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

Hi – I would like to introduce myself and my beautiful boy Flynn, he is a just turned 11 year old Foxie cross. I rescued him from wandering on a busy road when he was approx 6 mths old. No-one claimed him so he ended up mine and I love him to bits

Our problems started last November when he suddenly collapsed, he has doggie day care with my parents while I am at work so they rushed him to the vet. He perked up with IV fluids but an ultrasound scan showed a large liver mass. Bloods slowed very elevated liver tests with ALT and ALP off the scale. A biopsy was done which was benign and we rushed him to the specialist vets and he went on and had a 650g mass removed, histology showed a masive low grade hepatocellular cancer which we were upset about as the initial biopsy was negative but his surgeon said this tumour has a very low chance of recurrence. YAY. He hated the pet hospital and cried the whole two days he was there. Of note, a preop CT scan showed two nodules on the other side of his liver. They were biopsied, and are benign. The surgeon said if there had not been benign he would most likely not have operated.

Prior to this, Flynn had nondescript symptoms that included weight gain we thought because of his ravenous appetite so put him on a diet, less energy, panting when stressed ie if we were eating, lipomas removed a year prior but mainly all back again, pot belly, shaky like a lot of foxies and he has always done this but it is much more pronounced, not so good at jumping, occasional diarrhea. He seems in discomfort, hangs his head when in back of the car and no, its not my driving! He does have a history of arthritis in his hips (from all those years of pogo jumping I think) plus when he was about six he injured his back, just above shoulder area. I am unsure whether this discomfort is due to that or some other cause. Vet did get a positive pain result when stretching his legs back to test. Apart from the diarrhea which has settled these symptoms have not gone away with the surgery.

He recovered from his operation, but not as good as I thought he would. So we were back to the specialists vet (3 hr drive from us) in January after blood sample showed liver enzymes still elevated, protein in urine, high blood pressure plus all the other symptoms listed above. His vet suspected Cushing’s disease and did the LDDST, which was negative and apparently he suppressed nicely. She asked for cortisol/creatinine urine test to be done once we were home. Which we did but unfortunately the local vet wrote the wrong thing on the form! At this appointment Ultrasound was repeated, the nodules seen previously were rebiopsied and negative again, they mentioned adrenals on the large side of normal.

We went back last week for further review when we found out the wrong test had been done on his urine.. he had protein/creatinine instead! Blood shows liver tests still high but slightly less than January, still protein in urine. Now we have a new specialist vet, so yet another scan shows only very minimal change in liver nodules but enlarged adrenal glands on both sides. They still think he has cushing’s and they whisked him off for a cortisol/creatinine urine test (via stab into his bladder), BP was high but not surprisingly as he so stressed out being there!!

So we are still in limbo here… waiting for vet to call me this week with the cortisol/creatinine result, although I am kinda kicking myself for allowing them to do that to him while he was stressed AND did they have to stick him with a needle to get the urine? I have read that he should be calm when he has this test.

He does have a lot of symptoms of cushings but not the some of the common ones like hair loss and excessive drinking/urination. Sorry I do not have his lab results to type in, I will get copies. But if this cortisol/creat is positive do you think I need to ask for more testing before starting any treatment? Thank you for reading my novel

Trish and Flynn

Hi Trish,

Welcome to you and Flynn! Sorry for the reasons that brought you here but glad you found us.

You are correct that the UC:CR (Urinary Cortisol/Creatinine Ratio Test) should be done at home because of this being less stressful on the pet. Any kind of stress or illness can cause elevations in the UC:CR results. Also, any chronic health issue may cause the adrenals to be enlarged.

A confirmed diagnosis of Cushing's is not only based on test results but also on strong clinical symptoms displayed by one's pet. If Flynn is not showing obvious signs such as excessive water consumption, increased urination, and increased appetite, than I would not pursue any more tests for Cushing's Disease.

You mentioned that a UPC (Urine Protein-Creatinine Ratio) test was performed, could you post the results from this tests and all abnormalities listed from his senior wellness panel (CBC/Chemistry Blood Panel.)

Please know we are here to help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

Hello and welcome from me, too!

I agree with Lori. Even if Flynn does have an elevated UC:CR (either in relation the current sample or on a repeat sample taken at home), I would not move forward with Cushing's treatment based only on that result and the ultrasound. (And yes, you are right that he should NOT have been stressed when that sample was taken!).

