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

Sounds good so far, Carole! Little improvements that make us feel good.

Oh great to read this. Skippy seems to be doing very good compared to where he was before the radiation. Hopefully the improvements keep on coming!

Hi Everyone,
I am actually grateful that Skippy and I have been bumped off of page one and that folks who have dogs in crisis have filled the space and can get support that they desperately need.

So here is the Skippy update for those who are interested: Skippy is doing very well thank you. We are 15 days out from the last radiation treatment. He is showing a number of small signs of renewed interest in life:
He wags his tail again in a tiny wag.
He tells me, mostly with his presence and his eyes that he wants to go to the bathroom.
He is much more interactive; barks (in his little bark) to be let in, responds to petting and tummy rubs, follows me to the door if I'm leaving, sits and stares at me for meals.

His walks remain short, he sleeps a lot, he still has the occasional accident in the house on the papers, and he remains far far from the Skippy of old. But he does not appear to be in pain, confused or bewildered by his world, but his world remains pretty small.

He has not been stimmed again for Cushing's although I fully expect that his cortisol will be high and we will be back down the Vetoryl trail soon. But that may be a good thing for him and ultimately for me.

Skippy's radiographs on July 12 were identical to ones in June, meaning that medically he still looks as if he has bronchial pneumonia. He has never had one clinical symptom of pneumonia. While they think there could be a more serious underlying condition
they felt that a CT scan of his chest would be for their benefit, not Skippy's.

We are weaning off the prednisone and are nearly done with the last round of antibiotics. Skippy's heart murmur was undetectable by four vets in radiology; his swollen gland in his leg is as far as they can tell, negative for lymphoma and his chest was clear on x rays and CT scan. His liver was still swollen and he will remain on the Denamarin for the foreseeable future. After the next Stim test I plan to have the adenoma on his butt removed. So, nine months later, we are back to probably plain ole Cushing's. What a journey, what a relief in many ways. Even if I see no improvement in his quality of life beyond where he is today and knowing that it won't last oh so long, I am grateful that I could give him a shot at a better life for awhile. Indeed, we are both so fortunate! Thanks everyone for your hundreds of kind words, expert advice and support through the crises, chaos, and calamities. You all are the best! And, I will send more Skippy reports - the good, but no bad or ugly we hope.

Carole

Hi Carole. Happy to hear that Skippy is holding his own and does not seem to be in pain.

I do have a few thoughts... Prednisone does help reduce the swelling around the tumor. It can temporarily improve neuro symptoms. That could also account the inprovement in symptoms that you are seeing.

Also, Radiation therapy has been done in an attempt to shrink Skippy's macro-tumor. Vetoryl has been linked with causing macros to grow. You mentioned possibly starting Vetoryl again if Skippy's cortisol is high after testing. In this case, I probably wouldn't restart the Vetoryl. I would deal with the symtoms of his higher cortisol.

Quote:

---

Originally Posted by Carole Alexander

He has not been stimmed again for Cushing's although I fully expect that his cortisol will be high and we will be back down the Vetoryl trail soon.

---

Kathy, you raise a really important issue that I thought about a great deal after Skippy's MRI and the macro diagnosis. The evidence that Vetoryl causes the pituitary tumor to grow seems very solid. I have just begun to try to research this question and ran upon a couple of articles.
http://www.vetfolio.com/neurology/ca...ry-macrotumors
http://www.dvm360storage.com/cvc/pro...ocorticism.pdf. Neither fully address the question: should Vetoryl be used after radiation?

I think that Dr. Scott-Moncrieff at Purdue believes that the answer is yes. (She stated in June that Skippy would likely need to be put back on Vetoryl after radiation because radiation is unlikely to control his Cushing's.) My current thinking regarding these treatments for macros, i.e., radiation, surgery and Cushing's or Addison's meds after is that animals are often outliving the knowledge and expertise of veterinary medicine. This is a prime example that so far I can't find addressed in the internet literature. Neither radiology or internal medicine at Purdue think Skippy will not live longer than a year after radiation, so in reality does it matter whether I treat the Cushing's or not? I really don't know whether it would improve his quality of life or just further shorten his life.

