Tipper - adrenal tumor/breathing issues

Your post hit home with me for a couple of reasons. As you may remember my Annie had a pheochromocytoma tumor (pheo on the adrenal gland). She only had high blood pressure when the tumor was active. She was starved but would not eat for 2 years I opened like 5 cans of food a day to see which one she'd eat that day. Her stomach was always gurgling. Loudly I could hear it across the room. She never vomited, it wasn't pancreatitis - it was gas from the tumor. And lastly she had an ulcerated cornea - it started small and I was a total stranger to treating eyes and I wasted too much time at a local vet before going to a specialist in Omaha (1 1/2 hrs away).... long story I gave her drops for her last year but you must treat the eyes and if that screaming person is your only specialist you gotta deal with them because they are the only shot at knowing which drops are the right drops and how often etc.

It is possible you are dealing with a pheo. In Annie's case she was misdiagnosed and never even had cushing's. She had false positives (it read a pituitary) on the LDDS test twice and on the acth test 5 times. I suspect this is because her sex hormones were elevated and she had some cushing's symptoms from that and her body did create excess cortisol due to the fact it was fighting the tumor.

Please know I'm not trying to scare you but i want you to know your story is bringing back a whole lot of memories. I'm glad you went to the IMS - better to have answers then not. Will look forward to your update tomorrow. Kim

oh Patti, what a day for you and Tipper, I think it's time to take the bus out girls and visit this eye doctor, he needs some talking to....shame on him, nobody deserves that, you have a sick pup and then have to deal with doc too...so sorry hon, you hang in there, you are doing great!!!
hugs

Oh Patti,
Your Dave exhausted me just reading about it!:o That eye doctor is a pompous jerk! He should not be treating anyone like that, and if he charged you double, I would really look into that! As Kim said, you might need him. So I guess you have to tread lightly. I would be spitting nails!:mad:

I am so glad that you went to the IMS. Your doctor is way out of his league on this one! One step at a time my dear. Try not to get ahead of yourself. just try to handle what's right in front of your nose at the time. You are doing a great job, but I am worried about you. Your health is not the best and you are under a lot of continuous stress. Please try to take care of yourself too. I know that's really hard!:oxxxx

Patti,
wow! What a total $#^#@#$#%! You called ahead and nothing you can do about construction traffic unless you're in an ambulance. I am so sorry that you and Tipper has yet again, another horrible experience with someone who aught to know better!

As for the conflicting information, that indicates that the current vet certainly doesn't know enough about Cushings, right?

Despite the horrible part of the day, I am glad that you got to see more qualified people for Tipper's sake and will continue to pray for you both.

I think the way you were treated was completely inexcusable. After you are finished with this guy, I'd be telling him he's going to get some free unwanted publicity.
I'm really sorry to hear your experience was so bad, and can completely understand how emotional this guy made you.
You have done so much for Tipper, and I believe that all this turmoil in the long run will pay off for both you and Tipper.
Keep up the great care you are taking of your baby, Patti you are doing everything humanly possible and you are to be commended for all this upheaval you are going through.
I am away this weekend, but will check back on Monday to see how everything is going.
Please take care of yourself too.

Patti, I read your post last nite and got SO MAD I couldn't reply. :mad::mad::mad: I'm still mad this morning. How DARE that asshole treat you that way, treat any one that way! If you paid that creep by check, stop payment on it today and report him to the veterinary association. I would be all over social media telling what he did and said. And if you'll tell me his name and the name of the hospital, I'll call and give him a piece of MY mind. JERK! I would be very concerned that someone who has so little control over their emotions would take it out on my baby. There is no way I would leave my dog in that man's care without me being there every second. :mad: And I would be looking for a new eye doc today. ;)

As for the confusion on the films - it is possible the machine that was first used was not high resolution or the person doing those didn't really know how to position her to get a good look around nor how to read them correctly. I would be more inclined to trust the one from the IMS.

Looking forward to hearing from you sometimes today, sweetie. I hope you and Tipper were able to rest and put some of yesterday out of your mind for a bit.

Hugs,
Leslie and the gang

Patti, Just wanted you to know that I am thinking of you and Tipper and praying for you both.
Take care, Big Hugs

I cannot believe you were treated that way!!! What an A-HOLE!:mad::mad: Does he realize where his paycheck comes from? This angers me to no end...I cannot imagine how upset you were, and I commend you on your tongue biting ability, because I would have gone postal on his a$$.:mad:

