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Jennifer
01-28-2013, 12:36 PM
Hi All :)
I'm so very happy i stumbled upon this site! I have lots of questions and other than my vet, i honestly didn't know where else to turn :(

I thank everyone in advance for taking the time to read this!

Here's a little history on my dog

I have two dogs- My first is Max, a 10 year old black lab mix. He was my mother's dog for the first 3 years of his life-taking care of her during her last years-never leaving her side once when she battled cancer. i treasure him for this!

My second dog is Niko- a 4 year old Beagle. He's crazy and rambunctious- but loves his brother Max so very much :)


Max was diagnosed with Atypical cushings about 4 years ago. The vet at the time noticed his pancreatic levels were slightly elevated- but couldnt figure out why. After many tests, atypical cushings was his diagnosis. They told me to give my dog Flax seed and Melatonin every day- and he's been on this since.

His coat is beautiful- everyone always compliments me on it. So shiny and soft. He doesn't drink a lot- but he will eat whatever i put in front of him (but lets be honest, what dog wouldn't?) :) So he truly never been a typical cushings dog. He does, however, have that pot belly.

My dogs are on a homemade diet (boiled chicken, rice and vegetables- vitamins and salmon oil mixed in).

I have him in therapy every week for his arthitis. He gets laser treatment and walks in an underwater treadmil. He loves it and it keeps him pretty agile. (he tore his acl over a year ago, so we've just kept up with the therapy bc it helped him so much).

Here's where things took an unexpected turn.

Last Tuesday after we woke up i noticed his eyes were doing something strange. Sorta rolling behind his head? He couldnt look up at me- light bothered him. It scared the heck out of me. He didn't seem phased at all though. Brought me his ball to play, his bowl to eat- his tail was wagging and he was happy. Other than his eyes, he was "normal". But his eyes really freaked me out, so i got him the very first appt at his vet. On the car ride over his eyes were getting worse- droopy, heavy, very very red.

They admitted him right away and said they would run tests because they didn't know what was wrong. The Dr said he felt a mass in his stomach so they were going to run an u/s as well to check that out.

I went to visit him that night and was told his blood pressure was as high as 210 when they checked it. That they now have him on BP medicine to get it lowered. I asked if that was what caused his eyes to do what they were doing- and was told, "i just dont know". When i went to visit him he was his happy self, tail wagging- happy to see me. His eyes were looking better... still red- but not droopy/heavy. BUT within 5 minutes of being there, they started again. I put two and two together and realized i was getting him excited and probably elevating his BP- which was causing his eyes to act up again. So i left.

The Dr didn't see the connection still.. saying, "we just don't know". He went on to tell me that my dog indeed did have a mass on his right adrenal that was invading is Vena Cava. He recommended that i go to the University of Pennyselvania Vet to speak with a soft tissue oncologist and discuss our next move.

I was taken back... Was THAT what was causing my dogs blood pressure? Or was it something else?

I found an old post on here dating back top 2009- where someone recommended to test for his Aldosterone via a Tenneessee Adrenal Panal. That if his Aldosterone is high, a simple medicine could fix it and prevent his hypertension. I mentioned this to the vet- i specifically said i rather find the problem of the BP and fix that instead of just treating the symptom.

He told me he would run an ACTH test and it would give the SAME results as the Adrenal panel. Well, that came back with these results:
His baseline cortisol was 4 which i was told was normal. the second test came back as 24- which should be 20. So his cortisol is elevated.

I asked about the aldosterone, and he had no answer.
So i really dont know how the ACTH test is the same as the Tennessee adrenal panel if it didnt give the same results?

They released him the following day with blood pressure medicine and told me to make the appointment with the oncologist for further testing and to see if surgery was even an option.


This brings me to today. We're having pretty bad weather here- snow/ice mix so the roads are unsafe. My appointment was at 11am, but i've canceled it. It's an hour and half from my house, and i just wasnt comfortable taking the chance with my dog and newborn daughter in the car.


It's been 5 days since Max has been home, and he's doing great. He's back to his normal happy self. he's on blood pressure medicine, and though i don't know what that actual pressure is- I'm basing it off of his eyes-i'd say he's doing fine. I see them occasionally get red- especially after he gets excited for something, but other than that, they're normal.

So here are my questions:

What should I do from here?

I don't think i would opt for the surgery even if the surgeon tells me he can operate. From what i read about the tumor invading the vena cava it's a very risky surgery and i'm not willing to chance that. Especially since he's fine otherwise. Happy, eating, drinking, peeing- all normal.

his blood pressure scares me- and i don't know what's causing it. I don't know if it is his aldosterone or not since they didnt run the test i requested. Is there another test, maybe, that could tell? Or should i find another vet to get the adrenal panel done? is that test even worth it?

Anyone elses dog have high BP and do their eyes get red/heavy/droopy with it?

What specifically does the ACTH results tell me? Base line of 4 and post test of 24? Is this good? Borderline? Need for worry/immediate action?

The hospital in Philadelphia, though reputable, is just too far from home for me at this point. I understand that they're "the best", but i'm not sure i'm comfortable taking my dog there- 3 hours in the car, then the endless hours of testing and prodding.... for what? I'm trying to keep his BP in check, and i just feel like that wont help the cause.

