Brando has joined Snuggles at The Bridge; PHEO - Need Info and Advice Please

[beaglemom3]

Hi everyone,
I am owned by 2 beagles, Snuggles (14 years old) and Brando (13 and 3/4 years old)

A tumor was found on my Snuggles right adrenal gland, 2 weeks ago during an ultrasound which was ordered to check on his pancreatitis, which is chronic but controlled.
The diagnosis of the tumor was leaning towards a pheo tumor. The tumor is 2.5 cm. Snugs so far has no outward symptoms. My vet ran ATCH blood test and it came back positive for Cushings.
My vet found a lab in Wisconsin that runs urine tests for pheo tumors with results they claim are highly accurate. The results came back positive for a pheo tumor.
My vet referred us to a surgeon who has performed this surgery for removal of adrenal gland tumors many times. I have been up all night tormented with a decision I need to make, and I am hoping any information anyone here can give will help steer me in the direction of the right decision.
My boys are the loves of my life. My biggest concern is that Snuggles does not suffer in any way, I could not bare that.

These were the choices the surgeon gave us:
The surgeon said he just went through this with his 13.5 year old dog, had he surgery, the dog almost died on the table, they revived him and he is doing fine and the surgeon said he is glad he did the surgery.
He told me, as I knew, the mortality rate is high for this surgery.

Pros for having the surgery now:
My baby's tumor is small right now and no outward symptoms

A cat scan would be done before surgery and would tell if the tumor is embedded in large vein. (adrenal gland tumors
are right near the largest vein in the stomach.)
And show if it is a cancerous tumor, if it has spread to other organs.
Cat scan might come back saying don't do surgery, or come back saying do the surgery.

Or we can do the cat scan anyway whether we opt for surgery or not.

Or we can wait 3 months take another ultrasound, and see if it has grown and during those 3 months of waiting, see if he experiences any symptoms.

Cons to waiting 3 months:

Tumor can grow, if it is in fact cancerous, it could spread during the 3 months of waiting
He can developed symptoms ( symptoms can include high blood pressure, insatiable thirst, shaking, excessive panting, lethargy, fatigue, etc this would happen when the tumor would secrete
He could possibly collapse and bleed to death.

When asked he did say there is also a possibility the tumor would be slow growing the surgeon said it may be a possibility, and if that's the case my Snuggles would live no longer than 6-12 months.

Any input, thoughts or suggestions is greatly appreciated.
Thank you

[goldengirl88]

Welcome to the forum. I am so sorry you are faced with this. It is something I have been dealing with for months now. It was thought that my girl only had a pituitary tumor. Upon getting an ultra sound at the hospital the IMS said she has an adrenal tumor. It totally encapsulates her left adrenal gland, her vena cava has not been compromised. I was sick to death upon hearing this. My Tipper is 12 now, she has developed a heart murmur from the Cushings and has tracheal problems. To me that does not make a good candidate for surgery. Also we have no surgeons with a lot of real experience under their belts that have done many of these. With that being said I felt I would be sending her to a certain death and I could not live with myself if I did. I opted to have the tumor examined every few months to see if it is growing. The last exam showed it was exactly the same size and previously seen. I go again to check it on January 15. I am so sacred of these exams that I am already getting sick about it. Sometimes at nite Tipper had tremors and things that scare me that they could be associated with a Pheo. There is a member on here Kim whose dog Annie lived with a pheo for 3 years. I know the tuff position you are in believe me. All I can do is tell you my experience with this. I pray a million times a day this will not be my precious Tipper's fate. It is God's will now. I hope this information on my Tipper can help you in some way. I will pray for you and your baby. Blessings
Patti

[Squirt's Mom]

Hi and welcome to you and Snuggles! :)

It is amazing that you got a diagnosis for a pheo right off! They are typically very difficult to pin down so huge congrats to your vet team! One of our members has dealt with a pheo and I'm sure she will be along soon to chat with you about this. Her name is Kim, her user name is frijole. We also have several members who have dealt with cortisol secreting adrenal tumors and they, too, will be by I'm sure to share with you. We have another member who is just celebrating his one year anniversary from a pheo surgery today. His name is Flynn and his mom, Trish, will be along to chat as well.

It sounds like you have a good medical team and that is critical. We always tell folks facing any kind of surgery to make sure the surgeon is Board Certified and that you talk to them about their experiences with that type surgery, their success rate with it, and whether they would do this is it were their own pup. You seem have already covered most of this so kudos to you Mom!

I'm going to edit the title of your thread a tab bit to reflect the pheo so those with experience will see and be more apt to reply.

I'm glad you found us and want to let you know that you are no longer alone. You and Snuggles, and Brando, are family now and this is one heck of a family you have found. We will be with you every step of the way, helping in any way we can. Never hesitate to ask questions, to talk, to cry, to vent - we are here for you any time even if it is just to offer an understanding ear and soft shoulder to lean on.

Keep your chin up!
Hugs,
Leslie and the gang

[beaglemom3]

Welcome to the forum. I am so sorry you are faced with this. It is something I have been dealing with for months now. It was thought that my girl only had a pituitary tumor. Upon getting an ultra sound at the hospital the IMS said she has an adrenal tumor. It totally encapsulates her left adrenal gland, her vena cava has not been compromised. I was sick to death upon hearing this. My Tipper is 12 now, she has developed a heart murmur from the Cushings and has tracheal problems. To me that does not make a good candidate for surgery. Also we have no surgeons with a lot of real experience under their belts that have done many of these. With that being said I felt I would be sending her to a certain death and I could not live with myself if I did. I opted to have the tumor examined every few months to see if it is growing. The last exam showed it was exactly the same size and previously seen. I go again to check it on January 15. I am so sacred of these exams that I am already getting sick about it. Sometimes at nite Tipper had tremors and things that scare me that they could be associated with a Pheo. There is a member on here Kim whose dog Annie lived with a pheo for 3 years. I know the tuff position you are in believe me. All I can do is tell you my experience with this. I pray a million times a day this will not be my precious Tipper's fate. It is God's will now. I hope this information on my Tipper can help you in some way. I will pray for you and your baby. Blessings
Patti
Hi and thank you so much for sharing your experience and your precious Tipper with me. I can just imagine how horrifying it is for you, waiting and for results and the next set of results. My prayers are with you and Tipper.

Will be great to hear from Kim as well and hear about her Annie.

[beaglemom3]

Hi and welcome to you and Snuggles! :)

It is amazing that you got a diagnosis for a pheo right off! They are typically very difficult to pin down so huge congrats to your vet team! One of our members has dealt with a pheo and I'm sure she will be along soon to chat with you about this. Her name is Kim, her user name is frijole. We also have several members who have dealt with cortisol secreting adrenal tumors and they, too, will be by I'm sure to share with you. We have another member who is just celebrating his one year anniversary from a pheo surgery today. His name is Flynn and his mom, Trish, will be along to chat as well.

It sounds like you have a good medical team and that is critical. We always tell folks facing any kind of surgery to make sure the surgeon is Board Certified and that you talk to them about their experiences with that type surgery, their success rate with it, and whether they would do this is it were their own pup. You seem have already covered most of this so kudos to you Mom!

I'm going to edit the title of your thread a tab bit to reflect the pheo so those with experience will see and be more apt to reply.

I'm glad you found us and want to let you know that you are no longer alone. You and Snuggles, and Brando, are family now and this is one heck of a family you have found. We will be with you every step of the way, helping in any way we can. Never hesitate to ask questions, to talk, to cry, to vent - we are here for you any time even if it is just to offer an understanding ear and soft shoulder to lean on.

Keep your chin up!
Hugs,
Leslie and the gang

Hi Leslie and thank you so much for the warm and comforting welcome! I appreciate you editing the title, very kind of you. I will be anxious to hear from the others you have mentioned. I need to pull myself together, I tend to get ill when I get this upset, I need to be at my best for my boy, but I can't seem to stop crying or think of anything else right now.

[frijole]

Welcome - I am Kim and my baby Annie had a pheo. Congrats to your vet for figuring it out quickly. My journey was long and stressful - took a year to get the pheo dx. She was misdiagnosed as having cushings. Don't believe that acth test result is cushings. My girl have 2 false positives on the LDDS test and 5 on the acth test - all said cushings. Pheos are not cushings but they can have some of the symptoms. Your dog's cortisol is high not from cushings but from its body trying to deal with the pheo. So do not treat for cushings. Focus on pheo.

As you know you can have it removed or not. In my case my girl shriveled away to nothing (see her photos in my profile) and she couldn't eat due to nausea. I went thru years of hell but I am grateful to have had her for two full years with the pheo. I did not have the surgery because by the time we figured it out she was a real high risk. In her case I had to set her free because she was so frail she could no longer get up on her own or go potty on her own. That said she was a fighter and led a happy life despite her looks.
Read my thread - warning it is long and you will cry.

You are right the surgery is risky and Trish can really help you with questions to ask the surgeon to help make the call. It is about the location of the tumor, the experience of the surgeon and your dog's health. You will figure it out. Yes it can grow but in my case it did not so don't rush to make a decision until you have your questions answered.

I have to run to work but will check in later. Sending hugs and love Kim

[beaglemom3]

Hi Kim, I appreciate you posting before work, thank you! You gave me great advice and I so appreciate it. I will wait to hear from Trish it sounds like her experience and advice will be invaluable to me.

I am so sorry about your girl, I will read your thread today.

[Harley PoMMom]

Hi and welcome to you and Snuggles!

Sorry for the reasons that brought you here but sure glad you found us.

Below are a list of questions that Trish has so kindly made for parents of furbabies that are debating surgery for an adrenal tumor:

Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND 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?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.

Kim and Trish are our resident experts on pheo's, I see that Kim has seen your Thread and I am sure Trish will be along soon.

Hugs, Lori

[beaglemom3]

fantastic! Thank you so much.

[Trish]

Hi!

I laughed at your first sentence how you are owned by two beagles!! Snugs is so cute and I can tell how much you love your doggies just by your intro! I am glad you found us, I arrived here much like you although it took me a year or so to get a firm diagnosis of Flynn's pheo so you are ahead of the game with Snugs. Welcome!

Flynny's story is a bit of a marathon so I will try give you the shortened version but knowing me it will be long, so prepare yourself!!

Flynn was finally diagnosed with his pheo in November 2012 and had successful surgery a few weeks later. His was also on the right adrenal and had invaded into his vena cava. A year prior he had suddenly collapsed which started us on this pathway, an urgent ultrasound at the time showed a huge liver mass which was removed surgically showing a very low grade liver tumour. He did not pick up quite as well as he should have after this surgery so the vets were questioning cushings, as he had some of the symptoms like lethargy, hunger, panting, hind leg weakness but never the more common ones we see like polyuria and polydipsia (excessive urination and drinking), so over the next few months he had two LDDS tests which were negative. He did not have an ACTH. This is when we ended up here in the forum.

Over the year between his liver resection and the adrenalectomy he had three ultrasounds. The last one in Nov 12 showed the pheo with vena cava invasion. What made them suspect pheo were 1. the scan showed the tumour arose in the medulla of the adrenal gland, not the cortex and 2. his ongoing symptoms especially hypertension which could be >200. He had a scan about 5 mths before that last one and the tumour was not obvious at that stage so it did grow fairly quickly over that 5 month period. They did say on retrospect and a further very close examination of his CT prior to the liver resection there was a tiny speck in his adrenal so it obviously grew from that over the year.

Now the symptoms of pheo can fluctuate, Kim's dog Annie had definite episodes when Kim could obviously tell her tumour was excreting the catecholamines. But with my boy he was just generally "off" plus the very high BP. So symptoms can vary between dogs. Has Snugs had BP checked? In a dog like Annie the BP was only really high during her episodes which is also commonly seen in humans. So it can sometimes be actually quite hard to catch the hypertension if it is only shooting up when the tumour is excreting.

So with my dog, it was a fairly obvious decision we had to proceed to surgery with his very high BP, his general condition was still good. They checked him with CT to look for secondary’s and found none. He went on phenoxybenzamine which must be given preop, as during surgery their BP can spike which is tricky to manage if they are not loaded with that drug. They need a specialist anaesthetist to look after them and handle any complications like hypertension during surgery. His recovery was eventful to say the least but that was extraordinary situation and should not have happened but I won’t go into that here!

Thanks Lori for posting the questions list. We have had several people popping in over the year asking what questions to ask the surgeon, so we have came up with this list that we hope is helpful when discussing options.

Most of us have senior dogs that we love dearly and want to keep with us as long as possible and we will do anything within our powers to make that happen. Just a couple of weeks ago at Flynn's checkup with the specialists, we found he had another tumour in his liver (we hate November!). He is 12 now so definitely fits into the senior group! He had already had the two big surgeries and I had to seriously think about whether it was the right thing to do putting him through another operation at his age after the specialists told me they could remove it. We considered concurrent health issues and his expected breed lifespan which could potentially be another few years. But I still rang my local vet in a panic and asked him to be my voice of reason and to make sure if we proceeded with surgery that I was doing it in the best interests of Flynn and not just because of my fear of not having him with me much longer. I told him I needed him to be objective for us and to give his honest opinion as I had my emotions interfering with my decision making. He spoke to the specialists personally, got back to me and said yes it was the best option to proceed with surgery. I hope you have someone you can trust while you make this decision and to be your voice of reason and I totally understand your sleepless nights and worry. While we are a success story for adrenalectomy we have had a couple of people lose their dogs on the forum during the postop period this year and it has been devastating for them but they did it in the best interests of their dog. But you do have to be prepared for this as the current statistics do show one in five dogs to not make it. I rationalised that statistic and thought that at least I was giving him a chance and if he died he would not suffer, but that is all very well in retrospect when my dog survived. But you do have to consider whether the risks outweigh the benefits in Snugs especially with him not showing any symptoms.

Re Urine testing for pheo: there is not a lot in the literature on this. When Flynn was being assessed a couple of weeks ago we were considering if his pheo had recurred. I asked about this urine testing, our IMS told me that the urine testing in dogs has little studies behind it. It has been based on human studies and the reference range is tricky when using it in dogs. All urine passed in a 24hr time period needs to be collected which is obviously very tricky unless the dog is catheterised. He did not recommend it. This is also backed by the Veterinary Society of Surgical Oncology who write “ uncommon in cats and dogs due to limited availability, expense, lack of reference range, and inconvenience of 24-hour urine collection” http://www.vsso.org/Adrenal_Pheochromocytoma.html (http://www.vsso.org/Adrenal_Pheochromocytoma.html)
There is also good general info on that website on pheos. If I was you I would question the vets on the validity of Snugs test and what studies they base it on. How did you collect urine for 24hrs, man I would have had to kept Flynn on a tight leash!! My thoughts here are if Snug’s mass happened to NOT be a pheo could it be some benign nodule as he is not showing any of the common pheo/adrenal symptoms?? Flynn also has a nodule on his other adrenal, it has been visualized during his surgery and the surgeon did not think it looked nasty so as much as I do not like it being there, it can stay put for the time being and we will keep an eye on it with scans. If it became symptomatic we would reassess.

Pancreatitis – this is a real risk with adrenal surgery and Snugs already has a history of this. I would be particularly asking the specialists about this.

Wow I really have written a book this time!! Hope it was not too overwhelming but things kept popping in my head as I wrote! If I think of anything else I will pop back and if you have any questions we will do our best to answer them, thinking of you while you make this decision xx

[beaglemom3]

Hi Trish,
Thank you so much for your suggestions and information.
For clarification, are you suggesting that since he isn't exhibiting any outward symptoms at this point, to kind of watch and see?
My vet said if it was his dog he would wait a month or 2 and redo the ultrasound. And to bring Snugs in again in 10 days for another bp check. I have his bp readings but need to find it, I have over 50 pages of tests and results to look through and will post when I find it.
The surgeon I spoke with I felt was suggesting surgery because he pointed out he just did this surgery with his 13.5 year old dog. He did say he almost died on the table, but they were able to get him back to being stable and he is fine now.
The surgeon also said we have the option of waiting 3 months to redo an ultra sound to see if it grew and see if Snugs devolopes any symptoms, but he did say during that 3 month period there is a chance Snuggles can collapse and bleed to death.
That shocked me since he shows no symptoms. My question needs to be answered can that happen out of the blue or will there be a progression of symptoms occurring before hand.
I put in a call to him to ask that and the other questions I was given in the previous post.

Pertaining to the urine test we took, this is the email that was forward to me by my vet. The test is based on a study from University of Zurich
Zurich, Switzerland that was done on dogs:
Metanephrine fractionation, urine (MET-RND).

Human info: quantitation of urine normetanephrine (NMN) and metanephrine (MN), collectively referred to as “metanephrines,” is commonly requested in the diagnosis and follow up of patients with pheochromocytoma and related neurogenic tumors. Since pheochromocytoma is surgically curable, it is desirable to screen all hypertensive patients and identify any suspected cases for further studies.

Instructions for Vet samples:

Send to human side of their lab.

Call in advance to set up an account; check which day they run the assay for shipment purposes.

Call in advance to obtain sulfamic acid stabilizer for patient and for control patient.

Home-obtained urine sample from patient, 5 mls, refrigerated and ideally shipped via FedEx.

Also need home-obtained urine sample from an age and species matched control, ideally obtained about the same time as the patient’s sample; 5 mls, refrigerated and ideally shipped via Fedex (same shipment of course).

