Newf with Cushings - Dax has passed

[Kim]

My 11 year old male, neutered Newf, Dax, was diagnosed with Cushings in July. He had a left adrenalectomy that had a malignant mass. His symptoms abated with one Addisonian crisis as he tapered off of pred. A month ago his ACTH was 23, last week it was 29. We did an endogenous ACTH as WSU last week and are waiting for results and we are doing a low dose dex test today to try to determine if the current problems are pituitary dependent or adrenal dependent. WSU has suggested a second adrenalectomy (if AD) or radiation (if PD). He's my best friend and I want to make the right choices.

[Buffaloe]

Hi Kim and welcome,

Have some of the cushing's symptoms returned for Dax? Is that why you had the ACTH tests? It is good that you found out his cortisol is rising.

I really think your next step should have been to go straight to an ultrasound after the ACTH test. At this point, having an ultrasound performed is the only way you are going to find out what is going on, IMO. As I understand it, if any malignant cells escaped from the removal of his left gland, they like to find a similar area to invade (right adrenal gland) rather than the liver, kidneys, etc. Additionally, I think it is more likely for Dax to have a tumor in his right gland than pituitary cushing's. But, he certainly might not have adrenal or pituitary cushing's at this point. You need an ultrasound to find out if he has a tumor in his right adrenal gland.

Dax is still a relatively young boy. My Shiloh had her malignant, left adrenal gland removed when she was almost 12 and did very well. If Dax has a tumor in his right gland, you could probably have another adrenalectomy and he'd be cured. Surgical removal of the right gland is generally a little more difficult than the left, mostly because of the proximity of the pancreas and perhaps some blood vessels.

Even if Dax has either an adrenal tumor or possibly pituitary cushing's, you have alot of hope. You definitely have options. You and Dax will be in my prayers.

Ken

[Squirt's Mom]

Hi Kim and welcome to you and Dax! :)

How wonderful that he has already come through one adrenalectomy with success! And how scary that he may be facing another! :eek::( It is rare for a pup to have more than one form of Cushing's, but it does happen so PDH is a possibility as well. Bless both your hearts!

I am sure you will have an abdominal ultrasound during the testing phase and that will be the test that will let you know for sure if there is another adrenal tumor and what the options are this time. If it is ADH again, I pray this one can be successfully removed and Dax has no more problems with Cushing's.

If he has PDH, then you have more options than radiation to treat. The tumors involved with PDH are much, much smaller than those with ADH and rarely grow to the point they cause neurological problems. PDH typically involves micro-tumors and they remain as such. There are two main drugs used to treat PDH - Lysodren (Mitotane) and Trilostane (Vetoryl). Neither drug works directly on the pituitary tumor but rather disrupts either the adrenals ability to respond by eroding the adrenal cortex or by blocking the pathways.

Be sure to get copies of his testing and post the results here including the units of measurement (ug/dl, nmol/l, ect) and the normal ranges provided for each value. The more info we have, the better the feedback we can offer so don't worry about a long post...we just LOVE details! ;) We won't get really nosy about things until we know you a bit better! :p

I know you and Dax have already been through sooo much and this is just not fair that he may be facing problems again but ya'll are in good hands here and I am glad you found us. You now have a great resource for information, first-hand experience, and the best support system in the world. You and Dax don't have to take another step alone; we will be with you all the way, helping in any way we can.

Hang in there!
Hugs,
Leslie and the girls :D - always

PS. I see our resident ADH expert is on the ball! He got to you before I could contact him! Ken and Shiloh are very much heroes in our hearts!

[Kim]

Thank you so much for your responses. We really needed a little dose of hope.

Dax has had two ultrasounds since his surgery in July. Neither showed metastisis, however, even at the time of his adrenalectomy his other adrenal gland was slightly larger than normal.

We should have results from the Endogenous ACTH and low dose dex test tomorrow or the next day. I will gladly share those results. I'm hoping they will confirm each other.

