Confused and Overwhelmed-Diagnosed Anal Sac Carcinoma (Woody has passed)

Hi Tracy - have done my best to put a few comments in below, hope it helps :)
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Originally Posted by Woodydog

Evening - Sharlene we are both feeling pretty good, I just take my lead from Woody and do what he feels up to be it a long walk in the woods or playing in the leaves then I,m gonna be right beside him :D I can,t cure him god I wish I could but I,m going to make every day he is here count by doing things he loves.:D

I,ve read through his reports until my brain hurts and have came up with a few questions, if anyone has any clue then let me know.

His haematology investigation :- revealed a very mild leukocytois but with evidence of a left shift - no idea what any of that means
Increased white cells, usually inflammation. Left shift just means that there is a higher amount of baby white cells as opposed to older more mature ones. This is due to inflammation prompting the bone marrow to make more white cells so you end up with more immature ones in circulation and is very common when there is inflammation in action - his GU enterococcus for example
Biochemistry:- revealed increases in triglycerides and cholesterol and a mild increase in ALT 103/U/1. ALT liver test, good that only mildy up Ionised Calcium unremarkable previous 2 calcium were high
Ionised Calcium is the best test to do, so that is good it was normal. I was just talking about that test with my IMS and he said that is the one to do.
T4/cTSH had shown a high cTSH no numbers available now I think this has something to do with thyroid but not sure. It is thyroid but I am no expert on thyroid sorry so will have to leave that one to the others!
Liver was enlarged with rounded margins and a mixed generally patchy bright echogenicity (possible fatty change) they weren,t worried about this should I be worried. No, I don't think so
Prostate was small with a discrete capsule and bright hyperechoic areas of suggestive of previous prostatitis. again there not worried it usually gets bigger with inflammation, it looks like he has had it previously which could account for the multi drug resistant bug he has
Thoracic radiographs: Diffuse moderate interstitial lung pattern, associated with a mild bronchial lung patter (related with expiratory status, patient corporal condition or chronic broncho-pulmonary inflammation +/- hyperadrenocorticism related mineralisations). No evidence of pulmonary metastasis or thoracic lymphadenopathy. I,m assuming that the cancer at this time has not spread to the chest but not sure what the rest means.
Has Woody had chest infections or asthma or anything like that previously?? GREAT no sign of cancer in there, no lymph nodes swollen (lymphadenopathy) :)
Blood pressure 163/83 consistent with borderline hypertention - they put this down to white coat syndrome.
Yep, my vet would not be too concerned about that level either.
Urinalysis USG 1.016, ph 6.5 UPC 0.06 - I can,t find the normal range for this.
That urine is a little dilute judging by Specific gravity... was he drinking or have IV up when it was done, it can fluctuate through the day so this could be OK. pH fine. UPC (urinary protein creatinine ratio which is an indicator of renal problems) pretty good too, normal is <0.05 so Woody not far off there!! I would love Flynny to have that kind of result there!!

Liver FNA: Sheets of hepatocytes which in some areas show mild swelling. Other areas show fine cytoplasmi granular pigment. Several mast cells are present overlying these areas. The mast cells are most likely travelling through the liver rather than indicative of mast cell disease - I take this as liver is patchy and enlarged a little but no cancer in it (I dunno) I agree with you there
Microbiology Report:- Prostrate wash a MDR (multi drug resistant) Enterococcus was found and isolated (then it lists 25 AB,s its resistant to) That's weird, we are seeing more and more of this in humans too. Enterococcus is a bug more commonly seen in the bowel but it does pop up in the urine. It is usually fairly resistant to drugs and we use either amoxil or nitrofurantoin.

