Looks to be Adrenal-dependent Cushing’s for my Waly - any advice on surgery

[IWALY]

Hello! Im new, but I know these forums are the best support and information out there! My Waly is not yet 100% diagnosed but looks like we will be looking at adrenal-dependent Cushing’s - he has a tumor on one of his glands. Has anyone gone though the surgery to have the tumor removed? Im very interested in how things go and what to expect, to hear your experiences. We still have to do one final test, but the ultrasound today shows a tumor on his right side adrenal gland. Thank you.
Robin

[Harley PoMMom]

Hi Robin,

Welcome to you and Waly. Sorry for the reasons that brought you to us but glad you found your way here.

I have no experience with an adrenalectomy but some of members do and I am sure they will be along soon. In the meantime here are a couple links to other members threads with dogs that have had this type of surgery: Flynn 11 y/o Foxie Cross - Right adrenalectomy, 3rd Dec 2012 for Pheochromocytoma (http://www.k9cushings.com/forum/showthread.php?t=4242&highlight=adrenal+tumor) and Kira, 13 y/o Husky-Adrenal Cushing's (successful adrenal surgery) (http://www.k9cushings.com/forum/showthread.php?t=2742&highlight=adrenal+tumor)

I was wondering if you could tell us more about Waly, such as the symptoms he is displaying, his weight, if he has any other health issues, and is he taking any other herbs/supplements/medicines? Also if you could get a copy of all tests that were done on Waly and post any abnormalities that are listed...Thanks!

Please know we will help in any way we can so do not hesitate to ask all the questions you want. ;)

Love and hugs, Lori

[Roxee's Dad]

Welcome to you and Waly. :)

Looking forward to hearing more about Waly.

[Budsters Mom]

Hello and welcome from me too:)You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. So again welcome Robin and Waly.

Hugs,
Kathy

[molly muffin]

Hello and welcome to the forum.

Do let us know how much Waly weighs and breed, medications, etc. Have you also had his BP checked? Do they know if this is is a noninvasive tumor? Hasn't entered the vena cava section?

Sharlene and Molly Muffin

[Trish]

Hi Robin

Lori has posted the link to my Flynn's thread for you to have a read through. He had a tumour in his right adrenal too, it also invaded his vena cava and came out just fine.

I also would like to hear about Waly's symptoms as the others have mentioned plus test results to date including scan results so we can help you through this. Each time you have tests done ask for a copy of them so you can get a file together which is always helpful!

There are also members here who have chosen medical treatment to manage their doggies adrenal tumours so there is a wealth of experience here to help you along.

Are you seeing a specialist or your local GP vet at this stage?

Welcome again to you and Waly :)
Trish

[IWALY]

Thank you all. I will get all of Walys info and post it. But some info is... he is a 28lb standard dachshund age 10. For about 3 weeks now we noticed he was acting starving, he is on a diet so he usually is hungry however this was much more than normal. He has always been a panter all his life as he has been over weight so he get hot easy. But he started panting slightly more than normal and he started drinking a little more.the panting and drinking is so small of an increase over normal that had he not been so starving I may not have thought much about it. Skin and hair is fine. I have had one who was diabetic and knew a little about cushings and the signs so i had a feeling and too him to his regular ver. They did urin and blood and were starting the other tests the first urine of the morning one and the low dows dex? whatever that one is called. However, we arehave very closevery with our internal medicine specialist so we just went straight to her. He had an ultrasound today and it showed thr tumor on the right gland. She is doing another blood test and took a sample (i guess thats the right word) from his liver. Once all that comes back we will do the 8 hour blood test one. I do know his liver enzymes are elevated, they have been for years but have always stayed about the same so dr were not overly concerned i assume because he never showed any symptoms of anythimg and all the rest of his blood work has always been great. After the next test we will meet with the surgeon and talk with him for his opinion. Ive just started reading everything on this so its all a little overwhelming. But if im not mistaken surgery will basically cure it since it is removing the tumor causing it. But ive been told its a risky surgery! So being 10the and it being risky i am worried of course , but then medical management is only really controling the symptoms he has and then i think what if the tumor is cancerous! I appreciate all the feedback i will go read thru the thread that was mentioned and i will get more detailed info to post!

[Trish]

Hi Robin

Yes this is a scary time for sure, it will be good for us to see all the results when you get a chance to gather them up. Waly sounds like he has a few of the cushings symptoms. Glad you are seeing your IMS for this as it does take quite a bit of sorting out and testing at the beginning.

Did she say anything else about the ultrasound? Liver OK, just wondering as you said they took a biopsy from his liver? Anyway I am sure once you get the formal results in it will all become a bit clearer. Has Waly had his BP done?

The low dose dex test is the 8 hr one. So he is still to have that?

Yes, reading on the internet is overwhelming, just be careful to check the websites and make sure they are reputable. I have a few stored away in my favourites if you would like them I am happy to share.

They are right, surgery is risky so it really is best performed by an experienced board certified surgeon. So check out they have done it many times before and what their outcomes are. But on the other hand we have also seen a lot of success stories here. And you are right if the tumour is removed then hopefully all the cushings symptoms will go away. It is tricky for them to say whether it is cancerous or not, some of these masses are benign. Most surgeons would want a CT to better view the tumour and look for any spread before they consider whether it is operable or not.

Trish :)

[IWALY]

Thank you!
His liver was slightly enlarged so Dr was checking.

Yes that is the tests, we are doing the low dose dex test next Thursday.

I read everything, but I know the forums are the best and all the good info! Was on k9diabetes before and learned so much.

The surgeon is Dr. Bilbry at ASG in Los Angeles he is board cert. surgeon and did spinal surgery on Waly about a year ago for a blown disc. His reputation is one of the best surgeons.

Yes on CT that is recommend for sure.

I would LOVE links to the sites you have as your favorites! thank you!

Today his IMS advised its the adrenal gland is approx double in normal size. Also said normally they see the tumor as more of a growth on the gland - not that it is not possible its just not normal - also his left gland is perfect in size, reading about it looks like most of the time the tumor on one causes the other to be very small.

Again, Ill get all my info together and update more! Thanks for all the help!!!

[Trish]

Hi Robin
Maybe when they do a CT they will be able to get a clearer view of the adrenal, they can be tricky to see properly on ultrasound. Pleased to hear you have a good surgeon, it is also reassuring when they know your dog too having operated on Waly previously. I had the same with my surgeon having done a liver resection a year prior to adrenalectomy. Made me feel better anyway!

I have copied a few articles and research studies here, both adenocortical tumours and also pheochromocytoma. Hope they are helpful :)

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&

[IWALY]

Sorry I have been away and not able to reply. Thank you for the links! Ill look at them tonight.

We go tomorrow for the low dose dex test, and then I guess we go from there....

[IWALY]

What has me so worried about this is making the right decision! Other than being super hungry Waly seems perfect. I would not think about the 1 or 2 extra drinks of water or the very little extra panting, its very minimal. Im so so so scared fro surgery while he seems basically fine, seems from the studies that after the surgery there is a good chance of not making it. How do you take your baby and chance that when you look at him and he seems fine? But then you should you get the tumor before its larger or to the point you cant help ... ugh a very hard decision.

[frijole]

There are people who have been through this that can help you make the right decision - or guide you. Here is what I know - yes it is a serious surgery and you need to find a surgeon that is board certified and has done a LOT of this type of surgery. Meet with him/her and ask how many they have done, they will want to get film of the tumor and surrounding areas so they know the level of risk, location, size. These are all things that you will want to know as well.

I still think the best advice I ever read was this "look the surgeon in the eye and say if this were your dog what would you do?" then SHUT UP and pay close attention to the eyes and the response. Then you go with your gut.

Kim

[goldengirl88]

I have no experience with this, but want to support you whatever decision you make. I hope everything turns out just fine for your baby. Blessings
Patti

[Simba's Mom]

Hello and welcome to you and Waly, you have found the best place to be, lots of info and encouragement too, settle in, we are here for you and your furbaby!

[Trish]

What has me so worried about this is making the right decision! Other than being super hungry Waly seems perfect. I would not think about the 1 or 2 extra drinks of water or the very little extra panting, its very minimal. Im so so so scared fro surgery while he seems basically fine, seems from the studies that after the surgery there is a good chance of not making it. How do you take your baby and chance that when you look at him and he seems fine? But then you should you get the tumor before its larger or to the point you cant help ... ugh a very hard decision.

Waly seems good now but how long to your vets think before the tumour would become a problem for him?? That is the big question and I hope you have asked it of them.

This is what I based my decision on when trying to figure out what to do, I have included my rationale - keeping in mind Flynn was symptomatic esp from his high BP.

1. Expected life span for the dog - probably another 3 - 5 yrs for Flynn
2. Other health problems - heart, lungs no problems apart from BP. But past history of low grade hepatocellular carcinoma one year prior to finding adrenal mass. Successful surgery to remove his huge 650g mass with no sign of recurrence a year later.
3. Surgeon recommendations - yes he would do it for his own dog, yes he had experience with vena cava thrombus extractions with no deaths. University pet hospital - only vet training centre in NZ.
4. Risks - no sign of any tumour spread on CT including chest, understood all other potential problems eg bleeding, anaesthetic, vena cava complications, clots, pancreatitis, death
5. Prognosis if we treated medically - months only
6. Quality of life - for Flynn poor if we did nothing and death a few months away
7. Psychological - (me!) could I accept it if he died during surgery... probably would have hated myself for going through with it, but I still thought if he did die I had given him every chance of a full recovery and at least it would have been quick for him
8. Financially - yes I could afford it, if I keep working till I am 80 haha.. no, not really but it certainly is not cheap. Cost $3100.00 here in NZ including all preop scans including CT
9. Post-op care availability - support from vets, time off work for 2 weeks for me, should have taken more but ran out of leave but I'm lucky I have parents who look after him during day while I work

Hope this helps with your decision making!!

Have you got any results back yet? Whats the current plan?? Look forward to hearing from you :)

[IWALY]

Hello!

So I still do not have all the numbers but got a message from Walys specialist. The low dose dex test can not confirm cushings. The numbers were equivalent. Not high enough to confirm cushings and not low enough to be negative- So I will have to talk with her more. I think my plan at this point is to meet with the surgeon and do a CT scan if he recommends then make the decision to move forward with surgery or not... Does anyone know the average life span of a dog with adrenal tumor who is only treated medically?

[molly muffin]

It depends on the tumor and the dog. I would ask the specialist, what the expectancy is based upon Wally's tumor if you elect to not do surgery. This is who will be the most familiar with both his specific tumor and it's diameter, how fast it might or might not be growing and any likely hood of complications that might arise, based upon his ultrasound.

Sharlene and Molly Muffin

[Trish]

Yes, I agree with Sharlene. Life expectancy with a tumour would be very dependent on current symptoms, investigations and even the expected lifespan of the dog. It is hard to know what the actual type of tumour is, they can get some idea from the imaging and also the symptoms ie with my dog he had high BP which goes hand in hand with a pheo type tumour, whereas if cushings symptoms are present and they test positive then it is more likely a functional adrenocortical mass. You also need to know if there has been any spread of tumour to surrounding tissue, vena cava or even metastases to other parts of the body, Flynn's lungs were checked when they did the CT. Unfortunately they cannot biopsy the adrenals easily. Even now Flynn has a lump in his remaining adrenal, it was carefully checked at time of surgery when they took out the other gland and was not considered cancerous at that time, subsequent ultrasounds have not shown much increase in size so for now we are leaving it be and hoping like heck it is just one of those lumps and bumps that older dogs develop in their organs at times.

We do have a dog Chey on here whose owner Ro made the decision to treat medically and they are still trucking along now about 8 months later I think it is, you could search for her thread under Cheydogger.

