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

Oh Carole, I am sad to hear that Skippy continues to suffer so greatly.

I have not much more to offer other than comfort and supportive thoughts as you both continue to fight the good fight.

May all of the doggie angels above shine healing light down on you both as you travel this difficult road :( it really does break your heart being with them as they suffer and improve, suffer and improve, suffer and improve - what a roller coaster this terrible disease is.

You are in my thoughts.

I took Skippy for his follow-up visit at Purdue today. His IMS, Dr. Scott Moncrieff said that essentially I need to come to terms with what I can live with in terms of his quality of life. She feels certain that his lethargy, unwillingness to walk, interact much, play, etc., is related to his Cushing's. But, even with treatment with Vetoryl, this could be the best that he will be. She does think, and I agreed, that it's worth a shot to try him on a low dose (10 mg. BID) to see if it will improve his muscle atrophy, lethargy and unwillingness to interact that are my major concerns. I can live with the PU/PD, thin hair, bloated belly, etc. And, I'm grateful that he has not developed the bevy of other diseases associated with Cushing's. I did raise the issue of putting Skippy down and we had an extended conversation about "the end" for Cushing's dogs with a macro. She said that most often it's an owner decision because of nuerological issues and/or Cushing's related disorders, e.g., pancreatistis, liver or kidney failure, etc.

Skippy was not stimmed today and she doesn't plan to stim him again in a few weeks. We know he has Cushing's and her goal is not to get his cortisol under control but to see if we can improve his quality of life with a very small dose of Vetoryl. (Remember Skippy couldn't tolerate Vetoryl last winter.) Purdue did run a chem test to check his kidney values as the number was 100 in June, but I don't have the results.

I bathed Skippy before taking him to Purdue today and the adenoma on his butt bled again and continued to bleed modestly through our visit. They cleaned the adenoma and Dr. Scott-Moncrieff thought I should wait to see whether the Vetoryl might reduce the tumor, sex hormone related, before taking any further action. Her concern about the local vet removing it is that a slip of the knife by a less skilled doctor could leave Skippy incontinent.

How do I feel about all of this? Not great. I was on the edge of or in tears for most of his time there. I do understand that I need to come to terms with what I can live with. Skippy is not in pain and he doesn't have a vast array of Cushing's related issues that so many others struggle with. His nuerological symptoms are improved. Maybe he and I are fortunate. While at Purdue today, three or four people commented, in passing, about how cute he is. From a distance, he does look quite normal.

A funny final note. After Skippy let loose with pee along Purdue's hall way at the end of our visit, Dr. Scott-Moncrieff came strolling by. I asked her about water therapy for Skippy. She initially thought I was asking about water torture. I said "no" that's for me to alter my current state of mind. She suggested that I take him to the river since he used to love to swim. She thought a change of scenery would be good for both of us. To be continued...

Hugs for you and ear scritches for your cute little guy.

Big hugs! I had a laugh about the water torture comment.

The river might be a good idea, you'd be right with him, as not sure how strong he is and wouldn't want him to get into trouble with swimming. Would he engage with a puppy pool in the yard? (kid pool basically) He's small enough he might be able to try to swim in it.

It isn't easy going through this and you've been such a trooper, you and skippy both.

I think quality of life is most important, so maybe it would help to try a small dose of vetroyl. But I would want to know what his stim is first, that's just me, I like to know the numbers so I can see what the changes are numerically in addition to what I see happening, as for myself, I was always too close to mollys issues to feel like I could determine things by sight alone. I think that might have just been me though.

I am very appreciative of everyone's support regarding Skippy's saga. Your kindness is touching and I'm grateful.

While I still don’t have the numbers, the student intern did call with a Skippy follow-up:
• Liver: okay, no dramatic change. Keep him on the Denamarin.
• Kidneys: Proteinuria improved from June.
• Aspirated nodule on rear leg for the third time. They are not concerned about lymphoma any longer. Too many red blood cells in the draw but Skippy is not anemic.

On the 29th I started Skippy on a Vetoryl dose of 10mg. BID. Dr. Scott-Moncrieff’s thinking is as follows: Skippy clearly continues to have Cushing’s. He has multiple symptoms. I will not see any improvement in his quality of life unless I treat. Yes, it is standard protocol to treat Cushing’s after radiation with Vetoryl or Lysodren. The reason for the low dose is his intolerance of the drug before radiation. If I understand, her goal is not to necessarily lower Skippy’s cortisol so that he is under control in accord with the Drecha protocol, but rather to see if lowering his cortisol will improve his quality of life if he can tolerate it. Thus, no stim test on the 29th and no two week stim. He goes back to Purdue on September 26th and they will decide whether to stim him then, unless he show’s intolerance before that. If so, I will stop the Vetoryl.