The final report goes a bit like this - Woody,s diagnosis remains rather uncertain as the medial ilial lymph node histology is suggestive of a metastatic neuroendocrine tumour why is it "suggestive" I guess it would be good to know if it IS or if it isn't neuroendocrine, adrenal adenocarcinoma being high on the differential list so this means that if neuroendocrine is ruled out, then the adrenal tumour becomes more likely to be causing problems. But I wonder how they come to the adenocarcinoma conclusion as they have not biopsied it, it might be just a nodule and not causing the tumour cells in the node, so I guess it could be a bit of a red herring like Flynny's adrenal nodule has turned into??? The anal sacs on both sides do not indicate a primary anal sac neoplasm despite cytology prior to surgery being suggestive of a metastatic anal sac adenocarcinoma in the node Jeepers they really do not have a good handle on this node either preop or postop with it all being suggestive and I am sorry he had to go through that big surgery for that to turn out negative. Interesting Woody has a history of PU/PD although endocrine testing has failed to confirm a functional adrenal carcinoma Is he still drinking and peeing a lot. There are therefore a number of un answered questions and consultation with the pathologist has been initiated yes that is definitely needed! . It is hard to understand why an adrenal mass on the right (this has been measured at 9.9 mm) would mtastasise caudally to the medial iliac LN on the contralateral side rather than to a cranial abdominal node Good point, not usual as if it was in adrenal it would go to node closest that gland. One thing is certain, there are metastatic tumour cells in the bloods vessels adjacent to the enlarged medial ilac LN. So all they have so far is tumour in the lymph node that "could" be neuroendocrine and an enlarged adrenal that "could" be adenocarcinoma. I hope there further research shows up some definitive answers for Woody, be nice to know where the primary is as it may very well not be the adrenal. From what I know of neuroendocrine and I apologise as it is not much is that adrenal is much less likely for it to originate from. :confused::confused::confused: Woody is certainly turning into a mystery, but the best news is that he is doing so well!! Hope this helps

So this is pretty much the outline of the report and basically comes up with in my option Woody has an neuroendocrine cancer, that they are not sure where its coming from possibly adrenal gland, so far it hasn,t invaded any other organ but there are little terry,s running round his body trying to grab an organ to latch onto. The only treatment is chemo but as he,s not a good candidate for that then we,re not left with much, which is why Woody continues to be a mistery to them.

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Tracy:
Thinking of you and Woody. I said many special prayers as I was up most of the nite. But thank God Tipper is blessed with a good report. Blessings
Patti

Patti I read Tippers results and I,m so so g lad.

Trish - Thank you so much for the reply,s and taking the time to answer them specially when you are looking after Flynny at the moment. That's why I love this board, people taking time to read and answer despite having their own drama,s.

I couldn,t quote your answers but just a few things you brought up, he,s never had any chest infections, kennel cough, or asthma like symtoms you really don,t hear anything from him, but now you know I will be listening out for them lol. His urine sample which was dilute was taken first thing in the morning by me at home as the hospital wanted it to be as stressless as possible gives a better reading they said. He is still peeing a river and drinking for Scotland which to be fair is his original symptoms.

I have read his pathology report the first one says Two sections of the medial iliac lymph node are examined which are similar in appearance. With and expanding the capsule and effacing all normal lymph node architecture is a large, poorly demarcated neoplasm. Several arteries within the overlying capsule are partially or completely occluded by emboli of neoplastic cells similar to those in the main tumour mass. It talks about the size, shape of the node and cells within it. So defo cancer in the node. His comment says: There is no evidence of a neoplastic process or a lesion which would correspond to a grossly evident mass in the sections of anal sac and glands examined. Further sections and turned sections will be ordered. It was at this point that Ian oncologist asked for them to be re examined and re cut and re stained.
The next pathology report says: - The histological appearance of the mass in the medial iliac node, with prominent packeting of neoplastic cells is consistent with a neuroendocrine carcinoma. The finely vacuolated cytoplasm variably present in neoplastic cells is most consistent with the cells of the of the adrenal cortex and so an adrenocortical carcinoma should be firstly ruled out as a primary. Immunochistochemical staining is consistent of a neuroendocrine carcinoma. These are rare tumours in dogs and are reported to arise in the adrenals, intestine, liver (hepatic Carcinoid), skin (merkel cell carcinoma) oesophagus, nasal cavity, bile duct, gallbladder, liver and the nasopharynx. Apart from Merkel cell carcinomas which are usually benign in dogs, a characteristic immunohistochemical staining pattern has not been recognised for the different manifestations of these neoplasms. Further IHC may therefore not be useful in determining the organ of orgin.

