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View Full Version : Harry, Maltese w/ adrenal tumors - How best to treat?



HarryBoy
07-22-2015, 04:42 AM
Hello All,

I am a newbie and distraught over my sweet 10.75 yo Maltese Harry's second Cushing's flare w/ adrenal tumor.

He had right adrenal gland removed in 2012 - was scheduled for knee surgery & pre-anesthesia bloodwork showed obvious Cushings & they confirmed a tumor via ultrasound - so instead of fixing his knee, we had his tumor removed.

Last 4 months he's gone downhill, which I wasn't in tune with because my Father was in the hospital for 3 of the last 4 months. We went to vet in April and his numbers were pretty much off the charts for all Cushings markers - 5-10 times normal values. Ultrasound revealed tumor on remaining adrenal gland (2.9mm) and High Dose Dex Suppression led vet to think there probably isn't a pituitary tumor also contributing to values.

Thing is - we discussed Trilostane as I had done my research ahead of time -and she said really the tumor has to come out - it's the best course of action. But here's the kicker, my little guy is blind - PRD (progressive retial degeneration) AND he has two really bad knees (both Stage IV subluxating patellas) which are now preventing him from going on daily walks - he kind of hobbles around. It's a $5,000 surgery and I've already spent $2k on diagnotics and follow-up. Not that money is the/an issue.

It's more about putting him through the stress of the surgery to remove the tumor AND the lifelong need for steriods as he'd then be in Addison's disease -when we could try Trilostance and see if it improves his quality of life for 6-12+months. From what I've read, with complete bi-lateral adrenalectomy and lifelong medication his prognosis might only be 12-30 months anyway - and he might not even survive the surgery a this age & stress level.

They say they want to get the tumor out to confirm it's not cancerous and that it will grow into blood stream and perhaps spread - but other articles I'm reading says adrenal tumors are typically slow-growing and typically not cancerous & don't metastacize.

I just went for a second opinion today that had to be rescheduled for Friday due to an emergency surgery - so I'm super frustrated about having to wait for more discussion. As I was waiting there I began reading your forum and seeing how trilostane has helped your Cushings pups.

I want to march into my vets office and say -let's get him on it NOW and see if it helps! I would think that doing something that reduces the cortisol production could also potentially reduce the growth of the tumor - and is better than doing nothing as I try to wrap my head around scheduling the surgery and impact to Harry.

Right now his quality of life is dwindling - blind, can barely walk, pot-bellied, panting, having accidents, and really listless - but still the sweetest little angle ever who is pretty much my shadow & I am his seeing-eye human. Am I crazy or is a trial of Trilostane absolutely worth it for a couple of months to note improvements.

I am pretty much heartbroken but don't want to torture my sweet pup either. Appreciate your feedback!

PS - Molly - what is a food ball for taking pills? Harry is stealth about avoiding all attempts at medications - he even fakes eating the pill then I find them on the floor later. He won't take a pill in cheese, meat, peanut butter or a pill pocket. I have to grind it & put it in wet food, or else he'll pick it out. Can you grind trilostane or does it have to be in a capsule - how do you get a pill down with a dog who spits everything out?

Sorry if I'm posting in the wrong place - up late and trying to get out of my head and on to paper so I can sleep. : )

Thanks!
Sarah

labblab
07-22-2015, 08:00 AM
Hello Sarah, and welcome to you and Harry! You will see that I have moved your reply so as to create a new thread that is your very own. This way, it will be easier for our members to reply to you directly. :)

I apologize for only having a moment to write this morning, but I want to cut to the chase and tell you, yes, I think trilostane would be a reasonable treatment approach in this situation regardless of whether or not you decide to proceed to surgery. Vetoryl (brand name trilostane) is FDA-approved for treatment of adrenal Cushing's, and we do have members on the forum who use trilostane for dogs with adrenal Cushing's as well as pituitary Cushing's. However, just so you'll know, trilostane will not slow tumor growth, and symptoms caused by adrenal Cushing's may be somewhat more challenging to control depending upon the pattern of hormonal overproduction resulting from the tumor's activity. There is another Cushing's medication, Lysodren, which on rare occasion actually reduces tumor tissue itself. However, the trade-off can be that higher doses of Lysodren may be needed for effective symptom control when adrenal tumors are involved, with increased risk of unwanted side effects.

I certainly understand your reservations re: surgery for Harry, and if I were in your shoes, I believe I would be pursuing medication management at this stage, too. Just so you'll know, the most widely accepted initial dosing formula for dogs starting trilostane treatment is to not exceed 1 mg. per pound. Subsequent dosing changes are based upon symptom resolution and monitoring testing results.

Marianne

HarryBoy
07-23-2015, 07:26 PM
Thank you so much Marianne - that is super helpful and I appreciate your input regarding the medication approach vs. putting Harry through a surgery which could ultimately lead to more.

I'll see if I can find my thread now! Just finally having a minute to log back in.
Thanks!

molly muffin
08-04-2015, 09:18 PM
Oh gosh, I'm sorry I missed your question about a food ball. I use my molly's wet food to make a ball around the pill and then give it to her, while she can see another little ball of food in my hand that she can have once she takes the first one. So far it has worked. Mostly. They can be stubborn at times. Twice I had to put it in her bowl with the dry food as she didn't want to take from my hand, other times she doesn't want to take it from the bowl.

How is Harry doing? Did you get the second vet opinion?