It does sound as though something is causing him discomfort, but it seems as if it could be something other than Cushing's. As Lori says, if you could post any abnormal results from previous blood/urine panels, that will give us a place to begin our detective work.

I'm so glad you and your sweet boy have joined us!
Marianne

Thanks so much for the replies, I did not hear from the vet today about his results and I certainly have a few questions to ask him when he calls. Working on getting Flynn's results to share with you and will post them soon... hope you and all the pups have a great day!

The worst part of dealing with an illness is always waiting for the vet to call.

Hope everything is ok.

Hi all
Thanks for comments to date: I still have not heard back from specialist... 2 weeks later! Despite emails and phone messages.

I did visit his local vet today (his cat sister Nala had to be put down) and got some of his latest results.

These were taken on 9th May.
Full blood count normal including haemoglobin, rbc, wbc, platelets. only slight deviation is lymphocytes 0.9 (1-4.8)
Comment from lab - erythrocytes show anisocytosis 1+, polychromatic cells occ, leukocytes morphology appears normal. There appear to be increased numbers of both large and giant platelets but numbers are normal. Lymphopenia suggests stress.

Other bloods:
CK 637 IU/l high (74-385)
AST 65 IU/l high (18-51)
ALT 357 IU/l high (23-88)
ALP 683 IU/l high (13-87)
CHOL 10.9 mmol/l high (13-87)
creatinine 40 umol/l low (48-109)

Bil, urea, S.TP, albumin, GLO, AGR, S.Ca, S.po4, amylase, na, K, NAK, S.chl, HAEMO all normal.
Comment from lab: moderate elevations in ALP, ALT are more pronounced that what they would expect for age-related changes. could be due to liver disease (tumour recurrence ruled out on US and biopsy of two nodules). this can also be seen with endocrine disease and recommend checking glucose (my comment, previous tests had been in high end of normal range) gut disease and with corticosteroid response endogenous and exogenous. Hypercholesterolemia is a fairly non specific change which can be seen in post prandial samples (my comment, he was fasted for this test) with endocrine disorders eg diabetes, cushings and glomerular disease.

I do not have copy of his January blood tests but these ALP and ALT results are improved since then, so I was heartened to see they had not worsened but still pretty high.

Protein/creatinine urine test
U.TPCAL 1.84 g/L
U.Cre 13521 umol/l
PRCR 1.21
Lab comments: recent studies demonstrate that proteinuria is prognostic and the severity of proteinuria significantly correlates with renal survival times (JVIM 2007;21:906-916)
Staging of renal disease as suggested by International Renal Interest Society for cats and dogs are as follows, with the provisos there should be no evidence of urinary tract inflammation or haemorrhage and that routine measurements of plasma proteins has ruled out any dysproteinemias. Staging should be done on at least 3 urine samples collected over a period of at least 2 weeks.

Protein:Creatinine substage
Dogs <0.2 non proteinuric
0.2-0.5 borderline proteinuric
>0.5 proteinuric
I have no idea what that protein test shows!

Assessment: (this bit was at bottom of same form... I think blood pressure?!)
SAP 145 178 163 142 152
MAP 110 121 112 107 101
DIA 91 90 84 81 74



His other tests:
Dexamethose supppresion test was negative for cushings... apparently he suppressed nicely. ( I do not have actual result here)

Costisol/Creat has been done but I have no result yet.

Ultrasound ; 2 liver nodules that vet told me are common in older dogs - they have been biopsided twice and not a recurrence of his liver tumour as mentioned in above post. Bilateral enlarged adrenals.

So that is where we are with Flynn, he is good mostly. Active, daily walks which he loves. I still think he has some minor discomfort better with small dose of previcox daily, hangs his head in car, panting has mostly settled though still does this if stressed, hunger remains, weight gain settling with diet, does have pot belly, itchy knees.. he is always nibbling at them and recent balanitis. But he is not drinking excessively, not peeing excessively and no fur thinning.

If anyone has any ideas I would love to hear them!

Thanks
Trish

I have just been reading the other posts, one about leg trembling struck me. Flynn has always been a bit of a twitchy dog, but since his surgery I have really noticed his back legs both tremble much, much more. Even if he is standing still, sometimes at rest too.