So this is where we are up to, as there is no specific test to determine where his tumour is we are all at a stand still waiting to see where it will appear next. I have emailed the hospital with a few questions but haven,t heard back from them. Woody is really well at the moment which is great, but I need to know what I should be looking out for symtoms wise. Oh dear I appear to have written an essay again.

Well I guess adrenocortical tumour can be neuroendocrine, that must be pretty rare... trust our K9C dogs to be in the miniscule percentages... I wish they would start getting some of the run of the mill diseases that can be easily managed!

So they are taking the watch and wait approach? We had to do that with Flynn last year before the adrenal cancer was visible. Hard knowing something is wrong but they cannot just pinpoint it.

It looks like they are trying very hard to get the answers for Woody, so currently the adrenal tumour is not functional, do they have any idea what is causing the PU/PD?

Yes he.s a mystery lol. They still say possible cushings for the pU/pd but there not sure everything with Woody is all just possible this or possible that nothing concrete which is rather frustrating.

In other news I had Channel 4 TV station on phone asking if they can use the the filming they took of Woody and his microphone at the hospital off course they can. I will post a link as soon as I get it,

Tracy:
I am sorry that you continue to be plagued with more questions than answers on Woody. I am so thrilled that we will get to see the clip of Woody stealing the microphone cover, that should be a blast. I am hoping all this stuff with Woody is wrong and that her goes on for many years. Blessings
Patti

Tracy:
thank you for all the well wishes. I am much better today. got my meds straightened out and everything is pretty good this morning except my hands are still swollen. We have more snow this morning, I am waiting for them to plow the roads so we can walk. We are to get a lot more tonite. I am not going out anywhere so I do not care. I hope you and Woody are still doing well. I really want to see that clip of Woody stealing the microphone cover, you have me all excited to see it. God Bless you both
Patti

Thanks patti good to hear your on the mend. I took a video of Woody versus the fridge last night but I don't know how to post it up, it is rather funny I will go and see if I can manage it

I read a bit about neuroendocrine and the tumour Flynn had in his adrenal the pheochromocytoma is actually a form of neuroendocrine! On the websites there are many different types of these tumours. Has Woody had BP checked at any stage? I would guess so when he had his surgery.

When I was talking to my vet yesterday we were going through the difficulties pathologists have identifying some tumours, for example I wanted to know why they cannot say whether Flynn's tumour is an adenoma or a carcinoma. Similar to how they cannot tell where the tumour cells have come from in Woody's lymph node. He explained it to me as the tumours grow the cells become more disorganised and revert to types of cells they often see in the early life of the animal when they are developing (embryonic) which can all look quite similar and they can lose the appearance of an "adrenal" cell or a "bowel" cell or wherever it came from. So that must be the trouble they are having making a definitive diagnosis for our Woody. Just thought I would post that while we try and make sense of it all.

I hope you work the video out to, love to see the little fridge burglar!!

Thanks Trish yeah I did read that a pheo is a type of neurosndocrine tumour. I've read so much on this that I end up getting all muddled lol. Woody Bp is checked regularly and is always unremarkable. He has no symptoms of any endocrine tumour except the Pu/pd all other results are good except his ALT are slightly elevated, so you can see why it's frustrating to know he has a tumour somewhere and my fear is that by the time it shows itself or the decide a plan it will be too late:mad: I try and focus on the here and now and he.s good at the moment except this darn colitis may need to look at his diet next see if it can be altered to help the colitis.

