Skippy has passed; 12 y/o Yorkie with likely pituitary tumor (Trilostane)

[Harley PoMMom]

I took my Harley to Matthew J Ryan University of Pennsylvania Veterinary hospital for consults and was very pleased with their service, I believe a call to them just to see what they could offer is definitely a good idea.

Another vet. hospital my GP referred me to was the Chesapeake Veterinary Referral Center, they have 3 locations in Maryland; Annapolis, Towson, and Columbia. I went to the facility in Towson and was happy with their service too. The main reason for bringing them up is a long while ago a member posted that a Dr. Jay McDonnell (Veterinary Neurologist) trained in the Netherlands with a physician that has been doing pituitary surgery for 15 years, Dr McDonnell has an office in Annapolis:

Quoted from his bio:

Since moving to Maryland, Dr. McDonnell has become well-known for his work in the definitive treatment of brain tumors and spinal cord tumors, foramen magnum decompression/dorsal laminectomies and Wobbler's disease. He has lectured nationally, internationally and regionally, and has published more than 20 journal articles, reviews and book chapters.

"Teaching continues to be important to me. I'm an assistant clinical professor at Tufts University and a consultant in Neurology at the University of Pennsylvania College of Veterinary Medicine. I think having a balance of the academia and private practice enables me to keep at the forefront of veterinary neurology."

Most recently, Dr. McDonnell has been exploring the use of pituitary surgery to treat Canine Cushing's Disease here in the U.S.

"Surgery for pituitary macroadenomas in dogs and cats has been pioneered by Dr. Bjorn Meij of the University of Utrecht in the Netherlands. Despite his work and the proven success of the technique over other treatments such as radiation and chemotherapy, the surgery has failed to be widely adopted here as a viable treatment option. The procedure is technically challenging and has a very steep learning curve, so I went to the Netherlands in the spring of 2010 to study with Dr. Meij;and I also arranged a special seminar with Dr. Meij at the University of Pennsylvania College of Veterinary Medicine. Currently no one east of the Mississippi is offering this treatment option, so it's exciting to be able to offer this."

There are thousands of cases of Canine Cushing's Disease in the U.S. each year, but the current medical treatment is medication given daily or several times per week that treats the symptoms. "With this surgery, we finally have a treatment option that corrects the disease."

http://www.vetneurochesapeake.com/our-doctors/

email addy: info@vetneurochesapeake.com

Address: Veterinary Neurology of the Chesapeake
808 Bestgate Road, Annapolis, MD 21401

Phone: (410) 224-0121 - ext 5

Edited to add: I'm not even sure Dr. McDonell is even still looking into this type of pituitary surgery, I just thought that contacting his office may lead into finding additional information regarding pituitary tumor treatments.

[Carole Alexander]

Marianne and Sharlene,
Thank you for your support and your counsel. Marianne, my one year versus two year survival after radiation confusion probably arose out of reading too much research where theoretically they reported up to to a two year survival and this was reinforced by my selective hearing in talking with the Purdue radiologist. I trust the experience of people here and if that is that it's one year if he is very lucky. But, I would still like another option with more experience.

Sharlene, TY so much for the Maryland information. I have emailed a friend in Baltimore who is significantly affluent and loves dogs as much as me. If anyone knows Dr. Jay McDonnell at Chesapeake, she will. Otherwise, they require a vet referral to speak to me about Skippy and that could be tricky with Purdue. I will explore the Penn possibility on Tuesday. Skippy does have a vet in Baltimore but he knows nothing of Skippy's Cushing's, macro, etc.

In the meantime, yesterday's crisis, was that Skippy started crying and I looked down to see him laying down with his foot straight up in the air. I thought he was having a stroke but no, his toenail had become entangled in the long hair on his ear and his toe was bleeding
from his efforts to free himself. I untangled him but had to laugh at him and my reaction. I don't know which of us I feel sorrier for; Skippy losing his mind or me losing mine. Have a great holiday and long weekend everyone.

[labblab]

Hey Carole, I definitely don't mean for you to discount the research predictions. My comments only relect my personal (and sometimes faulty!) memory. Plus, as the technology advances, perhaps the remission time increases. Or then again..maybe not, since presumably all the tumors start regrowing again upon completion of treatment. Perhaps the greatest benefit of the newer techniques is instead more precise targeting and the lessening of adverse effects.

Poor little Skippy and his toe! That was a genuine "hang-nail," for sure!!

Hoping you guys can take a day off, yourselves, and savor some down time over the holiday.

Marianne

[Budsters Mom]

Hi Carole,
I haven't chimed in lately, but have been reading along. I applaud your determination and perseverance.

Buddy flew almost 4 years ago. At the time they were even less options for treating pituitary macro-tumors in dogs. I was advised by a veterinary neurosurgeon and her team. They said the once neuro signs appear, the tumor is usually too large to do much in the way of treament. Smaller dogs have less room for the tumor to go when it grows. Surgery was only starting to be an option in some cases. It was expensive and only a few surgeons in the country were doing it. The smaller the tumor, generally better the outcome. Radiation treatments were being done to shrink the tumor, allowing more time. After treatment, the tumor continues to grow and eventually take over.

