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  #231  
Old 07-30-2017, 12:17 AM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

Hi Carole,

It is true that the majority of pituitary tumors stay small and do not grow into a macro. At least not big enough to cause neurological deficit's. I am not against treating Cushing's with medications such as Vetoryl (trilo) or Lysodren. These drugs can/do manage Cushings symptoms well for many of our pups.

My concern is with restarting Vetoryl after radiation, when a macro-tumor is already present. Radiation is tried with no guarantee that it will do anything. It is hopeful that it will somewhat stall the tumor's growth, possibly even shrink it to some degree, relieving some neuro signs temporaily. All in hope to buy a little more quality time. I understand Marianne's thought regarding this and she does make a point. It is all about quality of life. However, it seems counterproductive to restart a drug to reduce cortisol, leaving the tumor unchecked to grow. Radiation has been done to help shrink the tumor in hope to relieve neuro symptoms. Mega $$$$ have been spent to do this. Restarting Vetoryl in this circumstance just doesn't make sense to me.

Skippy reminds me of my own little yorkie Buddy. All of this is heartbreaking. Watching Buddy slip farther and farther away and not being able to stop it tore my heart out. It still hurts over fours years later. So much that I still come here to help when I can. I do this as a pay it forward, so to speak for all the help and support that I received during Buddy's journey. That support was unwavering and literally kept me from going totally insane. We are here for you and Skippy and will remain here for you always.

You are a fighter Carole! Skippy is blessed to have you in his corner.

Kathy
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  #232  
Old 07-31-2017, 09:34 AM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

Carole, I know that Skippy has been so unwell for quite a long time. Did you feel as though you were seeing any improvement at all in his conventional (non-neurological) Cushing's symptoms while he was taking the Vetoryl?

Marianne
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  #233  
Old 07-31-2017, 11:44 AM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

Kathy, thank you so much for your kind words. I too appreciate your support and that of so many others on this forum, more than words can say. I have read your thread describing Buddy's deteioration and it is heartbreaking to watch our dogs slip away with this lousy macro.

I clearly understand that restarting Vetoryl is likely a high risk proposition. What I don't know is did the radiation reduce the swelling and perhaps will it shrink the tumor. In spite of reading about other dogs who saw immediate improvement, Skippy is not among them. Radiology was quite emphatic that if I saw improvement, it would be month, more like several, before there was improvement. And, I still don't know the quality of the radiation protocol or their equipment compared with other facilities.

Marianne, I can't recall what Skippy's cortisol level was at the beginning of December. I want to say he was in the 30's but I'll check. At the point of the last Stim he was down to 9 then back up to 11 but still with clinical symptoms. I did see modest improvement on the low Vectoryl dose, 10, 15 even 20. When we increased to 30, he became very ill, refusing to eat, tremors and severe lethargy and we stopped the Vetoryl in late March. I have never know from the outset which of his symptoms were caused by cushing's and, in retrospect, which were caused by the macro. Initially, five different IMS and the local vet all thought that his symptoms, lethargy, distancing, limited interaction and general dullness were all Cushing's related, until the MRI. He has consistently displayed the same symptoms but now intensified since last November. Both with Vetoryl and initially Cabergoline, he showed modest improvement. Cabergoline caused digestive distress consistently.

No word back from Dr. Scott-Moncrieff @ Purdue. I guess I could take him back to Purdue and get another Stim test and blood work to see how his liver, kidneys, BP etc., are doing. Clinically, he seems quiet, subdued and fragile. He walks slowly, doesn't want to be outside except to lay on the porch, doesn't bark much, never cries, doesn't respond to petting and is like a stealth dog. He can hear but I don't know how much. Pred tapering continues for three more weeks.

Or, I can just watch and wait and see. Thanks again so much for the feedback and questions.

Carole
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  #234  
Old 07-31-2017, 01:26 PM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

I made an appt. for Skippy to be seen by Dr. Scott-Moncrieff on 8/8. That will be six weeks after radiation.

Carole
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  #235  
Old 07-31-2017, 07:13 PM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

Dr. Scott-Moncrieff's reply to my email. Not sure what I think except there is no plan for follow-up imaging.

"Thanks for your email. I am glad that Skippy’s neuro signs are slightly improved. We will have to see how he does as you taper the prednisone.
Regarding the Cushing’s signs I would not expect any improvement until you have discontinued the prednisone and as we discussed even then his signs are likely to persist because the radiation is much better at managing the neuro signs than the endocrine signs. The concern about the tumor growing with medical treatment is something that we worry about prior to radiation therapy rather than afterwards. If the tumor responds appropriately then it is absolutely appropriate to treat medically and we could use either mitotane or trilostane. I would recommend that you make an appointment to see me after Skippy has been off the prednisone for at least 2 weeks. Then we can assess where things stand endocrinologically.
Of course I am happy to see him earlier if you would like me to. When do the radiation oncologists want to see him again? When are they planning follow up imaging?
Best Wishes
Catharine"
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  #236  
Old 07-31-2017, 09:05 PM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

I do understand the concerns expressed by folks here, but from our experience on the forum over the years, it is not unusual for clinicians to resume treatment with either trilostane or Lysodren subsequent to radiation treatment. I cannot say whether this is because they are less concerned about hastening regrowth once the tumor size has been significantly reduced, or whether it's because there simply are no other good options for controlling reemergent conventional symptoms.
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  #237  
Old 08-01-2017, 08:28 PM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

I notice what he said about the predinsone and it's true that it will cause all the same symptoms as cushings because that is it's nature, so maybe they think that is the cause of some of the symptoms.
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  #238  
Old Today, 09:08 PM
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Default Re: Skippy, 12 y/o Yorkie with likely pituitary tumor (Trilostane)

Hi Carole!!! So how is Skippy doing? I had to go looking but found you on page 2! LOL
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