March 11, 2008 - 19 days after second SRS

1:00am
Mati went outside to the bathroom. She came in and was restless. I got her a dog treat and she ate it eagerly. So I got her 1/4 cup of dry dog food (mixture) and she ate it down. Then she had a drink of water. After that she went walking around the living room and around 2am she went to sleep.

4:00am
Mati went outside to the bathroom. She came in and was not interested in sleeping. She ate about 1/8 cup of hard dog food (mixture). Then she had a big drink of water. After that she went walking around the living room and around 5am she went to sleep (slept until 9:30am).

9:30 am
Mati had her medications in liverwurst. She ate them easily. I offered her some dog food and she ate 10 or so pieces. She then had a drink of water.

12:00pm
Went for a walk for 1/5 mile. She had a seizure (2-3 seconds long) but confused her and she got turned around and walked home instead of finishing the block. When we got done walking she had a drink of water and 1/8 cup of hard dog food (mixture of royal canine low fat and purina one natural blends). She also got a couple little pieces of hot dogs as Mike and I were having them.

1:00pm
Mati had 2.25mg of prednisone in liverwurst. She ate them ok.

4:30pm
Mati went outside to the bathroom. She at 1/8 cup of dry mixed dog food. She had a big drink of water. She is restless. It seems like she wants to be up but her body is not really strong enough or coordinated enough due to the left side weakness she has had. She went to sleep.

7:30pm
Mati woke up and was ready to walk around the living room.

8:30pm
Mati went for 1/10 mile walk, took meds (very well), ate dry mixed dog food (choked on it 1/2 way through the 1/8 cup) and had a big drink.

March 10,2008 - 18 days after second SRS

To tired to write the update today!

:)

12:00pm
Mati went to the vet and had some blood test. Here are the results:

Sodium - 138.0 mmol/l
potassium - 6.5 mmol/l
chloride - 101 mmol/l
tco2 - 18 mmol/l
anion gap - 26
calcium - 10.1 mg/dl
phosphorus - 7.7 mg/dl
urea nitrogen - 90 mg/dl
creatinine - 1.0 mg/dl
albumin - 3.5 g/dl

Specimen Appearance - normal
Plasma Appearance - normal
Total Plasma Protein - 8.5 g/dl
RBC - 8.21 x 10^6 /ul
HGB - 19.5 g/dl
RBC HGB - 19.7 g/dl
HCT - 58%
PCV - 58%
MCV - 70.6 fl
MCH - 23.7 pg
MCHC - 33.6 g/dl
RDW - 14.5%
Platelet - 703 x 10^3 /ul
MPV - 11.6 fl
platelet estimate - appears wri
WBC - 8.36 x 10^3/ul
SEG - 6.688 (80%) x 10^3/ul
LYMPH - .920 (11%) x 10^3/ul
MONO - .752 (9%) x 10^3/uL
Rouleaux - 1+
PBC Artifact (lipemia) - 1+

Those in orange are not in the correct range.

Mati's weight was 2.93kg.

5:00pm
Mati had Sildenafil because she was not willing to take it in the morning. She ate it right up. I tried her on some softened dog food and home make dog food. She ate a small amount of each.

8:20pm
Dan Foy from UW vet school called. He is thinking about putting Mati on florinef to see if that helps her sodium/potassium levels.

9:00pm
Mati had all her meds except for Sildenafil. She ate them just fine.

10:00pm
Mati went for a short walk (8 houses). She did 1 and 2. She was interested in walking but it was cool out and I did not want her to get to cold. When we came back in I tucked her in bed and she went right to sleep cover in her pink blanket.

March 9, 2008 - 17 days after the second SRS

3:00am
Mati went outside to go to the bathroom. She then had 2 ounces of water. Mati was awake alot this night. She wanted to walk around and try to stand up.

7:00am
Mati went outside to go to the bathroom.

10:00am
Mati had meds hidden in liverwurst. She ate them without any issues. She ate 1/8 cup of softened dog food and had 1 ounce of water.

