adrenal tumor--starting Trilostane--darling Chey passed away

[cheydogger]

Hello everyone. My name is Ro and my dog's name is Cheyenne. Cheyenne is a 13 yr old spayed female, mixed breed (lab, chow, shephard?), 53 lbs. Cheyenne has been going through Cushing's testing for about a month now and we still don't have a definitive diagnosis. As I have read from most of you, I have been devastated....crying, sad, mad, anxiety ridden, constatly on the internet researching this disease. I will give you a little background on Chey's case even though I don't have all of the numbers. I should ask for copies of all of her tests. Cheyenne has mild heart enlargement, thickening of the valves and a murmur for which she started taking Enalapril 1 1/2 weeks ago. I have given her 1000 mg. of fish oil for at least two years and she has been taking Glucosamine/Chondroitin for about 4 months. I feed her EaglePack Senior dog food. I took her in for her yearly in July to which the vet detected a heart murmur. The vet suggested I do a senior panel blood work up and possibly an echo to stage her murmur. I declined at the time because I had just had a miscarriage and was trying to pay for all of that since we didn't have maternity insurance. I also thought they wanted to make more money. Chey has displayed exercise intolerance for at least 6-7 months (I attributed it to her age at first, then the heart murmur) and she quit jumping into bed around that time. After declining the blood work, I started noticing things the vet said to watch out for---excessive water consumption and frequent urination. I also noticed she was eating dirt and had a broken tooth. I took her back to the vet on Oct 12th and that is where it all began. The vet initially said she suspected Cushing's, so the tests began. I will post the numbers I know and remember.

Oct 12th-senior panel blood draw and urinalysis. 3lb weight gain from July visit (53-56lbs)
Results: Alk phos: 2400
Cholesterol and triglycerides: triple
Thyroid: a little low
Urinalysis:dilute

Oct. 22nd-ACTH stim test and abdominal ultrasound. Weight back
down to 53.
Results: ACTH stim test- "very Cushingoid"
Ultrasound:bilateral adrenal enlargement. Right adrenal: 3
cm, left adrenal gland: 1 1/2 cm. Her adrenals are
supposed to be .7. The radiologist report stated a neoplasm
in the right adrenal gland. My vet suspected adrenal
dependant Cushing's, so she ordered chest x-rays and and
an echocardiogram.

Oct. 25th- Chest x-rays and echocardiogram. They were only
going to do the echo if not signs of metastises were
evident.
Results: no obvious sign of chest metastises from x-ray
Echo: mild heart enlargement, thickening of the valves
and definite murmur. Treatment: Enalapril 10mg 1xdaily
Referal to a surgeon.

Oct. 30th- Surgeon consult: He only talked to me for about 5
minutes because he didn't think it was adrenal tumor
related. He suspected Pituitary. He then turned me over
to the internist. She was suspicious of pituitary also, so
she ordered two more tests (LDDST and Endogenous
ACTH.

Nov. 6th- LDDST and Endogenous ACTH
Results: LDDST-According to my vet, if she
was reading the results correctly (she actually said this),
Chey didn't test positive for Cushing's. My vet said she
would have expected a higher reading at 8 hrs. We are
still waiting for the Endogenous ACTH results. I guess it
takes a week. My vet called me to tell me the results of
the LDDST and she was really confused and could only
say she is going back to thinking it is an adrenal tumor.
She put a call into the specialist to discuss the LDDST
results and she may call me today with their combined
thoughts.

What the heck is going on? Thoughts from your experiences? I will add, Chey does not have any noticable hair loss, but she does appear to have a downward slope in the middle of her back. I personally don't notice the pot bellied appearnace though. She has a ravenous appetite, but she always has in my opinion.

[labblab]

Hi Ro!

Welcome to you and Cheyenne. I am so very glad you've found this forum and joined our family. I only have a few minutes right now, so I'm afraid I will have to make this first reply fairly brief. But if I had to bet on it, I'm betting that your vet will find that Cheyenne did indeed test "positive" on the LDDS, and she was initially interpreting the results incorrectly. Everything else about Cheyenne screams Cushing's: lab abnormalities, symptom profile, "positive" ACTH, and adrenal enlargement. So if the LDDS somehow comes back negative, I would actually be distrustful of that result.

Another piece that leads me to suspect that your vet is misinterpreting the results is her statement that she now is back to thinking the issue is adrenal. If the LDDS is negative, it is negative for both types of Cushing's. It is only if the result is positive that the numbers can sometimes point towards pituitary Cushing's.

So we will anxiously await those test results. And in the meantime, please know that you and Cheyenne are now in wonderful company. Our members will be here, right by your side, as you move forward.

Marianne

[cheydogger]

As I sit here and cry, thank you for accepting Chey and me. This has been so hard. I am so glad I found this forum during my many, many hours of researching Canine Cushing's Disease. Thank you again.

[labblab]

Oh you are so welcome. And I know it's hard for you to believe right now, but before long, you'll be posting helpful hints to other new members, too! I know it's impossible for you not to feel very worried and upset right now. But truly, if Cheyenne does have Cushing's, we have SOOOO many treatment success stories to share with you. With proper treatment, it can be amazing how quickly you can see improvement in your dog. And many dogs are then able to go forward and live out their normal lifespans with their Cushing's symptoms under control.

There may still be more tears along the way, but also the smiles that come from knowing you are not alone, and that Cheyenne is getting the treatment she needs!

[Squirt's Mom]

Hi Ro and welcome to you and Cheyenne! :)

Feels like your world is ending, huh? I remember well. The first time I heard the word it was more of a "huh?" response but when I saw the look in our vet's eyes as she confirmed the diagnosis, my heart stopped. I started crying then and didn't stop for months. All I could think was that my Sweet Bebe was dying. The more I read and the more I heard, the worse it seemed. I felt helpless, hopeless, scared, angry, guilty all the time, day in and day out. I couldn't understand most of what I read or what others told me; it was almost like being dropped into a foreign land in my sleep. Until I stumbled into this group. They gently threw a net over that bug-eyed, frazzle-haired, blabbering, blubbering, drooling old broad and started to teach me with a patience monks are envious of and a gentleness not found in any other group. That was nearly five years ago and my Sweet Bebe, Squirt, is still here doing good for one who will be 15 in Feb. ;)

You and Cheyenne are in the best of hands here. The knowledge available is amazing and wide-reaching, yours for the asking. The first-hand experience goes far beyond what most vets are taught in school - they read about it, we live with it - and are more than happy to share with you. The support found here is unbeatable, pure and simple. You and Cheyenne are no longer alone. You are part of our family now and you will never walk alone again.

I'm glad you found us and look forward to learning more as time goes by. Keep your chin up!
Hugs,
Leslie and the gang

[addy]

Oh, dont cry, it will be okay. Gosh, I cried for months, was in denial for months, what a roller coaster when we first get the news.

Yell and scream if you have to to get it all out. We are very good at supporting melt downs;) We all have had them so we know how it feels.

It'll be okay. You are not alone anymore. My Zoe was diagosed on her birthday, April 17th, 2010, diagnosis confirmed in June of that same year. We started treatment the following June, 2011. She still has a good quality of life and she has other health issues besides.

((((((((((((hugs))))))))))))))))

[labblab]

By the way, I just saw your photos of Chey and I love your avatar. :)

What a sweetie-pie!! :o

Marianne

[cheydogger]

Thank you, Marianne. I just love her with all my heart. She is a really good dog.

I didn't hear from the vet today.

[molly muffin]

oh my gosh, she is a cutie! LOL

Hello and Welcome! Tears is one of things that we all know, way to well it seems sometimes. I swear I cried forever over Molly's diagnosis and we're still trying to figure it out. I cry because I read of someone else crying or going through a tough time with this disease. Heck, I cry because something good was posted about one of our furbabies. As everyone has said, there is so much support here. It's really wonderful to be a part of that and know you aren't alone.

It does sound terribly confusing all the results back from Chey's tests. Lets see what the vet says and the specialist. It does sound like cushings, but when it comes to the LDDS, the question is did she suppress under 1 for the full eight hours. Also, you have to be wary of false results, which can be caused by a number of things, either on the yes or no side. Don't worry, the gang here is pretty good at figuring it out.

Definitely get copies of all test results. You're going to want to have your own file to refer back to off and on as you go forward. Plus if anything crops up, where you have to take Chey to an ER, you'll want to have those handy. We've all been through that.

I'm so sorry to hear that you have gone through some tough times yourself. It is very hard worrying about so many things at once. HUGS.

Feel free to jump in with questions or comments, whatever you feel like. Everyone here is really wonderful.
We're all a bit of worry warts though, so be prepared. LOL

hugs,
Sharlene and Molly Muffin

[cheydogger]

Thank you all for your kindness. I look at all of your fur babies and want to give them a big hug. They are all so precious.

I guess my biggest fear is an adrenal carcinoma. I have just been a nervous wreck. The radiologist believes there is a tumor in her right adrenal gland, but there aren't any calcifications or obvious mets to other organs or the vena cava on the ultrasound. The surgeon didn't feel this was the case since both adrenal glands are enlarged. I guess the text book sign of a tumor is one extremely large adrenal gland and one atrophied. On the contrary, why aren't her adrenals symmetrically enlarged as would be consistent with pituitary?

The thing I really miss is her sleeping with me. She has slept with me since I got her at 6 months old. She loved to snuggle. For about the last 5 months or so, she has no interest in sleeping with me. My husband or myself will lift her into bed since she can't jump, but she doesn't stay long. She would rather be on the floor beside the bed. I have even turned the ceiling and floor fans on to keep her cool, but she still gets down. She used to play bite my husband when he would try to get her off the bed when he was ready to get into bed.

Also, watching her creep along on her walks is so sad. She can gallop for a few seconds, then she walks as slow as a snail.

I just feel horrible for letting it get this bad. I should have caught on to the changes in her disposition, etc. much sooner than now. At the least, I should have done her senior panel blood work at her yearly visit in July even though I was going through a tough time. Her last blood panel was in 2009. I also got her shots last year at a clinic, so I doubt she had a thorough exam. I feel like it is my fault she is in this predicament. I am so thankful for every day I still have her here with me because I feel our time is limited at this point.

Sharlene- thank you so much for opening my eyes to the importance of having a file of all her tests and labs. I didn't even think about it like that.

Thank you all. Keep your opinions coming, please:)

[Trish]

Hi Ro

I wanted to say Hi, looks like my boy has a right adrenal tumour and we are trying to manage his blood pressure down to an acceptable level so he can hopefully have surgery. So I know exactly how you are feeling, Flynn's goes into or around his vena cava but they are not 100% sure until he has a CT in a few weeks. So I know the fear you are feeling right now, after my initial meltdown and panic I am now in a much calmer place trying to get him as well as possible to face whatever the future brings. I know once we have all the results in and a treatment plan in place we will be able to focus on that, not all the horrible 'what ifs' I have been thinking of recently. Just wanted to let you know you are not alone and we all here to support each other
Trish :)

[molly muffin]

Hi Ro,

You know I mention the file probably because I didn't have one prior to finding this forum either. Then I started one and since then have used it twice, once for the ultrasound with the specialist and the next on an trip to the ER for an ear infection. Just goes to show you never can tell.

Don't beat yourself up. Guilt is something like tears a road well traveled here. You'll find that even years after living with this and going through the ups and downs, that the ole guilt gremlin pops onto your shoulder.

The very fact that you are here, just shows that you really are only doing everything you can to give Chey the best care possible. Do remember, that not only having something off in their bodies can make them more grumpy and change their habits, but they are getting older and just like all of us, things change, what is comfortable before may not be now.

So, I'll tell you, Molly too always was on our bed. She's not allowed to jump down (and she knows it and will wait for the "lift") but she doesn't want to stay all night any longer. I think she hasn't the patience to deal with feet moving and disturbing Her sleep like she use to be. She too use to play snap if you tried to get her off the bed, whereas now it's a grumble to lift her off the bed. (she has also been known to grumble, loudly sometimes, at the tv being too loud, the light on, or us talking too much) Molly likes her sleep and she likes it when she wants it, not on my timetable. So, just remember that they change, they grow up and what they want and don't want changes. Sometimes they'll still big a big ole puppy, all feet and tumbles and rolling around their backs, looking for a toy, but it's going to be tampered down a bit.

There are text books and then there are more text books, and the one on cushings and internal medicine with canines is still being written and changes constantly. Some things you can count on and others you can't. Should one adrenal be much larger than the other for adrenal cushings? Text book says yes, reality says that sometimes they don't grow like that. It can be a bit of a difference, but it depends on which adrenal has the mass, and how much cortisol the other one is constantly pushing out, how long it's been going on a host of other things. So, can't say for sure. I'm sure that over the weekend, you'll get some more opinions and those much more knowledgeable than myself on the numbers and test results, including ultrasounds. Just keep on hanging in there. :)

Give Cheyenne a nice belly rub from all of us and try to get some rest. It's a long road.

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Hi Ro,

I know it's hard to hold onto hope right now but there is plenty cause for hope, honey. ;)

Yes, with ADH, or adrenal based Cushing's, we typically see one gland pretty large while the other is quite small, sometimes atrophied. With PDH, pituitary based, the adrenal glands are typically both enlarged - what is called bilaterally enlarged. But that doesn't mean they will both be enlarged to the same size, or symmetrical. One could be a bit larger than the other and still fit the profile for PDH. 85% of cush pups have PDH so the odds are that is what Cheyenne is dealing with.

When the cortisol is running rampant in their little bodies many thing change. In some ways, the cortisol gives them a bit a of "high", making them feel pretty good, masking pains that would otherwise be bothering them, like with arthritis. So on one hand, cortisol acts as a sort of natural treatment. But it also has a dark side in that it affects internal organs, all that extra cortisol tires them, causes their nights and days to get a bit mixed up so that they sleep during the day and are often restless at night. If you can imagine a constant supply of adrenaline in your own body you can start to see how they feel after a while of being overloaded with cortisol.

Squirt was one who always slept with me, followed me all around, until this Cushing's came along. I saw that she wasn't doing many of the usual things but put it off to her aging. She didn't want to sleep with me, she preferred to lay under the end table to following me through the house - I called it "hiding" -, she didn't play any more...all things that said she was just getting too old for that. BUT once we started treatment and her body became more balanced, my old girl came back. I will never forget the day she played with a toy for the first time in years...I cried with joy. She spends most of her nights back in bed where she belongs but there are times she prefers the floor - primarily because it is cooler, I think. Treatment has given me back my Sweet Bebe and I am sure you will see the same thing in your Cheyenne. I look forward to the day you post with joyful tears that she is bouncing around once again, begging to play and to sleep with you like she used to. You hold tight to the hope of this day because it is more than a simple hope - it is a very real probability, not possibility, probability. ;)

Hugs,
Leslie and the gang

[cheydogger]

Thank you, Leslie. You brought tears to my eyes. You all know how hard this is.

Trisha- wow, you and Flynn have been through a lot! I read your whole thread. I guess I am worried of an adrenal tumor after reading your posts since Flynn has bilateral adrenal enlargement and suppressed on LDDST.

I just spoke to my vets office and asked for copies of all the tests she has had done. I asked to pick those up today, so I will have numbers and reports to post for everyone to look at soon.

[cheydogger]

This is long....

Initial blood draw results (I am only posting the abnormal results):

Total protein: 7.5 (HIGH) Ref Range: 5.0-7.4 g/dL
AST (SGOT): 103 (HIGH) Ref Range: 15-66 IU/L
Alk Phos-Result Verified: 2409 (HIGH) Ref Range: 5-131. IU/L
GGT: 19 (HIGH) Ref Range:1-12. IU/L
Potassium:5.6 (HIGH) Ref Range: 3.6-5.5. mEq/L
Na/K Ratio: 26 (LOW) Ref Range: 27-38.
Cholesterol: 637 (HIGH) Ref Range: 92-324. mg/dL
Triglycerides: 949 (HIGH) Ref Range: 29-291 mg/dL
CPK:2073 (HIGH) Ref Range: 59-895. IU/L
Total T4: 0.5 (LOW) Ref Range: 0.8-3.5. ug/dL
Platelet count: 588 (HIGH) Ref Range:170-400 10^3/uL
Differential: Absolute
COMMENT: AST, CPK may be lower than reported due to a Hemolysis 4+ but is still abnormal.


Urine:
Dilute
pH: 7.5 (HIGH) Ref Range: 5.5-7.0
Protein: 1+ (HIGH) Ref Range:Negative
Urine Microalburninuria: 16.2 (HIGH) Ref Range: <2.5

ACTH Stim Test:
Cortisol Sample 1: 1.8 Ref Range:1.0-5.0 ug/dL
Cortisol Sample 2: >50.0 (HIGH) Ref Range: 8.0-17.0 ug/dL

Abdominal Ultrasound:

Imaging Findings: Ultrasound examination of the abdomen reveals marked enlargement of the right adrenal gland. The right adrenal gland measures 3.27 cm in width and is hypertrophic to the surrounding retroperitoneal fat. Color-Doppler examination of the caudal vena cava reveals normal blood flow adjacent to the right adrenal gland with no evidence of vascular invasion of the caudal vena cava by the adrenal gland. The left adrenal gland is also enlarged measuring 1.48 cm in width and appears hypoechoic to the surrounding reroperitoneal fat. The liver is diffusely hyperechoic and has a mottled echotexture. There is diminished visualization of the small hepatic and portal venous vascular structures. The liver contains multiple small hypoechoic nodules throughout the parenchyma. A small amount of gravity-dependant echogenic bile is evident within the gall bladder. Corticomedullary delineation is preserved within each kidney. No evidence of dilation of the left or right renal pelvis is seen. The contour of the kidney's is smooth. The relative echogenicity of the renal cortices is normal. No abnormalities are seen involving the pancreas, small intestinal tract, colon, spleen, or intra-abdominal lymph nodes.

