Lindy, 14 year old sheltie mix (update: Lindy passed away in May 2010)

[lindyandkim]

My 14 year old sheltie mix was diagnosed in December with Cushings using low dose test and in January an ultrasound showed tumors on her adrenal glands and the trigonal area of her bladder.
Previous to this she had been Denamarin for high liver numbers and is still on this.
I was told the bladder cancer would get her first so we have been seeing an oncologist.We have had her on piroxicam and chlorambucil for the bladder cancer since January. The bladder cancer seems not to have progressed. Her ultrasound looks about the same, her peeing is fine and oddly her liver numbers have now come into normal range. (I don't have these numbers available right now.)
Her problems from Cushings do seem to have progressed-namely skin and now weakness and occasionally shakiness.( She has had a ravenous appetite for over a year.) I took her to a skin doctor and she has both fungal and bacterial infection, so they gave her ketoconazole shampoo and an antibiotic and that has improved things. Lately I have been thinking she may be on her last days because of the weakness and shakiness, but then I found these are both Cushings symptoms. She is still feisty at times and toddles around for walks. The heat seems to get to her too.
Her diet consists of half Royale Canin early renal and then boiled turkey, rice, and vegetable and yogurt sometimes. We also give her water with chicken in it to get her to drink more.
I am wondering about the ketoconazole drug-both my oncologist and the skin doctor thought that would be too hard on her liver , but at that point they were talking about it for the skin condition and no one said about using it for Cushings.
I know we need to be careful about not promoting the cancer.
Any suggestions would be helpful.
Lindy's mom

[StarDeb55]

Lindy's Mom, I'm so sorry that you are struggling with a dual diagnosis of cancer & Cushing's. I have been there, too. My 1st boy, Barkley, had been successfully treated for Cushing's for about 6 years, then developed lymphoma. I did put him through chemo which gave him another 20 months. It does sound like the oncologist has gotten the bladder Ca stabilized with the chlorambucil which is great. Keto is, indeed, quite harsh on the liver, & must be closely monitored. Barkley was on lysodren which did not interfere with any of his chemo treatments. I will tell you that it took both an oncologist & internal med. specialist to coordinate all of Barkley's treatment. You might discuss the possibility of using a maintenance dose of lysodren with your oncologist or IMS, if you're using one. I doubt that your baby would be able to tolerate the strain of a lysodren loading phase, but a maintenance dose may make her more comfortable.

What is your name, by the way? It's a little more personal than saying "heh, you".

Debbie

[lucygoo]

Hi Lindy's mom...
I would ask your vet about a drug called Anipryl. It's used to treat cushing's symptoms, but doesn't have the harsh side effects the other drugs have. My friend's dog was recently put on this for cushing's and is doing great. Of course, I don't know if it would interfere with everything else you've got going on, but I would think this would be your best option.

Good luck to you:)
Gina

[lindyandkim]

My dog's name is Lindy. She is a rescue (of 13 years) that shares her home with five other dogs, two humans, and some sheep. She and we have been blessed with her good health up until this Cushings and bladder cancer.
Are there preferred drugs for the adrenal tumor Cushings?
Thanks for the kind words, Lindy's mom

[ventilate]

Hi and welcome from me and mine;
I believe that lysodren is the drug of choice for adrenal tumors. Unfortunately Anipryl is not a great drug for cushings. It helps in some cases to relieve the symptoms but I have seen here where almost always people start with anipryl then after some time move to one of the tried and proven meds, lysodren or trilostane. Sometimes it is recommended to try as some dogs can not take the loading of lysodren, or if people are just looking for a pallitive care option to help alivate symptoms to keep their dog comfortable. I am not sure if a maintenace dose of lysodren would work as it is the high cortisol that causes the symtpoms and you will need to lower the cortisol to a pretty low range to get rid of the symptoms and I dont think you can do that with just the maintenace dose. I wonder if a loading dose at the lower acceptable range would be tolerated. As Debbie said it would probably take the efforts of both an IMS and Oncologist to do what is best for your dog.
Good luck
Sharon

[Buffaloe]

Hello Lindy's mom,

My dog had a very large, malignant adrenal tumor surgically removed almost three years ago and she continues to do very well at 14 1/2.

You wrote that there were tumors in her adrenal glands. Did the ultrasound indicate a tumor in both the left and right gland? Do you know the size of the tumor(s)? What about their involvement with area blood vessels? Do they appear to be growing? This information should be readily available to you in the ultrasound reports.

