Meet Kaibo :) 9 y/o toy poodle - Myotonia, Diabetes, adrenalectomy; now PDH and CC

[kaibosmom]

Ugh. I see. Well she has now told me she is "not on clinics" for 2 months. So...um...why did she say to book an appointment in a month with her. Anyway, long story short, she has left me a voicemail that says she is available to talk to me between 5 and 6 today. So....if you can think of any questions I should ask, post them here and I'll check before I talk to her. I'm still a bit overwhelmed and confused! :confused:

[frijole]

I'm at work, have not read back yet on your thread but I would ask her if she has determined FOR SURE that this is not a tumor related to cushings and if so why she thinks your dog is still urinating and gaining weight. (signs of cushings) I would ask if they have checked the blood pressure previously (ie last visit) since that is a sign of a pheo. Pheo dogs also lose weight. I would also ask her if she isn't on clinic for two months how you can get an appt in 30 days AND most important who the hell you can call if you need help. How can you work with a vet that is so inaccessible? I am mad and frustrated on your behalf.

I promise to go back to the beginning tonight to see if i might have missed something. I am so sorry. Kim

[molly muffin]

Good grief. Really, not on clinics, news like this by email. I'm astounded and Not in a good way.

I too wondered if this is why he wouldn't hold his load of lysodren, as Leslie wondered. I am not particularly happy with them not giving you someone to be able to contact to work out a further plan of action now that this has been discovered. Do they think that this tumor is secreting cortisol and the cause of the cushing symptoms?

hugs,
Sharlene and Molly Muffin

[frijole]

OK I re-read the thread and I literally am feeling your pain. I am really concerned that these people are clueless - OR that the constant changing of vets that you are stuck with is resulting in differences of opinions and you have got to be spending a fortune for this negligence.

You have had 4 ultrasounds that I can tell since Dec of 2012! The first one didn't capture the right adrenal and the left was normal. The next one in March said right adrenal slightly enlarged but no sign of a tumor. Note that was a month ago! The next one simply said the adrenals are smaller than normal probably because of using lysodren. The one you just had done is saying adrenal tumor. You have had 3 ultrasounds in a 6 week period. Why in the world is that necessary? Who is reading the results? Why did they keep doing ultrasounds?

OK here is where my blood just boils over. You were on the same dang dosage forever trying to load and didn't get there. Oh and they'd only let you load for 3 days at a time. Remember we talked about the definition of insanity. Well for crying out loud they finally got 'brave' and increased the dosage to 375 mgs/kg twice a day for the last load you did - and it was successful! You were at 2.6

But where I think they went wrong was they decided to provide you with compounded capsules but when they did that they gave you 150 mg capsules to give twice a week. Well guess what? You decreased from 375 mgs a week which is where you should have been in order to maintain the load to 300 mgs and your dog's cortisol increased and you lost your load.

The reason why your dog might require a higher than normal dosage is because of the adrenal tumor. It made NO sense to lower the dose for maintenance - it was almost guaranteed to cause a loss of the progress you made.

I made notes in attempt to see if there any signs similar to my Annie's pheochromocytoma and I really didn't see any since Kaibo has high cholesterol and gains weight whereas trust me with a pheo your dog would lose weight.

My opinion is that your dog has cushing's. That is why Kaibos' symptoms goes away when cortisol is low and come back when it's high.

The only note that was strange to me that I made was in December the urine was concentrated. (yellow) Cush dogs can't concentrate urine and it is clear. Can you tell us what color Kaibo's pee is? :D

The comment from this new vet about young dogs not getting cushing's is pure rubbish. We have seen puppies with it. No it is not common for a 5 yr old dog but it happens. And if they have an adrenal tumor it could be why. And as Marianne said it could be that Kaibo has both an adrenal tumor and a pituitary one.

It seems like you've been loading forever but your first load was five days, your 2nd was 3, next was 3 and the next was 4. They kept making you stop dosing insisting on more tests and then you had to wait up to a week to get test results all the time losing ground. That's only a total of 15 days on lysodren if my math is right.

Heck most dogs doing a normal load in one attempt take that long. They have drug this thing out since mid December and it is just beyond me. Are you near any other town? I know you have already switched from a regular vet to go to the teaching hospital. Well... I don't think you have the right people on your case. Either you need to find them and insist on only seeing them or find someone in another town.

Seriously reading your entire thread just infuriated me all over again because I've read it numerous times. I feel so so so so so badly for you.

As a point of reference again my dog weighed 8 kgs and she was on a dose of 900 mgs a week. That is 3 times higher than Kaibo. It took her 45 days or more to load and that is loading days not counting the wait between for tests. Feldman wrote a paper and he came right out and said if a dog doesn't load at 50 mgs (which in your case was 250 where you started) then you slowly increase it and there are cases where dogs just need more. That was the situation in my case.

My point is that 375 where you loaded was not that much higher than standard protocol. So why did they DECREASE the maintenance dosage? That is in my opinion why you lost your last load.

Sorry to rant but I just spent 2 hrs reading your thread and I am frustrated because I don't know the name of a vet in Canada to send you to.

Are there any international specialists out of Canada that we can get in on this case? Anyone? Kim

[kaibosmom]

Oh, Kim...you are amazing! I can't believe you spent so much time looking over Kaibo's "case". This is greatly appreciated. I seriously did not put two and two together with his maintenance dose!! Holy guacamole. How could I let that one get by me. That definitely played into him not staying in therapeutic range!!! It is now late here and once again I have just spent time with my little man and not gotten ready for my kiddos tomorrow. So I will keep this as brief as I can. Today proved to be quite interesting.

So, yesterday morning, I had called the college and said that I was very upset that I had not had any contact with the vet regarding his blood work and ultrasound. They told me she was off, which I knew, and they said they could leave a message for her supervisor to call me. I said yes, that sounds fine. So, then, I get no call, but did get that email. I just assumed that the supervisor had given the vet the what for and voila, I got the email that I posted here. In the meantime....last night, I emailed the vet back (Dr. P, who emailed me the results) and said I wanted to meet with her ASAP, and this morning, she left me a message that she is not "in clinics" for 2 months!!! So she said I could meet her today between 5 and 6. I said I would either be at home to call me there or I would be in the clinic to pick Kaibo up from his rehab day. So...today, after I got off the phone with his rehab vet (knee not improving:mad:) my phone rings again with another number from the vet college. I answered and was a bit confused by who it might be since it was only 3:30. Turns out, it is the supervisor!!! She apologizes for not calling me yesterday and I said I assumed you just got in touch with Dr. Parker since I got the email from her. She says, no, haven't talked to her. I use this to my advantage to say how disappointed I was to get that info via email and basically question what I am supposed to do if she isn't around for 2 months because I am not waiting that long to deal with this. So she talks about continuity of care and getting my case turned over to another resident, a first year. I basically say I'm not interested in that and that at this point I would like to know if there is an endocrine specialist because that is what I think we need right now and if not I need to know where I can go. She says, I'm actually the endocrine specialist.:D Yay!!! So we chat some more and she says I will meet you and Dr. P at 5 to discuss!!! Wow, I was so excited.

Long story short...I met with both vets (the new resident that they will transfer my case to couldn't be there as she has been sick...I couldn't avoid that, but the supervisor assured me that she will be very involved from this point on, she just can't be available all the time due to lectures, etc. so she feels it is best that a resident be the primary contact).

[kaibosmom]

I met with both vets. I listened to Dr. P tell me about the email and his ultrasound, etc. I started telling her how I measured his water again and he is back up to drinking a cup and then overnight he had almost a 1/2 cup. I started telling her about how he was at therapy dog visits with the kids and then how he is now, etc. At that point, supervisor, Dr. S, hadn't said anything. She was on the computer looking at all of his blood work, listening. So, I can see the two vets looking at each other and finally, Dr. S pipes up. Basically stating how while there are some irregular results, she doesn't see how this can't be a case of Cushing's disease. She said she doesn't see the point in waiting longer and that from the brief conversation she had with me on the phone she gets the impression that we want to do something about this sooner rather than later. I said that is exactly right. So, she gets into what we should do, surgery complications, etc. Lots more conversation and questions but here is the plan.

We are going to do the low dose dex test...which has never been done so I was glad they said that instead of the ACTH again. Assuming those results are positive, then Dr. S wants to rule out (as best they can) the chance of it being the pheochromocytomas (I just copied and pasted that...but the other type of tumor) with some sort of urine test. After that, move to a CT scan to confirm the tumor and to make sure it hasn't spread or encroached on any other organs or blood vessels. Following that, we would meet with surgery and remove the tumor. It sounds like the surgery is very risky but I will not wait to see if it grows as that will only make it harder to remove.

I am still mixed with emotions but feeling much more settled tonight. Will do some work and post blood work tonight if not too tired. As always, any feedback is appreciated. Oh, as far as blood work goes, they were talking a lot about his super high cholesterol. Dr. S said that she felt Dr. P did the right thing by taking him off all meds and checking his thyroid. She also agreed that the ultrasound and new blood work were important steps as well, especially since the tumor was now seen and it wasn't in January. His liver enzymes and cholesterol both dropped dramatically since being off of the mitotane so they wonder if the meds were actually causing those 2 things to increase. Anyone else had any issues with the meds increasing liver enzymes or cholesterol?

[frijole]

I like the sounds of this vet more than the others but they still have to prove themselves to me. ;0

I don't buy that lysodren increases liver enzymes. It is cushing's and other issues that cause the liver enzymes to increase. It is true that most cush dogs have high enzymes and they might go down once treated but not by much. To be honest my vets were never really worried about that. I treated with milk thistle and my Haley's numbers went from close to 2000 down to 800 which is still way over 200 but much improved.

Others here in the US use denamarin which is available at almost any pet store. It is more expensive and designed for liver treatment. In all of your consultations have any of the vets ever recommended either of these? They are not prescriptions here in the US we can buy it anywhere.

High cholesterol is very common with cushing's dogs, especially when they are not under control. So again - I don't understand why they are concerned. Control the cushings and the cholesterol should go down. Your problem is you were only allowed to load for 3 days at a time then you waited so long for results that the cortisol rose again. So you wouldn't have the benefit of seeing these items go down. My opinion anyway.

Kim

[kaibosmom]

Low dose dex test tomorrow! The night should be interesting. Kaibo will not be impressed when he can't eat when he wakes up for a snack at 3:30 in the morning! :p. he hasn't had this test before. I'll keep you posted. Booked it for Thursday so we shouldn't have to wait the weekend for results! He had surgery consult for his knee today. It's not getting better, in fact a bit worse. So we wanted the ortho people to recheck it. They basically said its the same just a cruciate tear and to focus on the Cushing's first. He's also started having a clicking of his ankle. They saw changes in the X-ray and are chalking it up to ligament damage due to Cushing's. so.....once again it seems clear he has Cushing's. ;). Anyway, low dose dex tomorrow. Then go from there so we can get this tumour out of him!

[kaibosmom]

Oh as far as liver supplements he is on Zentonil.

[kaibosmom]

Kaibo was not a happy camper! No food makes a Cushing's dog cranky!

[molly muffin]

Cranky kaibo is not be messed with. :) Hope the testing went okay.
When do you get the results?

hugs,
Sharlene and Molly Muffin

[kaibosmom]

Well they said they went ok and that we should have the results tomorrow. Fingers crossed. Then we will see if we should do the urine test to see if the tumour is a pheo. I almost think we should to be on the safe side. Or is that overkill?

[Simba's Mom]

Praying for good test results, sending hugs too!!

[Trish]

Yes I am another wishing for good results today so you can get off this merry go round!! Your stress levels must be through the roof, I love your pic of Kaibo, adorable! :)

[frijole]

Well they said they went ok and that we should have the results tomorrow. Fingers crossed. Then we will see if we should do the urine test to see if the tumour is a pheo. I almost think we should to be on the safe side. Or is that overkill?

Please explain to me what urine test can determine that the tumor is a pheo. :confused: Kim

[kaibosmom]

Well. They said that he isn't presenting like it could be a pheo tumor but that in surgery if it was and the epinephrine ? (It's early so hope I'm getting the right stuff, but regardless) was released it could be bad news. So there is some special urine test (24hour collection) that would help tell if the tumor is a pheo. Then if it was you pre-treat with something. At least this is how I remember the explanation. :eek:

Thanks for the well wishes! I'm relatively at ease about this at the moment. Knowing there is a mass on the adrenal is kind of tying things together (like why he couldn't stay in maintenance for instance). I guess it's just a relief to start having some answers and a plan of action instead of the roller coaster we've been on. Oh and I don't think I posted about his knee surgery consult from Wednesday. They said he still has a cruciate tear and recommend surgery after all of this other stuff is sorted out. And they found no arthritis setting in but damage to his Achilles. This was connected back to Cushing's and its effects on ligaments, muscles, etc.

[kaibosmom]

Oh. Re:pheo urine test. It doesn't predict with certainty but has been showing solid results in predicting it. Just remembered so thing to that effect. :D

[Harley PoMMom]

I did some googling :eek::) and there does seem to be a urine test that may predict a pheo in a dog: Urinary catecholamine and metanephrine to creatinine ratios in dogs with hyperadrenocorticism or pheochromocytoma, and in healthy dogs. (http://www.ncbi.nlm.nih.gov/pubmed/20707840)

An excerpt from the article:
CONCLUSION AND CLINICAL IMPORTANCE:

Dogs with HAC might have increased concentrations of urinary catecholamines and normetanephrine. A high concentration of urinary normetanephrine (4 times normal), is highly suggestive of PHEO.

[kaibosmom]

Hi all. I'm stunned and at a complete loss. The low dose dex test does NOT support that Kaibo has Cushing's disease :eek: how can this be? He has all of the symptoms! So, seeing as I missed the vet's call and got this info by voice mail I couldn't ask that question. She will be phoning me on Monday to discuss the urine collection protocol for the pheo urine test. Said something about how the mass might be an incidental finding and that we would still have to look into his appetite. Huh? Oh my. The roller coaster continues....

I'm taking him for a walk now. I'll be back later.

[frijole]

Simple. If it is a pheo tumor it is NOT cushings. It happened to me. You don't treat with lysodren or anything. The only thing it doesn't explain though is the water intake and urination which my dog never had. Gotta be something else causing that. Kim

[kaibosmom]

His water intake hasn't increased since we took him off the Lysodren. The panting, appetite, and decreased energy are most noticeable. Why did he respond to Lysodren? Would that be normal? He doesn't have pheo symptoms. I don't think. Better keep reading :p. well I'm glad I've got you Kim. Sounds like Kaibo might be the same type of situation as your dog!

[frijole]

Except my dog had no appetite. Does Kaibo have high blood pressure or times when he is panting so hard you think he might have a heart attack? Does he get sweaty? Does his skin turn bright pink/red at times? Just sharing some of my symptoms.. and they came and went because pheos are not always active. when active is when you see these things.

It could be that there are other forms of adrenal tumors that are not cushings. I do not know.

