Scarlett - possible macro tumor? - sweet Scarlett has passed

[labblab]

Welcome from me, too.

From looking through Scarlett's labwork, it really seems to me as though her kidney issues may take priority over everything else right now. As you know, her values were already elevated prior to the ER visit. And even though her creatinine has come down a little bit from its peak, it is still elevated and her BUN is highly abnormal.

Can I ask what prompted the ER visit, and why you feel as though it was medication that caused the spike in her renal values? Uncontrolled blood pressure can wreak havoc on the kidneys, so I am wondering whether it is possible that it was high blood pressure that was associated with the spike rather than the meds.

But regardless of the cause, abnormal kidney function can cause a host of symptoms including excessive thirst and urination, lethargy, depression and seizures. And since both of the diagnostic Cushing's blood tests (ACTH and LDDS) can be skewed by the presence of other, nonadrenal illess, I'm not sure how trustworthy their results would be in the face of Scarlett's current renal abnormality.

Has Scarlett been on the Sub-Q fluids consistently since October? Does your vet have a gameplan as far as maintaining them indefinitely? Are you making any dietary changes or instituting other means of kidney support? I really do think it seems more likely that Scarlett's immediate problems are associated more with the kidney issues than with a macro.

Marianne

[molly muffin]

Oh my gosh! I can certainly see why you would want to stick with your own vet. We are more use to the exact opposite situation in general with cushings. I am sure that was a very distressing incident to you and Scarlet. I don't know if it was the medicine or whether it was a kidney issue, but either way, it is associated with that ER hospital and the specialist.

I actually agree with Marianne that the kidney is the most important issue right now. What did the kidney show on the ultrasound, did they look at that? When I look at my ultrasound report it does talk abut the kidneys too, so maybe yours does also.

Poor little Scarlet and you. Sounds like you have both been through the wringer the last few years.
It is however, your diligence and love for Scarlet that has gotten her to this point even, because the things you mention can have very serious consequences. You are obviously doing a very good job.

Sharlene and Molly Muffin

[Scarlett'sdad]

I think it was the increase in the BP meds, both at the hospital and at home for a week after because my regular vet said since her BP was likely not really elevated except at the stressful moment it was taken, the lack of sufficient blood flow to the kidneys caused the problem. She had gone up only from 1.7 to 2.2 creatinine between May 2010 and October 22 2012 (they took her blood upon admission to the clinic) and it was 3.9 on release two days later and 4.6 after a week at home. I feel pretty guilty for allowing this treatment to happen, but I was swayed by the internist's board certification and talk of a stroke, sudden blindness or a blood clot in the lungs. She went into the hospital due to an attempt to feed a lower phosphorus diet causing a recurrence of her pancreatitis - I know beef is really bad for having phosphorus, but her home cooked beef/sweet potato loaf is all she can eat without real digestive trouble - I have tried everything, believe me. I just wanted her to get some IV fluids to avoid dehydration,but they took her BP and things went downhill form there.

[molly muffin]

I am so sorry that you went through that. You must have been so scared for her. I'm sure you probably still are.

So back to your original question of could this behaviour signify a macro tumor. I would not say a definite yes to that until the kidney issue is fully addressed and you can see if the behaviour changes as the bun and other lab results become more normal. These are things that could also be associated with the kidney issue that scarlet is having currently.

Sharlene and Molly muffin

[Scarlett'sdad]

Scarlett has been to another clinic where she has had a much better experience with a board certified internist, this vet works closely with her regular vet and is totally up to speed on the blood pressure issue. The tremors have lessened, they may be a result of Canine Cognitive Dysfunction - even when her values were still pretty good, she had some symptoms of it. After three days hospitilization, her creatinine has gone back up but she has been helped by the daignosis of a liver infection; she was discharged 1/17 with ursodiol 75 mg once daily, denamarin 90 mg once daily, sevelemar phos binder 200 mg twice a day. She wouldn't eat her regular diet this morning, since she just had a recheck this past thursday I called the 24 hr clinic and got some Science Diet canned Liver diet. any experience here with this diet or those liver medications? It does certainly look as though she never had Cushing's. Thanks so much for the help, in the middle of the night it is helpful to just browse here and the kidney forums for info/support.