I think i'm going to find another vet in my area for a second opinion on everything first before i head all the way there to speak to a surgeon. Do you think i'm wrong in doing this? I feel sooo guilty, like i'm doing the wrong thing here- so i just want some honest opinions on what you would do if you were in my shoes?

When i get the second opinion- what should i be asking? What test should i have them run if any?

If Max were your dog, what would you do?

I truly hope i'm making sense with all this jibberish. Thank you for reading this if you got this far :) I look forward to hearing your opinions!!

-Jennifer

(hoping this doesn't post twice- i timed out with the previous one)

lulusmom
01-28-2013, 01:08 PM
Hi Jennifer and welcome to the forum.

You did in fact have a duplicate thread so I deleted the duplicate. I have also manually approved your membership so you can disregard our email asking you to respond in order to validate membership.

I'll be back later to share my thoughts with you. In the meantime, I am sure others will be by to welcome you and share their own comments.

Glynda

Harley PoMMom
01-28-2013, 01:26 PM
Hi Jennifer,

Welcome to you, Max, and Niko! Max and Niko sound like very special boys that have a very special mom taking care of them.

The ACTH stimulation test only shows the results for cortisol ( a pre and a post). The UTK adrenal panel tests the five sex hormones; Estradiol, Androstenedione, 17- Hydroxyprogesterone, Progesterone and Aldosterone plus cortisol.

Max's ACTH post cortisol of 24 is not that high, especially since Max is not feeling like himself.

Uncontrolled high blood pressure will cause a host of damage on organs. Red bloodshot eyes can be attributed to high blood pressure. What medication is Max taking for his high BP?

If Max were my dog I would ask a referral to an IMS (Internal Medicine Specialist). IMS' have more experience and knowledge dealing with concurrent medical issues.

I am wondering if the tumor on the Max's adrenal gland is a pheochromocytoma. A pheochromocytoma tumor can cause high blood pressure.

Please know we will help in any way we can so do not hesitate to ask and all questions.

Love and hugs,
Lori

Jennifer
01-28-2013, 02:27 PM
Hi Lori!
Thank you for your response!
I will call today and ask for an IMS referral... thank you!

I'm pretty sure the medication prescribed for the blood pressure is Lotensin- but don't quote me. I will double check as soon as i get home from work.

I'm praying his blood pressure hasnt caused extensive damage :( They didn't think to test it until later on in the day. I had him there at 8:05am! I sure do hope the medicine can control it for him!
I haven't noticed any obvious neurological problems yet... so keeping my fingers crossed there!



I wonder why the Dr told me the ACTH would yield the same results as the UTK? Very very frustrating! I'm happy to hear though that the 24 isnt "that" high of a #... some hope, at least? :(

Should i push for the ACTH test? I would assume having that knowledge is important- so i'm not sure why they just didn't run it. Maybe because it takes a while for the results to come back? But i would of have them by now since it's a week tomorrow since i brought him in :(

Thank you again for your kind words! As i'm sure we all feel- our dogs are an extension of our family. If only they could talk and tell us what's wrong!! Would make things a lot easier when trying to figure things out! :)

Harley PoMMom
01-28-2013, 02:51 PM
If this were me, I would not push to have the UTK panel done as of yet. Getting an IMS on board, IMHO, is one of the most important things.

I am familiar with the BP meds, enalapril and benazepril, which I believe Lotensin is the same as benazepril. Did the vet mention getting Max's BP rechecked with-in 10-14 days?

Love and hugs,
Lori

labblab
01-28-2013, 03:33 PM
The Dr didn't see the connection still.. saying, "we just don't know". He went on to tell me that my dog indeed did have a mass on his right adrenal that was invading is Vena Cava. He recommended that i go to the University of Pennyselvania Vet to speak with a soft tissue oncologist and discuss our next move.


Hi Jennifer,

I apologize that I only have a minute to post, but when I saw that your dog already has been diagnosed with an adrenal mass, just like Lori I have to wonder whether that mass may be a pheochromocytoma. One of the hallmarks of this type of tumor is that it can cause extreme elevations in blood pressure. I wish I had the time to tell you more, but as a short-cut, I'm including a link to another member's thread whose dog just had surgery for the removal of that type of adrenal tumor. I know it's a long thread and the first few replies don't specifically address the tumor. But if you keep scrolling through the thread, you'll get to the meat-and-bones of the diagnosis and related symptoms, etc. Sorry I've got to run for now!

http://www.k9cushings.com/forum/showthread.php?t=4242

Marianne

SoggyDoggy
01-28-2013, 08:06 PM
Hi Jennifer,

I can be on zero help re the blood pressure or symptoms etc, but I will definitely second the suggestion of getting an IMS on board. Having seen one myself for my boy Fraser, the level of confidence you get from them is on another level! It's almost as though you think "finally! Answers!" So yes, I would suggest making that appointment ASAP - and take copies of all your blood results and scans with you - it will help to save a little time and certainly some money.

