Re-introduction, new Cushings dog

[KristinB]

Hello all-
I'm Kristin and I live in Atlanta, GA. I was a member of this forum several years ago when my lab mix Maggie was diagnosed with adrenal Cushings. Maggie passed away at almost age 15 in 2010.

I am back because I just adopted a 10 year old dog who has tested as Cushingoid. Jake is a 21 lb terrier mix.

I'm quite rusty on Cushings and am hoping this forum will be helpful again.

Jake was started on 5 mg of Vetoryl. When he was retested, his levels were still high, so he is now on 10mg per day. I understand the need to gradually increase dosage to avoid Addisonian crisis. Vetoryl is completely new to me. I am curious as to the experience of others here...did it take a long time to find the correct dosage? It seems like a lot of bloodwork every 10 days, and it's quite expensive here.

I am hoping to just focus on quality of life for this sweet little guy at this point. His owner died and he ended up at animal control for eight weeks and was to be euthanized two weeks ago. I wanted to give him a chance.

Thank you in advance for any support and guidance.

[Spencersmom]

Hi Kristen and welcome back! I know everyone will be chiming in soon with questions about test results, so get ready!! Any advice is based on the info you provide...the more you can post, the better everyone is able to help! Thank you for giving your sweet pup a chance and doing all you can to give the love and care that precious baby deserves!!!

[labblab]

Hello Kristin, and welcome back to us. Bless you for adopting this sweet little boy!

In answer to your question, the amount of tweaking necessary to arrive at the optimal dose of Vetoryl can vary a great deal from dog to dog. But hopefully it will only take about 4-6 weeks and a couple of monitoring testings to get where you want to be.

One thing I've noticed is that your vet started out with an extremely low dose, so it is not surprising to me that he has needed an increase. At this time, the most commonly recommended initial dosing protocol is to use a formula of 1 mg. per pound. A noted endocrinologist at UC Davis recommends half that amount. But as you can see, beginning at 5 mg. was really low for a dog weighing 20 pounds. Another comment I'd make is that the manufacturer of Vetoryl recommends waiting 30 days to make a dosing increase, due to the fact that cortisol levels continue to drift downward during that time period. Therefore, by waiting, you are more likely to hit the dosing "sweet spot" the next time around. So now that your boy has been increased to 10 mg., even though that is still a low dose, you may want to ask your vet to hold off on another increase for another 3-4 weeks. That way, hopefully your next dosing change, should you need one, will more likely hit the "target."

Please keep us updated, and we are always anxious to see numbers for actual test results, both diagnostic and monitoring ;). Also, can you tell us more about the symptoms that prompted the Cushing's testing in the first place?

Thanks so much,
Marianne

[Squirt's Mom]

Welcome back, Kristin! Second cush pup, huh? :D They must know who to find that will give them a loving home as well as top notch care. ;) Lucky baby to find himself with you.

[3bostons]

Just wanted to say hello Kristin and say yay for you taking in the new pup. I have read so many stories lately here of dogs getting dumped at animal control simply for the reason of being too old or too sick. That just breaks my heart, of course when an owner passes thats hard enough too. But I wish I could take them all in, they need love and a good place to go for their senior years too. So glad you rescued this little one !
My girl has cushings for a couple years now, been on vetoryl, it did take a bit to get her stable but once we did she has been on the same dose now for over a year now and doing fine. I agree with you about the testing being expensive, I was so glad once the vet said that everything was good finally.

[KristinB]

Thank you all. I will get his actual lab results next time we are in.

I have emailed the vet about waiting the 30 days. He seems to feel quite good. You'd never know from his spirit he was sick at all, he actually has more energy than my beagle does! He does drink quite a bit still and has to go out frequently, but is a champ at using the dog door when I am not home.

I have a new vet now, as my other one moved. She is very young, and I think she is being ultra conservative with the dosage to start at 5 mg. I questioned it, and she was very adamant about avoiding an Addisonian crisis. I may have to go back to my old vet, who is farther away now, but he was so wonderful for so many years. If this vet does not agree with waiting 30 days, I am going to call or email my previous vet and get another opinion on it.

