Anyone have info? Pheo tumor removed/treatment PHENOXYBENZAMINE

[lucylovesdogs]

My 13 yr. old Buddy was happy healthy active, until he suddenly collapsed. ER removed two benign masses, and one Pheochromocytoma (final results pending re-staining).

It's been 8 days since surgery and Buddy still cannot stand up, or doesn't want to. After we carry him outside to urinate--he starts to teeter and fall over.

He is extremely lethargic, but still has an appetite.

Because of his falling over, we have brought him back to the ER twice--each time they say his blood work seems ok, except for a bit dehydrated.

Shouldn't he be improving?

The meds are supposed to regulate the hormones that effect the blood pressure (from the adrenals).

I'm worried we are just keeping him barely alive without any true chance of recovery.

Has anyone had a pet who recovered from PHEO surgery?

THANKS IN ADVANCE.

[frijole]

Wow. My dog Annie had a pheo but she wasn't a candidate for surgery and she lived with it for 2 years.

So was this surgery done by a specialist or your regular vet? These are very very rare tumors and this type of surgery usually requires a very skilled surgeon do it. If it was done by a regular vet it could be they are over their heads.

Note we have had pheo dogs survive - hopefully Trish (she's from Australia) will see the post and answer your questions re drugs.

I do know that because the surgery is so invasive it takes a while to recover. I am wondering if there isn't a med that is missing here.

I'll send Trish a PM so she is sure to see your message and question! Kim

[Trish]

Hi Lucy and Buddy

Yes my dog Flynn had surgery for a pheo, nearly six months ago now. Post op was a bit of a rocky road so glad you have found us to help you and Buddy out! Welcome :)

So was Buddy's surgery done as an emergency? What exactly did they do. Flynn's pheo was in his adrenal gland but they can sometimes spread but for now I will presume Buddy has had an adrenalectomy? Where were the benign tumours you mention removed from, also in the adrenal or somewhere else?

Flynn was able to stand up and walk the day after surgery. We had our share of hiccups postop but inability to stand was not one of them.

I am wondering if they ER vets checked Buddy's blood pressure when you have taken him in? Perhaps it has gone to low and that would make him wobbly when standing for sure. The phenoxybenzamine, as you write is meant to stablise blood pressure. We knew about Flynn's tumour on a scan about 3 or so weeks before he actually had his surgery. One of the hallmarks of a pheo is hypertension and it did give him a very high BP which they had to stablise with the phenoxybenzamine preop, it dropped it very fast. The med was stopped 48 hrs prior to surgery and he has not been back on it since. Although he has had to go on other BP meds to bring it back into line as it never did get back to normal after surgery and it is meant to, but they think he also has a problem with primary hypertension. Did Buddy suddenly collapse then immediately have his surgery? Because with pheo's they can have big BP swings during and after surgery and sometimes arrythmia's and need monitoring after the operation to make sure they have cardiovascular stability so hope that was done for Buddy.

My second thought is about the "benign tumours" if they were also in the adrenal could they be affecting his cortisol? Pheo's don't usually do this and the doggies should be perfectly fine with one adrenal gland controlling cortisol. If he is eating, not vomiting I guess this kind of is unlikely. But we did have an ACTH test done postop when Flynn had ongoing GI problems postop. His ACTH showed the other adrenal WAS working and we were able to rule this out. But dogs that have benign but functional adrenocortical tumours removed have to take prednisone for a while under the other adrenal starts functioning for the two. A dog would be pretty unlucky to have both of these tumours, but it does happen. So hopefully you can clarify that for us.

Third thought, is Buddy having enough pain relief? That would make him not keen to stand up if he is sore. I had injections initially to give him for pain. Then Previcox which is anti inflammatory.

Also, have you been giving him anticoagulant medication? I had to give Flynn injections for a few days. This is to prevent blood clots. Is he swollen anwhere (other than normal post op swelling around wound).

Is he pooping? Pancreatitis can be a problem for these dogs postop, but as you say he is eating so keep an eye on that.

