New to the forum - Ambro is now at Rainbow Bridge

[PittieLovers]

Hi guys. Brand new to this forum, and at a complete loss over our 70 pound (started this venture at 80.5lbs on 2/22/21) 10 year old pit/lab mix (Ambro). I’m going to draw out the timeline of events to see if any of you have suggestions or similar situations. We are desperate for answers and just don’t know what to do.

-Mid-Late February 2021—Ambro got up onto our kitchen table and pulled nearly an entire king cake down and ate it. If you guys don’t know what that is, it’s an iced bread cake that has cream cheese filling in it, and sugar sprinkles on top as well.
-Late February 2021 (about 2-3 days later from the King Cake incident) we noticed increased urination and accidents in house, increased drinking.
- Diagnosed early March 2021 with Cushings after going to vet for blood panel and ACTH test
- Mid March 2021 Started taking Trilostane (30mg Tabs 2x a day)
- Was bumped up in early April to 1.5tabs twice a day (per vet)
- May 2021 received 2nd ACTH Stem test, results were normal
- End of June 2021- Became extremely lethargic, lost interest in food, slight limp (Has arthritis in back leg and hips). At the time, we thought it could be pain related since he was so lethargic and uninterested in food and when you google symptoms, that’s what comes up. Prompted a discussion with the vet.
- July 12th, started 300mg of Gabapentin 2x a day to help with pain. He became very confused, unsteady, and just weird.
- Stopped gabapentin within two days (7/14)
- Began to research the effect of Trilostane and decided to take him off it entirely with last dose of 30mg on 7/17 am
- Within 24hrs of stopping Trilostane, we had a complete 180 (playing with toys, eating, drinking, etc.)
- Had vet visit on 7/19 to go over arthritis and using something different than gabapentin and to discuss stopping the trilostane and the results of that. Vet then prescribed Vetprofen to replace gabapentin. Said that he could have had an overdose of trilostane and to stay off of it for now. (at this time, he was still much better than he had been before stopping the trilostane).
- by 7/21, within 48hrs of stopping Trilostane, symptoms came back but worse. Began panting, pacing, circling, no interest in food, drinking minimal water.
- Emergency visit on 7/23 to check electrolytes...vet said test came back normal indicating that system was not suppressed. She suggested it was entirely pain related and he now had possible nerve pain in his back. He was given fluid under the skin for hydration and we were told to begin original Trilostane dosing (30mg 2x a day) once interest in food returned. We began fully picking him up to go to the bathroom up and down the stairs and up onto the couch, etc. to eliminate extra use of his leg.
- Began a chicken, rice, broth diet to promote eating starting 7/23 night.
- Appetite came back slightly, however symptoms did not stop on 7/24. Water intake minimal and had to use syringe to get water into him. Felt little tremors on sides of his head when touching it and every now and then he tried shaking his ears like dogs do, but just sort of flopped his head and couldn’t fully shake it. Began Trilostane 30mg dose on 7/24 pm since his appetite had come back. And continued with original dose on 7/25 (30mg am and 30mg pm)
- Stopped drinking almost entirely on Sunday, 7/25. Would stand over bowl not drinking acting drunk/dizzy when walking around. Stumbling over toys on the floor, kind of bumping into water bowl.
-7/26—Gave a larger dose of Vetprofen (100 mg) in the morning. Not an incredible amount of panting, but still present at times. Still circling/pacing. Still woozy, lethargic. Vet checked in and insisted that all symptoms were pain related and not at all related to Cushing’s. Suggested to add in tramadol and said if pain couldn’t be managed, euthanasia would be an option. Still extremely lethargic, on and off panting/pacing. Vet also said it could be meningitis, a spinal tumor or nerve pain now radiating to his neck or doggie dementia. Suggested treatment with a neurologist.
-Got his first dose of tramadol in him and he was completely zonked. Had to lift him up to get him to get out of his bed. Still no drinking. Still pacing when up. Minimal panting. Didn’t give him second dose of Vetprofen or trilostane.
-Decided that that maybe we eliminate all medications and start from a baseline to see what symptoms remain. Last dose of everything was 7/26 pm.
7/27 AM—Nonstop panting and pacing. Tried to walk down stairs by himself and successfully did. Panting once outside heavily. Ate breakfast, but still did his pacing and circling after each bite. Still acting woozy, and bumping into water bowl, barely sipping. It’s 9:50 and just gave him a dose of Vetprofen to see if that helps him to stop pacing and panting. 10:08 and has finally laid down and stopped panting/pacing.
- Another dog had eye infection so went to the vet today (7/27) and spoke to the other vet that had seen Ambro before. We asked about possibly hyper or hypoglycemia. He said absolutely not. And said that the improvement we saw with taking him off trilostane initially was possibly just a fluke. Said to go to neuro appt and that’s the next step.

