New with questions.

[Anne2]

Hi everyone.
Not sure where to begin as even though I have dealt with many pet illnesses over the yrs this one has me very confused as far as how to tell what the numbers mean and what to look for in the future as far as tests and treatments.
I'm not sure if my dog even has Cushing's,but it isn't for lack of trying to get answers on my part.
I'll start by saying that our old vet retired and we were spoiled by him as far as availability,compassion,and willingness to spend time and answer our questions.
Often he could tell what was wrong with a pet based on exam alone.
In looking for a new vet I spent hours pouring over reviews and the clinic I picked had great reviews for the most part.
So we took two cats to this clinic and the outcome wasn't great as one ended up worse off than before and had to be put to sleep.
Same with the other cat.
The first cat was 18 and of course I'm upset that she is now gone,but I think the 2nd pets treatment or lack of treatment upsets me the most.
All along three different vets at this practice promised to do a procedure and then flat out said no. I was even quoted a price.
What they did do with both pets was plenty of tests but when it came time for treatment they held back.They also had us do multiple visits for meds and blood tests which were costly.
Three vets at this clinic and each time would get different answers, evasive answers, or no answers.
The reason I'm posting this is that there are more vets than one involved in the current treatment of my dog Buddy.
I'm sorry to say that now Buddy is seeing a vet that we feel even worse about than the vets at the clinic we picked when our vet retired
We had seen this current vet only when our retired vet was out of town.He also lacks the ability to explain treatments or results of tests clearly and is always in a hurry.
Buddy has also been to Med Vet which is a vet hospital so we have yet more confusion.
Sorry to be so long winded but later I want to be able to explain who did what and where we are now.
I will start with the clinic vets that we picked after vet retired.
By the way Buddy is a Beagle Shih-tzu mix that we have had since he was 7 weeks old.
He used to weigh around 28 to 30 pds but now weighs in at 40pds.
Last summer we noticed he would have a few episodes of panting but we put it down to his needing to be groomed,the heat or his weight gain.
Our groomer brought to our attention that Buddy seemed to have some leg pain that she hadn't noticed before and shortly after within days we noticed his stomach looked swollen.
We took him to the vet and the female vet wanted to do vaccinations but we told her we would like an exam first.
She said he had a fatty liver and thought his stomach swelling indicated Cushing's.
I did take along a paper with his symptoms which she didn't look at so she did ask if he was drinking a large amount of water.
I told her yes but not a huge amount just more than he usually does.
She also asked if he panted. I said yes it is written here on this paper.
She did blood tests and said she would like to do another test which if he had no reaction to would indicate he had Cushings.
Aside from the test results that ends her involvement in the treatment of Buddy.
I may end this here as it is lengthy and start a new post with the first tests results?
By the way....glad to have this forum to turn to for answers and support.
ETA...not sure how this works. Should I just post the results that are high or the entire results?
I will check back in tomorrow.

[labblab]

Hello Anne, and welcome to you and Buddy! It surely sounds as though you’ve been on quite a journey so far, but I’ll wait to comment further until you’ve had a chance to post those lab results. In answer to your question, we only need to see results that are either too high or too low, along with the normal range that’s posted on the sheet for that particular value.

Also, I’m so sorry about your cats. It sounds as though your whole family has been suffering through a very tough time, and that takes a great toll on you all. I’m really glad you’ve found us, and we’ll do our best to offer our support and suggestions as we learn more about your sweet Buddy.

Once again, welcome to you both,
Marianne

[Anne2]

Thanks for the welcome,Marianne
And I'm also glad to have found you. It has been tough because we have had so little explanation and then when you add in more than one doctor with an opinion and you're confused about the disease to begin with....yes it is difficult because we want to make the correct choice to help our little guy.
So here goes....test results from the first blood draw.
Paper is a bit faded so will do my best with the numbers.
Alk Phosphatase Results 442 (High) Ref Range 5-131 Units IU/L
BUN/Creatinine Ratio Results 28 (High) Ref Range 4-27
Cholesterol Results 434 (High) Ref Range 92-324 Units mg/dl
Triglyceride Results 1596 (High) Ref Range 29-291 Units mg/dl
Platelet Count Results 510 (High) Ref Range 170-400 Units a little faded but think it's 10/ul
Platelet Estimate Results Increased
Differential Results Absolute %
Monocytes (High) Results 992 Ref Range 8 0-840

Comments on test Hemclysis 4,, Lipemia 3 No significant interference
Pancreattis is unlikely but normal Precision PSL result does not completely exclude pancreatitis for gastrointestinal signs.
That's it for the first test and female doc called us the next day to say he needed another test and an ultrasound.
Enter the next doc from the clinic who ended up doing the tests plus x-ray and ultrasound.
I will enter those results in next post.

