Page 8 - Summer 16

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liver is mildly enlarged and the hepatic veins are very dilated. The left adrenal gland is enlarged (0.89cm) and the right is normal (0.61cm). The iliac lymph nodes are mildly enlarged measuring 0.54cm. The spleen, kidneys, urinary bladder and intestinal structures all appeared normal. Echocardiography: There is a large volume of pericardial effusion causing tamponade. There is a large mixed echogenic heart base tumour measuring ~5.4cm x 5.2cm.
Treatment was now started with Carcinosin 200c 5 times daily for 3 days alternating with Cactus g 30c 5 times daily for the next 3 days ongoing. She showed no initial improvement after 7 days so pericardial fluid was drained.
Specialist report: In the last few days she has become more lethargic with a further decrease in appetite and exercise tolerance. Her respiration has not deteriorated but remains laboured. Physical exam: T - 38.2c, HR - 150, RR - 38 (laboured inspiratory pattern). MM - pink, crt - 1 sec. Cardiac: tachycardic, mild muffling of heart sounds. Lungs: decreased lung sounds. Abdomen: distended with fluid wave. Lymph nodes: NSF. Musculoskeletal: NSF. Assessment: Pericardiocentesis is indicated but given the mass, recurrence is virtually guaranteed. The owner understands this, and is hopeful of some improved quality of life for the short term (median survival time without pericardiectomy ~42 days). We discussed the risks and benefits of the procedure and the owner agreed to have pericardiocentesis performed. Procedures: Sedation: methadone IV. Thoracic ultrasound: There is a moderate pleural effusion and a moderate pericardial effusion (1.68cm rim of fluid) causing tamponade. Pericardiocentesis: Right lateral chest wall prepped for sterile procedure and local anaesthetic administrated. A 14g x 5 1/2 inch teflon coated catheter introduced via ultrasound guidance into pericardial space. 250mls of grossly bloody fluid drained.
The fluid draining helped her to begin with however 7 days later and she was breathing hard with any exertion and rolling on her back makes her uncomfortable. She is feeling chilly now and the ascites is building up in her abdomen. Her drinking has increased and she is ravenous for food. There has been no skin disease of any sort naturally enough, as she is so busy looking after her breath.
There are 2 remedies listed in Synthesis 2009 V for heart cancer ¬– Kreosote and Cactus. In Mac rep there is only the one – Crataegus. As there had been such severe moist skin disease for many years, I could see a reason to use Kreosote and so changed the alternating regimen to 3 days on Carcinosin 200c and then 3 days on the Kreosote 30c (That was the only strength I had).
After 7 days on this treatment the ascites began to decrease and she was improved in herself eating well and she had begun to do some scratching at her legs again. Another 14 days she is moving about well with no breathing issues and the coat has a good shine on it again.
Another 4 weeks and she is itching again quite badly, as she did 3 years ago. She seems withdrawn as if she cannot make contact mentally. The skin has quite a sour smell. She is wanting to eat earth. The heart and lungs sound quite normal. I change the treatment today to continue with the Kreosote but substitute Bovista in a 30c strength to use in alternation instead of the Carcinosin, as I am trying to improve the skin symptoms now and it has thickened skin with weeping.
3 weeks later and the skin has not improved at all. There is some
difficulty getting air at night and she is very slow on a walk. I decide to go back to Carcinosin with the Kreosote alternation and to stop the Bovista. For the next 12 weeks she continued on the Carc/Kreos alternation and this regime was then stopped, as the major problem was now the skin disease only. She is itching until despair and her conventional vet wants to give cortisone. I said if we use that the heart problem will return.
Treatment now started was Psorinum 30c twice weekly.
On the Psorinum she was happier with less itching, however the skin disease was not cured. She presented with greasy thickened skin again 5 months later. The Psorinum was now stopped and she was given Thuja 200c in 1 dose only.
In the next 4 weeks she poured out yellow smelly discharge from both ears and a green discharge from both eyes. She also had some pain in her right stifle.
6 months later she presented because she had become low in her energy again when on walks.
Chest auscultation seemed normal and a full blood count was reasonable showing only ALT 185 IU/L and ALP at 171 IU/L. Nevertheless, I put her back on to the alternating Carcinosin with Kreosote as I suspected that the tumour would be growing again. She seemed healthy in other ways. Another ultrasound was ordered in December 2013.
Was diagnosed with heart base tumor 54mm * 52mm back in July 2012.
Ultrasound assessment
Abdominal ultrasound
• large volume of free abdominal fluid.
• liverismildlyenlargedandthehepaticveinsareverydilated.
Echocardiography
• large volume pleural effusion (15mm rim of fluid)
• also a moderate volume pericardial effusion (9.5mm rim of fluid)
leading to tamponade
• there is also still a large mixed echogenic heart base tumour
measuring 76mm * 61mm (larger than previous).
This second time around the Kreosote/Carcinosin did not help and she slowly developed ascites. The remedies were then changed to Arsenicum alb 200 and Apis 200 but after another 6 weeks she was euthanased because of oedema under her throat and in her legs.
At this time she was 15 years old.
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