Surgery or treat medically -- Sweet Casey has passed

[jma1154]

I am new to this site and just looking for some advice or others who are going through or have gone through this as well. Our chocolate lab, Casey who will be 12 @ the end of April, has been diagnosed with atypical cushing's, she has a huge adrenal gland tumor (96mm, 4x regular size) on her left adrenal gland. She has another ultrasound this Thursday to try and determine how quickly it's growing. Currently it has not spread to other organs & we are trying to determine which way to go surgery which from what I understand is risky but is a cure all, or treat medically which will slow the growth. I know this seems like an easy answer but the risks our vet has associated with this are an 80% full recovery rate. Also noted that it is possible she may not survive surgery, the part I am having trouble with is that I am not ready to say goodbye as soon as 1 week if all doesn't go well in surgery. Any ppl out there with good or bad results with either method, I'd love to hear from you.

[cheydogger]

Hi and welcome, however I am sorry for the reason that brought you here.

My dog has a very large right adrenal tumor and I have and am going through the same thing. It really sucks. I had a consultation with the Internal medicine specialist and surgeon to which they both said they would not recommend surgery for my dog who is 13 plus has heart issues. They said, in my dogs case, they didn't feel like they could give her more years by doing the surgery since she is at the end of her lifespan, but the surgery could take her life very quickly. It was still my decision to make, so given their professional advice, I decided to treat medically with Vetoryl. I don't know that there is a medication to slow down the tumor growth rate. I am unaware of this, so I may be corrected plus we could be dealing with a different form of Cushing's. Vetoryl helps lower cortisol levels which in turn helps control the symptoms that come with Cushing's disease plus slows down the destruction the high levels of cortisol are doing to their body.

Did they check Casey's blood pressure? I suggested to my vet that we do that and we found out her blood pressure was extremely high due to the high cortisol levels. High blood pressure is common in dogs with adrenal tumors including pheochromocytoma's.

I know the more experienced members on here will want you to post a little more information such as lab results, symptoms, etc. I am sure they will be along soon to welcome you. A few members on here have been through the surgery. They can tell you more about that.

Take care and hang tight for more members to come along.

Ro and Chey

[Squirt's Mom]

Hi and welcome to you and Casey! :)

Just a quick clarification - Atypical Cushing's does not involve a tumor on the adrenal gland(s). This is called ADH, or adrenal dependent hyperadrenocortisim. Atypical Cushing's is a form that has normal cortisol but elevations in one or more intermediate hormones. ADH always involves elevated cortisol. So Casey does not have Atypical, she has ADH. ;)

Whether surgery is viable or not needs to be determined by a board certified surgeon, not a regular GP or IMS vet. The surgeon will be the best qualified to tell if Casey is a candidate or not and what the prognosis would be. Your GP vet can refer you to a surgeon for this evaluation and I would ask for that asap. If Casey is a candidate, then you will need to decide whether to go ahead or not. If you choose not to have surgery performed, ADH can be treated via meds, tho surgery can and often effects a cure. ;)

Can you tell the tests Casey has had to diagnose the Cushing's other than the ultrasound, posting the actual results here?

Regardless of which path Casey ends up on, ya'll are no longer alone. We will walk every step of the way with you. Never hesitate to ask questions and we will do our best to help you understand. If we don't know the answer, we will learn together. You and Casey are part of a truly amazing family now and I am very glad you found us!

Hugs,
Leslie and the gang

[jma1154]

Hi and thank you for responding, I too am sorry to hear about your dog. Casey's symptoms are typical, increased thirst she goes through about 3 very large bowls of water a day, increased urination sometimes inside, barrel chest, loss of muscle mass along her spine. She is a bit more fatigued lately but otherwise happy healthy pup. I originally took her to the ER vet because she wasn't interested in her dinner 1 night and she was trembling slightly. They took blood & said that her liver enzymes were very high. They thought possible hepatitis with possible anemia. I scheduled her for an ultrasound the next day and they found that her liver looked fine, but they also found a massive tumor on her left adrenal gland. Shortly after we had a ACTH test that came back saying that the tumor was producing hormones but it was producing sex hormones rather than cortisol. We are scheduled for a 2 ultrasound on Thursday to try and determine how quickly the tumor is growing, whether it has been there for years and years or whether its been shorter. Currently they have termed it an incidentaloma, meaning that they found it while looking for something else.
Her blood results are as follows.
11-26-12) Alkp 1509 normal is 23-212, Alt 876 normal is 10-100, Glob 5.2 normal is 2.5-4.5, Lipa 2758 normal is 200-1800, Tbil 2.8 normal is 0.0-0.9.