I think it is good for you to get CT done and speak directly to surgeon and get their opinion about whether proceeding is right for you and Waly, it is a tough decision and you need to have all the info and the opinion of the experts like your surgeon is most necessary. :)

[Budsters Mom]

This is all so hard.:) Sending you tons of hugs and healing energy.:)
Kathy

[littleone1]

I haven't been on here for quite awhile. Corky had an adrenal tumor which was invading his inferior vena cava. He wasn't a good candidate for surgery because of his age and other medical issues. He surpassed his life span, in spite of everything he was going through. He was successfully treated with Trilostane for 2+ years. There is always hope.

[Budsters Mom]

I am so sorry for the loss of your precious Corky.:( Thank you so much for coming back and letting us know. I know that you heart is breaking right now. Know that we will always be here for you. Corky has now crossed the rainbow bridge and is running free of pain with all of our other Cush pups before him. He will always be with you where it matters most, in your heart. Much love and many hugs,
Kathy

[Trish]

Pleased to hear Corky did well for that length of time with medical treatment, it will be reassuring for others treading the same path. Not sure how long ago Corky passed, was it a wee while back or just recently? How ever long it was they leave a big hole for a long long time don't they, hope you are having more happy memories than sad ones now :)

[littleone1]

Kathy and Trish,

I posted a response on Corky's 2nd thread.

Terri

[IWALY]

Talked in length to Walys IM specialist- I just cant get a numbers grasp on how many with the adrenal gland tumor are treated successfully with medication only. If I was to get something like "most are successful and live 2-3 years " it maybe easier to make the decisions... I also have caught it so early that its best to do surgery now, but for its bigger or invades vena cava. If we try medically and it does not help, then the tumor may grow into these areas and then surgery would be more difficult. The hard part is I feel I have to say, ok, if we do surgery are you able to live with yourself if he dies from complications since it seems its very risky. Maybe he could live another 2 years on medication only? Don't know until we try and then it could be too late to help with surgery.
Also the surgeon is on vacation now! Seems Dr are always gone when you need them. Now cant even do consult until Tuesday next week!
I realize I'm rambling, but I'm so confused on this decision. Im possibly making a choice which could kill my Waly.... but how do you not try to do everything possible?

[littleone1]

If Corky was a good candidate for the surgery, I would have had it done, but he wasn't. He had cushings for 3+ years. The only reason that he wasn't treated that long was because his clinical signs were in remission for 7 months. I know it's a very hard decision to make, but we always make the right decisions. Corky surpassed his expected life span. He had a very good quality of life being treated with Trilostane. I wish you both the best.

[IWALY]

Thank you Terri, I'm sorry you lost your Corky, but you were a good mom for sure and sounds like he did very well surpassing his expected life span. I guess I'm just looking for something to make me say - yes that's the right decision to make! Maybe after next week (which is like waiting forever) I will feel more confident in making a decision. Thank you all!

[Marmi]

Hi, I am Rudy's mom. He was diagnosed with Cushings disease and has a 3cm x 4cm tumor in his left adrenal gland...he was just diagnosed a week ago and is scheduled to have surgery a week from today. It was all such a shock and I know what you are going through trying to make a decision...I try not to think about the "what ifs" and instead focus on how much better he will feel if the surgery and recovery is successful...but I am scared :( Rudy was tested and diagnosed at a college of veterinary medicine and will have his surgery there. This is what they recommended for him since there was no indication that the tumor has spread yet. I am praying that it is a benign adenoma and that he will not have problems. He was so sick before he was diagnosed and was sent home with lots of medicines trying to get him healthy enough for surgery. And he is much better! He has been taking Trilostane, Clavamox, Diazepam and a low dose aspirin. He was also on a pain med but I got permission to discontinue that because he was so knocked out...this is a dog that was not taking any medicine before last week! But I want him to have every advantage possible going into surgery and it is helping him... I will be thinking about you as you are trying to decide what to do for your Waly...it is hard but I know these doctors have been trained well and will do their best to save Rudy. Let's keep in touch...

[Trish]

Hi Robin

I think you will feel better after you speak to the surgeon next week, so annoying he is on leave!! Does he not realise he has a star K9C patient waiting to be sorted out!!! :D:D I would be asking his success rates with this surgery and what he would do if it was his own dog. You do have to be prepared for the worst, we all know that but we need to keep perspective that most dogs do survive this surgery. If they get through the surgery and are discharged from hospital they have a good chance of living many more years. That is what I kept reminding myself of, but of course the worry never does leave you till you get them back in your arms. We are waiting for the final decision right along with you Robin, and that surgeon better be back on board asap!! :)

[IWALY]

Marmi, I have you and Rudy in my prayers! I read your thread actually just yesterday too, im trying to get caught up with all of you wonderful people on here! Thank you all for the support.
Trish, I know Dr are always out when you need them.
Im taking Waly for a follow up Ultrasound tomorrow to see if the tumor has changed any in one week, suspect not but he does seem to be panting a little more not much but some- although we are in a heat wave now in Los Angeles area. I plan on researching the success rate people have treating a adrenal tumor with medication vs surgery. I also started looking at holistic options. I choose to go medically Id like to incorporate some holistic treatment along with the Lysodren. I spoke to my IMS and she actually spoke to the surgeon who was on his way out for vacation... I asked what vibe he gave off about it, and she said basically he told her he was ok with it, but why does it have to be the right gland. I think im confident in the ability of the surgeon, its the recovery after which has me very scared. And, Waly is fat, so it add to the difficulty of everything :(

[Trish]

Hi Robin
Flynn's was the right adrenal and he had vena cava thrombus and he did ok!!! So don't worry to much about that, it is trickier but if the surgeon is worth his salt he will be able to manage it.

I would question the need for another ultrasound after only one week, we had the initial ultrasound that found it, then the surgeon wanted a CT to look at it more closely and also to check for any possible spread also to look at his chest. I hate to see you spend money on a repeat ultrasound and then have the surgeon comes back next week and asks for a CT! So just run that past them, they may have a good reason for repeating it so soon but if it was me, I would check their rationale for that. :)

I would be interested to hear if you find anything on holistic treatment for the treatment of adrenal tumours, unfortunately their is generally a lack of research in these treatment options for any conditions. So do let us know what you find out :)

[IWALY]

Yes I am confident in the surgeon, that's one thing on my side!

Walys IMS is actually more of a friend so I think she is just being nice doing an extra free ultrasound so I can see if its grown, so I wont worry so much waiting another week to see the surgeon.

Trish, did I see posted somewhere you have photos of your baby right after surgery? I tried to look at your album but maybe I am doing it wrong?

[Roxee's Dad]

Maybe I can help.... try this link.

http://www.k9cushings.com/forum/album.php?albumid=559&pictureid=4381

[IWALY]

Thank you! WOW Flynn looks amazing for 1 day out, nothing I would have expected.

[Trish]

Yep there he is! Thanks John. That picture is taken 22hrs after surgery when they had discharged him back to my care at the motel. He gets so stressed being in hospital that they thought he would be better out of there and back with me. They discharged him on the proviso I took him back for a checkup at 5pm, that day and then back again at 9am the following day. He was out with me that first night, then the next day started vomiting so he had to go back in and stay and have IV fluids overnight then I was allowed to take him back out the next day!! After that we stayed another 3 days in the motel to be close to the pet hospital so we had that backup close at hand. While it was scary at the time they said that was all par for the course and expected. I was worried it was pancreatitis causing the vomiting and he most likely did have a touch of that but the retained swab probably moreso!! We had to go back each day 1-2x depending on how he was for them to review him before we were all happy enough to let us drive the 2 1/2 hrs home. Then my local vet took over his postop care. Poor boy, seeing that photo brings it all back, but everyone here was right by my side through it all the same as we will be with you if you decide to go down that path :)

[IWALY]

So the ultrasound yesterday showed same size tumor as on 6/20. Dr. Got a better picture of it. If im reading it correctly its 1.66cm by 2.44cm. I have the ultrasound pics on disc but it all looks like a fuzzy blob to me. I asked her, by her i mean out internal med.spec. if she would do surgery it it was her dog she said no. I know she puts her feelings into it for us as well as her expertise. Im sure her no was just because of how devastating it would be if he didnt make it. She is all about quality over quantity. We will see what the surgeon says he is a very nice man on top of being a highly regared surgeon here in los angeles.

Trish, I am reading your journey with Flynn im on page 33 of the of the thread and oh my were you strong going though all of that! So far it sure seems like Flynn would have had an amazing recovery had they not left that swab in him. But what a strong baby he is! I keep trying to think that even though the death rate for the surgery is higher than most its still like 80%s success rate. Maybe if i look at it that way i will find the courage to do it.... i know its the best chance Waly has to be with us longer. (Sorry for typos done on cell)

[Trish]

Hi Robin

Good news the tumour is the same size, it is on the small size too. From what I have read tumours <5cm do better.

Was your IMS saying No to surgery just because of the risks associated with surgery? Waly is a fairly young dog at 10 so he could have a fair few years left in him! That counts in his favour with getting through surgery, plus it is a small size tumour with no apparent spread into vena cava so again they are good indicators.

On the other side you have a dog with relatively few symptoms with just excessive hunger being the main one, did you get a copy of his LDDS test for us to have a look at?

Your right, Flynn would have done better without that swab complicating his postop recovery, but even with that by the 3 week mark he was doing substantially better!

It would be great if we had a crystal ball to see what would happen if we did not do surgery! I guess if his tumour was benign then he could live with it just fine but we don't know that. Flynn has a nodule on his remaining adrenal. It was there before his surgery, his surgeon had a good look at it during the operation and thinks it is benign. It is not giving him any symptoms so we are watching it with surveillance ultrasounds. It has not grown significantly so we are not doing anything about it. But we have the benefit of him having actually visualised it. I think dogs do have little lumps and bumps in spleens, livers and adrenals the trick is in deciding whether it is going to cause problems in the future. That is where your surgeon comes in, I think you will have a much better idea on how to proceed once you have had your consultation with him next week!!

Hope you are having a nice weekend with your Waly! Oh to go back to the days when we didn't have to worry about all this confusing stuff, you will do the best for your boy whatever you decide! :)

[IWALY]

Hi Trish,

Im so off and on here that I seem to miss things more often than not, so Happy belated 7 months to Flynn!

My IMS has said she has seen dogs actually go home after the surgery and throw a clot, so I think she is kinda of thinking quality over quantity so to speak and that's why she said she would treat medically.

But yes, from all I am learning here on on the web so far it seems other than Waly being overweight, he has some things on his side, like the fact its not a huge tumor yet, and no spread as you mentioned. Average life span of a Doxie is 12-15 years so I'm trying to think 5 more years and 80% chance of making it though surgery.

And no I don't have my LLDS test info I'm sorry- I ran in and out so fast for the ultrasound I didn't have a chance to get copies. (I have another dog who is diabetic and it was shot time)

Thank you and everyone for the comments, advise and support! Im sorry Im so off and on here- with work and all its hard to find more time... I find when i'm on line I just read and read and read and search and search!

Tuesday can not come fast enough!

[molly muffin]

We're use to running in and out of the forum. We all do it. Plus, you are in crisis mode right now, so of course your main focus is, as it should be, researching.

Sharlene and Molly Muffin

[Trish]

Yes our time on here does come and go, I am usually on nights when your all asleep so it is a treat for me on the weekend to actually be on the same time as you Northeners!! Yes, you should research, research and research some more!! Although sometimes the numbers all get to be too much and your head spins :eek::eek: I think the numbers I was most interested in was my own surgeons, like how many he had done, how successful, what complications had he experienced etc So get your pen and paper out and make a list!!

Don't worry about keeping up with everything, in times like this you are quite rightly focussed on getting your Waly sorted, I was pretty self absorbed at that time too... you head can only hold so much Robin so you can get caught up with everything else on here once we have Waly's plan in place whatever that may be!!!

[IWALY]

Thanks all! Im excited and scared at the same time for tomorrows consult with the surgeon. Waly is so happy now and good, its almost like he's not sick, even though I know he has the tumor if that makes any sense at all. In fact the last few days he has been acting normal with his breakfast, not starving like he has been-Dinner though he still is very, very hungry! And any treats offered he jumps at them like he's never had one before. Here is hoping some answers or at least a better direction comes tomorrow! Thanks for all the support

[Roxee's Dad]

We are all right there with you in spirit :)

[spdd]

Sending all the best vibes that are absolutely possible to send.

