Dad of Lulu - sweet Lulu has crossed The Bridge

[addy]

Crossing all our paws too for good news for Lulu. So glad surgery went well.

Sending hugs for all of you,
Addy

[Squirt's Mom]

You are just tooooo quiet! I would have been posting so much my laptop would have gone up in smoke if Squirt underwent these surgeries!

I am glad Lulu has done so well and hope the results are perfect! Please keep us informed...even if you don't wail and moan and carry on like I do.

Hugs,
Leslie and the gang

[LabDad]

I thought I had posted Lulu's pathology results this morning, but I see that I must not have checked to make sure it was sent. Well here goes. Lulu got her stitches out yesterday and she was happy, the veterinarian was pleased, and we talked about having her retested for Cushings in a month. She pants at night when it's just a hint of warm. We do our best to keep it like a refrigerator in our room at night, and fall is coming with cooler temps.

The liver biopsy was benign, but she did have a grade II tumor mast cell, but the prognosis is good, in fact my research confirms Dr. Wilson's. He did excellent surgery.
************************************************** *
Below is the report I typed up this morning.


Okay, on Lulu and I am typing this into a Word Document, so that I can submit this to two Cushing Forums and to an AnneCollins.com weight loss web site, and other people interested in Lulu, our 11 yr. old yellow Labrador.

She had three masses removed Tue. Aug. 16, 2011. The largest mass, a ‘cyst’ that Dr. Wilson of Wilson Veterinary Hospital in Romeo, Michigan, aspirated and did not find any indication that it was cancerous after staining and looking under a microscope.

The mass which had grown since December of 2010 had been indicated by Lulu’s Port Huron Michigan veterinarian to keep a watch on. At this time, the Port Huron veterinarian had sensed that Lulu may have Cushing’s disease and suggested testing. We did this, though it can be costly, but is a viable for dogs that have more pronounced Cushing’s Disease symptoms. Lulu had increased water intake, frequent urinating, panting often which requires more ventilation, fans, a bit more air-conditioning, at times an aggressive appetite and in February experienced a much increased shedding of her fur.

Lulu hasn’t shed much since March of this year, though her fur coat has taken on a curlier and perhaps slightly coarser appearance on parts of her back. Perhaps her fur may grow back in this area. But she is still gorgeous and whether she has a permanent curly hairdo or again becomes a golden blonde is not that important and is very compatible with a loving and comfortable life.

Now Lulu’s three tumors, as well as a biopsy of her liver using ultrasound was done during the surgery.

We went in Sunday, Aug. 28, 2011 to have Lulu’s staples and stitches removed. She was very happy, and we let her bring her bright orange soft bone chewy into the vet hospital. I highly recommend doing this with your pet if they have doctor anxiety; it really helps reduce the nervousness. One other tip is DON’T park in front of the hospital if you can help it and it’s not an emergency. But rather park facing away from the building, because you see your dog is smarter than YOU are and ME!

Anyway, on to the pathology:

The liver showed a mild diffuse vacuolar change with several areas of benign nodular hyperplasia scattered throughout the parenchyma. Hematopoiesis is noted in very small amounts in the hepatic sinusoids. No significant inflammation appears.

The abdominal mass consists of a loosely demarcated and moderately cellular mast cell tumor which extends throughout the connective tissue stroma. There is mild to moderated secondary eosinophilic infiltrate throughout the mass. The tumor cells are well-differentiated, demonstrating abundant fine basophilic granules, minimal pleomorphic nuclei, small to absent nucleoli, and a mitotic rate of about 1 per 10 high power (400x) fields.


Microscopic Interpretation.

Liver: Moderate vacuolar hepatopathy with benign nodular hyperplasia

Abdominal mass: Mast cell tumor Patnaik grade II
(Low—well-differentiated type), complete excision
Additional tissue: No mast cell tumor is seen.

Comments: The liver lesions are typically incidental and may create a nodular appearance on ultrasound or grossly. I do not appreciate the presence of any hepatitis or hepatic fibrosis. Vacuolar change may be associated with a number of potential etiologies and is typically an incidental finding. There is NO EVIDENCE of mast cell tumor in the liver. (MY COMMENTS- THIS IS A GOOD THING)

Abdominal mass: The mitotic index is 1.

