Purdue Veterinary Clinical Pathology Laboratory

Transcription

1 Order Comments: 8/1/2017 2:27 PM OSA? rinalysis Final - Approved 8/1/2017 2:27 PM Color Turbidity Specific Gravity p Protein Glucose Ketones Bilirubin Blood robilinogen WBC RBC Epithelial Cells Bacteria rine Source Species: Canine Breed: Rottweiler DOB: 11/9/2009 RESLT Pale Yellow Slightly azy Trace Trace Voided Attachment Patient ID: P LIS ID: Received: 8/1/2017 1:38 PM SID: NITS Yellow Clear /hpf /hpf /PF

2 Admitted: 8/1/2017 9:50:48 AM Visit Summary for: "Chaos" Wilkey Discharged: 8/1/2017 2:12:00 PM MR: Chaos is a Black and Tan, Male, castrated Canine Rottweiler, 7 Years, 8 Months in age. Client: Pleasure Wilkey Primary DVM: Dr. Josh Busenbark - eritage Animal ospital North FAX: (812) Referring DVM: Dr. Josh Busenbark - eritage Animal ospital North FAX: (812) Senior Clinician: Dr. Michael Childress, Clinician: Dr. Marejka Shaevitz, MS, DVM DVM Student: Rachel aas Diagnosis: Discharge status: Discharged to owner 1. Lameness of the left thoracic limb months duration 2. Lytic bony lesion of the distal left humerus 3. ard bony swelling of the left elbow Appointments Please contact your primary veterinarian or our receptionists to schedule an appointment at Purdue VT in two weeks for a recheck exam and blood work. Summary of Visit Chaos presented to the PVT Oncology service for evaluation of a potential osteosarcoma on his left distal humerus. Chaos presented to his primary veterinarian on 7/25/17 for 6 week history of intermittent left forelimb lameness which had progressed to persistent lameness in the previous two weeks. Left forelimb radiographs revealed an aggressive and lytic bony lesion at the distal aspect of the left humerus. Chaos was prescribed carprofen and gabapentin for pain management and referred to the PVT for assessment by the oncology service. Since beginning the medications, Chaos does not vocalize on rising, but has been consistently to progressively lame on his left forelimb. e has shown some progressive lethargy over the time course of his lameness and had two days of reduced appetite and intermittent urine stream. Chaos has been doing otherwise well at home with a good appetite, normal water intake and urination, no vomiting, diarrhea, or cough. e has an extended history of not wanting to jump. On presentation to the PVT, Chaos was bright, alert, and responsive. e was weight-bearing lame on his left forelimb with a significant head bob, and had palpably firm swelling at the left elbow. On orthopedic exam, he showed resistance to extension of both hips, left more than right, and was painful on extension and flexion of his left carpus and elbow. e was over-conditioned with a body condition score of 7-8/9 (4/9 is ideal). e also had significant dental disease and discoloration of his lower left canine tooth. The remainder of his physical exam was unremarkable. Today we performed a complete blood count, serum chemistry, and urinalysis, which are pending. We will call you with the results today or tomorrow. Today we discussed possible causes of Chaos's discomfort and the radiographic findings, including a bone infection (osteomyelitis, either fungal or bacterial) and bone cancer. Given his clinical signs and signalment, the most likely etiology is cancer, and the most common cancer of bone in dogs is osteosarcoma. Osteosarcoma is a primary of cancer of bone that has a strong tendency to spread to other locations, most commonly the lungs. Standard of care treatment for osteosarcoma involves limb amputation to control the discomfort of the local disease, followed by systemic chemotherapy to help manage the systemic disease. Median survival times for dogs treated with surgery and chemotherapy is approximately 12 months. In Chaos's case, given his reduced mobility and the pain we noted in his hips, although he may do very well, we do have concerns about how well he would do with amputation. The alternative to definitive therapy involves palliative care aimed at managing the pain associated with osteosarcoma. Palliative care can involve medical therapy (pain medications) or radiation therapy. Median survival for patients with medical palliative therapy only is approximately 3-4 months. Palliative radiation therapy generally provides pain relief for 3-4 months, after which time an additional round of palliative care or a different option needs to be considered. Dogs with osteosarcoma usually develop either life-limiting metastatic lung disease or pathologic fractures in the area of the primary tumor which is life limiting. Given possible side effects of radiation, generally a definitive diagnosis is recommended prior to initiating radiation therapy. Page 1 of 2