I think you will have to consult with your veterinary professionals about possible interactions between the drugs Lindy is currently taking and the various medications available to treat adrenal tumors. Your options are Lysodren, Trilostane, Ketoconazole and possibly Anipryl. Depending on the size of the adrenal tumor(s) and how rapidly they are growing, one of the medications might be helpful. Adrenal tumors are tricky, there are many different kinds, they can be functional or non-functional, some are malignant, some grow rapidly, etc. A consultation with an experienced Internist would probably be a good idea. Good luck.

Ken

[lindyandkim]

Yes,there are tumors on both sides. I believe the most recent ultrasound said they had not grown. We consult with an internist Thursday.
I will try to round up Lindy's health info then and post it and add to the information base.
Thanks so much to everyone for their help.
Kim

[Squirt's Mom]

Hi Kim,

Just dropping by to offer a belated welcome to you and Lindy. :)

I am so sorry you and Lindy are having to deal with all of this. :( You certainly have your hands full but are doing a wonderful job of caring for your baby and I am sure she appreciates it a great deal.

Hugs,
Leslie and the girls

[Buffaloe]

Kim,

That is wonderful that Lindy will be seeing an Internist Thursday. Her situation is pretty complex and I'm sure the Internist will come up with the best possible treatments for her.

Because the tumors don't appear to be growing, there is a reasonable possibility that they could be non-functional. That would really be nice.

The heat alone does a number on our senior dogs. We're in Phoenix and I can barely get Shiloh to go outside. 'Can't say as I blame her.

Ken

[lindyandkim]

I had Lindy in for high dose dex test a week ago Friday. She came home that evening ready to conquer the world -or a sibling. By Sunday she had bloody diarrhea so we took her off the piroxicam for the bladder cancer. Monday she was put on metrodiazonal and vomited. Then more meds into the week-cerrenia, sucrafeld?, etc.She's at home now on IV with potassium and eating chicken and dog biscuits but little else. There's talk of the last days.

Her high dose test, as did the previous ultrasound and low dose test, indicated adrenal Cushings, and the internist wanted to put her on Trilostane.She also ran an ACTH test but I don't know of the results. Not sure if we will make it to that.
I did not have a chance to get lab results before this setback set in.

I am really doing the regret thing about not being more aggressive earlier -back in December before I knew she had cancer I was talking to my vet about Trilostane. Then the cancer became the focus.

[frijole]

Kim - No reason to second guess yourself though we all do .... there was no reason to rush with cushings treatment given the situation. Take care of yourself and enjoy every minute. Keep us posted and know we are sending are best wishes, hugs and prayers to you and yours. Kim

[gpgscott]

Kim sorry I have not posted to you before and welcome.

I am sorry you are having multiple issues and like Kim said no reason to rush into a Cushing's treatment until you know more about the bladder issue.

Best wishes.

Scott

[Harley PoMMom]

Hi Kim,

Just wanted you to know that you and Lindy are in my thoughts and prayers.

Best wishes too.
Lori

[Buffaloe]

Hi Kim,

I sure do hope Lindy is hanging in there and doing well. It is a tough thing to take great, great care of our elderly dogs. We can only do the best we can.

I wanted to briefly address the regret you mentioned you are feeling. I believe you need to think back to the time(s) you made the various decisions for Lindy. Remember what you were thinking and feeling at the time. I'm sure you always worked with excellent professionals and you did ALOT to glean the information you did. Then, you made the best decision for Lindy with the information you had. That's all you can do. These precious dogs trust us so much and we feel so responsible. We always think, in hindsight, we could have done something different or sooner. For what it's worth, I strongly feel you have made all of the right decisions for Lindy. I have to believe that most of her troubles are because of the bladder cancer, not the adrenal tumors.

Again, I just hope Lindy is hanging in there and doing fine. Every single day with them is so precious.

Ken

[Gabrielle]

Hi Kim and Lindy,

I just want to let you know you're in my thoughts and prayers, too.

Hugs,

Gabrielle

[lindyandkim]

Thanks to everyone for their very kind support.
Lindy has gotten back to eating pretty well and getting around well and barking. In fact the other day I took her out to work sheep briefly. She had an ultrasound Monday and the tumors on her adrenals and bladder have not grown since April. Her skin is cleared up and her coat is coming back. The issues for her coat/skin were fungal,bacterial and mange. The mange took a long time to get diagnosed but they think she was more susceptible to it because of her condition. (We have foxes on the property so maybe she got it there.)
Lindy's main issues with Cushings- I think -are muscle wasting, exhaustion from any stress, poor urinary uptake and then all the susceptibilities.
We will be starting Trilostane when we get it delivered -41 mg for a 28 lb dog. The internal medicine person we are taking her to has used it quite a bit and cited a positive study with 5 adrenal Cushings dogs. Yes- small sample size for the study but this is worth a go, I hope.
I'm sorry I haven't managed to get any numbers yet. Another dog had a massive disc rupture and surgery and paralysis 8 weeks ago and we are adjusting and growing and healing with that.
Blessings to you and your dogs,
Kim