[addy]

Just checking in to make sure who wrote down all your questions for the surgeon consult tomorrow.

Mother Hen clucking away, they say off me:D:D:D

[IWALY]

No I have not! My brain is so fried all I can think to ask is his track record with this surgey and if he would do it if it was his dog...I think the rest Ive got down... but I do plan to ask him general statistics too to see if he differes from what Ive read. But I think at this point, his track record and if he would do ot to his dog are my main thoughts. Anyone have a must ask?

[frijole]

Look him right in the eye when you ask the tough questions and use your instinct. Go with your gut - it's your best bet every time. We are with you in spirit sending strength and love! Kim

[molly muffin]

yes :) Exactly what Kim said look him in the eye and don't blink first :)
We are all riding shotgun with you :)
sharlene

[Tina]

Sending prayers and positive thoughts to you and Waly for tomorrow. You are not alone, we will all be right there with you!

Hugs,
Tina and Jasper

[Trish]

If you need any further ideas, here are the questions I would be asking (based on my actual list I had for our surgeon, but I have tried to adapt it for Waly's situation)!!

1. What type of tumour do you suspect, as his LDDS was equivocal, ?non-functional. If we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life? Taking into consideration he has minimal symptoms now. Plus he is relatively young at only 10.
2. Do we need a CT scan to look at the tumour more closely to check for vena cava involvement or any other spread?
3. What are the risks associated with this surgery, list them all... including bleeding, clots, damage to other organs, pancreatitis, infection, wound problems, bowel problems, anaesthetic risks, death (sorry but you have to ask that risk too) also, if we proceed with surgery does Waly need preop treatment with cushings meds, or anticoagulants to prevent clots, how will you treat to prevent clots postoperatively. Is there a specialist anaesthetist for the surgery?
4. What would you do if you found anything else during the surgery ie nodules in other places, would you remove them and what are the risks associated with doing additional abdominal surgery at the same time as adrenalectomy
5. How many operations of this type have you done? What complications have you experienced? What were the outcomes?
6. What increased risk is there with him being overweight?
7. How will the postoperative period go, how long would you anticipate he would be in hospital? What monitoring would be needed, eg heart monitoring, oxygen levels etc
8. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.
9. Please explain to me how you will do the surgery, which part likely would give you the most trouble? Will you be doing the actual surgery, not a resident in teaching situation?? How long will it take, when will you contact me so I know all is OK, when can I visit after surgery?
10. Definitely ask the would you do this for your dog.. . most important.
11. Estimate of costs!!

Hmmm I think that is all :D:D I know I am a little OCD, but I like to know exactly what is going on... you may not need all that information but it can give you a starting point to help form your own list. Hope that helps!

Time for a PAWS UP WALY!!!!!

Hope it goes well tomorrow, will be thinking of you and be looking tomorrow night to see how it goes!! Good Luck xxxxxxx

[molly muffin]

Checking on you guys too! Hoping for a good report! Stay strong!

Sharlene and Molly Muffin

[IWALY]

My thoughts are with Rudy at this time. But I wanted to post on Waly and our consult. Still don't know what to do!!

Most important question to the surgeon would he do it: he said not yet. He said its very small at this time, so he would try a month on meds see how he responds and do an ultrasound if the meds are working good, if the tumor has grown then he would say do the surgery. So I will probably make that very decision-

He said its a functional tumor probably benign- he sees clear on the ultrasound no spread at this time.

He is confident in his ability to get it out he has removed tumors inside the vena cava, opening it removing and then repairing.

He agrees the risks after are big- he said he feels 30% mortality is acurate, 1 in 3 dont make it, it is what we should be prepared for.

Time in hospital if all goes well, 2-3 days.

Estimate low-$4700 high $6900


*He said if Walys tumor was bigger today he would say we have to do it, the only choice. - but he thinks if its a very slow growing tumor we may have a chance with meds.

So now decision to be made.... I dont want to see him sick and on meds all the time either- IM said she would treat with Lysodren so, now what can you all tell me about this medication? Lots of side effects? Hard to get the dosage?

I still dont know what to do...

[molly muffin]

Well there is nothing wrong with using meds if there is something that can help. Is the surgeon thinking that he would rather do the surgery if the tumor is larger? Or what is it that he thinks the meds will do exactly? Keep it from growing?
I'm a little confused on that part of it.
These are not easy decisions to make. We all know that.

hugs,
Sharlene and Molly Muffin

[IWALY]

He felt since its small and it is does not appear to invade anything, if we wanted to try the meds for a month to see if it would keep the tumor from growing we could go that route. If it grew or did not respond we would need to pursue the surgery. It is of course more difficult to remove if it is larger (providing it does not metathesis) but even larger than it is now he is confident he will be able to remove it with our issue- that being the actual procedure, not the possible complications- that he feels 30% mortality is a fair % to expect.

I think we caught this so early on, that maybe both the IM and surgeon (two totally different practices) think we have a chance at the meds helping to kill it or at least keep it from growing. If that happens and he tolerates the meds then we dont have to chance the 30% mortality

The surgeon sad surgery is the best thing for it. But he will not force it, if the tumor was worse he would.

[labblab]

Hello from me!

Just wanted to stop by to say that there there do seem to be a small percentage of adrenal tumors that show reduction from Lysodren treatment. I don't think anybody can predict in advance which ones will respond that way. But it is not unheard of, so it may indeed be worth the attempt.

Marianne

[molly muffin]

As long as you would be monitoring it with ultrasounds to know if it is growing or how it is reacting to the medicine, then that is a possibility. If it started to grow, then you could talk to the surgeon again, and decide.
It is a hard decision to make and there will always be risk with any given scenario.
hugs,
Sharlene and Molly Muffin

[IWALY]

Who has experience with Lysodren? Wondering about how it works and side effects? And any advice where to buy it? Especially if we have to have it compounded.

[frijole]

I used it for 4 1/2 years. I'll link you to some information on using it that I used way back then. My dog Haley lived to be 16 1/2 and she passed of old age and not cushings. So I am a believer.

Key to using it is to make sure it is administered properly and that the vet knows what they are doing. Dogs only get in trouble when parents don't pay attention or vets don't follow protocol.

Cushings is caused by excess cortisol created by in your case an active adrenal tumor. Lysodren reduced cortisol production by eroding the adrenal cortex. The key is to only partially erode it so that the dog can still produce adequate cortisol required to live comfortably.

Dosing is 35 to 50 mgs per kg of weight. Take your dogs pounds and divide by 2.2 and multiply by 50. Most start at the high end of the range. Adrenal cushings dogs might require higher dosing but I'd start at 50 mgs/kg. Initially you give the dosage daily (once in am and once at night right after giving food) - you give this larger amount to get the cortisol down to a level of between a 1 and a 5 on a test called the acth test. Once you get there you want to maintain so you go on maintenance dosing which is the same amount only over the course of a week vs daily. Most take that dose and split into 2, 3, or 4 days so it is always working.

The only thing I noticed is that my dog got really bad gas at first. Others have had tummy issues so we recommend giving it with cream cheese to help coat the stomach. Haley never missed a dose with that cheese. :) Also at first I think they are a little tired but their bodies adjust and then the only complications that arise is if the dose is too high and as a result cortisol goes too low. Signs of overdose are: vomit, diarrhea, extreme lethargy as in can't walk/hold head up. You should be given prednisone (which mimics cortisol) to give in the case of overdose. Within a few hours your dog would get relief.

Never give lysodren to a sick dog - just withold until they are feeling better. I'm attaching a link to how to use lysodren as well as intro to cushings that might help get you up to speed.

Is your dog tiny? Otherwise you shouldn't have to have it compounded. I simply used a pill cutter. I bought from drugstore.com as they were the cheapest at the time and I never had any issues. I believe Walmart and Costco both carry it as well. People here have had success with Diamondback Drugs in AZ for compounding.

Kim

http://www.k9cushings.com/forum/showthread.php?t=181
http://www.k9cushings.com/forum/showthread.php?t=180
http://www.k9cushings.com/forum/showthread.php?t=193

[IWALY]

Kim your awesome! Thank you for such a detailed reply! You already made me feel much better about it.

Waly is 28 lbs. So IM said will start at 3/4 tab in the am and 1/2 at night for loading.

Did you give pepcid a/c as well? Did your baby have adreanal tumor? Ill look at the links thank you.

[Squirt's Mom]

We are also a Lyso house! Kim has covered just about everything very well as usual so I have little to add.

Lysodren works by eroding the adrenals like Kim said but that sounds much worse than it actually is. The drug only erodes a very tiny, miniscule layer of the outer cortex of the adrenal glands. This happens during the loading phase. This miniscule layer can and does regenerate, allowing the adrenal glands to once again start releasing excess cortisol. To prevent this regeneration yet preserve the basic integrity of the adrenal glands, the pup goes to the maintenance phase - which is exactly what it sounds like. The spaced out dosing is designed to "maintain" the level of erosion achieved during the load.

When you give the Lyso, give Waly a little extra fat or oil. Oils help the Lysodren be better absorbed in the body. Some folks give it in peanut butter or cream cheese or plain butter. Some have dissolved the med in a spoonful of warm corn or olive oil...coconut oil would work as well. It doesn't take much to help the drug but Waly does need a bit extra fat / oil with the pill.

You will do just fine! Holler if you need help and someone will be around!
Hugs,
Leslie and the gang

[Trish]

Hi Robin, such an up and down day with little Rudy, must be quite scary for you when you are considering surgery. We will all keeping sending the best of wishes to him. We also have Waly to look after too!! So many dogs that we can help here so glad you found us :)

I think your surgeons report is very sensible, if it is still small why not give the conservative management a trial in the first instance. Great to know there is no spread also. I don't like his 1:3 dog mortality though and think it a little high! Still who am I to argue with a surgeon, but mine was 1:5!

I am not much help with the Lysodren, as I have no experience with that at all. I will keep cheering you on from the sidelines though :D I see you already have advice from our experts that are very knowledgeable with that drug so Waly will do fine with both you and the angels helping you get to grips with it. Are you starting it soon? My boy Flynn did not have the cushings symptoms as his tumour type was different but I did have to deal with blood pressure issues but we are a diverse bunch and can usually find someone with experience in the needs of our new members that come along. I think this is good news for you and Waly today! xx

[frijole]

Kim your awesome! Thank you for such a detailed reply! You already made me feel much better about it.

Waly is 28 lbs. So IM said will start at 3/4 tab in the am and 1/2 at night for loading.

Did you give pepcid a/c as well? Did your baby have adreanal tumor? Ill look at the links thank you.

Your vet did the dosing math just right. I used pepcid a/c a few times but not all the time. I'd save it for when you need it unless you think his stomach is sensitive. Haley had pituitary cushings. My other dog however had an adrenal tumor but it was not the cushings type and we did not do surgery. Kim

[IWALY]

Thanks for all the help from everyone!

Im am confident in the decision to try the medication and repeat ultrasounds to stay on top of the size of it and monitor to see how its going.

Im just scared its not going to work and we will be forced to try the surgery... which today is more scary than yesterday

[Trish]

Yes, its a sad day on the forum having to say goodbye to little Rudy. But for Waly it is one day at a time!! He has a lot of good things on his side, not least of all you!!! So keep positive Robin, it is all going to work out one way or another :) xx

[molly muffin]

I know it is super scary and luckily, medicine is a valid option for you to try. Hopefully that will work just fine and no need to even go down the other road. As Trish said, one day at a time. :)

hugs,
Sharlene and Molly Muffin

[Trish]

Hi Robin

What's happening with Waly?? Has he started on the meds yet? Keep in touch won't you as we have grown fond of Waly and I am very keen to hear how he is doing!!! xx

[IWALY]

Hi,

Sorry for not updating! Waly will start on the Lysodren tomorrow night. We then have an appt on Thrusday for the ACTH stim - 1 hour test.

