Introduction & need advice please!

[Hillary2]

Hi! My 14 year old daschund Stewie was diagnosed with cushings after testing and put on trilostane. He was already on silogene. He declined so bad over the next three to seven days with constant diarrhea and breathing issues and lethargy and super swollen and hard stomach. Took him to the vet and he has enlarged heart and liver and possible fluids. They took him off all medications and giving me to Friday to see if he gets better or they want me to put him down. I am desperate, my dogs are like my kids and just looking for answers. Has anyone had this happen? Is it reversible? I am worried it’s from the trilostane...and maybe if he’s off of it long enough it will turn around. I don’t want to let my pup go unless I have to because he is my child. And have no way to know how he is feeling. I am hesitant because he is still eating, drinking, and while he is lethargic he shows glimpses of himself. Thank you!

[Hillary2]

Hi, my name is Hillary and my 14 year old dad bud Stewie was diagnosed with cushings after testing when I took him in because he had paced for 12 hours straight one night and I was concerned. They ended up putting him on trilostane and he started having diarrhea and became so sick lethargic, and stomach swollen and hard. Took him in this week and an X-ray showed enlarged heart and liver which explains breathing issues and what they think may be an adrenal tumor but say he’s not a candidate for surgery. I stopped all meds and he seems to be doing a little better but not completely. They wanted me to put him to sleep if he’s not better by tomorrow so I’m desperate to find answers about whether anyone has had same issue and whether it can be reversed or get better. He’s still eating and drinking but O don’t want to give up my baby if I don’t have too but don’t want him to be in pain and he can’t tell me. Anyone? Thanks!

[labblab]

Hi Hillary! Welcome to you and Stewie, although I'm so sorry that he's doing so poorly right now. I surely understand why you're so worried and frightened for him -- I would be, too! You'll see that I've consolidated your two earlier posts on this one thread. This way, we'll be able to keep all of Stewie's info organized together in one place.

It's hard to know exactly what has gone wrong for Stewie right now. In answer to your question, though, diarrhea and lethargy can indeed be caused by an overdose of trilostane. Of course, other illnesses can cause these problems, as well. But if trilostane was the cuprit, we can hope that Stewie will continue to perk up now that the medication has been stopped. However, there may be other issues at play, as well, of which his enlarged heart may be especially important. If he's unable to breathe properly and/or fluid is building up inside of him, then that may be a problem that's impossible to overcome right now. Enlargement of the liver can be consistent with Cushing's, but enlargement of the heart may be caused by something entirely different or even just by old age -- Stewie's heart may just be worn out and not able to pump properly anymore.

Going back to the Cushing's, can you tell us more about the symptoms and testing that led to the Cushing's diagnosis? How much does Stewie weigh, and what dose of trilostane was he taking? Is it selegiline (Anipryl) that he was already taking? For how long a time had he been on that, and did it seem to be helping any?

Going full circle, if Stewie was overdosed on the trilostane, that could account for at least some of his problems but not necessarily all of them. If he does have an adrenal tumor, for instance, the tumor might be cancerous and have spread elsewhere to other organs. Or as mentioned above, the heart issues may be independent of Cushing's and very serious in their own right. However, the decision to put Stewie down is obviously a huge one for you, and I'm wondering why the vet is pushing you so hard to make the decision by tomorrow. Is Stewie at home with you, or are they keeping him there at the hospital? Does Stewie seem to be in pain right now, or continuing to have a really hard time breathing? If the vet thinks that Stewie is suffering, then I more easily understand why they're pushing you to make a quick decision. But if not, then I hate to see them pressuring you to make a decision that you're not ready for and that you might end up regretting. Once again, though, a lot of this depends on how Stewie is actually doing right now.

So please do get back to us with as much information as you care to tell us, and we'll do our very best to help you sort all this out.
Marianne

[Joan2517]

Hi and welcome. Can you post any blood work, highs and lows w/ reference ranges only. Test results that confirmed Cushing's and the dose of Trilostane that they had put him on? Others more knowledgeable will need to see all of that in order to try to figure out what is going on with your darling Stewie.

[Hillary2]

Hi! Thank you so much for responding. Stewie is home with me now and is resting, off all the meds and and he is having issues breathing which is why I think they were worried they don’t want him to suffer or for me to have to deal with him suffocating at home over the weekend while they are closed and putting him through anything more traumatic or me. I just want to make sure I’m doing the right thing and there is nothing else I can do. I don’t have his bloodwork, everything happened so fast and have been relying on the vets which has been frustrating but The X-ray showed an enlarged heart and liver and I called about an hour ago after researching to see if they could treat his heart before putting him to sleep to see if that helped and now they are saying the cushings may be secondary and that he may have liver cancer and he is super far along and they don’t feel it’s helpfuk for me to prolong his suffering. I just want to make sure it’s not something else, but also don’t want to make him more stressed out than necessary by dragging him to an unfamiliar emergency vet or two since he is resting here at home if they will tell me the same thing. It all began with him pacing and staring st walls and they said it was dementia then I took him in after the night he paced 12 hours straight and they did they testing ACTH cushings and confirmed (has thinning hair) etc this all just happened so fast but feel he was somewhat normal until the trilostane...has anyone had the enlarged organs issue then turned around? Thanks

[labblab]

Thanks for writing back so quickly. No matter what, I'm really glad that you have Stewie home with you right now so that you can spend time together with him resting today. The difficulty with breathing may indeed be the game-changer, because no matter what was the initial cause, there may not be enough time to solve it and keep Stewie from suffering, even if it is theoretically reversible in the long run. It may take a whole bunch more diagnostics to figure out exactly what's causing the fluid retention and the organ enlargement, and it may be impossible to keep Stewie comfortable in the meantime.

