Adrenal Tumor Cushings - struggling with decision, treatment

[Catbud]

Hello,

My sweet Golden Doodle Teddy has adrenal cushings (ultrasound confirmed a tumor on his adrenal gland). Like many of you the diagnosis only came after I did my own research - he was put on Vetroyl for 4 months, but then clinical signs worsened (hair loss, pot belly, excess drinking/urination) My vet never determined the type of cushings so I asked for an ultrasound, and it is adrenal. The ultrasound doc says this type will not respond to Vetryol so I took him to NCSU for surgery, but didn't go through with it when they went over the cost (6-8k) and the risk (80% survive, but he could throw a clot and die even a few weeks after a successful surgery). They doubled his Vetryol - he now gets one 10mg in the morning and one 10mg at dinner (he weighs 30ibs) - but I don't really know why we are doing that - even their after care notes say it will produce short-lived improvement if any improvement at all. I don't see any improvement - his stomach makes gurgling sounds when he is resting. I don't know how the drug makes him feel I just watch out for signs of Addisons and so far that has not happened. NCSU did say his vet started him on a smaller does (10mg/day) then they do so they thought this increase might produce some benefit.

I am struggling with my decision not to do the surgery. He is 12.5 years old but very puppy like - loves to chase a ball, happy, sweet (other than biting my fingers when I try to give him food because he is so ravenous all the time. Also he now eats trash and poops paper towels if I am not very careful).

They said there was no vena cava invasion at this point but if I come back in 3 months that might not be the case. Also the other adrenal gland is a little smaller and it could continue to deteriorate if I wait on surgery.


Questions I failed to ask - What is his prognosis? How will the disease progress? (he started showing signs of disease about 16 months ago.)

I've been looking up alternative treatments and diet - not sure if it will help and I find some conflicting info about the raw food diet. Maybe diet could improve symptoms but I don't think it can actually change tumor growth?

He looks so pitiful with the bald patches, the thinning skin, a calcified tip on his tail - but I do not think that he is in physical pain but I am worried that I might not know if he is suffering.

I found a local vet that is described as holistic and I am calling tomorrow to see if I can get an appointment. Any thoughts on what I should ask?

How do I make peace with not doing the surgery - the thought of curing him is very appealing, but $8000 is a lot of money and I would hate to lose him in the process (and still pay that bill).

I've never gone through losing a pet and with him being so puppy-like it's easy to feel like he would be with me for many more years...I feel like surgery would be buying time but putting off the inevitable goodbye.. I just never thought about seeing my happy dog wither in front of me. It's hard. I feel like I need replies to that as much as to the treatment questions. Thank you for your time.

[labblab]

Hello and welcome to you and Teddy, although I’m so sorry about your worries. Those of us who have lost beloved companions can so easily relate to your anxiety and your pain. My heart goes out to you, because I know how much my own heart hurt when faced with life-and-death decisions for my two dogs who have passed away. They were both Labs — one a Cushpup and one not — and sadly, neither one made it to their 12th birthday. So I credit you with providing an already long and loving life to your Teddy!

I don’t have time to write as much as I’d like right now, but depending upon the exact type and growth pattern of his adrenal tumor, there may or may not be a lot you can do for him in terms of medications, whether they are natural or not. I think you rightly know that your big decision is surgery — whether or not to put both Teddy and yourself through it. If only we had that precious crystal ball to tell us in advance how things might work out! But since we don’t, we have to make the best decisions with the info we have in the present time. Nobody can tell you what’s best for you and Teddy, because nobody else has walked in your shoes and shared your personal life experiences. I can tell you that if Teddy were mine, given his age, I probably would not elect the surgery since he has already outlived my own retrievers. As my dearest grandmother used to say, “I’m going to die from something, and it might as well be from something I expect instead of something that’s a surprise” (she ending up passing from known heart problems). Given the risks and great expense associated with Teddy’s type of surgery, I would consider it for a younger dog, but not at his age. Again, that is just me. But I tell you this to let you know that you will not be judged harshly here, no matter what your decision turns out to be.

We’ve had members here who have had successful adrenal surgeries, and we’ve also had members who have lost their dogs due to complications. So again, no matter what you decide, we’ll be here to support you. Most of all, we’ll be here to listen and talk as you sort out your own path forward. When I released my first Lab, my darling Cushpup, both his mind and body were failing. When I released my beloved nonCush girl, her spirit was still fully intact but her hips and her legs had totally failed her. Oh my, they were both hard decisions to make. So as I say my heart does go out to you now. I’m very glad you’ve found us, though, because we’ll do our best to help. So just keep your thoughts and questions coming.

Marianne

[Catbud]

Thank you for your kindness and honesty. I thought I was at peace with not doing surgery, but now I am struggling.

I am attaching a photo - Teddy is a mini doodle. He is such a good boy. This is from February - He used to have a full doodle coat - he's lost more hair since this photo. I don't know if Vetoryl makes him feel bad or could make him feel better (or do nothing). Seems silly to give it and do the follow up tests if it cannot impact adrenal type cushings. Going to try and get him better food though - for whatever that is worth.

Thanks.

https://drive.google.com/file/d/0B6KHZ1dNcraGWVZyaXVMTGtlajVYel9kV2NJUUJfY1lRTkRN/view?usp=sharing

[labblab]

I’m afraid I don’t know a whole lot about adrenal tumors, but I do know there are different types. Some are cancerous, some are not. There is one particular type called a pheochromocytoma that causes problems from elevations in adrenal hormones other than cortisol. Since the vets don’t feel optimistic about the Vetoryl helping Teddy, I’m wondering exactly what type of tumor they’re diagnosing. Do you have specifics about that you could share with us?

Unfortunately, I’m not able to open your photo using my tablet. Maybe you’d want to create a photo album through your Control Panel, and upload a picture there. That might work better...

Marianne

[Catbud]

The only information I have on the tumor is from the ultrasound - I do not have the report, just the note from the NCSU review: "An abdominal ultrasound on 1/31/18 showed a heterogeneous adrenal mass(3.2cm x 4.6cm) with no overt caudal vena caval invasion." There is no commentary about it but that sounds kind of large for a dog of his size (He is a mini doodle and weighs 30lbs) Given how small adrenal glands are, that tumor sounds pretty big to me but I have nothing to compare it to.

I'm kicking myself for not getting copies of the records - I got one copy when I changed vets but I gave it all to them without making a copy for myself. I am going to get copies tomorrow and make my own copies before I try to see the holistic vet.

(I am on a little chromebook - not sure how to insert pics with a control panel - the insert photo on this text box asks for a url so I thought that would work - sorry) Teddy Photo (https://drive.google.com/file/d/0B6KHZ1dNcraGWVZyaXVMTGtlajVYel9kV2NJUUJfY1lRTkRN/view?usp=sharing)

But I put him on pinterest so maybe that is easier? https://pin.it/43ehlynlybr5m7

[molly muffin]

Hello and welcome from me too. He's a real cutie. Well that is a terrible position to be in and as Marianne said, we seen surgeries go both ways, but as far as I know, surgery is the only complete cure, but it may depend on what the tumor does as far as growth and positioning. (invasion of the vena cava)

We will support you whatever you do. It is a lot of money with no guarantee, we completely understand that. Complications can make the fee of the surgery and after care go even higher.

We have an outline that one of our memebers did in relation to discussions with surgeons about this. I don't know if it would help or not in your case, as you've already been down that road, but the link is here: http://www.k9cushings.com/forum/showthread.php?8555-Questions-for-dog-owners-considering-adrenalectomy

I wish we had some good answers for you, but each case is individual and you never know how things will go. Maybe he will have quite a while left with you and tumor won't grow. That's what I'm going to wish for!!

[Joan2517]

Oh, he is adorable. My Lena had a tumor, too. It had not invaded the vena cava, but was close. She was 14 1/2 and because of her age, my vet did not think it was a good idea to operate, and I chose not to. I could not put her through that. But that was my choice. She had had Cushing's for a long time before she was diagnosed and I don't think she would have survived the surgery...too much damage had already been done. She died a couple of months later, and choosing not to operate is the only thing that I have no regrets about.

[lulusmom]

Hi and a belated welcome to you and Teddy.

I am so terribly sorry that you are having such a tough time accepting your decision to opt out of surgery for Teddy. I have a female Goldendoodle I adopted a few years ago. She is 12 years old and in excellent health but I too would be hard pressed to elect surgery for her if her circumstances were the same as Teddy's. The most maddening thing about adrenal tumors is that there is really know way to know exactly what you are dealing until a dog is opened up and a surgeon has a good look at everything. Without surgery, you are flying by the seat of your pants and your options are pretty much limited to conventional treatment which is best for maintaining the best quality of life for Teddy. Adrenal tumors don't always over secrete cortisol so can I assume that your vet did a low dose dexamethasone test to make that determination? If you have a copy of those results, it would be great if you could share them with us. While we see many more dogs with pituitary dependent cushing's, we've seen our fair share of dogs with adrenal tumors and I don't recall any who did not respond well to Vetoryl. You mentioned that the ultrasound vet told you that Teddy's type of adrenal tumor would not respond to treatment. Given that Teddy has all the symptoms of cushing's, I'm not sure what that vet saw that such a prediction could be made. It would be great to see the ultrasound interpretation once you get a copy of it. Since surgery is not an option, it would be great if you could give us more information on Teddy's Vetoryl treatment. All dogs metabolize that drug differently and it is rare that a dog will ultimately stabilize on the starting dose so I am wondering if I am off base by thinking that resolving Teddy's symptoms may be as simple as a dosing change. Adrenal tumors almost always over secrete one or more of the intermediate hormones/steroids but not all over secrete cortisol. Was your vet able to determine through testing that the adrenal tumor is over secreting cortisol? Teddy has been treated with Vetoryl for four months and if his cortisol is too high, he should have had at least three to four acth stimulation tests done. Can you get copies of any acth stim tests that have been done share the results with us? Has the dose ever been increased since starting treatment? Are you giving the drug with food and are you having the acth stimulation tests done no later than 4 to 6 hours after the morning dose (with food). I apologize for all the questions but we want to help you effectively facilitate the only option left for Teddy and we can't do that without knowing his treatment history. We will look forward to hearing more about your precious Teddy. By the way, he is a cutie patootie and he sure knows how to smile for the camera.