The tumor was classified as grade II with grade I being low grade, II being intermediate grade and III being high grade.

Grade I has the best prognosis with an excellent survival rate. Grade III has a poor prognosis. Grade II (which Lulu has been rated) is of course in between. I have heard (see below) that she would have an 80% favorable prognosis. BUT to even paint a rosier picture, Lulu has a LOW mitotic index of 1 (1 per high power (400x) fields. Mitosis is the process that body cells make new body cells, and it is ‘out of control’ mitotic division that cancer creates that is devastating to mammals that get cancer.

So in my conclusion and Dr. Wilson is very confident based on the laboratory findings, Lulu has a very good chance of living another 5 years. LOL

Now nothing in life is certain, and Lulu has lived the best of life, and she has probably had a better upbringing than my wife Linda and me. She has had a great 11 years with us. We found her when she was 4 months old as she came here on her own, though she had a collar. We never found out who owned her, and we checked newspapers, the neighborhood and bulletin boards. My wife had wanted a yellow Labrador girl and wanted to call her Lulu. That is how Lulu became ours.

The report goes on further to state that if we want to see an oncologist for additional consultation that they would help us find one if we wanted. We presently feel that at this time, with the great surgery of Dr. Wilson and the age of Lulu that currently we are not considering this. We will keep a watchful eye.





Below is from a website I found of a Dr. Dressler answering dog owner with mast cell tumors.
__________________________________________________ ______________________





Dr. Dressler January 9, 2010 at 7:32 am
William
the ultrasound is a good idea. Painless, good information. If the scan is clean a wide excision, as you brought up, is a very good idea. Vaguely 90% of grade 2 mast cell tumors are cured with a wide excision (no radiation). Median survival time of dogs receiving conventional veterinary care with grade 2 mast cell tumors having a mitotic index under five is 70 months. Mandy is 8 years old. 70 months added on to that is 13.5-14 years of age. This is perhaps a year under average life expectancy (as a guess) for a dog like yours, in other words, close to a full life. Bottom line, I would look at these stats and decide whether radiation makes sense for you in the overall analysis of life expectancy and median survival times.
“However, there is some concern that even if they perform the second surgery, the pathologist won’t be able to determine conclusively if there are “clean margins.”” This is due to micrometastasis:
http://www.dogcancerblog.com/dog-can...hy-do-we-care/
Hope this helps,
Dr D

[LabDad]

All right, it was time for Lulu's ACTH test, so let me go through what the printed results show, because I'm not sure how to interpret. Dr. Wilson has said that she needs no medication at this time as results were low. On Oct. 6 Lulu had the one hour test. Her Pre-ACTH was 2.8 ug/dl and her Post-ACTH was 3.5 ug/dl.

ACTH Reference Range:

2-6 ug/dl for the Pre-ACTH
6-18 ug/dl for the Post-ACTH

>22 Post-ACTH Cortisol consistent with hyperadrenocorticism
<2 Post-ACTH cortisol consistent with hypoadrenocorticsm
1-5 Desired pre- and post-ACTH cortisol on Lysodren therapy.

The report goes on to say: ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticism (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs with HAC. If the ACTH response test is normal and HAC is still suspected, proceed with a low-dose dexamethasone suppression test.

It goes on to describe dogs with iatrogenic Chshing's disease.

The report also showed gross lipemia on the pre and post specimens, requiring ultracentrifuation. Fasting wasn't required, though Lulu did have some breakfast.

On Oct. 18 Lulu had a fasting urine sample with normal specific gravity of 1.045 thought cloudy turbid with some cocci bacteria. She had normal electrolytes, with the chloride slighty elevated, but not a concern.

Lulu is doing well, after her surgery and her symptoms of Cushing's are not as pronounced. I asked the vet if Addison's could be a possibility and he said it could, but did not recommend any prednisone at the time based on her test results.

Lulu does have some limping the last few days I have treated with Deramaxx and gentle massaging of her legs. She had tpl surgery on both back legs 6 years ago.

Lulu has a thundershirt which we have used for high pitched smoke alarm type sounds she hates. We haven't had a good storm to test her. She likes her coat as we have tested on her when she has gotten upset.