After five days on Vetoryl, he has improved, in some respects. He is brighter, much more alert and is now willing to take short walks. He has become a little picky about his food, declines treats and sometimes kibble, but generally is eating well and he could sure afford to lose a few lbs. I believe that his hearing is improving but that is likely coincidental. His stool is now soft and today I saw a little tremoring in his rear end. His hind legs are still pretty weak and he struggles to get up and often thumps down. He sleeps well, no panting and a little less PU/PD although his urine remains clear.

From a practical standpoint, the biggest problem of the week is Skippy is experiencing spontaneous bleeding from the perianal adenoma. It’s not profuse bleeding but continuing intermittently after Purdue cleansed it on Tuesday. It’s a mess and I’m applying triple antibiotic cream but it’s not doing much. Dr. Scott-Moncrieff said let’s wait and see if the Vetoryl might shrink the tumor. But I suspect she may have said let’s wait and see because the surgery is expensive and I expressed reservations about affording it in light of Skippy's tenuous hold on life. And, he’s had the adenoma since last December. I asked her about the local vet removing it and she was not in favor of that strategy. I sent her an email today saying that unless she has some confidence that Vetoryl could shrink the thing, Purdue needs to remove it. (I read somewhere that Lysodren might shrink it, but I can’t find anything to suggest that Vetoryl would.)

Either because of my emotional state about Skippy or because Dr. Scott-Moncrieff thinks his death is imminent, Purdue comped my last visit and his meds, including Vetoryl. While I am embarrassed to be such a wimp, this has become a long slog indeed. I am very grateful to Dr. Scott-Moncrieff for her compassion, skill and knowedge.

If anyone has heard of Vetoryl shrinking a perianal adenoma, please let me know. I have not searched this forum but I will. For anyone wondering, this is a relatively rare tumor near the anus, usually benign, that is caused by overproduction of sex hormones. Most often it afflicts intact dogs; Skippy is castrated.

my intact cush dog flynn [border collie] had one. it was bleeding on and off indeed.
i had the adenoma removed.
it is not a difficult operation and it was inexpensive.
vetoryl did not shrink it. and cream didn't help either
flynn was long haired, so it was a real mess.
my local vet did the surgery using local anaestetic and a seditive.
no big deal at all. keep the stool a bit softer for a few days.
don't let purdue talk you into expensive surgery.
skippy will feel a lot better after removing the adenoma.

Thanks so much for the feedback on the perianal tumor. My local vet felt confident that she could remove it for a fourth of the cost of Purdue surgeon and that it is not a big deal. I haven't heard back from Purdue but the tumor remains a mess. I wonder if they don't want to mess with it since he just started Vetoryl ten days ago.

This round, and for however long, Vetoryl is definitely helping Skippy. PU/PD is hugely better; appetite has diminished but no discernible change in belly, hair, etc. The change that I care most about is Skippy is beginning to show signs that he wants to live. He is walking much more, actually trotted yesterday. A tiny bit of tremoring but his rear legs are stronger. I know he will never be the Skippy of even a year ago. I'm still not seeing a wagging tail and he remains somewhat aloof but attentive. My decision to put him back on Vetoryl was yet again made out of no good options. Skippy has no long haul so whatever I can do now to try to help him will have to be good enough.

I will have a stim test done when he goes back to Purdue at the end of the month. Next week, I am flying to Maryland for ten days and Skippy will remain here in Indiana but I will check on him daily. I will deal with the butt tumor upon return. In the meantime and on behalf of my friend with whom we are living, I have another question. Skippy has horrible, stinky gas, frequently. I did change his food to low fat Wellness Core kibble about ten days ago when he started the Vetoryl. My friend's dog is eating the identical diet with no gas. Skippy usually gets chicken breast or beef mixed in with his kibble. If others have experienced this problem or have a clue what I can do, please let me know. His stool is soft but not diarrhea. Thanks so much.

Carole

Lena had terrible gas, Carole. You could hear and feel it, not to mention the smell! I couldn't figure out if it was the Vetoryl or the soft dog food I was giving her to make sure the pill was fully absorbed since she wouldn't eat the kibble anymore.

We got used to it!

Thanks Joan, just another example of your enduring love for Lena. I may be able to tolerate it; not so sure about my friend who will be his caretaker for ten days! This may have started before he went back on Vetoryl but clearly it is worse now. Maybe more frequent trips to the bathroom will help. Best,
Carole

I am glad that Skippy is doing okay on the Vetoryl! I hope he continues to... poor little guy has been through so much. Unfortunately I don't have any suggestions for the gas, though feel for you (and your friend). I have a rather pathetic olfactory system so those things don't usually bother me... but my husband must bear it and I hear about it!