Six Year Old Daschund -- Rolo -- cushings--(Passed away 17 August 2012) [Archive] - Canine Cushing's Information and Support Forums

Bgoods

12-22-2011, 05:50 PM

Our dog Rolo was recently diagnosed with Cushings Disease. Rolo is a purebred Mini Wirehaired Daschund.

https://lh4.googleusercontent.com/-irIt0P07JwE/TvOloufqzGI/AAAAAAAADbQ/djuQvXzWlXE/w588-h400-k/20060723_100_1313-1.jpg

This started back in the summer when we noticed that he had begun to drink and urinate a lot. We took him into our vet and after blood testing and an ultrasound concluded he has Cushings.

An interesting point in this is that we had a sr. wellness blood panel done on him in May, and there were no glaring abnormalities showing then. In July, we noticed the onset of symptoms and a followup panel led our vet down the road of Cushings. She always cautioned that while he was displaying some of the signs/symptoms (to include the pot-bellied look) he was not displaying all of the symptoms. She then proceeded to order the ultrasound and then a panel that was supposed to be the definitive test for Cushings. Based on those results, we began a regime of 10mg 2x daily of Vetaryl.

Since then we eventually upped his dose to 15 mg 2x daily, however, after a few weeks, he developed pancreatitis and we withheld the vetaryl while treating the pancreatitis. After getting him over the pancreatitis, we resumed the vetaryl (doing 10mg 1 x daily and 15mg 1x daily). However, after about 2 weeks, he begin to exhibit lethargy and extreme dullness (understood as a possible side-effect of the Vetaryl). We again withheld the Vetaryl since the only remaining sympton of the Cushings was the pot-bellied. After about 2 weeks off of the Vetaryl, the heaving drinking and the urinating began, feeling we were again headed for dehydration, we resumed the Vetaryl at 10mg 2x daily. We finally stabilized his drinking and urinating again and decided we would leave him on that dosage until early 2011 then have his Cortisol levels tested.

One of the concerns our vet expressed after the pancreatitis is that his "liver levels" remained elevated, something not seen before the pancreatits.

Last night, he appeared extremely dull and listless and would simply lay in his bed not reacting to us at all. For the first time, he refused food. We called our vet at 7:30 pm and she met us at her office. She examined him and he was exhibiting symptoms of a respiratory infection -- swollen lymph nodes in the throat, wheezy sounds by stethoscope (although you could also detect them by putting your ear to his back and listening). No fever, but she decided to treat as respiratory, however without steroids.

After the pancreatitis and because of the elevated liver levels still showing up, our vet prescribed Amoxicillin and he took his last does on the December 20. She told us the Amoxicillin is not really as effective in treating the respiratory and may have only suppressed the respiratory infection and when Amoxicillin was terminated, it finally allowed the RI to more completely exhibit.

I asked my vet for all of Rolo's blood work, I need to swing by and pick it up. She did give me the blood work from last night. I noticed in some other threads, that some of the levels of interest are:

(Numbers in Parens () are from 6 December testing)
bilirubin -- TBIL - 0.4 mg/dL [no Ref Range] --(0.4)
creatinine -- 0.5 mg/dL [with a Ref Range of 0.5 - 1.8] --(0.4)
creatine kinase -- I don't see it on the blood report
albumin -- 3.0 g/dl [with a Ref Range of 2.3 - 4.0]-- (3.2)

A few other out of range readings:

ALT 679 U/L [Ref Range10-100] (673)
ALKP 716 U/L [Ref Range of 23-212] -- (433)
GGT 300 U/L [Ref Range of 0 - 7] -- (166)

AMYL 460 U/L [Ref Range of 500 - 1500] -- (No previous)
CHOL >520 mg/dL [Ref Range of 110-320] -- (>520)
EOS 0.1 u/L [Ref Range of .1 - 1.49] -- (.22)

Harley PoMMom

12-22-2011, 07:09 PM

Bgoods

12-22-2011, 10:21 PM

Hi and welcome to you and Rolo!

Rolo is such a beatiful boy! I am so sorry for the circumstances that brought you here but very glad you found us.

I was wondering if you could tell us more about your boy, such as his weight, and besides the Vetoryl, is he on any other medicines/herbs/supplements?

He started off only on the Vetaryl, he was on that for probably 2 months before the pancreatitis hit. Following the pancreatitis he has been on Denamarin as a liver supplement. For the respiratory infection, she put him on Tramadol (pain), zeniquin (antibiotic) and tomorrow he starts actigall (gall bladder).

How was his pancreatitis confirmed? Did he have a cPL test done? The cPL test result is specific for the lipase enzyme for the pancreas.

Yes, the cPL test confirmed the pancreatitis.

Another question I have is, was the testing that was done for Cushing's performed while Rolo was having pancreatitis? The reason I ask this is because all Cushing tests can create false positives when a non-adrenal illness is present.