Im worried of course on overdose, was told 2.5mg of the pred is the dosage amount for his size if needed - I am worried because I'm reading all the signs to look for to stop the medication, when they stop being super starving, stop drinking tons and peeing - Waly does not have these symptoms, other than hunger, but he is always hungry anyway, hes a doxie and they are big time food hounds! Plus he's is restricted on food trying to loose a few pounds. So I'm just being overly worried that I many miss the signs I need to see, does that make sense?

But, I'm staying positive that he will tolerate the medication and we will go on Thursday for good results and hit the maintenance stage.

Keep my boy in your prayers as we take the first step on this treatment!
Thank you all, cant say enough what a great group this is!

[frijole]

You need to watch how he eats today and pay close attention. He should be inhaling and not chewing and not leaving any bits. You are looking for any change whatsoever regardless of how small. We have had dogs that simply paused between bites be loaded. so that is why you have to pay attention so you know if there are changes.

Have you measured water intake? If not you need to do so for a day to see what 'normal' is. If this means delaying the start so be it - sorry but better safe than sorry. One day won't make a difference.

You will be just fine and you ask us questions. Kim

[IWALY]

Kim,

We have 4 dogs all drinking from the same bowls... we have kept track of how often he drinks I dont know how to measure exact intake with all the dogs.

As far as food, he is hungry and eat but he totally pauses all the time, he eats slow too but he is defiantly super hungry he barks for the food and jumps when you bring his bowl. So I guess any change in the existing pattern is what i will watch for.

If that happens then I assume I dont give the Lysodren, but dont need to give the pred either- just call the his IM and have the blood checked asap right?

[IWALY]

Ok, Ive got a questions- probably has been already said but you know its all so overwhelming... Are there many here who have their baby on Lysodren who have the functioning adrenal tumor? Im getting confused on the statistics of how long average life span is when on the medication to treat the tumor. My IM said can be 20 days to 5 years but said she sees have lived a year, but end up passing from something other than cushings.

Also- I know lots use milk thistle for added support for his liver, anyone use denamarin? IM believes that's preferable to the milk thistle.

[Trish]

Hi Robin

I cannot help with your question not being particularly up with Lysodren therapy... but it always comes into my head there are "numbers, statistics and damned lies" haha not sure where I got that from. But I always try to not get too caught up with the numbers, all of our dogs are such individuals and it would very much depend on health of dog, size of tumour, age etc etc. I have found this on medical management of adrenal tumours by the Veterinary Society of Surgical Oncology, but there is no date so I do not know when it was published.

MEDICAL MANAGEMENT

General Considerations


•drugs used for medical management of hyperadrenocorticism include:
•mitotane (o,p'-DDD)
•ketaconazole is an anti-fungal agent which inhibits adrenal steroidogenesis with minimal affect on mineralocorticoid synthesis (5-15 mg/kg/day), but up to 50% dogs fail to respond
•bromocriptine is a dopamine agonist with limited success
•selegiline is a monoamine oxidase inhibitor which enhances dopaminergic tone to the hypothalamic-pituitary axis and inhibits ACTH secretion (1 mg/kg/day)
•metyrapone is an inhibitor of 11-β-hydroxylase which converts 11-deoxycortisol to cortisol and has shown good short-term results in cats with hyperadrenocorticism and can be used for preoperative stabilization prior to adrenalectomy
•aminoglutethimide inhibits conversion of cholesterol to pregnenolone and has been associated with short-term improvement in 1 cat and suppresses adrenal steroid hormones in normal dogs
•trilostane

Mitotane

General Considerations
•mitotane (o,p’-DDD) which is an adrenolytic agent which reduces cortisol secretion through selective necrosis of zona fasciculata and reticularis (i.e., glucocorticoid-producing portions of the adrenal cortex) and spares the aldosterone-producing zona glomerulosa
•adverse effects are common and include glucocorticoid and mineralocorticoid (rare) deficiency during induction therapy and toxic effects on GI, liver, and CNS (i.e., weakness, disorientation, and ataxia)
•response rate with adrenal-dependent hyperadrenocorticism is poor with 56% responding to induction therapy (although better response if no evidence of metastatic disease) with higher doses required for longer duration
•mitotane has been used in cats although they are traditionally sensitive to chlorinated hydrocarbons, response rate is less, and incidence of adverse effects higher

Induction Therapy

•aim: reduce serum cortisol levels to within reference range for both basal and post-ACTH stimulation
•mitotane: 50 mg/kg/day for 7-10 days or until end-point of induction phase is achieved
•response to mitotane is variable with adrenal reserves diminished in 5-60 days
•water intake, appetite, and general health should be closely monitored
•mitotane is stopped and treatment reassessed if dog becomes listless, inappetant, or develops GI signs
•success of mitotane induction therapy can be measured directly with ACTH stimulation test or indirectly with an eosinophil count or reduction in water intake (especially if pre-existing polydipsia)
•10%-15% dogs will not respond within 7-10 days and will require further induction therapy and repeat ACTH stimulation test in 7-10 days
•33% dogs will rebound with subnormal cortisol levels and may require glucocorticoid supplementation until cortisol levels are within the reference range (usually 2-6 weeks although can be months)

Maintenance Therapy

•mitotane: 25-50 mg/kg/week divided into 2-3 doses
•physical examination and ACTH stimulation test should be performed every 3-6 months for monitoring
•pituitary secretion of ACTH continues despite clinical control of hyperadrenocorticism
•40%-50% recurrence rate of clinical signs of hyperadrenocorticism within 12 months
•daily induction therapy restarted for short period followed by maintenance therapy if recurrence

Prognosis

•MST for dogs with adrenal-dependent hyperadrenocorticism is 11.5 months

http://www.vsso.org/Adrenal_Cortical_Tumor.html

There is no reference list here for me to read where they have made these assumptions on survival times

[IWALY]

Thank you Trish.. . I love the ""numbers, statistics and damned lies" I know, they are all different and I do agree it all depends on the dog. I just wondered how the babies are doing here, a more honest answer than the statistics! I think my brain is just looking for reassurance I'm making a smart choice by trying the meds.- Because my heart just is not ready to chance the surgery... does that make sense?

[frijole]

I used lysodren for 4 1/2 yrs on my Haley - she died of old age and not cushings but she had a pituitary tumor we BELIEVE (I never did an ultrasound).

I think the challenge in answering the question with an adrenal tumor is that it depends on the tumor and if it is aggressive and growing or not. Obviously if it doesn't grow then the dog lives longer. I don't know there is any way to know for sure how much the lysodren helps prevent tumors from growing.

Sorry I can't give you a real warm fuzzy - I don't think it depends on the dog - I think it depends on the dang tumor. Fingers crossed your tumor stays small. :) Kim

[Trish]

That is so true what Kim wrote, some tumours are slow and do nothing, some are fast so we will all be interested to see what the next scan in a month shows.

Flynn's pheo tumour was in right adrenal which was removed, but there is also a nodule in the left. It was 0.5cm last November, it was looked at during surgery and surgeon said looks benign (I kind of wish it was biopsied, but have to trust his judgement) but we are watching it, his last checkup ultrasound at the end of May it was 0.7cm.... but vets say it can very much depend on how they measure it and very hard to get it exact but the appearance was basically unchanged. It does worry me a little with Rudy's Mom just posting he had pheo tumours in both adrenals but Flynn has no symptoms currently so we will continue to monitor and next scan is due in November.

At least you know about it now with Waly and are onto the monitoring and have a good team of specialists including surgeons and IMs behind you... you cannot do more except spoil Waly rotten and follow their recommendations!! He is so happily blissfully ignorant of all this worry so make sure you have fun with your boy!!

[IWALY]

Yes, agreed! I am ready to do a ultrasound every week!

My head tells me to to the surgery but boy tell that to our heart... especially after sweet Rudy loosing his fight right now. I know Waly is not Rudy... still gives me more fear.

But yes, on the ultrasound and size of them, for your Flynn I agree the ultrasounds can vary, I went in with Waly for both of his and the second one was off by a little not much, but the IM pressed into him so much harder and, really they have to catch it on the screen just right and get the picture to mark. I can so understand your worry now with the nodule, after you have been though it all and know so much it must be hard to just wait and watch.

Waly is having lots of fun now no worries on that end! Ill add some pics of him he's been playing in the water alot last week- killed the water hose! :)

[Trish]

Yes, it is all to do with positioning and how hard they press with the probe as to how squashed things get etc etc, can be so many variables. Flynn has nodules in liver, adrenal, cysts in kidneys I cannot be worried about every little thing or it would drive me crazy!!

He is an older dog, they do get some of these things as they age so what we need the experts to do is weed out the ones that are going to cause trouble and not worry too much about the others!! One of my mantra's is to treat the dog, not the numbers (or the pictures!!) and Flynn is doing just fine :D:D

I think sometimes we become too stressed out when things are not 100% normal.. they are not going to be in older animals!! Things fluctuate and we watch and worry and more often than not in a day or two they right themselves... this is what I tell myself when I start worrying ohhhh has he drunk more today, is that poop normal??... I know I have to be careful not to fixate on stuff that is normal fluctuations and not obsess :eek::eek: That is why I like our home here on K9C we can come here and get rational answers from the members!!

[IWALY]

A few prayers tonight, Waly took his first lysodren. Here we go!

[frijole]

Don't worry - we'll keep an eye on your thread. Post any questions any time. You aren't alone! I remember I was scared to death... One day you'll give a pill and not think twice about it and remember back on today. Just follow the instructions and keep a close eye for signs discussed. Hugs, Kim

[IWALY]

I know your right! Thank you for all the support!

[Simba's Mom]

Sending hugs and prayer to you and your precious Waly, hang in there with the new meds, it takes awhile to see changes....

[molly muffin]

Right here with you!!
hugs,
Sharlene and Molly Muffin

[IWALY]

First night down! Im more worried about this loading phase ill relax more when i know hes at the right dose. Thank you all for the support!

[Squirt's Mom]

You're doing good, Mom! Keep up the good work and this loading will be behind you in no time!

[goldengirl88]

Robin:
I have read some of your posts and wanted to tell you that we all go thru this with meds, not matter what type they take. You are doing a real good job, and it takes a steady hand at the wheel to watch these babies. That is the most important thing is to watch for any signs of problems, not that you will have any. God Bless you and your baby.
Patti

[molly muffin]

Checking in to see how everything is going!

hugs,
Sharlene and Molly Muffin

[IWALY]

So far we are doing ok! He has only had 2 pills so far. No adverse reactions yet so thats good. Thanks for checking in on us!

[frijole]

FYI there is no set timeframe for a dog to 'load'. We have noticed that dog loads load faster than small ones - don't ask me why. We've seen dogs load in a day and my Haley holds the record - it was several months. Average is 7 to 10 days. That said because you are dealing with an adrenal tumor sometimes (not always) it takes longer as higher doses are required.

What symptoms do you think you'll most likely see changed: amount of water consumed a day or a change in eating (not inhaling food for example or pausing in between bites)? Obviously look for both but in my case Haley didn't have issues with water consumption so it was all about food.

Kim

[IWALY]

The fastest our IM has had one load is 4 days. But since on here seeing that its possi le sooner im making sure to pay clise attention to him. The only things hes shown any sign of is hunger and slightly more drinking and panting. BUT hes always hungry as hes been on a diet. He has always been a pnater because hes always been over weight. The drinking is hard too he is beyond spoild and half the time if he wants a drink he wont even get up to get it he stares at the bowl until its brought to him... ok bad but hes 10 and is been like that forever. Also with 3 others sharing the water its harder. But i was able to noticethe increasein all three so im sure ill notice the decrease too and im watching very closely. Im home with him work from home so tha helps too. Appt now for thursday to test.

Wow months to load? That must have been so overwhelming for you!

[frijole]

Just remember if you have any doubts don't give it. Lysodren continues to work for 48 hrs after the last dose. So if you cave and give it when in doubt he can go too low. You can't take the pill back. Another thing is that if you go in on TH for the test the dose he has that day will continue to work for two more days so in reality whatever the results are - his cortisol will be LOWER because it works for two more days.

