Good News??? Warning: Long Post including some words that Momma doesn't really understand

Sorry, it's Momma again but the results are back. We are not out of the woods. We can't even see the edge of the forest but there is a faint path and there could potentially be a happy ending to this chapter. Basically, they are not confirming that it is definitely cancer. It's not being ruled out but we have a better chance of it being an infection.

Tasha will be going in for more extensive tests. I don't like putting her under anesthesia but it is the best way to get a good lung sample and to take a bigger sample of her liver.

Please keep those positive thoughts coming. It appears to be working. Hopefully we can soon return to our regularly scheduled blog posts where we discuss trips to the park and treats.

For anyone who may be interested in additional details I have included a condensed version of my discussion with the vet and the follow-up email.

Needle Aspiration #1 of the Liver: Is highly suggestive of Hepatocellular Carcinoma AKA Hepatoma.

• These are generally considered benign masses. They are very unlikely to spread to other organs, but if left untreated they can continue to grow in size causing disruption of the liver or discomfort.
  
• Overall, a Hepatoma would be a relatively good finding for Tasha. As such, it does not explain her lung changes.

Needle Aspiration # 2 of the spleen: Is consistent with a benign lesion called a hyperplastic nodule. This is a term to describe a reactive area of an organ resulting in inflammatory cells infiltrating. It is unsure what causes this type of structure but no signs of cancer were evident within this sample.

Now that we have the above information on the liver and spleen, it seems highly possible that Tasha's lung changes are due to some other disease entity. Several disease processes could cause that type of infiltrate pattern in the lungs and these can include a fungal disease called blastomycosis, other infections in the lung such as mycoplasma or parasites (these can occur as complicating factors from a more common infection like kennel cough), or even some other complicated bronchitis.

Recommendations based on Tasha's lungs being the primary concern right now would include some type of sampling of the lungs. This can be achieved via needle aspirate, which has risk of introducing air into the chest. Other means include

a. Transtracheal Wash (TTW): This is a procedure generally done on an awake patient. A stab incision in the skin over the trachea allows us to pass a catheter into the trachea and lungs. A small amount of sterile water is flushed in and hoping the patient cough, a sample is retrieved. This often can be unsuccessful with regards to sample size and can be very stressful for all involved.

b. Bronchoscopy with bronchoalveolar lavage (BAL): This is a similar procedure to the above, but it allows us to visualize what is occuring within the lungs and airways themselve, and allows us to obtain much larger fluid samples to search for infection/disease. This is performed under general anesthesia.

Blastomycosis

This is the most common fungal disease found in Minnesota and often present with respiratory symptoms, although any area of the body can be infected. To diagnose this disease, most veterinarians prefer to actually find the organism in a sample, whether it is an aspirate of a lymph node, fluid drainage from a wound, lung sample/aspirate. However, it can be very difficult to find on occasion. There is a blood test, a titer that can be performed, but it often is less reliable because patients may not be mounting an adequate immune response (the test looks for antibodies to the organism) or it may be too early in the disease course. There is a new test looking for Antigens, markers on the organism itself. The studies performed on the test are very promising and the test can be run on blood, urine or even fluid obtained from the lungs if we do a BAL.

Thank you again for your support during this difficult time. It means more than you could ever know.

Momma, Dad, Eva and leading lady of this drama, the ever bewootiful Tasha