We have a neuro appt. on Thursday, but we just can’t shake the feeling that something else is going on. He’s had arthritis for a bit...never has been this bad of an issue to where he can’t function. He has no interest in playing, getting attention, drinking water, etc. He is uninterested in life whether he is on a pain med or off. We can’t help but keep questioning why taking him off trilostane and for those 48 hours he responded so well? He came back to life. Was that really just a fluke? We have driven ourselves CRAZY with nonstop research. Everything feels like it leads us in a big circle. We aren’t ready to just accept that this is literally unmanageable arthritic/nerve pain, but aren’t so blinded that we won’t accept the idea if that’s really it. But then why did taking him off trilostane help briefly? Why is he woozy/confused, even off pain meds??

Looking forward to hearing from everyone!

[labblab]

Hello and welcome, although I’m so sorry about Ambro’s problems. I’ll come back later to write a more thorough response, but I wanted to quickly give you my best guess as to what may be going on so that you can do some quick researching in advance of your Thursday visit. You don’t say whether or not Ambro has been diagnosed with Cushing’s arising from a pituitary vs. an adrenal tumor. If he’s believed to have a pituitary tumor, then it’s possible that his problems are being caused by enlargement of that tumor (“Macroadenoma”) and the pressure that it may be placing on adjacent areas of his brain. I’m going to give you a link to a thread elsewhere on our forum that’s devoted to discussion of the problems caused by Macroadenomas. It includes my experiences with my own Cushpup. I encourage you to take a look at this thread and then we can talk more if Ambro’s symptoms seem to be consistent.

As to why he may have temporarily improved after stopping the trilostane, of course the first thought would be that he was being overdosed on the medication. But if that is *not* the case and he does indeed suffer from a Macroadenoma, it may be the case that the initial elevation in his cortisol had an anti-inflammatory effect on brain tissue that is being encroached upon by the tumor. For dogs with known Macroadenomas, treatment can consist of actually adding prednisone alongside the trilostane in order to maintain a consistent but more therapeutic level of circulating steroid. You’ll read more about that on the thread. Anyway, here it is, and after you look it over we can talk further.

https://www.k9cushings.com/forum/showthread.php?3567-Macroadenomas

Marianne

[BetsyFoxhoundMix]

I don’t know if normal people are allowed to answer or just the moderators so I’ll take a chance. I love pitbulls I have two of them here. My first pitbull died of a frontal lobe brain tumor at age 12. Pacing and circling can be signs of increased intracranial pressure. Also some brain tumors can cause blindness in 1 eye. When my dog started banging into things I immediately tested her sightand realized she was blind in one eye which happened suddenly one morning. Along with pacing and circling. The other thing is veterinarians will give tramadol for pain but tramadol is not metabolized well enough in dogs for pain relief. It’s sedates them giving the appearance of relieving pain. The large new dog pain management centers do not use tramadol! So your dogs pain might not have been treated well enough. Also Galliprant which is a piprant cousin of dog NSAIDs is new in the last few years and many people have better luck with it for pain relief and it also seems to have a better side effect profile. That is the one I’ve been using on my dogs since 2018 when they have some sort of arthritis or disc problem. My other pitbull is on it right now because she had ACL surgery on Tuesday. I’m so glad your dog will be seeing a neurologist. Even if the pituitary tumor, if your dog has a pituitary tumor, even if that has not enlarged and is causing trouble, it is possible the dog might have a different brain tumor. You could have a few things going on at once. I did find out when my dog had a brain tumor that the neurologist do not like CBD products because they can cause neurological side effects that confuse the situation. Good luck and kiss your pitbull for me!

[labblab]

Dear Betsy’s Mom,

Absolutely you are free to post on anybody’s thread! That’s the huge benefit of a forum like this — that all our members can share their support, thoughts and suggestions. What you’ve written above is very informative and helpful, so thank you from us all!

Marianne

[PittieLovers]

Hello and welcome, although I’m so sorry about Ambro’s problems. I’ll come back later to write a more thorough response, but I wanted to quickly give you my best guess as to what may be going on so that you can do some quick researching in advance of your Thursday visit. You don’t say whether or not Ambro has been diagnosed with Cushing’s arising from a pituitary vs. an adrenal tumor. If he’s believed to have a pituitary tumor, then it’s possible that his problems are being caused by enlargement of that tumor (“Macroadenoma”) and the pressure that it may be placing on adjacent areas of his brain. I’m going to give you a link to a thread elsewhere on our forum that’s devoted to discussion of the problems caused by Macroadenomas. It includes my experiences with my own Cushpup. I encourage you to take a look at this thread and then we can talk more if Ambro’s symptoms seem to be consistent.

