First post about Rum (Rum has passed on)

[Rum's mom]

Rum is 13 year old Am Staff. He started showing signs of excessive drinking and urinating November 2013. In January of 2014 at his senior physical he had elevated liver enzymes. Repeated test in 30 days and they had elevated significantly had an ultrasound of his liver/abdomen. Liver basically normal found very small nodule near his spleen but could not tell if was actually on the spleen. Decided not to pursue at that time as seemed his symptoms seemed unrelated and didnj't want to put him through major surgery of spleenectomy when he seemed otherwise ill.numerous tests later, he was diagnosed with Cushings in April 2014 and started Vetoryl. Took some adjustments but ended up taking 143mg of Trilostane daily. He was much improved in some ways, but started showing other symptons - sensory issues. Took him to eye doctor - was told he could see quite well and he probably had canine cognitive disorder ir a brain tumor. Continued mecucine and added Sam-e. Continued fairly well until March 2015 seemed backend getting weeker. Had another acth test and he was over corrected .8. Stopped. All medicine and symptoms returned. Acth test one week after stopping medicine cortisol level 8.4. Resumed medicine at 45mg twuce daily. He ciuld not tolerate - could barely walk. He is now taking 10 mg once a day to once every 2 days. Excessive drinking resumes when off medicine fir more than 24 hours. Within hours of taking medicine, sypmtoms subside, but he becomes unstesfy and weak. Took him to alternative vet for acupuncture/chiropractic consultation. All they wanted to talk about was hus pacing and curcling and talked me into an E1 blood test - no results yet over a week. - said they don't belive he has Cushings. Some other hormonal condition or he has a brain tumor causing all his issues. Very frustrating, exhausting and don't know what to do anymore. Have an apointment with regular vet this Saturday for an examine. Have done a lot of reading and seems our story is not unique. Have always felt sonethibg was being missed. Up until a couple weeks ago he was still galloping through the yard. Thank you for any input. I love my boy and just want to do right by him. May have left out important details, wasn't sure what to say.but there is olenty more.

[labblab]

Hello and welcome to you and Rum, although I am very sorry about the current problems that have brought you to us.

Off the top of my head, I do have a couple of thoughts. Since it has now been a year and a half since his last ultrasound, it may be worth the expense to repeat it, and especially if it can be performed using high-resolution equipment by a specialized technician. The nodule may still be unchanged, or it may have blossomed into a more serious issue that is contributing to Rum's problems. Whether or not you would choose to intervene, the information may still be important to you. Additionally, you can recheck the status of his liver and other major organs. Importantly, this includes his adrenal glands. You do not mention them in relation to the previous ultrasound, and their appearance can give important clues re: the nature of his Cushing's, assuming he does suffer from the disease.

In the absence of any adrenal tumors or masses, we would assume that Cushing's is being caused by a pituitary tumor in the brain. And in that event, Rum can be suffering from both Cushing's symptoms and also neurological effects (including pacing, circling, mental confusion, lethargy, loss of appetite) if the tumor is expanding and placing pressure elsewhere in his brain. In that situation, keeping a functional balance of steroid levels can be a challenge. When cortisol goes too high, the Cushing's symptoms return. But steroids such as cortisol can serve a helpful, anti-inflammatory effect when it comes to the effects of a tumor on brain tissue. So when the cortisol drops too low, the neurological symptoms may worsen. Here is a thread on our Resources forum that discusses pituitary "macrotumors" in greater detail:

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

This is all hypothetical right now when it comes to Rum, but I just want you to know that he can be suffering from both the Cushing's and also neurological effects from the pituitary tumor. If that is the case, he might end up being treated with both trilostane and also some supplemental prednisone. Unfortunately, the only way to know for certain whether a pituitary tumor is enlarging is through expensive imaging of the head (CT or MRI). Even if you don't choose to proceed with the imaging, you may want to get the opinion of a neurologist if there is one available to you. At least it is something to discuss with your regular vet. But as I say, a repeat ultrasound may also be an informative first step.

Marianne

[labblab]

Wanted to add that I just now checked on an E1 blood test since I am unfamiliar with what that means. After having Googled it in relation to veterinary testing, I am sorry to see that it relates to the hormonal imbalance theories of Dr. Alfred Plechner ("Plechner Syndrome"). I openly acknowledge my bias against Dr. Plechner's explanations/treatment of adrenal hormone irregularities. We have had a few discussions of his theories here, which you can find using our forum "Search" option if you are interested.

One feature of Dr. Plechner's treatment regimen is giving supplemental prednisone to dogs who are already suffering from elevated cortisol levels. My personal opinion is that this treatment is generally harmful rather than helpful. You may find this odd of me since I've already mentioned the possibility of giving prednisone to Rum. But the situation of an enlarging brain tumor is very different from the "Syndrome" that Dr. Plechner describes and offers treatment for. Just my two cents worth.

Marianne

[molly muffin]

Hello and welcome to the forum.