To answer the question about his symptoms:

He is starting to drink and urinate a lot again. His hair from all of his shavings (neck, belly, all legs for blood draws) is not growing back. On the other hand a persistent wound (necrotizing faciaitis) on his elbow has healed, as have two in his mouth.

Right now his back is balding and the skin is scabby (cal? cutis), but I don't know if that is slow to resolve. He's had ear gunk and just finished a round of antibiotics.

Here are my questions:

Can a dog survive double or bilateral adrenalectomies?

Has anyone else done this radiation surgery on the pituitary?

How effective is the medical style of treatment? What are the drawbacks?

Thank you so much.

Kim and Dax

[Kim]

Dax's pre-cortisol levels were determined to be 7.31 ug/dL, and post-cortisol levels were determined to be on 29.2 ug/dL on 11/09/10.

I will post other test results as I receive them.

[Buffaloe]

Hi Kim,

I sure do hope you get some clear answers from the results of your LDDS test and the endogenous ACTH test. I have to believe the professionals you and Dax are working with at Washington State are top notch and will do an excellent job.

Since the two ultrasounds did not indicate a tumor on his right gland, it seems unlikely that he has one.

I think that is a big positive that the sores in his mouth and on his elbow are healing so well. Before Shi's adrenalectomy, her fur did not grow well, at all. After the surgery her fur grew back beautifully in 2-3 months and all of her sores healed nicely.

Dogs can do very well after having both adrenal glands removed. Two or three things the adrenal glands produce (prednisone, etc.) need to be supplemented for the rest of the dog's life. I guess some people don't want to mess with all that but I would have done it for Shiloh if that were the case. We have had a couple of dogs here who did very well after bilateral adrenalectomies.

Hopefully, others will provide you with more details about the treatment of pituitary cushing's but here's a short course: If the tumor/mass is small, it can be effectively treated with either Lysodren or Trilostane. If it is large (macroadenoma) then you can either use radiation or have it surgically removed, although both of these options are pretty involved. The vast majority of pituitary tumors/masses are small and are effectively treated with Lysodren or Trilostane.

Lysodren and Trilostane are also used to treat adrenal tumors although generally not as effectively as with pituitary. Then again, we've had people here who treated their dog's adrenal tumors medically very effectively for over a year. There are at least 6-7 different kinds of adrenal tumors, all shapes and sizes, malignant or benign....they're all different.

Kim, you're in the diagnostic stage with Dax for now. I sure do hope you get some clear answers from the blood tests. It took us two months and many tests to finally find out Shiloh had the one adrenal tumor. It drove me looney-tune, she was doing very poorly and I couldn't get any answers. I remember it clearly and that was in 2006. I know how you love Dax and I know it is really tough for you right now. But, hang in there. And, whatever it is, you will have viable options for Dax.

Ken

[littleone1]

Hi Kim,

Corky and I also want to welcome you and Dax. You have gotten alot of very good information from others, especially Ken, who has been through an adrenalectomy with Shi.

Ken mentioned that there are members that have been treating an adrenal tumor successfully with Trilostane for over a year. Even though the surgery is the best option, Corky is not a good candidae for the surgery. He's been doing very well on Trilo for over a year. His dosage has had to be tweaked, and he has been switched from once a day dosing to BID. Bless his heart, he's still going strong.

I hope you will be able to get positive answers as to what is going on with Dax.

Terri

[Kim]

Terri and Ken,

Thanks so much. I'm waiting to hear from our oncologist. You all are great.

Kim and Dax

[Kim]

Dax's tests showed a slow escape at 8 hours so the current belief is that this new Cushings is PDH. We are scheduled for another ultrasound next week since Dax is groaning whenever he is down. We will go to WSU the following week for an MRI and possible radiation surgery if the tumor is visible.

[Kim]

Dax will get an ultrasound, chest xray, CBC, and urine test today in Seattle in prep for WSU next week. His endogenous ACTH from two weeks ago and his low dose dex test confirmed pituitary Cushings. The plan is to do an MRI next Tuesday and radiation is a mass is present. Otherwise, we will look at medical solutions.

