Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

Really - wow, just wow, what a day! No wonder you were trying to avoid this post - in your shoes, my head would still be spinning this morning. How WEIRD that nothing fits Cushing's except the ultrasound results! :confused: We've had pups here who seemed to have read the book then done all they could to prove it wrong - Molly just burned her book before she even opened the wrapper!

Take your time, ask lots of questions, do all that research then ask more questions. You know we are right by your side and will do all we can to help. But first, just take some time to breath. ;)

Many hugs,
Leslie and the gang

Sharlene:
Of course I am happy about the good results, and I am just as sad about the other. I am understanding that Molly is in the same predicament Tipper is in, with not one but two tumors?? You know they said Tipper was not your typicalmCush dog either, just like Molly. Was this tumor present on her left adrenal on the last ultra sound? Are they going to monitor it to make sure it does not grow? You have a lot of information to go thru. You know even Dr. Bruyette said Tipper's numbers etc were not that of a typical cush dog. Hopefully this is just an adenoma, and it is not secreting anything. I know how you feel like your head is going to explode from all the information to digest. It's like a ouch to the gut hearing all this. Blessings
Patti

Wow Sharlene never expected any of that. I bet your head is still spinning and off course Molly will be going about like nothing's happened:p

So she is a bit of a conundrum re the cushings I wouldn't expect anything less from her she is a diva after all :D some good points about the back pain and no heart murmour yay

All joking aside I know you will do the best for Molly and what the next step is for her and you. Big hugs to you and butt scratches to Molly :)

Hi Sharlene - well someone once said to me that Flynn's scan results made them feel like a deer in the headlights, ditto to Molly's report! It is very thorough and kudo's to your vet team for working through it with you, have put some comments below. x

Quote:

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Originally Posted by molly muffin

So.... it could be better and it could be worse. That is what I am telling myself.


The good.
No heart murmer YAY
No back pain. Yippeee!
Liver enlarged but no nodules seen on it. Excellent, no nodules :)
Bladder stones have passed with no problem. Good girl Molly with your drinking!
Her BP was okay, they did 3 tests to make sure. 138 - 144 and they think that she was having some stress reactions so the reality is probably lower than that. Awesome, makes the adrenal nodule less likely to be anything nasty like pheo
lung xray is good Whoop, whoop, great to have good lungs!!
She doesn't have classic symptoms of cushings. Which makes deciding whether to treat or not that much easier

The Not as good

luxating patella, back left leg, stage two, so no surgery recommended at this time Darn wonky legs, they have been a bit of a scourge here

A kidney stone in each kidney. Left one is small, right one is smaller.
If they don't move, there won't be a problem. If they move to create a blockage, then kidney surgery (which she felt is invasive and often causes other problems) a stint via surgery at University of Guelph, or send us to the states to either Purdue or NYC, AMC to try to have it zapped with sonic to break it up, currently not offered in Canada. I can do kidney stones :), be good to know how big they are and which part of the kidney they are sitting in. If they do not cause blockages they often can just pass on their own which Molly may well have done previously. Her bladder stones could have started life as kidney stones and she has got rid of those quite nicely. I was also wondering if her back is good if that episode of pain she had may have been due to these??

The liver is enlarged, probably more than last time, but hard to tell exact diameters on the ultrasound even though "high res" but as I said, no nodules seen, but it is pressing on lungs, which causing some breathing noises. Hmmm yes it would be hard to tell this one, did they do updated LFTs?

The adrenal glands are bilaterally very enlarged more so than the last ultrasound.

Looking at the ultrasound, liver and adrenal glands she would say she is definitely pituitary cushings. But no symptoms, or positive tests

Add to that: Molly now has a left side nodule (tumor) 1.3 centimeters on the adrenal gland. Currently non invasive to the vena cava. She thinks most likely is benign, but of course no way to tell for sure. Since both adrenals are enlarged, she does not think primary adrenal cushings, as one is usually larger than the other in that case, while mollys are just both huge, therefore, likely pituitary and adrenal tumors. Flynn did not have one particularly smaller either, but no cushings for him. When was her last scan done Sharlene to see how fast this has come into the picture?

Molly Might just be in that 5% of dogs, where the tumor of the pituitary is in an area that does not respond to LDDS, it is unknown why she would continuously test negative on all LDDS test and we will likely be retesting that. We could do an MRI as that is the only way to know for certain.

She doesn't want to treat with lysodren, as that is very dependent on being able to watch for symptoms that molly doesn't have. No way to tell if she were to go too low during loading.

Trilostane she said, will normally cause the adrenal glands to enlarge, but might let the liver shrink, as the liver is a very resilient organ. So if treating was decided upon, would the main goal be to shrink the liver? You are much better at this sort of stuff than me, but I agree in absence of symptoms and high cortisol it could be quite dangerous?? Isn't the main goal of treatment to lower the cortisol and in Molly's case with the cortisol normal you could run into trouble?

We might try the flax and lignans depending on what the UofT test comes back with.