10:30am
Mati went for a 1/5 mile walk. She did 1 and 2. Stool was normal colored and firm (but not rock hard).

11:15am
Mati had a dog treat and then was put in blankets to warm up from the walk. She is now sleeping.

2:30pm
Mati had 1.5mg of prednisone and 1 ounce of water. She was not interested in eating, so giving some food with the prednisone was challenging.

4:30pm
Mati went to the bathroom, then refilled with 1.5 ounces of water. She was not interested in eating.

7:30pm
Mati ate 1/8 cup of Purina One Natural Blend dog food softened with chicken broth. Then she drank 1.5 ounces of water.

10:15pm
Mati had her evening drugs, followed by 1/4 cup home made dog food with chicken broth and 1 ounce of water. Part of one white pill with a bit of fresh liverwurst was found on the floor shortly after she ate. We gave this to her, but are not sure if she got everything she should have tonight. Topped it all off with a 1/10th mile walk with 1 & 2.

March 8, 2008 - 16 days after the second SRS

12:30am
Mati went outside to go to the bathroom. She had 1 ounce of water.

4:00am
Mati went for a short walk. She was walking well but it was so cold out so we kept it short. She did not go to the bathroom while outside. She had 1 ounce of water.

9:30am
Mati had her medications in liverwurst. She ate them well (not thrilled but no challenge). She ate 1/8 cup of softened dog food and 1 ounce of water.

11:00am
Mati had 1.5mg of prednisone in liverwurst. She at about 10 pieces of dog food.

2:00pm
Mati went for a 1/4 mile walk. She would have gone further but I was worried that she was getting cold. She walked slow. She went 1 and 2. After the walk she finished off her breakfast meal which was about 1/8 cup of softened dog food. She then had 1 ounce of water.

6:00pm
Mati ate 1/8 cup of softened dog food and drank 1 1/2 ounces of water, followed by a trip to the bathroom.

8:30pm
Mati made another bathroom stop then ate 1/8 cup of softened dog food eagerly and drank 1 ounce of water.

10:45pm
Mati went outside to go to the bathroom.

March 7, 2008 - 15 days after second SRS

2:00am
Mati had been unable to go to sleep last night. Finally at 2am we took her for a walk. She had a stool and then walked 1/3 mile. It was very cold out and when she came in at 2:30am she was very cold. It took her 1.5 hours to stop shaking and I had her in 2 blankets. She had her polar fleece coat on for the walk. She walked very well on the walk and the quickest I have seen her walk since October.

6:45am
Mati went outside and went to the bathroom. I offered her some breakfast and she was not interested. She went to sleep and is resting very well.

9:30am
Mati went outside and went to the bathroom. She had her medications in liverwurst but she was not really interested in it. She was not interested in eating breakfast.

11:45am
1.5 mg of prednisone was hidden in liverwurst and she at it but was not interested. She ate about 15 pieces of dog food and had a small drink of water (1/2 ounce). Took her outside and she was not interested in doing anything. Brought her in and put her in a blanket as she was shivering.

11:45am - 6pm
Mati slept.

6:00pm
Mati drank 2 ounces of water and ate 10 pieces of dog food. She went outside and did 1 and 2. The urine had a nice medium yellow color. The stool was firm and normal colored. I offered her food again and this time she ate all of the remaining 1/4 cup of softened dog food from this morning.

8:15pm
Mati had her medications hidden in liverwurst. She at them easily.

8:30pm
Mati had a 1/4 cup of softened dog food. She had 2 ounces of water.

11:00pm
Went outside to the bathroom. Had 1 ounce of water and 10 pieces of dog food. She was very interested in the food.

March 6, 2008 - 14 Days after the second SRS

4:00am
Mati got up and wanted to go outside. After going to the bathroom she came in and decided that she would like something to eat. So I made her a 1/16 cup of softened dog food (all Royal Canine low fat dog food). She ate it all and then had a drink of water. After that she went right back to sleep.