Hi Everyone:
Tipper and I were exhausted and got a few hours of sleep which was much needed. This morning Tipper did not want to walk. I had to make her. It seems from all this on the table stuff and people holding her legs that they are bothering her. When she does not lay like a frog, I know they are bothering her, and she is laying different. My head is spinning so I just emailed the IMS to ask her some questions about all this. First I will explain the questions I asked her. First of all the other Dr. told me her right adrenal was 2 1/2 times the size it should be and pointed to this round object on the screen about the size of a 50 cent piece. He told me he could not find the left one. Then all this time they told me she had Pituitary dependent Cushings using Trilostane. I can understand that they do not have a machine comparable to the hospitals, but how can you mistake the right adrenal from the left??? And how can you say it is blown up 2 1/2 times it's size??? In the email I told the IMS everything she had told me was the complete opposite of what this Dr. said and pointed to. I will get answers from her. I also asked if there was anything in her abdomen that could resemble what her showed me or was it an anomaly?? I need to know if there are any other problems in her abdomen, or is this other Dr. totally full of crap?? Also when I had her on the last visit the IMS told me Tipper did not have a macro tumor. So I asked her to go back and look at those scans and see if in fact there is any Pituitary tumor at all. If there is then the possibility if this being a pheo is much greater. She said unfortunately they can get both. She said it doesn't fit that the Trilostane is controlling her adrenal dependency as that is done and hard to control even with Lysodren. Which could this also point to pheo?? Does anyone know about this??
Ok onto the report:
Diagnostics:
Right Adrenal normal
Left adrenal enlarged 1.05 X 2.79 cm with irregular surface.
Left Kidney normal 4.55
Right Kidney normal 4.78
Liver multiple ill defined hypoechoic regions
Every other organ was normal, spleen, everything except Gallbladder has a large Gallstone.
Diagnosis:
Left Adrenal Gland Dependency hyperadrenocortism
VS pheochromocytoma VS non functional adenoma
What doesn't fit w/ active cortical tumor is her well controlled Cushings on Trilostane as as usually Lysodren is needed to control this. Also the right adrenal is normal and usually the opposite gland will be smaller .
I need some help and input on all this form as many of you as possible. I have never read up on pheo's as I though I didn't need to. I am scared to death as isn't this the operation that a lot of our babies did not survive? Can anyone give me an idea what the cost of removal of this is if it does in fact come into play I need to know a ballpark idea here.
The day that Tipper's blood pressure went to 190 and I kept asking my vet what should we do/ He said nothing. I am wonder if this event caused the bleeding in her retinas?? I also have another theory. During all the storm was her blood pressure going up from being so stressed and that did it or is it a combo?? In light of this thought I need to seek out something and it may have to be tranquilizers, which is a last resort to stop this stress. What would account for Tipper's pre number going low in fact if this is a pheo and the cortisol was so controlled it went low??
Good thing I never trusted my Vet, and will never think of it now. The one good thing the IMS said is that thank God it is the left adrenal as the right one involves the vena cava and this one can be removed without much worry and trouble. Is that true?? I am questioning everyone at this point as this is my only true source I can rely on. As you can imagine I am sick over all this. Your help will be appreciated greatly as my head is about to explode. One thing I don't know if I forgot to say before. Tipper's blood pressure is always normal with the exception of maybe 3 times in a year, and the IMS said pheo's usually have high blood pressure. She said the Gallstone should not bother her, and unlike humans cannot be dissolved. God Help my Girl, I will go on and get her whatever she needs, no matter what the consequences. I will not quit until I know she is safe. I am still contemplating the eye Dr. fiasco, I am still whirling from it. Blessings
Patti

Not sure why the IMS thinks Trilostane won't work on adrenal tumors. :confused:

http://veterinarymedicine.dvm360.com...09%09&pageID=4

Quote:

---

Historically, functional adrenal tumors are resistant to medical therapy.18 High doses of mitotane may be required to reduce hypercortisolemia, and some patients show no response at all.18 It should be noted, however, that mitotane may have a direct cytotoxic effect on neoplastic adrenal tissue, independent of its ability to effectively control cortisol production.19 Ketoconazole may control clinical signs in up to 30% of dogs, but side effects are commonly reported.20

In contrast, trilostane has been demonstrated to control the clinical signs of hyperadrenocorticism in dogs with adrenocortical tumors, even in dogs with distant metastases.21,22 The drug will not slow tumor growth, but it can control clinical signs and improve patient well-being.21,22

---

And another link -

http://veterinarymedicine.dvm360.com....jsp?id=731453

Quote:

---

Ultimately, 22 dogs with ADH were enrolled in this study and treated with trilostane. While this is the largest case series evaluating dogs with ADH, it is still a small population size, so it is possible that small differences between the groups may have gone unrecognized. Despite this, researchers concluded that medical management of dogs with ADH is a viable option and that either trilostane or mitotane may be used.

---

Maybe there have been more recent studies that contradict these?

It IS possible, tho very rare, that a pup can have both a pituitary tumor and an adrenal tumor...and even tumors on both adrenal glands but these are extremely rare cases. Kim is much more versed in pheos than most here but it is my understanding that with a pheo the BP is not consistently high but rather spikes high at times when the pheo is active - they are not active all the time, I don't think, while the cortisol secreting tumors of Cushing's are active all the time. I don't know if pheos are more active at night or not and might be behind some of the breathing issues. And, yes, it would be possible for Tipper to have a pituitary tumor, a cortisol secreting adrenal tumor PLUS a pheo tumor. However, my confusion is in how large that adrenal gland got in so short a time and if this is ADH, why the other gland is normal size. I would think if the Trilo were causing the enlargement, both would react similarly...but again, what do I know? :)

As for how they could confuse the left with the right, let me share an experience I had with my daughter. She had pneumonia and when the doctor was showing me her films, he pointed to the right lung to show me the cloudy area. As he was talking, he suddenly stopped, pulled the film off the light box and turned it over. He had hung it up there backwards and it was the LEFT lung that had fluid. ;)