Young boxer lily diagnosed

[nietodevin]

Hey everyone I'm new here and wanted to see If anyone had any advice for me and my family.

Our female boxer "Lily" is 3 yrs 8 months old. She has been diagnosed with pituitary cushings since about 2.5 years.. our local vet and the specialist we went to see in San Antonio said it was the youngest case of cushings they have seen.
Lily was at a weight of 44 pounds before she was diagnosed and her weight had skyrocketed to 66 pounds in a matter of months.
Currently she weights 58 and we believe that weight loss is due to not letting her drink water all day and night.
She is currently taking trilostane 37mg tablets 2x a day.
Besides the little weight loss we have not seen any change in her.
If we let her she will drink her bowl dry.
She use to be active but now just lays around all day.
She has lost a considerable amount of muscle.
her hair has not grown back from her ultrasound last summer.
And now she has been aggressive and growled at my kids which she has never done.
According to her test her cortisol level was a 3.59 but I don't understand why the signs and symptoms have not gone away.
Any help would be appreciated

[judymaggie]

Welcome to you and Lily! I am sorry that you have the need to seek out help but you have found a great forum with supportive folks, many of whom have a wealth of knowledge about Cushing's.

Before I forget to mention it, I wanted to provide you with a quote from Leslie, one of our moderators, posted regarding the withholding of water:


Withholding water is risky in any dog but one who is in questionable health it is especially risky because some diseases, like Cushing's, effect the kidneys and those organs are going to work overtime regardless of the amount of water they drink. So withholding water can quickly lead to dehydration.

Please, please do not withhold water any longer from Lily. It may be that she is emptying her bowl and needing to go out to pee more often but the downsides of withholding can be severe. If no one is home during the day to add more water to her bowl, you may want to consider one of the automatic water bowls.

Okay, enough from me on that ... I would have to agree with your vets that 2.5 years old is unusually young to be diagnosed with Cushing's. Lily is currently on a dose of trilostane that would be more often given to a dog who weighs closer to 75 lbs. The current recommendation from the manufacturer is to start dosing at 1 mg./1 lb. Over time it may be necessary to increase or decrease the dose but, starting at such a high dose, leads to more incidences of overdosing and resulting side effects. That said, since she is still exhibiting symptoms, it may well be that she needs to be on a high dose.

Have you been treating Lily for the last year? When was the last ACTH test done? Dechra, the manufacturer of Vetoryl (generic: trilostane), recommends a monitoring ACTH 10-14 days after starting, then again at 30 days and, if the dosing is correct with symptoms controlled, an ACTH every three months. In order for us to provide you with better guidance, can you post the results of all ACTH tests that have been performed -- each would have two numbers, a pre- and a post-.

There may well be other things going on other than Cushing's. Your comment about showing some aggressiveness worries me in that regard. This can often be a sign of pain. Please provide us with any highs or lows on recent blood tests. We would also need to see the range for each test. If a urine test has been done, please let us know if there was any protein in her urine and what the specific gravity is.

All from me for now -- others will be along to fill in the blanks and probably to ask more questions! :D

[westcoastflea1]

you need to have thyroid checked asap dont listen to the vet when they tell you the thyroid is fine, it may well be, but if tsh levels are low because of cortisol being too high tsh hormone is not telling the thyroid to produce what is needed you need to have copy of test results sent to you if numbers are low or low normal put her on meds. my declan went off meds for 2 weeks and i ended up getting bitten, worst bite ive ever gotten from him . when dogs need thyroid meds and dont have them they may behave in ways you dont expect that are not safe for you or children, growling may not indicate pain at all but until thyroid is normal anything can happen

[nietodevin]

The last acth test was this past Friday.. her base was 2.45 and post was 3.59.
We haven't necessarily been withholding water but the water is no longer in the house because she would drink all night.. now she has to get up and go out the doggy door to drink which she doesn't do unless she has to see. I will have to get the tests before that. I believe she was on 22mg 2x a day then she went 27mg 2x a day.. then went to 27mg 2x in morning and 1 at night.. this seemed to work beat but she started to develop shakes so vet decreased dose..