He had two rounds of the testing to confirm the Cushings prior to the pancreatitis. The second round of testing was because there was just some inconsistencies and we wanted to rebaseline him with confirmation.

According to Dechra's Product Insert; an ACTH stimulation test should be done 10-14 days after any dose adjustment. Also for the ACTH test to be accurate for monitoring it must be done 4-6 hours after the dose of Vetoryl. Were these protocols followed? Could you post all test/s that were done, this would help us to provide you with more meaningful feedback.

Yes, these protocols were followed. That was exactly the way she told us to go with the testing. He was tested after 10 days, dose adjusted, then again a month later. It was right after the last test that he developed the pancreatitis.

Pancreatitis is a serious illness but it can be managed. My boy, Harley, had pancreatitis too. Liver enzymes will usually be elevated when a dog has pancreatitis, even the high cortisol from Cushing's will elevate the liver enzymes.

The elevated liver enzymes were never mentioned until the onset of the pancreatitis. We have had quite a bit of blood work done on him and she has it ready for me to pick up. I will be doing that soonest.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

Thanks for the welcome. Our vet has been super and we have discussed a referral to an IMS. She has really worked well with us in walking through the learning. She really sits and goes over the test results with us and walks us through the options.

Tomorrow he has a sonogram because of her concern for his liver (this will be second one). While the clinic is closed, she has said she will call us with the results. She has also offered to set up a telephone consult with one of the Dechra vets she has spoken to about Rolo, as well as helping with working the consult to the IMS.

apollo6

12-22-2011, 11:31 PM

Welcome
I am glad you came to us for your Rolo. I have a 13 year od dachie, Apollo who has been dealing with many of the same issues as Rolo, the pancreatiis, taking 10mg Vetroyl, he weighs 10.7 lbs. Ask us all the questions you want. We are hear to support and help in any way we can.
Hugs Sonja and Apollo

Bgoods

12-23-2011, 12:39 AM

Rolo weighs 24 pounds. He always hovered around 18. Looking back his weight gain may have been an earliest symptom. Over the past year he has jumped to the 24. At one point, he was slightly over 25.

In October, we put him on Nutro Ultra Weight Management. He had been on Eukaneuba for Doxies his whole life. We just bought another bag of the Eukaneuba to switch him back. We are just trying to eliminate any of the variables that may have contributed to any of his troubles. The pancreatitis came on a few weeks after switching.

Bgoods

12-25-2011, 09:47 PM

A tough Christmas for Rolo. On Wednesday he was diagnosed with a respiratory infection. His lymph nodes were swollen in his throat making it difficult for him to open his mouth/eat. Vet administered fluids, gave us Tramadol for pain and zeniquin for the respiratory infection.

He had a followup sonogram on Friday am, little sludge in his gall bladder. Main concern was his liver and though enlarged (normal for Cushings), no remarkable findings.

Called vet yesterday because Rolo was still not eating more that a mouthful since RI. She finally decided we needed to add prednisone to fight the inflammation in throat. Gave him first dose and we noticed a little bounce. He even ate and drank some.

Today, he seemed to just hang in. Can get him to eat a little, but not much. This is the first time he has refused food in his life. He will show just a brief uptick, then seem to just bottom out again.

Squirt's Mom

12-26-2011, 10:06 AM

Hi Bgoods and welcome to you and Rolo! :)

He is a handsome boy for sure!

Is Rolo still taking the Trilostane (Vetoryl)? If so, please stop now or tell the vet to stop it if she is still giving it. It sounds as if his cortisol could have dropped too low. Prednisone is the antidote for this. It sounds like you vet has a fairly good grasp on this but I wanted to make sure you know the Trilo needs to be stopped and pred given. Regardless, it is never wise to give treatment meds for Cushing's while a pup is sick. The meds are stopped til they are recovered, then restarted.

Have his electrolytes been checked? If not, that needs to be done asap.

I am looking forward to seeing those test results from when he was diagnosed. My Squirt had five Cushing's tests - LDDS, HDDS, ACTH, UTK panel, and two ultrasounds. After the second ultrasound they told me about a tumor on her spleen. Once it was removed, her cortisol returned to normal and has remained within range ever since. I share this to illustrate how a non-adrenal illness can cause false positives on these tests. Cortisol is one of the body's natural responses to stress of any kind and these tests cannot tell why the cortisol is present in such high levels.

On his ultrasound, what did they say about his adrenal glands? Were they visible?

How is he feeling this morning? Is the RI any better? Is he eating?

I know you are worried but please know you are not alone. We are here anytime you need to talk, even if it's just to vent your fears and concerns. We have broad shoulders and soft arms to go with our loving hearts.

