Griffey 15 yrs old Yorkie - Radiation for macro?

[Griffey]

Hi, my name is Tom and my dog Griffey was diagnosed with Cushing's disease two weeks ago. Griffey is an 11 year old Yorkie and weighs slightly under 8 pounds. Griffey also has colitis and has had what they thought was pancreatitis twice. Back in June I took him to get his teeth cleaned and broken tooth fixed. They did blood work that showed that his bun and alkp was slightly elevated, so I took him to Ohio State Internal Medicine and they rechecked it and did an ultrasound of his kidneys. Everything came back normal except for his alkp slightly elevated. They said he might have swallowed some blood from the bad tooth to cause his bun to be elevated and the alkp could be from a cortizone shot he had. His alkp kept getting higher everytime he had blood work and his vet never mentioned cushing's disease. Three weeks ago I noticed he was drinking alot and urinating alot so I took him to the vet and I had him do blood work to make sure it wasnt his kidneys even though the vet didnt think it was needed. The fat was so thick he could do the blood test in office so he sent it out, after getting the results he then ordered a ACTH test that came back at 5.6 pre and 33.4 post. After being diagnosed I took him to Ohio State Internal Medicine and they did an ultrasound that revealed adrenal glands normal, a few indistinct nodules on liver either benign aging change or cancer, multiple nodules on spleen and right lobe of pancreas enlarged and irregular. The appearance of pancreas was most consistent with pancreatitis but cancer couldnt be ruled out.
The kidneys were noramal except for a cyst on left kidney. He has lost some muscle on the sides of his spine. I need help on deciding which medicine to give because of his other health problems. My vet recommends lysodren and Ohio State recommends trilosane. Is there any other treatments that anybody recommends or supplements and has anyone had the transsphenoidal surgery with success. Any help would be greatly appreciated

[addy]

Hi and Welcome,

It sounds like you and Griffey have been running back and forth between clinics, must be stressful for you.

From reading your introduction, it sounds like one vet diagnosed Griffey based on an ACTH test, some symptoms and some elevated blood work readings yet when you went to Ohio State the ultra sound showed normal adrenal glands but possible pancreatitis.

I think first things first and before we start talking about which meds to use, we want to make sure your pups has Cushings. No one test is perfect to diagnose Cushings so history and an ultra sound certainly aid the diagnosis.

Has Griffey been tested for Hypothyroidism? What did Ohio State say about Griffey's ultra sound?

If it turns out the Griffey indeed has Cushings, it helps to use the drug the treating practitioner is most knowledgeable about and has experience with. Having said that, my pup also has IBD/colitis and that was one of the reasons I chose Trilostane over Lysodren. But I don't think we are at that point of discussion yet.;)

Take a deep breath, others will come along with their input as well.

[Harley PoMMom]

Hi and welcome to you and Griffey,

The diagnosis of Cushing's when other health issues are involved is suspicious. Cushing's is one of the most difficult diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing it and other non-adrenal illnesses can create false positive results on all tests for Cushing's.

My boy, Harley, had pancreatitis which was first found on a ultrasound. His pancreatitis was confirmed with a spec cPL test, I highly recommend having this test performed on Griffey. Pancreatitis is an illness that can cause false elevations in an ACTH stim test. So I really do suggest that the Cushing's diagnostic tests be put on the back burner until the pancreatitis is confirmed and under control.

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

Love and hugs,
Lori

[molly muffin]

Absolutely agree with Lori and Addy.

You have 3 things that can cause cushings, a tumor on the adrenal gland, which has been ruled out with the ultrasound, prolonged use of steroids, (has that been the case with Griffey?) and a pituitary tumor, which could be confirmed with a follow up LDDS test (has that been done?).

Next, you have a pancreatic episode possibly happening, which needs to be addressed first and foremost.
Then you have nodules on spleen (this can cause high ACTH readings and was the case with one of our moderators dogs), you have possible nodules on liver (this can cause both the high liver values and the high ACTH values)
All of those things are there right now and need to be considered before treating for cushings. You don't want to give the medication for cushings till you know that is really what is going on and that ultrasound raises quite a few red flags for something Other than cushings.

I'm not saying it isn't cushings, just that you have some things that really need to be addressed first before going down that road.

Can you post test results with any abnormal high/lows and ranges and let us know about the LDDS test if that was done. Also you could try having a UC:CR test which cannot confirm cushings but if negative can rule it out.
Have they done a culture to check for a UTI? Thyroid panel? What is the glucose readings? These are just more questions that need to be addressed prior to treatment.

I hope we haven't overwhelmed you. We are a bit of worry warts around here, but that is because we see so many cases all the time and know through experience what needs to be looked at. Then we can talk about medication and dosing protocols.

Sharlene and Molly Muffin

[SoggyDoggy]

Hi Tom and welcome.

It sounds like you have been doing a bit of reading up on here, in your first post you answered the two most frequently asked questions! What does the dog weigh and posting of blood results (though there will inevitably be more questions, like those from Addy):D.

