Intro & questions

[r.j]

Hi everyone,

This will be a long post! My Westie dog, "D", is 9 years old and was diagnosed with Cushing's a few months ago. She's currently on Vetoryl 45 mg x 1 a day and she's responding well.

Yesterday, however, I found a small lump on the side of her stomach. I brought her to the vets today and they said they would need to remove the whole lump to assess whether it's cancerous and therefore put her under general anesthetic during surgery. Her Cushing's along with her age worries me as it increases the chances of complications.

The vet said that before anything can be done, her Cushing's needs to be 'under control'. She also has an inflamed bladder wall at the moment and she's now on antibiotics, so first the bladder needs to be treated, then she needs a Cushing's test (a routine check up), and only then can we do the surgery. So we have to wait quite a while.

My vet is away for a week (had to see a different new one today and the whole thing was over before I had a chance to process it) and so haven't been able to ask her all of my questions.

My questions are:

1) Is she at a high risk of not waking up after being put under GA, considering her age and her Cushing's? She's overweight (9.7kg) but apart from that is healthy (although she is prone to UTIs). I know no one can tell me an exact risk percentage, but any insight would be great. I will also ask my vet this question.

2) What does it mean when the vets say that Cushing's can cause 'complications' with GA, and what does it mean to have Cushing's 'under control'?

And if anyone can offer insight into whether local anesthetic with a tranquilizer would work instead of GA during surgery (or would it hurt her?), and how worried I should be that this lump is cancerous, that would be great… but I know that isn't Cushing's related.

I am going to ask my regular vet all of these questions but as I can't see her for a week I'm very worried and would really appreciate some info/reassurance! I'm new to this thing and I adore my dog and just want her to be okay. Poor thing has gone through a lot recently.

I don't have test results on hand at the moment but will be sure to get them ASAP.

Thanks in advance for anything you can throw my way.

[frijole]

So is the tumor hard or fluid filled? My cush dog got little bumps on her all the time - none were cancerous. I always waited til she had a teeth cleaning and since she was already under GA they removed them. She was a schnauzer.

I don't know how 'out of control' your cushings is but I think the vet is just being cautious. If they truly were concerned about cancer I would risk the GA because as it was explained to me - anesthesia is so different these days they can bring them to real fast in the case of emergency/distress that the risk is less.

Obviously keep an eye on it and if it changes at all go back to the vet. Again, I was never concerned about GA and I treated my dog for over 4 years and she was put under numerous times. Never an issue.

Back to the cushings - that is a pretty large dose for your dog's weight. Have you had any acth tests done since starting vetoryl? What were the results? If you don't know then please find out. Looking for the 2 numbers that are the results of the test. That will tell us how controlled her cortisol is. Kim

[r.j]

Thanks heaps for your quick reply.

The lump is soft and it's discoloured which worried the vet. It's not too big but it is definitely more than a small bump, and I haven't found any others on her as of yet. You have definitely eased a lot of my anxiety surrounding GA so thank you so much.

D's starting dose after a first test for Cushing's was 30mg, but after a second test they increased it to 45mg. I've just emailed the vets asking for a copy of her test results (the last one was done in September - her next one is scheduled to be done in a week but will need to be delayed because of her bladder problem) and will post it as soon as I get it.

Thank you - it's really useful talking to someone about my worries :)

[frijole]

No problem. We look forward to the results. It helps us help you better. The test tells you how much you have lowered the cortisol. With a cush dog you want it near the 3 to5 mark ideally but each dog is different. The main number you worry about is the 2nd one on the test. You might want to start a folder and get copies on future tests so you can track over time. It is very common to have to change doses both up and down over time and it helps to have previous tests to look at when making decisions. Kim

[Roxee's Dad]

Hi and welcome from me too.

Our Rozee went under GA at 17 years old. The regular vet wouldn't do it because of her age but sent us to a specialist in the field. She is now 18 1/2 and yes we were very worried. Their is always a risk, About 10 years ago our 12 year old Bailee also went under GA to remove some stones from his bladder and his heart stopped but they were able to bring him back quite quickly.

You mentioned she is responding well to the Trilo but yet the vet says we need to bring her under control. Can you clarify a little bit. Does she still have symptoms like the ravenous thirst and appetite?

[doxiesrock912]

Uncontrolled Cushings affects the healing process by slowing it down. This is another reason why your vet would be concerned.

Also, many vets are finding that giving Vetoryl twice a day at a lower dose is more effective. Definitely a question for your vet. I am concerned about the high dose. UTIs are common with Cushings.

[goldengirl88]

I just wanted to welcome you to the forum. My Tipper has many bumps and lumps right now. The vet used to remove them when cleaning her teeth. I have not put her under for cleaning since she started with Cushings as I am worried about her going under as she has a heart murmur also. Mostly all of her lumps have been fatty tumors, and Cush dogs and people with Cushings are prone to these. Could you post the abnormal readings on all the tests for Cushings you have had done, and the normal values of the lab that did them? It will give us a better picture of what is going on. Also how much does your dog weigh and what is the current Vetoryl dosage and how many times a day do you give it. What were the symptoms you dog was showing when you had him tested, and how are the symptoms now? Have you had LDDS, ACTH, Urine, Blood, and Ultra Sound performed? If so please show the results that are abnormal. I hope you dog just has a fatty tumor. Is it hard and can you manipulate it around? Blessings
Patti

[addy]

Hi and Welcome,

My Zoe was diagnosed in April 2010, started Vetoryl in June 2011. She has had two surgeries. Both surgeries we were able to use less anesthesia because of the location of the growths. We used a specialty clinic with an anesthesiologist, not a local vet. One growth was on her lower neck and the other was a vulva growth.