[labblab]

Kim, are the WSU vets planning to proceed with radiation treatment regardless of the size of the pituitary tumor? Traditionally, radiation has been reserved only for those tumors that exceed a certain size and present an imminent threat of producing neurological abnormalities. However, during my time here, I have run across at least one researcher who has recommended targeting somewhat smaller tumors in the hope of preventing future neurological problems from ever arising. But our experience thus far has been limited to seeing radiation used only to treat large, macrotumors. I think this is because the treatment is both rigorous and expensive. The typical treatment protocol has been radiation given three times weekly for about a month, requiring general anesthesia for each treatment.

Is this the same type of protocol that they are discussing for Dax? Or are they talking about something that is less involved?

Marianne

[Kim]

Marianne,

Thank you so much for your note. Apparently, this is not a normal or fractionated radiation. It is called radiosurgery and is intended to exclusively target the pituitary from all sides.

We declined the fractionated option since we would need to stay at WSU or leave Dax there for a month. Neither option would work for us or Dax.

Our oncologist in Seattle has recommended this treatment in order to try to "save" his remaining adrenal gland.

Should they not see a tumor on the MRI we will probably try the Trilostane option. Or if the tumor is larger than "the box" which I believe is 2mm.

They said the Trilostane would inhibit the pituitary's message to the adrenal thereby resolving the Cushings, but if the PDH is due to a tumor it would not inhibit the tumor.

It's hard to believe he has had both ADH and PDH. But both the endogenous ACTH and the lose dose dexamethasone tests direct us to PDH at this point.

He is also showing some bacteria in his urinary tract so we're adding meds for that today. His liver numbers are a little off as they were in previous tests. And his sugar levels are slightly elevated, but they are not sure if this is due to stress or the beginnings of diabetes.

I'm afraid my best friend's systems are failing on a lot of different levels. Our local vet suggested we just "let him go" rather than put him through the long haul to WSU and the treatment. We are so selfish, we just want to keep him with us as long as possible and as comfortable as possible.

We'll be making the seven hour drive on Monday, check in on Tuesday and may get his MRI then depending on the scheduling.

We welcome any comments or suggestions. Thank you all so much.

Kim and Dax

[Kim]

Okay, everyone, here's all Dax's details post-surgery this week.

CASE SUMMARY:
History: Dax presented to the WSU-VTH for an MRI and possible radiotherapy of a suspected pituitary adenoma. In August 2010, Dax was seen by Dr. Tripp who diagnosed a left adrenal carcinoma. A left sided adrenalectomy was performed in late August. Since that time, the clinical signs of hyperadrenocorticism (aka Cushing’s) consisting primarily of polyuria/polydipsia (PU/PD), calcinosis cutis, and alopecia (hair loss) have not resolved, although Ms. Roberts did mention that perhaps the PU/PD was a little bit better since the adrenalectomy. Results of an ACTH stimulation test performed on October 28th, 2010 and a low dose dexamethasone suppression test performed on November 16th, 2010 were consistent with hyperadrenocorticism. Dax was seen at the WSU-VTH on November 9th, 2010 at which time an ACTH stimulation test and endogenous ACTH levels were performed. These tests confirmed the suspicion of either pituitary-dependent hyperadrenocorticism or less likely, an ectopic source of ACTH. The latest evaluation completed by Dr. Tripp last Wednesday November 24th, 2010 included thoracic radiographs, abdominal ultrasound, complete blood count, serum chemistry, and urinalysis. The thoracic radiographs and abdominal ultrasound were unremarkable. Dax exhibited a luekocytosis with a mature neutrophilia and elevated glucose, BUN, ALT, GGT, ALP, and cholesterol on the CBC and chemistry. These findings are consistent with the previous diagnosis of hyperadrenocorticism. The urinalysis demonstrated a USG of 1.008 (still consistent with PU/PD) with no other remarkable findings. Mr. and Mrs. Roberts state that Dax continues to have PU/PD and that his alopecia is worsening. His appetite has been great and activity level has remained unchanged.