Hi Trish,

I can't imagine why the specialist has not gotten back with you after two weeks of inquiries! That is really inexcusable! :mad:

It is especially a shame because Flynn's situation does seem complex and confusing. I'm sure I'm not telling you anything that you don't already know, but aspects of his symptom profile are hard to "put together." Normally, you wouldn't expect the liver enzymes for a Cushpup to decrease without treatment. And there are certainly question marks about the evidence that he is leaking protein into his urine. I think protein in the urine can be due to primary kidney damage of some sort, or it can also be secondary to the effects of another condition including Cushing's. I know very little about the actual protocol for the renal testing that was done, but from the lab report it looks as though a series of urine samples are required to really validate the test results. So maybe some additional kidney evaluation is called for. Because even though it is an unsettled research question right now, some researchers think that excessive protein in the urine is not only an indicator of renal issues, it can also cause renal problems to worsen. Therefore, medication is recommended in some cases to try to decrease the amount of protein spillage. But I think Flynn would need more evaluation in that regard. And if it turns out that he does have Cushing's and any kidney involvement is secondary to the Cushing's, then the kidney issues may automatically be better controlled once he is treated for the high cortisol.

It sounds as though the low dose dex test was performed back in January -- is that true? If so, and if the current UC:CR comes back consistent with the possibility of Cushing's (even though it was drawn by needle at the vet's :(), I'm wondering about a repeat of the LDDS now that it is almost six months later. As Cushing's advances, those diagnostic test results can change over time and a "negative" can shift to a "positive." But the trade-off is that other, nonadrenal conditions can falsely skew the test results, too. So if Flynn does have some other issue flaring, that could give you a "false positive" on the LDDS.

For all these reasons, I agree that you really need the input of a specialist to sort out the next step in terms of diagnostics. And if this current specialist continues to be this unresponsive to your needs, perhaps you need to try to shift to somebody else...

Marianne

Hi Marianne
Thank you for your reply :D

Yes, his LDDS was done in January. I am going to get onto the phone again next week and stay there till I get to speak to the specialist :confused: It is so annoying, the surgeon who removed the liver tumour back in November was so good at calling me whenever results came through it is disappointing to have this trouble now. The specialist he saw is new to the country having come from California and his credentials are in the field of oncology so I think I will have to ask if there is another specialist we can see.

I agree, getting to the bottom of his problems is going to require more testing but I just have to make sure they do the correct ones! I will post any updates and thanks again for the input.

Trish :)

Hi all
Just an update on Flynn, after 4 ultrasounds and a CT prior to his liver surgery last November he has been back to the specialists this week for his routine checkup. His latest ultrasound yesterday has shown a probable tumour in his adrenal gland. Most likely a pheochromocytoma, also looks like some clot into his vena cava and an enlarged lymph node. :( This would explain his hypertension and they have noted changes in his eyes and also proteinuria so he started on BP medication yesterday. One nodule in his liver that has been biopsied prior to his surgery and once after and has been benign both times has grown a little so that has been biopsied again and also the lymph node. I am waiting for them to call me with results. In himself he is pretty good, still very trembly in his back legs but no excessive drinking or urinating, boy is he hungry though. I have noticed increased panting. Thanks for your advice previously.
Trish

Hi Trish and Flynn and welcome to the forum.

Well, he does have some mish mash results. My dog too has contrary results with the cushings testing and it's a very hard disease to diagnose. If Flynn Is suppressing fine on the LDDS then that isn't consistent with cushings. I've had two LDDS test on my dog in the last two years because some results seem to show cushings but she always suppresses on the LDDS. I'm thinking there could be other things going on with Flynn. Liver, Kidney, or something else. Hopefully the latest tests will give you some answers. It's very scary not knowing.
The good thing is that this forum has a lot of people with experience dealing with many of these items. At least you'll have others to bounce ideas off of who have been on the roller coaster too. :)

Don't hesitate to ask anything. Flynn has sure been through a lot already. He looks so happy in his picture. :)

Sharlene and Molly Muffin

Trish, My Annie was misdiagnosed with cushings - she had a pheochromocytoma. They are very rare and often not discovered til after death. If this ends up being the diagnosis feel free to ask questions and I will help any way I can. There isn't a ton of info out there. Kim