Regarding the prednisone, yes I agree I may be seeing temporary neurological improvements. I am weaning him off the pred now but he won't be finished for another three weeks. This week I have observed some loss of hearing. This may be a short term side effect of the radiation but I just don't know. While I am certain I could call and ask questions, I likely only would get generic answers. Purdue radiology said that they have "done all that they can do for Skippy". He did have a neurological exam about a week after radiation and his condition then was unchanged from prior to treatment. I have no clue as to why they did the exam so quickly after and didn't have the presence of mind to ask.

Thanks Kathy for raising the issue and I appreciate your recommendation that I not put him back on Vetoryl. I am trying to research L-Deprenyl but that drug is full with controversy as well.

Carole

Carole,
I am not a doctor, nor claim to be. I have lived the suspected Macro route with my little Buddy. From my pet parent perspective, which is all I have, I wouldn't restart the Vetoryl. Higher cortisol actually masks other symptoms such as arthritis and allergies, acting like a natural bandaid of sorts. It is possible that Skippy might actually feel a little better with a higher cortisol level. Yes, uncontrolled Cushings has it's own risks. Skippy is a very ill little boy. Uncontrolled Cushings may be preferable to restarting Vetoryl, leaving the tumor unchecked. It's a really tough decision to make. Quality of life trumps everything in my opinion. It's not about buying extra time. It's about helping Skippy be the Skippy you know and love, for as long as he's happy and comfortable.

Macro's SUCK! There are no cures. The tumor will continue to grow and eventually take over. Hopefully the radiation treatments will buy him more time. There is no cure for Cushings either, but I am confident that there will be someday. This is what makes it all so very hard. You are Skippy's best advocate. Do what you ultimately feel is best for him because no one knows him as well as you do. This is not meant to scare you and I apologize if it does.

Kathy

Carole,

I only have a minute but I wanted to support the idea of not putting Skippy back on trilo.

With Mojo, it is very clear to me that his tumor grew swiftly (more swiftly than it would have) because of the trilo. I have my own pet parent experience and the opinions of the experts I consulted during his treatment (Dechra and local vet).

With all that you have done, valiantly, to improve Skippy's quality of life it seems counter-intuituve to put him back on medicine that will likely make him feel worse as the tumor grows.

I concur that the higher cortisol is preferable to the terrible side effects of trilo and a macro.

Please keep us posted - you are the best decision maker for your dear boy and we chime in just to help you weigh all options.

Wishing Skippy continued improvement and stability :)

Carole, I know you will make whatever decision is best for Skippy and his unique set of circumstances. I decided to add a note here, though, really for the benefit of readers who may just be starting out on the Cushing's diagnostic journey and are becoming fearful about ever starting medication treatment due to a worry that treatment might hasten growth of a pituitary tumor. Until an actual cure for pituitary Cushing's is developed, I'm afraid that treatment decisions are always going to come down to judgements about quality of life. What may be best for one dog may not be best for another. My own thought is that lengthening a lifespan may not necessarily be a fair tradeoff for a more compromised lifespan. So, for instance, even if treating with Vetoryl may be associated with quicker tumor growth in some dogs, the tradeoff may be worth it if the quality of life is improved even for a shorter term.

I now suspect that my own Cushpup, a Lab, was suffering from a larger pituitary tumor long before he was officially diagnosed with the disease at all. After several months of trilostane treatment, he did end up with neurological issues that were characteristic of a macro. However, long before that, he exhibited classic Cushing's symptoms that were totally robbing him of his quality of life. By the time we started him on trilo, he spent his days and night either swilling water, peeing, starving, or panting on a small patch of our main floor that had hardwood instead of carpet. He could no longer jump on the couch, climb the stairs to our/his bedroom, jump in the car, chase a ball, or negotiate steps into his beloved backyard. He was living a shell of a life. Trilostane was an experimental med at that time, and I must tell you, I cried tears of joy when our first dose arrived in the mail and I could finally treat him. I do believe we would have released him at that time had the treatment not helped.