In other news my mother has to go into hospital on Monday for an op as she has cancer of the eyelid so there taking it away. Also my wonderful niece has told me she is 3 months pregnant and as she is only 18 my sister isn't taking it well, so will go over at wknd and try and help her smooth it out,

Tracy:
I have often wondered if Tipper's tumor on her adrenal was a pheo, I still am scared it could be. Her alt and alk phos is not sky high like the other Cush pups either. She has no cell found in her blood for now, and the IMS said there is nothing spread to the other areas so I don't quite know what to think either. None of this unfortunately is black and white, it all seems to fall into the grey category. I am so sorry your mom has to have eyelid surgery. Will she have to have some type of permanent covering over her eye? I guess that was shocking news about your niece for her mother, no mother wants that for her daughter, but as they say all things have a reason for happening. It may turn out to be a blessing in disguise. You niece is a wonderful and compassionate young lady, so I am sure from what you have told us she will be a great mother. You will be the wonderful Auntie that smoothes things over for her! Hope all goes well. Blessings
Patti

I hope this works :D

http://s876.photobucket.com/user/woo...e5bb3.mp4.html

Oh that is FUNNY! You say, "no more" and Woody says, "yes MORE!" You say, "enough", Woody says, "No! MORE!" LOL He talks to you like Squirt used to talk to me. I love it! :D

Tracy:
I really needed a good laugh today, I am missing my Dad and it is a depressing day here, or should I say it was. That Woody is a star in his own rite. I loved watching the video and kept playing it. He is just too cute, and I totally understand how he has you wrapped around his paw. I really needed the humor today and you came thru for me. I hope you were able to smooth things over with your sister. Some time if you ever go hiking with Woody up to the spot where you can look down on your village would you try and get some footage to show. I am just imagining how beautiful it is where you are, and would love to see it. Are you near any major cities? Do you have a place for groceries etc. in your village or do you have to travel? It just sounds wonderful where you are. Tell Woody he needs to get an agent and go to Hollywood! Blessings
Patti

Patti I'm glad Woody made you laugh,he is such a cheeky wee thing and full of life and character. I have village shop which sells the basics but have to travel for everything else vets, doctors, dentist etc. if the weather holds out this weekend will go back up the woods and I will make sure to take footage for you. There is one walk that is fab and shows the whole village in its glory but I've not been able to walk it since losing my bridge baby 4 years ago as it was his favourite walk, but have been thinking maybe it's time for Woody to explore this walk and enjoy it like Bruno did so when I manage it I will take pics and show you where I live. My sister is calming down I think it was just shock, but I will speak with her some more tomorrow.

Oh Woody is so cute!!!! Cheeky little guy indeed. He has soooo much to say. :)
Love the video! Thanks for posting it Tracy!
hugs,
Sharlene and Molly Muffin

Ohhh what a crack up... he is so totally back chatting you :D:D:D

That's great you worked out how to post them :D I have a few on here but god knows how far back they are... be good if there was a place we could put them like the photo albums. Maybe the website will upgrade to do that in the future, meanwhile we can look at this cute one!! Have a good Friday Tracy and Woody :D

What a little stinker! :-)
Like Daisy, he pushes until he thinks that you'll give in and then when you don't there is heck to pay.

Are you sure that Woody isn't part dachshund? LOL They can be stubborn and so cunning.

Too funny !! Persistent isn't he. I notice how fast the tail is wagging then when he realizes nothings going to happen, it becomes slower.
He's such a cutie. Keesh used to be able to talk back like that, but not so much now. BTW- Love, love your stove.

Thanks everyone he is a little stubborn cutie pie but then I'm biased. It does try and get the last word or bark when we have discussions lol. Now you can all see why he makes me laugh daily.

Trish I watched your video and Flynn is so much like Woody digging away at the sand. :D

Tracy:
Woody does so many things just like Tipper. The speed with which the tail wags, the talking back, that you're gonna pay for this look. It must be a jack Russell thing. Does Woody do the springy jump on his rear legs? Tipper used to be able to jump about 5ft high from a standing position. She still does it but not as high, and I try to curtail it as I am afraid of her hurting her rear legs. Sometime try some balloons to see if he tears into them to kill them. I can't do it with Tipper any more as she becomes too crazy and I am afraid of her hurting herself. I can't wait to see the village Blessings
Patti

Oh my god Woody has just collapsed on way to vets wish us luck im scared

Oh Tracy! Prayers and positive thoughts flying your way! Please let us know when you can.