So there you have it. We have some things to think about and we have some things to keep an eye on. It's not good, but others have had and continue to have it worse. That's all very well and good but it does not stop the worry about your own dog Sharlene!

Molly obviously knows how to win hearts. She surely does, she was won mine that's for sure! :D


She said to relax for the next bit and we'd see what the tests show and go from there. I like your IMS Sharlene, she sounds very thorough and wants to get to the bottom of all this.

Thanks for being around today everyone. I might be a tad bit emotional at the moment, and I'm sure I have written a book and yet still feel like there is more to say and yet nothing to say. There is always more to say!! I love your post with all the details, as I am a details girl myself :D

hugs
Sharlene and molly muffin

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Hello all and thank you for the replies, they certainly help. In answer to a few questions.

No the adrenal nodule wasn't there on the last ultrasound done in 2012.
We were going to do the repeat ultrasound in Dec 2013, between hubby getting pneumonia, then molly hurting her back, it didn't get done till now, so a difference of about 18 months (?) for this to show up.

No LFT's were done this time Trish. We had the Dec results which showed the ALP and ALT had gone up some. The ALP increased almost 500 pts.

She has had high cortisol since 2011 we think, confirmed in 2012, but no reason for it, since she has never and still doesn't show cushings symptoms. Her LDDS tests are what have been negative.

We thought maybe she hadn't gone full out, or maybe it was something else causing the higher cortisol levels. The IMS said, the only sign of cushings that Molly has, is the ultrasound and the higher cortisol, but no outward symptoms.

On the last ultrasound her adrenals and liver were moderately enlarged, no nodule seen, and now the adrenals are much larger and the nodule has shown up.

We'll know more about the kidney stone locations and size and the nodule and adrenal and liver size, once I have the report in my hands. That should give us the details.

There is really nothing to be decided until I can see the report and look at what is actually said on it, locations, recommendations and size of various things.

I wonder if the nodule didn't come into existence due to the higher cortisol levels. The thing is that the cortisol levels don't seem to affect molly outwardly at all, but do internally.

The IMS said that without symptoms she doesn't like to treat and that is what Dr. Peterson said too. This was before we knew of the nodule. The IMS doesn't want to jump into anything until all tests are back and we can have a clear picture of what is going on. I am loath to do surgery if it is a benign tumor that doesn't continue to grow and we'd have to monitor every few months with an ultrasound to know that for sure. We also don't know without an MRI about whether there is a pituitary tumor or if something else is causing the cortisol to be high. (this was discussed along with the could she have atypical and something else going on too)

My current plan is to not over think it till we have test results on everything back and I have the report. That will tell us more I think. Then I'll consider whether a $2000. MRI scan should be done too. Man those things are expensive (I think that is the cost, could be more)

Molly is the same as every other day. Playing, bugging me when she wants something, like it's dinner time right now. She hasn't even finished the dry stuff from this morning, but wants the good stuff put on top now. LOL She's had a walk, pranced around the neighborhood, dropped off the mail where needed. You wouldn't know a thing was wrong with her.

And one thing I would have to say no on, is the question for surgery, can you accept losing her if something happens during the surgery. No I couldn't accept that when she is so normal looking and acting.

hugs
Sharlene and molly muffin

She sure is a mystery that's for sure.

I love surgery as it has saved Flynn, but that being said if a nodule was not looking nasty and invasive and my dog had no symptoms I would not be doing it either so totally agree with you there. Flynn also has that pesky nodule on his remaining adrenal. There it will stay unless it starts playing up.

So we await formal report, get up to date bloods, LDDS, LFTs etc and then discuss further with IMS about way forward including further imaging?

Agree with Trish :D I kick myself everyday about doing Woody,s surgery with no outward symtoms either. So we will wait patiently for the written report

Woody's was nasty though Tracy, something had to be done and I would have done the same as you so don't kick yourself too hard OK>!

http://animalendocrine.blogspot.com/...c-dog-for.html
http://endocrinevet.blogspot.com/201...l-adrenal.html

Quote:

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Could this dog have Cushing's disease?
Hyperadrenocorticism (Cushing's disease) is a clinical diagnosis and is based primarily on the finding of compatible signs (e.g., polydipsia, polyphagia hepatomegaly, hair loss, pot-belly). In a dog suspected of suffering from Cushing's syndrome, we confirm the diagnosis by using one or more of the adrenal function tests (e.g, ACTH stimulation or low-dose dexamethasone suppression tests) (5-7).

One should never make a diagnosis of hyperadrenocorticism based on the finding of large adrenal gland size alone. Remember that the stress of any nonadrenal illness commonly leads to an overactive hypothalmic-pituitary-adrenal axis. Therefore, any dog with chronic stress or illness can develop bilateral adrenocortical hyperplasia as a physiological response. I know that some radiologists like to diagnose Cushing's disease based on adrenal gland size, but this just cannot be done using this criteria alone (5,6). Dogs with Cushing's disease certainly tend to have larger adrenal glands, but large adrenal glands alone are not diagnostic for this disease.

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I know you already know this- just a reminder how it all may come in to play for Molly.:):):)

Ok Mum (Trish) lol