Mira, 7yr old Husky - Cushings ruled out; liver cancer (Mira has passed)

[frijole]

Kim. We are still at ACC. But not much longer I think. Phenoxyhenzanine 10 mg they want her to take.

Looks like it is for high blood pressure as a result of an adrenal tumor? When you get home and have time please let us know what they are telling you. Also find out as much as you can about the surgeons experience, specficially how many of these exact surgeries he/she has done. Thanks!

[Squirt's Mom]

Hey sweetie,

Just so you know I am here, too.

Give Mira and Kira a kiss right between the eyes from me, ok?

Hugs,
Leslie and the girls - always

[Squirt's Mom]

Mornin' Janis,

How are you and the girls doing today? I hope ya'll are able to enjoy the day, maybe get out in the sunshine for while together, if nothing more than sitting around soaking up the rays.

I hope Bud enjoys his trip. It is deer and duck season in ARK right now so all the men packing up and leaving around here are going to the woods hunting. You will see trucks with four-wheelers in the bed along with all sorts of camping/hunting paraphernalia piled in around it being driven by guys with a harried look in their eyes and grinning like fools. Some of them even drool in anticipation.

Let me hear from you, ok?

Hugs,
Leslie and the girls - always

[Altira]

Men, I swear! Thanks, that little hunting scene made me smile. Bud is gone but our neighbors said they would come anytime if I needed them. That's the woman I told you about Leslie. The one with the past like yours.

Mira has been starting to cough again. Whined a little which could e normal. She ate quite a bit earlier but just treats right now. That is how it been for some time, off and on. We all slept a lot last night. Bud might come home tomorrow night. Awe she just went belly up. She looks comfortable.

Kira - YES how many times has this doctor done this type of surgery and what has been his success rate? It's at the top of my list. Dr Sebestyen did Kiras first TTA surgery in 2008 and did the same thing to the other knee in May of this year. Except for the expected long recovery from this, Kira breezed through the first one. The second one at age ten was a bit harder on her. But god she was a champ about it, we both already new what to expect, and she was so good about it. They have to be confind for like 8 weeks! This is why we were out walking so much. I was out PROTECTING my investment! Nearly $7,500 invested in her back legs. She would not be walking today if we hadn't. They actually saw off a piece if the bottom leg bone, tilt it outward attach a metal cage at the top and screws at the bottom. Then you wait for the bone to fill in the gap. This takes the pressure off the knee ligaments that normally are always under stress in a dog. You know their knees are always bent unlike ours.

But! For some reason the fur on Kiras back this last time did not grow back! The doctor was very concerned about it and kept asking me to let him know about that. I wasn't concerned at all for some stupid reason. I thought when she blew her coat it would come in. Well neither has happen. Seven months have past and it still looks like they just shaved her yesterday. Except the skin has turned a bit dark. ACC thinks it's from Cushings. Would you agree on that?

Dr Sebestyen is located in the same complex as Advanced Cridical Care (ACC) in Tustin California. They have their own building called Veterinary Surgical Specialists (VSS).

I will now gather up what technical details on Kira I can get. I'm glad to have something to do and not be watching Mira constantly. She is drugged up and that always freaks me out.

[Altira]

We tried a picnic outside Lesile. I was armed with pocket filled with treats. Mira excepted a couple then went off by herself so did Kira the other way. It was a lonely picnic. Mira used to stay right by my side even when it was 100 degrees out shed be laying on the hot cement beside me. Shed never go in the house without me. Oh well I hope it's just the meds. We'll try again later.