Hugs,
Leslie and the gang

Tracy:
Oh my God I am praying for you both. This cannot be for real, I am so upset and worried about you both. Please let us know how he is. Blessings
Patti

I'm back but little Woody dog is being kept in for a few hours. By the time I got to the vets 30 mins away Woody had come round and looked a bit better. My vet examined him, his temp was fine and his colour was good my vet thinks that Woody had a smpgo (sp) it when the blood pumping from the heart doesn't get pumped quick enough the the dog faints it's common in Boxers apparently so he reckons it's been Woodys heart murmour has caused the problem one thing after another. It didn't want to poke and prod Woody or take bloods he just wanted him to relax and get back to normal but does want to keep an eye on him for the next few hours so I will pick Woody up at 8pm tonight. I can't stop shaking as one minute he was having a drink of water and the next he had collapsed out cold with head in water dish I had to grab him flip him onto his side and take his head from the water dish he was out for ages. I'm scared that I'm running out of time with him (cry)

Oh, Tracy....I am so relieved! I was terrified something had broken loose, ruptured, something left in him again....my mind was going bonkers! I pray this is just a delayed reaction to the trauma he has endured lately, that he is home very soon, and that he will never, ever do this again.

I can only imagine how scared you were to see that! Your description brought back the day I found Squirt after her seizure. Horrified and heart-stopping fear, sick with worry. We are here with you, honey, praying and sending positive vibes to our sweet boy.

Hugs,
Leslie and the gang

Tracy:
Thank God Woody is ok. I am so sorry for you, I have been crying with Tipper and cannot stop. I just prayed to God to save Woody the whole time. I know that can happen because when Tipper was diagnosed with a heart murmur, I read about it. I am still thinking Woody has Cushings as the heart murmur goes along with that too. Dear God I have been sitting here scared to death of what was going on. Thank God for a miracle and he is safe. Please don't cry Tracy you make me feel so bad, I wish I could help you somehow. This has been a long hard road for both of you. I am glad they kept him for observation. He does not deserve this he is as cute as the dickens. I can only imagine how you felt seeing this happen. I was just sending a post to Leslie when I saw the post from you, and I hurried up and sent her a message, but she had already seen your post too. I am hoping this was a just a one time thing, and will never happen again. I have always been afraid of Tipper doing this too. Did explain how bad the heart murmur was to you? They told me Tipper's was very slight and probably just started not long ago. Are they going to call you when he can come home, or will they keep him over nite? This poor baby has really been through the mill. You are his saving Grace so don't get yourself down about this, we are all here with you through it all. I will be thinking of you both all day. Blessings
Patti

Woody is a fighter and he is not going to give up so easily. I am very happy he is okay now and keeping you both in my thoughts and prayers that he will continue to be okay.

(((HUGS)))

OMG... what a scare you've had. These pups just keep us on our toes for sure.

I'm so glad you were there to rescue him and tonight when he gets home he'll be his normal self. For sure he's a fighter and so is his mama.

oh my god. Tracy, you must be worried sick. :( Poor little mite. Did they say if they think this is a once off or if they think it will happen again? His BP has always been really good right?
Woody will definitely be around as long as he possibly can just to back talk at you and the refrigerator. :)

Hang in there Tracy. You did so good, getting his head out of the water bowl and then into the vets.

big hugs,
Sharlene and Molly muffin

OMG what a shock for you and Woody. Like Sharlene I hope they did check his BP, that adrenal mass could cause BP spike if it was a pheo. What is that smpgo thing? You did good managing that, even though you must have been scared witless... GOOD FOR YOU!! I hope you have him home soon, your probably at vets picking him up now. We are here with you Tracy **BIG HUGS**

Hoping you two are doing ok?

