Tipper - adrenal tumor/breathing issues

[molly muffin]

Hi Patti,
I can only repeat what the others have said and that is that no one knows Tipper better than you. How much she can go through, etc.
I think that there are many unknowns. It is unknown if it is functional or not, it is unknown how long she will live with no surgery and it is unknown if she would survive the surgery and post op.
I don't think there are Any answers to those questions that are definite, so you have to make the decision of what to do or not do, based on what you already know of Tipper.
Whatever you decide, we are here for you, every step of the way.
Super big hugs
Sharlene and Molly Muffin

[scoora]

Patti,
Sorry I have no advise or any help for you but sending lots of prayers and hugs for you and Tipper.

[frijole]

Patti, If I recall it was Trish who mentioned the testing for pheo. I would spend time reading her thread as well as Kaibo's. Kaibo was thought to have cushings at first and then it turns out it was diabetes and a pheo - so you can go to the later pages of the thread to where the pheo and operation are discussed. Kim

[Renee & the Furkids]

Patti... I've read through some of the posts on here, I am so sorry and so sad for what you are going through. I really have no advice, as I am very new to all this Cushings stuff, my dog Bentley was recently diagnosed with Cushings (due to the calcinosis cutis, and he has all the other symptoms, the pot belly and breathing issues are scaring me so badly). I just wanted to say I hope things get better for you and your sweet Tipper. I too lost all of my family, and only have my beloved pets left and they are my life, I know how it is.

Renee

[Squirt's Mom]

I wouldn't dismiss the surgery until I talked with the surgeon who would do the operation. Your GP vet nor the IMS are the experts in this arena - the surgeon is and the surgeon can give you the best information to use in making this decision. Where the GP or IMS may see high risk, the surgeon may say it's nothing compared to what he usually deals with and he would certainly do the surgery if it were his dog. I'm saying, don't rely on anyone but the surgeon in making this decision because he is the only one who can really tell you. The surgeon may be more qualified to tell what kind of tumor this is apt to be.

In some reading yesterday on imaging used in PDH, I found nothing that mentioned finding a micro - they all referred to seeing a macro. Now whether that is because no scan was done prior to the tumor starting to grow or whether a micro simply cannot be seen on an MRI, I haven't determined. As previously stated, it IS possible for a pup to have both PHD and ADH - even PDH with "duel" ADH (tumors on both adrenal glands) BUT these are very rare cases. Maybe someone here knows if a micro can be seen with MRI imaging? I would think a cat scan would be more apt to pick something that small up.

If you have definitely taken the surgery off the table, then forget about it and focus on medical intervention. I don't want you to say today that surgery is out then on down the road be beating yourself up when she starts to have more problems from the tumor as it grows for not pursuing it more closely now. There will come a time when it truly is much too late to contemplate surgery.

If you decide to take the meds route, I think I would work with the IMS from now on if they will take Tipper on a regular basis. This has gotten too complicated for a GP vet.

So, that's what I would do - talk in depth with the surgeon who would perform the surgery before taking that off the table. If he says it is too risky for Tipper, then that is no longer an option and you have no other choices but to treat with drugs. Please do check out the questions I posted - they are excellent and can help guide your decision.

I know whatever you decide, that decision will be made out of the deep love you have for Tipper and your desire to do the best you can for her. Honey, that is ALL any of us can do - the best we can with what we have to work with. When that decision is made, put it to bed (as a boss of mine would say about projects in the works) and enjoy every minute you can with that sweet girl. This very minute is all any of us have - we are not promised the next breath, much less another year or three. So it is imperative that we take time to cherish every good thing that comes our way, even if that is simply a night when our baby sleeps well.

Hugs,
Leslie and the gang

[goldengirl88]

Hi Everyone:
I feel some how defeated by all this, but never mistake it for weakness as from a toddler I have learned tenacity, will over take adversity. I have always been like that and will probably never change. It has more than likely gotten me thru the many tragedies I have faced in life. I will never quit because Tipper means too much to me. I said I would continue to my last breath and I meant it. I am still going to see the surgeon, and get her opinion on all of this. I am not completely ruling it out until I talk to her.. If it is not a good option, I am going to look into the tests that can help determine a pheo. If I can find some and it does point to this, I am going to talk to the IMS about maybe a low dose of blood pressure meds at nite to make sure that if this pheo becomes active that I can attempt to keep he bp down at nite at least. I just had her blood pressure checked this morning and it was 135. So if the bleeding in the retinas is caused by high bp it has to be happening at night. Addy I do have a report from the eye Dr. It says the calcium deposits have stayed the same, with a few retinal hemorrhages. Tear levels were 20 for the right and 19 for the left. Says new finding of retinal hemorrhages, could be due to hypertension, clotting disorder, metabolic disease,cushings, hypothyroidism, cancer, age related vessel fragility. I remember she had 1 day a few weeks ago with a bp of 190 and that could have done it too. I am going to track down these tests for the pheo and get on them. Also I am making an appt. at the hospital with the IMS to do a follow up Ultra Sound to see if the tumor is growing. Tipper will have to have an ACTH again in a month because of the dosage change. I gave her the 10 mg yesterday morning and then before she could get hungry I gave her the other 10 mg of Vetoryl at 6:00 pm. They said I could give the second dose early to prevent the hunger. So we are back with it this morning. It is too humid for Tipper to walk with all she has going on so I will paly with her inside, it is safer today. I am wondering if all the movement at nite that Tipper does could be coming from this tumor, even though I have heard others mention their dogs doing it, I am suspicious of it now. Her side will ripple, her legs and tail twitch usually after laying down and falling asleep it starts. I have never seen her do this before this illness so it is not the type of sleep mode like rem that she is in, or I would have seen it years ago. I am praying constantly for help and direction, and for God to have mercy on my baby. In the mean time I am going to check out some testing and ask the surgeon about it. I am going to use the questions that Leslie posted from Trish when I go, so she better be ready to spend at least an hour with me. If she starts to rush me that will set off alarm bells in my head. Any help on this from any one will be appreciated. Blessings
Patti