[frijole]

Oh and re the lysodren and responding to it... it is my opinion that Annie had high cortisol as a resort of her pheo even though it was not cushings. Her body was fighting the pheo and the pheo emits adrenaline so you can see why cortisol might rise. For this reason lysodren in small doses could actually have helped. But since my dog didn't have cushings she never went below like a 16 on the acth test. In short - 16 is normal for a normal dog so that's where she stayed and giving her more would have harmed her. Glad we figured it out.

How much water does Kaibo drink in a day? Normal dogs drink 1 ounce per pound. So an 8 lb dog would drink a cup of water. What other cushings symptoms does Kaibo have? Thanks

[molly muffin]

It is especially frustrating I think when tests seem to be contradictory of each other. Ldds negative, acth positive, responding to this, not responding to that. It's enough to drive a person batty.
Cushings is hard enough. Throw a pheo into the mix and it becomes even more difficult.
I think I read that like 12% of dogs have concurrent cushings with a pheo. So that isn't a very high number, but it remains a possibility until ruled out.
hang in there, you really are doing great. It's just very frustrating.

hugs,
Sharlene and Molly Muffin

[Trish]

Hi
My dog has been treated for a pheo with surgery. It was confirmed on histology.

His main symptoms were hypertension, hunger, shaking, lethargy, panting, pot belly, hind leg weakness, high liver function tests (but he does have history of liver tumour resection and benign nodular hyperplasa). He did not seem to have the episodic attacks that Kim's dog Annie had, like the sweating, pink skin, terrible panting etc, his were more generalised symptoms which made them think it was continuously releasing small amounts of the adrenaline rather than big bursts every now and then. These tumours can behave differently.

Some of Flynn's symptoms are similar to cushings, but he never had the more common ones like excessive drinking, peeing or hair loss. Still they investigated for cushings (which is why I ended up on this msg board when I was doing my own research into this!), his urinary cortisol was the only test that was very slightly elevated and they took that sample via stabbing his bladder which should not be done as they are meant to get the urine in a stress free environment like at home, so that is why his cortisol was up that day. He had two low dose dex tests, both negative, acth negative. So he remained undiagnosed for about a year (he had x1 CT and 2 ultrasounds in that year) until it finally grew big enough to be seen on the 3rd ultrasound, the scary thing was by then it had invaded vena cava even though the tumour was 1.8cm. So off to surgery he went.

Unfortunately he still has some of those symptoms to this day, which makes me think there may have been pheo spread but we do not know that for sure, he has another scan due next month. But he is otherwise doing good!!

I have heard of those urine tests for pheo, they do them in people a lot but I thought the problem was that they had to collect 24hrs worth of urine which is obviously hard to do with a dog. The other problem is if the tumour is secreting intermittently it is very possible the urine sample collected may be at at time when it is dormant.

Hope that helps, like cushings they can be tricky to diagnose the type of adrenal tumour until they get it out.

Trish

[kaibosmom]

Hi again. Sorry I haven't been around much. I will try to answer questions and finally get blood work on soon. It isn't that this isn't important to me, I just am busy and when I'm home I kind of just want to cuddle with Kaibo as long as I can before I have to plan lessons for my students. Then it is late...like now..etc. Anyway, here's the latest.

Heard on Friday that the LDDS test was not at all consistent with Cushing's and that the new vet, Dr. S, would get back to me on Monday with the protocol for urine collection for the pheo urine test. Didn't hear from her so I gave the college a call. She did call me almost immediately and said that she has been trying to get in touch with the lab in Regina (a city 2 hours away from Saskatoon) to come up with a protocol for dogs. Seems like they haven't done it before or for a long time. So, basically she said they don't really know what the pathologist is going to recommend. But, she is thinking it might be best to bring him in periodically during the 24 hour collection time for them to catheterize him so that bladder could be drained and all urine accounted for. :eek: So, I questioned this method and the fact that I have read that you don't want the dog to be under additional stress during the collection time, so wouldn't catheterizing him make the results kind of invalid or questionable at the very least. She went on about how the urine has to be acidized and we wouldn't know how much acid to add, how we'd have to store it in the fridge and get it to them the next morning, how it should be taken throughout the day since it isn't always producing catecholamines, and so on. Sorry, but this doesn't sit well with me. I did a bit of reading tonight and can't find anything about how to best collect the urine, just that in general it is best to collect the urine at home.

She said that we will see what the results of this urine test show but that ultimately the tumour should come out. Agreed. Depending on the results of the urine test she is also suggesting the next step would be an ACTH stim test that is sent somewhere in Wisconsin for a complete panel.....I know some of you out there will know what I mean...can't think of how she worded it exactly right now. I'm exhausted.

Oh and another thing...I don't think she likes all of my reading and research and has made some sort of comment before I even met her about "Dr. Google". :p

One more thing - we have started measuring his water again and it seems to be about 1 cup a day. He weighs 5.9kg at last check (If I remember correctly).

[labblab]

Gosh, but you have a lot on your plate to sort out!!! :o :(

Just wanted to add one thought, though, and that is about the urine collection. In terms of the preferability of collecting the urine at home, I am thinking you may be seeing recommendations that relate more specifically to the more common UC:CR test that measures cortisol in conjunction with diagnostics for conventional Cushing's. When performing that test, it is definitely best to collect urine when the dog is as stress-free as possible. But this urine test for the pheo sounds like an entirely different type of test altogether. So the "stress" component may not be an issue, whereas the certainty of getting a total collection may be more important. I don't know anything at all about testing for a pheo, but just wanted to throw that thought out for your consideration.

Marianne

[kaibosmom]

Thanks Marianne! That is a good point. I did find a journal article abstract for pheo. I'll check it again. Perhaps you are right. Complete collection might be more important. I wish I could just find a connection to an expert somewhere! Lol

[Squirt's Mom]

Wisconsin? Is this the full adrenal panel that will show the intermediates or something else? I ask because as far as I know the Uni of Tennessee is the only lab doing that testing so if there is another lab now testing intermediates, that would be great to know!

[kaibosmom]

I can clarify the next time I speak with the vet!

I did hear from her today. Basically, she gave me the 2 options from before. Get the urine samples by catheter throughout the day and evening or we try to collect it ourselves for 24 hours. She said they decided on a "pooled" sample so everything will go together for 24 hours, we take it to the lab, and they mix in the hydrochloric acid, freeze it and send it to the lab in Regina. They want the sample Monday or Tuesday. So, we are going to do a few practice rounds of trying to collect his urine. If it doesn't go well we will take him in I guess. I'm falling asleep at the computer. Two field trips in two days makes this grade one teacher sleepy and ready for some poodle cuddles!

P.S. Can anyone out there who has had a dog with a pheo or done the adrenal surgery tell me how long the recovery is, complications, how long dog needs to be in hospital post-surgery, etc. Thanks.

[Trish]

Hi
Flynn had adrenalectomy for pheo. He was out of hospital in 22hrs, back in 48hr later! Back out the next day :) So my advice would be stay in there a few days until they are certain he is right. We live about 3 hrs drive from pet hospital, so I got a motel close by and stayed there for five nights after surgery to make sure he was right before going all the way home, so we had access to followup in that initial period.

Keep in mind Flynn's post op recovery was complicated by a retained swab, so he had further surgery 16 day after adrenalectomy to remove it. This slowed things down considerably, he also had a touch of pancreatitis postop. You can read all the details in his thread but I believe without that hiccup he would have been a lot better a lot quicker. I had two weeks off work and needed every day of it. There is a photo of him in his album taken 22hrs following surgery. Tomorrow is our 5 month anniversary from surgery! Still have ups and downs with a few BP and kidney issues mainly. He is due his 6 month scan to check progress at the end of this month so have fingers crossed we get a good report. Happy to answer any questions you might have.
Trish

[Bo's Mom]

Don't you just love those poodle cuddles/kisses after a long day of little 6/7 year olds?? They are the best!! :D:D:D
Anyway, good luck with finding out everything....Kaibo sure has been an enigma to baffle those vets. But, our precious angels always are. :p

[frijole]

We didn't have the surgery but I've read about every case on this board and have a few thought that might help.

- it is important that prior to considering surgery that extensive imaging be done to determine the likelihood of success. this info needs to be shared with the specific surgeon performing the operation so that they can see how large the tumor is, the location, whether it is invading the vena cava and if anything else is going on that may impede success.

- you need to interview that surgeon to see if you are comfortable with them, their level of experience - this surgery is very tough and so you can't have just anyone perform it. Others have said that they had to have the mindset going in that they were willing to lose their dog in order to save it.

- prior to surgery the dog is put on drugs for a few weeks to help fight infection and thin the blood I believe. find out what their plan is and share it here.

- 50% of the risk is the surgery itself and 50% is recovery as it is very invasive and infections can occur post op. Some dogs are out after a few days and others longer than that - it really depends on the situation.

Given what has happened to you thus far with various vets I would demand to know who would do it, demand to see their credentials and to meet with them before making any decisions. You need a comfort level that they know what they are doing and would be great doing it. Kim

[kaibosmom]

Sorry about getting your hopes up...full adrenal panel was/is to be sent to Tennessee. Where I got Wisconsin from is beyond me :rolleyes:

[kaibosmom]

24 hour urine collection done to test for catecholamines. Should have the results by Friday. We will go from there.

[molly muffin]

Hope all results are good ones!!! Crossing fingers!

hugs,
Sharlene and Molly Muffin

[Trish]

HI
Wondering what is happening with Kaibo, very interested in hearing about the results of this urine test too, hopefully all is well and we hear from you soon :)

[kaibosmom]

I called yesterday and they didn't have the results back yet :(. I asked what the next steps were and was told when they come back they are going to take all of Kaibo's tests and sit down to go over everything with a clinical pathologist. That's all I know for now.

[molly muffin]

They certainly do take their own sweet time with these lab results. I'm sure I'd be chewing nails and grey haired by now. (this is what manicures and beauticians are for I'm positive!)

Have a wonderful Mothers Day.
Sharlene and Molly Muffin

[kaibosmom]

Ya. I'm getting pretty anxious. I just want to get to the bottom of it. Get the tumour out. Get on with life. It stresses me out the more time they waste the more the mass could be growing. It also gives me time to think the worst. Like sometimes lately I think about how much I should enjoy every moment because who knows what could happen. So many tears lately. I want to think the best but I know the surgery is risky. Anyway, he seems so happy and healthy lately. Hard to believe he's got this mass. I will want some more proof before the surgery since it isn't like they've had a stellar record with diagnosis ;)

[Simba's Mom]

Praying for good results, sending hugs too!

[frijole]

Ya. I'm getting pretty anxious. I just want to get to the bottom of it. Get the tumour out. Get on with life. It stresses me out the more time they waste the more the mass could be growing. It also gives me time to think the worst. Like sometimes lately I think about how much I should enjoy every moment because who knows what could happen. So many tears lately. I want to think the best but I know the surgery is risky. Anyway, he seems so happy and healthy lately. Hard to believe he's got this mass. I will want some more proof before the surgery since it isn't like they've had a stellar record with diagnosis ;)

How is Kaibo doing? I understand your stress but this is the place that after loading put him on a maintenance dose that was lower and wondered why his cortisol went up. I too would not rush into any surgery because they'd have to prove to me there is a tumor and that they have the skills to job.

If he's happy and healthy and you aren't seeing symptoms savor the time. xoxo Kim

[Mel-Tia]

Thinking of you both..

Hope you hear something tomorrow so you can work out your next steps

Hang in there, big hug

Mel
Xxxxx

[kaibosmom]

Hi. Awhile back someone asked the symptoms we were seeing. We measured his water and I don't think he is drinking excessively as was once thought. About 1 cup a day. He weighs 12 pounds. Hair loss/thinning hair. Panting. Excessive hunger although we changed his food and that seemed to get better. Made it clear when he stopped eating new food and went back to old food. Was then getting up two or three times t night to eat instead of once. Dry nose! Dry skin. Wrinkly, flaky, on belly. Dandruff. Heavy breathing. Decreased energy but bright and alert. Knee problem so hard to tell if he has hind end weakness or not. Those are the main things we are seeing at the moment. I'm sure I missed stuff. I'm rather exhausted. I took him to see his old flyball buddies today. He got lots of attention and wanted to play with his old buddy Zen. So cute. He was so bright eyed and happy! When he saw the flyball box he wanted to go play. Poor dude. I told a few people about the tumour so it was kind of a hard day.

[Mel-Tia]

Thinking of you both. Hope you get some news today

Big hug

Mel
Xxxxxx

[kaibosmom]

Nothing today and it is almost 6pm here :(

I think the little guy might have an eye infection. I'll have to keep an "eye" on it.

[frijole]

Wow nothing yet? So sorry. :(

Re the eye - please do keep an eye on it. I was totally unaware of eye health issues and Annie (who had the pheo) ended up with a corneal ulcer that never healed. I think if I had figured it out sooner it might not have been so bad. I ended up giving her 5 different types of drops 4 times a day.. 10 minutes a part... it consumed my life and you can't miss giving them so trust me - have that eye looked at if persists much more than a day or two.

Sending love because that 's all I got! Kim

[molly muffin]

Arrgghhh I cannot believe how long it takes to get results for you. :( I know you are probably on pins and needles waiting.
oh gee, an eye infection! Well, hopefully not. If so though it needs to be caught early and treated, as it can be a pretty rough experience treating if it goes too long. I know, one more thing on your plate that you don't need right now. I'm thinking of a couple members though who have gone through some eye problems and the key does seem to be treating early.

Hang in there!!! We're still here waiting with you.

hugs,
Sharlene and Molly Muffin

[kaibosmom]

He really doesn't seem himself tonight. I just got home from a ball game but he isn't even getting up to beg for Doritos. :eek: that's completely abnormal. If I ever figure out how to put pictures up ill post his Doritos picture. It's the cutest!

[Trish]

I hope we some more pictures of sweet Kaibo too, such a cuite with those flapping ears! Any news yet on test results? I bet you will be in there beating there door down soon! Hopefully we hear from you soon
Trish :)

[maria]

I am sorry little Kaibo is having problems. What I find interesting about his case is that he is so young to have Cushings but he has the symptoms. My Pumphrey was around 3-4 when she started getting symptoms. I was told at the time that dogs that young almost never get Cushings and usually they are > than 9 yrs. Did your vets mention Kaibo's age being a factor at all?

Someone else asked if he had been on steroids which can cause iatrogenic Cushings. I had a Beagle-mix who had very elevated liver enzymes (in the thousands) and she turned out to have autoimmune hepatitis. Did they mention that possibility? After the ultrasound, they wanted to do a biopsy to dx it for sure but I opted to treat her with steroids to see if it improved then we would know for sure and her liver enzymes went down as a result. She was also on the supplement Denosyl ( Sam E) to help her liver and friends have recommended milk thistle as well to help protect the liver. You could research them and see if your vet thinks it is okay to start him on the supplements. Pumphrey has an enlarged liver as well.

[Bo's Mom]

How is little Kaibo tonight? Any word on results?

