Possible Pheochromocytoma-13 yo Wire Fox Terrier (sweet Scout has passed)

[Scout]

Hi Folks,
While traveling in Florida recently, a bout of gastrointestinal upset resulted in a Saturday night trip to an emergency vet clinic for Scout and me. Pancreatitis was the likely cause, however, an ultrasound revealed that she may have liver cancer. The following Monday, our primary vet looked Scout over and arranged a referral to University of Tennessee Knoxville Small Animal Clinic for a possible biopsy.

At UT, Scout’s blood chemistry was found to be normal or at levels that caused no specific concerns. Her chest x-rays were clear and the doctor concluded that liver abnormalities previously thought to be cancer were more likely age-related changes and/or related to a bout of hepatitis from late 2008.
The more concerning finding from ultrasound was that her right adrenal gland was enlarged. At this point, for the first time in my life I hear the word “pheochromocytoma”. I can’t remember the size range the doctor told me that Scout’s tumor is, but I do remember he said it was a relatively small. He also gave me some of the basics regarding this type of tumor such as the high blood pressure that results from its presence, the high risk to surgical removal, and the need to lower blood pressure for many days prior to any possible surgery. He suggested that a urine test be performed to look for the presence of normetanephrine which would be more conclusive of pheochromocytoma.

An eye exam showed some retinal hemorrhages that confirm chronic high blood pressure. The exam/diagnostics took place just a few days before Christmas so we don’t have the results of the urine test yet, but based on the retinal exam and a BP reading of 190 they prescribed 10mg of phenoxybenzamine twice per day regardless of plans for surgery.

In a bit of a shock and possibly even happy that we were going to correct the high blood pressure that could have been causing Scout discomfort for quite a while, we headed out for home 4 hrs away.

Since getting back home, there have been problems with the medication. First off, the phenoxybenzamine costs almost $100 per capsule. So they switched her to 1 mg once a day of Prazosin. Then we found out that Diamondback Drugs can compound the phenoxybenzamine into a 5mg tablet for reasonable prices. But this dose made Scout lethargic and wobbly. We switched back to Prazosin. But after two days of noticeable lethargy(no trouble walking she just preferred to lay in one spot practically all day) we stopped that. So now we are trying 0.5mg of Prazosin. That dose was begun today at noon. So far so good, but it’s been frustrating because all I can think about is that the clock is ticking and the tumor is growing. And I can't help but wonder if high BP has caused some subtle but definite behavior/personality changes that I have seen in the last 18 months.

Back at UT, the doctor’s last words were that Scout is a good candidate for surgery even though she just turned 13 years old. Her main symptom as of now is the high BP. Her weight is good. She does tremble often though. My concerns are that she wasn’t able to take the medicine of choice, phenoxybenzamine and that the tumor may have invaded major blood vessels. And I also wonder if anyone here who has had experience with this used UT Knoxville.

My goal is to learn more in hopes of making the most informed decision I possibly can for her quality of life. Scout is my first dog. She found me when I wasn’t looking so to speak(Thanks to Kelly for introducing us) and the bond that has formed is really, really deep. She has been a wonderful companion. I want to know I did the very best for her. I would appreciate any advice. Thanks for your time, Lindsay.

Edit: March 19, 2015--In case I don't come to this site very often--For those who may be new here and want to contact me for any info about Scout's sickness, just pm me. I should get an email notice and will get back with you. I'm not sure if I can be of help but I will certainly try in memory of Scout.

[Harley PoMMom]

Hi Lindsay,

Welcome to you and Scout! Although I don't have experience with pheo's we have members that do, so I am providing a link to a member's thread, Trish and Flynn, and hopefully it will help. Flynn 11 y/o Foxie Cross - Right adrenalectomy, 3rd Dec 2012 for Pheochromocytoma (http://www.k9cushings.com/forum/showthread.php?t=4242)

I'm sure Trish will be along soon and can answer questions you may have. I am also including a list of questions, which Trish thought up, for owners with dogs where they are considering adrenalectomy:
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.

Hugs, Lori

[Scout]

Thanks Lori. I have read the first 40 pages of Trish and Flynn's story. So far I am understanding that even if the surgery itself goes well, it's no easy road.
I'd also like to thank you and whoever else put this website together and maintain it.

[molly muffin]

Hello and welcome Lindsey and Scout.

You want to bring the BP down, so that the chance of a successful surgery is greater, or if you chose not to do surgery so there aren't BP complications in the future.
The post operative time is important to get through safely and it is usually better to have them stay in the hospital until the surgeon and vets are fairly sure that there won't be any complications like clots, etc
They normally will do a CT scan to verify that there is no invasion or that the invasion is operable.
It sounds like other than this that Scout is a healthy girl.
One thing that is very important is to make sure that you have a board certified surgeon that has done many of these surgeries successfully. University of Tennessee has a good reputation and is in fact the only place that also specializes in Atypical cushings (which is cushings caused by high hormones other than cortisol, which isn't something you are concerned with but it does let you know they are a top vet school in regards to cushings) We've had some of our members on FB, have surgeries on adrenal glands etc done at the University of Tenn with good results, so I have high hopes for them and their treatment of Scout.

Welcome again to the forum. I've left Trish a message that you have joined the forum and she will pop by, her time zone is just a bit different from ours in North America as she is in New Zealand.

[Trish]

Hi Lindsay and Scout

Welcome to K9C, darn pain you have to be here but hopefully we can help you sort this all out!!

Scout does sound similar to Flynn... they are both Fox Terriers too!! Don't think we have had many pop up on this forum in my time here, well Flynn is a mix but mostly foxie! His BP was high too, up to 200 or sometimes over. He had the eye changes, wondering if Scout has had a urine test to look for protein? As that kinda goes together with the hypertension at times. The changes in his eyes noted initially, bulging veins have come right by the way :)

They must have had a good scan and look at her adrenal to come to the pheo conclusion, these tumours arise in the medulla. My vets had a clear view of it too and that was their initial diagnosis after imaging. his was small too, around 1cm but it did invade into his vena cava. A lot of ppl do not think you can/should operate in that situation but his came out just fine in surgery when they did a venotomy alongside the adrenalectomy and extracted the tumour thrombus without issue. Flynn's was also on the right, which is supposedly the harder side to operate on, when I asked my surgeon about this he said that it is true it is a bit fiddlier with access but no problems otherwise. Flynn is now 25 months postop! Unfortunately he has had liver tumour issues, but that has been managed so far with surgical intervention also.

Great that her other labs are good, plus no sign of spread anywhere in CXR etc. hard to tell with the trembles, he does that as well. But then I think foxies do it a lot anyway, he definitely had it worse though when his BP was high. He has had to remain on meds even post surgery, some of them have BP go back to normal after adrenalectomy but his hasn't and he is on amlodipine and benzapril which also protects his kidneys as we have never got rid of the proteinuria.

I think that dose of Phenoxybenzamine was maybe on the high side at 10mg twice a day to start with, how much does she weigh? I just read back and Flynn was on 3.5mg twice a day to start, then to 7.5mg then finally to 10mg twice a day. He is around 13kg. She may have also been lethargic and wobbly with the BP coming down, Flynn was like that a wee bit initially until his body got used to the lower BP. But Prazosin is also a drug that is used and that is confirmed on the Veterinary Society of Surgical Oncology (VSSO) I have included their recommendations in a link below so that might ease your mind a little.

I agree if Scout is in good health otherwise which sounds like she is, then I would be seriously considering surgery too... my uncles dog died a year or so back at 18, so Scout potentially has a few years to go!

Here are a few articles that I have in my favourites, you may have already seen them.

http://histovetsdhv.files.wordpress.com/2011/09/adrenal-tumor.pdf
http://www.vsso.org/index.php/9-education-1/education/286-adrenal-pheochromocytoma
http://www.vsso.org/index.php/9-education-1/education/287-adrenal-cortical-tumor
http://www.experts.scival.com/reachnc/pubDetail.asp?t=pm&id=42829116&o_id=115&
http://www.avsts.org.uk/sites/avsts.org.uk/files/event-proceedings/avsts_proceedings_spring_2012.pdf
http://veterinarycalendar.dvm360.com/pheochromocytomas-proceedings
Re the urine testings from Dr Mark Peterson http://endocrinevet.blogspot.co.nz/2013/07/top-10-clinical-endocrinology-research.html

Hope that helps and I am about most days so happy to give any advice I can, whats the next step for you guys... do you have another appointment for BP check soon?

Trish :)

[Squirt's Mom]

Welcome to you and Scout! :)

Lori and Trish have given excellent guidance so I just wanted to welcome you both and let you know that even tho everyone may not post, we are reading along and hoping for the very best for Scout.

Hugs,
Leslie and the gang

[Scout]

Sharlene, Trish, Leslie-Happy New Year and thanks very much! Scout and I are grateful and humbled by your contributions and kindness. I hope this link will take you to a picture of Scout with her adopted brother Buddy http://rennlist.com/forums/991-gt3/834144-cl-to-5-lug-conversion-4.html#post11654534 Scout is on the left. :-)

Trish, Flynn is one impressive little man! He must be made of steel. Sounds like the adrenalectomy is just a distant memory now...I hope he kicks the liver issues in the pants just like he did the pheo!
Scout seems pretty healthy in a lot of ways, although in my first post I didn't mention that she has a 3/6 heart murmur, collapsing trachea, and has been hypothyroid for a couple of years. I hope none of those things complicate the current issue. The good side is she pees and poops normally. Her appetite seems normal. Her weight seems to be healthy at an even 20 lbs(9kg). UT gave her a body condition score of 6/9. I hope that's positive...have never inquired about body condition scores before.
I don't recall any mention of looking for protein in Scout's urine. From the reading I've done it sounds like the creatinine/metanephrine ratio is possibly the most accurate preop indicator of pheo. Maybe that's what you're alluding to? (Thanks for the links, btw)

The initial rx for 10mg of phenoxybenzamine wasn't filled due to that being the commercially available dose which sells for horrendous amounts of money. The dose that made her wobbly was 5mg 2x/day. She has just taken the third dose of prazosin. We are currently giving it at 0.5 mg 1x/day. There are no visible problems so far. We are going in to the local vet for a BP check day after tomorrow.

We are still waiting for the results of the urine test. It’s been two weeks now but timing has not been on our side due to the holidays and the complicated logistics of this particular test. I am under the impression that we will develop a plan of action upon getting those results. Until then I keep trying to understand this complicated disease. Reading on this forum has really made me aware of how relatively uninformed I have been regarding her vet visits in the past. The collective experience here really is amazing. Lindsay

[Trish]

Hey Lindsay!!

Just saw Scout and Buddy's photo... what a gorgeous pair :D Those dogs are quite famous in my country after a lotto ad campaign a couple of years back, everyone fell in love with them!

https://www.youtube.com/watch?v=mLW6L7cL1vI

The urine test for protein is different, that requires just a standard urinalysis to check. If the BP has been up for a while it can affect the kidneys and you can see protein. Your test for pheo is quite different. Those tests are still emerging, we cannot get them here so have not had them done. Some of the research looking at study design have been quite small in numbers but it appears to be gaining more recognition as an effective test, my vets are still not convinced though.