ADVANCED CRITICAL CARE & INTERNAL MEDICINE IDEXX LABORATORY SERVICES
TUSTIN, CA

NAME: BEGHTOL, KIRA
AGE: 10 YRS
SEX: F
SPECIES: CANINE
BREED: SIBERIAN HUSKY
COLLECTED: 11/19/2010
REPORTED: 11/20/2010

TEST PROCEDURES RESULTS REFERENCE RANGE UNITS

DEXAMETHASONE SUPPRESSION
PRE DEXAMETHASONE 5.1 1.0-6.0 UG/DL
POST 4 HR DEX 3.4 LESS THAN 1.5 UG/DL
POST 8 HR DEX 2.7 LESS THAN 1.5 UG/DL

LOW-DOSE DEXAMETHASONE DIAGNOSTIC INTERVALS (CANINE)
4 HOURS 8 HOURS INTERPRETATION
< 1 < 1 NORMAL
1.0-1.5 1.0-1.5 INCONCLUSIVE
>1.5 AND >50% >1.5 AND >50% CONSISTENT WITH HYPERADRENOCORTICISM
OF BASELINE OF BASELINE FURTHER TESTING REQUIRED TO
DIFFERENTIATE ADRENAL TUMOR FROM
PITUITARY-DEPENDENT
HYPERADRENOCORTICISM (PDH)
< 1.5 OR < 50% > 1.5 OR > 50% CONSISTENT WITH PITUITARY-DEPENDANT
OF BASELINE OF BASELINE HYPERADRENOCORTICISM (PDH)
< 1.5 OR < 50% > 1.5 OR < 50% CONSISTENT WITH PITUITARY-DEPENDANT
OF BASELINE OF BASELINE HYPERADRENOCORTICISM (PDH)
> 1.5 OR > 50% > 1.5 OR < 50% CONSISTENT WITH PITUITARY-DEPENDANT
OF BASELINE OF BASELINE HYPERADRENOCORTICISM (PDH)


HIGH-DOSE DEXAMETHASONE DIAGNOSTIC INTERVALS (CANINE)
4 HOURS 8 HOURS INTERPRETATION
< 1.5 OR < 50% > 1.5 OR > 50% CONSISTENT WITH PITUITARY-DEPENDANT
OF BASELINE OF BASELINE HYPERADRENOCORTICISM (PDH)
> 1.5 OR > 50% < 1.5 OR < 50% CONSISTENT WITH PITUITARY-DEPENDANT
OF BASELINE OF BASELINE HYPERADRENOCORTICISM (PDH)
< 1.5 OR < 50% < 1.5 OR < 50% CONSISTENT WITH PITUITARY-DEPENDANT
OF BASELINE OF BASELINE HYPERADRENOCORTICISM (PDH)
> 1.5 OR > 50% > 1.5 OR > 50% FURTHER TESTING REQUIRED TO
OF BASELINE OF BASELINE DIFFERENTIATE PDH FROM ADRENAL TUMOR

HYPERADRENOCORTICISM IS A CLINICAL DISORDER WITH CLINICAL SIGNS. IF THE ANIMAL HAS NO CLINICAL SIGNS,
WE DO NOT RECOMMEND TREATMENT. APPROXIMATELY 5% OF DOGS WITH HYPERADRENOCORTICISM WILL
HAVE NORMAL LOW DOSE DEXAMETHASONE SUPPRESSION RESULTS. CONVERSELY, SOME ANIMALS WITH
SIGNIFICANT NONADRENAL DISEASE MAY FAIL TO ADEQUATELY SUPPRESS ON THIS TEST.

URINALYSIS
COLLECTION METHOD CYSTOCENTESIS
COLOR YELLOW
CLARITY CLEAR
SPECIFIC GRAVITY 1.022
GLUCOSE NEGATIVE NEGATIVE
BILIRUBIN NEGATIVE NEGATIVE
KETONES NEGATIVE NEGATIVE
BLOOD NEGATIVE NEGATIVE
PH 7.0
PROTEIN NEGATIVE NEGATIVE-TRACE
WBC NONE SEEN 0-5 HPF
RBC NONE SEEN 0-5 HPF
BACTERIA NONE SEEN HPF
EPT CELL 1+ (1-2) HPF
MUCUS NONE SEEN
CASTS NONE SEEN HPF
CRYSTALS NONE SEEN HPF

TEST PROCEDURES RESULTS REFERENCE RANGE UNITS
OTHER AMORPHOUS DEBRIS PRESENT
UROBILINOGEN NORMAL
Triostane 80mg is what they want to put her on right away with one blood results still pending and weither or not surgery is done. I think she said. They will send me this by mail.