[kaibosmom]

Hi everyone. I just saw the recent posts when I came on to write about how Kaibo is doing now. I posted a few days ago that he wasn't himself. He hasn't been for the most part. He is rather bright eyed and perky but not overly energetic. He has been panting lots and kind of lethargic. HIs nose is still very dry, but that isn't new. He has been breathing rather heavily. My husband says it is because of the heat...I don't buy it. It isn't that hot here about 20 celcius. I have noticed that he doesn't really want to walk lately and because of my husband's theory of the heat we have been taking him in the evening when it is cool. He walks very slowly and pants heavily. The other thing we have noticed is the other day one of the dogs peed on the rug. We assume it is Kaibo but Molly is almost 12 so who knows. Today, my husband had to come home in the middle of the day so he let them out to pee. He said Kaibo had a HUGE pee around 3 pm. I cam home around 6:30pm and let them out. He peed but I didn't pay attention to how much. Then, came inside and sat down on the rug to play with him and stepped in wet...you guessed it, pee. So, I put my hand on it...don't judge ;)...and it didn't smell strong but obviously it had to be pee. So I got some paper towel and sure enough very light yellow in colour so quite diluted then, correct? I went to feed him and noticed that his water bowl was empty. I filled it and he took a huge drink. I just let him out again as he was scratching at the door like it was urgent and he had a big pee once again. It is about 8:45 here now. I also just noticed his upstairs water bowl is dry too so I just filled that and he had a big drink again. So...that left me searching about urinary tract infections, diabetes, etc....everything I read references possible adrenal issues, Cushing's, cancer, and obviously, diabetes. OMG....how, when will I ever get an accurate diagnosis here!!!!

That leaves me to the update on the vet and urine catecholamine test results. NOTHING yet!!!!!! Are you frigging kidding me???? I had called last Friday and vet called and said she would call me when they came in and that she would be meeting with her supervisor and a pathologist when they came in to determine a plan for Kaibo. Still hadn't heard by Tuesday so I called again, only to get an EMAIL!!!!! The email stated the same things as the conversation on Friday, ending with a "thank you for your patience" comment. Well, guess what? I'm out of patience, especially in light of this new peeing issue. If this mass diagnosis is correct, then let's get on with it. Maybe they are wrong, it is diabetes? But no blood test results showed increased glucose, except the last 2. Yes, tonight will be the night I finally post blood work. Stay tuned. Now I'm just mad and searching for answers on my own....well, perhaps with all of you! I'm so fed up!

p.s. I posted photos!!!!

[kaibosmom]

@Maria....his age was brought up recently because when his liver enzymes started elevating he was only 2 (discovered during blood work for his first patella surgery) and because we couldn't keep him in the right range when on mitotane. His liver enzymes did drop after taking him off mitotane. Again....time to post blood work. This could take awhile!

[kaibosmom]

Blood Test Results

I'll go back...way back...
I will put the ref. int. in brackets after the result; will not repeat the reference level if already in a previous result.

July 13, 2009 (25 months old) (luxating patella surgery on left leg)
*urine test slight cloudy bright yellow in colour; protein 1+; no ketones.
creatinine 40 umol/l low (41-121)
cholesterol 8.80 mmol/l high (2.7-5.94)
ALT 67 u/l high (19-59)
GLDH 14 u/l high (0-7)

August 12, 2009
creatinine 38 umol/l
glucose 808 mmol/l high (3.1-6.3)
cholesterol 9.41 mmol/l low
ALT 106 u/l high
GLDH 17 u/l high

October 14, 2009
cholesterol 9.37 mmol/l high
ALT 81 u/l high
GLDH 16 u/l high
albumin 40 g/l high (28-38)
a/g ratio 1054 high (0.73-1.49)

Note: creatinine has normalized since previous submission. ALT has shown mild improvement; however, there is no significant change in GLDH. Hypercholesterolemia persists and is non-specific finding that could be due to post-prandial sampling, high fat diets, cholestasis (no supportive evidence) or some endocrinopathies. Mild hyperalbuminemia suggests dehydration.

July 12, 2010 (luxating patella surgery on right leg)
urine test had ketones 1+; only comment was ketonuria indicates increased lipolysis; cloudy yellow in color; glucose normal.

hmmm....I don't seem to have the blood work on this one....

August 25, 2010 - I believe we were following up on the liver enzymes at this time; post surgery
*urinalysis protein 1+; glucose normal; ketones 2+; bilirubin 1+; blood 4+; high urine concentration...bacteria in sample could reflect contamination, no evidence of inflammation. Positive protein and bilirubin reactions are not concerning at this time. Positive ketone reaction suggests enhanced lipolysis for energy production.

cholesterol 11.12 high
alk phos 215 u/l high (9-90)
ALT 72 u/l high
GLDH 43u/l high
albumin 42 g/l high
SDH 8.0 u/l high (0.04.0)

relatively comparable hepatocellular leakage enzyme values compared to last chem panel. Alk phos elevation - potential bone isoform contribution on top of liver, steroid induced isoforms?; hypercholesterolemia persists.

posting now...don't want to lose this...so time consuming!

[kaibosmom]

June 20, 2011 – chocolate toxicity
*urine yellow, slightly cloudy; protein 1+; glucose normal; ketones 2+; bilirubin neg; blood 3+; adequate urinary concentration – consider UPC to further quantify the degree of proteinuria, if desired. Ketonuria – prolonged anorexia or negative energy balance could cause this.
urea 1.2 mmol/l low (3.5-11.4)
creatinine 27 umol/l low (41-121)
cholesterol 15.27 mmol/l high (2.7-5.94)
alk phos 473 u/l high (9-90)
ALT 95 u/l high (19-59)
GLDH 54 u/l high (0-7)
a/g ratio 1.91 high (1.06-1.82)
hypercholesterolemia – related to cholestasis or possible underlying endocrinopathy. The liver leakage enzymes are higher (mildly) than the last chem panel from Aug 2010. Low urea and creatinine values – has this patient received IV fluid therapy recently? Body condition score? if recent fluid therapy has not been given, the urea value is concerning for inadequate hepatic production.

November 7, 2012 (had been diagnosed with Cushing’s at this point)
chloride 101 mmol/l low (105-120)
anion gap 28 mmol/l high (12-26)
creatinine 25 umol/l (41-121)
cholesterol 15.43 umol/l (2.7-5.94)
alk phos 1356 u/l high (9-90)
ALT 188 u/l high (19-59)
GGT 56 u/l high (0-8)
GLDH 127 u/l high (0-7)
CK 804 u/l high (51-416)
albumin 45G/l (32-42)
liver enzyme elevations persist. cholestatic liver enzymes (ALP and GGT) have at least doubled since the last submission and hepatocellular leakage enzymes (GLDH and ALT) have also increased. These changes could be consistent with a steroid hepatopathy secondary to Cushing’s; direct induction of ALP by endogenous glucocorticoids is also likely contributing. although the liver enzyme elevations are likely secondary to Cushing’s an underlying hepatic disease cannot be ruled on serum chemistry alone. (Has Cushing’s disease been confirmed through endocrine testing?). The moderate hypercholesterolemia is unchanged since the last submission and is likely due to a combination of elevated glucocorticoids with Cushing’s and cholestasis likely occurring, and is characterized by a high anion gap metabolic acidosis and hypochloremic metabolic alkalosis. Low creatinine could be consistent with muscle wasting. The urea is now within the low end of the reference interval. Mild hyperalbuminemia could be related to dehydration, or due to increased production stimulated by elevated glucocorticoids.

***a later blood work up states that he had chemistry panel, UPC ratio and urinalysis done December 15, however, I can’t find those results

January 8, 2013
*urinalysis: dark, yellow slightly cloudy; protein 1+; glucose normal; ketones neg; bilirubin 1+; blood 1+; well concentrated urine sample; slight proteinuria may not be significant at this USG; consider monitoring for persistence +/- urine protein; creatinine ratio to further quantify. 1+ bilirubin reaction is normal for dogs at this USG. Blood reaction may reflect method of collection (not indicated on submission.

chloride 104 mmol/l low (105-120)
anion gap 31 mmol/l high (12-26)
creatinine 39 umol/l (41-121)
glucose 6.8 mmol/l high (3.1-6.8)
cholesterol 22.89 umol/l (2.7-5.94)
alk phos 2004 u/l high (9-90)
ALT 365 u/l high (19-59)
GGT 74 u/l high (0-8)
GLDH 310 u/l high (0-7)
albumin 43G/l (32-42)

changes are similar to the previous submission in Nov 2012; the anion gap remains elevated; the cause is not readily apparent; lactic acidosis secondary to poor oxygenation? mild ketoacidosis? is patient on any medication? A very mild hyperalbuminemia may also be contributing mildly to the elevated anion gap, but the effect is expected to be minor. The mild selective hypocholoremia also persists, and is usually attributable to vomiting or upper GI stasis/sequestration. Together these changes suggest persistence of the mixed hypercholoremic metabolic alkalosis and high anion gap acidosis (blood gas could be performed to further investigate acid/base status and to rule in/out lactic acidosis). Mild hyperglycemia is likely due to the effect of endogenous glucocorticoids +/- insulin resistance. The cholesterol has trended upwards since the last submission, again reflecting effect of glucocorticoids and/or cholestasis. ALP and GLDH have also both increased. Marked elevation in ALP and moderate elevation in GGT reflect cholestasis, with induction by glucocorticoid contributing to the ALP elevation. Moderate elevation in ALT and marked elevation of GGT reflect hepatocellular leakage. Liver enzyme elevations could all be due to steroid hepatopathy secondary to hyperadrenocorticism, though previously noted, underlying hepatic disease can not be ruled out. Mild hyperalbuminemia is likely due to mild dehydration/volume contraction.

March 8, 2013 – ACTH stim test and blood work was done; was in maintenance phase at this time but we were seeing symptoms return. ACTH stim test showed that he was not in therapeutic range; cortisol levels high post ACTH stim.

chloride 103 mmol/l low (105-120)
anion gap 29 mmol/l high (12-26)
creatinine 33 umol/l (41-121)
glucose 6.4 mmol/l high (3.1-6.8)
cholesterol 24.89 umol/l high (2.7-5.94)
indirect bili 2.7 umol/l high (0.0-2.5)
alk phos 2266 u/l high (9-90)
ALT 272 u/l high (19-59)
GGT 49 u/l high (0-8)
GLDH 320 u/l high (0-7)
total protein 77 g/l high (55-71)
albumin 45G/l (32-42)
*comment page was missing

March 27, 2013 Thyroid function test normal (t4 resting and TSH – endogenous)


April 12, 2013 – I believe he was off of the mitotane at this point for a month.
chloride 99 mmol/l low (105-120)
anion gap 29 mmol/l high (12-26)
creatinine 29 umol/l (41-121)
glucose 9.5 mmol/l high (3.1-6.8)
cholesterol 15.22 umol/l high (2.7-5.94)
total bilirubin 0.8 umol/l low (1.0-4.0)
lipase 1297u/l high (25-353)
alk phos 1005 u/l high (9-90)
ALT 81 u/l high (19-59)
GGT 41 u/l high (0-8)
GLDH 149 u/l high (0-7)
total protein 75 g/l high (55-71)
albumin 46G/l (32-42)

Hyperalbuminemia consistent with dehydration. Low creatinine can ben seen with diuresis (enough to result in dehydration?usg?) or low muscle mass? Mild stress hyperglycemia. Selective chloride loss – history of vomiting? Mild AG acidosis – lactic? Normal bicarb in this picture suggests mixed disorder. A new 3.7 fold increase in lipase consistent with active pancreatitis, although with evidence of dehydration there could be support for decreased GFR contributing. Pancreatic health warrants further investigation. Hepatobiliary enzymes persist although there is general improvement – this may reflect better control of the hyperadrenocorticism; however, pancreatitis could be contributing to these elevations also. Hypercholesterolemia has also improved, but can be seen with pancreatitis, cholestasis, and endocrinopathies – all of which could contribute in this case.

There seems to be no rhyme or reason to these results. The last ones, when off of mitotane for 4 weeks, show improvements in some areas.

[Squirt's Mom]

I wasn't familiar with GLDH so I looked it up since Kaibo's has been getting steadily higher for some time. What I found is concerning to me - but that don't take much ya know :o. I read this as saying elevations in this value always mean an injury to the liver in all species.


GLDH – Glutamate Dehydrogenase

Localized with the mitochondria. High activity within centrilobular liver cells.

High specifity for liver injuries in all species. Hypoperfusion of liver tissue induces solitary increases, parallel increases with transaminases indicate liver cell necrosis.
http://www.vetmeduni.ac.at/zentrallabor/Enzyme/Enzymbeschr_e.htm

Has your vet talked about the possibility of liver issues?

[frijole]

OMG I want to drive up there and grab you and Kaibo and kidnap and take you to a vet that we know will figure this out.

For those of you chiming in - please note that this poor dog and its owners has been through what I call 'vet hell'. They ARE at the teaching hospital but they keep getting switched to different vets/interns. Everyone has a different opinion.

She used lysodren and actually was loaded. For some odd reason they put Kaibo on a maintenance dose that was LOWER so of course the symptoms (urination) came back. At that time a new vet came on the scene who didn't think Kaibo had cushing's.

So they did another ultrasound (they've done like a billion on the poor guy) and say they found an adrenal tumor. They have been doing more tests to determine if its a pheochromocytoma.

I can only say that this case is nothing like Annie's experience with a pheo. When using lysodren and when loaded the dog felt fine. The urine is dilute. Has Kaibo ever had high blood pressure? If not then you can rule out pheochromocytoma. That from the head of the teaching school at Kansas State University.

Did you ever discuss with them that the load was lost after the maintenance dose was reduced?

Sending you continued strength. Kim

[kaibosmom]

Hi. Thanks for the accurate and brief summary Kim. I am at my wits end at this point. Last night he was breathing heavy, panting, drinking excessively, peeing lots, restless, and generally seems uncomfortable. I am ready to pack him up and take off to another province or even into the states at this point. You have no idea how I wish it were June and school was over so I could do this. I forgot to mention that his pot belly has actually disappeared since being off the Lysodren. It was very distended around the time of the April blood work when the question of pancreatitis was brought up. I do believe he was having an episode however he didn't present with vomiting or diarrhea as he has in the past.

I do believe that his blood pressure was checked at some point this year (I'm on my iPad now and Kaibo's binder is in my office) and was normal. He doesn't have pheo symptoms that I can tell, besides those that look like Cushing's.

Liver issues have been brought up numerous times. That is the reason for at least two of the ultrasounds. We had liver function tests and bile acid tests done in 2010. It was brought up recently that they would biopsy the liver when removing the adrenal mass.

I have had a fairly restless sleep and have been going over an email in my mind. She asked for my patience this week. I gave it to her but will not anymore. One reason for my call besides requesting the urine catecholamines results was to discuss symptoms I'm seeing now and to see if we can speed things up by having chest X-rays or the CT scan...that I requested they just do in March as opposed to another ultrasound. As you know we have spent lots of money on diagnosis. I'm quite fine with spending it but I'm tired of spinning wheels and getting nowhere. I asked in March what was the point of another ultrasound and that perhaps a CT scan or MRI would be more beneficial at this point. Anyway, I digress. Nothing I can do about that now. Thanks for your support and knowledge. I appreciate it more than you know.

