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

Trish
Wow!!What a great report!I hope Flynn is a litle less stiff today-could have been from all that poking around plus the long car ride.I can't believe you were only charged that amount!Over here,I paid just under 500 for just a consult with that first IME we saw:eek:.She did nothing but talk to me and then took Fella's BP.It's always nice to hear reasonable charges.Sounds like a great day in every way!
Hugs to you and your boy and speak to you soon!

Hi all - Flynn's full report is in, she did not call but has sent an email which I had suggested she do so I have the full results for my records!! :D:D (you have all taught me well to keep everything up to date :)) I have cut out normal lab values and the urine test which was ok apart from 3+ protein. Honestly that ultrasound has the potential to freak me out :eek: But surgeon visualised the left adrenal nodule during his surgery and did not suspect anything other than benign nodule and he has no cushings symptoms so whatever it is in his remaining adreanal it is not getting worse and is causing no problem so I am not going to worry about that one for now.

The kidneys have quite a few of the things you have on Zoe's Addy! Still I am going to concentrate on the improvements in his protein/creat ratio and normal renal blood panel. My mantra has been treat the dog and not the numbers so I will listen to my own advice on his dodgy kidneys too!! Big liver nodule unchanged and most likely benign. The newest thing is change in small bowel, please those of you with inflammatory bowel disease experience I would appreciate comments and thoughts on the IMS dietary recommendations made at the end of her letter. Flynn has had normal poops for six days now, YAY! But I will proceed with the hypoallergenic diet to try and get on top of it. I presume we will continue with the supplements he is on now, she knew about them but has not mentioned anything about them in her report. Any input appreciated as always, but despite all his little bumps, internal and external... overall I am pretty happy with my boy at the moment! xx
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Thank you for your referral of Flynn, a 11y 6m old, Male Fox Terrier belonging to Trish, who presented to the Massey University Veterinary Teaching Hospital on the 22/05/2013. Pertinent case details for Flynn are as follows:

Physical examination
Multiple lumps over body. BWt 13.5kg, BCS 5/9
Blood pressure cuff#3 left fore Doppler 180mmhg, Pet Map 118mmHG
Fundic examination – normal, no evidence tortous blood vessels, assume blood pressure stable
Ultrasound: Abdomen.

History: History of pheochromocytoma from the right adrenal gland removed 6 months ago. Prior extension into the caudal vena cava identified. History of benign liver nodule. Recheck for possible metastatic disease.
Significant findings: Ultrasound is compared to 19/12/12.
The gallbladder is similarly positioned to the left of midline. The right liver contains a 1.9 cm ovoid hypoechoic nodule. Additionally, within the right liver, 2, 0.8–1.5 cm ill-defined hyperechoic nodules are present. Similar the prior date, adjacent to the left caudal margin of the liver, a 1.4 cm irregularly ovoid echogenic nodule is present. At the liver margin cranial to this nodule, linear hyperechogenicity with distal acoustic shadowing suspicious for surgical clips are present. The left adrenal gland is enlarged (0.9 cm), and contains a 0.7 cm hyperechoic nodule in the caudal pole. The right adrenal gland is not identified. In the region of the right adrenal gland, clear hyperechogenicity with distal acoustic shadowing consistent with hemoclips are present. There is no evidence of caudal vena caval invasion or turbulent flow. The kidneys bilaterally have decreased corticomedullary definition, hyperechoic cortical echogenicities, and small cortical cysts. The mucosal layer of multiple jejunal segments contain pinpoint and linear hyper echogenicities.
The spleen, urinary bladder, prostate, jejunal and medial iliac lymph nodes, stomach, right pancreatic limb, and colon are normal.
25/22-gauge fine-needle aspirates were performed in the left cranial abdominal nodule and right liver nodule, with no immediate complications.
Impressions:
1. Absent right adrenal gland consistent with prior adrenalectomy. No sonographic evidence of regrowth or vascular invasion.
2. Left adrenal megaly and adrenal nodule. Given size, differentials include hyperplasia or neoplasia (such as adenoma) most likely. If there is clinical suspicion for pheochromocytoma, this cannot be excluded.
3. Persistent gallbladder malpositioning consistent with prior left liver lobectomy.
4. Hepatic nodules. Differentials include hyperplasia, extramedullary hematopoiesis, hematomas, or neoplasia.
5. Left cranial abdominal nodule. Given proximity to suspected hemoclips, ectopic hepatic tissue is considered. An abnormal mesenteric lymph node cannot be completely excluded.
6. Bilateral nonspecific nephropathy and cystic cortical degeneration.
7. Altered small intestinal wall layering. Lacteal dilation is considered.

Lab work:
ALP 1094 H ( 0 - 185 )
ALT 296 H ( 0 - 75 )
CHOL 13.2 H ( 3.0 - 9.0 )
LIP 246 H ( 13 - 200 )

Urine protein creatinine ratio:
UCRE 11781 Ratio
UTP 2.45 Ratio
PRCR 1.84 Ratio

CYTOLOGY
Liver Nodule: Hepatocytes showing disorganisation. No overt signs of malignancy
Cranial Abdominal Mass: Epithelial cells with cytological features suggesting hepatocytes. No overt signs of malignancy
Comment: cells from both sites are not markedly abnormal in appearance. However, they are more variable in size and shape than usually seen in aspirates from normal liver, and they are arranged in disorganised patterns. The latter can be a collection and spreading artifact. The features noted in these aspirates can be seen in nodular hyperplasia, ectopic liver tissue, hepatomas and well differentiated carcinoma. Cytologically, we cannot differentiate these.

