early stages of diagnosing cushings

[hogie7171]

Hello all

My vet wants to test my 9 year old beagle for cushings. I am hoping you guys could tell me what i should be watching out for and also what i should be asking my Vet.

Here is a little background on my dog if that helps. He was diagnosed with psycho polydipsia at a very early age (1 or 2). For the last couple of months he has been drinking twice and much as usual plus has been urinating excessively.

He has had two urine analysis and one blood test. The early results are showing his urine is very diluted and has protein in it. I was also told his Albumin was elevated .

[labblab]

Hello and welcome to you! I know that psychogenic polydipsia exists as a diagnosis, but I'm afraid that's about all that I know about it -- just the name :o. Can you tell us some more about any testing that was done at that early stage that resulted in the diagnosis? Also, has there been any treatment associated with the condition?

In addition to the excessive thirst and urination now, are there any other abnormalities that you are noticing with your dog? There are a number of different symptoms that may be associated with Cushing's including excessive hunger, skin and coat issues, pot belly, panting, and seeking out cool places. The more of those other "classic" symptoms that are present, the more confidence we can place in assuming that it is Cushing's that is the cause of excessive thirst and urination, as well.

You've mention a high albumin level. I know that low albumin can be associated with a number of health issue, but I'm honestly not sure about any significance to high albumin other than dehydration at the time the testing is performed. Were there any other abnormalities noted on the blood test? Cushpups typically exhibit elevated liver enzymes such as ALKP and ALT, high cholesterol, and some irregularities in white blood cell counts.

The main reason why I am asking about these other abnormalities is because protein in the urine and excessive thirst/urination can be associated with primary kidney problems as well as being issues associated with Cushing's. So that is why I am wondering whether there are any other markers that point towards Cushing's as being the culprit.

Do you know which specific test your vet plans to perform tomorrow? I am guessing either an ACTH stimulation test or a LDDS test.

Marianne

[hogie7171]

So far there has been Two urine analysis , some blood work and his blood pressure taken. The results from those test were a low concentration of urine, protein in the urine, elevated levels of albumin and his blood pressure was slightly to moderately high. He is not a fan of going to the vet so i am guessing that might be the reason for the high blood pressure.

He has experienced no other signs or symptoms of cushings.

The test he wants to do tomorrow are. Another urine analysis. He wants a sample of his urine from when he first wakes up to see if he is concentrating it over night. Also wants to take his blood pressure again to see if its still high.

He also wants to do an ultrasound and another blood work type test. It would involve taking samples over an 8 hour period.

My vet does not think its a kidney problem because of a few reasons. Some of them being because if it was kidneys he would not have a low urine concentration . also because if it was a kidney issue my dog probably would not be able to make it through the night with out having an accident.

This is all very new to me so i am sure i may have mis understood some of the things i have been told.

[jas77450]

Hi and welcome, we are here for you!!!

[Squirt's Mom]

Ask about the possibility of a rare form of diabetes called Diabetes Insipidus, or DI. It has nothing to do with blood sugar but rather with how the body processes water. The signs are similar to Cushing's in the drinking, peeing and low concentration. Testing for this is risky so most vets simply start treatment and if it works, there is the diagnosis. Treatment is an eye drop I believe.

[hogie7171]

Thats for the reply. DI was mentioned and yes the treatment is an eye drop

I brought him in today with a sample of his urine from when he first woke up. It was still very dilute. They will be keeping him for the day to do an Ultrasound and a The Low Dose Dexamethasone Suppression Test. So i should know more later today

[molly muffin]

Hello and welcome to the forum.

Ultrasound is a good option to see what is going on with the organs. It sounds like they will be doing the LDDS, low dex suppression test.
It will be good to see those results and easier then to make decisions on treatment.

Welcome again

[Dixie'sMom]

Hello and welcome! I will be waiting along with the others to see what the test results show. I am fairly new to this group myself so I can't really offer any helpful advice, but I'm happy to walk along beside you until we figure out whats going on with your sweet pup. I have a soft spot for the hound dogs and the fact that you have a beagle makes me smile. :) Keeping my fingers crossed that you get good news and some good info to help determine how best to manage his problems. I look forward to getting to know you.