Hope to hear from you soon and learn that he is doing better.
Hugs,
Leslie and the gang

Bgoods

12-26-2011, 11:01 AM

We had stopped the trilo on 22 December when he was first diagnosed with the respiratory infection. We did resume it on 24 December with a pm dose when the prednisone was also started. Not going to dose him with the trilo this am and we are dropping the prednisone back to 1/2 tablet (2.5 mg final dose).

His electrolytes were checked on 22 December and were normal. His electrolytes have been monitored pretty closely by our vet (she always mentions them after a blood test). I think she says she checks the to make sure we aren't edging him toward Addison's.

Thanks for the info on non-adrenals! Since the beginning our vet has cautioned that we may have something lurking under the Cushings. She says Rolo only read about half the book on Cushings. That is why we did the whole retest/rebaseline. The sonogram last week was concentrating on the liver. I think they said one of the adrenals was enlarged as was the liver. Our vet has been out of town and we have been on the phone daily with her (she demanded we call and always calls back if we leave any messages), so we have not sat and gone over the results completely. We will do that this week.

This morning he is eating and drinking some. He got up a few times last night to drink, no urinating. We have him on Eukanuba wet right now. Usually, we do a combo of the wet and dry but he has been very hesitant about anything that has to be chewed since 22 December. His lymph nodes still feel slightly enlarged, but better than Saturday.

It's been a long journey so far. Luckily, I have been able to work from home and monitor him. I have also spent way too much time reading about Cushings, but it has helped understand what our vet is saying.

Hope everyone had a wonderful Christmas with family and friends, even the non-furry ones!

Bgoods

12-29-2011, 10:37 PM

The last couple of days have been especially hard on Rolo. Our vet returned from her time with family and friends and I met with her on Tuesday. Rolo was not eating almost anything but a tiny bite here or there. She administered fluids and we tried some different antibiotics. He seemed to pick up, the Tuesday night while he was eating some turkey from my hand, I watched him literally pass out. He was out for a few hours, woke up and within minutes crashed again.

Yesterday, I did get him to eat a little more if I hand fed him. We made the decision to take him to UT Knoxville and we have an appointment on Tuesday morning. Today, he has eaten a little better, even eating some dry food tonight. Hopefully, the UT visit will give us a better grasp and plan for his care.

frijole

12-29-2011, 11:47 PM

I've been following your story and just wanted to let you know I'm sending best wishes and prayers for Rolo. It is great that he is at UT and in great care. Do keep us posted ok? Kim

addy

12-30-2011, 08:53 AM

I have been following along also. I hope UTK can help Rolo and get to the bottom of things.

We are here with you.

Sending prayers and hugs,
love,
addy

Squirt's Mom

12-30-2011, 10:41 AM

Hi B,

Please let us know what you learn at UT. I hope they have some answers and a plan of action to help Rolo get to feeling better real soon.

Hugs,
Leslie and the gang

Bgoods

01-03-2012, 10:39 AM

I went through all of Rolo's testing last night. I made a spreadsheet that can be viewed at:

https://docs.google.com/open?id=0By43iEm74cTeZTE4NmI1ZWItYjcwOS00NjNiLWE3Z TktNDBlNmI4NzE1MWM5

Hopefully that works. Note, that the Blood test is three sheets wide. Wasn't sure how else to best demonstrate that. On the blood work, the L/C column just indicates which tests were ran. Some of the tests don't include all of the testing values returns. So a Lasercycle Test and a Catalyst DX are the two testing options. Some of the tests were run by Antech, which also did the analysis of the cortisol testing (LDDS and ACTH).

Heading over to UT in a bit for his first appointment.

If any more insight is wanted on the individual testings, I have all of it, just not all available to everyone online. I can make selective portions available as I have more time.

Bgoods

01-03-2012, 07:31 PM

Day 1 at UT -- Radiographs, CBC, Cortisol testing, and Ultrasound --

Both Adrenal Glands visible on Ultrasound and both enlarged.

Rolo has some tenderness around base of skull.

Tomorrow -- MRI -- Looking for macroadenoma/mass that may have extended from base of skull (would explain upper neck tenderness). If macroadenoma is found, then probably radiation as treatment of choice, but will know more tomorrow.

Also expressed that they observed some mental inappropriate activity. When they described it, fit with what we have noticed in regards to his sometimes standing over the water dish and seeming to not know how to drink.

Little guy is slightly sedated but sleeping in his bed here at the hotel. He stays so sweet about all of this -- I would be biting everybody that touched me by now.

labblab

01-04-2012, 09:53 AM

Thanks so much for this update! It sounds as though Rolo is getting a very thorough assessment, and we'll be so anxious to hear what the recommendations turn out to be.