Glynda

[labblab]

I’m so glad Glynda wrote her excellent reply, because it captures many of my same musings. And just to follow up re: the Vetoryl dosing — since Teddy weighs 30 pounds, I have to wonder alongside Glynda whether he would benefit from a dosing increase. For dogs with cortisol over-production, the generally recommended starting dose of Vetoryl follows a formula of 1 mg. per pound, with subsequent dosing changes based upon symptom relief and monitoring tests. So if Teddy’s tumor is stimulating excessive cortisol and unless monitoring ACTH blood tests have established that a lower dose is sufficient for Teddy, he may experience greater symptom resolution on a higher dose than the 20 mg. daily total that he now receives. Just another thought for you to consider. And yes, indeed, he looks like SUCH a sweetheart! It’s easy to see why you love him so!

Marianne

Oh, and a P.S. about setting up a photo album here. Your links to Teddy work great, so you don’t need to bother with an album here unless you want to. But if you’re interested in setting one up, here’s a link to the instructions.

http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums

[Catbud]

Thank you for all this information!

I am leaving right now to get copies of his records including the ACTH tests we have had done and post it in about an hour. I do not know if she did tested for all the things I see mentioned here - but I will post everything I get in his records.

The doc at NCSU (as well as the new vet I am switching to) say the ACTH test just lets them know if he is danger of Addisons not whether he is on the best dose. My regular vet was not very knowledgeable and very afraid of Addisons so she went conservative. The new vets say she started him on 1/2 the does they would have tried. Despite his levels being in the normal range on the ACTH test, they say that his clinical signs show that his cushings is not regulated so that is why they changed his dose. The new vets doubled his dose of Vetoryl from 10 to 20mg (1 10mg pill 2x day with food) beginning on 3/16. They even said he could go up a little more in a couple months if there is no improvement and he is tolerating it. He weighs 30 lbs.

He is scheduled for a ACTH test on this Thursday at my new vet. They said for me to feed him and give him his pill as normal in the morning and mark the time so they can be sure to test him at the appropriate time. (My old vet messed that up and had to re-test him on another day and she also tested him 1 hour after the med dose which seems to differ from what is described on this forum?)

As far as why they do not think he will respond significantly to Vetoryl, they did not say it was b/c of the type of tumor, just that adrenal tumor cushings is not treated effectively with Vetoryl. The notes from NCSU say he might show some improvement in symptoms but it will not last. Most articles I found on line also say adrenal tumor cushings is best treated with surgery and pituitary tumor is treated with Vetoryl. The other drug mitolane is an option - it's more like a chemo drug designed to destroy the tumor cells but also likely to destroy the adrenal gland with it. It has side effects that could make him feel pretty bad so I don't think they pushed that one much but they did mention it.

In addition, I have an appt on Wednesday with a holistic vet who does herbs and acupuncture - I read a few articles about that and figured with as much money as I put out, I might as well have one more vet visit to learn about those options.

I am getting him some better food (he has been on pedigree canned food for a long time with IAMS dry food) - I regret not doing better by him with food and dental care but I did read a post from a dedicated dog owner on here who had very conscientious with food and her dog still developed cushings so I guess it is not my fault.

Please check back in a couple hours and I will have posted his records. I really appreciate the guidance. I have been doing research - I was the one who told my vet he had cushings - she was treating him for thyroid and dismissed the hair loss, darkening snout and scaley elbows as "old dog traits" I also was the one who told her we needed to figure out what type of cushings he has so I asked for an ultrasound. It makes me very sad that I didn't figure it out sooner. She even said he tail had died from an injury - even though we didn't know of an injury. She snipped off the end and said the bone was exposed - but the new vet said is is calcified and that is due to cushings. It makes me want to cry honestly. Some day I will write a letter to the old vet - she should have referred me some where else when she was out of her knowledge and experience or she should have at least googled his symptoms like I did! Anyway - that is pointless now, I just want to get him as healthy as possible. I really appreciate all the knowledge here! Off to get the records - will post again soon!

[Catbud]

Okay - I think I have all Teddy's records ...so here goes:

Ultrasound 1-31-2018:
Liver: grossly upper normal in size, overall normal in shape and echogenicity. No obvious contrasting legions appreciated.
Spleen: is homogenous and no observable pathology
pancreas: no abnormalities grossly appreciated
kidneys: renal architecture is grossly normal, as there is normal contour and corticomedullary distinction without pelvic dilation
Adrenal glands: LEFT (original ultrasound report mistakenly said right!) approximates a low/normal caudal pole width of 5/1 mm. There is a heterogenous mass of the right adrenal causing loss of normal shape and architecture that measures 32.4mm x 46.7 mm. There is no gross evidence of CVC invasion or local heterogenity and fluid of the adjacent tissues.
GI: the astric lumen contains mild gas and fluid and there is normal wall layering observed.
Lymph Nodes: The left and right medial iliac lymph node measure 6.5mm and 5.0 mm.
Assessment: Left adrenal tumor; likely primary cortical over medullary as cause for the Cushings.

12/19/2017 Endocrinology results:
Cortisol 1 Result: 2.5 ug/dL
Cortisol 2 Result: 4.0 ug/dL
Ascn: MEEB06457085 Profile Cortisol Serial 2 ACTH Re: 5032 Tube Labeled 12:00 Re: 5034 Tube Labeled 1:00

11/27/2017 Chemistry results
ALB = 2.4 g/dL
ALKP = 585 U/L H
ALT = 105 U/L
AMYL = 1049 U/L
BUN/UREA = 15 mg/dL
Ca = 8.6 mg/dL
Chloride = 118 mmol/L
CHOL = 217 mg/dL
Crea = 0.8 mg/dL
GGT - 7 U/L
GLU = 119 mg/dL
LIPA = 1333 U/L
PHOS = 3.2 mg/dL
Potassium = 3.6 mmol/L
TBIL = 0.2 mg/dL
Sodium = 153 mmol/L
GLOB = 3.4 g/dL
OSM calc = 303 mmol/kg
ALB/GLOB = .7
BUN/CREA = 20
Na/K = 42

Hematology results
BASO= 0.00 K/uL
EOS = 0.16 K/uL
HCT = 44.9 %
HGB = 15.7 g/dL
LYMPHS *2.05 K/uL
MCH = 24.5 pg
MCHC = 35.0 g/dL
MCV = 69.9 fL
MONOS * 1.27 K/uL H
MPV = 9.4 fL
RBC = 6.42 M/uL
%LYMPHS * *15.7 %
%MONOS * *9.7 %
NEUT * *9.61 K/uL
%NEUT * * 73.4 %
%EOS = 1.2 %
%BASO = 0.0 %
PLT = 333 K/uL
%Retics = 1.4%
RDW = 17.8 %
PDW = 11.5 fL
PCT = .31 %
Band * *Suspected
Band neitrophils suspected

9/9/2017 Endocrinology results
Cortisol 1 1.7 ug/dL
Cortisol 2 2.6 ug/sL
Tube labeled pre Tube Labeled Post

7/30/2017 Endrocrinology results
Cortisol 1 3.9 ug/dL
Cortisol 2 SEE COMMENTS

Result Verified 3.0 Result Verified

7/25/2017 Endocrinology Results
Cortisol 1 2.1 ug/dL
Cortisol 2 See Comments
Result Verified 1.5 Result verified
(I think this is when they messed up the testing then brought him back in at no charge to repeat test, but I am not sure, there are not notes)

7/10/2017 Started on Vetoryl 10mg - 1 capsule once a day (weight @34lbs)

7/7/2017
Endocrinology Results
Cortisol 1 5.4 ug/dL H
Cortisol 2D 4.6 ug/dL H
Cortisol 3D 4.5 ug/dL

I don't think this part is specific to Teddy - maybe just general info for vet to help interpret test results"
Interpretation of dexamthasone Suppresssion test
Low-does dexamethasone suppression test:
Normal: Cortisol Level less than 1.4 ug/dl 8 hrs post-dex. Hyeradrenocorticism: Cortisol level greater than 1.4 ug/dl 8 hrs post dex


7/4/2017 RMC : Test T4 POST 2.7 ug/dL
I think that this takes us to when they were treating him as if it was thyroid and he was on Thyroxine 0.8 mg ("give 1/2 tablet once daily and bring pet in for thyroid bloodwork"


6/9/2017 Endocrinology Results: T4 Post 6.4 ug/dL

4/22/2017 Endocrinology Results: T4 Post = 1.9 ug/dL

3/17/2017 Endocrinology Results T4 <0.5 ug/dL Result verified. The Total T4 result is less than 1.0 mcg/dl. A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism. Please contact customer service for this testing.