Will post more in amoment

[jma1154]

Sorry clarification- Casey's cortisol levels are normal.

12-3-12) pre ACTH test of cortisol level 4.9, normal is 2-6, post ACTH test 5.7, normal is 6-18.

Same date her alk was 727
Alt 144
GGT 39
Tco2 25
Lipase 815
T4 was .5 normal is 1-4
At the same time her bloodcell count is low

[Squirt's Mom]

Has your vet mentioned a type of adrenal tumor called a Pheochromocytoma? We have had a couple of pups here with that type of tumor and I am sure they will be along to share their experiences with you. Pheos are very rare and hard to diagnose apparently. You might bring this up next time you are talking with the vet. ;)

[Squirt's Mom]

A link about Pheos -

https://www.addl.purdue.edu/newsletters/2007/Spring/CP.htm

[Trish]

Hi to you and Casey

My dog had a right adrenal tumour, it was invading into his vena cava. He had surgery one month ago, he is finally starting to come right after a rocky ride for a while there. He is about the same age as your dog.

They thought he had cushings, despite not having any excessive drinking, peeing or hair loss. But he did have panting, very good appetite, tiredness, weakness in hind legs. So he had all the Cushings tests, all were negative. His BP was high, they treated him with meds. We were referred to surgeon and I was told if we left him it would be a matter of probably months. Right from the beginning I decided that surgery would be the way to go for us, he was going to die very shortly if I left him so I decided he deserved a chance despite the risks of surgery. But in saying that tumours can act differently, be slower or faster growing. ie ADH tumours with symptoms of cushings can be helped with meds. Because his was in vena cava it was faster and they could tell the growth over a series of scans he had over the previous year so surgery was recommended.

When they took the tumour out it was confirmed as pheochromocytoma. Quite often benign, it all came out nicely even from vena cava. So I am hoping to have a few more years with my boy yet!

I know what you mean about making the decision, it was awful to make it and then to stick to it. I remember taking him for his last walk before surgery and thinking to myself... what have I done?? To be fair, I have thought that a few times since as well!! But we are still here, he is recovering and the wonderful members on this board will help you through with whatever decision you make as they did me! You can read Flynn's thread to hear all about it. Hopefully it will not put you off. Despite all we have been through I am still glad we did it.

But you do need to see the surgeon and get the facts!

Best of luck
Trish and Flynn xx

[jma1154]

Thank you for the information I will certainly ask the vet next time I speak with her which will hopefully be Thursday.

We actually have 3 vets that we have been consulting with, her regular vet who is very trusted and absolutely amazing, her possible surgeon who while we haven't known long is also great and very informative with every aspect of Casey's results and care. The third, I guess you really can't say is her vet but he performs the ultrasounds, we are hoping that her other vet will be there for the ultrasound on Thursday as well because she would like a better look at what's going on inside Casey before possibly going into surgery.

Sorry if I seemed short before, I was postig from my andriod which makes typing a bit hard. I have to say that we have been very blessed with our vets and now with finding this site after searching endlessly for more information about her condition. Thank you again.

Casey's mom

[Trish]

http://www.vsso.org/Adrenal_Cortical_Tumor.html
http://www.vetsurgerycentral.com/oncology_adrenal_tumors.html
http://www.vsso.org/Adrenal_Pheochromocytoma.html
http://veterinarycalendar.dvm360.com/avhc/content/printContentPopup.jsp?id=766820
http://histovetsdhv.files.wordpress.com/2011/09/adrenal-tumor.pdf
http://www.avsts.org.uk/sites/avsts.org.uk/files/event-proceedings/avsts_proceedings_spring_2012.pdf
http://www.experts.scival.com/reachnc/pubDetail.asp?t=pm&id=42829116&o_id=115&

Hi again, here are a few articles I had researched ... thought you might find them useful if you have not come across them already.

Trish

[labblab]

Hello and welcome from me, too!

It sounds as though you've assembled a great group of consultants to help you arrive at a decision. However, I am surely sorry that it is such a major decision to have to make!

The one piece I can add is that if the vets are talking about the possibility of reducing the size of the adrenal tumor through medication, I'm guessing they may be referring to the option of treating with Lysodren. Lysodren's therapeutic action in controlling adrenal hormonal over-secretion is to erode the outer layers of the adrenal cortex. In a few cases, I believe that Lysodren has also been shown to promote some adrenal tumor shrinkage as well. However, if your dog's adrenal tumor is not overproducing cortisol, then I don't know that a very high dose of Lysodren would/could be prescribed. Usually, only "maintenance" doses of Lyosdren (i.e., lower doses) are prescribed for the reduction of adrenal hormones other than cortisol. But I may be missing the boat entirely, and your team may be referencing some other treatment drug. Just some idle musing on my part...:o

Anyway, once again -- welcome! And I will be very anxious to hear the results of your ultrasound this week.