[hogie7171]

The latest update on Bailey is He has a tumor the size of a tennis ball on his right adrenal glad or at the end of his liver. His left adrenal gland is enlarged. He has to go back again on the 20th to see a specialist to determine exactly where the tumor is and what our options are.

I wont get the results of the LDDS for a week or two. Until we get the results the vet thinks it is either cushings or Pheochromocytoma ( a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure .)

Its has also been determined he has high blood pressure.

Is high blood pressure a symptom of cushings ?

[hogie7171]

Also i would like to thank everyone for there advice and kind words. I am glad i found this group so i dont have to go into it blind.

[molly muffin]

Yes high blood pressure can be associated with cushings, it can also be associated with a pheo tumor.

I've sent a message to one of our members who has been through both having liver masses removed and a pheo adrenal tumor that was removed with her dog.

Her thread is here: http://www.k9cushings.com/forum/showthread.php?p=164785#post164785

Left side is easier to get out than the right. So that is the better side for it to be on. That big, I think you're going to want it removed.

We have another member with a beagle who has an adrenal tumor, it isn't that big yet though. Her thread is here:

http://www.k9cushings.com/forum/showthread.php?t=5904&highlight=snugs

Another members just had an adrenal tumor removed 3 days ago, her dog is doing fine and is recuperating at home now.

I know it is scary, but we are here with you.

hugs

[hogie7171]

Thanks for the quick reply Molly muffin. Maybe you (or someone) could answer a question i didnt ask my vet. Whats worse , the tumor being on the adrenal gland or on the end of the liver?

Also could he have both Pheochromocytoma and cushings ?

[molly muffin]

As my specialist told me tonight, it would be very rare to have both, but not unheard of to have both.

If there is a mass on the adrenal or the liver, it is possible that the LDDS will come back positive either way as any chronic illness and a mass is chronic, can cause false positives.

I am not sure myself, which is worse to have, but Trish, might have a better idea as she has been through both kinds of situations, although I don't know if Flynn's was on the end or not of the liver.
I'm sure she will pop in later as I've messaged her about your situation and that we need some insight. :)

[molly muffin]

Okay just heard from her, she is out right now, but will check in when she gets back home.

[hogie7171]

Thank you so much to going out of your way to help me get some answers. I cant tell you how much i appreciate it.

[judymaggie]

I will let other much more knowledgeable folks give you the technical advice but just wanted you to know I will keep Bailey and you in my thoughts and prayers.

[hogie7171]

Thanks Judy. I also have a Maggie , she is also a beagle

[molly muffin]

Awww, what cute beagle pictures are showing up on the thread. :) He is a handsome guy.

[judymaggie]

Loved all your photos! Definitely can relate to the "head tilt" and Bailey's "guy-liner" is super. :D How old is Maggie?

[hogie7171]

Maggie is almost 8

[Trish]

Hey, welcome to you and Bailey! My dog has had both liver tumours and an adrenal gland removed for a pheo.

The first thing I want to do is give you a whole lot of hope!! His liver tumour came first in 2011 when he was 11, it was massive just a bit over 600g, it was very low grade so he had a good prognosis after it was taken out. Then a year later we found the pheo in his right adrenal it had also invaded his vena cava... so out the adrenal came. Then finally last year about this time, that darn liver grew another big 9cm tumour which we also had successfully removed. I love surgeons, they have saved his life numerous times :D:) so I hope the same is going to true with Bailey!

I see you have an appointment in a couple of weeks with a specialist, I guess the pointers I can give will be more pertinent once the location of Bailey's tumour has been established.

Was this scan done at your local vets? As often the specialists have a much higher definition scanner that will be able to more accurately locate where this tumour is. I am suspecting adrenal, with the cushings type symptoms... maybe adrenocortical?? But that is only guessing from what you have told us andI hope the specialist will be able to clarify that for you.

You asked which one is worse? The surgeries were very similar in regards to his recovery. I asked our surgeon this question once and he told me that both the liver resection and adrenalectomy gave him moments but they were both in his case relatively straight forward. I think when we are talking about what is worse, is related to the type of tumour as some are obviously more aggressive than others.