Physical examination: Dax was bright, alert, and responsive. His weight was 51 kgs and he had a body condition score of 3/5 (ideal). A mild amount of muscle atrophy was noted in the hind limbs. Dax’s heart rate was 88 beats per minute, his respiratory rate was panting, and his temperature was 99.8°F. His eyes had a mild amount of ocular discharge, although his nose was clean and clear. A couple of oral abrasions and gingival hyperplasia were noted on the buccal surface of both Dax’s upper lips adjacent to each maxillary 4th premolar. Mucous membranes were pink and moist with a capillary refill time of less than 2 seconds. A moderate amount of dental tartar was observed. Both ears had a moderate amount of debris. His heart and lungs ausculted normally and abdominal palpation revealed no abnormalities save for mild hepatomegaly. The prescapular lymph nodes were mild to moderately enlarged bilaterally, attributed to chronic ear disease as no other nodes were abnormal. Asymmetrical alopecia and skin changes consistent with calcinosis cutis were noted on Dax’s dorsum and ventrum over the thorax and the abdomen, but most prominent over the dorsal lumbosacral area. In addition, Dax’s left elbow was alopecic and hyperkeratotic with a grey discoloration. The Roberts reported the left elbow was once affected by a necrotizing fasciitis previously and that area is pink and hairless.

Diagnostics:

Magnetic Resonance Imaging of Head (unofficial report): A contrast enhancing mass of approximately 0.9 cm in its greatest dimension was seen on axial and sagittal sections of the brain; the mass is in the area of the pituitary gland and is considered radiographically consistent with a pituitary macroadenoma.

Diagnosis: Functional pituitary macroadenoma resulting in hyperadrenocorticism.

Treatments: Radiosurgery was performed once with a total dose of 15 Gy focused on the pituitary mass. This is a single large dose compared to other radiation therapy protocols where a smaller dose is given multiple times (fractionated radiation therapy). Pituitary adenomas are usually slow growing, so positive results, if seen, from radiosurgery are most likely not going to be observed until weeks to months after treatment.

Side effects immediately related to the dose of radiation are not likely to be observed. Some reported signs related to the radiation effects on the surrounding brain tissue might include behavioral changes (which could include changes in appetite), depression, pain, or a change in mentation- these may not be seen for weeks to months. If at any time you observe any of these changes please call Dr. Tripp, Dr. Stevenson or an oncologist at the WSU-VTH. Dax will need to be examined and possibly treated with prednisone (counterintuitive for his underlying disease, but sometimes needed).

It is expected that signs of hyperadrenocorticism should begin improving by 3 months; however, literature has shown that some cases require a longer period of time for clinical signs to subside. If clinical signs of hyperadrenocorticism persist past 3 months, Dax should be examined in case he needs to be treated a second time with radiosurgery and also to evaluate the effect of the first radiosurgery. It was mentioned that a discount could be provided if Dax was re-evaluated with MRI 3 months after radiosurgery. This would provide valuable information as to the future care of Dax and other dogs regarding possible outcomes and consequences of radiosurgery.

Radiosurgery was focused on the pituitary gland to treat the macroadenoma; hence, the radiation could possibly result in pituitary dysfunction. Since the pituitary gland plays a critical role in a number of functions, if any of these functions are compromised one or more of the following could develop at some time in the future (although none may actually be seen, and if seen, the time course with which they may develop is unpredictable):
a. Decreased production of ACTH could lead to cortisol deficiency because the adrenal glands are not stimulated to make cortisol. This possibility can be monitored by periodic (every 3-4 months) ACTH stimulation tests to see if the trend suggests a reduction in adrenal gland function (hypoadrenocorticism), or periodic measurement of endogenous ACTH concentrations (with again a trend toward steady decline suggesting a need for close monitoring). If clinical signs of vomiting, diarrhea or loss of appetite are seen (particularly if these are seen after a period of time where he has been eating well), he may need to be assessed for adrenal gland function sooner than a scheduled stimulation test. Importantly, this form of hypoadrenocorticism will not be suggested by classic biochemical abnormalities (specifically, electrolytes) characteristic of classical forms of hypoadrenocorticism.
b. Decreased thyroid function, which is treated with thyroid hormone. However, thyroid function may also increase due to decreased inhibition by the tumor. Please speak with Dr. Tripp or Dr. Stevenson about checking Dax’s thyroid hormone levels several months (3-4 months would be a reasonable starting point) after his radiosurgery. If you notice excessive weight gain, lethargy, or poor hair coat and skin please have him checked sooner as these may be signs of a decrease in his thyroid hormone levels.
c. Loss of antidiuretic hormone (ADH) from the pituitary gland could lead to an even greater increase in water consumption and urine volume; in some cases, the volume of water consumed can be quite marked. Treatment of this complication involves the administration of topical (eye drops) ADH replacement drugs.