I wish you good luck. Do let us know how it goes and remember - the first rule of the Forum - ASK QUESTIONS :D:D:D:D

molly muffin
01-28-2013, 11:32 PM
Hello and welcome to you and Max and Niko from me too.
I know that when I went to see the IMS after not getting enough answers from my vet it really did as Naomi said, is on just a different level. A pheo would definitely cause high BP. I think every dog who has had one has had to deal with the high BP. Surgeries are doable, and survivable, but they come with risks.
One thing to find out is what to do if you choose not to do surgery. What most of us find is that we need a plan of action. Something to help with the anxiety that we feel when confronted with this. So, that is something that you will be looking to develop with your IMS.
Another thing is make sure you get copies of all tests results for Max going back however far you want. You'll really want to have this to take with you to the IMS as you don't want to duplicate tests you've already had done.
Plus it might give them an idea of where to start looking for possibilities. You are going to be addressing a couple issues with the IMS. The eye rolling, droopy, red (is that attributed to the high blood pressure or something else) and the adrenal tumor.
Welcome again.

Sharlene and Molly Muffin

frijole
01-28-2013, 11:50 PM
Hello. My girl Annie was misdiagnosed with cushing's a few years ago and after an exhausting number of tests and switching vets multiple times we went to a specialist who was able to finally give me answers - she had a pheo. This took a full year. Pheos cause HBP and are adrenal tumors.

My girl did not have the eye redness that you described but when her tumor was active her skin turned bright red. Over time she lost alot of her hair. She also developed a corneal ulcer which never healed due to what I believe was pressure from the HBP. Perhaps this is what you are seeing only with different symptoms? My understanding is that when a pheo is active (they are often intermittently active) they emit adrenaline. It is described by humans with the ailment as like having a very strong flow of blood go thru the veins from the heart to the head. It can cause migraines and exhaustion when the episode is over. Episodes can last seconds or minutes.

If you suspect a pheo you really should see a specialist even if you choose not to treat. I ended up not treating simply because by the time we figured it out my dog had lost a great deal of weight and wasn't a good candidate. If you want to see what happens over time go to my photo album and look at my Annie. Don't let it scare you - she led a very happy life and had the pheo for at least 2 yrs -

Pheo dogs do tend to have elevated sex hormones. There isn't a great deal known about pheo's as they are usually not discovered until after a dog has passed.

I hope your dog simply has atypical cushings but you might want to read up on pheochromocytomas just in case. Sending best wishes, Kim

Trish
01-29-2013, 06:34 AM
HI Jennifer

Glad you joined us here, hope we can help you through this period of uncertainty and diagnosis.

My dog also had right adrenal tumour invading vena cava and did have surgery - after a rocky postop period, we are now nearly 2 months postop he seems to be doing better. Marianne linked his thread to you above (Thx Marianne!:)) . Flynn also had BP issues up to 220.. which settled down with medication, he did not have the eye symptoms of Max. Have a look through his thread, sorry it is so long. I never seem to be able to write in 10 words what I can write in 50!! :D Flynn had negative cushing tests, adrenal tests have never been done. His was proven pheochromocytoma, confirmed on testing when they removed it.

If Max was my dog, I think the trip to the pet hospital would be worth it. I got so much good info from the specialists, both IMS and surgeon that I would have to recommend you visit them if you can. We also had a close to 3hr drive to get there, but in our case I would have been quite lost without them. If it is a pheo then as the others said they are quite rare. My local vet said that in his 28yrs of being a vet, Flynn's is the first confirmed pheo he has seen. So I really think getting the advice of those that deal with this type of thing more often would be very helpful. I also say this because you are considering another opinion from local vet, the thing is if surgery was going to be his best option it would not be wise to get a local vet to do it. They need someone very experienced in this surgery, so personally I think seeing another local vet would be a waste of money when what you need right now is to talk to the specialists experienced in this area. You need to hear all the information, risks and options available to you and Max which they would be much better able to do than a local vet. Your first vet sounds like they have done the main tests, I cannot think of any others right now.

If I can help in any way please let me know, this is a hard time when you are trying to make a decision what is best to do for your baby so happy you found us!

Trish

Trish
01-29-2013, 06:39 AM
Oh, I would get them to check his urine for protein, just to see if BP has not affected kidneys which it did for Flynn. Better to be aware of that in advance.

Probably also worth mentioning, while Flynn had no droopy eye, when they did look inside his eyes they did see BP changes to some vessels, I am praying there is no permanent damage there but his vision seems fine now.

Trish

Jennifer
01-29-2013, 05:12 PM
wow! thank you all for your responses! i am going to dive into the mentioned thread now and read up on that type of tumor!

btw: i was incorrect with the bp med Max is on... it's actually Amiodipine 10mg 2xday

im off to read that thread now! :)

molly muffin
01-29-2013, 07:52 PM
I hope you have a really comfy chair! It's long, but so worth it, everything is pretty much covered in that thread as Flynn went through some ups and downs to get to where he is today. I'm sure you'll glean some important knowledge from the thread.

(i'll put the coffee pot on for you)

Sharlene and Molly Muffin