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Frankie Update Feb 16.[Long]
Here's the update from the biopsies. Sorry it is so long!
Short version: Biopsies are back, with celebratory results. The skin problems are probably secondary to his steroid use, and not super-dooper serious. The mouth mass is not cancerous, and might be simply bacterial in origin. The former we are addressing through continued reduction of steroids. The latter we are addressing short-term with antibiotics, and maybe later through dental cleaning or, perhaps, excision. Frankie is happy, improving, and while still beset with numerous conditions, nonetheless is acting quite well. Long version: Frankie went to have stitches removed this afternoon, and we found that his pathology results had come in. Basically, it is all fairly encouraging news, all things considering. Our worst fears were found baseless. He neither is having another immuno-rejection, either of his skin or of some other bodypart, nor is the oral mass consistent with cancer. Here's the technical language, and then my best lay rendition: On the skin biopsies: Diagnosis: calcinosis cutis. "Changes are diagnostic for calcinosis cutis. These lesions are due to degeneration of dermal collagen with subsequent dystrophic mineralization and are almost always associated with hyperglucocorticoidism of either endogenous or exogenous cause. Ruling out Cushing's disease may be indicated. Late stage lesions may progress to osseous metaplasia of the dermis resulting in cutaneous plaque formation." But the vets are pretty sure that this is not due to Cushing's, but due to the steroid administered for the Immune-Mediated Thrombocytopenia. The calcium buildup in the skin can be related to such steroid use, and can lead to this condition. It is not typical, but possible. It suggests that Frankie hasn't handled the steroids as well as we had hoped, but assuming that this diagnosis is correct, and given that we are at a point where he is on a low steroid dose and we are considering taking him all the way off, the skin condition is not a critical concern right now. On the Mouth Biopsies: There are two different conditions in the mouth, a flat, white, hardish tissue on the lips (#1), and the under-the-tongue masses (#2). "#1: The lesion is a circumscribed submucosial mass, which is characterized by prominent mineralization and degeneration of callagen fibers, with a locally severe granulomatous inflammatory response. No organisms are noted within the lesion. Comment: The first lesion is consistent with a region of dystrophic calcification. This may accompany naturally occurring or iatrogenic hyperadrenocorticism. Lesions of this type are commonly observed in the skin (groin, axilla, back of the neck) rather than the oral cavity." "#2: The specimen is devoid of mucosal lining, and is instead coated with a very thick layer of fibrin and neutrophils. Well-vascularized granulation tissue thickens the underlying submucosa, and occasional small granulomas surrounding mineralized foci are observed within the submucosa. Comment: The second lesion (beneath the tongue) may be due to a number of factors, including abrasion and bacterial infection. There is no evidence of malignancy in either of the tissue specimens examined." In other words, the first biopsy seems to be directly related to the same condition on the skin: steroid use leading to increased calification in cells. We are hoping that this will either stabilize or decrease on his now lower dose of steroid, and potentially go away if we take him off of it all together. The masses under the tongue are not cancerous, and could be related to a bacterial infection or an abrasion of some sort, maybe from chewing on a bone or something. Were do we go from here? Well, a total health blood exam is due on Thursday morning. From that, if his p count is still high and his liver enzymes still are lower and lower, we have to decide about whether to continue immuno- suppression or not. Then we'll decide future care of his secondary issues: murmur, bladder stones, etc. His walks this week have been exceptional, very energetic and happy. He's acting pretty much like he was before his IMT, and we are thrilled with that. His skin condition doesn't look worse, though it has spread a bit. The oral masses seem slightly improved, not in size but in appearance. Frankie sends his continued thanks for your wellness-vibes, and sends many arrrr-ro-ro-roooos for everyone to have a terrific week. More info pending the results of the next blood-draw and our next medical adventure. Be well, Chad -- Looking for a pet? Adopt one! ** http://www.petfinder.com Info for a healthy, happy dog? * http://www.dog-play.com Illegitimi non carborundum |
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