Blood clot in my Boston Terrier

[Mollyann]

My 14 yr old neutered male Boston, Buster, has had his Cushings well controlled by Trilostane for the last two years. Or so I thought. Recently, he began having what I thought was the start of arthritis symptoms that became quickly worse. He wouldn't put weight on his rear right leg. Today, an ultrasound revealed that he has a large blood clot in the artery leading to his leg. He also has a large mass in his liver that may or may not be malignant. The most immediate situation is the blood clot that has almost cut off all blood to the leg. He is not in any evident pain thankfully at this point although he will be if the clot cuts off all blood to the leg. Has anyone had this happen? Vet specialist says there is nothing that can be done about this clot. He is on a tiny bit of aspirin as of today to hopefully prevent any others from forming. I am distraught and would appreciate any input. Thanks.

[littleone1]

Hi Mollyann, and welcome to you and Buster.

You have found a wonderful group of very caring, supportive, and knowledgeable people.

I'm so sorry for the issues that Buster is having. I'm sorry that I can't offer you any advice about Buster's blood clot, as I don't have any experience with blood clots.

I also have a Boston Terrier who is being treated with Trilostane. He's only been on the Trilo for a little over three months.

You might want to get a second opinion to see it there is a vet or a specialist that knows more about clots and what can be done about them.

I'm sending positive thoughts and prayers that someone will be able to help Buster.

Terri

[Mollyann]

Thank you for your kind response. It helps so much just to hear from people who care even if they don't have answers, so thank you. I will keep you all posted as I learn more.

[Franklin'sMum]

Hi Mollyann and Buster,

Welcome to you both, and I'm very sorry about Buster's blood clot and liver mass. I agree with Terri, a second opinion would be beneficial to find out what can be done to help Buster.
Mind if we ask some questions? What tests were done to diagnoes Buster's Cushing's? What were the results (nmol/L ug/dl) ?What dose of trilo is Buster receiving? Is he on any other meds/ herbs or supplements? If so, what is he taking, and what dosages, please.
The more experienced members can provide you with more accurate feedback if they have more info to go on :).
The folks here are amazing, Mollyann. Kind, supportive and SO very knowledgable about Cushing's and a number of other disorders that can afflict our precious pooches.
Again, so sorry for your circumstances,

Jane and the gang xxx
________
Mexico City Hotel (http://mexicocityhotel.info)

[MiniSchnauzerMom]

Hi Mollyann,

Welcome to you and Buster from me also. I am so sorry to read about Buster's problems with the blood clot in the artery to his leg and the large mass in his liver. Although my Munchie has several issues that I am experienced with they are not the same as Buster's.

I do agree with both Jane and Terri about getting a second opinion for Buster from another specialist if you are able to do so. I can certainly relate to how distraught you are and please know that you're not alone. I may not be the person who can give you the input you are looking for, but I do offer my support.

Give Buster a big hug from me. Will keep both of you in my thoughts and prayers.

Louise

[Casey's Mom]

Hi Mollyann, I too wish to offer my support and I believe that getting a second opinion is a good idea. Sorry that I don't have any knowledge about what you are going through but wanted to let you know that you are not alone,

Love and hugs,

[bgdavis]

Hi Mollyann,

I believe your Buster is in a serious situation. Did the vet check for hemangiosarcoma? Is Buster showing anemia (are his gums pale)? Given the blood clot and mass on the liver, please get a second opinion.

Bonnie and Angel Crissy

[Squirt's Mom]

Hi Mollyann,

Welcome to you and your precious Buster! :)

It always amazes me when folks come here and they already have years of dealing with Cushing's under their belt. Man, I was such a mess when my Squirt was diagnosed it was unreal! :(:eek::mad::eek::(:eek::( If not for these gentle folks, no telling what might have happened to her....or me! :p So, first and foremost, congratulations to you for doing so well on your own for 2 years! :cool:

Secondly, you won't be alone any longer. We may not have immediate access to help you but we will work with you to find info and we will discuss with you what we do know, what we have experienced ourselves and even share our wool-gathering thoughts. On top of all that, you couldn't find a more caring, supportive, loving group of folks and there will always be a shoulder, a hand, and gentle arms here for you and Buster. By introducing yourselves, you became family here and like true family, we stand beside each other through thick and thin.

