Maisie - Can Trilostane cause tumors to grow?

[jani]

Hello,

My Maisie was diagnosed with Cushing's disease in the fall of 2009 following a tooth being pulled.....surgery. The diagnosis was directly after the surgery and we always felt it was somehow linked. My baby passed away 3 weeks ago. I am so devastated. Words cannot describe the loss and my sadness.
I read that your dog Alivia was diagnosed after two teeth being pulled. I wonder if the stress of the surgery brought on the Cushing's. Maisie was on Trilostane. Whether the tumor grew on her pituitary from a micro adenoma to a macro adenoma or else a new brain tumor grew they could not tell me. She was so weak from the disease from having it almost 2 years I opted out of an MRI. The doctors said it would have told them what they already knew anyway.
Where did you hear that Trilostane can make tumors grow faster? Could you please let me know your resource for that information?

I am so sorry for your Avilia.

take care,
jani

PS. Jani, I copied your post from Alivia's thread so that you can receive more response to your questions from our members. Your original post is still in her thread, too.

[addy]

Jani, I am so sorry to hear about your Maisie. The pain can be so hard to stand especially after caring for her and trying so hard.

I am hoping others will be along soon to voice an opinion on your question.

In the mean time, please know we are here for you.

Hugs,
Addy

[Cindy Thoman]

Jani, I am so sorry for the loss of your Maisie. My thoughts and prayers are with you.


xoxo,
Cindy, Alex and Bear

[jani]

Thank you Addy and Cindy. I tried my best to make her comfortable.
I cooked all of her meals. I read somewhere to get her off of commercial dog food asap. There are no regulations on pet food. Or minimal anyway. All her meat came from Whole Foods....I wouldn't even trust Safeway for her meat. Mixed with fresh organic veggies and brown rice, along with vitamins. The pain is enormous. I know that she was ill and this disease was going to shorten her life, but the brain tumor just happened so fast. It was so painful.
Somehow, her tumor grew. I wonder if the Trilostane had something to do with it? She weighed 24 lbs and the vet had her up to 170mg a day. 100mg in the morning and 70mg at night. They are vet specialists in SF. How much Trilostane are other dogs taking?

thanks,
jani

[labblab]

Dear Jani,

I am so sorry for the loss of your Maisie. But I am really glad that you have found us, because we will be here to support you in your sorrow. And I surely do understand that talking over some of your questions may feel very important to you right now. At least, that's the way it felt to me back when I lost my Cushdog to what we assume was a rapidly enlarging pituitiary tumor (although we did not opt for an MRI, either).

I am not a vet, so everything that I write here is based only my own reading and my own experiences as a member of this forum. But I do not believe that the tooth extractions would have played any role in the development of the pituitary (or adrenal) tumors that cause Cushing's. It is often the case that Cushing's ends up being diagnosed at the time of a surgical procedure, because routine blood panels performed in conjunction with surgery may reveal specific lab elevations that are associated with Cushing's. But the tumors that cause the Cushing's have been developing for a period of time prior to the surgery -- the "big picture" just had not yet been recognized or diagnosed.

Secondly, though, we did learn through our experience with our Cushpup that researchers suspect that in some cases, treatment for Cushing's may end up hastening the growth of an associated pituitary tumor. This is because of disruption to the normal feedback loop that controls production of ACTH. Here's an explanation from an article in our Resources section:


Because most chemotherapeutic agents have no effect
on the pituitary itself, they do not inhibit ACTH secretion,
which may actually increase with therapy.This phenomenon,
known as Nelson’s syndrome, has been well
documented in humans with pituitary tumors treated
with bilateral adrenalectomy. Nelson’s syndrome refers
to rapid enlargement of a pituitary mass that occurs after
loss of negative feedback from adrenal cortisol production,
which has an inhibitory effect on ACTH release.
While this phenomenon has been suggested to occur in
dogs, studies have shown no correlation between
treatment with mitotane and pituitary size or rate of
pituitary tumor growth. However, because the exact
mechanism behind the development of Nelson’s syndrome
is not completely understood, the potential for tumor expansion
as a result of adrenal corticolysis or decreased cortisol production seems plausible.

http://www.k9cushings.com/forum/showthread.php?t=229

The above 2008 article says that no correlation had yet been established at that time with treatment by mitotane (Lysodren), even though it seems reasonable that the potential for that treatment effect does exist. When my specialist told us about this possible effect back in 2004, trilostane really wasn't being used widely in the U.S., even though that is what we were using to treat our dog. So based on my specialist's comments, I assume that it was mitotane that had already been theoretically linked to this effect.

