Mystery Condition

Hi, my 6.5 year old hound mix was taken to the emergency vet about a month ago because she had poor/ decreasing appetite for a month and had started to limp a day earlier. She was also lethargic and seemed depressed. Her back legs also seemed stiff and every time she barked, yawned, or drank water she would have to cough after (retching, hacking sound with no vomit). they ran a CBC, ultrasounds and x-rays. CBC came back normal. They found a mediastinal mass that they initially thought was swollen lymph nodes. Fluid in her lungs and pleural lines. They gave her a differential diagnosis of lymphoma. We went back in the next day to get a FNA of the mass. The mass came back inconclusive and they did not see signs that it was lymph nodes, they believed the mass was mainly blood. They put her on clavamox as a precaution. After 3 days of the Clavamox she started eating better and the limp went away. The oncologist didn’t think the antibiotics had anything to do with her improvement, but after a 7 day course, and significant improvement, they gave her another 14 days of antibiotics. We went back to take an X-ray and the mass was still there but the fluid was gone. And with the antibiotics, her symptoms which we could see, seemed to be improving. After the antibiotics course, a week later, her symptoms started to appear again. Poor appetite, lethargic, stiff legs and limping. We also noticed increased coughing while barking, drinking water and yawning, it is a dry hacking cough/retching sound. the oncologist gave us more antibiotics for her, but they don’t know what her condition is. They said it could be thymoma or a fungal infection and gave many different possibilities but they said the only way to tell is to cut her open which we refuse to do without more testing. We are taking her to UF in two weeks but I’m worried that won’t be soon enough. We’re hoping the antibiotics help again. any thoughts on what this might be?

Hello!   What a complex-sounding case. and how difficult for you.  I hear that you already have a cancer specialist involved, who has not only met your dog but also seen the scans / any radiographs / sample results etc. and I am sure that you understand that without seeing any of these  -  and certainly without your specialist's qualifications or experience - I am not really qualified to make recommendations as to the choice that you make.    (More, however, is to follow)

In my experience, owners like to comment on what is not known, but let's consider what IS known.  It sounds as though your specialist has already got a list much better than I could give you, of things that this might be (I wonder whether a mediastinal foreign body causing an infection remains on it?)   They have also offered a way of finding out, which is one choice, but understandably you feel that it is too invasive a path.  That's okay.   Choice number two then, in absence of being able to reach a proper diagnosis, is to give treatment that seems to improve the symptoms.  Will this work? - well, it depends what is causing the symptoms (which you can only know for definite by following choice one).   There are, of course, two other choices - one can go for a second opinion (but in order to get a decent one, you need to go to someone with suitable experience to be in a position to meaningfully comment on your specialists' work.  And of course, they may not expand your choices any).  Choice four is to simply say 'this is all too much' and opt for euthanasia (it sounds as though things were improving however, to some extend, with antibiotics).

You sound, therefore, to be in the stressful position of having to chose between several imperfect options.  These is extremely difficult at the best of times.  We would always recommend talking any concerns through with your vet or your specialist.  Best of luck.

It sounds like your specialist already has a far better list of possible causes than I could (I wonder whether a foreign body in the mediastinum still generating an infection is on it?). They have also provided a means of learning which is an option, but it seems sense that you believe this to be an excessively intrusive route. It's alright.