Marianne, I thought Cushings might be a possibility when I took him in. I've been down this road before, as you know. The main obvious issues were his pot belly and loss of hair on his flank. AC said he had terrible fleas and worms when he came in, so there was a possibility those were causing these symptoms, but in the back of my mind (and with my luck) I knew it was probably more. Obviously at AC they cannot monitor how much he is drinking or peeing, and they cannot afford testing. His kidneys, liver, heart all look good, so hopefully, for now, Cushings is the only evil to deal with.

Jake deserved a chance. He is the most well mannered dog I've ever had, including my own lol. He knew sit, down, "go to your mat", is housebroken and does great with my dog and cat. I'm not sure how he got in the condition he did when he came to AC, but he was the dog I could not stop thinking about, the one I knew I had to help.

I'd like to post a photo, but I don't have online hosting.

[labblab]

Oh Kristin, I repeat, you are an angel for taking in Jake. We will do everything we can to help support you both!!

Here is a link that may make the conversation a bit easier with your vet. It is monitoring flowchart prepared by Dechra (manufacturer of brandname Vetory). It is a little hard to read on the computer, but if you print it out on paper, it is easier to trace the "flow." At any rate, you'll see that unless a dog's cortisol has dropped too low on the initial dose that therefore needs to be decreased, the recommendation is to leave the dose unchanged for the first 30 days and then move forward with reassessment.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

Sometimes it helps to have official publications to show our vets. ;)

As far as posting a photo, do you mean that you don't have a way to store photos on your computer for uploading? As long as you can save a photo on your computer, hopefully you can also upload one to our site. In other words, you don't need a separate hosting system. Have you had a chance to look at these Frequently Asked Questions?

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

Marianne

[KristinB]

Thank you Marianne! I have just sent my vet the PDF and asked her to print and review it. My previous vet was very open to my questions. This one, not so much. Maybe it is time to seek a new opinion.

I'll check the FAQS. I only saw a place to add a link of an image, not an attachment.

[KristinB]

Added an album with two photos of Jake. Hopefully you all can see it. In the second photo, you can clearly see the pot belly and hair loss

[labblab]

You're right that members can only upload images as opposed to attachments. But if you are wanting to create a photo album or an avatar to accompany your username, an image is the only thing you need. :)

Also, in addition to that monitoring flowchart, you can find a lot of helpful written info about Vetoryl/trilostane here:

http://www.k9cushings.com/forum/showthread.php?t=185

Marianne

Edited to add: Just saw your photos and what a sweetie-pie, and yup, that hair loss and belly sure look pretty typical! :o

[KristinB]

His initial bloodwork showed creatinine of .6, BUN 11

His first ACTH test on Sept. 25:
pre-ACTH cortisol: 3.3 ug/dL
post: 35.6 ug/dL

At this point he was put on 5 mg Vetoryl.

Second ACTH test on October 7:
pre ACTH: 2.2 ug/dL
Post: 23 ug/dL

He was then increased to 10mg Vetoryl.

Thoughts please?

[Squirt's Mom]

What are the normal ranges given for the BUN and creatinine? Was a ratio shown?

[labblab]

I'm assuming those kidney values are within normal limits? How about Jake's liver values? Cushpups typically exhibit elevations in ALKP and frequently also in ALT. In fact, it is rather unusual if all liver values are totally normal. How about cholesterol and urine specific gravity? Cholesterol is often high and specific gravity is usually always low.

Also, are you certain that all worms and parasites have been totally eradicated? I know some worms (roundworms?) can cause a pot- bellied appearance and coat issues. It seems as though you've moved on from suspecting the worms, but the absence of any lab abnormalities whatsoever is unusual for Cushing's...

The original ACTH is indeed elevated, but the cortisol level did respond to the 5 mg. and should fall further with the 10 mg. Desired therapeutic range for a dog treated with trilostane should not exceed 9 ug/dl, and should be even lower if symptoms are not ultimately alleviated at 9.

Marianne

[KristinB]

normal ranges for BUN: 9-31 mg/dL, creatinine: 0.5-1.5 mg/dL

Urine specific gravity was 1.009. Ph was 7.5. I must also note that he did have a UTI, which he has taken 14 days of antibiotics for.

ALP was 884 H, very high with 5-160 U/L listed as normal. ALT was 139 H, also high with 18-121 listed as normal. What are the concerns here?