Where are you located at? I know of an outstanding surgeon (who performed my little ones adrenalectomy) amazing Internal Medicine doctor, good Nutritionist, and fairly impressive ophthalmologist. I do know folks come from all over the Nation to receive these doctors care and i can certainly understand why.
My little one had a tumor on her adrenal gland and thanks to the angels here.....we managed through it. You simply will not believe how amazing the support and knowledge is here.
I am almost wondering if there is also nerve type damage to the back......have back x-rays been taken? if he has back issues cosesquinn double strength sprinkle capsules are good, and so are the adequinn injections....have heard miracles about those. His posture is indicating discomfort.........but where all from is the big question.
Any chest x-rays of lungs and heart? combining with labs and such just wondering how the health of upper organs were doing.
what food are you feeding? any diet changes? treat changes? is he on a probiotic? (sorry not meaning to flood you with questions)
you are amongst the most amazing angels who will help offer their input every step of the way. Lots of experiences here and if i can help please let me know.

HI all and thanks so much for your replies, it seems most people except those that really love Flynn think it might be time to pull the plug :eek: We think he can fight a bit more and he has not come this far to give up on him now. He is still a such a happy dog, enjoys his life, playing, running and ripping up his soft toys.

I live in New Zealand and we see the vets at our national veterinary university and they do have maybe the best in our country. Unfortunately, they are 2 1/2 hrs drive away and Flynn does not particularly like to travel!

I had a message on my phone tonight when I got home from work, his vet said with the benefit of hindsight they can now see on the previous CT back in Nov 2011 that there was a little enlargement on right adrenal. His liver blood tests which have never normalised following his liver resection last November is still very similar from his last test in July. His ALP especially is high. She did not give me the numbers in the message and she never mentioned the histology on the biopsy from his lymph node and the liver nodule.

She wants to repeat his LDDS which was normal back in January.

His surgeon has been away this week so she is going to discuss with him next week the need for further CT, and whether proceeding to surgery is the right option.

He still has none of the more common Cushings symptoms such as drinking and peeing too much, his fur is beautiful! He is hungry but not to the stage of rummaging in the bin and will often leave his biscuits in the morning choosing the chicken part of the meal, he eats the biscuits later on :p

I think the symptoms he has developed starting about 18 mths ago, mainly trembling, panting, occasional lethargy could have been from the adrenal mass. She said it arises from the medulla which is why she is thinking pheochromocytoma.

The liver problem came to a head last November when he suddenly collapsed, he was immediately seen by our local vet and was quite shocked, they did ultrasound and found the liver tumour which was then resected the week later. The surgeon was 95% he got it all plus it was a low grade tumour so all good there. It was big though, 650g which is a huge for a litte foxie. But now I am remembering when the surgeon rang me straight after surgery he mentioned they had trouble stabilising his blood pressure it was going way high then low. Now of course in my reading up on phae they have to be so very careful with anaesthetics to limit release of the catecholamines which can cause BP problems. So now in retrospect I am thinking it was probably his adrenal tumour causing the problems all along, when he collapsed, he had not had a bleed as they suspected from the liver and the vet told me at the time he was not sure of reason for collapse. So MAYBE the liver tumour just happened to be picked up and then all attention turned to that. Postop he was so stressed, shaky and whimpered pretty much for the two days he spent there despite having good pain relief. They were so concerned postop that they re scanned him to check he was not bleeding. I sat with him both days in a separate room trying to calm him down but the only time he was happy was when I took him out for a wee. I am thinking now it is only by the grace of god he did not have a stroke or worse!! Tough wee boy, I love him so :D

In the past year, they have tried to find the cause of his abnormal blood tests and continued trembling, panting, hunger etc and were focussed on Cushings, his ultrasound scans have shown adrenals on large side of normal but no lumps. But nothing positive has shown up and they have taken the watch and wait till something declares itself. Well now it has :(

His BP is high, 200 systolic, protein in his urine changes in his eyes... I am upset this has been going on so long that he is developing hypertensive complications. But he is on tablets now, an ace inhibitor which is not the drug I see mentioned in the literature. Plus I am upset this tumour has likely been present for 18 mths and spread goes knows where ie lymph nodes. :confused:

So as you most likely can tell from this novel, my mind is all over the place and I will be much better next week when we hopefully have a plan in place. I hope surgery is an option for Flynny he was so tough getting over his major surgery last year I just think he deserves a chance to get back to his normal happy self and enjoy his remaining time with us.

