Tipper - adrenal tumor/breathing issues

Now that's funny! :p I can just hear it - "Who's this for?"

"Elvis!"

"Who?!"

"ELVIS!"

:p:D:p

Hi Everyone:
I just heard back from the IMS and she sent me a very lengthy report on Tipper after consulting with her eye Dr. I am going to narrow it down to the main points of concern.
1.) There is absolutely no evidence of as shunt in her heart. With the exception of tiny leakage her heart is strong and functioning well.
2.) Bone marrow cancer is most unlikely because in this type of cancer multiple cell lines are affected and hers are not. There has never been found any circulating cancer cells in any of her blood work.
3.) Causes of high hematocrit can be from a cancer process in the kidneys. There was nothing found on her kidneys during the ultra sound to suggest this. This hematocrit is a concern if it reaches 65-75% as it will sludge the blood, then phlebotomy and meds are used. This process does have inherent risks as when you remove red blood cells the cardiovascular system is compromised.
4.) She has a number of patients that have high hematocrit and reticulocytes. They are healthy and no underlying cause has been found.
She said we can check her blood gases, as the pulse ox is not the same as the blood gases which shows more of the oxygenation. They can also do an aspirate of her bone marrow while she is there and the eye Dr. can check her at the same time plus the cardiologist.
I am wanting some opinions on all of this. Tipper has had it with these vet visits. When we went for laser therapy she was really annoyed to the point of getting nasty.
If in fact all the things Dr. Bruyette said he would check, check out according to her my first instinct is to not trust anyone. My second is to get the oxygen, so a blood test after using it for a month and see if that has made a difference in her numbers. If she is not in immediate danger this would be the least stressful to her. I am not totally agreeing with the IMS opinion either. I heard the aspirate for bone marrow is painful and I cannot think of her in that hospital all day long, she would be out of her mind with stress. If it would come back positive, I would more than likely not treat her anyway. The thing with the kidneys does worry me cause I read in depth about this days ago. So my plan is to take her to the eye Dr. for her check up and the cardiologist sees her at the same time. If the IMS wants to pop in and see her fine. No all day marathon, and no bone marrow aspirate or blood gases. If I find on her next blood panel elevations again, I will then opt for blood gases. So for right now I am hunting down oxygen concentrators and plan to give her oxygen at nite, and sometime in the day. I will schedule a blood panel in 30 days after starting the oxygen. I believe the 7mg has done the trick for Tipper at nite, so I am glad I stuck to my decision on the total of 27 instead of the 30 that put her too low the last time. Also I have to say this IMS did not ask for a dime from me, and I know how much time this took for her to compile a 2 page in depth document. I applaud her for that, and am very grateful for the help. Tipper really wheezed last nite and it started pouring very hard with lots of wind. She started around 4 o'clock with gastro symptoms. I had to take her out and give her some food. It finally stopped about a half and hour later. I need to call that gal at the vets office , the one looking for the oxygen concentrator for me. I need to talk to her in person as I think my vet is up to his old tricks again to gouge me. The one tech called me last nite and said they found a few machines but they are so expensive. I said " He told me he had he thought two of these in another office and he would loan me one." She said oh he never told us that. They were wanting to sell me a cage and machine- so he could make more money. I am calling her and tell he exactly what he said to me. I will bite the bullet and buy one if they have no loaners. After all this he is still trying to stiff me. So I will post later when I get all this straightened out. Blessings
Patti

Patti, for what it's worth, I don't think it's a good idea to move forward with the oxygen therapy unless you first have Tipper's blood gases checked to see whether her own level is low. We usually think of oxygen as something benign, but apparently too much oxygen is not necessarily a good thing. I just now quickly found this article and it relates to humans, but I'm guessing the same issues apply for animals as well:

http://www.ems1.com/columnists/mike-...n-oxygen-hurt/

It does seem to me as though your IMS's comments are reasonable. It doesn't sound as though she disagrees with Dr. Bruyette's suggestons -- it's just that she has some additional info re: Tipper's previous testing to which he was not privy.

I understand why you don't want to do a bone marrow on Tipper. I wouldn't, either. But if you are serious about the supplemental oxygen, I really think you should go forward with the blood gas testing beforehand in order to make sure Tipper really needs it. You don't want to risk harming her by raising the oxygen level too high.

Marianne

Marianne:
I am glad you emailed me this information about the oxygen. I asked my vet about that and he said it could do no harm! Well I have learned never to trust him long before this. Do you think there is that much difference between a pulse ox measurement and blood gases? If not I am not going to subject her to it. The pulse ox said her O2 was good. I am so glad I come on here all the time before doing anything. Hope this is a lesson to everyone. Blessings
Patti

1) There is absolutely no evidence of as shunt in her heart. With the exception of tiny leakage her heart is strong and functioning well.

Teddy has also a leak, in his Mitral heart valve, also he does have irregular arrhythmia's and a loud vagal heart tone.

2.) Bone marrow cancer is most unlikely because in this type of cancer multiple cell lines are affected and hers are not. There has never been found any circulating cancer cells in any of her blood work.

This is what I have learnt, Usually the white cells are down, then the platelets, then other reds, Teddy's white were down for three months PLUS and his reds are too high like Tipper, although his platelets were low end of normal.

3.) Causes of high hematocrit can be from a cancer process in the kidneys. There was nothing found on her kidneys during the ultra sound to suggest this. This hematocrit is a concern if it reaches 65-75% as it will sludge the blood, then phlebotomy and meds are used. This process does have inherent risks as when you remove red blood cells the cardiovascular system is compromised.

