Alivia was recently diagnosed with Cushing's - Alivia has passed

I'm crossing mine too, Mary Beth!!!:D:D:D

Hugs,
Addy

Hello,

My Maisie was diagnosed with Cushing's disease in the fall of 2009 following a tooth being pulled.....surgery. The diagnosis was directly after the surgery and we always felt it was somehow linked. My baby passed away 3 weeks ago. I am so devastated. Words cannot describe the loss and my sadness.
I read that your dog Alivia was diagnosed after two teeth being pulled. I wonder if the stress of the surgery brought on the Cushing's. Maisie was on Trilostane. Whether the tumor grew on her pituitary from a micro adenoma to a macro adenoma or else a new brain tumor grew they could not tell me. She was so weak from the disease from having it almost 2 years I opted out of an MRI. The doctors said it would have told them what they already knew anyway.
Where did you hear that Trilostane can make tumors grow faster? Could you please let me know your resource for that information?

I am so sorry for your Avilia.

take care,
jani

Hi Jani,

I just wanted to let you know that I have copied your post here to a new thread of your own. In this way, the members can discuss the questions you asked here and you will be able to keep up with all the info in one place.

You will find your thread at this link in the Questions and Discussions (same section as this):

http://www.k9cushings.com/forum/showthread.php?t=3385

I am glad you found us and hope we are able to help answer some of your questions and ease the pain of your loss.

Hugs,
Leslie and the gang

Hi Mary Beth,

Stopping by to thank you for your support and to see how Alivia is doing. It was a hard day for me yesterday, hearing someone else say how high Zoe's coritosl is. I started doubting myself. I think it scared me because I was worried I waited too long. Not about starting treatment but that I did not start it soon enough.

You will like Dr. Peterson. He is really nice. Carol in his office is very nice too.

Happy Memorial Day:D

Hugs,
Addy

Hi, Jani.

I just wanted to welcome you and thank you for your post here, but I will respond in more detail on your new string.

Hi Addy -

Glad you are feeling better about things today. What is Zoe's cortisol level? Just curious as to what it is in relation to Alivia's. Carol is who I spoke to at Dr. Peterson's office and she was very nice!

Hi, everyone!

Just finally getting to posting an Alivia Update. She had a re-check last night with the IMS (the first since her 5 day hospitalization for pancreatitis). Her abdomen was not swollen and she had no pain! Her color was good; temperature normal. Her weight had dropped from 18 lbs. to 16 lbs. since she was not able to eat or drink for 7 days. It is now up to 17.5. They did complete blood work with a chemistry panel so I am waiting for those results. So far, so good.

Surprisingly, her Cushing's symptoms seem milder. I asked about whether I should consider starting treatment and got this response, "She has Cushing's because of the adrenal tumor. Surgery would cure that. Since you don't want the surgery, if her symptoms aren't bothering you, there's no reason to start treatment. Lysodren can create its own problems." First of all, Alivia's symptoms NEVER "bothered" ME, other than me worrying about HER health. It seems with this doctor it is surgery or nothing and I don't agree with that for multiple reasons: 1) Alivia is 13+ and has had other health issues, 2) The adrenal "tumor" is not clearly diagnosed and I am not 100% convinced that is what it is, and 3) Whatever is there is on her right adrenal, making surgery even more risky. On the other hand, I never want her to suffer through another bout of pancreatitis and if that takes medication, I'll have to get over it.

Why do I doubt the original diagnosis? It will make this post super long and I apologize in advance, but I would like some opinions on the "Assessment" in the ultrasound report prepared by an independent vet, specializing in ultrasound.

"Assessment: Continue to detect adrenal asymmetry with suspected nodule in cranial pole of the right adrenal gland. Normal appearance to left adrenal gland and caudal aspect of right adrenal gland suspicious for autonomous nodular function (adrenal adenoma). Cannot rule out atypical nodular hyperplasia since LDDS did reveal suppression. Recent onset of abdominal discomfort and fever suspicious for flare-up of pancreatitis. Cannot rule out concurrent or inciting cholangitis secondary to bile clumping. Visualization of “meaty” pancreas, hyperechoic peripancreatic fat, and trace of regional effusion all support inflammatory disease (pancreatitis/cholangitis). Hyperadrenalcorticism likely contributing to predisposition for pancreatitis.”