Today, I am likely taking him to his old vet. She was never really involved with him directly besides doing chiropractic treatment on him but she is relatively up to speed on his case. The vet in her clinic that primarily saw Kaibo is now gone but she also passed us on to the vet college in December/January as she felt his case was perhaps too difficult for her. In the meantime, old vet clinic has a new vet...one stolen from the college...with an internal medicine internship under her belt.

[kaibosmom]

Kim I didn't discuss the load and maintenance issue with them yet but plan on it. I feel at this point the new resident will brush it off anyway since the Low Dose Dexamethasone test came back negative.

[molly muffin]

This is completely unacceptable. I am shocked that they have such shoddy service when it comes to results.

I know this is the hospital and should be the best around, but at this point, I'm not convinced that they are.

You might have said before, but which lab are they sending these tests out to? It should say on some of your results from the hospital at the top of the lab report which one did them.

Hang in there.
Sharlene and Molly Muffin

[kaibosmom]

They generally send the tests to a lab on campus. I'm not sure if it is in the same building as the vet hospital or not. The urine catecholamine test was sent to Regina, a city about 2 hours from Saskatoon.

[frijole]

OK so I was outside mowing... halfway done.... and I had a thought. I am pretty sure that the LDDS test was done recently and I believe right after Kaibo was loaded. If his cortisol levels were under control at the time wouldn't that skew the results? Throwing it out there. Kim

[kaibosmom]

I'm hesitant to take him to yet another new vet but he has drank almost a cup of water in about 4 hours. This is not right, right? College is closed for the long weekend and it would be a new vet there anyway. I'll keep you posted

[kaibosmom]

The LDDS was done after he was off of lysodren for over 4 weeks. So it shouldn't have impacted the results.

[frijole]

Still his adrenal cortex wouldn't have completely grown back yet which is why you are just now seeing symptoms again. The LDDS test is done BEFORE you use lysodren to diagnose. You were on it for quite a while and I'm just wondering if that could explain it.

Pheos are not cushings and so your dog wouldn't be drinking all of this water. If it isn't cushings the other culprits would be diabetes which is a no brainer to diagnose and you've had a billion blood panels done, the thyroid (hypothyroidism) and diabetes insipidus which is a different form of diabetes.

After all of these tests what does your gut tell you? Going out to finish mowing but I'll check in. Kim

[kaibosmom]

I'm at the old vet clinic now. Waiting to meet the new vet. Ok. She came in as I was typing. She seems great. We are doing urinalysis and blood work today. She would like a LDDS test but can't do that today. I said I would pay the extra fee for a rush to get the results back today. As for my gut. I think he has Cushing's. however the tumour part is weird. Would it be growing for 4 years? Anyway. Need to get to the bottom of this. Sigh. I might be all cried out for the day.

[kaibosmom]

P.S. Kim. That makes sense. I think new vet agrees. Thanks for always being calm and worried about my boy. She is confused about the tumour and still says things font add up. Agreed.

[molly muffin]

would the teaching hospital give you a copy of the uktrasound on a dvd so your old vet coud look at it?
sharlene

[frijole]

I think he has Cushing's. however the tumour part is weird. Would it be growing for 4 years?

Sure but here's the thing you have about a million and two ultrasounds done including one just WEEKS before they spotted a tumor. Sure they can just show up but you had so many done either they missed it over and over and over OR they saw something they thought was a tumor.

Bless you - I have been in your shoes and I know the feeling of helplessness. This board saved my sanity (well sort of hahaha) and I'm glad to help you in any way I can. Take a rest - sometimes we get so caught up in figuring out what is wrong we fail to take time to take care of ourselves and to hug the dog we are so worried about. Go hug Kaibo and put your feet up for the rest of the weekend.

Kim

[kaibosmom]

He has diabetes!!!!!! Will write more later. I have company right now.

[frijole]

OK... this is so hard to comprehend since you've no doubt had blood work done so many times. Only one question - did he fast prior to this morning's test? Because if he had breakfast that would skew the results. Just checking. Kim

[molly muffin]

Hmm, looking back over the lab results, Kaibo had had a history of high glucose readings, or high end of the range. I believe we were all concerned about ketones in 2012. So this could very well be the diagnosis and that makes the cushings diagnosis completely suspect. I also seem to remember that the adrenal glands were looked at and were even on the small size at one point, not sure if that was 2012 but I think so.

Do let us know when you have time. In the meantime, enjoy your company

hugs,
Sharlene and Molly Muffin

[kaibosmom]

When I took him in this morning I said, I'm wondering if he has diabetes. New vet...Dr. Stephanie said that the higher values on blood work since January weren't cause for concern and could have been due to stress. When she phoned with the results she said it is definitely diabetes. I asked, hopefully, if the tumour finding could be wrong. She said, no. They sent her the results and adrenals are 4.4 mm and the tumour is 9.5mm. She said there are still lots of questions remaining for my little man:(. She also said that before there were no signs of diabetes but there is now. Urine had 4+ glucose but no ketones. Glucose in blood was 27. I better go visit now.

[kaibosmom]

Oh. We go to see her on Tuesday to find out about insulin. She wants to talk to Dr. S at the college before starting and doing another LDDS. She felt like Kim that maybe the last results were skewed.

Yes he did eat this morning. However, he has drank almost 2 cups of water since the morning. He's peed in the house twice.

[labblab]

Did the vet know that Kaibo had eaten? How long after breakfast was the blood drawn? I agree with Kim -- that is critical information. Unless the blood draw was several hours later, I don't think the the blood sample could be an accurate indicator of diabetes. Unfortunately, I don't know as much about fasting and urine glucose levels, although I believe that a nondiabetic dog will never be spilling glucose into the urine. So if glucose was present in Kaibo's urine, that is meaningful in it's own right.

[kaibosmom]

He would have eaten 5 to 6 hours before the blood and urine samples were taken.

[Trish]

Oh lordy, so it looks like diabetes now PLUS the adrenal tumour? Well that is a turnup for the books! How frustrating for you, but diabetes can be managed with the help of the K9 diabetes posters who I hear are as good as all the experts on here! Did she not have the catecholamine urine results yet to give an idea if it is pheo or not on the adrenals? Kaibo is not doing it easy for you is he!! I am hoping in a month or so this will all be settled down and you will be moving ahead with Kaibo feeling a ton better :)

[kaibosmom]

Yes he is being quite difficult isn't he? He likes to be special :D. Anyway, I'll be heading over to the diabetes site to introduce myself. I wonder if the adrenal tumour is growing and the diabetes has something to do with it. My friend is a pharmacist and says the adrenal tumour may be releasing cortisol so the diabetes is showing up. The old vet clinic tried to get the catecholamines results on Saturday but they said the results weren't back yet. I am very nervous about the surgery but I'm also hoping that in a month this will be over and Kaibo will be back to his old self. I'm just thinking out loud but perhaps this is another reason he seemed to respond to the mitotane. It helped the cortisol get under control which made the diabetes more controlled. Maybe he was producing some insulin then? I don't know. Throwing things out there. Lol. I guess it doesn't matter. Need to focus on what we know now.

[Jenny & Judi in MN]

I hate that they aren't in a hurry to get him on insulin. I don't understand that at all. As long as he isn't throwing off ketones he should be ok till tomorrow but I really wish she had started you on insulin pronto.

I wouldn't schedule anymore Cushings test till you work on the diabetes if I were you. Their cortisol can be raised from the stress of the diabetes. If you have time today, I'd see if I could at least get him in for an insulin shot today.

and come on over to the diabetes forum. very helpful folks there.

Drugstores have strips you can use to test a dog's urine for ketones. If a dog is throwing off ketones due to high blood sugar it can be life threatening. Every dog has a different tolerance. Jenny never did but some dogs do at much lower levels of blood sugar.

Sorry about this diagnosis. Judi

[kaibosmom]

It's a holiday here today so that is why she said to start on Tuesday. She also wanted to connect with the vet college before starting anything. I'm just glad I had already booked Tuesday off. It was to spend it with Kaibo and I guess I still will be just in a different way than I planned!

[Jenny & Judi in MN]

that Kaibo! :) hopefully he will be like Jenny and not easily go into ketonacidosis (or whatever it is called). If he gets lethargic or anything tonight though you will need to go to the doggy ER.

hang in there. The diabetes is easier to manage than the cushings because you can test blood sugar and get immediate results

[kaibosmom]

Here's an interesting tidbit. The new vet, who I think I love so far, talked with the vet at the college. The supervisor vet. I like that! No messing around. So, she said that the supervisor vet thinks the LDDS tests were misinterpreted and he does have Cushing's. I'm meeting Dr. Steph at 3 to discuss insulin etc so I'll get the scoop on that too!

[Mel-Tia]

Wowsers. I don't know how you are keeping sane through all of this

Good you have built a rapport with the new vet. Hopefully she will work through everything at 3

Will be looking out for the update.

Big hug to you

Mel
Xxxxx

[frijole]

INteresting! I love them too! Keep us up to date. xoxo Kim

[kaibosmom]

After I posted, I sent an email to the resident expressing my disappointment in what felt like being brushed off as a bother last week....yes, I wanted info on the catecholamine test results but I also wanted to talk to her about Kaibo's "funk" and how I felt like something was going on (obviously, we know now it was diabetes going on!). Well, I cc'd her supervisor too. Very quickly I had a response from boss vet lady. I kind of felt like maybe I overreacted but man...my frustration hit a new high on Friday. I am barely keeping sane and took a personal day today to prove it. Funny thing is, I pre-booked this personal day because I knew I was losing it and that my poor innocent grade ones were feeling the brunt of it!

In the middle of posting this I got a call from the resident. Many of my questions were answered and I feel better about many things. Will expand more later because now it is time to take off to learn about insulin shots!

[molly muffin]

I don't blame you one bit for being stressed out over this. I am very disappointed in the responses that you have had to a very serious issue. So, vent as much as you want to. :)
I do like that you new vet went straight to the supervisor and no messing around. Kaibo deserves the very best, every one of the furbabies out there deserve nothing less.

hugs,
Sharlene and Molly Muffin

[kaibosmom]

We FINALLY got the results!!! Just as I suspected, they are not supportive of a pheo!!! Thank goodness. I was surprised that the test DID support Cushing's disease....only because I didn't know the catecholamine test would show evidence to support it. I'm not surprised that it suggests he may have Cushing's because I have always believed that he does have Cushing's.

So, here's the new treatment plan. We have to get Kaibo's diabetes controlled first. The vet at the college said, up to a month or when we see signs of improvement and a good glucose curve. Our first one is Friday. At this point, I am sure we need more insulin as he is still drinking and peeing buckets. Poor goomer...pees inside...I know he feels bad. He seems to still be losing weight and he is hungry all the time! The panting is really bad now. I started giving him omega 3 oil this week because his nose is SO dry and his skin on his belly looks so wrinkly, thin, etc. Whoa...I'm getting sidetracked.

Anyway, I am to make an appointment in a month to see the vet we are now seeing at the college and to meet the surgeon. Apparently, they have talked about Kaibo a lot with many of the doctors there. Seems like everyone is on his case. I found this out after I cleared up some communication issues and what not last week on Tuesday when he started his insulin. So, what I know about the surgeon so far is that the intern and the boss lady think she will be great. She is fairly new to Saskatoon but comes from Georgia. She has done the surgery successfully in the past (I don't know how much)...but the great thing....she does it laparoscopically!

She said something about redoing the LDDS as well. We will also do a CT scan and if it looks like it hasn't invaded any other tissues the laparoscopic surgery can happen (otherwise it will be the traditional way). I will of course, get more info when I meet the surgeon myself. Oh and then we will monitor symptoms, etc. after surgery and they will put him on Trilostane if needed. I, of course, hope that everything gets better and all of the symptoms (even diabetes...ok....dream world maybe??) will disappear when the tumour disappears. I feel much more at ease and taken care of since my phone call and emails last Tuesday. The only thing I worry about (ok, not the only thing) is that the tumour is growing slowly. I am worried though because it wasn't seen in the ultrasound in January and was in March...and, I found out it is measured at 9.5mm. That just sounds bad :(

Ok. I think that is it for now. My husband asked after I got off the phone about putting him on Trilostane now. It sure would be nice to get rid of the hunger and panting like we saw disappear when he was on the mitotane. But, I guess we deal with one thing at a time and for now it is the diabetes. I hope that when he is better controlled maybe some of the hunger issues will disappear then as well.

[Trish]

Hi there

I am pleased to hear you finally got that result!! I would really appreciate if you could post it here, the actual numbers and what they have measured is very interesting to me. With my boy having had his pheo removed, maybe this could be a way they could test him in the future if we were worried about recurrence.

Good luck on getting the diabetes stablised so you can move onto the adrenal surgery option. There could be total resolution of cushings symptoms as the adrenal tumour could be the sole reason he has cushings. So that would be great wouldn't it!! Not so sure that the surgery would fix the diabetes though considering they are two quite different problems, but in saying that Kaibo is one that has most definitely not read the instruction book!!!!

Will be keeping an eye for the CT results, so hope it goes well.

Trish :)

[kaibosmom]

Thanks Trish. I will try to get a hold of the actual results and post here. Have a good day!

[kaibosmom]

Well the week was crazy so I didn't have time to call the vet college and request the catecholamine test results. Kaibo had his first glucose curve today. They sent him home early because he was too high. They increased his insulin to 3 units twice daily. He lost another .1 kg in two weeks. Hoping that is due to the diabetes and not the tumour. It is hard to know that tumour is in there. I just hope it is not growing quickly. I need that. After all of this, I really need it not to be growing quickly. I'm enjoying time with him every day. I'm not as weepy as I was a few weeks ago when I would just keep thinking the worst outcome of the surgery. I know I have to be prepared for anything but I also know I need to just focus on him. Right now that is learning about the diabetes and making sure I'm present in the moment and the time I have with him, Molly, my husband, and so on.

Oh and Trish...you've got it right when you say Kaibo hasn't read the instruction book. So true. That's why I'm pretty sure everything is going to be better when the adrenal mass is removed ;)

[Trish]

Yikes, you are juggling a lot of balls aren't you! But I think we are finally getting to the bottom of the Kaibo puzzle!!! Glad to hear you are dealing with it all though and have your eye on the prize! Is it onto the CT once diabetes stablised??

Have you been over to our sister site K9diabetes I know they are very helpful to our members that are dealing with both problems?

Hope your having a lovely weekend too :)

[kaibosmom]

Yes I am on there too. It's pretty quiet but then again I haven't had much time to be there either. School is winding down so ill be starting report cards soon. So time consuming. We really need to get him to sleep at night. He us pretty much up every hour. I think I'll look into the melatonin again. Part of me wants to just demand we start treating the Cushing's to see if that helps but the vets seem to want to just focus on the diabetes. Fair enough I guess. Just hate the other symptoms and wonder if they would clear up if he was back on mitotane or if we try trilostane. Anyway. I'm off to school for a bit.

And yes, lots on my plate. Kaibo. Teaching. Soccer (two teams). Slopitch. Therapy dog visits...when we can. I tried on Saturday. He was panting so heavily on the way there I turned around and came home. And, training for my first half marathon! I can't wait until school is done so I can rest a little.

The plan is the CT scan in a few weeks. Hopefully diabetes is controlled then.

[kaibosmom]

This is my recent post in the diabetes forum...