As per the head of the department, they have run a modest number of cases and controls and they are in the process of generating their own reference range for normal. Unfortunately they don’t have specific information to report regarding how well the results correlate with adrenal tumour histopathology.

As I mentioned, other internists have commented on the ACVIM SA listserve that they have used the test and it has been accurate, although numbers reported are small.


Below is information from some of the IM papers on this topic:

Urinary and Plasma Catecholamine and Metanephrine in Dogs with Pheochromocytoma, Hyperadrenocorticism and in Healthy Dogs

ACVIM 2013

E. Salesov1; F.S. Boretti1; N.S. Sieber-Ruckstuhl1; L. Galeandro1; K. Rentsch2; B. Riond3; R. Hofmann-Lehmann3; E. Grouzmann4; C.E. Reusch1

1Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; 2Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland; 3Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland; 4Division of Clinical Pharmacology and Toxicology, University Hospital Vaudois, Lausanne, Switzerland

24828825

Pheochromocytoma (PHEO) is a rare, malignant, catecholamine-secreting tumor of the adrenal medulla. Catecholamines and metanephrines in plasma and in 24-h urine are approved biomarkers for the detection of the disease in humans; however, the question which of the tests is best is controversial. We previously demonstrated that measurement of urinary catecholamine and metanephrine to creatinine ratios is helpful for the diagnosis of PHEO in dogs and that urinary normetanephrine to creatinine ratio may be the best test to discriminate between PHEO and hypercortisolism (HC). Knowledge of plasma catecholamines and metanephrines in dogs is scarce and no comparison between urinary and plasma parameters has been performed. The objective of the study was to measure urinary as well as plasma catecholamines and metanephrines in dogs with PHEO, HC and in healthy dogs and to determine the test with the least overlap between the group.

Six dogs with PHEO, 9 dogs with HC (6 with ATH, 3 with PDH) and 10 healthy dogs were included. Urine samples were collected into HCl-containing tubes to ensure a pH ≤ 2; blood samples were collected on ice, centrifuged at 4°C and immediately snap frozen in liquid nitrogen. All samples were stored at -80°C. Urinary epinephrine (U-Epi), norepinephrine (U-Norepi), metanephrine (U-Meta) and normetanephrine (U-Normeta), and epinephrine (P-Epi), norepinephrine (P-Norepi), free and total metanephrine (PF-Meta and PT-Meta) and free and total normetanephrine (PF-Normeta and PT-Meta) were analysed by HPLC. Urinary catecholamines and metanephrines were expressed as ratios to urine creatinine concentrations. Data were analysed by non-parametric tests (p < 0.05).

Similar to our previous findings, U-Epi, U-Norepi, U-Meta and U-Normeta were significantly higher in dogs with PHEO and U-Norepi and U-Normeta were significantly higher in dogs with HC compared to healthy dogs. Comparison between dogs with HC and dogs with PHEO revealed significantly higher U-Meta and U-Normeta in the latter group. U-Normeta was the only parameter with no overlap. In dogs with PHEO P-Norepi, PF-Meta, PT-Meta, PF-Normeta, PT-Normeta were significantly higher and in dogs with HC P-Norepi, PF-Normeta and PT-Normeta were significantly higher than in healthy dogs. Comparison between dogs with HC and dogs with PHEO showed significant higher PF-Meta, PT-Meta, PF-Normeta, PT-Normeta in the PHEO group. Overlap was present with all 4 parameters, but was least with PF-Normeta and PT-Normeta. According to our results U-Normeta, PF-Normeta and PT-Normeta are valuable parameters for the diagnosis of PHEO, so far U-Normeta performed better than the plasma parameters.

(ESVE Award Winner)



Speaker Information

(click the speaker's name to view other papers and abstracts submitted by this speaker)

Elena Salesov
Clinic for Small Animal Internal Medicine
Vetsuisse Faculty, University of Zurich
Zurich, Switzerland

Urinary catecholamine and metanephrine to creatinine ratios in dogs with hyperadrenocorticism or pheochromocytoma, and in healthy dogs.

J Vet Intern Med. 2010 Sep-Oct;24(5):1093-7.

S Quante1; F S Boretti; P H Kook; C Mueller; S Schellenberg; E Zini; N Sieber-Ruckstuhl; C E Reusch

1Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.

Copyright © 2010 by the American College of Veterinary Internal Medicine.

Article Abstract

BACKGROUND: Urinary catecholamines and metanephrines are used for the diagnosis of pheochromocytoma (PHEO) in dogs. Hyperadrenocorticism (HAC) is an important differential diagnosis for PHEO.

OBJECTIVES: To measure urinary catecholamines and metanephrines in dogs with HAC.

ANIMALS: Fourteen dogs with HAC, 7 dogs with PHEO, and 10 healthy dogs.

METHODS: Prospective clinical trial. Urine was collected during initial work-up in the hospital; in dogs with HAC an additional sample was taken at home 1 week after discharge. Parameters were measured using high-pressure liquid chromatography and expressed as ratios to urinary creatinine concentration.

RESULTS: Dogs with HAC had significantly higher urinary epinephrine, norepinephrine and normetanephrine to creatinine ratios than healthy dogs. Urinary epinephrine, norepinephrine, and metanephrine to creatinine ratios did not differ between dogs with HAC and dogs with PHEO, whereas the urinary normetanephrine to creatinine ratio was significantly higher (P= .011) in dogs with PHEO (414, 157.0-925.0, median, range versus (117.5, 53.0-323.0). Using a cut-off ratio of 4 times the highest normetanephrine to creatinine ratio measured in controls, there was no overlap between dogs with HAC and dogs with PHEO. The variables determined in urine samples collected at home did not differ from those collected in the hospital.

CONCLUSION AND CLINICAL IMPORTANCE: Dogs with HAC might have increased concentrations of urinary catecholamines and normetanephrine. A high concentration of urinary normetanephrine (4 times normal), is highly suggestive of PHEO.

[beaglemom3]

Hi Trish,
I found his last bp readings
Left Hind Foot
BP MAP HR
160/80 100 80
180/85 120 120
170/100 115 90
170/95 115 90

Tail
175/115 130 100
170/110 130 90
180/105 125 95
170/110 130 90
175/105 130 90

I don't know what MAP or HR mean

His ultrasound results stated:
Medications are no necessary at this time Baseline thoracic radiographs are recommended along with blood pressure measurements. A recheck of echocardiogram is recommended in 6-12 months.
Pheochrocytoma is suspected more than a cortisol secreting tumor.
ACTCH stimulation test is recommended as well as blood pressure measurements given the presences of the adrenal gland mass. Ultimately surgery is recommended to remove the adrenal mass.

The left adrenal gland was normal at 1.62 x 0.47 cm the right adrenal gland contained scantly mineralized round to oval mass that measured 2.55 x 1.52 cm. No overt invasion of the adjacent vascular was noted.

Live biopsy is recommended to better define(my vet said this is nothing to be concerned about)

Snuggles pheo urine test from Marshfield Labs in WI were:

Creatinine RU-Vet
creatinine random urine 100.00 mg/dl Snuggles

Creatinine RU-Vet CTRL
Creatinine Rnd Ur Vet ctrl 141.0 mg/dl Control

Metanephrine/Creat-Vet
Normet/creat 732 ug/g Snuggles (Pheo)
Met/creat 87 ug//g

Metanephrine/Creat-Vet Ctrl
normet/creat vet ctrl 282 ug/g Control
met/creat/ vet ctrl 117 ug/g

[Trish]

Hi Trish,
Thank you so much for your suggestions and information.
For clarification, are you suggesting that since he isn't exhibiting any outward symptoms at this point, to kind of watch and see?


Hi - sorry I was a bit longwinded. The problem I have in making recommendations for these dogs as to whether surgery is a good idea or not is that it is usually very complicated and very individual. Each dog brings their own set of issues and problems regarding surgery and there is so much to take into account that I find it could be very misleading if I said, yes do it.. or no... wait and rescan. I do not know all that your vets know by a long shot. I am not a vet, just a person who has been through this with my dog so I really think the best people to make that decision are the ones that have all of the information at their fingertips and have actually assessed the dog. They and you are clearly in the right place to decide the best course of action.:) I would really, really hate it if I gave you a bum steer when you have professionals helping you make these kind of big decisions.

I know that seems a bit of a cop out but what I try to do is point out the things that stick out to me so you can go and ask your vets to perhaps provide a little more clarification, red flags etc to help you decide what to do. I personally, would find it very hard if I said do one thing and it went wrong. BUT I will support you every step of the way once you make up your mind what needs to be done :)

Thanks for providing that info on the pheo studies, I had not seen them. I guess the one thing that really sticks out to me are the small sample sizes. The 2nd one has some significance, but again only 31 dogs were tested and only 7 of those had a pheo. they are saying if the urinary normetanephrine is 4x the control it is highly suggestive of pheo. It looks to me that Snuggles numbers are only 2.6x higher than control. Does that mean it could be HAC, because it appears the studies had some overlap in the pheo and HAC dogs? Especially with the positive ACTH in Snugs. Keeping in mind that can show false positives (Kim's dog Annie had that, while my dog never had positive cushings tests so we can see the variability in just our small group of 3!) The first study also mentions urinary metanephrine was significantly higher in pheo dogs when in fact Snuggles is lower than the control?? This is where I have the problem with these small volume studies and think larger ones are needed before we can rely on them for pheo diagnosis.


The surgeon also said we have the option of waiting 3 months to redo an ultra sound to see if it grew and see if Snugs devolopes any symptoms, but he did say during that 3 month period there is a chance Snuggles can collapse and bleed to death.
That shocked me since he shows no symptoms. My question needs to be answered can that happen out of the blue or will there be a progression of symptoms occurring before hand.
I put in a call to him to ask that and the other questions I was given in the previous post.

My understanding with this is that pheo's suddenly secrete catecholamines (adrenaline etc) that can make them collapse suddenly when it surges through their systems. In the past this was thought to be one of the causes of sudden deaths in dogs, as often these tumours were not diagnosed until too late. I was not aware of them suddenly bleeding though, but I guess it could be a possibility.


I don't know what MAP or HR mean.

They stand for Mean Arterial Pressure and Heart Rate (pulse). Snuggles BP is a bit on the high side, but not at the collapse kinda high! Are they suggesting any treatment for this? An IMS told me that a dog with normal BP but who gets stressed at the vets can go up as high as 160 systolic (which is the first number on the BP recordings) but it if it much higher than that it can indicate hypertension.

The scan does not say whether it is arising in medulla, I wonder if a CT would show that more clearly and I note you are considering this.

As this tumour has been picked up incidentally during his scan to check pancreas status, and he is asymptomatic to the tumour there is no absolute rush to get in there and I would make sure I had all the facts on this before making a decision. It sounds to me like you have a good team, I think I would be interested in an IMS opinion as well as they look at the whole picture of the dog whereas a surgeon looks what they can do immediately!! (I know I work with some!)

Hope this helps and please keep us posted on what is happening!
Trish xx

I forgot to say sorry I am so late getting back to you, I am in New Zealand so most likely totally different time zones! I don't tend to log on in the morning as it usually makes me late to work, so post in the evenings when I get home :)

[beaglemom3]

Thank you so much Trish, you gave me a lot to think about. I do not know what an IMS is, but I made an appointment yesterday for another opinion with an internist whose specialty is endocrinology and is very familiar with adrenal gland tumors, for an evaluation. The hospital is in Manhattan called the Animal Medical Center, it is one of the biggest and best in the country here (USA) My appointment is for Wed at 2:30 PM.

No treatment yetis suggested for his bp right now, we will be doing another check on it, next week. As for a ct my vet and the surgeon both said not to have one unless I want to do the surgery. My vet said there is a risk of morbidity with the anesthesia. So I am not sure whether to have one done or not, but hopefully the Dr at the Animal Medical Center will help clear up things for me more so I can make better decisions.

The lab in WI marked his urinary normetanephrine as pheo next to his values, (just like I typed it in the above post) on the test result report I have. The control, was the urine from Brando, my other sweet beagle boy, who is only 7 months younger than Snuggles.

[frijole]

IMS is an internal med specialist - board certified and yes you want an endocrinologist that is familiar with pheos. You then want that person to recommend a surgeon that has done a whole lot of these surgeries to weigh in by looking at the info on the tumor.

Are you in NY or WI? You mentioned Manhattan and Wisconsin so I got confused. I ask because that would help us perhaps help you with recommended IMS/surgeon contacts.

You don't have to make a decision yet- just get opinions from the best of the best. Who is the person you are seeing that you referred to in your last post? I disagree with the vets firm stance on anesthesia - yes use caution but a pheo doesn't mean you can't use it. I lived it and so did Trish. You are doing great! Kim

[beaglemom3]

Hi Kim,

Thank you so much! Everyone has been so kind and helpful I can't tell you how much I appreciate it.

I live in Staten Island NYC which is one of the 5 boroughs in NYC. My boys vet for the past 14 years is the one that searched for ways to help confirm the ultrasound doctors diagnosis of a pheo. He found it hard to believe. He knows Snuggles since he was a baby and was shocked when the results came back.

Upon his researching he found Marshfield labs in WI, and they fedexed the kit to him and my vet fedexed the samples to them (overnight).

My boys vet (he's a graduate of University of Pennsylvania School of Veterinary Medicine and did his post-graduate veterinary medical and surgical training the Animal Medical Center of New York) he referred me to the surgeon in New Jersey who he and this surgeon did their post graduate training at the AMC in Manhattan many years ago. The AMC is the largest Animal Hospital in the world. (which is where I am seeing the endocrinologist Dr Elizabeth Appleman) next Wednesday, her profile http://www.amcny.org/node/761)

My dogs vet Dr. Cohen (his profile http://baystanimalhospital.com/our_staff.html), speaks very highly of him (the surgeon) Dr Scavelli (his profile http://www.gsvs.org/staff/surgery.html ), and says he is very talented as well as a good person and has done this surgery many many times, and he just had his 13.5 year old dog have the surgery. But I agree with Trish and you Kim, I need someone to look at Snuggles as a whole and see what they think.

I am also open to any surgeons/vets anyone has to suggest.

I did read your precious Annie's story. I did smile at times and cry through it. What a sweet sweet courageous little girl. You were a great mom to her and loved her so dearly!

[goldengirl88]

I am so glad you are knowledgeable of good surgeons in your area as to me that is the main component in the whole procedure. I will be watching to see what path your journey takes you on. This is so hard I know, so I will be thinking of you and your baby. Blessings
Patti

[beaglemom3]

I am so glad you are knowledgeable of good surgeons in your area as to me that is the main component in the whole procedure. I will be watching to see what path your journey takes you on. This is so hard I know, so I will be thinking of you and your baby. Blessings
Patti

Hi Patti,
Thank you for your kind words and blessings, I will keep you and Tipper in my prayers as well.

[frijole]

I'm so glad you are in NY vs WI. :D Just more options! I will read thru the links tonight when I get home from work. There is so little out there on pheos I am shocked your vet figured it out. The urine test wasn't even an option 'in my day'. I had to read about it on 'human forums' so that I could understand the symptoms. Yes my little girl was a fighter. I hope her story helped in some way. Again, very impressed your vet figured it out. Kim

[beaglemom3]

hehe me too! Kim, I appreciate you taking time to read through the doctors profiles, thank you.
I just received the report the surgeon sent to my boys vet.

Symptoms: Ultra sound preformed for pancreatitus and adrenal gland identified. No specific tumors relative to adrenal mass.

Diagnostic Tests: Right adrenal gland tumor 2.5 cm in size Elevated urine catecholamines.

Clinical Impressions: Right adrenal tumor-pheochromocytoma suspected

Recommendations: I recommended CT scan to evaluate for potential vena caval involvement. Risk of adrenalectomy were discussed. Owners decided to discuss at home prior to performing CT scan and performing potential adrenalectomy.

My boys vet said not to take the ct scan due to danger of anesthesia and he would wait to re test Snuggles by ultrasound in a month or 2. So the two doctors have different recommendations, which is part of my torment. I can't wait to see the Dr Endocronolgist on Wednesday so maybe I can get out of this mental maze of going back and forth over and over on what to do.

[Woodydog]

Hi and a belated welcome from me. I have been reading your thread with interest as my boy has a possible adrenal tumour my IMS diagnosed as endocrine cancer so I will be waiting to see what your IMS says see if the info will help my boy x

[beaglemom3]

Hi and thank you for the welcome, I am so sorry to hear that your boy may have endocrine cancer, I pray it is not so. I hope you find the answers you need!

[frijole]

Just got home and checked out Dr Appleman the IMS and her bio isn't very long but she does specialize in endocrinology which is just what you want and she was an honor student at Stanford I believe. My brother always said "remember Kim 50% of docs graduated in the top half of their class" :D So she's got them beat.

Meanwhile onto Dr Scavelli. WOW. First off write your questions out in advance - I'd have a hard time concentrating after seeing his photos. :o:);) I read quite a bit and that story about Patrick that he rescued is unreal. That coupled with the fact he just did the operation on his own dog tells me he knows exactly the shoes you are in right now so he should be compassionate that way.

Can't wait to hear what he says. Fingers crossed. Kim

[beaglemom3]

Thanks Kim,
I already saw Dr Scavelli two nights ago, and the report I posted is Dr Scavelli's report to my local vet.

"Symptoms: Ultra sound preformed for pancreatitus and adrenal gland identified. No specific tumors relative to adrenal mass.

Diagnostic Tests: Right adrenal gland tumor 2.5 cm in size Elevated urine catecholamines.