Please give Rolo a big hug from me for being such a brave little boy! :o
Marianne

Bgoods

01-05-2012, 08:49 PM

Macroadenoma was diagnosed yesterday. I saw the MRI and it was huge! Met with the oncologist and he recommended 16 radiation treatments. Rolo begins treatments on Monday. I was told that 30% of the dogs that receive radiation will NOT require further medication for Cushings. It would be nice, but if we have to give Rolo a couple of pills a day, that would be a blessing. The median survival is 1400 days, but we were also told that since this is typically an 'old dog' disease, we have his age on our side. However, a limited study also shows that with the pituitary/brain/mass ratio Rolo has is against him.

Returned home with him yesterday. He had a good day today! Finally eating without any medication for his appetite. He even climbed the stairs to the couch a couple of times today! Maybe he knows that the future now is brighter.

addy

01-05-2012, 09:06 PM

Sending hugs and healing prayers for your little guy. You have a plan of action and you know now what you are dealing with.

I'm praying Rolo has a bright future too.

UTK sounds amazing, how thorough. Rolo is a lucky dog to have you.

hugs,
addy

frijole

01-05-2012, 10:33 PM

Thank you for the update. While not wonderful news, you know you went to one of the best sources for info and you got answers fast so you can fight the macro. Had you not, you could have wasted valuable time. I know this is hardly a consolation prize but Rolo is in great hands with you guiding the way. Please give Rolo a big hug for me. Keep us posted ok? Kim

apollo6

01-05-2012, 11:36 PM

Will be praying for you and Rolo
Hugs Sonja and Apollo

Squirt's Mom

01-06-2012, 10:39 AM

Hi B,

You are so brave! I would be a basket case and you sound so calm and positive! Way to be, Mom! Rolo has the best medicine possible on his side - a strong, loving mom who is ready to face anything for her boy.

We have a thread started by another member who's baby also had a macro. Several folks have posted their experiences there so I thought it might help. Here is the link -

http://www.k9cushings.com/forum/showthread.php?t=3567

We are with you all the way, B. Anytime you need to talk, we will be here to listen, to hold your hand, to laugh and to cry with you.

Prayers and healing white light flying your way!
Hugs,
Leslie and the gang

Bgoods

01-09-2012, 02:59 PM

labblab

01-09-2012, 04:26 PM

Thanks so much for adding your thoughts to the Macroadenoma thread! I know from your note there that Rolo is completing his first radiation treatment today. I am beaming healing energy up to Tennessee, and will be so anxious to hear how things go throughout Rolo's treatment!!

Best wishes to all three of you!
Marianne

Bgoods

01-11-2012, 08:36 AM

Two treatments under his belt!! So far, nothing extraordinary to report. Monday, I dropped him off at 9 am and they didn't call until 6pm to pick him up. They said they had several dogs getting treatment and we knew it would be a little longer for him because it was his first treatment so they had several setup things to get done. Tuesday, dropped him off at 9, picked him up around 1130. The oncologist has called after both treatments to go over the day with me! Great communication from the UT staff!

On another note, the oncologist recalled that Rolo's tumor was 2 cm by 1.47 cm. Considering he is a doxie and not that big a head, that is hugenormous! The oncologist remains extremely optimistic about Rolo's prognosis. The little guy is doing well, even ate two pretty good meals yesterday. He did throw up a small bit of his food, will have to discuss this with the Dr. today.

2 down, 14 more to go!

labblab

01-11-2012, 09:09 AM

This is great news that Rolo is doing so well -- and eating!! WHOOPEEEEEEEEEEEEEEEE!!

We're right beside you, crossing off those treatments. So keep the updates coming!

Marianne

Squirt's Mom

01-11-2012, 09:26 AM

Hi Mom and Dad, :o:D

Wonderful news that Rolo is handling the treatments well so far. An appetite is a GREAT thing! :D I pray the next 14 go as well for both of you and that they work to their highest expectation.

Hugs,
Leslie and the gang

PS. Please note, I covered both genders in this post. :o:p Reminded me of a funny that happened a few years ago. I met a gal online and we got to chatting via email. I started noticing her emails were getting rather, hummm, flirty as time passed but put it off to missing nuances in communication via print. One day she finally made a blatant suggestion and I had to "gently let her down". Come to find out, based on my name, Leslie, she had thought I was male! Talk about embarrassed. :p

addy

01-11-2012, 09:39 AM

Go Rolo Go!!!! I hope things stay on track.

Sending love and hugs,
addy

Bgoods

01-11-2012, 12:58 PM

Something that stuck in my head when the oncologist was talking to me last week was his comment that in people, the first sign of a potential macroadenoma is headaches. Obviously, people let us know if they have headaches. For dogs, we just have to learn if there are symptoms that can lead us down that path.

