(Shirley) we're down to diagnostic choices (long)

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Posted by RJ Mello on August 21, 2001 at 16:10:19:

**CONDITION & CHOICES**:
Latest news on Shirley is that we�re at a point where the vets (yes...multiple vets have now examined & discussed her X-Rays & blood work) think it could either be kidney failure OR egg binding (going fwd = KF & EB). The next step is to do either a sonogram/ultrasound or endoscopy to better exam both the kidneys and the reproductive organs and, based on those results, determine how to proceed.

Trouble is, not knowing what�s actually wrong w/her (in addition to a few �other significant complications� I�ll explain below), I�m torn between which diagnostic method to pursue. My first choice would be the non-invasive ultrasound because, if it turns out to be KF, having to heal an endoscopy incision would just add to balance of what her already compromised system is trying to battle. However, if its EB the incision is a non-issue because we�d have to open her up to taken the eggs out (and possibly do a hysterectomy) anyway.

I�d probably be less hesitant to go w/the endoscopy if it weren�t for her age (10+) and the fact both her phosphorus & calcium levels are high (calcium can be high for either EB or KF, but high phosphorus is more indicative of kidneys). Until this morning, I was trying to remain positive about the fact that it might turn out to be EB, but I�m having a harder time w/that since Dr. S explained to me the fact a �normal� white cell count and uric acid levels could be attributed to that she�s already past the initial stages of KF and/or associated infection, where those indicators neutralize.

The one CBC indicator that IS high, and IS NOT indicative of both conditions is her high phosphorus level (which indicates KF). Most of the other symptoms she�s displayed can be indicators of either KF or EB (not eating, trouble eliminating, lethargy, etc...). I thought the CBC white cell & uric acid levels would indicate whether or not it was KF, but now I find out they do not always do so. So we come back to that one CBC level (phosphorus) that points in a single directions. . . .the one I did NOT want it to go . . . and the one that says I should continue to fight for the non-invasive procedure.

**�OTHER SIGNIFICAN COMPLICATIONS� to following through with the non-invasive ultrasound.**. . . .
Dr. M, who she saw at the Emergency Clinic Sunday, is an exotic vet but she was honest enough admit herps are not her specialty and refer me to Dr. S, someone she personally knows has allot of herp experience, and is about an hour closer to me. Dr. S could do the endoscopy (Friday morning), but doesn�t have ultrasound equipment.

The Emergency Clinic DOES have ultrasound equipment, but Dr. M. is only working a �relief� schedule (Sundays & Mondays), and after August 31 will be gone altogether. Besides....she really didn�t feel comfortable doing the ultrasound anyway.

There will be new herp vet (reportedly very experienced), at The Emergency Clinic beginning September 4. He could do the sonogram, but September 4th is 14 days away.

Another ultrasound option would be to go to Dr. K. for the ultrasound. He has exotic experience and an ultrasound in his office, although I had a hard time getting past his receptionist & am not sure he�s used it on anything besides ferrets. He�s further away than either of them (which is not my primary concern for a single visit) so would not be a follow up possibility and would just add another vet to the list of hands this has been (and potentially will be) passed through (THAT is my PRIMARY concern w/Dr K, and the vets agree).

**QUESTION**:
As you can see, it seems like a combination of factors are making this situation even more complicated than it would otherwise be. . . . .So. . . . if any of you have stuck w/me this far. . .where would your hearts and heads would lead you on this one?
1.) Ultrasound - w/new, additional doctor at additional clinic, who�s not yet seen her and won�t be doing follow ups (unsure of timeframe, but probably sooner than 14 days).
2.) Ultrasound � wait for new doctor at previously visited Emergency Clinic (14 days from now � soonest)
3.) Endoscopy (invasive) w/new recommended Dr. S, who will be able to do her follow up�s. (3 days from now � soonest)

A crystal ball sure would come in handy right about now.
Thanks in advance for your input/feedback/advice/etc.....
Rebecca (& Shirley)

Follow Ups:

Re: (Shirley) we're down to diagnostic choices (long) BabyHerp 08/21/01 (1)
- Also.... BabyHerp 08/22/01 (0)
This may sound strange but.... Mr. D 08/21/01 (0)
Re: Shirley iZ's mom 08/21/01 (1)
- Re: Maybe I'm using "renal failure" to generically RJ Mello 08/21/01 (0)
Re: (Shirley) we're down to diagnostic choices (long) xta 08/21/01 (1)
- Re: X-rays did show because..... RJ Mello 08/21/01 (0)
Re: (Shirley) we're down to diagnostic choices (long) Tif 08/21/01 (0)

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: **CONDITION & CHOICES**: : Latest news on Shirley is that we�re at a point where the vets (yes...multiple vets have now examined & discussed her X-Rays & blood work) think it could either be kidney failure OR egg binding (going fwd = KF & EB). The next step is to do either a sonogram/ultrasound or endoscopy to better exam both the kidneys and the reproductive organs and, based on those results, determine how to proceed. : Trouble is, not knowing what�s actually wrong w/her (in addition to a few �other significant complications� I�ll explain below), I�m torn between which diagnostic method to pursue. My first choice would be the non-invasive ultrasound because, if it turns out to be KF, having to heal an endoscopy incision would just add to balance of what her already compromised system is trying to battle. However, if its EB the incision is a non-issue because we�d have to open her up to taken the eggs out (and possibly do a hysterectomy) anyway. : I�d probably be less hesitant to go w/the endoscopy if it weren�t for her age (10+) and the fact both her phosphorus & calcium levels are high (calcium can be high for either EB or KF, but high phosphorus is more indicative of kidneys). Until this morning, I was trying to remain positive about the fact that it might turn out to be EB, but I�m having a harder time w/that since Dr. S explained to me the fact a �normal� white cell count and uric acid levels could be attributed to that she�s already past the initial stages of KF and/or associated infection, where those indicators neutralize. : The one CBC indicator that IS high, and IS NOT indicative of both conditions is her high phosphorus level (which indicates KF). Most of the other symptoms she�s displayed can be indicators of either KF or EB (not eating, trouble eliminating, lethargy, etc...). I thought the CBC white cell & uric acid levels would indicate whether or not it was KF, but now I find out they do not always do so. So we come back to that one CBC level (phosphorus) that points in a single directions. . . .the one I did NOT want it to go . . . and the one that says I should continue to fight for the non-invasive procedure. : **�OTHER SIGNIFICAN COMPLICATIONS� to following through with the non-invasive ultrasound.**. . . . : Dr. M, who she saw at the Emergency Clinic Sunday, is an exotic vet but she was honest enough admit herps are not her specialty and refer me to Dr. S, someone she personally knows has allot of herp experience, and is about an hour closer to me. Dr. S could do the endoscopy (Friday morning), but doesn�t have ultrasound equipment. : The Emergency Clinic DOES have ultrasound equipment, but Dr. M. is only working a �relief� schedule (Sundays & Mondays), and after August 31 will be gone altogether. Besides....she really didn�t feel comfortable doing the ultrasound anyway. : There will be new herp vet (reportedly very experienced), at The Emergency Clinic beginning September 4. He could do the sonogram, but September 4th is 14 days away. : Another ultrasound option would be to go to Dr. K. for the ultrasound. He has exotic experience and an ultrasound in his office, although I had a hard time getting past his receptionist & am not sure he�s used it on anything besides ferrets. He�s further away than either of them (which is not my primary concern for a single visit) so would not be a follow up possibility and would just add another vet to the list of hands this has been (and potentially will be) passed through (THAT is my PRIMARY concern w/Dr K, and the vets agree). : **QUESTION**: : As you can see, it seems like a combination of factors are making this situation even more complicated than it would otherwise be. . . . .So. . . . if any of you have stuck w/me this far. . .where would your hearts and heads would lead you on this one? : 1.) Ultrasound - w/new, additional doctor at additional clinic, who�s not yet seen her and won�t be doing follow ups (unsure of timeframe, but probably sooner than 14 days). : 2.) Ultrasound � wait for new doctor at previously visited Emergency Clinic (14 days from now � soonest) : 3.) Endoscopy (invasive) w/new recommended Dr. S, who will be able to do her follow up�s. (3 days from now � soonest) : A crystal ball sure would come in handy right about now. : Thanks in advance for your input/feedback/advice/etc..... : Rebecca (& Shirley)

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