Thanks for your support, it is great to be able to tell people that know what I am talking about instead of those that possibly think I am a little crazy fighting so hard for a dog haha I will keep you updated
Trish xx

Sorry Skye I meant to answer your questions before I went off on my ramble!! I am so pleased your furbaby got through it ok, it gives me hope :D

He has not had a chest xray, she said his heart sounded ok but that was just stethoscope testing. He is panting more with stress, but rests quite comfortably. No puffiness I can see anywhere to indicate any heart problems?!?

He has had long standing back pain, he was a typical foxie and would leap in the air time and time again like a pogo stick! He had xrays about 4 years ago that showed arthritis in both hips. Then maybe 3 yrs ago was acutely sore one night, in his back, half way down about T12 if that helps. An xray showed a disc was slightly protruding, he got over that with anti inflammatories but I have been able to tell over the years when it is a little sore. He is tender in this area now, the vets palpating were able to pinpoint the sore spot. He can run around outside like a pup, but goes up the step into the house real gingerly.

I took him to our local vet 2 weekends ago as he started vomiting, they thought due to something bad he ate. He had loose bowels as well, not real runny diarrhea though. He only vomited a few times on one day, but his bowel took a week to get back to normal.

Food: Here is where I feel like a bad dog Mummy! Before his liver surgery he was putting on weight, quite a lot... we started him on diet r/d dog biscuits - Hills brand and he did lose some weight, this was when he started with the increased hunger. Little did we know that he was not getting fat because of being a hungry porker but he had that massive liver tumour!! Ohhh the guilt... mine not his :confused: AFter his surgery when I guess we were spoiling him as he did looks so much skinnier with that mass gone, he overate and put on a kilo in a couple of months. So he has been on the R/D biscuits, but he has never really liked them so I recently took pity on him and changed him to a chicken mince frozen food that we get in our local pet food store, this is what the vet thought cause his recent stomach upset. So now I have changed his biscuits to a different version of hills science diet light plus I mix it with chicken which is his favourite. If you have any thoughts on his diet and how I can improve it I would appreciate it.

His current meds are half a Previcox to help with his aches, a supplement for bone health and benazopril hydrochloride his new BP med that he has been on for only two days.

Thanks again

Also thanks to Sharlene and Kim for your replies, so nice to have your support and experience in dealing with these things! I love that pic too Sharlene, we were walking that day on a march to support prostate cancer fundraising hence his "blue" colouring :D I will sure be glad for the day when he can make sense of his mish mash results too! This waiting does your head in :eek: Oh to have a plan so we can start to move forward!

One final question from me tonight, I was just outside with him playing... he loves tennis balls and playing fetch... then likes to peel all the green fluff off the ball. He gets so excited playing that game... is it safe??? I don't want to get him overexcited and put his BP up, how much exercise to you think is good for him at this stage. He came inside after our rather shortened game quite disgusted with me and he lay straight back down on his side only a little puffed. This is a dog that never knew walking existed, he never went slower than a quick trot... now he walks. If I take him for an off leash outing, he still runs like the wind... just for not as long.
xx

Exercise will do him good as his muscles will start wasting. It really depends on how active his tumor is. My Annie's pheo tumor at first was only active once a month but it gradually became more active. In later stages there were times when I feared she was in cardiac arrest but the episodes only lasted a few minutes. IT is my understanding that when pheos are active the blood rushes to the brain and it leaves them exhausted. (I read this on a human pheo forum) This did match what I saw with my girl.

She too had off and on cush symptoms but Pheo's are not cushing's so I wouldn't spend money on an ldds test. You might see some cushing's symptoms - more like atypical cushings (hair loss/skin issues) over time.

The risk of surgery is exactly what you mentioned - if the bp goes high during the operation. My girls' story is very long and it took us a good year to conclude it was a pheo (she had alot of false positive cushing tests) ... By the time we figured it out surgery wasn't an option. You can read her story if you'd like. You can also view the photos. I set Annie free late February of this year. It wasn't her heart that did her in - it was weight loss that resulted in muscle wasting. When the pheo is active the body loses weight. She became skeletal but just like you described she was always very happy and alert. In the end she lost the strength in her legs. It was the saddest day of my life. I know she had this thing before I noticed the symptoms but she lived 2 yrs after I did notice them. And they were good years.

