16 yo Mini Schnauzer has Pituitary Cushing's, Bladder Stone, Spleen Tumor, etc

[HowardSchnauzer]

About 6 months ago, my 16 year old (almost 17) male Miniature Schnauzer, Howard, was suspected of having Cushing's. Over the course of the 6 months, the symptoms progressed rapidly and after many, many tests, ultrasounds, x-rays, ACTH stimulation test, etc, he was diagnosed with numerous problems.

They found a 5cm mass in his spleen, large bladder stone, pancreatitis, and Pituitary Cushing's. The vet said that since he's a male dog, both the bladder stone would have to be removed and could not be dissolved and the mass in his spleen would also have to be surgically removed. While in there, they would do a bunch of biopsies. The Pituitary Cushing's, she said, would have to be treated with radiation if we forgo surgery.

Considering his age, we decided to forgo surgery and take our chances. We just got through his antibiotics to dissolve the bladder stone. As far as the Cushing's goes, we really don't want his last bit of life to be spent doing radiation therapy. Could anyone provide any insight?

I'm not sure what is happening to him, but in the last week, he's been acting really weird. Obviously the peeing accidents have increased significantly (almost every 2 hours even though we take him out every few hours), he won't eat his morning meals, but will eat his afternoon and evening meals. Now when he does have an accident, he'll drink his own urine. He walks around aimlessly. And he won't even lay on his bed, he just lays in the middle of the room on the hardwood. But his coat is still shiny and when he has moments of clarity, he seems really happy. What more can we do for him?

[labblab]

Hello and welcome to you and Howard. Gosh, congratulations on nurturing your little guy throughout a lifetime that is now almost reaching 17 years! I'm surely sorry to hear that he's having a rough time of things now, and has been for several months. As far as the Cushing's, though, I must tell you that one of the hardest aspects of Cushing's diagnostics is the fact that other, nonadrenal issues can also elevate cortisol levels. So when dogs are suffering from other unresolved health issues, "false positives" can result on Cushing's tests even when a dog does not have the disease at all. If possible, it is usually best to wait to test for Cushing's until other stresses on the body have been reduced or eliminated.

However, now that the testing has been done, one of the diagnostic questions that I am especially wondering about is how your vet has come to the conclusion that Howard suffers from the pituitary form of Cushing's, as opposed to the form that is caused by an adrenal tumor. On the one hand, she is talking about abdominal biopsies and surgical tumor removal, which would be consistent with a tumor on his adrenal gland. But then radiation is also mentioned, which would typically be used instead to treat a large tumor growing on the pituitary gland in the brain as opposed to an adrenal tumor. Has Howard had either a CT scan or an MRI performed on his head in order to view his pituitary gland? Either of these would be very expensive tests performed under anesthesia, so I feel certain you'll know if either was done. I'm guessing that the diagnosis was made based on abdominal ultrasound findings, but I just want to check.

Before talking further, I'll go ahead and await your answer about that. Because if Howard does indeed have Cushing's, his prognosis and treatment intervention may differ depending on the location (and size) of the tumor that is causing it.

Marianne

[HowardSchnauzer]

Thanks, Marianne. We haven't done a CT scan or MRI. They did do an abdominal ultrasound and the ultrasound results didn't say anything about the Cushing's only the spleen mass, pancreatitis and bladder stone. But the vet said they suspected Cushing's which is when they did the all day blood test and after that, she told us he had pituitary Cushing'a and that steroid treatment was not recommended and radiation was his only option. The surgery she recommended was to remove the spleen mass and bladder stone and while in there, they would do some biopsies.

Honestly we're very confused about the whole thing. The vet did not give us any alternative treatments or management options and she did not agree with us about the no surgery. But it just seems so harsh to put him thru surgery at his age. We just want to make his life comfortable but every day goes by and it seems it's getting drastically worse.

[labblab]

Thanks so much for your quick reply! OK then, I'm guessing the pituitary Cushing's diagnosis was based upon the LDDS blood test (8-hour test), and also the results of an abdominal ultrasound that did not show any masses or growths on the adrenal gland. My worry about the validity of the overall Cushing's diagnosis remains, however, due to the fact that both the LDDS and the ACTH can return "false positives" when other serious health issues are present.

That being said, surgical removal of pituitary tumors is still experimental in the U.S. and offered by very few veterinary centers. And radiation treatment is typically reserved for cases in which the pituitary tumor is enlarging to the extent that it is placing pressure elsewhere in a dog's brain, producing neurological problems (loss of appetite, mental dullness, pacing, circling, restlessness) in addition to or instead of the more classic Cushing's symptoms (excessive thirst, urination, hunger, skin/coat problems, etc.). Given your description of Stanley's behavior, this may be what she is suspecting: an enlarging pituitary tumor. If that's the case, then I'm afraid it is true that his cognitive condition will likely continue to worsen.

Just so you'll understand the more typical scenario which you'll read about here, the majority of dogs have pituitary tumors that remain quite small, and the dogs are treated with oral medications that serve to reduce the amount of circulating cortisol that the body produces. In turn, that reduces the unwanted conventional Cushing's symptoms. But if an expanding "macrotumor" is involved, then beginning or continuing with those medications may not be the best option.

I have to back up to say that I totally understand and endorse your decision to not subject Howard to any invasive treatment at his age, and given the combination of his health issues. Frankly, I am very surprised that your vet would even consider him to be a candidate for major surgery and/or radiation. So if she's pressing you to move forward on all these procedures and making you feel uncomfortable about your choices, shame on her!

But once again, before writing more, I want to check and see whether anything that I've written about an enlarging pituitary tumor sounds like anything that she's spoken about.

