curvemudgeon: (kitty hatred)
[personal profile] curvemudgeon
ONCO - Medical Record - Initial Consult
Dec 11, 2013

Technician notes
History: 17y/o MN Domestic Shorthair. Hx of episodic inappetence,
vomiting and constipation dating back to June/July 2013. Owner had been
managing the chronic issues with supportive medications at home due to
Fezzik's extreme stress when going to see a a vet - dyspnea, requiring
oxygen therapy on arrival. Fezzik inappetence and vomiting issues
seemed correlated to constipation episodes for some time. Abdominal
lymphadenopathy and effusion noted on AUS on 12/5/13. Prior abdominal
lymphadenopathy noted on AUS on??? Hx of azotemia.

Prior Blood work: 10/4/13 -- ALB 3.9 (H), Crea 2.4 (H), Amy 1224 (H),
Abs. Lymphs 880 (L)
Biopsy Report: Fluid analysis and cytology - neoplastic effusion r/o
carcinoma v. adenocarcinoma
Date of initial diagnosis: open
3 view thoracic radiograph: not performed at time of ultrasound but
performed in June
Ultrasound: 12/5/13 - abdominal lymphadenopathy and effusion


CM
PHYSICAL EXAM: Fezzik not present for appointment so no PE

Assessment:
Fezzik has a metastatic carcinoma of his intestines and peritoneal
(abdominal) effusion. His recent abdominal ultrasound shows the changes
in his intestines are diffuse as most of his intestines are thicker
than they should be. We do not have a confirmed biopsy of his
intestines, but it is my opinion that the carcinoma effusion on his
abdomen is product of carcinoma in his intestines and lymph nodes. We
discussed this type of cancer and how it can spread to regional lymph
nodes, liver or lungs. We discussed prognosis with no treatment (likely
only a few weeks or as long as we can keep him comfortable (or if we
try chemotherapy (likely less than 6 months, but we are hoping for a
year). We talked about quality of life concerns and how treatment and
traveling would impact his quality of life.

Recommended staging discussed today include: Bloodwork (CBC, Chemistry
panel), Urinalysis, Chest x-rays, Abdominal ultrasound, Fine needle
aspirate

Results of today's diagnostics: none performed today

Treatment options discussed and to be considered:
· Surgery: to remove the tumor. Recommended if possible to remove
primary tumor or reduce tumor burden. However, due to diffuse changes
in most parts of the intestines (based on ultrasound report) surgical
resection not likely possible.
· Radiation therapy: not recommended due to diffuse intestinal disease
· Systemic chemotherapy. We discussed general side effects of
chemotherapy (bone marrow suppression and gastrointestinal signs), the
frequency of treatment and costs. Recommend following surgery to
address metastatic cancer or in the palliative setting (if not surgery
pursue) to target cancer cells and stop or slow down the progression of
his cancer. We compared injectable treatment with carboplatin or oral
options with Palladia (off label use), but Fezzik would need to come to
our clinic for treatment and monitoring.
· Other options such as palliative care to treat systems and make sure
your pet is comfortable. We discussed how to monitor pain and quality
of life issues such as behavior or appetite changes. We also discussed
end-of-life decisions to prevent suffering if we cannot make him feel
better.

Treatment plan:
You have indicated you would like to consider your options and I have
sent you home with cost estimates to review at home. Our main challenge
with treatment is how the trip to the clinic would upset Fezzik and
without checking him we would not be able to give him chemotherapy
safely (side effect risk). Without treatment his cancer will continue
to develop and will soon affect his quality of life to such a degree
that humane euthanasia should be considered to prevent suffering. You
are considering trying him on general supportive medications to help
with possible intestinal pain, inflammation and appetite to try and
keep him comfortable.

Treatments given: none

Medications to continue at home: no changes, but to consider
buprenorphine and steroid for palliative care


My buddy is dying and there's not a thing I can do.
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December 2013

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