Pls do keep an eye on Flynn's eyes. Annie ended up with ulcerated cornea - I'm sure from the pressure from the tumor.

I know that drive to the specialist is a long one but so worth it! I had to drive 5 hrs each way. I wish I would have gone that path sooner than I did - I would have saved so much time, money and stress.

Sending love your way. Kim

Hi Kim
Thanks for the info on exercise, I will keep him playing but maybe just a little more gently than normal and on leash walks only. He will be disappointed.

I have noticed today he is not trembling as much, it is nice to see him resting without the shakes. He is lethargic though, I am hoping it is his body getting used to the BP meds. He needs to go and have his blood pressure checked early next week. Before that I need to talk to vet about why she wants repeat LDDS, I agree with you, seems little point?!?

You mentioned your dog had intermittent symptoms, I think Flynn is the same but not so pronounced... I had thought recently he was better but the trembling certainly never went fully away.

You mentioned to keep a check on his eyes as your pup had corneal ulcers. They looked in his eyes the other day, noted change likely due to his hypertension so I will keep that very much in mind thanks. A couple of months back he broke a tooth and the vet gave him an anaesthetic to remove it, she noted he had two areas of ulceration at the back of his mouth sort of at the bottoms of his gums under his tongue, she cut them out. I am wondering if this is somehow related. I am cringing now at him having that anaesthetic with the risks... he was very stressed that night, whimpering most of the night. Poor baby.

I am going to read Annie's story now. I hope we are not to late to operate but if my feelings are correct and he has had it for 18 mths it may be too late :(
xx

The reason the shaking is intermittent is because the tumor isn't always active - meaning emitting adrenaline. After the episodes dogs (and humans) are exhausted - just like we are after adrenaline rushes from exercising. Another symptom is nausea. My girl rejected all kinds of food and it was different every day. So if your guy is eating well do yourself a favor and try to add some lbs. Trust me, it'll help up the road. Kim

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

Thanks for the dietary advice Glynda. I will cut out the Hills, when I'm at the specialists vets next I am going to try and see a nutritionist as there are so many things I need to take into account with his food, like the cancer, hypertension and liver problems so hopefully with their advice I can work out a healthy food plan for him.

I spoke to the local vet today, he had spoken to the specialist vet and said the scan did not sound as bad as we had interpreted it as! Also the surgeon who did his liver resection last year had been consulted and shown the ultrasound and in his opinion it is resectable. Yay good news! They wanted the LDDS as both his adrenals are enlarged and they would have expected only one side if it was just an adrenal based problem, so they have done it to rule out the very unlikely case of him also have a pituary based problem. He said so far Flynny has been a very unusual case. He has had the LDDS done today. Specialist vet also said that depending on result of LDDS they would swap his benzapril to phenyoxybenzamine or at least cut the dose. He has been pretty good yesterday and today, but first thing this morning when he got up he looked very green and I thought he was going to vomit, but he came right in a few minutes so I think when he got up his BP dropped. They were going to check it today but I do not know result, as my parents picked him up as I was at work.

So plan now is to get result of LDDS tomorrow, then book for CT and further consultation at specialist vet eg they need to rule out spread to lungs etc before planning for surgery. Fingers crossed that is clear.

Trish and Flynn
xx

Hoping for good results from the LDDS. Flynn certainly doesn't need anything more on top of what he already has going on!! Flynn manages to give us all the 'wide eyed blinking' look. LOLOL

Sharlene and Molly Muffin

Hi all

Good news from me! He suppressed nicely on his LDDS test, the numbers I scribbled down when the vet rang me are:
Pre 184
I think 4 hrs post - 9
8hrs post - 5
So they doubt pituitary involvement. I hope I got those results right.

He is starting phenoxybenzamine today, they want him on it for 2 - 3 weeks to stablise his BP then he goes back to specialist vet for CT. Hopefully nothing nasty shows up on that and they will do surgery a day or two after that.