IF ANY OF THE ABOVE SIGNS ARE OBSERVED AND BECOME A CONCERN PLEASE CONTACT DR. TRIPP, DR. STEVENSON, OR THE WSU-VTH FOR EVALUATION.


INSTRUCTIONS FOR CARE OF DAX:

Medications: No medications were sent home with Dax.

• Trilostane is recommended for the short-term management of hyperadrenocorticism until the effects of radiosurgery are realized or if Dax doesn't respond to radiosurgery. Trilostane is a competitive inhibitor of the enzyme that produces cortisol in the adrenal gland in contrast to mitotane which is used to destroy the cortisol-producing adrenal cells. Depending on the success of the radiosurgery, administration of trilostane could be a lifelong commitment which is a downside; however, its effects are often reversible once administration is stopped and the enzymes are able to increase cortisol concentrations. Trilostane is administered orally with food and Dax's starting dose would be 180 mg (3 x 60 mg capsule). Around two weeks after starting trilostane and every time the dose is adjusted an ACTH stimulation test (done 4-6 hours after administration of trilostane) should be completed 2 weeks later. Based on a very recent paper (JAVMA 2010; 237:801-8805), dogs treated with trilostane that have a baseline cortisol between 1.3 and 2.9 ug/dl are highly likely to have adequate control of hyperadrenocorticism and would not need dose adjustments, and would not need a complete ACTH stimulation test. Dogs outside of these ranges, or dogs that have not had any improvement in clinical signs, should still have a complete ACTH stimulation test. The goal is to have pre- and post-ACTH cortisol results (if ACTH stimulation testing is performed) between approximately 1 and 5 ug/dl. Once the optimum dose has been reached, examination of Dax should be completed at 30 days and every 3-4 months after that so long as he remains stable and clinical signs or side effects are not observed. Trends toward decreasing cortisol results could suggest either overdose, or reductions in endogenous ACTH as a result of radiosurgery. Each examination should include a thorough history, physical exam, serum biochemistry, and an ACTH stimulation test or basal cortisol measurement. Overdose of trilostane could result in an Addisonian (hypoadrenocorticism) presentation that should be treated with corticosteroids, possibly mineralocorticoids, and possibly fluid therapy. Prednisone tablets (10 or 20 mg size should be fine) should be kept on hand just in case signs of an hypoadrenocorticism, such as decreased appetite, vomiting, diarrhea, weakness, or collapse are observed. If any of these signs are noticed stop administration of the trilostane and contact Dr. Tripp, Dr. Stevenson or the WSU-VTH immediately. If you are not able to contact a veterinarian, and Dax exhibits features consistent with hypoadrenocorticism, then give 20 mg of prednisone by mouth; if improvement is not seen within 3-4 hours, seek veterinary care as soon as possible.
• An additional element of his monitoring that should prove useful in assessing the effects of radiosurgery is periodic measurement of an endogenous ACTH concentration. With benefits of radiosurgery, we expect endogenous ACTH concentrations to normalize at some point in the future, although as already noted and discussed yesterday, the time frame of this response is not predictable, nor is it guaranteed to happen. As mentioned above, it is also possible that radiosurgery will eliminate Dax’s capacity to make ACTH, in which case clinical signs of hypoadrenocorticism are expected. Our initial recommendation would be to measure an endogenous ACTH concentration between 3 and 4 months after his radiosurgery. Measurement before this time could be considered depending on his clinical status after treatment with trilostane, so there is unquestionably a “play it by ear” element to the timing of his endogenous ACTH measurements. Because of the unstable nature of ACTH, Dr. Tripp or Dr. Stevenson will appreciate advance notice of an appointment with them so that necessary handling instructions as dictated by their laboratory can be defined and implemented.