When anyone tells me "nothing can be done about it" in a situation like Buster's, I get kinda fired up and set about proving them wrong. :p I'm a bit of a rebel. :o So, like others have already said, a second opinion is needed. I'm not sure, however, that I would go to another IMS but rather I would ask for a referral to a specialist in that area - I don't know what they would be called - would it be a cardiologist? phlebotomist? If I know that, it is irretrievable at the moment. :o But I will do a bit of research and let you know what I find.

Where is the clot - upper leg, lower? Do you have a copy of the ultrasound that found the clot and liver mass? If so, would you mind posting what it says in detail? If you didn't get a copy, call and ask for one. You will want to get copies of the actual results of every test he has from now on and keep in a file at home. I would also want copies of the testing that led to this discovery. This has multiple benefits, like if you ever have to see a different doc...or to answer all our questions. ;)

For now, you just take a couple of deep breaths and try to relax a bit. I imagine you have been in quite a state for a few days and understandably so. But ya'll are home now and you have a whole new family to help you both deal with these new developments. I do know how scared you are. A tumor was found on Squirt's spleen in '08 and removed successfully; it turned out to be benign, but I just fell apart when they told me about it. I thought my world was ending. Again, these gentle folks held me up, gave me their strength and hope when I had none, and stood with us through the whole ordeal. We will be here for ya'll, too. So get a cup of coffee or a bottle of wine ;) , jump in a hot bubble bath, and let yourself unwind a bit.

Keep your chin up, sweetie!
Hugs,
Leslie and the girls - always

[SasAndYunah]

Hello Mollyann and Buster,

welcome from us as well.

Knowing something about human thrombo-embolic disease, I have no a clue about it in canines. In humans it's neccesary to treat an emboly with tromboytic therapy within hours to dissolve the clot, for example...

So I did an internet search about thrombo-embolitic disease in canines. There's not much out there but I found one interesting case study and review.

http://dspace.library.cornell.edu:8080/bitstream/1813/2745/1/2003%20Geiger.pdf

This will surely help you to better understand and to decide wich course you can take from here. The thing that stood out to me is at the bottom of page 9:

"As discussed, canine thromboembolic disease is a secondary manifestation of an underlying disease process, and all cases require a treatment plan which addresses both the acute ischemic crisis as well as the underlying disease."

Hope this will help some,

Saskia and Yunah.

[Mollyann]