Marianne

[molly muffin]

Hi Casey's mom and welcome from me too.
I just wanted to pop in and tell you that whatever you decide we have a great support group here.
It is great to have a good team put together to help you through this with diagnosis and options. That helps so much and often we have members who don't have that right away. I'm glad that you do.
Again, welcome.
Sharlene and Molly Muffin

[labblab]

I just wanted to add that Leslie and I have been comparing notes and definitions behind the scenes, and want to clarify that a diagnosis of "Atypical Cushing's" can be associated with an adrenal tumor (ADH) -- as appears to be the case with your dog. This would be the diagnosis that is given when the adrenal tumor is prompting oversuppression of hormones other than cortisol (i.e., the cortisol level is normal but other intermediate adrenal hormones are elevated). Here is a great article that summarizes much of the work re: "Atypical Cushing's" pioneered by Dr. Oliver at Univ. of Tennessee at Knoxville:

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128

Here's a quote that discusses the different possible manifestations of Atypical:


Steroids that may be involved with atypical Cushing's disease are androstenedione, estradiol, 17-hydroxyprogesterone, progesterone and aldosterone. Other steroids that are not measured commonly may be involved as well, such as corticosterone and deoxycortisone.

Estradiol is unique because treatment of excess estradiol can be difficult. The hormone can be secreted by tissues other than the gonads or adrenal glands and secretion is independent of ACTH stimulation or dexamethasone suppression testing, as currently done.

For dogs with atypical Cushing's disease (PDH cause), expect the presence of hepatomegaly, hepatopathy and bilateral adrenomegaly, along with increased endogenous ACTH levels and the usual clinical signs, blood-work results and often hair-coat problems.

For dogs with atypical Cushing's disease (ADH cause), expect the presence of hepatomegaly, hepatopathy and unilateral adrenomegaly (and maybe atrophy of contralateral adrenal glands) along with decreased endogenous ACTH level and the usual clinical signs, blood-work results and often hair-coat problems.

For primary hyperaldosteronism conditions, due to primary adrenal tumor or bilateral adrenal hyperplasia, expect hypertension in association with hypernatremia and muscular weakness (cervical ventroflexion, hind-limb weakness) due to hypokalemia. Retinal hemorrhage and blindness and renal disease can occur in cats. For hyperadrenocorticoid cases that also have low aldosterone levels, this pattern can be indicative of a primary adrenal tumor, and ultrasound study is indicated to confirm a tumor's presence or absence.

I get so easily confused by all this info, myself (!), so I just wanted to set it out here for my own benefit as well as that of our other readers. And as I said earlier, I'll be really anxious to hear the results of your ultrasound later this week.

Marianne

[jma1154]

Thank you all for your posts and Trish for all the web sites, it seems to me that most everything I have read indicates that success of the surgery can be largely based on size of the tumor and whether it is over 5 cm. Casey's is 9.2cm does anyone have experience with tumors this large, if so please respond. I also wanted to ask about the association of gas. Casey has been having horrible gas the past 10 days, I have also noticed that she has been tripping quite frequently, like stumbling. She has a history of severe hip dysplasia, categorized as such because she was diagnosed with it when she was 2. She has also had her ACL repaired around the same age. But she seems to be tripping over her front paws, could any of these symptoms be related?

[jma1154]

Just read the additional posts from this page, didn't realize it was there before. Casey doesn't seem to be doing to well this morning, she fell this morning around 2am, 1 of our many trips to visit the restroom and it took her awhile to get back up. She has been moaning a bit while lying down resting and her head at the back of her skull keeps twitching almost like she is being her teeth or something. I have called her vet and left a message but it will probably be a while before I get a response. I want to thank you all again for the support, well wishes and information, it has been a tremendous relief to know we are not alone.

[Buffaloe]

Hello and welcome,

I am very sorry you have to deal with an adrenal tumor with Casey. My wonderful shepherd/collie mix, Shiloh, had a very large, mildly malignant corticol adrenal tumor surgically removed when she just turned 12. Her adrenalectomy was very successful and she lived as a happy and healthy dog well into her 15th year. Prior to her surgery, she was doing very poorly, just hanging on. We had a very skilled and experienced surgery team. For us there was just no option, surgery was the way to go. I was just so thankful that our surgeon felt Shiloh was a good surgical candidate and the tumor was operable.