His recommendations were for the immediate hospitalization and treatment of the pancreatitis and then when she was recovered to “…continue endocrine work up with plasma ACTH level. Presence of potential complications associated with hyperadrenocorticism (pancreatitis, cholangitis) suggests that HAC should be managed more aggressively with Mitotane(rather than trilostane)if suspect macronodular PDH, or Lysodren/adrenalectomy if suspect adrenal adenoma.”

So, as usual, nothing is ever clear cut with my Alivia. I think the next step is to get her ACTH level tested then get all her records together for the consultation with Dr. Peterson I had planned on before the pancreatitis crisis. I don't want her to ever have to suffer through another attack of pancreatitis.

Sorry for the extra long post, but I wanted to hear if any of you had any thoughts on the ultrasound report, Also, I should mention that there is a bit of discrepancy between this u/s report done by a vet who specializes in u/s and Ali's regular IMS who simply said, "I don't see what he's seeing". :confused:

Oh Mary Beth,

I wish there was a clear cut answer out there and why do these vets seem to differ so much....I never had an ultrasound done on Maddie because she had Cushings no doubt about it and I just wanted her to get comfortable again. The lyso did help and she had no side effects so I was grateful. I just wish we could have seen the cancer coming, but that was a surprise and then it went so fast.

You are doing a great job and I think talking with Dr. Peterson like Addy did will help you figure it out. You will make the right decision for Alivia!!!:)

Things really are so much more confusing when the vets are in such disagreement. I had actually talked with Dr. Peterson's office about the consultation a few weeks ago and then the pancreatic crisis occurred, so it was postponed. I do think that is my next step. Although, since Ali seems to be doing so well, I think I will give us a bit of a break! This recent hospitalization took a lot out of both of us!

I forgot to post that I just added Milk Thistle to Alivia's routine. I found an alcohol-free Milk Thistle extract on The Vitamin Shoppe's website for only $9.99 and got her IMS's blessing on it. She calculated the dosage for me and gave me syringes to measure it more accurately, since Ali's dosage is pretty small. Ali's doctors are all for using human grade products as much as possible because they are better regulated.

It is confusing when things are not clear cut. I do know Dr. Peterson has written that a serious illness can also enlarge the adrenal glands.

That blog was one of things that spurred me on about Zoe and rethinking the lysodren and wanting to talk to him. Not that I doubted Zoe's diagnosis. It was just that all her tests were not conducted in a optimal way which left me uncomfortable to some degree. Her cortisol was too high to doubt it.

She was post 32ug in June 2010 and after her illness at the end of the year she was post 44ug:eek::eek: Dr. Oliver did say her illness could have contributed to some of that but the number was way too high to contribute all of it to a concurrent illness.

All her UTK tests are marked :Significant adrenal activity yet she started with just hair/coat problems and looked like a hypothyroid dog not a Cushing dog when we started this journey. The hind leg weakness came on fast. The appetite got huge the last few months and she also started drinking more water though not buckets, she does not drink more than normal but more than she did which is alot for her.

I waited for stronger symptoms and wanted to give her time to get strong, she had been so sick. I had hoped to change her food but I ran out of time:) we only made it to 2 teaspoons:(

I don't think there is a right or wrong answer, Mary Beth. My husband made me promise, when all this started, not to look back and blame myself. The decisions I make are the best I can do and whatever the outcome, I did the best I could.

You will do the best you can for Ali, you always have. Go with your gut and don't look back.

When I started this journey, Zoe's colitis bothered me more than her Cushings. We have tried to fix that as best we could. Now we work on the Cushings. I could have fixed the colitis better but I ran out of time.

Love,
Addy