You need to consider what happens if the growth is deeper than they think which happened to Zoe's vulva growth.

You need to think about post op as they are slower to heal and need antibiotics.

The last surgery was more extensive for Zoe and the post op was harder as we lost all control of her Cushings though she breezed through surgery with a spinal and GA. Our surgeon put it this way- old age is not a disease and a good anesthesiologist can work with that. She also warned that sometimes GA can cause problems with a current condition we may not know of- example if Zoe would have had kidney disease that did not show up on her pre surgery tests, it could push that disease forward.

So, you need to have a good team and a frank discussion and weigh options. Every dog is different and outcomes can be so different.

I did not give my Zoe her Vetoryl the day of the surgeries and she had a post of 7ug/dl on the last one and 6ug/dl on the first one.

Glad to meet you

[r.j]

Thank you everyone for your replies and welcomes. I’ll try to answer each question as best as I can now that I have some of her test results.

How much does your dog weigh and what is the current Vetoryl dosage and how many times a day do you give it.

9.7kg, 45mg x 1 a day

What were the symptoms you dog was showing when you had him tested,

- Pot bellied
- Always hungry
- Increased water intake
- Recurring UTIs
- Irritable and slightly aggressive towards my other dog (they would fight quite a bit)

and how are the symptoms now?

Much better. She hasn’t had a UTI since starting her Vetoryl (we recently thought she had one but turned out to be inflamed bladder wall), she’s more relaxed and less anxious, she has more energy and is more playful.

Have you had LDDS, ACTH, Urine, Blood, and Ultra Sound performed? If so please show the results that are abnormal.

These are the results my vet emailed me today:

Date 01/09/13
ACTH Test
Baseline: 3.9 ug/dl
Therapeutic monitoring: 5.4 ug/dl
(Prescribed 30mg Vetoryl x 1 a day)

Date 15/09/13
ACTH Test
Baseline: 5.0 ug/dl
Therapeutic monitoring: 6.7 ug/dl
(Prescribed 45mg Vetoryl x 1 a day)

Her recent ultrasound came up okay while we were checking for kidney stones and crystals (there were none). Urine is fine as well.

Her next test was scheduled to be on Friday but has been postponed because of bladder wall inflammation.

I hope you dog just has a fatty tumor. Is it hard and can you manipulate it around?

It’s soft but isn’t really ‘moveable’ in that sense – the vet said it was approx 1cm in diameter. It doesn’t appear to hurt her when I touch it and it hasn’t grown, but I did just notice it overnight so I’m not sure whether I just wasn’t paying enough attention or whether it grew rapidly.


Does any of that help? Sorry as I mentioned I’m new at this and have just been trusting my vet (who is really good) as I’ve also been taking care of a cat with kidney failure and haven’t had much time to research Cushing’s. I feel bad because I don't know what any of her results mean. Now I have extra time I definitely will be doing more independent research.

Also, many vets are finding that giving Vetoryl twice a day at a lower dose is more effective. Definitely a question for your vet.

I will most definitely ask this as soon as I can talk to her.

Thanks everyone. I'm waiting until my vet gets back on Saturday and then I can ask her all of the other questions I have!

[molly muffin]

Hello and welcome to the forum.

I discovered two lumps on my dog that I had never seen before and took my dog into the vet who did a needle aspiration to check cells for whether they were just fatty (lipomas) or something else. The general consensus by her was that they were lipomas, which are not life threatening. They can however, depending on where they are, become uncomfortable, in which case they would be removed.
My vet too said that an GA can be tricky with cushings or with any type of liver issues. (doesn't sound like D's liver is at issue though, since you didn't mention it from the recent ultrasound).
I would ask your vet about doing a needle aspiration to check for fat cells and ask your vet if they think it is lipomas. There might be a reason that they think it is something other than lipoma that we are unaware of.

Actually D's cushings, if symptoms are gone, does appear to be controlled. If symptoms are fine, control (the post number) can be up to 9.0. Optimally they like a 3 - 5, but every dog is different. Since you upped the dosage I'd keep an eye just to make sure that it doesn't go too low on this new dose. Just a precaution, not saying that it will.

Again welcome
Sharlene and Molly Muffin

[r.j]

I would ask your vet about doing a needle aspiration to check for fat cells and ask your vet if they think it is lipomas. There might be a reason that they think it is something other than lipoma that we are unaware of.

I asked the vet that I showed the lump to about doing a needle biopsy (is that the same thing?) and she said that it wouldn't show enough info and that they would need to remove it anyway... this vet wasn't my regular one, and the whole thing was very rushed so I didn't have much time to ask questions, so I'll be asking my regular vet this question again.

Thanks for your welcome :)

[molly muffin]

The best plan we've found is to write out the questions that you want to speak with your vet about and take them in with you. Often, once you get in that office, everything you planned to say or wanted to say goes right out the window in the midst of discussions.

Sharlene and Molly Muffin

[goldengirl88]

If you keep a daily diary on you dog it is most helpful to refer back to for things that happened and when they happened. Try to always get copies of anything done with the vet. You will be able to post results that way and if you decide to go to another vet you already have a completed file on your dog. Every few months I also ask that they copy the Dr.'s notes for me and I put them in Tipper's file. It is very helpful when you want to know something. Is your dog exhibiting any symptoms at all now that the cortisol has been lowered? Blessings
Patti

[Freckles#3/Louise]

I am so glad I started a daily diary (actually hour by hour at first) when Freckles first got sick. It helped me to pinpoint the problem medicines.
Also, I was able to provide the Vet a timeline of the problems and my efforts to help her.

Louise