It's also interesting to me that you mention that Stewie was pacing and staring at walls. Yes, that could be dementia. But it could also be a symptom of a pituitary tumor that is enlarging and placing pressure on his brain. Such a tumor could both cause Cushing's and also these additional problems with his pacing, lethargy, and confusion. That's what happened with my own Cushpup -- he started developing those same types of symptoms and even stopped eating and drinking on his own. So my husband and I were faced with the same heart-breaking decision, and we did go ahead and release him when it seemed clear that he could never be normal again without some type of drastic intervention. We never did know for certain if the tumor was the problem, so I know how the uncertainty is so hard to live with. But he was suffering, and we decided we just couldn't let that continue, no matter what.

So in Stewie's case, sadly you've got multiple issues: Cushing's, possibly cancer, and heart/respiratory failure, and overall an aged body. The truly horrible bind that you're in right now is that it's impossible to know exactly what's going on without putting Stewie through more testing. Can his little body withstand that? Do you want to run the risk that he'd end up in crisis at the hospital while the testing is being done?

If you can find a way to come to peace with not having a definite answer as to what is wrong, then you may decide to spend these final hours, at home, just loving on Stewie with all your heart. When I say, "come to peace" with that, I think it's impossible to ever really come to peace when there are such huge unknowns involved. But when you weigh the options in your heart and mind, if it seems as though the kinder decision is to let Stewie pass peacefully, we'll be here tomorrow to support you every step of the way. If you decide you want to try to find out more answers, then we'll be right here to support you with that, as well. I do hope that you may gain some clarity over the next 24 hours by seeing how Stewie is doing. If his breathing gets harder and harder, or if he seems to be suffering in other ways, that may be the signal you need to go ahead and give him relief, even though unaswered questions may always remain.

For now, though, while he's there with you, please give him some gentle hugs from his very new family here at K9C. We're surely pulling for you both, and hoping for peace for you both.

Many hugs,
Marianne

[Squirt's Mom]

Hi Hillary,

My heart-n-soul dog, Squirt, developed dementia and it was heart-breaking to watch. Back then there was a supplement that worked miracles for her but it is no longer available unfortunately. Thankfully she was in pretty good health otherwise except for arthritis and Cushing's. But the day came when she refused to eat or drink anything, even if I put it in her mouth. I knew she was telling me she had had enough, that it was time. So I made the arrangements that broke my heart into a million, million pieces. I still cry for her 5 1/2 years later. But no one told me when to do that. If they had tried I would have been livid that they dared. I knew my baby just as you know Stewie - better than anyone else. Listen to your baby boy and he will tell you when he is ready, he will tell you when he has had enough. Sadly it's not always easy to hear them. I failed to hear another of my precious babies, Trinket, and told myself she was fighting so hard because she wanted to stay with me a little longer. But the truth was I was the one who didn't want to let her go, I was the one who wanted her to stay a little longer and I allowed her to suffer terribly because I didn't listen to her. So love on your sweet Stewie and ask him what he wants. Then be still in your Soul and listen, listen with your heart. You will know when he is ready....even if you are not because he will tell you. Cherish every moment with him and know he trusts you completely because he knows how very deeply you love him.


I want to let you know that we are with you and Stewie even tho you can't see us.
Hugs,
Leslie

[Hillary2]

Thank you both! I do think it’s all been caused from more of a tumor and they piled on more and more drugs that harmed him and wish I would have had a diagnosis and assistance and also found this earlier. I am still undecided about tomorrow given he is still eating and excited about taking a short walk and has little spirts of energy here and then. I’m going to insist that they do another X-ray tomorrow and that unless he is in pain and suffering and they can explain to me I’d rather have him at home with me. I appreciate all of your help and advice and thankful for this forum! Going to snuggle with my pup and hopefully I’ll be bringing him home tomorrow but have his best interest st heart. Thank you! He is like my child so appreciate all of the help again.

Hillary

[Squirt's Mom]

I am sure the snuggling did the both of you great good. Please let us know what the vet has to say today when you can. We remain at your side thru it all.

Hugs
Leslie

[lulusmom]

Hi Hillary and a belated welcome to the forum. Let me just say that a dog on death's door is not usually excited to go for a walk nor eager to eat so I can understand why you may be thinking there could be something else going on that may not be that dire. If finances allow, I would ask for a referral to a board certified medical specialist asap. If you have a 24/7 er specialty facility near you, you could bypass the referral process and go through the er. These specialty facilities have internal medicine specialists on staff that would be called in right away. If you could let us know where you are located, we may be able to provide a name for you. It would be helpful if you could get copies of the blood chemistry and cbc and share them with us. You can't really see the adrenal glands on xrays so I'm wondering if your vet did an abdominal ultrasound? If not, that's another good reason to get a speedy consult with a specialty facility.