Impression: Right adrenal neoplasia. Differential considerations would include adenoma, adenocarcinoma, and pheochromocytoma. Left adrenalmegaly. Differential considerations would include pituitary-dependant hyperadrenocorticism and cortical hypertrophy associated with age. Primary differential for the ultrasonographic appearance of the liver would be vacuolar hepatopathy with nodular regeneration secondry to hyperadrenocorticism.

Comments:Your concern for hyperadrenocorticism is confirmed. There is a right adrenal neoplasm, which may be functional and might explain the majority of this pet's clinical signs. The enlargement of the left adrenal gland may be age related change or could represent co-existing pituitary-dependant hypercorticism. Recommendations would be to consider surgical exploration of the abdomen and removal of the right adrenal neoplasm with histiopathologic analysis. A liver biopsy might also be considered with the liver. Prior to interventional procedures, radiographic examination of the thorax would be recommended to rule out nodular pulmonary metastasis.

Chest x-rays did not show any obvious signs of metastasis.

Echocardiogram:

Chronic Valvular Disease (CVD, Endocardiosis) with MR. Mild cardiomegaly. Left atrial dilation with normal systolic function. The mitral and tricuspid valves are thickened. Doppler studies show marked mitral regurgitation (MR) and trivial tricuspid regurgitation. RX: Enlapril 10mg. daily.

LDDST:
Cortisol Sample 1: 1.6 Ref Range: 1.0-5.0 ug/dL
Cortisol Sample 2: 1.1 Ref Range: 0.0-1.4. ug/dL
Cortisol Sample 3: 0.9 Ref Range: 0.0-1.4. ug/dL

Endogenous ACTH: 39 pg/ml. End ACTH will be increased (>45 pg/ml) in approximately 90% of dogs with PDH and will be decreased (<20 pg/ml) in approximately 60% of dogs with adrenal tumor hyperadrenocorticism. A value between 20-45 is non diagnostic
This result does not enable dogs with pituitary-dependant hyperadrenocorticism to be differentiated from dogs with hyperadrenocorticism due to a functional adrenal cortical tumor. In dogs with Addison's disease, this result is indicative of secondary hypoadrenocorticism.

My vet is waiting for a call back from the specialist to discuss these results. I fear she has an adrenal tumor that has went non functional. Any opinions?

[cheydogger]

Please see my other thread for all of the labs to date. I am really scared and confused.

Thanks!

[labblab]

Hi Ro, thanks so much for giving us all these results. As you will see, I've merged your new post into your original thread. This way, all of Cheyenne's info and related replies will stay organized all in one spot.

I confess I am stumped by this LDDS result, and apologize for questioning your vet's confusion -- because I am baffled, too. It is hard to reconcile the extremely high ACTH result with this LDDS test that is indeed "negative." But there is a lot that I don't know about adrenal tumors and the various abnormalities that can be associated with them. So rather than speculate, I am gonna stay right here by your side and also await the feedback from the specialist...

Marianne

[Squirt's Mom]

Hi Ro,

Some good things to hold onto -

ADH, or adrenal dependent hyperadrenocorticism, can be cured via surgery. It is a serious surgery but the ultrasound shows the vena cava is not involved and that is a major plus.

The x-rays show no sign that there are other tumors. This is a great thing to know, trust me. ;)

If this is a pheochromocytoma, we have a resident expert on those type tumors, which are apparently rare to discover prior to death and autopsy so if this is a Pheo, you are already way ahead of the game.

So hold onto the positives here that we can see right now while we trust the vets will be able to see the crux of the problem and offer some good solutions.

Keep your chin up!
Hugs,
Leslie and the gang

[cheydogger]

I will add, not that it could account for all of the high numbers, but she is severly freightened at the vet. She shakes like a leaf on a tree. The vet actually came out to get her at the last test visit and she was going to get her a blanket because she was shaking so badly. I told her it wasn't because she was cold, but due to her fear of being there. I have read that stress can cause false positives. No matter what the numbers are, there is a great enlargement of the right adrenal gland.

[Trish]

Hi Ro
Wow there are a lot of similarities between our dogs, be very interested to hear what your specialist has to say. Is Chey's blood pressure up? Flynn's is very high and this can be associated with the pheo type of tumour. Flynn's does appear to have thrombus into vena cava, but I am holding on to the comments after his surgeon was shown his ultrasound that it is still operable. Please please please!!

I totally get the fear at the vets, one of his major symptoms is trembling. I cannot get him to stop at the vets, which makes it hard for them to get a good BP recording. Recently, when they take him away for scan or whatever, he plants his little feet, braces his legs, refuses to walk and looks at me pleading to save him. Gawd it breaks my heart. But the trembling seems better lately, I am hoping that is because his BP is coming under control with the phenoxybenzamine. He gets rechecked this week. I absolutely hate the thought he might need surgery again, but by crikey if that is his only chance I am prepared to take the risk.
Trish

[cheydogger]

I honestly don't know what her blood pressure is. She is on Enalapril, so I check her resting resperations daily.

[Trish]

I am no expert but think it would be good to check her BP with the link between pheo's and hypertension. Flynn had a week of Benzapril which is similar to Enalopril, but then swapped to phenoxybenzamine last week as it works better with the pheo type tumour they suspect he has. If surgery is an option, they need this type of drug to stablise potential for wild BP swings with anaesthetic/surgery. Maybe you could mention about checking BP when you next see your vet??

Because I am so new to this adrenal type stuff I feel unsure giving advice... I'm sure if I say anything wrong the more experienced members will put us straight!

[molly muffin]

Yes, I agree that the ultrasound shows a significant size difference on one side.

We've had some here who have dealt with this and I hope they can jump in and offer some advice on proceeding to the next step, what should be looked into now, etc. I'm sure they will. :)

It's good to at least have some sort of idea what you are going to be dealing with, so hearing what the specialist has to say.

Sharlene

[frijole]

Hello. My name is Kim and my baby Annie had a pheochromocytoma adrenal tumor. I read your entire thread and at first I was wondering whether or not your regular vet understood cushings based on the comments. Was the abdominal ultrasound done at that clinic or by a specialty vet on a high resolution machine? I'm asking because the findings are only as accurate and good as the equipment and the person reading the film and writing the report. (I had to have mine done twice - the second time I was at a specialist and that is where I got answers)

If you have not consulted an internal med specialist (IMS) I implore you to do so. I waited and I shouldn't have. I had to drive 5 hrs each way to the closest one but it was worth it in the end. I threw thousands of dollars away on tests that shouldn't have been done and trying drugs that did nothing. If you tell us where you live (area) we might be able to make recommendations.

Leslie is right - there is good news on the ultrasound report if the vena cava is not affected. That means surgery is an option. Pheos are tricky because of the blood pressure issues while sedated. It is better to have surgery done sooner rather than later (if you opt to do so) because as the tumor grows over time, at least in my case, it is active more frequently.

I'm sure the vets thought I was crazy at first (well maybe they still do ;)) but Annie was totally normal and she'd suddenly have incidents where she'd lose it (fall to the ground) in her back legs. She also would tremble all over, be sweaty and her skin would turn bright bright pink. Sometimes she'd pant heavily - and on several occasions it was so rapid I thought she was in cardiac arrest. I know now these were episodes where her pheo was active.

The vets at K State Univ hospital (the IMS I went to) were able to tell me after the ultrasound and extensive films they took that Annie's tumor was not (at that time) cancerous. They did a brain scan and ruled out pituitary cushings (she had like 5 positive acth test and two positive ldds tests!!!!)

Annie's blood results were never too concerning. Her liver enzymes were high - her triglycerides were high once and then normal the rest of her journey. Other than that I can't remember anything really being off bloodwork wise.

The other thing is that her acth tests were strange in that her resting cortisol (the first number before they injected her) were already very high (cortisol). Normally that number is like your dog's at 1.8. Annie's were always double digit and closer to 20 than 10. To me that said her body was stressed and fighting something. I think that's why she had some cushings' symptoms. She did have high cortisol but it was from fighting the pheo and not cushings.

You are doing an excellent job and my advice is to keep doing what you are but to surround yourself with vets that are able to give you the answers you deserve so you can decide what you want to do.

FWIW Annie probably had this thing a while before I noticed it but from when I did she lived another two years. She lived a very happy life and this pheo was much harder on me I think. She lost weight and became very very frail. In the end - she did not pass of a heart attack as I assumed would happen. Her weight loss and muscle wasting were her demise.

Removing adrenal tumors is one of the most difficult surgery a vet can perform so you need to pick a specialist that can also refer you to the best surgeon in your area. (again should this be the path you go down)

Please don't be afraid to reach out for help here - we are here to help in any way we can. Sending love, Kim

[cheydogger]

Hi Kim-

The ultrasound was done at our regular vet's office. They have a sonographer come in a couple of times a week to do ultrasounds. I don't even know who the equipment belongs to, the vet or the sonographer brings it.

I was referred to a surgeon who turned me over to the IMS because he believed the origin was pituitary. The IMS requested the last two tests, LDDST and Endogenous ACTH. I had the tests done at the regular vet's office though. Neither vet had the special specimen tubes needed for the Endogenous ACTH test, so it was easier for me to drop Chey off at the regular vet office to do the tests once the tubes were ordered and received.

I have read a lot about adrenalectomies and it freighters the heck out of me!!!!!! It is a really dangerous surgery.

The regular vet should talk to the IMS this week and get back with me on what to do next. The IMS is being slow at getting back to our regular vet.

I do know our regular vet personally talked to the radiologist and he stood firm on his impression of a right adrenal neoplasm. It was the surgeon who threw us a curve ball and thought it was pituitary related. The IMS also had a suspicion of pituitary. The LDDST results aren't consistent with pituitary or Cushing's at all and the Endogenous ACTH was inconclusive.

This is all I know right now. I will keep the thread posted as I find out more.

Thanks again for taking the time to read my thread.

Hugs,

Ro

[frijole]

Is there only 1 IMS available? Just asking because you mentioned they were slow at responding. They certainly aren't all created equal. :) Are you close enough to go to Purdue? I ask because often the teaching schools have not only the best equipment and technology but the costs are less.

I paid $500 for an ultrasound in Omaha at what was supposed to be the 'best'. They missed the adrenal tumor and their recommendation to my local vet was to do nothing. (at the time they were all still thinking cushings and refused to listen to what I was telling them about the symptoms). The ultrasound at K State was $150! They did alot of other tests so the bill was much more than that but I got answers!

Looking forward to updates. I did a ton of research and there isn't much published about pheo's because they aren't usually caught. So you are ahead of the game if that is the case.

Best of luck! Kim

[cheydogger]

I am not sure how many IMS specialists are in my area since I have never looked for one. My regular vet sent me to VCA Advanced Veterinary Care to see a surgeon, but he felt it was pituitary related. He left the room and sent in the IMS. I think the Endogenous ACTH test just came back Friday or yesterday, so maybe the IMS was waiting to call back until both tests were in. I will give it until tomorrow or Tuesday at the latest before I start getting upset.

I am only 1 1/2 hours from Purdue.

I have found a little information on Pheochromocytoma's, but Chey doesn't exhibit most of the symptoms related to it. She isn't vomiting. I realize, however, that symptoms are not always textbook.

[frijole]

FYI Annie never vomited. She did get inappetance though I assume from nausea. I'm not sure enough is known about pheos to know what the 'symptoms' are except for the obvious HBP. That's why I share as much as I can. Good luck!

Here is a link to all the IMS in your area (note accuracy might not be 100% but it's a start). Just type in IN

Kim

http://www.k9cushings.com/forum/showthread.php?t=182

[Trish]

Hi Ro
Just checking in to see if there is any news? How are you and Chey doing? Hanging in there I hope :)
Trish and Flynn xx

[cheydogger]

Hi Trisha-

I didn't hear anything yesterday (Monday). I don't think the regular vet is in on Monday's. I think she is in today, so maybe I will hear from her this afternoon. I will let you know.

Thanks for thinking about us.

Ro

[molly muffin]

did you hear anything today???

Inquiring Minds here

Sharlene

[cheydogger]

Trish-

Sorry, about misspelling your name in the last response....iPad auto correct. I caught it this time.

No word today, maybe tomorrow. I know Chey's energy is really low. She has just been creeping along on her walks and she stumbled trying to get over a small tree that had fallen in our walking path.

How is Flynn?

Hugs,

Ro and Chey

[cheydogger]

Sharlene-

I just saw your post. Thank you for thinking about us. Still waiting.

I spent a lot of time on the Internet this weekend and I am baffled with Chey's test results. The only thing I could come up with is she may have non-adrenal disease such as a neoplasia as a primary disease and the adrenal secondary or possibly concurrent pituitary and adrenal. I just fear whatever it is. The radiologist made remarks about her liver. I was reading that non adrenal diseases can give false readings on some of the Cushing's tests. Her hair is growing back from being shaved to do the abdominal ultrasound.

We ran into a small issue over the weekend. She was continuously licking the shaved spot on her front leg where they did her LDDST. I have started wrapping it with an Ace bandage because it was looking raw.

I will keep you posted when I hear anything.

How is your furbaby?

Hugs,

Ro and Chey

[molly muffin]

Thanks for asking Ro. My molly is fine for now, or at least she acts like she is fine. :)

Molly tends to lick at things she can get to like needle draws, shot spots, etc and I don't let anything happen to her paws or she will lick them forever. Nothing seems to prevent her from going to town on them. We've tried the bitter stuff and all, and she just licked anyway. It's a habit with her, not allergies.

I don't know, if you haven't heard tomorrow I'd call and see what the vet has to say. It Sounds like adrenal, but then there is the dratted LDDS negative that is baffling. Lets just stay calm for the moment and see where we go from here. That will be based upon what the vet comes back with.

Hang in there!!! Hugs,
Sharlene and Molly muffin

[cheydogger]

Btw, Sharlene....that is the cutest darn avatar pic:). Also, the name Molly Muffin just tickles me. Too cute.

I am glad to hear Molly Muffin is doing well.

Ro and Chey

[molly muffin]

Awww thanks. Molly hates cameras but sometimes we can get a good picture of her. Now with my iphone she doesn't notice that there is a picture being taken and we get good ones on that. Yay!
I can't imagine that someone didn't want her, she is so cute, but it's true, our molly is a rescue baby from a high kill shelter in Quebec. It actually freaks me out sometimes if I think of how close it came to us not having her.
I think that is one of the things I love most on most on the forum, the pictures of all our babies. They are all so adorable and loved. Sort of a feel good feeling.
Hopefully we'll get Chey figured out and she can be feeling good one day too. Crossing fingers. It just hurts to see them not themselves.

hugs,
Sharlene and Molly Muffin (that came originally from Raggamuffin, then from muffin top LOL)

[Trish]

Hi Ro

Darn, I just got home from work and was hoping to see news on Chey! Waiting is the hardest part I think.

Flynn is pretty good, I notice he is a bit quieter than usual. For example if I let him outside he used to tear out like a mad thing barking, but now he will just trot out and perhaps give a little bark at the gate. But still it is better than a week or so back, when he would walk out and lay down after about 10 paces. His energy is up and down a little. I think I am making myself paranoid, always looking to see what he is doing, what his breathing is like, I hate to see him panting which I am sure has lessened recently. He kinda did a wee cough before and the first thing I think of is gawd, hope that is not secondaries in his lungs.. or oh no, his heart is in trouble. It's ridiculous!

Anyway enough rambling from me, I did not hear from vet today either. Hopefully tomorrow or I will call them.

Have a good day tomorrow! :)
Trish

[lulusmom]

Hi Ro,

I'm much more likely to believe a board certified surgeon who probably knows as much as a radiologist in interpreting imaging. If an IMS agrees with the surgeon, then I think it might benefit the radiologist to understand why both these specialists disagree with him. I think Dr. Mark Peterson, a renown endocrine specialist, may also disagree with him or at least one of his blogs makes me think that. If what the radiologist said is true and all of Chey's symptoms are being caused by a functional adrenal tumor, according to Dr. Peterson, the LDDS should have been consistent with cushing's 100% of the time. See Dr. Peterson's comments below. You can find this and more about the LDDS at http://endocrinevet.blogspot.com/2012/05/helpful-tips-to-improve-accuracy-of-low.html Dr. Peterson maintains this blog for both pet owners and the continuing education of veterinarians who may be dealing with problematic cases. Your vet can always submit Chey's case and get a third (or is it fourth) opinion at no cost.


