We recapped what she has been going through. Since she has been on meds for a bit, Dr. Crow was not able to see her symptoms in full swing. The rimadyl has helped a lot with the joint pain. Her bumps are still on her ears. They are better than they were but not gone. He asked a lot of questions and examined her. He does not believe that the bumps on her ears are related to vasculitis.
A brief overview of her symptoms are joint pain (related to trouble getting up or sitting), lack of energy, bumps on her ears with crusting skin and licking her front legs. While he was examining her he found a lump on her right back leg located on her tendon.
He didn't believe that any additional testing was needed at this point. We have caught and started treating her symptoms early. Dr. Crow agreed with Dr. Johnson's choice on her starting meds.
At this point Dr. Crow's primary clinical concern is Systemic Histiocytosis which is a Reactive Histiocytic Disorder. His physical findings match up best with this but since she did not display enough clinical symptoms at the appointment he could not arrive at a definitive diagnosis. Typically by the time he see's a patient with this it is clearly evident by the large nodules (plaques) visible on the animal. We could take her off all meds and see if her lumps worsen to be able to make an exact diagnosis but since she has been experiencing joint pain and lack of energy associated with this he did not want to go that route. He has changed her meds to Tetracycline and Niacinamide. We will continue to give her rimadyl as needed for pain.
So, what is a Reactive Histiocytic Disorder?
It almost invariably involves the skin where it is associated with nodules that form in the dermis and subcutis. These nodules are most commonly seen on the face (muzzle, nose and eyelids), scrotum, and trunk, but can occur in any location. The nodules may ulcerate and ooze. This pattern is typical of cutaneous and systemic histiocytosis. In systemic histiocytosis, there will be some additional evidence of spread beyond the skin. This is most easily recognized when there is involvement of the ocular and nasal mucous membranes. Reddening and swelling of the conjunctiva, corneal edema, and corneal vascularization may be seen. Nasal discharge and snoring respiration, which indicate nasal mucosal infiltration by histiocytes, may also be seen. Dogs with cutaneous histiocytosis are often bright, alert and outwardly unaffected by their disease. In contrast, dogs with systemic histiocytosis, are often anorexic and lose weight; they may be clinically depressed as well. This reflects the more aggressive and widespread tissue involvement in systemic histiocytosis. (Info from http://www.histiocytosis.ucdavis.edu/faq.html#Question_1)
I have been researching this subject since we got back from our appointment. Some sites that I came across state that this is cancer but Dr. Crow stated that it is cancer like but hardly ever results in cancer. This disorder is very rare.
We will give her these meds for 2 months and then take her back to Dr. Crow for a check up. If we find any plaques or nodules we are to let him know so that he can examine them. He wants her to set the pace. She can do as she wishes, no restrictions. We will treat any pain with rimadyl. I wish this was more cut and dry. It still feels like a wait and see type game but at least we have a better idea now of what is most likely going on with her. We are to continue with the same food but no dairy with her meds.
In keeping with the doctors orders, Lucie decided to join us for a walk this afternoon. She also enjoyed lots of snuggle time with Hailey. Hailey always knows when to play with Lucie and when to just snuggle.
Thank you to all of our friends for your well wishes and prayers. We are truly blessed! Keep them coming. We will get her through this one way or the other!