Wow Patti!
Someone is looking out for the two of you!
Prayers coming your way!
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Wow Patti!
Someone is looking out for the two of you!
Prayers coming your way!
Patti, even though it is counter-intuitive, I believe trilostane treatment for pituitary-dependent Cushing's usually enlarges the adrenal glands rather than making them smaller. I am not sure about the impact on adrenal glands if there are tumors present there. But just wanted to mention this so you'd know that adrenal enlargement, at least to some extent, is actually the norm for the majority of trilostane patients.
http://www.ncbi.nlm.nih.gov/pubmed/14703251
Marianne
You can do this Patti. We are with you. Praying for you and Tipper the Ripper.
Sending hugs and prayers, fingers crossed, paws too!!!
Hi. I was just catching up on things with Tipper. You had wondered about Kaibo. Yes, Kaibo did have an adrenal tumour that was causing the Cushing's. He was treated with Lysodren but we were having a hard time keeping him in the maintenance phase. At one point, a vet at the college thought the diagnosis of Cushing's was wrong so she wanted him off of Lysodren for at least a month and then repeat an ultrasound. He had several ultrasounds previously both at the vet clinic and at the teaching hospital. They finally saw the tumour in April. We decided quickly that he would have the surgery despite the risks, especially because he is only 6 years old. We expected the surgery to happen quickly but they wanted to know if it was a pheochromocytoma (pheo) or not. While we were waiting on those test results (they tested urine catecholamines) he was diagnosed with diabetes so the surgery was put on hold until his blood glucose was controlled. During this time, his Cushing's was not being treated. It was hard seeing all of the Cushing's symptoms return because we had seen such amazing improvement with him when on the Lysodren.
Someone mentioned the numbers of pre and post ACTH test meaning something. I wonder if you were thinking of the low dose dexamethasone suppression test (LDDS). In that test, the results at the 4 and 8 hour time can help determine if the Cushing's is caused by the pituitary gland or the adrenal gland. Kaibo never had high blood pressure so that was another way to rule out it being a pheo. I am not sure what else to write at the moment. If you have questions ask away!
I know this is all very scary and overwhelming. The key for us was to remain positive. Always focus on what is good in your life. There is something to be grateful for every day even when it seems like there isn't. I wish you well on Friday and will be watching for an update.
Take care.
Kaibo and Nikki :o
Hi Everyone:
I am a nervous wreck, but decided to post as Tipper is at my feet going crazy. She is so hungry this is going to take everything I have to get thru this. Three times in three days is a lot to expect from her. I never slept a bit last night and got Tipper to bed late so she would sleep late and not be hungry so long. It did not work, she was up at the crack of dawn. My favorite time of the whole day is her sticking her face in mine and kissing me to wake me. Little did she know how still I stayed, and in one position not to wake her. I must have gotten a call last nite after I silenced my phone, from the hospital. They informed me a radiologist was now going to do Tipper's US. I told them I had to have a report on what exactly this was, so maybe they changed from the IMS to a radiologist. I think that is even better I hope??? I will have a Dr. that reads these things looking at it, which seems like the best scenario to me. Had some coffee and it gave me a stomach ache as I was unable to eat much yesterday. I hate those moments where your whole world seems to turn upside down. All of you on this forum have shown Tipper and I such kindness and have been so helpful in this journey. I could not do this with out the support of this forum. Each and everyone of you that have posted to me are wonderful, and I appreciate all of you immensely. This will be in God's hands today and I pray he has mercy on my precious girl.
Blessings
Patti
We also go to Dr. Peterson at PVSEC!! Good Luck!!!!!!Quote:
Originally Posted by goldengirl88
Patti-Drive safe, and I'm praying for you and Tipper. You are in the BEST hands at PVSEC. I have such faith in thier entire staff. love and hugsQuote:
Originally Posted by goldengirl88
Patti, I just got caught up on Tipper, and I am wishing you the best of luck with things today. You and Tipper are in my prayers and I will be thinking about you. I will be watching for an update.
Hugs,
Tina and Jasper
Hang in there, you are doing just fine, best of luck today
Right by your side, Patti! I think the radiologist is a good idea - that person will more than likely perform the test and read the results, which is the best approach IMO. That is also the person most likely to be familiar with that particular machine and any quirks it may have. ;) They may sedate Tipper to make sure she will be still and more easily positioned with less resistance which would allow them to see the most they can so don't worry if they want to sedate her - it is a mild sedation and would help them as well as her.
I think this is a good plan, honey, tho I know it is stressful on you both to have to see the vets so frequently lately. I am praying you leave with a more definitive answer as to what may be going on in there.
Hugs,
Leslie and the gang
Popping into top up the prayers for you and Tipper:)
Me too.
Sorry I haven't been about much. Am thinking of you. I did ask Tia yesterday and today to look after you both
Tight hugs to you and kisses to Tipper the Ripper.