After I left UT with the diagnosis of a huge macroadenoma for Rolo, I got curious about headaches in dogs. This morning, I finally googled dog headaches and found this potential list of symptoms (http://www.health-for-dogs.com/eight-dog-symptoms-a-possible-dog-headache#more-676):

You suddenly find your dog wants to hide in the closet where it is dark and quiet.
• Now your most affectionate dog in the world does not want you touching their head or stroking them at all.
• Dog symptoms like rubbing their head against furniture or on your body hoping for relief of this invasion in their head.
• Total avoidance of people and loud noises which only make their head pound more.
• Not interested in playing and only wanting to be left alone.
• Squinting with their eyes to avoid sunlight which worsens their pain.
• Seeking out cool places to rest their head upon.
• Not very enthusiastic about eating their meals (putting their head down to feed from their bowl can cause that throbbing)

The four bolded ones are definite behaviors we have observed in Rolo over the past several weeks. Last week we were chalking some of it up to "mentally inappropriate" when he would just stand at his water bowl and not drink. I wonder now if it had to do with not lowering his head. He also didn't like to eat from his dish. He would eat if I hand fed him -- he wasn't lowering his head! (duh!). He also seemed to appreciate it when we put his water bowl on a little wire stand that holds them up a bit. Now, seeing the last symptom, that really seems to fit.

I think recognizing advanced signs of the growth of pituitary tumors can help us seek out the help our pets need faster. I wish I had been a little more aware of the headache angle a couple of weeks ago, it might have sped up our coming to UT.

Bgoods

01-24-2012, 12:28 PM

We are 9 treatments into the 16 scheduled for Rolo and we couldn't be more excited. Although we had been warned that it could be several weeks after treatment before we saw positive signs, we have seen so many improvements in our little guy so far! In late December, we were having to medicate him with an appetite enhancer to even get him to eat. Rolo was never an "aggressive" eater, he always seemed to be more of a social eater. He would mostly not even eat unless we brought the food into the living room where we sat. Since we adopted our second dog back in October, Rolo had become more active in his eating, however, with the URI back in December, he almost quit eating entirely. I had to sit and hand feed him (could have been associated with the headaches mentioned in previous post).

Rolo now is an eating machine. While he still can't hold a candle to how quickly our other dog eats, he quickly cleans his bowl! He also does fairly well in the day, but at night, he tends to drink and urinate more. As the radiologist at UT said, only 30% of dogs can be medication free after the treatment, but we are hoping Rolo is one of them, but will gladly accept only having to give him pills daily.

Also, I can't commend the staff at UT enough. Our radiologist is wonderful and gives me daily calls to let me know how treatments go. We decided to board Rolo at UT for the remainder of his treatments because of some professional and personal reasons. It was tough dropping him off yesterday and knowing it would be a bit before we see him again, but we keep telling ourselves that we are doing the right thing for him and he is getting the care he needs.

Squirt's Mom

01-24-2012, 12:41 PM

Hi,

Oh, I can imagine how hard it was to leave your sweet boy! But I am sure you are making the right decision for him and yourselves - you made it out of love. ;)

It is so good to read your reports and see how well Rolo is doing with these treatments. You give hope to others who may follow in your footsteps - and hope has value beyond measure. I hope he continues to do as well and that he is soon back home in ya'll's loving arms.

Hugs,
Leslie and the gang

Cyn719

01-24-2012, 01:17 PM

Hi I was just catching up on your thread. DITTO TO WHAT LESLIE SAID. Praying for Rolo

Sending you lot of support strength prayers and hugssssss xo

apollo6

01-27-2012, 11:35 PM

Dear Rolo's parent.
You are doing a great job. He knows it. Hugs Sonja and Apollo

Bgoods

02-22-2012, 06:15 PM

Rolo Update:

Rolo completed his radiation on schedule at UT a little over 2 weeks ago. The oncologist recommended no Cushing's meds for 2 weeks post radiation to watch for side effects from the treatment. He did continue on the Denamarin and Actigoll (for liver and gall bladder) during the entire treatment.

When Rolo first started his treatments, we were giving him a pill to increase his appetite, post the treatments, he mows through his food (remembering that ravenous appetite is a "normal" in Cushing's). When we first picked him up, he was still having PU/PD, but not as bad as it had been. In the two weeks since, his PU/PD has significantly reduced!! This is exciting since the oncologist told us that only 30% of dogs treated would NOT require meds. He even told us at the session following the last radiation treatment that he did not expect that Rolo would be med free...

Last Friday we had his ACTH stim done to assess his status. The vet called Monday and told us that he is "borderline". She spoke with the UT oncologist and the path forward for Rolo is to just monitor for the return of symptoms then ACTH and possibly HDDS testing.

Rolo had gone down quiet a bit in his muscle tone. He was always a dog that would "sit pretty" and beg for treats. He had gotten to the point where he didn't even try to do that anymore. When we first picked him back up, he at least was trying to sit up, but didn't have the muscle mass to get more than about 1/2 inch off the ground with his forelegs. Last Friday, I was sitting on the couch eating a sandwich and I looked over and Rolo had gotten himself into a sitting up position!! When Susan came home we showed her, but it did take Rolo a few attempts to get there... So, while he has lost muscle mass, it is slowly returning!! He has even gone outside on some short walks (he was never much of a walker to begin with)! We are excited to see the improvements.

