Lola's tentative pheo diagnosis

[Erika L.]

Hi,

I'm thrilled to have found this group as it seems like such an informed, helpful and loving group of people.

Lola is a 6 year old bulldog and the light of my life. She is perfectly healthy, happy and energetic (no symptoms of anything). On Christmas Eve I received a shocking call from my vet telling me Lola had a large tumor on her adrenal gland. Since then we have done several tests and talked to several docs (internists, surgeons, etc)
and here are the "facts" about what we know/don't know.

- We can't do the full biopsy needed because of the dangers associated with surgery.
- It "looks" like a pheo on the ultrasound.
- An experimental blood test (they have a pretty good track record) done at UC Davis suggests it is NOT a pheo.
- A low dex test has shown that it is not Cushings or a cortisol producing tumor.
-- Despite the good news from Davis, Lola's vets aren't convinced it is not a pheo...they suspect it is but admit that they really just cannot know for sure.

The surgeon has told me (and it has been confirmed by another surgeon) that Lola's best bet for survival (and to really understand what this darn thing is) would be to have this thing out BUT her chances of surviving the surgery are a little bit better than 50/50. And realistically *if* she survives the surgery, *and* the cancer doesn't return, etc. I can expect it to extend her life roughly 1 to 1.5 years.


Given that Lola is perfectly healthy, happy and energetic in every way. I just cannot bear the idea of taking her in and having her die on the table. The surgery seems to be a HUGE gamble with what is currently a "perfectly healthy" life.... for a relatively small payoff. Compounding the decision is that they really don't know WHAT this is and have said that there's an outside chance it could be a benign mass.

For a month now I have been beside myself with worry, grief, and confusion. I don't know what sort of advice, if any, I'm actually looking for, I just know that the people I have seen here will understand what I'm going through and hopefully will be able to provide hope, strength, information, experience and mostly support during what I anticipate to be a very rocky road that lies ahead.

I'm sorry this is so long, I'm just trying to balance so much information and it all seems excruciatingly relevant .... and yet so iffy and vague.

Erika

[molly muffin]

Hi Erika and welcome to you and Lola.

University of Davis has a pretty good track record with cushing and adrenal tumors, diagnosis, etc. We actually have another member who is going there currently for her dog, that is being treated with radiation for a pituitary tumor (large). Has Davis given any kind of recommendation on what they think it is?

Another of our members dog also currently has a mass on adrenal gland and they are monitoring with ultrasound and Blood Pressure readings and will make a determination on what to do based on what the tumor dose. Her thread is here if you want to read it: http://www.k9cushings.com/forum/showthread.php?t=5904

Speaking of Blood Pressure, often with a pheo you will have fluctuations with blood pressure where it periodically will go up, when the tumor is having an active moment. They aren't active all the time. Kim one of our administrators has experience with pheo's, as does Trish one of our members whose dog Flynn has been through the surgery for removal.

I'm so glad you found us as the worry can be quite overwhelming and a diagnosis of a tumor, very traumatic. We're a great support group here and you aren't alone on this journey.

Sharlene and Molly Muffin

[goldengirl88]

Welcome to you and Lola. I am so sorry you are going thru the ordeal of finding out if your Lola has a Pheo or not. My Tipper has an adrenal tumor that we check every 2-3 months to see if it has grown. Thank God so far it hasn't. Maybe you could do the same by getting your baby checked with a high resolution Ultra sound every so often. I am still not 100% convinced that my Tipper does not have one, but it is encouraging that is has not grown. It could simply be an adenoma. None of this is easy, and none of it is cut and dry. There are always so many twists and turns you kind of have to roll with the punches. It is a shame things aren't more black and white. I hope for both of your sakes it is not a pheo. If it turns out to be one you will have to decide what to do then. I do not want my dog to have to undergo the operation either as I feel she has too many other issues that would make for a bad outcome. I am just in limbo and every time I take her to get the tumor checked I have a knot in my stomach as to what they will come out and tell me. Kim on here is a wonderful resource as her dog had a pheo. So she is really in the know about all things concerning them. I hope things work out for you and Lola. Blessings
Patti

[Renee]

I am wondering what even led to the diagnosis of the tumor.. if your girl is happy, healthy, and no issues? Why was she taken to the vet in the first place? Why was an ultrasound done? What prompted this in the first place?

