Large lymph nodes.

Dr. Marie replied:

It's good to hear from you again Robert. The findings on the physical exam from the vet are unusual.

It is really really uncommon to be able to feel a dog's thyroid gland. The only times that I have felt an enlarged gland are if there is a tumor in the thyroid gland or if there is a parathyroid tumor. (The parathyroid gland sits on top of the thyroid gland. But dogs with a parathyroid tumor usually have a very high calcium level.)

It's also uncommon to feel enlarged lymph nodes. Lymph nodes are usually enlarged either because of rampant infection or because of cancer. Unfortunately with Edward's age, cancer sounds most likely. If there was an infection he should have a really high white blood cell count.

It is really unusual to have a potassium level this high. It's possible that this is lab error. This can happen sometimes if the blood sample gets hemolyzed which can happen quite easily. It can also happen if we accidentaly used the wrong type of blood tube. We can see high potassium with a condition called addison's disease but the symptoms really don't fit. And, usually the sodium level is really low with Addison's.

A high ALP can be relatively normal in an elderly dog. Or, it can be a sign of liver problems. But if I have a high ALP and the rest of the liver enzymes are ok I don't get too worried about it.

If this were my case I would likely be recommending a fine needle aspirate of the lymph nodes. I'm concerned that he may have lymphoma which is a cancer affecting the lymph nodes. This cancer may also be affecting his thyroid gland.
An xray of the chest is a good idea as well.

But, I think we really really need to prepare ourselves for bad news. This is looking more and more like cancer.

What does your vet think is going on?



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Dr. Marie replied:

The area you are describing certainly does sound like the thyroid area. It's sounding more to me like thyroid tumors rather than parathyroid tumors. Dogs with parathyroid cancer almost always have an increased calcium level, not a decreased level. Do you have a T4 level on the bloodwork?

In either case though this is not good news. If there is a tumor on the thyroid or the parathyroid and it has spread to lymph nodes then the chances of treating it successfully are really small.

Were any tests done on his lymph nodes? I think this is likely to give you an answer as to what is going on. If I was going to xray I would definitely want to see the lungs to see if there is evidence of cancer there.

Dr. Marie replied:

Well, a potassium level this high could cause the heart rate to be slower than usual. But, an irregular heart rate would not cause a change in his potassium level.

I can think of a few reasons for his breathing to be off. It's possible that there is cancer inside of the chest. Or, here's another possibility - it's possible that the tumors that your vet is feeling are actually on the larynx. If this is the case then they can be constricting the trachea and this can definitely cause breathing issues. Realistically if this was a thyroid tumor we should be seeing a high thyroid level which is not the case.

I don't think there is anything else on the blood tests that can help us here. I think an aspirate of the lymph nodes can really help and additionally chest xrays will tell us a lot.

Dr. Marie replied:

The hair loss could be related to cancer. If the body is fighting cancer then the coat suffers.

Similarly, the balance loss could be due to spread of cancer to the vestibular part of the brain. While dogs can get "idiopathic vestibular syndrome" which they recover from, this wouldn't account for any of the other symptoms he has.

I don't think you're wrong to concentrate on his breathing. Really, we're concentrating on his overall quality of life. If he is struggling and if we can't cure him then it is right to start thinking about euthanasia.

I'll be heading offline soon (it's bedtime!), but feel free to reply tomorrow if you have more concerns after the xray is done.