Overall impression of Flynn
Flynn looks like he is feeling great and is doing well. I would not chase his lab values too much when he is clinically well (ie his liver enzymes are increased, and we do have evidence for liver changes, however they appear benign and have been aspirated and biopsied a few times). Renal parameters and protein should be monitored as should blood pressure.

There are numerous changes on the Ultrasound, however there is little change from previous scans, the left adrenal has had nodules before, the liver nodules look the same and there has always a round abdominal mass that aspirates as ectopic liver. There is no evidence for return of the pheochromocytoma.

The new finding is evidence for some gastro-intestinal disease. The findings were in the jejunum and could be consistent with lacteal dilation and inflammatory bowel disease.

Followup:
Continue amlodipine and benazepril for blood pressure and urinary protein loss
Recheck blood work & blood pressure every 3-6months
Repeat ultrasound & thoracic radiographs in 6-12months
Colitis – consider feeding hydrolysed protein diet such as Royal Canin Hypoallergenic, Purina HA, Hills ZD Ultra. Feed exclusively for 8weeks. If no improvement then sulfa-salazine can be considered.

kidney cysts - sound familiar;) I read they can throw protein into the urine.

inflammatory bowel disease- check on that one too:):) I'll send you a link I think I have at work on it but the new IMS told me this

Quote:

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Inflammatory bowel/colitis: The three general approaches available are diet, antibiotic/probiotic, and anti inflammatory.
We certainly don't want to use systemic steroids in Zoe's case, but we could consider budesonide,which is an oral steroid that isn't well absorbed into the blood. Diet would involve a change to a hypoallergenic diet -either a novel antigen or a hydrolyzed protein.

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so we have 2 different types of diet to try which is why I always tell people- don't use up all your novel proteins but if we have we can try the hydrolyzed protein diet, the molecules are so small the protein does not bother them.

I think to start with diet considering Flynn is not having daily problems or water, runny stool, is good and is great advice.

Hopefully I have the article I wanted to send you on my work computer.


found it- diet is toward the end of the article and it is from 2008 so a bit old

http://veterinarycalendar.dvm360.com...date=&pageID=3

Hope you have a great weekend, will read his report when I get back as I have to bathe and pack!

Will try and check in if I can while I am away, will be back in the middle if your night so will probably catch you wed morning

Big hug, bum scratches to Flynn

Melxxxx

Well, over all that is a pretty good report. Now to see if a diet will fix the poop.

This is going to be interesting. Flynn has ideas about what he likes and doesn't like. LOL

You're doing awesome as always Trish.

hugs,
Sharlene and Molly Muffin

Hey Trish, quick question, when you discussed probiotics with your vet- what was the doseage for a dog when using a human probiotic?

I just found the same probiotic strains in Zoe's Azodyl in a human probiotic thanks to Mary Strauss and her Dogaware site- gotta love that girl:D one third the price:D:D:D:D

dont need to refrigertate either, score for me I think, just need to figure out the dose for Zoe

Thanks!!!

Hey Trish
Didn't see you this morning-hope all is okay with you and Flynn.How is his tummy and poops?Overall,sounds like you got a pretty good report-they results can be so overwhelming sometimes.Big hugs to you and Flynny.
Patty

Hi all
Thanks for all your well wishes :) We doing pretty good, the occasional mucous covered poop still, only a couple of softish ones. I do think it is uncomfortable though and some symptoms I have kinda not realised may well be associated with this, like in the mornings after he eats he can hang his head and I wonder if that is his tummy protesting, usually straight after he eats I drive him to Mum and Dads while I go to work and in the car he sits on the back seat with his head down. Also occasional bad breath. He has had these intermittent symptoms a couple of years, when they get put down to all the other problems he has had like the liver cancer then the adrenal tumour. But maybe all of these things are related to his bowel issues after all.

I have not had the chance to talk to my vet other than get a txt to him about the no pheo recurrence!!! The IMS has sent him copy of report too, but I think he is on his 4 days off now so will catch up with him early next week and get the hypoallergenic diet underway. Not sure which one to use but I want wet food and some kibble as Flynn likes the variety and if he has to be on it for 8 weeks I really want something that is tasty for him. He loves his food :D:D

Thanks for checking in on us, have a good weekend all xxxxxxxxxxxxxxxx :D

When I was on the Dogaware site, they had mentioned that the Hills d/d could also be used as a good renal diet for early renal disease. I am not a big fan of Hill's prescription food but thought I would mention it. They had a venison and potato, a salmon and potato and one other food. I thought about it for Zoe but not sure how she will do with the oils in it and all the starch. Her IBD does not do well with high fiber which is why we are having the issues we have now. Some IBD dogs can handle fiber and it helps them, some cannot.:confused::confused::confused: The only novel protein for her would be the venison.

Hi Addy
Thanks for that dogaware website, I am spending a bit of time this morning researching diets for Flynn and checking those recommended by the IMS. I am looking forward to getting him started on this!! xx