As to why he may have temporarily improved after stopping the trilostane, of course the first thought would be that he was being overdosed on the medication. But if that is *not* the case and he does indeed suffer from a Macroadenoma, it may be the case that the initial elevation in his cortisol had an anti-inflammatory effect on brain tissue that is being encroached upon by the tumor. For dogs with known Macroadenomas, treatment can consist of actually adding prednisone alongside the trilostane in order to maintain a consistent but more therapeutic level of circulating steroid. You’ll read more about that on the thread. Anyway, here it is, and after you look it over we can talk further.

https://www.k9cushings.com/forum/showthread.php?3567-Macroadenomas

Marianne

Thank you so much. We went through those posts and he seems to tick a majority of those boxes. Panting, pacing, confusion/wobbliness, tremors in hind legs (he's had those for a while..even well before his Cushing's diagnosis), foggy/drunk acting, diminished interest in food, nearly no interest in water, and absolutely no interest in playing, getting attention, etc. Our vet diagnosed him with pituitary cushings (she said that 90-95% of dogs have that kind. We didn't have an MRI or CT performed). She did mention yesterday that we could try a steroid but that she gets cautious with dogs with cushings because it can cause issues. We just called the vet to inquire if he could be put on the steroid just to see (I assume prednisone?). We are not extremely well off, and live in NY where vet care is outrageously expensive. An MRI would cost nearly 5,000 and we just don't have that type of money. However, a CT would run us about 500 and we could definitely swing that. Would the tumor show on a CT? Just getting questions ready for the neurologist as well.

[PittieLovers]

It should be noted that he is not on Trilostane right now. His last dose was yesterday AM (30mg). I am not sure if that would be a huge factor if we ended up starting him on the steroid if our vet prescribed it.

[PittieLovers]

I don’t know if normal people are allowed to answer or just the moderators so I’ll take a chance. I love pitbulls I have two of them here. My first pitbull died of a frontal lobe brain tumor at age 12. Pacing and circling can be signs of increased intracranial pressure. Also some brain tumors can cause blindness in 1 eye. When my dog started banging into things I immediately tested her sightand realized she was blind in one eye which happened suddenly one morning. Along with pacing and circling. The other thing is veterinarians will give tramadol for pain but tramadol is not metabolized well enough in dogs for pain relief. It’s sedates them giving the appearance of relieving pain. The large new dog pain management centers do not use tramadol! So your dogs pain might not have been treated well enough. Also Galliprant which is a piprant cousin of dog NSAIDs is new in the last few years and many people have better luck with it for pain relief and it also seems to have a better side effect profile. That is the one I’ve been using on my dogs since 2018 when they have some sort of arthritis or disc problem. My other pitbull is on it right now because she had ACL surgery on Tuesday. I’m so glad your dog will be seeing a neurologist. Even if the pituitary tumor, if your dog has a pituitary tumor, even if that has not enlarged and is causing trouble, it is possible the dog might have a different brain tumor. You could have a few things going on at once. I did find out when my dog had a brain tumor that the neurologist do not like CBD products because they can cause neurological side effects that confuse the situation. Good luck and kiss your pitbull for me!

Hey!

Thank you so much for sharing your experience! As of right now, Ambro isn’t showing any signs that indicate blindness in either of his eyes. He responds well to stimuli in both.

In regards to the tramadol, we weren’t fond of the way he acted on his first dose, so we actually haven’t taken him off of it and he is only talking the Vetprofen at the moment.

As mentioned in the above post, we are def reaching out to our vet to inquire about starting a low dose prednisone prior to our neuro appt.

Thank you so much!

[PittieLovers]

Just an update:

Our primary vet is refusing to try a trial of prednisone, even after suggesting it during a phone call yesterday.

Her reasoning: She has never seen an enlarged pituitary tumor cause this type of response.

[labblab]

Well, um, then I'd have to venture a guess that your vet has not had a lot of experience with treating Cushing's dogs. Please bear in mind that I'm not a vet myself, but I did learn a lot about macrotumors back when my own dog was ill, and as you've read, we've had a number of dogs here with confirmed enlarged pituitary tumors that have suffered from symptoms that are consistent with Ambro's.

Since you only have one more day to wait until Thursday, it's likely not a big deal to hold off on the prednisone. It's probably best to get the neurologist's opinion about that, anyway. But it seems striking to me that your vet hasn't even entertained the possibility of a macrotumor. Back when my own dog was ill, our internal medicine specialist said that any time he sees a Cushing's dog with a cortisol level that hasn't dropped too low but who is inappetant, the first thing he suspects is a macrotumor due to the possibility that the tumor is placing pressure on the part of the brain that controls hunger and thirst.

As far as the helpfulness of a head CT, the neurologist will be your best guide in that regard. My general understanding is that both a CT and an MRI can reveal the presence of a pituitary tumor, but I've never been clear as to their relative advantage or disadvantage in terms of the best imaging for this purpose.