A urine culture was taken with his urine sample the weekend he was diagnosed. it was negative at that time. When he urinates in the house it is not a dribble but more of a river . We had his second curve done Friday. I left the results of both curves at work. I'll post them later. What I do remember is that his 12:30pm reading was 23 mm/l both weeks (2units first curve, 3 units 2nd curve). He has been increased to 4 units twice a day. He continues to lose weight and is now an even 5 kg. we bought the AlphaTrak on Friday. I go in on Monday to learn how to use it and take his blood samples. I'm worried about the weight loss and hoping it is not a result of the adrenal tumour. How long does it normally take a dog to get regulated on insulin? I know it is harder for Cushing's dogs but what is the general time line for other dogs? Should I be asking about treating for his Cushing's at this point or hold off? I think the idea was not to treat it, have the surgery, and see what happens after as far as Cushing's symptoms go. We have seen a decrease in panting and overnight restlessness in the last few days.

[frijole]

Good to hear from you. I wasn't sure what you meant by 'what is the normal time'? Are you talking about regulating a cush dog? If the dose is right it's pretty quick with trilostane and with lysodren it'd be 7 to 10 days (normal load time) ... but as you know no two dogs are the same. Kim

[kaibosmom]

No....I mean the diabetes! I meant to go back in and clarify this post and what info I was hoping to get from others. I am so busy writing report cards that I don't have time to think straight. But, I do make sure I give Kaibo his insulin and cuddle him up when I can! Still learning this diabetes stuff. Got a blood glucose meter on Friday and going in to the vet clinic to learn how to use it tomorrow. He is up to 4 units of insulin twice a day. I think today, there has been some decrease in water intake and urination (finally!). I hope we are on the right track. I am in a rush but not in a rush to get the adrenal mass out, if you know what I mean. It is so risky that I am fearful but I also don't want it to keep growing! Fella's story has me feeling less confident but again, each dog is different! The other question I had was if I should be asking about treating him for the Cushing's at this point. I think the idea was get the diabetes under control and then remove the adrenal mass and see if the Cushing's symptoms go away (they will! I know they will!!!!!!!!). However, if we keep having difficulty with the insulin I wonder if treating the Cushing's would be beneficial. His continued weight loss also concerns me but I hope that it is due to the diabetes, not the tumour.

Oh, I am meeting with the resident and the surgeon on July 17th. It seems like the surgery might be the next day if we go through with it, which I am quite certain we will. The receptionist seemed to think the CT scan could be done that day and surgery the next. I'll keep you posted.

[kaibosmom]

Ha ha...I just realized, I think I posted the wrong post from K9diabetes...even more confusing......seriously....report cards are making me crazy!

[Trish]

Good luck on getting the blood sugars stablised, so not fair you have to battle both of these things with Kaibo, but hopefully if the surgery goes ahead we can cross one problem right off that list!!! :)

[Trish]

Haven't heard from you in a while, how is Kaibo doing, is the diabetes under control??? Hope all going good for you and that little darling :)

[kaibosmom]

Hi Trish. Thanks for thinking of us. I'd love to report that Kaibo's diabetes is under control but it isn't. I was beginning to research more and coming across things like "insulin resistance" as I was getting really frustrated last Saturday when we did his curve and had no values under 20mmol/l. However, I am pleased to report we finally saw some changes in response to yet another increase in the insulin dose, starting as early as Monday last week. We noted a decrease in water consumption and, in turn, less peeing. We saw some increase in energy and overall, he looked more alert and bright eyed. His nights are getting better with less getting up. And, we made it through the entire week with no peeing in the house during the day.....however, my husband is coming home daily to let him out at lunch. We know he can't hold it the entire day yet. So, it was nice to see some positive changes but we knew the dose still needed to be increased.

So, I did a glucose curve yesterday (Saturday) on him. The results were improved and we finally had a reading under 20mmol/l...19.4 and 19.8 or something like that. I spoke with the vet and she hesitated to increase the dose by a full unit so we increased just by half to 5.5 units twice a day. I managed to weigh him on Thursday and he hadn't lost any weight...again, positive as he has been losing about .3kg per week. He stayed stable at 5kg this week.

The vet situation has improved in my opinion. The vet that diagnosed his diabetes (at our "old" clinic) has been wonderful. She is now away for 2 weeks holiday and before she left she made sure she touched base with the vet college to keep them up to date on his diabetes and to put me in their hands until her return. Turns out, the new resident they put me with is now off to study, but the old resident is back to cover the void until she moves to Australia in July. So, the old resident is in charge and she very quickly got back to me yesterday. I do think that is why she was being a bit conservative on the dose increase but then again, if we are getting close we wouldn't want him to go too low, especially when I'm not home during the day....yet....this is my last week of school! Kids are done on Wednesday. :D Anyway, I'm feeling pretty positive that people are on top of his care and everyone is working together to get the diabetes under control so we can move forward with the removal of the tumour. As for that, I have an appointment with the resident and the surgeon (and maybe the boss lady?) on July 17th. Surgery is booked for July 18th with the understanding that we may change our minds or that they may not be ready for him at that point due to his diabetes. I'm very scared at the thought of the surgery but feel that it is the best option for my soon to be 6 year old! His birthday is on June 26th!!! Well, I better run. Thanks for thinking of us.

Nikki and Kaibo

[molly muffin]

How nerve wrecking! Glad that school is almost out, and on Kaibo's birthday too! whoo hooo! LOL

I'm glad you are feeling good now about the care he is getting. That helps alot.

hugs,
Sharlene and Molly Muffin

[frijole]

Don't let them rush you into surgery - that is one tough surgery and you need Kaibo at full strength. Sending huge hugs.

I am adding diabetes and adrenal tumor to your title if that is ok so that those members with most experience in these areas will pay close attention to it. Kim

[Trish]

HIya, hows the week been? Hope the glucose is coming down finally?? Poor Kaibo could do with a break!! I agree with Kim, I would want the diabetes sorted pretty well before going into any surgery. It's risky enough without having to deal with unstable blood sugar.

So pleased you are happy with the vets now, such a relief when you have that trust with them. Hope the reports are finished and you have a bit more spare time! Hope we get a good report from you soon :)

[kaibosmom]

Hi! Well, I am done school!!! I am just doing a curve today on Kaibo and well, the results are confusing once again. I'm about to do another test so I'll post results after I'm done. I would say his diabetes symptoms of water intake and excessive urination have gotten better so I feel as if we are getting closer to the right dosage for him for the insulin....that being said, all readings today have been over 20mmol/l! :confused: It doesn't seem like he has lost any additional weight so that is also a good sign. He is very playful and energetic which is also lovely! He doesn't have much stamina on walks but he is very alert and bright eyed....getting closer to "my boy" than he has been in recent months. He had his birthday on June 26th and is now 6 years old! I'll be back later with his glucose readings.

[Squirt's Mom]

Happy 6th Birthday, Kaibo!!

[molly muffin]

Ohhh Kaibo had a birthday!!!!

Happy 6th Kaibo!

hugs,
Sharlene and Molly Muffin

[kaibosmom]

Kaibo says thanks!


Today's glucose curve results make no sense especially since he was on a higher dose this week. Not surprising really. He doesn't play by the rules. Just waiting for a call back from the college. Here they are if anyone is interested.

6am 34.2 mmol/l. Gave 5.5 units of insulin and food.
7:11 32.2
8:15 25.6
11am (either alarm didn't go off or I slept through it!) 25.8
12:15 27.0
1:20 21.9
2:20 20.7
3:20 20.4
4:20 24.0

Was hoping for better results especially since we have seen a decrease in water consumption and increase energy/better mood overall.

[kaibosmom]

P.S. thanks Kim for adding Adrenal tumour and diabetes into the thread title. If you want you can change his age now too. I haven't figured that out yet. Lol

[Trish]

They are pretty high aren't they. Your posting in the diabetes group I think?!? Glad school is out and you have a bit more time on your hands :) OH and HAPPY BIRTHDAY KAIBO!!! Sorry but no cake for you with your sugars up the wop!! :D:D:D How about a nice bone :D:D

[kaibosmom]

Yes I am posting on the diabetes forum as well! Poor guy is getting virtually zero treats these days. He did enjoy a bone from his Bark Box last night!

[Trish]

Oh good, so pleased he had something tasty for his birthday! Whats a Bark Box?? Never heard of that one!

[kaibosmom]

Bark Box is really fun! It's a monthly subscription so every month we get a box in the mail. It is filled with size appropriate treats and toys. It's a fun way to try out new stuff. Kaibo really does bark at the box too so that's cute. All products are made in the USA or Canada. Many are environmentally friendly and as natural as possible. We love it. I got a good deal for the first 6 months so not sure if we will keep it up after that just because shipping charges to Canada are kind of high.

https://barkbox.com/

[Trish]

Tooo cute!! Flynn would love his own box of goodies, but alas they only ship to USA and Canada, will have to search for something similar here!!

[Harley PoMMom]

Happy 6th Birthday, Kaibo!!!!

[Budsters Mom]

Happy birthday Kaibo!! Birthdays are so sweet for our fur babies that they must be celebrated! Big hugs,
Kathy

[kaibosmom]

Thanks for the birthday wishes for Kaibo. I just stopped by quickly as it is late. It's been awhile since I checked in. Kaibo has been doing well. We increased him to 7.5 units of insulin, which I think is kind of high for a 5kg dog. That being said, I did a curve today and we saw some nice results. First time in the 7 mmol/l range. I could tell he was feeling better even at the 6 units he showed improvement. Last weekend I took him out to Pets in the Park. It's a big event here. Lots of fun and lots of pet related stuff of course. He saw all of his buddies and their people from his flyball and agility days. We were volunteering at the Therapy Dog booth. Good times. So many people that saw him were impressed with how great he looks. On Monday I took him to see the teenagers he visits at the mental health ward. He did well but really seemed a bit tired from his outing the previous day to be honest. He seemed a bit off the rest of the week. Really tired. Breathing heavy. On Thursday I took him to our vet clinic to see the vet who does chiropractic work. She fixed him up ( his back and hips were out of line) and went on and on about how great he looks. She praised us for the work we've done with him and says he looks like a different dog. I agree. He looks great. He has really responded to the insulin treatment and has kept the weight off that he lost in the initial stages of the diabetes. No more pendulous belly! Weird but good. To look at him, you would only think he just needs his knee fixed up...not that he has a tumour. I've been struggling the last couple of days with that concept. As our appointment with the surgeon comes closer I get more apprehensive. I try not to think of the worst case scenario but its kind of hard not to let those fears enter sometimes. I'm trying to love him up as much as I can. I'm trying not to cry and worry that something may go wrong during the surgery. I don't like the unknown that is coming up next week. Like first of all, I don't even know if they will do the surgery as his diabetes is just starting to show some control. Secondly, is the surgery the right thing to do? I stopped researching it a long time ago. I got too busy with work. Our first thought is that we must. He is so young. The alternative? The tumour grows and gets more difficult to remove and then the surgery seems even more risky. It seems like a no brainier but that fear of something happening is there. Is that a sign not to do it!? I know I just need to calm down. Wait for the appointment. Get more information. Go from there. Our appointment is Wednesday morning. They have reserved a surgery time for us on Thursday. It once seemed so far away and now it's not. I'm so scared and nervous. Well I guess this post was longer than I expected. Didn't know I needed to get that out (all while having a good cry!). Maybe if he seemed as sick as he did months ago it would be easier! He is just so healthy looking. Happy too! We only see panting from time to time but everything else Cushing's related seems to have subsided. His hair might even be filling in...that's a stretch....but maybe....lol. Well thanks for reading. If anyone has experience with the adrenal tumour and diabetes or anything they want to say, I'd love to hear it.
Nikki

P.S. I almost forgot....tomorrow (well in a few hours now!) I'm taking Kaibo to a scenting workshop. He's always had a gift with the sniffer so now we get to go have fun with that. Something he can do with his bum knee! Yay. I can't wait to see what it's all about and to see him have fun!

[Squirt's Mom]

Hi Nikki,

I am so glad to hear that our sweet Kaibo seems to be doing so much better! And I can imagine how that effects your thinking about next week. When Squirt was diagnosed with that tumor on her spleen and we had to wait for the surgery to take it out, I had some of those same feelings - "she looks and acts so good and has shown no signs of a problem....is this the right thing really?" But the other side of my mind was in abject terror of that thing rupturing because if it did, that would probably be the end of my Sweet Bebe - and a horrible end at that. :( She was 10 yrs old and in my mind that was much too young to give up on heroic measures....plus she deserved a chance and I could give it to her. ;) So I crept around for about four days torn in half, fighting with myself, yet knowing this was the only hope she had so this was the only recourse we had.

The day she had the surgery, I polished my kitchen - not cleaned, polished. I was a nervous wreck and the seconds were hours so I kept busy, busy, busy. Of course, I had to go back and find many things I had "put up" because I had no idea where they were when it came time to use them again! :p Aaannd I was on here every minute or so in a total panic. :o:rolleyes::D When it was all over and she was in recovery, I bugged the hospital so often they finally set up a schedule when they would call me with a report! :p:D:p

So you be just as bonkers as you wish - you'll have to work hard to top me! LOL Many of us understand what you are going through and are here to listen and hold your hand any time of the day or night.
Hugs,
Leslie and the gang

[frijole]

Wonderful news re the diabetes. And I so understand your concern re surgery. I think it is critical that you have a comfort level that the SURGEON doing the surgery knows what they are doing. Have you had a chance to meet with THAT person? Not the other vets - just the one that counts.

Our dear Trish has compiled a list of questions previously that I think is pretty helpful and I am hoping she will post them on your thread for you to ponder. It is a huge decision and only you can make it based upon facts.

Know we stand with you regardless of your decision and again - so happy to hear how great dear Kaibo is doing. Kim

[kaibosmom]

Funny that you should mention questions. I was going to ask if anyone had questions I should ask. We meet the surgeon on Wednesday morning. I have some info on her...all good! Must go play with my little man now. Thanks for your words of encouragement and comfort so far!

[doxiesrock912]

I think that you've answered you're own questions about doing the surgery. Of course you're frightened and that is to be expected. The fact that Kaibo's diabetes is well controlled is going to go a long way toward a successful outcome.

I would ask how many diabetic dogs have undergone the same surgery and what they do to insure proper monitoring before, during, and after.

What the outcome was for these dogs and if there are any special concerns after the surgery that you should watch for. For example, how his diabetes might be impacted during the recovery process.

Also, if there is something that you can do prior to help to get Kaibo ready if you do decide to have the surgery done.

[Trish]

Hi!
Fantastic you have the diabetes under control!! Well done you!! So cute to hear about Kaibo's visits and outings, you are packing a lot of fun things in now he is feeling better. That is awesome to read about. I understand how nervous you are about the surgery, I was pretty nervous too! I had a list of questions for my surgeon and have rewritten it so hopefully it will be of help to you... some you may already have the answers to, but I have copied them all here so you can pick and choose if any are helpful for your visit this week, hopefully you will be able to update us when you can as we will all be hoping for a great outcome for cute little Kaibo!

Questions for surgeon:

1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
Managing his diabetes
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances
12. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
13. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
14. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.

