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DrRalston
DrRalston, Veterinarian
Category: Vet
Satisfied Customers: 2205
Experience:  Over twelve years of internal medicine, surgery, and preventive care.
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Further to my last question and your reply on 6th February,

Resolved Question:

Further to my last question and your reply on 6th February, Charlie was referred to Langford Vetinerary Hospital and was finally diagnosed with chronic inflammation of the lung. Heart and liver are fine. Her final test result proved positive for mycoplasma bacteria in the lung tissue. If after ten days of a specific antibiotic Ronaxan 20mg x 2 and a half tablet daily. her breathing does not improve (presently 110bpm and 48 breaths pm) she will need lung biopsy. I may have to decide whether we want her to have a needle biopsy or a full lung biopsy to check for fibrosis or a tumour. Please have your any comments or advice to give me. She is still very bright, full of fun. can run very fast for a ball, but just the once and only about 15 yards. I then wait a few minutes and she will run again for the ball, but gets very puffed out.
Submitted: 2 years ago.
Category: Vet
Expert:  DrRalston replied 2 years ago.
Hello, I'm Dr Ralston, thanks for your question.

I have reviewed Charlie's case and your information from the 6th of Februrary. So far it sounds like all the right steps have been taken in diagnosis of Charlie's condition.

I was wondering if he has any other signs including urinary problems, or joint paint? One of the strange things about mycoplasmas (there are 4 or so main bacteria in this group that affect dogs) is that they lack a true cell membrane. Many medications work by destroying that membrane. This can make them challenging to treat, but robaxin works actually very well.

These mycoplasmas also tend to invade many different tissues. So, they can show up in the respiratory tract, blood brain barrier, prostate, urinary system, and even in the joints. There aren't a lot of pathogens that have that wide of a range of effect. People are susceptible to some mycoplasmas as well. They tend to be worse in moist, humid environments were several people are in close quarters for an extended period of time. So, a road trip with 5 people in the car in Southern US for 2 weeks while raining in the middle of July is a good example.

These mycoplasmas don't like dry environments at all. Because of that, you should try to use disinfectants like lysol in the house, and try to aim for lower humidity. IF that is the present condition, good. If you have a humidifier I would consider turning it off.

Extended treatment might be necesssary extending out to up to 30 days. But that will depend on results with Charlie. You should start seeing a resolution in the first 5-7 days though, however small it is.

Typically, mycoplasmas do like to attack a weakened immune system. That can be from old age, from another infection also working, or sometimes a tumor which the body is also trying to fight. So, it is possible that something like that could be happening in Charlie. However, from your description it doesn't sound like that is where the Doctors are going with this case.

Time will tell at this point. Lung biopsy is an invasive procedure, and not something we go into lightly. I have performed this on several occasions. The advantage is it gives a direct visual of the lungs. You can see micro tumors that don't show up on x-ray. Small pathogenic lesions can be sampled directly which is useful. There is some risk to this procedure as well, with most of the risk being immediately during and shortly after the procedure : ligature slipping and bleeding.So, you would definitely want to think about it before proceeding.

If given the option I would always take an MRI before surgical biopsy. Much more can be learned from MRI, and it might negate the need for biopsy. The cost is often prohibitive for some clients. It's not unusual to be between $2000 - $4000 US. But, that varies WILDLY from location to location. But, an MRI can help locate specific tumors if present, and narrow down the biopsy location area versus blind sampling of lung tissue.

I would definitely give the robaxin a chance to do it's work. Animals with healthy immune systems that are given proper treatment with antibiotics have a good prognosis and are expected to recover fully. Short walks outside in warm sunshine might be helpful if possible instead of running. The deep breathing helps.
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Customer: replied 2 years ago.

Thank you Dr. Ralston for your reply. As Charlie seems to have had this reluctance to walk since she first went on the lead at three months could she have had this mycoplasma bacteria all that time or is it more likely she has had a tumour growing or the fibrosis. The last two months her breathing is noticeably worse but no cough, or urinary or muscle problems. If she is finally diagnosed with a tumour or fibrosis, is it kinder to let her go during the next surgery/exploration/lung tumour? I am trying to prepare myself. Thanks, Rosalyn

Expert:  DrRalston replied 2 years ago.
Mycoplasma can hang out for awhile and form long term carrier states in the mucosal surfaces of the respiratory tract. So, it can be debilitating and a very long term condition. Reluctance to walk could be a sign of joint pain, or just unwillingness to take to a leash. Depends on the personality of the dog. But yes, he could have been a carrier for a very long time. Mycoplasma can sometimes be a co-infection, part of the kennel cough syndrome with Bordetella bacteria. So, a brush with that as an early pup could have been the original infection.

Primary lung tumors in dogs are not very common at all. In fact, most lung tumors are actually metastatic in origin, meaning that there is a tumor someplace else in the body (liver, bone, some skin tumors) and it is spreading to the lungs. In that case, you will usually see multiple small nodules in the lungs on x-ray. Not always, but usually. Sometimes they will be too darn small to see (less than 1-2 mm) and there is a size where x-ray fails us and MRI is better.

Rosalyn, I'll tell you as honestly as I can tell you without knowing you or your Charlie my opinion ok? That's just the way I like to practice medicine. I'd want the same for my pets. I think that there is nothing wrong with going all out and doing whatever you can to help a patient. It's an individual decision and choice. Having had to make the same decision on my pet, I had a cat that had intestinal lymphoma, I decided to remove the lesion and treat with chemotherapy. Same with loved once facing cancer and tumors. I really let them know that it was their decision to continue treatment or not, and I would support them on that.

That being said, if I was performing a lung biopsy on my own pet, and I realized immediately there was metastatic disease in the lungs that had not been detected before surgery by x-rays or MRI, I would elect to euthanize at that point. There are options. Not all cancers are the same. Some of the newer drugs can give us 6-12 months or sometimes more. So, it is a tough call. But for me, metastatic lung disease is not a good thing at all, with very poor outcome and poor prognosis. There is science, and then there is experience and actual truth. From what I have seen in practice, I would let my pets go on the surgery table if I saw the metastatic disease.

The unfortunate truth is that the Vet might not have that luxury either. It might not be apparent. And if it isn't, for certain, they will perform the biopsy.

Hopefully, this is all speculative, and Charlie is just feelin great a week from now.
Customer: replied 2 years ago.

Thank you so much Dr Ralston for giving me such an honest reply. It gives all the answers to my thoughts. I feel the outcome will be bad but couldn't understand how it has all happened to such a young dog. However, I shall try and hope for a miracle that she will get better. You will help me prepare myself and I am very grateful to you for such a full explanation of everthing. Thank you, Rosalyn