Just to let you know, when dogs are initially diagnosed with Cushing's, it's typically an abdominal ultrasound that is performed in order to determine whether the disease is likely due to a pituitary or adrenal tumor. This is because abnormalities with the adrenal glands will give you important clues. When Cushing's is pituitary-based, both adrenal glands will typically be enlarged. However, a mass or growth seen in one adrenal gland alongside a shrinking of the other gland suggests that an adrenal tumor is the culprit.

At this point, however, my guess is that if you are able to spend money on imaging and the neurologist recommends it, a view of Ambro's head would be the top priority. As Betsy's mom says, even if he doesn't have a pituitary tumor, he could be suffering from some other brain tumor. As you saw in my post on the Macroadenoma thread, my husband and I didn't proceed with any head imaging, partly due to the expense and partly due to the fact that in our boy's case, we wouldn't have felt able to launch into the extensive radiation treatment that would have been necessary to try to treat him in the event that he did have a macrotumor. So I definitely understand that it's not an easy decision to proceed with any imaging.

But the first step will be to let the neurologist examine him and find out his impressions and recommendations. At that point, you can make your decision about moving forward. I confess that I'm a bit bothered that the ER vet apparently didn't check his cortisol level in addition to his electrolytes, because dogs treated with trilostane can suffer effects of adrenal oversuppression even in the face of apparently normal sodium and postassium levels. However, since you report that Ambro had worsened again even during the time that his trilostane was halted, in my own mind that does point more towards neurological issues separate from medication effects. However, once again, the neurologist should be much better able to draw some conclusions after examining Ambro and going over his history of problems.

No matter what, please do keep us in the loop and let us know how things go. Again, I'm so very sorry that you guys are going through this, including sweet Ambro. I'll never forget the difficult days and nights I spent worrying about my own Cushpup. If only they could talk, and tell us what is wrong. It's such an awesome responsibility to try to figure out the best path forward, but I believe you're doing exactly the right thing at the moment. So hang in there, and keep us updated.

[labblab]

And I'm back with a quick P.S. to what I wrote above. According to this article, an MRI is the preferred imaging for a pituitary macroadenoma, but a CT can also reveal the presence of an enlarging tumor.

Also, here are some of the clinical signs listed by the article that are associated with a macroadenoma:


Mental dullness, disorientation, blindness, head pressing, behavioral changes and seizures may occur secondary to direct compression of the overlying diencephalon or the adjacent optic chiasm. Increases in intracranial pressure due to the mass or associated vasogenic edema may also contribute to the general deterioration in mental status.

https://www.avmi.net/information/imaging-diagnosis/pituitary-macroadenoma/

Also, here's a very technical, jargon-filled research article, but even by skimming it, you definitely pick up on the fact that an enlarged pitutiary tumor could be responsible for the types of problems that Ambro is experiencing:

https://www.tandfonline.com/doi/full/10.1080/01652176.2019.1622819

Really, all you need to do is Google "Canine Pituitary Macroadenoma" and you'll come up with numerous lists of corresponding symptoms, so I remain baffled by your vet's apparent lack of familiarity with the issue :-(((((

Marianne

[PittieLovers]

Well, um, then I'd have to venture a guess that your vet has not had a lot of experience with treating Cushing's dogs. Please bear in mind that I'm not a vet myself, but I did learn a lot about macrotumors back when my own dog was ill, and as you've read, we've had a number of dogs here with confirmed enlarged pituitary tumors that have suffered from symptoms that are consistent with Ambro's.

Since you only have one more day to wait until Thursday, it's likely not a big deal to hold off on the prednisone. It's probably best to get the neurologist's opinion about that, anyway. But it seems striking to me that your vet hasn't even entertained the possibility of a macrotumor. Back when my own dog was ill, our internal medicine specialist said that any time he sees a Cushing's dog with a cortisol level that hasn't dropped too low but who is inappetant, the first thing he suspects is a macrotumor due to the possibility that the tumor is placing pressure on the part of the brain that controls hunger and thirst.

As far as the helpfulness of a head CT, the neurologist will be your best guide in that regard. My general understanding is that both a CT and an MRI can reveal the presence of a pituitary tumor, but I've never been clear as to their relative advantage or disadvantage in terms of the best imaging for this purpose.

Just to let you know, when dogs are initially diagnosed with Cushing's, it's typically an abdominal ultrasound that is performed in order to determine whether the disease is likely due to a pituitary or adrenal tumor. This is because abnormalities with the adrenal glands will give you important clues. When Cushing's is pituitary-based, both adrenal glands will typically be enlarged. However, a mass or growth seen in one adrenal gland alongside a shrinking of the other gland suggests that an adrenal tumor is the culprit.

At this point, however, my guess is that if you are able to spend money on imaging and the neurologist recommends it, a view of Ambro's head would be the top priority. As Betsy's mom says, even if he doesn't have a pituitary tumor, he could be suffering from some other brain tumor. As you saw in my post on the Macroadenoma thread, my husband and I didn't proceed with any head imaging, partly due to the expense and partly due to the fact that in our boy's case, we wouldn't have felt able to launch into the extensive radiation treatment that would have been necessary to try to treat him in the event that he did have a macrotumor. So I definitely understand that it's not an easy decision to proceed with any imaging.