The sad thing is that we know the tumor is still there and will only regrow. Hopefully, the growth will be slow and we can enjoy many years with him! When it regrows, there are some options the oncologist said we can explore then, it will depend greatly on how our little guy is doing overall then. So, we will watch him for any returning symptoms and love him through it all. We are so excited that our puppy is slowly returning to us.

Squirt's Mom

02-22-2012, 07:14 PM

What a wonderful report! :) I am so glad Rolo is showing such strong signs of recovery to his former self. You both must be beyond ecstatic and justly so. I think your plan of action is great, especially the part about simply enjoying every moment with Rolo - that is all any of us have with our babies anyway, right this moment. ;) I pray your moments compound into years.

Hugs,
Leslie and the gang

Bgoods

08-08-2012, 01:35 PM

We are in August now, with Rolo's radiation from early this year behind us. The little guy seemed to be doing so well. His improvements were gradual and we kept marking the milestones as he worked his way back toward his pre-2011 form. Rolo had gained weight with the Cushings, he was almost up to 25 pounds at one point, in spite of us trying more and more to control his diet. Recently, he weighed in at 19.2 lbs! He had gained a lot of his muscle tone back and lost his "pot-belly".

The week of July 4th, we went traveled to spend time with family. As usual, Rolo went with us. Just prior to our leaving, we had noticed he was starting to drink a little more, and pee a little more often. While on the trip, it became even more prevalent. Shortly after our return home, we were up almost every other hour taking him outside and he was again consuming lots of water.

We took Rolo back to our vet. The urine tests showed no proteins in his urine, however there was slight lack of concentration. His ACTH results, which had been "gray area" before were higher. Based on a consult with the UT doctors, they had recommended that if there were no clinical signs present except the gray area results, then just carry on. With clinical signs (PU/PD) they recommended retesting and he was elevated.

Following the elevated results, we put him back on the Trilostane 19 July. Over the next couple of weeks, we watched the PU/PD decrease. Last week, we could detect a change in his eyes. He would sit there and it almost appeared as if he was ready to cry -- his eyes seemed very teary. We took him back in and they retested his ACTH. The vet said there did not appear to be any issue with his eyes, we were concerned because the size of the tumor previously had caused the UT staff to comment they were surprised his vision had not been effected.

The ACTH stim tests came back slightly high, but only barely above normal (4.x and 18.x I think I remember). However, since last week, we have noticed a decreased activity level and appetite. This week, he pretty much eats and lays around. When up, he sometimes just wonders around and will go stand by the water bowl but not drink. If he does drink, he reaches his head across the bowl and will only drink if the bowl is completely filled. This symptom was earlier attributed to the size of the tumor and the pressure from lowering his head.

Obviously, we are growing more concerned for our puppies health. We had hoped with the radiation to have a few more years at least before facing this again, however, it appears to not be the case. If the tumor is rapidly growing, it is not typical of the pituitary tumor which normally exhibits slow growth I am told. The UT vets had expressed that when the tumor grew back, there were still some minor things that could be done, but the radiation was the major thing that had the greatest prospect for improvement.

Our concern is that if it is the return of the tumor, given the rapid cycling, then any minor procedure/treatment seems like it would only potentially by him weeks. Have a call into our vet now to go over these latest symptoms. I don't like the prospects we are facing at all.

Squirt's Mom

08-08-2012, 02:54 PM

Hi,

If it were me, I would stop the Trilo. Letting the cortisol run a bit high might be more beneficial that lowering it at this point. Here is a study that found that Trilostane caused the pituitary to enlarge and may allow pituitary tumors to enlarge faster.

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

Trilostane-induced inhibition of cortisol secretion results in reduced negative feedback at the hypothalamic-pituitary axis.
Teshima T, Hara Y, Takekoshi S, Nezu Y, Harada Y, Yogo T, Teramoto A, Osamura RY, Tagawa M.
Source

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.
Abstract

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.

PMID:
19041802
[PubMed - indexed for MEDLINE]

If Rolo was doing better without the Trilo and the signs you were seeing are not an issue for you, I would certainly think hard about continuing treatment...with either drug ;)

Keep in touch and let us know how things are going.
Hugs,
Leslie and the gang

molly muffin

08-09-2012, 04:54 PM

Hi,

Just checking in to see what the vet had to say about Rolo's symptoms. Hoping for something positive!

Hugs,
Sharlene

Bgoods

08-10-2012, 02:04 PM

Wednesday I had a long discussion with our vet. We took Rolo off the Trilo. The feeling was that the medication could be causing the symptoms OR the tumor. The simplest way to check was to remove the meds and monitor to see what happens.