[Cyn719]

So glad Lulu is doing good - thank God she found such wonderful parents!! Will be checking in on Lulu to see how she progresses and ?? of Addisions -

[Harley PoMMom]

All right, it was time for Lulu's ACTH test, so let me go through what the printed results show, because I'm not sure how to interpret. Dr. Wilson has said that she needs no medication at this time as results were low. On Oct. 6 Lulu had the one hour test. Her Pre-ACTH was 2.8 ug/dl and her Post-ACTH was 3.5 ug/dl.

ACTH Reference Range:

2-6 ug/dl for the Pre-ACTH
6-18 ug/dl for the Post-ACTH

>22 Post-ACTH Cortisol consistent with hyperadrenocorticism
<2 Post-ACTH cortisol consistent with hypoadrenocorticsm
1-5 Desired pre- and post-ACTH cortisol on Lysodren therapy.

2-6 ug/dl for the Pre-ACTH and 6-18 ug/dl for the Post-ACTH are reference ranges for healthy dogs that do not have Cushing's and are not being treated with either Trilostane/Vetoryl or Lysodren/Mitotane.

1-5 Desired pre- and post-ACTH cortisol on Lysodren therapy are the reference ranges for a Cushingoid furbaby being treated with Lysodren/Mitotane.

Is Lulu on Lysodren? If she has not had Lysodren for a period of time than her ACTH results would concern me a bit.

On Oct. 18 Lulu had a fasting urine sample with normal specific gravity of 1.045 thought cloudy turbid with some cocci bacteria. She had normal electrolytes, with the chloride slighty elevated, but not a concern.

Dog's with Cushing's disease will usually not have concentrated urine and seeing that Lulu's USG is 1.045 is confusing to me but it doesn't take much to confuse me!

Lulu is doing well, after her surgery and her symptoms of Cushing's are not as pronounced. I asked the vet if Addison's could be a possibility and he said it could, but did not recommend any prednisone at the time based on her test results.

So happy to hear that Lulu is doing so well and please keep us posted.

Love and hugs,
Lori

[LabDad]

Thanks Lori. I will try to keep informed more on disease. Lulu has not had ant drus for Cushings since January. I am wondering abt the 8 hr. Test some time in the future? I aam going to monitor her water intake this winter to see how much she drinks. She should drink abt 2 liters a day for her 85 lb. Weight.

[LabDad]

Lulu does have some limping the last few days I have treated with Deramaxx and gentle massaging of her legs. She had tpl surgery on both back legs 6 years ago.

I took Lulu to the vet one week ago because her front left paw she was limping on we saw what looked like a cut paw. This was strange because it came all of a sudden and not really inflamed and she didn't like us looking at it. The vet came back with a relieved Lulu, who had a corn that was a quarter inch long and narrow which had been growing causing it to push into her paw. She is walking much better, with an occasional misstep because it is still a bit sore.

We take her with us from (Port Huron area) to Cleveland tomorrow, since I have a every two year surgery I had for Colitis 25 years ago. We will be staying at the same nice Red Roof Inn nearby we were at two years ago after visiting with some Cleveland friends of ours.

[LabDad]

Just a quick note, to say that Lulu is doing well. She thinks she is a pup, and I don't tell her otherwise. She had to have surgery for the corn, which turned out to be a non-viral wart I believe. Then she has had a chalazion cyst in her left eye which the vet has squeezed twice. I'm afraid she will have to have it removed surgerically.

Though I think Lulu may still have symptoms of Cushings she hasn't had any medicine for it in over a year. She seems to be coping well, though I do watch her water intake, and of course she has healthy appetite. She has stayed in good shape, and physically she appears to be as healthy or more so than she was a year ago.

I will arrange for the two hour test when I can get a chance. It's funny with the surgery she had in last year, her fur started to grow back and then it seems stunted in parts. It doesn't look bad, and I wonder if that is permanent?

You know it's what is best for the pet, and sometimes if the disease isn't serious sometimes no treatment may be better than treatment. I'm taking it day by day!

[Harley PoMMom]

Thanks so much for the update on Lulu. If Lulu is not displaying strong symptoms than not treating is a choice I would probably make myself.

Please do keep us posted and wishing you both the best of luck.

Love and hugs,
Lori