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Frankie Update Feb 16.[Long]



 
 
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Old February 16th 04, 09:29 PM
Dimpled Chad
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Default 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


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