We did do a LDDS when getting the pheo diagnosis, it was negative plus Flynn did not really have the more obvious cushings symptoms, they were pretty sure we were dealing with a pheo from the get go, as he also had very high BP which with pheos can either spike intermittently or in his case stay high all the time. Plus he had proteinuria, probably due to high BP and also changes in his eyes from the BP. So it all added up, plus his scan showed the location of his adrenal tumour in the medulla which is where it is common to see pheo's.

Will stop there, we need more answers, I kind of think I would hold off on more testing with local vets unless they have been in consultation with the specialist... as you do not want to have to pay for stuff now if they are only going to repeat it later.

Welcome again, I know this is a scary time... I remember the feelings that whirled through my head well. OH and I also caution about using Dr Google unless you are going to very well reputed websites, as they can just plain scare you senseless unnecessarily!

Trish :)

[jas77450]

I am so sorry to hear about Baily, keeping you in my thoughts and prayers!

[hogie7171]

Trish thanks for your input and insight. I really appreciate it. I am glad to hear that all the surgeries went well for your pup.

Yes the scan was done at my Vets office. The specialist that we will be seeing is traveling specialist, meaning he will be coming to my Vets office to do the scan. So i am hoping/assuming my vets office has a the proper scanner to be able to help determine where the tumor is.

So far my local Vet has been very far with me. I have not been charged for any blood pressure reading , 2-3 in house urine analysis. Also they did not charge me for the Ultra sound they did since they want me to have it redone by the specialist. Also i have been only charged with one office visit so far. We are on visit #3

Also i was not charged for his blood pressure medication. His blood pressure was in the moderately high side. I am not sure if thats a good thing or not.

The one question i keep asking myself is. Could it be possible that he was misdiagnosed with psycho polydipsia when he was 1-2? Could a tumor be slow growing that it would take 7-8 years to get worse?

Once again. That you everyone for your help and kind words and prayers.

[Dixie'sMom]

Thank you for posting pictures of Bailey and Maggie. They are precious! I go all mushy over the hound dogs.

As far as Bailey's tumor... well, it of course, isn't what any of us wanted to hear, especially you. But as others here have walked this walk successfully, I have high hopes that you can get Bailey thru this. And we will help you get thru this...one step at a time... one day at a time.

Sending prayers of faith, hope, comfort and strength your way. Give those babies a belly rub for me!

[Trish]

Hi

That is great your local vet is cutting you some slack with bills. But I would be asking them about their scanner and its accuracy. For example I would love my local vet to be able to do scans but as he tells me the quality of his scanner is enough for him to get good pictures in pregnant pets and that kind of thing, but nowhere near good enough for high quality pictures the kind we need when looking for tumours and planning care in that scenario. He said his scanner probably costs $20K while the one at the specialist with the high definition is $200K or thereabouts. I would just be a little leary of paying out my good money if the are then going to turn around and say it was not clear enough and you have to travel anyway. Unfortunately I have to travel 5hrs to get to our specialists, but that is just what I have to do to get the best care and advice for Flynn.

I have not heard of the specialist coming to you, are you in a particularly rural area? I think everyone I have heard of have had to travel to the actual specialists office which I think is a good thing to have access to their equipment and most of them work in conjunction with other specialists like the surgeons and they can do cross specialty consultations.

Is this specialist well qualified? As if surgery is going to be an option you do want to have a board certified surgeon on hand but also the same high qualifications in an IMS. Perhaps if you went to a bigger clinic you might be able to get in quicker.

I do not know the answer to the psychogenic polydipsia question, it will be interesting to hear what the specialist says about that. What BP medication has Bailey been started on?

Don't want to freak you out about the length of this list but we have put together a list of questions to ask the specialist if it is in fact an adrenal tumour and I include them here for you to think over before you meet with them. Even if it does end up being a liver tumour, you could adapt this list to suit. Hope this helps :)

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.
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. 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
12. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
13. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
14. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.
Trish :)

[hogie7171]

Thanks for the info Trish. I will male sure i ask about the quality of the scanner.

The specialist , and to be honest i am not sure what type of specialist he is. I am/was under the impression that he specializes in doing and reading ultra sounds. He visits my vets office on a regular basis and he is schedule to be there on the 20th.