If he were to have signs of loading on Tuesday or Wed I'd withold the drug but keep the appt for TH as the results would actually be more representative.

What will happen is you go in on TH for the test and you stop giving lysodren until you get results which will be a few days. If he's loaded you go on maintenance. If not you repeat daily dosing until you see signs of loading and test again.

Oh yeah we were all overwhelmed. The admins on this site at the time were dumbfounded I'm sure. We slowly increased the dose from the maximum recommended (50 mgs/kg) to over 100 mgs/kg before she loaded. She was diagnosed with pituitary cushings but we all suspected maybe she had an adrenal tumor due to the high dosing requirements.

FYI vets always told me Haley was fat too but I now know it was the cushings. What happens is their organs expand (heart, liver etc) and it gives them that rounded look. So you can end the diet. :D

I had 2 dogs and I measured total daily consumption and looked for change. I marked bowls with tape to make it easier every morning I filled them up. At night I measured and then refilled. Wow he makes you bring him his water - that is funny.

Hang in there - you are doing great. Kim

[IWALY]

Interesting info on the load ... the part about witholding befor the test. My IM wanted him to have it in the morning before the test. Its a 1 hour test, dont know the name. Ill ask about it more as what you said makes logical sense.

He will get water himself but sometimes he just sits and looks at it until you bring it. And if you dont he will just lay down again even though he wants it. We have always said hes a little "special".

I wonder with it being adreanal tumor is it a waste of time to even start at 50mgs/kg. ?

[frijole]

Follow the vets instructions and give the dose on Thursday. What I was saying is that if you see signs of loading - regardless of what day it is you always STOP immediately. So if that was on TU or WE there is no rush to do the 1 hr test (ACTH Test) - you could still do the appt on TH.

Nope I'd start you at 50 mgs because it's safer. You can always increase if you need to. Kim

[IWALY]

I got ya! Thank you for all the tips! Just hope that tumors not growing.

[Simba's Mom]

Sending hugs and prayers for the loading process, my Simba is on trilostane so he doesn't have to load, all the drugs are different....your Waly sounds precious, my Sim is way spoiled too and should be on a diet too, maybe i will see what the vet puts him on next appt if us ACTH comes back ok, anyways take care!

[Trish]

Sounds like all is going well Robin! Hope Waly loads soon and you can get this step behind you, it looks like you are getting great advice from those experienced with Lysodren! xx

[molly muffin]

Yep, here I am, checking in on you and Waly. :)

hugs,
Sharlene and Molly Muffin

[frijole]

Good job Sharlene! I assume all is OK with our little guy. Kim

[goldengirl88]

Robin:
How is Waly doing? I have been following your thread, and I know you are on pins and needles seeing how this goes. Just watch him closely for any signs of problems. Blessings
Patti

[IWALY]

Hi! Waly is doing fine so far! No change at all as far as hunger and drinking. So, he can tolerate the meds that's good- Hope he loads soon! Im not as worried now of course since i have a few days under my belt giving him the meds. Im of course worried about it all and now hoping they work and help stop the tumor- I flip flop on what worries me so I guess it all does just as much you know? I just want to hear the IM tell me that hes loaded and its working!

[molly muffin]

Yea, we do know what you mean. It's like you can make a list of the things to be worried about and then just go down the line checking them off for the day. Worried about this? yep, CHECK, next, worried about that? Yep CHECK. We do understand around here. :)
I do hope this helps to control the tumor. :)

hugs,
Sharlene and Molly Muffin

[IWALY]

Going for his first test 5 days after Lysodren... I do not think he is loaded at all! He is actually drinking more I think... but for sure no change in hunger! Still starving! So, maybe it will be upped? Wish us luck!

[spdd]

Wishing you all the luck in the world.

[frijole]

I wish they would have waited 7 to 10 days to test because it could just it wasn't enough time... and the tests are not cheap. Perhaps ask the vet if you could dose 3 more days and come in and skip today's test. I would given an increase in water. kb

[IWALY]

Agree on waiting a little longer... $400 day and I know hes not loaded. But should have blood work/tests back late this afternoon so its possible she will make a change I guess in his dosage? Oh well, I guess better safe than sorry right? And how hard was it not to do an ultrasound and see whats up with that tumor... VERY hard! Next week I will I just need to know how its looking... especially if it takes awhile to get him loaded. But he took a nice picture today at the park! Ill update my profile pic!

[molly muffin]

Ohhhhh love the new profile picture. What a handsome guy!

Well I don't know how they do it with lysodren, kim or one of the others will know though, if they increase the dosage, or if you just extend the dosing time. It's doesn't work the same way as trilostane, so I can't tell ya for sure and don't want to get it wrong.

But I love the photo!! :)
hugs,
Sharlene and Molly Muffin

[IWALY]

Was back at vet with my other dog and Walys IM came in and told me results... he is loaded! After tonights dose he goes on maintenance! I jotted down his test result will post later from my pc on my cell now but so happy i wanted to share with you all!

[frijole]

I'm shocked as I know you are since you said no change in appetite and water intake might be increased. Please please get the numbers - actually you need to get a file folder started and get copies of all blood work and tests - trust me they'll come in handy up the road.

There are 2 numbers on the test. The one that matters is the last one. It should be between a 1 and 5 for the dog to be considered loaded.

You said something that has me totally confused. You said he'll start on maintenance AFTER tonights daily dose. Whoa. Have you been continuing to give daily loading doses AFTER the test? I ask because whatever the test results are - if you continued to give daily loading doses... the cortisol will be LOWER because you continued to give it. Protocol is you stop when you see signs of change in symptoms OR after you have the acth test. You always wait for the test results because if your dog is low it will be even lower. Given your description of no change in symptoms I doubt you have anything to worry about but that is not the way it is supposed to work. I share for in the future should you have to change dosing. Remember this drug keeps working for 2 days after the last dose and by working I mean eroding the adrenal cortex. So you can see why this could cause problems.

Can't wait for the results. Fingers crossed he really is loaded. Great photo. Take care, Kim

[IWALY]

Ok still on phone but to be more clear test came back today pre he was 3.8 and after he was 5.4 so she wants him to have tonight dose as he has been 1/2 in the pm for the last 5 days. Said it will bring him down to under 5. Then sunday is first maint day we will give 3/4 sunday and 1/2 wed. Two weeks we recheck. His ALK was higer than last cbc it was 1913. I will be watching water intake closely. Is it possible it can take a little time for that sign to lessen? Also starting on denamarin for liver support.

[Squirt's Mom]

Hi,

That post number is not within range to indicate the load is achieved. A post of 5.4 is still just a tad too high. The range for a cush pup on Lyso is a post number between 1 - 5 ug/dl. Waly doesn't have far to go and since you have continued the med instead of stopping when the ACTH was done, his level has continued to drop. On one hand, that is good as that will more than likely achieve the load. On the other hand, it can increase the risk of a crash. Keep a very, very close eye on him for the next few days because that last dose last nite is going to reach it's peak 48 hours later. That means that even tho you don't give Waly any more Lyso until Sun, what he has already taken is working hard in his body and will continue to lower the cortisol.

If you see any signs of loss of appetite, nausea, loose stools, or listlessness that could mean his cortisol has dropped too low and he needs prednisone. If you see any of those signs, call the vet and let us know asap. With his signs currently still strong and the 5.4 post on this ACTH, he will probably do just fine. But I want you to be on your toes for the next few days just in case. ;)

The schedule for the ACTH after starting maintenance is spot on!

Since his cortisol is not quite back to normal level, signs like the drinking will not show much, if any, improvement. But once that post number is closer to 2.5 ug/dl you will probably see a marked change in him. Be sure to watch appetite as well as drinking. Some pups don't give the water intake sign but show strong changes in appetite, or the manner in which they eat. Where before they wolfed their food never looking up, when the load happens they will eat slower, chewing their food, even looking up when their name is called.

And to be real clear - no more Lyso until Sun....and maybe not even then if he has problems, IF. :)

You're doing a great job, Mom! Keep up the good work!

Hugs,
Leslie and the gang

[IWALY]

No its not in the 1-5 range - the test was done Thursday morning and results provided Thursday afternoon. Upon the result of 5.4 post, IM is confident with one final induction/load dose of 1/2 tablet with pm meal it would bring him into range 1-5 and be would be considered loaded.

I did not provide any medication to him waiting while waiting for results to come back, his test and results were all completed within hours.

Im sure the water intake will be less soon too! His panting is already back to normal. His hunger is probably the same, as i mentioned before he is always hungry- diet and well hes a dachshund!

Thank you all for the support and fingers crossed this stops that tumor... Im so scared if forced to surgery.

[Trish]

Hi Robin

Good job so far!!! I just laughed myself silly looking at your photo's, that one of Waly with his bottle of wine is hysterical!! Nice clear pics on the ultrasound of the tumour too. Hope your weekend goes well and Waly keeps on doing as good as he has been! xx

[molly muffin]

I laughed too Trish. That is a great picture! I like the water one too. Waly is a dog with mucho personality.

You're doing good!
hugs,
Sharlene and Molly Muffin

[kaibosmom]

I just wanted to say hi. I'm finally getting some time to read some posts. My dog also has an adrenal tumour. It has invaded the vena cava...or they highly suspect as much. We are in the final stages of deciding about the surgery. Good luck to you and Waly. Take care.
Nikki and Kaibo

[frijole]

Here's hoping that the last dose helped push him below the 5.0 mark. That number is magical because dogs over that tend to creep up and lose the load so you have to start all over again which is stressful.

I agree with the others - that photo with the wine is a classic. Love it. Kim

[Trish]

Hi Robin, Hi Waly!!! All going good with you two?? Hopefully we get another good progress report today! Have a good weekend! x

[IWALY]

Hello All! So far so good for Waly. He has been fine I think the panting is back to his normal level of panting and his hunger is back to his normal amount ... he is always hungry since he is restricted. He was outside playing in the water today feeling ok! So tomorrow we give the first of the maint dose. Im very eager to have an ultrasound to see if this thing has grown. But ill wait the two weeks....

Once he is loaded does that mean if the lysodren is going to work andand stop the tumor from growing it will already be stopped? So if its grown in two weeks that means it didnt work?

Thanks for all the support! Hope everyone is enjoying the weekend!

[frijole]

I have no idea how lysodren affects tumor growth. What I do know that the purpose of the load is to erode the adrenal cortex which is where cortisol is produced... by reducing that area cortisol is lowered which helps resolve the symptoms (eating, drinking, panting). Maintenance is a smaller dose that allows you to keep cortisol at bay.

Kim

[Squirt's Mom]

In some brief reading on Lyso and adrenal tumors, I find reports that Lysodren does have an "effect" on the tumor. Now whether you will see changes in 2 weeks or not, I haven't a clue. But if your vet is wanting to look, then they must believe it is possible and I certainly hope that is what they find.

I'm glad Waly is doing ok! Way to go, Mom!
Hugs,
Leslie and the gang

[IWALY]

Hi!

Ok, so for sure the panting is less and the eating is a little less, but the Water is still a lot I think- nit crazy but a good amount more than normal. Anyone know how long it it takes for the meds to slow down the drinking? Im starting to get all worried that the last dose of Lysodren to put him from the 5.4 to under 5 may not have done that... But if it takes awhile then that may just be what's happening... thanks!!

[Squirt's Mom]

I'm a tad bit concerned that dose didn't load him too but I wouldn't worry just yet. If you see the signs increasing tho, I would have another ACTH asap to see if he is actually loaded since we really don't know if he is or not. ;) You may see the drinking start to slow over the next week. Just keep watching all the signs to see what is decreasing and what, if any, is increasing. If he needs to redo the load, we want to get it started as soon as possible rather than let what work the drug has done be lost.

[IWALY]

Thank you! I will watch closely still! Again, so far the panting is way less, but the water is the same. If I don't see a decrease in water by the end of the week I will ask for another ACTH re-test! Maybe I should just do the test this next week anyway? It cant hurt to do it right?