The initial price for your phenoxybenzamine is horrendous, we did have another poster complain about that but for the life of me I cannot remember who it was. Hopefully the prazosin will have worked and we will see a lower BP tomorrow!!

[Spencersmom]

Scout & Buddy are ADORABLE!!! You are in the best hands here with furparents that bring vast experiences to support and guide you through the coming months! Welcome to the forum!

[Scout]

Trish, the video is hilarious lol. Terry, thanks. They are wonderful dogs.
Scout's bp was down about 25 yesterday, after 4 days of prazosin. It was in the range of 175. But she gets extremely nervous when at the vet office. How do they correlate that to her relaxed state bp?
Trish, they looked at kidney function via blood sample and said it was ok. I just realized you suggested checking it via urine.
I'm starting to see that her local vet just can't answer a lot of the questions I have about pheo.
I'm really hoping for the urine test results from Univ. of Tenn. and to be able to talk to the doctor there tomorrow.
All in all, she seems to be tolerating the current dose of prazosin well. Lindsay

[Scout]

Finally I heard from UT today. Unfortunately the urine test results we have been waiting on for over two weeks are useless. There was a miscommunication. The specimen wasn't tested for the requested substances. Maybe the mistake is due to the rarity of pheochromocytomas, but it sure is frustrating.
Now we have to discontinue the prazosin for one week and then resubmit a sample. Back to square one. <heavy sigh>
Lindsay

[molly muffin]

Well that is certainly frustrating! How is Scout doing?

[Scout]

She had to get groomed today which she is never happy about, but other than that she seems to be doing really well, thanks for asking. I think someone who didn't know about the tumor would never have any idea that there is a potentially very serious situation at hand. At the moment she's comically wagging her nubby little tail and lightly growling which is her way of saying "put me on the couch beside you!".

[Scout]

Hi folks, I haven't posted in a while. If you recall we have been in limbo for approx. 1 month due to a botched urine test for metanephrine and normetaneprhine levels and then having to stop prazosin for a whole week to let it clear her system so new test would be accurate.

Finally I have some news. An additional blood test for inhibin levels was performed as well the urine test. The inhibin level was undetectable and the metanephrine/normetanephrine were so high the levels were out the reference range. The lab is diluting the sample and retesting today. I haven't spoken with her doctor, but I know both results support the initial presumption that she has a pheochromocytoma.
As I said I haven't spoken directly with the doctor at Univ. Tenn., but I know from my regular vet that they are asking if I want to set up a surgery consult. Nothing is set in stone yet, but it's hard to imagine that in a few days I could be deciding to arrange a surgery for Scout that she may not survive.
She seems to be feeling so good lately that the thought of doing that is totally foreign or unreal. Relative to her first 10 or so years, she isn't as vigorous and robust as she once was, but I think when people who don't know her see her they are surprised to find out she is 13 years old and would be shocked to know she has cancer.

The surgery consult will be key to the decision, but I have repeatedly been cautioned by UT of how risky the procedure is. I am having a hard time with the thought that I could send a happy dog to her death. The tumor is about 1cm so hopefully it hasn't invaded nearby tissue or blood vessels.

[Dixie'sMom]

Oh heck. Definitely not the news you wanted. I don't know squat about pheo's but a 1 cm tumor is pretty small so hopefully there is little chance that it has invaded the areas that make the surgery so risky. Please keep us posted as to the final test results. You and Scout are in my prayers and I know you will make the right decision if/when the time comes. We are here for you. Hugs!

[Scout]

Thanks Dixie'sMom! I spoke with the Internal Specialist at UT a few hrs ago. He explained that adrenalectomies done electively as opposed to those done in an emergency situation have a much, much better survival rate. Also, the pre-surgery treatment with phenoxybenzamine lowers the risk. I feel better having talked to him. I will call tomorrow to schedule the surgery consultation. My plan is to go into the consultation leaning towards doing the surgery, but will make the final decision during/after the meeting.
Because she's feeling so well right now and has such a good quality of life I'm doing a lot of second guessing. I'll never forgive myself if it doesn't go as planned, but the thought of not addressing the tumor leaves too many uncertainties for the future.
Trish, did you face this? As I remember, Flynn was so sick you felt no other choice but to go ahead with surgery, right?

[Trish]

Hi Lindsay

Glad they finally got the test right!! We never had that done, it is not available here in New Zealand as far as I know. It does appear to be the up and coming test but from what I understand after speaking to my specialists here and research that studies done to date are not high in number. Anyway it sounds Scouts results were off the scale!

Yes, Flynn was very symptomatic, very hypertensive >220, protein in urine, retinal changes and generally feeling funky! The pheo's can secrete intermittently and cause acute problems, one of the admins here who unfortunately isn't posting lately had a dog, Annie, with a pheo that was managed medically. They had a dickens of a time getting it diagnosed and when it finally was Annie was not able to undergo the surgery. She had episodes of suddenly feeling yuck, shaky, high heart rate, skin pink, sweaty and that was when the pheo was secreting. But I think from memory lived with it for a couple of years Whereas in Flynn I never noticed those intermittent episodes it was more a constant high BP and its associated problems. He had been undergoing regular scanning as FU from his liver tumour removed the previous year and they spotted the tumour on that. So yes, I did have a highly symptomatic dog so the decision for us was fairly easy, he could not go on how he was or I think we would have ended up in a scary situation. A lot of dogs with pheo's never get diagnosed until it is too late, a lot will find out after the dog passes from something like a major stroke or cardiac event.

Not to scare you but Flynn's pheo was small, 1cm and his did invade into the vena cava also. Which did complicate things but thank goodness it came out just fine. He was on phenoxybenzamine 10mg twice a day for a while before surgery. Handling the pheo during surgery can make it secrete catchecholamines like adrenaline so that had to be under control with a good BP before his surgery, as you say to lessen the risk of compications. He had blood thinners I had to give by injection for a few days postop to help prevent clots.

But I know just how you are feeling, the night before surgery I had all those thoughts about was I sending him to his death. But the flip side of that for me, was if we did nothing then as sick as he was we did not think he would do too well, possibly risking him having a heart attack or going blind etc etc. So it was a no-brainer for me, but we are all different. I would have absolutely kicked myself if he did not make it, but from my point of view that was a risk I was prepared to take to just give him a chance. Not sure how I would feel with an asymptomatic dog though. I wonder how much of the initial symptoms of Scout when you were away could be pinned on the pheo? Might be something you could ask. Make sure you take all the questions and your own, right stuff down, ask them to draw it or show you the scans so you really understand what they intend doing. Mind you I like to know all that stuff, others might prefer to leave the gory bits in the hands of the surgeon. It just really helped me understand what he was going to do when he drew pictures on a whiteboard for me and showed me the scans.

Phew that's a novel, sorry about that! I will be looking out for your report on the surgical consult! x :)

[Dixie'sMom]

Let us know when the surgery consult is scheduled, so we can be nervous right along with you. Thats what friends are for, right? :D

I'm glad the IMS was able to make you feel better and what he said made good sense.

Just remember you don't have to do this alone. We'll be right here with you every step of the way. Hugs!

[Scout]

Thanks Suzie and Trish. It really is nice to have the input. Not sure about the December sickness and whether it could be attributed to the pheo but that is a question I will ask. The surgery consult is scheduled for Jan. 27th at UTK.

I read the thread about Annie. Honestly there were so many things going on that it is hard to draw a correlation. I had a hard time telling which of her problems were definitely related to the pheo. I can say for sure that Scout's hind legs are definitely weakened in the past 12-16 months. She walks really well, but she is a little slower getting up than when she was at her best, and she can't jump on the couch any more. She doesn't spontaneously run much any more but I attribute that to the number of candles on her birthday cake. She also has a patch of skin on her back, between her shoulder blades that is different. It's not as supple as the rest of her skin, almost like it's crinkley if that makes any sense. She also has some minor "fat pads" on either side of her spine just ahead of her hips, they are symmetrical. I wonder if those and the skin are linked to something important. Anybody know?

We went to the local vet this morning for a BP check. There was no significant change from last time. Meaning it's still in the 175-200 range. She has been on phenoxybenzamine 2.5 mg 2x/day for the last 8 days. I'm wondering if they are going to try to up the dose.

When I asked Dr. Lane at UTK what I could expect in the future if we don't do surgery, he said it's really hard to say because it can progress in many ways. Mostly he mentioned the possibility of a fatal hemorrhage from invasion of the blood vessel. I have been trying to come up with a rational, logical way to make the decision. It would be nice to have clarity...whichever way I choose. It's just not happening though. So far, the only thing I know to do is base the decision on the surgeon's confidence level.
Lindsay

[My sweet Ginger]

Hi Lindsay,

A belated welcome to you and Scout from me.
I thought of another pup named Amanda as I was reading your posts who had not too long ago gone through what you and Scout maybe facing soon and I thought you might be interested in reading her thread. Her mom was faced with the same difficulty as to whether to have a very risky surgery to give her better quality of life or not. I hope Amanda's story will help you in any way possible. Here's her thread.

http://www.k9cushings.com/forum/showthread.php?t=6731

[beaglemom3]

Hi Lindsey nice to meet you but sorry we all need to be here.
My Snuggles has a pheo and was confirmed by a special urine test only done by a lab in WI. I am not sure if you had the same test done.

This was back in Oct 2013 and because Snuggles was acting so well and was 14 years old I chose not to do the surgery. But like you was tormented for months on to do it or not. We had a consultation with a surgeon I took him to the biggest animal hospital in the world in NYC and after weeks, months of tormented thinking I opted not to do it. I did a lot of research and started giving him Chinese herbal meds that supposed to shrink tumors and so far so good. His initial measure of his right adrenal pheo was 3.6 cm 3 months ago it was 2.9 cm. Then they found a right adrenal gland tumor in my other boy Brando, when we ran that special urine test it came back Cushings. So we started him on Chinese herbal meds. So far no symptoms for each Thank God.
Snugs turned 15 last August and Brando will be 15 in March God willing.

My choices were hard and tormenting to make and had no idea if it was right or not and probably not right for others. So I understand how you are feeling.

I will keep you and Scout in my prayers and pray whatever you do it works out well! HUGS to Scout and you!

[Scout]

Hi Lindsay,

A belated welcome to you and Scout from me.
I thought of another pup named Amanda as I was reading your posts who had not too long ago gone through what you and Scout maybe facing soon and I thought you might be interested in reading her thread. Her mom was faced with the same difficulty as to whether to have a very risky surgery to give her better quality of life or not. I hope Amanda's story will help you in any way possible. Here's her thread.

http://www.k9cushings.com/forum/showthread.php?t=6731
Hi, and thanks for posting the link. Amanda's case went amazingly well. It's encouraging to hear of a success like that.