Is his wound OK? No red bits, or areas of acute tenderness?

What does your surgeon say? Yes, good point Kim - who was your surgeon as this is tricky surgery and ongoing support is very important. I had excellent postop followup from our surgical team and I was in frequent contact with him during the postop period and he saw him or advised when we did have problems.

I think he needs to be seen by the surgical team to check out all of these things, I am just running over in my head the things I was told to watch out for and hope I have covered them all for you here without freaking you out too much! Hopefully Buddy will perk up soon, he is probably feeling very sorry for himself but I do think he needs full review by his surgical team. How long was he in hospital?

Lots of hugs and come back any time to ask questions!
Trish :)

PS Kim - I am in New Zealand!! Just across the ditch from Australia but most definitely a different country :D:):D:)

[Trish]

I just had another thought to add to my list, unlikely as you said the ER vets did bloods. But did they check his blood counts? They can have quite a bit of bleeding with this surgery so I would want to rule out he is not anaemic as if that is low it would also make him wobbly.

[frijole]

LOL Trish of course I know Australia is the small island off the coast of New Zealand. :p:D:p Sorry about that.

Back to this baby. Trish asked several important questions - one that stood out to me was whether or not the adrenal gland was removed entirely or if they just removed the tumor. Normally they'll take the adrenal gland but you didn't say that. So that would be helpful to know.

She is our expert so please read her post carefully and answer the questions. Sending healing thoughts, Kim

[lucylovesdogs]

Thank you both so much.

We went to a specialty surgical group.

We took Buddy in as an emergency.

He has been a healthy, happy, active dog until that morning when he just looked up at me and collapsed, slid to the floor, and then jerked to his side...but still conscious.

They went into an exploratory surgery and REMOVED two SPLENIC masses both BENIGN, and the third mass was in a lymph node near the descending aorta (I think) where it bifurcates to both legs. They checked the adrenals but did not see or feel anything. But, they believe this is a MALIGNANT Pheo, and Matastatic--and they think it may be coming from a microscopic pheo in the adrenal. But it's inconclusive until we get the FINAL results this Monday. It has been 9 days since surgery.

Meanwhile they are treating it like a Pheo and have given (I guess) the common protocol of Phenoxybenzamine.

My concern is Buddy has shown NO improvement in mobility. He is continually in the reclined position-and sometime appears to have discomfort. He knows now that the moment he stands, within a minute his feet will be sliding, he'll be rocking, unsteady, and jerk his butt down.

Sometimes when he goes down he'll roll, jerkily, to his side.

We have gone back to the surgical team (the ER) twice. Once Buddy stayed over night to be monitored. They said he was (a bit) dehydrated
, that his red cells had increased after surgery (he was bleeding from one of the tumors), and that his blood pressure was on the low side of normal:confused:.

Something doesn't make sense--either it really is CANCER and maybe it's throughout his body--although they said his lungs are clear, and it is definitely not lymphoma....

They're ruling things out--but, they still don't know definitively if the Pheo is what is causing Buddy's current prone state.

I worry that the med is made to lower BP, and Buddy has white gums immediately after he stands and then collapses--making me think he already has low BP.

Unfortunately, I don't have a doggie blood pressure monitor.

I'm grateful to you both for any other clues you can share.

[molly muffin]

Hello and welcome from me too.
White gums is something I usually associate with anemia, not enough red blood cells to produce oxygen to the muscles if that makes any sense.
I'll leave it to the others who have more knowledge in this specific area to comment more.
When are you scheduled to go back to the hospital for a check up?
Do they seem concerned at all about his not being able to stand yet?
Hopefully you'll see some positive signs soon and Buddy will be able to stand on his own and stay there. :)

Sharlene and Molly Muffin

[frijole]

Thank you for more information... I am relieved that he was at a specialty group (I assume he's being seen by internal med specialists vs regular vets).

