Main goal:
Primary owner (my partner) does not want to pursue chemo or radiation therapy, due to potential side effects, costs, and QOL concerns. Patient is already on XCHT (for hypercalcemia, see below), and I'm contemplating adding modified XFZYT. Open to other suggestions, especially considering that after LU lobectomy earlier today, my very experienced/excellent surgical colleague said he "didn't like how the mass was trying to invade the hilus" (he took as much as he could, but is suspicious that the margins will be dirty), and "didn't like the appearance (color, texture, size, etc) of the lymph node".
Do not have a current T&P dx, as patient has been under anes twice in last 5 days. However, I will update this post with info later this week, once he's off some of his postop drugs. I didn't think of doing it last week before anes :( Overall, he's a slightly deficient, older dog with Liver tendencies (fussy about certain things, such as his ears and nail trims ).
Picky eater, not food motivated; current diet is Dr. Harvey's Paradigm and/or Raw Vibrance base with cooked salmon or pork or beef (primary owner is immunocompromised and therefore prefers not to feed raw).
Bloodwork: CBCs consistently normal; most recent CBC (today) normal except for elevated platelets (476K) and slight monocytosis. Chemistries historically normal, including last week, except for incr Ca (12.3 mg/dl) and slightly incr ALP (has been around 130 for the last 5 years).
Clinical History:
1 - Pulmonary carcinoma
mild, non-productive, static cough, approx 6 mo duration
- thoracic radiographs in March 2025 were suspicious
- due to struggles to get reliable images of cranial thoracic area, thoracic/abdominal CT w/ U/S guided aspirates done 7.3.25, confirming R cranial lung lobe mass, aspirates confirmed carcinoma
2 – hypercalcemia (primary hyperparathyroidism)
- serum Ca fluctuating between 11 - 12 mg/dl over the last 2-3 years; crept up tor 13 on bloodwork done prior to a March 2025 dental
- parathyroid panel done June 2025; N PTH in face of incr iCa (1.74 mmol/L); Parathormone Related Protein 0; cervical U/S confirmed a R parathyroid mass
- started XCHT 3 weeks ago, which has dropped the iCa from 1.74 to 1.53 mmol/L
- decided not to pursue parathyroidectomy today, due to the possibility of the thoracic mass being a high grade/invasive carcinoma, and the fact that this dog does not do well with repeated blood draws or prolonged hospitalizations.
3 – C 6-7 disc disease
- apparent on thoracic rads
- one episode, July 2024, of significant R-sided neck pain (medically managed), with root signature sign; intermittent, mild R forelimb lameness was noted summer/fall 2024, during which time he received Meloxicam PO 0.7mg (0.1 mg/kg) and occasional chiro adjustments.
- no obvious issues w/in last 6 months, no meloxicam given
4 – atopic dermatitis/chronic otitis externa
- ongoing mgmt w NCSU Derm team
- currently on weekly immunotherapy, w/ rare Cytopoint injections
(peak pollen times – spring & fall), plus topical Posatex daily AS + weekly AD
- when ears flare, typically very low grade yeast, but the most recent AS flare was rods, tx with short course of Florfenicol.
5 – KCS, pigmentary keratitis, endothelial dystrophy/degeneration, intermittent corneal edema w/ historical corneal ulceration
- ongoing mgmt w NCSU Ophtho team
- currently on topical OU Diclofenac q 12, Tacrolimus q 12, Muro-128 5% (saline ointment) q 8, artificial tears at night (q 24)
- despite consistent tx, pigmentary keratitis is worsening