[westcoastflea1]

get a uccr test done if results show cushings you need to increase dose

[nietodevin]

I'm sorry guess I missed it.. lily is on thyroid medication.. and it was checked again Friday also.. I can post this with the acth test

[westcoastflea1]

what is dosage? and yes please post test results for thyroid

[nietodevin]

How do I post attachments

[labblab]

Hi and welcome from me, too! Unfortunately, members do not have the ability to upload attachments (a security issue). However, you can create a personal photo album and then upload digital photos of test results for members to view. Or you can simply type specific results within the body of your reply.

Marianne

[nietodevin]

Acth

FindingsEndocrinologyLily -

Serum - 1Test: Cortisol (ChL - K9-ACTH-1HR)
CORT-BASE 2.45 ug/dL (0.1 - 6)
CORT-1HR-P-ACTH 3.59 ug/dL (0 - 20) Cortisol(ChL):

A normal response to ACTH is a 3.5 to 4.5 fold increase in the average normal baseline cortisol (2.0 to 3.0) concentration with concentrations of post ACTH cortisol above 20 ug/dl considered confirmatory for hyperadrenocorticism if the dog exhibits compatible clinical signs. Concentrations exceeding 14 ug/dl but less than 20 ug/dl on post ACTH cortisol are suggestive, but not confirmatory for hyperadrenocorticism. Cushing's disease is a progressive disease and if results are suspicious, it is recommended to perform either an ACTH stimulation test or a low dose dexamethasone test at a later date (1 to 2 months later). It is not uncommon for the baseline cortisol to be elevated due to the stress of the environment. However, baseline cortisol concentrations can be elevated in the Cushing's animal. Dr. Scott JaquesSection Head: Diagnostic Endocrinology

[nietodevin]

Cbc and t4

Total Serum Protein6.9 g/dL(5.6 - 7.9)
Albumin3.8 g/dL(3 - 4.5)
Calcium10.8 mg/dL(7.2 - 12.8)
Phosphorus5.6 mg/dL(2.3 - 6.5)
Glucose105 mg/dL(60 - 120)
BUN7 mg/dL (Lo) (8 - 30)
Creatinine0.7 mg/dL(0.5 - 1.4)
Total Bilirubin0.2 mg/dL(0.1 - 0.4)
ALP599 U/L (Hi) (12 - 122)
CK34 U/L (Lo) (58 - 241)
AST (SGOT)11 U/L (Lo) (13 - 52)
ALT(SGPT)84 U/L (Hi) (13 - 79)
Globulins3.1 g/dL(1.8 - 4.2)
A/G Ratio1.2(0.8 - 2.2)
GGT8 U/L(0 - 10)
Amylase627 U/L(454 - 1380)
Cholesterol484 mg/dL (Hi) (124 - 335)
Sodium153 mEq/L(141 - 156)
Potassium5.1 mEq/L(3.8 - 5.5)
Na/K Ratio30Chloride112 mEq/L(109 - 124)
General ResultsJulie Piccione, DVM, MS, DACVPClinical Pathology Section HeadEndocrinologySpecimenTest
NameResultRef. Range- ResultLily - Female-spay - 3 YearsSerum - 1Free T4 (RIA - Free T4)25.64 pmol/L (12 - 33)

[labblab]

When was that monitoring ACTH test performed?

Marianne

[nietodevin]

The test was done this past Friday March 31st

[labblab]

Well, I'm afraid I must say I am stumped, too. Did the initial diagnostics establish whether Lily suffers from a pituitary vs. adrenal tumor?

At this point, I believe I'd arrange a return visit to the specialist in order to get his professional opinion as to what may be interfering with Lily's symptom resolution. Would that be possible for you to do?

Marianne

[LaurieS]

Im so sorry to hear about your girl having been diagnosed at such a young age. My boxer, Charlotte is 7 years old and was diagnosed last December.

