15 year doxie w adreneal tumor

[pseaton2003]

I am a neewbie. Chloe, my beloved doxie will turn 15 on Aug 2. She was diagnosed with cushings about 2 years ago. She has been on trilostane and has done remarkably well until this week. She had an absessed tooth that was removed on tuesday. Her labs were normal except for the alt level that was 2000. It had risen dramatically in 5 weeks. Scheduled an ultrasound of her liver on Thursday. Vet diagnosed her with adreneal tumor. She is not eating at all but continues to drink water. I am awaiting biopsy results. I am force feeding her fresh cows milk. Her stomach was very inflamed. Possible ulcers he stated. Vet prescribed some pill that would coat her stomach as well as pepcid. How do i get her to start eating. I am going crazy
Any advice much appreciated.

[Roxie]

Very sorry to hear about your little doxies health problems. I too have a 15 year old miniature dachshund who was just diagnosed with cushings disease. I do not have answers for you on how to make her eat but I hope others with more experience will chime in. Good luck to you and your doxie!

[apollo6]

Welcome. So sorry about your baby. My Angel Apollo ,a mini dachshund,had ulcers through out his intestines due to medications taken for skin infections. His stomach was making gurgling noises. He was one month short of 14 when he died of this disease. Something else is going on. Not eating is a sign of something else going on. Maybe painful to eat? If you can afford an ultrasound may give you more insight.
Sonja

[Squirt's Mom]

Hi and welcome!

What are the meds she on other than the Vetoryl? Is nausea or loss of appetite a side effect?

Any sign of loose stool or diarrhea? How is her energy level - same, higher, lower?

How long has it been since she ate? Is she still drinking well?

Some things you can try are stinky foods like cod, salmon, tuna water (not oil) over the food, Parmesan cheese over the food - something that she can smell real well. You might try a canned food, some flavor new to her. If all else fails, try Beechnut baby food - they do not add cornstarch and seasonings like Gerber, things our babies do not need. ;) Some chicken broth might appeal to her and be easy on her tummy too. Just fresh chicken and water - nothing else boiling in the mix. If that works ok for a meal or 3, you might add a little well cooked, to a paste consistency, white or brown rice to the broth.

If you don't have NutriCal or some other nutrient supplement, get some to have on hand. You can get a tube at PetCo, etc. It has all the vitamins and minerals they need and can keep them going in a tough spot.

Let us know how she is doing!
Hugs,
Leslie and the gang

[pseaton2003]

Thank you all for the posts. Chloe has ulcers, per the vet. Her biopsy came back positive for adreneal carcinoma with very high cellularity and moderate pleomorphism. She will start lystrodane on monday. Anyone have advice on how your pet did with this drug. She is still not eating but i managed to get some goats milk down her. Peggy

[Squirt's Mom]

If she is going to use Lysodren, it is best to wait until she is eating again on her own. Lyso can cause tummy upset so it is never a good idea to start this when they are already having digestive and appetite issues. ;) I would give her a bit of time for the ulcer to heal....but I would also discuss with my vet first about this tumor - how big is it? Which gland is it on? Is he POSITIVE it is a cortisol secreting tumor and not a pheo (another adrenal tumor that does not secret cortisol)? Is the vena cava involved?

As far as how Lyso is used - she will go thru what is called a loading, or induction, phase where she will get a dose twice a day. NOT for a set time but until *you* see signs the load has been achieved. Those signs are very subtle - like looking up from the feed bowl when before she would wolf her food (tho with a pup already off her feed, you can see how that will confuse things) and/or drinking less (you will need to monitor and measure the amount of water she drinks usually then compare what she is drinking during the load to know when that amount decreases). Here is some great info from the Helpful Resource section on Lysodren - http://www.k9cushings.com/forum/showthread.php?t=181

[pseaton2003]

Squirts mom..... could i send you the pathology report. I was lost reading it or could i post it on here? . I am still feeding her the goats milk by syringe. She pooped just a little today, so i know she is getting something. She is still drinking water fine. She even played ball this afternoon for a few minutes. She has not eaten on her own since last tuesday.

[pseaton2003]

Thanks for your reply Leslie. Chloe is drinking water fine. I am giving her cerenia, pepcid, some pill that coats her stomach , and the trilostane. Her energy level is playful at times, but she sleeps a lot.