Her bp was 220. I have a script for the bp meds. Should I go get that right way? She said it wasn't as important as the above. She also said to watch for dizzyness or weekness and if so to discontinue it. To me that sounds like thier not sure she needs it. What do you think should I do it or not?

[Altira]

She scared me just now. She was rolling around on the floor whining slightly. That damn pounding chest is so scary to watch. I went to the front door and told her I was leaving without her she better come. She didn't. I looked at her gums they are still pale but pinkish. I got the kong toy and said peanut butter? Ok now she's on her feet with interest and is currently very much enjoying that. Was the little minx just bored? She's not supost to scare me while bud is gone!!!

[Altira]

PETER SEBESTYEN, DMV, DIPLOMATE ACVS

Doctor of Veterinary Medicine - University of Veterinary Sciences, Budapest 1989
Internship - Sonora Veterinary Surgery and Oncology, Arizona 1995
Residency - North Carolina State University 2000

Dr. Sebestyen graduated from the University of Veterinary Sciences in Budapest, Hungary in 1989. Following his graduation, he underwent two years of post-graduate training in anatomical pathology. In 1991, he moved to British Columbia and joined a general small animal practice. Early in his career as a veterinarian in clinical practice, he developed a strong interest in surgery and decided to pursue further academic training in this field.

In 1995 he joined Sonora Veterinary Surgery and Oncology in Scottsdale, Arizona and completed a rotating small animal internship. He enrolled in a 3-year residency program in small animal surgery at the NCSU College of Veterinary Medicine. After completing his residency, he joined the faculty of the CVM as a clinical assistant professor from 2000-2001. He also held a research position at the Department of Anesthesia at Duke University Medical Center in Durham NC and participated in microvascular surgical research. Dr. Sebestyen became board certified by the American College of Veterinary Surgeons in 2001. Prior to his relocation to California, he has been in a small animal surgical referral practice in North Carolina.

During his residency and his academic and referral surgery positions, he completed several research projects, gave numerous seminars, and participated in advanced surgical courses. His research interests include total hip replacement, spinal biomechanics and tibial plateau leveling osteotomy. Dr. Sebestyen has a wide range of clinical experience in veterinary surgery from academic and private practice settings. His clinical interests are surgical oncology, reconstructive and microvascular surgery

[frijole]

Ok I got all the recent detailed results I emailed it to you but I'm not sure it's readable.

Pre Dexamethasone 5.1 1.0-6.0
Post 4 hour dex. 3.4 less then 1.5
Post 8 hour dex. 2.7 less then 1.5

There is a bunch of stuff after that too.

Collection cystocentesis
Color yellow
Clarity clear
Specific gravity 1.022
Glucose negative
Bilirbin neg
Ketones neg
Blood neg
Ph 7.0
Protein neg
WBC none
Rbc none
Bacteria none
Ept cell 1+(1-2)
mucus none
Casts none
Crystals none

Other:
Amorphous debris present
Urobiltnogen normal
(did I miss anything?)

Triostane 80mg is what they want to put her on right away with one blood results still pending and weither or not surgery is done. I think she said. They will send me this by mail.

Her bp was 220. I have a script for the bp meds. Should I go get that right way? She said it wasn't as important as the above. She also said to watch for dizzyness or weekness and if so to discontinue it. To me that sounds like thier not sure she needs it. What do you think should I do it or not?

Thanks for these numbers on Kira. Like I said, they are probably concerned about the high blood pressure coming from an adrenal tumor. Yes that bp reading is HIGH. I wouldn't hold off on getting her the meds for that. The dizziness and weakness she described to you are POSSIBLE SIDE EFFECTS from the drug they are recommending. I know this because I googled it.