But the first step will be to let the neurologist examine him and find out his impressions and recommendations. At that point, you can make your decision about moving forward. I confess that I'm a bit bothered that the ER vet apparently didn't check his cortisol level in addition to his electrolytes, because dogs treated with trilostane can suffer effects of adrenal oversuppression even in the face of apparently normal sodium and postassium levels. However, since you report that Ambro had worsened again even during the time that his trilostane was halted, in my own mind that does point more towards neurological issues separate from medication effects. However, once again, the neurologist should be much better able to draw some conclusions after examining Ambro and going over his history of problems.

No matter what, please do keep us in the loop and let us know how things go. Again, I'm so very sorry that you guys are going through this, including sweet Ambro. I'll never forget the difficult days and nights I spent worrying about my own Cushpup. If only they could talk, and tell us what is wrong. It's such an awesome responsibility to try to figure out the best path forward, but I believe you're doing exactly the right thing at the moment. So hang in there, and keep us updated.


IMO opinion, they have become frustrated with my wife and I regarding our input into “their profession”. My wife handled the phone call this afternoon as I am too short fused to listen to the vet tell me why she has suddenly changed her mind on the possibility of using a steroid and that her “never seeing this before” as another reason. Not saying that she’s not good at what she does, but she has only been practice since 2018.

We received pricing for imaging in addition to our consult Thursday and a CT SCAN is absolutely in the cards for us. Unfortunately, an MRI is just out of the question financially at the moment.

We actually have halted all meds at the moment, except for vetprofen this AM. But stopping that tonight as the vet used it as another excuse for not attempting prednisone.

I greatly appreciate all of your advice and input on this. We will absolutely update the thread after his Neuro appt Thursday morning.

[PittieLovers]

Hello and welcome, although I’m so sorry about Ambro’s problems. I’ll come back later to write a more thorough response, but I wanted to quickly give you my best guess as to what may be going on so that you can do some quick researching in advance of your Thursday visit. You don’t say whether or not Ambro has been diagnosed with Cushing’s arising from a pituitary vs. an adrenal tumor. If he’s believed to have a pituitary tumor, then it’s possible that his problems are being caused by enlargement of that tumor (“Macroadenoma”) and the pressure that it may be placing on adjacent areas of his brain. I’m going to give you a link to a thread elsewhere on our forum that’s devoted to discussion of the problems caused by Macroadenomas. It includes my experiences with my own Cushpup. I encourage you to take a look at this thread and then we can talk more if Ambro’s symptoms seem to be consistent.

As to why he may have temporarily improved after stopping the trilostane, of course the first thought would be that he was being overdosed on the medication. But if that is *not* the case and he does indeed suffer from a Macroadenoma, it may be the case that the initial elevation in his cortisol had an anti-inflammatory effect on brain tissue that is being encroached upon by the tumor. For dogs with known Macroadenomas, treatment can consist of actually adding prednisone alongside the trilostane in order to maintain a consistent but more therapeutic level of circulating steroid. You’ll read more about that on the thread. Anyway, here it is, and after you look it over we can talk further.

https://www.k9cushings.com/forum/showthread.php?3567-Macroadenomas

Marianne

Hey,

My wife and I have been going back and re-reading the posts from the link you supplied.

Are we understanding correctly that surgery or Radiation is the only viable treatment for an enlarged pituitary tumor or is prednisone also a treatment option? It seems all the posts discuss radiation as the main form of treatment.

[labblab]

As far as I know, radiation remains the most common intervention aimed at physically reducing the size of the tumor. The treatment doesn’t totally remove the tumor, but it reduces its size so as to minimize the encroachment on brain tissue that’s responsible for producing the neurological symptoms. Ultimately the tumor will likely continue to grow again, but you’re trying to provide an interim symptom-free time period.

I don’t believe that prednisone affects the size of the tumor, but instead may relieve swelling and inflammation of the brain tissue that’s being invaded. So you may hopefully see at least some short-term relief from the worst of the neurological symptoms.

Again, though, the neurologist will be a more reliable resource re: the current state of available treatment options should he think a macrotumor is likely. And of course it may be the case that he doesn’t think this is the problem at all. If so, I’ll be sorry that I’ve placed this worry in your minds — I know it has to be a big worry for you now. But I just wanted you to be prepared to ask any related questions about this possibility on Thursday.

Marianne

[labblab]

I’ve just now gone back to re-read that thread myself, and I see some of our members talking about prednisone shrinking the tumor size for their dogs. So I may be wrong in saying that I think it only reduces swelling/inflammation. Once again, the neurologist should be able to clarify that for you.