I was going to ask the same question as Marianne, was Lily diagnosed with pituitary or adrenal cushings? Charlotte has pituitary cushings and we believe has a macro tumor. Although her ACTH stim tests showed she was responding well to the trilostane, her body didnt handle it. The only symptom that improved was her water intake and after 6 weeks on trilo we almost lost her. Since then we have been treating her as if she has a macro, although we couldnt afford the MRI to confirm. It seems like dogs with macros wont respond to the cushings meds and need to be treated differently so im wondering if that could be the case with Lily.

Laurie

[molly muffin]

Hello and welcome from me too. Have they considered doing a full thyroid profile to see anything specifically might be off there? I just wonder since thyroid is most often associated with aggression.

[nietodevin]

They did a test to determine it was pituitary and then did a ultrasound of her adrenal glands and both were enlarged but no tumors found on them.
I would have to look but would guess they did a full thyroid test because the vet was sure it was her thyroid until I did some internet searching and told her to check for cushings.. the vet and the specialist couldn't believe she was so young and have cushings

[westcoastflea1]

you need to have a complete thyroid test done t3 free t3 t4 free t4 and tgaa find out where the levels are on all if low normal or below normal meds need to be increased acth tests are not very reliable have a uccr done just need a sample of urine first morning catch do 2 or 3 days worth mix together keep refrigerated then drop at vet if test results come back saying your dog is non cushings means you have cortisol under control if it doesnt come back non cushings it means you need to increase meds

[westcoastflea1]

if she cant handle meds try one of the new dopamine agonists cabergoline for one, no side effects and if it works it will shrink pituitary tumor or eliminate it altogether,

[labblab]

...acth tests are not very reliable have a uccr done just need a sample of urine first morning catch do 2 or 3 days worth mix together keep refrigerated then drop at vet if test results come back saying your dog is non cushings means you have cortisol under control if it doesnt come back non cushings it means you need to increase meds
I need to point out that we are unaware of any research that suggests that UCCR analysis is preferable to ACTH monitoring for dogs being treated with either trilostane (Vetoryl) or mitotane (Lysodren). In fact, clinical testing thus far suggests the reverse: that UCCR analysis cannot reliably be used as the basis for decisions regarding dosing increases. Here's a related reply posted by another one of our staffers.


The UC:CR is not recommended for monitoring treatment. I'm including this excerpt from a study and was published in 2009 and titled: Urinary Corticoid : Creatinine Ratios in Dogs with Pituitary-Dependent Hypercortisolism during Trilostane Treatment


Conclusion and Clinical Importance: The UCCR cannot be used as an alternative to the ACTH stimulation test to determine the optimal dose of trilostane, but might be helpful in detecting dogs at risk for developing hypocortisolism during trilostane treatment.

http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2009.0374.x/abstract

Lori
Although perhaps not a perfect monitoring tool, the ACTH stimulation test remains the preferred method for evaluating the appropriateness of dosage increases during the course of trilostane and Lysodren treatment.

Marianne

[westcoastflea1]

as you can see what your vet did for thyroid was nowhere near what should have been done you need all the info below to make an informed decision as to how well thyroid is performing it may be healthy but cortisol suppresses production of thyroid stimulating hormone or tsh so thyroid does not perform as it should.
every level on declans test was low or very low except the t4 which they said was normal but low normal is 1.15 and he was 0.89 which is not normal. Because the free t4 was 0.80 and normal is 0.70 or over these 2 results caused dr dodds to say thyroid was normal but again TSH is suppressed by cortisol
test results below:
T4 0.89 /// NORMAL RANGE is 1.15 - 2.60

Free T4 0.80 /// NORMAL RANGE is 0.70 - 1.70

T4/FT4 Ratio 1.11 ///NORMAL RANGE IS 1.25 - 1.75

T3 13.8 // NORMAL RANGE is 30 - 70

Free T3 0.90 /// NORMAL RANGE IS 1.6 - 3.5

Thyroglobulin Autoantibody
(TgAA)
< 1 Negative < 10 < 10 %

Dear Toni and Heather: Thyroid levels here are indicative of a non-thyroidal issue. The normal FT4 (NOT NORMAL IT WAS LOW) and
low T4/FT4 ratio suggest the low levels are not due to hypothyroidism.