[Trish]

Hi Erika

Welcome to you and Lola we will try and help you as much as we can negotiate your way through this.

You asked for some hope, I can give you this My dog Flynn had an adrenalectomy for a pheo 14 months ago. He has no sign of it coming back confirmed by his surgeon that removed a liver mass late November which was not related to the pheo. He said his insides were clean with no sign of recurrence so that was a big relief! I am going to go through your post and add a few questions and comments.

Hi,

I'm thrilled to have found this group as it seems like such an informed, helpful and loving group of people.

Lola is a 6 year old bulldog and the light of my life. She is perfectly healthy, happy and energetic (no symptoms of anything). On Christmas Eve I received a shocking call from my vet telling me Lola had a large tumor on her adrenal gland. Since then we have done several tests and talked to several docs (internists, surgeons, etc)
Why did she have the ultrasound done if she was so well, was there something going on and that you suspected a problem and did the scan? How big is the tumour? What side is the tumour - left is easier to operate on but never fear Flynn's was on the right and his was ok. Any sign of local invasion?
and here are the "facts" about what we know/don't know.

- We can't do the full biopsy needed because of the dangers associated with surgery.
Yes indeed, unfortunately the adrenal gland where it is located makes biopsy a tricky procedure.
- It "looks" like a pheo on the ultrasound.
Often they get a pretty good idea of the likelihood of the tumour type, a pheo is usually seen arising from the medulla of the gland.
- An experimental blood test (they have a pretty good track record) done at UC Davis suggests it is NOT a pheo.
I would be real interested to hear the specifics of that test, there are urine tests that have been done on dogs, but studies do not have many participants to it is difficult to just rely on them. We have had quite a big discussion on testing for pheos on Snug's thread which is the one Sharlene has copied above. UC Davis is a well respected institution so it would be great to hear what they are doing. Was Lola seen by them or was the blood test just sent there?
- A low dex test has shown that it is not Cushings or a cortisol producing tumor.
Same as Flynn, he had two of these and suppressed on both. But Kim, another member here had false positives on her pheo dog Annie who ended up with the pheo diagnosis.
-- Despite the good news from Davis, Lola's vets aren't convinced it is not a pheo...they suspect it is but admit that they really just cannot know for sure.
That is the difficulty with diagnosing these tumours, often they can only tell for sure is by taking it out and looking at it under a microscope.

The surgeon has told me (and it has been confirmed by another surgeon) that Lola's best bet for survival (and to really understand what this darn thing is) would be to have this thing out BUT her chances of surviving the surgery are a little bit better than 50/50. And realistically *if* she survives the surgery, *and* the cancer doesn't return, etc. I can expect it to extend her life roughly 1 to 1.5 years.
Are these board certified surgeons? If surgery is proposed you need the big guns that have a lot of experience with adrenalectomy. If you get to that stage I have a list of questions that might help you when you are speaking with them. 50/50 seems kinda high to me, the studies I have seen have success rates 80/20. Flynn's tumour was invading his vena cava and that makes it more tricky. We have had several dogs have this surgery successfully (not always for pheo) but unfortunately we have had a couple not make it and that has been very sad. I would also respectfully disagree with the prognosis of 1 - 1.5yrs after surgery, they can do very well for a number of years following this surgery and Lola is young too which would stand her in good stead. I have info to back this up if you would like it.
http://www.vetsurgerycentral.com/oncology_adrenal_tumors.html
http://www.vsso.org/Adrenal_Pheochromocytoma.html

Given that Lola is perfectly healthy, happy and energetic in every way. I just cannot bear the idea of taking her in and having her die on the table. The surgery seems to be a HUGE gamble with what is currently a "perfectly healthy" life.... for a relatively small payoff. Compounding the decision is that they really don't know WHAT this is and have said that there's an outside chance it could be a benign mass.
That is something you really have to be at peace with before going into any surgery for Lola. I told myself if Flynn died during surgery at least it would be quick and he would die peacefully, but you do have to weigh it all up and considering she is well now, but that would be one of my questions to your team... if we do nothing how soon would be expect to see deterioration in her condition?