Clinical Impressions: Right adrenal tumor-pheochromocytoma suspected

Recommendations: I recommended CT scan to evaluate for potential vena caval involvement. Risk of adrenalectomy were discussed. Owners decided to discuss at home prior to performing CT scan and performing potential adrenalectomy."


He recommended doing the surgery and doing the CT scan first.
He gave us an option of waiting 4 months and redoing the ultrasound but said there's a chance if we wait, my baby could collapse and bleed to death since it is so near that vein.
Unfortunately I didn't have yours and Trish's list of questions yet. He will be back in the office Saturday and I am calling him to ask more questions over the phone.

My local vet Dr Cohen said if it was his dog he would and redo the ultrasound in a month or 2. But I am not sure how much he knows about pheo tumors.

[molly muffin]

I am super impressed with your vet and your surgeon, what a really great group you have on your side and now to add Dr. Appleton to the team, well, it seems that whatever decision you end up making, that you are going to be in good hands.

We see way too many vets, who don't have the knowledge and won't look any further into it than reading the insert on cushing medicine. Very sad really, so it just makes me more impressed when some good ones come along. (we do have some good vets on board with the people on this forum too :) )

Sharlene and Molly Muffin

[frijole]

Trust me most regular vets know very little - in fact you and I know more than most because of our situations. They are very rare. We have had more cases in the last year but when Annie was diagnosed a few years back you couldn't find an article to read on google - well hardly anything. Most dogs were diagnosed after they died. So there isn't alot of experience in the general vet community - you have to trust the specialist and the surgeon.

So your next visit is with the IMS right? I think that would be wise - kind of a tie breaker to get an opinion from someone who is a specialist but not making the money doing the surgery.

Trish's list is solid. Good you have time to review it and talk to him on Saturday about questions. I'm interested in his thoughts re the vena cava involvement - more specifics like how close. Why did he say your dog could drop dead - what specific risks - are they specific to your dog or just a generality? Why did he say now or wait 4 months vs now or wait 2 months? Just curious.

Will the IMS have access to all filmwork done already as that would be helpful to her and really necessary to give an opinion.

Kim

[beaglemom3]

I agree with you on trusting the specialist and the surgeon. Yes my next visit is with the IMS. I am not sure why he said that about bleeding to death, I think it was a general statement for tumors on the right adrenal gland but I will be sure to ask him was it meant directly for Snuggles situation or a general statement.

He was giving us all the options there are.
1. To do the surgery which is what he said he would and did do if it was his dog.

2. or wait 3 months and redo the ultrasound to see if it grew, and watch for symptoms. Danger of that he said was collapsing and bleeding to death while waiting. (I am not sure why Dr Scavelli picked 3 months)

3. To have a CT scan done to see if the vein is involved but he said if we are not considering surgery there is no point to doing the CT Scan.

He was basically giving us options but he clearly was for doing the surgery.

Yes I will be bringing the same referral pack with over 50 pages of tests and results from June of this year to now plus a disc with Snugs ultrasounds.

[beaglemom3]

Thanks so much Sharlene and all of your opinions on the Doctors I am speaking with is comforting to me since you are all much more knowledgeable with this than I am it reassures me I am going in the right direction, where the vets are concerned.

[Trish]

Yep, Dr Scavelli can join our Dr McDreamy vet club!! :D Great credentials too, as they all have.. I think your team is great!! It is a wonderful thing to have trust in the people who you are trusting your baby's life with. Trust and excellent communication are two requirements super high on my list of what we require in our vets :D:D Oh, and the ability to make a good plan and listen to our never ending questions and take them seriously!! :D:D Hmmm I think that's it! Ohhh and kindness to the dogs, melts my heart when my vet gives Flynn a kiss on the top of his head like he did the other day when Flynn was feeling poorly, just to see they really care for the animals in their care is big plus!!

Pleased to hear about the appointment next week with Dr Appleton. I really value the opinion of the internists as they are great at looking at everything, not just the surgical options. Hopefully after she goes over his case she will be able to help you decide what to do, but if surgery is the final choice I would be very happy with Dr Scavelli. x

[labblab]

Did someone mention another Dr. McDreamy????? :) :) :) :) :) :) :) :)

I've off to have a look at that link....!!!!!!!!!!!!!!!!!!!!!! :p :p :p :p :p

Marianne

P.S. OK, I'm back again and yup, if you opt for the surgery, I'm thinking you'll be needing LOTS and LOTS and LOTS of consultation! ;)

[beaglemom3]

Thanks so much Trish. Its funny I never noticed if Dr Scavelli was good looking or not, my eyes were filled with tears during the visit and I was concentrating hard on what he was saying.
But in retrospect yes he is handsome.

But so glad you all think the team I am working with is so good. Makes me feel a lot better about when I do make a decision based on their advice.

[beaglemom3]

Hi Marianne,
Thank you for your advice, my husband thinks I am going overboard with consultations, but I need to do what I can live with no matter what the outcome. The last thing I want is to have any regrets, it would haunt me for the rest of my life.

[labblab]

Your entire team looks to be very well qualified, that's for sure!

And I was really just teasing you about the need for "LOTS" of consultations with the surgeon because he looks very handsome to me, too! (No need to tell your hubby about that part of my recommendation...:p).

[beaglemom3]

LOL my lips are sealed hehe

[goldengirl88]

I am praying for and your baby and believe in what you said. You have to do what you have to do, so you live with no regrets. I do that with my baby, as I never leave any stone unturned that could possibly help her. I will be anxious to see how things progress from here, as it may give others insight into what can be done in this situation if they are dealing with the same thing. Blessings
Patti

[beaglemom3]

Thank you so much for your prayers! I will post about my appointment with the Specialist, and if I learn anything else on Saturday when I hopefully get to speak to the surgeon Dr. Scavelli. So far Snuggles has been acting fine. I am praying for a miracle that it is all a big mistake, but I know that is just wishful thinking. ;(

[goldengirl88]

Miracles happen keep praying. I will pray for you and your baby too. I pray for a miracle healing for many babies on here, including my wonderful Tipper. Blessings
Patti

[beaglemom3]

Thank you so much Patti and my prayers are with Tipper and all those on this forums who need them, it is so heart breaking, they are our babies!

[molly muffin]

All aboard the McDreamy team train. (boy good thing I didn't leave out train, that would have looked VERY bad) :D:o:D:o

Sharlene and Molly muffin

[Trish]

Haha maybe we should do a 2014 K9C calendar with all the Dr McDreamy's!! :D:D OMG at least we can find something to smile about during these stressful times!! Marianne started this off by recognising Flynn's recent surgeon was a nice looking guy too :)... we did end up having lots of consultations, one memorable one outside on the grass under the tree's :eek::eek::eek: (talking about Flynn of course!) :D He was excellent and we were lucky to get him just as you will be with Dr Scavelli!

[molly muffin]

at least we can find something to smile about during these stressful times!!

That is the whole point right there in a nutshell. When the times get really stressful and worrying about our furry ones is right at the top of the list, then we need to be able to find the humor in the small things. :)

Hugs,
Sharlene and Molly Muffin

[frijole]

Man I feel cheated - I took Annie to so many different vets and not one of them were even close to McDreamy. I had McWimpy, McClueless and McNiceGuy. :D Kim

[beaglemom3]

LOL you all are making me laugh! I haven't done that in weeks, THANK YOU!

I have two videos I took of my baby boy Snugs, my 14 year old who thinks he's a puppy.

I took this one just now
http://s1102.photobucket.com/user/Vicki-615/media/snuggie_zpsa5c22fc0.mp4.html

This one about a week ago
http://s1102.photobucket.com/user/Vicki-615/media/snugsnewtoy_zpsfdf5a21d.mp4.html

I hope you enjoy them.

[Woodydog]

Oh loved the videos, in the first one reminded me some much of Woody shredding his toys I love to see them do this as to me it is a sign of normality in amongst all the illness. I loved the way Brandy walked away in a I,m not playing with that mood. Looking good for 14 years old :D

[beaglemom3]

Thank you :) Yes Branny had no intentions of playing then lol Their personalities are very different. Brando is incredibly sweet, he loves everyone, he is a rescue, have him since he is 7 months old, he will be 14 in March and I have never heard him growl once!
Snuggie is my goofball and I feel special to say he is a real mommys boy. If we are in public he makes sure to mark me every time LOL I never had a dry foot when we are amongst other people and dogs. He makes sure to let it be known I belong to him :)

[frijole]

Awesome videos. Fun to see their personalities. Boy Snuggie doesn't seem sick at all... very healthy looking. They are so cute together Thanks for sharing!! Kim

[beaglemom3]

Thanks Kim I know that is what is killing me, how he can die from this, from the surgery and not doing the surgery. He is so full of life and energy still.

[frijole]

Without a doubt he doesn't look at all like a cush dog. He doesn't have a round tummy or any of the other things like weak hind legs, hair loss, skeletal face - he sure doesn't look his age either! Nor does he act it. :D The good news is that if he is a candidate for surgery he looks very healthy. My girl was healthy when she got the first symptoms but by the time we figured it out she was too frail.. and that was a year later.

One step at a time. You are doing a great job and are surrounded by a great support team so you will be fine. Kim

[beaglemom3]

Good points about if hes a candidate for surgery. I am so sorry Annie wasn't diagnosed sooner. Life can be so unfair at times.

I appreciate your encouraging words very much.

[frijole]

You are quite welcome. Don't worry - trust me none of us had really dealt with or heard of pheos back then - only a couple of members had them but there was so little known and published. Just like the urine test - it's all new stuff. At least there is progress. If my story can help anyone else then that is a good thing. Annie was feisty and fun and had a very good life. I miss her horribly but I know we gave it all we had at the time and that is all we can ask for. I'm still recovering from it - haven't been able to get another dog yet. One day. Kim

[beaglemom3]

I found these 2 very interesting studies on pubmed, which specializes in reviews of clinical effectiveness research, with easy-to-read summaries for consumers as well as full technical reports, for those who are not familiar with pubmed.


Clinical features, outcome and prognostic factors in dogs diagnosed with non-cortisol-secreting adrenal tumours without adrenalectomy: 20 cases (1994-2009).
http://www.ncbi.nlm.nih.gov/pubmed/24145503

Abstract

The aims of this study were to describe the clinical features, the outcome and the prognostic factors of dogs with non-cortisol-secreting adrenal masses without adrenalectomy, and also to provide clinical data that can be useful for making decisions when managing dogs with these types of neoplasms. Medical records from 1994 to 2009 were reviewed and 20 dogs were included in the study. The results showed that mean age at diagnosis for dogs with non-cortisol-secreting adrenal masses was 12 years with no sex predisposition. Most dogs were asymptomatic. The most frequent clinical signs, when present, were lethargy, weakness and hypertension. Radiological evidence of metastases at diagnosis was not frequent. The maximal dorso-ventral thickness of the adrenal mass ranged from 10.0 to 45.0 mm. Right adrenal gland masses were more frequent than left-sided. Hypertension was found to be related to tumour growth during follow-up. The median survival time of dogs with non-cortisol-secreting tumours was 17.8 months. Body weight at diagnosis, tumour size and the presence of metastases at diagnosis were inversely related to survival. In conclusion, survival of dogs with non-cortisol-secreting adrenal tumours without adrenalectomy is relatively high and comparable with that of dogs treated with adrenalectomy. Dogs with metastasis and large adrenal tumours have a poorer prognosis. Hypertension is related to tumour growth, and might be used as an additional tool to assess the potential growing capacity of the tumour.

and this one for testing for pheos:

Plasma-free metanephrine and free normetanephrine measurement for the diagnosis of pheochromocytoma in dogs.
http://www.ncbi.nlm.nih.gov/pubmed/23311717

CONCLUSIONS AND CLINICAL IMPORTANCE:

Plasma fNMN concentration has excellent sensitivity and specificity for the diagnosis of pheochromocytoma in dogs, whereas fMN concentration has moderate sensitivity and excellent specificity. Measurement of plasma-free metanephrines provides an effective, noninvasive, means of identifying dogs with pheochromocytoma.

Copyright © 2012 by the American College of Veterinary Internal Medicine.

[doxiesrock912]

The videos are cute! Brandy is smart not to get between someone else's play session. I agree with Kim, he doesn't look like a Cushings dog at all.

Interesting research with the two tests! They're making progress.

[beaglemom3]

Hi Valerie and thank you :) I am going to bring that study about dogs having comparable longevity without the surgery to my appointment Wednesday and see what the specialist says about it.

[beaglemom3]

Kim..I am sure you miss her terribly! When my first beagle Cuddles passed away(14 years ago) 9/9/1999 I did not want another dog for a while, I was so deep in grief and exhausted from his battle with prostate cancer I couldn't bare another dog right away, my brother seeing how bad I was taking it all, demanded I get another right away and said if you don't get one I will get one for you so you better get one. He meant well and I did, I dragged myself to a reputable beagle breeder and found my Snuggles(who was named after Cuddles) and I could swear Cuddles and Snuggles are the same dog, as if Cuds came back to me through Snugs. Snuggles helped me so much to deal with my grief, he kept me so busy as a baby 8 weeks old and I fell so in love with him which I thought I could never love another dog like I did Cuddles, but Snuggie proved me wrong.

I am not suggesting you get another dog, but for me it ended up being the best thing I did, even though I was against it at first.

[goldengirl88]

Such cute videos. What a sweet and loving pair of dogs. I think this disease is criminal for what it takes away from these sweet babies. I pray everything turns out ok. Blessings
Patti

[frijole]

Just a reminder that if it is a pheo it is not cushings so that explains the lack of symptoms. Pheos can cause false positive on tests. I'm still shocked your vet figured it out this early. Very good.

Those articles are interesting. I just wish the sample size was larger but its still a rare tumor so I guess it's hard to get a larger sample. Kim

[Freckles#3/Louise]

Hello from another beagle mom,

I am glad you have found this board, as they are so knowledgeable and caring. In just a couple days they have helped me so much.

Sadly, I have had more experience with cancer in beagles than I ever imagined I would. In the end, we opted for the surgeries for each beagle and do not regret the decisions. I, too, asked each Vet if they would have done the surgeries on their dog, and all 3 said Yes.
#1 had breast surgery with chemo at 15 yrs old and lived another 1.5 years with good quality of life.
#2 had abdominal surgery with chemo(which we knew probably would not work due to the type of cancer) at 12 yrs old and lived 6 months, acting like a puppy the entire time.
#3 had bladder surgery with chemo in July 2012 at 13 yrs old and is still cancer free although the last ultrasound showed irregularities in the bladder wall, so we are prepared for bad news in the future. #3 was diagnosed with Cushings at the last ultrasound, which is how I found my way here.

I hope you will get a clear explanation of your options so you can make the decision that will be right for you and your baby beagle.

Louise

[beaglemom3]

Just a reminder that if it is a pheo it is not cushings so that explains the lack of symptoms. Pheos can cause false positive on tests. I'm still shocked your vet figured it out this early. Very good.

Those articles are interesting. I just wish the sample size was larger but its still a rare tumor so I guess it's hard to get a larger sample. Kim

Hi Kim,
Yes I believe they think more it is a pheo and the positive result for cushings is a result of the pheo, at least that is my understanding.

I agree with you on wishing the sample sizes were larger, but it was comforting to read abut the longevity and lack of metastasis and symptoms on dogs w/o surgery for tumors like pheos.

I am waiting for Dr Scavelli to call me back to ask a few more questions.
I want to ask him about the risks of anesthesia during a CT for Snuggles, he never went into that although my local vet mentioned it.

I also want to ask him since Snuggles is 14 what will the benefits of the surgery be given his age, since he said he could possibly live 6 more months to a year w/o surgery.
and given the status of his health now with pancreatitis etc and his age does he feel he would make it through the surgery.

I want to ask him the question you raised, the possibility of him bleeding to death, is that due to Snuggles position of the tumor or for any dog with a pheo tumor on right adrenal gland. and if there are any signs or warning before hand if God forbid this was to happen.

Also ask him are pheos slow or fast growing tumors, and at what point will he start exhibiting symptoms, given his tumor is now 2.5 cm.

Another question is do pheo tumors usually metastasize ( I want to see if he answer coincides with that study I posted above)

and what his success rate is with this type of surgery.

Can anyone think of anything else I need to ask?

[beaglemom3]

Hi Louise,
Thank you so much for your information about your babies and their surgeries. If this surgery had better odds I would not be so conflicted, but I am hoping the IMS can say something that helps me decide. I hope and pray your baby will be okay!

[beaglemom3]

I am disappointed Dr. Scavelli hasn't called me back yet. They told me this morning he sees patients until 12 pm then returns phone calls until about 1 PM then leaves the hospital. It is 2:15 PM now so I am not sure he will be returning my call, unless an emergency came up for him.

[frijole]

Ask him/her if they've ever seen a dog that didn't get treated and what were the symptoms, outcome, length of life. I'd be real curious to see if their answers are the same and also how they compare to my Annie's story.

Not sure how much of my thread you made it through but she lived with hers for over two years - not sure of when it started exactly but I noticed it due to all over body trembling one winter. Over time she quit eating. I think while she didn't have cushings she had elevated sex hormones that you see with what is called atypical cushings (not true cushings). She lost a whole lot of hair, had major muscle wasting and lost her appetite although she wanted to eat.

She never ever collapsed as that vet predicted. She did have a couple of episodes when her breathing was so fast I thought she might go into cardiac arrest but after a few minutes it subsided. I have no idea how big her tumor got but obviously it wasn't malignant.