The BP medication he is on is Benazepril 10mg once a day

Thanks for the list of questions, i will make sure i print the out and take them with me to Baileys nest app.

[hogie7171]

How much water should i be letting my dog drink a day? Should it be limited to a healthy amout or should i just let him drink as much as he wants?

[Budsters Mom]

Someone wil be along shortly to merge this thread with your other one. It makes this easy to keep track of you and Bailey that way.;)

Cush pups need to drink a lot so that they don't get dehydrated. Their kidneys work overtime. That's why they pee excessively. My cush pup had three bowls going simultaneously. Do not limit the water. Let Bailey drink as much as he want/needs.

[Trish]

Hi

I think I would ask and clarify the specialist that will be coming. Personally I think you need one that is a well qualified IMS, you do not want to mess about with another scan if the person doing it is only going to then refer to an IMS. Well just my opinion anyway. If there is a tumour there which fairly clearly there is, then I would want a referral to an IMS in a big practice to consult with asap.

Benzapril is a good drug, Flynn is on that along with a few other dogs here. I cannot remember how big Bailey is... Flynn is on 5mg once a day. We used a different drug though when he was first diagnosed with the pheo which works better on that particular type of tumour although some of the other BP meds like benzapril can also be useful

[hogie7171]

I will be making a called to my Vet today to ask a few questions that you have talked about. 1. the quality of the scanner 2. the name of the specialist and where his home office is that is coming on the 20th

Also i am assuming that IMS is short for internal medicine

Bailey is 40 pounds

Thank you Kathy for your input on the water question.

[hogie7171]

Does anyone have any tips on trying to train Bailey to use a puppy pad? The last two days i came home from work Bailey had peed in his crate. I would like to be able to leave him out while away at work if possible.

[Squirt's Mom]

There is a two sided crate available that has one side for sleeping, etc. and another for the potty area where you put a peepee pad down.

http://www.youtube.com/watch?v=IPQAazegMQg

[hogie7171]

I have done a little research and have found only one maker. Its called the potty training puppy apartment. That looks like it might be the best and easiest solution. But i would still like to hear about how others might be dealing with this issue

[molly muffin]

What about some of those pads with the pheromones that are suppose to make them want to use them?

[hogie7171]

Updates. I created an area i and gate Bailey in. He has enough room to sleep and also have a separate area to use to relieve himself.

Trish i also got more info in the specialist and and the imaging equipment. He is an imaging specialist , he has 20 years of experience, also teaches at the Cornell University College of Veterinary Medicine. I was told the imaging equipment is high end that the vet has, also that the specialist brings hid own equipment.

[molly muffin]

Oh that is reassuring about the specialist and the equipment.

Good job on figuring out a system that will work for Bailey

Hugs

[Squirt's Mom]

Glad that worked out for you and Bailey!

[Trish]

Hi Shane

Glad you checked about the scanner, hopefully this time they will get some good shots of what is going on with Bailey then you can work out a good plan from there.

Pleased you got the peeing situation sorted out too :D

[hogie7171]

The test for cushings came back and its borderline. I will get more information when i bring him in on Thursday for him ultrasound with the specialist.

I also have another question i hope some of you could help me with. Could diet cause symptoms to worsen? The reason i ask is because he was on a home cook diet of chicken and rice due to being sick. I have since switched him back to his normal dog food and now his thirst and peeing is even worse.

[hogie7171]

Also i am still having trouble with him peeing will i am at work. I have created an area where his can sleep and an area for him to pee when necessary. I paced pee pads on the floor outside of his crate/dog bed. The problem i am having is that hes peeing in his sleeping area and also on the pee pads. And its not just a little , its alot. If i had to guess its at least 2 cups worth.

[molly muffin]

Okay Shane, found your thread on here too now. I was having some weird moments as I kept thinking I knew more about what was going on and didn't find that information on the facebook page. LOL Well, duh because it is here. ;) :)

Okay did you get those LDDS results back? As in have the numbers you can post here? I know you said borderline? The thing is, that if it is secreting cortisol then it is likely Not a pheo, as they don't secret cortisol. You want to know if it has invaded any of the surrounding arteries or vena cava, but first you want to know if it is on the liver or on the adrenal gland.