[frijole]

Before getting too worried I think we need to know what you mean by water intake is 'alot'. Keep in mind that water intake in dogs varies depending on weather, type of food consumed etc so unless you have been measuring it daily over a long period of time I would not be concerned to the point of doing an acth test 2 weeks after loading - especially since you are going to have to do one in 2 more weeks...

That said - if it is increasing quite a bit I would be concerned. How much water does your dog drink and what is the weight? Normal is an ounce per pound.

Did your vet have a plan to do a follow up ultrasound? Curious what the time frame is on that. Kim

[IWALY]

Its more water than normal- probably the same as its has been since diagnosed.

The IM wants him back in 2-3 weeks - that would be Aug 2nd- two weeks. to retest to make sure levels are good.

Yes we are doing an ultrasound! I cant wait! I just need to know if this tumor is growing. The Surgeon said give him 1 month on the lysodren and then do ultrasound and go from there based on that. So I just would like to know where its at!

[molly muffin]

I think it's always hard when you start a new treatment or switch to a different treatment or when you make a decision that affects the life of someone or something that is in your care.
It is hard to not worry, to not second guess yourself and to hope that what you did is the best for them.
That is where you find yourself now and until you get that validation that things are at least not getting any worse and hopefully are even improving, it is going to be hard.
I haven't treated with lysodren, but I trust the experience of those here who have and I know that they will be with you every step of the way.
The rest of us will be right here too, cheerleading you and Waly on.
I just wanted to send you a hug and say, you are doing an excellent job.

hugs,
Sharlene and Molly muffin

[IWALY]

Ive decided to have Waly re-tested. His water has increased in my opinion and he has peed the bed now for the first time in all of this. Panting is resolved. Food is more normal.

[Squirt's Mom]

Sounds like a good idea unfortunately. As for switching meds, it is way to soon to start thinking of that. Waly was put on maintenance before he was within range for a load on a wing and a prayer that one more dose would bring him in line. It doesn't seem to have worked. Your gut was on the mark when you didn't think he was loaded in the first place and it's probably on the mark now. I would go ahead and call the vet now if you haven't already and have the ACTH scheduled asap. You could simply start the load again but I would feel better knowing where the cortisol is before doing that. ;) Let us know what you learn and how things are going!

Hugs,
Leslie and the gang

[lulusmom]

Hi and a very belated welcome to the forum.

I’ve not posted to your thread before now and have just had a chance to review it in its entirety. While I have a few questions, there is no question in my mind that you are an excellent advocate for Waly and love him with all your heart.


He had an ultrasound today and it showed thr tumor on the right gland. She is doing another blood test and took a sample (i guess thats the right word) from his liver. Once all that comes back we will do the 8 hour blood test one. I do know his liver enzymes are elevated, they have been for years but have always stayed about the same so dr were not overly concerned i assume because he never showed any symptoms of anythimg and all the rest of his blood work has always been great.
I have read your thread three times and could not find where you ever posted the abnormal highs and lows on the blood chemistry and complete blood count nor did you post the results of the low dose dexamethasone suppression test (LDDS). Please, please get copies of these tests and post the abnormal highs and lows on the blood chemistry and CBC and please include the normal reference ranges.


After the next test we will meet with the surgeon and talk with him for his opinion. Ive just started reading everything on this so its all a little overwhelming. But if im not mistaken surgery will basically cure it since it is removing the tumor causing it.
Yes, it would be a cure but only if the source of the excess cortisol is coming from a functional adrenal tumor. Without the benefit of seeing more of Waly’s test results, I have a nagging suspicion that he may have pituitary dependent cushing’s in addition to an adrenal tumor so even if you had the adrenal tumor surgically removed, symptoms may not resolve and you will have to continue treatment. The three things that raise the question for me is that 1) your IMS admitted that the LDDS was equivocal which leads me to believe that Waly definitely suppressed at 4 and 8 hours. Dogs with functional adrenal tumors fail to suppress; 2) dogs with a functional unilateral adrenal tumor don’t have a normal looking contralateral adrenal gland like Waly and 3)adrenal tumors are highly resistant to Lysodren at normal doses which usually causes a very protracted loading period.

Walys IMS is actually more of a friend so I think she is just being nice doing an extra free ultrasound so I can see if its grown, so I wont worry so much waiting another week to see the surgeon.
You mentioned in one of your posts that you had a $400 day. Was that the cost of a stim test? If so, you may want to talk to your IMS about trying to save you money. She may already be aware of this but if she is using cortrosyn as the stimulating agent, she should be able to get three stim tests out of one vial. Be sure to ask her about that. If she isn't aware of the savings she can pass on to you, give her the URL below to Dr. Mark Peterson's veterinary blog which provides information on how to reconstitute and store cortrosyn for future use.

He said its a functional tumor probably benign- he sees clear on the ultrasound no spread at this time.
Was the surgeon absolutely sure that the tumor is functional? If so, it would be really interesting to know how he makes that determination.

Ok still on phone but to be more clear test came back today pre he was 3.8 and after he was 5.4 so she wants him to have tonight dose as he has been 1/2 in the pm for the last 5 days. Said it will bring him down to under 5. Then sunday is first maint day we will give 3/4 sunday and 1/2 wed. Two weeks we recheck.
I am a Lysodren veteran and know the drug quite well. With the stim test being done directly after the last dose of Lysodren in the am, you wouldn’t expect to see the full impact of the last two or three doses. Not that I’m a veteterinary professional but my experience and knowledge of how the drug works says that your IMS was spot on in her assumptions.

I will be watching water intake closely. Is it possible it can take a little time for that sign to lessen? Also starting on denamarin for liver support.
The answer is yes. Sometimes this symptom can take longer to resolve due to medullary washout. Some dogs who have had polyuria for so long can take longer to recover/rebuild the solute that concentrates the urine.

I’ll be looking forward to your posting those test results.

Glynda

[IWALY]

Appt set for Monday to retest! Im not thinking of any switch in meds, just wondering if he did not load... Again, his panting is totally resolved- the food is close to normal its the drinking- we did BG also last week and it was normal.

Ok, Lulusmom first- we are local- Im in west covina!

I did not get the results from the LDDS test. - I will however on Monday.

Interesting take on the possibility of Pituitary dependent cushings as well. Im going to email the 3 points you made on that to my IM and see what she says.

The $400 day was higher we did a full CBC as well.

I can not say the surgeon was absolutely sure on it being a functional - it was an initial meeting he reviewed ultrasound and test results.

I cant scan the results of the original tests- so what is the best way to upload them? just manually post the ones out of norm?


Thanks for all the help!

[lulusmom]

Howdy neighbor. :D I go through West Covina every day on my way to work on the Metrolink and I hung out there as a teenager more than a few decades ago. I lived in Covina (Charter Oak).

The preference would be for you to post the abnormal results manually and include the normal reference range. If Waly had a lot of abnormal values, you can always scan the tests and upload them as pdf files. Manual posting works best as some members don't have a lot of luck opening attachments.

Glynda

P.S. Duh, just noticed that you said that you cannot scan the test results. My specialist can email me pdf files so you may want to ask if your vet(s) can do the same. If that's not possible and posting the abnormal values is too burdensome, let me know.

[IWALY]

Glynda,

Who is your vet and IM? Just wondering we are at PVS in Pasadena for IM and ASG in LA for Surgeon and Neuro for other issues...

[IWALY]

Here is a response from my IM when I posed the 3 comments:

The ultrasound showed a small but normal shape right adrenal gland, so definitely suppressed from overactive left adrenal gland.

You can't rule out concurrent pituitary tumor based on testing so far.
You can do a MRI of the brain and see but most often are microadenoma

Yes, adrenal tumor is more difficult to load but I have enough cases that did load within a good period of time.

[lulusmom]

I'm glad you got such a speedy response from your IMS and I see that she does agree that you can't rule out concurrent pituitary dependent cushing's. Please see my further comments below in blue:


Here is a response from my IM when I posed the 3 comments:

The ultrasound showed a small but normal shape right adrenal gland, so definitely suppressed from overactive left adrenal gland.

Which ultrasound was the IMS looking at, the first one or the second one that showed no change? I ask because according to one of your previous posts, it was mentioned that on the first ultrasound, the IMS wasn't seeing the normal adrenal tumor and that the other (left) gland was perfect in size. :confused: See quote below:


Also said normally they see the tumor as more of a growth on the gland - not that it is not possible its just not normal - also his left gland is perfect in size, reading about it looks like most of the time the tumor on one causes the other to be very small.[/B]

I believe the follow up ultrasound one week later showed no changes so I'm wondering if there was a third ultrasound done that now shows the left adrenal shrinking in size?

You can't rule out concurrent pituitary tumor based on testing so far.

Does so far mean that she is thinking about doing additional testing to rule out pdh? Further testing could be the endogenous acth which measures the amount of circulating acth. Dogs with adrenal tumors secrete cortisol independent of the communication from the pituitary gland so the adrenal tumor keeps pumping out the cortisol and the healthy pituitary gland does its job and quits releasing acth. Therefore dogs with adrenal tumors usually have low levels of acth in their blood, whereby dogs with pdh have normal or high levels of acth. I'm not quite sure how much acth a dog with an adrenal tumor and concurrent pdh would have but I'd have to guess normal or higher. Your IMS would be able to tell you that.

You can do a MRI of the brain and see but most often are microadenoma.

Yes, most dogs have a microadenoma and sometimes they are indiscernable on imaging which would be a real bummer if you paid an arm and a leg for an MRI that didn't tell you anything.....and you still couldn't rule it out. I've been reading a bit about dynamic CT's which are more likely to identify even the smallest lesion but I would think the bill would be pretty dynamic too. :eek:

Yes, adrenal tumor is more difficult to load but I have enough cases that did load within a good period of time.

I have no idea how many days your vet considers to be a "good period of time" nor how many of her adrenal tumor patients actually responded better and quicker than most PDH dogs. There are a few iconic endocrine specialists in the U.S. and two of my idols are Dr. Edward C. Feldman and Dr. Mark Peterson. Dr. Peterson readily states, and this is a direct quote from his veterinary blog, "If the dog has an adrenal tumor, the standard doses of mitotane would be unlikely to help, but this failure to control the cortisol levels would help "suggest" that an adrenal tumor is the underlying cause." Waly certainly responded to a standard dose in pretty short order too. Dr. Edward Feldman, a 40+ year prescriber of Lysodren, covers his and UC Davis' experience with Lysodren in his lectures. He says that the average loading time for a dog with PDH at max 50mg/kg is 5 to 8 days, but dogs with adrenal tumors most often will require a protracted loading period at this dose or will not respond at all.

Your IMS' experience with Lysodren is not the norm and I hope you understand that I am not challenging her. I'm an insurance professional by trade so she'd horse laugh me and rightfully so. The reasons for the questions that pop into my head are based on my own experience with three cushingoid dogs, the benefit of tracking hundreds of case studies on this site and almost nine years of reading peer reviewed studies, fda summary reports for various drugs, veterinary textbooks on various subjects and listening to lectures on tape given by various world experts on endocrine diseases. I know, I know....I am hopelessly obsessed and need to get a life. :o Knowing what a geek I am, you have know that I am very envious of you for having a friend who is an IMS. How wonderful it would be to be able to pick her brain when those nagging questions keep me up at night. :D Since she is a personal friend and if time permits, can you please email her and ask her to give you the results of the LDDS test? There are only three numbers (pre Dex injection, 4 hour post and 8 hour post injection. I would only take her a few seconds. The suspense is killing me. :D

[IWALY]

My error on the size of the gland-

Was advised if he did have pituitary cushings treatment would be Lysodren as well to control symptoms

Im not doing an MRI if the treatment is the same, it to me would be a waste and no reason to put him thru it if it does not change the treatment path.

I will get those numbers on Monday! She is out of town today thru the weekend now.

BUT what you have told me about the possibility of having both adrenal tumor and pituitary cushings, I've given much more thought to what if we have to do surgery. If he did have both as you mentioned, its would be a reason to not pursue the surgery as I'm scared to death to take the chance on loosing him like that.