I read on a human forum that they have appetite swings - nausea. Also they have depression and when the tumor is actively emitting they can feel the blood vessels expand and going from their heart into their head. They get headaches and are exhausted afterwards. This matched up with Annie because she would breath real fast and then she'd just lay there with her eyes closed and her body was sweaty and her skin was bright red. I share this because I believe this is what you could be dealing with if you elect to opt out of surgery. Am interested if any others have the same experience. Kim

[beaglemom3]

I will ask for sure and if he doesn't call back I will definitely ask the endo when I see her Wed.

Kim if you could have known earlier on would you have opted for the surgery, knowing what you know now about the surgery and its risks and knowing what your sweet girl went through?

It breaks my heart hearing what Annie went through.

[goldengirl88]

Kim :
I am so glad you are sharing all this. The thing about they can feel this going to their head kills me, this is God awful. Tipper never gets sweaty or red, sometimes breathes a little different when she has tremors, but not rapid more like a couple deep breaths,and she does not seem upset or exhausted afterwards. I guess I am having a case of the nerves while trying to figure this out. If they would have never found this adrenal tumor I would not always suspect a pheo. when she does this. Sorry to be a thread hijacker! Blessings
Patti

[beaglemom3]

No problem at all, we all are looking for answers we love our babies so much. Kim's feedback and is valuable as is Trish's and everyone's who have gone through this ordeal.

[beaglemom3]

I just got off the phone with the surgeon Dr Scavelli, I am happy he called back.
To answer your question Kim, he has seen dogs that the owners have not opted for surgery and within time (he didn't say specifically) they develop severe symptoms and either need surgery or they put the dog to sleep.

He said pheo tumors usually do not metastasize.

Pertaining to a CT he said there is a risk with anesthesia/sedation with a dog with a pheo tumor but it is minimal.

He said Snuggles is in good health other than the pheo and is likely to get through the surgery and after okay, but of course he can't predict with certainty.

He said even though Snuggles is 14 he has a good state of health he feels the surgery will be a benefit.

He said the sudden bleeding to death is not just for Snuggles situation but any adrenal tumor near that vein may cause that to happen.

I asked if pheos growth rate are fast or slow he said it is individual, some fast some slow etc.

He said pheo tumors always eventually secrete.

I think that covers the responses I got.

[frijole]

Quote:

To answer your question Kim, he has seen dogs that the owners have not opted for surgery and within time (he didn't say specifically) they develop severe symptoms and either need surgery or they put the dog to sleep.

Curious if he said what the sever symptoms were. As you can tell I still have unanswered questions. Appreciate it.

Regarding what I would have done... I honestly do not know and the reason is because there was far less experience a few years ago then there is now and success of the surgery is dependent upon the skill of the surgeon as well as the health of the dog. I know Annie was a fighter and had a strong will to live so if the surgeon would have been experienced enough she certainly would have made it thru so long as there were no complications.

K State really didn't seem to want to do the surgery - they didn't push for it. There was still a bit of a question as to whether it was a pheo because she did not exhibit high blood pressure while there either time. That said I am confident she did have high blood pressure during those episodes.

Back to your situation - you know you have a skilled surgeon who even operated on his own dog and that is a huge plus. Your dog is healthy. The question is if you don't do it what can you expect for quality of life?

I shared Annie's story to see if that is what he described as symptoms. The episodes were not long in length and in the beginning they were months apart but they became more frequent. I do not believe she was in pain - she never whimpered or cried in pain EVER. She just couldn't eat even though she wanted to. That was the hardest part. And she lost weight, alot of weight. But even when she was skeletal she was a very alert and happy girl. My friends and family could not believe it. I took her for acupuncture treatments which she loved and I believe it gave her extra strength.

I don't know if this has helped or not but I hope it has. Luckily you are not seeing symptoms so you have time to make a decision that is right for you. I don't think I would wait four to six months as health could deteriorate and make it a bigger risk. Hugs, Kim

[Squirt's Mom]

You are bringing some great info to us about pheos - something we don't know much about at all. I think Annie was our first pheo baby and we have had a couple others since. You may have noticed our banner at the top of the page in which "Educate" is listed as our second purpose. While we wish this forum was echoing with emptiness that isn't likely to ever happen so when our members share what they are learning on their journeys it helps all those who come along later. So whether you know it or not, you are doing us a great service while in the middle of your own worries and stresses. I wanted to take a moment to tell you thank you and make sure you know what a wonderful thing you are doing not only for Snuggles but for all pheo babies who will come here in time.

Thank you very much.

[beaglemom3]

I will ask the edno the severe symptoms when he called it took me off guard. I have been carrying the questions with me all day then I was in the kitchen when he called w/o them and felt a bit unprepared, it is almost 5 PM here so I didn't expect his call anymore.

When I was in his office last week he did mention some symptoms when the tumor secretes, tremors, insatiable thirst and hunger, excessive panting, high bp, possible cardio issues weight loss. That is what I recall him mentioning.

[frijole]

Interesting about the thirst and hunger because Annie had neither of those. She did have the others. As Leslie said - we are all still learning. Bless you for sharing. We are in this together girlfriend! :D Kim

[beaglemom3]

You are all very welcome. I am glad I am possibly helping others, our dogs are so precious to us all.

[Trish]

Good morning

Flynn had his tumour at least a year, possibly longer before it was removed. The symptoms I noticed in him were hunger, increased panting, tiredness. He had high BP, he did develop problems with that ie kidneys struggling and they still are and also eye changes with torturous vessels noted at the back of his eyes. He has always been a dog with tremours, it seems to go with his breed of Fox Terrier (but he is a mutley and has bits of others, vet possibly thinks a bit of JRT and beagle but who knows), so they did not think his tremours were that significant. He never had the thirst or weight loss either. His ultrasound in May was OK, then by November the tumour had invaded his vena cava so the tumour can pick up a bit of speed.

Pleased Dr Scavelli got back to you today as he said he would, another tick for him!!! So the bleeding issue is associated with vena cava, that makes sense if it invaded there. As far as I know the risk with pheo and anaesthetic is related to BP and arrhythmias. They would use a fairly light one for CT. But these dogs should be given phenoxybenzamine prior to surgery to minimise the risks. Flynn had to be on it a good couple of weeks before his operation, but his BP was pretty high when this was diagnosed up to 220 at some stages. This is where I think it will be good to get the IMS input, we had that and she was the one managing his meds and monitoring BP etc in that preop period to make sure he was as safe as possible for surgery.

Here are a few articles I have in my pheo folder that may be of interest to you :)

http://histovetsdhv.files.wordpress.com/2011/09/adrenal-tumor.pdf
http://veterinarycalendar.dvm360.com/avhc/content/printContentPopup.jsp?id=766820
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&

[beaglemom3]

That's interesting and good to know that Flynn had the surgery done at least a year after developing the tumor. Is that when he was diagnosed right before he had the surgery?

I asked Dr. Scavelli if Snuggles would need meds before the surgery for bp and he said if we do the surgery soon, no because Snugs is not hypertensive.

Thank you for the files I will look at them for sure.

[My sweet Ginger]

Hi beaglemom,
I just wanted to come in to say thank you for all the information you've been putting out regarding Pheo on your thread. I've been getting a lot of info on Pheo from your posts including the metanephrine urine test as I was considering getting one done for my Ginger just for the purpose of ruling it out. Her IMS thinks it's unlikely going by the Ultrasound as no tumors were seen on her adrenal glands. A Pheo is still on my mind for two reasons. 1) The tumor might be inside the adrenal gland. 2) Her high blood pressure at 250.
A macro tumor is another possibility for her as she is exhibiting different symptoms. With what I know now and considering her state of health, we are going to opt out of any surgery even if it turns out she has one or the other. I don't know what other treatments are available without a surgery but we will have to go that route for my baby. I know in my heart of heart she is not going to make it out of a surgery.
I have decided no CT scan, no MRI, no aspirations for now for my baby. I'm going to do my best so that her days will be peaceful and pain free.
I wish you and your Snuggles the best of luck if you decide to go for a surgery and it surely looks like he is an excellent candidate with his health and most caring mom and a very solid medical team behind him. Thank you again for your educational posts and your efforts. Song.

[Trish]

Hi Song

I just wanted to say that diagnosis of pheo can be tricky as we have seen. These tumours are in the medulla (inside layer) of the adrenal gland. As I have said to other posters this was how Flynny's was diagnosed. The other types of adrenal tumours are in the cortex (outside layer) of the kidney and these are the ones that we see with our pups that have adrenal based cushings. Initially Flynn's did not show up on ultrasound either, it was only until it had grown that the specialists were able to spot it, but in retrospect it was in there brewing away affecting his BP which was similar to your Ginger. If this was what the vets decided was wrong with Ginger and surgery was not going to take place then supportive measures such as achieving BP control would be important. I totally respect your decision not to rescan if you are not going to proceed with surgery, it seems to be so stressful to be rescanning if that is not an option. I would save my money to use on other aspects of treatment for my baby. Wish you all the best Song. xx

[Trish]

Hi Beaglemom3

Yes, Flynn was diagnosed just before he had the surgery. This was based on location of the tumour in the medulla or inside layers of the gland combined with hypertension made pheo most likely.

I thought Snuggles did have hypertension from the numbers you posted? :confused: My understanding of the rationale of preop medication is that a pheo is capable of releasing the catecholamines at any time and especially more so when the dog is under stress and surgery is a stressful situation for sure! If there is a huge surge of these catecholamines (adrenaline etc) then BP can spike dangerously, there is a risk during surgery when they obviously have to handle the tumour. My surgeon had a specialist anaesthetist looking after Flynn during surgery to monitor him and to be able to treat if it occurred during surgery. He did have some swings in his BP too, but luckily not dangerous ones. They need to have careful monitoring to be on the lookout for these complications. Maybe the surgeon does not think Snuggles BP is high enough for this?

Look at page 135 for preop management.
http://books.google.co.nz/books?id=0xEblbsqfIEC&pg=PA135&lpg=PA135&dq=pheochromocytoma+dogs+does+phenoxybenzamine+nee d+to+be+given+to+all+dogs+preoperatively?&source=bl&ots=CFD1jvvk7n&sig=zYMc5XWK7ZP7T1-LNI9Q-Wlf1vM&hl=en&sa=X&ei=fRWkUqy_FYaIkAXpgIHgAw&ved=0CD0Q6AEwAw#v=onepage&q=pheochromocytoma%20dogs%20does%20phenoxybenzamin e%20need%20to%20be%20given%20to%20all%20dogs%20pre operatively%3F&f=false

This issue would be high on my list for questions for the IMS on Wednesday.

[beaglemom3]

Hi Beaglemom3

Yes, Flynn was diagnosed just before he had the surgery. This was based on location of the tumour in the medulla or inside layers of the gland combined with hypertension made pheo most likely.

I thought Snuggles did have hypertension from the numbers you posted? :confused: My understanding of the rationale of preop medication is that a pheo is capable of releasing the catecholamines at any time and especially more so when the dog is under stress and surgery is a stressful situation for sure! If there is a huge surge of these catecholamines (adrenaline etc) then BP can spike dangerously, there is a risk during surgery when they obviously have to handle the tumour. My surgeon had a specialist anaesthetist looking after Flynn during surgery to monitor him and to be able to treat if it occurred during surgery. He did have some swings in his BP too, but luckily not dangerous ones. They need to have careful monitoring to be on the lookout for these complications. Maybe the surgeon does not think Snuggles BP is high enough for this?

Look at page 135 for preop management.
http://books.google.co.nz/books?id=0xEblbsqfIEC&pg=PA135&lpg=PA135&dq=pheochromocytoma+dogs+does+phenoxybenzamine+nee d+to+be+given+to+all+dogs+preoperatively?&source=bl&ots=CFD1jvvk7n&sig=zYMc5XWK7ZP7T1-LNI9Q-Wlf1vM&hl=en&sa=X&ei=fRWkUqy_FYaIkAXpgIHgAw&ved=0CD0Q6AEwAw#v=onepage&q=pheochromocytoma%20dogs%20does%20phenoxybenzamin e%20need%20to%20be%20given%20to%20all%20dogs%20pre operatively%3F&f=false

This issue would be high on my list for questions for the IMS on Wednesday.

I agree with you it concerned me he said no meds before, if I do choose the surgery option I will discuss this further with him before proceeding and discuss it with the IMS I am sure they will take his bp on Wednesday at our appt.

[beaglemom3]

Hi Song

I just wanted to say that diagnosis of pheo can be tricky as we have seen. These tumours are in the medulla (inside layer) of the adrenal gland. As I have said to other posters this was how Flynny's was diagnosed. The other types of adrenal tumours are in the cortex (outside layer) of the kidney and these are the ones that we see with our pups that have adrenal based cushings. Initially Flynn's did not show up on ultrasound either, it was only until it had grown that the specialists were able to spot it, but in retrospect it was in there brewing away affecting his BP which was similar to your Ginger. If this was what the vets decided was wrong with Ginger and surgery was not going to take place then supportive measures such as achieving BP control would be important. I totally respect your decision not to rescan if you are not going to proceed with surgery, it seems to be so stressful to be rescanning if that is not an option. I would save my money to use on other aspects of treatment for my baby. Wish you all the best Song. xx

Thank you for the clarification of location.
BTW my name is Vicki :)

[goldengirl88]

Still praying for your baby. Hope you both are doing well. Blessings
Patti

[My sweet Ginger]

Thank you so much for your reply and I'm sure by now you must know that you and Flynn are an inspiration to all of us Pheo or not with your courageous and incredibly difficult journey you two have been on and sharing your story for others. If you you didn't, yes you are most certainly and thank you so much for that.

'We do not feel Ginger likely has a Pheo however her owner is concerned. The likelihood is low due to not finding a mass associated with the adrenal gland.' This was in the ims's report after Ginger's latest US which was done two wks ago. Still I couldn't relax because of what Kim said about Annie and also the possibility of it being inside. I'd be still willing to go with the metanephrine urine test if I'm convinced of it's reliability to some extent.
Ginger's been on treatment (Amlodipine Besylate, 1.25mg) for her hypertension for two wks now which her GP never mentioned it to me. Her BP last Monday was down to 208 from 250 the wk before and she's going in to check it tomorrow and I'm hoping for a better number since the IMS doubled her dose to 1.25mg last wk.
They haven't pinpointed on her diagnosis yet and they still seem to be going with cushings which is frustrating to me because that's not what I'm seeing (to my untrained eye) if we were to go by her ACTH numbers. Something is off and we are not any closer today after a couple of wks with our IMS to finding out why her ACTH numbers do not match her behavior and demeanor.
Although I'm opting out of CT Scan and MRI mainly due to Ginger's poor health, I'm still going to monitor her with periodic ultrasound and try to keep her cortisol and high BP under control. She will have to pick up her appetite, tho. It is still not good at all. Thank you, Trish.

[goldengirl88]

Song:
I am doing exactly what you are doing. I am monitoring the situation every few months. The hospital feels Tipper is good under anesthesia and could undergo an operation. I know this dog like she is part of my DNA and I know that would be the end. With her heart murmur, trachea issues, and anything else unforeseen I cannot do that to her and watch her struggle thru massive recovery like that. To me I would be doing that for myself, and that for myself. I certainly do not want to lose her, and if it were between life and death I would certainly go for it with only the most experienced surgeon, which we do not have in my area. I would be forced to travel. Her quality of life right now is good , not near what it used to be when she could run like the wind, and play all day and never tire out, but it is good. She still does run etc. not as often. Maybe this time off from Dr.'s etc. will help clear your mind and think things thru about what you want in the future. I know for Tipper I limit all contact with vets as much as possible as she was and still is resentful of all medical offices. The stress this puts on them has to affect their health also. I know I talk to Diana on here and she said the stress of all things medical nearly did her sweet Teddy in. When you love a dog and they are so engrained in your soul, it is hard to look at things only from their perspective. I must do that now above anything else, Tipper deserves the best quality of life I can give her. I am sure you feel the same about Ginger. I hope you both have many years to enjoy one another. Blessings
Patti

[beaglemom3]

Hi beaglemom,
I just wanted to come in to say thank you for all the information you've been putting out regarding Pheo on your thread. I've been getting a lot of info on Pheo from your posts including the metanephrine urine test as I was considering getting one done for my Ginger just for the purpose of ruling it out. Her IMS thinks it's unlikely going by the Ultrasound as no tumors were seen on her adrenal glands. A Pheo is still on my mind for two reasons. 1) The tumor might be inside the adrenal gland. 2) Her high blood pressure at 250.
A macro tumor is another possibility for her as she is exhibiting different symptoms. With what I know now and considering her state of health, we are going to opt out of any surgery even if it turns out she has one or the other. I don't know what other treatments are available without a surgery but we will have to go that route for my baby. I know in my heart of heart she is not going to make it out of a surgery.
I have decided no CT scan, no MRI, no aspirations for now for my baby. I'm going to do my best so that her days will be peaceful and pain free.
I wish you and your Snuggles the best of luck if you decide to go for a surgery and it surely looks like he is an excellent candidate with his health and most caring mom and a very solid medical team behind him. Thank you again for your educational posts and your efforts. Song.

You're so very welcome and thank you for your good wishes. I have Ginger in my thoughts and prayers as well.