3/17/2017 UA/Microscopy
Appear Clear
Bacteria None seen HPF
Bilirubrin Negative
Blood 1+ H
CASTS None seen LPF
Color Light Yello
Glucose Negative
Ketones Negative
PH 7.5 H
Protein 2+ H
RBC 0-1 HPF
TRIPHOS CR 0-1 HPF
SQUAM 0-1 HPF
Urine protein : Creatinine ratio testing is recommended (if the sediment is inactive) to help determine the clinical significance of proteinuria

3/17/2017 Chemistry Results
ALB 3.5 g/dL
ALKP 372 IU/L H
ALT 72 IU/L
AMYL 646 IU/L
AST 26 IU/L
BUN/UREA 13 mg/dL
Ca 9.8 mg/dL
Chloride 111mEq/L
CHOL 572 mg/dL H
CREA 0.9 mg/dL
GGT 9 IU/L
GLU 107 mg/dL
Mg 2.1
PHOS 3.9
Potassium 4.9
TBIL 0.1 mg/dL
TP 7.0
TRIG 267
Sodium 149 mEq/L
A/G Ratio 1.0
B/C 14
Na/K Ratio 30
GLOB 3.5 g/dL
CK 155 IU/L
PSL LIPA 453 U/L H
summary for those say "elevations correlate with abnormal PLI concentraionts. In dogs with appropriate clinical signs, a PrecisionPSL result >216 is supportive of, but definitive for a diagnosis of pancreatitis"

3/17/2017 Hematology
HCT 57%
HGB 20.7 g/dL H
MCH 27.4 pg
MCHC 37 g/dL
MCV 75 fL
RBC 7.6 10^6/uL
WBC 7.3 10^3/uL
ABS BASO 0/uL
Platelet C 312 10^3/uL
Platelet E Adequate
Neutrophil 80% H
Bands 0%
Lymphocyte 13%
Monocytes 6%
Eosinophil 1 % L
Basophils 0%
Aboslute N 5840/uL
Absolute L 949/uL
Absolute M 438 /uL
Absolute E 73 / uL

12/2016 - Not sure why they started the records in March 2017 - we first started asking about his signs: losing hair especially on his tail which looked dead on end in December 2016. She believed the tail was from an injury and change in snout was due to age (although we felt it was sudden and no known injuries).

[Catbud]

One more thing, when I went into my vet to get these records, the girl at the counter tells me that she had a Jack Russell Terrier diagnosed with adrenal tumor Cushings at 14, she had the surgery and he lived another 4 years. So I now feel sick.

[Catbud]

I can't seem to sub-reply to each of you, but I wanted to say to Joan2517 - I read through all of threads about Lena before I posted - I am sorry, you both went through a lot. I am glad you found this board and had support as you went through it. I don't think my friends understand.

Thank you to each of you that asked for more specific information about Teddy. I appreciate your time and caring.

[labblab]

Thank you so much for all this additional information! For our purposes right now, I think these are the three most important results. First, Teddy’s July diagnostic LDDS test result is indeed consistent with a cortisol-producing adrenal tumor:

7/7/2017
Endocrinology Results
Cortisol 1 5.4 ug/dL H
Cortisol 2D 4.6 ug/dL H
Cortisol 3D 4.5 ug/dL

Secondly, it looks to me as though his most recent monitoring ACTH was performed in December, and these were the results. At that time, Teddy was taking 10 mg. of Vetoryl once daily.

12/19/2017 Endocrinology results:
Cortisol 1 Result: 2.5 ug/dL
Cortisol 2 Result: 4.0 ug/dL

If that’s the case, I’m somewhat surprised that NCSU feels it is safe to fully double his Vetoryl dose now. Previously I was wondering whether he could indeed benefit from a dosing increase, but now I wonder whether this doubled dose may be driving his cortisol too low, especially since you say you see no improvement. When does NCSU plan to check his cortisol level again?

And finally, the ultrasound shows that the tumor is in the right adrenal gland. I do believe right adrenal gland surgeries are generally trickier to perform than are surgeries on the left gland. I think this is due largely to the closer proximity to the vena cava. So this is a factor that may increase the riskiness of surgery for Teddy. I am really interested in seeing your new thread this morning about laparoscopic adrenalectomy this morning, though, and wonder whether laparoscopic vs. open adrenal surgery affects the relative risks at all. For folks who have info to share about laparoscopic adrenalectomy, please visit this thread:

http://www.k9cushings.com/forum/showthread.php?8922-Adrenalectomy-via-Laparascopy-Any-experience

Marianne

[Catbud]

Hi Marianne - Thank you for sorting through all that. My local vet is doing an ACTH test Thursday and I will see her in the afternoon so if there are any questions I should ask, please please let me know.

The NCSU vet and my new local vet both agree that the ACTH test does not indicate a dosage increase is called for but Teddys clinical signs say otherwise so that's why they upped his dose. I don't know how quickly I should see a change if there is going to be one, but I cannot tell a difference nor do I see any adverse signs. Mainly his stomach makes loud gurgling sounds that are unsettling and he is pooping less often. I did not see him poop at all yesterday. He is still chasing the ball as many times as I will throw it, but he does plop down when he is beside my bed. This is not new for him to lay around, but he does plop down kind of hard.

Tomorrow I am taking him to a wellness-holistic vet who does Chinese herbs and acupuncture.mainly I am curious.

I started thinking about surgery again but worry the tumor will grow too much by July and also I read Aggies sad story on here last night and was back to being too nervous about surgery. I've sent an email to ask NCSU about larascopy but I do not know if I will get a response. I am going to confirm location of tumor bc there was contradictory info on report.

If you think of anything I need to ask any of theses vets please let me know. I'm checking on here frequently. Thank you!!!

[labblab]

Please know that you are doing a fantastic job of advocating for Teddy! I forgot to write earlier to reassure you that I don’t believe there’s anything we pet parents do, either rightly or wrongly, that leads to Cushing’s. I think it just “happens.” We’ve had dogs here of all breeds, who’ve been fed every type of food under the sun, and who’ve lived very different lifestyles. As of now, there’s just no explanation as to the cause of these tumors, either pituitary or adrenal. But what you’re doing now does matter — you’re doing an outstanding job of educating yourself and weighing alternatives. So kudos to you, and we’re grateful to have you and Teddy as members of our family!

I’ll come back later to post a couple more thoughts in advance of Thursday.

Marianne

[Squirt's Mom]

Here is a link to a list of questions one of our former members put together after her pup, Flynn, faced several surgeries including the removal of a pheochromocytoma, a different type of adrenal tumor than the ones seen with Cushing's.

http://www.k9cushings.com/forum/showthread.php?8555-Questions-for-dog-owners-considering-adrenalectomy

[Catbud]

Thank you - I am trying to learn more but it feels like I am always getting info late in the game. I found these wonderful questions after my surgical consult at NCSU and I have emailed them with questions but no reply yet. Of course they did touch on a few of these - blood clots seemed to be her biggest concern, they mentioned that his unaffected gland has atrophied and might not rebound resulting in meds for life to do that job. I think what really got me is after I decided not to do the surgery they came back in with the info on upping meds and said the internist stated that they didn't expect significant improvement with meds, surgery was the only fix and if I wait there is possibility that there will be invasion by then and/or other adrenal will be further damaged. The surgeon had made it seem like doubling the meds could actually make him a better candidate for surgery - so this was conflicting info and frustrating.

The holistic vet I was supposed to see tomorrow called and said he has jury duty. He also asked if I had considered mitolane to destroy part of the adrenal - I had researched the diff between that and Vetoryl and there was not significant increase in longevity and the side effects are typically worse so I had not given it a lot of thought. He said Chinese herbs could be complement to Vetoryl and would try to reschedule me. Frustrating.

As I put in another post, I am researching larascopy as an option for the adrenal surgery - just surprised NCSU a leading vet school did not mention this when I found multiple practioners in the state who list it on their website. UC Davis had an article in August that says they are pioneering it, but I have found previous articles on it. Wonder why this isn't the go to? Mainly it seems like access is an issue - some of the research studies detailed propping dogs up for procedure. Anyway - I did get a date for surgery in July - do not have to keep it but since NCSU is so difficult to get an appt I thought I would at least get on their books.

I still have Teddy's ACTH test on Thursday and will see vet so if anyone thinks of anything I should ask, please let me know!