[kaibosmom]

These are great questions! Thank you so much. I tend to be more of a listener and digest stuff then have questions after! He is doing so well....except his knee. Oh my the poor guy is walking with a limp and barely putting weight on it. I'm fearing something has happened and we now have a complete tear. Yikes. We know the tumour surgery needs to come first but this is so hard to see. I just finished running 10km race so I have to eat. I'll check in later. I hope you are all having a great weekend. Thanks for everything. Oh the vet was really impressed with his glucose curve from Friday! She increased him by half a unit up to 8 units twice a day!

[goldengirl88]

Hello:
I am catching up and reading some posts I haven't had a chance to read. You certainly have your hands full , and I wish the best for you and your baby. What a cute avatar! Blessings
Patti

[Trish]

Your surgeon will probably go over them all, but its nice to have them up your sleeve to give your brain a jog if needed!! I know my brain needed it when I met with the surgeons as it was spinning with all the information I received. Poor Kaibo hurting his leg at this time too... one more thing you just didn't need right now. I guess they will take that into account when they see you on Wednesday. Good luck with the appointment and I will be waiting nervously right along with you :)

[Squirt's Mom]

Thinking of ya'll today! Hope you and Kaibo are having a good day!
Hugs,
Leslie and the gang

[kaibosmom]

Thanks Patti and Leslie! I'm exhausted but still awake. Too many things on my mind. I had an email today from the resident. They are happy with his glucose curve from last week. They told our vet that surgery could indeed proceed on Thursday. ugh. what!? oh my. They want to do a low dose dexamethasone test tomorrow. Our vet said she wouldn't proceed with the surgery unless a new ultrasound or CT scan was done. agreed! So I'm taking him in before our appointment time for the LDDS. I wrote out all of the questions and added a few of my own. Well. It's a big day tomorrow so I better try to sleep! That's all for now!

[Trish]

Good luck for tomorrow, what did they say about Kaibo's leg or has that settled down, we are all nervous right along with you but fingers crossed all goes well tomorrow, hopefully you will get a chance to update us so we know what is happening and when we need to send all our extra special wishes to Kaibo.... heck I will just start sending them now!!!! You and Kaibo will be in my thoughts xxx

[doxiesrock912]

Sending positive thoughts for an awesome outcome tomorrow and a speedy recovery!!!

[spdd]

Just popping in to wish you all the best.

[frijole]

sending love and strength to you both. KIm

[Squirt's Mom]

Let us know what you learn today and remember you are not alone!
Hugs,
Leslie and the gang

[molly muffin]

Sending you best wishes and know you are in my thoughts today.

Hugs,
Sharlene and Molly Muffin

[Tina]

You and Kaibo are in my thoughts today also.

Hugs from me and Jasper

[kaibosmom]

Thanks everyone! I dropped Kaibo off for his LDDS test. I'm just getting ready to head back to meet the surgeon. I'll post later when I know more!

[kaibosmom]

Hi. Just updating everyone on what we found out today. I guess I was thinking ACTH when I should have been thinking LDDS....as far as time goes. LOL. Oh my. Anyway, can't get my little man back until later today but that means I will be able to sit in the sun with Molly a bit and get cleaning and organizing my office without feeling bad that I'm not spending time with Kaibo. :cool:

So, we met the surgeon today. She answered many of the questions and was very straight forward with the risks and complications we could encounter. She said that we need to be comfortable with our decision and that if Kaibo should be in the 20% that don't make it through surgery or have post-op complications that end in death we need to feel that we made the decision that was in his best interest. The surgeon seemed like she would be very prepared for any types of blood loss that might happen during surgery and confidently answered many other questions we had. I feel quite comfortable with her and that will definitely go a long way. She just did one of these surgeries a few weeks ago and the dog made it through and was out of the hospital in 2 days. She will not do this surgery laparoscopically, although she would if it was on the left. She said that if there was a bleed or invasion of vena cava that wasn't seen on CT scan that minute it would take to open him up could make the difference so she does the right adrenal surgeries the old fashioned way. I asked about how his diabetes would impact things and she feels confident that it will be fine and easy to keep him monitored during and after surgery. She said it may take him longer to heal and that might affect they type of suture she does to close him up. She will do every part of the surgery herself from start to finish but there will be a big team of people on hand to help her should there be complications during surgery. She basically said this surgery is too risky for a resident/student to even get involved in. Whew!

So, today they are doing the LDDS test. They will also get his blood type today too. Tomorrow we will do the CT scan. The resident actually wanted to do the CT scan in the morning, surgery in the afternoon tomorrow but the surgeon wasn't comfortable with that and she, herself, said, "we don't want to or need to rush it." Whew! That's what I was thinking! So, CT scan tomorrow and surgery is scheduled for next Tuesday. She expects to keep him in hospital for at least 3 days. I had heard that she was very upfront about the surgery. Like this is how it is. This is the worst case scenario...and that is exactly how she was. She was very clear about all of the worst case things....which of course, made me cry. However, I appreciate that honesty because if something was to happen and I didn't know that was a possibility I would be even more devastated!

At this point, we will wait and see the results of the CT scan. That being said, assuming the tumour is there, we will go through with the surgery. My hubby had to go to work right after the meeting and we will discuss this again tonight but it is how we are both leaning. If there were any way to tell with certainty what type of tumour it is then perhaps we would leave it but we certainly don't want it to get bigger and invade surrounding tissue it already is such a delicate procedure.

I can't thank you enough for the support and information I get from this forum. The surgeon was impressed with my questions and noted how I "had done my homework"! I am definitely going to need everyone to help me through. My husband is leaving for Australia (for work) tomorrow so he will be gone when the surgery happens. :eek::eek: In fact, he will miss most of the healing, recovery time too (gone for 2 1/2 weeks!).

[Squirt's Mom]

Well, Nikki, ~~gulp~~ now it gets real, huh? It sounds like you had a really good visit with the surgeon and that she was open with you, covering as much as she could. Tho I gotta say, I was with you and thought Kaibo was going to have the ACTH today! :D Let us know when they give you the results of the testing today.

You know we will be right here with you the whole way, honey, tho I'm sorry the timing worked out this way. I know you would prefer him home for this.

Hugs,
Leslie and the gang

[spdd]

Your surgeon sounds wonderful. Let us know how the CT scan turns out. Will be thinking of you, and certainly next week if the surgery goes ahead.

I know what it's like to go through this stuff all alone, but there are people here that will support you. I know it's not the same, but at least it's something.

[doxiesrock912]

Nikki,
the surgeon sounds wonderful!!!

Please keep us posted and prayers for Kaibo.

[mcdavis]

Just checking in and wanted to let you know that you and Kaibo will be in my thoughts and prayers.
Your surgeon sounds very good - I like her taking the time to discuss things with you, not rushing things and also being very open and honest.

[frijole]

One of your many fans just checking in to let you know we are rooting for you and dear Kaibo. Sounds like the meeting went great and you like the surgeon.

Not sure what your thoughts are after the talk and what the next steps are... but don't let anyone rush you into a decision until you are 100% confident and always go with your gut instinct. We support whatever decision you make.

Sending strength and love, Kim

[Budsters Mom]

You have much to mull over, but it sounds like you had a good meeting.:) Please take your time to make a decision that you can feel comfortable with. Sending hugs and prayers your way,

[molly muffin]

Hi!

Just popping in to let you know keeping you and Kaibo in my thoughts and heart. It sounds like a productive meeting today. I like that the surgeon is a straight forward person. I think that is actually reassuring.

Hugs
Sharlene and Molly Muffin

[Trish]

HI - I like the sound of her too. Be interesting to see what the LDDS shows, good luck for the CT scan tomorrow too. Hope there are no complications seen on that.

Hubby may be gone, but we will all be here with you to cheer on Kaibo! xx

[goldengirl88]

Hope all goes well with the scan. We are all thinking of you, and surrounding you with our angel wings. Blessings
Patti

[Jenny & Judi in MN]

your vet sounds very experienced which to me would mean a lot. hoping it all goes well! Judi

[kaibosmom]

Hi! It is nice to see so many people commenting on the surgeon! That certainly makes me feel a lot better. My husband and I both felt that she seemed very confident and was able to answer all of the questions we had. I like how she told us she would be prepared for possible hemorrhage issues during the surgery and then proceeded to tell us all of the "things" she would have available should things go wrong. She also didn't hesitate to tell me that I could visit him post-operatively. Again, being very blunt that if he was not doing well I would still be allowed in to have a "last visit". Gulp. Ugh...can't think about that! I honestly feel that things can't go wrong for him. He is too little, too sweet, and has given so much to other people through his therapy dog work and by just being Kaibo. People always smile when they see him. Anyway, he should be having his CT scan right now. :eek: I certainly can't wait to get the results of the LDDS and the CT scan. I'm full of butterflies today...so nervous. Brett is here until around supper time so I hope we can get as much information before then so he can be with me for that. I'll keep you posted!

[doxiesrock912]

We'll be waiting!

[Bo's Mom]

(((((HUGS))))) Kaibo!!! ( I just love that name) :D

[kaibosmom]

He's been home for a few hours now. He so drowsy from the sedation! We might get results this afternoon. I'm hoping for that since hubby hasn't left yet. I'd like for him to hear those results himself. Anyway, we are going to leave sleepyhead Kaibo under his sister's watchful eye while we go eat. I posted a couple of new pictures. Two from today. One of happy Kaibo from his scenting workshop. Wow. He loved that so much! He even told off some big dogs....which he's never done. Everyone was surprised because they've never even heard him bark, let alone put another dog in it's place!
P.S. I love his name too! There s a place on Grand Cayman Island called Kaibo! That's how he got his name ❤

[molly muffin]

Right here with you!

You would probably be surprised at how many read your thread on Kaibo and follow his journey. :) I bet there are a lot more than you realize. He is such a cute little guy, we all want the best for him.

I know it is sooo hard to think of the what if's and it's not pleasant to do so, but you need to be just as direct with the surgeon about those things as about everything or anything else. Know going in, what you would want them to do to save his life, and all the risks and other what nots, so that everything is as prepared as possible prior to surgery starting. Then hope none of the issues will ever come up or be needed.

So glad Brett is still there and I do hope you hear something back soon. hmmm Australia, iphone? Text messaging works wonders. Used it in Europe to text back home to Canada.

Hang in there!!
Sharlene and Molly Muffin

[Trish]

Good point Sharlene, when I was on here last night, there were 63 visitors online reading through the threads! So I bet Kaibo has quite a few well wishers checking in on his progress!!

No results yet? Ohhhh hope you get them tomorrow and we get the final plan put in place! Hope you had a nice dinner with your hubby before he left, ugh I don't envy him that... I love it when I get to my destination but hate hate hate those long flights so hope it goes fast for him!

[kaibosmom]

Hi. Well I took hubby to the airport then came home to settle in for the night...or so I thought. I got suckered in to playing soccer because we were short players all of a sudden. I figured why not, after his surgery I won't be going anywhere so might as well. Then, I got suckered into playing a second game with another team. Lol. So, in the middle of that game I checked my phone. To my surprise there was a message from the vet college. I was nervous to listen but I had to. Ready for this? The LDDS test results are consistent with Cushing's! The last one was inconclusive but the clinician felt that it was also positive, but the resident said no. Then, that catecholamine test was also suggestive of Cushing's. all of his ACTH tests were positive. So....I'm feeling like he's got Cushing's disease ;). Yesterday the resident kind of lost me with her wondering if the tumour was an incidental finding or functioning or non functioning. Like I said, she kind of lost me there. Anyway, so now I will ask her (and you!) is it now more suggestive that the adrenal tumour is creating the Cushing's symptoms? Hmmm. Well, I'm listening to the little man snore away beside me. That sedation from the CT scan sure wore him out! Speaking of the CT scan, the resident apologized for not getting the report back before Brett left. She said she hoped to have the results by noon tomorrow. I'll have to email Brett (and the forum!). He will get them when he lands again in Hong Kong. I think he said he's got 30 hours of travel left before he gets to Australia. Poor guy. I'm used to him leaving for work but this time was extra hard.

[Trish]

Adrenal tumours can certainly give you cushings disease and can most definitely interfere with the cortisol production. The hope is with the surgery that will go away! I thought the catecholamine test was to check for the pheochromocytoma? I cannot remember the result without going back through your thread, wasn't it positive? From what I have read though, that test can be tricky to get clear results and is used more in humans and I had not heard it being used in dogs before Kaibo.

It's good you are getting all your nervous energy out with a couple of games of soccer! At least in this day and age Brett is never too far away, electronically at least!!

[kaibosmom]

You are right. The catecholamine test was to see if it was for a pheochromocytoma. However, when she told us the results she said that it was suggestive of a Cushing's dog. Come to think if it, I never did get copies of those results! I forget how she explained the connection to us. All we really cared about at the time was that it wasn't a pheochromocytoma I guess. Saying it was suggestive of Cushing's was just more proof to us I guess too. (That followed the LDDS test that was sketchy...for lack of a better word. Lol.). Anyway, I guess the next step is hearing the CT scan results. Then we go from there. I suppose I should try to sleep. It's always hardest the first night Brett's gone.

[frijole]

The LDDS test has 3 numbers on it. If you can get them for us we can see if it suggests adrenal tumor vs pituitary tumor. That would then answer whether the tumor is what is causing cushings or if a pituitary (brain) tumor is causing it. Kim

[Trish]

I remember before Flynn's surgery they did LDDS as well, they wanted to check whether there was any chance there was PDH as well as the adrenal tumour. It was negative which gave further strength to the pheo diagnosis based on the ultrasound report.

[kaibosmom]

I'm feeling numb as I type this. I got word about the CT scan about an hour ago. It was not the news I was hoping (which was there was no tumour of course!). They think that the tumour has invaded the vena cava. I forgot to ask if they could tell if it has grown since April. I was reading someone else's threat last night (Waly) and saw that Trish mentioned to ask, if this was your dog, would you do the surgery. Personal choice I know. However, when I asked the resident, she said, she honestly wouldn't do it and that the 1 in 5 dogs (20%) not making it through the surgery was too much for her. Anyway, I have a call in to the surgeon to ask questions...although I don't know what they will be at the moment. I just feel the need to talk to her. I asked if there was anything else seen on the CT scan but was told that the radiologist hasn't completed reading it, just focused on the adrenal mass for the time being. I think I would want the whole interpretation before surgery...no? The resident told me that this news doesn't impact the outcome or odds of the surgery and that the surgeon would proceed with the surgery as she had laid out in our meeting on Wednesday. Clamp off the vena cava, remove the tumour, etc.

As for the LDDS test, she hesitated to give me values and started going on about how information on the internet is not always correct, US values, etc. What she did tell me, however, was that the results suggest that it is not pituitary in nature. So, I asked, then this gives us even more support that the tumour is playing a part in the Cushing's sypmtoms. She said, that 25% of dogs with pituitary tumours do not suppress at 4 hours. Not what I was asking, but from what I know, to me, this does support it and further leads me to believe that the tumour has to come out.