[Scarlett'sdad]

Scarlett apparently never had Cushing's but took Triolstane from Sept 2009 to April 2010 after being misdiagnosed as so having. At the bottom of this post I have listed all the things she is dealing with, but we had had a great month after the addition of B-vitamin complex at 25 mg twice a day, Ursodiol and Denamrin for her liver, and Sevelemar as a phosphorus binder. The labs I am posting from 2/14 showed no hint to me or the vet that she was about to get stuck against furniture Sunday morning 2/17, press her head against the wall, and hardly be able to walk. Her tremors and pacing have returned after stopping for a month following the three medicine and vitamin additions listed above. The vet suspects that the pneumonia has stopped her from compensating for a brain tumor, but with her kidneys as bad as they are I am reluctant to have an MRI done. Any ideas on anything else it might be?
Larry/Scarlett 15 y/o Silky Terrier Central CA
Neurologic deficits, chronic active pancreatitis, pneumonia, IBD, CRF, Mitral valve/Tricuspid valve disease, High blood pressure, T3-L3 myelopathy, increased liver enzymes
Budesonide,Pepcid,Ursodiol,Sevelemar,Cyclosporine, Denamarin,Clavamox for the following week,buprenex for a few days then back to Tramadol,Amlodopine
ALB 3.9 g/dL 2.5-4.0 235 5-107
ALKP 115 U/L 10-150
ALT 142 U/L 5-107 High
AST 28 U/L 5-55
BUN/UREA 119 mg/dL 7-27 High
CA 11.8 mg/dL 8.2-12.4
CHLORIDE 101 mEq/L 105-115 Low
CHOL 148 mg/dL 112-328
CK 75 U/L 10-200
CREA 3.4 mg/dL 0.4-1.8 High
DBIL 0.1 mg/dL 0.0-0.2
GGT 13 U/L 0-14
GLU 119 mg/dL 60-125
PHOS 4.0 mg/dL 2.1-6.3
POTASSIUM 5.2 mEq/L 4.0-5.6
SODIUM 144 mEq/L 141-156
TBIL 0.1 mg/dL 0.0-0.4
TP 7.1 g/dL 5.1-7.8
GLOB 3.2 g/dL 2.1-4.5
ANION GAP 29 mEq/L 12-24 High
BICARB 19 mEq/L 17-24
IBIL 0.0 mg/dL 0-0.3
A/G Ratio 1.2 0.6-1.6
B/C Ratio 35 High
Na/K Ratio 28 27-40

Hematology Results
HCT 46.1 % 37-55
HGB 16.3 g/dL 12-18
MCHC 35.4 g/dL 32-36
WBC 20.0 K/uL 5.7-16.3 High
LYMPHS 6.9% 12-30 Low
MONOS 4.7 % 3-10
EOS 0.1 % 2-10
BASO 0.0 0-1
RBC 6.71 M/uL 5.5-8.5
MCV 69fL 60-77
MCH 24.3 pg 19.5-26
NEUT SEG 88.3 60-77 High
PLATELETS 425 K u/L 164-510
RETIC CNT 0.5 %
ABS BASO 0 u/L 0-100
ABS EOS 20 /uL 100-1250 Low
ABS LYMPHS 1380 /uL 1000-4800
ABS MONOS 940 /uL 150-1350
ABS RET 34 K/uL 10-110

Moderator's Note: I have merged your latest update on Scarlett into Scarlett's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other member's to refer back to the pup's history, if needed.
Administrator's Note: I have highlighted abnormal values for easy reference.

[Scarlett'sdad]

Scarlett died yesterday, April 12, 2013. The neurological deficits turned out to be GME. The symptoms were kept mild for the first eleven months she had it, because she was taking cyclosporine for her atopy (she was such a fighter, she had so many problems to deal with, I forgot to list that one; despite that she kept part of her spirit until the end). The symptoms of depression and excessive circling prior to urinating, pacing at night were thought to be related to her kidney failure or just canine cognitive dysfunction. When the severe symptoms emeged, she could not walk unaided within a week. She shivered constantly the two hours a day she was awake . Despite the addition of prednisone for inlammmation, and mirtazapine for appetite, she would not eat and things went rapidly downhill. Thanks for all the concern and help shown here, my heart is broken. I wish many healthy days for all of you and your babies.

[frijole]

I am so sorry. May Scarlett RIP and run free of pain. Kim

[molly muffin]

Oh no. I am so sorry to hear that Scarlett has passed. What a fighter she was. You and her both fought for her for the longest time and through the greatest of trials. The love you have for her will live on forever in your heart. There is no greater tribute to a live lived than one filled with love as her's was.
I know you are heartbroken. My condolences on your loss.
hugs,
Sharlene

[Bo's Mom]

I am so terribly sorry to hear about sweet little Scarlett. Prayers of strength and peace be with you now and in the days/years to come.