However, here's a 2009 article that also makes a possible linkage between trilostane and this effect:

http://www.ncbi.nlm.nih.gov/pubmed/19041802


Trilostane-induced inhibition of cortisol secretion results in reduced negative feedback at the hypothalamic-pituitary axis
Domest Anim Endocrinol. 2009 Jan;36(1):32-44. Epub 2008 Nov 11.
Teshima T, Hara Y, Takekoshi S, Nezu Y, Harada Y, Yogo T, Teramoto A, Osamura RY, Tagawa M.
Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan

Cushing's disease caused by pituitary corticotroph adenoma in dogs is usually treated by medical treatment, and the efficacy of this treatment has been reported. However, controversy remains as to whether reduced negative feedback through the inhibition of cortisol secretion, similar to Nelson's syndrome, may appear as an adverse effect.

The purpose of this study was to investigate the effect of reduced negative feedback through the inhibition of cortisol secretion by daily trilostane administration on the pituitary-adrenal axis in clinically normal dogs.

Dogs were administered 5mg/kg trilostane twice a day every day for 8 weeks (n=8) or 16 weeks (n=3). After the initiation of trilostane administration, plasma adrenocorticotropic hormone (ACTH) concentrations were increased remarkably.

As assessed by magnetic resonance imaging (MRI) during administration, the pituitary became enlarged. After trilostane administration, the cytoplasmic areas of the pituitary corticotrophs were increased and the ratio of pituitary corticotrophs to all cells in the anterior lobe was greater in the trilostane-treated dogs than that in untreated animals.

In addition, histological examinations revealed bilateral adrenal cortical hyperplasia. Using real-time PCR quantification, the expression of proopiomelanocortin (POMC) mRNA in the pituitary and ACTH receptor (ACTH-R) mRNA in the adrenal gland was greater in the dogs treated with trilostane than in untreated dogs.

These results indicate that reduced negative feedback induced hyperfunction of the pituitary corticotrophs and pituitary enlargement in healthy dogs. These changes suggest that the inhibition of cortisol secretion by trilostane may increase the risk for accelerating the growth of corticotroph adenomas in dogs with Cushing's disease.

I want to stress that this possible effect probably should not be a reason for owners to opt out of Cushing's treatment. Regardless of the cause, it is not common for canine pituitary tumors to enlarge to a size sufficient to cause major neurological problems. And so when weighing quality of life issues, it is important to consider the damage/discomfort that is known to be associated with untreated Cushing's in symptomatic dogs. My own dog was miserable prior to starting trilostane treatment. He then had several months in which he rebounded prior to exhibiting serious neurological abnormalities. So even had I known that the trilostane might hasten the growth of his enlarging tumor, I still would have chosen to treat for those months in order to relieve him of his awful Cushing's symptoms. I don't know if this is the type of information you were hoping to find, but I hope it will help.

And just as a P.S., my boy also required a very large dose of trilostane in order to keep his cortisol under control. I don't know whether or not that was related to the fact that he probably already had a large pituitary tumor, even at the time that treatment was begun. But he was on a very large dose in relation to current recommended dosing protocols.

Marianne

[MBK]

Hi Jani and welcome.

Thank you for your concern for Alivia when you are going through such pain yourself. I am so very sorry for the loss of your sweet Maise. I can only imagine how devestating that must be. It sounds like you did everything possible for her. You went above and beyond to care for her and she was very lucky to have someone who loved her as much as you did. You deserve to take some comfort in knowing you did everything possible for her.

In hindsight, I think my Alivia has had mild symptoms of Cushing's for some time. I don't think the dental surgery caused her Cushing's but I do think (however, this is only my lay opinion) the anesthesia from the dental surgery and/or the stress of it all may have exacerbated her symptoms. But, getting treatment for her 2 absessed teeth was not optional. I'm guessing Maise's dental procedure was just as needed. Alivia has an adrenal tumor and offhand I can't recall where I read about the possibility of Trilostane causing those to grow faster but, I will look through my research and get back to you on that. Please, please don't second guess yourself on your decision to treat Maise with Trilostane. There is so much contraversy on which medication is best and under what circumstances even among the top experts. Lysodren also has potentially serious risks (some even scarier than Trilostane), and there are also serious risks with not treating at all. Sometimes tumors are just fast growing and nothing you could have done or not done would change that. It is clear that you did the best you could for her with what science is currently available.

