Macroadenoma - Beatrice has passed

[jfarrel1]

Hi. We adopted our Beatrice, whom we believe to be five, in November, although we had her as a foster for several months prior to that.

Less than three months after we adopted her, she was diagnosed with Cushings after an ultra sound to check liver functions (due to blood tests) showed that she had symmetrically enlarged adrenal glads (leading us to test for Cushings).

Here Cushings appeared controlled with Vetoryl for the first several months, but then about a month and a half ago, we got abnormal bloodwork back, and went to see an internal medicine specialist two days ago. She believes, based on dullness, lethargy, blindness in one eye, and tremors that our Sweet Bea has a pituitary tumor that has continue to grow (possibly a macro adenoma).

I am heartbroken, scared (for her and for us), and so unsure of what the best thing for her to do is, and am looking for information from others who have been down this path.

We've discussed doing an MRI to determine (1) if there is a pituitary tumor (which the vet believes likely, and seems to fit everything else I've read about macro adenomas); (2) possible treatment if they do find something -- radiation and/or looking into surgical removal.

The MRI is expensive. Radiation would require a 5-6 hour drive for the treatment, and I haven't even looked into that expense. The vet called that the "reasonable" option, although she said it's likely the tumor would regrow. She called surgical removal the "heroic" option attempting to help her.

I am concerned about spending a large amount of money to put her through so much stress, wondering what the side effects and negative impacts to her could be, and then trying to weigh how much time that might even give her IF it's successful. The back story here is that my last dog had cancer and I took his treatment too far trying to prolong his life and instead I feel like I made his last days uncomfortable, and took away his quality of life (and he ended up dying in an animal hospital, alone in his crate, in the middle of the night instead of at home, with his family who loved him, in a peaceful, pain-free manner).

I am scared that if I give up on treatment, I'll be giving up her too soon. But I'm also scared that if I chase down a treatment, that I'll take away her quality of life for whatever is left, and that I'll be doing it for selfish reasons (me wanting more time with her) instead of making her life better.

If you've pursued treatment, what was your experience, how long did your dog live post-treatment, and would you do it again if faced with the same choice? And what treatment did you choose?

If you didn't, how much longer did you have, and what were the end days like? And when did you know it was time to let go?

Thank you all so much in advance for reading this, and for any insight or thoughts, or personal experiences you can offer.

[labblab]

Hello and welcome to you and to Beatrice, although I am so very sorry for the worries that have brought you to us. I lost my own Cushpup to what we believe was an enlarging pituitary tumor, although my husband and I did not proceed with the imaging of his head that would have told us for sure. I will return a bit later on and talk to you in more detail about my boy, but in the meantime, here's a thread that summarizes a variety of experiences of our members. It was started by one of our members who did choose to intervene, but as you will see, some of the rest of us did not (including my own reply on the thread). So I think this thread is a good place for you to start.

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

As I say, I will come back again later to add a few more thoughts of my own. But in the meantime, welcome to our family even though this is such a difficult time for you.

Marianne

[3bostons]

Hi, sorry to hear you are going thru this, as you can read on my thread I just lost my Kona to this very thing.
She was not a candidate for treatment. Her symptoms got very noticeable in March this year and progressed over the summer until now, so for her it didn't take long.
Just remember you know your pet best and I am regretting not listening to my gut about when it should of been time to let her go.
Debbie

[molly muffin]

Hello and welcome to the forum.

If it is a pituitary macro tumor, then they do tend to grow without treatment and things get worse.
Radiation treatment is an option and would need to be confirmed by a CT scan or MRI, but treatment is going to be expensive. Not that you shouldn't consider, just you have to be aware of it.
Side effects of the radiation treatment is minimal with the radiation treatment they use now, there would only be a few treatments. She might or might not need vetroyl afterwards, that is sometimes a toss up. For dogs that are a good candidate for radiation, then the results have been good.
I don't think you have had that determined yet correct? As the specialist where they do the radiation would need to see her and probably do a CT.

If it is a macro tumor then it will continue to grow and symptoms will get worse, and eventually there will be periods of distress. I wish there was an easier way to say that but that seems to be generally how it progresses.

Welcome to the forum. I really wish there where some easier answers, but there really isn't.

[jfarrel1]

Hello and welcome to you and to Beatrice, although I am so very sorry for the worries that have brought you to us. I lost my own Cushpup to what we believe was an enlarging pituitary tumor, although my husband and I did not proceed with the imaging of his head that would have told us for sure. I will return a bit later on and talk to you in more detail about my boy, but in the meantime, here's a thread that summarizes a variety of experiences of our members. It was started by one of our members who did choose to intervene, but as you will see, some of the rest of us did not (including my own reply on the thread). So I think this thread is a good place for you to start.

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

As I say, I will come back again later to add a few more thoughts of my own. But in the meantime, welcome to our family even though this is such a difficult time for you.

Marianne

Thanks! That was a helpful thread. I'm hoping to hear back from the vet hospital about the three different types of treatment so we can evaluate taking her there for an MRI if we decide we might pursue something. The vet hospital is 5 hours away, so we're evaluating the stress of the trip (she HATES the car -- it terrifies her) and the treatment with possible gains. Thankfully we have pet insurance, so we know at least some of it will be covered.

Thank you to everyone for the info you've provided. I'm over the initial shock and am on to trying to think rationally about what to do. It helps that the last two days she seems more like her old self, and has some energy and appetite back.