Cholesterol was 305, with 131-345 mg/dL listed as normal range

I was told the worms have been eradicated. He was dewormed twice at AC and vet saw no signs of any parasites or worms. Records say "slide reviewed microscopically, no parasites seen"

[labblab]

It may sound strange but those liver elevations are reassuring in that they are consistent with the profile of a Cushpup and therefore make the diagnosis more credible. ;)

[KristinB]

I do feel the diagnosis is correct based on the labs and the symptoms

[labblab]

Just wanted to add that, given the fact that Jake's cortisol dropped down to 23 from 36 on the 5 mg. alone, I would truly advocate for leaving him alone on the 10 mg. dose for close to the 30 days. It may well turn out that, at most, you may only need to make one more dosing alteration after that. :)

He sure is a cutie!

[KristinB]

I've gotten his records and made an appointment with my previous vet for Saturday to get his opinion on all this. I don't want to do premature, unnecessary testing every 10 days. It's stressful for Jake and expensive for me.

My previous vet was wonderful. He got me through Cushings, an adrenalectomy, two CCL surgeries, laryngeal paralysis and cancer with my previous two dogs. He never over prescribed, over tested, was conservative but always had their best interest (and mine) in mind. They lived to be 14 and 15. We did something right. I should not have changed. He is worth the extra drive now, I feel.

[KristinB]

3Bostons, I think Jake may have some Boston in him.

[labblab]

It sounds as though you will gain a lot of peace of mind by re-connecting with your old vet.

Of course I can't predict what his recommendation will turn out to be. But if you decide to leave Jake on the 10 mg. for the month, one monitoring option during that time period might be to perform a resting cortisol alone. This involves only a single blood draw without the cost of the stimulating agent. As long as the resting cortisol is higher than 2.0 (and of course, as long as Jake is acting well), you can have some reassurance that his cortisol is not dropping too low on the 10 mg. dose. From a safety standpoint, that is your biggest concern and the main reason for the more frequent testing.

However, if Jake seems to be tolerating the dose without a problem, your vet may feel that it is safe to just await another full ACTH at the 30-day mark. Definitely keep us updated, OK?

Marianne

[KristinB]

I will, thank you!

[KristinB]

Here was my current vet's response:

"Thanks for the literature. The purpose of the stim test 10 days after is to detect early addisonian issues . Yes, we can wait 30 days to test him again. In that case , please watch him closely for any lethargy , vomiting , diarrhea, or inappetance.
I understand your situation is tough. Thanks for letting me know. We'll make it work for you and Jake ."

So, it's just over-caution with the 10 day testing. I am certainly capable of watching for these symptoms myself.

[labblab]

In your vet's defense, the manufacturer's recommended protocol is indeed to test 10-14 days after beginning treatment and after any dosing increase because the ACTH is the best available method for accurately assessing how the drug is affecting the cortisol level. In order to avoid an Addisonian issue, you are wanting to identify a cortisol level that is drifting too low BEFORE it translates into observable behavioral/systemic distress. That way, the dose can be decreased before the dog risks getting into genuine trouble. So by extending the time period between tests, you are always taking a calculated risk that you may be missing important changes in cortisol levels.

The tests are indeed expensive and stressful, however. So in the real world, although it may be associated with the fewest side effects, the combination of starting at a very low dose and tweaking upward in small increments can lead to a lot of testing and cost. That's one reason why I'm a big fan of giving a dose 30 days before testing and increasing again -- so that you'll have the best chance of really knowing the optimal effect of that given dose before trying to judge how much additional change is really required.

Marianne

[Squirt's Mom]

You do have pred on hand? And know the rescue dose for your baby? And what to do if it does not work?

[KristinB]

Update: we went to see my previous vet this morning for a second opinion on Jake's treatment. He reviewed all of Jake's lab work. He does think we can safely wait 30 days or so to retest him. It will be closer to 25 days as we will run low on the Vetoryl by then and need to get a new supply.

He thinks Jake looks great, and he seems to feel great. There are no signs of Addisonian crisis. I am seeing a decrease in thirst and urination on the 10mg. I'm hoping we will get to his desired dose soon, if this is not it.

[molly muffin]

If you are seeing a decrease already, then this is probably working for him (the 10mg) If you see any problems, you can always retest sooner.