We want to hear everything about Rum. It does sound like you are going through a real balancing act with the cortisol. I know the worry about a brain tumor is very scary to contemplate. Marianne covered that very well.

The only way to know for sure if it is a brain tumor is with a scan.

There is also the possibility of the area on the spleen growing and being a tumor . This actually happened with one of our moderators dogs, and after the spleen was removed there was no further cushings problems, because cortisol will also rise when there is another nonadrenal chronic illness.

So, some things to discuss at the vet appointment. Let us know how it goes and welcome to the forum.

[Rum's mom]

Haven't given Rum any vetoryl since 5/11. He is drinking moderate amount, but not excessive. He was starting to seem worse when i gave him just a 10mg dose. Had Rum's regular vet appt this morning. Took blood for the normal panel for a senior under his circumstances. Took in a fresh urine sample so vet could see it wasn't diluted or concentrated. Since had stopped the vetoryl for now, vet suggested doing a cortisol/creatinine test. He has a slow heart rate since all this began (40 - 50/minute.) May have been that way before, don't remember it ever being mentioned. One bad thing came from visit - vet says felt what feels like a mass in abdomen - could be that the small nodule found in ultrasound last February has become larger. Didn't take x-ray as i will call for scheduling ulrasound on Monday for soon as can get. Rum is no better. On and off weak in backend. Continuing with deramaxx and tramadol for any discomfort though he shows no real sugns of pain. Exam for arthritis, shows some issue in one hip but nothing extreme. Minor coaxing still gets him through all meals, once gets started has always earen with enthusiasm though not quite as interested. Thank you very much for the responses and suggestions. Did finally get the results of the EN1 test and took took my vet. Dr. Pletchner seems to consider a much lower level of cortisol as normal. Test said Rum's estrogen level was high, but appeared barely out of that test's range. Wish i'd never gone to that vet - lesson learned - was a waste. Thanks again, Rum's mom - Pamela

[molly muffin]

So you are going to schedule another ultrasound? That is probably a good idea if the vet felt a mass in there. You want to know what it is and where.
A mass could account for all the ups and downs with response to the cortisol meds if this isn't caused by Cushing's.

Sure wish they could talk sometimes.

[Rum's mom]

Yes, plan is to get another ultrasound. Vet called this afternoon with blood test results. Mostly good, no infections, diabetes, no indicators associated with cancer. Slight elevation on couple liver enzymes was only issue. Results on urine not back yet. Thank you for your reply. Yes, i wish he could tell me how he feels. We had a fantastic Sunday afternnon nap together - a rare treasure these days - i'll take it.

[molly muffin]

Awww, Sunday afternoon naps, okay naps together Anytime are awesome moments. The ones you want to grab and hold close to your heart.

Good to hear you both got to enjoy one of those moments in time.

That is good that the blood tests are within normal range.

[Rum's mom]

Didn't realize how quick things would change. After a pretty good Memorial Day weekend, Rum went down hill pretty fast. Wednesday, May 27th, had to let my baby boy go. He loved life and me and i loved every minute of having him. His backend got very weak and he coukd not walk well or safely. His multiple issues were finally too much for him. Thank for the support and kindness.

[LauraA]

I am so sorry to read that Rum had to make his journey to the Rainbow Bridge, we never have these precious pups long enough :(

[mytil]

I am so very sorry your boy has passed. You both were very blessed to have each other. I have added his name to our very special remembrance list in our In Loving Memory section where he will be honored along side the others who have passed on.

Terry

[budindian]

I am so very sorry for your loss, we never have them long enough.

[Squirt's Mom]

I am so very sorry to hear about your precious Rum. May you find comfort in the memories of the life you shared.

Our thoughts and prayers are with you all,
Leslie, Trinket, Brick, Sophie, Fox, Redd, and all our angels


Time to Go

The time has come I think you know
the Lord is calling so I must go
I love you so much; I wish it wasn't so
I wish I could stay; I don't want to go

You're the best family a dog ever had
so kind and gentle, never mean or mad
I'll never forget the day that we met
I was so lucky to become your pet

You opened your door and showed me your heart
I'll never forget you; we'll never part
You loved me and cared for me over the years
you taught me everything and took away my fears

The Lord is calling now I must go
but before I go I want you to know
I know it hurts to lose a friend
but I'll always be with you even to the end.

Written by John Quealy

[judymaggie]

My sincere condolences to you -- it is always difficult to lose one of our pups but even harder when you have not had any time to prepare. Please take some comfort in knowing that many of our precious Cush pups greeted Rum at the Rainbow Bridge and are taking care of him.

[doxiesrock912]

I'm so sorry for your loss. Rest peacefully Rum. Hugs

[molly muffin]

I am very sorry to hear that Rum has passed.
My sincerest condolences to you and your family. We know what a horrible time this is for you.

[mommyslittlegirl]

So very sorry about your baby boy.You were a great mom.You gave him a great life.Rum will live forever in your heart.Memories of all the fun you shared together will comfot you.