[molly muffin]

Let us know how you and Beatrice are doing and what you decide to do.
None of it is the wrong thing, but it is hard to make decisions when it is such an emotional situation. We understand that.

[jfarrel1]

Thanks for the information and kind words, everyone. We have an MRI scheduled at a vet teaching hospital later this month (the first appointment they had available). I am hoping for a call back from one of the neurologists before then so we can discuss the different types of treatment they provide there (radio surgery, radiation and tumor removal).

Beatrice's eyesight seems to be worse, but she seems to have more energy and seems to be feeling a bit better. I've added some of the tilapia and rice that my other dog gets for digestive issues to her kibble (slowly so I don't cause more problems), and that has increased her appetite too.

While we realize that we may not be able to do anything for her, we still have more questions than answers and are working to get answers to try to figure out what's best for our sweet Bea.

[jfarrel1]

I just wanted to update this thread for anyone else who is facing these same question and issues and looking for answers.

I took Beatrice to the vet teaching hospital at Washington State University, where one of the vets who performs the tumor removal surgery works. Their MRI machine was broken the day we were there, but they were able to do a CT scan, and the results and tumor were far worse than I ever expected. It was VERY large - so much so that even if she had been able to undergo the surgery, it would've been too big to ensure we would get all of it. Unfortunately the anesthesia caused some swelling in Beatrice's brain, and even with steroids, it was too much for her to overcome. We had to make the decision to say goodbye to her, because it was the only loving, humane thing we had left to do for her because it was obvious she had reached the point where her tumor was causing her to suffer.

Here's what I learned about the treatments, though.

If you catch it early enough and the tumor is small enough, radiation can help. I talked with radiologists in oncology at Colorado State University, and with the vets at WSU. Radiation is the most common treatment, and while there is some question (and disagreement it seems) about the effectiveness of the radio surgery, everyone seemed to agree that smaller fractions of radiation given across the course of several treatments does have some beneficial impact on this type of tumor.

But it can take up to four weeks before you really see the full improvement. And if you don't live near a hospital where they perform this type of treatment, you'll have to either relocate for maybe even a month, or board your pet. And you pet will undergo anesthesia for every single treatment (and anesthesia can cause swelling in the brain that complicates matters when you're dealing with a brain tumor). The radiologist at CSU told me it would be important for me to find out how Beatrice did under the anesthesia for the MRI (CT scan in our case). Obviously, it caused swelling that didn't really come under control.

BUT, if you catch it early enough, are fortunate to live near a place where you can seek treatment, and want some relief, the smaller fractions of radiation have shown really promising results. We had pet insurance, so if it had been an option, the fractions of radiation are what I probably would have done. Unfortunately the tumor was so big, and her side effects to the anesthesia what they were, so we were beyond that point.

The tumor removal surgery really does feel like a hail mary to me. They take the pituitary gland with the tumor, so there is another lifelong, hormonal management regiment. Because there's a chance they won't get all the tumor, there may be radiation afterward. And this is all if things go well and as planned. There is a lot that can go wrong, additional complications that can arise. The cautions I hear were so extreme that I wouldn't have put sweet Bea through this, even if I thought it would get rid of the Cushings. Because we would have left her with so many other problems (and she also still had epilepsy to contend with). Maybe the right choice for some dogs, but wouldn't have been for us.

Ultimately, about the only thing I think we could've done differently would take us back to doing an MRI at the start of her diagnosis to see how large the tumor was then. Who knows if it would have changed the course or not. Maybe I would've known better the road we could end up walking down and been more aware of the signs that it was as big as it was, and we could've saved that last day where she struggled so much. But, ultimately, I think we probably would have come to the same point.

Cushings is a hard disease. I cried when I got the diagnosis, and I'm tearing up as I write this, for all of you who are facing this with your beloved pets as well. Best wishes to you all. Give your dog all the love he or she deserves, and help them live the best life they can for however long you are lucky enough to be with them.

[judymaggie]

My heart goes out to you for having to make the most difficult decision we have to make for our beloved pups. Thank you for giving Beatrice so much quality time during the short span she was with you.

[molly muffin]

I am so sorry to hear that the tumor had gotten that big and there where no other options left. :(
My heart just breaks for you and your family.

RIP Beatrice.

[Harley PoMMom]

Oh, I am so sorry for your loss and my heart goes out to you.

We are so very grateful that in your time of pain that you shared that additional information with us, please know we are here for you always.

With Heartfelt Sympathy,
Lori

[Squirt's Mom]

I read your post late yesterday and couldn't reply for the tears. To walk in those doors with hope filling your being then to have that hope ripped away in the space of seconds is crushing. You walked in that door with sweet Beatrice promising her to do the best you possibly could on her behalf...and that is exactly what you did. You gave her the greatest gift of all - freedom from a badly damaged vessel.

Today your sweet girl is running free and wild in the Rainbow Fields with a whole host of friends, new and old. She is strong again, as she was in her youth, no pain, no fear, no confusion. From those fields she will always be watching over you with all the love in her heart she can hold. And when your job here on Earth is done, she will be there to greet you as you cross through the Veil, flying into your arms once again, this time never to be parted.

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox, Redd, and all our Angels

[addy]

I'm so very sorry for your loss and I do want to thank you for sharing your experience. That must have been hard. So many of us have dealt or are dealing with this disease. It can be heart wrenching at times.

Beatrice was very lucky to have you and you of course we're so very lucky to share your life with her.

My heart goes out to you and your family.