[beaglemom3]

I was just petting Snugs, he was standing in front of me I was sitting on the couch, then all of a sudden his front legs gave way and the front half his body was on the floor although his back half and his hind legs were standing upright. Almost like the play position but this was definitely not him wanting to play. I never saw this happen before, it is usually his hind leg that are a bit weak, due to his acl surgery and old age.
He got back up on his own and proceeded to walk around the living room just fine and came back to me for more petting.

Could this be related to the pheo tumor? It scared the heck out of me and as worried and anxious as I was before my anxiety and fear is reaching new heights now. I have a call into our local vet, waiting for a return call.

[goldengirl88]

I feel awful that happened to your baby. I would be calling the vet too. Please let us know what he thinks. God Bless you Both.
Patti

[beaglemom3]

Thank you Patti I am in tears, I have not been doing well last couple of days I have been so consumed with this decision I need to make and researching almost non stop, I started to get anxiety attacks, I can't fall apart though my baby needs me.

[Squirt's Mom]

Oh, how scary! Since pheos effect the BP I would think that could cause some weakness, especially if it spiked high then dropped again fairly rapidly. But that's just me navel gazing - I don't know for a fact that is possible; just seems logical to my simple mind.

Please let us know what the vet has to say.

I know only too well how worry and stress can get to us at times. Try to find a moment or three for yourself today and let your mind rest from the research a tiny bit. Take a walk, watch a movie (LOTS of good Christmas movies on now!), have lunch with a friend - something to take your mind off of things for just a little while. You deserve it. ;)

Hugs,
Leslie and the gang

[beaglemom3]

Thank you for your input Leslie, I appreciate your advice as well. I will try to take a breather but not sure I can, but I will try.
I will definitely ask if that could be do to his bp spiking.
I wish we were going to the IMS sooner than Wednesday, I tried getting an app't for yesterday Sunday but she was all booked.

[frijole]

YES!

One of the earliest signs from Annie (when we thought it was cushings still) was that she would be running around all playful and all of a sudden she would fall to the ground. Hers was back legs but it was the pheo I now know.

Vets thought I was crazy too. So I video taped it. It evolved to the point where she could not go down steps without falling (couldnt' handle weight/pressure) however she could go UP them ok.

Kim

[goldengirl88]

You are right your baby does need you. We are not made of steel, and everyone handles stress differently. I get stressed at the thought of anything going wrong for my Tipper, I know where you are at, and it is so very hard not to panic and fall apart. Tipper always keeps me going even if I feel I can't I do it for her. I do things for her I would not do for myself!. People that do not understand this have never loved an animal with all their heart and soul. I try not to ever judge peoples feelings, as I have been there too many times myself. This journey with Tipper has sometimes pushed me to my brink. I just reel it in when I realize I am all she has. My heart is hurting for you, and I pray that you can get you and your sweet baby through this. It just hurts me to see people trying so hard to do anything to save their beloved babies as I know how they feel. Blessings
Patti

[frijole]

Thank you for your input Leslie, I appreciate your advice as well. I will try to take a breather but not sure I can, but I will try.
I will definitely ask if that could be do to his bp spiking.
I wish we were going to the IMS sooner than Wednesday, I tried getting an app't for yesterday Sunday but she was all booked.

Wednesday will be here before you know it. Deep breaths. My opinion is Annie's was not related to BP. I can't remember the explanation I later got from reading on pheos... could have been neurological... I simply can't remember.

Anyway just remember you caught this very early. Take time to make the decision that is best for your dog. Sending hugs and strength. Kim

[beaglemom3]

YES!

One of the earliest signs from Annie (when we thought it was cushings still) was that she would be running around all playful and all of a sudden she would fall to the ground. Hers was back legs but it was the pheo I now know.

Vets thought I was crazy too. So I video taped it. It evolved to the point where she could not go down steps without falling (couldnt' handle weight/pressure) however she could go UP them ok.

Kim

Thank you Kim, then this is the first sign/symptom, which is upsetting me greatly. I hope my local vet knows of this, I just cant wait to get to the IMS on Wednesday. Do you think I should call the surgeon? for his input on this? Is this an urgent matter?

[beaglemom3]

ok thank you Kim I posted my response before I saw your last post. Oh boy I don't like any of this AT ALL.

[beaglemom3]

You are right your baby does need you. We are not made of steel, and everyone handles stress differently. I get stressed at the thought of anything going wrong for my Tipper, I know where you are at, and it is so very hard not to panic and fall apart. Tipper always keeps me going even if I feel I can't I do it for her. I do things for her I would not do for myself!. People that do not understand this have never loved an animal with all their heart and soul. I try not to ever judge peoples feelings, as I have been there too many times myself. This journey with Tipper has sometimes pushed me to my brink. I just reel it in when I realize I am all she has. My heart is hurting for you, and I pray that you can get you and your sweet baby through this. It just hurts me to see people trying so hard to do anything to save their beloved babies as I know how they feel. Blessings
Patti

Thanks so much Patti you said it very well and just how I feel too, about what I am feeling, about my situation and everyone else's.

[frijole]

I am calling for calm :) It is simply a reality check that yep Snuggles has a pheo and will eventually have symptoms from them. You have the advantage of knowing that he has a pheo and a bit about what the symptoms might be. Reminder most owners don't find out until after a dog has passed that there was a pheo - if ever.

Is this a good thing or a bad thing - who knows. In my opinion it is a good thing because it gives you time to make a sound decision based upon your circumstance and while Snuggles is healthy enough to survive surgery if he is a good candidate.

I think you got the message but there is no need to phone a vet. If you can video it do so. Its a pain because it is sporadic. Don't fret that this is a bad sign because it really isn't. Hugs Kim

[beaglemom3]

Thanks so much Kim, I will try if and when it happens again. I will carry my cell phone with me at all times (to use its camera or video feature)

Your advice and facts you point out always make me feel better, thank you.

[molly muffin]

Well just catching up on the forum today and read your update and my heart went right into my throat. I am sure that was terrifying. As Kim said though, no need to panic, (and remember she went on this journey for years with Annie), you have the appointment on Wednesday and if it happens again, then you can video tape it.
Molly collapsed once and it wasn't till after we got her to the emergency vet and back home that I felt able to breath again. It just scares the heck out of you. (not due to a pheo) in General though anything like that sets the heart to pumping and adrenal coursing through us.
You can ask the IMS for her thoughts on it.
But Kim is right, you do Have to take a breather, just so you can keep yourself together. Constant stress is taxing on us humans and this will do it. So, chamomile tea? Something soothing to just give yourself a few minutes at least.

Hang in there,
Sharlene and Molly Muffin

[Trish]

Hi Vicki
That does sound scary, but I agree with the others not to hit the panic button just yet. Sounds like Snuggles was acting fine immediately before and after going down. Maybe it was just a reaction to the scratching, sometimes Flynn will put his butt in the air like that to make sure I get to scratch the right spot?? I would have thought if it was his BP he would have shown a few more symptoms. If he was acting sick at the same time I would definitely whip him into the vet so they can check his BP.

Flynn only collapsed once, that was when the initial liver tumour was diagnosed. He went down and was real unwell, no unconscious but getting there, pale gums, panting etc. He had an ultrasound and they found the big tumour and that took over as the primary concern. In retrospect the IMS thinks that collapse could have been related to the pheo as while we did find the liver tumour there was nothing about it that could have caused the collapse so they think it might have been the pheo. But he definitely had symptoms, that happened a full year before we got the actual pheo diagnosis.

Yep, hurry up Wednesday. I do hope you can chill out a bit, one of our posters recommends when it is all getting too much to put in the drawer, close it and just try and forget it for a while chill out and enjoy your pup. Easier said than done sometimes, but remember we are here with you too and will be hoping for the best possible outcome from Wednesday's appointment. xxx

[goldengirl88]

Just checking in to see how Snuggles is doing today? You have an appointment this week right? Hope all goes well for both of you. Blessings
Patti

[beaglemom3]

Thanks so much Sharlene, I am trying :) Oh My! I am sure you were terrified when your baby Molly collapse.

[beaglemom3]

I so appreciate your support Trish and everyone else's thank you from the bottom of my heart, I tried pushing it out of my head for a bit, was semi successful. But I do enjoy my play time with Snugs and Bran, and love watching Snuggles rip the stuffing out of all his new toys LOL he enjoys doing that so much. He does it with such gusto! :)

[beaglemom3]

Hi Patti, except for that one incident Snugs has been acting like his 14 year old puppy self. I did hear back from my local vet and he wants me to bring Snugs in for a bp check and examine and If his bp is high this is what he said:

"If we go to an antihypertensive drug it would probably be Labetalol. Maybe you should start reading about it and see where you can get it the cheapest. I will write a prescription if the blood pressure is high. It is an adrenergic receptor blocking agent that possesses blocking activities for both nonselective, competitive beta-adrenergic receptors and selective, competitive alpha(1)-adrenergic receptors ...like a combination drug. This is important with pheochromacytomas."

I would have loved to bring Snugs in today but it is snowing heavy here, I do not drive due to an inner ear disease which messes with my balance, and my husband is at work and then needs to go to his Dr which is around the corner so driving there is not an issue with the snowfall.. But tomorrow I see the IMS and Friday will see my local vet, he is off on Thursdays.

[goldengirl88]

Vicki:
The blood pressure is really important with these dogs. The only problems is there are so many interpretations of what each vet considers high. My IMS said she doesn't worry unless it is over 200 Everyone has given me a different answer. If you research it 170 is normal by some findings. Tipper is usually 120-150 range usually the lower end. She has been running 140. Have you tried or looked at the herb Hawthorne? Ask your IMS but mine all ok's it. It regulates high blood pressure and brings up low blood pressure. Tipper is on it everyday. It is not snowing here instead we have freezing temps around 12 degrees and the wind whipping. They said lake effect snow tomorrow so we will get a lot of that. I know this is hard to deal with, so just take care of yourself and know I am thinking of you both. Blessings
Patti

[beaglemom3]

Hi Patti,
I have a lot of trust in my local vet, I've been bringing my boys to him for 14 years and he trained at the AMC(the hospital I am going to tomorrow to see the IMS), I feel comfortable with his assessment of high bp. He has been an internist specializing in cardiology for over 30 years. plus he's a very caring doctor who puts a lot of time and thought into my boys. But I do appreciate you bringing that point up.

As for Hawthrone, I am not a big fan of herbs etc since they are not regulated and there are usually no info on how herbs and such react with prescribed medications. But I do know many people and animals have benefited from herbal supplements and the like. I am just not comfortable with them as a rule.

I do appreciate your advice and support it means a lot to me..thank you. You are both in my thoughts as well.

[beaglemom3]

OMG Snugs just gave me a heart attack LOL my little goofball. I work at home I have online pet boutiques, my office is upstairs so I have an ip camera that I watch them on. They are downstairs. I just came upstairs from one of our daily playtimes, I look over to my other monitor and Snugs is climbing on top of the sofa arm onto the glass end table where the the lamp is and taking his paw and knocking over the things on the end table. So I run downstairs and say a firm no! I did not want him jumping off the end table, well ofc being a beagle he totally ignores me and jumps off onto the floor, happy as can be. Meanwhile my heart stopped as he jumped. He is something else for sure my baby boy.

[goldengirl88]

So glad this story had a happy ending! Go Snuggs GO!!

[beaglemom3]

LOL me too!

[beaglemom3]

Finally Wednesday is here. If anyone has any questions they would like me to run by the endocrinologist, feel free to let me know.

[goldengirl88]

I can't think of any off hand except the one about the Pheo. Please ask if they think it takes on a different appearance while doing an Ultra Sound as my IMS said?? Also is it correct that a pheo would be more on the inside than the outside, or is that backwards or what? Good luck I will anxiously be awaiting to hear about you visit. Belssings
Patti

[beaglemom3]

will do Patti but I believe the inside outside question was cleared up on the boards here. Pheo inside since it is a tumor of the adrenal medulla which is in the indie of the gland, but I will ask just to make sure.

What exactly do you mean by takes on a different appearance on an unltrasound, so I can understand the question I am asking her.

[goldengirl88]

All I know is that is what my IMS said that it looks different than other tumors I guess. She said " It has a different appearance" I did not find out anything further so that is all I know. Thanks and good luck to you I will say a prayer for you and your baby.
Patti

[beaglemom3]

Ah ok now I understand what you meant by looks different I thought you meant it looks different on an ultrasound than an mri or something. I will take your questions with me and ask her.

[My sweet Ginger]

Hi Vicki,
I hope today's visit will be a meaningful one for you and Snuggles.
I have a comment and a question which is not related to Pheo.
This Mon I asked our IMS about the locations about a Pheo tumor and regular cushings tumor and I got nothing out of the way she was explaining them to me.:o:eek::rolleyes: I thought a Pheo tumor is inside of medulla as others said on here but she was dismissing a Pheo in Ginger going by her US which only shows the outer side of AG which were normal, am I wrong?
Could you please ask her if a CT scan would be sufficient enough as a diagnostic measure for a Macro adenomas rather than much more expensive MRI? Only for a diagnostic purpose. My IMS seems to prefer MRI but when I'm not even considering a radiotherapy or a surgery I'm not convinced MRI is the best choice for us medically or financially if CT scan do the job. If you can, it will be so great as I'm seeing Ginger's symptoms more towards a Macro than a Pheo except for her hypertension. Thank you. Song.

[beaglemom3]

Will do Song

[beaglemom3]

I will be leaving about 1 PM EST (about 2 hours from now) I am not sure when I will be home, but will post about the consultation and your questions as soon as I can.

[My sweet Ginger]

Thank you so much, Vicki.

[beaglemom3]

I've read a lot about curcumin on the net in the past few years that it may able to prevent and treat certain cancers, since I don't think the spice could hurt Snuggles I am going to ask the endocrinologist what she thinks about it in his situation.

[goldengirl88]

Good idea, I was also going to give Tipper Tumeric it prevents inflammation.

[Squirt's Mom]

To get the optimal benefit from Turmeric (Curcumin) add a tiny bit of black pepper. Ginger root or olive oil will also increase the efficacy but black pepper works the best. BTW, Turmeric (Curcumin) is an herb. ;)

http://umm.edu/health/medical/altmed/herb/turmeric

[molly muffin]

Peeking in and waiting "impatiently" for the low down on the IMS consult. LOL

huggers
Sharlene and Molly Muffin

[beaglemom3]

I'm in the car on the way home. The IMS said she is not convinced it is a pheo she said you cannot tell a pheo from a cortisol producing tumor from an ultra sound. Snuggles blood pressure was normal! She recommends the low dex test I'm not saying the name right but she feels if it shows high cortisol then less likely it is a pheo. I'm on my ipad so just giving the highlights and will go more in depth when I'm home at my PC. She agrees with my local vet no surgery for now unless he starts showing symptoms then we revisit that option again. So right now I feel a bit more at peace. More to report when I'm home.

[molly muffin]

Well isn't that interesting. Although with a pheo they don't definitely have high BP all the time right? just when it is acting up I thought. It's hard to keep it all straight sometimes.
So what would She use to differentiate between pheo and adrenal tumor? The LDDS (low dose dex, yes you said it right :) )
Can't wait to hear what else she said. Did she have any input on the front legs collapsing?
Okay, I'm putting on my patience hat. :) You do need time to get home and get settled in.

hugs!!!!
Sharlene and Molly muffin

[beaglemom3]

Hi everyone I just got home,
Thank you Molly for checking in :)
Sharlene, it wasn't so much that his bp was normal but she said one cannot tell what type of tumor from an ultrasound. She said one can't really see if it is in the inside or outside. I asked why did the ultrasound Dr think it was a pheo, the IMS after reading the ultrasound report said she is not sure why.

I asked your questions Pattis' yes the pheo is a tumor inside the adrenal gland. and as I she pointed out above she said one cannot really tell what type of tumor it is from Ultrasound, so no it would not look different than others since they cant tell exactly which type it is from an US.

Song I apologize but when I was asking my questions and my husband his it was towards the end of our consultation I was going to ask yours, but there was an emergency on that floor (it is a 6 story hospital) and we ended our appt quickly. But we were there with the IMS for about 2 hours.
I will copy and paste the part of the report, it was in my email when I got home.