Hi Lindsey nice to meet you but sorry we all need to be here.
My Snuggles has a pheo and was confirmed by a special urine test only done by a lab in WI. I am not sure if you had the same test done.

This was back in Oct 2013 and because Snuggles was acting so well and was 14 years old I chose not to do the surgery. But like you was tormented for months on to do it or not. We had a consultation with a surgeon I took him to the biggest animal hospital in the world in NYC and after weeks, months of tormented thinking I opted not to do it. I did a lot of research and started giving him Chinese herbal meds that supposed to shrink tumors and so far so good. His initial measure of his right adrenal pheo was 3.6 cm 3 months ago it was 2.9 cm. Then they found a right adrenal gland tumor in my other boy Brando, when we ran that special urine test it came back Cushings. So we started him on Chinese herbal meds. So far no symptoms for each Thank God.
Snugs turned 15 last August and Brando will be 15 in March God willing.

My choices were hard and tormenting to make and had no idea if it was right or not and probably not right for others. So I understand how you are feeling.

I will keep you and Scout in my prayers and pray whatever you do it works out well! HUGS to Scout and you!
Hi Vicki, I'm glad to hear your dogs are doing well. Yes, we did have that test run. If I'm not mistaken it is the ratio of metanephrine and normetanephrine to creatinine and Scout's levels were literally off the charts. The lab is Marshfield and I am told it's the only lab in the US that runs the test.
That's great that the tumor is shrinking. Can you describe the primary factors that lead you to forego the surgery for Snuggles? Is he on BP medication? How is his quality of life? Sorry to bombard you with questions...and I'll probably have a lot more:D but you are exactly the person I have wanted to hear from! Thanks!

edit: I just saw you're thread...I'll start digging into it.

[Scout]

I have a 13 year old wire fox terrier named Scout. Some of you may have seen the thread I started in Cushing's Question and Discussion forum. She was diagnosed with pheochromocytoma a few days ago. Her only symptom is hypertension, and she still has a very good quality of life.
I am starting this thread because I have seen some noticeable changes in her that I first began recognizing about 18 months ago. (About 22 months ago she was diagnosed as hypothyroid which we treat with 0.1mg of soloxine 2x/day)

1. She began sleeping really deeply, so deeply that sometimes I have to shake her to wake her up. And she now spends much, much more time sleeping every day.

2. She doesn't respond quickly to verbal commands and sometimes just doesn't respond at all. This is a major change as she used to respond immediately in some way or another to all my verbal cues. Now it takes me about three tries to get her to respond. And a quick couple of claps of my hands works best to get her attention. (for the record I am positive she has some type hearing loss but I think I see that it shows up as not being able to determine -where- the sounds are coming from) It is more like she is just not focused or is maybe mentally dull.

3. She no longer wants to go on long walks. She is very content to just do her business in our yard and quickly go back in the house. I know she has some vision loss because she always misses the ball toss that she used to catch every time. She doesn't fall or bump into things because of it though. What's odd to me is when she and I were on vacation for two weeks this fall, she was a lot more eager to walk and check out the new surroundings. (She has some arthritis and has had some issues with lameness a few years ago. Extreme exercise would cause her to be lame the following day but clearing up in short time. It hasn't happened in a few years though and when she walks she moves well. In fact when I take her to the farm, I let her go off-leash. She will run some on her own and chase after balls I throw)

4.Also she shows very, very little of the "greeting humans excitement" she showed 2 yrs ago. And in general she is just less engaged with the people around her.

I have talked to our vet extensively about these changes. He mostly attributes it to aging. He says it's a good sign that she sleeps deeply meaning she must be comfortable and pain-free. He says the lack of response to verbal commands is possibly due to cognitive decline. He says the resistance to extended walks is due to vision loss. To me it seems more like boredom. I know she is getting old but I can't help but wonder if this is something I could get treated.

Didn't mean for this to get so long but I wanted to include everything that I though to be relevant. Does anybody have any insight to offer? Thanks

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about age related changes into Scout’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[beaglemom3]

Hi, and thanks for posting the link. Amanda's case went amazingly well. It's encouraging to hear of a success like that.

Hi Vicki, I'm glad to hear your dogs are doing well. Yes, we did have that test run. If I'm not mistaken it is the ratio of metanephrine and normetanephrine to creatinine and Scout's levels were literally off the charts. The lab is Marshfield and I am told it's the only lab in the US that runs the test.
That's great that the tumor is shrinking. Can you describe the primary factors that lead you to forego the surgery for Snuggles? Is he on BP medication? How is his quality of life? Sorry to bombard you with questions...and I'll probably have a lot more:D but you are exactly the person I have wanted to hear from! Thanks!

edit: I just saw you're thread...I'll start digging into it.

Thanks Lindsey :)
The factors that helped me to decide were
1. His age, at 14 years old, beagles life span are on average of 13-15.
2. His bp has been good so far. ( I attribute that to the Chinese and western herbal meds I started him on over a year ago. after he was diagnosed.)
3.His behavior, to this day you would think my Snugs was free of illness. He acts like a puppy. Has more energy than I can ever have, playful, mischievous, curious etc.
4. He exhibits no symptoms so far, thank God.
5. Given the above I could never live with myself if my boy died on the table knowing how full of life he is. I would be as if I robbed him of whatever time he had left.

This was a tormenting decision because ofc I had no idea what would happen to him w/o the surgery. Would I lose him tomorrow? next week? next month?

But this was what I decided after weeks, months of torture trying to decide.

[Scout]

Vicki, I just read your thread. My gut feeling is that you made the right decision. You have been so diligent in taking care of your pups. They are lucky to have you!

I am sitting here now thinking about criteria for making the decision myself.
This is what I've come up with:
1.Is it likely to become malignant?
2.How confident is the surgeon?
3.Has it invaded the vena cava?
4.How risky is the anesthesia?
5.What is the condition of her other organs?
6.Even if the surgery is successful could there be some long-term side effects that I don't know about?
Regarding that list, if it's likely to become malignant, the surgeon is confident, the vena cava isn't involved, and the anesthesia isn't hugely risky I will likely tell them to do it.
On the other hand, if some other serious conditions are revealed that could shorten her life, and it's not likely to become malignant, I may opt not to do it.
I've thought about it so much I'm not totally sure I'm making sense so if any of you have some input please let me know.

[Squirt's Mom]

Good questions! If you will go back to post #2 on your thread here, you will also find a list Trish put together.

[beaglemom3]

Thank you Lindsey, I think I did too, but ofc when having to make the decision I had no idea, it was so torturous, my heart goes out to you.

Scout's pheo is much smaller than Snugs when first diagnosed and Scouts is not invading the vena cava, so those are two very good things.

Whatever decision you come to you, you have mine and I'm sure everyone else support. It is one of the hardest decisions to make. It is a very cruel situation for us to be in. I will keep you and Scout in my prayers.

Great question btw HUGS!

[Squirt's Mom]

It's Jan. 27th! Are we having surgery today or was it postponed? gulp

[Scout]

Hi everyone, after a 4 hr drive we just arrived at UTK. The appt is in 20 min. I'll report back asap. Thanks!

[Squirt's Mom]

We are with you all the way, honey! Check in as you can and know there is a whole host of K9C Angels fluttering around you and Scout's surgical team.

[Dixie'sMom]

I'm here too! Sending prayers your way. Go get 'em Scout! You can do this!

[Scout]

Just finished meeting with the surgeon. There was a mistake in the first diagnostics...in this case it was a good mistake. The tumor is on her LEFT adrenal!!! That means the risk to the vena cava is much much less. I'm paraphrasing of course but she said that the tumor has to go through the phrenicoabdominal vein to get into the vena cava and she sees no sigh of this. We high-fived on that :-)
Scout's bp is not responding to 2.5 mg of phenoxybenzamine. Dr. Tobias offered to do the surgery anyway saying that the anesthesia team is very confident of controlling it on the high side. She says she is very very comfortable with the actual surgery. The anesthesia is the hard part and the first 24 hrs afterward is critical. She explained that the remaining adrenal gland needs to "turn on" after basically being dormant since the other has been secreting so much hormone. She says that the response is just different from one dog to the next.
For now we are going to increase the phenoxy dose for two weeks then come back. I feel more confident that surgery is the right option now. Of course, I will sleep on it for a few nights to let things sink in. But I liked what i heard.
Lindsay

[Squirt's Mom]

OH that is good news! Not so much on the BP but the other gives you a bit more time to let it work so not a bad trade off in my book!

I saw Dr. Tobias and got excited...then I saw the feminine reference. A Dr. Todd Tobias removed the tumor on Squirt's spleen and half the organ while we lived in Cordova, TN. He was wonderful.

[judymaggie]

Lindsay -- it sounds like you had a very productive visit with the surgeon and I am glad that she was able to give you a level of comfort with the surgery.

[Scout]

Home finally...it's been a long day.
Karen Tobias is her name. Maybe she is related to Todd. I guess it’s a longshot, but that’s not a name I hear often. My initial impression of her was favorable. She was very personable and positive. She quickly volunteered her business card with her e-mail address.

She seems to be very well versed on the issues at hand. She says the surgery should be uneventful. So much so, that she doesn’t want any more imaging because of the extra anesthesia that it would require. In all the pages I read I never knew that bp going low could be a problem and that low is harder to correct than high. Anyway, she says there will be an anesthesia team of 3-5 board-certified anesthesiologists and board-certified technicians. She said that her bp would be monitored at two sites for better awareness and control.

From our talk, I got the feeling that even with the amount of material on pheochromocytoma that can be found on the web there are still many question marks on the treatment of it. I don’t know the in’s and out’s of how medical studies are produced but apparently more case histories are needed. She said that most of the tumors are only discovered during necropsies. Hopefully the data will build so the unknowns on how to treat will diminish.

I’m still worried, but I do feel better knowing the surgery itself should be straightforward. We are going to up the phenoxybenzamine to 5mg in the morning and 2.5 mg in the evening. I tentatively scheduled the surgery for Feb. 11. That’s a Wednesday. If all goes well, I think I would like for Scout to stay in the hospital at least until Monday morning(or longer if req’d). I’m afraid if they happened to release her after 2 days that would put us at home during a time when things could still go wrong. We live an hour’s drive from her home vet and a half hour from the closest 24/7 emergency vet clinic. I would rather her stay extra days with the team who is up to date on what’s she dealing with.
Thanks for the support…it means a lot!
Lindsay

[Trish]

Hi Lindsay

Glad you got home safe and sound!! Long day, I am doing much the same tomorrow... 4hr drive for Flynns checkup scan. Wonder how they managed to mix up the left and right... bit of a worry!! That did happen to us once, but it was because from a previous liver resection Flynn's gall bladder moved to the opposite side so was confusing for them!