Advantages of the LDDST as a diagnostic test
Compared with the ACTH stimulation test, the LDDST is much more sensitive in confirming Cushing's syndrome in dogs. The sensitivity of the LDDST is excellent, approximately 90% to 95% in dogs with pituitary-dependent hyperadrenocorticism (PDH) and virtually 100% in dogs with a cortisol-secreting adrenal tumor (1-3).

Glynda

[cheydogger]

Hi Glynda-

Thanks for chiming in here. I have read many of Dr. Peterson's blogs, however, I can't remember all of them off the top of my head since I have read so much over the last month.

I still didn't hear anything today and I don't think our regular vet is in on Thursday's......maybe Friday I will hear something. As much as I want to get to the bottom of this, it is almost a reprieve not to know anymore than I know right now. I just fear the worst. I walk around with that sick feeling in my stomach all of the time.

Anyway, thanks to all for your continued concern and support:)

Ro and Chey

[cheydogger]

I still haven't heard anything!

[molly muffin]

Ok. You call the bet then. :). It is ridiculous for them to keep you waiting like this. Oh and Adkins them why they didn't call you.

Hugs
Sharlene

[molly muffin]

Darn spell thingeee. Adkins is ask them.

Loblol
Sharlene

[cheydogger]

I finally called the regular vet today and she has not heard back from the specialist. She said she has called and faxed the test results with notes on the fax sheets to call. The specialist is in today, so she is going to call again. The regular vet has a short day today, but she is going to leave the specialist her cell phone number. In my opinion, the specialist is not being professional. The specialist has had the results of the LDDST and Endogenous ACTH for over a week! The regular vet said she should know something by tomorrow and will call me.

[cheydogger]

I heard back from our regular vet today. The specialist is worried it is an adrenal tumor now. The specialist wants Chey to have one more ultrasound at their office to be reviewed by a surgeon. I asked our regular vet if they have ever taken Chey's blood pressure and she said, "no, but we should have." I took Chey in just a few minutes ago and her blood pressure is really high, 244. They said even for a stressed dog it shouldn't be over 200. Mind you, Chey is severely stressed at the vet, shaking and heavy panting, but I guess it is still high.

[molly muffin]

Yep, I think that is high. Did they give you BP medicine?
So, the specialist are still going back and forth as to what the cause is, it sounds like. Hopefully if you do another ultrasound, then they will get a clear view of the adrenal glands and hopefully tell if there is a tumor or not. It is very frustrating I know, not to have a clear answer and a plan of action.

Have a wonderful Thanksgiving. Take some time and just enjoy hanging out with Chey for a bit. :)

hugs,
Sharlene and Molly Muffin

[cheydogger]

She started on Enalapril for her heart a couple of weeks ago. The vet assistant took Chey's Blood pressure today. She took it three times then went to talk to the doctor. I was told just to hang tight until my vet can talk to the specialist again. I sure hope it isn't another two week wait.

Honestly, I just feel like giving up. I just don't know that I would consider surgery if Chey was a candidate. How much do you put a 13 year old big dog through???? I just know our time is limited, so I continue to give her all the love I can and cherish our time. I am just becoming more and more depressed.

Happy Thanksgiving.

Ro and Chey

[addy]

Dont give up yet, it is the waiting and leaving you hanging that is so troubling for you.

Ring, ring, ring, hello, I need to speak to Dr. bla bla today. Please have the dr call me asap preferably within the hour.

(no call back within the hour- call again)

Hello Dr Bla Bla, I was not able to speak with you yesterday. I have some questions I need answered.

1- what were the results of the blood pressure test?
2- in your opinion how should the results be interrpreted?
3- how does stress affect the reading?
3- is it possible for me to speak with the specalist directly?

Just a thought. I cant handle waiting for call backs:(:o;)
I know it is hard, all of it is really hard. I'm hoping I made you smile though;)

[molly muffin]

Oh Ro, HUGS! I know it is frustrating. You may Not end up opting for surgery, If you find out it is an adrenal tumor. Those are all decisions to be made once you know. It may also be that what you end up wanting to do is "quality of life" care. Just give the best care that you can so that her remaining time, whether that be years or whatever, are as comfortable as possible.

It is so very easy to become depressed when confronted with these horrible thoughts. They sort of creep in side you and burrow in. That isn't what you or Chey need though. The thing to concentrate on is the good moments, the things that give you both pleasure.

Here is the deal, no matter what you decide, you'll have a support group right here whenever you need us, and I can't say it enough, no matter what you decide. It's okay.

So big virtual hugs, enjoy Thanksgiving. Enjoy each day, each hour. :)

Addy really doesn't like waiting for call backs! hehehe (made me laugh too Addy) You know they have a parking space with Addy and Zoe's name on it at the vets office she has spent so much time there!

hugs,
Sharlene and Molly Muffin

[frijole]

Hello - I posted a while back. I shared a bit of my Annie's story (pheo tumor). I have no idea if your baby has an adrenal tumor but if she does it doesn't mean she can't have a decent life. My girl lived with it for two years after diagnosis. She was happy and very loved. In hindsight I truly think her whole case overwhelmed me and bothered me more than she was affected by the tumor. I fought for a very long time for a diagnosis, switched vets, went to specialists... and we finally figured it out. And when we did I got to spend time focused on just loving her. Don't forget that is an option. Keep us posted and know you aren't alone. Kim

[Trish]

Hi Ro

Well that sounds to be kinda what you were expecting :( I so know that depressed feeling, but it is not a done deal for both our furry ones until we know exactly what we are dealing with, treatment options, risks, benefits etc etc.

So you hang tight and it is not over until the fat lady sings! It would be best if you went and spoke direct to specialist to get the word straight from them, you can have your list of questions to go through and get it real clear in your head. Or are you too far away??

It doesn't sound like Chey is ready to give up yet, so you keep fighting for your baby!

Hugs
Trish and Chey's adrenal tumour twinny Flynny :)

[cheydogger]

Thanks everyone. I now fear she is going to stroke out or have a heart attack due to the extremely high blood pressure.

Trish- I only live about 20 minutes from the surgeon's office/ animal hospital, so not far at all. I am just sitting tight now seeing what they want to do about the blood pressure.

Hugs all!

Ro and Chey

[cheydogger]

The vet called in Amlodipine Besylate 2.5mg for the blood pressure. Our regular vet said this is the highest blood pressure reading she has ever seen. Chey's right adrenal gland is the largest she has ever seen too. Geez, this is a teaching case for her. I will start Chey on the Amlodipine tomorrow morning, but I have to watch her closely for signs of her blood pressure dropping too low. Sooooo, Chey will be going to my in laws for Thanksgiving dinner. Wish us luck! The regular vet wants to talk to the specialist next week about this new blood pressure problem.

Happy Thanksgiving all.

Ro and Chey

[molly muffin]

I'm glad that they are going to get Chey on the BP medicine. I think it's important to get a handle on that, no matter what else is going on. Did they tell you what to watch for in regards to low BP? Gee, do they give discounts for teaching cases ;) :)

Have a good Thanksgiving Ro!

hugs,
Sharlene

[Harley PoMMom]

My angel boy, Harley, was on Amlodipine for his elevated BP. Is Chey still taking the Enalapril? If so, with Chey's BP being on the high side, they are probably hoping that this combination will bring that BP down fast.

Keeping you both in my thoughts and prayers, Lori

[cheydogger]

She is still taking the Enalapril. She has been on it for about three weeks now. I am still supposed to give her the Enalapril too.

The vet said to watch for lethargy. Like, if I can't get her to stand or raise her head for food, I am to take her to emergency if it is after hours or call them immediately during office hours. Do you have any other things I should watch for concerning low BP?

Did Harley have any problems with Amlodipine?

[Harley PoMMom]

Harley did well with the Amlodipine as long as we gradually increased his dose.

Another sign of low blood pressure are pale gums and/or mucous membranes. Normally, the gums and the mucous membranes of the dog should be pink. A dog may have an increase in drinking too.

[frijole]

Is the vet that said its the largest adrenal gland and the highest blood pressure your regular vet or the specialist?

I think you said they wanted to redo the ultrasound to try to see a tumor right? If I recall the first one did not show one. I would get that done because you'll see if there is one, it's location and size. That right there will rule in or out surgery.

I think I shared that there were several episodes where Annie's breathing was so fast I couldn't simulate it and I truly thought she was in cardiac arrest. The episodes did not last long. I just tried to talk to her and calm her down as best I could. Hers always were at night for some reason.

I'll be thinking of you tomorrow and am glad you are able to bring her with you for dinner. Try to enjoy the day but know we are all with you in spirit and sending strength. Take care, Kim

[cheydogger]

Regular vet is the one experiencing her first biggest and highest evers. lol. Mind you, she looks pretty young, so she probably hasn't been practicing all that long.

Before we learned of the high blood pressure, I was to call the surgeon next week to set up an ultrasound. I posted the report from the radiologist from the first ultrasound. The radiologist said there IS a neoplasm in the right adrenal gland, but he doesn't really describe the tumor in my opinion. I don't know if he saw a tumor or just thinks there is one due to the size of the adrenal gland.

I have not seen Chey breathe heavily like you described Annie doing. Holy heck, that would scare me to death.

I hope Chey does well like Harley on the Amlodipine:). I don't know if I would know pale gums from, regular gums. Yikes. I haven't started her on the Amlodipine yet, but it seems like she has been drinking more water than usual tonight.

Thanks for helping me:)

[frijole]

:D That is why I asked the question :D It sounded like something a young vet might say.

I'll be brutally honest - I'd only trust discussions about adrenal tumors and treatment options and testing of tumor to a specialist. And I'd find out somehow who the BEST is in the area and that is where I'd go. I say this because I tried to stay locally and I lost precious time and in the end it cost me extra money too with wasted tests. I had an ultrasound done that cost $500 and they never saw her adrenal tumor - they only got one on the film. K State took the time and got film of everything. They charged $150 for the ultrasound go figure. I had a cat scan done and we ruled out pituitary cushings because she had 5 acth tests and 2 ldds tests that came back as pituitary cushings believe it or not. The cat scan ended that insanity.

No vet office has the type of equipment that the specialists have nor the experience of the people reading the results/film.

You seem to be a worrier like I am and while your dog is smiling and happy you are in serious pain. :D Knowledge is power and I believe you can get answers if you get the ultrasound done at the specialist's office.

Didn't mean to scare you with the breathing thing - that only happened about 3 times over 2 yrs but it scared the crap out of me. Most of the time when the pheo was active she panted heavily with a big smile on her face. That too passed within minutes.

Hope this helps a bit. Kim

[Trish]

Hi Ro
So glad that you got her BP checked and have the meds for it. Flynn has been on his meds two weeks now. Sometimes I do think he might go a bit low. Once he jumped out of his bed, then sat straight back down with his head low, I think his BP dropped when he got up, it took a few minutes but he came right. Sometimes he is a bit more lethargic but on the whole he is coping with it quite well.

I had it checked after a few days, maybe for my peace of mind! His was 200, my vet told me they take stress into account, but stress would not put it higher than 180... maybe different in breeds though I guess. His came down to 160 after a few days and local vet wants to check it again on Monday before he goes to specialist on Tuesday. In the literature pheochromocytoma is commonly associated with hypertension, which is why the vets think Flynn has that type of adrenal tumour. I guess time will tell.

Hope your getting some sleep tonight, and Chey's first pill in the morning is the start of her feeling much better!

Trish xx

[Skye]

Hey!!!
VCA.....what type of doctors are there? i for some reason thought that was internships only..........i could very well be incorrect......however i would seek out what type of experiences they have in this area, how many surgeries in this area......if the tests performed...the ldds and the acth test was there risk of them being done incorrectly? and if bp is issure factoring a surgery...the surgeron should have bp prepardness if it soars or drops or if any bleeding issues etc.....meaning any thing an every thing is right there on hand ready to rectify situations. i so wish you could speak with Dr. Heald and Dr Hottinger at Gulf Coast Veterinary Specialist in Houston Tx. and about keeping track of labs...it seemed every time my little one turned around they were drawing blood, doing test, getting urine....btw i am now pro at free catch ladle morning pee..lol! running around in my jammies with my ladle ready to swiftly position it to catch the pee. lol, and her looking at me like WHAT are you doing??? But goodness keeping track of it all and knowing if there was a pattern going on, what was high what is low what is changing......ugh......i was confused constantly and still get that way and reflect to my notes all the time. I PROMISE you have found the most amazing forum for life time friends, support, encouragement, incredible experiences. And yes the angels here if you can vision this.....will wait at the computer screen clicking refresh to see if any new news has been posted....leaping from chair arms extended cheers, tears, hugs, smiles you name it.....you are now and going forward being carried in the wings of angels. listen carefully you will here their little wings just a fluttering away! And if you have a melt down....they will help you through your melt down and then sit you down and help you get yourself pulled together. anyways....i am rambling.....sorry.....here is a spread sheet i made of my little ones labs and tests...i still have one more to add on there...lol, but this is what i did to see if could understand at least the lab part better. hope it lets me post. oops!!! okay...i dont know how to attach it. :(

[cheydogger]

VCA has a lot of specialists, cardiologists, IMS, ophthalmologists, surgeons, neurologists, emergency/critical care, etc. I do believe interns are there too. I saw a board certified surgeon and an internal medicine specialist. This particular VCA is in Fishers, Indiana.

I did ask my regular vet if there could have been any handling error while doing the blood tests or if Chey's extreme freight could have askewed any of the tests, to which she replied, no. No matter what the blood tests say, she has enlarged adrenal glands, the right being markedly larger. The blood work just isn't matching the enlarged adrenal glands. This is why I am reading more about pheochromocytoma's. Pheo's can mimic Cushing's, but blood test results can be inconclusive.

I posted all of Chey's test results earlier in this thread. It is baffling.

[cheydogger]

If anyone has a minute, could you look at the side shot picture I posted of Cheyenne to see if she has the pot bellied look. Sometimes I think she does and other times I don't.

Thanks! I hope everyone has had a great Thanksgiving.

Ro and Chey

[frijole]

It's kind of hard with the 'hair cut' to tell but no - I don't think her tummy is cushinoid. If you go to my albums and look at Haley's photos you will see a nice plump cush shape. She had cushings. I used to get so upset because vets told me to watch her diet and she was fat but she wasn't eating much at all.. silly vets missed the cushings for years! :D Kim

[frijole]

It's easier to see the tummies on the smaller dogs so I googled and found a larger dog to show you. If you click on the photo is will enlarge and give you an idea. Kim

http://piperbasenji.blogspot.com/2011/07/i-have-cushings-disease.html

[cheydogger]

Thanks for looking, Kim. Isn't that a nice "hair cut?" Lol. I looked at your pictures.....such sweet babies. I have looked at pictures of Cush dogs and I just didn't think Chey had the typical look. She does, however, have a slope in the middle of her back.

She seems to be doing ok with the first dose of Amlodipine today. She has been watched closely all day. We did notice she has had softer stools today though.

[molly muffin]

I think Chey's tummy and form is actually very well defined for a dog that is older. We've all see how older dogs get that sort of tired, dragging look. Chey doesn't have that at all.

I love the picture of the two of you together.

hugs,
Sharlene

[cheydogger]

Thank you, Sharlene. I had my husband take some pictures today:).

[frijole]

Not too many Thanksgivings where you can where sleeveless shirts huh? God I love global warming! :) Great photo - it shows how much you love her. Kim

[Blaze's Mom]

Oh my gosh! She is so cute! They are wonderful pictures. I'm glad she is doing well on her meds today. I read what Skye wrote and had to chuckle bc I do the refresh thing all the time...lol. I am like a sponge, trying to take in and learn as much as I can! And then I think, why am I not taking notes?? I will forget these things and I should be taking notes. Which is why I need to run out to my car in my pj's, in the dark, in the cold and go get my new notebook that I left in there.

[Trish]

Hi Ro
Has Chey got her appt with the specialists yet? I had to go through all that to and fro with the local vets consulting the specialists too, it is such pain! I hope she see's the specialist soon and gets a proper diagnosis. Hope you have a lovely weekend with her:)

[molly muffin]

Just checking in to see how Chey's doing on the BP meds. Hope it's another great day for you both.

Hugs,
Sharlene and Molly Muffin

[cheydogger]

Hi Trish-

Yes, Chey is a medium- large dog, 53 pounds. I have had to keep her front leg wrapped because she licked it raw where they shaved a spot to do the LDDST. Anytime I take the wrap off, she licks it more. It starts to look better then she irritates it again. It has been about three weeks now. Ugh!!!!

I haven't made an appointment with the surgeon for another ultrasound yet because the regular vet told me to wait until she talks with them about the blood pressure issue.

Love the new pic of Flynn:)

Sharlene-

Thank you for thinking about Chey. She seems to be doing alright....fingers crossed. I had a scare today though. I took the girls for our normal walk to the park. Chey seemed to be doing ok until we were almost back home. She stopped to sniff in a yard and I thought she started acting a bit off. Maybe I am just too sensitive to her every move, but I noticed she stopped and kind of just looked around in a daze and a little stumbly. I became shaken with fear and picked her up thinking she was going to go limp. I carried her for a minute then put her back down to see if she could stand and she did. We very slowly walked back home and she acted ok. I thought for sure I was going to be rushing her to the vet. It took me a minute to settle down and quit shaking. This is when it is rough because she is a big dog. I am afraid I will reinjure my back lifting her. I think I will just walk her around the block until she is stabilized.