Sharlene and molly muffin

[KristinB]

So, Jake's most recent ACTH test showed cortisol at 14 ug/dl, down from 23 ug/dl, after being on 10mg of Vetoryl for about 30 days. His original level was 36.8 ug/dl when I adopted him and got him initially tested.

The vet who did this test tells me that 14 ug/dl is within normal range and she was "very pleased" with the results.

I am hearing from others and reading that on Vetoryl, however, that his cortisol is actually not controlled at 14 ug/dl and that it should be lower. This concerns me. I called the vet and asked her about this, even shared the Vetoryl information. She disagrees with me, telling me she is confident we do not need to adjust the dosage and that he is responding well, that his levels are normal.

This is all very confusing and frustrating. Do I need to see yet another vet who agrees that his levels should be lower and increase the Vetoryl? Help!

[Renee]

Your vet doesn't know what she's talking about. Run, don't walk, away from this vet. If she can't even follow the product protocols for Vetoryl, she should not be prescribing it.

[labblab]

Hi again! You will see that I have merged this most recent update into your original thread. It helps us to offer our most accurate feedback when we know the full context within which questions are being asked. And especially so in this case, because I am now reminded that this is not the first protocol irregularity if you are still seeing the new young vet.

There may be reasons why a vet would feel comfortable with not lowering a treated Cushdog's cortisol below 14 ug/dl, but there would need to be an explanation that is specific to that dog's circumstance. In other words, that would be the exception and not the norm. An example might be an elderly dog who is troubled by arthritis -- you might want to let the cortisol run higher as a compromise in balancing the two health issues. But in your case, your vet's reluctance to lower the cortisol into the desired therapeutic range seems like yet another example of an overly cautious approach to treatment. If it is not just caution -- if she is instead telling you that 14 ug/dl is within the desired therapeutic range because it is "normal," she is flat-out wrong. Either way, I do think you have a huge problem because she is avoiding a discussion with you re: the published protocol that you have already provided to her.

You had written earlier that you had consulted with your original vet when questions first arose. Even though it may be less convenient to go back to him, I think this new vet has pretty much struck out at this point. I agree with Renee that I would not feel comfortable letting her oversee my dog's care.

How is Jake doing in terms of symptom resolution and/or any ill effects from the medication? If he is outwardly doing great, that may be fueling your vet's reluctance to increase the dose. But a secondary goal of treatment is to lessen the risk of unseen internal damage. From what we know at this point, a cortisol level no higher than around 9 ug/dl offers the best hope for this type of protection.

Marianne

[KristinB]

We will not be returning to this vet practice. This was yet another very at the newer practice, thought I'd try another. Obviously the knowledge and attitude of this practice is not acceptable, for Jake, or me.

He does not have arthritis, or any other issue that I am aware of. He's feeling good, he's happy. That is his attitude though, he has such a great spirit. I have seen a decrease in thirst and urination, but it is still more than most normal dogs.


I will travel back to my previous vet. He should be able to use this test result and modify the dosage as he sees fit.

Thank you all. Jake is the priority here, not convenience.

[KristinB]

Appt made for tomorrow. Hopefully I will get some clarity.

[Dixie'sMom]

Kristin, I have been reading Jake's story and just wanted to say hi and welcome. What a blessing for that little boy after losing his home that you found him and love him! He is adorable. I recognize that bald little pot belly as my own cush baby looks just like that. haha. I am a new to this so you actually have more experience than I do, but my girl is managed very well on the 1mg per pound dosage. We were lucky in that we hit the nail on the head the very first time so we did not have to do any adjustments. You will find his correct dose soon and I believe that going back to your old vet was a wise choice. I also had to change vets to get with someone who I felt comfortable with and who followed the protocol set by the manufacturer of Vetoryl. I have still had to put my foot down over a few issues, but all in all, I feel that my baby is getting good care.

Once you get the proper dosage, you can switch to a compounding pharmacy and get trilostane which is sooo much less expensive than the brand name Vetoryl. Being on a fixed income, this was a huge blessing to me. So carry on Mom! You're doing a great job!

[KristinB]

Thank you, Suzie! Your little girl is darling, and I am glad she is doing well.

I just don't understand how a vet can ignore the literature on the drug, from the company. It baffles me.