[Anne2]

This test is a Cortisol Serial 2 ACTH and was done on 2-22-20

Time1 Results PRE 8:45
Time2 POST 10:45

Cortisol SAMPLE 1 Results 7.1 (High) Ref Range 1.0-5.0 units can't read looks like ug/dL

Cortisol Sample 2 Results 11.2 Ref Range 8.0-17.0 ug?/dL

On that day the vet also did an x-ray and an ultrasound.
He showed us the x-ray and said it looked as though something was pushing the small intestine to the side and also looked as though Buddy had an enlarged spleen. He said there was also something he couldn't make out behind the colon as Buddy had fecal matter in the colon.
I asked if he thought it was cancer. He said "yes"
He sent us to Med Vet for an ultrasound as he admitted he had only been doing ultrasounds for 6 months. He didn't charge us for the ultrasound that he did in office.
So while waiting for MedVet appointment we fretted our dog was full of cancer.
Results of MedVet coming up in next post.
May need a short break...whew that is a lot of typing.

[Anne2]

MedVet ultrasound was done on 3-4-20
Basically we were told that Buddy had a nodule on his left adrenal.I asked a few questions and was told that he would send report to clinic doctor.
For history clinic wrote Swollen abdomen and elevated liver enzymes.Possible abdominal mass.
MedVet findings:
Liver is mildly enlarged in echogenicity and has mildly irregular texture diffusely.
Left Kidney:The left kidney is normal in size and shape.Indistinct hyperechoic foci (consistant with mineralization) are noted within the cortex and there is a mild reduction in corticomedullary distinction.
Right Kidney:The right kidney is similar to the left kidney but also has distinct minuscule hyperechoic foci (nephroliths) are present within the pelvic recesses.
Left Adrenal:The cauoal aspect of the left adrenal gland is mildly enlarged (0.86 cm short axis) and moderatley hyperchoic.
Liver: The liver is mildly enlarged,normal in echogenicity and has mildly irregular texture diffusely.
Everything else was NSA = No significant abnormalties.
All that follows was NSA
Gall Bladder
Spleen
Urinary Bladder
Stomach
Small Intestine
Colon
Pancreas
Peritoneum
Lymph Nodes
Right Adrenal...NSA (0.6 shore? axis)
The Radiologist did mention surgery as a possibilty for the adrenal gland nodule but it is major surgery and Buddy is almost 11 yrs old.
Next test coming up back at the clinic....almost done.lol
ETA...missed a page
Left adrenal nodule. Differentials include nonfunctional and functional tumor.Because the right adrenal gland is not reduced in size,pituitary ceoendent? codependent? hyperchoic should still be considered.
Mild nonspecific diffuse hepatopathy
Mild chronic degenerative changes at bilateral kidneys

[Anne2]

Last test done at clinic on 3-10-20

Cortisol Serial 3 Dex
Time 1 Results 820
Time 2 Results 1220
Time 3 Results 420

Cortisol Sample 1 Results 4.9 Ref Range 1.0-5.0 units ug/dl
Cortisol Sample 2 Dex Results 0.4 Ref Range 0.0-1.4 units ug/dl
Cortisol Sample 3 Dex Results 0.2 Ref Range 0.0-1.4 units ug/dl