How is that cutie patootie, Molly Muffin?:)

Hugs,

Ro and Chey

[molly muffin]

Oh yea, that would freak me too. You can't risk hurting your back again either. So, slow walks, not too far (even if she wants to) for now. It might have been nothing, but rather than pick her up, unless she actually collapses, just go to her, pet her calmly and let her get her bearings again. I could have been some smell that got to her in that yard too.

Take care of yourself and Chey!

Molly Muffin is her normal adorable, bratty self. Wind almost blew her over when she went to take a potty break this evening. Her ears were flying backwards in the wind and she was trying her best to do the squat thing with one leg sticking up, (no idea why she does it that way, then she hops away from the area, like it has offended her). She's a trooper though, she tried 2 more times after that one. LOL

hugs,
Sharlene and Molly Muffin

[Trish]

Well I bet it is just her BP coming down, my vet told me they are so used to the high BP they can feel a bit shaky when it comes down... so for now I think that is a good thing?!? Obviously it wouldn't be too good if it came down too fast, so I think too many more episodes like that then another vet trip would be warranted to check BP. Flynn did that once when he got up too fast, he sat back down staring into space but came right in a few minutes, but luckily we were at home and I did not have to carry him anywhere and he is only 14kg! Your poor back :eek:

[cheydogger]

I know I am obsessive about this, but has anyone dealt with concurrent PDH and ADH on this forum? There isn't much literature about it since it is rare, but I did read that the test results can be quite confusing.

As I sit here and write this, Chey grabbed a toy and rolled on her back. Ah, I love that and don't see it much anymore.

She seems to be doing ok on the blood pressure med, no more scares. She has, however, been really slow on her walks. I thought I have seen this before, but I confirmed it yesterday.....Chey ate poop out of a yard. She was sniffing, then grabbed something and I opened her mouth to see what it was and I am pretty sure it was poop. She has never been a poop eater. I just think she is sooooo hungry. She also still eats dirt. Ugh! It just breaks my heart. I want to just give her more food, but I don't think I should do that.

Sharlene- I hope the wind isn't blowing Molly Muffin around. Lol. And, what is up with these dogs.....they use the bathroom, then hop away from it like it is repulsive???? Lol. I have seen Chey do that a lot.

Trish- I had to show my husband Flynn's picture. He and Macy look so much alike:). You call him a Foxie cross? I don't know what a Foxie is, but he sure looks like a rat terrier without the pointy ears:)

Sorry for being a pest.

Ro and Chey

[StarDeb55]

Ro, I haven't posted to you & Chey before, but saw your post about Chey's voracious appetite making her eat undesirable things. I know it's disgusting, but it's not that unusual in our pups. The excess cortisol makes them feel like they're starving all the time. I don't know if anyone has posted this suggestion previously, but if they have, I will repost it. A lot of members will use fruits & veggies to help their pup feel fuller. Things like carrots, green beans, would be could, if Chey will eat them There are some veggies that aren't such a good idea, & I believe that is the broccoli family. Leslie will probably see your post & she can fill you in better as she has taken some classes in canine nutrition, & does a lot of reading on it.

Debbie

[Squirt's Mom]

Hi Ro,

Poop eating is gross, huh? :eek: Some are worse than others, for sure. I had one that was bad about it, reeeeally bad, and someone suggested raw cabbage. I started feeding her a little bit every day and it did help. Have no idea why, but it did. She weighed around 30 lbs and got a piece about the size of a half dollar. It didn't stop her but she did get much better about it. (She's the worst I've seen - I could send everyone reading this running for the bathroom, gagging, but I'll be nice. :p) If this was the first time she's done this, it could be that the dog had eaten something producing a particularly alluring aroma or it's even possible it could be a side effect of the new med. There are some school of thoughts that say this indicates a mineral or vitamin deficiency but there doesn't seem to be a consensus on this and that wasn't true in my babies case. Unless there is an absorption problem, neglect, or they are just eating crappy feed, deficiencies don't seem that common and poop eating certainly is.

This same pup developed Pica, a condition in which they are driven to eat nonfood items, sometimes in lieu of their normal feed. She was one of these - she would walk away from her feed to eat an Azalea bush. :rolleyes: Nothing helped; she ate three muzzles off of her face before I finally had a metal one made for her that she couldn't eat. She wasn't hungry like our cush babies are, she just wanted weird things instead of food and I had to protect her from herself even tho it made her look like Hannibal Lector. :eek::D Doubly bad since she was a Pit mix. :rolleyes:

If you think Cheyenne is doing this from hunger you can try the things Debbie mentioned for sure. Foods containing fiber will help her feel full longer but you don't want to overdo it or she could get diarrhea. Give fresh, raw veggies and fruits for treats and as toppers on her feed if you wish from time to time. Just be sure to cut the feed back a tiny bit when you do to maintain weight. Try anything you eat (fresh, raw) to see if she likes it. Avoid grapes, raisins, garlic and onion in ANY form, macadamia nuts, and avocado. (Avocado is eaten by some dogs and is in some dog feeds but there is concern about their safety for dogs so I choose to err on the side of caution. ;)) Anytime you have a question whether a food can be given to her or not, google is your friend - mine, too! :D

Hugs,
Leslie and the gang

[cheydogger]

Thanks Debbie and Leslie. Chey just started eating feces a few weeks ago and dirt a few months ago. I haven't seen her eat feces out of our yard, just in other yards. I sure hope she hasn't developed Pica:(. I really think it is her ravenous appetite. I did buy some canned green beans (no salt added) and have given her carrots. She had a weight issue quite a few years ago, so the vet told me about using green beans because they are empty calories. I have given her a tiny bit as a snack before bed the last few nights along with a baby carrot. I " think" I feed her a decent food, EaglePack Senior. She has always had a huge appetite, but add the adrenal issue and it's so much worse. I read somewhere on here that someone called it counter surfing. Lol. Yep, Chey used to do that too. I don't know if her back legs are strong enough to do it now though.

Gosh, Leslie, I can't believe the lengths you had to go to for your baby with Pica. That would be awful. It's not funny, but you're comparison to Hannibal gave me a chuckle.

I guess I will just continue to give her a little snack of fruits and veggies.

Thanks again,

Ro and Chey

[frijole]

Ro, Annie was a dirt eater. I never figured out why but I landscaped wherever she was digging and used landscape rocks. Although her 16 yr old sister promptly ate one of the rocks once when I did that.. I about crapped.

My sister has a schnauzer that will eat anything - including Christmas ornaments! Dangerous stuff.

:) Kim

[Tina]

Hi Ro,

I haven't posted to you before, but have been following along on Cheyenne's thread. I meant to post a while back when you first mentioned about her eating dirt. Jasper, my cushpup, eats dirt also. I don't believe it is related to Cushings, because he has done it off and on throughout his life. Sometimes he would do it constantly, then it would seem to lessen, or stop for a period of time. Since he has had Cushings, he seems to do it almost constantly. Sometimes I have to take him out in our fenced yard on a leash to keep him from doing it! :rolleyes: He acts almost obsessed with it, and eats tufts of dry grass also. My vet has never really been able to figure it out or offer any advice or suggestions. He was completely healthy before the Cushings diagnosis, and has always had good nutrition.

His baby sister (also a miniature schnauzer) eats dirt also, and she didn't learn it from him. She started the day I brought her home! :eek: :eek: I about died. The vet has no explanation.

I saw Kim's comment that her pup Annie ate dirt so thought I would post. I wish I could landscape where they dig, but there are small holes all over the yard. :rolleyes: I'm sorry I can't offer any insight, but thought it might help to know you aren't alone. Moral support. :)

Hugs,

Tina and Jasper

[lulusmom]

Jojo, my cushdog that passed in June, loved to eat dirt. He liked wet dirt in particular and would paw at it to make tasty mud pills which he lapped up. He did that from the first day I took him home from the shelter. He had uncontrolled cushing's then but dirt stayed a delicacy for him even when cortisol was under control.

[Trish]

I was wondering if Flynn was eating dirt too... he likes to dig little holes in the lawn and sniffs around in them but I have not actually seen him eat any. He does love grass though, well a particular type not the lawn but more some of the tall grass that grows in parks. Haven't seen him eat a poop, though he gives them a jolly good sniff when he does one and then stands in front of it and kicks grass up to try and cover it haha.

You mentioned in a post somewhere about his breed, Foxie is a fox terrier here in NZ. But he is not a pure breed as I rescued him when he was about 6 mths old. He has something else mixed in but we are not sure what.. hence the foxie cross :) I have never heard of a rat terrier like your doggie here in NZ, maybe they are something similar that has been lost in translation?!?

[Trish]

I just googled the Rat Terrier and boy they do look like Flynn, bigger sticky up ears though

"Like all terriers of this type, Rat Terriers most likely developed from crosses among breeds like the English White Terrier, Manchester Terrier, Smooth Fox Terrier, and Whippet" that quote was on wikipedia so there we go they are related :)

[Trish]

Hi Ro
What's happening with Miss Chey's BP? Has your vet heard back from specialist yet?? Hope she is doing good :)
Trish xx

[cheydogger]

Hi Trish-

Chey has been on the blood pressure med for 6 days now. She acts ok at home, but she is really slow on her walks. I have only walked her around the block the last two days and it scares me how tired she is. I don't think I will walk her anymore for now. I also think her water intake has increased a tiny bit. I tried to look at her gums, but it is hard to tell if they are pale because she has mostly black gums. I then tried to look at her lower eye lids and from my interpretation, they look kind of pale. I think my regular vet is in today and I think the IMS is in on Tuesday's as well. Hopefully, the two of them can talk today and let me know the next step. At the least, I think she may need a blood pressure check. I just feel like this has been going on so long. I haven't left Chey alone yet, but I have to go back to work tomorrow. Luckily, I can usually make it home at lunch time to check on her.

Any changes in Flynn after increasing his BP med?

I do know that I am mentally exhausted from all of this. I have just been in a funk and not taking as good of care of me as I should. My anxiety is high.

I will let you know if I hear something today.

Thanks for checking on us:)

Ro and Chey

[Trish]

Hi Ro

I hope you have been on the phone to your vet nice and early to say you are expecting to hear back from them today, give them fair warning you want answers!

Flynn is tired too, he would still go for a run if I let him, but he is definitely slower too. My vets have said they are tired with BP coming down... so unless it is proven otherwise I am going with the drugs making her more tired theory!!! I will keep a good eye on Flynn, when he first started BP meds I thought he was better, tremours were less, but in retrospect they slowly increased so I almost didn't notice it, but they were definitely back so I think that was an indication his BP went back up. Like Kim said that with pheo the tumour can secrete at different times which makes BP control difficult. The IMS asked me yesterday about his tremours, she seemed to think it was a good thing that tremours tied in with BP and not something else. Perhaps take her in for BP check, will help your peace of mind too.

Now about this funk... I am with you in that black hole but we have to crawl out and to do that we need a plan! I cannot tell you about taking better care of yourself as I am in the same boat there too.. I am pretty sure my diet of malteasers, eggs benedict, macdonalds and coke (diet, yeah that made me feel better!) yesterday is also not going to help!! God knows what my BP is, but it cannot be good :eek::rolleyes: So today it changes, I have had cereal for brekky and I am packing a salad for lunch!

I found this quote which is hopefully now in my signature below to help me try and keep positive on this bloody roller coaster but you can use it too ;)

Hugs to you Ro and loads of pats for Chey.... and I will be checking this thread as soon as I get home tonight looking for news on your beautiful girl xx

[molly muffin]

Soooooo did you hear anything today?

You have to take care of yourself!! There is a lot on your plate these days and you have to remember that you are the most important! Really! How can you take care of all the others if you are not treating yourself too. :)

hugs,
Sharlene and Molly Muffin

[cheydogger]

I did not hear anything today. Maybe she will call me tomorrow:confused:

Love the slogan, Trish. Sharlene, you are so right!

[addy]

Call her first thing in the morning:
ring, ring, ring, hello, where is my call back?

the squeaky wheel gets the oil;);););) and maybe a dark chocolate candy bar:D:D:D I hear dark chocolate is good for anxiety. At least that is what I tell my waistline:rolleyes:;):D

Hang in there guys, the dang roller coaster will hopefully slow down. I think blood pressure meds can make people tired so stands to reason it could make your puppies tired.

[Tina]

Gosh Ro, I would be a nervous wreck with all this waiting! No wonder your anxiety is high. I'm with Addy, I would be on the phone calling first thing in the morning.

Jasper has had so much going on in the recent weeks that before I hang up with my vet each time, I make sure that I clarify with her when she will be checking in again, and when I can expect a call. It really helps to keep my anxiety in check, as least as far as that goes. I do a pretty good job of worrying about everything else though! :rolleyes:

I hope you are able to get some answers in the morning.

Hugs,

Tina and Jasper

[Trish]

Awww stink... so wanted to hear news tonight, how frustrating for you and a little typical of what we are going through. Fingers crossed they get back to you tomorrow Ro xx

[Trish]

Oh I forgot to tell you, I was talking to the surgeon about BP taking at the vets and how much it could be raised by stress. He said it can be quite a bit higher, he said he had a dog of his own with BP trouble and it was always higher when he brought it to the pet hospital for checkup so he took the equipment home and it was much less! I said can I have the stuff to do it myself at home haha.. unfortunatly not :) Was funny when he told me that, the first thing I thought of ohhh I must tell Ro!

[Harley PoMMom]

Oh I forgot to tell you, I was talking to the surgeon about BP taking at the vets and how much it could be raised by stress. He said it can be quite a bit higher, he said he had a dog of his own with BP trouble and it was always higher when he brought it to the pet hospital for checkup so he took the equipment home and it was much less!

This is known as "white coat syndrome" and happens in people as well as animals.

With my angel boy, Harley, we found out if we took him back into an examine room as soon as we got there and the vet tech would take his BP right away, it was less stressful. Also if the BP was checked on his rear leg instead of the front ones he did much better.

Some even will check the dog's BP in the owners car, as this can make the dog less nervous.

[cheydogger]

I suggested they take her BP in my truck last time, but the vet wasn't going to be there. The assistant did it. I am going to really push for this next time!!!! I am starting to get angry. This has been going on way too long.

I think one of the problems is the days in which both vets are in. I think they hit and miss on their working days.

Sorry for the rant, but I am getting uneasy. I don't like to bug people which is why I don't call them until I can't take it any longer.

Still waiting for that call!

[cheydogger]

Ok......the regular vet called me tonight. She spoke to the IMS and she suggests we increase the Enalapril to 1.5 tabs daily plus stay on the Amlodipine. Secondly, she told me that if this is an adrenal tumor, NOW is the time to do surgery since from the ultrasound a month ago there didn't appear to be any thrombus in the vena cava. Or, if I choose not to do surgery, we can probably start her on Trilostane to decrease her Cushing's symptoms. If I don't opt for surgery, however, the tumor will invade the vena cava. Thirdly, I am to call tomorrow to schedule a second ultrasound with the IMS while Dr. Elkins (surgeon) is there. At that point, my options will be laid out on the table. Lastly, Chey is getting her BP checked Friday and the regular vet agreed to do it in my SUV!

My regular vet said Dr. Elkins (surgeon) is supposedly the go to guy for adrenal surgery. Supposedly, he loves this surgery and does a lot of them. This was told to her from the IMS. The thought of the surgery itself just makes me want to vomit especially since Chey is 13 and has the heart issues.

I also have started a diary and measuring her water consumption.

We may be getting somewhere now. I will keep everyone posted.

Hugs,

Ro and Chey

[molly muffin]

I'm really glad that you heard back from the vet today! whew.

One thing to ask the vet perhaps, surgeon, IMS, maybe at the ultrasound or even before ask your vet, is what do they think of Chey's over all health, minus the tumor and cushings. If there is an adrenal tumor causing the cushings, remove that and you should be okay, no more cushings. Would that be better then on her heart too. So what is the prognosis of her health without that tumor in the way. If it's good and you are looking at several more years with a healthy Chey, then that might be a factor. How fast do they they think the tumor is growing and without the surgery, then how long do they think till it would become a factor in her health over all.

Just things that you can go in ready to find out about and perhaps based upon their answers, it will help you to come to some sort of decision.

It's a hard one to make especially at 13, but at least you do have a plan and some options to think over. What medicine would they want to give Chey for cushings with the adrenal tumor too.

I hope you did something for yourself today!

Hugs,
Sharlene and Molly Muffin

[molly muffin]

I'm really glad that you heard back from the vet today! whew

Some things to ask the vet now and the surgeon, IMS, at the ultrasound is what do they think of Chey's over all health, minus the tumor and cushings.

If there is an adrenal tumor causing the cushings, remove that and would she be okay, no more cushings?

Would that be better then on her heart too?
So what is the prognosis of her health without that tumor in the way? If it's good and you are looking at several more years with a healthy Chey, then that might be a factor.

How fast do they think the tumor is growing and without the surgery, then how long do they think till it would become a factor in her health over all?