Anyway great no sign of any tumour spread, very pleased to hear that. :D You have one massive anaesthetic team!! Great to have all that back up! Hope Scout handles the increased phenoxybenzamine dose, Flynn did feel a bit yuck when BP coming down, but they were very sure they wanted him on it at least couple of weeks and BP right down. We also had to travel to the pet hospital so we had to get our local vet to check it and make sure it was down before surgery could proceed. Yes low BP during surgery is a problem, sometimes when they handle the tumour the catecholamines like adrenaline are released in a surge which can be dangerous and make the BP labile, our surgeon said that only happened a little when they were removing the thrombus from vena cava otherwise his BP was good throughout. The phenoxybenzamine makes that easier for the anaesthetists to manage if it happens, prior to this the mortality rate was much higher. That drug has really helped make this surgery a lot safer.

Flynn was allowed out the very next day, he gets very anxious in there and they knew we would be close by and I had their phone numbers to contact if anything went wrong and we went back for daily checkups too. I had booked into a pet friendly motel as like you I did not want to be too far away those first few days in case we needed their expertise, which we did. I had to give him injections of pain relief, nausea and also blood thinner to prevent clots. I am a nurse so comfortable doing that. Here is a pic of when I got him back to the motel, this is 22hrs after adrenalectomy http://www.k9cushings.com/forum/album.php?albumid=559&pictureid=4381

Hmmmm I was given different information about the other adrenal "turning on". I was worried about that, but was told that is not the case. It is for adrenocortical tumours that are effecting the cortisol, often with those tumours the opposite adrenal shrinks so is not producing much cortisol and those dogs need supplementation with prednisone until it does kick in. But we were told that is not the case with a pheo. We did do an acth postop when he was sick, but it was normal as they expected. But I have heard the same about the amount of studies, which is why some of the testing in dogs such as the urine testing is met with scepticism, as they have not had decent sized studies as yet.

Hope you all have a nice relaxing day tomorrow, thinking good BP lowering thoughts for Scout!! :)

[Squirt's Mom]

I am glad you are pleased with your Dr. Tobias. Dr. Todd was amazing. He was compassionate, knowledgeable, kind, a good sense of humor, and Squirt loved him the moment she met him. He and his staff never talked down to me or made me feel bad in any way. His whole team, surgical and recovery, were awesome. I hope you and Scout have the same experience and from your description it sounds great.

[Scout]

Thanks Squirt's Mom.
Trish, not sure how the mistake was made, but I do know they double checked the ultra sound film yesterday and confirmed it's the left adrenal. Flynn looked amazingly good at 22 hrs post op imo. Like I said before I think he is the man of steel :-)
Regarding the remaining adrenal turning on, I may have taken what she said out of context and she could have been referring to the epinephrine/norepinephrine binding sights being taken up by the phenoxybenzamine pre-treatment and needing new ones to develop. I started to record our discussion with my iPhone since I can't take notes and listen at the same time. Anyway, it looks like Scout just doesn't tolerate the increased doses of the bp medicines. After the 5mg dose this morning she is noticeably down in activity and a little unsteady when she gets up for a walk. I'm back in contact with UTK about what to do next.

[Scout]

Just got back from a bp check. Wow, one 5mg dose dropped it almost 100 points. Too much too fast...she's still feeling wonky 8 hrs later. Now we will go back to 2.5 mg 2x/day and add 0.5 mg amlodipine(sp?) once/day.

[Trish]

Its doing the job though, just needs to be wee bit more gradual, flynns came down with a clunk too

[beaglemom3]

Great news that the tumor is on the left adrenal gland! Oh how I wish Snugs and Branny's were but happy to hear this about Scout!

I hope you can get the best dose of the bp meds for Scout Prayers and HUGS!

[Trish]

Hey Lindsay

How is Scout doing with the BP meds?? Hope she is tolerating them a bit better at the lower dose, whats the plan with rechecking it?? How are you dividing 0.5 mg of amlodipine. Flynn takes that, we have 2.5mg tablets, and he is on 1.25mg twice a day. Maybe you get lower dosage tablets? would be pretty tricky splitting our size pill into 5 bits!! :eek: Hope all going good for you two :)

[Scout]

Thanks Vicki
Hi Trish
The amlodipine was made into a solution which I give with a syringe like thing. 0.1ml = 0.1mg
We checked her bp Fri
170/137 142
161/114 134
200/105 136
191/134 153
186/103 129
I heard from the IM doc today. He felt that the 170 and 161 were positive and that her bp when not stressed is likely lower than that. He also said he'd be hesitant to try to get it lower because they feel there is greater anesthetic risk from hypotension than hypertension. We are going ahead with the surgery on Feb 11. Fingers crossed!
All is good. We walked about 1.5 mi today. I'm trying to find food choices for her that have higher quality ingredients. Farmina and Carna4 are two that I've decided to try. She likes the Farmina. The carna4 hasn't arrived yet.

[Trish]

Hi Lindsay, I don't know whether I would be changing her food up at the moment, think I would leave her on what she is used to till after surgery. I would not want to risk upsetting her tummy at the moment.

Well that is nifty having it in a liquid form. Never heard of that.

Your vets sound to be approaching it different to mine regarding the hypertension, ours were definitely more worried about high BP than hypotension and they wanted him on the phenoxybenzamine at a good dose before they did surgery. Our surgeon made us stop it a 24-48hrs (sorry cannot remember exactly) before his operation so that if his BP did swing the drugs would be able to work properly to reverse abnormalities. But they wanted his BP right down before surgery. But his was pretty high 200+

This is from the Veterinary Society of Surgical Oncology regarding preop management and also anaesthesia http://www.vsso.org/index.php/9-education-1/education/286-adrenal-pheochromocytoma
SURGICAL MANAGEMENT
Preoperative and Anesthetic Management
General Considerations


pheochromocytomas are catecholamine-secreting tumors associated with a high risk of anesthetic complications
complications can be reduced if the physiologic consequences of epinephrine and norepinephrine secretion are addressed prior to anesthesia and surgery, specifically α blockade, blood volume restoration, and treating cardiac arrhythmias
hypertension is treated with α blockers, but therapy needs to be continued for > 10 days for complete α blockade
phenoxybenzamine (0.5 mg/kg q 12 hrs in cats and 0.2-2.5 mg/kg q 12 hrs in dogs) is a non-selective and non-competitive α-1 antagonist with a long duration of action
prazosin (0.5-2.0 mg/kg q 8-12 hrs) is a selective and competitive α-1 antagonist which is an alternative to phenoxybenzamine
β blockers (i.e., propanolol) can be added to this regime if hypertension, cardiac arrhythmias, or tachycardia persists
β blockers are only used following α blockade in dogs with pheochromocytomas as a β-blocked heart will not be able to maintain adequate cardiac output with unopposed α-mediated vasoconstriction resulting in exacerbation of hypertension due to loss of β-2 vasodilatory effects
propanolol: 0.4-1.2 mg/kg q 8 hrs in cats and 0.15-0.5 mg/kg q 8 hrs in dogs
esmolol is a short-acting β 1-adrenergic antagonist which is administered in dogs with persistent tachycardia despite adequate α-adrenergic blockage and vascular volume expansion
labetalol is a combined α and β antagonist but does not have an ideal α-to-β ratio with β predominating and resulting in hypertension



Anesthesia


anesthetic protocol should not stimulate catecholamine release, blunt the sympathetic nervous system response to anesthesia and surgery, and maintain hemodynamic stability
acepromazine is preferred for premedication because of α-blocking actions
animal should be well-sedated for placement of intravenous catheters to reduce stress and catecholamine release
opioids should be added to acepromazine for preemptive analgesia and additional sedation
morphine may cause histamine release and is avoided in animals with pheochromocytomas
lidocaine (1-2 mg/kg IV) can be administered 2-3 minutes prior to induction of anesthesia to reduce the induction dose and protect against catecholamine-induced arrhythmias
anesthetic induction agents include etomidate, propofol, or opioid-benzodiazepine combination
ketamine increases sympathetic stimulation and is avoided for induction of animals with pheochromocytomas
isoflurane and sevoflurane are preferred to halothane for maintenance of general anesthesia as they do not sensitize the myocardium to catecholamine-induced arrhythmias
fentanyl CRI is preferred (1-20 μg/kg/hr) because of superior analgesia and, because of a dose-reduction effect with inhalation anesthesia, cardiovascular stability
epidural analgesia should also be considered for dose-reduction effects and postoperative analgesia
non-depolarizing neuromuscular blocking agents should also be considered, particularly for flank approaches, although atracurium should be avoided because of the potential for histamine release
direct arterial blood pressure monitoring is recommended because of risks of hypertension
intraoperative hypertension can be treated with:
short-acting α-adrenoreceptor blockers (i.e., phentolamine 0.02-0.10 mg/kg IV or 1-2 μg/kg/min)
direct vasodilatory agents (i.e., nitroprusside 0.1-8.0 μg/kg/min CRI)
hypotension following removal of the adrenal pheochromocytoma is caused by a decrease in vascular tone and is usually poorly responsive to pharmacologic therapy
large volumes of crystalloids should be used ± natural or synthetic colloids
ventricular arrhythmia: lidocaine
ventricular tachycardia: β-blockade with propanolol (0.02-0.10 mg/kg IV)

[Scout]

I think this is the thing they are most concerned with:
"hypotension following removal of the adrenal pheochromocytoma is caused by a decrease in vascular tone and is usually poorly responsive to pharmacologic therapy"
I believe they are saying they can do a lot more to correct hyper than they can for hypo.
I'm starting to worry a lot again. Do you think I should get a second opinion at a different clinic? The surgeon is board certified with the ACVM. Also she told me that the anesthetic team is board certified as well as some of the ICU staff.

[Trish]

I think they are good, I would just clarify that part, I would not want his BP spiking too high if it is already high to start with. Maybe discuss with IMS/anaesthetic team not just surgeon?? Oh and nerves par for the course, even the morning Flynn went in I was still second guessing myself but we did not have an option and I wanted to give him the best chance going forward. So keep the faith!!

[beaglemom3]

I am praying for Scout that his surgery and recovery is success.
HUGS! to you both!

[Scout]

Thanks Vicki! I hope Snuggles and Brando get a great report from the ultrasound.
Lindsay

[Scout]

I think they are good, I would just clarify that part, I would not want his BP spiking too high if it is already high to start with. Maybe discuss with IMS/anaesthetic team not just surgeon?? Oh and nerves par for the course, even the morning Flynn went in I was still second guessing myself but we did not have an option and I wanted to give him the best chance going forward. So keep the faith!!

I'm trying...I have a feeling there will be very little sleep next week

[beaglemom3]

Thanks Lindsey :)

[molly muffin]

Checking in on you and Scout! This is the week and tomorrow is the 11th.
On pins and needles. :)

[Scout]

Hi Sharlene. We arrived in Knoxville two hours ago. She approves of the hotel room and has fallen asleep :-)
Meanwhile, dad is a wreck...ugggg
We'll get to the clinic at 730 AM. I'm praying this goes well. She's 2nd or 3rd in line for surgery tomorrow. I'll report back asap.
Thanks.