9:00am
Mati woke up and went outside. She did 1 and 2. The stools were normal colored (vets had wanted to know if they were black/tarry) and looked just like they always had. She then ate most of her breakfast - 1/4 cup of softened dog food (about 15 pieces left over and it was a mix of Royal Canine low fat and Purina One Natural Blends). After eating she had a drink of water.

9:30am
Mati had her medications (enalapril, lasix, levothyroxine, phenobarbital, glucosamine-conjointin, sildenafil) hidden in liverwurst. She ate them down without any issues - not as eager as the past.

12:30pm
Mati had 1.5mg of prednisone. She also went outside to go to the bathroom. She had a couple focal seizures while in the sunlight. She also finished off her breakfast.

5:00pm
Mati had 1/4 cup of softened dog food. She ate it all. Then we went outside for a walk but she was not interested in walking. She did 1 and 2. Stool was normal.

10:00pm
Mati went outside and went to the bathroom. Then she came in and ate 1/8 cup of low fat royal canine.

11:00pm - 2:00am
Mati went outside 2 times to go to the bathroom.

Lab Resultls
Got the cortisol levels back from Monday and they were 3.4ug/dl. This is interesting as it is up from the previous 2.9ug/dl from Friday.

March 5, 2008 - 13 days after the second SRS

Today is the second day that Mati is on prednisone. For breakfast she ate about 1/8 cup of softened dog food (mixture of Royal Canine low fat and Purina One Natural Blends). She was interested in eating the liverwurst that hides her medications but not as interested as she has been in the past. She had her medications at 9:30am. At 1pm she was given 1.5mg of prednisone and ate 1/4 cup of softened dog food (mixture of Royal Canine low fat and Purina One Natural Blends). Then she had a good drink of water. Hmmm thinking about water I should probably start measuring the amount she is drinking. She went for a walk at 2pm for just a couple houses and did 1 and 2. Some of the results came back from the blood work she had yesterday. Everything was normal except:

potassium level elevated at 6.1 mmol/L (sodium level is normal at 147 mmol/L)
BUN elevated at 65 mg/dL
alkaline phosphatase elevated at 586 U/L (this is down from 1366 U/L on 2/14/2008)

ALT is back to normal and has not been normal for 8 months. I believe that the ALKP and ALT are both down due to her cortisol levels being down. The cortisol test is still pending and hopefully results will be in by tomorrow.

At 5pm Mati went for a 1/4 mile walk. Then when she got home she had a 1/4 cup of softened dog food (1/8 cup royal canine low fat and 1/8 cup purina one Natural Blends). Then she had a big drink of water.

Tonight I did some research and it appears that addisons is often seen with increase in BUN and potassium and a decrease in sodium. It looks to me like this is in line with what Mati is seeing and what everyone is expecting with SRS on the pituitary gland.

Mati had her heartworm medication tonight along with her other medications.

March 4, 2008 - 12 days after the second SRS

Today Mati was not willing to eat anything. I struggled to get her to eat the liverwurst which hides her medications. I called the UW Vet school and set up and appointment to have a CBC and electrolytes and a cortisol test. I picked up a prescription for prednisone and levothyroxine. At 1:45pm she had the blood draw. At 2:30pm she had 1.5mg of prednisone in liverwurst. I talked with Barb Biller and Sue LaRue from CSU Vet school. They were both surprised by how Mati's cortisol levels had dropped so quickly. Sue thought that Mati should have prednisone to supplement her current levels. Furthermore she reminded me that she might need an anti-inflammatory dose to reduce swelling in the brain due to the SRS. Barb told me that when we have her thyroid tested for changes due to SRS to have just the T4 tested. Mati ate less than 1/8 cup of softened dog food at night. She took her medications in liverwurst. She was not real excited but did eat them without to much work. Mati was up all night and finally went to sleep at 4:30am.

Mati's weight was 2.98kg.