[Squirt's Mom]

You might get better response if you set up a consultation with the surgeon who would actually perform the adrenalectomy and ask those questions face to face. ;)

Also, Lysodren is not typically used to destroy the gland or any part of the gland in the US. Some other countries do use it that way and purposely cause Addison's. When used correctly Lyso erodes a minuscule layer of the outer cortex of the adrenals...and that layer will quickly regenerate. It is not destroyed. The drug is used in 2 phases - loading to erode that layer then maintenance to maintain that level of erosion to keep it from regenerating. As for side effects - they are exactly the same for both drugs. What makes Vetoryl seem safer is the short life in the body. It is quickly leaving the body while Lyso stays for up to 48 hours. So if a crisis does happen the Vetoryl is out quicker than Lyso. But BOTH have the same risks up to and including death when incorrectly used. So don't let propaganda scare you. I personally prefer Lyso to Vetoryl. Lysodren works ONLY on the adrenal glands while Vetoryl works on the HPA axis or loop (hypothalamus, pituitary, adrenal) and we are still learning the effects of messing with that loop. ;) Both drugs have the same risks and both drugs are life-savers for our babies. The keys are that YOU are educated on the disease and the drug chosen and that your vet is well versed in the chosen drug with many success stories with it behind them. ;)

[Catbud]

Does this just seem too hard to anyone? Every time I feel hopeful or think I understand, I realize that I don't. I thought I understood the difference between the meds - and the Vetoryl seemed easier on the dog - but now I am questioning that choice. I missed my chance with the surgical consult - it takes 3-4 months to get an appt. I had one on 3/15, but I didn't know all the right questions to ask - I thought it was going to be pretty straight forward. Now I have an appt with a regular vet Thursday for ACTH test on new dose so I will ask about the 2 drugs. The thing is, most people seem to know about and treat the pituitary variety - my original vet didn't even check to see which kind he had - so they only seem to talk about Vetoryl.

Teddy's stomach makes these very loud gurgling sounds and he passes the stinkiest gas now. I wonder if it hurts?

I am trying to stay positive and proactive, but this is hard.

Even his ultrasound report was messed up - it described the tumor on his right adrenal but then in the assessment it refers to tumor on left adrenal. My vet didn't even notice so she probably didn't read the report. I didn't get to see it - so the first time I heard about it is when the surgeon at NCSU asks me which gland it is because of the contradiction. My old vet said yesterday afternoon they would inquire - but I just found out the ultrasound doc is out the rest of the week. Makes me very upset. Not that it determines anything at this point - just frustrated by the incompetence of highly educated people.

[Squirt's Mom]

My apologies.

[labblab]

OK, I’m back again with a few more thoughts. First off, unfortunately there can be a lot of uncertainties associated with Cushing’s diagnostics and treatment in general. So please know you’re not alone in terms of moments of confusion and frustration! We’ve all had our own “moments” at one time or another.

Next, here’s what I hope may be some clarification about Vetoryl. It has been approved by the FDA for treatment of both adrenal and pituitary Cushing’s, and we have seen dogs here with adrenal tumors who have benefited with symptom reduction when treated with Vetoryl. So I’m not exactly sure why the vets at NCSU are so decidedly pessimistic about it helping Teddy. However, I do believe that symptoms, in general, can be harder to keep under control with adrenal tumors, partly because the hormone overproduction can be episodic and somewhat unpredictable.

We have been told that the majority of specialists in the U.S. now prefer Vetoryl over Lysodren to treat patients suffering from adrenal tumors. This is because larger doses of Lysodren seem to be required to manage cortisol overproduction associated with functional adrenal tumors, and in turn, this does increase the risk of unwanted medication side effects. As you’ve already learned, Lysodren has been used more frequently to treat adrenal tumors in Europe with the express intention/hope of destroying tumor cells alongside the other cells that make up the adrenal gland. But this can be a risky proposition involving invoking an Addisonian condition, and I don’t believe that all adrenal tumors will even respond to this type of treatment. I honestly do not know of any members here in the U.S. who have been treated with Lysodren to achieve this goal. So the bottom line is that I believe Vetoryl would be recommended for Teddy by more specialists here than not.

As far as figuring the correct dosage of Vetoryl, we have always relied on ACTH stimulation tests here in the U.S. However, we’ve recently discovered that vets in the U.K. and Europe are switching to a monitoring protocol that involves testing the resting cortisol right before the next dose of Vetoryl is due to be given. This has resulted in some different dosing recommendations, and this may be what the vets at NCSU are referring to when they say the ACTH is best used to make sure that overdosing is not occurring, as opposed to deciding when to increase a dose. I’m going to give you a link to a new monitoring chart that the makers of Vetoryl have published in Europe. As you’ll see, the increase in Teddy’s dose may be warranted since his Cushing’s symptoms remain present. However, fully doubling the dose does seem like a lot, and for his safety, I think it will be good to have a full ACTH preformed again this week. Anyway, here’s the link:

http://www.k9cushings.com/forum/attachment.php?attachmentid=8265&d=1521562345

Right at the moment, I don’t have any new questions for you to ask on Thursday. But I’ll definitely add any that come to mind tomorrow.

Marianne

[lulusmom]

Thank you - I am trying to learn more but it feels like I am always getting info late in the game. I found these wonderful questions after my surgical consult at NCSU and I have emailed them with questions but no reply yet. Of course they did touch on a few of these - blood clots seemed to be her biggest concern, they mentioned that his unaffected gland has atrophied and might not rebound resulting in meds for life to do that job.


It is not uncommon for dogs with unilateral or bilateral adrenal tumors to be on lifelong gluccocorticoid and mineralcorticoid supplementation after surgery so this is not such a bad thing as these dogs’ prognoses are usually better than dogs who are treated palliatively with mitotane or trilostane. The NCSU professionals seem to be Debbie Downers. LOL Have you asked them straight up what they would do if it were their dog and did you ask the surgeon how many of these surgeries he has done, what his success rate is and average survival time in dogs with circumstances mirroring Teddy’s? Based on the information you have shared with us, it sounds as though Teddy is an excellent candidate for surgery but dang, it's still so dang scary. If you were in So. California, I would be pushing you to see an amazing surgeon there who is one of the most brilliant surgeons I’ve dealt with. I’m a special needs rescuer and he saved dogs that other surgeons suggested we euthanize. He’s performed adrenalectomies on two members’ dogs with great success. I believe risks of adrenal surgeries are definitely reduced if the surgeon is highly skilled and has done a whole lot of adrenal surgeries.


I think what really got me is after I decided not to do the surgery they came back in with the info on upping meds and said the internist stated that they didn't expect significant improvement with meds, surgery was the only fix and if I wait there is possibility that there will be invasion by then and/or other adrenal will be further damaged.

I don’t believe the internist was talking about symptoms when he said he didn’t expect significant improvements with Vetoryl but rather that Vetoryl would not have any affect on the slowing down progression/invasion of the tumor. As Marianne has already mentioned, with the vast experience with Vetoryl in the last decade, Vetoryl has become the treatment of choice for those dogs who are either not good candidates for surgery or surgery is not financially feasible. It is usually very effective in reducing cortisol in dogs with adrenal tumors. It is well known that adrenal tumors are highly resistant to mitotane so it’s normal for people to think that might be the case with Vetoryl but that’s not the case. I discovered in my research that adrenal tumors are very sensitive to Vetoryl and specialists aften initiate treatment at lower doses than those recommended by Dechra. I have cut and pasted an excerpt from an article entitled SELECTING THE BEST TREATMENT OPTION FOR A DOG WITH CUSHING`S SYNDROME by Sara Galac, Dept. of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrech, The Netherlands. Sara Gala is a well known clinician I follow and believe she is very much influential in establishing treatment protocols adopted by Utrecht. FYI, Utrecht is no less renowned than U.C. Davis and I am always looking for new publications coming out of both of those institutions.

“If there is metastasis of a functional AT or if neither adrenalectomy nor adrenocortical
destruction with mitotane is an option, trilostane therapy can be used as a palliative
treatment [67, 68]. Although the manufacturer’s recommended dose of trilostane
does not differentiate between treatment of pituitary and adrenal hypercortisolism,
experience has shown that ATs are more sensitive to trilostane than are hyperplastic
adrenal glands. At this institution, the starting dose of trilostane used in dogs with AT
is 1 mg/kg body weight is. Monitoring of trilostane therapy consist of evaluation of
clinical signs and the ACTH stimulation test, as in trilostane therapy for PHD [1,12].
The median survival time in dogs with ATs treated with mitotane were 10 and 15.6
months and in those treated with trilostane it was 14 months [69,70]. In both studies
mitotane was used in a protocol for selective destruction to resolve the clinical signs
and not for complete destruction of the AT and metastases. It is thus not surprising
that the survival times for mitotane and trilostane were similar. However, in both
studies survival of animals with metastases was significantly shorter than in those
without. This supports the use of the protocol to attempt complete destruction with
mitotane and continuing weekly administration.”

I’ve attached the full article for your reference below. The excerpt above is the last two paragraphs of Medical Treatment starting on page 12. The entire text is a very good read so you may want to read it when you have the time. The author has done a good job of writing this article in terms that are easier for us laypeople to understand.


The NCSU vet and my new local vet both agree that the ACTH test does not indicate a dosage increase is called for but Teddys clinical signs say otherwise so that's why they upped his dose.

I was happy to read that they added a 10 mg pm dose. Vetoryl has a short half life, meaning it’s enzyme blocking abilities start to fade as early as 8 hours post dose so it’s possible that prior to switching to twice daily dosing, Teddy’s cortisol was not being well controlled 24 hours a day and thus symptoms did not resolve. I will be interested to see the results of the next acth stim test. I realize you still haven’t seen any improvement in symptoms but it’s not always instant gratification with Vetoryl so it may take a bit more time.