After this test vet said that he didn't think Buddy has Cushing's. He said that usually when you shoot a dog full of cortisone they will drink or pee.
Buddy did not drink or pee during the 8 hour test.
I told the doctor that he made up for it on the way home as we had brought water and he also drank a lot after he got home as well as peeing.
It also took him a while to get over the testing.He actually had episodes where he would tremble.
Doctor said someone from MedVet would call us in a few days to confer with us.
Nope that didn't happen.
I called after two days to be told that radiologists only do the tests that they don't address the findings with clients.
Finally after a week and a half of my calling MedVet and also making doc at clinic aware that we wouldn't be getting a call, I spoke several times with a director of radiology.
She said that she would try to get an internal medicine doctor to speak with our doc at clinic.
After not hearing from anyone for over a week...doc at clinic finally called.
He said (and I don't know if this is true) that he did speak with a doc at MedVet and they agreed with him that Buddy didn't have Cushing's.
He said maybe we should just make Buddy comfortable.
He also suggested that we collect a urine sample (to test kidneys) from Buddy per doc at MedVet.
This didn't happen,and I do regret that as it may have given us more info.
I did collect the urine and took it to clinic only to find doctors had left for the day.
At this point I had had enough and enter new (previous) vet that really we went to as a last resort in the past.
I feel as though this last doc at clinic had me doing his work in the contacting of MedVet. Very stressful for me trying to get answers. Plus after all the money spent my goal wasn't to make Buddy comfortable until he passed on.Unless he has no other options.
Tomorrow or later this evening, I will post a short post about our last visit to the next vet.
Thanks to all who may be reading and sorry for the long posts.
I promise the next one will be shorter.

[Harley PoMMom]

Hi Anne,

Welcome to you and Buddy from me as well! Please do not ever apologize for a long post, we very much appreciate all information you can share with us, the more details that we have will allow us to provide you with better feedback, so thank you for your long posts!



This test is a Cortisol Serial 2 ACTH and was done on 2-22-20

Time1 Results PRE 8:45
Time2 POST 10:45

Cortisol SAMPLE 1 Results 7.1 (High) Ref Range 1.0-5.0 units can't read looks like ug/dL

Cortisol Sample 2 Results 11.2 Ref Range 8.0-17.0 ug?/dL





Anne, this test is known as the ACTH stimulation, this type of test requires 2 blood draws; the first blood draw measures the "pre" or resting cortisol value, than the dog gets injected with a stimulation agent (ACTH) that makes the adrenal glands dump cortisol in the body, the second blood draw is performed which is known as the "post" and this measures that amount of cortisol. According to those results, Buddy is negative for Cushing's, however, I see that Buddy's post draw was taken 2 hours after the pre which usually means that the stimulating agent used was the gel type. Does the paper copy of the test state what type of stimulating agent was used? The majority of vets use a synthetic form of ACTH which is considered more reliable than the gel.


Last test done at clinic on 3-10-20

Cortisol Serial 3 Dex
Time 1 Results 820
Time 2 Results 1220
Time 3 Results 420

Cortisol Sample 1 Results 4.9 Ref Range 1.0-5.0 units ug/dl
Cortisol Sample 2 Dex Results 0.4 Ref Range 0.0-1.4 units ug/dl
Cortisol Sample 3 Dex Results 0.2 Ref Range 0.0-1.4 units ug/dl



These results are from a low-dose dexamethasone suppression (LDDS) test, which is considered the gold standard for testing Cushing's. This type of test uses dexamethasone which suppresses the level of ACTH causing a decrease in cortisol levels in the blood for a period of time. According to those results, Buddy tested negative for Cushing's.

At this time my recommendations would be to have a liver function test performed, known as a bile acid test, and to test the function of his kidneys I suggest having a SDMA test. The justification for these two tests are the elevations in his cholesterol, triglycerides, and ALP. The ALP is a liver enzyme and can be high for many reasons both kidney and liver disease can cause some of these abnormal levels.

One questions I do have, was Buddy fasted (no food for 12 hours) for his chemistry blood panel test, this test analyzed his ALP, cholesterol, triglycerides..etc?

I am sorry for the reasons that brought you here but so glad you found your way to us, and we will help in any way we can.

Hugs, Lori

[Anne2]