*T4/FT4 Ratios at or below 1.25 generally, but not always, signify the presence of non-thyroidal illness
(NTI), or, hypothyroidism + NTI. High T4/FT4 Ratios usually are not clinically relevant except in thyroxine overdose or thyroid-secreting tumors.
TGAA CONFIRMATORY TEST RANGES < 10% =Negative; 10%-25% =Equivocal;>25%= Positive
If positive (elevated), the TGAA level confirms autoimmune thyroiditis. False positive results can occur if
the dog has been vaccinated for rabies within 30 to 40 days. Thyroid hormone supplementation can
decrease TGAA levels.
SO IF YOU DONT HAVE THE ABOVE INFO ON YOUR DOG YOU NEED TO GET A FULL THYROID PANEL DONE MAKE SURE IT INCLUDES EVERYTHING ABOVE AND I WOULD GET IT SOON IF YOUR DOG IS GROWLING

[Budsters Mom]

I am not aware of any medication that may/will shrink a pituitary tumor. Other than a series or radiation treatments to shrink the tumor, which often grows back in time, that was about it. Surgery to remove the tumor is not an option in most cases, but has been done effectively. So, I am very interested in you claim concerning the use of Cabergoline. It sounds too good to be true. Do you have any links to studies that support your claim? If so, please post those links to share with us here.

Thank you,
Kathy


try one of the new dopamine agonists cabergoline for one, no side effects and if it works it will shrink pituitary tumor or eliminate it altogether,

[labblab]

I'm answering on behalf of westcoastflea1 ;), but here's a link to an article authored by Dr. David Bruyette that discusses the potential benefits of cabergoline. I must admit, it does sound almost too good to be true. But apparently, for a percentage of Cushpups (40% according to Dr. B), it may be a very positive treatment option. I'm frankly puzzled as to why we've not heard more about it, and I'm anxious to learn more, myself.

http://veterinarynews.dvm360.com/new-possible-cushing-s-treatments-work-root-cause

Marianne

[nietodevin]

Ok guys I have all the test from my local vet on my photo album page.. I do not have the test from the specialist and I truly believe at least 1 test is missing, but they said that's all of them

[Budsters Mom]

Thread Hyjack!!!!


Marianne --- Thank you for the link to Dr. Bruyette's article regarding Cabergoline. It is very encouraging!! :)

Kathy

[Squirt's Mom]

I looked at the screen shots you posted but my old eyes won't let me see the print. So hopefully someone else can and then talk to you about them. :o

[Harley PoMMom]

I'm not seeing them clearly either, and when I zoom in the text gets even fuzzier.:(

[nietodevin]

I'm going to make several posts so the results don't get mixed up.

Urinalysis on 01/12/2017
Bilirubin neg
Ketone neg
Sp. Gravity 1.0 /R 1.000
Blood +
pH 8.0
Protein NEG
Urobili NEG
Nitrite NEG
Leukocytes NEG
Sediment NONE- looked like water
Route: Free catch

[nietodevin]

AbaxisVetScanIITest 11-11-16 12:25p
Prefix VetScan VS2 Thyroxi
T4 3.5 1.1 4.0 ug/dL

CHOL 430 H 125 270 mg/dL


AbaxisVetScanIITest 11-11-16 12:25p
Prefix VetScan VS2 Com

ALB 4.7 H 2.5 4.4 g/dL
ALP 403 H 20 150 U/L
ALT 116 10 118 U/L
AMY 815 200 1200 U/L
TBIL 0.3 0.1 0.6 mg/dL
BUN 6 L 7 25 mg/dL
CA 11.6 8.6 11.8 mg/dL
PHOS 5.8 2.9 6.6 mg/dL
CRE 0.8 0.3 1.4 mg/dL
GLU 108 60 110 mg/dL
NA+ 149 138 160 mmol/L
K+ 4.7 3.7 5.8 mmol/L
TP 8.0 5.4 8.2 g/dL
GLOB 3.3 2.3 5.2 g/dL