Summary of prior medical record:
4/1/13: Vomiting/painful abdomen. Temp 105. ALP 1172, ALT 2671. AUS: neither adrenal gland seen,
suspect mild-mod pancreatitis, mild GB wall thickening. Treated supportively with pepcid, amoxi,
baytril. 5/8/13: Recheck pancreatitis. 35 lbs. Bloodwork: BUN 14/Creat 0.8, alb 3.2, ALP 295. cPL 244,
TT4 1.9. 4DX negative. CBC normal. 6/14/13: Normal CBC, ALP 203. cPL 315. U/A: s.g. 1.024,
WBCs/RBCs, no baceria. TMS prescribed. 7/3/13: Urinary signs, vomited once. CBC normal; chem:
ALP 381.U/A: s.g. , pH 7.0, protein negative. 11/5/13: Annual exam. OPG negative. CBC normal; ALP
222. U/A: s.g. 1.017, pH 8.5, protein negative. Cortisol 7.1. UCCR 58, UPC 0.2. Echo: mildly enlarged
LA, otherwise normal heart. AUS: right adrenal mass (2.55x1.5cm, mineralized, no vascular invasion),
left adrenal (1.6x0.47cm), renal mineralization, hyperechoic right pancreas. BP: 160/80. Urine
catecholamines: elevated normetanephrine (732 vs 282 control); normal metanephrine (87 patient vs 117
control) [Control is housemate]. ACTH stim: post 26 (verbally conveyed by Dr Cohen).
Clinical signs:
V/D/C/S - none
Urination/drinking - Snuggles has always been PU/PD and this has not changed in several years
Appetite/energy - very good
Weight loss/gain - Snuggles weighed 35 pounds in April and his owners purposefully helped him lose
weight with a diet change, in the past few weeks they feel that he is a little too thin and have added in
extra food to help him gain weight
Travel history - none
Vaccine history: UTD

Medications:
1) HG/FL only
Diet: "Fromm" diet as well as low fat diet and Hills I/D
Physical examination -- mild caution
Temperature: 100.7F; Respiratory rate: pant Heart rate: 130bpm
Weight: 13.9 (previously 15.9 kg on 4/2013 at rDVM) BCS: 4/9 MCS: 2.5/3
Hydration: euhydrated CRT: <2s MM: pink, moist
Demeanor: QAR/caution
General Examination:
Eyes/ears/nose/throat: OU: serous discharge, tear staining, lenticular sclerosis, AU: mild ceruminous
debris, NNDC, negative cervical palpation
Retinal examination: WNL OU
Oral examination: Severe dental tartar and periodontal disease with moderate halitosis, no oral
ulcerations or lesions noted
Peripheral lymph nodes: smooth and symmetrical
Respiratory pattern/effort: Panting/eupnic
Respiratory examination: Normal bronchovesicular sounds bilaterally
Cardiac examination: NMA, NSR, SSP
Abdominal examination: SNP, NMP
Rectal examination: normal rectal anatomy, formed stool present, anal glands small and firm, thickened
right anal sac though no discrete mass palpated
Musculoskeletal: Ambulatory x4, two small (1x1cm) subcutaneous fluctuant masses in right axillary
region, inflamed hygromas on both elbows, mild bilateral hind limb muscle wasting
Neurologic: CN WNL, not further assessed
Urogenital: MC, no MGT
Dermatologic: Multiple wart-like lesions on head, dry coat
In-hospital therapy/procedures:
1) None
Diagnostics performed
1) Doppler blood pressure - 142 mm Hg (#3 cuff, LHL, excited)
Problem list:
1) Right adrenal mass with mineralization - r/o cortisol secreting v. pheochromocytoma v. benign
2) Elevated ALP
3) Elevated post-ACTH stimulated cortisol
4) History of suspected pancreatitis with elevated liver enzymes
5) Episode of forelimb collapse (12/10/13)
6) Left CCL (surgical repair, 7/12)
7) History of UTI (3/13)
8) Hx of IVDD (2012)

Interpretation/Plan:
At this time we do not know the etiology of Snuggle's right adrenal gland mass. Our top concerns are for
a cortisol secreting tumor v. pheochromocytoma v. non-functional adrenal tumor (i.e. adenoma).
Currently available diagnostics do not provide a definitive diagnosis. We recommend performing a
LDDST to further investigate if the adrenal mass could be cortisol secreting, as his ACTH stimulation test
was high. We also recommend thoracic radiographs to r/o metastatic disease.Although there is some suggestion of a pheochromocytoma, I do not feel this is definitive. Snuggles'
urinary normetanephrine was higher than his housemate's, but it was only 2.5x higher. The recent study
by Reusch et al (J Vet Intern Med. 2010 Sep-Oct;24(5):1093-7) recommends using a cut-off of 4x normal.
He also does not have documented hypertension, and his ACTH stimulation test was elevated.
Pending results of a LDDST, we discussed two primary options:
1) Continued medical monitoring with a recheck abdominal ultrasound in one month to assess for
growth. The risks of waiting include that the mass may begin invading blood vessels (i.e. caudal vena
cava) making surgery riskier, it may metastasize or it can acutely bleed which can be life threatening. (If
further diagnostics make us suspicious that this is a cortisol secreting tumor we can consider medical
adrenalectomy with Lysodren.)
2) Surgical removal of the mass for diagnostic and therapeutic purposes. We discussed that this surgery
has a relatively high morbidity and that we don't necessarily recommend surgery at this time as Snuggles
is asymptomatic. Should he become clinical, or if the tumor continues to grow, then surgery would likely
be recommended. Explained that an abdominal CT would likely be recommended and that pre-treatment
with phenoxybenzamine for two weeks would also be indicated.
The owners have elected to monitor at this time and will pursue a repeat ultrasound in one month with
their local veterinarian.
Medications dispensed: None
Follow-up:
One month for repeat abdominal ultrasound to reassess size of adrenal mass; recommend thoracic
radiographs and LDDST.

[beaglemom3]

More was discussed but can't remember it right now if I recall anything important I will post BUT

On our way home my local vet Dr Cohen called and he said his friend who is an experienced UltraSound doctor got a new machine that is 4D that gives amazing pictures or w/e you call them and she needs to test it out so he asked if I would bring Snuggles in tomorrow for a FREE UltraSound to re-measure his tumor. I am thrilled he asked us :) We will be there at 12 PM

Oh about the turmeric, she said she does not know if it is beneficial or not for a pheo

[flynnandian]

sounds interesting, and for free...not bad at all. good luck tomorrow.

[beaglemom3]

thank you flynnandian It is 5 days and 1 month since his last Ultrasound when they found the tumor, I am hoping the 4D Ultrasound shows more details about the tumor, but not sure it can.

[molly muffin]

Well if it can great, if not, you've got another picture for the team of specialist to take a look at and make some reevaluations if anything different is noted.
Excellent vet that Dr. Cohen, you might have to keep him. (yes, I know you like him and he's been your vet for a long time :) one must kid now and then) :) :) :)

Over all I thought that was at least positive sounding and less scary than the immediacy of do it now or who knows what could happen.

Did you talk about the front leg collapse and what that might have been about?

I know it is so hard to remember everything when you are there and going over issues of importance.

I hope you can get some rest tonight, it has been a long day for your whole gang.

hugs,
Sharlene and Molly Muffin

[beaglemom3]

LOL Molly ....and yup he's a good guy. You're right I had two opinions before both different now the IMS agrees with Dr Cohen so that's the route I am taking, feels good to have made a choice, for now. All depending on how Snugs is the choice may need to change.

Yes we did discuss his front leg collapse, it was in her report but I am not sure I copied that part is was long so cut some of it out.

"Snuggles had an episode
yesterday where he "collapsed" in the forelimbs for several seconds while being pet in the cervical region,
but recovered completely within 20-30 seconds. He has never had a collapse episode before. However,
he may have weak hind limbs with possible arthritis."

She really didn't say more than that but did say watch for it if it happens again.

Thanks Molly I am pretty beat.

[frijole]

I know this is so exhausting and you are taking it all in and I can tell you are absorbing it like a sponge. Great work mom. and a free ultrasound on a new machine sounds fantastic.

Only thing I want to caution you on re the LDDS test is that when non cushings illnesses are present you can get false positives for cushings. Annie had two LDDS tests that both came back clearly as cushings. She had like 5 acth tests that were false positives. Her cortisol was high but from fighting the pheo and not from cushings. The only acth test that came back as normal and no cushings was the one sent to Michigan State's lab vs Idexx.

Maybe another one of the senior members can recall but there is an alternative test that I think helps further identify adrenal cushings because in all likelihood since you know there is an adrenal mass you want to know if it is adrenal cushings, a pheo, or just a tumor that is dormant. Right?

Put your feet up and chill for the rest of the night... you deserve a break!!! Oh and hugs those 2 doggies. Kim

[Trish]

Hi Vicki

Well that is a very comprehensive report and plan... I like it!!

So pleased to hear Snuggles checked out well and BP was good too!! That is a relief :):) Sharlene is right it, sometimes the BP will only go up during an attack when a pheo is secreting. In my boy's case his BP was up all the time, hence changes seen in his eyes (which I note are clear in Snugs yay!) and also kidney problems.

I am glad she interpreted those catecholamine tests the same was I read them, I agree with her it is difficult to say this is definitely a pheo based on those test results. It still could be a pheo, but it could also be an adenoma that is not going to cause too much trouble so it would have been a real risk to put him through surgery for it to turn out to be a benign mass.

So the ultrasound Snuggles has had does not clearly show where the tumour is? Ultrasounds can be unclear at times. In my dog it most definitely did appear in the medulla and they could see that on his ultrasound. But they also went on to do CT as your IMS is recommending, including his chest to look for any spread.

Also the same as Flynn had in the initial assessment stage, she is recommending LDDS, Flynn had two of those and neither of them were indicative of cushings. My IMS did want to see if there was concurrent PDH that could have been causing some symptoms so I agree with doing those tests too, even though there can be false positives as Kim has written.

The tricky bit with these adrenal masses when assessing and treating is to not put your dog through surgery if it is not needed. So I agree with your IMS and you taking the watch and wait approach especially as Snuggles is asymptomatic. I am doing the same with the nodule that Flynn has on his remaining adrenal and I really, really hope it does not get to the stage where we need to operate on him again as I do not know if my nerves or the rest of the K9C team here could take more Flynn surgery!! :D:D We do have the benefit of his nodule being visualised during his recent liver operation and I just have to trust his surgeon when he said it does not look cancerous macroscopically :D:D:D

I hope you have a good sleep tonight Vicky, that's great about testing out the new scanner for free tomorrow! Definite bonus! I am so glad it went well for you guys today and it really goes to show the benefit of having an IMS on the team as well xxxxx

[beaglemom3]

Hi Trish

I do feel more at ease, having made the decision to wait and watch for now. I appreciate the info about Flynn's ultrasound being able to show where his tumor was located, now I know it can show location. I am hoping this 4D ultrasound today can show that. I am keeping Flynn in my prayers that the nodule on his other adrenal gland is of no consequence.

I have an appointment with Dr Cohen on Friday, he will not be there today when Snugs get this ultrasound it is his day off I will ask him what he thinks about the urine test only being 2.5 times more than the control, and yes you spotted that right on :)

Hopefully on Friday he will take another chest Xray of Snuggles and we make a appointment to do the Low Dex Test. I do appreciate you Sharlene and Kim pointing out it can result in false positives.

[beaglemom3]

Hi Kim,

I appreciate you giving me the heads up about false positive on the testing. It is something to definitely keep in mind when the results are in. I am very tired this morning although I did sleep okay, but I am anxious to see if the 4D ultrasound can give us more info on Snugs tumor.

Hearing of another test to help determine what the tumor is would be great. Thanks so much Kim :)

[goldengirl88]

Vicki:
I know yesterday had to be a stressful day for you. I am glad that you got some answers and have formulated a plan to go forward. I am hoping and praying that this is just an adenoma and not a pheo. I hope you get some better ideas on that after this week and the LDDS etc. Praying for you and your baby. Blessings
Patti

[beaglemom3]

Thanks so much Patti I so appreciate your prayers and good wishes. I do keep Tipper n my prayers as well.

[beaglemom3]

Me and Snuggles just got home, boy am I exhausted, we left at 11:30 AM and its now 4:30 PM But they told me Dr Cohen will call me with the results, today is his day off so he wasn't in the hospital. So I am sitting waiting for the phone to ring, I am on pins and needles. The Ultrasound Dr. said she going look at Snuggles from head to toe with the 4D Machine. So ofc being the neurotic mom as I am, I am thinking, he hasn't called because it's bad news. My mind works that way always, afraid it is bad news.

I do have an appointment with him tomorrow at 10 AM unless he tells me otherwise after hearing the results, that is how we left it off yesterday.

[goldengirl88]

Praying for the best outcome for you and Snuggles. I hope everything turns out ok and he calls you today so you do not have to wait. Blessings
Patti

[beaglemom3]

Bless you Patti and thank you!

[molly muffin]

Hoping it's all good.

hugs,
Sharlene and Molly Muffin

[beaglemom3]

thanks so much Sharlene HUGS!

[frijole]

Joining the others in the group hug. Kim

[beaglemom3]

Thank you Kim HUGS. I fell asleep, I could not keep my eyes open, I just woke up and so far no call. He may be waiting to go over the results during our appointment tomorrow, but I wish he would call tonight as I thought he would.

[addy]

Dang that waiting game is so hard.:(

Hope the call comes soon

[beaglemom3]

Thanks Addy, you are so right, waiting is so hard. I doubt he is calling tonight it is 8:41 PM here. I am assuming we will go over the results tomorrow at our appointment.

[Trish]

Good luck for today's appointment you guys!! You will be hanging out for the weekend and no vet trips. Finger's crossed for good news on the scan today, but I guess we have to remember it is her first time using it too, so might be a bit of operator learning curve going on there! Snuggles will be getting suspicious every time you load him in the car that you are taking him to the vets again!! :) xxxx

[goldengirl88]

Good luck at your appointment today. I am thinking and praying for you both. I know how hard this has to be on you. I hate waiting and I hate waiting for answers that could possibly be bad, even worse. You are doing a wonderful job of keeping it together while being scared to death. I know that feeling. I have to take Tipper on the 15th to see if her heart is worse, and if the tumor has grown. I do not think I can handle two devastating things at once so I am praying all is good. I will be eagerly awaiting to see what the Dr.'s have to say today. God Bless You Both.
Patti

[beaglemom3]

thank you Trish, Patti and everyone for your prayers and good wishes. I just got back from my 10AM vet appointment with Dr Cohen(local Vet)

The tumor is just about the same size, Doc said just a couple of mm bigger but he is counting it as same size more or less. (last ultrasound was done on 11/5/13) The ultrasound also shows no invasion of that big vein(I can never remember how to say it correctly). Everything else on the 4D machine showed normal. She looked everywhere :)Snugs bp today was high normal, so no meds yet. His xray showed no metastasis, his heart looked good, his lungs are clear, his back is very bad, but we knew that, but Snugs shows no outward signs of his bad back except he sits down very cautiously, but he jumps up and on couches (even though I have pet steps for him and his brother next to the couch)he jumped off that end table a few days ago sheeesh! God Bless him. So all and in all I would say it was a good report :) I am to bring Snugs in once a week for a bp check and another 4D ultrasound in 6-8weeks unless God forbid he starts showing symptoms etc. He gave me a script for that bp med Labetalol but not to fill it until needed.

He is still considering it a pheo tumor. I am so tired I could sleep for a month but I am happy with todays report under the circumstances.

Patti, my prayers going up for Tipper to get a good report on the 15th as well and my prayers include as always, all of our dogs for good reports and long happy and healthy lives with us.

[goldengirl88]

All around I would say a good report. Just like with Tipper you will have to keep doing Ultra Sounds to make sure the tumor is not growing. Does anyone know if Pheos grow rapidly or slowly??? I am glad you can rest a bit now, and ease your mind a little. It seems nothing is ever definite with these Cush dogs so I guess we have to take what we can get. God Bless You and Snuggs.
Patti

[beaglemom3]

The surgeon Dr Scavelli said it is individual some pheos grow faster some grow slower.

[goldengirl88]

I guess there is nothing of absolute certainty about this disease, but that it is surely terrible. Blessings
Patti

[Trish]

Hi Vicki

Pleased to hear there was no enlargement, still not able to see if it was in the medulla? Glad to hear there is no vena cava invasion, that is great and BP holding steady!! Would you consider ultrasound at the IMS, or are you happy with this one? I was just thinking it maybe would be beneficial to have an expert radiographer do one on their high tech equipment?

I hope you guys have a relaxing weekend after this week of appointments and stress, you deserve it and I think you are doing a fantastic job exploring all the options for Snuggles :D

[beaglemom3]

Thanks Trish, I do need to rest and catch up on work as well. The person who did the ultrasound is an experienced Sonographer. Her title is Clinical Sonographer and Mobile Imaging Consultant.

I believe she is the one who did the first ultrasound as well but not sure.

But she needed to test and train on the new 4D machine. I think I will stick with her for now since Dr Cohen thinks highly of her and she worked with Dr Scavelli, the surgeon at his hospital as well.

[goldengirl88]

I think this 4d machine must be new? I don't recall anyone at my hospital using this terminology so I am wondering if they have this type? All I know is it was high resolution. I would certainly want this if available here. I hope you and snuggles rested up and have a good weekend. Blessings
patti

[Trish]

Oh my apologies, I thought the woman doing it was a general vet. I know my own local vet has fancy equipment, but he prefers in tricky cases like Flynn that they are done by the specialist radiologists consistently so hopefully they pick up any little changes that can be missed by general vets doing scans :)

[beaglemom3]

hehe no need to apologize you were looking out for me and my boy :)

[beaglemom3]

thanks so much Patti

[Trish]

Trish glad it wasn't a big one, that must be so scary! Happy you and Flynn are safe.

I have a question about the pheo, I believe you said Flynn's was benign, did it grow at all that you know of?

It did show signs of malignancy. With capsular invasion and signs in blood vessels also extended into the vena cava.

It most definitely did grow. It was finally diagnosed on ultrasound in November 2012 with the vena cava extension. His ultrasound before that was in May 2012 when it was not seen. He had a CT scan in November 2011 and they said in retrospect they could see a tiny spot on that, but it did not show up on two ultrasounds until the 3rd 6 months later, so it grew heaps in that final six months and invaded the vessels.