[SaxLady]

Hi Kim,
It's almost 2 AM here and I just came across your post. Dogs that have adrenal tumors should not be given Trilostan because it can greatly increase several of the hormones which are found in adrenal tumors. That is what happened to my little doxie Katrina. Adrenal tumors are usually treated surgically or with Lysodren. I am sure others will be along in the morning to give you more advice on this. It's late and I need to catch some sleep.
Hugs,
Candy

[Buffaloe]

Hi Kim,

That is such great news that Lindy is feeling much better and even working with the sheep. You keep it up, Lindy. And that is wonderful that the tumors have not grown.

I do feel strongly that next time, instead of doing the regular ACTH stim test, you have the ACTH/full adrenal panel done at the U. of Tennessee. The cortisol is not the only consideration in treating adrenal tumors medically. Adrenal tumors typically secrete an excess of some of the other hormones (progesterone, estradiol, aldosterone, 17-hydroxyprogesterone and androstenedione), hence, dogs with functional adrenal tumors invariably also have Atypical cushing's disease. Trilostane raises some of these other five hormones whereas Lysodren will effectively lower most of them. None of the cushing's meds will lower aldosterone (which raises issues with electrolytes and also significant hypertension) but there are other meds that will lower aldosterone effectively. You absolutely need to know what's going on with these other five hormones to treat an adrenal dog the most effectively.

The ACTH/full adrenal panel may cost a little more than a straight ACTH stim test but it tells you so much more. Also, besides Lysodren, there are other more conservative things (melatonin, lignans) that will lower cortisol and some of the other hormones. Please speak with your veterinary professional; if s/he really knows about treating a functional adrenal tumor medically, they'll be all for your doing the above mentioned test at Tennessee.

Ken

[labblab]

We will be starting Trilostane when we get it delivered -41 mg for a 28 lb dog. Kim
Dear Kim,

I just wanted to caution you that if you DO decide to proceed with having Lindy's full adrenal panel tested by the lab at UTK (ACTH test of cortisol in addition to testing the levels of the other adrenal hormones, as well), you should have her blood drawn PRIOR to beginning trilostane. Within just a few days of beginning trilostane treatment, the levels of some of her intermediate hormones may be skewed by the medication itself. So in order to get a true picture of her adrenal profile, the test should be performed prior to starting the trilostane. Otherwise, she will need to be taken off the trilostane for approx. one month before performing the full adrenal test.


Marianne

[Squirt's Mom]

Hi Kim,

Good to hear that Lindy is herding sheep and feeling ok, PLUS those nasty tumors haven't grown any! :D That is great news!

Trilo has been used with success on adrenal tumors:

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=491107&pageID=1&sk=&date=

However, the concern expressed here about the effect of Trilo on the other hormones associated with Cushing's is a very valid one. This article by Dr Nelson explains a bit about how adrenal tumors can cause these other hormones (Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone) to come into play:

Diagnostic Approach to the Incidental Adrenal Mass
Richard W. Nelson, DVM, Diplomate ACVIM
http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2557

I join Ken and Marianne in urging you to have the UTK panel run before starting the Trilo so you know for sure what hormones Lindy is dealing with and which approach would be best for her.

Keep your chin up!
Hugs,
Leslie and the girls

[Buffaloe]

Kim,

Your choice of using Trilostane to treat Lindy's adrenal tumor is a good one and I wish you all the best.

For anyone treating an adrenal tumor medically, having the full adrenal panel done at any time in the process, regardless of the medication used, is very valuable. It provides necessary information in effectively treating an adrenal tumor (adjusting medications and doses) whether it is done before commencing treatment, after two months or after six months

This will be my last post on this message board. By the grace of God, she continues to do very, very well. She's a happy, healthy girl and is a complete tool.

Shiloh and I wish all of your precious dogs great health and happiness. Take full advantage of them every single day.

Ken

[SaxLady]

Ken-----Please don't stop posting! I for one have depended on your information regarding Katrina's adrenal tumor.
Sincerely,
Candy and Katrina

[lindyandkim]

Thank you all so much for the timely information.I still have to put my time in and do the reading -but I will do it and the testing before we start anything. I am particularly interested in the lignans and melatonin and need to look into that further too.
I also have some questions regarding what the different hormone imbalances cause. But perhaps I should do my reading before I take up time. What causes the muscle deterioration- can exercise help delay that? And the mental fogginess?
Ken I hope you don't leave. Your information and support has been very helpful. Plus your dog's picture pleasantly reminds me of my last elder dog who lived to be 16. I understand not having time, though.
This forum represents the true spirit of a good community and our Cushings dogs (as well as others) benefit much. In comparing helping that 16 year old dog through his last couple years 13 years ago to working with Lindy, I see what a difference this forum can make.
Thank you all,
Kim