For a month now I have been beside myself with worry, grief, and confusion. I don't know what sort of advice, if any, I'm actually looking for, I just know that the people I have seen here will understand what I'm going through and hopefully will be able to provide hope, strength, information, experience and mostly support during what I anticipate to be a very rocky road that lies ahead.
Well it is lucky you have found us then!! What is the plan for Lola at this stage?

I'm sorry this is so long, I'm just trying to balance so much information and it all seems excruciatingly relevant .... and yet so iffy and vague.
Don't worry about how long it is, some of us are more long-winded than others they are all acceptable though especially when you are trying to get info on your sweetie Lola!


Erika

Hope this helps in some way, please come back and ask any questions and we will do our best to help you and Lola
Trish

[frijole]

Hello! My Annie had a pheo tumor as well. I am interested in knowing location and size... We have seen before where huge wasn't really huge.

My story is different than Trishs because 4 yrs ago very little was known about pheos. It took me over a year and firing 4 vets before we figured it out. My girl by then wasn't a good candidate for surgery. However she lived with the tumor for two years and her quality of life was good. What did her in wasn't heart failure as I predicted, it was loss of muscles in the legs. She lost so much weight and fought Hard, she justs lost the use of her legs over time.

Feel free to click on our profiles to read our long stories. Glad you are at Davis ! Kim

[Erika L.]

Gosh, it was great to come home to all these responses. I will try to answer your questions. I'm not exactly sure how to respond to each person directly but I'll address some of the things you have asked.

- I originally took her in because of some small lumps on her nipples. Since Lola was a puppy she has had a very full vulva and enlarged nipples. She always looks as if she is heat or has recently had puppies. It's all just part of being Lola. However she developed small lumps on several of her nipples that make her skin look like the surface of a raspberry. The biopsied them and they are benign BUT they wanted to see what was going on internally (was some bit of tissues missed when she was spayed? or was there an issue with her kidneys?). This is when they found the tumor.

-The tumor showed on the ultrasound. It is about 1 3/4". They did a fine needle aspiration but didn't get many cells and they were fearful of being more aggressive because of the vascularity of the area.

- Chest Xrays, blood work, etc. are all very normal. They do not believe that the cancer has moved to the VC or surrounding organs but they cannot be sure without actually doing surgery.

-The test at Davis is brand new research done over the last few years and the study was published in 2013. Apparently it has been adapted in tests used in humans. It has successfully been done on horses for several years, and some of the folks in the endocrinology dept. have been adapting it for dogs. The research is very new but promising. When I talk to Lola's vet I'll try to get more specific information about it...but it theoretically has the capacity to rule out pheos...and according to the test Lola's was NOT a pheo...but the surgeon (board certified) and other specialists are not fully convinced.

-Lola is currently on a "wait and watch" which includes me monitoring her behavior and then going in every couple of months for additional ultra sounds to see what, if anything, the tumor is doing.

-The summary I have received from all the docs involved is that they strongly suspect it is a pheo but they can't really say ANYTHING for certain.

I'm trying to be strong and focus on the dog I have before me and not project into the future and worry about the myriad of possibilities and outcomes...but it is hard. Some days I'm pretty good with it, some days I just lose it.

[Erika L.]

Oh, and the tumor is on the right adrenal

[Erika L.]

One question for those who have lived with pheos. The doc has me on the lookout for symptomatic behavior (ravenously hungry or thirsty, lethargic, etc.). Since Lola is an English Bulldog she is always extremely hungry or thirsty and has a tendency to fluctuate between lethargic and ridiculously hyper (which causes her to pant a lot). When I mentioned this to the vet she told me, "You are looking for behaviors that are uncharacteristic for her. You'll know them when you see them."

Do those of you who have dealt with this condition agree with her assessment. As it is anytime she begs for food as if she's starving to death (completely normal for her), is taking a nap, or begins to pant after playing, I get a sick feeling in my stomach and wonder if this is actually something I should be "noticing".

[Renee]

I have pugs, and much like english bulldogs, they are ALWAYS hungry. And can be very lethargic all day and night. Even so, I could tell, and I think you will be able to tell too. Just watch the subtle differences. My girl never, ever bit me to get food... when her cushings was very bad untreated, she was so hungry, she would bite me taking a treat. And she started getting in the trash (or trying to), which she never did before.