Yesterday (Thursday) he was still very symptomatic. He showed increased signs of wondering around and demonstrated difficulty in eating (he would pick up the food, attempt to chew, then just let it fall back out of his mouth). He also was hardly drinking any water and hardly any waste evacuation.

This morning, he did show some improvement, he ate all of his food. He was drinking some water, but still walking around aimlessly. The Trilo should be completely gone from his system by tonight, so we are hoping that the aimlessness will continue to drop.

Squirt's Mom: I had read the study about the possibility of the negative feedback loop potentially causing increased tumor growth. It was a minor concern of mine. However, the findings of the study don't demonstrate direct correlation has been positively identified nor does it suggest discontinuation of treatment. I think it raises a valid concern but I would have to consult with the Endocrinologist prior to discontinuing treatment based on a single study. I do appreciate your raising the study, having all the information at hand is so important in trying to decide what is best for Rolo.

If the withdrawal of the Trilo causes the neurological symptoms to go away, then we will have to monitor him for the reappearance of the cushings symptoms (primarily PU/PD has been the first noticeable). If those symptoms reappear, then we are going to consider Lysodren, but will consult with the UT staff first.

Bgoods

08-14-2012, 11:15 AM

We took Rolo to the vet yesterday. She characterized his condition as pitiful, which we think is pretty accurate. Since withdrawing him from vetoryl, he has not "bounced" at all. There was a slight uptick in his condition noted on Friday, but he has since slid further back. He has lost a lb since his last visit, only 2 weeks ago. He only lays around and hardly drinks/eats. He will walk around in circles then if you call him, he will jerk his head around as if very surprised.

We are trying to have a discussion with the UT staff today. But, here is where I think we are:

Radiation in January of 2012.
Return of Cushing symptoms (PU/PD) July
Treatment with Vetoryl, symptoms of Cushings resolved.
Coincident with Vetoryl notice of neurological symptoms (hesitancy drinking - standing over dish, aimless walking, circling, loss of appetite, glazed eyes).
Removal of Vetoryl after testing showed only very slight elevation on ACTH and resolving of PU/PD, but high onset of neurological symptoms. Only improvement was slightly less glassy-eyed look, the nictitans (third eyelid?) became slightly less noticeable.
Increased neurological symptoms.

Last night we started him on a pain med. A blood panel yesterday showed nothing remarkable in the blood work.

We were looking at two primary causes of the neurological -- the Vetoryl or the tumor.

The oncologist at UT had stated that the majority of Pituitary tumors are slow growing and non-malignant.

Removal of the vetoryl and no resolving of neurological with no other medical factors presenting seems to point to tumor.

The rapid onset of neurological and reaction of ACTH to Vetoryl may indicate that the pituitary is not the primary point of the tumor, what if this tumor is not "typical" and is malignant and/or fast growing? What if the tumor has taken a different path than the pituitary this time?

To confirm the tumor, we would need an MRI most likely at UT. That is an option. However, the MRI would only confirm the state of the tumor, its effects seem readily apparent.

Given his condition, we are having to look at quality of life for him. We maybe can medicate him for a short time, but the tumor growth seems so rapid that we are only delaying the inevitable. There is a possibility that the MRI would show no regrowth -- but then we seem to be at a loss as to what is wrong. All symptoms point to tumor with no other viable candidates for cause.

Am I overlooking something? Should we proceed with MRI? We have always chosen aggressive treatment with him, but this time I just wonder if we are delaying the inevitable.

Bgoods

08-15-2012, 04:30 PM

We had the MRI this morning. The tumor is back and larger than before. In addition, it is swollen and bleeding. We are putting him on steroids to see if we can get any response to the bleeding/swelling. However, this is only a short term "fix" and his prognosis is weeks to month. We will work with our vet to determine when his quality of life warrants a peaceful ending.

lulusmom

08-15-2012, 04:42 PM

Hi Rolo's mom and dad.

I am so sorry to hear that the MRI revealed that the tumor has once again reared its ugly head. You have worked so hard to give Rollo more time and a better quality of life so it broke my heart to read your update today. I realize it's little consolation at times like this but please know that I think you two are amazing caretakers and I'm sure Rolo would agree with us that he's a lucky guy to be your boy.

My thoughts and prayers are with you both and with Rolo. Please give your boy a hug for me and savor every moment you have left with him.

(((Huge Consoling Hugs)))
Glynda

molly muffin

08-15-2012, 11:41 PM

Oh no, I'm so sorry to hear this diagnosis. :( You have done so much for Rolo. You are such good parents that it is hard to hear of any further difficulties. I hope that the steroids help with the swelling and bleeding.

My heart goes out to you and to Rolo.

Hugs,
Sharlene

frijole

08-15-2012, 11:47 PM

I too want to commend you for all you have done. Sending love and strength to you and Rolo. Kim

Squirt's Mom

08-16-2012, 09:02 AM

Oh, I am so sorry to hear the tumor is back. :( Like Glynda, I was heart-broken to read your post and I know how very hard you have worked to make his life the very best possible. Please know we are here anytime you wish to talk.