I did ask the survival rate of surgery vs. no surgery and just treating with Trilostane. All I was told that if the tumour has invaded the vena cava and continues to grow it could rupture the vena cava and that result would be fatal. Well, I'm going to send this off for now. I'm waiting for a call from our regular vet who has been treating him for the diabetes...again, not sure what I will ask beyond if she still recommends removal of the tumour. If anyone has ideas of what I should ask, please let me know. Thanks.

[frijole]

OK... here I go again... but you know I am an advocate for you and Kaibo. This university hospital drives me nuts. I do not think the intern had any right to answer some of those questions because some of it is not right.

First off she said "they THINK it has invaded the vena cava"... many times we've seen that where it hasn't and vice versa. Don't talk to the student talk to the SURGEON AND ONLY THE SURGEON.

The person you need to ask 'if this was your dog' question is the SURGEON and not someone who is not skilled at this. Yes, dogs die with this surgery and it is real hard. But more dogs die from not having it done - like eventually most of them.

You said " The resident told me that this news doesn't impact the outcome or odds of the surgery and that the surgeon would proceed with the surgery as she had laid out in our meeting on Wednesday. Clamp off the vena cava, remove the tumour, etc. " This is poppycock. The reason you do the CT scan is so the surgeon can map out a plan for the surgery AND to tell you what the chance of success is etc. If it has invaded the vena cava and surgery is not recommended by the surgeon then you DO NOT have to do it. You can elect to bring your young dog home and spend more time until you are forced to say goodbye.

What were the results of the ldds test? Did she give you the numbers? I'm sorry but that whole conversation was mumbo jumbo to me and not at all helpful to you trying to make a decision.

I say you do what you plan to do already and that is to speak to the surgeon. I pray that Trish sees this and responds - Kim

[molly muffin]

Which side is that tumor on? the left or right? I think it makes a difference in how risky the surgery is.

Do you have the list of questions that Trish posted? I'd go over those again and see what you think has been answered and what has not.

Then yes, I know it is awful to think about, but if you do choose to go forward, then talk about what should or should not be done in case things go wrong for him either during surgery or after. Things like CPR, etc. You want them to have a game plan going in and not have to take the time to stop and call during an incident.

So now having said that. What do you think about if you choose to go forward with the surgery of waiting till Brett is back? Do they think it can wait for a couple weeks? I don't know how you feel about that.

So it does sound like they think that it is an active tumor, probably causing the cushings if I am reading what the tech said correctly.

I guess I would ask also what the chances are of a rupture, statistically speaking.
How long could he live with the tumor did they think if you don't do it?
Just know what your optios are and perhaps ask them what your options are and life expectancy with each option.

Hang in there. I know it isn't what you wanted to hear but you still have to talk to the surgeon to and see what she says based on the CT scan.

hugs,
Sharlene and Molly Muffin

[Trish]

Oh lordy.... who is this student, have you had anything to do with her at all?? I would not be wanting to talk to anyone but the surgeon who is going to be doing the job. I agree with the 1:5 dogs do not make it but that means 4:5 dogs do!!!!

You need to speak with the surgeon urgently so you can get this plan finalised. If the tumour is in the vena cava that does not make it inoperable... Flynn's was in his vena cava and it came out fine. But I do think opening a major vessel make's the surgery more tricky so you need to know your surgeon has the capability to do that.

My local vet who is excellent simply did not have the experience with adrenalectomy, so ALL decisions regarding surgery I made with the surgeon. So that is who you have to listen too.

Yes, you do need to know the results of the whole scan, they need to look carefully for any other signs of spread other than the local spread you may have if in deed it DOES go into vena cava. But you have written she "thinks" that it has, that is not good enough and you need to know exactly what is going on.

My questions for surgeon:
1. Do you have the final confirmed results of the CT? If not, speak to her when she does.
2. Is there invasion into vena cava? Is it major or only just in there? Is there any signs of other local invasion ie into kidney etc?
3. Is there any other signs of spread to distant places ie lungs
3. IF there is invasion: how does this complicate surgery? Does this worsen Kaibo's odds of a successful outcome?
4. IF there is invasion and we treat medically, how long do you think Kaibo has?
5. What is the LDDS result, does this confirm it is most likely adrenal cushings therefore a likely adrenocortical tumour?

Do not speak to resident or local vet about this as they are just muddying the waters, if you are not happy with the surgeon I would seriously look elsewhere though that can be difficult.

Let us know when surgeon has got back to you and what her recommendations are. How nervewracking for you, so sending big hugs and we will look at the next step once we have all the information for you to make this decision. xx

[kaibosmom]

Just going through responses quickly. I will look again. What the resident said was something like highly suspicious that it has invaded the vena cava or something to that effect. What I got from it is that the radiologist feels that it has invaded. I'm still waiting to hear from the surgeon. Apparently it has been a very busy day at the college with many critical cases so it might be well into the evening before I hear from her. That is fine. I am just starting to be able to talk and not cry like a baby! :rolleyes: I did talk to our vet just now. She had some good questions for me to ask....basically just how comfortable the surgeon is doing the surgery and how she feels about the CT scan results. We want what is best for Kaibo.

[Trish]

Good, get those tears out then toughen yourself up and get ready for the chat with the surgeon. I know it is so hard to ask the questions that need to be asked when you are feeling so emotional about it all, you need to make a totally informed decision about this so try everything to get a clear head.. coffee, shower, chat with us... there is still a HEAP of hope that we are going to get a successful outcome for Kaibo!! :)

[frijole]

I'm so glad Trish was able to read your post. Like she said what is important is what the SURGEON thinks - not the radiologist, a vet, an intern - because the surgeon is the one doing the work. Make sure they have a chance to really look at the film before commenting - it's better to wait and make sure they get it right.

You have been so much and your baby is so young. I have no doubts whatever decision you make will be the right one. We are here for you. Hugs, Kim

[Trish]

I just had another thought while I was out hanging up a load of washing :D, ask her what his pancreas looks like. Just with the diabetes rearing up recently it would be good to know there was nothing there that could be interfering with his insulin production. xx

[kaibosmom]

Holy! I wasn't really done typing but the phone rang and it was the surgeon so I pressed send!

[Trish]

OMG, that waiting for them to call is so nerve wracking..... AND?????

[kaibosmom]

Ok. I wish I read that part about the pancreas before I hung up with her. I was just trying to focus on everything she was saying! I feel lighter inside after speaking with her. Does that make sense? Hard to explain........Brett has also called in the mean time...and now Kaibo wants his supper (and insulin!). So I will make this quick; if that is possible.

The surgeon has not actually had a chance to see the CT scan or to talk with the radiologist at this point. We did have a good conversation regardless. She basically said that the message she got was that it "might" be invading the vena cava. She said that, as one of you mentioned, that it is very hard to tell on the CT scan if it is just resting on the vena cava or if it has actually invaded it. She basically said that that is what they always tell her so that she doesn't get mad at them. :rolleyes: The only way to know for sure (until she sees the CT scan with her own eyes as well) is to see it during surgery. She said it won't change her plan because she is always ready for the chance that it is invading the vena cava. She mentioned again that there is a huge difference in it "might" and it "is" invading. She mentioned she has had several adrenalectomies that have had the same CT scan interpretation. She would suspect that it was so small to begin with (in April) that it would not be invading the vena cava at this time.

When asked about survival times she said that is hard to answer because once it is removed, there is no reoccurrence and the dog's death ultimately isn't from the tumour. Does that make sense? It made sense when she said it but maybe not they way I typed it.

I did ask the million dollar question...would you do it if it were your dog? She very tastefully answered. She recognizes that it is a difficult decision and it isn't easy like, say, a knee surgery (ironic!). She can't say, trust me this will work, it is for the best, etc. because there is a bigger risk of death than with many other surgeries. Ultimately it is what we are comfortable with and how will his quality of life be effected. Will we have peace of mind knowing that we chose to do the surgery because we thought it was in his best interest. She said that her mentor told her if people ask that question they don't have enough information. I appreciated her answer and her honesty and her asking me if I needed more information or if there was anything she missed. There isn't. I don't think;)

Since the very beginning, we didn't question or hesitate that we would have the tumour removed. I know it is scary. I know it is risky. But I just keep going back to the fact that if we did nothing, how would I feel. I believe I need to take more time to go over everything again but at this point, Brett and I do feel that it is in his best interest. I have spoken with Brett twice today. His gut is still telling him that we need to try the surgery. My gut...more like my chocolate brown persistent poodle, is telling me to get off the darn computer and feed him already! I must oblige. I'll check in later!

[kaibosmom]

Oh. I see I didn't really finish. Sorry Kaibo...just a minute! The plan. The surgeon is going to review the CT scan on Monday (for some reason she wasn't able to see it while she was talking to me). She said that she will review it with the radiologist and call me on Monday. Then she said, aren't you bringing him in on Monday anyway? I said well I wondered that because for his knee surgeries I had to bring him in the day before surgery, etc. Anyway, the resident told me just bring him in Tuesday morning. Surgeon said, no way! She wanted to do a physical exam on him and because of his diabetes anesthesiology needs to see him first and come up with their plan and so on. How reassuring! So she will call me Monday.

[Trish]

Hi, so pleased she called back and that all sounds much more positive. So we still do not know definitely about the vena cava so the phone call on Monday will be the one where we know whether it is all go! I am pleased you got to talk to her today.

I know what you mean about the risk of not doing anything and then always questioning your decision. I was like you and Brett, as soon as I heard about the tumour my immediate thoughts were to get it out and that did not change when I heard it was in the vena cava, to me that just made it more urgent to hurry up and get it out before anything bad happened. Again like you I understood the risks, but my way of thinking at the time was that if he died, it would be quick and he would not suffer. I agree with your plan of action, so I hope that phone call on Monday is a good one.

Meanwhile this weekend, spoil that little Kaibo rotten, take loads of pics and video and enjoy him. I know it is impossible, but try not to doubt yourself, you are doing this to save him. I have every reason to believe you are giving him his best chance at life and this time next week he will be back home with you recovering xxxxxxxxxxx

[frijole]

I think Trish's advice is very sound and yes do spoil dear Kaibo rotten. Glad you got to talk to her tonight. Kim

[doxiesrock912]

I would also go for it because it is the best chance that Kaibo has.
Tumors don't just disappear and he's healthy enough to withstand surgery.

Your surgeon sounds GREAT!

[goldengirl88]

Sorry you are put in this predicament, but I would have to go for it also. If you don't like you say you will always wonder what the result would have been. God help you to be strong and make good decisions for your baby. Blessings
Patti

[Trish]

Hope the weekend is going well and you are having lots of fun with Kaibo! I thought I read somewhere you had a photo up, can't see them!?! :confused:

[frijole]

Trish did you go to the photo album? Adorable shots. Hope you and Kaibo are having a great weekend. Kim

[Trish]

I must be dense, I cannot see a photo album on Kaibo's profile

[Squirt's Mom]

Weird...neither do I. :confused:

[Trish]

Phew, glad its not just me :D

[frijole]

? maybe she has it on private and only admins can see it??? dunno. Sweet photos of Kaibo as a volunteer, doing agility training, as a puppy oh and one he is wearing a tie! :D I know I just made it worse.

[kaibosmom]

Ha ha! Oh my I better see if I've got special settings on there. Everyone should see him ;). We are having a pretty quiet day as it is glucose curve day. It's pretty dismal so far :(. It's soon time to fees him and give him another insulin dose. I'll continue into tonight to see if its any better. My mom is visiting and that cheeky monkey snuck into her bedroom and was scarfing down her Dog's food!

[kaibosmom]

Ta da............check out my album!!! I will add more pictures later! I have to go to a wedding reception :( I just want to be at home with Kaibo!!! Anyway, hope you can see the pictures now!
Nikki

[Squirt's Mom]

Yes! Now I can see them and he is precious! Molly, too! They remind me of a black and white male pair I had once - Dr. Bob, called B, and Dork.

I hope the reception goes quickly and you are back with your sweet Kaibo soon.

[kaibosmom]

I'm glad you can see the pictures! I didn't stay long. Kaibo's diabetes is a nice excuse to leave things early I am finding out! I was home and added more pictures to the album after about 2 hours. I was still doing his curve. How terrible it was yesterday. I'm not sure if it was that he fasted twice last week or what. Hmmm. I wonder if it will change their minds about him being ready for surgery. I guess I will find out tomorrow. Well I'm supposed to be getting up to go for a run with my run club. However, it is raining and I haven't had the chance for a good sleep in for ages. So, Kaibo has been fed and had his insulin and is sleeping soundly once again. I know that means I've got a few hours of cuddles coming my way. Yay!

[molly muffin]

I love the pictures of Kaibo and Molly. What a cute pair. He is obviously a love bug. :) Kisses and more kisses. Love it!
Crossing fingers for this week to go smoothly! That darn curve, yea, I imagine it could be the fasting a couple times this week that has thrown him off. BG seems to like things to be nice and smooth or it acts up.

hugs,
Sharlene and Molly Muffin

[kaibosmom]

I just wanted to share a bit of an email from our "new" vet...the one who diagnosed and has primarily treated Kaibo with his diabetes. I mentioned that I called her on Friday. She said she would do some research on the procedure and get back to me. True to her word, I got a lengthy email on Saturday. It was very lovely of her to do this. This isn't the entire email, but wanted to share this.

"So overall, I think the surgery may be a good idea for Kaibo. It is a bit of a gamble still; if all goes well, this may cure him of his disease and he may have years to live with a great quality of life, but there is a possibility that we would lose him during or shortly after the surgery. From what I have read, he is a good candidate for this, with or without involvement of the vena cava, but this does not necessarily mean that all will go well, since one out of every 4 or 5 dogs that undergo this procedure (with or without vena cava involvement) will die.

The alternative, though, is to leave the mass in place, in which case it will continue to grow and eventually seed other organs or cause the vena cava to rupture or occlude it enough to make Kaibo feel sick and cause failure of some organs. This could be in months, in weeks, or in days. Thus, leaving the mass there is also somewhat of a gamble, because we can't say how long Kaibo will have that way either. He could die suddenly, or become sick and deteriorate slowly."

It is almost 2 am. I gave the boy a bath an hour ago! I am generally a night owl but the last few nights I just don't want to go to sleep. Maybe I'm hoping that if I don't Tuesday won't come. Lol. I feel like having the surgery is the right choice. I'm not done my adventures with Kaibo yet. Last summer I planned to take him to Boston with me for a month in July 2014. I'm using the money I've saved for that trip for his surgery....good thing I started saving early! I'm confident that he will be by my side as we spend peaceful moments in Boston Garden and live on Beacon Hill next summer. This certainly isn't easy though. I randomly burst into tears at any given moment. I push away thoughts of me dropping him off. What will I do during the surgery! Come home? Stay at the college? I only live 10 minutes away. I try so hard to let those thoughts go. The what ifs. Let them go. Live in the present. Feel his warmth. Listen to his breathing. Listen to him chew his bone. Feel his chest rise and fall as I lay next to him (he is totally loving me being by his side 24/7 by the way).

I came across a quote today that struck me. The more I read it, the more I love it. "You never lose by loving. You only lose by holding back." We are making this decision because of our love for Kaibo. We can't control what happens but we know we are doing what we think is best for Kaibo. I can't wait for that tumour to be out. To see his energy return. To see his luscious, thick coat return. To hold him in my arms for years to come. Those are my late night, tearful ramblings! I'll keep you posted on what happens tomorrow. The surgeon has promised to call me with the complete CT scan results. Bye for now.