Mel
Xxxxxx
Patti,
Tipper is in the best hands possible today. Prayers for both of you!
Patti- Hoping everything went well today. Thinking of you and Tipper and sending lots of positive thoughts your way.
Barbara
I'm still here Patti, waiting and thinking of you and Tipper the Ripper.:p
Hi Everyone;
What a day, I will have to explain a lot tomorrow as we are exhausted. First there was terrible road construction and it made me 15 minutes late for her eye appt. I called on the way and told them what was happening. I ran into the Dr's office with her and the Dr. who I have known for many years began screaming at me and having a hissy fit in front of everyone. I just burst out crying and told him I was sorry as the construction would not let me thru. The drive is over 2 hours. He started yelling and telling me he had a patient under sedation, and how terrible I am for doing this. I could not stop crying the whole time he examined her. He said she has hemorrhages in her retina. Asked if she had high blood pressure and I said no, maybe 2 times in a year it was high. He said they are extremely tiny. She is to be kept calm- great what about storms?? I need to talk to my vet. I ran downstairs with her after the appointment- he charged me double- I guess to show me a thing or two. She has to go back in 4-6 weeks for a recheck. I got to the ultra sound in time. We went over things that the other Dr. giving the other US told me. I was there almost 4 hours and was getting a sick feeling. There was an older lady sitting by me that tried to make me feel better. Tipper's stomach was making gurgling, gastro sounds by this time. I asked for something to calm her stomach, as I know that hurts. They gave her Cerenia and that helped. Basically everything the Dr. at the first US told me she told me the opposite. I am really upset. She said Tipper has a large Gallstone. She also said her right Adrenal is fine ( the one with the vena cava etc.). The left adrenal has a tumor. We did not discuss size it will be in the report. She said it has not gone anywhere else so she is hoping it is non cancerous. She said they could have missed it on the initial diagnosis at my vets, as it may have been a little nub then. My vet diagnosed Pituitary Dependent. So this is a real switch. She also said they use Lysodren on these and was surprised at Tipper being managed so well on the Trilostane. The other scenario is she could have Pit. Dep. cushings and this could be a pheo that she also developed besides that as Leslie said. Although she said those dogs usually have high blood pressure. To know 100% it has to be removed. She said I need to think about all this first. The previous Dr. said he could not find her left adrenal and the object on the screen he pointed to that was like as big as a fifty cent piece had to be her right adrenal. This is the complete opposite of what she told me today. I am sorry but what the hay??? I took Tipper food so I fed her as soon as we got in the car. She was starving and inhaled it and drank like a camel. She has had no Vetoryl today, I will start tomorrow. The IMS said to continue on the new dosage of 20mg and she is going to have to have another check to see if the tumor is growing. Then we need to make decisions after consulting surgeons etc. I will post the report as I will have it by tomorrow probably. I am very concerned about all of this. I am also concerned about her eyes. I almost told him where to go, but I am glad I waited as I found out about her eyes by being silent and letting him rage on. He should be ashamed of himself. The nurse just looked at me like I'm sorry honey. I just wanted to post what I know and get some feedback so I can read it all in the morning as a lot of you have jobs and post at nite. Thank you all for your help in advance. Blessings
Patti
Patti, Oh my gosh. What a day you and Tipper had. That was horrible of the eye doctor to treat you like that. That is so irritating that he yelled at you like that. I am sorry to hear what was found on the US and by the eye doctor. I'm sorry I can't give you any advise as far as this goes but know that Tipper is and will be in my prayers.
Big Hugs
That is inexcusable to yell at you for something that wasn't your fault and how dare he make you cry. :(
This is totally wacky compared to what the first US seemed to show. Did they have a copy of the other ultrasound to make comparisons too? My IMS puts all ultrasounds on a DVD for me and then sends a copy to my vet. I'd think they should be able to do that, or hope so. It could be beneficial as they should have all the information possible.
Now what is this about a gallstone? What is the suggestion in regards to that?
The tumor is on the left side they said? and never seen before. Maybe it is small. If it doesn't grow, then is there a possibility that it can be left alone? Would leaving it affect her lifespan? We do have Wally who is currently on medication and his tumor has actually decreased a bit. So, is that a possibility? He is on lysodren to do that, not trilostane.
I think there should be some options for you to consider and some questions that can be answered here.
Hugs and love to you and Tipper
Sharlene and Molly Muffin
Patti--You must be so tired...emotionally and physically! Do I understand correctly that this eye vet blew his stack at you because you were 15 minutes late?? 15 minutes?? You called ahead that you were stuck by highway construction and he got angry with you...all for 15 minutes?
That is crazy!! Then he charged you double? I can't even believe how awful this man sounds!
Your head must still be spinning from this day. So much different information than what you thought you were dealing with all along.