Please post some pictures of Maise and tell us more about her. What breed was she? You will be in my thoughts.

[littleone1]

I'm so sorry for your loss, Jani. My thoughts and prayers are with you.

Terri

[jani]

Maisie was a wired haired Jack Russell terrier. I love her beyond words. I always will. I cry every day because of missing her so very much. I can't believe she's gone. She was only 11.5. She was extremely smart, sweet, flawlessly beautiful and well behaved. We were very connected. I would love to post some photos of her, but I'm not sure how to do it. Is it easy?

About her tooth surgery suspicions. She had a full blood panel prior to her surgery and everything came out perfect. Which is what they do before to make sure the dog can handle the anesthesia. She never had any symptoms of Cushing's prior to this surgery. But afterwards, both my boyfriend and myself noticed changes in her. It was right on the heels of the surgery. The stress of it might of pushed her over...just not sure. She was only 9.

Thank you Marianne for all of your information. In the end it was pretty brutal for her. The tumor had grown or another tumor had grown, the vet did not know if it was a macro adenoma or another tumor. I think I would have opted out of Trilostane if I knew this is how it would have ended thats all. I never would have used Lysodren.
The idea of destroying the adrenals sounds crazy to me. There just are not many options I guess. I am finding everything I can about Trilostane...for what reason, I'm not sure. I think it helps me for some reason. Just having more information. This is a serious disease. When humans have it, they have surgery. That's their only option.

thank you all for your kind words!

jani

[labblab]

Jani, it will be wonderful for us if you are able to upload some pictures of Maisie. If you have digital photographs stored on your computer, the process is really very easy. Here's a link to the portion of our "Frequently Asked Questions (FAQ)" menu that includes the creation of photo albums and also how to add an "Avatar" (or little photo) of Maisie that will always appear alongside your name when you post replies.

http://www.k9cushings.com/forum/faq.php?faq=vb3_board_faq#faq_vb3_user_profile

Also, I can indeed relate to your desire to try to figure out what happened to Maisie. I spent a lot of time reading and researching after I lost my Cushpup. There were both good and bad aspects to it for me. The good part was that it helped bring some closure to what had happened, since we were left with some important unanswered questions. And the best part is that I learned a lot in the process, and I have since been able to share that info with other folks who come here. That has felt like a special way in which I have been able to continue to honor the memory of my boy.

The not-so-good part was that I spent quite a long time second-guessing the decisions that we made. And that made the pain of missing him even worse. I hope you'll be able to spare yourself that part of things. I finally found peace in accepting that even if we did make mistakes, we made the decisions that we thought were the very best for him given what we knew at the time. And he always knew how much we loved him. Always. It took a long time to arrive at that place, but now my memories are primarily of all the good times. And that is a blessing.

Jani, if you should ever wish to start a thread in Maisie's honor on our special "In Loving Memory" forum, it will be our privilege to share in your memories of your precious girl. You can write whatever you want there, and we will remain with you every step of the way.

Sending many hugs,
Marianne

[MBK]

Jani -

Now I know what drew you to my string! We are both JRT lovers!! They can be so sensitive and intuitive and somehow they manage to own your heart.

I have two, rough coated Jacks. Alivia (13 years old), who of course is the reason why I am here and Maxwell, who will be 11 in August (and fortuantely has always had perfect health!). Your Maise sounds just like my Alivia, so I can truly understand your connection to her and the pain you are feeling. I have never experienced a loss like yours, but I know when it happens, I will not handle it well.

I'm glad you found this place because the people here truly get that your dog was a family member and not a possession that can be replaced. You took awesome care of Maise, so as Marianne said, please don't regret your decisions. The experts do not agree on the best treatment, so all you could have done was to try your best for her. And, that you did!! I am sure she knew she was loved.

Posting photographs is super easy if you have any digital ones on your computer! Marianne directed you to the instructions. I am anxious to see pictures and when you feel up to it, it would be nice to have a memorial here for Maise, as well. I am so terribly sorry for your loss. I wish there was something I could do to ease your pain. You mentioned how brutal it was for Maise in the end. I am so sorry you both had to go through that. I hope those awful memories fade in time and you remember your beautiful, sweet Maise and all of the good times you spent with her.

[jani]

Well, I created an albums of photos of my Maisie.