I started thinking about surgery again but worry the tumor will grow too much by July and also I read Aggies sad story on here last night and was back to being too nervous about surgery. I've sent an email to ask NCSU about larascopy but I do not know if I will get a response. I am going to confirm location of tumor bc there was contradictory info on report.

That’s fine but in the meantime, as the surgeon has already mentioned, it would be optimum to get Teddy stable on an effective dose. Dogs undergoing adrenalectomies are routinely treated with Vetoryl prior to surgery. I’m keeping fingers and paws crossed that Teddy’s symptoms start to improve.

I agree with Marianne, you are an awesome advocate for Teddy and are leaving no stone unturned. There are few things in life that we are confronted that are less traumatic than having to make these tough decisions. We can only do the best we can with the information we have and I sincerely hope that we’ve been able to help with the information. No matter what you ultimately decide for Teddy, we’re here for you both.

8274

Here is another good read by J. Catharine Scott-Moncrieff, MA, Vet MB, MS, DACVIM DECVIM
Department Veterinary Clinical Sciences, College of Veterinary Medicine
Purdue University, West Lafayette, Indiana, USA Dr. Scott-Moncrieff is a well published and expert endocrinolgist and internal medicine specialist who has co-authored many chapters in internal medicine teaching textbooks.

8275

Hugs,

[Catbud]

Thank you for the thorough and thoughtful reply. It was very helpful.

I just got a call from my vet, and I am really upset - I think I mentioned in one of my posts that there was contradictory information on the ultrasound. Under descriptions it said right adrenal and under assessments it said left. I did not get a copy and only learned about it when I was sitting in front of the surgeon at NCSU - and I told her I thought it was the right. I spent today trying to find out and just got a call that the ultrasound doctor is so sorry for the mistake - it is the left. So the surgical consult was based on incorrect information, my vet never read the report or she would have seen it. I feel really sick. Maybe it would not have changed my decision or the advice- but they definitely made a point of saying that the right adrenal is harder to access.

[labblab]

Well dang — that is beyond annoying!!! However, maybe the good news is that you may be less pressured to make a surgical decision as quickly? If the risk of invading the vena cava is eliminated, then perhaps a bit of the urgency also falls away?

Marianne

[labblab]

Just now saw the new photos in your album, and they are soooooooooooooooooooo sweet!! (And that includes the human sweeties, too ;-)))))))

[Catbud]

Believe it or not, that is the same boy in all the pics with Teddy! Adam got Teddy in November of 2005 for his birthday and the last pic together is from January 2017.

[labblab]

Omigish, that makes me cry it’s so sweet. I just now showed the pictures to my hubby and he is ooooohing and awwwing, too. Adam is so handsome, and seeing him and Teddy growing up together — well, that’s just about as good as it gets...! No wonder Teddy is so closely bound to your heart.

[Catbud]

Thank you - it made me feel good to share the pics. I just added one from today so it shows what he looks like with cushings - kind of pitiful but I have lots of happy, healthy pics and I need to focus and be grateful!

[Catbud]

Update on Teddy - I went to the holistic vet today who did acupuncture and made food and supplement recommendations based on his chi. It was interesting. He was surprised at how peppy and sweet Teddy is - he had never seen a dog with adrenal cushings and did not know of any dogs who had surgery. I went to a specialty pet store and got some food that fits his suggestions - that was expensive! I'll have to check out the internet for some deals. He said no dry food or dry treats so I bought cans because it is not realistic for me to cook food for Teddy (I don't even cook for myself - just had toast and peanut butter for meals today!). I see a normal vet tomorrow for the ACTH test. My old vet has been reaching out - they are trying to schedule another ultrasound to make up for the botched one and offered to have me meet with a different vet in the practice. I think Teddy is pooped from his outing and he has more fun tomorrow with the test. Marianne had a good point about it being a blessing about the ultrasound mistake because at least I might get another picture of what is going on inside Teddy without having to pay another $400. I'll check back in case anyone has any suggestions for the meeting with new vet tomorrow. Thanks!!!

[Catbud]

Help - confusion continues.

Teddy had his ACTH test yesterday - the first one since he doubled is Vetoryl for 2 weeks

His levels were 6.7 and 7.1,

They want to up his dose again from 20mg (10mg 2x/day) to 30 mg (15mg 2x/day). the 5mg have to be ordered so not sure when I will actually start that. I said i was surprised his levels went up despite doubling his meds and she said that adrenal tumors are erratic and harder to control.

He is having another ultrasound Monday. There is a local surgery center that would do the surgery for much less than NCSU- but my son says he doesn't want to put Teddy through all that. Honestly, if it was just me, I would do the surgery and accept the results because it could make him better and he is deteriorating as he is. But technically he is my son's dog and I don't know that I could face him if I push for surgery and Teddy dies.

If anyone on here can help me understand those test levels, I would appreciate it!

[labblab]

They want to up his dose again from 20mg (10mg 2x/day) to 30 mg (15mg 2x/day). the 5mg have to be ordered so not sure when I will actually start that. I said i was surprised his levels went up despite doubling his meds and she said that adrenal tumors are erratic and harder to control.
Under these circumstances, I do think it makes sense to increase Teddy’s dose. Every dog must be treated individually, and it appears as though an increase is warranted given his continuing symptoms and the cortisol increase on this test. That does seem to be one the big challenges of adrenal tumors — gaining consistent control of the hormone production.

We’ll all be so anxious to see the results of the new ultrasound. I’m really hoping it will lend more clarity to your path forward. Let’s see what you find out on Monday, and hopefully we’ll then have even a better basis to review your options. In the meantime, please give Teddy a big hug from all his family here!

Marianne

[Catbud]

Teddy had his ultrasound today and a consult with a vet. His ultrasound did not indicate the tumor had grown. The other adrenal gland was noted to be smaller than it was in January. Nothing else significant was reported - she did mention imaging of testicles showed some type of nodules but she was not concerned. There was no indication of any blood vessel invasion by the adrenal tumor.

I met with a new vet (free consultation at my original vet to make up for the previous lax treatment). She said if it was up to her she would do the surgery because she expected Teddy would continue to decline and it would be worth it to her to try for improvement given his upbeat disposition. She acknowledged the risks and asked me what my fears/concerns were.

Cost: Their is a local surgeon who could do the surgery and provide aftercare for considerably less than NCSU estimated. I would need to find out his level of experience but cutting the cost in half certainly helps and I would not have to take off work if I did it locally. Furthermore, this Vetoryl is not cheap and they are upping his dose. a 30 day supply is about $120 and then there is the testing. So I am easily spending $200/month.

Fear: He could die and my son doesn't want him to have the surgery. I would feel bad to tell my son I did the surgery and his dog died but he is not here (he is in college) watching Teddy decline. He will not likely be here when I have to make a decision about Teddy if he deteriorates further. I would be sad and miss Teddy if he died, but I would know that I was trying to give him a better quality of life and he is not suffering.

Worried about emotional impact on Teddy: I am worried Teddy will feel abandoned at the animal hospital and not know why he is being put through that . The vet says I am putting my own emotions on Teddy and that although he may miss me and be happy when I visit , as long as his pain is managed and he is cared for, he will not be emotionally upset. Not sure if I believe her. My other dog Tucker acts low when Teddy isn't here and he is cared for - so I think they do feel emotions.

Worst case scenario: Teddy suffers physically following the surgery. This would be very hard to deal with and I would feel guilty and sad. I didn't think about this too much until I read a story on here about a dog that suffered, I think his kidneys failed - and it made me very sad.
I feel selfish letting him deteriorate because I am scared and I feel selfish putting him through surgery when he could potentially live a year or more like this.

My husband wants me to do the surgery. The Vet says I need to decide in the next week or two. I am still struggling. I know no one can help me with the decision - I am an incredibly indecisive person to begin with so this is awful. I don't know what to do and how to find peace.

[labblab]

My heart goes out to you while you struggle with your decision! I’m a very indecisive person, too, and often torture myself (and those around me!) with my uncertainty...

You are right, however, that ultimately you’ll have to make the final decision yourself. Whatever you decide, though, I urge you to discuss it with your son as thoroughly as possible beforehand. At best, your physical relationship with Teddy will last only a couple more years. God willing, your relationship with your son will last for the rest of your lifetime. It would be very sad to have a shadow of resentment cast over that relationship for years to come. So I think it’s very important for you to talk with your son in depth, beforehand, so as to discuss the feelings and thoughts you both have about this.

Another reason why I think it’s very important for him to know beforehand if surgery is to take place is to give him the chance, if he wishes and if it’s possible, to come home to see Teddy, perhaps for one last time, beforehand. Otherwise, if Teddy were to die during surgery, your son would never have had the chance to say a preparatory goodbye and try to gain some peace for himself. During my years here on the forum, I do believe that the lack of the chance to say goodbye has brought the greatest grief and regret in this type of situation — when death has occurred abruptly when the dog is in the hospital and is separated from the family who loves him so dearly. Hopefully, none of this will even apply if Teddy has the surgery. Hopefully he’ll do well and make a full recovery. But as the old saying goes, you hope for the best but prepare for the worst.

I know there is no easy path forward for you, and I’m so sorry. The natural aging of a pet, in and of itself, can be so daunting. The years pass by so quickly — how is it possible that our puppies are puppies no longer, and the muzzles start graying and the walks grow shorter and slower?? When you layer on top the cruel ravages of disease, it all seems so unfair. Both for our pets, and for ourselves. Please know that we understand, and will remain right here by your side no matter which decision you make.