Long post, I apologize in advance - Hi Terri, Jane and the Gang, Louise, Leslie and the Girls, Casey's Mom, Bonnie and Angel Crissy, and Saskiah and Yunah, and Bless you all for the warm welcome and compassionate words. It helps so much. I'm swinging between despair and "we're gonna fight this and win" and am utterly exhausted. Only people who take their relationship with their furry companions as seriously as we all and people like us do, can understand what this is like. Even though I say I'm preparing myself, that he's 14 and has had a good life, etc., etc. in truth I mean to fight this and in my heart I really do think we will beat this and I can have him for another few years. As I swing emotionally back and forth, I can see how I'm setting myself up. He has been my excellent little intelligent bright companion for so long, I will be utterly and forever devastated when he goes. Saskiah, Thank you for the research, I will read the link as soon as I send this.
To answer your questions so far: Vet said they used to immediately suspect hemangiosarcoma when they see a situation like this, but that the liver mass, which is cavitated, could be benign, that needle biopsies are inconclusive so only way to know is to remove mass which she won't do before finding & fixing underlying problem causing the clotting - which is the immediate issue, as Saskiah pointed out. She says the "underlying issue", could be the Cushings - that dogs can have clotting even in well-controlled Cushings. Have any of you heard that? Blood clot is in the right external iliac artery. They couldn't even get a blood pressure reading on that leg. He isn't in pain now but will be in terrible pain if the clot blocks the blood flow completely, which it is close to doing. She said if that were to happen, and it were her dog, she'd rush to the Vet to have him put down as there would be nothing else that could be done. I don't know what to make of that. I worry that this specialty Vet (Neurology) isn't thinking creatively as I want to do. She says they can't do surgery to remove the clot or give Warfarin or other blood thinner to dissolve it without knowing what's going on with the clotting issue. Blood pressure is 180, his adrenals are enlarged (is that a sign the Cushings isn't being well controlled? or are they always enlarged when there is Cushings, even though it's well-controlled? I forgot to ask.) Buster has Pit. Cushings. I haven't seen the ultrasound and don't have actual numbers of size of clot or size of liver mass - only that they are "large". I will be asking for all that info when Buster is seen by Internal Med. in two days when they will do blood & ACTH tests, thoracic x-rays and a coagulation profile to see what we get. Thinking is, as I understand it, that maybe the Cushings isn't being as well-controlled as we thought and that if so, and we do a better job of controlling it (don't know what that would mean - higher dose of Trilo?) that that could help the clotting issue - assuming the clotting is coming from the Cushings and not something else. I will report all results of tests. Buster's normal vet hasn't done a ACTH test in awhile because Buster has been doing so beautifully (no Cushings symptoms, gorgeous, thick coat) we assumed his Cushings was well under control. He has been on Dechra Trilo from UK until the last six months when I've been getting it compounded from a local pharmacy since it's legal over here now. 20 mg morning and another 20 mg evening. Of course I'm worried that the compounded stuff wasn't as good and am going back to Dechra Trilo immediately.
Sorry for rattling on. Would love any thoughts/feedback.

[Squirt's Mom]

Hi Mollyann,

Here is a link on blood clots in cush pups:

Cushing’s and blood clots
http://archsurg.ama-assn.org/cgi/reprint/136/9/1003.pdf


Hugs,
Leslie and the girls - always

[Harley PoMMom]

Hello Mollyann and Buster,

And a very belated welcome from me and my boy Harley. I am so sorry to hear about Buster and we will try our best to help you out. Cushingnoid pups can develop complications known as thromboembolism (blood clots in the circulatory system), sometimes these clots start in the lungs.

Trilostane is known to enlarge adrenals because of the way it blocks the pathway of cortisol in the pups body. So whether you use the compounded version or not, it will not matter.

Please feel free to ramble on as long as you want, we all do. ;):p:) Ask as many questions as you want also, and we will try to answer them the best we can.

Remember your not alone on this journey, we are here for you and Buster, always.

Hugs,
Lori

[labblab]

Hi Mollyann,

In answer to one of your questions, I just wanted to add that trilostane, itself, tends to increase the size of the adrenal glands. For dogs who have not yet started Cushing's treatment, it is definitely true that bilaterally enlarged adrenal glands are a hallmark of uncontrolled pituitary Cushing's. But I believe it is the case that dogs who are subsequently treated with trilostane can exhibit increasing adrenal enlargement as an effect of the drug itself. I'll try to get back with a quote for you.

But I think the bottom line is that, without an ACTH test, you cannot take the size of the adrenal glands as an indicator of Cushing's "control" for a dog being treated with trilostane.

Marianne

P.S. I see Lori and I were writing at the same time, so please forgive the duplication!

[StarDeb55]

Molly Ann, I have been thinking over Buster's situation all day trying to come up with some information & possibilities for you that might help Buster. First of all, let me tell you I'm a lab tech with 29+ years experience, most of it in hematology where we do the monitoring/testing for human patient who are suffering with serious blood clotting problems. I will try not to make thing to "lab oriented" for you, but I do think a little background will be helpful.