Thanks so much for the welcome,Lori and all the helpful information.
My sister is co-owner of Buddy and try as we might we can't recall if Buddy was fasted for the blood chemistry panel test.
I'm thinking he probably wasn't as he always has a bowl of food at hand, he also gets his little 5 calorie coming in bones. Bones he gets for coming in from outside because as a youngster he would ignore us when called in from outside.
Also at the time we thought we would be addressing his leg pain,sometimes limping with the vet as well as his swelling in the abdomen.
We thought the swelling was due to weight gain,but in our hearts I think we knew the swelling was abnormal.
So we didn't really count on his having a blood test or fasting him for the test.
What is odd to me is how fast the swelling appeared in his stomach area.
He has always had a healthy appetite,weight issues(still does) but I did have to adjust his harness/halter two times within a month due to the swelling.
I'm not sure if a synthetic or gel was used and at this point we just have blood tests results and no notes from the doctor.
I will call the clinic tomorrow and if the doctor is in I will see if I can speak to him or one of the other doctors to find out. At the very least they should be able to give us the notes if they have made notes in his chart.
The receptionist will love that as she is charming...not.lol
Really the last doctor at the clinic was nice and we didn't leave it on a bad note and I don't think he would take issue that we have consulted another doctor if it should come out during the conversation.
My issue with him was lack of communication and unavailability.
Kind of what we are dealing with yet again with the vet we have now.
The "new" vet did do some tests but they are hard for me to understand as far as results.
Some have numbers. Some have the word,no,so not sure if that means that test wasn't performed or was negative, and also there is a rectangular box with a shaded in area with a black bar,so not sure how to read those tests,unless I just post the numbers and see if anyone here can make anything out of the results.
I did take a clean fresh urine sample,and mentioned that the previous vet wanted to test the urine but he said they would draw the urine from Buddy so as to make sure it didn't contain bacteria.
I had my mouth open to explain that the previous vet wanted to do some kind of test for kidney on the urine,but he was out the door and down the hall before I could get any words out.lol
When he came back he said Buddy had no bacteria in his urine so that was 30 bucks wasted.
He did do a thyroid test and I think he said that was okay.
He also mentioned that he would like to re-do the stim test,but seemed to veer away from that but did do another blood test.
He said that the liver enzymes had doubled since his last test and mentioned that he could test Buddy again in a month (which is coming up in three days) to see if his enzymes were getting higher.
He also said the symptoms sounded like Cushing's (panting,drinking more water,appetite and the abdomen swelling) he thought Buddy may be atypical.
He also did give us the meds,Vetorl 10mg but we didn't give it to Buddy out of fear that we really didn't know for sure.
The vet doesn't know that we haven't given Buddy the meds.
So I expect in three days we will take Buddy back to check his enzymes and I will mention the tests that you suggested.
I do have a question...isn't that a sign of Cushing's when the liver enzymes,cholesterol and triglycerides are elevated?
It isn't as though I want to have a Cushing's diagnosis...just trying to get as much info as possible to rule it out.
Also you may have said but is the SDMA and the Liver function tests a blood test or urine sample test.
Thanks for all your help and will post the test results in next post. May have to post the whole thing as I don't really understand the numbers.

[Harley PoMMom]

He also did give us the meds,Vetorl 10mg but we didn't give it to Buddy out of fear that we really didn't know for sure.
The vet doesn't know that we haven't given Buddy the meds.

I'm relieved to hear that the Vetoryl hasn't been started, no rx medications for Cushing's should be administered until a diagnosis is confirmed.


I do have a question...isn't that a sign of Cushing's when the liver enzymes,cholesterol and triglycerides are elevated?

Yes, dog's with Cushing's commonly have elevations in those levels but there are also other health issues that can cause those same elevations. Also, Buddy doesn't have other abnormalities that are usually found on a chemistry/CBC blood panel, such as what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS).

Anything you don't understand please do post and we will try to help! :)


Also you may have said but is the SDMA and the Liver function tests a blood test or urine sample test.


Both of these tests require blood samples. I'm including links with info regarding those two tests:
Bile acid - https://www.thesprucepets.com/bile-acid-what-does-it-mean-3384801

SDMA - https://www.idexx.com/en/veterinary/reference-laboratories/sdma/sdma-faqs/

Lori

[labblab]

Hi again, Anne. Thanks so much for all this additional information, and I’ll be awaiting your final testing summary. Gosh, there’s a lot going on here, and a lot to think over. I do think, though, that the presence or absence of an adrenal tumor is a key issue here, perhaps *the* key issue. After all my years on the forum, there’s still so much that I don’t know about adrenal tumors, especially because they can take different forms. The majority of Cushing’s cases are caused by pituitary tumors, so that’s what I’m more knowledgeable about. However, we’re well aware that adrenal tumors can also cause elevated cortisol levels. Not all adrenal adrenal tumors do so, however. Some instead cause elevations in other hormones, some don’t result in hormonal elevation at all. Some tumors are benign, some are cancerous. So whether or not Buddy suffers from an adrenal tumor, and if so, what the nature of the tumor may be, seems very important to me.