I guess if you have blood removed you are altering the volume and you don't want to leave less blood that is more sludgy as I guess * and it is a guess * it could increase risk of clotting.

I HAVE BLOOD CLOTTING PROBLEMS and do understand a tiny bit, but not as much as your experts where it is in an animal.


high hematocrit and a cancer in kidneys, Like Tipper they did not tell me they saw anything in Teddy's kidneys, only that they are the SMALL SIZE of normal the kidneys themselves.

He does have a small amount of creatinine in his urine and higher urea in his blood, but not a lot of either, but I have been told he may have the START of some kidney failure.

He is not drinking enough still, and has had TWO ACCIDENTS in the house, in the past 10 days which he NEVER does?


BLOOD GASES and OXY meter I agree there, as I have had my blood gases done TWICE they take the blood out of an artery in a human, I don't know about a dog?

A bone marrow aspirate would show one way or the other, as you know we reached this with Teddy shall we or not, we choice not to, as he has had enough. But that is NOT TO SAY you shouldn't have one done on Tipper, it is down to how you feel.

We were tempted, but after the way he came home from one night away and a sedation, we said NO to another ultrasound and NO to bone marrow biopsy.

But you may feel totally differently to us Patti.

But you do say the same as us if something was found in the marrow you wouldn't treat it anyway, and nor would we. So you have to ask if it is worth it, it does hurt them, I am told.

Also we were told Teddy would need a GA to have it done too. He is too ill to risk a GA for his teeth to be cleaned, so why would we risk it for a bone marrow biopsy that we wouldn't treat if it were cancer, as it buys a short time, and what do they go through to get a bit more time with us?


I know that blood gases and Oxy meter will be different they are with me, but in my layman's in-experienced humble opinion, I wonder this, if Tippers oxygen was very bad would the OXY test been totally normal? Just a thought, as I don't know.

But all I do know is you and I are in a similar place with what to do next, we both have babies who have had enough of the vets, yet we love them SO MUCH we want to help them. X

Patti you mention: hematocrit is a concern if it reaches 65-75%

Teddy hematocrit (HCT) is 66.9% and with his low platlets, where platelets aid clotting and 66.9% HCT that may make it sludgy I am hoping the low platest will help it not to be so likely to clot.

It is a worry X

This is the FreshPet I've given Squirt -

http://freshpet.com/product/delifreshchickenformula/

Patti, I'm afraid I don't know how the two different kinds of oxygen testing compare. You can always ask the IMS if she thinks it's safe to go ahead with oxygen without doing the blood testing first. But even if not harmful, I hate to see you go to the effort and expense of the oxygen if it is not warranted for Tipper. Plus, no matter how you set it up, I'm thinking it would still be at least somewhat stressful for Tipper.

Marianne

Hi Everyone:
I am still looking into Tipper's oxygen issues to see if I want to do the blood gases. She has just had so much it is hard to ask any more from her. I feel I do not have the right. I am thinking this all over in my mind and still knowing Dr. Bruyette has tons of experience and said I was right about the cause of the reticulocytes so I need to weigh all this. Knowing Tipper has a heart murmur and added stress on her heart from wheezing at nite, I could not let them take some of her blood she could have a heart attack, although I have heard many vets say dogs do not have heart attacks, I don't believe it. I trust no one at this point and need to make a good judgment call here. I need to think this over for a day or two. Maybe just give Tipper some oxygen here and there??? just so not know yet. I never let go of anything so I will get to the bottom of all this. Blessings
patti

Hi Patti I know you are still undecided about the oxygen so when I saw this on a website I wanted to pass it along.
It talks about just renting the tank and buying a special oxygen mask for dogs. This is what one person said on the website about her experience with oxygen needed for her dog.
My personal experience with Hudson:
Hudson just got his own personal oxygen tank. I didn’t make this decision lightly; at $75-a-month rental, plus special dog oxygen masks at around $20, it's a money crunch. But Hudson is 13 in January, too old (in my opinion) for potentially dangerous surgery.
The oxygen is helping. When Hudson's breathing is labored or his tongue looks bluish, I put the mask on his grizzled muzzle (he doesn’t really mind it), turn it on, and hold it there for a few seconds. It's very simple and, thus far, not needed often.
Keeping an oxygen tank for my dog may be hard to explain to non-dog friends, but if it makes life a bit easier for Hudson and a bit less worrisome for me, it’s worth it. This is the site I got it from.
http://www.dogster.com/lifestyle/dog...thing-problems
In my opinion I don't think they can get too much oxygen from this type of cage. The vet tells you how much to give. Also every time the door is opened the oxygen concentrations drop to room air level so it's always fluctuating. My dog did very well in the cage. You could really tell a difference after he slept in it all night. But this was prescribed for him when he got out of the hospital due to his congestive heart failure. We rented the oxygen concentrator for $200/month but it was cheaper than getting the tanks by the hours. We started buying 40 hour tanks at $46 then found out that we could rent the oxygen concentrator monthly we were thrilled. During the day I was home and he slept a lot so I just put the cage in the room I was in and just watched him. He was fine with it. After awhile he didn't need it as often then he didn't need it at all. If we had to do it again we would. Actually we never took the cage apart and he passed away in 2009. I'm sure whatever you decide will be the right one for you and Tipper. Good luck. T