[lindyandkim]

I am maybe starting to get an idea of what causes what with this Cushings business and of course that leads to more questions. I am trying to get things lined up before I call the internal medicine veterinarian.
Here are more details from January on Lindy:
her ultrasound report from Jan is at
http://www.k9cushings.com/forum/album.php?albumid=93&pictureid=752
It indicates both adrenal glands were abnormal and similar in appearance with masses.
Her LDDS was 5.9,6.7,6.3
ALT 138 ALP 241 BP167/139; 174/109
(both of these numbers have come down to near normal since then)
Drugs up until recently have been piroxicam (for bladder cancer) Chlorambucil
and Denamarin.
We are currently only giving the Denamarin.
Prior to diagnosis the concerns were PU/PD and ravenous appetite.
On the Piroxicam (or something?) PU/PD seemed to disappear, now it is back. Has anyone heard of this?
The ACTH -done recently-was <10
HDDS numbers were 4.6,3.7,3.4.
I spoke with the internal medicine specialist and she was aware of the UTK panel but said that because of Lindy's HDDS test results no further hormones needed to be tested. Where is there indication of otherwise?
Thanks so much,Kim

[Wylie's Mom]

Bumping this up.

[Harley PoMMom]

Hi Kim,

I am sorry that I have no words of wisdom to share with you.

I don't know why your IMS doesn't think a UTK panel wouldn't be a valuable tool, I would think if Ken believes it is, especially when it comes to play with adrenal tumors, then I would want one done, I had a UTK full adrenal panel done on my boy, it was a vaulable tool for him and me...but all dogs are different and all IMS think different.

Please know you and Lindy are in my thoughts and prayers and please let us know how you both are doing.

Love and hugs.
Lori

[lindyandkim]

Hi,
Just to update to the list. Lindy passed away in May. She had made a remarkable recovery last fall and did very well until the end.Although there was some old girl decline. We kept her on the trilostane and potassium. She regained a luxurious coat, would run and bark and just had good quality life. Her last day she barked at me to get up and get her breakfast, also ate her dinner, and then had a seizure and passed away later that night. The shape she was in last summer, I still feel amazed and blessed to have her do well.And the neat thing was she was lovier during this last year than she had ever been.
Thank you to the list for your support during that trying time last summer.
Kim

[mytil]

Thank you for coming back and letting us know about your Lindy. I am relieved to read her last year with you she was happy and her quality of life was good.

We will always remember your girl here and we have added her name to our very special Remembrance list http://www.k9cushings.com/forum/showthread.php?t=1588.

Please come back and when you feel up to it, please post some additional photos and also feel free to post some more on your life with wonderful Lindy in our In Loving Memory (http://www.k9cushings.com/forum/forumdisplay.php?f=8) section.

Always in Loving Memory of your sweet Lindy,
Terry

[Casey's Mom]

Thank you for letting us know about Lindy although I am so sorry that she is gone. I am glad that you were able to enjoy her that last year and she had a great quality of life right till the end.

Love and many hugs,

[Spiceysmum]

Kim,

So sorry to hear about Lindy but glad that you enjoyed the last year together when she had improved so much. Thinking of you.

Linda and Spicey

[littleone1]

I'm so sorry for your loss KIm. You gave Lindy a good life.

Terri

[Squirt's Mom]

Dear Kim,

Thank you for letting us know about your sweet Lindy tho I know how hard that had to be for you.

It is a blessing that her last year has given you such wonderful memories to cherish. It is a testament to the loving care she received from her mom.

Your heart may ache and the tears still fall but never doubt that one day we will all hold our babies in our arms once again and cover their faces with kisses, never to be separated.

With sympathy,
Leslie, Squirt and our angels, Ruby and Crystal

[zoesmom]

Hi Kim - My heart goes out to you on your loss of Lindy. You gave her a full and happy life, and how wonderful that she enjoyed living it right up until the end. Sue

[Harley PoMMom]

Dear Kim,

I am so sorry for the loss of your beloved Lindy. You and your family are in my thoughts and prayers. Please know that we are here for you always.

With Heartfelt Sympathy,
Lori

[mypuppy]

Dear Kim,
I am very sorry for your loss. Leslie's words are a great expression of comfort. Your precious memories with Lindy will remain for all the days to come. Tight hugs. Xo Jeanette

[sunimist]

I'm so sorry Kim. As hard as it must have been for you, thank you for letting us know. We will always honor your precious Lindy here.
You are in my thoughts and prayers.

Shelba and Suni