Marianne

[WinstonTheWestie]

My heart goes out to you making this tough decision. I spent many nights crying in bed, stroking Winston's fur, asking him what he wanted me to do and begging him not to die. I don't envy you having to make this decision for Teddy. Like Marianne and everyone has said, we understand and will support you here with whatever decision you might make.

[Joan2517]

Marianne is right about the goodbyes. My Lena died in the hospital without me and even though I said goodnight and told her over and over how much I loved her, it still torments me that she died alone and I didn't get to say goodbye.

[molly muffin]

I wouldn't wish on anyone to be in this position. It's a hard decision to make as there are no guarantees and it can go either way.
I'd want to know the surgeons experience with adrenalectomies and what the success rate has been. Where they most often see complications, etc.

I'd definitely have your son have the chance to see Teddy before if possible and you decide to do the surgery.
I think we often put our emotions onto our pets and what they would think or feel, but I agree they have their own emotions for their own reasons. They are never as happy as when they are at home with their pack, which is what we humans are to them. When our molly was in the hospital we went to see her as often as we could, as we couldn't bear to be away from her. She on the other hand, while I'm sure missed us what making friends with everyone at the vet hospital that she didn't already know and have under her paw. (She was a bit of a diva I admit) :)

Let us know what you decide and if you want to talk anything over we are here for that too.

[Catbud]

Teddy is scheduled for surgery Thursday. He goes in for blood work tomorrow. They will do a CT Scan and if there is any sign of other disease, we will not do surgery. We are doing it locally. I can't afford NCSU - really I can't afford local but they are $4000 rather than 6-8,000. The surgeon has done 3 of these surgeries since August. He said he was involved in about 10-15 in residency. He thinks Teddy is a good candidate.

I talked to Adam about it. He was okay with it. He is being much more practical. He says Teddy has had a good life and I should not feel like I have to do extreme things for him. He said he is off at college and chances are that he will not be home when the dogs pass and he has accepted that. I am not sure that I believe he will not still be upset.

As far as me, my rational head says we do not have $4000 for this - and it's possible that Teddy will not live that long even if the surgery is successful. And there could even be other things wrong with him. I gave him a bath tonight and he has lost even more hair and there are red blotches on his back that I do not remember seeing before. He had a wart like growth on his eye - I guess unrelated - but when I was throwing the ball for him in the yard, he came in and it was bleeding. That freaked me out - so imagine what I will be like if he has complications from surgery.

I feel sick and sad. It hurts my heart to watch him deteriorate. He doesn't know that there is an option for surgery. No one - except maybe my husband - will make me feel bad for not doing the surgery.

He is still active and in a good mood. Hungry all the time and scrawny. Doctor at NCSU when pressed said she guess he could live about 12-14 months as it progresses.

If I don't do the surgery Thursday - if I change my mind - that will be the end of the debate. They said I need to do it if I am going to do it. They said they can up his Vetoryl to 30 (15 2x/day) but since 20 isn't doing anything, I do not have hope for that.

As you can tell - I am still struggling. I have never watched a dog decline. I guess I should have been prepared for this but it is sad. And this is my first year with an empty house - my husband took a job out of town and only comes home on the weekends and the boys are away at school. My job is super stressful - all I do is take care of other people. I am exhausted and trying to figure this thing out. I keep praying for a clear answer. I love my dogs but when I come home after I feed them and throw the ball for Teddy it's not like I am actively doing things with them - they just lay on their beds or floor in Teddy's case next to my bed. I did not expect this to be so hard.

[M&Inu]

Hi, I am also a junior member, struggling with this terrible disease in my dog. But I wanted to give you good thoughts and wishes for all the decisions. And just a thought about the warts: my dog Inu has two, one on the head right in the middle of both ears, and one on her right front leg, I put CBD oil directly on them, and they have closed, wont bleed and are regressing a bit even. Also for difficult to heal sores (Inu has them on her hind leg, pressure sores, higromas) I have been using propolis in spray, followed with honey membranes with success for a month and a half now.

[DieselsMom]

Such a difficult decision. I'm in the beginning stages of this journey. Wishing you and Teddy good thoughts regardless of what you decide.

[labblab]

We are all here alongside you, anxiously awaiting those test results today. I’m so glad you had the chance to talk with Adam about this, and now we’ll all just see which path beckons Teddy forward. I hope you can truly believe that there’s no wrong decision here, because whatever you decide, it’s based upon your love for Teddy. Either way, it’s because you love him dearly.

So let us know as soon as you can. All fingers crossed for you guys!

Marianne

[Catbud]

Thank you - that was really sweet. I didn't hear anything today - the bloodwork was to match him for possible transfusion. The doc said they might wait and do CT scan in the morning when he is sedated so they can inflate his lungs and see clearly. If they see anything abnormal they will not do surgery which would be sad but good to know. If it's a go, they will do surgery and call me. I just tried to go see him and they said they were too busy which made me sad. They said they were down two rooms because they were disinfecting from something contagious - that was not very conforting. I wanted to see him but I also thought it might upset him. It's been a long time since he was boarded and even then his pal Tucker was with him so I worry he is sad. I know I am sad. I've been weepy for several days now. I want to be able to come on here and post happy updates - I need to try and think positive.

I was surprised the doc said if Teddy is tolerating anesthesia and the surgery well they were gonna go ahead and neuter him at the same time which kind of surprised me at this stage of life to bother to do that they did see some nodules in his testicles on the ultrasound and he said all those those are not likely to spread it's just good to deal with that just seems like additional unnecessary trauma the vet says that Surgery is not very Trumatic and it won't be a big deal and I forgot to even ask him about it today I'm wondering about calling back but I guess he knows what he's talking about I don't know why we never got Teddy neutered but we just never did.

Anyway so many things I'm second-guessing now and just having hard time - thanks again for your kind words

[Joan2517]

If he were my dog, I would not go for the neutering at this point. I was also afraid to upset Lena while she was in the ER, but am glad that I kissed her goodnight and told her how much I love her both times.

[labblab]

Holding you all in my heart today. Surely hoping that all will go well!

Marianne

[Catbud]

Teddy came through the surgery. Doctor said there was not much bleeding. The tumor was much larger than he has seen. The right adrenal was very small - so we will wait to see if it functions. Doc took a couple spots from his liver and sent for biopsy - they were not masses, just variation in color so he doesn't think they are anything but he wanted to check. Teddy is in ICU - I just talked with the nurse - they are monitoring him. He has had some re-gurg but the nurse said that is not unusual. She said they were going to get him up which shocked me. She kept describing him as very flat. They also neutered him - which I had mixed feelings about but there were nodules in his testicles on the ultrasound so I think they thought that was a proactive thing to do - I wondered if it wasn't too traumatic, but it's done so no sense in wondering now. I visited Teddy last night (thought of Lena and your advice). I knew I would regret not going. He looked pitiful and it's so obvious he was deteriorating that I think the surgery was worth the risk - but I am of course scared for him now. I've read posts on here where things went wrong after surgery, but I am trying to stay positive. Thank you for your good thoughts and prayers.

[labblab]

Thank you so much for posting your update! Such a huge relief to know that Teddy came through the surgery. WHEW!!!! I know there’s still a lot to get through, but thank goodness the surgery is all done. Still keeping my fingers crossed, and sending healing thoughts straight to Teddy. Hoping you’ll be able to rest just a tiny bit easier tonight, yourself. We’ll anxiously await tomorrow’s news.

Huge hugs to both of you,
Marianne

[WinstonTheWestie]

I'm glad Teddy made it though the operation! I think they told us that it was really important to get them up after surgery to help avoid the pulmonary thromboembolisms. I thought about you all several times today I'll keep my fingers crossed that he continues to do well!

[Joan2517]

So happy that he made it through the surgery. And I'm glad you went to see him...praying that he continues to do well and comes home soon.

[Catbud]

Update on Teddy -

He is doing okay! I went to see him Friday evening - had to wait over an hour because they were busy - and when they brought him out, he walked right past me heading to the door. I tried to visit with him in the visiting room, but he got too worked up, panting and shaking, so I have stayed away since then. I had it in my head that he would feel abandoned if he didn't see me, but I think dogs don't have a sense of time like us and as long as he is cared for, I think it's okay. They have called each day to say he is doing well. Up and walking around, eating, going to the bathroom. When they called today, they said he would be discharged on Monday (tomorrow) so I should expect a call to set up the discharge appointment. They said I would see the nurse/assistant, not the doctor which surprised me but I don't need to be reactive, if he is okay then that is fine.

I am anxious about bringing him home. Keeping him safe and making sure his meds are correct. I have work this week of course. I have a student who I can pay to come and dog sit but there will still be some hours when the dogs are alone. I may have to separate them to ensure Tucker does not mess with Teddy's stitches or try to play. I don't crate them - they have a little room under the stairs and I use a baby gate to keep them in there together. Seems cruel to lock Teddy in and have Tucker on the outside looking in. I am not sure what the bet thing to do is - it's hard for me to miss work so I am trying to do the best thing I can. Kids taking a test on Thursday so I am take that day off if I can find a sub who won't let them cheat!

