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.