I don't know anything herbal that will keep him from having to drink and pee as much, but vicki's whose thread I gave you both here and on facebook is using some herbals with her beagle Snugs and Brandy.

I think that he must have to go very badly to soil his sleeping area. Usually that happens when they can't get up in time, or when they are leaking, which this doesn't sound like.

[Squirt's Mom]

Home cooked foods and canned foods have much more moisture than kibble so the dog is going to drink much more eating kibble than they would eating a wetter food. However, that should not translate into peeing a great deal more for a normal dog.

One thought is that of incontinence - it happens sadly. There are drugs that may help but please please please research them carefully if offered. Proin nearly killed my Squirt but it sure stopped her peeing in her sleep. :eek: Have you looked into belly bands? There are herbs that can help but you would need to seek out an animal herbalist to help you with those. There are several available but each also has other actions that may not work to your baby's advantage so work with someone who knows herbs.

Let us know what the ultrasound shows and I'm looking forward to seeing those test results!
Hugs,
Leslie and the gang

[hogie7171]

Sharlene i will have the #s on Thursday and post them.

Leslie He sleeps in my bed at night with me and has not had any problem making it through the night. We usually sleep about 7-9 hours a night. Also he does not have accidents in the house while i am home. So i dont think its incontinence.

I am just really baffled as to why he is peeing on his dog bed and crate while i am not home. By the amount of volume i am seeing it appears that hos first choice to relieve himself is his bed/crate

[beaglemom3]

Hi Shane,
This is what I am giving Snuggles who has a pheo.
Chinese Herbal Meds
Stasis Breaker
Wei qui booster
Immune system booster powder

Western Herbal Meds
Maritime Pine Bark-anti cancer

Kelp- Thyroid support

St Marys Thistle- Liver support

Fennel- Pancreas support

Withania- Adrenal health

Hawthorn- Heart and circulation

Buchu- Kidney health

Specialized Urine test that tests for a pheo and or Cushings.
AFAIK this lab Marshfield Labs (Wisconsin) 1-800-222-5835
is still the only lab in USA (not sure where you are located) That performs this test. My vet did some research when they first suspected Snuggles having a pheo and contacted them.

We had to do it twice and both times came back positive for a pheo, reason we had to do it a second time is we used Brandos urine for the first test for the comparison and unbeknownst to us at the time Brando had an right adrenal gland tumor as well..so weird. But Snugs results were still a pheo for both tests.

We ran one for Brando and his results came back as Cushings

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.

I hope this helps and lots of hugs and kisses for our beagle cousin arooooooooooooooooooo! from Snugs and Brando

[hogie7171]

Thank you Vicki for taking the time to supply me with all this info. Looks like i have alot of goggling to do.

[beaglemom3]

you're very welcome and Good Luck! fingers crossed,

[hogie7171]

I brought Bailey in for his second ultrasound this morning. He is down 3+ pounds from his last visit on 11/7/14. I was also able to get a print out of his test result to date.

Also i am not sure if it is relevant but on 2/14/14 he had a growth on his left groin area witch was treated with antibiotics. (first vet said it needed to be removed , second vet said it was most likely an abscess)

Note. All esults are with in the normal range.

10/17/14 UA analyzer
PH 7.0
LEU 25
PRO neg
GLU neg
KET neg
UBG Norm
BIL neg
BLD 50

10/17/14
ProCyte Dx

RBC 7.86
HCT 51.3
HGB 17.2
MCV 65.3
MCH 21.9
MCHC 33.5
RDW 19.2
%RETIC 0.3
RETIC 24.4
WBC 10.18
%NEU 79.5
%MONO 3.3
%EOS 2.5
%BASO .08
NEU 8.10
LYM 1.41
MONO 0.34
EOS 0.25
BASO 0.08
PLT 244
MPV 13.0
PDW18.1
PCT .32

Catalyst Dx
GLU 103
BUN 17
CREA 0.8
BUN/CREA 21
PHOS 3.7
CA 10.3
TP 6.7
ALB 3.7
GLOB 3.0
ALB/GLOB 1.2
ALT 78
ALKP 175
GGT 5
TBIL 0.1
Chol 170
NA 157
K 3.8
NA/K 41
CI 118

