Wednesday, June 4, 2008

Hannah gets a haircut (for her ultrasound)

Hannah continues to test the knowledge of her medical team. This morning she was upset to have to skip breakfast -- yucky pills but not breakfast! -- before having an ultrasound performed. She was shaved for the ultrasound and looks snazzy with her new hairdo.

Short version: Blood work bad, ultrasound good, ATCH stim test today, eating normally now that her tummy not upset (but still on EN)

On Monday, Hannah had a blood panel done. The results came back yesterday and they were not good. In the vets' words ther has been "a dramatic shift in the past two months." The results seem to indicate that it is most likely that Hannah didn't want to eat purely due to nausea. Her four major liver enzymes are off the charts bad. Either she got into something (not likely but possible) or there is a tumor in her liver or blockage in her bowels or something else going on. Yesterday afternoon, we brought her back to the vet to have her clotting factors checked in case they needed to biopsy.

This morning they did an ultrasound. Her liver looked fine (no nodules) but her left adrenal gland was mildly enlarged (2.56 x 0.75 cm). They are doing an ATCH stim test now and results should be back tomorrow. They did not start with the stim test because all of her liver enzymes were so high. She will start on denamarin and actigol (homeopathic milk thistle based supplement) have been added for liver supportive care starting as soon as possible. As of today, the plan is that she will have another blood panel in 1-2 weeks to see if those high liver values have come down. If not, then that will be followed with a liver function test.

Here are the high values from her blood work (with normals in parens). All were normal as of March 15th.
Urea Nitrogen29(6-25)
Creatinine 1.9 (0.5-1.6)
Total bilirubin 0.6 (0.1-0.3)
Alkaline Phosphatase 2821(5-131)
ALT (SGPT) 1901 (12-118)
Cholesterol 900 (15-66)
GGTP85 (1-12)
Platelet Count 431 (170-400)
WBC 4-10 (0-3)

The notes from her ultrasound are as follows
  • The spleen was mildly heterogenous and contained several hypoechoic nodules, up to 6 mm in length (our vet said that this was relatively normal for a dog of her age)
  • The left renal pelvis was mildly dilated (6 mm) (our vet said that this is probably due to her past history of chronic UTI)
  • The left adrenal gland was diffusely, mildly enlarged (2.56 x 0.75 cm)
  • The right adrenal gland was difficult to visualize but appeared normal (1.87 x 0.48 cm)
  • The stomach was moderately distended with ingesta and gas and could not be well evaluated
  • The colon was moderately distended (2.86 cm in diameter) with non-formed feces
The most worrying thing from the notes on the ultrasound is, "left adrenomegaly, likely due to neoplasia." Adrenomegaly, enlargement of the adrenal glands. Neoplasia, an abnormal growth, a group of diseases commonly called tumor or cancer.

With all of this going on, Hannah remains in a very good mood. She is active and has good color both on her lips and gums. She was not bothered by her "veterinary grooming" done for her ultrasound. She is still resisting her pills but is eating the EN dog food as as Labrador should and she wanted more food last night.

UPDATE: Someone asked about her sodium and potassium levels. Sodium is 151 with normal being 139-154 and potassium is 4.8 with normal being 3.6-5.5.

6/6 UPDATE: Hannah's ATCH stim test for Cushings (primary adrenal) was positive. Normal is 15 or less, she is 29.4.

Her current treatment plan is to get her liver healthier. We'll recheck her liver enzymes in about two weeks. Once her liver is healthier, we will discuss lysodren versus trilosane. Our vet said, and we tend to agree, that she is not sure that surgery is appropriate for a dog her age.

In the meantime, I am happy to report that Hannah is in an excellent mood and is eating well and wanting treats, etc. She is even taking the denamarin well (must be given 1 hour before meal without food).

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