Tess, radiation therapy (Tessie has passed)

[Sammie]

OK the E-Vet Faxed over a complete panel, except for the ALP that would not read so they are sending that out will have it tomorrow. On the phone she said there was also something wrong with Tes liver. So we are now dealing with Cushings, a Anal Tumor and lift glades (one being really big out of the 4 that are also big) and the Liver. I said to the E-VET that it was just dum luck that we found the tumor. She said yes it was. The E-Vet on Monday when I rushed Tessie in did not do a anal exam.

A recap: Below will be Tes first Labs when I rushed her to the E-Vet on Monday morning.

07/06/09 VETSCAN 05:44 AM

ALB 2.8 2.5-4.4
ALB>2400 20-150
ALT 377 10-118
AMY 907 200-1200
TBIL 0.3 0.1-0.6
BUN 50 7-25
CA++ 11.9 8.6-11.8
PHOS 6.8 2.9-6.6
CRE 4.2 0.3-1.4
GLU 85 60-110
NA+ 149 138-160
K+7.2 3.7-5.8
TP 6.0 5.4-8.2
GLOB 3.2 2.3-5.2

NOW TODAYS TEST

I-STAT EC8+ 07/12/09 1:35 PM

GLU 95 MG/DL
BUN 27 MG/DL 10-20
NA 145 MMOL/L 140-159
K 4.0 MMOL/L 3.7-5.8
CL 111 MMOL/L 105-115
TCO2 32 MMOL/L 23-29
ANGAP 7 MMOL/L
HCT 38 %PCV
HB* 12.9 G/DL
*VIA HCT
PH 7.447
PCO2 45.1 MMHG
HCO3 31.1 MMOL/L
BEECF 7 MMOL/L
IF THERE IS KNOW RANGE ITS BECAUSE IT WAS NOT ON THE PAPER WORK.

HEMATOLOGY RESULTS 07/12/09 2:39 PM
HCT 38.4 % 37-55.0
HGB 13.6 G/DL 12.0-18.0
MCHC 35.4 G/DL 30.0-36.9
WBC 16.9 x10 9/L 6.0-16.9 (H)
GRANS 14.7 x10 9/L 3.3-12.0 (H)
% GRANS NEUT 13.9 x10 9/L 2.8-10.5 (H)
EOS 0.8 x10 9/L 0.5-1.5
L/M 2.2 x10 9/L 1.1-6.3
%L/M 13 %
PLT 507 x10 9/L 175-500 (H)
RETICS 0.8 %

VETSCAN 07/12/09 AT 2:45 PM
ALB 3.8 2.5-4.4
ALB WAS SENT OUT
ALT 408 10-118 THIS IS HIGH
AMY 727 200-1200
TBIL 0.8 0.1-0.6 THIS IS HIGH
BUN 25 7-25 This came down from Saturdays BUN which was 33
CA++ 13.2 8.6-11.8 THIS IS HIGH
PHOS 6.5 2.9-6.6
CRE 0.8 0.3-1.4
GLU 101 60-110
NA+ 152 138-160
K+ 4.2 3.7-5.8
TP 7.2 5.4-8.2
GLOB 3.4 2.3-5.2

VETSCAN 07/12/09 3:18 PM HIGHER LOWER IS FROM THE 2:45 TEST

ALB 3.9 HIGHER
ALP
ALT 406 LOWER
AMY 721 LOWER
TBIL 0.9 HIGHER
BUN 26 HIGHER
CA++ 13.3 HIGHER
PHOS 6.6 HIGHER
CRE 0.7 LOWER
GLU 95 LOWER
NA+153 HIGHER
K+ 4.3 HIGHER
TP 7.2 SAME
GLOB 3.3 LOWER

Notes from E-VET 07/12/09 at 13:30
soft SQ swelling over dorsal scapula, multiple pigmented raised masses E: moderately cloudy lens E: clean N: no d/c T: tonsils NV, nooral masses seen MS: BCS 6/9, amb x 4 CV: NSR, no murmur, mm pink, CRT 1 sec, pulses fair Resp: Clear BV GI/GU: Oral- severe calculus with few areas of recession, abdom soft and non-painful, cranial organomegaly, F/S, Rectal- small growth floor of colon near anus. AG full and emptied, L anal gland mass lateral cranial to anal gland LN: inguinal (2cm) lymph nodes and axillary (1 cm) lymph enlarged, popliteal/prescaps/manibular 1 -1.5 cm NS: P,P,M okay