I am surprised they haven't decreased his dosage but there must be a reason. I would point blank ask them. Make sure you report the white gums after standing. The thing with pheos is that the blood pressure isn't always high. At least in my case my dog was mostly normal except when the tumor was active. Obviously your dog's episode was extreme and sudden. I am curious what the symptoms were when you took him in.

Did he ever have issues with falling down prior to the surgery and discovery? I tend to think it might be a side effect from the drug and/or low blood pressure but that is a guess.

Poor little guy must be so confused. Have you tried supporting him with a towel under his tummy to see if he can stand up if you give assistance? Does it appear to be dizziness, strength, coordination?

My case was different but I'll share what I went through in the event any single thing might help... I had a dog Haley that had cushing's and she lived to 16 1/2. Annie was 2 yrs younger and always very healthy. I noticed that she wasn't as feisty and I would catch her at times shaking all over (trembling) - it would come and go - very intermittent and I couldn't tie it to anything. Of course it was winter at the time but I really didn't think it was the cold... then I noticed that she was losing weight and she was always a tall skinny schnauzer. I noticed her tummy appeared larger (I know now it was enlarged organs) but the rest of her was wasting away.

She had a few accidents in the house (urination) and I also noticed she would sometimes fall for no reason. She would be running around being playful and all of a sudden it was like her back legs gave out.

Of course none of this ever happened while at a vet and my vet thought I was pure nuts. Because of the tummy and urination (which wasn't that often) my vet tested her for cushings and it came back positive. I'll save you the LONG story - she had like 7 false positives on the two main diagnostic tests for cushings over a period of a year. We tried treating her but it did not work.

The symptoms continued and I noticed that when she was shaking her skin would turn bright red and she would be sweaty. On a few occasions (always at night) her breathing was so fast I thought she was in cardiac arrest. I could not replicate the speed with which she was breathing. I would hold her close and in a matter of minutes the episodes ended.

I now know that those episodes were when the pheo was active. I read on a human pheo forum that they could actually feel the blood vessels widen as the blood rushed from their hearts to their heads causing migraines. Annie never seemed to be in pain but after them she did seem drained and would just close her eyes and sleep or so I thought.

I live in a town of 25k in Nebraska and there were zero internal med specialists in my entire state at the time. Yep. I had an ultrasound done in Omaha and they missed the tumor only capturing one of them on film.

Oh and she quit eating. She was starving and acted hungry and looked at me for food but when I gave it to her she would take one bit and spit it out. It was like she was nauseous. For over a year I would open up to 5 cans of different types of dog food until there was one that she would eat. It was bizarre and to this day I don't understand it.

I finally went the five hr each way trek to KS State Univ vet hospital where they discovered the adrenal tumor and ruled out cushings. They knew it was small, not cancerous but her blood pressure was normal on both visits. The breathing episodes hadn't happened at that time - so obviously I didn't need a monitor to know her blood pressure soared when it was active and it was normal most of the time.

By the time we figured out what it was I no longer felt surgery was an option because she had lost so much weight. She was skeletal but a mostly happy dog. I let her go Feb 2012 because she lost the use of her legs to muscle wasting.

Trish's story is different and she went thru the surgery so hopefully she can give you additional information. We are seeing more and more of them - when I went through it there were hardly any cases (most died and then were diagnosed).

Just know that you are right in questioning why no improvement. Especially the leg issues. Honestly they may not know as it is probably not something they see on a regular basis.

It's been awhile but it seems like I remember reading that they are not usually cancerous. I will certainly be thinking of you guys and send healing thoughts your way. Kim

[frijole]

Another thought since a picture is worth a thousand words... video him when he tries to get up and falls so you can actually show it to the vets. Kim

[Trish]

Good to hear Buddy's lungs are clear and they have ruled out lymphoma.

Hmmm I wonder why they think the lymph node was a pheo? It could be anything, maybe just inflammation? Has he had a scan at any stage to see if they can find anything that could be causing his symptoms? I remember Flynn had a lymph node up on the scan prior to his adrenalectomy, they biopsied it then and there and it was not malignant at all. Funnily enough he also had a splenic nodule which the surgeon considered benign during surgery so left it alone. From my understanding the smaller pheo tumours have much less likeliehood of metastatic spread and as you say there was no sign of any macroscopic tumour on his adrenals during surgery.