Thank you both so much for all of your kind words. This is such a difficult time for me. My girlfriends say to each other, we love our dogs, but nobody loves Maisie like Jani does. Maybe it's because I don't have kids, but you know even if I did I truly think it still would hit this hard.

Marianne, have you ever heard of Relora? It helped tremendously in reducing Maisie's symptoms. The Trilostane alone did not stop the panting and everything else, but with the Relora it did. It is a supplement from the health food store. Her vet said it was fine to give it to her. It REALLY made a difference.

I hope you enjoy the photos. I cried putting them up.

[labblab]

Oh Jani, I've just been to your photo album and your pictures of Maisie are WONDERFUL!!!!!!!!!!!!!! What a cutie-pie!

We would very much like to add Maisie to our special memorial thread of honor here:

http://www.k9cushings.com/forum/showthread.php?t=2865

If you will let us know the date of her passing, and also tell us which one of your sweet photos you would like for us to use as a link, we will be able to complete her memorial line. You can either tell us in a reply right here, or send me a Private Message with this information.

I definitely understand about your deep connection with Maisie. I have no human children, either, and my furbabies are the focus of my love and my time. They absolutely "rule" my daily activity calendar! :o :)

I am not familiar with Relora, but I've just been to the manufacturer's website. It appears to be a combination of two herbal extracts that are said to reduce anxiety (and also cortisol as a result). Some studies are referenced on the website, and I will plan to take a look at them.

Once again, your pictures are so special. Thanks ever so much for sharing them with us!

Marianne

[Squirt's Mom]

Hi Jani,

The pics of Maisie are just wonderful! My favorite is the one of her in the little hat; the expression on her face is priceless.

Some of us were blessed with fur-less kids but we have all been blessed with kids that are covered in fur. Regardless of the variety of kid we have, when we lose them we have lost a child that can never be replaced. The love and care we give to our babies is the same. We worry about their welfare, we make sure they have all they need to be well and safe and happy, we dote on them, show them off with pride, we give them our all. When they are gone, the void they leave behind in our souls is vast and, at times, threatens to consume us. When those times come, having someone to talk to who understands our pain is vital.

Honey, we do understand so well what you are going through. We understand the depth of love you feel for your sweet Maisie - and that you will always feel this love for her. Please know we are here for you anytime you need to talk. As Marianne said, we have a special place where you can share your memories of your life with Maisie. She will always be remembered and honored here.

Hugs,
Leslie and the gang

[MBK]

Jani,

I am so glad you were able to post the pictures of Maise!! I truly enjoyed looking at them. I liked them all so much, that I can't decide on a favorite. She was a gorgeous, happy baby. One thing that is clearly evident is that Maise had a very full, rich life. She was so lucky to have been loved by you and I know you feel you were even more lucky that she was in your life. I once heard that dogs are not here as long as people because they already know what people take a lifetime to learn (if ever). They are kind, they never hold grudges, they take pleasure in the simplest things, they are always happy to see you and they love unconditionally. I'm sure you learned a lot from Maise and she will always be a part of you.

What incredible memories you have. Thanks for sharing her pictures with us...they made me cry, too.

[jani]

Thank you all so very much. I cried reading everyone of your notes. I know.... a lot of tears these days. She was such a special little dog. I found her as a rescue, but she is the one who rescued me. Yes, I agree, we learn more from them then they do from us. Just to give love always and unconditionally seems so effortless for dogs. Last year I took on my ex-boyfriend's dog Sparky. I have known him 13 of his 14 years. He and Maisie were best friends. He is pretty depressed these days and I know misses her. The worried look on his face when I brought her home from the hospital when her tumor created havoc in her.......he knew. It's not the same here at the Dog Spa without her. My goal with Sparky is to get him into the Guinness Book of world records as longest living dog ever!

I have found a support group at the SPCA for losing a pet. It is only once a month and I look forward to my first meeting which is not until June something.

Marianne, do I put up the memorial for Maisie? Or do you do it?

Also, the more I research Trilostane the more I think it was the drug that enlarged her tumor or created a new one. Or maybe just enlarged her pituitary. I think it cut her life short. I know the Cushing's was going to do that as well....but not all Cushinoid dogs have this happen to them.....right? Isn't it different in every dog? If you want to answer me privately that would be fine. I don't want to be a drag on this site. But the vet would not give me a straight answer. Do most dogs with Cushing's just not wake up one morning?
I don't hold it against her vet. I know they all just want to help and figure out this damn disease as much as i do.