I’m going to give you a link to an informative paper by noted European endocrinologist, Claudia Reusch. It was written back in 2006, but I think most of the content remains accurate. You’ll see that both the ACTH and also the LDDS may return “negative” results in the face of adrenal tumors, which further complicates the diagnostic picture. You’re correct that many of Buddy’s lab abnormalities are consistent with Cushing’s, even though his ACTH and LDDS were within normal range. Are these abnormalities the result of a “functional” (hormone-producing) adrenal tumor? I don’t have the knowledge to give you that answer. But I’m guessing it’s a possibility. Anyway, here’s the link. Take a look and see if any of this sounds consistent with the test results and info that you’ve been given thus far.

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11223&catId=31457&id=3858997

Marianne

[Anne2]

I'm relieved to hear that the Vetoryl hasn't been started, no rx medications for Cushing's should be administered until a diagnosis is confirmed.



Yes, dog's with Cushing's commonly have elevations in those levels but there are also other health issues that can cause those same elevations. Also, Buddy doesn't have other abnormalities that are usually found on a chemistry/CBC blood panel, such as what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS).

Anything you don't understand please do post and we will try to help! :)



Both of these tests require blood samples. I'm including links with info regarding those two tests:
Bile acid - https://www.thesprucepets.com/bile-acid-what-does-it-mean-3384801

SDMA - https://www.idexx.com/en/veterinary/reference-laboratories/sdma/sdma-faqs/

Lori

Hi Lori
Thanks for the links and yes I'm still confused,but reading tests results have always been an issue with me as far as understanding results.
I do see the Platelet Count is high 510 (High) Ref Range 170-400,but does the platelet count have anything to do with white blood cells in the blood?
I also see Monocytes are 992 8 Ref Range 0-840 so that would be high?
And I can't find a Stress Leukogram or anything called Neutrophils (Neu) on the tests results.
I'm sure it is there and that I'm missing the information on the results.

[Anne2]

Marianne
According to MedVet Buddy does have a nodule on his left adrenal glad.
And thanks for the link.
Some of the things in the link seem to apply to Buddy.
Abdominal Enlargement
Panting with mild exercise ( a short walk of a few blocks) and panting at random without exercise.
His fur seems fine. No patchy spots or thin coat. He does have some very small dry flakes of skin on his rump and back that he loves to have scratched.
Not really noticed until he comes over to get scratched.
He also has bouts of limping and a few times he has held his front leg up but it never lasts very long.
He is sadly lethargic. He had one good day this week when he seemed his old active self.
He loves going for walks though and responds well to that and at times,not lately he will play with his toys without prompting.
He is taking Gabapentin for pain at 100mg twice a day and that does seem to help but not always.
The reason that was prescribed is because he would whimper and whine as though in pain when lying down.
A few other things I have noticed is that at times he will get what I call a scared horse look while lying down as though he feels terrified. You can see the whites of his eyes shifting around and nothing is going on as far as any disturbances to cause this.
Also have noticed that while at the vet due to the bright lighting that Buddy has very red gums and the white part of his eyes appear reddish colored.
Very strange all of these different symptoms.

[Anne2]

Next up three pages of test results. Not sure how to read these as some of them have the word no and could mean not tested and there is a rectangular box that has grey shading that goes more to the right or to the left or to the middle and in some not even half is shaded. Also has a black bar in the box at different levels so I will at least post the numbers if they look high or low or may post the whole thing.
Starting with the in house Urinalysis.This was drawn from Buddy at the vet versus using the sample I had brought in.

Leukocytes - Negative
Nitrate - Negative
Urobilinogen -Normal .2
Protein - Negative
ph - 6.5 This number is in a white box.
WBC per hpf 0 Also number in a white box.
Epithelial cells - No
Casts- No
Crystals - No
Bacteria - No
Blood - No
Specific Gravity 1.020 Number in white box
Ketone - Negative
Bilirubin - Negative
Glucose - Negative
RBC per - 0 Number in white box
Appearance yellow clear
End of urine test. The reason I'm not sure if all theses things were tested was that he said no bacteria as though that was all he had tested for, so sounds like I need to have a convo with him to make sure.