It does not sound like they have come up with the answer for the initial collapse, it could well have been a pheo hypertensive crisis but could have been something else. Are the collapses he is having now similar to the initial one? If they are similar it makes me think the cause of that initial collapse needs further investigation. But like Kim, I am still suspicious of low BP. White gums is a sign of shock, it can be low haemaglobin causing anaemia as Sharlene suggests, but it also can be due to low BP or other stress on the dog's system.

Is his back OK, he didn't injure that somehow before his initial collapse, something like that could be causing ongoing mobility issues. Flynn hurt a disc on his back a few years back and he went down pretty quick and was sore for quite sometime before coming right. I guess the vets will have checked him for things like that? But just how you said when he goes down and jerkily goes to his side made me think of something like that, it sounds painful.

Were the splenic masses bleeding before they went in or did it start during surgery? Did they end up taking the whole spleen out? One of our members Leslie, Squirt's Mom went through splenectomy with her so she will be good to get an opinion from.

The more I hear of this story, the more suspicious something else other than pheo is causing Buddy's problem. But I guess the histology will tell when that comes back on Monday.

I think my questions for when I next spoke to your surgeon would be:
1. Was Buddy's BP high on initial presentation, during or after surgery to make you suspicious of pheo? Why do you think from the lymph node removal that it could be pheo and not from some other cause?
2. Current BP management with Phenoxybenzamine - do we need to lower dose if his BP low normal - taking into consideration their BP can go up at the vets so it could in fact be lower at home. Flynn is a 30 pound fox terrier, he was initially on 3.5mg twice a day and they increased it to 10mg twice a day when that did not bring it under control and his BP plummeted on that dose and he was quite lethargic but still able to walk.
3. What do you think was the cause of his initial collapse? eg was there any bleeding on scan, BP, something else, sudden acute back pain? Just as an aside, Flynn did collapse back in Nov 2011, he was rushed to vet and they did an ultrasound and found he had a massive liver tumour. He went on and had successful surgery to remove that. When he went to the specialists, the surgeon was a little concerned that the liver tumour showed no sign of bleeding and he was not convinced it was the cause of his collapse at that time. Over the next year Flynn did not recover 100% from the liver resection and went for more testing where they considered cushings (which is why I ended up here!), but eventually they found his pheo on a scan and he then had adrenalectomy. So now they think the reason for his initial collapse was defnitely not the liver tumour which they now consider to be an incidental finding (lucky for us they did find it though, as it had already spread to omentum but they were able to get clear margins) but was most likely due to the pheo causing a BP spike. So in my long winded way I am just saying this to highlight the importance of finding out why Buddy collapsed in the first place. It may not have been due to these splenic nodules or the lymph node but something else.

I hope this helps, be looking forward to see what they say when you get histology. But in the meantime I would be ringing or taking him back is these worrisome symptoms of poor mobility continued as I do not think they are due to surgery.

Trish

[lucylovesdogs]

The surgical group said they tested for anemia--they said it was slight but gave him transfusion post surgery.

Thank you for this insight.

[lucylovesdogs]

Thanks all for your great insight. I will definitely pose those questions to the Dr./Surgeon.

I recall they did detect some anemia (post-surgery) and gave him a transfusion.

His tumor(s) were bleeding. But, they removed them and they report that the bleeding was stopped.

Buddy had white gums from the very first 'episode' of collapse, prior to surgery. His gums continue to go white for a period of 10-20 minutes after any physical exertion (standing up, etc.)

Also, Dr. says he didn't see any report on the charts of hypertension (a key symptom of a Pheo, correct?)

I will also video Buddy's 'falling down'--so they may take it more seriously.

He's scheduled to have his stitches removed this Thursday.