Just things that you can go in ready to find out about and perhaps based upon their answers, it will help you to come to some sort of decision.

It's a hard one to make especially at 13, but at least you do have a plan and some options to think over.

What medicine would they want to give to Chey for cushings with the adrenal tumor too?

I hope you did something for yourself today!

hugs,
Sharlene and Molly Muffin

[cheydogger]

Sharlene-

You have brought up some good questions. Dr. L (regular vet) said that minus the tumor, it is a possibility it could help her heart and get her off the BP pills.

Keep the questions coming as to what I should ask the surgeon. It could be that they say surgery isn't an option given her overall health and age. I hate paying for another ultrasound, but I think it will give us a conclusive diagnosis.

Dr. L. mentioned Trilostane as the drug of choice if I don't opt for surgery or she isn't a candidate.

Thanks for the help, understanding, and support along this sucky journey.

Ro and Chey

[frijole]

Ro,

I googled the guy and he's been at Auburn and TX A&M both good schools. I wish I had more local knowledge but I encourage you to do whatever you can to make sure that this guy is qualified and the BEST option if you elect surgery. This is the very toughest surgery a vet can do. You don't go into it without knowing that the surgeon is absolutely the best in the area and without knowing the risks.

As you have probably read the issues are complications both during and AFTER the surgery during recovery. I would be very blunt with the guy and ask him to be the same with you. Ask him point blank what the size of the tumor is, the likelihood it will grow and impede the vena cava, look at the film and make him POINT it out to you. Ask him if it were his dog what would he do and look at his eyes when he answers you.

Don't let anyone talk you into anything - you must be 100% comfortable with any decision you make. Yes, surgery sooner vs later is obvious but you also do not want to make a major decision like this without taking time to truly think it through.

Re treatment with trilostane - I would make sure it isn't a pheo. Trilostane seems to be the drug of choice for CUSH dogs with adrenal tumors but pheos are not cushings tumors. My opinion is that pheos raise the sex hormones that result in cushings like symptoms (atypical type cushings). I am pretty sure I've read here that trilostane can actually make things worse with atypical dogs - dang wish I could remember exactly what I read - perhaps some of the other seniors will see this in chime in...

Again, a pheo isn't cushings and with the hbp you gotta know you might be dealing with one. I'd really drill the IMS for thoughts on that - and keep in mind that these things are so very rare that he might never have treated one before.

And remember if you aren't comfortable with these people you have Purdue Univ Vet School up the road.

We are here for you! Kim

[cheydogger]

Kim-

How did you get an absolute diagnosis of a pheo?

[cheydogger]

I told Dr. L tonight that I was disappointed in the radiologist that read Chey's first ultrasound because he did not elaborate on the tumor. He only said that there is a neoplasia in the right adrenal gland. She kind of felt the same way. She said of what she knows and has seen, most adrenal tumors are on the cortex and he mentioned nothing like this.

[frijole]

K State did extensive film of it. They were confident it was not cancerous. They ruled out pituitary cushings by doing a cat scan. They said to ignore the 2 LDDS tests that said pituitary cushings - so that was ruled out. So it was either an adrenal tumor/cushings or a pheo... but she did not present hbp while there (we were there twice). Upon physical inspection - while her stomach was distended she did not look plump like a cush dog. They instructed me to have her bp checked during the next episode... well... as I mentioned they happened at night! By the next day she was normal... it took months before I got the confirmation. But to be honest - she had a scary breathing episode and even though I didn't have a bp reader at my home I knew... The lead on Annie's case was the Head of the Dept of Animal Science at K State Univ Vet Hospital.

I can't say enough good things about what that hospital did for us after a year of false positives and testing for all sorts of things. I literally fired every vet in my town! I had no where to turn. It was a five hour drive each way but man it was worth it.

They had specialists from every field on hand and all of the equipment. I think I shared that the $500 ultrasound that I had done in Omaha (where they missed the tumor) was only $150 at K State too so that was a bargain.

They also did an endoscopy because she wasn't eating (that's a whole different story) but the point is simply it was like "one stop shopping" because in a day I got my answers because they had the personnel, equipment and the knowledge all under one roof.

[cheydogger]

From what I have read, it is hard to tell what type of tumor it is unless they do pathology on it. Chey doesn't look plump like most Cush dogs either. You saw the pic I posted. Now, when she lays down, it looks like she has a big belly.

[frijole]

We ALL look big when we lay down! :D:D:D:D:D:D:D

Just write all your questions down and go with your gut.

[Trish]

Hallelujah!! Thank goodness you finally heard phew. Booking that ultrasound can't come soon enough! I will be very interested to hear what her BP is, Flynny goes in for his check in the morning. Hope it is good but he has been shaking a bit tonight. The surgeon said they may proceed with IV medication to control it if it does not come down. The surgeon sounds experienced Ro, it will be so good for you to have a decent talk to him. Fingers crossed for a speedy scan and a normal BP!
Trish and Flynn

[cheydogger]

Chey has an appointment Monday for an ultrasound with Dr. S (IMS) followed by a consultation with Dr. Elkins (surgeon) to review the ultrasound.

[molly muffin]

Oh wow!

You have your pad and paper that you've been writing down all the questions you're going to have?

hugs,
Shalene and Molly Muffin

[frijole]

You go girl. We'll be by your side in spirit. You are doing a great job. Know that. Kim

[cheydogger]

I will be writing out my questions this weekend;)

[Skye]

you know were all here if you need any help or feed back!!!!

[Trish]

Gosh, I am so nervous for both of us! While I wish there were no other dogs and their owners going through this, I am kinda glad to have your support and know that you know exactly how I am feeling! Monday is going to be a big day and last doubly long with our time differences! Keep the faith Ro, we are getting there!

[cheydogger]

I am walking in your shadows, Trish. This is a scary journey we are on with our babies and not to mention extremely expensive. I told my vet the other night that I would gladly give the surgeon 6 grand or whatever the surgery costs, but I want to know she will be ok for another couple of years:). I know in reality I am not going to have an absolute:(

I just can't get over Chey testing so high on the ACTH, suppressing the entire 8 hours on LDDST, testing in the grey zone on Endogenous ACTH and having such an enlarged right adrenal gland and a moderately enlarged left adrenal. This is such a hodgepodge mix of results.

A reference range wasn't given on the Endogenous ACTH, so I looked it up on the labs website. She is definitely in the grey zone, but closer to the pituitary number.

I guess I am still trying to come up with a non adrenal reason for the enlarged adrenal's. I think this is called denial:confused:

Anyway, she is getting her BP checked in three hours. I am kind of anxious to see what is it. I will let everyone know.

Her are the questions I wrote down for surgeon:

1) what do you think of Chey's overall health aside from the tumor? Ie, high urine microalbumin-- is she starting into renal failure? Low thyroid-- can she take a medication for this

2)if tumor is removed, will her overall health improve? Ie, heart, kidney

3)how fast is this tumor growing? When will it take her life? Life expectance if tumor is removed?

4) Pheo vs. cortisol secreting tumor? Trilostane?

5). Sex hormones? Worse with Trilostane?

6). What would you do if this were your dog?

Any other questions I should ask?

Thanks again for all of the support.

[jmac]

Just wanted to wish you good luck today! I totally understand the anxious feeling. It looks like you have a good list of questions!

Julie & Hannah

[cheydogger]

So, Chey's BP is down to 180 systolic. Even though this is still high, the vet was pleased and recommended we stay on the same dose of medication and re- check in two weeks dependant upon Monday's ultrasound appointment. She took Chey's BP in the hatch back area of my SUV. It was perfect. She still shook a tiny bit, but NOTHING like when in the actual clinic. She still knows we are at the clinic:(. In reality, the vet thinks her BP dropped 20 points given the extreme freight during the first reading at 244 vs. today's mild shaking at 180. Her weight was 54.4 lbs, which is up almost a pound from the last weigh in a week or so ago. My husband asked me and I don't know the answer: will her BP continue to drop staying on the medication? We got a good drop after only being on the medication for a week.

So now, we wait for Monday which I am dreading, but looking forward to in the same breath.

Thanks everyone!

Ro and Chey

[frijole]

I'd add the following questions:

1. How many of these surgeries have you done? (ask if they were pheo cases or regular adrenal tumors)
2. Ask what the success rate has been. Get details if you can on the cases.
3. Ask what the avg life expectancy is if you nothing vs doing the surgery.


As you can tell I like to get right to the point. :D This surgery is expensive and very invasive. You want to make sure that you are up to it, the dog is up to and the doc is up to it.

You will be fine but don't be afraid to ask tough questions. You are your baby's voice and by the way doing a great job.

[Trish]

HI Ro
YAY, its coming down... that must be such a relief to you :D:D so nice they did it in the back of the car! I love they did that to limit Chey's stress for the test :) They will probably do it at the specialists on Monday too and we will see even more improvement.

Well Saturday morning here, just about 9.30 here and a beautiful day.. not a cloud in the sky, I had the best sleep in a month :) Flynn just had his last BP pill so I am hoping it does not bounce right back up again :confused: I am going to lunch with my work team at a winery for our Christmas party. But it is only for a few hrs and Flynny can go stay at my parents for a bit.

Have you gone back to work Ro? How is that working out?

Trish xx

[Trish]

HI Ro - I asked most of these questions, will tell you what vet told me...


I am walking in your shadows, Trish. This is a scary journey we are on with our babies and not to mention extremely expensive. I told my vet the other night that I would gladly give the surgeon 6 grand or whatever the surgery costs, but I want to know she will be ok for another couple of years:). I know in reality I am not going to have an absolute:(

I just can't get over Chey testing so high on the ACTH, suppressing the entire 8 hours on LDDST, testing in the grey zone on Endogenous ACTH and having such an enlarged right adrenal gland and a moderately enlarged left adrenal. This is such a hodgepodge mix of results. all of Flynn's cushing tests have been normal, suppressed nicely on LDDS and his tumour is also in the right, but left adrenal enlarged too but with no sign of tumour on that side, surgeon told me he is going to have a very close look at it during surgery and if any sign of tumour he will take it out too :eek::eek:

A reference range wasn't given on the Endogenous ACTH, so I looked it up on the labs website. She is definitely in the grey zone, but closer to the pituitary number.

I guess I am still trying to come up with a non adrenal reason for the enlarged adrenal's. I think this is called denial:confused:

Anyway, she is getting her BP checked in three hours. I am kind of anxious to see what is it. I will let everyone know.

Her are the questions I wrote down for surgeon:

1) what do you think of Chey's overall health aside from the tumor? Ie, high urine microalbumin-- is she starting into renal failure? Low thyroid-- can she take a medication for thisFlynn also has microalbuminuria, they think most likely from the hypertension, so he is hopeful that will improve but may not fully reverse, his blood tests for kidneys are normal at this stage

2)if tumor is removed, will her overall health improve? Ie, heart, kidney It should do, he said that many of the things we put down to 'old age' could very likely improve, tiredness, panting etc

3)how fast is this tumor growing? When will it take her life? Life expectance if tumor is removed? this was a big one for me, he said that at the rate it is growing ie not visible on last ultrasound in June (well enlarged adrenals were but not tumour) then it could be only a few months esp as it is now in vena cava

4) Pheo vs. cortisol secreting tumor? Trilostane? Flynns tumour arises in the medulla of the adrenal, that combined with the hypertension is what makes them suspect pheo

5). Sex hormones? Worse with Trilostane?I did not ask this one :confused:

6). What would you do if this were your dog?Operate!

Any other questions I should ask?

Thanks again for all of the support.

[Trish]

I also asked Kim's ones...


I'd add the following questions:

1. How many of these surgeries have you done? (ask if they were pheo cases or regular adrenal tumors) I did not get definite number, but he said that he had done 'many', but only about 5 in vena cava as he said they are so rare and we are only a small country (pop 4 million)
2. Ask what the success rate has been. Get details if you can on the cases. Eek, was scared of answer on this one, but all dogs including vena cava surgeries had survived
3. Ask what the avg life expectancy is if you nothing vs doing the surgery. a few months in Flynn's case.
.

Other questions:
What type of complications to be expected?
Management of BP during surgery, is anaesthetist experienced in this area?
As Skye suggested in Flynn's thread, postop management and monitoring?

Will post anymore if I think of them!

[Harley PoMMom]

So, Chey's BP is down to 180 systolic. Even though this is still high, the vet was pleased and recommended we stay on the same dose of medication and re- check in two weeks dependant upon Monday's ultrasound appointment. She took Chey's BP in the hatch back area of my SUV. It was perfect. She still shook a tiny bit, but NOTHING like when in the actual clinic. She still knows we are at the clinic:(. In reality, the vet thinks her BP dropped 20 points given the extreme freight during the first reading at 244 vs. today's mild shaking at 180. Her weight was 54.4 lbs, which is up almost a pound from the last weigh in a week or so ago. My husband asked me and I don't know the answer: will her BP continue to drop staying on the medication? We got a good drop after only being on the medication for a week.

So now, we wait for Monday which I am dreading, but looking forward to in the same breath.

Thanks everyone!

Ro and Chey

That is a good drop in the BP and that is great! I would think that the BP would stabilize after a week on the same dosage. When Harley's vet would increase his BP medicine we would recheck within 7-10 days.

[molly muffin]

It's good that Chey's BP is going down and yea, I'd hope that after a week or so on the drug that it would be stable.
I think you guys have covered all the questions. It's the uncertainty that is nerve racking.

Hang in there!

hugs,
Sharlene and Molly Muffin

[Skye]

hey!!!!! just thinking about you all!!!!! and wanted you to know that! i hope all is well!

[cheydogger]

Thanks for thinking about us! Chey had a pretty good day. We walked to the park and she chased a squirrel. I told her she almost caught it (far from it):D. She also played with her toys and me for a minute today:). I had tears of joy. Her walk was a a mixture of slow trotting and slow walking, but I'll take it;). She stumbles a little here and there and i can hear her nails drag against the cement:(. I think my husband doesn't know what to do with me right now. He sees me crying so much and not myself. He knows I am struggling.

[molly muffin]

Oh Ro, I am glad you guys had a good day. Those count for so much. Have another good day tomorrow!

hugs,
Sharlene

[Skye]

i am so glad you all had shared in joyous times today. They are sooooo awesome. Does she have back injury? shysie nails on back legs drag a little...i can hear them on concrete. Keep watch on top of the nails and top of foot.....for signs of wear. I have my girl on supplement year round and i think that helps alot. Fall and winter of course aches and pains are more apparent for our babies and us! I bet she was close to catching that squirrel....lol smiling sooooo big.....isnt that awesome to see them do that!!!!!!! sweet sweet baby. Precious mom you are!

[Trish]

Hi Ro - glad Chey enjoyed her walk even at a slower pace, playing is good though. I bet her BP is coming down more, especially as she is showing interest in playing. Praying for good results on Monday :)
Trish xx ds

[addy]

Zoe's drag too, I can hear them if we walk too fast. We have learned to walk slower and stop more often, that seems to help her.

Having a day when things seem "normal" is important. We mourn what we have lost. Of course you are not yourself. Anticipatory grief is hard but that is what you are going through.

I hope today will have something "normal" too:)

[cheydogger]

Skye-

No back injury. She has hind leg weakness though which makes her a little stumbly.

I am really nervous about tomorrow....fear of what I am going to hear, but I need the mystery solved. I am sure I will be lighting up the message board tomorrow. Stay tuned......

You nailed it.....the anticipatory grief is killing me.

My heart and thoughts are with Trish and Flynn today. It's a big day.

Hugs all,

Ro

[Tina]

Hi Ro,

Just wanted to let you know that I am thinking about you and Chey today, as well as Trish and Flynn. I totally understand how nervous you are about tomorrow, I am the same way. I am hoping that in getting all your questions answered, you get some positive news for your baby.

Glad to read that you had a good day yesterday and that she was playing! I know the joy that makes you feel. This morning Jasper was chasing his little sis around the house, wresting and playing rough with her for a bit. I almost cried to see that, he has been so uninterested in any type of playing. I guess the increased prednisone dose is making a difference. Hang in there today.

Hugs,

Tina and Jasper

[Squirt's Mom]

Hi Ro,

Our thoughts and prayers go with you and Cheyenne tomorrow.

Hugs,
Leslie and the gang

[cheydogger]

Tina-

Thanks for the support. I am glad Jasper had a good day yesterday too. They are certainly moments to cherish. Unfortunately, today is a weak day for Chey. She was slow on her walk and stumbly. My husband got to see it today and he agreed she is struggling a little. I just fear the worst. I have seen this before, but Chey had the head tilt while on her walk today. Don't know if that is something to worry about or not. She doesn't seem to walk around the house tilting her head. I have cried a lot today. I think I need to get on some "happy pills". I just have no control over my emotions anymore and I have no desire to socialize.

My thoughts are with Leslie tomorrow too.

Hugs,

Ro

[Tina]

Ro, I wish I could say something that would ease your worry. I am a worrier also, and I struggle to take things one day at a time, and sometimes even one hour at a time is necessary. I have to constantly work on this. So I understand completely how you feel and where you are coming from. I cry a lot also, I can't seem to help it. You probably haven't had a chance to read much about my Little Man, but our journey began in May, with a Cushings diagnosis coming at the end of June after many other tests. He proved to be extremely sensitive to Lysodren, and got toxic on it at the end of August with essentially no warning signs. He had an Addisons crisis (very scary), and so far his adrenals have not recovered. For a while it was one thing after another. So now we have been treating him for Addison's, which has proven to have its own challenges. It has been an absolute roller coaster, and I am hoping that now we are on the way to getting it figured out.