[PittieLovers]

I’ve just now gone back to re-read that thread myself, and I see some of our members talking about prednisone shrinking the tumor size for their dogs. So I may be wrong in saying that I think it only reduces swelling/inflammation. Once again, the neurologist should be able to clarify that for you.

UPDATE:

We just got home from the neuro and it is what we feared. Ambro has a Macroadenoma and according to the doc, we are pretty far along. No CTscan or MRI done because we ruled out the possibility of surgery and radiation is way to expensive. He did support the Prednisone theory, but strongly discouraged the use of Trilostane and Prednisone together, basically saying that you are “robbing Peter to pay Paul”.

So for now, Prednisone is the course of action. With the hope that we can see a quality of life improvement and give him an enjoyable next few weeks to months.

Thank you again for all of the insight and information!

[labblab]

Oh my. Gosh, I’m so sorry I was right about this. But hopefully there may be at least a little peace in knowing what the problem is so that you can focus 100% on loving him instead of chasing more diagnostics. I know you’ll do exactly that — shower him with love and praise for being such a good brave boy.

I’ll sure be hoping that the prednisone will buy you more good quality time together. With my own sweet boy, it was his loss of appetite and thirst that we just couldn’t work around for very long. But we also didn’t have the chance to try prednisone, and maybe that would have helped him. I surely hope it will be a help for you guys.

Please do keep checking in if we can continue to be a help to you in any way. Plus, we’ll just be anxious to know how things are going.

Please give Ambro a big hug for his family here, OK? And I’m sending a big hug for you and his mom, too. I know this is a lot to take in and deal with. Don’t forget we’ll always be here to listen and talk.

Marianne

[PittieLovers]

Oh my. Gosh, I’m so sorry I was right about this. But hopefully there may be at least a little peace in knowing what the problem is so that you can focus 100% on loving him instead of chasing more diagnostics. I know you’ll do exactly that — shower him with love and praise for being such a good brave boy.

I’ll sure be hoping that the prednisone will buy you more good quality time together. With my own sweet boy, it was his loss of appetite and thirst that we just couldn’t work around for very long. But we also didn’t have the chance to try prednisone, and maybe that would have helped him. I surely hope it will be a help for you guys.

Please do keep checking in if we can continue to be a help to you in any way. Plus, we’ll just be anxious to know how things are going.

Please give Ambro a big hug for his family here, OK? And I’m sending a big hug for you and his mom, too. I know this is a lot to take in and deal with. Don’t forget we’ll always be here to listen and talk.

Marianne

There is definitely some “relief” in having an answer. Me and my wife were talking it over last night and it’s really a double edge sword of emotions. We get him back, to whatever degree the prednisone will help, but at the same time we have to watch him make the turn again at SOME POINT. When that is, who knows, and that’s the worst part I think.

With that said, we are into our first 24hrs on prednisone. Appetite and drinking are back to full power, as well as the peeing. He’s done extremely well with warning us that he has to go outside. And as long as we are paying attention, he has a very easy tell that it’s time to go outside. Still very tired, as anyone would be after dealing with what he has for the past 2 weeks. He has stopped the constant pacing and only pants for 5-10mins at a time as opposed to pacing and panting for 1-2hours straight. We have seen glimpses of the playful boy that we knew prior to everything starting.

We unfortunately have a trip coming up that we scheduled back in April and will be leaving for 8 days on Monday. My wife and I are both kind of dreading it. Luckily we have a really good support system and sitter here at home, and are really hoping that he continues this upward trend while we are gone.

Marianne, we cannot thank you enough for all of your kind words and advice. Even though the info you were giving us was SPOT ON and it really pained to see that he may have that, it helped us tremendously for the mental prep. Once we read your input and then combed every inch of the Macroadenoma Thread, we had all the questions that we needed prepared for the Neuro. He even commented on our prep when he came to the room and admitted that we had basically diagnosed Ambro and the only reason we were really there is because our regular vet refused to acknowledge our findings.

We honestly can’t thank you enough for EVERYTHING you do for those of us with cushpups!

[labblab]

Oh my, you’re so welcome for any help I’ve been able to give. I’m truly just “paying it forward,” though, for the support I got back when my boy was so ill. Those were some of the worst days of my life, I was so worried and confused about what I ought to be doing to help him. I know I made mistakes along the way, and that made things even harder for me. But I swore I’d try to help others from the things I had learned, and in that way I feel like I’m continuing to honor his own bravery every day that I’m here.

I know the week away will be very bittersweet for you, and I surely hope alongside you that he’ll continue to stabilize on the prednisone while you’re gone. Just for the sake of conjecture, if you find that his Cushing’s symptoms really rebound with a vengeance that’s making him uncomfortable (thirst, urination, etc.), that might be reason to revisit the trilostane/prednisone combo with your neurologist. I’ve never known for sure, but I think the combo has been prescribed in the past in order to keep the total steroid level from becoming unpredictably high and uncontrolled. In other words, if you keep the cortisol level under control with the trilostane, you can then add a consistent and predictable amount of supplemental prednisone. Just something that might be worth talking over with the specialist — or not. Keeping Ambro eating and drinking will be crucial. And if keeping him off the trilostane altogether bucks up his appetite, then that alone will be worth it.

