Hello, my name isXXXXX am a licensed veterinarian and I will try and help you as best as I can.
I am sorry to hear that your boy is not doing well right now.
First a few questions: how long has this been going on?
What is his normal diet?
The straining to defecate has been going on for just over a week. He eats Blue Buffalo Turkey and Potato (dry and wet), which is a limited ingredient diet. Two years ago he seemed to have digestive problems in that if he didn't eat frequently he would experience borborygmus (sp?), experience yellow stool and lose his appetite. He underwent similar tests at that time and no conclusions were achieved. He has been well since then.
I see. Has a gastrointestinal (GI) blood panel been sent out yet (this contains a few special tests: PLI, TLI, cobalamin, folate levels)?
I am looking at my vet bill. It indicates urinalysis complete, catalyst full profile, complete blood count, cytology histovet, 2 radiograph. I'm not sure if that answers the question...?
It was indicated though that all other levels are within normal range, indicating normal organ function.
That does. It has not been run. It is a pricey test, usually about $150-200. The test specifically looks for issues with the pancreas and indications of inflammatory bowel disease and is much more specific than the general chemistry panel. This is something that will likely be run by the medicine specialist.
Based on the signs you describe and the changes in the bloodwork, there is likely some disease affecting the liver and gall bladder/biliary tree. There could be multiple issues here as well, including concurrent atypical cushing's disease or cancer as you described
Thank you. The costs have already exceeded $1000, with a further $700 for the specialist and ultrasound to come, so $200 is nominal at this point.
Do you think it's cancer?
The ultrasound is going to provide a large amount of information and I think they will likely find some problem with the gall bladder. They will likely want to take some aspirates (cytology) from the liver and gall bladder during the ultrasound to confirm any visual findings
Cancer would be low on my list here, i think it is more likely some cholangitis/cholangiohepatitis, which is inflammation of the gall bladder/liver systems
There is always the potential for cancer
Cancers can cause pretty much any signs, so it is always on the list, however I think it is a little bit lower on the list of possible causes
I think the concern for cancer relates to the small perianal growth. Would it travel to the liver? They have said that atypical Cushings could also cause the growth though. Thank you so much for giving me hope.
Unfortunately, x-rays can show a large organ, however ultrasound can show that it is normal. The ultrasound is key here. The perianal growths are almost always benign perianal adenomas, which would not cause any systemic problems. There are tumors that grow inside the anal gland, which you would likely not see (you would feel it on a rectal exam): these are aggressive tumors which can cause the increase in drinking/urination and potentially constipation. These spread locally, so I would not expect any spread away from the pelvis/rectum
Wow! The rectal exam was normal. The vet initially said perianal growths are almost always malignant but subsequently indicated it might be benign, caused by adrenal malfunction. That is cause for hope. This chat has been money well spent.
Thank you so much for all of your help. It means a great deal.
you're very welcome. I wish you and your boy the best
Hi Dr. G,
You're just fantastic - thank you so much for following up.
The cytology came back showing that he has a benign growth caused by testosterone. As such, all signs are pointing to Atypical Cushings. We have an appointment with an Internal Medicine specialist Tuesday, which I'm guessing will be followed by an ultrasound.
I'm hoping a malignant tumor on the adrenal gland is not found. He has been doing better this weekend. Thank you very much again for your insight and concern - I am very, very grateful.
I'm writing to give you an update after our specialist appointment.
It is not Atypical Cushings. The perianal adenoma is a non-issue at this point. The ultrasound showed no other masses anywhere. His liver is enlarged and coloured wrong. The specialist suspected a heart problem, lymphoma or an infection. As I've now spent $2000 and diagnosing a potential heart or cancer issue would lead to the same end anyway, I went home Tuesday night with Doxy tabs and Denosyl.
He seems to be improving considerably. There has been a rash of leptosporosis in our area due to the wet weather. Our area is on clay soil, which makes it worse and I know for sure he was walking / sniffing on a nightly basis in an area inhabited by racoons. I am hopeful. Thanks again.