A: Vomiting and anorexia today: r/o gastroenteritis ( drug reation, infectious, neoplasis, Addison's Hx Cushing's disease
Hx elevated Calcium
A few days of dark stool and BUN/Crea ratio 37: r/o Gl bleed
Mass next to left anal gland: r/o neoplasia, benign, ingectious Periodontal disease Lymphadenopathy
P: Electolytes panel. Electrolytes WNL, BUN slightly elevated remainder OK. Rec injection of anti-nausea and recheck with normal vet.
Anzemet 20 mg/ml 0.26 ml SQ
Reglan 10 mg (#10) 1/2 tablet PO BID
Sucralfate 1g (#10) 1/2 tab PO TID
Recommend anal gland and inguinal LN FNA ASAP Owner requested full panel.

When the E-VET called me to fax over the full panel, she also said that something was wrong with Tes Liver.

Medication Tes was sent home with Metoclopramide 10mg
give one half tablet every twelve hours. Gave it to Tes at 6:00 PM
She is now moving around like she is uncomfortable and panting.
Very large pill.

Sucralfate 1g give 1/2 tab every 8 hours Gave this to Tes at 4:00 PM, know side affects.

Gave her a tine bit of cute up chicken and rice, she did not want the rice ate the chicken. She smelled it cooking and went in to the Kitchen like her old self to beg for something to eat.
OK I think thats it.. TY all for translating all of this for me Big Hug for today and being there Dottie

[Sammie]

Dottie, with the swollen glands, along with the growth they have found in her rectum, did the vet say anything about this possibly being lymphoma? They can't tell for sure without a needle biopsy, but with swollen peripheral nodes that is easy enough to do. I did a quick review of your thread, & I don't see where you posted how old Tess is? If they think this may be lymphoma, I can probably help you with information about that.

Debbie

Hi again Tessie will be 13 years on 7/29/09. I will be taking Tes to my Vet on Monday and I will ask him to run the test for that too. With out all of you here helping me to help test I would of never known to ask about about Lymphoma TY dottie

[frijole]

Dottie, I will let someone with more knowledge read the lab reports -I really appreciate the update and am glad to know Tess ate tonight. She's fighting and that is good.

Did the doc say anything specific about the liver? I ask because cushings (and other diseases) affects the liver so it isn't really surprising to me. I was wonder if there was something besides elevated enzymes (the alks on the blood tests) that they were talking about.

Wish I could do more than say Hang in there but it's the best I can do. I will say prayers for your family and Tess. Maybe others will come on later and be of more help. Thanks again for updating us. Hang in there! Kim

[StarDeb55]

Dottie, at this point in time, your GP vet needs to give you a referral to an IMS. If this is indeed cancer, or if the anal growth is due to elevated estradiol, this is going to take an IMS to get it sorted it. The type of medical issues that Tess & you are dealing with are beyond the scope of most general practice vets. Seeing an IMS is really going to be in Tess' best interest over the long haul because as I said earlier, I have serious doubts about the validity of the Cushing's diagnosis.

Debbie

PS-If the Cushing's diagnosis is incorrect, this is why Tess became so critically ill when you gave her the trilo, not from too much trilo. I'm also VERY, VERY CONCERNED with Na/K ratio as this is back down to 20.6. I am not a vet, but IMHO, Tess needs to be put on florinef & a steroid replacement because with this continuing electrolyte balance, you may lose her to a cardiac problem before you have a chance to get to the bottom of everything that the ER clinic found today.

Just in case you don't know, IMS means internal medicine specialist.