Here are the results from the vet school:
sodium - 147.0 mmol/l
potassium - 6.1 mmol/l
chloride - 105 mmol/l
tco2 - 23 mmol/l
anion gap - 25
calcium - 9.9 mg/dl
phosphorus - 7.2 mg/dl
magnesium - 3.0 mg/dl
glucose - 98 mg/dl
urea nitrogen - 65 mg/dl
creatinine - 1.0 mg/dl
total protein - 6.7 g/dl
albumin - 3.3 g/dl
globulin - 3.4 g/dl
alkaline phosphatase - 586 u/l
creatine kinase - 122 u/l
ast - 20 u/l
alt - 102 u/l
cholesterol - 294 mg/dl
total bilirubin - .1 mg/dl

cortisol - 3.4 ug/dl

February 18, 2008 - First SRS treatment

Today is the first of two SRS treatements that Mati is going to have to try and kill her pituitary macroadenoma. I was to arrive at CSU Vet school at 8:00am. Once there they listened to her her heart and lungs. Things looked good. Mati was moved to 2pm for her SRS. So we went back to the hotel. Mati had 1/2 of her normal breakfast. Then we hung out at the hotel until 11am and then we went back to the vet school. Mati was ready to go back for anesthesia at 1pm. First they put her in the oxygen chamber for 30 minutes and then put her under anesthesia. At 2pm Mati was taken to the radiation room. There they positioned her on the table and got her aligned to the CT scan that was taken on Friday February 15,2008. Then they gave her 7 radiation beams with each of them being 3 grays. The alignment and radiation took about 1 hour. After that she was taken back to the anesthesia room to recover. Once she was awake and breathing on her own she was put back into the oxygen chamber to help her breath. After 30 minutes of that she was brought to the human waiting room and was put in my arms to let her relax and recover. By now it was about 4:15pm and we stayed there until 6:45pm just to make sure she was ok. That night she was very tired.

February 15, 2008 - CT scan day for SRS on Monday

Today is the CT scan day! We arrived at CSU Vet School at 8:00am. Dr. Barb Billers listened to Mati's heart and lungs and said that it was a go. At 9:00am Mati was taken back to the anesthesia room and put in the oxygen chamber for 30 minutes. Then she was put under anesthesia and moved to the CT scan room. There they made a mouth mold, a head net harness and a foam pad to go under her chest and head. This was all done so that they could strap her down to the CT scan bed. This is important because these will be used to hold Mati in place when she has her SRS treatment. Then they did the CT scan. This took about 1.5 hours to do. The CT scan is used by the radiation machine to do the planning for the SRS radiation. After the CT scan Mati was taken back to the anesthesia room to wake up. When she came out of anesthesia and then put in the oxygen chamber to help her get oxygen. Around 1pm Mati came back to the human waiting room and was given to me to hold and allow her to recover and wake up. Around 4:00pm we left the CSU vet school and went back to the hotel. When we got home Mati seemed to have forgotten that she was just out of anesthesia and decided that she wanted to eat dinner and then go walking. She was very happy that night and seemed just fine.