I feel like my life has been on hold during all of this. Until last weekend, I had not gone anywhere for months, other than work. So I complety understand your emotions and not wanting to socialize. It just wasn't as important as spending time with him, and honestly, I didn't have the energy.

I'm sorry to read that Chey is not feeling well today, that is so hard. I hope your able to spend some quality time with her.

Yes, my thoughts and prayers are with Leslie today also, and will be with her tomorrow too. None of us are alone.

Hugs to you and your baby from me and Jasper

[frijole]

Ro, Be sure to mention the head tilt to the vets tomorrow - it might be something besides the adrenal tumor and they should know. You probably added it to your list but just wanted to make sure.

We will all be with you guys and sending love and prayers your way! Kim

[Trish]

Hi Ro

It is weird how they have good days and bad days, Flynn is like that too. He has had a couple of stumbly episodes too. So lets just see what tomorrow brings with the scan etc.

It does become all consuming, watching every little thing they do, despairing if something seems worse. I have never let myself cry in front of him, they know when you are sad and I am not wanting that to reflect onto him... even this morning when I dropped him off and was howling inside I told him what a good boy he is and to go get better to come home to us soon and he trotted off fairly happy, without there being a scene which may have upset him. I did sob in the car after I got out tho.. so I don't totally have a heart of steel! I think you need to try and get out a bit Ro, it might just perk you up and maybe a chat with your doctor would be good, you have had a bloody rough year all round and sometimes that black hole can be hard to crawl out of without a little help.

I feel for you, I feel for us, I feel for all the pups struggling and want to send you a big hug xx

[molly muffin]

The anticipation is the worst. Once you know and know what your options are then hopefully it will be better. The pressure to figure things out can be daunting.
Hang in there!

hugs,
Sharlene and Molly Muffin

[Trish]

PAWS UP CHEYENNE!! and Ro too :)

[cheydogger]

I wish our appointment was earlier than 10:30. I think Chey knows something is up because she only got a few green beans and her meds this morning for breakfast:(. They said I could give her a tiny bit of something to wash the meds down. Hoping for the best today. All positive vibes sent this way please:D

[Tina]

Ro,

Wishing you and Chey all the best today. Prayers and positive vibes definitely being sent your way. I will be thinking about you, will focus on 9:30 my time. Know that I will be checking in on you guys throughout the day, but am not able post from work. Good luck, I am hoping that everything goes smoothly. Give your baby a pat from me this morning. :)

Hugs,

Tina and Jasper

[molly muffin]

Great big positive vibes heading your way. :) It'll be okay Ro. :) Chey is a trooper too.

hugs, Sharlene

[cheydogger]

They have a couple of dogs ahead of Chey, so it will probably be a couple of hours before it is her turn. They are doing an abbreviated ultrasound since she just had one a month ago, looking mainly at just the adrenals.

[Boriss McCall]

Sending good vibes your way today. Hope everything runs smooth for you two.

[Trish]

How you doing Ro, she gone in yet? Everything crossed here xxxxx i'm still in bed but blearily grabbed my phone to have a checkin xxxxx

[cheydogger]

I don't know if she has went back yet. My husband and I came back home since they said it would be a couple of hours. A board certified radiologist was doing her ultrasound today from what I understood. I asked if they had high resolution equipment and the tech said it is new equipment and they have been pleased with it.

[cheydogger]

They just called. We are heading back to the vet for the results. All paws crossed.

[clydetheboosmom]

Hi - Just getting caught up on your thread. Paws up indeed. Let us know what is going on.

XO
Lynne

[Trish]

C'mon Chey, good news for your Mom and Dad please!!! GOOD LUCK!!!!!

[milosmom]

hoping and praying for you guys...

[molly muffin]

We need good news only today! So glad your husband is with you. :)

hugs,
Sharlene and Molly muffin

[Trish]

I swear my refresh button is going to wear right off this laptop after the last couple of days.... waiting with you Ro xxxxxxxxxxxxxxx

[frijole]

Paws, fingers and eyes crossed and waiting. Kim

[cheydogger]

Well, there is a tumor in Chey's right adrenal gland that is pressing on the vena cava, but not into the vena cava yet. Her left adrenal is also enlarged. Both adrenals are the same size from a month ago. They don't know what type of tumor it is though, could be cancerous or benign. She doesn't feel like it is a pheo because she feels like Chey would be having more severe symptoms. If I were to opt for surgery, now would be the time to have it done because later will be too late.

Both the IMS and surgeon don't feel like surgery is our best option. The IMS said she is very aggressive with her own dogs as far as removing tumors, growths, etc., but she doesn't think she would go after this one. The surgeon came in and said he could do the surgery, but he wouldn't on his own dog. He didn't feel the benefit outweighed the risk. He said Chey could still need medical management after removing the larger adrenal gland and the surgery is too risky at her age and given the heart issues. He did say he could probably get her through the surgery, but he wasn't optimistic it would be a complete cure for Chey. They feel like Chey is at about her life expectancy, maybe another 6 months to a year and her quality of life is ok right now. It is however, my choice to do surgery or not:confused:

The IMS said this may be a non functional tumor since Chey suppressed on LDDST and tested in the gray zone on Endogenous ACTH. She also doesn't feel Chey has concurrent PDH due to these two tests.

Between Chey and my Rat Terrier, they drink about 10 Cups of water/24 hrs. She said Chey isn't excessive, however she is right on the line. Chey has symptoms of Cushings plus the high ACTH results, but she doesn't think Chey has the Cushing's plumpness/ enlarged abdomen. She definitely thinks Chey has Cushings.

I asked about these sex hormones and she said it would be a waste of my money.

So, she gave me a prescription for Trilostane and recommends Diamondback pharmacy or Wedgewood Pharmacy for the compounding. She would start Chey off with 75mg daily with an ACTH and blood pressure check in 10 days. She will do the blood pressure check in my truck like last time at our regular vet. No matter if I opt for surgery or not, Chey can take the Trilostane. She said she has he pretty good luck with Trilostane.

Chey still has a decent quality of life. It bothers me more than her, but I know she isn't healthy.

What would you guys do, honest opinions????? Would you risk the surgery? Would you treat with Trilostane? Do nothing?

Hugs,

Ro and Chey

[labblab]

Hi Ro,

Thanks so much for your update -- you had an awful lot of folks here sitting on pins-and-needles!! :o

I know you are faced with a truly tough decision. But for me personally, I do put a lot of weight into what vets say their decisions would be in relation to their own dogs. So since you are asking for feedback: for what it's worth, if both the IMS and surgeon feel as though surgery is not the best option, I doubt that I would opt to go forward with surgery if it were me.

As for starting the trilostane, I am somewhat confused as to why the IMS is recommending trilostane if she is not convinced that the adrenal tumor is functional and she doesn't believe that Chey has PDH.


The IMS said this may be a non functional tumor since Chey suppressed on LDDST and tested in the gray zone on Endogenous ACTH. She also doesn't feel Chey has concurrent PDH due to these two tests.

Can you remind us as to Chey's outward symptoms that are consistent with Cushing's and that you would be hoping to alleviate with treatment?

Marianne

[cheydogger]

Hi Marianne-

Since we don't know what kind of tumor we are dealing with, she felt Trilostane would be the safest option since you can stop it without permanently destroying the adrenal tissue (in most cases....I guess there are a few cases of adrenal necrosis reported). We want to see if we have any luck with it in getting the blood pressure down too. She agrees Chey's case is a tad bit confusing.

Chey drinks a lot of water, pees a lot, ravenous, lethargic, exercise intolerant, hind leg weakness(she won't jump onto the bed or into the car), high blood pressure. I would really love to see Chey regain some of her strength. She is a little stumbly sometimes too.

She also said that we may add a little thyroid if Chey's energy doesn't perk up after being on Trilostane. Dogs don't have primary hypertension, so Chey's hypertension is secondary to this tumor more than likely.

I admit confusion on a non functional tumor.

[lulusmom]

Your vets probably think it's a non-functional tumor because the other adrenal gland is normal or a bit larger than normal. Functional adrenal tumors dump cortisol independent of the pituitary so in essence, it turns off the pituitary. Because the adrenal gland without the tumor is not getting signals from the pituitary gland, it starts to shrivel up from lack of use.

With respect to the negative LDDS and very positive ACTH stimulation test, I have seen a study or abstract of a study where a small number of dogs with hyperadrenocorticism had a normal LDDS result with a positive ACTH (greater than 24 ug/dl). Some were eventually diagnosed with PDH and some with an adrenal tumor. Like Chey, these dogs were all clinically symptomatic too. It's a rare occurrence but it does happen.

[labblab]

In his article discussing interpretation of LDDS results, Dr. David Bruyette also offers the statistic that 5-10% of dogs with early PDH will test negative on the LDDS but positive on the ACTH.


When interpreting LDDS test results, first evaluate the eight-hour postdexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

But since your IMS is discounting the likelihood of PDH, I guess that would not explain Chey's test pattern. Given all the problematic symptoms you've listed, though, I guess I would go ahead and give the trilostane an initial trial in order to see if that improves Chey's quality of life during your remaining time together. How much does Chey weigh?

Marianne

[Trish]

Hi Ro
I am back now, have picked Flynn up from the pet hospital and have him back at the motel with me, will post more on his thread soon.

Well, there are a few options to consider for Miss Chey. They are hard ones too. I do not know enough about the Cushing's side of things to even offer any thoughts on that, but I am sure all the other angels will be in with their excellent advice. I just wonder about treating it with normal LDDS?

Of course I am now biased towards surgery, but I was ready to listen to what the specialists told me regarding risks, and that question you asked about doing it to their own dogs is a goodie. Quality of life is so important, interesting the comments and I have heard a couple of people write that the symptoms they see affect them more than their dog! So I am sure Chey is going to guide you in whatever decision you make, I know you are going to do the best for her whatever you decide.

Big hugs for you, hubby and Chey and Macey too! xxx

[cheydogger]

Yes, her results are very confusing. I am still not 100% convinced it isn't a pheo and/or 100% convinced she doesn't have concurrent PDH.

Chey weighed 55 lbs at the vet today. She has gained a little. What is interesting is at her yearly in July, she weighed 53, then when she started eating dirt and I took her in October, she weighed 56, Friday's BP check was 54.3, now today she weighed 55. Could she have a tumor that doesn't secrete all the time, only periodically? The LDDST and Endogenous were done on the same day. The ACTH was done before these two tests. The only thing that has changed dietarily is I have started giving her a few green beans and a baby carrot or apple slice as a bedtime snack. I have never weighed her at the specialists office until today. I guess different scales could give a small variance of measurement.

I have read that there are a small percentage of dogs that test negative for PDH despite having it. The Endogenous was supposed to be the tell all and she tested non-diagnostic. Either way, she does have an adrenal tumor.

[labblab]

Well, just to muddy the water further for you :o, if it were me starting my dog on trilostane under circumstances that remain so questionable, I would want to start on a lower dose unless your IMS has a specific rationale for the 75 mg. dosing. Since Chey weighs only 55 pounds, I'd prefer to start at the lower end of Dechra's initial dosing formula which is 1 mg. per pound. Using that formula, you could actually use Dechra's brandname Vetoryl in the 60 mg. capsule form. Many of our members have been very satisfied with Diamondback's compounded products, but I would prefer to use the brandname product if it came in a dose that was appropriate for my dog and if I could afford the additional cost.

I know that dogs with functional adrenal tumors may require a dosing regimen that differs from dogs with PDH. But since we're still unclear as to what is really going on with Chey, I'd personally rather be conservative in starting out with the trilo.

Marianne

[cheydogger]

I was just reading Dechra's website and it says 1-3mg/ lb of body weight as the starting dose. With that, it looks like she is starting Chey off in the middle:confused: she said to monitor her water intake closely and definitely don't give the med if she didn't eat and call her immediately. She also wants to do the ACTH at 10 days instead of 14. I am just lost and scared. This whole process has been so hard and I don't want to deal with her levels going too low. The good thing about Trilostane is it leaves the body fairly quickly. I just don't want to put Chey through a bad time while trying to help her. Ugh!!!!

[Trish]

I am with you there, about not being 100% convinced its not a pheo either and they do secrete at different times. She had such a high BP too, did they check it today? That was interesting dogs do not have primary hypertension, I did not know that.

I am wanting to know Flynn's histology which is not back for day or two. His other adrenal looks ok at surgery, he does not need to take any steroids and they suspect pheo but thats the trouble is we cannot biopsy with the adrenal gland being in such a stink place! Flynn's surgeon said if the adrenal was anwhere else in the body than where it was the surgery would be a doddle. It would be so much easier if you could make the decision knowing what Chey was actually dealing with. Geez it is hard isn't it... least you do not have to rush with the decision Ro, the scan said there is no growth in past month so at least it is not something moving real fast and you have time before you need to decide or start treatment. xx

[cheydogger]

BP was not checked today since it was just checked Friday. She will check it at 10 days if I choose to start with the medication.

Yep, she said it is very rare for a dog to have primary hypertension. The darn adrenals regulate to many things in the body. The IMS said if this tumor was on any gland other than in the adrenal, she would consider surgery.

[molly muffin]

It's like you got answers and then you got more questions. :( It is a very hard decision to make when you don't know positively what is going on. Like you do know there is an adrenal tumor, but not what kind (benign or malignant)

It is a hard decision to make as to what to do and if surgery is not going to really be the cure for Chey as it should be with Flynn, then that might make the decision to do it or not a lot more complicated.

For instance though, if I was told I could do surgery on molly but that she'd still have these same medical problems, then I don't know that I would and probably wouldn't. If they said that it would cure her and she'd go on to live out her normal life span, then I probably would go for it. It's all so very hard. :( I'm sorry that it isn't more clear cut for you and Chey.

I do know though that whatever you do, Chey will have the best life with you and the family. That she will be happy being with you no matter what and that you will do what you think is best. Though we can say what we would do or not do, only you know Chey, how she is and what perception you came away from the IMS, surgeon, and vet with. We support you no matter what you end up doing or not doing.

hugs,
Sharlene and Molly Muffin.

[cheydogger]

Sharlene-

The vets were trying to tell me that Chey has pretty much lived out her lifespan. They said around 14 for a dog of her size. I think they were saying regardless of surgery or not, it probably wouldn't lengthen her lifespan, but I could certainly end her life quickly if surgery didn't go we'll. I probably won't opt for surgery, but it is still swirling in my head. If she were 9 or 10, then yes, I would be more for it.

I am still debating the Trilostane. I guess I want to because I have this vision that we will go on a normal walk again and maybe she will want to sleep with me again. Maybe, I am expecting too much from an old girl. I have just read stories of people getting their old dog back after treatment with meds:). I hope for that outcome if I choose medication:D:D:D

Either option I choose, I will live with guilt for not choosing the other. Like, when her time comes to cross the rainbow bridge, I will wish I had opted for surgery......on the contrary, if I opted for surgery and she didn't make it or ended up worse, I wouldn't forgive myself. It's really a no win situation:(

[Trish]

Stop right there Ro!!!! You do not have to live with any guilt, as the only thing you are doing is wishing her here with you longer, as we all do! I to was petrified I was going to kill Flynny off with the surgery, but I came to an agreement in my mind that it was NOT my fault if he died. I would have been devastated but I was only trying to do the best I could for him. We try and make the right decisions with the information we have for our babies. Please do not blame yourself for what is inevitable for all our pets, do not get blame/guilt mixed up with sadness at the potential loss of Chey which could be months/years away for all we know! ALL of our pets are going to pass at some point, so are we for that matter but it is never going to be your fault Ro, or due to the decisions you make that cause it... So you can feel sad and rage at the world for what your Chey is going through, but please do not put it all on your shoulders... for you are the perfect Mom!

[frijole]

Hello! You have a lot of decisions to make and we can only share what we've seen in other dogs or in our own... in the end you have to go with your gut and what you believe is right. We support any decision you make.

Perhaps in the last year things have changed but when I was researching surgery options the average expectancy after pheo removal was 6-9 months after a successful surgery - alot of dogs didn't make it thru either surgery or the few weeks afterwards (infections). We lost precious time before we figured the pheo thing out and she had lost some strength. So I gambled that my Annie would live longer than 6-9 months if we did nothing and I was right. She beat that by a year. Yes she lost weight and hair. But she was a happy dog surrounded with love. Don't think that doing nothing is not doing what is best in your case -

Back to the cushings/trilostane debate.. I too am confused by why the vet wants to treat it even though she said it isn't cushings. I never used trilostane so I'm just sharing what I've seen here over and over and over... you don't want to go middle of the road with dosing - you want to go low end as Marianne mentioned. Some dogs don't tolerate it and its always best with trilo to start low and tweek upwards.

Every dog is different and you know your baby best. You will figure out what to do. If you are still unsure get another opinion at Purdue. I am confident you will make the best decision for Chey.