Hope that helps :)

[goldengirl88]

Just checking in this morning to see how Snuggs is doing? Hope you are both safe and warm and enjoying your Sunday. Blessings
Patti

[beaglemom3]

Thanks Patti, so far no outward signs, so he is acting like his 14 year old puppy self, mischievous, bossy and my little goofball. He melts my heart every time I look at his beautiful face :)

[molly muffin]

So glad to hear that the tumor hasn't taken off and grown much since the last ultrasound and that Snuggs is doing so well. :) Great news.

hugs,
Sharlene and Molly muffin

[goldengirl88]

That is the best thing you can ask for is when they act like themselves. I hope and pray this bad tumor just goes away, and your baby continues to show no symptoms. This is a hard job being a Cush mom and you are doing fantastic. Blessings
Patti

[beaglemom3]

Thank you Patti and Sharlene!

[goldengirl88]

Just the sweetest face ever!!!!!!!!

[goldengirl88]

Just checking I to see how your baby is today. It is frigid here and Tipper cannot walk again and she is really disgusted and acting out. Stay safe and warm. Blessings
Patti

[beaglemom3]

Hi Patti,
So far hes been acting himself, making a lot of mischief LOL but I love that about him! Snugs keeps me on my toes for sure.

I so hope you get to the bottom of your sweet babies issues really soon Lots of hugs n kisses for Tipper

[beaglemom3]

I have been doing a lot more research and read a lot about vitamin C and its ability to kill off cancer cells. The studies involved IV Vit C not oral but all sounded very promising. I used to give Snugs vit C for years until he came down with pancreatitus, and just asked our vet this morning if we can start again and he said yes but if it upsets his stomach in anyway I am to stop.

I also found this article on pheo tumors, most of it we are familiar with but the last couple of pages discusses new treatments w/o surgery that scientists are studying:
http://www.medscape.com/viewarticle/741162

[goldengirl88]

That is very interesting about the vitamin C. I know that it is all the rage on your face now as it fights free radicals etc. so that's along the same lines. I know my vet prescribed it one time for my cat. I got it down and as soon as it hit the old stomach up it came, so I know it can be hard on the stomach as it is ascorbic acid and all. Hope that everything is still going well for you two. This disease sure can get you researching things! Blessings
Patti

[beaglemom3]

I will post the studies later, it really is amazing it totally got rid of tumors in people and they did follow up a year or two later and still no tumors.

So far Snugs is tolerating the Vit C well, I put it in his lunch time meal so the food hopefully is buffering it.


Today I take Snugs in for hi weekly bp check, will post how it was when I come home, I am leaving within the hour.

[Trish]

Hi Vicki

How did the BP check go? Hope Snuggles is behaving himself!!

I must say I do not have a lot of faith in that whole Vit C thing, I will read your studies though and see if they can change my mind! I have seen too many people resort to that when other treatmetns have failed to try and bring a miracle cure (this is humans, not dogs) all they have done is ended up in clinics for long periods of time, having infusions, spending loads of money on it and it never helped any of them in the end.

[goldengirl88]

Vicki:
There are always miracles to hold onto, and if it does not hurt her and could possibly help her according to the studies ,follow your heart. I am with you 100% with whatever you do. Hope you and Snugs have a warm and safe weekend together. Blessings
Patti

[beaglemom3]

Thanks so much Patti,
Hi Trish, I was holding off posting Snuggles bp readings until I got a faxed copy. I am going to email the IMS tomorrow(she is not in on Saturdays) to me they appear high, I am not sure why my local vet says they are normal on high end and no need for meds at this point:



12/13/13 forearm

bp HR MAP
180/100 110 126
150/110 70 125
185/90 85 110
170/100 85 120
180/85 80 110


12/20/13-Hind

BP HR MAP
190/140 95 155
190/115 105 125
200/130 90 150
185/110 90 130
185/110 100 135

Yesterday the Vet said Snugles was nervous and trembling while they took his bp. Do you think these readings warrant a bp pill? I am very nervous about the readings I do trust my vet buy I want to see what the IMS says

[flynnandian]

the bp is pretty high. does your vet want him on bp medication? you can try it out for some time. stress can indeed put the numbers up.

[molly muffin]

I don't think it could hurt to fax them to the specialist. She might be looking at it in a different way than your regular GP vet is.

To me they look a tad on the high side. All the trips to the vets might be taking it's toll on the BP, but if consistently higher, then maybe a BP med would be in order. I'll let those most familiar with the BP chip in their opinions.

Sharlene

[beaglemom3]

Thank you Sharlene and flynnandian, I emailed the IMS I saw she read the email about 20 minutes ago from a read receipt but she hasn't answered so far. No my local vet said no bp meds a this time, that is why I am concerned, unless vets know something I don't which is just about everything. That is why I am hoping the IMS responds to my email.

[beaglemom3]

I found a site which show normal range of blood pressure but it differs for different breeds.
http://www.submedvet.com/Php/frmbuilder.php5?dateiname=%2FDocs%2FMemoprint%2FSc ientific_2.htm
you need to click continue to see the bp chart
Normal range for a Beagle
systolic
140+/- 15

diastolic
79+/- 13

Pulse Rate
104+/-16

[flynnandian]

ok, hope it was just stress for snuggles at the vet.

[beaglemom3]

Thanks you flynnandain, I am so concerned my stomach is in knots.

[molly muffin]

Hopefully the specialist will answer you. I'm sure Trish and others will be by when they get a chance. I know Trish has been through the high BP meds with her Flynn, so hopefully some insight will be had.

hugs,
Sharlene and Molly Muffin

[frijole]

Hello. I can only share what my vets did with Annie's pheo - I can't say if it was the right thing to do. The challenge with dogs with pheos is that their blood pressure can be normal most of the time but be very elevated when the tumor is active and the chances are it is NOT active at the vets - just like when your car won't 'make that noise' when you take it to the shop to be looked at.

They put Annie on a low dose of high blood pressure meds as a precautionary measure. She never had any issues so I assume it didn't do her any harm. So I'm unsure why your vet is hesitant to give it. Again I am only relaying my story and I'm no blood pressure expert.

I can only tell you there were a couple times when her breathing got so fast I didn't need a machine to tell you her bp was high. I was afraid she'd go into cardiac arrest but after a few minutes it all stopped and she was back to normal and happy. I'm glad she was on the meds. Kim

[Trish]

Hi Vicki
BP in pheo dogs can be high when the tumour secretes or like Flynn they can be high all the time. His got up to the 220 range and was consistently there.

Snugs are high, but they fluctuate between his different limbs too. So I guess would have to work out averages. They really can change a lot during a series of readings which is why one off BPs are not to be relied upon. My vet does similar to yours takes up to 7, then discards the highest and lowest and averages the rest. If Snugs is consistently at this level I would be thinking antihypertensives could help him. The problems we ran into that were associated with high blood pressure were with Flynn's kidneys (proteinuria) and also torturous blood vessels at the back of his eyes. The eyes came right after we got the BP down and now his kidneys seem to be controlled, but it has taken meds to do it.

Why was the the local vet hesitant to start them? With pheo dogs before surgery they often use phenoxybenzamine which your IMS has already mentioned and Flynn had that to get his BP down as it works well on pheo's. Flynn is now on Amlodipine for BP and Benzapril for his kidneys. No side effects apart from in early stages when he felt a bit woozy getting up on occasion which we think was his BP lowering and his body getting used to it.

Let us know what the IMS tells you, I will be most interested to hear it. xx

[beaglemom3]

thank you Kim and Trish. I am having great doubts about my local vet pertaining to treating Snugs and the pheo tumor. another thing is recommended a different blood pressure pill and I don't know why. He gave me a script and said not to fill it yet last week it is for Labetalol, he said it works well with pheos.

When the IMS took Snuggles bp it was 140, but when my local took his bp a few days before seeing the IMS his readings were high but not as high as Fridays it was:

Readings a few days before seeing the IMS
Left Hind Foot
BP MAP HR
160/80 100 80
180/85 120 120
170/100 115 90
170/95 115 90

Tail
175/115 130 100
170/110 130 90
180/105 125 95
170/110 130 90
175/105 130 90

Last 2 reading again
12/13/13 forearm

bp HR MAP
180/100 110 126
150/110 70 125
185/90 85 110
170/100 85 120
180/85 80 110


12/20/13-Hind

BP HR MAP
190/140 95 155
190/115 105 125
200/130 90 150
185/110 90 130
185/110 100 135


I am confused and getting very anxious because I don't understand. When the tech brought Snuggles back out Friday I said how was his readings, she said normal I said what was it she said 190 I said WHAT! She said Snuggles was very scared and trembling, so she called my vet out to talk to me and I said isn't 190 high he said it was 130, and that Snuggles is fine and I shouldn't worry. That's why I wanted the print out, to see what the readings said.

I am very confused and worried. I am going to call the IMS today and hopefully I can talk to her.

[beaglemom3]

I think I figured it out. But will still call the IMS. I think the vet is going by the MAP not the actual systolic and diastolic readings. I found this chart.

Breed Systolic Diastolic Mean
Labrador Retriever 118 ± 17 66 ± 13 99 ± 19
Golden Retriever 122 ± 14 70 ± 11 95 ± 15
Great Pyrenees 120 ± 16 66 ± 6 95 ± 15
Yorkshire Terrier 121 ± 12 69 ± 13 120 ± 14
West Highland 126 ± 6 83 ± 7 112 ± 13
Border Collie 131 ± 14 75 ± 12 101 ± 21
King Charles Spaniel 131 ± 16 72 ± 14 124 ± 24
German Shepherd 132 ± 13 75 ± 10 108 ± 23
Terrier 136 ± 16 76 ± 12 104 ± 16
Bullterrier 134 ± 12 77 ± 17 122 ± 6
Chihuahua 134 ± 9 84 ± 12 109 ± 12
Miniature Breeds 136 ± 13 74 ± 17 117 ± 13
Pameranian 136 ± 12 76 ± 13 131 ± 14
Beagle 140 ± 15 79 ± 13 104 ± 16
Dachshound 142 ± 10 85 ± 15 98 ± 17
Saluki 143 ± 16 88 ± 10 98 ± 22
Greyhound 149 ± 20 87 ± 16 114 ± 28
Pointer 145 ± 17 83 ± 15 102 ± 14

and Snugs MAP average was about 130 or 140 on Friday. I guess that is what they go by, I am assuming, but I need a professional to confirm that for me so I can rest easy.

I get so nervous when I don't understand things.

[beaglemom3]

I just heard back from the IMS and she agrees no need to treat with his numbers the way they are, I just emailed back and asked if they go by the MAP instead of the systolic and diastolic and waiting for a response. OMG I feel so much better now! My stomach just got a lot more calmer.

[Squirt's Mom]

Bless your heart. I'm glad the IMS was able to ease your mind a bit. Nothing like twitching, huh? :p

[beaglemom3]

LOL Omg yes was a rough day and night yesterday worrying, woke up at 6 AM and googled my brains out. I am thrilled she answered me so quickly this morning. Sigh of relief :)

[goldengirl88]

Vicki:
I hate that waiting game when you feel something is wrong and you want validation if it is or not. It just kill me when I have to wait for an answer on something. I am glad she put your mind at ease. One time my IMS told me she is not concerned unless they go above 200which seems high to me, but I guess not to them for some reason. I am hoping the bp stays down so snugs does not have to be on the drug. I always feel the least amount of drugs I have to give Tipper the better off she is. Blessings
Patti

[beaglemom3]

I agree with you Patti, on both. I am a terrible waiter. But I feel better about my local vets handling of this, and happy I have an IMS to consult with as well, except when or if it does get time to give him bp pills I am going to make sure to ask my local vet why is he prescribing what he is and not the other one that the IMS and everyone else seems to think is best.

I hope tipper is feeling better today. Hugs!

[molly muffin]

Patience is not in our vocabulary when it comes to our furbabies. I'm the same way. Hate waiting. I think we all are. These vets just don't know what they are up against do they. :) :) :) We will have answers and they best just figure that out and have the answers ready from the get go. Good to understand your patients eh and it's not always the pup. LOLOL
Glad that one got figured out. :)

huggers,
Sharlene and Molly Muffin

[Trish]

Great she got back to you, that's a relief! Wonder what their protocol is for starting antihypertensives? Be interesting to hear when you have contact with her next xx

[beaglemom3]

you're so right! Sharlene, we all sit on pins and needles when it comes to our furbabies.

and oh yes those vets better get on the ball! ;)

[beaglemom3]

Thanks Trish, I don't know but next time I speak to my vet and the IMS I am going to ask at what point do you decide its time for meds.

[doxiesrock912]

Vicki,

When we first started Daisy oon Trilostane, she had one episode where she was breathing seriously fast and is scared me so much! She was relaxing on her bed inthe kitchen, not doing anything strenuous. It lasted a few minutes, things went back to normal and it never happened again.

How frightening!

I'm glad that the doctor finally responded.

I'm glad that

[goldengirl88]

Vicki:
Hoping that Snugs does well over the Christmas holiday. Do you decorate? I know I had read on someones thread about a blood pressure drug that caused a lot of problems for their dog. I guess you have to be careful what you use there too. It's like everything with a cush dog is a major decision, and has to be well thought out. It seems some of us may not have a white Christmas, and others have nothing but ice. Stay safe and warm with Snugs. Blessings
Patti

[beaglemom3]

Hi Valerie, OMG I bet you were terrified! I am so glad it hasn't happened again. Have a wonderful Holiday!

[beaglemom3]

Thanks Patti, he isn't on any meds yet, so no worries there at this point. I hope you and Tipper have a wonderful happy healthy safe holiday!

[beaglemom3]

I finally got an answer about when blood pressure warrants medication:

The IMS said this exactly,

"I would not treat Snuggles unless his blood pressure is consistently above 200 mm Hg. "

also I mentioned to her my local vet so far has not mentioned anything about the LDDST test and she said this:

"I think the LDDS will help us differentiate if Snuggles' adrenal mass is a pheochromocytoma or from the adrenal cortex."

She feels that way because she says:

"there is some suggestion of a pheochromocytoma, I do not feel this is definitive. Snuggles' urinary normetanephrine was higher than his housemate's, but it was only 2.5x higher. The recent study recommends using a cut-off of 4x normal.

He also does not have documented hypertension, and his ACTH stimulation test was elevated."

I am not sure why my local vet isn't pursuing this test but will pin him down for an answer.

[beaglemom3]

MERRY CHRISTMAS! AND HAPPY HOLIDAYS!

Click the link to view your card :)

You can view your card here (http://www.jacquielawson.com/viewcard.asp?code=4532997734290&source=jl999&utm_medium=internal_email&utm_source=pickup&utm_campaign=receivercontent)

[Squirt's Mom]

How beautiful! Thank you and from the gang and me -

A Very Merry Christmas to you and yours!

[frijole]

I finally got an answer about when blood pressure warrants medication:

The IMS said this exactly,

"I would not treat Snuggles unless his blood pressure is consistently above 200 mm Hg. "

also I mentioned to her my local vet so far has not mentioned anything about the LDDST test and she said this:

"I think the LDDS will help us differentiate if Snuggles' adrenal mass is a pheochromocytoma or from the adrenal cortex."

She feels that way because she says:

"there is some suggestion of a pheochromocytoma, I do not feel this is definitive. Snuggles' urinary normetanephrine was higher than his housemate's, but it was only 2.5x higher. The recent study recommends using a cut-off of 4x normal.

He also does not have documented hypertension, and his ACTH stimulation test was elevated."

I am not sure why my local vet isn't pursuing this test but will pin him down for an answer.

The LDDS test is a good test to determine if it is pituitary or adrenal tumor. The problem with it is that when another illness is present you can have false positives. Annie had the test twice and both times it showed pituitary cushings. She didn't have pituitary cushings. We did a cat scan or MRI to rule out pituitary cushings. So that is probably why your vet hasn't pursued it.

I am late for work but hope someone will read this and chime in. I believe there is a specialized test that helps diagnose adrenal tumors. You know there is a tumor - you just want to know if it is the kind that causes cushings or if its dormant or if its a pheo. I am not sure LDDS is the best test as I fear you'll just get a false positive and I'd hate to see you start cushings treatment in a non cush dog like I did.

Sorry to post and run but I am already late! Hugs and Merry Christmas!!! Kim

[beaglemom3]

Thanks Kim I will do some googling and see if I can find it and you have a great and Merry Christmas!

[beaglemom3]

You're very welcome!

[beaglemom3]

This Is what I found but its for humans I am not sure if the same goes for dogs:

MRI Scan

MRI scans provide similar information to the CT scan. Adrenal tumors have a very rich blood supply and a pheochromocytoma light up very brightly on MRI scans providing the diagnosis.

MIBG Scan

Additional studies that are available for localizing a pheochromocytoma include the MIBG scan and octreotide scan. MIBG scans is used to detect adrenal pheochromocytoma. This test does not detect any other type of adrenal tumor. This is a radioisotope study in which a substance that is required by the adrenal gland to manufacture adrenaline is labeled with a radioactive isotope. Tumor tissue, which makes large amounts of catecholamines, will selectively take up the radioactive labeled substance. This is then identified as hot spot under a machine that detects the radioisotope.

Octreotide scan

Octreotide scans are useful in many neuroendocrine tumors. Many neuroendocrine tumors have receptors (tiny molecular holes) into which a hormone called somatostatin enters. In octreotide scan an antibody to this receptor is labeled with a radioisotope. Tumors that are rich with these receptors will have many of the antibodies bind to them. Many neuroendocrine tumors have much higher concentration of the somatostatin receptors compared to normal tissue. Injection of the antibody to the somatostatin receptor that is coupled with a radioisotope will selectively go to neuroendocrine tumors. Imaging the patient under a machine that recognizes the radioisotope produces a hot spot where the tumor is located. This is an important for study for localizing neuroendocrine tumors that are not visible on studies such as the CT scan and MRI scan

[labblab]

Hey Kim, I think you may be referring to the endogenous ACTH test (this is different from an ACTH stimulation test)? It is a blood test that can help differentiate between Cushing's that has its origin in a pituitary tumor rather than an adrenal tumor. The collection/transmission of the blood sample for this test is really "picky" though, so we don't often see this test performed.