First of all was Sas has told you about an underlying problem causing the problem is dead-on. Some of the possibilities do include cancer, & yes, Cushing's can predispose our pups to develop blood clots. The blood clotting system in our body, which will be pretty much the same in our pups, is actually made up of 2 parts, the system that helps us to form a clot when we are bleeding for whatever reason. The other system is the one that breaks down these clots once the bleeding has stopped or the injury has healed. This system is termed the fibrinolytic system. Both systems work in delicate balance with each other as you obviously don't want excessive bleeding, nor do you want excessive clotting. With excessive clotting, something has thrown this balance out of whack. There is probably one of 2 things going on with Buster, the system that helps the body to form a clot has become hyperactive, or the system that helps breaks down a clot is not working like it should. The last possibility is that there is a combination of issues with both systems.

Some of the basic testing that needs to be done will include a complete blood count to specifically look at a platelet count. Platelets are a tiny blood cell in our blood vessels that are the body's first line of defense in building a clot. If there are too few or too many platelets, or platelets that have become hyperactivated causing excessive release of the factors that trigger clotting to start , this may be one of the reasons that lead to the formation of a blood cloy. Another test is called an aPTT, activated partial thromboplastin time, which will take a look at how well the blood clotting part of the system is working.

Based on what you have posted, I know your vet has already told you that Buster's situation is grave. I'm don't know if you would consider it or if it's even possible, but a possible option might be to amputate Buster's leg. I'm saying this because if any part of that clot breaks off, traveling to Buster's lung, this is will be a life-threatening situation that I'm not sure you would even have time to get Buster to a vet.

I did find one link that goes over the treatment for blood clots in dogs that discusses the lab testing I have mentioned, along with several treatments including therapy in an oxygen cage, along with the possibility of treatment with drugs that would help breakdown the clot. I think an IMS should be able to handle this, but you want to see about one who is specifically interested in hematology/blood clotting disorders. There may be a possibility that a vet oncologist might do this as human oncologists are hematology/oncolgy doctors who specialize in treating blood clotting disorders. Here is the above link I mentioned.

http://www.petmd.com/dog/conditions/cardiovascular/c_multi_hypercoagulability

Debbie

[Harley PoMMom]

Hi Mollyann,


, his adrenals are enlarged (is that a sign the Cushings isn't being well controlled? or are they always enlarged when there is Cushings, even though it's well-controlled? I forgot to ask.) Buster has Pit. Cushings. Thinking is, as I understand it, that maybe the Cushings isn't being as well-controlled as we thought and that if so, and we do a better job of controlling it (don't know what that would mean - higher dose of Trilo?)

I did find a study that confirms that Trilostane enlarges the adrenals over a period of time. Here is a quote and a link to that study:



EFFECT OF TRILOSTANE THERAPY ON ADRENAL GLAND SIZE IN 13 DOGS WITH PITUITARY DEPENDENT HYPERADRENOCORTICISM: AN ULTRASONOGRAPHIC STUDY

Conclusions: Ultrasonographically, adrenal glands increase in size during trilostane therapy, a not unexpected finding as the negative feed-back mechanism is lost during decreased cortisol production.
This is in contrast to the reduction in adrenal gland size that was observed in dogs treated with mitotane(o,p’ DDD) (2).

References:
Neiger R et al. Trilostane treatment of 78 dogs with pituitary-dependent hyperadrenocorticism. Vet Record, in press

Hoerauf A., Reusch C. Effects of mitotane therapy in dogs with pituitary dependent Cushing’s syndrome on the adrenal gland size – an ultrasonographic study. Schweiz Arch Tierheilkd 1999; 141:239-245.



Love and hugs,
Lori

http://cheval.vet.gla.ac.uk/EVDI/MURCIA02/AMantis.pdf

[Squirt's Mom]

Hi Mollyann,

How is Buster today? How are you today? I hope you both are ok, but would like to hear that ya'll are great! ;)

Let us hear from you when you get a chance.