[Trish]

Hi Lindsay! Yikes that came around fast! Great Scout has settled in well. She can sleep and you get all the worry, take her for a good walk first thing so she can do a good poop before she goes in :) your team is well qualified and sounds like a got place to be, that won't stop your nerves though, my recommendations for the wait are lots of chocolates, coke and checking in here because loads of us will waiting right along with you till we hear good news! The stars are aligned for a good outcome. Will be around tonight if you can't sleep and want to talk x

[Squirt's Mom]

Hey Lindsey,

We are with you and Scout today! Prayers and healing energies surround you both. Let us know when you can, sweetie!

Hugs,
Leslie and the gang

[Scout]

Thank you thank you thank you
They just took her back. Surgery is in 2-2 1/2 hrs.

[Tina]

Lindsay,
I am thinking about you and Scout today, and sending my prayers that she just sails through this.

Hugs,
Tina and Jasper

[judymaggie]

Prayers headed your way for you and Scout!

[Harley PoMMom]

Sending positive energy your way, and will keeping you both in my thoughts and prayers.

[Scout]

Hey folks, still waiting for surgery to begin. They gave her a sedative and told me she is sitting quietly in her cage.
Lindsay

[Scout]

Surgery has begun

[Squirt's Mom]

We are right by your side!

[Scout]

We made it through surgery!!
The surgeon said she was very stable and that they are taking her into icu as std procedure. Thanks for the prayers!!!! Now we have to get through the next 24 hrs....whew

[Trish]

Fantastic news! First hurdle over :) hopefully they let you in to see her later today. Such a relief for you! Paws up SCOUT! X

[Scout]

I don't know whether to be happy or keep holding my breath. Dr. Tobias did stress that she did well through the entire procedure. Hopefully that bodes well for the next 24 hrs...

[Squirt's Mom]

YAY!! Great news! Prayers and healing energies continue to fly Scout's way. Let us know how she is doing as you can.

[Harley PoMMom]

Oh That is great news!!! WOOOHOOO!!

[molly muffin]

Great to hear she did so well during surgery.

Just get through, I'd say the next 48 hours, because you want to make sure there are no complications, although it doesn't sound like any are expected, which is great.

How long do they plan to keep her?

[judymaggie]

Great update! Will continue to send prayers -- "very stable" is the best surgical description you could get.

[Renee]

Checking in with positive thoughts!

[Scout]

They gave me an update a little while ago. Her bp is 120. She is still not fully out of the anesthesia. And they are giving her pain medication. I think she will be staying a minimum of 48 hrs. We may stay in Knoxville for another day after that. I want to be on the safe side and stay close to these folks who know what she's going through. I had already booked the hotel room to Saturday. I'm cautiously optimistic.

[Dixie'sMom]

ATTAGIRL SCOUT!

That's awesome news. I know you are afraid to be too optimistic but things are sounding really good. Sending prayers for continued good news and speedy healing!

YAY! :D :D :D

[beaglemom3]

Fantastic news! praying hard for a successful and uneventful recovery Much love sending Scouts way..YIPEEEEE

[Scout]

I just got the latest update. She's still heavily sedated. It's not as encouraging as before. They are seeing some abnormal nuerological signs. I couldnt catch the scientific term but they are seeing strange eye movements and head tilt. She says that it's difficult to assess due to all the medicine that's been used on her today.
Also, her bl press went down. She did respond favorably to drugs that correct it. Heart rate and temperature are normal.

[Scout]

I just saw her. She's struggling some. They are reluctant to reduce the pain med because of that. It's going to be a tough night.

[Trish]

Hey Lindsay
Just got in from work and checking how she is doing. I hope it is just the meds she is on making her a bit funny, I bet that is it. I was allowed in to see Flynn for a bit that night too, he was definitely drugged up and not much interested in what was going on but perked up the next day, hoping she settles overnight. They will be keeping such a close eye on her overnight. Hard the first few days when your not used to seeing them like that.

[Scout]

Hey Trish
They are giving her major attention. Basically standing right over her.

[Trish]

That's fantastic, she is sure I the best place. Was she awake enough to recognise you?

[Scout]

She didnt recognize me. It was heartbreaking. I couldnt stay in the room long. Im just sitting in the waiting area now.

[Trish]

I think itis good she is out to it, least she is not in any discomfort while she is getting better! How long you going to stay?

[Scout]

2am is the latest I can stay. Two hrs from now. Just hoping somehow my being a little closer to her helps.

[Trish]

Well hopefully they will let you in to see her when she settles a bit more, have you been there all day? you must be knackered

[Scout]

Most all day except for about 3 hrs. Im too worried to be tired right now.
I hope Flynn is feeling good.

[Trish]

When are you expecting them to come out and update? Hopefully soon. I remember when I saw Flynn that first night, he had someone with him holding his head up so he was breathing OK, he had oxygen on it, IV, wound dressings. He looked a mess and kinda grunting breathing. Gave me a bit of a shock too, know how you are feeling. He did look at me but not much other than that. I was so surprised they had food in his cage, but he was not interested in that!

Make sure you can get a phone number off them so you can ring through the night and get updates.

Flynny is good, thanks for asking. 2 yrs 3 months now since his surgery so I sure am hoping Scout gets a good outcome like him, he is the same age as her.. 13. He is such a cute little guy... just like your girl!

[Scout]

they just had to give her atropine and intubate her. She responded well to the atropine and started breathing on her own again after a few minutes. It's bad.

[Trish]

Oh no, sorry to hear that. What do they think has gone wrong, feel sick for you Lindsay. C'mon Scout! sending best of wishes across the ocean. Big hugs xx

[Scout]

Thanks Trish
They were on the phone with the critical care doctor as it happened. She is now on the way to the clinic.

[Trish]

Hurry up woman!! Sticking right here to keep you company.

[Scout]

Heart rate is good but they had to intubate her again

[Trish]

What a roller coaster, wonder if she so sopped they just leave the tube in overnight, GREAT her heart rate is good. Will take that bit of good news and want more. I hate to think what is going through your head right now but just keep telling yourself you have done this to give her he BEST chance of recovery OK!

[Trish]

Sopped = doped! stupid ipad

[Scout]

Poor Scout. Her heart is going but she's still not breathing on her own. There is no response when they shine a light in her eyes and no blink reflex when they touch her eyes. They say a clot could have gone to her brain and affected the breathing center. They really don't know. Even if she makes it they say there could be permanent neurological damage. I will let them breath for her till morning in hopes that some miracle occurs.
Thanks for your companionship Trish. Your a good soul.

[Trish]

I hope no news is good news, just taking Flynn for his walk will be back in an hour or so. Hope The specialist has got her stabilised x

[Trish]

Well I am all for miracles, go Scout!! Glad her heart is strong, so we will be too x

[Trish]

I am back, be here for a couple more hours if you want to talk x

[Trish]

Hey Lindsay
Getting late here, so will be heading to bed soon but I am sure others will be here to keep you company if you need it. If hope all the good vibes I am sending across to Scout are doing some good and she has improved by morning. Big hugs for you x

[molly muffin]

Checking in. Oh I hope no clot. Do we have news yet this morning? Breathing on own. Or any eye reflex? Let us know. Jus worried sick for you and scout.

Hugs

[labblab]

Oh Lindsay, I am here too. I had not had a chance to write to you before but I have been following along with everything, too. I am so hoping to hear some better news this morning. We will stay right here beside you and Scout, no matter what.

Sending healing thoughts and prayers,
Marianne

[Scout]

Just got to the clinic. There is no improvement and they are very concerned about the lack of neurological function. The surgeon should be in any minute, but I think it's time to let her go.

[labblab]

Oh Linday, there are no words to tell you how much my heart aches for you and dearest Scout. I know you will be strong for Scout, and we will be strong for you. I promise we are here for you.

[molly muffin]

Oh dang it. :(. I had hopes this morning would see some improvement.

[Scout]

Rest in peace sweet pup.
Thank you all.

[labblab]

Lindsay, reaching out my heart and arms to you across the miles. Words cannot tell you my sorrow for your loss.

Fare thee well on your newest journey, dear brave Scout. Your family here will never forget you, and our angel babies already stand right by your side to care for you and to show you the way.

[Squirt's Mom]

Oh, Lindsey, this is just heartbreaking to see this morning. :( We are with you, sweetheart, right by your side.

[molly muffin]

RIP sweet Scout.
My heart just breaks for you. I am so very sorry.

[beaglemom3]

I am so very sorry, my heart is breaking for you. Rest In Peace Sweet Brave Scout.

hugs Lindsey so so sorry ;(

[Squirt's Mom]

FRIEND

I lost a treasured friend today
The little dog who used to lay
Her gentle head upon my knee
And shared her silent thoughts with me.

She’ll come no longer to my call
Retrieve no more her favourite ball
A voice far greater than my own
Has called her to his golden throne.

Although my eyes are filled with tears
I am thankful for the happy years
She spent down here with me
And for her love and loyalty.

When it is time for me to go
And join her there, this much I know
I shall not fear the transient dark
For she will greet me with a bark.

~Author Unknown

[labblab]

Lindsay, I just have to come back to tell you what a wonderful dad you have been to Scout. I am hoping against hope that you are not blaming yourself for the decision to proceed to surgery. Under these circumstances with her outwardly seeming to be just fine, I know how hard this surgical decision was for you to make. But Lindsay, it was really her only chance to continue to live out the rest of her life. You left no stone unturned for your little girl. She left this world without having suffered, knowing she was loved dearly. These are the two greatest gifts that are within a human's power to give. And you gave them to Scout, even knowing the cost that you might have to pay, yourself.

If it brings you any comfort at all, I hope you will stay with us to talk, Lindsay. You and Scout are forever part of our family now. We will always remember and honor her, and we will always remain here for you.

Marianne

[Tina]

Lindsay, my heart is also breaking with this sad news. I am so very very sorry for your loss. Ever on sweet Scout. xo

[judymaggie]

I saw the new subject line and my eyes teared up--my heart goes out to you, Lindsay. Please know that Scout was greeted at the rainbow bridge by our beloved dogs who traveled there before Scout--they will take good care of her.

[Budsters Mom]

So very sorry.:o:(

Fly free dear Scout, fly free!

Hugs,
Kathy

[Renee]

So, so sad. My heart just sunk seeing the updated subject line. I do hope you will be kind to yourself and know that you did everything you could.

Sail on sweet Scout.

[Trish]

Dear Lindsay, I am so sorry to hear this news. My heart is breaking for you and Scout. You are a rave man for making this decision. I had firmly told myself before Flynns surgery that if the worst happened then so be it, at least there would be no suffering, no lingering decline and I still truly believe you have done the right thing here for your girl. She will not have to face and cope with getting sicker with that tumour in her, she has passed only knowing your love. Just gutted for you both. Big hugs xx

[Dixie'sMom]

Oh no! Like the others, I teared up and my heart broke upon seeing the updated status line. I am so very sorry for your loss. I think you are amazing with your devotion and love to her and both of you fought the good fight. Something obviously unexpected went wrong.