Thanks Leslie for your words. Thanks for understanding so much.

[addy]

Jani, you are not a drag. Please don't think that. We understand your need to try and figure out what happened. I honestly don't know if you can. So many things can develop, can happen.

You will work through this and all the stages of your profound grief and we will be there for you to help in any way we can.

Sending you love and hugs and understanding.

Addy

[littleone1]

Corky's adrenal tumor has increased in size, but his last U/S showed no further increase. He's been taking Trilostane for 19 1/2 months. It has really helped him. His IMS felt that Trilo would be easier on Corky than Lysodren because of all of the medical issues he has. I personally am glad that Corky is taking Trilo. Some furbabies do better on Trilo, and some do better on Lyso. Corky's quality of life has been so much better with the treatment.

Even though some furbabies with cushings do cross over, most of the time it's due to other issues. Please don't think it's anything you did. You did what you felt was best for Maisie.

Terri

[labblab]

IMarianne, do I put up the memorial for Maisie? Or do you do it?

Also, the more I research Trilostane the more I think it was the drug that enlarged her tumor or created a new one. Or maybe just enlarged her pituitary. I think it cut her life short. I know the Cushing's was going to do that as well....but not all Cushinoid dogs have this happen to them.....right? Isn't it different in every dog? If you want to answer me privately that would be fine. I don't want to be a drag on this site. But the vet would not give me a straight answer. Do most dogs with Cushing's just not wake up one morning?
I don't hold it against her vet. I know they all just want to help and figure out this damn disease as much as i do.

Hi Jani,

There are two different ways in which our Cushpups can be memorialized here :o :o. The first is by listing them on our thread of honor, and this is something that can only be handled by a staff member (like me ;)). So if you would like to tell me the date that that Maisie passed and also which photo you would like to have linked to her memorial line, I can take care of all the rest. You can either post that information in a reply or in a Private Message to me. Here is a link to that memorial thread:

http://www.k9cushings.com/forum/showthread.php?t=2865

In addition, we invite every member who wishes to do so to start a new thread of their own on our "In Loving Memory" forum. This is something that would be entirely up to you, as is whatever you would choose to write. Some folks write tributes, others just write their thoughts about their furbabies and how they are doing. Everything and anything is OK! Here is a link to that forum:

http://www.k9cushings.com/forum/forumdisplay.php?f=8

Also, if you have some specific questions that you'd like to ask about what happened to Maisie, we can try our best to help you make some sense of things. None of us are vets, so our answers are based solely upon our personal experiences and reading. And as Addy has said, there just may not be answers to some of your questions. From my own experience, I know that can be the hardest part. Since I did not have an MRI or CT scan performed on my dog, I can never know for certain what caused his failure. But if there are some specific questions that you'd like to ask, we will do our best to help you, OK?

Marianne

[jani]

Hi Marianne,

Maisie passed away on May 4, 2011. I think the photo which is her album cover. The one with her comics crown on. She has this regal look on her face.

thank you Marianne.

You all are really helping me through this. I can't thank you enough.
I added some more photos to her album. A couple with Sparky her big brother. Sparky is 14!

[labblab]

Oh Jani, that is such a wonderful picture. Maisie's memorial line is now complete, with her sweet face shining through.

And Sparky looks like a sweetie-pie too, all in his own right! I love the picture of the two of them sleeping together on the couch.

Big hugs,
Marianne

[MBK]

Wow, Jani! Sparky does not look like he is 14!!!! What a handsome guy! If you hadn't said anything I'd have guessed he was still a puppy! I saw Maise's memorial...love that picture!

Hope your pain is easing a bit and the good memories are filling the void. Keeping you in my thoughts!

[jani]

Hi Marianne,

I was wondering in the time you have been on this site and learning about Cushing's, do you ever find out what the final blow is to the Cushinoid dogs? Maybe you have information from another source? My Maisie basically had a brain tumor that made her lose her vision, dementia, neurological mayhem basically. Whether this was a
macro adenoma or some other sort of mass the vets did not know. They just knew it was a brain mass. How many times have you heard this? Is this the usual thing? Do you think the small tumors grow larger usually? What do other dogs experience in the end? Now I'm thinking I should have given her melatonin.
Sorry for all the questions. I'm just trying to cope with this and not doing such a great job. I cry all the time missing my baby.

thanks,
jani

[StarDeb55]

Jani, I have not posted to you before but have been reading. First of all, let me offer my deepest sympathies on Maisie's passing. I know words don't mean a lot right now, but I am thinking of you.