[KristinB]

Today we went to see my previous vet. He agreed that 14 is not a regulated level. Jake will go on 12.5 mg of compounded Trilostane for a month, we'll see how he does. He has responded well to small dose changes thus far, so hoping this will get him down to where he needs to be with cortisol levels and symptom improvement.

[labblab]

I hope this will turn out to be the perfect dose for Jake. I do think you were wise to return to your original vet, and we will be anxious to hear how Jake does on the increased dose.

Marianne

[molly muffin]

I'm glad you went back to your normal vet too. It's better to have someone who is on the same page as you are when it comes to our furbabies.

Crossing fingers!

hugs

[jas77450]

That is so sweet for you to take Jake in and give him a chance. Just wanted to say hi and welcome back.

[KristinB]

So, Jake was increased to 12.5 mg Trilostane last weekend. He seems to be feeling fine, but has had some diarrhea/loose stools. I am wondering if this is due to the increase from 10 mg to 12.5? He is eating well, good energy levels, etc. No vomiting. I had also been giving him fish oil and Denamarin, so these could be contributing to diarrhea. Have any of you who use Denamarin seen diarrhea as a side effect? My vet suggested going back to 10 mg for a few days, and cutting everything else out, then trying the 12.5 mg again. I also plan to include a probiotic in his diet.

[Dixie'sMom]

Hi to you and Jake. I'm glad to hear he is feeling good and acting normally despite the diarrhea. I have heard others mention fish oil as a possible cause, but I have no first hand experience with it myself. Have you just recently added this to his diet? I also have no experience with Denamarin but hopefully someone will be along soon who does. I wouldn't think that a 2.5 mg increase in the trilo could cause the diarrhea, but I guess its possible. Let's see what the others say. I'm sure someone will be along soon that can help.

[Harley PoMMom]

Are the fish oil and Denamarin new to his diet?

[judymaggie]

Kristin--I am giving Denamarin to Abbie and have not seen any side effects. I can only speak to fish oil for myself--I could not tolerate it at all.

[KristinB]

Are the fish oil and Denamarin new to his diet?

Yes, I was probably over enthusiastic about getting him on all of these things at once to fight this, so there are many variables. I have since discontinued the fish oil and added a probiotic (Vetri-Science). Per my vet's advice, I will go back to the 12.5 mg again starting tonight, we will see how he does again. If necessary, we can go down to 11 mg compounded or something like that.

Come to think of it, Jake's stools have never been firm since I adopted him recently, even before the Trilostane. He may need the probiotic, more time on a good diet, etc. It's tough when you adopt a 10 year old dog with no history, there are a lot of possibilities.

[molly muffin]

The omega-3's gave Molly a bit of the runs. I changed it to give it to her in the morning and I give the sam-e at night (denamarin). That seems to have done the trick. Not giving it to her isn't an option as omega-3, or fish oil etc, is recommended for kidney support. Or maybe try a lesser dosage of the fish oil?

hugs

[Squirt's Mom]

I was taught to start with a low dose with fish oils then increase to the point of loose stools. At that point you back the dose up til the stool is firm again. It is almost impossible to follow this with encapsulated oils so I use the liquids like Nordic Naturals Pets, Only Natural Pets Salmon Oil, etc.

[KristinB]

We have had a rough night, just back from the ER. When I came home after being gone for only a few hours, Jake's abdomen had swelled up tremendously. Since it seems his Cushings is getting under control according to the recent ACTH test, I was confused and worried. CBC shows liver values off the charts. Xrays show a horribly enlarged liver. They did an ultrasound and did not find a distinct mass, but just a HUGE liver. It was ascites, fluid leakage through the wall of the diseased liver. They did drain about 350ml of fluid from his belly and will analyze that to see if the cells show anything. At this point, they think it is liver failure, but there is also the possibility of cancer.
My heart breaks. As some of you may remember, I only adopted Jake about two and a half months ago at age 10. I have no previous medical history on him. I do not think he had any medical care for 10 years. I am trying desperately to reverse that, but it may be to no avail, it may be too late. I have no idea how long he has had Cushings before I got him. He is such a wonderful little man, and I want his life to be happy, quality over quantity. I am very worried though. He has been on Denamarin for about two months, he is already getting that. I am waiting on the results of the fluid analysis, and for a radiologist to officially review the images. I am scared for him. I cannot let him suffer.
We are supposed to be traveling for the holiday, to see my family. Jake is going with me in the car. I am so scared something will happen on the way. It is a six hour drive each way

[Harley PoMMom]

I have merged your post into Jake’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

Oh Kristin,

I am so sorry to hear that Jake is having some issues with his liver. Has a liver friendly diet been recommended?