[Trish]

Hi
I bet Kaibo is loving having you with him 24/7, there will be many many days, weeks, months and years of this loving to go!! The one blessing is they do not know what they are in for and therefore do not have the worry and guilt we do... which is a good thing!! I understand you are doing this to give him a chance at life, I made that same awful decision and I hope the outcome for Kaibo is good like Flynny's has been.

Our pet hospital is a good 2 1/2 drive from home, so I was in a motel and went back there while they did the surgery. I went on my one too because of circumstances of the time, so I had people calling and texting for updates, plus I was logged on here with all these angels propping me up for the duration! What would we do without them eh! Surgeon rang me when it was over and I was allowed to visit a couple hours later. If I was you I would go home, at least you can pace and rant without the pet hospital staff getting in the little white trucks!! :D:D Plus 10 mins you can be back in a flash if you need too. I know some on here would stay though so you just do what feels right for you.

Let us know what the CT shows, so nervous for you and Kaibo, but so HOPEFUL too!! Glad he is nice and squeaky clean, I did that too not at 1am in the morning though :D:D I like your quote too, you should put it in your signature. Mine came from around surgery time with Flynn too, I read and thought.... yep that is what I need to do start waiting for things to go right!!! Lots of positive energy coming to you guys.. hope you get some sleep! xxxx

PS LOVE LOVE LOVE his pics!! What a special little doggie!! x

[goldengirl88]

Hoping and praying for Kaibo that all turns out well. Blessings
Patti

[frijole]

Please know all the cush angels will be out in force fluttering over your shoulder through the coming hours. We send you strength and love. Praying for you both. Kim

[addy]

I've been following along and just wanted you to know, there are many of us, more than you think, praying for you both and hoping so very hard that Boston is a reality for you both:)

[doxiesrock912]

Hoping that all is going well with Kaibo!

Sending HUGS.

[Trish]

ohhh no post on the CT results?? Hope all went well today and even better tomorrow :) xx

[Budsters Mom]

Sending lots of prayers and positive energy your way.:)

[kaibosmom]

Oh no. Sorry. I was just trying not to be on my computer today. I didn't hear from the surgeon until about 2pm. She said that it was really hard to tell if it has invaded the vena cava or not. She said her gut feeling is that it hasn't but might be soon. She said there is no way to know except go in. I took him in to see her. He stole her heart instantly. So I drop him off between 7:30 and 8:00. Only 8 more hours. I've spent a lot of time crying tonight. Not thinking bad thoughts or not being positive, just can't stop crying. Anyway my BFF came down for the night and will spend tomorrow with me. I'll update you when I can. Thanks for the well wishes. I just keep feeling that he's not done here yet so things will be fine!

[doxiesrock912]

We're all sending positive thought and prayers! Glad that you won't be waiting alone tomorrow.

[Trish]

Of course he will be fine, I refuse to think anything otherwise!! Try get a bit of sleep, you don't want to be in too much of a daze tomorrow. It's time for a big old....


PAWS UP KAIBO!!!!!!!!!!!!!!!!!!!!!!

We will all be with you and Kaibo tomorrow, but I am really glad your BFF is staying with you, I bet Brett is on tenterhooks too. Loads of hugs... and maybe a stiff drink to get you to sleep! xxxxxxxxxxxxxxxxx

[spdd]

Thinking and praying with you and for you today.

[Tina]

Nikki,
I have been following along and have been thinking about you and your sweet boy so much, and will continue to do so today. Sending tons of prayers your way. I hope you have been able to get a bit of sleep. We will all be by your side and checking in. I too am glad your BFF can be there. I second it:

PAWS UP KAIBO!!!

Huge ((((Hugs)))) from me and Jasper

[Mel-Tia]

Hi

I too have been following and am sending postive vibes, love and hugs. I have asked my angel Tia to look after him for you.

Paws up Kalibo, be strong for your mom

Mel
Xxxxx

[infoviewer]

Sending positive thoughts to your sweet little dog. Paws up Kaibo. We will be waiting with you for a good report. Love, JoAnne

[frijole]

Kaibo my little man please know we are all cheering you on and sending you love and strength today. Paws up little guy!!!!!

Nikki, So glad that your BFF is going to be with you. Huge hugs, Kim

[Squirt's Mom]

We're all right with you, Nikki. Let us know how things are going when you can.
Hugs,
Leslie and the gang

[goldengirl88]

Nikki:
Sending prayers and blessings to Kaibo in this most critical time. We are all praying for a good outcome for your baby. Please let us know what is happening when you get a minute to collect your thoughts. Blessings
Patti

[Budsters Mom]

PAW UP KAIBO!!!I am so glad that you have your BFF with you today, along with all if us in spirit. Praying for you and the little man. Mass hugs,

[kaibosmom]

OMG! My mom left the door to her bedroom open. Kaibo took that as the prime opportunity to go and help himself to my mom's Dog's food! I don't know how much he got. OMG! The one time it's so important he not eat. Why did this have to happen!?

[Budsters Mom]

Okay Nikki it's time to breathe. Take a deep breath in and out slowly. Now call the hospital and explain what's happened. maybe they can reach the doctor for direction. It's best to be safe, so they may need to postpone. At least it was dog food he got into, right. Sending more prayers and calming, positive energy. Please keep us posted. We care. Xxxxx

[lulusmom]

That's happened to me about a hundred times. I'm a rescuer so surgeries are frequent...primarily dentals, spay and neuters. My own baby is going in this morning to have a rhinoscopy and CT scan done. He got out of bed and immediately drank some water. Ugh! When they've gotten into food before surgery, the vets almost always delay the surgery until the afternoon. Hopefully the surgeon will do the same for Kaibo.

[goldengirl88]

I would delay it to be certain there is no food in his system. Just a small amount of food or water can be aspirated into the lungs, which causes major problems you do not need. It will all work out, who knows maybe that was supposed to happen today for some reason. God Bless
Patti

[kaibosmom]

Thanks everyone. We are now home. Yes. We. The surgery is postponed until Thursday. I was mentally prepared (as much as I could be) for today but as we sat waiting to find out what they were going to do I just worried about aspiration. So I was a bit relieved when they said no go. Try again on Thursday!

[Budsters Mom]

Postponing is for the best. I'm sorry you have to wait longer though. :o I know that you wanted to get it over with. Well, it does give me more prayer time.:) Big hugs,

[addy]

Better safe though I know mentally, it is a hard one.

[Jenny & Judi in MN]

little stinker! well 2 more days

[goldengirl88]

Glad you postponed, I know it was the harder choice on you, and you were thinking of Kaibo when you made that choice. God Bless Patti

[kaibosmom]

Thanks! More prayer time is good ;) He was quite happy to come home and enjoy a full meal and the rest of his insulin. He looked quite impressed with himself overall. He got to say hi to a bunch of people and then he came home to eat and sleep. Cheeky monkey. He is napping soundly now.

[doxiesrock912]

Oh I've been there before!
We have a baby gate with a door opening between my father's room and the rest of the house.

He forgets to latch it properly and Daisy eats the cat's food or visits her litter box.

So glad that you've postponed. Best to be safe.

[Trish]

Oh no, after you got yourself all psyched up for the big day!! Little rascal Kaibo! Nice you get another couple of days to ready yourselves!! x

[molly muffin]

I'm sure Kaibo was quite pleased with himself. He was hungry, he ate, therefore all must be good in his world. LOL Got to love it, but yes, definitely glad they postponed. Best not to take chances.
I sense some good cuddle time tonight. :)

hugs,
Sharlene and Molly Muffin

[kaibosmom]

Just wanted to pop in for a moment. Kaibo is so full of energy and so playful tonight. Oh I'm so glad to have had this night. I can't wait for many more once that tumour is out and he's feeling better. I'll try to post a few pictures. I've only taken a hundred or so in the last few days ;). Oh and this morning Molly must have sensed something was up. She's usually not the biggest fan of Kaibo's but she was close by his side all morning before we left for the hospital. It was pretty cute.

I posted some new pictures!

[doxiesrock912]

Animals are SO smart! Molly can tell that Kaibo isn't quite himself.

[Trish]

Awww sounds like you had a lovely evening with your little mate!! Love the new pics, Molly is keeping a watchful eye on him. I remember when Flynn was sick and waiting for his surgery, the devil cat Elle walked right up beside him and instead of whacking him she gently rested her paw on his back, was kinda sweet of her :) maybe she was doing Reiki or something, she is Siamese after all :D:D and she is pretty crafty!

[Budsters Mom]

Those are the moments you will treasure forever! There are many angels praying for you and Kaibo. He couldn't be in better hands. Xxxx

[goldengirl88]

That is too funny about the cat. These animals know thing that we humans can't even fathom. We are all praying for you and Kaibo everyday. Love your babies pictures etc. Blessings
Patti

[doxiesrock912]

Our cat, Gracie tries to "hug" Daisy every time that we come in from our walks. It's adorable :)

People who have the attitude "it's just a cat" have never really experienced living with one. They have as much personality as dogs do.

Praying that all goes well for Kaibo and anxiously waiting for Thursday.

[kaibosmom]

Hi. I have had a lovely day with Kaibo. He spent time soaking up some morning sun. Lots of cuddles. He wanted to play ball. We went for a long walk too. He hasn't wanted to walk for awhile. We went to a park and I let him off leash. He had fun following our neighbour's dog Maggie and my mom and her dog Russ. He had a nice little run around, met some kids...what a happy boy! I thought he'd be tired so tried to take him and Molly home but he was having none of it. He followed Maggie and Russ the whole time. What fun. He is sound asleep now. I'm sitting close by. I just massaged his knee. It looked pretty sore by the time we were finished walking. I'll give him a little snack shortly...then confiscating my mom's dogs bowl! Lol. I'm actually feeling really calm and almost at peace with the surgery. Kind of in a better place than Monday night. Weird. I think I'm just ready for him to be better. I hope feeling calm inside is good! I'm sure it will be different later tonight or tomorrow morning! I talked to the surgical resident tonight and asked her to take care of my boy. I know you are all with me and Kaibo tonight, tomorrow, and during those critical first 24 hours. I'll keep you posted when I can. Hugs to all of you.
Nikki

[frijole]

Great to hear from you though we all knew you were spending time hugging your baby. Glad you had a great day. Things happen for a reason so I have faith there is a reason he ate that food on Tuesday.

You are right, Kaibo's fan club will all be ready and sending him our very best, strength and healing thoughts. And to you we offer our shoulders and many hugs. Keep the faith and know we truly are with you in spirit. With love, Kim

[goldengirl88]

Nikki:
We are all thinking and praying for you and sweet Kaibo. Hoping for a wonderful success on his surgery. Love you babies avatar. Blessings
Patti

[Squirt's Mom]

It warms my heart to know that you and Kaibo had a good time over the last couple of days. Those memories are always precious but especially so when facing a surgery. I still remember those days before Squirt's tumor on her spleen was removed and wouldn't trade them for anything.

The k9c Angels are fluttering all around you, Kaibo, and his surgical team. None of you will be alone for one single second, Nikki. If you need to talk, to vent fear, to state your worries, to share - whatever, we are here.

Many hugs, belly rubs, prayers and healing energies flying your way!
Leslie and the gang

[Tina]

Nikki,
Sending love and prayers for you and Kaibo today. You will be in my thoughts.

Big hugs from me and Jasper

[Mel-Tia]

I am thinking of you both too

Be good Kaibo, no more food and stay strong young pup, lots more fun to be had.

Love
Mel
Xxxx

[Budsters Mom]

Thinking f you both. We are all right there by your side Nikki.:) Paws up Kaibo!!!!!

[kaibosmom]

Ok....the hard part is done. Saying good bye at the vet college. That was tough. The rest is out of my hands. I can't wait to see him later! I saw the surgeon. I wished her good luck and told her to take care of my baby. She is so positive. On my way home now. I decided it was better to be home. So I'll go cuddle the old gal up. They said they would call around noon. Just over three hours.

[kaibosmom]

P.S. I can feel all the love today. I really feel better today than I did Tuesday. I'll be hugging my little monkey in no time!

[Mel-Tia]

Glad you feel better today, like Kim said everything happens for a reason

3 hours and counting, we will all be here with you waiting

Big hug

Mel
Xxxxx

[Trixie]

Sending all positive thoughts for Kaibo today! Great results and speedy recovery for the little guy!

Barbara

[spdd]

I know everything will go well today. Waiting anxiously with all the others that care to hear from you.

[frijole]

More love sent, Kim

[Budsters Mom]

I know the waiting is really hard!:o We are still here waiting news along with you. Fingers, toes, and paws crossed that all goes well! Many, many hugs,

[Mel-Tia]

I am the worst at waiting!

More hugs and love from me too

Mel
Xxxx

[molly muffin]

Thonking of you and Kaibo today

I hate the waiting part too
hugs
sharlene and molly muffun

[kaibosmom]

Oh my goodness. I'm getting so anxious. Butterflies like crazy in my tummy. But still feeling calm...if that makes any sense. Hard to describe. A good feeling inside. Like I'm anxious just to have them confirm he is ok.

[Trish]

Lots of good wishes and hugs being sent to you today, have to be at airport in an hr to fly up north for a meeting but will check in when I can xxxx

[Mel-Tia]

Still here with you waiting. Sending more love and postive vibes.

Big hug

Mel
Xxxxxx

[kaibosmom]

I just got the call! He is out of surgery and everything went smoothly. No hemorrhaging. No vena cava invasion. Oh my gosh. I am so relieved. I know there is still chance for complications but I'm so relieved. They are sorting out his insulin and they have some steroids on board already. Sounds like I might not get to see him today but I'll ask again next time they call. Two more hours until the next call! I was so excited I couldn't think of what questions I should be asking except the two I just mentioned. She commented on his incision but talked vet talk so I'm not sure what that was about. Thank you everyone for your prayers and positive energy. We couldn't do this without you.

[Squirt's Mom]

Oh, what a relief to hear it is over and he is doing ok! :cool::cool::cool: I know you are ecstatic! Keep in touch and let us know what the next report is. We are still by your side...all the way!

Hugs,
Leslie and the gang

[Roxee's Dad]

Keeping fingers and paws all crossed here, sending positive energy and prayers your way.

[Trish]

Phew!!!! Me at airport now waiting flight will be happy getting on plane!! Go Kaibo!

[kaibosmom]

Safe travels Trish! Oh I did forget to say they will do an ACTH stim test tomorrow. He might get to come home on Saturday! I was expecting Sunday. Doesn't matter to me really as long as he keeps doing well!

[Budsters Mom]

AWESOME!!! So thrilled for you! Continuing prayers. :) Many hugs,

[frijole]

Whew. Continued prayers and love sent to you both. Keep us posted and know we are right there. Kim

[Mel-Tia]

Go Kaibo. So pleased for you.

More hugs and love

Mel
Xxxx

[spdd]

:)Yay Kaibo!! Glad to hear the news.

[Jenny & Judi in MN]

this is such good news! Judi