The LAB results from the re-staining due Monday or Tuesday--will inform us whether to treat as a (malignant) Pheo, or if the cause of Buddy's condition/state is still unknown.

It will also inform whether we shepherd my dear boy to doggie-heaven since this is no quality of life for 13 yr. old Buddy who was running about the yard 9 days ago.

Thanks for being here with great information for Buddy. We will write again when we have more info.

Much appreciated!

[molly muffin]

Recovery can take a while with these kind of surgeries. So, I am not really that surprised that since it was an emergency surgery that recovery could take longer. I know one of our members said that 2 weeks in, was better than day 2, on month was better than 2 weeks and at 3 months they thought that recovery was finally almost completed.
Trish's Flynn on the other hand had a very good recovery with some minor hiccups, but they also prepared for weeks to get him ready for the surgery, blood pressure medications, etc. It was a lot of work, that paid off in the end. You didn't have that option.
I would think a couple possibilities about the white gums and Definitely discuss with your vet, is anemia, Blood Pressure, Red Blood Cell count. Is there any kind of bleeding internal that might have caused the collapse to begin with and could still be hampering recovery. Based upon what kind of answers you get, you can decide on next step. I'd also make sure to ask every single question that Trish mentioned so as to get as complete of a over view as possible.

Hang in there. This is a tough road.
hugs,
Sharlene and Molly Muffin

[frijole]

To answer your question - yes high blood pressure needs to present in order for a dx of pheochromocytoma. It is not always present - only when the tumor is active. That is why I described the episodes just in case it triggered a memory.

It could be that it is a different form of tumor entirely.

About cancer in dogs - obviously there are different types but we have had members treat lymphoma successfully - not near as much of a challenge as it is in humans - not sure of other forms.

Sending healing thoughts and prayers, Kim

[Trish]

Hi Lucy

Just checking in to see how Buddy is doing today, I hope he is feeling better and getting some energy back. Hopefully you get results tomorrow asap so you can start moving forward and get some answers as to why his mobility is so poor and get him back on the road to feeling better.

It really sounds he has still not recovered from whatever caused that first collapse to me and that is what they need to get to the bottom of, but the results tomorrow should be very helpful. If you do not get the answers they are expecting I suspect they may need to do further investigations. GOOD LUCK! Lots of pats for Buddy!

Trish :)

[Trish]

Hi Lucy

How is Buddy doing? I would really love to hear an update on how he is. Hope he has improved over the week :)
Trish

[lucylovesdogs]

UPDATE FOR 15 year old BUDDY!
We just celebrated his 2 YEAR anniversary post-surgery.
The surgeon and dr.'s continue to be amazed.
He is leading his best life with his daily med of Phenoxybenzamine 15mg 2x/day. So glad we said "Yes" even though the surgeon said Buddy's case was a great risk. Thank you all for your kind words, knowledge and support. :)

[Harley PoMMom]

That is GREAT news...YAAAA!!! Thanks so much for coming back and letting us know how Buddy is doing, WOW 15 years old, you are doing an amazing job with Buddy.

Hugs, Lori

[molly muffin]

Well isn't this just a wonderful update! So great to hear that Buddy continues to do well.

Whooo hooo!!! Thanks for coming back and telling us too!

[Squirt's Mom]

Thank you so much for coming back and letting us know Buddy is doing so well! We need and love success stories - they give hope to others who follow in your steps. ;) I am very happy for you and for Buddy and hope you have many more years together ahead.

[Trish]

Fantastic! I so love to read good news on our adrenalectomy pups! Flynny is now 2 years and 7 months from his pheo surgery and still trucking along at 14 :) I am so glad you said yes too!!

Flynn never had to stay on his phenoxybenzamine post op, but he is on amlodipine as his BP never really came back done to normal and he is doing just fine on that one too. The IMS said if we did not get good BP control with that they would put him back on phenyoxybenzamine. His tumour had some positive margins so I would not have been surprised to see it return but fingers crossed so far so good, delighted with this news about Buddy, thanks for coming back :D