Exactly which liver enzyme/s are very elevated? If it is the ALP, approximately 80% - 90% of dogs have a steroid induced isoenzyme of ALP so if a dog does have Cushing's you may see anywhere from a mild to severe increase in ALP. These increases are not because the excess steroids are killing liver cells, it's because the steroids are causing an abnormal accumulation of fat in the liver and it is having to work a bit harder.

Please do keep us updated and I will be holding you both in my thoughts and prayers.

Hugs, Lori

[Squirt's Mom]

Let us know how she is, Kristin!

[KristinB]

ALP 2739
ALT is off the charts
ALB 3.9

BUN 30

White cell count 28.8
Red 8.83

Glucose 181
Phosphate: 8.5

[KristinB]

They have now found a large irregular mass in the left portion of the liver which is highly believed to be malignant (biopsy will confirm). He is too weak and old to withstand surgery or chemo. I am devastated

[rexifer]

You are an angel for taking care of this little one.They are such precious gifts aren't they? I'm new to Cushing's so I don't know that much to help a lot but I can offer support as others have offered to me.

[Trish]

Oh Kristin, that is not good news for you guys :(

I have stood where you are now with my dog Flynn, who at the time was also 10 and he is also a terrier mix, so you can see some similarities here!! He had collapsed and had a scan that also showed a very large irregular shaped tumour on the left side of his liver. They said there was not much to be done for him, I took him home we thought to die that night. But boy did he rally, so we went ahead with the biopsy like you have. It came back benign and long story short, he did go and have surgery to remove it. It came back as a low grade massive hepatocellular tumour and he is still here to tell his story and give you some hope 3 years later. I do not think 10 is too old for surgery in a terrier breed, my uncles lived to 18! Flynn was also weak/unwell at the time but he came through it like the little champ he is. Only in hospital for two days. My point is, some liver tumours are better than others and even when they are big like Jakes, that can sometimes be better than when they are diffuse and spread through the liver. So don't give up hope, see what the biopsy shows and take it from there. Big hugs.. x
Trish

[labblab]

Kristin, I am beyond sorry to hear this news. I felt so very worried after reading your report re: the ER visit, and feared this was a possibility given the severity of the problems. But I hoped I would be wrong. I know you still don't have a definitive diagnosis without the biopsy, but it does appear that something is terribly wrong. Bless you for doing your best to give Jake the love and care that he has missed all these years. No matter what happens, he now knows what it means to be loved and cherished.

What a horrible time for you, though. We will be here for you, so please keep updating us as each step unfolds, OK?

Sending both you and Jake strength and comfort across the miles,
Marianne

[KristinB]

We will not be traveling this week for Christmas. Jake is too weak, and there is nowhere to stop for six hours to get help. I will stay home with him.

[KristinB]

Trish, did your dog have Cushing's too? Two vets strongly disagree that Jake is a candidate for such surgery

[KristinB]

According to Dr.Axam, the radiologist, the liver mass was not surgically removable. Left side liver lobes are affected.

[molly muffin]

Oh no, I'm so sorry to hear this. Jake is such a doll and you are too.
Whatever happens, what you have done for Jake is priceless. He is loved and he is safe with you and that is what counts more than anything in the world. You rescued him and gave him some great times and even if this is inoperable you have given him the best gift ever.

Sending big hugs and love yours and Jakes way tonight.

[KristinB]

Oh no, I'm so sorry to hear this. Jake is such a doll and you are too.
Whatever happens, what you have done for Jake is priceless. He is loved and he is safe with you and that is what counts more than anything in the world. You rescued him and gave him some great times and even if this is inoperable you have given him the best gift ever.

Sending big hugs and love yours and Jakes way tonight.