Diet: No changes in Dax’s diet are warranted at this time.

Activity: Dax can dictate his own activity level.

PLAN FOR RE-EVALUATION OF DAX:
1. Dax (well, we here at WSU) would benefit from a follow-up MRI of the pituitary and surrounding tissue. As mentioned above, this could be scheduled for between 3 and 6 months after radiosurgery and a discount was mentioned for the cost of the MRI. The exact timing of re-imaging can also be influenced by his clinical status (resolution of his clinical signs of hyperadrenocorticism or not).
2. If Dax is placed on trilostane, a basal cortisol and/or ACTH stimulation test should be performed 2 weeks after starting therapy.
3. If there are any questions regarding his care and monitoring, please do not hesitate to contact us!


Thanks for giving us another opportunity to help Dax and you.

[labblab]

Dear Kim,

Thank you so much for posting the report from Dax's radiosurgical procedure! I so hope that he is doing well. This is the very first that I have heard of this type of one-time procedure being used on dogs with pituitary macroadenomas, and it sounds as though it is "cutting-edge" therapy. I'm familiar with "Gamma Knife" surgery being performed on humans, and wonder if it is a similar technique. What a boon it will be if it proves to be as successful as hoped, and available on a more widespread basis. SOOOO much better than the traditional month-long fractionated protocol!! Did you get the impression that WSU is one of the only centers currently offering this treatment? I'm guessing that is the case.

Please keep updating us as to Dax's progress. He is really a pioneer on behalf of so many other pups! Please give him a big hug for me...

Marianne

[Kim]

Marianne,

Yes, I did get the impression that they are the only ones doing this surgery. They offered him the fractionated option, but I could not bear to be away from him for a month. The other aspect of this type of surgery is that the radiation was directed solely to the lesion with less than a percentage of overlap to the rest of the pituitary or other aspects.

On the other hand, I am having difficulty determining if we should now start the Trilostane or if we should let him stabilize. Do you have an opinion?

Kim

[labblab]

Kim, are you seeing any changes in Dax since the procedure? How about his thirst and urination?

Marianne

[lulusmom]

Hi Kim,

In reading through your post, it appears that the vet is giving you the option to give Dax Trilostane to manage the cushing's until you can figure out how much the circulating acth level has dropped in three to four months. In that time, it sounds like there is a very real possibility that the adrenal gland could stop producing cortisol completely so administering Trilostane to a dog with low cortisol would really make me nervous. Additionally, the reports states that low thyroid and diabetes insipidus can result, both of which share many of the same symptoms as cushing's.

Honestly, if I were in your shoes, I think I would base my decision on how dire my dog's symptoms are and whether s/he and I could live with them for 90 days. I live with a dog with diabetes insipidus and he drinks and pees buckets daily so that symptom I'm used to it. All four of my dogs would eat until they exploded so acting like their starved all the time doesn't phase me either. However, festering infections, dangerously high triglycerides, blood pressure and uncontrolled diabetes mellitus in the face of high cortisol would definitely prompt me to start Trilostane treatment. What symptoms are you seeing today?

We are keeping fingers and paws crossed that the procedure is a total success and that Trilostane will not be necessary at all.

Glynda

[Buffaloe]

Hi Kim,

You've sure had alot on your plate with the adrenal tumor and now having to deal with a macroadenoma. Obviously, I know nothing about radiosurgery but it sounds promising. Evidently, they can target the strong dose of radiation to the pituitary mass accurately and effectively.

