Below are all of the high blood chemistry as of June 18
|ALT (SGPT)|| 505||(12-118)|
Hannah's BUN was normal as of her tests June 4 (25) but was high on June 3 (29). Her creatinine was 1.9 on June 3, 2.0 on June 4 and has increased to 2.1 on her latest test. Both her akaline phosphatase and her ALT have improved. I made a few tables below to show her progression.
We also need to make some decisions about her Cushings (hypoadrenocorticism) . It is important to have her liver and kidneys functioning well before we can move forward on that. I am trying to take the "What Would Hannah Do" approach to this.
- Hannah does not want to be in pain (who does)
- Hannah does not want to take pills (but she has to take some regardless because of pain meds)
- Keep Hannah comfy (pain meds)
- Treat the Cushings (Lysodren + pain meds) -- Trilosane is out because it's lots of pills and our vet said that given Hannah's clear desire to not have pills, a twice a day medication would probably not be the best choice. Our vet said repeatedly that Lysodren is chemotherapy and that it is a derivative of DDT. The literature on this is pretty scary too. This treatment option would most likely result in a prednisone prescription.
- Treat the Cushings aggressively. Surgery (adrenalectomy) might be a good option but she would still have to take pills even with surgery so it does not solve the pill problem and it is a risky undertaking since the adrenal gland is so close to the aorta. The adrenal gland is located between the aorta, the renal artery and vein, which are the sole blood supply to
the kidney, and the phrenicoabdominal artery. In fact, the more I have looked into this, the less I feel that this is a good option. According to the Textbook of Veterinary Internal Medicine, "Approximately 50% of dogs develop severe postoperative complications, including pancreatitis, pneumonia, pulmonary thromboembolism, acute renal failure, sepsis, and hypoadrenocorticism due to insufficient steroid levels." We know that she has a tumor because it showed up on ultrasound but we don't know if it is malignant or benign because it is not easy to determine if an adrenal mass is malignant or benign before surgical removal and histopathologic evaluation. If the tumor is benign, surgical removal is a cure but if it is malignant, surgery may help for a while but is not a cure. I have read that while only approximately 15% of canine Cushing's syndrome patients have adrenal tumors, half of these patients will have benign tumor and half will have malignant tumors.
I will continue to do some research and thinking this weekend, discuss it with DH and meet with our vet sometime in the next week or so to come up with a treatment plan for The Brown One.