Marianne

[HowardSchnauzer]

Thanks so much for helping me understand more about this. The vet did mention that she suspected macroadenoma. But is this based on his behavior since they don't know exactly what the tumor looks like?

And if it is this, could this be the reason why he just wanders around aimlessly? Also is drinking his own urine because of excessive thirst or a mental thing? And at this stage, how advanced is this? I don't know what to expect next since it got so bad so quickly.

And is radiation even safe for a dog his age? The vet did say that even if we got the Cushing's under control, we'd have to deal with the spleen mass and bladder stone. But all of the treatment options seem so invasive...

Thank you again! This is so helpful.

[HowardSchnauzer]

Also, he can't lift his hind leg anymore to pee, he just pees on himself as he's walking. But he can still get up and down stairs. I don't know if that's Cushing's symptom...

And are dogs in severe pain when going through these symptoms?

[labblab]

The only way to diagnose a macrotumor for certain is to perform imaging of the head -- either a CT or MRI. Both of these tests are quite expensive and require sedation, though, and are beyond the means of many parents. So a macrotumor is often simply assumed, based upon symptoms. Actually, I went through this experience with my own Cushpup, who began exhibiting several worrisome neurological problems that culminated in a crisis for us when he stopped eating and drinking entirely. At that point, we decided to release him rather than pursuing head imaging. A big part of that decision was because we would not have opted for radiation treatment even had the macrotumor been confirmed. At that time, radiation involved a dozen treatments spread over a month, each requiring general anesthesia. There are now additional, shorter-term radiation options offered by some centers, but it would still be a major decision to make for a dog of Howard's age.

As far as the degree of discomfort that the dog experiences with a macrotumor, of course it's hard to know for certain :o. Some dogs will press their heads against hard surfaces, and the assumption is that this may signal headaches from the enlarging tumors. Plus things like pacing and restlessness would imply some degree of discomfort, but it's just hard to know for sure.

I guess one of the hard parts about Howard's situation is figuring out exactly what medical issue is producing which symptom. For instance, if he has a malignant tumor in his spleen, that may be responsible for increasing discomfort and disability. You know Howard better than anyone else, and so you are undoubtedly the best judge of his level of comfort or discomfort. If he only suffered from one serious problem, it might be easier to make a decision to intervene with aggressive treatment. But as you already know, there are multiple issues to be confronted with Howard. At his age, I understand why that may seem like too much to ask him to tolerate for long.

Marianne

[Scoovale]

Thanks so much for helping me understand more about this. The vet did mention that she suspected macroadenoma. But is this based on his behavior since they don't know exactly what the tumor looks like?

And if it is this, could this be the reason why he just wanders around aimlessly? Also is drinking his own urine because of excessive thirst or a mental thing? And at this stage, how advanced is this? I don't know what to expect next since it got so bad so quickly.

And is radiation even safe for a dog his age? The vet did say that even if we got the Cushing's under control, we'd have to deal with the spleen mass and bladder stone. But all of the treatment options seem so invasive...

Thank you again! This is so helpful.


Hello, my dog Scooter had a spleen tumor that has been removed three years ago. he was still 9 years old then. symptoms were a few, and different than cushing symptoms. He had pain and hard abdomen. sometimes he was normal but other times he stopped while walking. we had to carry up the stairs. later he would also make noises. one evening he would not walk and made noises, was dizzy. I pull him up and took him home, then to the doctor. the first told me he had leg pain (what an idiot), I did not believe him and took him to another. we did a picture of his internal organs and he was immediately put through surgery. he could have died any moment as the tumor was very big and could have open. he recovered well but the missing of the spleen might have played a role in the cushing. this surgery was a very hard one though. he had troubles waking up and was given adrenaline, then again sedative because he was screaming like hell. a disaster. I was up all night talking to him after the surgery to keep him from crying. it takes some time to get him back in shape. for an old dog ...possibly very dangerous.

with his cushing scooter also started to pee differently. when he is feeling well he does it on one leg, otherwise on two legs. his poop is what startled us the most, he just does is suddendly in the middle of the street, scattered around. that is odd as he always used to hide it.

drinking the own pee or eating the own fecal rests, is something that dogs do when they are ashamed and they know that is not right to pee or poop there. basically is a way to hide what they did.
it should be enough to show him that you are not disapproving, maybe telling him that his ok, patting him on the back. old dogs know the rules and will not forget anyway, that they should do it outside. it is just that with cushing they are not in control of their instincts or of themselves. it is very sad, also because I believe they see that but they cannot do anything about it.
dogs are clean animals and generally do not like to be dirty or to live in a dirty home. they have an own cleaning code. obviously older dogs are a bit like old people, or babies, they need to be taken care of, a little bit more as they cannot do everything like before. they are a bit ...more lost...old.

nevertheless, sometimes animals eat poop or pee because they contain particular vitamins, proteins and so on. this could give you an hint about a particular deficiency in his organism. maybe it could be interesting to do a littel research on this.

scooter has also some kind of neurological issues lately. i have found very helpful to give him Phosphatidylserine in the evening. it relaxes him. i think is 100 mg. i buy the one of Jarrow, is a good quality. it is also good for the brain capacities and sinks a bit the cortisol level (especially after particular exercises or stressful activities, which means also positively stressful. in case of cushing there is not difference between stress, if is happiness or rage, or whatever, is just stress that puts the cortisol level up).and it works a bit against thirst too.
i know it might sound funny, but i play a lot of meditation music for scooter in the late afternoon and he really relaxes a lot. otherwise he is often pacing around restless. I find the music in youtube, there are files with 3 or 4 hours. like indian meditation music.
he loves it.


keep us posted!

valentina