Please question anything and everything! Is the best way for me to learn, and to ask more questions so I am making the right decisions.

For what it is worth, Waly has improved in symptoms which were very minimal in the first place, it is just the water intake- and Ive checked BG myself yesterday in case- he's ok on that front.

[lulusmom]

Hi Robin,

I forgot to answer your question about our IMS. Both of my cushdogs have passed but they were treated by Dr. Michael Moore at VCA All Care Animal Referral Hospital in Fountain Valley. If I ever have a reason to suspect that any of my dogs in the future may have cushing's, I wouldn't hesitate to have them seen by Dr. Moore or one of his staff. Dr. Moore was never annoyed with my questions or my asking him to slow down while I took notes. As the years passed, he also never got offended when I asked him questions that he could have easily interpreted as me challenging his authority. He appreciated that I took a very proactive participation in my dogs' treatment and he really liked that I actually understood what he was telling me.

I would have loved to have found a local gp vet to care for my dogs but I came up empty. I'm a special needs and senior small dog rescuer and have gotten to know a good number of gp vets in the area, but unfortunately, none are well versed in cushing's. However, a few are good for discounted acth stim tests, which were faxed to Dr. Moore. Driving 50 miles in traffic to Fountain Valley was worth it because I knew my babies were in good hands when they weren't in mine.

Glynda

[IWALY]

good info to have, thank you!

So, both of your dogs with cushings... pituitary or adrenal? Both on Lysodren? How long were they on that?

Fortunately I have insurance- it covers all but 20% so still a high amount but at least it helps, I can juggle and manage- its a costly disease - and in our area its very ridiculous pricing.

[frijole]

As we mentioned earlier - it would not be unusual at all for a dog with an adrenal tumor to require a larger dose than 50 mgs/kg. I'm sure your vet knows this too. So if an increase is in order do not sweat it in the least. Kim

[IWALY]

Heading out for re-test! I will get blood work and results from the first 8 hour test to post! Wish us luck!

[Squirt's Mom]

Good luck! How are his signs this time? Let us know how it goes!
Hugs,
Leslie and the gang

[IWALY]

Ok, im back will see what the results are tonight I hope they get them back by tonight. He is drinking way way more water- Ill get more details on it all later the ultrasound was dont too and i think its either the same or a tiny bit smaller. I got some paperwork with the results from the 8 hour test and last weeks blood work- i will see if I take a picture if it will show good enough to add vs typing stuff out.

[IWALY]

Ok I posted the Low Dose Dex test and lastest CBC as photos in his Album.

[frijole]

So the LDDS test was done when he was diagnosed and the blood panel done 10 days ago? Not too bad - looked to me like just the alk phos was high and it's typical with cush dogs.

So did you have the acth test done today? I assume it's a 24 hr wait so we'll be wanting that asap... there will only be two numbers so you can type those! lol

If he's drinking more the symptoms are getting worse meaning that the tumor is actively emitting cortisol and/or the lysodren dose isn't strong enough.

Refresh my memory - how much does your dog weigh and what is the current dosing amount? Thanks! Kim

[IWALY]

Kim,

Yes did a second acth today. (The first one came back 3.8 before and 5.4 post- but he still had a final loading dose to take that day of the test so IM was confident he would be under 5.4)

I hope to get the results tonight if they come back in time- but appt was later int the day so maybe tomorrow.

Yes water is increase -defiantly more. Food is not he is not jumping at breakfast at all he eats it slow and looks around and eat some more....

he has gained weight- 30lbs now and is on 3/4 tab on Sunday and 1/2 on Wed.

I think the tumor is smaller just a little but its not bigger - didnt get to talk to IM when leaving so she will call in a couple hours -

[IWALY]

Ok dr called his pre is now 4.3 and post is 5.7 upped lysodren to 1/2 monday 1/2 wed and 3/4 fri. Tumor is changed easy way to say it is head and tail are smaller head eent from 1.26 to .99 and tail from 1.7 to 1.38 but length went from 2.28 to 2.54. Also checking protein level in urine its gone down but still high so checking some other test incase he needs somethim for his kidneys. I think thays it!

[frijole]

Thanks for the update. It will be interesting to see if the increase lowers the cortisol. You went from 5.4 to 5.7 If it doesn't go down after this increase I suggest talking to him about doing a mini load which is basically a couple days of loading to bring the number down.

You are now at 64 mgs per kg which is not at all surprising given the fact that it is an adrenal tumor. Fingers and toes crossed. Since you increased it same rules apply - look for signs of decrease in water consumption (duh like you wouldn't LOL) but also a decrease in appetite.

Glad they are checking the kidneys out. What happens is that when cortisol isn't controlled the kidneys are working overtime and that is what causes the urination which in turn causes the thirst. So you have to get the cortisol down so that the kidneys get a rest.

Keep us posted! Hugs to Waly. Kim

[IWALY]

Thanks Kim! I agree on a mini load totally! I asked about doin it now but dr feels this is a better step to try first. If the water intake does not go down in the next week i dont think i can wait two weeks i will take him for another test. Did you ever just go up in the dose vs a mini load?

[frijole]

Nope. I continued loading and retested. I think I told you my girl was stubborn and took forever. If I would have done it the way your vet suggested I'd still be loading. :D She ended up at way over 100 mgs per kg. Kim

[IWALY]

Yes record holder! Oh gosh... im giving it one chance to just increase if that does not do it i will push it to a mini load! I dont think we have months to wait for it to be right.... ill be right back to surgery being the option.

[kaibosmom]

Hi. I'm not sure if I have ever said Hello officially or not but I have been reading your posts. I just wanted you to know that I had treated my dog with Lysodren and we ended up on a really high dose. A series of events happened, in which the vets thought they misdiagnosed my dog so he was taken off Lysodren. In the end, we finally found an adrenal tumour. On July 25, we had the tumour removed. He is home and getting stronger every day! If you have any questions in the future, don't hesitate to ask :)

Nikki and Kaibo

p.s. I see now I did say Hi a few pages ago! Anyway, hi again. I hope things are going well for you and your pup!

[Squirt's Mom]

How is Waly doing? Any indications of a load yet?

[IWALY]

Hi All! Sorry for no updates... Waly is the same in my opinion I actually just emailed to see about going in this week for another test to see- He needs more I'm sure! He is totally the same I think its getting harder to tell some days as it becomes the new norm you know what I mean? But I really don't think he is loaded- I'm going to talk about a mini load as you suggested. The more I look at him the more torn I am... I know surgery should be done but its so hard to bring myself to chance that with the odds so bad of making it. I look at him now hes happy and playing and acting as nothing is wrong other then the few signs....

[kaibosmom]

I totally understand where you are coming from. There were days that Kaibo seemed so normal and you wonder about surgery because everything seems so fine. I firmly believe that you will get the answers you need. You need to educate yourself and go from there. Trust your instincts. Listen for and watch for little signs here and there. That will lead you in the right direction. You have to be sure in your choice for surgery and be able to know that you made the right choice for Waly no matter what the outcome of the surgery is. Yes it is risky but consider what you want for Waly and what your best options are to give him the life he deserves. Kaibo is only 6 years old so his young age played into our decision as well. Good luck and know we are here to support you no matter what you choose!
Nikki

[Trish]

Hi
How is Waly doing? Really hoping you have seen some improvement. For me the decision was not hard to make regarding surgery, I guess I am a cup half full kind of person and from the reading I did and my surgeons recommendations he said 4 dogs out of 5 make it, so I thought those are pretty good odds!! Not that we can make that decision for you but you have to be careful that a couple of bad outcomes on this board in the last little while does not cloud your judgement.

[IWALY]

Hi! Waly is ok... he goes Wed for the 1 hour test to see where his levels are. He does seem to be drinking a little less! Ill post after I get the results.

Ive been thinking a lot over it all and if I can keep him happy and he responds to the meds - unless the tumor grows significantly I will continue medical management. He is 10 and average age is 12-15 for his breed. So I dont know if its worth chancing loosing him from complications of surgery. But! Its not totally off the table as a possibility if needed. I think I will get another ultrasound on Wed to see if there is a change from two weeks ago... Thanks for continuing to think of us!

[molly muffin]

It's always good to have a plan and yours is a good one. That is really all anyone can do is see what happens, what the tumor does and adjust if needed.

Hoping for a good test on Wed.
hugs,
Sharlene and Molly Muffin

[Trish]

Glad Waly is doing good :D That is great news! Will be keeping an eye out for any new results so keep in touch :) xx

[IWALY]

Back from the test, should have results tonight. Good news ultrasound showed tumor has not grown, so thats good news. His water intake is less I dare say close to normal? But we will see what the results are later and I will post pre and post! Thank you all for all the continued support!!!!

[Squirt's Mom]

Oh, that sounds like a good day all around! Wonderful news on the tumor size! :cool::cool::cool:

[molly muffin]

Yay, sounds good that the tumor is not growing any longer. :)

hugs,
Sharlene and Molly Muffin

[IWALY]

Oh this is just crazy! So his pre was 5.1 and post 5.9! Really? He is not drinking as much or panting.... so good new yes indeed the tumor shrunk! Very very little but still thats good. We are doing a mini re-load! Will be going back on tuesday for another test. Liver alt or alp (?) is down to 1600 so that's going the right direction. Ugh....

[doxiesrock912]

Good news!!!

[Budsters Mom]

When a tumor shrinks at all, that is great news!:) I am thrilled for you and Waly. :)

[Trish]

Pleased to hear the tumour is smaller, are they expecting it to shrink totally? Is the whole adrenal shrunk or just the tumour? Pleased to hear the symptoms have subsided somewhat, hope the mini load does the trick and the number come down a wee bit more! xx

[IWALY]

The whole gland over all shrunk- very very minimally! I hope the mini reload lowers the per and post too- But Ive emailed his Dr as the dosage per day seems off to me- seems like the same amount- so we will see waiting on a reply.

[molly muffin]

Well I am very glad it shrank, even if just a little bit. :) It's all better than growing. :)

hugs,
Sharlene and Molly Muffin

[IWALY]

Hi all! So we did a mini reload and went to test today. Came back pre 2.7 and post 3.0! So now on new maint dose of 2.5 pills a week (m,w,f -3/4, 3/4, 1/2) will recheck in 23 weeks unless we see other issues. Fingers crossed this dose will stick :)i thank you all for always being so supportive! Ill keep checking back in and hope to be able to support others too!

[frijole]

Just confirming that the mini dose was done at the same dose as your current weekly dose. Great news on those numbers. They are perfect. Kim

[Squirt's Mom]

Good news! I'm glad Waly is doing well and hope it continues! DO let us know how things are going!
Hugs,
Leslie and the gang

[IWALY]

Hi! Yes the dose is the same as the mini reload sorry its 2 pills a week not 2.5.

[IWALY]

Hi! Ive been missing i know! Waly had been doing good. Last week however he has started frinking again like crazy but he hates his food? He basically refuses the kibble but will eat the grpund turkey we give him and anytbimg else thats good not kibble. Strange? We have put good stuff on the kibble to get him to eat it and for the most part he would but hates it and walks away from it. So its strange because he has been eating it for years and no problem with it. So here is the thing, his IM has been gone all week and we see her tomorrow. Today he had dihareha actually in the middle of the night a few times we had to get up. Talked to his IM she said give the pred just incase... so we did he didnt go anymore today until now at 10:30 and now he has colitis looking fresh red blood dihareha and ve vomited his dinner. He had just grpuns turkey amd rice. Soooo has anyone heard of them having too much lysodren and still drinking like crazy? Only thing i can think of is if he does have too much and he has developed diabetis? Idk... thanks for any input. Ill let you all know how it goes tomorrow too!

[frijole]

Have you had any acth tests done since you last posted? Kim

[frijole]

Diarrhea and vomit are signs of low cortisol. did the drinking start after giving the prednisone because that would explain it. If not then please define what excessive means - give us amount of water a day drinking and dog's weight. thanks, Kim

[Squirt's Mom]

What is the kibble he has been eating and is now refusing? Has he eaten any of that kibble lately? Was it from a new bag?