As it turned out, the trilo DID help with those symptoms, and we had about six months of improvement until the neurological problems emerged. For reasons that I've talked over with you elsewhere, we did not opt for radiation and we lost him. However, had radiation been an option for us, I have no doubt but that we would have resumed the trilo again had his typical Cushing's symptoms remained or reemerged. Regardless of whether or not it would have hastened tumor regrowth, his immediate quality of life would have trumped all else.

Once again, I am not writing this to advise you as to what is best for Skippy. But instead, I just want folks to know that there is really no cookie cutter approach to all this. Every dog's lifestyle and symptom profile has to be taken into account when making these types of decisions. But if classic Cushing's symptoms are making a dog miserable, I hope our readers won't discard consideration of treatment simply out of the fear that tumor growth may ultimately somehow be affected. Thank you for letting me hijack your thread, and I continue to wish you and Skippy my very best!

Marianne

I don't think there are any easy answers, if dealing with a macro. Most dogs don't have a macro, the tumor never grows (when I say most, i'm referring to the ratio of dogs on this forum that do have macros/neurological symptoms vs those that don't and our facebook page, where the ratio of most being small pituitary tumors vs those having neuro symptoms symptomatic of a macro) but for those that do and even go through radiation, it often seems that the tumors grow. I'm not sure about after radiation. I think Dawn had a year or two with Buttercup after her radiation treatment at Davis. She was I think put on vetroyl about 6 months after the radiation treatment. (I'm going by memory here) as I haven't looked that the thread for awhile.

It seems to me that if a tumor becomes a macro then it just wants to grow, so there could be a risk if that is true and that is just a guess/observation on my part. There really isn't enough research and documentation regarding the after radiation treatment options.

My thanks to each of you for responding to my dillema with Skippy. I think your comments are valid on both sides of this argument. Kathy, I agree that Skippy is a very sick boy and that a macro and Cushing's suck. I also agree with Liltara's comments about Mojo; I believe that Vetoryl sped up the growth of Skippy's macro although I have no proof of that. (Except that his deteioration began in November with Vetoryl treatment and continued to advance untill I stopped Vetoryl in late March.) It's also curious that between his MRI in early April and radiation planning in late June involving a CT scan there was no growth in the size or height of his tumor according to Purdue Radiology.

Marianne, I don't feel as if you hijacked anything. Many times knowing what we don't know is the most important thing. And, we all agree that quality of life is the only factor in this decision. Because his symptoms, i.e., weakness, pu/pd, lethargy, dullness, hunger, hair loss, etc., are and always have been nearly identical to many dogs with severe Cushing's, I still don't know what I'm looking at. I'm currently treating his liver, BP, kidneys and he just finished another round of Clavamox for his lung condition. To be clear, I'm saying that I don't know if these symptoms, especially the lethargy, weakness and dullness, are caused by Cushing's, by the macro or both.

Yesterday I sent an email to Dr. Scott-Moncrieff but haven't heard back, expressing my concerns about restarting Vetoryl and asking whether, short of Vetoryl, there was anything else medically that I could try to help Skippy. Or, if medically we are at the end of the road except to see if he survives and whether the radiation helps him over the next several months. I have again begun to research some of the other Cushing's drugs and most or all have been deemed effective with only specific tumor types, e.g., L-Deprenyl, or are simply unaffordable. So, as usual, I am stuck but I'm not giving up - yet. I will send Dr. Bruyette an email and seek his opinion again. I really appreciate everyone's feedback as your experiences and knowlege are incredibly valuable to me.

Carole