Couple other questions -

1. Has Kira had an ultrasound to take a look at the size and location of that adrenal tumor? IMHO this absolutely should be done prior to any surgery because it gives the surgeon a better idea of how to approach the surgery and frankly the likelihood of success. If too risky then you could opt for treating with lysodren or trilostane. I am not sure why they are recommending trilo right now unless it is to give her some relief while you decide on surgery?

What are the docs telling you? Without this info we don't have the full picture and so it is hard to help.

2. The vet seems experienced at surgery from the bio you posted. I did not see anything specific to this type of surgery and you will probably only get the answer by having discussions with him directly. It is OK to ask him - he will understand. Just like if you were having heart surgery you would want to know that your surgeon has done a lot of them successfully..

Sorry you are dealing with alot at the same time. Hugs, Kim

[Buffaloe]

I see that Dr. Sebestyen did his internship at Sonora Veterinary Surgery and Oncology in Phoenix, AZ. It is now called Sonora Veterinary Specialists and there are two locations in the Phoenix area. It is a wonderful facility and has a great reputation here. The owner is a fantastic surgeon and performed my Shiloh's adrenalectomy in 2006. I have to believe that Dr. Sebestyen received some great training while at Sonora.

Ken

[Squirt's Mom]

Hi Janis,

How is Mira this morning? How are you?

The results on Kira aren't clear to me, but that's not surprising! It might help you could post all the info given with these numbers:

Pre Dexamethasone 5.1 1.0-6.0
Post 4 hour dex. 3.4 less then 1.5
Post 8 hour dex. 2.7 less then 1.5

There is a bunch of stuff after that too.

That "other stuff" might help. And, of course, I am sure others will be along who can tell you much more about what all that will mean than I.

Her specific gravity of 1.022 appears to be normal to me. According to the Merck Veterinary Manual, 9th Edition, the normal range for canine specific gravity is 1.001-1.070. Did they do a blood panel, what is often called a CBC, on Kira? There are several values from this test that are also used as indicators for Cushing's.

I'm not sure I agree with the vet concerning which is the most important to focus on for Kira. In my simple mind, the BP needs attention now. But what do I know?!

The vet is right in that the Trilo can cause some of the signs mentioned to watch for, but that is just part of the treatment with either drug, Trilo or Lyso. INSIST they give you some prednisone to have on hand just in case Kira needs it. This is not an option - it is a necessity but some vets are loath to give it when pups are on Trilo because they hold to the false belief that Trilo is so much safer than Lyso that the pred isn't needed. The fact is, both drugs can have serious consequences if the diagnosis isn't right, the dose isn't right, and/or the pup isn't properly monitored. So pred is something a parent needs to have on hand with either treatment.

I am curious...are they wanting to treat Kira's adrenal tumor until it is removed or are they going to try the treatment path instead of surgery?

When you talk of Mira going "belly up", that sounds so cute! The pics of her playing patty cake are too precious. I know it is so very hard, almost impossible, to look at her and accept how sick she is. My heart just aches for you, Janis. You asked if you would be allowed to live after Mira has to leave us... yes, honey, you will. Mira needs you to, Kira needs you to, Bud needs you to, I need you to, we all do, Janis. Dear god, I know it seems you won't be able to take that next breath - how could you, right? It seems impossible. But you will take that next breath, and the one after, and the one after. In time, those breaths will stop being such a struggle and you will look up to find you have breathed your way through many days. It won't be easy, sweetie, I won't lie to you about that. It will be absolute Hell at times, but you will survive in spite of all the pain. You will.

I am so glad your neighbor is willing to help you if needed. It was breaking my heart to think you would have to face these days with no one to hold your hand or wipe your tears. Give her a hug from me for helping you and from one mom to another who understands. We are all three moms who understand, huh?

Big hugs,
Leslie and the girls - always