The professionals at WSU sound outstanding. I think you just need to stay in communication with them and follow their directions. My layman's opinion would be not to be in a rush to start Dax on Trilostane; give the radiosurgery some time to see the results.

I hope and pray that you end up having several wonderful years left with Dax as a happy, healthy boy.

Ken

[ktzndgs]

Kim,

I have absolutely no advice for you as I'm somewhat new to Cushing's in my Newf as well. I just wanted to send you and Dax good thoughts from our Newf family to yours. Hang in there.

Macy was diagnosed in late May and it's been a roller coaster ride since then. We seemed to finally be making progress when things started to fall apart. Looks like a bladder infection might be the problem so I'm hopeful we'll get back on track soon!

Kathy
& Macy

[Kim]

Marianne,

Even though the docs thought it would be months for Dax to show improvement, his PU/PD seems resolved already. He is pretty tuckered out and I'm a little worried about him going Addisonian. He is eating and drinking normally, but showing a little weakness in his rear end. Could be due to the precipitous drop in cort I guess. WSU said to start Trilostane if we need it. At this point I don't see a need, but I'm wondering if we should suppliment with pred. We're going to watch him tonight.

Kim

[Kim]

Glynda,

Thanks for the feedback. We have opted out of Trilostane for now. Dax's symptoms abated considerably. We though he was having an Addisonian crisis two nights ago and gave him some pred. Did it again this morning. Both times he was miraculously better in about three seconds. We think he's groaning just to get the peanut butter. We'll knock off the pred now since it seemed to make him start drinking/peeing again.

Kim and Daxie the Brilliant

[Kim]

Ken,

I am still struggling to navigate around the forum, but I wanted to post to all that Dax's radiosurgery at WSU Vet Teaching Hospital (12/4/10) seems successful. PU/PD abated in about three days. He has regained his strength and enthusiasm. He will get an ACTH stim tomorrow to get new numbers. His current mysterious symptoms are alopecia and skin flaking in addition to groaning. We will be checking for thyroid problems perhaps as a result of the radiation. Kim

[lulusmom]

Hi Kim,

I'm really glad to hear that Dax is feeling better. We'll be staying tuned for the results of his upcoming tests. I'll be thinking positive thoughts.

Glynda

[AlisonandMia]

You can get some really dramatic hair loss (with a blizzard of skin flakes to go with it) when the cortisol is lowered to a more healthy level. I noticed with my dog that she ceased to shed at all when her cortisol was high but when she was treated (Lysodren in our case) she blew her coat, had terrible dandruff for a while - it seemed to peak about three weeks after lowering her cortisol, if I remember rightly. She then regrew a strange, fluffy "puppy coat". This seems to be what happens more often than not not matter what treatment is used so I think it is a reaction to high cortisol initially and then going to a more healthy level. It is messy while it lasts!

With the groaning - that sounds like it could pain or discomfort of some sort (but not necessarily). Maybe the lowering of the cortisol has unmasked some arthritic issues? Unfortunately, groaning is also a typical symptom of pancreatitis so getting that checked out by the vet could be a good idea. Have you mentioned the groaning to the vet?


Alison

[Kim]

Alison,
Thank you so much for the info on the flaking skin and coat. You are right, it's like a blizzard, yet at the same time he is regrowing hair in some of his bald spots. Dax's calcinosis cutis, which was quite severe, is slowly abating. Our local vet prescribed Cephalexan as he thinks Dax may have a staff infection on his skin as a result of his lowered immune system. We are giving him Tramadol for his groaning. Dax is becoming resistant to pills, now only taking them in raw meatballs. Nonetheless, his eyes sparkle, he has more energy, and his ACTH stim showed numbers that are non-cushinoid. His ultrasound this week had no evidence of metastis from the removed adrenal.

[Kim]

Glynda,
Dax's ultrasound this week had no evidence of metastis from the removed adrenal. His liver numbers are improved and his acth stim says he's non-cushinoid. We are watching now for Addison's and actually gave him 5mg of pred this morning since he was boycotting food and has (consistently) loose doodles.