What is the purpose of measuring endogenous ACTH?
In dogs, endogenous ACTH is usually measured to differentiate the origin of hyperadrenocorticism. It should only be measured once a diagnosis of hyperadrenocorticism is made. Endogenous ACTH concentration is not useful in the diagnosis of hyperadrenocorticism, only in differentiation. If an adrenal tumor is present, the concentration of endogenous ACTH is very low due to negative feedback inhibition of ACTH release. With pituitary-dependent hyperadrenocorticism, the endogenous ACTH concentration can be elevated, may be within ‘normal’ limits, or may even be a little below normal.

On occasion, endogenous ACTH is measured in cases of hypoadrenocorticism. In those cases, the endogenous ACTH concentration is typically very elevated in an attempt to stimulate cortisol secretion by the adrenal glands.

But this may not be what you're talking about since we already know there's an adrenal tumor present and the question is whether or not it is a pheo vs. a functional tumor. So I don't know whether the ACTH level would be of any help in this regard. But it might be a question to ask the IMS.

Marianne

[goldengirl88]

Vicki:
Thank you for the beautiful card. You have lots of good information on these tumors. Maybe that is what my IMS meant when she said a Pheo presents differently than an adenoma. Happy Holidays. Blessings
Patti

[beaglemom3]

you're very welcome! I asked the IMS about that she said if it is a pheo the entire adrenal gland gets enlarged.

[molly muffin]

I love Jacquie Lawson card! Thank you. It's beautiful!

I don't know enough to give any feedback on the testing to differentiate type of tumor. :( Sorry, I thought the LDDS could help to determine between pituitary and adrenal, which we know, but maybe there is something else that the IMS is looking for. The only way to know is ask her how the LDDS differentiate between Type of adrenal tumor.

Merry Christmas Eve :)
hugs,
Sharlene and Molly Muffin

[Trish]

That card is so pretty!! Thank you and Merry Christmas to you and the doggies and rest of the family too!! x

[goldengirl88]

Hi Vicki:
I hope that you and Snugs have a very special Christmas. I have all I need for a present in Tipper. I am blessed she is with me today. I said Merry Christmas to her when she got up, and she made that look like she knew what I meant. She has the best memory of any dog I have ever had. I can't believe she would remember that from last Christmas though. Maybe it is just wishful thinking on my part. She is my biggest blessing, and for that I give thanks. Blessings
Patti

[frijole]

Wishing you and your babies a very merry Christmas! Kim

[addy]

What a beautiful card. :):)

Merry Christmas!

[molly muffin]

Merry Christmas to you and Snugs!

hugs,
Sharlene and Molly Muffin

[beaglemom3]

You are all very welcome for the card! and thank you all for your Seasons Geetings! I hope you all had a fun and safe Christmas.

Tomorrow, Friday we go for Snugs bp check. Fingers and Paws crossed!

[goldengirl88]

Vicki:
I am hoping you and Snugs had a wonderful Christmas. Did Snugs sneak any Christmas treats?? I did not let Tipper have anything. She has had enough problems lately. Her trachea is acting up again and the loud snoring noises. I am getting nervous thinking about her tumor check, and heart check coming up. Part of me just wants to not go. I don't think I can stand any more bad news. Blessings
Patti

[beaglemom3]

Hi Patti,
We have a lovely day. I am extremely cautious about Snuggles and his diet due to his chronic pancreatitus, which is under control so far. So no Snugs unfortunately is not allow any treats anymore except a very low fat prescription dry food I give him as treats. His food is Fromms Senior. It is an excellent family run business since 1904.

My boys were on Innova since they were babies. It was a great food, human consumption standard, w/o any recall history until last year when Proctor and Gamble bought the Natura Company. Since they purchased the company they have many recalls.

I switched their food over quickly due to the first recall, I was appalled, and by changing their diets so fast (need to do it slowly for dogs) Snugs came down last year with a serious case of pancreatitus. My baby had 106 fever and was hospitalized for 4 days. His blood values were through the roof. I was so afraid I was going to lose my boy. I was and still am so angry! how this P & G company caused this, in fact there's a major recall of Iams and Eukanuba dry dog & cat foods going on right now,which is also owned by P & G.

I was always so careful to keep them at a good weight and healthy treats, healthy food and then this.

But we got through that thank doG

[goldengirl88]

Vicki:
That is terrible about the pancreatitis. I heard it can kill them. I try to be so cautious of what Tipper has. I know all about the recalls that is how I ended up on the Newmans Own. Human grade organic chicken. Now I found out it has sorghum in it though. I am going to look up the food you use. Is that all you give Snugs is kibble? I know my friend had a bad bout with her pancreas and wasted away to nothing from it. Blessings
Patti

[goldengirl88]

Vicki:
I never saw this food before. I just looked at it, looks like a great food. Which one does Snugs eat? I am assuming one is low fat, I saw the senior but remember for some reason these dogs should not eat organ meats and liver was the main ingredient in that one. I am interested in the calories and fat so I am going to keep looking until I find it. Blessings
Patti

[beaglemom3]

Snugs food doesn't have organ meat he eats this one http://frommfamily.com/products/gold/dog/dry/reduced-activity-senior-gold

First ingredient is duck. Its the Senior reduced activity-Gold My vet gave it his okay after researching it when he came out of the hospital from having pancreatitus. This company was recommended highly by a few pet owners I trust with their food choices. I like its a family run businesses for over a century and never had 1 recall.

Yes Patti, pancreatitus can kill that is why I am so diligent with Snugs diet, but beagles are extremely food oriented and Snugs would grab anything at anytime and not give it back. So I am always on my toes with my little boy.

I am keeping him a few pounds lighter than he usually was and the vet said he is good, not too thin.

We just got home from the vet for Snugs bp readings, it took quite a awhile because Snugs gets so upset and he is very sensitive about being poked and proded and the readings were through the roof, but my vet knew it wasn't accurate. So they tried to calm him down and after maybe 30 minutes they tried again and it was 140/120 then 140/110. So I asked what I can do he said buy a pediatric cuff and use it on my Omron bp machine I have at home, it wont be so exact as his but will give us a good idea.

After the vet we went to some stores and I took Snugs and Bran out to Lowes (home improvement store) The PO, Bank, Snugs seemed particularly interested in the bank lol and walked around the shopping centers and parking lots. They both got a lot of pets from people and attention.

I took some funny pictures of them in the car will upload them in a few, Snugs wearing my ear muffs and Branny was shivering so I put my scarf around his head and my hoodie ski jacket on him. I have tons of coats for him but he is afraid of clothing but I told him from now on he wears his coat when we go out, the poor baby was shivering so. Snugs loves clothes but he takes the cold well.

[molly muffin]

Those BP readings seem pretty good actually.

Love the pictures. I had to laugh at the expression on Bran's face. LOL
Snuggs wears those earmuffs like they are his. :)

We hear of that all the time, get a good food and then they get bought and the formula changes and it all goes kaput! Sucks

hugs,
Sharlene and Molly Muffin

[Trish]

Good news on the BP! YAY.... be interesting to see your home recordings to see if there is much difference when he is in his own environment.

Why does he have earmuffs on? Has he got chilly ears? :)

[beaglemom3]

LOL Trish was having some fun with them in the car, I guess I got a little silly hehe
I agree it will be interesting to see the difference in readings.
I am actually looking at some vet blood pressure monitors most are so expensive but hoping to find something I can afford.

[beaglemom3]

LOL thanks Sharlene, true when a big company buys a small company out, all they care about is profits :(

[Trish]

Ohhhhh LOL :D I thought it must be so cold there he was getting frostbite!!

[beaglemom3]

LOL nope just a silly beaglemom ;)

[Trish]

Haha! Love silly Mom's that play games with their dogs... mine is a terrier and he had to wear a wee santa hat at Christmas, that did not last too long and a good old shake got rid of that pesky thing!

[goldengirl88]

Vicki:
I have to reread what you said about doing this BP at home. That would be great if it works out. I am glad you had some fun with Snugs today. It was a warm day here in the 40's. Monday another arctic blast!! The ice melting here is bad though, you have to be careful where you walk. Blessings
Patti

[beaglemom3]

Haha! Love silly Mom's that play games with their dogs... mine is a terrier and he had to wear a wee santa hat at Christmas, that did not last too long and a good old shake got rid of that pesky thing!

LOL Trish He must have looked so cute! I know those hats I carry them in my online pet boutiques, and antler headbands and elf hats LOL they have everything for dogs nowadays.
I tried mine on Snugs he shook it right off Like yours did, Brando keeps his on but Snugs pulls Brando's off his head. lmao

I just ordered a bp monitor for Snugs, They don't make a pediatric cuff for my machine and the vet machines were in the 1000's of dollars UGH so I purchased one that has tiny cuffs for infants etc
http://www.amazon.com/gp/product/B009FOHPFU/ref=ox_ya_os_product

I will definitely let you know Patti and everyone if it works out. It received some good reviews on amazon. (for humans) I can get his pulse, his oxygen level and of course his blood pressure. Also connects to the internet. Although I hope Snuggles doesn't figure out my online passwords or he is going to be ordering a lot of treats and toys ;)

[Trish]

That looks pretty good, I do think they get the best recordings from Doppler, but this should hopefully give a ballpark figure! Not too pricey either :)

[beaglemom3]

I agree Trsih but the dopplers I can't afford, but hopefully this will be okay. Hopefully Snugs will let me do it LOL he doesn't like this sort of things but in the car ride home I put my wrist bp machine on him while he was sleeping and he didn't budge LOL I kept getting an error it was a bit to big for him but glad he let me do it.

Very difficult finding an automatic bp monitor for infants. I am glad I found this and yes the price wasn't too bad, I figured I am so in debt already from all the vet bills, consultations testing etc. what's another hundred dollars LOL

[Trish]

True LOL!! That's my take on it too :) let me know how it works and I might invest in one for Flynny!

[beaglemom3]

LOL yup..Oh I sure will. I wil bring it for his next bp checkup up and let them compare theirs to mine and how big of a difference the readings come out.

My vet said I don't need to come back every week now but every other week, but I think I will bring him in 10 days instead of 7, I really don't mind going every week, it gives me peace of mind.

[Trish]

I like peace of mind too!! I remember before Flynn had his ultrasound in November, the pet hospital had said it would be OK to wait a year. It was six months and thank goodness I did it as they found his liver mass! Imagine if we had waited a year, we are now at different specialist practice and they have said to recheck scan in 2 - 3 months... think I will be there at two which is end of January!

[beaglemom3]

OMG thank God is right! I am so glad you didn't listen to them! I'll be praying all comes out fine at end of January! Snugs goes for his next ultrasound in about 4 or 5 weeks if no symptoms rear their ugly heads.

[beaglemom3]

This is interesting, I couldn't sleep (it's 4 AM) so did more searching for veterinary blood pressure monitors and found a store selling the exact same one I bought on amazon, but describing it for veterinary use as well.

http://www.bpmonitordepot.com/08a-versatile-digital-blood-pressure-monitor-with-pediatric-cuff-for-veterinary-use/

"three patient measurement mode for Infant , Pediatric and Adult . Use infant mode for small dog and cat , use pediatric mode for big dog , use adult mode for horse , pig etc."

[Trish]

That's good to know, can't wait for it to arrive! You are up late!!

[beaglemom3]

Now I wish I paid the 21.00 for expedited shipping It says it will be delivered between Jan 3-Jan 8th.

I went to bed my regular time woke up and my mind started worrying about Snuggles and his bp.

I haven't said anything but something is worrying me. My local vet cares a lot about me and my dogs, but I think he is going overboard with trying to reassure me things are okay. Last week I showed you all the bp readings and they were quite high although not high enough yet to warrant medication confirmed by the IMS. But when the tech brought Snugs out last week she said it was 190, which the report said, I was upset and the vet came out and said don't worry he doesn't do well taking his bp and was very anxious, his bp is normal 130. I said the tech said 190, he said no 130. That's why I wanted the written report to see was it 130 like the vet said or 190 like the tech said. Well as you know it was an average of 190.

That made me feel anxious that the vet said no it wasn't 190 it was 130 don't worry.

Yesterday they had a hard time getting Snugs to calm down for a reading, took quite awhile. Our vet came out and talked to me for a few minutes and said he's going in back to see how its going, came back to waiting room and said Snuggles readings are through the roof.

Then he went back again to check on Snugs again and came out just a few minutes later said its normal 140. and then said he didn't believe last weeks readings of 190.

We got the written report and instead of it having the HR MAP and several bp readings it just said 140/120/110

I am sure hoping those readings are legit and not just to give me readings he thinks Snugs bp is If Snugs wasn't so anxious during testing.

I know this sounds crazy but something doesn't feel right to me.

[Trish]

Hmmm that does sound a bit suss. It is nice he cares and does not want you to worry but he needs to give you the correct results!! Does he do it by Doppler? From what I understand stress can put it up so much, but not through the roof! You might have to have a wee chat with your vet. I know the vet nurses won't give me any results and tell me to wait for Mike, I hate that as it just makes me think it must be bad!

[beaglemom3]

Yes they use a Doppler. I am not sure how to talk to him about this w/o offending him or sounding like a nut.

[doxiesrock912]

Stop by another vet's office and ask for a BP check. Explain that you just need confirmation.
If you have Petsmart stores with Banfield clinics in them, that would work too.

[beaglemom3]

My vet owns the entire hospital and has several other vets working for him. One of the vets in his hospital does house calls two times a week. I was thinking of asking my vet if the one that does house calls also can take blood pressure when he comes to the house. Maybe that will help them get a more accurate reading.

[beaglemom3]

Thanks Valerie that's a good idea.

[doxiesrock912]

If this reading is super high, then I would have the discussion with your vet as you'll have "proof".

[Trish]

Well sometimes we have to make ourselves heard!! Think I might have offended mine last week just a tad, he was going to take off a warty thing from Flynn's nose +/- sedation. A few weeks back he hurt his back jumping only a week or so after his surgery. The vet gave him a real hefty dose of Temgesic, Flynn cried all night and I am pretty sure it was not his back but the drug making him dolally!! So when I dropped him off for his BP check, bloods and nose I told the vet nurse who checked us in to make sure they did not give him Temgesic. Mike the vet, kind of brought it up in a round about way later when I picked Flynn up that if he thought he needed Temgesic then he would have given it but at a lower dose!! Ooops considered myself told LOL I said righto, you can come sit with him and pet him all night when he goes loopy on it!! Luckily he did not need sedation so did not have anything like that!!

We are our pets advocate so we have to speak up no matter how uncomfortable it makes us. I guess once we do it, they know they cannot pull the wool over our eyes and neither should they... we should all be in this as a partnership for the best of our dogs. I don't mind about hurt feelings now, do it in a calm voice and just say you are still concerned about Snugs BP and what caused the discrepancy last week and why are the recordings you have been given in a different format? Just say you were reading up on BP recordings and what protocol does he use?

[doxiesrock912]

Let me add that you are paying him. You have every right to ask questions, especially if you think that something is off.

[beaglemom3]

You are right Trish, this is my baby's life and its my job to make sure he is being well taken care of. That is why I can't sleep, because of the discrepancy and because I didn't push the issue and get clarification.

I am going to call the vet today and ask why the report is so different than the pervious ones and also ask if Snugs bp can be taken in my home by the other vet.

[beaglemom3]

Very true Valerie and I am paying 1000's just since Snugs got diagnosed with the tumor

[Trish]

Wow do they do home visits like that? I am impressed! I know some here have not taken the dog out the car at the vets and had them come out and do the BPs there. It has to be pretty clear if they give you a printout from the machine with all the recordings on. I know my vet does discard the highest and lowest to get rid of the outliers.

[doxiesrock912]

Exactly. My vet has no problem answering questions. He likes that I'm an educated pet mom.

[Trish]

Mine's the same, but he also knows I am quite capable of going to the IMS if I am concerned. I am trying my best not to do that though as it has caused trouble in the past. But I still would if I was overly concerned!

[beaglemom3]

That's great Valerie :)My vet doesn't mind either he just tries to tell me things are fine and not to worry.

Yes Trish one of the vets that work for him does house calls 2 times a week, I am just not sure he takes blood pressure during the house calls, if the machine is mobile, which it may be.

[doxiesrock912]

Doing the BP reading at home would give a more accurate reading since Snugs would be more relaxed. I would arrange that asap.

[beaglemom3]

Two weeks ago when I was at the IMS she got a reading of 140 and just a 2 days after that my vet got a reading about 180

[beaglemom3]

I think he does his house calls on Tuesdays and Thursdays I will find out today.

[Trish]

Well thats all well and good him trying to put a positive spin on it, but you need the facts... if the BP was going up then Snugs needs treatment, for what its worth I would go with the IMS recommendations on meds too, not sure about that Labetalol, have not heard of it being used before although I am sure it must have been.

Worth a try anyway with the home visiting vet, but I really think you doing it at home with no strange people around would be the best option. Early Jan is not far away!

Mike said I could take their BP equipment home (so it must be portable) and do it myself, but we never got to that as his BP settled down nicely.