[nietodevin]

AbaxisVetScanIITest 09-26-16 8:39a
Prefix VetScan VS2
Com

ALB 3.8 2.5 4.4 g/dL
ALP 367 H 20 150 U/L
ALT 179 H 10 118 U/L
AMY 789 200 1200 U/L
TBIL 0.4 0.1 0.6 mg/dL
BUN 6 L 7 25 mg/dL
CA 11.6 8.6 11.8 mg/dL
PHOS 6.5 2.9 6.6 mg/dL
CRE 0.9 0.3 1.4 mg/dL
GLU 106 60 110 mg/dL
NA+ 150 138 160 mmol/L
K+ 5.2 3.7 5.8 mmol/L
TP 7.8 5.4 8.2 g/dL
GLOB 4.0 2.3 5.2 g/dL


AbaxisHMIITest 09-26-16 8:45a

WBC 8.58 6.00 17.00 10^9/l
LYM 1.09 1.00 4.80 10^9/l
MON 0.43 0.20 1.50 10^9/l
NEU 6.88 3.00 12.00 10^9/l
LY% 12.7 12.0 30.0 %
MO% 5.0 H 2.0 4.0 %
NE% 80.3 62.0 87.0 %
RBC 8.54 H 5.50 8.50 10^12/l
HGB 22.3 H 12.0 18.0 g/dl
HCT 62.37 H 37.00 55.00 %
MCV 73 60 77 fl
MCH 26.1 H 19.5 24.5 pg
MCHC 35.8 H 31.0 34.0 g/dl
RDWc 14.9 H 0.0 0.0 %
PLT 369 200 500 10^9/l
PCT 0.34 H 0.00 0.00 %
MPV 9.2 3.9 11.1 fl
PDWc 38.8 H 0.0 0.0 %

[molly muffin]

I think that if I had a dog with a macro tumor I would try cabergoline. If it works it is worth it.

So it looks like the only thing that was out of range in January was the ALP, ALB, BUN (remaining at 6 where it was) and Cholesterol. Was this a fasted test? If not the food could have something to do with the cholesterol, but the liver has improved. (ALT now in range)

[nietodevin]

Well guys the vet wanted to see lily to run a acidic (?) Test in her liver.
We won't know the results til tomorrow.
But question is the vet also wants to put lily on prednisone for pain.
Is this normal?
Do now lily is on
.4mg thyro tabs
37 mg trilostane 2x a day
10mg prednisone 2x a day

[westcoastflea1]

so no thyroid panel results? prednisone can actually cause cushings

[westcoastflea1]

prednisone is a corticosteroid= cortisol = which means you are giving your dog something that increases cortisol which is the exact opposite of what you should be doing missing tests? maybe the thyroid panel? maybe a new vet is in order?

[Harley PoMMom]

What is Lily feeling pain from? Prednisone is also used for its anti-inflammatory properties.

The vet is probably running a bile acid test to see how the liver is functioning, let us those results when you get them.

Hugs, Lori

[westcoastflea1]

might be worthwhile having an ultrasound since gall bladder stores liver bile and if the gallbladder is sludgy or if sludge is turning hard gall bladder can burst and will also effect liver function you will have an issue easily cured by ursidiol. Bile is stored in the gallbladder, a tiny organ located behind the liver. Because of their intimate association, gallbladder dysfunction can adversely affect the liver, manifesting as an elevation in certain key enzymes, namely the transaminases ALT and AST.