Sending love,
Kim

[cheydogger]

Kim-

She does think Chey has Cushing's vs. Pheo.

[frijole]

Sorry.. somehow I read that she said no cushings but I think you wrote no PDH... my bad.

[molly muffin]

If you think it is worth a try and that it will help Chey, then go with what you feel is best for her. That is all any of us can do. Really. If you feel that it isn't working, then you can stop it. But yes, do start low and go up if needed. Some are very sensitive to it.

Ro I wish we could just go take a walk, watch the dogs play for awhile and forget that this exists in any of our lives. I'd probably have a big park with all of us there and our dogs running and playing and happy if I could. :)

hugs,
Sharlene

[Skye]

Hello......hey hun...........((((((hug))))) chey.....kiss on snout and tummy rub....
would you be willing to seek 2nd opinions out?
did they discuss the risk of the tumor pressing into vena cava and the outcome if it did grow and do this?
and to clarify, the reason to not perform surgery is age, and bp.
she does have cushing symptoms that can be treated with Trilo
It is a horrifically invasive surgery, i understand the words you typed...guilt either way......oh goodness could i relate to that.
you have ims and surgeon saying they would not if their own, maybe if you got 2nd opinion and the response was the same, you would feel better about your own decision?
hugs..........

[labblab]

Hi Ro,

You know, another thought that occured to me overnight is this...

Since your vet is comfortable with ordering compounded trilostane, perhaps an option would be to place the first order in the form of 25 mg. capsules/tablets. That way, you can start out with the 75 mg. that she has recommended, but you can also easily alter the dosage (either up or down) depending upon Chey's response.

Once again, this would be a more expensive option because you'd be starting out giving 3 capsules daily. But in the long run, it might save money because you'd have greater dosing flexibility. Otherwise, if the 75 mg. turns out to be too much, you're stuck with those bigger capsules...

Marianne

[cheydogger]

Marianne-

That sounds like a good idea, however, I don't know if they can manipulate the prescription since it is written for 75mg. I will ask when they call to get billing and payment information. My husband is faxing the prescription to Diamondback today.

Skye-

All I remember her saying about vena cava impairment was the potential to throw a clot and bleed into the abdomen. I think I felt like vomiting at that point and tuned it out. I just feel doom and gloom. I couldn't stand to see her suffer from those occurances. I just feel hopeless. I go through periods of thinking about trying the surgery and then I think, "no way!" I am at a loss here. I do think about getting a third opinion, but then I think I already got two big fat no's. I guess either route will not extend her life. She is at the tail end of her lifespan. I just don't want her to suffer either way and honestly, I can't stand the thought of seeing her hit rock bottom. I solely took care of my mom with cancer and watched her go down fast and I still have post traumatic stress from that and this was 6 years ago. I don't handle traumatic experiences well. I suffer for a long time. I have anxiety issues anyway and it gets bad in instances like this. I have been a mess....can't sleep without medication, having anxiety attacks, etc. This extreme stress isn't helping my chances of conceiving either, especially at 40. I just feel hopeless all the way around. Why does my dog have to be in the 15-20% category of hyperadrenocorticism being caused by an adrenal tumor???? Makes me angry:mad:

[labblab]

Ro, you're correct that the Rx would have to be rewritten in order for the dosing change to be made. But the pharmacy might be willing to call your vet's office in order to obtain a verbal revision if that was a route that you wanted to go and you don't want to wait to obtain a different written prescription. Either way would involve talking it over with your vet first, though.

[cheydogger]

Marianne-

I asked the IMS about prednisone and she said I don't need it since Trilostane is short acting. What do you think about that?

[labblab]

We really do enourage members to always have prednisone on hand, regardless of whether their dogs are being treated with Lyosdren or trilostane. I understand what your vet is saying in that, theoretically, the effects of trilostane are relatively short-lived and most overdosing episodes can be managed simply by temporarily discontinuing the medication and subsequently re-instituting at a lower dose. However, having said that, we have had experiences here in which dogs treated with trilo have exhibited very worrisome and uncomfortable symptoms in the meantime such as vomiting, diarrhea, extreme lethargy, etc. And we have had some dogs for whom the trilostane was never again re-instituted and supportive prednisone remained necessary due to longterm suppressive effects on the adrenal glands.

If your vet has an emergency service whereby you could immediately take Chey in for evaluation at any time during the day or night in the event of a cortisol crash, then the prednisone may not be necessary. But if not, I would want prednisone on hand in the event that problems arose during the night, weekends, or holidays (as often seems to be the case!). As long as your vet knows you understand the prednisone is only to be used for emergency rescue, I don't know why she would have a problem with dispensing a few for you to have on hand.

Marianne

[cheydogger]

It is a 24 hour emergency hospital where the IMS works. It is about 20-25 minutes away from home. Is that close enough? During normal business hours, my regular vet is only 10 mins away.

[labblab]

And just as a P.S. as to the trilostane dosing, I would think the IMS would also be OK with re-writing the Rx to be filled in terms of 25 mg. capsules. Virtually all dogs taking trilo end up with some degree of dosage "tweaking," and there's not really anywhere to go with a 75 mg. capsule in the event the dose needs to be adjusted downward. If you're willing to pay the price to initially administer 3 capsules daily, I don't know why the IMS should have a problem with that. Once Chey gets stabilized on a dose down the road, then you can settle in on a larger capsule size if that's what's called for.

Sorry, I was typing this while you posted your new reply and so I had missed seeing it. Yes, your vets sound close enough to field an emergency. But I'm always puzzled when they are reluctant to give a few prednisone to owners to have on hand, just in case. It just doesn't seem to me as if it should be a big deal, and it can be a real comfort to know you've always got that on hand no matter what time of day or night or weather condition, etc. might arise.

[Skye]

Ro.........okay its good to know I am not alone but sad to hear someone else suffers like i do. I do not take medication as I force myself to battle it all alone and at times i am certain i am having heart attack or stroke or both. I have anexity and traveling can set that off, I dont handle situations near to the heart in crisis well at all. I lost my mom in 1997 and it feels like yesterday. I too took much care of her. Held her as she passed to her new home.
weigh things out.......black and out. Facts only with your baby. Hard to do, very difficult to set emotions aside. But focus on her only and best for her and weigh the odds out pros cons on two pieces of paper. Remember facts only. Sometimes its not easy to accept the answer that way.....but it is sometimes clearer on what you should do. I want you to know i am here for you in any of the battles you face........listen to your baby......she communicates to you all the time as you know, listening to your baby with your emotions off to side you might hear what their saying better..........Just trying to offer anything i can to help, not easy, doesnt always work. But in the chance it may........want to mention it.

[Trish]

Hope Chey is having a good day Ro ... are you getting your head around everything? xx

[cheydogger]

Chey had a decent day. She trotted and walked slow on her walk today. If she isn't lying around, she's searching for food. God, love her. We have birds so there is always an opportunity to find a pellet of food on the floor.

I don't think I will ever get my head wrapped around this. I ordered the medication today, so we will see how that goes. I am nervous about it, but I really want to try to help her. I am obsessed with her every move. She did some hard blows through her nose tonight that scared me. I thought she was coughing. I have no idea what that was about.

[Tina]

Hugs to you Ro, I just had a chance to get caught up on everything. I wish there was something I could say to help, and I am so sorry you are having to go through this. It is a lot to think about, and as others have said, you have my support with whatever you decide.

I do want to chime in about the prednisone. Please ask your vet for a few to have on hand. I know that trilostane goes out of their system quickly compared to Lysodren, but after what I saw happen with Jasper when he crashed and his cortisol bottomed out, I would not be without it even if he was getting trilostane. As Marianne said, it seems like problems happen late at night or on weekends or holidays. That is just what happened to Jasper. And you certainly don't need anything extra to worry about. Just my two cents on that.

Hugs to you and Chey,

Tina and Jasper

[Trish]

I am hopeless on all the cush meds, so won't offer any advice with all these experts/angels here to guide you :D but I can be in the cheer squad hip horaaying the improvements we are going to see with Chey in the near future!! Have a good day Ro, Chey's thread is one of the first I check everytime I log in, I am so hoping we see a big improvement with this treatment for your baby xx

[Skye]

hey!!!!! stopping by to check in on you and Chey. ((((((hugs)))))

[Tina]

Ro, just checking in to see how you and Chey are doing and to let you know I'm thinking about you. Hugs....

[molly muffin]

Hope Chey is doing okay and you guys are continuing to enjoy some nice slow walks.

Sharlene and Molly muffin

[Trish]

Hi Ro - whats happening with Chey??? She doing OK?? You doing OK? You got the meds? When you starting? So many questions :D:D Hope all is OK on your side of the world xx

[cheydogger]

Hey All-

Chey is doing ok. She did pretty good on her walks the last couple of days:).

I got the pills today, so will start her on them tomorrow morning. I am very nervous about it.

I called Dechra yesterday to get information on The medication. Wow, they are very helpful! I talked to a tech for about 15 minutes, then she got Dr. Fertig on the phone and we discussed Chey's case for about 40 minutes. I was a few minutes late getting back to work:eek: I walked in and my patient was waiting for me. Lol. Anyway, Dr. Fertig couldn't understand why Dr. Stanley started Chey off at 75mg. He didn't know how she came up with that number. I went over Chey's test results and symptom profile to which he would diagnose Chey as Cushing's. He would have rather seen a starting dose of 60 mg., but he didn't think 75 was too much. He said to go ahead with 75. I will discontinue the meds if she refuses to eat and I will watch her closely. He didn't think having prednisone on hand was necessary since I can get her to the vet fairly quickly if need be. As I have read on here, she could feel puney from cortisol withdrawal at first.

So,...... Tomorrow will be day 1. Wish us luck. My 1 year anniversary is this weekend, so hubby and I are going to dinner tomorrow night. I will be taking Chey to stay with a friend for a couple of hours because I don't want to leave her alone.

Dr. Fertg at Dechra said I talked like I was in the medical field since I knew so much. Lol. I laughed and told him I am in the dental field, but learned so much from many hours of researching Cushing's and from being on this site. He was familiar was K9Cushing's;)

I will keep everyone posted.

Hugs,

Ro and Chey

[Trish]

Hi Ro

Wow, it sounds like Dechra provide a great service... nice to have access to their vets with experience. Reassuring to hear his thoughts too.

HAPPY ANNIVERSARY WEEKEND to you and hubby! I hope you have a great night out to celebrate. I am sure your baby will be in good hands for a few hours so you go out eat, drink and enjoy your evening!

Nervous times for sure for Chey, pleased to hear she is enjoying her walks and I am sure you will be getting her symptoms under control and the medication is going to perk her up and feel even better :)

Go Chey!
xx

[molly muffin]

Have a wonderful evening out! You two sure do need some "away" celebrate by yourselves time. It's very stressful on a couple going through something like what you guys are with Chey. So, enjoy.
Several of the members here have ended up speaking directly with Dechra as you did. They seem to be pretty good about willing to do that, so I'm very happy that you have an extra contact at the company.

I'm sure tomorrow will go okay. Enjoy date night!

hugs,
Sharlene and Molly Muffin

[milosmom]

ro i also called dechra last week and again today.i must say they are very caring,helpful,will answer any questions you have and will even speak with your vet.very grateful to this kind of availability.they also have a "safety call" that is available 24/7... enjoy you date with your man !!! patty and milo

[cheydogger]

First dose at 7:15 a.m. Feeling really nervous about this.....

[molly muffin]

Just keep an eye out. It'll be okay. You know all the things to watch for. Jump on here and ask if you notice something, if it is extreme call the vet.
Sending you lots of big hugs. Positive vibes only!

hugs,
Sharlene and Molly Muffin

[cheydogger]

I took her for a walk just a few minutes ago and she tripped a couple of times, one of the times she face planted into the mud. She has been a bit stumbly at times, but she has never face planted. I don't know if maybe the cortisol is coming down or what. Any advice???? She is still moving about through the house. She has had three bowel movements already this morning. The first BM was right after taking the capsule and it was a firm poo, then the two after we're mushy, but not diarrhea. The face plant really bothered me. She mostly walked slowly with a few trots here and there. She also grabbed a hotdog out of a neighbors yard, so that may give her a little diarrhea at some point today. Who in the world throws hotdogs in their front yard:mad:??????

[Trish]

Haha at grabbing the hot dog, that's funny... go Chey!

Would it work that fast though? You poor thing, you are going to be watching her like a hawk, even more so than usual until you get a handle on the drugs and she settles down, which she will!

Keep the faith Ro, it is going to work!
xx

[molly muffin]

Well, yes she could be a bit off without going too low after her first pill. She how she is doing the rest of the day, although vetroyl does wear off pretty quickly.

I don't why people would throw food in their yard, but I know Molly would be all over it as fast as lightening.

Sharlene

[cheydogger]

She has been fine around the house all day....just not so good on the walk.

[Trish]

Ohhh tricky, was trying to find Chey's thread and you changed the title! Pleased to hear Day 1 has gone fine.... long may it continue :)

[molly muffin]

That is good that Chey has been fine around the house.

Sharlene and Molly Muffin

[cheydogger]

Day 2 going alright so far. We probably won't go for a walk today since it is raining. I pray she continues to do well:)

[frijole]

Appreciate the updates! Have you seen any changes in the cushing's symptoms? Kim

[Tina]

Hi Ro,
Glad to hear Chey is doing ok on the meds so far, that is good news. I hope you and your husband had a nice celebration for your anniversary. You deserve some time out. :)

Hugs,
Tina and Jasper

[jmac]

Hi there-

Glad to hear Chey is doing well so far. I sure hope it continues!

Julie & Hannah

[cheydogger]

Kim- Thanks for listening to my updates. Lol. Chey has been laying around a lot, but that is typical and hard to estimate changes. Water consumption seems to be a little less. Between both of our dogs, they were consuming about 10 Cups of water daily. I gave them 6cups at 8:00 a.m. (It's now 5:00 p.m.) and only about 1 1/2 cups seem to be gone so far. She just had a solid bowel movement and hasn't vomited at all. I will call tomorrow to schedule her ACTH test, BP check, and electrolytes for next Monday. That will put us at 11 days post first dose. I hope all continues to go well.

Trish- I changed my thread title so others dealing with adrenal tumors and treating with Trilostane may chime in.

Thanks for the support.

Ro and Chey

[frijole]

That's what I'm talking about! Less water consumption means it is working. That is what the purpose is! It won't get rid of the tumor but it is designed to fight off the symptoms it causes. This is great news.

Keep an eye on the poops (fun isn't it?) Look forward to the acth test results. You are doing everything you can and it seems to be working - not more you can do so this is truly great. Celebrate all the wins on this journey!!! Hang in there. Kim

[cheydogger]

She had diarrhea tonight. Should I give her the medication in the morning?

[frijole]

Diarrhea is a sign that cortisol levels are too low and you should NOT give trilostane tomorrow. If you have a pamphlet it should tell you that. Did you make any food changes or give any new treats? Just double checking. I'd hold off on prednisone for now (give it only if Chey seems to be in distress as in can't get up, hold head up). If you just don't give trilostane tomorrow am you should be ok.

That said - I would report it and ask for an immediate acth test. Its the only way to confirm cortisol levels.

If you think its something else then ignore my advice. :D Kim

[frijole]

Here's a link with all sorts of info on trilostane from Dechra who makes it

http://www.k9cushings.com/forum/showthread.php?t=185

[cheydogger]

The only thing I have given her today other than her food is a few green beans, but she has had them before with no problems. She ate a hotdog yesterday afternoon. Would she just be getting diarrhea from that? I don't have any prednisone as the doc didn't think it was necessary. I gave her the capsule at 7:45 a.m. and she had diarrhea at 8:45 p.m.

[Trish]

Wonder how long that hot dog was sitting in the yard for? If it was food poisoning though you would think she would have some crampy tummy pain too, during our walks on the beach over the years Flynn has eaten some pretty nasty manky looking dead things and ended up with a crook gut a couple of times, but I could tell as along with the diarrhea he had pain, whimpering etc and vomited. How often do her bowels go? Hopefully next one will be back to normal... hope she has a good night Ro.
xx

[labblab]

I see that when Chey grabbed the hot dog out of the neighbor's yard yesterday, you were already speculating that it might give her diarrhea. :o :(

Is that fairly common -- that she will have diarrhea if she eats something out of the ordinary? The safest thing is to hold the trilo dose tomorrow, but if the diarrhea clears up I would go ahead and resume the trilo on Tuesday.

Marianne

[frijole]

If the hotdog were that bad it would have happened yesterday - the body would reject it quickly so to speak. ;) I'm betting it's the trilostane. Don't panic - we've seen this plenty of times. Just do not give any more trilostane and get the acth test done tomorrow. I know it's a pain but you need to know.

Also re the prednisone - it is for emergencies and hopefully the trilostane will leave the system and the symptoms won't get worse. Just so you are aware - not to scare you - you will KNOW if Chey needs prednisone. If it were to happen does your vet have a 24 hr emergency number to call? If not go to any animal hospital that is close and tell them you need prednisone.