[Squirt's Mom]

You can post the results of the test here in Chloe's thread. Some folk upload to an outside site like Photobucket or Google Docs then post the link here. If you type out the test results, all we need to see are those values that are abnormal along with the normal ranges and little letter that follow each value. It would look something like - ALP 269 115-150 ug/dl. All the info on the LDDS is needed including the interpretation at the bottom - there will be 3 numbers for the LDDS. If an ACTH was done, there will usually be 2 numbers, sometimes 3 depending on the country.

[labblab]

Hello, and I am so sorry Chloe is having these problems! I have a few questions to ask that will help guide us on the path forward. You say that Chloe has done well on trilostane for a couple of years now. Has she had monitoring ACTH blood tests during thus time? If so, can you tell us the numerical results, at least for the most recent testing? Loss of appetite can be caused by many things, of course, but one of the causes can be a cortisol level that has dropped too low.

Also, I am wondering why your vet wants to make the change to Lysodren if trilostane had been working well. Is it because he hopes the Lysodren might actually physically affect the adrenal tumor? One worry about this, though, is that normally a "wash-out" period is recommended when switching from one drug to the other. And right now, what with all that is going on with Chloe, I would think you would especially be wanting/needing to have a monitoring ACTH test done so that you know exactly where her cortisol level is. Has this been done?

And finally, what did the ultrasound tell you about the state of Chloe's liver? Was her liver biopsied as well as the adrenal tumor? Or was just the liver biopsied and the report is that an adrenal tumor has spread to the liver?

As far as the pathology report, one viewing option is to take a photograph or scan the report, and then upload the image to your photograph album here. Otherwise, you may just want to type the body of the report into a reply here. I agree it would help us to read the actual wording.

Marianne

[lulusmom]

Hi and welcome to you and Chloe

I am so very sorry to hear that your precious Chloe has an adrenal carcinoma. Approximately 15% of dogs with cushing’s have an adrenal tumor and half of those are malignant so it’s a rare finding in dogs for sure. I saw the pathology result you posted and would like to know how the vet got the adrenal tissue sample. I’m not sure we’ve ever had a member whose dog was diagnosed with an adrenal carcinoma via a tissue sample without invasive surgery so I’m always interested in learning. Has it spread to other organs? Does your vet have any idea what Chloe’s prognosis is with and without treatment? Has your vet consulted with an internal medicine specialist to discuss Chloe’s current condition as well as the best palliative treatment option for her once she has recovered sufficiently from her current stomach ulcers?

I am very worried about your girl and based on the information you have provided thus far, I'm more than a little worried about the road your vet is taking, which would indicate that s/he has not consulted with a specialist. Chloe is sick and you never give a sick dog Trilostane or Lysodren. Please stop the Trilostane now and do not give either drug to Chloe until she is eating on her own again. Did your vet actually tell you to continue dosing with Trilostane?

I apologize in advance for duplicating Marianne and Leslie’s questions and concerns but duplication is not such a bad thing when it comes to learning more about cushing’s. It’s also not a bad thing when a new member is on information overload and may forget to answer some of the questions. I actually arrived on the site with some experience under my belt but I was still addled by all of the information members were giving me. It takes a while to digest all of it and even longer to understand it all so just take it one question at a time.

I too have no idea why your vet would switch Chloe from Trilostane if she has been doing so well on it? Regardless, you must not switch from Trilostane to Lysodren or vice versa without 1) a 30 day washout period or 2) an acth stimulation test shows that cortisol levels are well outside the therapeutic level and the Chloe is symptomatic again. I must caution you that if you start treatment with Lysodren on Monday, the consequences for Chloe could be severe and even fatal. Washout period aside, you never, I repeat, never give Lysodren to a dog who is not eating normally and you most certainly never give Lysodren to a dog with GI problems. Gastritis is a common side effect of Lysodren. Adrenal tumors are highly resistant to Lysodren and therefore, much higher doses are necessary to achieve enough erosion to the adrenal gland to stem the overproduction of cortisol. A lot of dogs receiving those kind of massive doses of Lysodren do get sick. How much does Chloe weigh and what dose of Lysodren did your vet prescribe? Were you give written loading instructions?