3 Admitted: 8/1/2017 9:50:48 AM Discharged: 8/1/2017 2:12:00 PM MR: Today, we discussed diagnostic options including biopsy and staging, and you elected to continue to manage Chaos's pain medically while you consider all of the diagnostic and therapeutic options. We have prescribed an additional pain medication for Chaos and adjusted the dose and timing of one of his other medications. We recommend you monitor him closely while on his new medication regimen and follow up with us or your primary veterinarian in two weeks to discuss his response to therapy and whether adjustments can be made to better manage his pain. In addition, if you decide you would like to pursue biopsy, staging, or other palliative or definitive therapy, please let us know. Specific instructions for Chaos Please monitor Chaos's appetite, energy level and mobility. Please also monitor him for side effects of the medications as noted below. As discussed, Chaos is at risk for fracture of his left forelimb due to the bony lesion that is present. If at any time, he is unable to rise, has a dramatic change in behavior, or if his pain appears to be resistant to medical management, he should be re-assessed by a veterinarian. In addition, if you notice him having difficulties breathing, notice coughing, or if his mucous membranes or tongue appear purple or blue, he should be assessed immediately by a veterinarian. Medications to go home: 1. Carprofen 100mg tablets: Please give 1.5 tablets (150 mg) by mouth every 12 hours with food. This medication is a non-steroidal anti-inflammatory medication used to control pain and inflammation. The primary side effects of NSAIDS are kidney toxicity and gastrointestinal (stomach/intestine) ulceration. Please monitor Chaos for changes in appetite, vomiting, diarrhea, or dark and tarry stools. If you notice any of these changes, please discontinue this medication and call a veterinarian immediately. Do not give this medication with other NSAIDS or with steroid medications. 2. Gabapentin 300mg capsules (prescription to go home): Please give 2 capsules (600 mg) by mouth every 8-12 hours. This medication is used to treat pain. The primary side effect of this medication is sedation. 3. Tramadol 50mg tablets (prescription to go home): Please give 6 tablets (300 mg) by mouth every 8-12 hours. This medication is an opiate-like medication used to treat pain. The primary side effects of this medication are sedation and constipation. Diet: Normal diet. Please work with your primary veterinarian to develop a weight management plan for Chaos. Exercise Restrictions: Please limit Chaos' exercise to leash walking only. Let him set the pace of any of his walking. Attention Referring Veterinarians - Please try our new rdvm portal - Electronically Authenticated By: (3154) Shaevitz, Marejka on 8/1/2017 2:11:46 PM Client Signature Printed: 08/17/ :27 PM By: (2486) Amanda A. Weaver Page 2 of 2

4 Species: Canine Breed: Rottweiler DOB: 11/9/2009 Patient ID: Visit ID: LIS ID: Received: P S /1/ :54 PM Order Comments: 8/1/2017 1:29 PM Bone tumor SA CBC Final - Approved 8/1/2017 1:29 PM SID: Total Protein (plasma) Red Blood Cell ematocrit emoglobin MCV MCC RDW White Blood Cells Segmented Neutrophils Lymphocytes Monocytes Eosinophils Platelet Anisocytosis Reactive Lymphs Platelets Comments: Enlarged Platelets noted Platelet Estimate Reticulocytes RESLT Too clumped to count 1+ Noted ; Adequate 44.4 Attachment <100.0 NITS M/uL % g/dl fl % SP2 Final - Approved 8/1/2017 1:29 PM SID: Comments: 8/1/2017 1:29 PM Slight emolysis Glucose Blood rea Nitrogen Creatinine Phosphorus Calcium Sodium Potassium Chloride Carbon Dioxide RESLT NITS

5 Patient ID: P Visit ID: S Species: Canine Breed: Rottweiler LIS ID: DOB: 11/9/2009 Received: 8/1/ :54 PM Anion Gap Total Protein Albumin Globulin A/G Ratio ALT I/L Alkaline Phosphatase I/L GGT I/L Total Bilirubin Cholesterol Amylase I/L Lipase I/L