11/07/14 UA analyzer
PH 7.0
LEU neg
PRO neg
GLU neg
KET neg
UBG Norm
BIL neg
BLD neg

[hogie7171]

I am not sure i am reading the cushing test correctly but here is what i believe it says

Normal Range is between 1.0 - 6.0

Dexamethasone Suppression
Post 4 Hr Dex .08
Post 8 Hr Dex 1.5

Dexamethasone Suppression

Pre Dexamethas 1.6

[hogie7171]

Got a call from the vet , The specialist doing the ultrasound (A Internal medicaine specialist) is not 100% sure where or what the tumor is. They think the tumor might be on the liver. They are going to do a needle stick to get cells from the tumor to help them figure what they next step might be. They also found a small lump next to his gallbladder.

[Squirt's Mom]

Would you mind editing the lab values to show the normal ranges? Thanks! If it helps, we only need to see those that are too high or too low. ;)

[hogie7171]

Sorry about that , I have edited the post to show that all his results are with in normal range.

I was asked to post the results. If the results post are not helpful i can delete them.

[labblab]

Got a call from the vet , The specialist doing the ultrasound (A Internal medicaine specialist) is not 100% sure where or what the tumor is. They think the tumor might be on the liver. They are going to do a needle stick to get cells from the tumor to help them figure what they next step might be. They also found a small lump next to his gallbladder.
We will be waiting right here and very anxious to hear what those cells turn out to be.

And no, there is no need for you to delete the lab results. We were just hoping to save you all the effort of typing them out unless something was highlighted as being abnormal. But now we know all those values are normal, so that will also be useful information.

Please keep us updated as soon as you find out anything, OK?
Marianne

[hogie7171]

So i just got back from picking up Bailey and was told they were unable to do the Needle stick because he was squirming too much. right . Between this and still not knowing exactly where the tumor is after a second Ultrasound makes me one unhappy camper. I actually called the vet prior to this ultrasound to verify that between the specialist and equipment that they would be able to pin point the tumor.

sorry Just had to vent

[molly muffin]

so, it sounds like, they think the tumor is on the liver and that there might be another small mass by the gallbladder?
What do they suggest as the next step to figuring this out since they can't?

So, all his blood work is in normal range and that LDDS isn't show much of a slip at the 8 hr mark and suppressing at 4 hour. So, hard to say cushings from that.

[hogie7171]

I an not sure what the next step is , i have to wait for the Vet to call me.

So far all i know is that they are unsure what it is and that it is Not cushings. When i get the call from the Vet i will be asking about PHEO and also it the tumor has grown in the last weeks.

[Squirt's Mom]

wow, I would be frustrated, too. With masses seen, but not sure where or what kind, I would sure want some answers and fast. Bless yours and Bailey's heart. All this and still no clear answer. Do let us know what the vet says when you talk to them.

[Dixie'sMom]

Oh, I'm sorry Shane. I was hoping you could get some clear cut answers, but it sounds like there's still more testing to be done before you will know anything concrete. I'll keep you and Bailey in my prayers. Hang in there!

[hogie7171]

Just got off the phone with my local vet again. Turns out the reason they could not do the needle stick is because bailey would keep tensing up his abdomen. They tried several times.

As far as the tumor goes they are back to thinking it is an adrenal tumor and that it has not invaded the Vena Cava yet.

There is pretty much nothing more that my local vet can do. I now have to decide if i want to peruse surgery If its even an option. My next step would be to schedule a consultation and most likely another Ultrasound at Cornell University Hospital for Animals. Or The Syracuse Veterinary Medical Center.

[Trish]

I have to wonder why the heck they did not sedate Bailey, my dog had a fine needle biopsy couple weeks ago and he was most definitely sedated for the procedure. He has had a few of these over the last 3 years and is always sedated. I just shudder when I think of them putting a needle into biopsy a dog that was not sedated, jeepers would have have happened if Bailey moved then :eek::eek: If they were even trying to aim at an adrenal that makes me even more horrified as that is technically very difficult with those big blood vessels around. Plus if it was a pheo then there could have been serious complications if they caused it to secrete all of a sudden.

I agree you totally need a specialist, I don't blame you for being a very unhappy camper! What a waste of time and money this appointment was for you, not to mention the stress for Bailey.