[Anne2]

Blood Tests 3-19-20
I'm going to post all and just ignore the boxes with the grey shading and black line at different levels.

GLU 112 Range 70-143mg/dl

Crea 0.6 Range 0.5-1.8 mg/dl


BUN 12 Range 7-27 mg/dl

BUN 20 no range listed

Phos 3.1 Range 2.5-6.8 mg/dl

CA 10.4 Range 7.9-12.0 mg/dl

TP 7.8 Range 5.2-8.2 g/dl

ALB 3.5 Range 2.2-3.9 g/dl

GLOB 4.3 Range 2.5-4.5 g/dl

ALB/GLOB 0.8 no range listed

ALT 145 (High) Range 10-125 U/L

ALKP 478 (High) Range 23-212 U/L

GGT 0 Range 0-11 U/L


TBIL 0.4 Range 0.0-0.9 mg/dl

CHOL 282 Range 110-320 mg/dl


AMYL 771 Range 500-1500 U/L

LIPA 713 Range 200-1800 U/L

Na 155 Range 144-160 mmol/L

End of pg 2 Page 3 coming up.

[Anne2]

K 3.8 Range 3.5-5.8 mmol/L

Na/K 41 no range given

CI 114 Range 109-122 mmol/L

Osm Calc 306 no range mmol/kg

TT4 1.4 Range 1.0-4.0 ug/dl

RBC 7.41 Range 5.65-8.87 M/uL

HCT 45.8 Range 37.3-61.7%

HGH 16.8 Range 13.1-20.5 g/dl

MCV 61.8 Range 61.6-73.5fL

MCH 22.7 Range 21.2-25.9 pg

MCHC 36.7 Range 32.0-37.9 g/dL

RDW 18 Range 13.6-21.7%

%RETIC 1.9 Range %

RETIC 140 (High) Range 10.0-110.0 K/uL

RETIC-HGB 24.5 Range 22.3-29.6pg

WBC 11.12 Range 5.05- 16.76 K/uL

%NEU 73.7 Range %

%LYM 16.5 Range %

%MONO 5.0 Range %

%EOS 4.6 Range %

%BASO 0.2 Range %

NEU 8.20 Range 2.95-11.64 K/uL

LYM 1.83 Range 1.05-5.10 K/uL

MONO 0.56 Range 0.16-1.12 K/uL

EOS 0.51 Range 0.51 Range 0.06-1.23K/uL

BASO 0.02 Range 0.00-0.10 K/uL

PLT 457 Range 148-484 K/uL

MPV 13.4 (High) Range 8.7-13.2 fL

PDW 12.5 Range 9.1-19.4 fL

PCT 0.61 (High) Range 0.14-0.46%

At last done with the tests I have for now.

[labblab]

Anne, thanks for this final list of lab results. Interestingly, aside from mild/moderate elevation in the two liver markers (ALP and ALT), it looks to me as though most everything else is within normal range this time around, including cholesterol. So I’m remaining focused on the existence of the adrenal nodule, and what issues it may be causing. In particular, I’m wondering if it may be a particular type of tumor known as a pheochromocytoma. Here’s an excerpt from that article I cited above that describes pheos:


Pheochromocytoma (Pheo) is the second most common adrenal tumour in dogs. It is of neuroectodermal origin arising from chromaffin cells of the sympathoadrenal system. Clinical signs result from excretion of excessive amounts of catecholamines and rarely from the direct presence and space occupying nature of the tumour. Pheo is identified most commonly in older dogs (> 7 years). There does not seem to be a sex or breed predilection. Symptoms are subtle, episodic and often complicated by concurrent disease. The most common clinical signs are generalized weakness and episodic collapse. Further symptoms include intermittent agitation, pacing, excessive panting, pu/pd. Systemic hypertension may occur leading to retinal detachment or retinal haemorrhage or hemorrhage into the retroperitoneal space, the abdominal cavity or the CNS. Vomiting, diarrhea, inappetence, weight loss, tender abdomen and cardiac arrhythmias may also be seen. Signs related to a space-occupying process are a palpable mass, enlarged abdomen, ascites and rear limb edema. Collapse and death from a sudden, massive and sustained release of the catecholamines and massive haemorrhage due to sudden increase in blood pressure or rupture of the tumour is possible. Many of the clinical signs caused by pheo are unspecific and vague and may be associated with a variety of more frequent diseases. There are no consistent abnormalities on haematology, serum biochemistry and urinalysis which would raise the suspicion of pheo. Up till recently the majority of cases were therefore only diagnosed at necropsy and were not suspected antemortem. However, due to the fact that abdominal ultrasonography including adrenal imaging is increasingly used as part of a diagnostic work-up, the situation has started to improve. Often, pheo is only considered after an adrenal mass is identified on abdominal ultrasonography. Although normal sized adrenal glands do not rule out pheo, there seems to be a relationship between tumour size and severity of clinical signs. In most dogs with obvious clinical signs the tumour is easily detectable. Different to the situation in human medicine the majority of pheos in dogs are malignant. Ultrasonography can provide information regarding local invasion to surrounding tissue and vessels, tumour thrombi and metastasis to other abdominal organs. In more than 50% of dogs with pheo tumour thrombi and/or metastasis are present at the time of diagnosis.