I will be keeping you close to my heart and in my prayers in the coming days. You will always have a shoulder to cry on and a hand to hold here and we will always remember Scout with love.

[Scout]

Scout was as fine a dog as I could've ever dreamed of. The joy she brought to me really was immeasurable. I hope I gave back to her enough to be worthy of how wonderful she was to me. It always struck me how obedient she was. And it's not that I have any true dog training skills. I just think somehow she and I were made for each other.
I'm gutted and not being a tremendously gabby or social person the kindness you all have shown is all the more humbling. Thank y'all so much.
I have been told by many that Dr. Tobias is top notch. From what I know of her she is a very sincere person and doctor. She cried right along with me as Scout left this morning. Dr. T told me this morning that she didn't think my pup would've lived much longer without the surgery. I know she truly believed that. I let them do an autopsy on Scout's body in hopes that it will somehow increase the understanding of this disease and how to more successfully treat it for the next dog that comes through.
My life is going to feel so empty without her. A huge part of my day was trying to make sure her needs were taken care of. I really enjoyed that. She loved apples so much I don't know if I'll ever be able to eat one again. I always had to share them with her :-)
Except for summer months, she went almost everywhere with me. She was so comfortable just sitting in my car waiting on me to come back from whatever I was doing. I can't believe she's gone. I love you sweet girl.

[addy]

I'm so very sorry. Please know that we are here for you during this time of such sorrow. We all have said over the years, when one of us falls, we all fall. We all also help each other stand back up.

Scout will always be remembered here, never to be forgotten.

[labblab]

Lindsay, I cannot tell you how much your words about Scout touch my own heart. I have only lost one dog so far in my life, and he was my Cushpup who is my avatar here. Before he died, I did not know how much my heart and soul could ache. Losing him hurt more than even my human family members who had passed before him. That was because my connection with him was different, I guess you could say purer, than any other relationship in my life. It was pure love and devotion for us both. From what you have written about Scout, I sense the same kind of connection and the same loss for you. I wish so much there was something I could say or do that could make things different. It breaks my heart today to think of you going back home without Scout.

I know one of the only things that helped me back then was having this family here to talk to. So please, please, please keep talking to us, any time of day or night. Others in your life may not understand, but we do understand how much Scout meant to you and why you loved her dearly. We understand how a little dog can change your life forever.

I don't know whether you are yet home, but I am sending huge hugs west to Alabama to await you.
Marianne

[Scout]

Thanks y'all. I just bought some fresh flowers for her and put on my mantle with her pictures around them. I also found one of those decorator type candles. I put in in her food dish and lit it and placed it by another grouping of pictures of her. I have a pretty nice shrine going for Scraps(that was my favorite of about 40 nicknames I had for her...don't ask me where it came from). The emptiness is gut wrenching.

[Renee]

You are not alone.

[labblab]

Your shrine sounds just beautiful. Just so you'll know, we also have a very special memorial thread here, and Scout has already taken her place of honor there. I will be contacting you soon via PM re: the possibility of adding a photo link to her memorial line.

http://www.k9cushings.com/forum/showthread.php?t=6879

In the meantime, if it would not make you too sad, would you tell us how you and Scout found one another? Only tell us if you want to right now. Otherwise, that story will keep.

Marianne

[spdd]

I am just reading your post now. I am so sorry for your loss. Gut wrenching, emptiness, grief, unbelieving are all part of this terrible pain we feel and in some cases still do. My connection to my pup is still here in this forum, but I light a candle for him everyday in the memory section. I'm still waiting for it to get a bit easier, and some days are, and he will have been gone 3 months on valentine's day. The people on this forum are beyond incredible, and all of them including myself are here for you. A lot of our fur babies from here are now free and running together. My deepest condolences.

[Scout]

Your shrine sounds just beautiful. Just so you'll know, we also have a very special memorial thread here, and Scout has already taken her place of honor there. I will be contacting you soon via PM re: the possibility of adding a photo link to her memorial line.

http://www.k9cushings.com/forum/showthread.php?t=6879

In the meantime, if it would not make you too sad, would you tell us how you and Scout found one another? Only tell us if you want to right now. Otherwise, that story will keep.

Marianne
Thanks Marianne
Kelly who is now my former wife(we are still friends) came up with the idea of getting a dog while we were dating. I can be stubborn and unwilling to try new things so I was against the idea. I tried to tell her not to get a dog. Thank heavens she didn't listen. Next thing I know we are meeting a guy in TN who has WFT puppies for sale. Somehow someway a 6 wk old pup soon to be known as Scout is on the way to a new home in Alabama. As she got older, for whatever reason she wanted all the attention that Kelly's 2 kids were getting. Although she wasn't a great kids' dog, she and I began to really hit it off. Pretty soon she was spending 75% of the time with me. When K and I got married then divorced we had to separate Scout and Buddy. So Scout came with me and lived out her days hardly ever having to stay without human company. And as I mentioned I took her with me everywhere I could. She loved to go for car rides. I'm mostly retired and even on the few days here and there when I couldn't keep her, my mom would. Scout and her Grandmother got on wonderfully, so that was a treat for both of them.

So thanks to my former wife, I had the richest experience I have ever known, a bond called Scout.

[labblab]

Ohhh, thanks so much for sharing this story about Scout. It is amazing how that special bond forms, and I think a bit of a mystery as to how it happens. Barkis, my Cushpup, came to my husband and me as a puppy. He and my husband loved one another dearly, but from Day 1, it was clear that Barkis was my special boy. That was just the way it was. He followed me everywhere, always. We were inseparable in the house, and he went on every car ride with me that he could. I thought my own heart had died the day he died. We got our older girl, Peg, as a puppy, too. It was only by great good fortune that she came to us. Shortly after Barkis died, we went to play with some puppies (we knew we couldn't live with the empty house for long). But supposedly the puppies were already spoken for -- we were just getting our puppy "fix" for the day. We were sitting in the pen, and the first puppy that came over to us was Peg. She sniffed at me, but then walked over to my husband, proceeded to untie his shoelaces, and then fell asleep with her head in his lap. What a sweet pup, we said. Long story short, the family who had spoken for her couldn't take her and she ended up with us. Peg and I love each other dearly. But you know where this story is headed -- she is Daddy's girl. Always was, and always will be.

I feel sorry for people who have never known that bond, although the pain of the loss is so profound. No matter the religion or the philosphy, there is a special blessing in that kind of bond.

Thank you so much for sharing Scout with us, Lindsay.
Marianne

[Dixie'sMom]

What a beautiful story Lindsay. You and Scout were so blessed to have each other.

I believe that we will be with our furbabies again one day and that they are waiting for us when our time on Earth is done. When you are able, I hope you can picture Scout in your mind waiting for you just over the bridge chasing squirrels and butterflies. I hope that brings you some small comfort in your time of sorrow.

[Trish]

I like to read those stories too, so I will add to the others that you are very welcome to hang out with us at anytime... sometimes it is nice to go somewhere in life where people do not judge and totally understand how you are feeling. So nice to read of the empathy from your vets, I like how caring she was. Hope you have managed to get some rest today, you sound just like my brother when he lost his darling cat... he made a little shrine with a candle, photos, toys and even a saucer of milk for Timmy. You do what you have to to help you through and if you ever need an ear they are not far away here. Big hugs

[Scout]

I haven't really worked in over 1 1/2 years and I just realized that she and I had literally been no more than a few feet apart for 21 hrs a day in that time. I loved being her guardian.

[doxiesrock912]

Lindsay, my sincere condolences on your loss of Scout. Thank you for allowing an autopsy. I hope that they can eradicate this disease once and for all.

Scout surely knew how much you loved her. They all know. Too many of us are lost without having to care for a cushpup. The sudden, dramatic change in schedule with so much free time magnifies their absence.

I have always had pets. Even as a child. I don't think that I could ever live without animals at home. Your story is wonderful and when you're ready, I encourage you to adopt a dog. You'll be amazed at how many different breeds are available and need a loving home.

I did and as much as I miss Daisy Mae, Bella has helped me and she's just as incredible as Daisy with many similarities. Must be dachshund traits I think. It will get better and happy memories will outnumber the sad.


Hugs

[labblab]

I am so glad to see you here today, Lindsay. Awakening this first morning without Scout, well, thank goodness you only have to do that one time. I think that was the hardest "first" of all for me. :o

I can imagine how totally odd your daily routine must feel, because everything is different today. I don't think people who have never shared this kind of bond can possibly understand how the whole rhythm of your day can be tuned to the time spent with your pup, and taking care of her needs.

Are you finding things to do with your time today, or is it just plain hard filling in those minutes? Plus, I've been thinking about your mom and how much she'll be missing Scout, too. There are just so many hard parts to the loss...

Marianne

[Robert]

So sorry for your loss. Praying for you and scout. Your story bout scout rang a bell - I only got my first two little dogs tom and tam cause my wife was terrified of big dogs. Didn't want them at the start but they left with me and ended up loving em and now missing em. T

[Trish]

I sure hope the autopsy shows what went wrong so they can stop it happening again, does not help you or Scout but hopefully it will help the next dogs coming along. Good on you for allowing them to do it, sure hope they are not charging you for it though. Routines are hard to change when a little doggy heart has wound its way around yours and is suddenly physically gone, but I do believe her spirit will not be far from home x

[addy]

I love hearing about your life with Scout. I hope the special memories comfort you.
I lost my little girl a year ago. I still miss her, she was a huge part of my life

It is hard to adjust after losing that huge part of your life. I'm very grateful to you for allowing an autopsy. I hope they can determine what happened so the next pup can benefit. That is a huge gift in Scout's name and honors her so.

[Scout]

I am so glad to see you here today, Lindsay. Awakening this first morning without Scout, well, thank goodness you only have to do that one time. I think that was the hardest "first" of all for me. :o

I can imagine how totally odd your daily routine must feel, because everything is different today. I don't think people who have never shared this kind of bond can possibly understand how the whole rhythm of your day can be tuned to the time spent with your pup, and taking care of her needs.

Are you finding things to do with your time today, or is it just plain hard filling in those minutes? Plus, I've been thinking about your mom and how much she'll be missing Scout, too. There are just so many hard parts to the loss...

Marianne

My mom was devastated. Scout may have actually preferred her in some ways over me...not that it mattered or that I dwelled on that but she just was always soooo excited to go to her Gan's house.
I went to a counselor today. Since that put me close by I stopped in at Scout's primary vet office and had a cry with her doctor there.