Thank you, Molly. That was my goal for him

[molly muffin]

Oh I was going to say since Trish might be out and about that Flynn did not have traditional cushings, he had a pheo tumor on his adrenal gland, that was also operated on. He has had several surgeries as he also had a liver surgery last year to remove another mass.

hugs

[Squirt's Mom]

Oh sweetheart, like Marianne I feared something like this. :( But before you throw in the towel, consult with a board certified surgeon, not a regular vet, about operating. The GP vets don't know near as much about what is doable or not as the surgeon who would perform the operation would know. So for your own peace of mind, see what the surgeon thinks.

Whatever the outcome, we are here with you, Kristin. You are an angel for taking Jake in and bathing him in your TLC. You have probably given him more in the short time he has been with you than ever before in his life. You have shown him what it means to be loved and cared for. Bless you.

Hugs,
Leslie and the gang

[KristinB]

Oh sweetheart, like Marianne I feared something like this. :( But before you throw in the towel, consult with a board certified surgeon, not a regular vet, about operating. The GP vets don't know near as much about what is doable or not as the surgeon who would perform the operation would know. So for your own peace of mind, see what the surgeon thinks.

Whatever the outcome, we are here with you, Kristin. You are an angel for taking Jake in and bathing him in your TLC. You have probably given him more in the short time he has been with you than ever before in his life. You have shown him what it means to be loved and cared for. Bless you.

Hugs,
Leslie and the gang

Leslie, I am trying but the holiday has delayed everything, particularly getting into the specialist. I was told the reason it could not be removed safely was that it has affected multiple lobes. There are not many treatment options for animals diagnosed with nodular and diffuse hepatocellular carcinoma since multiple liver lobes are affected. The prognosis is poor since surgery is typically not possible due to the involvement of multiple liver lobes rather than one.

He is not eating today, will not eat anything. I am beating myself up because I was so focused on getting the Cushings under control maybe I missed this?? I have only had him a few months so it is possible that this was too far gone when I got him but I always feel like I could do more. My heart is breaking and I feel so helpless on a holiday when there is little to no help

[Squirt's Mom]

aw, honey, you have given Jake more than anyone else in his life. The odds are, if this has progressed that far he was very sick when he came to you. You have given him what he needs most - a safe place to be, warm arms to hug him, gentle hands to stroke his head, good food and clean water, the best medical attention you could, and most of all more love than he has ever known. It is normal to feel guilty no matter what the circumstances are but remember - you do not deserve to let it get hold of you, you have not earned that guilt. ;)

If you have some Nutrical or NutriStat you might give him some of that later on today if he still won't eat. It isn't a big deal to miss a meal or two but in this case the loss of appetite may be a sign so if he simply will not eat, don't force him. Make sure he gets water tho. Will your vet be in tomorrow? If so, I'd try to get him in.

Let us know how things go and remember we are here if you need us for anything.
Hugs,
Leslie and the gang

[molly muffin]

Sending love and hugs your way. Anything that will tempt him will work.

hugs

[KristinB]

He did eat after I got his appetite stimulant into him with some canned cat food. He ate some dog food and an egg, seems to be feeling much better.

Right now his temp is 103.1. I know that is elevated, but not sure he needs to go back to the ER vet?

My vet is available starting at 7:30am tomorrow

[KristinB]

Also, we got worked in to the specialist tomorrow morning. They don't have the images yet, but will see us and we will hopefully get the images while there. This is the same surgeon that took out my Maggie's adrenal gland years ago, they are excellent. I will get an honest answer, and then can make further decisions with peace of mind that I did indeed try everything possible

[molly muffin]

So glad that you are getting in to see the specialist tomorrow and that Jake ate.
I'd watch the temperature and if it keeps going up then I'd take him in, but otherwise see the specialist tomorrow.

Wishing you peace this holiday season.

[KristinB]

https://www.youtube.com/watch?v=VjHN_2q7hFE

Merry Christmas to you all, from Jake

[Squirt's Mom]

What a sweet baby! Merry Christmas to you, Jake!

[molly muffin]

Merry Christmas!!! Jake is just adorable.

Hugs

[Squirt's Mom]

How is Jake today?

[Tina]

What a sweet boy in the video. I have been thinking about you both the past few days and keeping Jake in my prayers. So happy to see you are able to get him in to a specialist today. I will be checking back for an update.