Before I would even be thinking whether surgery was an option, I would want Bailey seen by a well qualified IMS and surgeon and get some decent imaging done so you can tell exactly what you are dealing with. Your earlier post said they thought it liver, then when you talk to them they now think it is adrenal???? That would be too airy fairy for me to make a well informed decision. If you can, I would hightail it to a specialist centre and get them to figure out what is going on. I sure hope you did not have to pay for that ultrasound today. Good Luck with your next steps.
Trish

[hogie7171]

I am not normally the guy who will bitch and complain because i can always see both sides of every situation. But in this case i have already called the Vets office and requested to speak with the owner or his son about yesterdays visit.

I wouldnt be so mad if i did not call and ask if the equipment they had would be good enough to tell where the tumor is and was told yes. If they had any doubts they should of had me go straight to Cornell University Hospital for Animals.

Now on the flip side , i do believe that the specialist was a qualified IMS and surgeon. He practiced for 2 years plus he was a teacher at Cornell University Hospital for Animals. Also i was told that he spent alot of time on Bailey trying to pinpoint the tumor and trying to get the needle stick , and i do agree that Bailey should of been sedated.

[My sweet Ginger]

Did you ask them when you called if their US machine was high resolution US? We were referred to a hospital who has the HR US machine to get our 1st US by our GP vet for a diagnostic purpose. The first time she didn't have to be sedated but the second time she did because she wasn't cooperating. I'd be upset too if they used regular vet's US machine which pretty much used for counting how many puppies are in there even a specialist was doing the scanning.

[hogie7171]

Yes i did ask, That is the main reason i am upset. Not only have i wasted money on an ultrasound that provided no help i wasted 2 weeks. Now i will have to wait another 2-3 weeks to get an appointment at Cornell University Hospital for Animals. And i am sure they will want to do their own ultrasound.

[My sweet Ginger]

I will wait another 2-3wks for an appt. at Cornell and def. do another US if your vet's US machine was not high resolution.

[Renee]

That is unacceptable and I am glad you are speaking up about it. It makes no sense that they did not sedate Bailey for the procedure. Why would they be so careless?

At this point, you are very smart to just move onto a specialty hospital.

[Trish]

Ask your vet to do the referral to Cornell asap, plus get him to ask for an early appointment as all this mucking about has put delay onto getting a treatment plan for Bailey. So frustrating for you when you did specifically ask about just this. Not many are both IMS and surgeon, that is unusual. Hopefully the office manager acts on this for you.

[hogie7171]

Well i finally have an update but its not a good one. After talking to the specialist that did the ultrasound i made the hard decision to not attempt surgery to remove the tumor from his right adrenal gland. He is not sure but does not believe it has invaded the Vena cava but it is extremely close in two spots. Also he was not 100% sure if removing it would help with Baileys excessive drinking and urinating since he is thinking it is a non producing tumor.

I made an appointment with a TCVM ( Traditional Chinese Veterinarian). By looking at all his test and results , with the exception of todays that she did not see, she thinks she can help bailey.

[Squirt's Mom]

I would seek a second opinion on the surgery from a board certified surgeon. ;)

[molly muffin]

I think I would do the same if You want to pursue the option of surgery. Even my specialist said, she sends people that want to have surgeries done on their dogs to the surgeon for evaluation as only they can say if it is doable and a dog is a candidate or not.
So, what is the herbalist thinking of trying? The same sort of herbs that Vicki is doing with Snugs?

[hogie7171]

This is how i see it , Yes a surgeon might have a different opinion that the imaging specialist. But the surgeon is going to be going off of the image, notes and what the imaging specialist tells him. The complications that the tumor caused are the following.

1. the tumor has squished the vena cava. The may has caused the tumor and vena cava to stick together, If that is the case there is an uncertainty that they would be able to remove them with out damaging the vena cava

2. the tumor has invaded another tumor another vein that runs into the vena cava. He does not think it invaded the vena cava but can not be positive. Because of how close the tumor is to the vena cava there is a chance the there will not be enough area to cauterize it.

On top of this they can only guess that this will cure baileys symptoms.

Bailey tested negative for cushings and all the other disease that would cause him to have excessive thirst and urination. He is also not showing any other signs of cushings. He is not showing any signs of being sick at all.