[westcoastflea1]

prednisone may very well be used for anti inflammatory but it is not good for cushings dogs it lowers immune system and cushings dogs already have compromised immune systems it raises cortisol so taking prednisone while on vetoryl just isnt good. If dog is in pain there are other meds available that dont work against the vetoryl in cortisol reduction and what is the pain caused by? would be interesting if once prednisone is stopped that cortisol levels decrease enough to decrease vetoryl dosage but..... thyroid panel needs to be done

[nietodevin]

I'm trying to get thyroid panel.. our vet has been talking to an internal medicine specialist.. she is the one that diagnosed lily with cusihings..
The specialist is the one who told my vet to put lily on prednisone..
I want to get a second vet opinion but we have already spent around 4k on lily on the past year and half.. it just breaks my heart cause my kids don't know what's wrong with their fur baby..

[Harley PoMMom]

Did the specialist tell the vet the reason she wants Lily on the prednisone?

Sending tons of comforting hugs to you and your children.

More hugs, Lori

[Squirt's Mom]

Personally I would not waste the money on a full thyroid panel at this time. But I would want clarification on why the pred was being recommended.

[westcoastflea1]

if lily is growling, thyroid could very well be the cause, so that makes it important.A thyroid test by dr dodds is under 100.00 . Unfortunately specialists are not always correct. my specialist said she wanted to ultrasound declans gall bladder every month since it was sludgy, she never bothered to tell me that ursidiol at 50 .00 a month would clear out his gall bladder completely, this is the same specialist that sold me expired vetoryl so because a specialist says use prednisone on a cushings dog doesnt make it the right thing to do. it increases cortisol so acts directly against the vetoryl. prednisone can even cause cushings so it certainly makes sense to use something for pain other then prednisone
its only simple logic

[nietodevin]

Lily had a bile acid test done yesterday and results were good
bile fasting- 3.3
Bile 2hr- 8.3

After talking with vet the prednisone is being used for possible GME and inflammation.
The vet we have has been recommended by many people and she even says she is beating her head against the wall on this one..

Just asking if anyone else has these problems, but lily will zone out occasionally and just stare at the wall.. she will also shake occasionally.. is this part of the cushings or possible nervous system problem

[Squirt's Mom]

GME? Has Lily been diagnosed with GME or are they thinking this is a possibility? You need to do some research on this and see if you think this fits anything you are seeing in her. If so, then the pred makes more sense.

[nietodevin]

They are just thinking that might be a possibility.. So they wanted to put her on prednisone..
They said to diagnose they need to do a MRI and the quite was $2500 which is out of our price range..
How did y'all dogs react once on meds?
Lily just lays around all day and doesn't run and jump like she use to.

[molly muffin]

I know that they also have treated dogs with macro tumors with both predinsone to keep down inflammation and vetroyl for the cortisol. It does seem counter productive but in dogs that do have macros, it seems to help some.
My molly had active days and not very active days, it just depends on how she felt at any given time and that might be true with Lily too.

[nietodevin]

We want to take her out and try to get her to run around, but the last time we went walking she was panting extremely hard after 1 block

[molly muffin]

At this point, probably walking at any kind of regular pace is not going to work for her. Do you have a yard she can just run around in? Of just do a short walk not even around the block with frequent stops and see how she does. :(

[nietodevin]

Yea we have a decent size yard.. our male dog runs around like crazy , but lily doenst even get up when we come back from a trip.. she just looks at us as we walk by

[westcoastflea1]

http://www.delawarevalleyacademyvm.org explains in detail the central nervous system diseases mri is expensive but what about dna test looking for fmhc haplotype? lily may have something which was inherited or a genetic mutation which would be found using dna which is about 100.00 if what she has is able to be found using dna then you treat for disease not just guess at what it might be. there are other drugs that can be used if steroids are not working for inflammation even combinations. if it is dm physical rehab might be in order to prolong her use of hind legs i would go high protein maybe merrick all meat canned food protein will help build up muscles

[nietodevin]

How long after starting the trilostane did it take your dog to get more energy and muscle mass back?
We do believe overall her water consumption has gotten better.
But her energy and muscle mass are nowhere near what she was before