[Sammie]

Dottie, in light of what the ER clinic found today, I'm going to be frank, a Cushing's diagnosis is, now, highly questionable. This is why it is so important to not rely on a single diagnostic test. Even if Tess might have Cushing's, it's now on the back burner, until they can figure out what that mass is. I'm concerned about lymphoma as my 1st Cushpup, Barkley, developed lymphoma about 6 years after his original diagnosis. His symptoms were very vague, nothing specific, & any abnormalities on his labs could be explained by the pre-existing Cushing's. It took an IMS to figure out why he was getting sicker by the day. She found multiple swollen peripheral lymph nodes on exam, did an abdominal US, finding further swollen nodes that were throughout his abdomen. To make the diagnosis, she simply did a needle biopsy on one of the swollen nodes in behind his knee. This simple means that a needle was stuck in the node, taking out a small amount of material to send to Pathology for diagnosis. I really hope that Ken is right. If I were in your shoes, though, I would opt for a biopsy of one of the swollen nodes before I put Tess through a surgical biopsy of that mass in her anus/rectum.

Debbie

PS- There is also a possibility that this growth may, indeed, be a perianal adenoma due to elevated estradiol levels. Susy, (Wylie's Mom), has had an on-going problem with this type of growth on poor Wylie. In fact, Wylie had surgery within the past week to try to remove one. The elevated estradiol is what's causing this, so it may also be worthwhile to have at least an estradiol level done, if not the full adrenal panel. One other question, has Tess' been spayed?

Hi Debbie just hang in there is really good. Just talking about it to people that have walked the walked is so helpful. Now what is IMS?
AND what is a abdominal US? The ER Vet was great. She is about 4 years out of UC Davis were my Vet graduated around 20 years ago. She has explained a proceeder to My Vet, which he might already know how to do, but it wont hurt Tes and you don't have to but her out to do it to do a needle biopsy of the tumors. YES tes was spayed a 6 months. I can not ty you guys enough. Dottie

[StarDeb55]

IMS=internal medicine specialist

abdominal US=abdominal ultrasound

Please see my "PS" on my prior post.

[Squirt's Mom]

Hi Dottie,

In reading your post, I am confused by the following reference to a "full panel" -

Recommend anal gland and inguinal LN FNA ASAP Owner requested full panel.

When the E-VET called me to fax over the full panel, she also said that something was wrong with Tes Liver.

Is the the full adrenal panel from the Uni. of TN in Knoxville we have mentioned? If so, this is not the time for that test. Her current stress levels will cause results that will not be accurate. Nor will it be able to tell you what is wrong with her right now.

As has been said, Cushing's is the last thing you need to be concerned about. So if Cushing's is where your focus is, take a step back, shake your head and get ready to start all over.

But that doesn't mean you get to leave....no way! We just need to be able to look at Tess from a broader perspective, with Cushing's last on the list, if on the list at all...'k?

If I have misread these statements, then never mind....

Hugs,
Leslie and the girls

[Sammie]

Dottie, at this point in time, your GP vet needs to give you a referral to an IMS. If this is indeed cancer, or if the anal growth is due to elevated estradiol, this is going to take an IMS to get it sorted it. The type of medical issues that Tess & you are dealing with are beyond the scope of most general practice vets. Seeing an IMS is really going to be in Tess' best interest over the long haul because as I said earlier, I have serious doubts about the validity of the Cushing's diagnosis.

Debbie

PS-If the Cushing's diagnosis is incorrect, this is why Tess became so critically ill when you gave her the trilo, not from too much trilo. I'm also VERY, VERY CONCERNED with Na/K ratio as this is back down to 20.6. I am not a vet, but IMHO, Tess needs to be put on florinef & a steroid replacement because with this continuing electrolyte balance, you may lose her to a cardiac problem before you have a chance to get to the bottom of everything that the ER clinic found today.

Just in case you don't know, IMS means internal medicine specialist.

I am on hold with the ER Vet to ask her about the Na/K. TY Deb
Was on hold 15 min another emergency walked in to there clink so she will call me back.

[SachiMom]

Is the the full adrenal panel from the Uni. of TN in Knoxville we have mentioned? If so, this is not the time for that test.

Leslie, I think Dottie is referring to a full blood panel . . .like they get on their yearly or senior well checks. Not really anything to do with cortisol or cushings at the moment. Just trying to figure out what's going on.
~Mary Ann

[Sammie]

IMS=internal medicine specialist

abdominal US=abdominal ultrasound

Please see my "PS" on my prior post.

How can they test for estradiol? is it located some where on my current Labs test? If it is could you tell me were on the Labs? If its not I just ask my Vet to test for a high estradiol? ty