One quick question for you. Did the neurologist indicate whether the prednisone actually shrinks the tumor itself or whether it just eases brain swelling or inflammation? As I wrote earlier, I’ve never known the exact answer to that and I’d like to be able to advise people more accurately if I can.

In the meantime, do travel safely and we continue to send our healing hugs to Ambro.
Marianne

[PittieLovers]

Oh my, you’re so welcome for any help I’ve been able to give. I’m truly just “paying it forward,” though, for the support I got back when my boy was so ill. Those were some of the worst days of my life, I was so worried and confused about what I ought to be doing to help him. I know I made mistakes along the way, and that made things even harder for me. But I swore I’d try to help others from the things I had learned, and in that way I feel like I’m continuing to honor his own bravery every day that I’m here.

I know the week away will be very bittersweet for you, and I surely hope alongside you that he’ll continue to stabilize on the prednisone while you’re gone. Just for the sake of conjecture, if you find that his Cushing’s symptoms really rebound with a vengeance that’s making him uncomfortable (thirst, urination, etc.), that might be reason to revisit the trilostane/prednisone combo with your neurologist. I’ve never known for sure, but I think the combo has been prescribed in the past in order to keep the total steroid level from becoming unpredictably high and uncontrolled. In other words, if you keep the cortisol level under control with the trilostane, you can then add a consistent and predictable amount of supplemental prednisone. Just something that might be worth talking over with the specialist — or not. Keeping Ambro eating and drinking will be crucial. And if keeping him off the trilostane altogether bucks up his appetite, then that alone will be worth it.

One quick question for you. Did the neurologist indicate whether the prednisone actually shrinks the tumor itself or whether it just eases brain swelling or inflammation? As I wrote earlier, I’ve never known the exact answer to that and I’d like to be able to advise people more accurately if I can.

In the meantime, do travel safely and we continue to send our healing hugs to Ambro.
Marianne


He basically said that we are relieving pressure and swelling. That’s the one question that we didn’t ask though (shrinking). We are hopeful that with the prednisone, Ambro will experience SOME shrinkage. Prior to being diagnosed with Cushings, there were ZERO Neuro symptoms. He was healthy, happy, and playful. So we are hoping that maybe his cortisol was SO suppressed(he was on 90mg of Trilostane/day) that the size of the tumor is actually fairly small and an “early” macro that just ran rampant with the complete lack of cortisol. A CT scan would give us a finite answer and we may still opt for it once Ambro stabilizes on the prednisone. He is on 20mg of prednisone a day and gets bumped down on Thursday next week to 10mg a day, then the following week 10mg every other day. Neuro said that he wanted to load him up and then go down to a lower dose. Reason being 2 fold: 1. He had/has swelling and that was priority. 2. As we move down the dosage, we can gauge his cognitive signs and if we see them start returning, we can find a holding a lot for the prednisone dosage.

We are really hoping that we can get down to the every other day dosage without seeing any signs return. With the hopes that a response like that would indicate a smaller tumor overall. So, we will see!

[PittieLovers]

Yesterday was day 2 on Prednisone for Ambro.

Overall, a down day behaviorally. Appetite and water intake is definitely up, just not very active overall until late afternoon. Late afternoon he played with the football with my Brother-in-law while we were out picking up some groceries. Another positive is no noticeable pacing and very limited panting.

[labblab]

So it sounds like it’s a bit of a rollercoaster for you guys, but we’ll hold onto the positives and hope that they’ll end up overtaking the rougher spots. Do have a safe trip! I know Ambro will never be far from your minds, nor will he be far from ours during the coming days.

Beaming warm thoughts and healing energy your way!

[BetsyFoxhoundMix]

