Flynn 11 y/o Foxie Cross - Right adrenalectomy- Good Bye Flynny We will miss you

It'll be good to get through next week. Right now you're all over the place because you are still looking for definitive answers. They are it seems, always hard to come by with our furbabies. They just can't tell you everything they feel, so it's like playing the 20 question game, but without the answers. :(

Hang in there!

Sharlene and molly muffin

Trish, Don't assume it's too late. This is one tricky procedure though and it has to be done by specialist/surgeons that have done alot of these. No regular vet. Not sure where you are located but I drove to K State Univ Vet School. Highly recommend seeking advice of specialist (IMS) or going to a teaching institution as they tend to have the equipment and technology. Only they can tell you if it's operable or not.

That said - my girl lived a normal life. I suffered more than she did with this I think. Hope my thread helps a bit... sorry it is long.. it took so long to figure it all out. Hugs, Kim

Thanks for the support :D:D

We have had a nice day, I am in New Zealand so its spring here and starting to warm up. I've been doing yard work today, Flynn likes to have me in his sight so he comes outside with me but pretty much straight away lies down to rest. I put his bed outside in the sun and he lay there most of the day getting up to have a wee walk every now and then and frequent snacks! His lethargy is worse since our trip to the vet, I am still putting it down to starting his BP medication as I have read on here that other dogs have had the same. I took him for a walk (on his leash) up at the beach, his favourite place to walk - he liked that and kept looking back as if to say "why are you not letting me free??" :cool:

After reading up here on diets I boiled up a chicken for him today, and put some beans and carrots in and have saved the broth. I think that was more for my benefit than his, as there is nothing wrong with his appetite :rolleyes: but he gobbled it down with a few of his biscuits mixed in. He has not been losing weight, puts it on too easily if anything which is why I have had him on light hills biscuits. I am going to the pet store tomorrow as I want to get him some snacks low in salt to help the BP situation and to have more treats on hand.

He is going to NZ's one and only vet university so I do believe he is in the best hands, its a 2 1/2 hr drive away. The surgeon that resected his liver tumour last year was excellent. Well I hope next week we get the answers we want, ie that it is operable. His liver tumour was on the left side which is the easiest to resect, but his adrenal is the right side which I have learnt is the more difficult to operate on.

I read your story Kim, what a roller coaster. I laughed, I cried at all the ups and downs and it was so helpful for me to read so thank you for having that there for newbies like me as it really does help. One section struck a chord, when Annie had the ulcers in her oesophagus, Flynn has had them in his mouth and I wonder if they go further down. Another question for me to ask the vet. I guess unlikely because he has not refused food at all, apart from preferring wet and soft food over his biscuits but he does eat them all by end of the day. He does smack his lips a lot, and rub his face along the carpet like he has an itch on his nose but he has always down that. He does not seem to have the real downs that Annie had either like not able to get up and go out. I cannot tell if the tumour is 'spewing' as you put it!

Do you think I need to be concerned about them doing a LDDS test with the adrenal tumour, I don't want to set anything off??

I am tired, I have read and read then worked and worked outside trying to get rid of my nervous energy. I made myself go out with friends tonight, but only a couple of hours as I had left Flynn with his Nana and Grandad and did not want to be too late (I have not produced any grandchildren for them so he is their granddog and they love him dearly :D:D) it was nice to get out and not be totally focused on reseraching doggy cancer and my feelings of impending doom ... I am so angry as well, at how unfair it is for such a sweet little dog to have to go through this cancer ordeal TWICE :mad::mad:

So on that note, we are off to bed.
xx

Hi Trish,

One comment about the tennis balls. That green covering can really damage the teeth. It acts like sandpaper, wearing the enamel off, leaving the teeth exposed. I had a Pitty mix who had Pica and dearly loved tennis balls. When we had to go in because she ate some things, including a tennis ball, our vet told me about the harm they can do...other than not intended as food! :D I don't know if you have access to Kong toys in NZ, but they are great toys, almost indestructible and come in a variety of shapes for various games. Just FYI!