[IWALY]

His drinking has been excessive for a week, just gave pred yesterday. The amount is approx 1525x25 times more than he has been drinking. I dont measure sorry can advise on that. The kibble has been the same not a new bag. Just all the sudden would spit them out eat all the ground turkey around the kibble. Then of we put some crushed treats on it we cpuld get him to eat the kibble some. So last two days just gave him turkey and rice. He went with blood dihareha once more last night a.d this morning and he drank a bowm or water this morning and vomited it in about 2 minutes. Now he is staring at me ears up looking for breakfast! Was holding off on that until i hear from IM.

[IWALY]

Oh kibble brand Hills R/D

[IWALY]

Sorry and not test. Was scheduled for 3 weeks which was tomorrow but going today now.

[Squirt's Mom]

HA! Waly may have decided he just doesn't care for the plastic coating on Hill's kibble they started using. ;)

OR he could just be telling you he don't want no stinking kibble period, he wants what YOU eat! :)

[molly muffin]

It's hard after they've had the ground good stuff to entice them back to kibbles. I'm doing a transition back with my dog now after a spell of diarrhea and when I put dry food in she looks at me like she is saying, "really, is this it?"
However, the vomiting doesn't sound right, unless he guzzled it down and then just threw it back up from going too fast.
What did the IM say today?

hugs,
Sharlene and Molly Muffin

[IWALY]

Just got back- test results probably tomorrow- but BG is good and tumor is a little hair smaller so thats good but- he has mild stage pancreatitis!

[molly muffin]

Well, back you go onto ground turkey and rice.

Glad to hear the tumor is a bit smaller, we'll take a hair :)

Just sort of sneaked that pancreatitis into the picture. Cushings dogs are prone to getting that though.

Hugs,
Sharlene and Molly Muffin

[IWALY]

Yes Im reading on it now! I assume since its not really bad the diet change is the first thing to try, that with pepcid a/c! Got lots of samples from the IM he actually at some of the kibble so for the next day or so I guess Turkey and kibble or potato, IM said rice actually has higer fat content so dont use.

Anyone have good advise for me on the pancreatitis? He has metronidazol as well for the bloody poop and an antibiotic as he has a nasal infection too!

Poor guy just got it all at once.

[IWALY]

Walys test came back he was very low pre 1 and post 1.2- this is after having two doses of pred. So, that explains the trouble. He is off the lysodren for a week, then recheck. He is doing feeling much better too not normal but improved- he is now on canned Royal Canin LF and the kibble if he will eat it, as well as still his 99% FF turkey. He likes the can so thats good.

[molly muffin]

Oh my gosh. Yes he did go low. :(

Hugs,
Sharlene and Molly Muffin

[Harley PoMMom]

Anyone have good advise for me on the pancreatitis? Poor guy just got it all at once.

Oh poor Waly, cortisol too low and pancreatitis too. :( I can help you out with the pancreatitis: feed several small meals throughtout the day, the diet needs to be low fat, try to keep Waly hydrated by either giving him homemade broth or putting some water /broth in his food, and a really important thing is to make sure that he isn't in any pain because pancreatitis can be very painful and pain can cause inappetence.

Keep us updated and wishing you both the best of luck, let me know if I can be of help. ;)

Hugs, Lori

[Boriss McCall]

Oh no.. Poor Waly.
Hope he starts feeling better quick.

[frijole]

I'm scratching my head because you did a mini load and the numbers were perfect and you kept the dosage the same right? (you gave the same amount in a week that you gave in a day during the mini load)??

Those numbers are very low - addisonian low. Are you still giving the prednisone? Are you having regular checkups on the electrolytes? All of this is important when cortisol goes low.

Bless you and to have to deal with pancreatitis at the same time. I wonder how much of the tummy issues were caused by the low cortisol? Certainly makes a dog not want to eat when the cortisol is low.

You are working with an IMS right? What are they telling you to do? Thanks, Kim

[Altira]

Hi, sorry I didn't read all of your thread but it looks like your having fears about an adrenalectomy. My Kira (siberian husky) had one of those in December of 2010. She is now 13 1/2 and doing darn well considering. It was a small tumor. It was a very rocky road for a long time. But she is better. I just wanted to tell you that at least for my Kira the operation was a breeze. She got up like nothing had happened. Then we took her off the prednisone and it all went to hell for close to two years. I have a thread here that's a zillon pages long and full of a lot of... Well I don't know how usefull but its her. SKYE has one to that you might want to read. Anyway. Don't be afraid of the surgery. You'd probably find that parts not a problem. Best wishes.

[spdd]

Hoping he's feeling better soon. Poor Wally.

You know we are pulling for everyone of the pups on this forum and wishing there was a magic wand we could wave to make every single one of them better, sadly there isn't one.

I empathize with you.

[molly muffin]

How is Waly doing today?

Hugs,
Sharlene and Molly Muffin

[IWALY]

Hi, Sorry its been kinda crazy! Ok, so Waly is off lysodren for the week- he had two doses of the pred. only. He was on metronidazole for the blood diarrhea which has cleared and he now wont poop at all... Here is the kicker of all of it! He is happy! he ran and got his toy! he however wont eat! he ate a little of the prescription food the vet gave and he ate his ground turkey- now today he does not even want to eat the ground turkey. But he is hungry! He comes running for kitchen and wants something but wont eat. Trying other stuff now like chicken or steak- all less than 5% fat!

As for his numbers, yes we did a mini reload tested after that good- kept him on the same amount spread out over the week time as normal he went 3 weeks before recheck, and the last week is when he must have dropped low because he did not want to eat the dry kibble like normal- but he ate everything else so that's my fault I thought he was just being picky.

Yes we are with an IM specialist. and following direction from her. I actually just emailed her with the update on him not wanting any ground turkey now, we are to go back for a recheck 7-10 days depending on how he was from last Monday- so that is this Monday or Tuesday.

Its all so confusing as to what is causing what. Ive decided no surgery at all- regardless. But Ive also decided (I think) I wont push him to eat any food he does not like- he can just live on home cooked meat and whatever he will eat for as long as he can, of course, all low fat for his pancreatitis, Im not going to not feed him properly. But worring about enough carbs and veggies and all -

Thanks everyone!

[Harley PoMMom]

Is he on any pain meds? Maybe he also needs to have the pred for a bit longer, if this were me, I would give him another dose or two of the pred and see if his appetite perks up.

[IWALY]

If his cortisol is too low still can he act like normal but just not want the food offered?

[IWALY]

I just emailed his IM to ask if I could/should do that with the Pred! He does not seem to be in any pain at all- he ran after a toy even!

[IWALY]

Im at my office today but was just told he ate the boiled chicken breast! About 3/4 -1 cup!

[molly muffin]

Yay!!! Waly ate! :)

We can all get together and do a happy dance for that. :)

hugs,
Sharlene and Molly Muffin

[IWALY]

Im giving Waly 1.25mg of pred once a day until recheck on tuesday. He has not pooped since monday! He is happy as can be today and has his first dose of metamuicle (?) He is only eating boild chicken breast no dog food refuses it and spits out most of the rice gicen with the chicken! Im hoping he will begin to eat better with this small amount of pred added and mayne once he finally goes! Prayong that happens tomorrow! Its been too long.

[Skye]

horray!!!! eating is a good thing! will he eat pumpkin? that might help him pooh,

[Trish]

Awww sorry to read Waly has had a rough week or two... hope he settles back down with the Prednisone. Flynn takes Metamucil, more to give him some fibre to settle down his IBS. I just put a 1/4 tsp in approx. 50ml water and dissolve and mix it in with his dinner and he eats it all no problem. I give it straight away or it sets like wallpaper paste if left too long before giving it to him! Hope Waly perks back up soon, very pleased to hear no growth in the tumour that must be very reassuring for you :)

[molly muffin]

Hope Waly has a poop soon, he doesn't need to have a blocked up system on top of everything else he is going through. Might want to let the vet know about that too.
Hope his testing on Tuesday comes back good!
hugs,
sharlene and molly muffin

[IWALY]

Today was day 7 and I think he finally pooped! Lol it sounds funny... but we stunbled across it where it should not be... in our patio amd it must be Walys because it sure is not like the other two dogs! He seems better been plYing with his toys some. We go tomorrow afternoon wont get anytning back until wed. But I guess we restart they lysodren not sure how this works now he has been off it for a week. Eating is better. Still wont eat kibble but ate canned food and chicken ... ill update tomorrow after we visit the dr. Thanks all!!

[doxiesrock912]

Sounds like things have improved :-) Good thoughts for tomorrow!

[Budsters Mom]

It sounds like Waly is improving. YAY! It's weird. We panic when they poop too much and when not enough. ;) He's eating and pooping, so that's definite improvement. Fingers, toes and paws crossed fir a good news from the vet. Xxxx

[frijole]

Have you had an acth test to make sure that the cortisol is high enough to restart the lysodren? What dose is your vet going with? It needs to be a lower dose than the last maintenance. Just checking. Kim

[IWALY]

We are doing the acth test today and his IM will determine the dose based on those results I would assume. Yes lower than before ;)

[frijole]

Very good... just making sure. :D You are doing great. Kim

[molly muffin]

I know you won't have the ACTH results today, but wonder if the vet had anything to say?

hugs,
Sharlene and Molly Muffin

[IWALY]

Hi.... yes Addisions! How how how did this happen! Tests come back tomorrow so I guess we know more then? Got meds for potassium and salt? Dont have with me the name sorry... he got fluids today as well....

[molly muffin]

Oh dear! An adrenal tumor and now addisons?! well that is new. Have they taken a look at the adrenal gland to see how it looks?
Poor Waly, what a thing to have happen. Do they think he is fully Addison's or having an Addison's crisis?

Hang in there!
Sharlene and Molly Muffin

[frijole]

Understand that a dog can be temporarily addisonian or permanently so you will not know for a while.

I'm a bit confused because you haven't been treating him or having any issues since he went low have you? Normally if a dog is truly addisonian you would have had him on an IV for a few days as well as these meds from the 'get go'. To have this happen now is a bit strange to me. I wonder if they just didn't catch it.

How has he been feeling? You only caught this because of the acth test right? If so I have to believe it is a temporary thing. Do give us the med details once you have time. Hugs to you both, Kim

[IWALY]

I assume its my fault. He changed in his eating he was hungry but refused his kibble. Ate turkey and chicken so I assumed he was being picky. I think it must have been the firat sign he was too low. It is definitely due to dropping to low. But its possible its tempory yes! I will know more tomorrow on his numbers. He did vomit twice and had diareaha for a couple days. He stopped they lysodrwn then but i guess enough damage had been done?

[IWALY]

Test came back ....after being off lysodren for a week he dropped even lower... he was at .7 and .7 somthing pre/post. So before adding pred we are doing the other med to see if he comes up and we go on tuesday as long as he seems ok... restest tuesday and see if we add pred or what based on results. The good news he finally really pooped for sure caught in action lol! And he is eating the canned hills food with turkey and chicken so coming back slowly... but again he is still happy as can be so thats good too! Thanks all for the support always and ill update if anything changes or on tuesday with the info from dr.

[Roxee's Dad]

Eating... pooping... life is good :o


(((HUGS))) and belly rubs.

[Harley PoMMom]

Test came back ....after being off lysodren for a week he dropped even lower... he was at .7 and .7 somthing pre/post. So before adding pred we are doing the other med to see if he comes up and we go on tuesday as long as he seems ok... restest tuesday and see if we add pred or what based on results.

I am a bit confused and worried that prednisone is not being started especially since his numbers have dropped lower. Could you find out what other medication your vet is talking about?



The good news he finally really pooped for sure caught in action lol! And he is eating the canned hills food with turkey and chicken so coming back slowly... but again he is still happy as can be so thats good too! Thanks all for the support always and ill update if anything changes or on tuesday with the info from dr.

So happy that Waly pooped and his eating has picked up! YAAA!!!

[IWALY]

The new med he is taking is called fludrocortisone