I am glad your pitbull is feeling better. When my pitbull Callie had her brain tumor she was first diagnosed with a stroke by the neurology team at Ncstate emergency department. They told me that her symptoms would resolve in a few days if it was a stroke, but that if it didn’t resolve it was a brain tumor and my regular vet should prescribe prednisone. It did not resolve, it got worse. The vet started her on prednisone. My Callie did improve stopped the pacing and circling and confusion. She was so confused she was trying to jump on top of dresser drawers and into bookcases onto shelves and things that she knew not to do and would never have done. She was really a danger to herself and I had to keep her on a leash. Anyway she responded to the first round of prednisone for a couple weeks but then she got worse so we had to raise the dose of prednisone and she did better and then she got worse and then she was on the top dose of prednisone and got better and then got worse again. Then she was worst of all just incredibly bizarre behavior. I had not put her through MRI, because I felt the risk of having her have anesthesia to be intubated to lay still for the MRI could put her at risk for stroke. Plus, I was not going to have her brain radiated. Callie has been such a fantastic dog and by the way a therapy dog at UNC Chapel Hill with me for five years, I could not put her through radiation which might cause brain swelling, numerous scans before and after radiation etc. etc. Knowing that the signs were of increased intracranial pressure and the next step would be to start seizing, I took her emergently to the vet to be put to sleep. I knew there was no where else to go with this. I also had taken her to an eye doctor, apparently by looking in the eyes they can see something that tells you good information about whether or not they have a brain tumor and he agreed that she did. I just can’t remember how he could tell. But I had read that an ophthalmology exam was the poor man’s way to tell if there was a brain tumor when you don’t want to do MRI. Anyway I just want to warn you that your dog may be up and down as you experiment with different doses of prednisone if he indeed has a brain tumor, including or aside from a pituitary tumor. I’m not sure if you know I did a lot of reading about brain tumors in dogs at the time and pitbull‘s are in the group of dogs with the increased rate of brain tumor. Apparently pitties are considered one of the breeds with a smooshed face including boxers and Boston terriers also and these breeds are overrepresented with brain tumors. I’m sorry your pitbull has these problems, they are the most amazing awesome precious dogs imaginable. They are like little children, which makes them so endearing. I hope your dog will improve.

[PittieLovers]

Hey everyone,

It is with great sorrow that I tell you that Ambro has made his journey across the Rainbow bridge today.

Our lack of posts have been due to the fight we were waging with him and his illness. On Sunday, when we were on the way back from our trip Ambro had a grandmal seizure, followed by a series of facial seizures. Our sitter immediately took him to the Evet and had him cared for. He was in and out Sunday night and placed on Kepra. On Monday, he again started having cluster facial focused seizures. Again, our sitter was amazing and scooped him up and had him at the Evet, this time he was held for 24hours. While there he had one seizure but they were able to stop it and added another seizure Med in with the Kepra. All this is while we are stuck in airports due to weather and flight delays.

We finally got home at 2am Tuesday and immediately went to pick Ambro up. When we picked him up, we could tell that this took a serious toll on him both mentally and physically, he had also lost 5-6lbs in a matter of 8days. Wednesday morning, our AMAZING Neuro called us and told us what happened during his stay and that in all reality, since we had been seizure free for 24hrs, they seemed controlled and we could take our time and enjoy it with him. As the day went on, we realized that Ambro had already left us. What we had in front of us was a trapped boy and it was no longer fair to keep fighting this fight. As much as we wanted to, it was not longer a viable option for him. So Wednesday we called and made our appoint for today.

Ambro crossed the bridge around 2:30pm est today on 8/12/21. He was the bestest boy a family could ask for. I just pray that they have stuffed hedgehogs and tennis balls at the gate for him, he loves them.

To everyone that has been a part of our journey and helped us find answers, we cannot thank you enough. This is never easy, but having a community with so much love and knowledge of this terrible disease is an amazing support system.

[labblab]

Oh my, I read your news soon after you had posted it yesterday and have been thinking about you all ever since. I was hoping that, by this morning, I would find the words that I wanted to write. But honestly, I know there really are no words that can change the depth of your loss. So I will simply say this. I am just so very sorry. Even though we couldn’t change the course of Ambro’s journey, we’re so grateful that you’ve shared him with us. It has been our privilege to welcome him into our family. What a dear, brave boy. We hope it may give you a bit of comfort to know that he’s now joined our other Rainbow Bridge babies on our special memorial thread of honor.

https://www.k9cushings.com/forum/showthread.php?9294-Remembering-All-Who-Have-Left-Us-(2020-2021)

He’ll always be remembered by his family here, and please know that you will always be welcomed back at any time to talk, to vent, to question, or just to share stories of your lives together. I was so hoping that things would turn out differently for you guys. But I truly do believe in my heart that love is forever. So fare thee well, Ambro, as your spirit sets off on your newest journey, cradled in love.

Sending my sympathy and warmest thoughts to you all from across the miles,
Marianne

[Joan2517]

I'm so sorry for your loss of Ambro. Losing our beloved babies is just so, so hard. Sending hugs to you and comforting thoughts.

[jenner1026]

I am so sorry to hear of the passing of Ambro. You did all you could, and I am glad you were able to find this Cushings family. Everyone here is so amazing.
Sending so much support to you and your family.

[Jonathan]

There is an endless supply of stuffed hedgehogs and tennis balls!
- THAT I'm sure of!

Bless Mr Ambro, and my thoughts and tears are with you and your family right now.

I believe we grieve as an almost 'selfish' act (for lack of better word)
Because our pups are now free of any pain/suffering/discomfort, unfortunately we have that loss do go thru (for now, until we see them again)