I’m especially wondering about the “wild-eyed” episodes that Buddy sometimes experiences, since they might represent the sudden release of adrenaline surges due to a pheo. His reddish eyes might also signal episodic high blood pressure from a pheo. As the article states, though, some of the other symptoms can be caused by hormone-producing adrenal tumors, as well. So it would really take a specialist who’s knowledgeable about adrenal tumors to be able to tell you more, and to help with making a differential diagnosis. The Vetoryl could indeed help with a hormone-producing tumor. But I believe that different medication would be prescribed to help treat the effects of a pheo.

At this point, even though you’ve already been dealing with multiple vets, you may want to seek out yet one more consultation. You may want to talk directly, yourself, with a specialist. If, for instance, you’re anywhere near a veterinary school, you’d have a whole staff of experts available with whom to consult and the cost might be less than at a private specialty vet practice. Having said that, I know the COVID-19 crisis is really putting a lid on the opportunity to schedule appointments right now. So an in-person visit may need to wait. But if Buddy were mine, I believe I’d be mostly focusing further diagnostic questions on the nature of that adrenal nodule. And that’s what I’d really be asking the vet about this week.

[labblab]

I wanted to come back to add that, as you probably already know, surgical removal is the only complete cure for any adrenal tumor, including a pheo. However, this type of surgery is very risky and very expensive. I don’t know whether I would choose this surgery for my own dog, even if I could afford it. There would be an awful lot to weigh. So I do understand if surgery is not an option you’d consider for Buddy. Without surgery, though, your sole goal is indeed to keep a dog as comfortable as possible, for as long as possible. So perhaps that’s what your one vet was attempting to tell you, but unfortunately without a thorough explanation.

Of course I am totally speculating with everything I’ve written this morning. And if you already know that surgery is not an option, then perhaps it’s not even worth it to pursue more specialized diagnostics about the nature of the adrenal nodule. But if it would give you more peace of mind to gather more information, then I’d encourage you to do so. And that way, you might get a better handle as to which medication would be most helpful. The dose of Vetoryl that’s been prescribed is quite a low dose for his weight (10 mg. for a 40 lb. pound dog), so the risk of side effects might be minimized. If the tumor is indeed secreting hormones, the Vetoryl might help with symptoms. But if it’s a pheo, then something to help control blood pressure and/or the adrenaline release may be even more important.

OK, I guess that’s all I can think of for now ;-).

[Anne2]

You all have been a wealth of information and support and I appreciate all your suggestions and help.
I never would have found all of this info searching the net.
I'm going to come back later and make some notes so it will be fresh in my mind while speaking with vets in the future.
The vet from the first clinic didn't call me yet so will try again tomorrow regarding the synthetic versus the gel.
I think surgery isn't something that I would consider unless they have any procedures that are less invasive.
I do want Buddy to be comfortable but also if there is any treatment (meds) obviously that would be my choice.
The Covid-19 is making things a little difficult but I think we are set to open up in May and I actually have been leaning toward a specialist at MedVet.
In the meantime I still have my always in a hurry,don't like questions vet,but I will just have to be more forceful in my dealings with him.
Thanks so much all for your help and I will check back in later if or once I do find answers about Buddy.
As said it may be a bit before I can get him in to a specialist.
Thanks again and wish you all luck with your fur babies.