I can tell you how I lost my 2 Cushpups. ( Yes, I have been lucky or unlucky enough to have to fight this dratted disease with 2 pups, now.) My first boy, Barkley, had been successfully treated with lysodren for nearly 8 years without any major problems with his Cushing's when he was diagnosed with lymphoma. I did put him through chemotherapy which gave us 20 more months together for which I will be forever grateful. B had an excellent quality of life during those last months. B was 15 when he crossed the bridge. I lost my 2nd boy, Harley, last October. He had been successfully treated with lysodren for 2 1/2 years. Harley developed what was probably a rapidly growing bone cancer in his upper jaw that had already spread to both lungs by the time I realized something was very wrong. With the spread to both lungs, there was no other choice but to help him in his journey across the bridge. He was 15 1/2 when he passed. I have discussed the fact that I lost both boys to some type of malignancy with my derm vet who I have tremendous respect for, & he is also extremely knowledgable. My thoughts, which I expressed to the derm vet, were that since Cushing's suppresses the immune system, is it possible that with the immune system being compromised, it can't recognize malignant cells as "foreign", & attack those cells to try to get rid of them. This poor immune response then allows the cancer to grow/spread unchecked. My derm vet said it's possible, but there is absolutely no research to support my idea. I maintain that idea to this day as it's the only thing that keeps me from shoveling blame onto myself. I, also, know that our babies are very, very good at hiding when they feel bad, & you may not notice anything until the situation is "out of control". This is what happened with Harley, & I still blame myself to a certain extent.

With Barkley, he suddenly quit eating, & I knew that something was desperately wrong as B would never turn down food under any circumstances. I spent 2 weeks running B between the derm vet & his regular vet with neither of them being able to give me any answers. When the derm vet sent us to an internal med specialist, is when the lymphoma was finally diagnosed.

I know you are grieving terribly right now. I can tell you from my personal experience that you have to tell yourself that you did the best you could with the information you had available. Maisie knows you tried very hard on her behalf, & she would not want you blaming yourself.

Debbie

[labblab]

Hi Jani,

I have been a member of this canine Cushing's family since 2003. And during this time period, it has been a small percentage of members here who have reported the kind of neurological problems that became catastrophic for both Maisie and my Barkis. It does happen, but it is definitely not the norm. From what I have seen here, for the majority of dogs who suffer from pituitary Cushing's, the tumor does not enlarge sufficiently during their lifetime to place enough pressure on the brain to cause the problems that you and I experienced. And this includes dogs who are being treated with both trilostane and Lyosdren.

Many Cushpups are already seniors when they are diagnosed. So once their Cushing's symptoms are effectively controlled by medication, they go on to live out their normal lifespans and end up dying from the types of problems that are inevitably associated with the end of life: failures of the heart or kidneys, or a stroke, or cancer as was the case with Debbie's boys, etc. It is not the Cushing's, per se, that ends up being the final chapter. It is an old and failing body.

But there are also younger dogs who are diagnosed. And once again, if the Cushing's is effectively controlled, then they can go on to have many quality years. However, if the Cushing's is not controlled and cumulative chronic organ damage occurs, then the dog may suffer from serious problems such as major organ damage, or uncontrolled infections.

For those few of us who have had dogs who suffered from enlarging pituitary tumors, however, it is a very different picture. It is not organ or systemic body damage that is the culprit -- it is the catastrophic effect on the brain's ability to function normally. And from what you've written, I'm guessing you and I both know what we are talking about and how hard it is to witness that happening in your beloved companion. For my boy, it included pacing, acting dazed and confused, loss of coordination, and finally the inability to even eat and drink. Since I would never wish this experience upon anyone else, I am very grateful that most members here will never have first-hand knowledge of what you and I both saw. Thankfully, it is not common. I have now witnessed a lot of dogs being treated with trilostane and Lysodren, but very few who develop these neurological complications.

So it is not something that you could have predicted or forseen. And if Maisie suffered from elevated cortisol (which I assume she did), then melatonin would not have been a sufficient treatment to control her cortisol. In good faith, you made the treatment decision that made the most sense for her.