I must admit that am shocked that your vet would even consider administering Lysodren to a dog in Chloe's condition, and the fact that s/he has actually prescribed it with instructions to start on Monday leaves me speechless….and I’m never speechless. We do not tell members to defy their vet's instructions but there are times when it is necessary and this is one of those times. Please do not give Chloe Lysodren or Trilostane until she has completely recovered.
A dog who has to be force fed goat or cows milk for five days is a very, very sick baby that is not getting the nutrients needed. Since you are already force feeding, I recommend that you force some dog food into her and the sooner, the better. Vets almost always recommend feeding a prescription diet formulated specifically for dogs with stomach issues like Chloe's. If your vet did not recommend and provide you with cans of prescription food, please call today and ask if you can pick up either Hills AD or ID canned food and a large syringe for force feeding. Some vets carry the Royal Canin equivalent to this food which is fine too. AD is used for recovery of illness and ID is an intestinal diet for dogs with sensitive stomachs. Either will work and most dogs like the taste of both. Dilute the food with just enough water to allow you to get the food through the syringe. Optimum diet for dogs is lower in carbohydrates but in my opinion, it’s more important to get some sustenance into Chloe and get her eating on her own, and then you can research the most appropriate diet for a cushingoid dog with a malignancy.

Do you have copies of Chloe's blood chemistry and CBC? If so, please look at them and make absolutely certain that ALT is the only value that is abnormal. I am having a really hard time believing that Chloe's ALT was 2000, which is hugely elevated, yet she had no other abnormalities. That does not compute for me on any level, especially for a dog with a lot going on in the gut. Can you please look at the lab results and reconfirm that the ALT was the only high or low result? If you don't have copies of the labs, can you please get them from your vet?

This is turning into a novel but there are a few more bits of information that would be very helpful. You mentioned that Chloe was doing well on Trilostane. A dog doing well on Trilostane doesn’t have any more symptoms and current acth stimulation test results are within the desired therapeutic range. What dose of Trilostane is Chloe getting and is it once a day or twice a day? What were her original symptoms and have those symptoms been completely remedied with treatment. When was the last acth stimulation test done and can you share those results with us? Was the elevated ALT discovered on pre-dental bloodwork done for the dental? Was she displaying any signs of being ill before or on the day of of the dental procedure? Did she quit eating before or after surgery?

I will be very anxious to receive a lot more information about your precious girl. The more information you can give us, the better able we can follow the course of events in chronological order which will help us try to understand your vet’s rationale. Both will help us provide you with much more meaningful and specific feedback that can help you get Chloe on the road to recovery.

Glynda

P.S. If Chloe were my dog, I would definitely want her to be seen by an internal medicine specialist.

[pseaton2003]

Chloe has been in the hospital at MS state. After a liver biopsy and stomach scoping, She was diagnoised with inflammatory bowel disease, problems with her liver and something to do with bile ducts. . She is so much better, although she still not eating well. She started an appetite stimulant yesterday. I am thanking God for her life. I will post medical terms at a later date... tired tonight. Thank you all for the replies. They are not going to terminate her trilostane although her dosage went from 12.5 to 14.5.

[Squirt's Mom]

If this were my dog, I would tell them to STOP the Vetoryl (Trilostane) NOW. This is your dog, not theirs and a dog on treatment who is not eating does NOT get an appetite stimulant - the drug is stopped, period. I am very worried about your baby surviving this if they do not stop this drug immediately. She is YOUR dog and you have every right to tell them to stop giving it now. ;) Once all these current issues have been handled, then you can look at Cushing's again, but no way in you know where would they give my baby that drug right now, none.

[labblab]

Usually Leslie and I are on the same page, but in this situation, my thoughts about things differ. Since Chloe has been hospitalized, biopsied, and diagnosed by the specialists at the veterinary school at Mississippi State, my recommendation would be to follow their treatment advice. In Chloe's situation, it may be the case that elevated cortisol is contributing to or even worsening the problems that are affecting her behavior and appetite. Since they are recommending even increasing her dose, they must believe that controlling her cortisol is an important piece of the treatment plan.

Now, of course, they may be wrong :o. But I do not feel comfortable telling you to alter the treatment plan they have recommended after what appears to be a very thorough diagnostic work-up. I really hope Chloe's appetite does improve, though, and will be anxious for further updates. I am especially wondering what their thoughts are about the pathology report re: the adrenal cancer.

Marianne