comfortable.

[MattB]

Thanks so much everyone. I spoke to the vet and he was happy, based on my description to give a few days of gabapentin and I'll bring her straight in if that doesn't help.

 

I may have explained badly, I wasn't meaning to imply that I was just going to wait for it to get worse but rather questioning if diagnostics would change the outcome. I don't think I explained very well. Of course if is a case of, well it could be X which is very treatable then it's absolutely worth it. But I still have the vet's words in my head from my lovely Charlie who we lost 8 months ago, when he put him to sleep while he was still under he said 'We all knew there was only a small chance there would be a good outcome but at least you tried everything', but I'm not sure I had known that so I sometimes wonder if the X-ray was the right thing to do. Anyway, it's time for our short bedtime walk now - thanks all.

[MattB]

Just an update. We went to the vet today who says she's fairly sure Daisy's problem is back-related and the swelling on her ankle is arthritic (Daisy was diagnosed with advanced arthritis in her front legs 7 years ago) We talked about my x-ray worries and she said she doesn't think we need one right now but if we do she will saute Daisy in the car and x-ray hey straight away and have her back on her sofa asap. So for the moment we're doing gabapentin + paracetamol and cuddles - Thanks everyone for your input.

[Remolacha]

I am glad she doesn’t need the X-ray right now! As someone who has had two greys with back problems, I sympathize, pain meds and rest seem to be about all you can do. I don’t know what your situation is in England, but I found acupuncture did wonders for my grey’s back problems.

[macoduck]

MattB, did you look at Dr Feeman's TikTok video? Here's his LS one but he has several other medical ones.