Hugs,
Leslie and the gang

Bgoods

08-16-2012, 12:24 PM

Got Rolo home last night. He had an ok night, pretty restless. He did eat a little at 4am when we got up once. He is drinking some water.

Attached is a picture of the MRI. The image on the left is 15 August. Right is Jan of this year pre-radiation. I added the annotations to demonstrate the areas of concern.

https://plus.google.com/photos/116983186504348189629/albums/5777291594540638241?authkey=CMPHwMeFiLeIfA

You may have to click on the image to see the entire thing.

molly muffin

08-16-2012, 08:13 PM

Oh my goodness. That has really grown. Much more than I would have though with radiation being involved. A good night, even a restless one is probably a good thing at this point.
How will they determine if the medication is working? I'm just curious about that as it seems only another MRI would really tell or is there some differences in behavior that they asked you to watch for.

Hugs, thinking of you guys always,
Sharlene

Bgoods

08-16-2012, 10:51 PM

In this case "working" is a relative term. At best, the prednisone will help reduce the inflammation, curb the bleeding, and potentially help him "process the blood out of the tumor". It will not fix anything. The size of the tumor and the rapid growth are the primary issues, there is not medication to correct either of those (without destroying his brain). I asked the vet how long we would have to give the prednisone, she said, "the rest of his life, a week or so most likely if we are lucky." I never thought I would feel that a week would be "lucky", now each day is.

frijole

08-16-2012, 11:07 PM

You enjoy every single minute. Treats, hugs, kisses, whatever Rolo wants. Know we are with you throughout. Love and strength, Kim

molly muffin

08-16-2012, 11:20 PM

Oh I'm so sorry. I thought the medication would give him longer. :( Months maybe. Hoped anyway. As Kim said, anything he wants, every minute, it all counts.

hugs and more hugs,
Sharlene

Bo's Mom

08-17-2012, 12:48 AM

I am so sorry to hear about Rolo. He is so obviously loved and know that we are all here for you at any time.

Tina

08-17-2012, 03:44 AM

I have been following along with your thread and this news is heartbreaking. I am so so sorry. Please know that you and Rolo are in my prayers. I know you are treasuring every minute with him.

Love and many hugs,

Tina

Squirt's Mom

08-17-2012, 08:59 AM

Just popping in to let you know you and Rolo are in my thoughts and prayers. I know too well the horror of knowing something evil is growing inside your baby and there is nothing you can do to stop it. To know that each day may be the last. I am so sorry this has been laid on your plate. :(

All we can do is let them know every minute how much they mean to us, how much we love them, how much we want them to be happy and try to bring some small measure of joy to each day. I have no doubt that Rolo knows he is much beloved.

Hugs,
Leslie and the gang

Bgoods

08-17-2012, 02:17 PM

This morning we gave Rolo sweet rest. He did not have a good night. Had not gotten him to eat more than a tablespoon of food since Tuesday and he was not even drinking water. We held him while he drifted away then while he passed. Glad we could give the little guy some peace.

addy

08-17-2012, 02:21 PM

I am so sorry. My heart goes out to you. Words dont come easy at times like this.

Godspeed Rolo.

lulusmom

08-17-2012, 02:34 PM

I am so sorry for your loss. My prayers are with you.

Godspeed sweet Rolo.

molly muffin

08-17-2012, 03:16 PM

I am sorry for your loss of sweet Rolo. RIP.

Sharlene

Boriss McCall

08-17-2012, 03:57 PM

I am so sorry to hear about your baby. I know how painful it is.. :(

((((Big Hugs))))

Roxee's Dad

08-17-2012, 04:51 PM

So very sorry for your loss.

Rest in Peace Sweet Rolo. You are our newest and brightest star in the sky.

Squirt's Mom

08-17-2012, 05:17 PM

I am so sorry for your loss. There is no doubt in my mind that Rolo left this old world on the wings of your love, knowing he was most cherished.

Our thoughts and prayers are with you both,
Leslie, Squirt, Trinket, Brick, Tasha and our Angels, Ruby and Crystal

If it be I grow frail and weak,
And pain should wake me from my sleep,
Then you must do what must be done,
For this last battle can’t be won.

You will be sad, I’ll understand,
Don’t let your grief then stay your hand,
For this day more than all the rest,
Your love and friendship stand the test.

We’ve had so many happy years,
What is to come will hold no fears,
You’ll not want me to suffer, so,
When the time comes, please let me go.

I know in time, you too will see,
It is a kindness you do me,
Although my tail its last has waved,
From pain and suffering, I’ve been saved.

Do not grieve that it should be you,
Who has to decide this thing to do
We’ve been so close, we two, these years,
Don’t let your heart hold any tears.

Unknown