GO FLYNNY!!
Trish xx

Quick question! Flynn's phenoxybenzamine comes in a 10mg capsule. His dose is a third of each capsule twice a day. I work in a hospital so rang our pharmacist and he said there are pharmacies that will split it up for you but it costs a fortune, he suggested I mix the powder from the capsule into some chicken meat until it turns into a paste. Then split it into thirds. I have just done this and gave him his first drugged chicken dose and he gobbled it down quite happily :D:D I was a little nervous I might get a clumped bit and he would get more in one dose and less in another.

The local vet just said to tip out the powder onto paper and split it into thirds with a razor blade and tip it into his food? Imagine if someone saw me doing that... they would think I was doing cocaine :eek::eek: I was also worried about spillage and losing some of each dose.

I thought I would ask all your knowledgeable people if there is a better way to do it?

Thanks :)

Hi Trish,

Making a paste is how I've always divided capsules that needed to be given in portions. If I can get meds into food, I know it will all be taken without a battle. ;) And you can mix up the paste from time to time - use chicken, fish, liver, green tripe, even some veggies like sweet potatoes - which all my dearly love. Mine think they are getting a treat this way. :D

Hugs,
Leslie and the gang

Quote:

---

Originally Posted by Trish

Quick question! Flynn's phenoxybenzamine comes in a 10mg capsule. His dose is a third of each capsule twice a day. I work in a hospital so rang our pharmacist and he said there are pharmacies that will split it up for you but it costs a fortune, he suggested I mix the powder from the capsule into some chicken meat until it turns into a paste. Then split it into thirds. I have just done this and gave him his first drugged chicken dose and he gobbled it down quite happily :D:D I was a little nervous I might get a clumped bit and he would get more in one dose and less in another.

The local vet just said to tip out the powder onto paper and split it into thirds with a razor blade and tip it into his food? Imagine if someone saw me doing that... they would think I was doing cocaine :eek::eek: I was also worried about spillage and losing some of each dose.

I thought I would ask all your knowledgeable people if there is a better way to do it?

Thanks :)

---

If both the hospital pharmacist and your vet told you that it's OK to open the capsules and split the powder, then it sounds as if this particular drug may not be one that is affected adversely by altering the form in which it's given. But generally, I just want to warn folks that altering the form of a capsule in this way may also alter its effectiveness and safety (for both the animal and also the human who is exposing him/herself to the contents). So I wouldn't personally tamper with a drug unless a pharmacist gave me the go-ahead. For instance, the absorption of some drugs ought not to begin until they've safely made it into the stomach. Mixing the contents with a moist paste beforehand may totally alter the effective action of the drug. For capsules containing time-released drugs, altering the contents can also totally alter the effectiveness. And in the case of the trilostane capsules that many of our dogs take, the manufacturer of brandname Vetoryl publishes a specific warning against opening capsules and dividing contents.

What the hospital pharmicist is talking about is a "compounding pharmacy" -- a drugstore where the pharmacist is able to repackage or manipulate existing medications into a form or a dose that is workable for an individual patient. If affordable, I would think this would definitely be a preferable alternative. It will indeed cost money, but perhaps not as much as you think. So if were me, I'd Google "compounding pharmacies" in your area and give them a call to see what they may be able to do for you. A number of our members here use Diamondback Drugs, an internet compounding pharmacy located in AZ that ships drugs throughout the country. You could always give them a call to see what their recommendation would be regarding phenoxybenzamine.

Marianne

Very glad to hear that the LDDS had good results and they don't think it's pituitary.
Any good news is a happy day.

hugs,
Sharlene

HI all - thanks for the tips on the capsules. Very good point to check it out with pharmacist first Marianne. All appears to be going well for my boy, he is very perky tonight so I am happy :) Thanks again for the pointers and support, just what we needed... I feel much calmer now and I'm catching up on some sleep :)
Trish and Flynn xx

Hope you're getting lots of sleep and rest! Both of you.

Sharlene and Molly Muffin

HI Sharlene
You are such a sweetie thinking of us all :D:D Flynn is doing pretty good, one worry is he seems to have one kinda formed but soft with a bit of mucous poop (TMI?!?) each night, normal and formed in the morning. His breath stinks. Energy goes up and down a bit, but still think he is getting used to his phenoxybenzamine. He has been on it 3 1/2 days now. But otherwise he is good, we are both sleeping.. him more than me :p

Hope all good with you too!
Trish