I don't know what to expect as far as Teddy's recovery. Will he gain back the muscle mass he lost? Will his hair come back? Will his eating and thirst be normal? How long until we are out of the woods for blood clots and infections? I am kind of scared about these things.

Thank you all for following and supporting me during this - I felt crazy, but I think I did the right thing. I just want things to go okay when I bring him home and for him to be his old self!

[molly muffin]

Hello and very glad to hear that Teddy is recuperating. I think they say a couple week for the blood clot issue to go away. Once they are healed internally, then they should be okay. Crossing fingers of course.
They will probably have him on prednisone for awhile and try to slowing taper that off to see if the other adrenal gland will kick in.
Hopefully his coat will come back in once the cortisol levels are where they should be, either on medication or naturally.
Hind leg weakness can either come back or not. We've seen it go both ways.

The main thing is to take it easy for awhile, no running and jumping till he's healed.

Kellie, having been through this will have more insight I'm sure for you.

[Catbud]

He's home - I picked him up after school. He jumped over the seat in the car when I went around to get him out so of course I am paranoid he did some thing to himself. That has been about 45 min so I guess he's okay. He ate some food and walked around. I tried to lock him in his dog space so I could get stuff out of car, but he started yelping. Not sure if he jumped up and hurt himself or if he didn't want to be left. He's never been vocal so I felt bad.

He's lying on the floor beside. His legs are shaking. Can you tell I am obsessing? He used to shake a lot when he was excited, but not just when he is resting. Hopefully both of us will calm down and relax so he can get better!

[labblab]

Sooooooooooo glad that he’s home!! I totally get it about the obsessing— my dog was boarded over the weekend (just boarded — not major surgery!) and even I’m obsessing because she’s agitated and trembling and that’s weird for her.

So I definitely get it and I know you’ll watch him like a hawk. Continuing to keep all fingers crossed for a complete recovery!

Marianne

[Harley PoMMom]

That's great he is home, I bet is so happy to be with you!

[Mari]

I hope Teddy is doing well today. We thought about going up to NCSU but our vet found an excellent Cushing's specialist here in the Triad and referred us. So glad Teddy is home!

[Catbud]

Teddy's eye is irritated where they took off a growth - it was oozing so I took him in. Then the surgeon noticed his skin is dying where the stitches are on his abdomen and is worried the wound will open. I have to bring him back Thursday afternoon for recheck (or before if it opens). He said he never saw it before but attributed to poor circulation in Cushing dog. I'm worried. Taking day off tomorrow but I hate to miss school.

[Joan2517]

Oh man, that's terrible news. Poor Teddy, poor you! I hope it is a minor complication and can be resolved quickly. I'm glad you're taking the day off...I wouldn't leave him by himself until it was given the all-clear.

[labblab]

Gosh, I’m so sorry, too! We don’t want ANY extra problems at all for Teddy! But I guess it’s lucky in a way that the eye issue came up so that you took him in to be seen and the surgeon is now on high alert re: his skin/stitches. This way, if something needs to be done about it, he’ll know sooner rather than later. Like Joan, I’m sure hoping it’ll turn out to be a minor glitch, though.

[Catbud]

This is hard. He's breathing kind of heavy for a resting dog - my other dog is resting and I can't hear him but teddy is breathing loudly. I just had him up, fed him and he peed. Then back in the crate beside me. I just want something to be easy. He wasn't breathing loudly last night and he saw the vet just six hours ago so I think they would know if there is stuff to worry about. It's very disconcerting to sit here and hear his breathing. He pops right up if I move and he is eating and drinking fine. I don't know what this is about. Sorry for the blow by blow.

[Joan2517]

This is what happens with us, we watch, we listen, we obsess over every little thing. If you think something is wrong, take him to an emergency clinic. You know him better than anyone else.

[Budsters Mom]

Pain can cause heaving breathing and restlessness. Did the doc give you any pain meds, such as Tramadol for Teddy?

[Catbud]

Yes - He gets Tramadol and Gambentin every 8-10 hours. I was thinking that too about the pain. He has not been crated in years so that's different too but he's tolerating it as long as I am close by. He is having lots of gas so upset stomach may add to it. He was up at 5:30 peed and pooped and ate and took all meds. Put in eye ointment to best of my ability. Hopefully everything improves. I'm staying home with him but would love to run out to store - wish I had someone to sit with him (or a personal assistant to go to store)

[Budsters Mom]

Could being crated be upsetting Teddy? Maybe an exercise pen or soft sided pen would help? Possibly gates and a small corner would work also?

[Catbud]

I have a little room under the stairs that he is used to - I use a baby gate so he's not just in a closet - but he can jump around so that's why I am doing crate. Plus he would not deal with that at night - he had to be near me. Crate is right beside my bed.

The vet called right after I posted that about his breathing and he told me not to worry about it unless he seems in distress. I think he does get more restless when the pain pills wear off. His eye aggravates him too. Wish that thing would heal - I'm supposed to put ointment on it 2x a sag but I've been doing 3 because it starts to bother him and he'll push his head into the bushes to rub it.

His stomach looks the same - I used my phone on selfie mode and hold it under there to take a pic. That helps because I can compare - it's about a 5 stitch section that's black and it is not any bigger or blacker so that's gotta be good. I just want that thing to stay closed!!!

He is pooping and peeing and eating and he gets up without trouble so those are all good signs.

Back to vet tomorrow to check the incision. I'll update and let you know what he says. Tomorrow will be 7 days since surgery.

[Harley PoMMom]

Yep, the eating, getting up without trouble, pooping and peeing are all good signs!!! Wishing you both the best of luck tomorrow! Will be waiting anxiously for that update!

Lori

[Catbud]

Hi - I posted yesterday after vet visit but I don't see it so I guess I didn't do something right. Sorry - quick update bc I'm late to work - Vet said his stitches / dead skin did not look worse so that is a good thing. He said his eye did not look worse so that is a good thing. so apparently our bar is "not worse". That's okay. He said the disease will make him slower to heal so just be patient with eye. He says we may get lucky with incision and it may be superficial skin that died and underlayer may hold and heal.Im going to work today. I have someone coming by to let dogs out and sit with them at 11:45. Hope that goes well. Waiting til the last minute to give Teddy pain meds so they last the day. He has already eaten, peed and pooped. He slept til 7am. Sad that I (and his old vet) let him deteriorate and I'm hoping he can gain back his muscle and his skin improves. Hoping he continues to do well - thank you for your support.

[labblab]

So glad to get this update! I’m sure hoping all goes well today, too, so that the weekend can be a peaceful one for you guys.

Marianne

[molly muffin]

Come on Teddy. Hoping to hear that he starts to heal in both areas soon. It's a worry until they are all better and back to normal.

I've often though a personal assistant would come in handy too. LOL You really do need one.

[Catbud]

Teddy has had a set back. He's bleeding from stitches and oozing so there is infection. They are putting him under anesthesia to cut out dead skin and starting him on antibiotics. Will keep him at least overnight - risks with anesthesia, doc is hoping they caught infection in time. I feel sick.

[labblab]

Oh no!!!! We’re right here beside you, sending healing wishes and prayers to Teddy. Please let us know as the day unfolds.

And tons of comforting hugs to you as well!
Marianne

[labblab]

Checking back again and hoping so much to hear some good news.

[Catbud]

Sorry - really long day. They. Had to put Teddy under and cut out dead skin and close. They kept him. Started him on IV antibiotics and sent skin for culture to identify infection. His incision is so long - it literally goes from one end to the other -he said some areas had healed and some places had to be redone. I have not heard anything else. I've gotten too run down with worry - I worry over my kids, my dogs, my students...I'm not ready to lose Teddy so I'm hoping he comes back from this - doc said his immune system is compromised from Cushings and now prednisone ...he may cut him back on prednisone sooner than planned but of course have to watch out for Addison crisis. I have not heard from anyone this morning - going to go to work. Thank you all for your thoughts and prayers.

[labblab]

Poor little boy, and poor you :-(((((((((((((((((((((

Surely hoping that today will be a better day, all the way around!

[Harley PoMMom]

Tons of healing thoughts and prayers being sent your way along with huge loving hugs.

[Catbud]

Hanging in here - Teddy home, on antibiotics, acting okay, maybe a little sleepy - no pain pills this time so he may hurt a little idk - hasn't pooped yet but eating, drinking, peeing...incision looks okay but they told me to keep it clean - he lies on the floor and dog beds that are not sterile so not sure how I keep it clean - but hoping for the best. Adam is home so he got to see him first time since surgery - he feels bad for him but sees that he acts pretty much the same. Going back Thursday for recheck - thanks for thinking of us

[Squirt's Mom]

Just wanted to let you know that Teddy and you have not been forgotten.

[molly muffin]

Recheck tomorrow right? I hope that this time those incisions heal and no more infections. If he can just get past the infections now and get weaned down on prednisone so you can see if that other adrenal gland will produce on it's own (what you really want to happen) then it seems he can surely over come this dratted infection. Positive vibes here for you. :)

[Catbud]

Yes - Teddy has a recheck tomorrow - not sure if any more sutures will come out, the discharge papers said a couple weeks.

He is down to 1 prednisone a day (2.5mg tablet). I hope that lowering the dose will also increase his healing ability. I have not been able to get a good look at his incision since Sunday - if he is lying down and I try to get a look, he immediately pops up - mainly to see if he can get a treat.