Buddy's neuro signs were already severe by the time he was evaluated by the neuro team. I asked the surgeon if she would go through with any further diagnostics and radiation treatment if he were her heart dog. She looked me in the eye and said that she wouldn't put her best friend through any more pain and suffering, just to buy time. She would make him as comfortable as possible, for as long as she could, then painfully let him go. That way it would be her pain and not his. She then said, that it was my call. That was very interesting being heard from a surgeon who cuts for a living. She cared. She even kissed Buddy on the head when we left. She managed his care through our regular vet until it was time to release him.

I am not advising you as to what is best for you and Skippy. There are more options available now, than four years ago. I'll be following along and hoping that Skippy does well for many months/years to come.

Kathy

[Squirt's Mom]

Hey Carol,

You are doing a great job of researching and finding all the info you can in order to make the best decision for your sweet baby. The main factor, tho, is Skippy. Not us, not a vet, not you, not by comparing to other dogs in similar, SIMILAR, circumstances....but just Skippy. You know your baby best of all and by listening to him and following your gut you will make the right choice. He knows that as do most of us here. You are never alone on this journey even tho we may not all respond often...trust that we are here by your side.

Hugs,
Leslie and the gang

[Whiskey's Mom]

Carole please know that I think of you and Skippy every day, and am
Hoping for the best. Your love for Skippy and perseverance to help him is so inspiring and heartwarming.
Annie

[molly muffin]

How is Skippy doing? Time for an update

[Carole Alexander]

Kathy, Leslie, Annie and Sharlene,
Thank you so much for your sharing your thoughts and experience. It is very helpful to me. This has been an agonizing week as I've gone down the road of pursuing radiation options for Skippy. I'll try to share briefly as perhaps it will help others.

I contacted my affluent friend in Baltimore who has had 14 rescues and 4 who developed Cushing's over the years. She knows Dr. McDonnell as he did disc surgery on one dog; a 10k intervention. She does not believe that he is still performing pituitary surgery. She also had a dog treated at VCA in Springfield, VA. Her opinion is that the VCA practice has become quite corporate, with all of the meanings that have come to surround that term. They have invested heavily in diagnostic equipment and their fees, but not their service, now reflect that decision.

I also contacted Penn with an inquiry similar to my letter to Wisconsin. They politely referred me back to Purdue. Yesterday, I emailed Dr. Bruyette and briefly asked if he thought there were other options that I could or should pursue for radiation. He responded that he thought that I definitely should pursue radiation at Purdue and that they would do an excellent job. As a side note, my friend's daughter did move her dog's surgery from Tufts in Boston to the Angel Clinic, a private speciality clinic there.

What I have learned is subject to interpretation, but obviously there is a very small and close knit group of professionals in the US and probably internationally who are involved in research and treatment of oncology and endocrine disorders. They seem to exercise absolute professional courtesy across the university systems and even those who have gone into some form of private speciality practice were previously affiliated with a university. Second, regardless of any action on my part, Skippy has a soon life ending condition so he would never be anyone's success story. Third, I now suspect that with a macro as large as Skippy's, equipment and maybe experience with this type of tumor doesn't matter much given the state of the art.

Skippy is scheduled for a CT scan next Tuesday at Purdue; he is relatively stable and still ravenous, chubby, pot belly and food driven. He has increasing muscle weakness in both his front and back legs and has the old dog look in his eyes. He remains responsive to commands, a little slower though. His butt adenoma bled some after Purdue's rectal exam but seems to have healed over. He actually runs occasionally and barks (with his little bark) at the dog next door. No tremors, lots of sleeping. He's still on BP meds, nothing else; drinking lakes and peeing excessively; his cortisol was 36 last week when they stimmed him. He doesn't have a parasite but does continue to have modest diarrhea even after being off the Cabergoline for nearly two weeks.

I have agonized over the decision of whether and where to radiate. I am now resolved that radiation gives him the best shot at an improved quality of his remaining life; the matter of where has been mostly decided for me and perhaps that's just as well as it certainly will be easier.

I do think that university based vet schools (funded by state dollars and their clients) should publish their outcomes of treatment regarding various medical conditions, especially life threatening ones, to enable owners to make informed decisions on their pet's behalf. As you all know, this is such an expensive and emotional roller coaster, information to decide on treatment (or not) should not be an added treasure hunt. (Angel Clinic and Washington State have begun to do this.) While I agree that all dogs and their conditions are unique, it would be helpful information in making an informed decision.

Thank you again for all of your thoughtful and kind words and I will post more when I know more - soon.

[Budsters Mom]

We are pulling for you and Skippy.

These decisions are heartwrenching. Knowing that whatever we decide, we can't fix them and that's all we want to do. You are not alone Carole. There are many of us here who have had to face the toughest news possible. I will admit now to having been envious of other members's pups. Some joined the forum around the same time as I did. Buddy had to be the one with a macro. The others were responding to treatment and doing very well. I wanted their pups to do well. I really did, but why wasn't mine too? Yes, heartwrenching.

After exhaustive effort, you have decided to go forth with the treatment you feel will give Skippy the best shot. That's all anyone can do.

Please keep us posted,
Kathy

[liltara]

Carole,

What a relief to finally have a course of treatment after all of your research. I am glad you have made a decision in what you know are Skippy's best interests.

I am hopeful that the radiation gives him a wonderful quality of life and anxiously await your news on his progress once treatment is started.

I am rooting for Skippy and think of you often. You are making the best decisions you can for your companion and he is lucky to have such a caring and loving parent.