[westcoastflea1]

i believe within the first few months water and food consumption were down. it took longer to see results as the specialist sold me expired vetoryl, which declan took for the first month. the only symptoms relieved in the entire time he was on vetoryl about a year or so getting up to 300mg per day was water food consumption. it wasnt until i put him on thyroid meds that everything changed complete 180. if i were you i would see what thyroid levels are. you want to see lab results of t3 t4 ft4 ft3 tsh if in low ranges regardless of ft4 being normal i would increase thyroid meds feed lily merrick 96% meat canned dog food protein will help with muscle building diabetes can go hand in hand with cushings so no carbs since they convert to glucose also low fat to keep pancreatitis away. has her gall bladder been looked at ? if it is sludgy it can adversely effect her liver causing alp alt to increase you can put her on ursidiol $50.00 a month to clear out gall bladder to help keep liver healthy. key is to keep cortisol levels down and try to keep all other organs healthy.

[westcoastflea1]

uccr is the first test that should be done when trying to diagnose a possible cushings dog although it does have false positives its negative results are much more reliable. so if i have a uccr done and the lab says my dog is negative for cushings than i have a pretty good idea that cortisol is under control. here is one quote from a vet "Although the UC:Cr is more frequently elevated than it is normal, when it is normal, you know that your patient does not have Cushing's disease" pub med www.ncbi.nlm.nih.gov states that " Using the cutoff of 12.27 nano mol/ micro mol(based on data of normal subjects) for the urine cortisol creatinine ratio we get a sensitivity of 93.75% and a specificity of 100%. Also the positive and negative predictive value as calculated with this cutoff is 100% and 93.3% respectively.

Administrative Note: please see westcoastflea1's own thread for a continued discussion of the use of the UCCR for both diagnostic and monitoring purposes.

http://www.k9cushings.com/forum/showthread.php?p=200524#post200524

[nietodevin]

Update on lily.

We brought lily to another vet to get a second opinion and he said all test look good..
He does recommend doing a full thyroid panel, go from prednisone to a non steroid anti-inflammatory, and to try lysodren.
Both the cushings and thyroid number show to be under control, but the symptoms aren't.
The second vet does agree with the first that most likely the tumor is growing, but no way to tell without MRI which is out of our price range

[Harley PoMMom]

What symptoms is Lily still displaying?

[Carole Alexander]

Yes, I would be very curious to hear more detail about Lily's behaviors. Nearly six months ago, my dog Skippy started down the Vetoryl trail after two ultra sounds and extensive testing. While his symptoms were never under control nor were his numbers. If you can plow through it, I describe in detail Skippy's symptoms on my thread. No circling or getting lost in corners but lots of cognitive issues, dullness, often refusal to walk, seeming fear of going outside, starring and so on. Also, see Mojo's thread by Lilytara, Kathy's thread, who posted on yours, and Laurie's thread about their boxer Charlotte all who have or had macro tumors. Also, search this forum for macro tumors or macro adenoma. Both Vetoryl and Lysodren will only make the macro tumor grow if she has one. A steep learning curve is still ahead of you in trying to help Lily who is a very young Cushing's dog indeed. I would hesitate to start Lysodren but I understand you have few options. I can find no medical treatment options for a macro that are affordable except Cabergoline. There is a little evidence with humans that it shrinks ACTH secreting and Prolactin secreting pituitary tumors and one old study on dogs by Castillo. We know Lilly is secreting ACTH. I can offer more info depending on what you decide to do but believe me, there are no easy answers.

[nietodevin]

She has the dullness, and doesn't like going outside..
Also she is real weak and limps everywhere.
Our main vet says she doesn't want to put on lysodren.
But is doing another full thyroid panel.

So is there anything else yo take for the macro tumor?

[Budsters Mom]

Pituitary macro Tumors continue to grow until they eventually take over. There are a few things you can do to help Lily feel more comfortable, but there is no known cure other than surgery. Surgery isn't an option for most of our pups. Radiation therapy is a possibilty, which can shrink a tumor allowing more time. Even then, the tumor generally grows back. Both of those treatments are very costly.

Pain meds are a must. You already mentioned a non-steriod anti-inflammatory. That could help release some of the swelling around the tumor, taking some of the pressure off of the brain. Trammadol - is also an option, paricular for restlessness at night.