Without question, tumors in the left gland are easier to remove than in the right. Shiloh's tumor measured 4.6cm x 5.6 cm, was in her left gland and was described as "huge." It was deviating the CVC but had not invaded. My surgeon told me all he cares about with adrenalectomies is the size of the tumor and its involvement with area blood vessels. As you know, it is a major, major surgery but will usually provide a complete cure. My surgeon said they have an 85% long term success rate with similar adrenalectomies. Shi's tumor did not produce excess cortisol but did produce excess intermediate hormones. I just wanted it OUT.

I hope you have an excellent ultrasound. I really doubt that Casey's tumor is much larger than Shiloh's but it's possible. I don't think you need to be in a big hurry; you need to find out if the tumor is operable and if the surgeon thinks Casey is a good surgical candidate. From our experience, it is the board certified surgeons who really know about these things. You will be in my thoughts and prayers.

Ken

[jma1154]

Heard back from Casey's vet and her ultrasound has been moved to today. I will be asking about the pheochromocytoma, have even written it down because i have know idea how to pronounce it. Any other questions that come to mind that I should ask? Thanks again, Jill - Casey's Mom

[lulusmom]

I think the ultrasound will answer most of your questions about the adrenal tumor but I would want to know why Casey is tripping over her front feet. Macro tumors in dogs diagnosed with pituitary dependent disease can cause neurological issues but Casey has an adrenal tumor so that doesn't fit. It could be a spinal issue totally unrelated to the adrenal tumor so I would definitely discuss the tripping, moaning and the twitching, with the vet. These are not common symptoms of typical or atypical cushing's.

Glynda

[jma1154]

I was reading about the different parts of the adrenal gland and came across something that mentioned glucocorticoid being produced in the adrenal gland. I couldn't help but relate it to glucosamine since they start with the same thing. So I researched a bit more to see if they were even a little related, they are. Here is my question, Casey takes 3-4 glucosamine chondritin pills per day, couldn't these affect blood results? Please excuse the spelling, they could make these things a bit easier to pronounce and spell.

[Squirt's Mom]

I moved your post concerning the difference between a glucocorticoid and glucosamine to your original thread as it will be seen by more members here and it pertains to Casey's case in particular.

Hugs,
Leslie and the gang

[lulusmom]

Glucocorticoids are found in the adrenal glands and glucosomine is a fluid found in a joint. However, most glucosomine supplements are made from the shells of shellfish but can also be made in lab. To my knowledge, glucosamine does not affect cortisol (a glucocorticoid) levels. I have read that it does screw with insulin but I checked on our sister site, www.k9diabetes.com, and apparently members report no adverse effect on blood glucose. I hope this helps.

[jma1154]

Thank you for all your comments, the cancer spread to her liver and prob brain . thats all I'm posting for now.

[molly muffin]

When words will not suffice as in a case like, this. {{{{{HUGS}}}}} I am so very sorry to hear this.

Sharlene

[lulusmom]

I am so terribly sorry to hear this news. Please know that my thoughts and prayers are with you both.

Glynda

[Trish]

Oh no, how awful for you. I am so sorry to read this news. xx

[labblab]

Oh, how I wish the news had been different. I join the rest of our family in telling you how sorry I am. Please know that we will stay right by your side in the coming days.

Marianne

[Tina]

I am so sad to read this news, and so very sorry. Sending prayers and hugs to you.

Tina

[mytil]

Oh no I am so very sorry to read this update. My thoughts and prayers are coming your way.

(((hugs)))
Terry

[Squirt's Mom]

Oh, J,

I am just crushed to read this. :( Having just been through cancer in one of my own, I understand your angst only too well. Hers started as breast cancer and spread to her brain in the last stages.

Please, please know we are here for you anytime. You are free to unload on us, to cry with us, to scream with us...you are always safe here with your K9C family. If there is anything, ANYthing, we can do to help, please don't hesitate to ask.

Many hugs,
Leslie and the gang

[jma1154]

She's gone and I'm crushed. Please see my posts under in loving memory.

[labblab]

She's gone and I'm crushed. Please see my posts under in loving memory.

For all our members, here's a link to Jill's companion thread on "In Loving Memory":

http://www.k9cushings.com/forum/showthread.php?t=4796

Please join us there as we support Jill and honor Casey.

Marianne

[Skye]

oh i am so sorry, so very very sorry. ((((((((hugs))))))))

[addy]

Im so sorry this happened, I'll go read your link.

[mytil]

I am so very sorry.

((((hugs))))
Terry

[bgdavis]

I am very sorry for your loss of Casey. No one can doubt your love for her.

Bonnie and Angel Criss Ann

[milosmom]

sorry for your heartbreak,sending you hugs and kisses and wishing you peace...patty (milo)meka