Sending lots of positive mojo

Mel
Xxxx

Evening everyone. Woody is home :D I picked up him a few hours ago but we both fell asleep on the sofa when we got in. He was still a little wobbly when I picked him up walking like a wee drunk man, but the vet wasn,t overly worried and said he would keep him in over night if I wanted, but I wanted Woody home where I knew he wouldn,t be too stressed. He got up about 30 mins ago had something to eat and went to the toilet, he was walking much better, and now he is curled up next to me in my bed.

The vet reckoned this could be just a one off a bit like a fainting fit, but once I explained that if it was his BP (my vet can,t check BP I can,t remember why something like facilities), then it maybe coming from the suspected adrenal tumour he agreed that Woody,s BP may have went too low causing him to collapse. I,ve told my vet that he needs to be able to monitor woodys BP or I may have to change vets :( He said Woody had been fine when he was with him and his Obs were good. My vet will be contacting the hospital on Monday regarding this as will I.

Trish - can you point me in the direction of material on the pheo please.

I just can,t believe how quickly this happened, one minute asleep on the sofa to getting a drink to collapsing my Woody sure does know how to scare the living daylights out of me. Thank you all for your good wishes we needed them. I just need to stop shaking now and get that image of him lying there out my head. ;)

Oh good
I am glad we got an update from you Tracy, I was getting worried! But glad to hear he is home and resting with you.

With pheo, when they have an episode it is usually because BP goes too high, not too low. When it goes high, stroke, heart attacks etc are the concern.

Here is a good website about pheo's

http://www.vsso.org/Adrenal_Pheochromocytoma.html

xx

Thanks Trish I,m sure the vet said he thought his BP went too low, but I may have picked him up wrong as I was too busy being kissed by the lovely woody.:D

The thing the vet mentioned earlier was Syncope, it is when the brain is starved of oxygen and the dog basically faints. I have looked it up and it says it is a symptom of an illness then lists a few illnesses like epilepsy and one of them is cushings. Now this keeps cropping up for Woody yet all tests are negative for cushings. I need to get to the bottom of this, as it scared the hell out of me and I need to be prepared if it happens again. I will go look at the site you posted as don,t think I,ll get much sleep tonight although Woody is happily snoring at the moment :p

He maybe just fainted then with low BP... did this vet actually check it?

Jeepers, just read about the police helicopter crashing into a pub full of people in Glasgow. Sounds just awful, hope no fatalities.

I've never posted before but wanted to send well wishes to you. I know how scary passing out can be as mine just had seizures on Sunday. I'm very glad Woody is okay. When my Cavalier was diagnosed with heart problems our first sign to bring him to the cardiologist was a fainting episode which we found out was called syncope like you said. He had a couple of them and that's when he was diagnosed with the mitral valve problem. I'm not saying that's what your Woody has only that the heart caused my dogs fainting. He ended up having a really bad heart murmur. I watched your video of Woody what a beautiful dog. I'll pray he doesn't have anymore.

I have copied and pasted below a url to a page on pheochromocytomas on the Pet MD site. You will not that there is a long list of symptoms and not all dogs will have all of them nor are they consistent....they are episodic. Kim can definitely attest to this as her dog Annie had a pheo. Dogs with pheos usually have "high" blood pressure, as do dogs with cushing's, so it would be a good idea to find a speciality facility that has the proper equipment to take Woody's blood pressure. It's easy to take a human's blood pressure but that's not the case with our canine friends. Even with good equipment, it can be a challenge, especially for a dog who is very stressed out at the vet's office.

http://www.petmd.com/dog/conditions/...eochromocytoma

I hope you can get to the bottom of Woody's problem.

Glynda

Loved the video, heart stopped when I read Woody had collapsed, so relieved he came out of it alright! You must be about ready to collapse yourself! I hope you and Woody get some good rest and that both of you have a good day next.