[labblab]

In some reading yesterday on imaging used in PDH, I found nothing that mentioned finding a micro - they all referred to seeing a macro. Now whether that is because no scan was done prior to the tumor starting to grow or whether a micro simply cannot be seen on an MRI, I haven't determined. As previously stated, it IS possible for a pup to have both PHD and ADH - even PDH with "duel" ADH (tumors on both adrenal glands) BUT these are very rare cases. Maybe someone here knows if a micro can be seen with MRI imaging? I would think a cat scan would be more apt to pick something that small up.

Hi Patti, I surely understand why these are such difficult decisions for you. If only we had that crystal ball...

As you continue to gather information, though, here's a quote that seems to imply that pituitary microtumors may indeed be present but too small to show up on imaging. The quote is taken from a 2007 article, so it is not the most recent. But it still may remain accurate. At that time, the author (Dr. Ellen Behrend) was throwing out the possibility that all dogs diagnosed with PDH might benefit from imaging of the head in order to determine tumor status from the outset. Due to the expense (and maybe also for other reasons) that idea has not gained much traction. But per this quote, it appears that tiny pituitary tumors are often not visible.

Based on this information, recognizing that the number of dogs studied is small, the recommendations are: All dogs with PDH should have a CT or MRI at the time of diagnosis. If no mass is visible, medical treatment should be implemented and no follow-up is needed. If a mass 3-7 mm in greatest vertical height is seen, medical therapy should be implemented with a repeat scan in 12-18 months. If a mass > 8 mm in greatest vertical height is seen, radiation therapy should be done and medical therapy used only if clinical HAC fails to resolve within 3-6 months of finishing radiation. These recommendations are based on clinical experience and theoretical considerations53 and no studies have been performed to date to assess their validity.

For what it's worth, I've gotten the impression that an MRI is actually the more precise imaging tool for pituitary tumors. When we suspected that our own Cushpup had an enlarging tumor, our specialist told us he could perform a CT at is office which could reveal the tumor, but that if we were considering radiation therapy, the vet school we were considering would likely want to perform an MRI of their own in advance of actual treatment. So even though he didn't explicitly state that an MRI is more precise, that's the impression I was left with.

Also, hopefully Kim will stop back by to talk about the urine testing for pheos because I think it was her (or perhaps Trish) who mentioned it in the past.

Marianne

[goldengirl88]

Marianne:
Thank you for your help. I am going to talk this over with the IMS, and see what we can come up with. My head is spinning, but I will never quit helping my girl. All the phone calls, research, posting and emailing Dr.'s is taking a lot of my time, so I have let other things go onto the back burner. Tipper is the single most important thing in my life, I must keep trying to get some resolution to this. Blessings
Patti

[addy]

Addy I do have a report from the eye Dr. It says the calcium deposits have stayed the same, with a few retinal hemorrhages. Tear levels were 20 for the right and 19 for the left. Says new finding of retinal hemorrhages, could be due to hypertension, clotting disorder, metabolic disease,cushings, hypothyroidism, cancer, age related vessel fragility

Tear production is good then and the hemorrhages may resolve on their own, Zoe's did. Our eye vet was not overly concerned about Zoe's, he said he often sees them in older dogs. He has shown more concern about her other many eye issues which surprised me as we use Fluribiprofen which can cause bleeding in the eye. Tipper's calcium deposits will most likely not get better but the good news is they are not getting worse.

The written report is not bad but of course I have been to hell and back with Zoe's eyes so maybe that is why I think that.

[Trixie]

Hi Patti,
Such an overwhelming amount of things to think about. Your head may be spinning-whose wouldn't?- but you are amazing in your capacity to plow forward and gather as much info as you can and you're doing a great job! Your tenacity is like Tippers!
How is Tipper doing today? That new blood pressure number is really good, isn't it?
Does the morning 10mg dose seem to keep her symptom free most of the day? Is her night time breathing still better? I hope she's doing well today!! Jack Russells are tough little cookies...sounds like Tipper is living up to her breed!

Barbara