I do not want to put his life at risk for maybes. I may be totally wrong but thats how i feel.

[hogie7171]

I am uncertain what the herbalist is thinking about trying. She had me send her all baileys test results for her to look at. When i called back she told me she thinks she can help him with out the use of traditional medicine. My biggest concerns are baileys very sensitive stomach. When hes been on pain medication in the past for prior surgeries he stopped eating , have bloody diarrhea and also vomit

[molly muffin]

That's fair and a bit more detail of what the thought might be about the tumor. Surgery isn't always the best option and is always a risk. A lot of factors have to be considered and in the end only you can make that decision.

I know Vicki has had good luck with her herbalist. I'd just make your concerns of reaction possibility known to the vet so they can take that into consideration.
Hopefully they can get him started soon.

Let us know what's going on. We are always interested in anything that helps and is a option for treatments.

[Trish]

Personally, with a beagle who is only 9 I would be like Leslie, wanting a second opinion from a well qualified board surgeon. They can do amazing things these days... my dogs adrenal tumour was not only close to the vena cava but actually invading it and it came out just fine. I would be wanting to speak to someone well versed in surgery who would also be able to view the scan and discuss with you the risks as they see it. Yes, the surgeon would be going off the imaging, but in this day and age they should be digital and be sent to him, so he can clearly see for himself not just rely on your imaging guys recommendations. If it was not a good scan they will take another one. Perhaps a CT which will clearly show what is involved, I do remember you saying that they did not have clear pictures and there was confusion as to whether this was in fact an adrenal tumour vs a liver one. I would not want to be left with all the unanswered questions such as it "might be stuck to vena cava" or it "might be in vena cava" or it "might not be enough room to cauterise the vena cava" .. that last one is puzzling to me as far as I know they do not cauterise the vena cava if it is involved, they cut it open, remove the tumour then sew it back up. They would cauterise little bleeders around it during surgery but not that huge vein.

In saying the above, one of the points to consider is that the owner of the dog must be comfortable with the risks involved with surgery. If you are not happy to proceed and believe the risks are to high then I believe you are doing the right thing for you and Bailey. But for me I would be wanting to base that decision on the recommendations of a surgeon who regularly performs this operation as with all due respect to your imaging specialist he is not an expert in this area.

Good luck with your path forward.

[hogie7171]

Thank you for all your responses and input. This has not been an easy road or was it easy to make my decision. I am already feeling unsure of my decision so i may end up having a consultation with the surgeon. I do realize i am going to have to make the decision sooner than latter.

[hogie7171]

Vicki your reply does give me a little more hope (maybe) because i was told that it it has already invaded the vena cava there is nothing that can be done.

I will try to clear up some of your questions and uncertainties. I am not the best and putting my thoughts to text.

The surgeon i would talk to if i decide to go that route is in the same building so he would be able to see the image and talk directly to the person that did the ultrasound

This was a third ultrasound and it showed alot more information than the first two. Not only was he able to pinpoint the tumor but also seen the two things that would complicate the surgery but also found something in baileys bladder, He said it was small and insignificant at this point but if i did surgery he wold want the surgeon to inspect it.

cauterize may have been the wrong word. Basically his concern was that there might not be enought room between the invade vein and the vena cava to remove it with out damaging the vena cava.

[hogie7171]

I just had a thought after writing my reply. Could what ever is in baileys bladder be causing his symptoms? Excessive thirst and urination.

I have been told over and over how baileys case is very unique. He has tested negative for all the normal diseases that would cause his systems.

[Trish]

If you are feeling unsure, then I would have to reinforce my suggestion to see the surgeon. Down the road you do not want to be facing the "What if's...." if you consult now and the surgeon agrees that it would be too risky then you can have a clear mind that you tried everything you possibly could for Bailey.

Flynn tested negative for cushings too... he did not have excessive thirst and peeing that you have described. Did he give you any indication what he thought was in the bladder?? Stone, tumour?? They could cause excessive peeing as something in there could be irritating the bladder. I am pleased to read they did another scan after the confusion on the first two.

Trish

[molly muffin]

Sending good wishes to you and Bailey this holiday season and hoping all is going well