Some of our members are trying Cabergoline, as a chance to shrink the tumor. It is said to help in about 40% of the cases, depending on what part of the pituitary gland is affected. I don't know much about it, but am anxious to learn more. I have no idea how effective it is. You might want to ask your vet about it.

Sorry, I wish I could do more.:o

Kathy


So is there anything else yo take for the macro tumor?

[Squirt's Mom]

These drugs used to lower cortisol will cause a macro to grow faster according to studies done on Vetoryl. To my knowledge there are no such studies on Lyso but logic says it will do the same. So if a macro is in play, stopping all cortisol lowering drugs is usually best. In fact, Prednisone is often used to help in these cases.

[LaurieS]

I wish more vets understood the importance of knowing whether a tumor was a macro, but I also know that not all of us can afford the scan or MRI to determine it. We were unable to afford those diagnostics for our dog Charlotte but in the end it was apparent she had an enlarging tumor since she was displaying so many of the symptoms. We said goodbye to Charlotte a couple of weeks ago, she was only about 7 years old.

I wanted to add to what the others have said, only because I think everyone should know about all the options for treatment. It's hard to believe that natural/holistic treatments could help when drugs don't seem to be working but I believe that sometimes they can actually be more effective. We had Charlotte on some very strong anti-inflammatory herbs and supplements at the end of her life, along with prednisone. Unfortunately, we didn't start them in time to even give them a chance to work (natural substances take longer to work than drugs). But I believe that these supplements don't hurt and can only possibly help in a case with a macro tumor. Below are some of the things that were recommended to us for shrinking a tumor naturally and although each individual dog is different depending on the meds they are taking I believe most of these supplements would be safe to add to the medical regimen.

Milk Thistle - supports the liver but also has been studied in humans in regards to shrinking pituitary tumors

Curcumin - a constituent of turmeric, it has powerful anti-oxidant and anti-inflammatory properties. I was given an article written about studies on how it can shrink brain tumors in dogs only 2 days before Charlotte died. I'd be happy to share that if you are interested. But I do know it has to be given properly in order for the body to utilize it. We found a good quality capsule that was easy to give to Charlotte because she had become so finicky with her food but you can also make a golden paste out of turmeric, coconut oil and black pepper and add it to their food if they will eat it that way.

Boswellia - also extremely anti-inflammatory. It comes from the same plant that we get Frankincense Essential Oil from and it has been studied for it's anti-cancer and tumor shrinking properties. The capsule we gave Charlotte with the curcumin also contained boswellia.

In addition to reducing inflammation it's important to support the body's own ability to fight and repair itself so boosting the immune system is something that should be a priority. Here are a couple of things that were highly recommended to us for Charlotte. The first on the list is one I purchased and gave to her the last 5 days of her life (clearly not long enough to see a difference) and the second I had planned to order if she had lived longer.

APF - this is a herbal supplement that supports the dog's immune system and contains Adaptogens that help the body adapt to stresses and increase resistance to factors that cause damage.

Max Immune Forte - another immune booster that contains probiotics. Gut health is so important and although it's not what we are treating when we are concerned with Cushings it's imperative that a dog's gut be healthy so it's immune system can work properly and fight what is causing damage.

I believe the body can heal itself when given the proper tools. It doesn't always work that way and often times I think we don't catch things in time for the natural treatments to work. But I also know, and you of course need to consult your vet and also a good holistic practitioner about this, that most of the above treatments can be combined safely with the meds our cush pups are taking. Many humans and pets respond better to holistic treatments than they do drugs so I feel it's worth a try and wanted to share with you since I think everyone else has covered all the other options.

I wish we had known earlier what we were dealing with so we could have started Charlotte on all of the above before the tumor had gotten out of control. I also wish the diagnostics were more reasonable so more people could afford to do them right away upon diagnosis. My heart aches for you, and everyone else on this forum who is going through, or has gone through, this journey with their pups. And it's especially heartbreaking when the dog is as young as Lily!

Hugs,
Laurie