He is eating okay - but has decided he doesn't like the fancy duck dog food I bought him - and considering he was eating paper towels before, it's interesting to see him be picky.

One change though is that his skin is looking worse - he's lost hair on his elbows and they are red and scaly - they were not like that before the surgery. Also his tail - which had a calcified tip - is more pronounced and looks like it has been bleeding today. If these are cushings symptoms, I don't know why he would be getting worse. I know I should not expect symptoms/clinical signs to reverse so soon after surgery, but I didn't expect things to look worse.

I'll try to update after to visit to the surgeon tomorrow. Hopefully infection is not an issue and skin is healing.

Thank you for checking in!

[Catbud]

The vet was pleased with Teddy's progress - he thinks the skin is healing/closing. Plans to see him back next Friday for suture removal.

He thinks the bald elbows and bleeding tail may be from the crate. I'm not convinced but I think that answer better than other possibilities.

Teddy will not eat his canned food - but he eats other stuff like treats and tonight some dry food - so I don't think his appetite is compromised.

He is very peppy - have to hold him back.

He is still so skinny - and bald - but trying not to focus on that.

The eye seems better - I'm going to keep doing the ointment in hopes that it heals.

Surgeon made plans to do a ACTH test the day we take the sutures out - but suggested several times I might want to do that at his regular vet so I may change that plan since after the sutures come out they are probably who I will work with on the plan with the prednisone dosing.

I need recommendations for some healthy dog food he will eat! I was getting him duck and whitefish based on a chi-thing and his energies (he needed the cooling food ) but I may have to scrap that.

That's all I have for now - I am kind of exhausted!

[Harley PoMMom]

All in all it sounds like good news!!! Will continue to send healing thoughts and prayers. Regarding weight gain, carbs can help with that, things like pasta, potatoes...etc.

[Catbud]

I feel like it will seem like I am looking for trouble, but I feel there is something wrong with teddy. He is drinking noticeably more water. His stools are loose - I thought it might be because I have tried some new foods, but not sure. He is losing more hair. And I've been grading papers for hours and he cannot settle - usually he lays down and falls asleep,but he will settle for a few minutes and then jerk up and seem like he cannot get comfortable. He is getting pickier with canned food, but will eat some dry food for now. He is practically bald in places and I have put a pillow in the crate and he has dog beds all around the house so I don't think it's just from crate. Supposed to have ACTH test this week and another stitches check - not sure if I should take him to his normal vet for a check or keep going to surgeon. Honestly if anything significant is wrong, I don't think I can keep this up. It's very draining - I'm selfish, I just want him to be better now. I don't leave him except to go to work - I don't get out, exercise or socialize. I should be grateful the surgery went well - just want a sign that he is going to get better and I can stop worrying and being hyper-vigilant. Maybe when the incision is fully closed ...

[Catbud]

So Teddy has a bump - like a small bulge on his upper belly, right about where the incision started. I noticed it a few days ago - it is flexible, I can press on it and it gives, but it is solid... looks like the end of a bone or something ... my son wondered if it might be a hernia. I looked up pics - of course the most crazy ones come up first, but I did see something similar. I have emailed regular vet and I guess I'll call surgeon tomorrow. I certainly hope I wrong.

[labblab]

Darn, yes, a hernia does seem like a possibility. I wonder if another possibility might be a hematoma, or collection of blood, from some sort of leakage or tear associated with the incision. I do think it’s best to notify the surgeon and/or let your vet take a look. I’m so sorry that Teddy’s post-op course has been so difficult. There was so much stress leading up to the surgery itself — I was really hoping you guys would catch a break afterwards.

Prior to hearing about the bump, I was planning to write to encourage you to get that ACTH done, because I was wondering whether some of his discomfort/symptoms might be due to the early weaning of the prednisone/low cortisol. But now I also wonder whether the bump — whatever it is — is contributing to his restlessness. Poor guy, and poor you! Please let us know what you find out.

Marianne

[Catbud]

I emailed his vet and she responded this morning which was nice. She asked me to bring him in sooner for the acth test bc of the symptoms. She said bump might also be fluid build up - I'm hoping it's just weird scar tissue. It's not getting worse and it's not discolored. I'm relieved to get the test done and get her back in the picture. He will still see surgeon Thursday. His eye is looking better which is nice - that made me wince. Hoping to get the cone off soon - poor thing! I'm hoping it's something simple - not a hernia. I don't know what fluid feels like, but this feels solid but moved back or gives. Idk - I'll let you know if I learn anything tomorrow. Most likely Thursday before we get ACTH results.

[Catbud]

Teddy Update:

ACTH test showed low levels so he is addisonian. Follow up bloodwork showed his electrolyte was okay so they are upping his prednisone back to 2.5 2x/day but don't have to do the injection med for addisons. I knew his signs looked worse so it makes sense. The surgeon says it can take months for the remaining adrenal gland to start working but it's a delicate balance because if you supplement too much adrenal gland won't feel the need to do it's job.

The follow up blood work had an elevated BUN/UREA level so they suspect some bleeding in GI tract/ digesting blood. They started him on sulcrafate (some stomach stuff) and metrazidole. And I am supposed to get some Pepcid AC . His Crea level was normal so that was good - I think if both were elevated it can indicate kidney issue.

On positive - he got his stitches out. Surgeon didn't say anything about that nodule (I didn't see him but I think he would have addressed it if it was hernia). No more cone head - his eye looks a lot better. He seems pretty comfortable.and I don't have to take him back for 3 weeks so hopefully I get a break too.

[molly muffin]

What an excellent update on Teddy. I think the vet would have mentioned if it was a hernia too. You could always just call and ask the vet to clarify what it is.

I'm glad he is doing so much better. yes it can definitely be a balancing act to get that adrenal gland to kick back in. Some do and some never do. You just wait and see.

[labblab]

Just thinking about you guys today and hoping that all is going well.

Marianne

[Catbud]

I am so sorry that I have been silent - you all offered me so much support and then I disappeared. I apologize. I am here with a Teddy update . I will try to add a photo to my album as well. As you know,Teddy had an andrenalectomy in the spring. It was a very tough decision for me given his age and the uncertainty of surgery. He did pretty well with surgery. He had an incision revision but ultimately recovered. When they tried to wean his prednisone, he had a crisis, but after IVs and TLC, he recovered from that as well. His remaining adrenal gland has yet to kick into gear. He is not full blown addisons -the vet says that he does not need the additional steroid or medication often used for Addisons but he still takes 2.5 mg prednisone 2x/day. Most of his hair has returned. It is still sparse on his shoulder area but his nose and tail look almost normal. His stomach is not abnormally bloated and he gained some weight back. He is pretty active - I think he tires more easily, but he just turned 13 so I should probably cut him some slack. He is happy. He chases the ball and he follows me around. He eats non-food items. This has been serious at times. He got a shaving razor off the bathroom counter and swallowed the head in August. They vet could not do surgery so they gave him special food and X-rays every few hours to track the razor - miraculously he passed it. A friend of mine is now convinced he is actually a cat (9 lives). For anyone debating the surgery - it is not a quick fix, but in my case I am glad I did it. I was not ready to let him go and he was not ready to go. Addisons does not seem to be as degenerative as the Cushings was for Teddy so although I wish I could get him off prednisone and get him to stop eating dangerous or gross things, it is better than watching him with Cushings. Of course every dog is different and Teddy wa and is pretty young at heart. I wish he had not been misdiagnosed and gone so long that his healthy adrenal gland atrophied, but here we are. I am very grateful for everyone on this board that followed the blow by blow of his treatment and my difficulty in trying to decide on surgery. I am glad Teddy is still here with me and I hope that he keeps improving. Thanks to all for caring about us!

[labblab]

Awwwww, no need at all to apologize! We are here to be of service to you whenever you need us, no matter how much or how little time has passed. Thanks so much for your update! Teddy is such a sweetheart, and I’m surely glad to hear your report. Every bit of info may help yet another Cushpup down the road. I think this is especially the case with adrenal tumors since the treatment journeys can be so variable among our members. Please give Teddy a huge hug from his family here, and like you, we’ll surely hope for even more improvement as time goes on.

Warm wishes to you both, always.
Marianne

[Catbud]

Thanks - I just added 2 recent photos to his album! No one can believe he is 13 - he still has his puppy personality, but he does plop down hard after playtime. I cannot tell if it is from his condition, prednisone or age - but he’s still happy so I’m just going with it. We still have expensive ACTH Stim tests periodically and his levels are not going up so his remaining adrenal may not kick in, but at least he’s not wasting away - that was what ultimately pushed me to surgery: I couldn’t watch him deteriorate and if he had died in surgery I would have spent money for nothing but would not have lost anything else because he was going downhill.

I hope his journey is helpful to others but it is such a personal decision and every dog seems to present differently. I was about to respond to the person who just posted about her 13yr old with Venus cava invasion and say that if Teddy had invasion I was not going to do surgery, but then I saw a post from someone who did surgery despite invasion with a great outcome. Getting lots of info was helpful to me - Thanks to this forum I definitely knew more than my first vet who ignored and dismissed him when he first started showing signs and I got a new vet.

It’s very kind of you all to keep this board going and so current. I’ll be sure to post future developments.