Even being new to the cushing's merrygoround myself, I would still question the cushing's diagnosis if the adrenals looked normal. That in itself is... well.... not normal, but I am glad to hear that you are already seeing an IMS. Before going any further with the cushing's though, I would probably follow Lori's advice re the spec cPL test. Hopefully that will give you a more accurate picture of what is going on with Griffey's pancreas and you can tackle one issue at a time.

Basically I just wanted to say hi and glad you found this place. There are some amazingly knowledgeable folks here (I don't claim to be one :p) who do a brilliant job answering questions for others, so whenever you have one, do ask. Good luck and we look forward to hearing more about Griffey.

[Griffey]

On Griffey's ultrasound report it says his adrenal glands are normal size and bliaterally smooth and symmetric. What does that mean? I thought one or both would be enlarged depending on what type of cushings he had. I'm going to a different Vet tomorrow to see what he recommends and I will post some of Griffey's lab work tomorrow. Thanks for everyone's help.

[labblab]

The ultrasound report makes it highly doubtful that Griffey has an adrenal tumor -- a mass or growth would typically be visible on the imaging. The majority of dogs with pituitary Cushing's exhibit enlargement of both adrenal glands, but it is my understanding that up to 30% of dogs do not -- presumably when the disease is mild or in the early stages. So the fact that Griffey's adrenals are not enlarged does not totally rule out pituitary Cushing's.

Marianne

[Griffey]

My dog is experiencing neurological symptoms. Ohio States Internal Medicine Department thinks his tumor has become a macro tumor. What is the best type of radiation therapy?

[judymaggie]

Hi, Tom -- welcome back to you and Griffey! I am thrilled that Griffey has made it to the age of 15 and I'm sure your good care has a lot to do with that. I have merged your current inquiry with your original thread about Griffey. I know there are members who have had their dogs undergo radiation therapy -- I will do a search to see if I can come up with the links to their threads. I am wondering if any radiation therapy center would consider Griffey as a candidate because of his age. Did Ohio State think this was a possibility?

[Griffey]

Thanks Judy. Yes Ohio State mentioned radiation and was wanting to do an MRI. Any help would be greatly appreciated.

[labblab]

Hi again,Tom! You'll see I've taken the liberty of revising your original thread title in order to better describe Griffey's situation right now. As Judy says, you've done a wonderful job of shepherding him throughout these past few years. If you'd be willing to fill us in, at least generally, as to what's transpired during this time, that would be a big help to us. Also, we'd appreciate it if you can tell us more about Griffey's neurological symptoms.

I am guessing Ohio State has already let you know that radiation therapy is not necessarily a permanent cure for either Cushing's or for the effects of a macrotumor. The goal is to reduce the size of the tumor to the greatest extent possible, thereby relieving the pressure on the brain that is causing the neurological issues. Some dogs also receive at least a temporary respite from Cushing's treatment, as well, although others do not. Over time, the expectation is that the tumor will resume growing again at some point. But what you are hoping to gain is an extended hiatus during which your dog is allowed to return to a much more normal state.

As far as what is the best type of radiation, unfortunately I don't think we can answer that question for you. Traditionally, the radiation to reduce a macrotumor has involved around 12 separate treatments spaced throughout a month. Some centers are now offering more cutting edge laser treatments that involve only a few sessions. The obvious benefit to fewer sessions is the need for fewer anesthetics and fewer hospitalizations. However, I honestly cannot tell you what the comparative statistics are in terms of overall treatment success. Have the folks at Ohio State given you any idea as to what type of treatment regimen they would be offering to you?

One of the huge drawbacks to any type of radiation is simply the cost. Imaging of the head is very expensive; actual treatment is even more so. I lost my own Cushpup to what we assume was an enlarging macrotumor, but cost was one of the issues that kept us from pursuing either advanced diagnostics or treatment.

Given Griffey's age, you would have a lot of variables to factor into this type of treatment decision. First and foremost, can he withstand the rigors of the treatment itself? Secondly, what is the general status of his overall health, including his Cushing's? Would you expect that he would have enough quality time left to enjoy the benefits of radiation treatment assuming all goes well?

These are just a few preliminary thoughts. As I say, it will help us a great deal if you'll tell us more about what all has transpired since we saw you guys last. Once again, we're really glad to see you even though we're sorry Griffey is experiencing some new and serious problems.

Marianne

P.S. Here's a link to a thread in which a number of folks have posted their experiences with macroadenomas. I'm hoping you may find some of the information there to be useful.

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

[molly muffin]

I dont know which specific radiation therapy it is called but university of Davis California now uses one that only takes a series of two treatments instead of the older 12 treatments. Ohio state could certainly find out what Davis is using.

[LauraA]

There have been handful of people that have had cyberknife radiation on their dogs.

http://www.k9cushings.com/forum/showthread.php?t=7741&highlight=cyberknife+radiation

http://www.k9cushings.com/forum/search.php?searchid=1009902