February 14, 2008 - First CSU visit - prep for SRS

The appointment was for 10:30am to meet with oncology at CSU Vet school. Yes oncology! Seems odd as the pituitary macroadenoma is more than likely not cancer. But in order to get radiation treatments you have to go through oncology. Around 11:30am the 4th year vet student came out and met with me. Her name was Shaila (not sure about the spelling). We weighted Mati and then went back into a room to talk. In the exam room I gave her all the previous blood work, MRI CD, and a list of medications that she takes. Then I gave her a list of questions that I had. She left the room and said she would talk to the clinician and come back. She then came back and told me that Sue LaRue and Barb Billers would be ready to meet in about 1 hour. We waited. Mati was very stressed out. She was coughing and panting. Her tongue was light blue and she was very unhappy. At 1pm Sue, Barb and I met in the exam room. Barb did a quick exam of Mati and then explained that she was not healthy enough to have the procedure. She went on to tell me that she would probably only live 6 months and that I should not do the radiation. Instead she talked about how I should put Mati to sleep. That I should love her and when it was time to put her to sleep. She left the room to go talk to cardiology and anesthesia about Mati's health. While she was gone she sent in the support person to talk to me about Mati not making it. I found working with this group to push all of my buttons. But thank goodness GE Healthcare had provided me with the ability to continue pushing for my direction and to try to come to a protocol that we all could feel good about. Soon Barb returned with the anesthesiologists Ann Wegner (I think her first name was Ann - my apology if I am a wrong). Ann came in and said that she believe that Mati could make it through 1 or 2 anesthesias but could not make it through 20 of them. I then spoke up and said that Mati was there for stereotactic radiosurgery (SRS) and that she would only need 2 or 3 anesthesias. Ann then looked and said really....I thought she was here for fractional radiation. Barb then said well they are here looking at SRS. WOW...what a disconnect. I was not there to talk I was there to act. I did not drive all the way from Wisconsin to Colorado to just talk. I had already done all my talking to Sue LaRue via email. So things continued to be stressed between Barb and me. I then told Barb that I was going to talk to my husband. It was now 3pm. I called Mike. I was at the end of my rope. But luckily Mike was my strength at this time. I told him what had been going on. We chatted for about 20 minutes and Mike came up with the idea of lets do the CT scan and see how Mati does under anesthesia and go from there. I loved the idea. It was what we had alway planned. But it just put it in such simple terms. I then met with Barb and offered up the idea. She liked the idea. She felt that Sue would then be able to see if they could do SRS and anesthesia would be able to see how Mati did under anesthesia. So Mati then headed back to have her blood drawn for the pre-anesthesia blood panel (CBC and electrolites). 15 minutes later Mati returned and we agreed to be back at the vet school on Friday at 8:00am for the CT scan. That night around 7pm Barb Billers called me to tell me that Mati's blood work looked very good for the anesthesia so we were all set for tomorrow.

Here are the results from Mati's pre-anesthesia blood work:

Phenobarbital - 13.8 ug/ml

nucleated cells - 14.7 x 10^3 /ul
band neutrophils - (1%) 0.1 x 10^3 /ul
seg neutrophils - (80%) 11.8 x 10^3 /ul
lymphocytes - (9%) 1.3 x 10^3 /ul
monocytes - (10%) 1.5 x 10^3 /ul
plasma protein - 7.4 g/dl
rbc - 6.8 x 10^6 /ul
hgb - 17.2 g/dl
pcv - 48.0 %
mcv - 71.0 fl
mchc - 36.0 g/dl
reticulocytes - (1.5%) 102,300 #/ul
cell hemoglogin-retic - 26.7 pg
mean clee volume - retic - 92 fl
rdw - 12.9
platelets - 604 x 10^3 /ul
mpv - 10.2 fl
giant platelets - exist

glucose - 112 mg/dl
bun - 38 mg/dl
creatinine - 0.4 mg/dl
phosphorus - 5.1 mg/dl
calcium - 10.1 mg/dl
magnesium - 2.6 mg/dl
total protein - 6.6 gm/dl
albumin - 3.6 gm/dl
globulin - 3.0 gm/dl
a/g ratio - 1.2 ratio
cholesterol - 258 mg/dl
t-bilirubin - 0.1 mg/dl
ck - 143 iu/l
alp - 1366 iu/l
alt - 181 iu/l
ast - 30 iu/l
ggt - 44 iu/l
sodium - 144 meq/l
potassium - 5.4 meq/l
chloride - 102 meq/l
bicarbonate - hc03 - 25.2 meq/l
anion gap - 22 calc
calc osmolality - 297 mOsm/kg
iron - 154 ug/dl
tibc - 312
sat percent - 49
uibc - 158
lipemia - 20 mg/dl
hemolysis - 34 mg/dl
icterus - 0 mg/dl

The above lines in orange are not in the normal range.