Hoping that a treatment plan can be worked out asap. maybe it can stay the same for awhile since Tipper has been controlled.
Sounds like Tipper was just the greatest sport through the whole thing.
I'm sorry for everything you've gone through all week. You take the best care of Tipper (and all your babies) and I know you're going to figure this all out Patti and you know everyone here will be right behind you!!
Barbara
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
And another link -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
http://veterinarymedicine.dvm360.com....jsp?id=731453
Maybe there have been more recent studies that contradict these?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.
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. ;)
Leslie:
Is the 2.89 on the tumor large? I do not know the size comparison with what, an eraser on a pencil??- and it could have been that large all this time and the idiot at the vets did not know or reading it incorrectly?? Blessings
Patti
I'm not sure what is considered a normal size for an adrenal gland. I'll have to research that! :o
I'm at work and can't post alot but dogs with pheos don't always have high blood pressure. That is why most are never diagnosed. The blood pressure only goes high when the tumor is active (it emits basically adrenaline) and trust me it almost always happened at night with my Annie so by the time I drove 5 hours to the closest IMS her BP was normal.
Gotta go but I will check back in later. Kim
I just checked Zoe's ultra sound from April 2013. Her left adrenal measures .96cm cranially and 1.1cm caudally. I can go back to her original ultra sound to get the original measurement from 2010when I get home tonight unless I can find it here on my work computer.
Dr. Mark Peterson blogQuote:
Pros and cons of Lysodren vs Vetoryl
So which drug to use—mitotane or trilostane? If the dog has PDH, she should respond clinically to either drug (1,4-6), but if an expanding pituitary tumor is present, that might lead to neurological signs within a few months (3,7). If the dog has an adrenal tumor, the standard doses of mitotane would be unlikely to help, but this failure to control the cortisol levels would help "suggest" that an adrenal tumor is the underlying cause (1,8,9).
Use of standard doses of trilostane, on the other hand, is more effective in lowering cortisol values in dogs with adrenal tumors so this may be the way to go if the client refuses any additional workup (6,10). However, if adrenal carcinoma is present, this drug would do nothing to stop tumor invasion or metastasis. And again, if the dog has non-suppressible PDH with a pituitary macrotumor, this might lead to neurological signs within a few months.
Hi Everyone:
I am still as confused as ever about all this. I don't know if she has Pituitary Dependency and a pheo or just Adrenal dependency. I am waiting for the IMS to email me some answers to the questions I asked. It doesn't seem to me that this adrenal gland is large according to the info Leslie sent me. Of course my vet is away again, won't be back until Monday. Blessings
Patti
Patti,
Stop and breathe!!!!!!!!!!!!!!
You are going to give yourself a heart attack or a stroke!:eek::eek:This will all become clearer and sort itself out. I feel very confident that it will. Right now you are still in shock and understandably so.:o You have all of us here helping in every way we can. You and Tipper have literally tons of love, prayers and support surrounding you. We aren't going anywhere, so stop and breathe! Xxxxx
Hi Everyone:
The IMS has not emailed back my answers yet. Her assistant did call me however and tell me that she would want to check the tumor in 6-8 weeks unless I decided on surgery. They are to set up a consult with a surgeon for 125.00. I do not know if I should do this as they will not tell you how much this will cost until then. I could pay out 125.00 for a consult and have her tell me how much it will cost only to find out I cannot afford it. I would sell my car, but then how would I get her around? If anyone can give me a cost for this I would appreciate it. I told them to call me after Monday to set something up as I am overwhelmed right now, and need time for the forum to help me sort thru this. My other question is how much of a life span is this going to give her if I do this operation. I have searched on the forum and seen many different estimates from 1 year to 5. For 1 year is it worth putting her thru this bad surgery, or letting her go on as long a she possibly can like this. What if they remove it and she then has a pituitary one also?? I have been through 1000 scenarios in my head today. I have to take Tipper to the consultation, and do I really want to make her do this again after yesterday?? She is fed up with all this, it is making her crazy and me too. Blessings
Patti
Hello. Again, let's focus on the facts. We don't know what we are dealing with and you don't have enough info to make a decision re surgery yet. The only way you get that info is with the consult.
I would have no idea how much it cost but its definitely in the thousands of dollars. Oh boy that really helped huh? If you want I could add adrenal tumor to your thread title and then those that have dealt with them would tend to come in and read... trust me that is how it works. ;):)
You asked about Annie's breathing problems. I found the part in her thread where I linked videos. One showing her stumbling on stairs (her legs would give out suddenly and then she'd run around like a puppy), another with the breathing/body shaking and lastly a link just to show how her stomach was huge (from enlarged organs) - Glynda and I were having a conversation at the time and a big tummy like this is NOT a cush dog - it's a skinny dog with enlarged liver, heart etc.
Go til you see the video links:
http://www.k9cushings.com/forum/show...?t=933&page=72
Kim