There are some researchers who advocate for proactive MRI or CT imaging for any dog who is suspected of having a pituitary tumor, so as to permit early radiation intervention to reduce the liklihood that any large tumor can increase to an even more problematic size. This sounds great in theory, but knowing how much this imaging costs and also what is involved in current standard radiation therapy -- I cannot imagine many owners who would be willing or able to go this route with their dogs. So for the most part, we are all left with making the best decision we can with the information that is readily available to us. I think Debbie has already said this so well, and I hope you will be able to take what she has said to heart :o:


I know you are grieving terribly right now. I can tell you from my personal experience that you have to tell yourself that you did the best you could with the information you had available. Maisie knows you tried very hard on her behalf, & she would not want you blaming yourself.

Sending you many, many hugs.
Marianne

[jani]

I'm so sorry for your dog Barkis. Was he on Trilostane? How long did he have Cushing's?How old was he when he passed? Maisie was only 11.5. At least 5 years was carved off of her life. After reading your note, now I know why her doctor felt so bad. This is not the norm. The SF Vet Specialists sent a cash contribution in Maisie's name to the UC Davis Veterinary School. I'm sure he was behind it. He has his Phd from Yale and UC Davis in Internal Medicine in canines. He kind of knew his stuff....but I feel a little like......did he?? Why wasn't she on high blood pressure meds? Her blood pressure was really high when she went into the ER hospital. At first they thought a stroke for her, but then knew it was a brain mass because of her severe symptoms. If they had asked me for an MRI on her brain a year ago I would have said yes. She was so much stronger then. I would have to say the last 4 to 5 months things started to get worse. More loss of hair....panting...more water etc.... Another ACTH and the doctor upped her meds again to 170 mg a day. She weighed 24 lbs. Two weeks later after her meds were raised.... the meltdown happened. Also after her meds were raised she developed calsinosis cutis. Now I diagnosed this from the internet. I pointed it out when she was in the hospital, but she had much more serious issues at hand.

re radiation:
I agree. Radiation therapy is 4 to 6 weeks everyday. The poor little dog is then put under anesthesia many times through this. Also a dog with neurological symptoms of the tumor being larger is not a good candidate apparently. But you probably know all of this. The state that Maisie was in....well....I can't imagine her being able to endure any of that.

I feel once again....why my dog?? Why does Maisie have to have a mental meltdown to the point of being blinded. She was so pampered and loved on a daily basis. It just doesn't make sense to me. I would give anything to have had her live until she was 15 or so even with the Cushing's. None of it bothered me. It worried me, but did not bother me....I would take care of her until the end of my life. She knew how much I loved and adored her.
The thing about all of this is that though she Cushing's and as we all know it's a really bad disease....her meltdown came suddenly and it all happened so very fast it was a shock. I was not expecting it at all.
My boyfriend walked her that afternoon and said everything seemed fine......well for how she was lately. Her hind legs were getting really stiff.

And Debbie....I'm with you. Like any disease that suppresses the immune system....like HIV.....different diseases invade the body and it can't fight it off. I'm so sorry for your pups. I can't believe you went through it twice. Were they the same breed? How long did it take for you to feel better. I'm still a mess. Tomorrow it will be a month.

thank you all again!
jani

[StarDeb55]

Jani, I will miss Barkley until the day I rejoin him. He was truly my "heart dog". The acute grief over Harley probably lasted about a month, then it gradually started easing. I am really a believer in the old saying, "time heals all wounds". It's been 8 months since I lost Harley, & not quite 5 years since Barkley crossed. I have wonderful memories that I can reflect on without breaking down in tears.

Barkley was a Lhasa/Shih Tzu mix, Harley was 100% Shih Tzu.

Debbie

[apollo6]

Dear Jani
You did all the right things. I looked at your photo album of Maisie and can see how greatly she was loved. I am glad to hear you joined a support group. It is hard enough to see them go through this awful disease and question if we did the right thing by them and then to lose them before their time. My thoughts and prayers are with you. My Apollo is on Trilostane since June of last year. And yes it is a give take. The side effects.
Hugs Sonja and Apollo

[jani]

Hi Sonja,

Thanks for your note. Perhaps Appollo will live out his life on Trilostane. I hope so. I thought maybe, by chance, Maisie would. But she was broad sided by this neurological meltdown. It was just so horrible. Marianne said it is not the norm. Why Maisie.....I will never understand....never.
A tumor is a tumor, who knows how they are going to grow or not grow. The doctors barely know if at all.

Give apollo a big hug for me. He looks so cute!

take care,
jani