Like I said - this is precautionary. Sending best wishes, Kim

[cheydogger]

I just assumed the hotdog would give her diarrhea. She doesn't get much in the way of extras, except fruits and veggies. I know rawhides and dairy give her diarrhea, but she hasn't had any of those. She is acting ok....going up and down the stairs. I don't believe she is in crisis mode, but I am still a little uneasy. It sucks watching her bowel movements tonight because it is raining. I had to change clothes after her last outing.

[labblab]

Since Chey has only had two doses of trilostane so far and you know that she has had diarrhea in the past in conjunction with dietary "extras," I would guess the hot dog may be the culprit. But certainly you can contact your vet tomorrow for feedback if she still seems "off" in the morning. It does make it really hard (frustrating!) when you are monitoring her behavior so closely now, and she ends up doing something out of the ordinary, like grabbing that hot dog. But if she otherwise seems OK, I agree that it doesn't sound like a crisis situation. So I'll hope that she straightens out tomorrow and you can resume her normal routine.

Marianne

[molly muffin]

Poop patrol. Why does that always seem to need to happen during icky weather :(
Just wanted you to know, I'm sending bestest wishes for a normal poop in the morning. Walking up and down the stairs doesn't sound like a crisis moment. Did eat okay during the day?

Sharlene

[Trish]

Hope you all had a good night Ro... i hate poop patrol. I am longing for the day I do not feel the need to stalk my dog every time he wants to go outside for whatever reason, he is starting to get a supicious look on his face and taking himself into places that are deliberately harder for me to follow, even though I try and be stealthy ie the undergrowth behind the garage.. :cool: Thank goodness it is not raining here though :D Looking forward to a good report tomorrow xx

[cheydogger]

She ate like normal yesterday and would like her breakfast this morning, but I held off feeding until I hear back from the vet. I put a call in about an hour ago. Her first bowel movement this morning was soft followed by a couple of solid droppings. She did kinda trip on the bottom step of the deck last night while trying to go up. Hopefully, the vet calls me shortly.

Yes, poop patrol is a ball of fun. Lol

[molly muffin]

Did you hear from the vet?

Sharlene

[cheydogger]

Nope, I haven't heard a word from the vet! Unreal!!! I called Dechra and they said I should withhold this mornings dose, so I did. The original concern of starting her too high may be the culprit. I will wait to see if the IMS calls me back. Dechra didn't think I really needed to do blood work at this point since she only had a couple of doses. They recommended not giving the med for 48 hours then starting again at a lower dose. Some dogs just need to start much lower and work up, I guess. I was kind of shocked to see the water consumption cut in half with just two doses though.

I took her for a walk and it seems like she trips over her front paws. I don't know how to explain it , but it's like she almost steps on the top of her paw instead of the bottom paw pad. I wonder if it is just weakness or neurological. Her bowel movements are in between soft and solid today. She lays around, but will get up to meander around the house and will go up and down the stairs periodically.

[labblab]

Ro, I'm afraid I can't speak to the issue of Chey's tripping, but I'm not at all surprised that Dechra is recommending a dosage decrease. If your vet agrees with a decrease, I hope he/she will write the new Rx for a much smaller dosage unit this time around. You're just where I was afraid you'd end up -- with a bunch of 75 mg. capsules that may be too large to ever use. :o :(

I don't know why vets so seldom think of that when they write prescriptions for new Cushing's patients -- that it's much better to start with smaller dosage units that can be combined rather than large units that cannot be split. Anyway, this time around, I'd sure ask your vet to keep this issue in mind if a new Rx is written. For instance, as we said before, you could ask for 25 mg. compounded capsules. Or if you want to use brandname Vetoryl, you could shoot for 30 mg. capsules.

Marianne

[molly muffin]

Can you get the 75mg tablets, compounded into a lower dosage maybe? Check and see if there are any compounding pharmacies around you and what they would charge to do that.

Sharlene

[cheydogger]

Oh, yes, Marianne, you called it! I still haven't heard from the IMS. I am very thankful for this site and Dechra! I don't want to act like a know it all to the vet which is why I didn't ask for a lower dose plus Dr. Fertig said to give the 75mg a try. He too would have liked a lower starting dose, but didn't think 75mg was horribly high. Thankfully, we didn't have a crisis. I will keep the 75 in case we need to increase later.

[cheydogger]

Sharlene-

There is a compounding pharmacy close by, so I may check into that once the vet and I agree on a new dose.

[Boriss McCall]

Good luck with finding the new dose. Hope you find the sweet spot soon. :)

Don't get discouraged if it takes awhile. It has taken us a while with Boriss. He has been on the meds since September & we still haven't gotten his numbers down all the way to the recommended number.

Hopefully you will be one of the lucky ones who gets the right dose & never looks back. It seems like there are several dogs on here that have gotten it just right pretty quick. ;)

[frijole]

I think that in order to treat cush dogs vets must have to treat their very own dog and experience it first hand. The drugs are chemo drugs for crying out loud - not aspirin! I know they have to deal with all kinds of issues but heck if we can research and learn about it for FREE the very least they could do while charging hundreds per visit is to get up to speed. Oh yeah - and return phone calls.

Like I said - if they had gone thru what you are going thru and many of us have - they would be calling back as they'd understand what a big deal it is and overdoses DO happen with trilostane.

Glad you found us Ro - hang in there. I agree that compounding might be a very good way to not waste the supply you have. Keep us posted! Kim

[cheydogger]

I just talked to the IMS and she is really surprised the water consumption was down by half so quickly. I told her I wanted to back down to 60 at the highest. I also told her I talked to Dechra and they suggested 60 too. I didn't mention this site and the suggestions on here as to not further push any buttons. Lol. So......she is giving me 60's for free! I will wait 48 hours as suggested by Dechra tech and restart on Wednesday. I asked about the paw issue and she said it could be due to weakness or neurological and that the neurologist could look at her next time I am in. There is a term for it where it could be a miscommunication from the brain:(.

[frijole]

Good mom! Measuring that water gave the IMS a FACT to work from which made the decision to lower the dose easier. It's the little things you are doing that count. We don't care if you tell the vets about us. ;):p We've been there too. :D

Anyway it's just wonderful that the IMS stepped up and is giving you the 60s for free. So glad to hear it worked out.

Also good for you for calling Dechra. It can be nerve racking but that's how you get answers sometimes and it shows the IMS you are serious about helping your Chey... and who can fault you for that.

Re the walking thing - yeah there is a name and I'm at a loss also. Annie got it on occasion and I do believe it is neurological. Maybe others can be more helpful but at least you know it isn't uncommon.

Again, good job. Oh and I hope you have fed Chey by now! Poor starving baby. LOL Kim

[molly muffin]

Yay Ro! Awesome mummy. So glad that everyone is now on the same page at 60mgs and that the vet is giving it to you for free! It's always the facts that do the trick. Journals are good to have to for that very reason and some of the members here keep one for that very reason.

Sharlene

[Trish]

Free drugs is good, glad it worked out and Chey is doing ok apart from the stumbling. Is she due a BP check to check the antihypertensives are working? How did the anniversay to? Nice dinner?
xx

[addy]

Trish I am so glad you are cutting the dose, good job. Zoe does the front paw thing but she had issues with that paw prior to Trilostane so we assume it is an old problem gotten worse by lowering her cortisol. After her surgery and subsequent dose change she was falling on her face alot. The paw would just give out.

Her back legs are stiff and she knuckle drags on the one leg and walks on her toes but again, she did that prior to Trilostane. I had that better for a while by walking one day on and resting day off, starting with a ten minute walk only and then working up, adding 5 minutes a week as long as she could handle it. That excerise regime really did help her. Her surgery cancelled all our gains though:(

[cheydogger]

No BP check yet since we were going to do that at the 10 day aCTH test. It looks like that will be pushed back a little now since we had to decrease the dose. I am just praying this new dose goes smoothly without diarrhea.

I was reading up on the paw issue last night and a lot of those problems stem from spinal issues, such as a disc. Who knows. I know she has a downward slope in the middle of her back, so maybe that is part of the problem.

Chey's back legs are stiff too. She was getting a little stumbly prior to taking the Trilostane too. It was just very apparent the day I started her on the med. I think she had her head down while sniffing and happened to trip which is why she face planted into the mud. It certainly was heart breaking. I want to keep walking her at least a little before she completely looses muscle tone, plus exercise is good for her heart problems. She doesn't trip when she is trotting, only when she is walking really slow. It will really tear me up when she has a full blown fall:(

Yes, hubby and I had a wonderful dinner, but was it expensive!!! Poor hubby, I have just been so depressed and consumed with Chey that I haven't put a lot of energy into us. He understands though.

[Trish]

I was wondering if it is something to do with her back too? Flynn has had a bad back in the past too, he was stumbling a little as well. But lately he has been going so slow I have not noticed it.

So happy you had a nice dinner out for your anniversary... yay expensive?! You deserve it, your hubby sounds a good man supporting you through this!
Trish xx

[molly muffin]

It's Wednesday! Did you start the 60mg today? How is Chey responding?

I'm so glad your husband is being supportive of you and Chey through all this. It really helps to have someone just There when things get tough.

hugs,
Sharlene and Molly Muffin

[cheydogger]

Yes, first 60 dose this morning around 7. I am home on my lunch break at noon and she seems to be doing ok. I worry about her all day while I am at work. I can't wait to get home around 5 to hear her barking because she wants foodies. I usually hear her as soon as I step out of the car:). Praying for a smooth ride.

Thank you so much for thinking about us.

Trish- Chey stumbles when she is walking slow, not usually when she is trotting.

[addy]

Hoping that smooth ride is continuing through the night:)

[cheydogger]

Water consumption has been up a little tonight. She did great on her walk tonight and ran down 4 steps to chase the UPS truck, running to each side of the house just like she used to do when she was well. I always tell her she almost got them;). All of her bowel movements have solid except the tail end of the last one was softer about 30 minutes ago.

I have noticed something a little different when she is on a walk...... You know how a horse does its mouth when it blows out air and it's cheeks move and you can hear the puff....that is what she is doing. I don't know how to describe it. Blow air of your mouth with your lips together and your lips kind of vibrate. It seems she has a new symptom all of the time.

As she lays on the floor next to me right now, she is having a few twitches here and there...nothing too alarming though. She's had twitches before starting on Vetoryl though.

I just hope the 60 mg dose works for her.

[milosmom]

keeping an eye on you two ...patty and milo xoxox

[frijole]

Ro, I don't want to scare you but I do know exactly what you are talking about re the horse breathing thing. That is how Annie would breath when her tumor was active. It freaked me out. I first noticed her doing it when she was sleeping because I heard the noise. I know they said it wasn't a pheo but I freaked when you described it just now because it was exactly like that and I had never shared that with anyone.

When are you scheduled to have an acth test? That is when you'll get a feel for how the trilo is working. Keep us posted and give Chey a hug. Kim

[Trish]

That's weird, I have never heard Flynn make a blowing noise. Since his op he has snored a little more than he used to, but I am just putting that down to recovery.

Glad to hear the walk went well today, go Chey!

We always have a big family dinner at my parents on Thursday nights, so we were all around there tonight, including Flynn showing off his stitches to everyone and getting fussed over. It was a lovely evening so we were all sitting outside and my nieces partner said ohhhh look Flynn is doing a poop in the garden. I went over to have a look and they were all disgusted especially when I told them about the in's and out's of this weeks poop patrol! It was probably bad timing as we were eating chocolate cheesecake at the time :eek::eek: Honestly, some people are squeamish!!!! :D

Hope Chey has another good day!
xx

[cheydogger]

Kim-

If all goes well on the 60mg, I will schedule her ACTH for next Friday which will be 10 days after starting the new dose. I am still not 100% convinced it isn't a pheo even though the IMS said it wasn't because Chey wasn't have more severe symptoms. I thought the breathing thing was possibly related to her heart. It was weird that the first two doses of the 75mg cut her water consumption by half very quickly. I will be home at noon to check on her today. She had a fairly solid poop this morning and has acted alright.

Trish- lol. Poop patrol is fun.

[Bo's Mom]

Chey,
You catch that UPS truck and tell them to slow down. :D:D
Honestly, they speed down our street at well over the speed limit and we have tons of kids and animals all in our neighborhood. I know they are trying to do their job quickly but as soon as I hear them coming, I hold my breath.

Hoping you find out you are on a good solid dose of meds and you continue doing well.

[Trish]

It's weird eh... symptoms can be so different in the dogs. Flynn has never had severe symptoms with his pheo, only one collapse that was a year ago and possibly tied in with his liver cancer diagnosis. But the past year I think most of his symptoms are tied in with his BP. Reading Kim's thread on Annie she had definite periods where she could tell the tumour was secreting, but I never saw that with Flynn, so I am with you on still being suspicious she has a pheo especially with her elevated BP. But then Chey has more symptoms of cushings that Flynn never had like the drinking, so hard with these pups to know exactly what we are dealing with... I wish they could speak and tell us!!

Hope today was another good day!! xx

[cheydogger]

So far, so good. I just went on poop patrol and it was softer than earlier today, but still not diarrhea....water consumption is a little lower, and she played with me and one of her toys tonight. So, I am considering it a good day;). She is eating a lot of dirt though. I have to really watch her outside. I will shoo her away from one spot and she goes to another and digs it up to eat. Crazy dog!!!:D.

Trish- yes, I wish they could tell us how they feel. You are right....Chey has the Cushing's symptoms, but it still makes me uneasy that she suppressed the whole 8 hours and tested in the gray zone on Endogenous. She didn't test for having an adrenal tumor on either of those bloods. So, I do still wonder about a pheo. I guess we will see where we stand in a week, assuming all continues to go well on the meds.

Thanks for the well wishes, Belinda!

Ro and Chey

[cheydogger]

I hate to continue to talk about poop, but what constitutes diarrhea? Chey's BM was mooshey this morning, no form, but it wasn't watery. Also, she didn't squat multiple times like Sunday evening.

[frijole]

From your poop patrol reports you've gone from well formed to loose to mooshey... on your way to diarrhea. ;):D;) I'd be phoning the vet with those details. Any other signs that the cortisol is too low such as lethargy, inappetance or reduced water consumption? YOu might need to push the acth test date up. But I'd call the vet to discuss. Kim

[labblab]

I agree with Kim totally -- I'd call your vet to report the mushy poops. And like her, I'm also wondering how Chey is doing aside from that. Of course, you need to be guided by your vet. But if Chey is otherwise looking fine -- normal appetite and activity level -- I'm wondering whether the loose stools may just be a transitory side effect to the trilostane that may normalize in a few days. Since she's only had a couple doses of trilo again and it is at the lowered dose, it's hard to imagine that her cortisol has truly dropped too low. But maybe her GI tract is just especially sensitive to the drug itself and will take some time to get used to it. We'll be really anxious to hear how Chey is doing otherwise.

If your vet is concerned, though, one possible alternative to performing an ACTH at an early stage might be to check Chey's baseline cortisol. While you would want a full ACTH stim test before making any dosing increases, there is some research evidence to suggest that a baseline cortisol above approx. 2 ug/dl would lessen concern that the cortisol level has dropped too low. Just a thought to discuss with the specialist if Chey generally seems to be OK but you all think that early testing prior to the 14-day mark is warranted.

Marianne

[cheydogger]

Water consumption has went from 10 cups a day to 5 cups (this started with the first dose of Trilostane on12-8), she is acting fine, still gets really excited for her food, no vomiting, urine looks more yellow at times, she slept with me the whole night last night.

Her poops have definitely changed since starting the 60mg, but she acts fine in my opinion. I was just wondering if her digestive system needs to get used to the Vetoryl:confused: I will monitor today as I am home with her all day. The IMS was surprised she had the diarrhea on the 75mg, but water consumption was down. She said usually when you are getting closer to an Addisonian crisis/and or the cortisol drops too low there will be an increase in water consumption.

At what time of the day after dosing can they do the resting cortisol?

[lulusmom]

For resting cortisol, you would follow the same protocol as an acth stimulation test, which is 4 to 6 hours after dosing.

[cheydogger]

Well, I just took Chey for a walk around the block and her stool was soft, not mooshey. I called to set up her ACTH test, BP check, and electrolytes for next Friday. I am continuing to monitor her bowel movements. Her regular vet is in tomorrow, so if the BM's take a turn I will get her in there tomorrow. Otherwise, she seems ok. Her walks are shortened from a month ago as she walks too slow now to go any further.

[Trish]

Hi Ro
Glad to hear things are going relatively smoothly for our Chey! It will be so nice when we get her symptoms and results on a nice even keel and the stress levels can go down!!

Have you got much time off over the Christmas break? We get two public holidays over Christmas and the same again over New Year, so if I have any leave left I might take the 3 working days in between and will end up with another close to two weeks off! YAY! I will check it out when I am back at work on Monday, feeling ok about leaving Flynn with Mum and Dad by then he seems relatively stable now, just ongoing tiredness which is understandable. I live next to a school which is semi-rural and I took him for a little walk on his leash on the fields last night, we came across another couple of dogs going for their walk and Flynn soooo wanted to play with them, he looked back at me quite cross I would not let him free! I must check with the surgeon when I can let him run loose again.

Have a nice evening xx

[cheydogger]

Chey still seems to be doing alright:)

[frijole]

Fanatastic!!!!