Big hugs,
Tina and Jasper

[Trish]

So cute!!! Lovely wee boy, good luck at the specialists from me too :)

[KristinB]

I did get some more info. Unfortunately multiple liver lobes are affected by the huge tumor and it is also invading the gall bladder. Unfortunately, treatment options are very limited for those cancers affecting more than one lobe of the liver, and for those that are metastatic. There are likely a lot of risks involved with opening him up. He may not survive the surgery, they may not be able to remove it all, and if they do, he may need blood transfusions, get infections, etc. All that being said, the one good thing is that Jake is not in liver failure. He has a very large tumor and some complications with that, yes, but he is not in liver failure. He could have some good time left with dietary and lifestyle changes. We need to focus on living, not dying. I am all for fixing things, there is no price too high for that, but when we cannot fix things I must accept that and make peace, living life to the fullest each day we have.

[Squirt's Mom]

I am so sorry for the continuing bad news concerning Jake. But I gotta tell you, he sure did hit the jackpot when you took him in your arms and into your heart. Cherish every moment with him, make memories you both will hold close to your hearts til you meet again and can share them together. Spoil him rotten. Fight for every good day you can make happen for him. And just simply love him.

You might contact Monica Segal or Dr. Jean Dodds for a diet. Monica works on an individual basis but I'm not sure how Dr. Dodds works, if she has set diets for certain conditions or if she also works based on the individual's whole needs.

Hugs,
Leslie and the gang

[Dixie'sMom]

I'm sorry to hear about Jake's tumor. It's really good news that his liver is still working. Hopefully the tumor is slow growing and you will have much more time and precious moments with your sweet boy. You have a wonderful attitude about things and sometimes it's just a relief to accept the inevitable and not have to "fix" things. I know you would if you could, but at sometimes the right thing to do is nothing. Just love on your boy and enjoy him. Hugs and prayers.

[KristinB]

I am going to get an opinion on whether removal is even a consideration before doing a biopsy, yes. If this tumor is not surgically removable, there is really no point in putting him through that. His treatment would be the same, palliative, keeping him comfortable and happy for as long as possible with the liver failure.

I have had time to go through his records today. The bad news is his liver values have gone up considerably in the three months I have had him. HIs first CBC was done on 9/22, and latest on 12/23. In this time, ALP has gone from 884 to 2739. His ALT on 12/23 was so high it didn't even register on the charts. His BUN, glucose, and phosphorus have also gone up. This does indicate liver disease is progressing. This tumor is aggressive, large and causing the disease to accelerate.




Kristin

[Trish]

Hi Kristin

I thought you had already had the surgical opinion? Must be confused! :rolleyes:

Flynn's biopsy was no problem, fine needle, not open. First surgery at age 10 removed 1/3 of his liver which was most of the left side. It regenerated nicely. Recurrence two years later and they took another 25% at age 12. Now 13 months post 2nd operation and no sign of recurrence although his ALP rising a little too which worries me. he also still has other various nodules which have been biopsied during surgery and show nodular hyperplasia but one still has hepatocellur tumour, they presume low grade like the others have been. But he has done great for over 3 years since his liver disease was diagnosed and treated. We were lucky it was low grade and operable. He was in hospital only 2 nights for each surgery and recovered well.

Has Jake got renal problems as well? As rising BUN and phosphorus could be related to that?


Crossing fingers for good news for you guys :)

[KristinB]

Appointment was rescheduled to the 5th.

Was your dog's tumor one mass or nodular and diffused like Jake's?

[Trish]

He initially presented with collapse, the local vet did a scan but they do not have high resolution and they thought it was a diffuse tumour as it looked to cover most of his liver. They did a biopsy, it came back benign. He was then referred urgently to specialists which were 3hr drive away. CT showed it was one massive tumour involving the left lateral and left medial lobes, at surgery they discovered it had also spread outside his liver onto his omentum which was resected to clear margins. It was reported as low-grade hepatocellular tumour and weighed 650g which is pretty big for a fox terrier. He also had suspicious nodules on the right side of liver which were biopsied and reported as nodular-reactive lesions only.

But two years after this surgery we suspect one of those nodules suddenly grew and that 8cm mass was removed along with the quadrate lobe of his liver. It is now over 3 years since his original liver surgery and he has done well and hopefully no more of those "nodules" will suddenly grow like the other one did. He is having regular scans and no sign of that happening although I am suspicious as his ALP has been climbing of late.