Hugs,
Leslie and the girls - always

[Mollyann]

Hi Leslie, Debbie, Lori and Marianne, thank you all for the kind companionship and Lori and Debbie thank you so much for the research you did and sent. As I type with one hand, Buster is in my lap on a pillow from the bed (as my lap on it's own doesn't comfortably accommodate his long body - he's a big Boston, and so handsome - and that's not just 'cause I'm his mom). I am so grateful for another day and that he's not in pain. The gravity of his situation is sinking in and knocking the wind out of me over and over. I am not coping very well but I do my very best not to sob in front of him. He is an intelligent and perceptive boy, so I must keep a positive front.
I have the alarm set for 3:45 am so Buster can get his Trilostane (Previcox, Tramadol and aspirin) in time for his ACTH and other tests at 8 am tomorrow (well, technically, [I]today[I] as it's now after midnight). In a couple of days we'll have some answers and I will report the findings for your input - which I appreciate, so much. The article on hypercoaguability in Cushings dogs was not done on treated dogs, I saw, but the vet said that clotting happens even in dogs whose Cushings is under control. I fear that the compounded Trilo was a bad move, even tho Buster continued to look great and had no Cushings symptoms, and that his Cushings wasn't as controlled as we thought. I don't think his gums look pale, but I realize that the liver mass could be cancer and that the clotting is a response to that. Buster has gotten doggy-breath lately, which he has never had before, and I haven't found a problem with his teeth. Is bad breath a symptom of liver cancer? I'm going to put my scrambled brain to bed, and tuck in my boy. Thank you all again & bless you.

[MiniSchnauzerMom]

Mollyann,

Hope Buster's appointment went well. Will be waiting to read your update. Bad doggy breath can come from many things. This is a link from WebMd-pets about dog breath and a quote from that article that gives the various causes. The article doesn't specifically mention liver cancer but does mention liver abnormality as a cause. From an expensive experience with my Munchie, I can attest that you can't always tell there is not a dental problem by a vet just by looking in the mouth either. :( Anyway, if you haven't already, I suggest you discuss this new bad breath issue with Buster's vet and/or specialist.

http://pets.webmd.com/dogs/guide/bad-breath-dogs



If plaque is the culprit, your dog might require a professional cleaning. If it’s an issue of diet, you might have to change your dog’s regular food. If the cause is gastrointestinal or an abnormality in your dog’s liver, kidneys or lungs, please consult your vet about steps you should take.



Mollyann, when you feel really down and you're not coping well....log on and "talk". There's always someone on the forum at any given time and we're here for you. You may need to keep up that front for Buster, but you don't have to for us. Have ears....will listen!

Louise

[Harley PoMMom]

Mollyann,

Mollyann, when you feel really down and you're not coping well....log on and "talk". There's always someone on the forum at any given time and we're here for you. You may need to keep up that front for Buster, but you don't have to for us. Have ears....will listen!

Louise

I too hope Buster's appointment went well, and Louise is absolutely correct that we are here for you always, whenever you may need to talk, rant or rave or whatever will make you feel better, ok. ;):)

Love and hugs,
Lori

[littleone1]

Hi Mollyann,

I wanted to see how Buster is doing.

Corky also has a mass on his liver, which has remained about the same size for almost a year. He also developed doggy breathe toward the end of last year. It didn't have anything to do with his liver. He did have three fractured teeth and two masses in his mouth which had to be removed. Since then his breath has been great.

As I posted before, I don't know anything about blood clots, but thinking back, I have a friend that had a large clot in her leg, and she had to take blood thinners. I really don't know if this is an option for our furbabies.

As others have said, we are always here for you. Even though my knowledge is not even close to what so many others have, I can be a good listener if you need to vent or discuss anything.

Bostons are very special to me. I can definitely understand how you feel.

My thoughts and prayers are with you and Buster.

[Squirt's Mom]

Hi Mollyann,

Just popping in to see how ya'll are doing. When you get a chance let us know how things are, 'k?

Hugs,
Leslie and the girls - always

[littleone1]

Hi Mollyann,

I was just doing some research on blood clots in dogs, and I did find on several different sites that blood clots in dogs can be treated with anticoagulant medication and fluids to prevent further clots. They do have to be under supervision and stay quiet.

I hope this helps.