You are so right about the rhythm of the day. Everything else I did was planned around that. Giving her medicines...making sure to wait the req'd time before letting her eat. Making sure I gave the second dose of the day exactly 12 hrs after the first. Brushing her teeth...I brushed them every night. Most dr's commented on how nice they were. I wanted to make sure she didn't have to have anesthesia just because her teeth were dirty. After I put her in bed for the evening I would go in my bathroom to get the brush and toothpaste. She slept at the head of the bed but she would always be at the foot of the bed nearest the bathroom waiting for me to bring the toothbrush. She seemed to enjoy me doing that for her. I guess I'm just beginning to realize how much of my life was devoted to her.
Kelly let Buddy with me last night and today so that was nice. One hobby I like is driving sports cars. For the last three-four weeks I had been negotiating the purchase and cross country delivery of an old Porsche...not a significantly collectible car but a fun kind of clunker. Anyway, it arrived while we were in Knoxville. I finally looked at it today. And Buddy got his first ever ride in a Porsche :-)
My sister who is a dog lover came by with a card and a book about dog heaven.. It was nice of her to do that. I looked at lot of old photos too.
The UTK veterinary social worker just called to check in. I thought that was a nice touch too.

By the way, if I don't acknowledge a post specifically please don't think I didn't read or didn't appreciate it because I read and thank you for all of them.
Thanks,
Lindsay

[Scout]

I wish I could show y'all a cell phone video I took of her swimming to get a stick I threw for her early last fall. I have access to a place in the country that has a big pond on it. She loved to go there and run off leash. She also liked to wade and swim in the pond. I'm so glad I took her there last Saturday and let her play.

[Trish]

Would love to see it, I download mine to youtube and post the link. Then we can see it, I think photobucket works too

[Scout]

voila https://www.youtube.com/watch?v=UAiquNIl6D0&feature=youtu.be

[addy]

That's a big stick, love the video.:):)

[Trish]

Awwwww she sure loves that water, she is beautiful Lindsay xxx

[steiny]

I am so, so sorry for your loss. My best buddy Steiny passed a little over a month ago and I know how especially difficult these first days can be when our whole world is turned upside down. Our routines are no longer the same. We miss everything about them not being with us. For me, creating a photo book and writing down everything I never wanted to forget about him, has and continues to help. From your posts, it sounds like you were a wonderful owner who did everything in your power to make her better. Feel very sad for your loss.

[Dixie'sMom]

Awww... I loved the video. Go Scout Go! I bet Heaven has plenty of water to swim in :)

[molly muffin]

Love the video. She sure loved the water.

Awww a ride in a Porsche for Buddy. Bet he enjoyed that!
Your family sounds very supportive. That is important. Dog sitting is definitely a good thing to help with the emotions. Dogs just want to give love and loyalty and have it given in return. We need that too. Especially when it is suddenly taken from us. It leaves a huge hole in our lives

[doxiesrock912]

The video is adorable!
Daisy wasn't a huge fan of the water. She liked it more as a pup :-)

Didn't you know that gran's are always more fun? LOL

[labblab]

Loved, loved, loved the video! Who says a terrier can't also be a retriever? ;) :)

Lindsay, I noticed you mentioned stopping to see a counselor, and kudos to you for doing so. It gives me the kick in the butt to arrange for a few sessions myself. I've suffered some significant human losses lately and keep saying I'm gonna arrange some time for counseling but haven't yet made it happen. Counseling has helped so much at other times of my life, and I know it would now, too. Good for both you and the counselor for recognizing that Scout's loss merits the same attention and support as that for any other family member. In fact, perhaps even more!

In addition to the video, I just love the photo of Scout you've shared with us to add to our memorial album. You just feel as though she's looking straight up into your eyes. Yup, that little girl was sure a keeper.

What kind of doggie is Buddy?

Marianne

[Scout]

He's a wft also. I think there is a picture of him with Scout in my album.
I truly know the meaning of agony. I am having lean on people in ways I never have.

[labblab]

Oh yes, there is a picture of Buddy, too. They look like twins!! Were they around the same age?

I hope my dad and my grandmother who passed before Barkis will forgive me, but without a doubt my first day without Barkis has been the saddest day of my life.

Marianne

[Scout]

Bud came along in 2004. So he's a little over 2 yrs younger than Scout. Yes, my dad died many years and it was excruciating but this feels harder.

[addy]

Many people feel losing their beloved dog is harder than losing a family member. Maybe because the process is so different.

Sometimes, I think people may not understand or think badly of me but I honestly loved my little dog more purely than anyone else.
It was a simple, pure, uncomplicated love.

We all have pretty broad shoulders to lean on. I am still smiling about the size of the stick Scout carried out of the water. I'm glad you shared the video.

[Scout]

It was so hard for me when I realized about 18 months ago that her activity level and enthusiasm was going down. Her vision was losing its sharpness too. But when she was at that lake she seemed to perk up and run. She couldn't see the sticks on the water too well toward the end. So after I threw the stick I would sometimes have to throw little rocks at it so she could home in on the splashes until she found the stick. Another sweet memory is how she would wade into the edge of the water to get a drink. What was funny was she would stick her whole snout in the water and blow bubbles.

[Trish]

My fox terrier will not go near the water, hates it!! Only time I saw him swim was when he took a fancy to a pretty like girl dog and followed her in!! What love does to a boy :) I bet he would have followed Scout in too!!

[Scout]

Trish, she may have shown him the teeth :-) She was pretty bossy at times.

I wonder if y'all could give me a reality check.
Last night I didn't sleep well. So, in the late hours I began to have thoughts of regret for trying the risky surgery when she seemed to feel good.
Follow this logic and see if you agree:
Scout's surgeon is a respected board certified surgeon and professor at a major veterinary teaching college. Scout's surgeon is a dog-lover based on my feeling from conversation with her and she told me she used the UT grief counseling service after losing one of her dogs last year. If it hurt that much she must be a lover of dogs. Right?
If she loved dogs, and she knew Scout meant everything to me(because I had told her so) there is no way she would recommend a procedure that she didn't think was the best option for Scout's well-being right?

[addy]

During the grieving process we sometimes second guess things we have done and also start blaming ourselves. I think from my almost five years here on the forum, I cannot remember many who did not, including myself.

I think your logic is sound. I think you gave Scout the best chance you could. Sometimes unforseen things can happen. There is always a risk to surgery, even easy ones can go bad.

Dang, look what happened to Joan Rivers and that wasn't even surgery.

Medicine is not an exact science, unfortunately, things can happen, drugs can cause unwanted side effects, etc.

Try not to go down that road.
Hugs

[Trish]

I agree, your surgeon sounds lovely and from what you have written had Scouts best interests at heart. I think the decision to proceed with surgery was absolutely the right one. What I would want to know what went wrong to cause the neurological complication, like was it a stroke and would better BP control and a more therapeutic dose of phenoxybenzamine preop have lessened that risk. Or was it a clot, in which case I would want to know what anticoagulant therapy they were using to prevent that from happening. I hope the results from the autopsy can put your mind at rest. Still, even knowing these things is unfortunately not going to bring her back, but it might help you process it all.

[pansywags]

I am so sorry for your loss. This is one of my favorite quotes from Betty J Carmack regarding pet loss and the what-ifs:

"In the face of all the guilt experienced, I have the following bedrock belief: it's truly the exception that people did not act as best they could for their animals' highest good. They acted on their animals' behalf with the goal of having the best possible outcome and quality of life. Whatever decisions or choices were made, they were based on love and a consideration for the animal."

[molly muffin]

Everyone I know that loses their much loved companion fur baby goes through the what if guilt stage.
What I have said to others is what if you hadn't done the surgery or made the choices you did and things had become worse for scout. For every what if there is a flip side and it doesn't always work out for the better. That is the nature of the what if. If I am remembering correctly the doctors didn't think she would have had that long without the surgery and if that is true she would have deteriorated health wise and at some point been in distress. That wouldn't have been something you would want either.
You gave her the only chance she had for a longer stay with you, that something went wrong is just heart breaking. I hope they can come up with some answers as to what happened and caused this.

[labblab]

Lindsay, given the outcome, I don't think there is a single one of us who wouldn't be second-guessing the surgery if Scout had been ours. But stepping back as an observer rather than her dad, I absolutely think you did the right thing for her, and I absolutely think her surgeon believed it was the best option, too. It is such a tragedy that she did not survive the surgery intact. As Trish has said, there are a couple of logical explanations for what could have gone wrong. Sometimes errors are made, even under the best circumstances. But having worked in a hospital myself, I know that even when everything is done correctly, there are risks that always remain. So even assuming the medications and the monitoring were totally correct, a stroke or a clot could still have happened.

If I were you, I think the hardest thing for me would have been taking Scout in while she still outwardly looked so well. And then for her not to make a recovery, afterward. Well, that is just gut-wrenching. But I guess my perspective on that is a little different now, after recently losing two of my very best friends to cancer (that's what I was talking about earlier re: the counseling...:o). Tumors can be such stealthy killers. Both my friends were diagnosed during spring, and their original complaints were so innocent. I was having patio lunches with them even as they were diagnosed. They seemed so healthy -- we were all stunned when they got the cancer diagnoses. It seemed impossible to believe, because outwardly they were just fine and they remained that way for a little while. But inwardly, they were not fine, and the tumors were not operable and they progressed. And what proceeded was not pretty.

When I look at that wonderful video of Scout swimming with her stick, I think back to my patio lunches with my friends. In so many ways, I wish those were the images I could return to the forefront of my mind. And so this is what I want to offer you, even in the midst of your misery. Hold those happy images of Scout close to your heart. Because even though you would have wished so dearly for more time with her, you would only have wanted quality time. Without the surgery, those good days would have been limited at best, and she might have really suffered at the end. She was spared that, and left this world a brave and happy and noble girl. You did the right thing, Lindsay, and so did Scout's surgeon. I truly believe that.

Marianne

[Scout]

Hey Trish I want to thank you for staying by me the night Scout went down.
I have watched my dad die from inoperable cancer and I have been through a divorce and the various other pains of 49 years of living, working with family, employing dozens of local people, and just in general making mistakes I wish I hadn't made. Scout's death has left me hurting more than all that combined I think.

I was confused by the treatment of pheo. I have a biology degree, but since it was from almost thirty yrs ago and I never used it in a profession most of that knowledge is long forgotten. I did read a lot about pheo in the 2 months that we knew Scout was sick, and I could've read thousands more pages I suppose, but it still wouldn't have made me a surgeon. It did enable me to ask some relevant questions and have some degree of understanding that I suppose offered some comfort at the time. And I think it allowed me to advocate on Scout's behalf to the point that all involved knew that I needed help and that I wanted the best for Scout.

In the end though I had to put my trust in professionals. I asked Scout's surgeon more than once about the pretreatment. I am paraphrasing but I believe she told me that pretreatment helps dogs that are tolerant to it. I think she defined tolerant as having an immediate positive response to a therapeutic dose. I think it was thought that that just wasn't the case with Scout. More than once I heard what I believe was her concern about the pretreatment being somehow related to hypotension following the procedure. I believe that is what she said and in the end that is what happened.

The autopsy showed that low blood pressure caused lack of oxygen to her brain. She stopped responding to the vasopressin. The remaining adrenal gland was underdeveloped. No clots were found.