[lulusmom]

Hey Kim,

With the exception of the "loose doodles", I'd say things are looking much better. Is he feeling better since giving him the Pred this morning?

Glynda

[Kim]

Ken and all,
Dax is now suffering from what looks to be cognitive disorder. He became so aggitated at the last ultrasound that we did not complete it. Our oncologist believes that his pituitary tumor has returned or that the radiosurgery caused his symptoms. We have tried tramadol, codeine, prednisone, and gabapentin to allow him to sleep at night and not pace in the day. None have worked. He's so sad and miserable. Any suggestions?

[Buffaloe]

Hi Kim,

I am sorry Dax seems to be suffering from cognitive disorder and is so restless. I haven't ever had to deal with a these things in a dog. My only thought would be to try melatonin. I think it helps to restore the normal sleep cycle and it is natural. You could google melatonin and see what you think.

My guess is that the issues Dax is suffering are more likely a result of his pituitary situation than his remaining adrenal gland. I hope Dax gets some relief. I know it is difficult but hang in there.

Ken

[lulusmom]

Hi Kim,

There are treatments out there for canine cognitive dysfunction but they are not always effective. I think you would find helpful advice and guidance from a CCD group like the Yahoo Group. You can use this link: http://pets.groups.yahoo.com/group/caninecognitivedysfunction/?v=1&t=search&ch=web&pub=groups&sec=group&slk=1

My thoughts and prayers are with you. Please keep us posted on how things are going for Dax.

Glynda

[Harley PoMMom]

One of our members, Terri, is using Sam-e to help her sweet boy Corky with his cognitive issue.

[Kim]

Said goodbye to my best friend Dax tonight. He was an amazing soul. Thank you for all your support. Our prayers remain with all of you.

[lulusmom]

Oh Kim, I am so sorry for your loss. My thoughts and prayers are with you.

Godspeed sweet Dax.

Glynda

[Bichonluver3]

Kim, I am so sorry to hear of Dax's passing. Our thoughts and prayers are with you and, hopefully, before too long happy memories will replace the pain.
God speed and God bless, sweet Dax.
Carrol

[mytil]

Kim,

I am so very sorry to read about Dax's passing. You two have been a lot together - you are such a good Mom.

We will always remember your boy in our very special section In Loving Memory (http://www.k9cushings.com/forum/showthread.php?t=2865).

My thoughts are with you.
(((hugs)))
Terry

[Squirt's Mom]

Dear Kim,

I am so sorry to hear about Dax. You worked so hard to help him have a happy, quality life and I know he is grateful to you for all you have done on his behalf.

Today Dax is watching over you as he runs and plays in the Rainbow Fields. His body and his mind are once again whole and strong. He holds his memories of his life with you as closely as you do yours, knowing that one day he will be there to greet you as you cross The Bridge and those memories will live forever.

Please take care of yourself and know we are here if you need an ear or shoulder to lean on.

Our deepest condolences,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

[ktzndgs]

Kim,

I'm so sorry to hear about Dax. Your love and devotion to him really showed through so I know how difficult this must be for you. God speed Dax.

Kathy

[labblab]

Dear Kim,

You did everything within your power to provide Dax with as many happy, "dog-worthy" moments as he could possibly enjoy. I am so very sorry that his earthly journey has ended. But I hope that you will forever feel his spiritual presence in your heart and in your memories. Thank you for sharing your boy with us, and for now allowing us to join you in honoring him.

With many hugs, in loving memory of your brave boy ~
Marianne

[k9diabetes]

I am so sorry to learn of Dax's passing. He was an incredibly handsome boy and obviously much loved.

Natalie

[jrepac]

Rest easy Dax.

My condolences to you.

Jeff & Angel Mandy

[Casey's Mom]

I am so sorry to hear about Dax. He was a beautiful boy and I thank you for sharing him with us. Rest easy boy and be at peace.

Love and hugs,