Hugs,
Leslie and the gang

:D Well you get doggie mom of the year if you read that whole saga. Interesting that Flynn had mouth ulcers. Glynda helped me research and put pieces together - we felt it came from gas being produced as a result of the active tumor. Should you start to notice episodes of inappetance you might try giving pepcid ac (100% famotidine - not the other varieties of Pepcid) to ease the tummy.

Re the ldds test I don't think it would hurt Flynn but I don't understand why they would do one if they have a pheo dx. We did two of them and both came back positive. We did about 5 acth tests and all but one came back positive. Only the one sent to a university came back negative. We finally decided they were unreliable - Annie had cortisol because her body was fighting. I guess I would simply ask what they were looking for from that test.

The hospital we went to finally ruled out pituitary cushings by doing a brain cat scan. So this just left us with an adrenal tumor that they could tell from imaging was not cancerous at that time.

The inability to walk didn't occur until the end. She had inability to go down stairs earlier on - like landing hard on one of her hind legs caused her to fall.

Do keep us posted on what you end up doing and the results. I am glad you are going to the specialists at your university. I remember now you mentioned that before. Sending love across the pond. Give Flynn a hug! Kim

Hi again, probably another lengthy post so prepare yourselves!! I took Flynn to his local vet this morning as I was concerned about his ongoing lethargy. He did not check his BP but said to stop the Benzapril until he has a chance to talk to his specialist vet tomorrow (it is Sunday here today). He said heart and lungs sound OK and checked out ok otherwise.

He had the results from specialist. So here goes:

They only listed abnormal bloods - ALP 957 (normal 0-185), ALT 396 (0-75), Cholesterol 11.7 (3-9).
Urine Protein:Creatinine ratio- 1.48 dogs with glomerular proteinuria >1.0

Ultrasound - compared with last scan on 16th May
The liver is similarily diffusely heterogenous, and contains multiple, varying size (0.5-1cm) ovoid ill defined hypoechoic nodules and a single ill defined hyperechoic nodule (2.4cm). Additionally, within the right liver a single 2.2cm irregularly ovoid heterogenously hypoechoic nodule is present - this was biopsied. The gallbladder contains a moderate volume of unorganised echogenic debris, and is located to the left of midline. Within the left cranial abdomen, caudal to the liver and cranial to the dorsal extremity (head) of the spleen a 1.2cm ovoid structure is present which is isoechoic to the spleen - this was biopsied. The spleen contains a single small (0.3cm) ill defined hypoechoic nodule. The renal cortices are hyperechoic bilaterally, being isoechoic to spleen. The renal cortices also contain multiple small hyperechoic foci. The left adrenal gland is enlarged at the caudal pole (0.89cm) with the impression of a 0.5cm hyperechoic nodule within. The right adrenal gland is also enlarged (1.1cm caudal pole, 1.5cm cranial pole). Confluent with the cranial pole of the right adrenal gland a 1.0cm echogenicity is present which protrudes into the lumen of the caudal vena cava. On doppler interrogation turbulent flow is present cranial to this structure. The mucosal layer of the duodenum contains a few, linear hyperechogenicities which are perpendicular to the luminal surface. The urinary bladder contains a few specular hyperechogenicites.

The jejunum, large intestines, abdominal lymph nodes and prostate are normal.