I think they gave it a mighty effort. There were half a dozen people around her in the icu. For that very small window of time in the wee hrs of the morning when the critical care dr went from being in the building to being on call, I paid extra to have a degreed vet there in the icu. This was even though the staff that was already in the icu were I think -very- experienced tech's.

I believe they cared for her as if she were their own. I hope they didn't make a mistake. I'm not qualified to even remotely suggest they did. Since hearing the autopsy news I have wondered why they couldn't determine beforehand whether or not her "good" adrenal was up to the task. I have to believe if they had had a way to do that they would have done it. I had to put my trust in them. All I know is that I did that, I miss Scout something awful, and I am profoundly grateful for the help all of you here have offered.
Lindsay

[molly muffin]

It is quite common for the remaining adrenal to be under developed due to the one with the tumor over secreting. So this wasn't just a pheo but also a case of Adrenal Cushing's. After the surgery the dogs are put on a therapy to help with that till and if the remaining adrenal kicks in. It doesn't always.

This seems to have been directly related to scouts bp issues with her going too low and not getting the oxygen needed. Bp issues can be so scary in relation to surgery. I never had realized it so much as I do in the last couple years on here.

I am fairly sure that they where aware of the bp factor and watching it but I am guessing if she didn't respond to the medication to make her bp come up then they didn't have a lot if options. That is not something I think they could have told prior. I don't actual recall that specific issue occurring. Normally it is blood clots that are the huge worry and problem with surgery recovery.

Trish is a real gem. It helps that she has been down this road before and understands the medical terminology and procedures.

I have been known to be texting from the vet specialist office and getting feedback from the forum during consultations and testing. Got to love this place. Trish and so many others have often been right there answering back in real time when it counts.

[MBK]

Dear Lindsay,

Thank you so much for the kind post on my thread when your own heartbreak is so fresh. I am truly sorry for the loss of your sweet Scout. I, too, was not planning on getting a puppy when I got my Alivia. Funny how that happens and how they become such an important part of you. We are lucky to have had them for the time we did and no amount of time would ever had been enough. I feel sorry for anyone who doesn't know the pure love of having a "heart" dog.

I am one year out from losing my Alivia. I can tell you it does get better and as time goes on, you will remember the good - mostly. Scout was very lucky to have you, as well.

Take good care of yourself.

[doxiesrock912]

I also wasn't planning on adopting so soon after losing Daisy Mae, but when Bella "came alive" outside in the enclosed area at the humane society - I couldn't leave her there. It was obvious that she had chosen me, as Daisy had 14 years earlier. ♡

Bella is just as sweet and has come so far already! She came from a home where there was domestic violence and this was her second time coming to the Humane Society in her short life (she's 3 now). There weren't many details given when she was brought in but if I yelled at one of the cats, Bella would run upstairs and hide under my bed for hours. She doesn't do that anymore. So, she's realized that scolding is not followed by violence in my home.

Like you and Scout, I take her wherever I can. She cried ALOT in the car at first, but is doing better with that too. She gets along great with all of the cats!!!! We had no information about that beforehand.

I like to think that adopting Bella is the legacy that Daisy set for me.

Lindsay, it sounds like surgery was the only chance that Scout might have had and that the team was phenomenal. At some point though it is up to the animall's body to do the work. Poor Scout's couldn't.

Time does help. Some also find that volunteering with animals helps too. Hugs

[Scout]

Thanks Valerie.
Mary Beth, that is such an appropriate way to put it. Scout was my heart dog. I'll never forget when she was young and had just been spayed. I took her out for a walk not long after getting her home from the vet clinic. When she tried to poop the abdominal press must've hurt a lot. She looked up at me while doing it. I promise it looked like her eyes teared up. Maybe I'm a nut because I don't think dogs cry, but the bond got stronger right then.

[Scout]

Found another neat video. This was from January 2011. We rarely get snow here so when we do it's fun. http://youtu.be/4ae5MBc7BtU
Thanks for letting me share with y'all.

[doxiesrock912]

They do cry. I saw Daisy cry once. Broke my heart.

[Trish]

Snow video is super cute!! Looks like she was having a ton of fun.

That autopsy has given some answers, not sure why the opposite adrenal was small as from what I understand that is not common with a pheo. But they were so sure with her strongly positive urine tests. Are they doing histology to find out what the tumour was? I cannot remember if her LDDS was normal, but I think it was so would rule out a functional adrenocortical tumour.. So not sure what was going on there. Most of the dogs that have not made it through have passed because of clots but that does not appear to be the case for Scout. Maybe the final histology results will make it clearer. I hope they have not made a mistake either, doesn't sound like it.. apart from the lack of phenoxybenzamine, but you have explained what she thought about that which was total opposite of what my vets made me do with the meds.

No need to thank me Lindsay, many of the ppl here have been there for me too when we needed it, so just paying it forward! I am not much help with cushings but I do like to keep an eye on the adrenal tumour pups as we have been there and done that and if I can pass anything on am very happy to help when I can! :)

[labblab]

Awwwww, I love the snow video, too!! That's the kind of fun my two Lab girls have when it snows here, too! ;) :)

I was hoping we might finally get some snow again here yesterday, but it ended up icing instead. We've had some pretty big limbs come down, but we've still got power, thank goodness. How about you -- any ice or was it all rain for you?

Marianne

[doxiesrock912]

Marianne, I'll share our snow! We're expecting more!!!!

[labblab]

Oh Val, I wish I could share at least a little bit of yours! I know all you people who have been buried in drifts will want to just spit at me. But I would really love to see at least one snowfall before winter is over down here. :o

[Trish]

Hi Lindsay
Hope your day is going OK, thinking of you as you try and process all that has happened. Don't be too hard on yourself, OK!

[molly muffin]

Thinking of you and Scout.

The video of her in the snow playing was so adorable.

[Scout]

Thanks everybody...just kinda going through the motions. Found a lot of great pictures of her and Buddy. Hadn't seen them in years. It was like finding treasure. Gosh I sure do miss her.

[addy]

Hope the motions are getting a bit easier.

Let us know how you are

[labblab]

Just checking in on you, too, Lindsay. Hopin' you'll stop by again soon...

Marianne

[Scout]

Hi Marianne and Addy,
Just trying to adjust to the new world. I have spent hours and hours making a photo book on iPhoto. I just ordered the prototype a bit ago. I think it's going to be epic. There were so many good times with Scout. And all her quirks just made her so memorable.
I remembered a couple of times in early 2011 when she "sleep-howled"...it was so strange. Both times it happened around dawn. When it woke me up I saw her sitting up in bed...howling. I promise she was asleep. :-)
Then there was the way she would run to me when she was excited to see me. She would scrunch her back up and her body would get kind of wiggly as she was coming toward me. What a dog. It's just tragic to me that she's gone. I've been shown how easy it is to undervalue and take for granted good times, good health, good people. I don't feel like I particularly undervalued her although I would've taken more pic's and taken on her more adventures if I could've known. And I would be ***utterly, completely, and totally privileged*** to take her on a cold winter night walk right now. I guess what I'am saying is this loss has shown me a lot things in general that I hope I never forget.
I hope good things are happening for the dogs and owners here.
Lindsay

[molly muffin]

I think a book is a wonderful idea! You'll always be able to just pick it up and browse through, share some memories and say hi Scout, thinking of you today.

[labblab]

Hi Lindsay, I love the idea of your photo book, too. What a special way to revisit your memories of your lives together. Hoping you'll stop by again with an update once you get the finished album in your hands!

Marianne

[Scout]

Hi Lindsay, I love the idea of your photo book, too. What a special way to revisit your memories of your lives together. Hoping you'll stop by again with an update once you get the finished album in your hands!

Marianne

Hi Marianne and everyone,
I did get the album finished and it's really nice. I gave it to Scout's Gan(grandmother). It's been tough going these days so I haven't really been able to come here. I did want to stop by and tell y'all about the memorial we had for Scout late yesterday afternoon.
It was a fabulous tribute to her. 2 dogs and 9 people gathered at the little farm with the lake in the country. This is the place where she loved to go to run and swim.
We had an outdoor event with wonderful champagne and hors d'oeuvres. I had set up a lot of pictures of her and Buddy. We had multiple flower arrangements. Scout's mom and her son were there. From my family, my mom, sister, uncle, two aunts, and a cousin were there. Everyone there had had special attachments to pets except for one aunt. She has always been special to me even though she doesn't particularly like pets and I believe she never even touched Scout. So the fact that she came and brought a bouquet of flowers was really noteworthy.
After we finished eating I thanked everyone for the contributions they had made to Scout and to me. I told them the reason for having the ceremony at the lake was that she had spent so much time there and loved swimming and wading in the water. Then my other aunt who loves animals read some really nice anecdotes and poems. I haven't gotten to asking her for the exact wording, but one went something like this " I asked God for a tree and he gave me a forest, I asked God for a river and he gave me an Ocean...I asked God for a dog and he gave me Scout." It was really sweet and so appropriate.
At that point I brought out candles and placed them along a low stone wall. I lit one for Scout and asked everyone who had lost a special pet to light one in their memory. Seven candles burned as the sun started going down.
All of us then went down to the pier that goes out into the lake. I took part of Scout's ashes and submerged them in the water. Of her own accord, my aunt who had never touched Scout got the flowers she brought and gave us all a couple to toss in the water. A nice breeze blew them slowly down the lake. I tell you it was a spectacular way to honor her. And I believe I even saw my aunt cry a little.
Kelly(Scout's mom), Buddy, and I stayed after the others left. Kelly read two sweet poems she had written for Scout. It was so peaceful to sit in the darkness and see the seven candles burning. We took a few bites of the last apple(Scout's favorite snack) I had bought for her. Buddy and I stayed on for a little while longer after Kelly left. We talked to Scout a bit. I didn't want to blow the candles out and they were in a safe place so I left them burning and said goodbye to her.

I have never conducted or even been to a pet funeral before yesterday. I was worried about how to do it beforehand. But I tell you it was a magnificent thing to do for her, and I am so so glad we did it. It was really fitting. I can't imagine not doing it now. It left me with a very warm, peaceful feeling

I'm not sure how much I'll be around since it's so hard right now to read about dogs who are not well. Once again, thanks to all!

I set my e-mail notification for pm's in case someone new has a pup with pheo and they read this thread. Don't know if I have anything significant to offer but pm if I can be of help.
Lindsay

[labblab]

Lindsay, I cannot tell you how touched I am to read about your memorial for Scout. Your description is so pure and so sweet. It makes me feel as though I had been right there, too. So really, you've given us all a chance to join you in honoring Scout and all she means to you, and I thank you for giving us this gift.

I understand about it being hard to come back here, especially so early on in your days of loss. But we will always be right here, so eager to see you, whenever you may wish to return again for a visit and a chat. And in the meantime, Scout's candles will always remain burning brightly in our mind's eyes.

Sending warm wishes and my best regards,
Marianne

[pansywags]

Lindsay, what a beautiful way to honor Scout - thank you for sharing with us.

Your aunt sounds like a very caring woman. I'm so glad you have her.