Impressions:
1. Hepatic heterogenicity and nodules. Given clinical history of hepatocellular carcinoma, recrudence of neoplasia is considered. Additional differentials include extra medullary hemotopoeisis, hyperplasia, vacuolar hepatopathy or haematomas.
2. Probably right adrenal nodule with cranial vena cava invasion. The primary differential is neoplasia such as carcinoma or pheochromocytoma based on invasion, invasive adenoma is also considered.
3. Left adrenal nodule. Differentials include neoplasia such as adenoma or hyperplasia.
4. Hypoechoic splenic nodule. Differentials include extramedullary hemotopoeisis or hyperplasia. Neoplasia or haematoma are considered less likely.
5. Left cranial abdominal nodule. Differentials include ectopic splenic tissue, atypical lymph node or mesenteric nodule.
6. Urinary Bladder debris is consistent with crystalluria
7. Bilateral non-specific nephropathy and nephrolithiasis.
8. Duodenal mucosal striations. Lymphangectasia is considered.

Biopsies
Liver nodule: highly cellular with excellent cell preservation and spread. They consist of multiple clusters of mildly to moderately pleomorphic hepatocytes that occasionally have a fluffly vacuolar appearance. Small to moderate numbers of very thin tapering spindle cells ?capillaries and slightly larger plumper mesenchymal cells surrounded by small quantities of pink matrix are noted. The remaining two smears contain no cells but small to moderate quantities of necrotic material.
Left cranial abdominal nodule: samples are heamodilute, containing small numbers of generally poorly preserved hepatocytes that also have associated mesenchymal cells present.
Interpretation: The hepatocytes show no cytological abnormalities other than mild vacuolation. Vascularisation or fibrosis? to account for the presence of the mesenchymal cells. Evidence of necrosis in liver nodule.

So overall:

Problem List
Hypertension
Liver nodules
Bilateral adrenomegaly
Right adrenal mass with vascular invasion
Proteinuria
Hepatic enzyme increas
Polyphagia
Trembling

Differential diagnosis
Hyperadrenocortism is still possible - either with pheochromocytoma or other adrenal tumour

Plan
Recommend a LDDS to rule out hyperadrenocortism. At the same time repeat blood pressure.
If the LDDS comes back normal then I would recommend changing medications to phenoxybenzamine as it is likely the hypertension is secondary to pheochromocytoma.
Further workup of the adrenal mass is recommended to decide if this is surgically resectable - this includes CT of the abdomen and most likely thorax.

So I guess on the good news front, the biopsies are not cancerous although his local vet today said the necrosis in the sample makes him suspicious. But I was pretty stunned to hear of the nodules in other adrenal, spleen and problems with bladder, duodenum etc. Crikey such a lot to take in.

Local vet going to call specialist vet tomorrow, check about the antihypertensive situation and he also wanted to clarify her thoughts on the ultrasound, as he was confused by some of the more in depth reporting... phew so was I! Plan for LDDS on Tuesday, then hopefully we can get booked into specialist vet later in week for CT.

So there we are, my news for the day.

Oh my gosh. That is an awful lot of information to take in. I'm sure some of the more knowledgeable people here can read it and understand it. I'm not one of them!
I do hope though that the next week will bring some clarify of a path to follow to get Flynn bak on track.

hugs,
Sharlene and Molly Muffin

Thx Sharlene, my head is sure in a spin trying to rationalise these results. Thx for the hug and same back to you and your gang! :)

Hi Trish.

I have to agree with Sharlene, that's a lot to absorb at one time. I usually don't tilt on information overload but Flynn's data left me like a deer in headlights. :eek: I'll be anxiously awaiting your vet's report after he's talked to the specialist to get his take on the ultrasound results. I think that's what you need before you can more forward with a plan.

The one thing I wanted to mention is that if Flynn does have cancer, carbohydrates should be minimized as cancer cells seem to feed on carbs and use them to proliferate. Carbohydrates are also stored as fat which contributes to obesity. In my opinion, anything Hills makes is usually guaranteed to be crap. They are a huge conglomerate and one would think that with their resources they would use good quality ingredients in their foods. The light Hills bisquits you mention are anything but low calorie. They are more than 65% carbohydrates, with most of that coming from the main ingredient, corn. If you are going to include any grains in Flynn's diet, corn should not be one of them. You may want to consider getting rid of the Hills bisquits and buying treats that are grain free.

Glynda